[Federal Register Volume 72, Number 148 (Thursday, August 2, 2007)]
[Rules and Regulations]
[Pages 42470-42626]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 07-3490]



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Part II





Department of Health and Human Services





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Centers for Medicare & Medicaid Services



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42 CFR Parts 410 and 416



Medicare Program; Revised Payment System Policies for Services 
Furnished in Ambulatory Surgical Centers (ASCs) Beginning in CY 2008; 
Final Rule

  Federal Register / Vol. 72, No. 148 / Thursday, August 2, 2007 / 
Rules and Regulations  

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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Medicare & Medicaid Services

42 CFR Parts 410 and 416

[CMS-1517-F]
RIN 0938-AO73


Medicare Program; Revised Payment System Policies for Services 
Furnished in Ambulatory Surgical Centers (ASCs) Beginning in CY 2008

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

ACTION: Final rule.

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SUMMARY: This final rule revises the Medicare ambulatory surgical 
center (ASC) payment system to implement certain related provisions of 
the Medicare Prescription Drug, Improvement, and Modernization Act of 
2003 (MMA). This final rule establishes the ASC list of covered 
surgical procedures, identifies covered ancillary services under the 
revised ASC payment system, and sets forth the amounts and factors that 
will be used to determine the ASC payment rates for calendar year (CY) 
2008. The changes to the ASC payment system and ratesetting methodology 
in this final rule are applicable to services furnished on or after 
January 1, 2008.

DATES: Effective Date: This final rule is effective on January 1, 2008.

FOR FURTHER INFORMATION, CONTACT: Alberta Dwivedi, (410) 786-0378. Dana 
Burley, (410) 786-0378.

SUPPLEMENTARY INFORMATION:

Electronic Access

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password required).

Alphabetical List of Acronyms Appearing in This Final Rule

AHA American Hospital Association
AMA American Medical Association
APC Ambulatory payment classification
ASC Ambulatory surgical center
BESS [Medicare] Part B Extract Summary System
CAH Critical access hospital
CBSA Core-Based Statistical Area
CMS Centers for Medicare & Medicaid Services
CPI-U Consumer Price Index for All Urban Consumers
CPT [Physicians'] Current Procedural Terminology, Fourth Edition, 
2007, copyrighted by the American Medical Association. CPT[supreg] 
is a trademark of the American Medical Association.
CY Calendar year
DRA Deficit Reduction Act of 2005, Public Law 109-171
FY Federal fiscal year
GAO Government Accountability Office
HCPCS Healthcare Common Procedure Coding System
HOPD Hospital outpatient department
HQA Hospital Quality Alliance
IOL Intraocular lens
IPPS [Hospital] Inpatient prospective payment system
MAC Medicare administrative contractor
MedPAC Medicare Payment Advisory Commission
MMA Medicare Prescription Drug, Improvement, and Modernization Act 
of 2003, Public Law 108-173
MPFS Medicare Physician Fee Schedule
MSA Metropolitan Statistical Area
NTIOL New technology intraocular lens
OCE Outpatient Code Editor
OMB Office of Management and Budget
OPPS [Hospital] Outpatient prospective payment system
PM Program memorandum
PPAC Practicing Physicians Advisory Council
PPS Prospective payment system
PRA Paperwork Reduction Act of 1995
RFA Regulatory Flexibility Act
RVU Relative value unit

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

Table of Contents

I. Background
    A. Legislative and Regulatory History
    B. ASC Payment Method
    C. Provisions of Public Law 108-173 (MMA)
    D. Issuance of Proposed Rule
    E. Changes to the ASC List for CY 2007
II. Revisions to the ASC Payment System Effective January 1, 2008
    A. General
    B. Factors Considered in the Development of the Revised ASC 
Payment System
    C. Rulemaking for the Revised ASC Payment System in CY 2008
III. Covered Surgical Procedures Paid in ASCs On or After January 1, 
2008
    A. Payable Procedures
    1. Definition of Surgical Procedure
    2. Procedures Excluded From Payment Under the Revised ASC 
Payment System
    a. Significant Safety Risk
    b. Overnight Stay
    B. Treatment of Unlisted Procedure Codes and Procedures That Are 
Not Paid Separately Under the OPPS
    C. Treatment of Office-Based Procedures
    D. Specific Surgical Procedures Excluded From Payment Under the 
Revised ASC Payment System
IV. Ratesetting Methodology for the Revised ASC Payment System
    A. Overview of Current ASC Payment System
    B. ASC Relative Payment Weights Based on APC Groups and Relative 
Payment Weights Established Under the OPPS
    C. Packaging Policy
    1. General Policy
    2. Policies for Specific Items and Services
    a. Radiology Services
    b. Brachytherapy Sources
    c. Drugs and Biologicals
    d. Implantable Devices With Pass-Through Status Under the OPPS
    e. Implantable Devices Without Pass-Through Status Under the 
OPPS
    D. Payment for Corneal Tissue Under the Revised ASC Payment 
System
    E. Payment for Office-Based Procedures
    F. Payment Policies for Multiple and Interrupted Procedures
    1. Multiple Procedure Discounting Policy
    2. Interrupted Procedure Policies
    G. Geographic Adjustment
    H. Adjustment for Inflation
    I. Beneficiary Coinsurance
    J. Phase-In of Full Implementation of Payment Rates Calculated 
Under the Revised ASC Payment System Methodology
V. Calculation of ASC Conversion Factor and ASC Payment Rates for CY 
2008
    A. Overview
    B. Budget Neutrality Requirement
    C. Calculation of the ASC Payment Rates for CY 2008
    1. Proposed Method for Calculation of the ASC Payment Rates for 
CY 2008 in the August 2006 Proposed Rule
    a. Estimated Medicare Program Payments (Excluding Beneficiary 
Coinsurnace) Under the Current ASC Payment System in the August 2006 
Proposed Rule
    b. Estimated Medicare Program Payments (Excluding Beneficiary 
Coinsurance) Under the Proposed Revised ASC Payment System in the 
August 2006 Proposed Rule
    c. Calculation of the Proposed CY 2008 Budget Neutrality 
Adjustment in the August 2006 Proposed Rule
    d. Application of the Budget Neutrality Adjustment To Determine 
the Proposed CY 2008 ASC Conversion Factor in the August 2006 
Proposed Rule
    e. Calculation of the Proposed CY 2008 ASC Payment Rates Under 
the Revised ASC Payment System in the August 2006 Proposed Rule
    f. Calculation of the Proposed CY 2008 ASC Payment Rates Under 
the Transition in the August 2006 Proposed Rule
    2. Alternative Option for Calculating the Proposed Budget 
Neutrality Adjustment in the August 2006 Proposed Rule
    a. Estimated Medicare Program Payments (Excluding Beneficiary 
Coinsurance)

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Under the Existing ASC Payment System in the August 2006 Proposed 
Rule
    b. Estimated Medicare Program Payments (Excluding Beneficiary 
Coinsurance) Under the Proposed Revised ASC Payment System in the 
August 2006 Proposed Rule
    c. Calculation of the Proposed CY 2008 Budget Neutrality 
Adjustment in the August 2006 Proposed Rule
    d. Discussion of the Alternative Calculation of the Budget 
Neutrality Adjustment
    3. Calculation of the Estimated CY 2008 Budget Neutrality 
Adjustment According to the Final Policy
    4. Final Calculation of the Estimated ASC Payment Rates for CY 
2008
    a. Estimated CY 2008 Medicare Program Payments (Excluding 
Beneficiary Coinsurance) Under the Existing ASC Payment System
    b. Estimated Medicare Program Payments (Excluding Beneficiary 
Coinsurance) Under the Revised ASC Payment System
    c. Calculation of the Final Estimated CY 2008 Budget Neutrality 
Adjustment
    d. Calculation of the Final Estimated CY 2008 ASC Payment Rates
    D. Calculation of the ASC Payment Rates for CY 2009 and Future 
Years
    1. Updating the ASC Relative Payment Weights
    2. Updating the ASC Conversion Factor
    E. Annual Updates
VI. Information in Addenda Related to the Revised CY 2008 ASC 
Payment System
VII. ASC Regulatory Changes
    A. Regulatory Changes That Were Finalized in the CY 2007 OPPS/
ASC Final Rule With Comment Period
    B. Regulatory Changes Included in This Final Rule
VIII. Files Available to the Public Via the Internet
IX. Collection of Information Requirements
X. Regulatory Impact Analysis
    A. Overall Impact
    1. Executive Order 12866
    2. Regulatory Flexibility Act
    3. Small Rural Hospitals
    4. Unfunded Mandates
    5. Federalism
    B. Effects of the Revisions to the ASC Payment System for CY 
2008
    1. Alternatives Considered
    2. Limitations of Our Analysis
    3. Estimated Effects of This Final Rule on ASCs
    4. Estimated Effects of This Final Rule on Beneficiaries
    5. Conclusion
    6. Accounting Statement
    C. Executive Order 12866
Regulation Text
Addendum AA.--Illustrative ASC Covered Surgical Procedures for CY 
2008 (Including Surgical Procedures for Which Payment Is Packaged)
Addendum BB.--Illustrative ASC Covered Ancillary Services Integral 
to Covered Surgical Procedures for CY 2008 (Including Ancillary 
Services for Which Payment Is Packaged)
Addendum DD1.--Illustrative ASC Payment Indicators

I. Background

A. Legislative and Regulatory History

    Section 1832(a)(2)(F)(i) of the Social Security Act (the Act) 
provides that benefits under the Medicare Supplementary Medical 
Insurance program (Part B) include payment for facility services 
furnished in connection with surgical procedures specified by the 
Secretary that are performed in an ambulatory surgical center (ASC). To 
participate in the Medicare program as an ASC, a facility must meet the 
standards specified in section 1832(a)(2)(F)(i) of the Act, which are 
implemented in 42 CFR Part 416, Subpart B and Subpart C of our 
regulations. The regulations at 42 CFR 416, Subpart B set forth general 
conditions and requirements for ASCs, and the regulations at Subpart C 
provide specific conditions for coverage for ASCs.
    The ASC services benefit was enacted by Congress through the 
Omnibus Reconciliation Act of 1980 (Pub. L. 96-499). For a detailed 
discussion of the legislative history related to ASCs, we refer readers 
to the June 12, 1998 proposed rule (63 FR 32291).
    Section 1833(i)(1)(A) of the Act requires the Secretary to specify 
surgical procedures that, although appropriately performed in an 
inpatient hospital setting, also can be performed safely on an 
ambulatory basis in an ASC, critical access hospital (CAH), or a 
hospital outpatient department (HOPD). The report accompanying the 
legislation explained that Congress intended procedures currently 
performed on an ambulatory basis in a physician's office that do not 
generally require the more elaborate facilities of an ASC not be 
included in the list of ASC covered procedures (H.R. Rep. No. 96-1167, 
at 390-91, reprinted in 1980 U.S.C.C.A.N. 5526, 5753-54). In a final 
rule published on August 5, 1982, in the Federal Register (47 FR 
34082), we established regulations that included criteria for 
specifying which surgical procedures were to be included for purposes 
of implementing the ASC facility benefit. Medicare only allows payment 
to ASCs for procedures that are specified on the ASC list.
    Section 626(b) of the Medicare Prescription Drug, Improvement, and 
Modernization Act of 2003, Public Law 108-173, repealed the requirement 
formerly found in section 1833(i)(2)(A) of the Act that the Secretary 
conduct a survey of ASC costs for purposes of updating ASC payment 
rates and, instead, requires the Secretary to implement a revised ASC 
payment system, to be effective not later than January 1, 2008. Section 
5103 of the Deficit Reduction Act of 2005 (DRA), Public Law 109-171, 
amended section 1833(i)(2) of the Act by adding a new subparagraph (E) 
to place a limitation on payments for surgical procedures in ASCs. 
Section 1833(i)(2) of the Act provides that if the standard overhead 
amount under section 1833(i)(2)(A) of the Act for a facility service 
for such procedure, without application of any geographic adjustment, 
exceeds the Medicare payment amount under the hospital outpatient 
prospective payment system (OPPS) for the service for that year, 
without application of any geographic adjustment, the Secretary shall 
substitute the OPPS payment amount for the ASC standard overhead 
amount. This provision applies to surgical procedures furnished in ASCs 
on or after January 1, 2007, and before the effective date of the 
revised ASC payment system implemented in this final rule.
    In the November 24, 2006 final rule with comment period for the CY 
2007 OPPS and ASC payment systems (71 FR 67960), we addressed the 
changes in payment to ASCs mandated by section 5103 of Public Law 109-
171 and finalized Sec.  416.1(a)(5) of the regulations to implement 
this provision. (Hereinafter, the November 24, 2006 final rule with 
comment period is referred to as the CY 2007 OPPS/ASC final rule with 
comment period.) We also addressed additions to and deletions from the 
ASC list of covered surgical procedures that were implemented on 
January 1, 2007. In addition, we made changes in the process to review 
payment adjustments for insertion of new technology intraocular lenses 
(NTIOLs) under section 1833(i)(2)(A)(iii) of the Act.
    Section 416.65(a) of the regulations specifies general standards 
for procedures on the ASC list. ASC procedures are those surgical and 
other medical procedures that are--
     Commonly performed on an inpatient basis but may be safely 
performed in an ASC;
     Not of a type that are commonly performed or that may be 
safely performed in physicians' offices;
     Limited to procedures requiring a dedicated operating room 
or suite and generally requiring a postoperative recovery room or 
short-term (not overnight) convalescent room; and
     Not otherwise excluded from Medicare coverage.
    Specific standards in Sec.  416.65(b) limit covered ASC procedures 
to those that do not generally exceed 90 minutes operating time and a 
total of 4 hours recovery or convalescent time. If

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anesthesia is required, the anesthesia must be local or regional 
anesthesia, or general anesthesia of not more than 90 minutes duration.
    Section 416.65(b)(3) of the regulations excludes from the ASC list 
procedures that generally result in extensive blood loss, that require 
major or prolonged invasion of body cavities, that directly involve 
major blood vessels, or that are generally emergency or life-
threatening in nature.
    A detailed history of published changes to the ASC list and ASC 
payment rates can be found in the June 12, 1998 proposed rule (63 FR 
32291). Subsequently, in accordance with Sec.  416.65(c), we published 
updates of the ASC list in the Federal Register on March 28, 2003 (68 
FR 15268), May 4, 2005 (70 FR 23690), and in the CY 2007 OPPS/ASC final 
rule with comment period (71 FR 67960).
    During years when we have not updated the ASC list in the Federal 
Register, we have revised the list to be consistent with annual 
calendar year changes to the Healthcare Common Procedure Coding System 
(HCPCS) and Current Procedural Terminology (CPT) codes. These annual 
coding updates have been implemented through program instructions to 
the carriers that process ASC claims. (We note that Medicare Part B 
carriers are transitioning to Medicare Administrative Contractors 
(MACs) through 2011, as described in a final rule with comment period 
published in the Federal Register on November 24, 2006 (71 FR 68229).) 
We last issued program instructions to update the list only to conform 
to CPT and HCPCS coding changes on December 20, 2006, via Transmittal 
1134, Change Request 5211. This transmittal can be found on the CMS Web 
site at: http://www.cms.hhs.gov/Transmittals/).

B. ASC Payment Method

    On August 23, 2006, we proposed in the Federal Register (71 FR 
49635) a revised payment system for ASCs to be implemented effective 
January 1, 2008, in accordance with section 626(b) of Public Law 108-
173, including revisions to the ratesetting methodology and the 
applicable ASC regulations to incorporate the requirements and payments 
for ASC services under the revised ASC payment system. We also proposed 
a new ``exclusionary'' approach for revising the ASC list of covered 
surgical procedures beginning CY 2008. We proposed to evaluate surgical 
procedures to identify those that could pose a significant safety risk 
or that would be expected to require an overnight stay when performed 
in ASCs, and that would, therefore, be excluded from Medicare payment 
under the revised ASC payment system. Using that exclusionary method, 
we developed a list of surgical procedures that we believed were safe 
for Medicare beneficiaries in ASCs and that were appropriate for 
Medicare payment. We proposed to adopt an exclusionary approach for 
identifying surgical procedures that were appropriate for payment under 
the revised ASC payment system, and the result of that process was a 
proposed list of surgical procedures for which separate payment would 
be made. We refer to that list of payable procedures hereinafter as the 
ASC ``list of covered surgical procedures.''
    There are two primary elements in the total cost of performing a 
surgical procedure: (a) The cost of the physician's professional 
services to perform the procedure; and (b) the cost of items and 
services furnished by the facility where the procedure is performed 
(for example, surgical supplies, equipment, and nursing services). 
Payment for the first element is made under the Medicare Physician Fee 
Schedule (MPFS). The August 2006 OPPS/ASC proposed rule addressed the 
second element, payment for the cost of items and services furnished by 
the facility.
    Under the current ASC payment system, the ASC payment rate is a 
standard overhead amount established on the basis of our estimate of a 
fee that takes into account the costs incurred by ASCs generally in 
providing facility services in connection with performing a specific 
procedure. The report of the Conference Committee accompanying section 
934 of the Omnibus Reconciliation Act of 1980 states that this overhead 
amount is expected to be calculated on a prospective basis using sample 
survey data and similar techniques to establish reasonable estimated 
overhead allowances, which take into account volume (within reasonable 
limits), for each of the listed procedures (H.R. Rept. No. 96-1479, at 
134-35 (1980)).
    As stated earlier, to establish those reasonable estimated 
allowances for services furnished prior to implementation of the 
revised ASC payment system, section 626(b)(1) of Public Law 108-73 
amended section 1833(i)(2)(A)(i) of the Act that required us to take 
into account the audited costs incurred by ASCs to perform a procedure 
in accordance with a survey. Further, beginning January 1, 2007, and 
prior to implementation of a revised ASC payment system, in accordance 
with section 5103 of Pub. L. 109-171, no ASC standard overhead amount 
may be greater than the OPPS payment rate for a given service for that 
year. Except for screening colonoscopies and flexible sigmoidoscopies, 
payment for ASC services is subject to the usual Medicare Part B 
deductible and coinsurance requirements, and the amounts paid by 
Medicare must be 80 percent of the standard overhead amount. As 
required by section 1834(d) of the Act and implemented in regulations 
at 42 CFR 410.152(i), the amount paid by Medicare must be 75 percent of 
the fee schedule payment amount for screening colonoscopies and 
flexible sigmoidoscopies.
    Section 1833(i)(1) of the Act requires us to specify, in 
consultation with appropriate medical organizations, surgical 
procedures that are appropriately performed on an inpatient basis in a 
hospital but that can be safely performed in an ASC, a CAH, or an HOPD 
and to review and update the list of ASC procedures at least every 2 
years.
    Section 141(b) of the Social Security Act Amendments of 1994, 
Public Law 103-432, requires us to establish a process for reviewing 
the appropriateness of the payment amount provided under section 
1833(i)(2)(A)(iii) of the Act for intraocular lenses (IOLs) that belong 
to a class of NTIOLs. That process was the subject of a separate final 
rule entitled ``Adjustment in Payment Amounts for New Technology 
Intraocular Lenses Furnished by Ambulatory Surgical Centers,'' 
published on June 16, 1999, in the Federal Register (64 FR 32198). We 
proposed changes to the NTIOL request for review process in the CY 2007 
OPPS/ASC proposed rule published in the Federal Register on August 23, 
2006 (71 FR 49631 through 49635) and finalized changes to that process 
in the CY 2007 OPPS/ASC final rule with comment period (71 FR 68175 
through 68181).

C. Provisions of Public Law 108-173 (MMA)

    Section 626(a) of Public Law 108-173 (MMA) amended section 
1833(i)(2)(C) of the Act, which requires the Secretary to update ASC 
payment rates using the Consumer Price Index for All Urban Consumers 
(CPI-U) (U.S. city average) if the Secretary has not otherwise updated 
the amounts under the revised ASC payment system. As amended by Pub. L. 
108-173, section 1833(i)(2)(C) of the Act requires that, if the 
Secretary is required to apply the CPI-U increase, the CPI-U percentage 
increase is to be applied on a fiscal year (FY) basis beginning with FY 
1986 through FY 2005 and on a

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calendar year (CY) basis beginning with CY 2006.
    Section 626(a) of Public Law 108-173 further amended section 
1833(i)(2)(C) of the Act to require us in FY 2004, beginning April 1, 
2004, to increase the ASC payment rates using the CPI-U as estimated 
for the 12-month period ending March 31, 2003, minus 3.0 percentage 
points. Section 626(a) of Public Law 108-173 also requires that the 
CPI-U adjustment factor equal zero percent in FY 2005, the last quarter 
of CY 2005, and each calendar year from CY 2006 through CY 2009.
    Section 626(b) of Public Law 108-173 repealed the requirement that 
CMS conduct a survey of ASC costs upon which to base a standard 
overhead payment amount for surgical services performed in ASCs, and 
added section 1833(i)(2)(D) of the Act. Section 1833(i)(2)(D)(iii) of 
the Act requires us to implement by no earlier than January 1, 2006, 
and not later than January 1, 2008, a revised ASC payment system. The 
revised payment system under section 1833(i)(2)(D)(i) of the Act is to 
take into account the recommendations contained in a Report to Congress 
that the Government Accountability Office (GAO) was required to submit 
by January 1, 2005. Section 1833(i)(2)(D)(ii) of the Act requires that 
the revised ASC payment system be designed to result in the same 
aggregate amount of expenditures for surgical services furnished in 
ASCs the year the system is implemented as would be made if the new 
system did not apply as estimated by the Secretary. This requirement is 
to take into account the limitation in ASC expenditures resulting from 
implementation of section 5103 of Public Law 109-171 beginning January 
1, 2007, as we described in sections XVII.A.1. and XVII.E. of the 
preamble to the CY 2007 OPPS/ASC final rule with comment period (71 FR 
68165 and 68174, respectively).
    Section 1833(i)(2)(D)(iv) of the Act exempts the classification 
system, relative weights, payment amounts, and geographic adjustment 
factor (if any) under the revised ASC payment system from 
administrative and judicial review.
    Section 626(c) of Public Law 108-173 added a conforming amendment 
to section 1833(a)(1) of the Act, which provides that the amounts paid 
under the revised ASC payment system shall equal 80 percent of the 
lesser of the actual charge for the services or the payment amount that 
we determine under the revised ASC payment system.

D. Issuance of Proposed Rule

    As stated earlier, in the August 23, 2006 Federal Register (71 FR 
49635), we proposed to implement revisions to the ASC payment system so 
that the revised system is first effective on January 1, 2008.
    In addition, we set forth an analysis of the impact that the 
proposed revised ASC payment system would have on affected entities and 
Medicare beneficiaries.
    We received over 8,900 pieces of correspondence in response to our 
August 23, 2006 proposal for the revised ASC payment system, which 
included some comments recommending various changes to how CMS pays for 
ASC services and processes ASC claims that we did not propose in the 
August 23, 2006 Federal Register. While we read those comments with 
interest, we generally do not address them, nor have we made any 
changes in this final rule based on them. We summarize the numerous 
comments and recommendations that are pertinent to what we proposed, 
and we respond to them in the appropriate sections of this final rule.

E. Changes to the ASC List for CY 2007

    As part of the CY 2007 OPPS/ASC final rule with comment period, we 
finalized additions to and deletions from the ASC list of covered 
surgical procedures, effective January 1, 2007 (71 FR 68166). We did 
not change the criteria for adding or deleting items from the ASC list 
effective January 1, 2007. However, in the August 2006 proposed rule 
(71 FR 49628), we discussed changes to the criteria in the context of 
developing the proposed revised ASC payment system to be effective 
January 1, 2008. The changes to the criteria that we proposed resulted 
in the proposed addition for CY 2008 of many procedures that do not 
meet the current criteria for addition to the list.

II. Revisions to the ASC Payment System Effective January 1, 2008

A. General

    As we discussed earlier, generally, there are two primary elements 
in the total cost of performing a surgical procedure: (a) The cost of 
the physician's professional services for performing the procedure; and 
(b) the cost of services furnished by the facility where the procedure 
is performed (for example, surgical supplies, equipment, nursing 
services, and overhead). The former is covered by the MPFS. The latter 
is covered by a Medicare benefit enacted in 1980 that authorized 
payment of a fee to ASCs for services furnished in connection with 
performing certain surgical procedures.
    Section 1833(i)(1) of the Act requires us to specify surgical 
procedures that are appropriately and safely performed on an ambulatory 
basis in an ASC. Moreover, we are required to review and update the 
list of these procedures not less often than every 2 years, in 
consultation with appropriate trade and professional associations. The 
ASC list of covered surgical procedures was limited in 1982 to 
approximately 100 procedures. Currently, the list consists of more than 
2,500 CPT codes encompassing a cross-section of surgical services, 
although 150 of these codes account for more than 90 percent of the 
approximately 4.5 million procedures paid for each year under the ASC 
Part B benefit. Eye, pain management, and gastrointestinal endoscopic 
procedures are the highest volume ASC surgeries performed under the 
present ASC payment system.
    In CY 2007, Medicare only allows payment to ASCs for procedures on 
the ASC list of covered surgical procedures. Except for screening 
colonoscopy services, payment for ASC facility services is subject to 
the usual Medicare Part B deductible and coinsurance requirements, and 
the amounts paid by Medicare must be 80 percent of the standard 
overhead amount. As discussed earlier, under section 626(b) of Public 
Law 108-173, Congress mandated implementation of a revised payment 
system for ASC surgical services by no later than January 1, 2008. 
Public Law 108-173 set forth several requirements for the revised 
payment system, but did not amend those provisions of the statute 
pertaining to the ASC list.
    As we proposed in the August 2006 proposed rule (71 FR 49635), in 
this final rule, we address two components of the ASC payment system 
that will go into effect January 1, 2008. First, we are establishing 
the ASC list of covered surgical procedures for which an ASC may 
receive Medicare payment for facility services under the revised ASC 
payment system, as well as those covered ancillary services that may be 
separately paid if they are provided integral to a covered surgical 
procedure. Second, we are specifying the method we will use to set 
payment rates for ASC services furnished in association with covered 
surgical procedures. In this final rule, we also specify the regulatory 
changes that we are making to 42 CFR Parts 410 and 416 to incorporate 
the rules governing ASC payments that will be applicable beginning in 
CY 2008.

[[Page 42474]]

B. Factors Considered in the Development of the Revised ASC Payment 
System

    On August 2, 2005, we convened a listening session teleconference 
on revising the Medicare ASC payment system. Over 450 callers 
participated, including ASC staff, physicians, and representatives of 
industry trade associations. The listening session provided an 
opportunity for participants to identify the issues and concerns that 
they wanted us to address as we developed the revised ASC payment 
system.
    Callers encouraged us to foster beneficiary access to ASCs by 
creating incentives for physicians to use ASCs. The issues raised by 
participants included suggestions to expand or eliminate altogether the 
ASC list, recommendations to model payment on the OPPS, and concerns 
about how we would propose to treat the geographic wage index 
adjustment and the annual ASC payment rate update. Several callers also 
raised concerns about ensuring adequate payment for supplies, ancillary 
services, and implantable devices under the revised payment system, as 
well as developing a process to allow special payment for new 
technology.
    We also met with representatives of the ASC industry over the past 
several years to discuss options for ratesetting other than conducting 
a survey, to discuss timely updates to the ASC list, and to listen to 
industry concerns related to the implementation of a revised payment 
system. We appreciate the thoughtful suggestions that were presented. 
We considered the concerns and issues brought to our attention, the 
proposals for revising the ASC list of covered surgical procedures, and 
the suggested methods by which we could set ASC payment rates in 
developing the policies in this final rule.
    In the August 23, 2006 Federal Register (71 FR 49506), we proposed 
the policies for the revised ASC payment system to be effective 
beginning in CY 2008. In response to those proposed policies, we 
received over 8,900 pieces of correspondence from the public that we 
are addressing in this final rule.
    Subsequent to publication of the August 2006 proposed rule for the 
revised ASC payment system, the GAO published the statutorily mandated 
report entitled, ``Medicare: Payment for Ambulatory Surgical Centers 
Should Be Based on the Hospital Outpatient Payment System'' (GAO-07-86) 
on November 30, 2006. We considered the report's methodology, findings, 
and recommendations in the development of this CY 2008 final rule for 
the revised ASC payment system. The GAO methodology, results, and 
recommendations are summarized below.
    The GAO was directed to conduct a study comparing the relative 
costs of procedures furnished in ASCs to those furnished in HOPDs paid 
under the OPPS, including examining the accuracy of the ambulatory 
payment classifications (APC) with respect to surgical procedures 
furnished in ASCs. Section 626(d) of Pub. L. 108-173 indicated that the 
report should include recommendations on the following matters:
    1. Appropriateness of using groups of covered services and relative 
weights established for the OPPS as the basis of payment for ASCs.
    2. If the OPPS relative weights are appropriate for this purpose, 
whether the ASC payments should be based on a uniform percentage of the 
payment rates or weights under the OPPS, or should vary, or the weights 
should be revised based on specific procedures or types of services.
    3. Whether a geographic adjustment should be used for ASC payment 
and, if so, the labor and nonlabor shares of such payment.
    To compare the relative costs of procedures performed in ASCs and 
HOPDs, the GAO first compiled information on ASCs' costs and the 
surgical procedures performed. It conducted a survey of 600 randomly 
selected ASCs from the universe of all ASCs to obtain their CY 2004 
cost and procedure data. The GAO received 397 responses from facilities 
and, through data reliability testing, determined that data from 290 
responding facilities were sufficiently reliable and geographically 
representative of ASCs. Furthermore, to compare the delivery of 
surgical procedures and their relative costs between ASC and HOPD 
settings, the GAO analyzed OPPS claims data from CY 2003. It also 
interviewed officials at CMS, representatives from ASC industry 
organizations and physician specialty societies, and representatives 
from nine ASCs.
    In order to allocate ASCs' total costs among the individual 
procedures they performed, the GAO developed a specific methodology to 
allocate the portion of an ASC's costs accounted for by each procedure. 
It constructed a relative weight scale for Medicare's covered ASC 
procedures that captured the general variation in resources associated 
with performing different procedures. Primarily, it used data that CMS 
collects for the purpose of setting the practice expense component of 
physician payment rates, supplemented by information from specialty 
societies and physicians who work for CMS for those procedures for 
which CMS had no data on the resources used.
    To calculate per-procedure costs based upon data gathered through 
its survey of ASCs, the GAO deducted costs that Medicare considers 
unallowable, that is, advertising and entertainment costs. In addition, 
it also removed costs for services that Medicare pays for separately, 
such as physician and nonphysician practitioner services. The remaining 
facility costs were then divided into direct and indirect costs. The 
GAO defined direct costs as those associated with the clinical staff, 
equipment, and supplies utilized during the procedure. Indirect costs 
included all remaining costs. Next, to allocate each facility's direct 
costs across the procedures it performed, the GAO applied its relative 
weight scale. It allocated indirect costs equally across all procedures 
performed by the facility. For each procedure performed by a responding 
ASC facility, it summed the allocated direct and indirect costs to 
determine a total cost for the procedure. To obtain a per-procedure 
cost across all ASCs, the GAO arrayed the calculated costs for all ASCs 
performing that procedure and identified the median cost.
    To compare per-procedure costs for ASCs and HOPDs, the GAO obtained 
the list of OPPS APCs and their assigned procedures, along with the 
OPPS median cost of each procedure and its related APC group. It then 
calculated a ratio between each procedure's ASC median cost as 
determined by the survey and the median cost of the procedure's 
corresponding APC group under the OPPS, referred to as the ASC-to-APC 
cost ratio. It calculated a corresponding ratio between each ASC 
procedure's median cost under the OPPS and the median cost of the 
procedure's APC group using CMS data, referred to as the OPPS-to-APC 
cost ratio. In order to evaluate the difference in procedure costs 
between the two settings, the GAO compared the ASC-to-APC cost ratio to 
the OPPS-to-APC cost ratio. Next, to assess how well the relative costs 
of procedures in the OPPS, defined by their assignment to APC groups, 
reflect the relative costs of procedures in the ASC setting, it 
evaluated the distribution of both the ASC-to-APC cost ratios and the 
OPPS-to-APC cost ratios.
    The GAO also analyzed Medicare claims data for the top 20 
procedures with the highest Medicare ASC claims volume in CY 2004 to 
examine the delivery of additional services with

[[Page 42475]]

surgical procedures in ASCs and HOPDs. Last, to calculate the 
percentage of labor-related costs among the responding ASCs, for each 
ASC, the GAO divided total labor costs by total costs and then 
determined the range of the percentage of labor-related costs among all 
of the ASCs between the 25th and the 75th percentile, as well as the 
mean and median percentage of labor-related costs.
    Based on its extensive analyses, the GAO determined that the APC 
groups in the OPPS accurately reflect the relative costs of the 
procedures performed in ASCs. GAO's analysis of the cost ratios showed 
that the ASC-to-APC cost ratios were more tightly distributed around 
their median cost ratio than were the OPPS-to-APC cost ratios. These 
patterns demonstrated that the APC groups reflect the relative costs of 
procedures performed by ASCs and, therefore, that the APC groups could 
be used as the basis for an ASC payment system. The GAO determined, in 
fact, that there was less variation in the ASC setting between 
individual procedures' costs and the costs of their assigned APC groups 
than there is in the HOPD setting. It concluded that, as a group, the 
costs of procedures performed in ASCs have a relatively consistent 
relationship with the costs of the APC groups to which they would be 
assigned under the OPPS. The GAO's analysis also found that procedures 
in the ASC setting had substantially lower costs than those same 
procedures in the HOPD. While ASC costs for individual procedures 
varied, in general, the median costs for procedures were lower in ASCs, 
relative to the median costs of their APC groups, than the median costs 
for the same procedures in the HOPD setting. The median cost ratio 
among all ASC procedures was 0.39 (0.84 when weighted by Medicare 
volume based on CY 2004 claims), whereas the median cost ratio among 
all OPPS procedures was 1.04.
    The GAO found many similarities in the additional items and 
services provided by ASCs and HOPDs for the top 20 ASC procedures. 
However, of these additional items and services, few resulted in 
additional payment in one setting but not the other. HOPDs were paid 
for some of the related services separately, while in the ASC setting, 
other Part B suppliers billed Medicare and received payment for many of 
the related services.
    Finally, in its analysis of labor-related costs, the GAO determined 
that the mean labor-related proportion of costs was 50 percent. The 
range of the labor-related costs for the middle 50 percent of 
responding ASCs was 43 percent to 57 percent of total costs.
    Based on its findings from the study, the GAO recommended that CMS 
implement a payment system for procedures performed in ASCs based on 
the OPPS, taking into account the lower relative costs of procedures 
performed in ASCs compared to HOPDs in determining ASC payment rates.
    Comment: A number of commenters noted that, by the close of the 
public comment period for the August 2006 proposed rule for the revised 
ASC payment system, the GAO had not yet provided recommendations 
regarding ASC payment in a report to Congress that it was required to 
submit by January 1, 2005. Some commenters recommended that, although 
CMS was directed to take into account these recommendations in 
implementing the revised ASC payment system, should the GAO's 
recommendations be provided before publication of the final rule 
establishing the policies of the revised ASC payment system, CMS should 
not take them into consideration, given the public's inability to 
provide input to CMS during the comment period regarding the GAO's 
methodology, findings, and recommendations. Other commenters 
recommended that, if the GAO Report was forthcoming shortly, CMS should 
provide another opportunity for public comment prior to finalizing the 
policies of the revised ASC payment system in order to allow the public 
to provide CMS with their perspectives on those recommendations.
    Response: As described earlier, the GAO published its report (GAO-
07-86) on November 30, 2006. In accordance with section 
1833(i)(2)(D)(i) of the Act, we did take into account the 
recommendations made in the GAO Report in developing the final policies 
for the revised ASC payment system. The GAO's findings and 
recommendations are summarized above, and its specific recommendations 
are further discussed in the particular sections of this final rule 
that address the related topics. We appreciate the public's interest in 
providing us with detailed input regarding the revised ASC payment 
system from a variety of perspectives. In regard to the commenters' 
recommendation for a second opportunity for public comment prior to 
finalizing the policies of the revised ASC payment system after the GAO 
Report was published, we note that the GAO's recommendations are in 
complete accord with our August 2006 proposal for the revised ASC 
payment system. Therefore, we are not providing another opportunity for 
public comment prior to finalizing the policies of the revised ASC 
payment system, because the proposed revised system is fully consistent 
with the recommendations of the GAO Report and we already provided a 
90-day comment period regarding our proposal for CY 2008. We believe 
that the comment period for the August 2006 proposed rule provided the 
public with ample opportunity to comment on the policies that were 
recommended by the GAO. The considerable operational changes required 
to implement the revised ASC payment system necessitate significant 
lead time that would not be possible if we were to provide another 
comment period prior to finalizing the policies. We also believe that 
our consideration of the recent GAO study, as well as other available 
information regarding HOPD and ASC costs and payments, in addition to 
our prior discussions with stakeholders and the many public comments on 
the proposed rule, provide us with the necessary breadth and depth of 
information and viewpoints to finalize our payment policies for the 
revised ASC payment system in this final rule.
    At its December 2006 meeting, the Practicing Physicians Advisory 
Council (PPAC) made two recommendations to CMS regarding the final rule 
for the revised ASC payment system. First, the PPAC recommended that 
CMS establish a process to consult with national medical specialty 
societies and the ASC community to develop and adopt a systematic and 
adaptable means of fairly reimbursing ASCs for all safe and appropriate 
services, allowing for changes in technology and current day practice. 
Second, the PPAC recommended that CMS apply any payment policies 
uniformly to both ASCs and HOPDs, as appropriate.
    We have considered the GAO Report, in addition to the 
recommendations of the PPAC, all public comments received on the 
proposed rule, and other concerns and issues brought to our attention 
by interested parties over the past several years, in developing this 
final rule for the CY 2008 revised ASC payment system. Specific 
policies are discussed, comments summarized and responses provided, and 
policies finalized in subsequent sections of this final rule.

C. Rulemaking for the Revised ASC Payment System in CY 2008

    In response to comments submitted timely regarding the proposals 
set forth in the proposed rule for the revised ASC payment system 
published on August 23, 2006, this final rule establishes the final 
policies and regulations of the

[[Page 42476]]

revised ASC payment system for initial implementation in CY 2008. All 
tables included in this final rule listing HCPCS codes subject to 
pertinent final policies of the revised ASC payment system, as well as 
estimated payment rates, are illustrative only, based on CY 2007 HCPCS 
codes and final CY 2007 OPPS and MPFS information, with application of 
the most current update estimates for CY 2008. The information in the 
Addenda to this final rule is also only illustrative, to provide 
examples of the results of applying the final policies of the revised 
ASC payment system, based on the most recent information available for 
CY 2007. As further discussed in sections V.E. and VI. of this final 
rule, we will propose the CY 2008 relative payment weights, payment 
amounts, specific HCPCS codes to which the final policies of the 
revised ASC payment system would apply, and other pertinent ratesetting 
information for the CY 2008 revised ASC payment system in the proposed 
OPPS/ASC rule to update the payment systems for CY 2008 to be issued in 
mid-summer of CY 2007. We will then publish final relative payment 
weights, payment amounts, specific CY 2008 HCPCS codes to which the 
final policies will apply, and other pertinent ratesetting information 
for the CY 2008 revised ASC payment system in the final OPPS/ASC rule 
to update the payment systems for CY 2008. The ASC payment system 
treatment of new CY 2008 HCPCS codes published in the CY 2008 OPPS/ASC 
final rule will provide interim determinations, open to public comment 
on that final rule, and we will respond to comments about those 
determinations in the OPPS/ASC final rule for CY 2009.

III. Covered Surgical Procedures Paid in ASCs On or After January 1, 
2008

A. Payable Procedures

    In its March 2004 Report to the Congress, the Medicare Payment 
Advisory Commission (MedPAC) recommended replacing the current 
``inclusive'' list of procedures, which are the only surgical 
procedures for which Medicare allows payment to an ASC, with an 
``exclusionary'' list. That is, rather than limiting payment to ASCs to 
a list of procedures that CMS specifies, Medicare would allow payment 
to ASCs for any surgical procedure except those that CMS explicitly 
excludes from payment. MedPAC further recommended that clinical safety 
standards and the need for an overnight stay be the only criteria for 
excluding a procedure from eligibility for Medicare ASC payment. MedPAC 
suggested that some of the criteria, such as site-of-service volume and 
time limits, which we have used in the past to identify procedures for 
the ASC list of covered surgical procedures, are probably no longer 
clinically relevant.
    In the August 2006 proposed rule for the revised ASC payment 
system, we noted that we had given careful consideration to MedPAC's 
recommendations and participated in considerable discussion and 
consultation with members of ASC trade associations and physicians, who 
represent a variety of surgical specialties, regarding the criteria 
that we would use to identify procedures for payment under the revised 
ASC payment system. We agreed that adoption of a policy similar to that 
recommended by MedPAC would serve both to protect beneficiary safety 
and increase beneficiary access to procedures in appropriate clinical 
settings, recognizing the ASC industry's interest in obtaining Medicare 
payment for a much wider spectrum of services than is now allowed. 
Therefore, in the August 2006 proposed rule (71 FR 49636), we proposed 
that, under the revised ASC payment system for services furnished on or 
after January 1, 2008, Medicare would allow payment to ASCs for any 
surgical procedure performed in an ASC, except those surgical 
procedures that we determine are not payable under the ASC benefit.
    Further, we proposed to establish beneficiary safety and the 
expected need for an overnight stay as the principal clinical 
considerations and decisive factors in determining whether ASC payment 
would be allowed for a particular surgical procedure. As discussed in 
section XVIII.B.2. of the preamble of the proposed rule, we also 
proposed to exclude from separate payment under the revised ASC payment 
system those surgical procedures that are on the OPPS inpatient list, 
that are not eligible for separate payment under the OPPS, and that are 
CPT surgical unlisted procedure codes.
    We discuss below the criteria that we proposed as the basis for 
identifying procedures that would pose a significant safety risk to a 
Medicare beneficiary when performed in an ASC, or procedures following 
which we would expect a Medicare beneficiary to require overnight care.
1. Definition of Surgical Procedure
    In order to delineate the scope of procedures that constitute 
``outpatient surgical procedures'' in the August 2006 proposed rule, we 
first proposed to clarify what we considered to be a ``surgical'' 
procedure. Under the existing ASC payment system, we define a surgical 
procedure as any procedure described within the range of Category I CPT 
codes that the CPT Editorial Panel of the American Medical Association 
(AMA) defines as ``surgery'' (CPT codes 10000 through 69999). Under the 
revised payment system, we proposed to continue to define surgery using 
that standard. The CPT Editorial Panel is responsible for maintaining 
the CPT nomenclature, with authority to revise, update, or modify the 
CPT codes. A larger body of CPT advisors, the CPT Advisory Committee, 
supports the work of the CPT Editorial Panel. Members of the CPT 
Editorial Panel include individuals nominated by physician and hospital 
associations and insurers, providing for diverse specialty input.
    In addition, in the August 2006 proposed rule for the revised ASC 
payment system, we proposed to include within the scope of surgical 
procedures payable in an ASC those procedures that are described by 
Level II HCPCS codes or by Category III CPT codes that directly 
crosswalk to or are clinically similar to procedures in the CPT 
surgical range. We proposed to include all three types of codes in our 
definition of surgical procedures because they all may be eligible for 
separate payment under the OPPS and, to the extent it is reasonable to 
do so, we proposed that the revised ASC payment system parallel the 
OPPS in its policies.
    In the August 2006 proposed rule, we provided an example of a Level 
II HCPCS code that we believe represents a procedure that could be 
safely and appropriately performed in an ASC, specifically HCPCS code 
G0297 (Insertion of single chamber pacing cardioverter-defibrillator 
pulse generator). We developed this Level II HCPCS code for use in the 
OPPS because CPT code 33240 (Insertion of single or dual chamber pacing 
cardioverter-defibrillator pulse generator), which describes the 
surgical insertion of a cardioverter-defibrillator pulse generator, 
does not distinguish insertion of a single chamber cardioverter-
defibrillator generator from insertion of a dual chamber cardioverter-
defibrillator generator. Under the OPPS, we were concerned that 
different facility resources could be required for the insertion of 
these two types of cardioverter-defibrillator pulse generators, so we 
developed Level II HCPCS codes to permit HOPDs to more accurately 
report the resources required when these surgical procedures are 
performed. In instances such as this, when a Level II HCPCS code is

[[Page 42477]]

established as a substitute for a CPT surgical procedure code which 
does not adequately describe, from a facility perspective, the nature 
of a surgical service, we proposed to allow payment for the Level II 
HCPCS code under the proposed revised ASC payment system. We proposed 
not to allow ASC payment for Level II HCPCS codes or Category III CPT 
codes that describe services that fall outside the scope of, that is, 
that do not correspond to, surgical procedures described by CPT codes 
10000 through 69999.
    We recognized in the proposed rule that continuing to use this 
definition of surgery would exclude from ASC payment certain invasive, 
``surgery-like'' procedures, such as cardiac catheterization or certain 
radiation treatment services which are assigned codes outside the CPT 
surgical range. However, we believed that continuing to rely on the CPT 
definition of surgery would be administratively straightforward, 
logically related to the categorization of services by physician 
experts who both establish the codes and perform the procedures, and 
consistent with our proposal to allow ASC payment for all outpatient 
surgical procedures. Given the number of other changes that we expected 
to implement as part of the revised payment system, along with the 
significant expansion of ASC covered surgical procedures that we 
proposed, we explained that we believed it would be prudent at the 
outset to continue to define surgery as it is defined by the CPT code 
set, which is used to report services for payment under both the MPFS 
and the OPPS. During the development of the August 2006 proposed rule, 
we reviewed thousands of CPT codes in the surgical range (CPT codes 
10000 through 69999), and we proposed to not exclude from payment over 
750 surgical procedures previously excluded, in addition to providing 
ASC payment for the more than 2,500 CPT codes on the CY 2007 ASC list 
of covered surgical procedures.
    However, we are cognizant of the dynamic nature of ambulatory 
surgery, which has resulted in a dramatic shift of services from the 
inpatient setting to the outpatient setting over the past two decades. 
Therefore, in the proposed rule, we solicited comments regarding other 
services that are invasive and ``surgery-like,'' which could safely and 
appropriately be performed in an ASC, and which require the resources 
typical of an ASC, even though the procedures are described by codes 
that fall outside the range of CPT surgical codes. In particular, we 
were interested in considering commenters' views regarding what 
constitutes a ``surgical'' procedure.
    We received many public comments about our August 2006 proposal to 
define the surgical procedures for which we would make payment to ASCs 
as those falling within the surgical code range specified by the CPT 
Editorial Panel.
    Comment: While, in general, hospital associations and device 
manufacturers supported the proposal to maintain the definition of a 
surgical procedure used under the existing ASC payment system, many ASC 
industry representatives provided a broad range of suggestions about 
how the definition should be expanded. Some of the commenters requested 
that CMS place no limit on the procedures that would be payable in ASCs 
because there is no such limit on Medicare payments to HOPDs. Other 
commenters suggested a more limited expansion of procedures eligible 
for payment under the revised ASC payment system. These commenters 
specifically recommended that CMS expand its definition of a surgical 
procedure to include:
    (a) Medical procedures that are invasive and require general 
anesthesia or that are specifically designated as intraoperative 
procedures;
    (b) X-ray, fluoroscopy, and ultrasound procedures that require 
insertion of a needle, catheter, tube, or probe via a natural orifice 
or through the skin;
    (c) Radiology procedures integral to performance of nonradiologic 
procedures, performed either during or immediately following the 
surgical procedure; and
    (d) Level II HCPCS and Category III CPT codes that describe 
procedures that crosswalk directly or are clinically similar to those 
listed in suggestions (a) through (c) above.
    Response: We have given consideration to the many recommendations 
of the commenters. In general, we continue to believe it is appropriate 
to provide payments to ASCs for the resources associated with 
performing those services that are surgical procedures as defined by 
the CPT Editorial Panel. From the Panel's broad experience in regularly 
addressing the complex issues associated with new and emerging health 
care technologies, as well as the difficulties encountered with 
obsolete procedures, we believe its members are well-positioned to 
maintain and refine the existing coding taxonomy, which defines certain 
procedures as surgery, to appropriately reflect medical practice in an 
evolving health care delivery system. In addition, we believe that our 
proposal to pay for surgical procedures in ASCs that are reported by 
Level II HCPCS and Category III CPT codes that directly crosswalk or 
are clinically similar to procedures in the surgical range of CPT codes 
that are payable in ASCs is consistent with our definition of surgery 
according to the CPT surgical code range, while providing ASC payment 
for some procedures that have not yet been categorized by the CPT 
Editorial Panel or for which Medicare recognizes alternative HCPCS 
codes for payment.
    Although we are not changing our definition of surgery as suggested 
by commenters, we did review procedures that are coded by specific 
Level II HCPCS or Category III CPT codes that were identified by 
commenters as surgical procedures that should be payable in ASCs. We 
assessed those procedures using the same final criteria discussed in 
section III.A.2. of this final rule that we used to evaluate all 
surgical procedures for their safety or the expected need for an 
overnight stay in making decisions about their exclusion from ASC 
payment. As we proposed, we also evaluated the codes in the context of 
whether they directly crosswalk or are clinically similar to procedures 
in the CPT surgical range that we have determined do not pose a 
significant safety risk or for which an overnight stay is not expected 
when performed in ASCs. As a result of that review, 14 additional Level 
II HCPCS codes and 15 Category III CPT codes beyond those we proposed 
for CY 2008 payment will be payable as covered surgical procedures when 
performed in ASCs beginning in CY 2008.
    Furthermore, as discussed in section IV. of this final rule, 
although we are not expanding our definition of surgical procedures, we 
will provide separate ASC payment for a number of covered ancillary 
services when they are furnished on the same day as a covered surgical 
procedure and are integral to the performance of that procedure in the 
ASC setting. Those services include certain radiology procedures, such 
as some fluoroscopy and ultrasound services, that some commenters 
recommended we define as surgical procedures for addition to the ASC 
list of covered surgical procedures.
    Comment: Several commenters expressed concern regarding CMS' 
proposed exclusion from ASC payment of all procedures described within 
the range of Category I CPT codes defined as ``radiology'' in 
accordance with the CPT Editorial Panel designation. The commenters 
asserted that regulations regarding the Federal physician self-referral 
prohibition (section 1877 of the Act) exclude interventional and

[[Page 42478]]

intraoperative radiology services from the definition of ``radiology'' 
services subject to the law's self-referral prohibition, and that CMS 
should, therefore, treat those services as surgical services that are 
eligible for payment as covered surgical procedures under the revised 
ASC payment system. They believed that interventional radiology and 
intraoperative radiology services that require insertion of a needle, 
catheter, tube, probe, or similar device are appropriately considered 
surgical in nature for purposes of ASC payment.
    Response: The commenters' statements with respect to the treatment 
of interventional radiology procedures under the physician self-
referral regulations seem overly broad. The physician self-referral 
regulations provide that the following services (which may include 
some, but not all, interventional radiology procedures) are not 
``radiology and certain other imaging services'' for purposes of 
section 1877 of the Act: (i) X-ray, fluoroscopy, or ultrasound 
procedures that require the insertion of a needle, catheter, tube, or 
probe through the skin or into a body orifice; and (ii) radiology 
procedures that are integral to the performance of a nonradiological 
medical procedure and performed either during the nonradiological 
medical procedure or immediately following the nonradiological medical 
procedure when necessary to confirm placement of an item inserted 
during the nonradiological medical procedure. We do not believe that 
Medicare's exclusion of specific services from the definition of 
``radiology and certain other imaging services'' for purposes of the 
physician self-referral prohibition should result in such services 
being considered ``surgical services'' for purposes of the revised ASC 
payment system.
    Further, as we explain above, we believe that the characterization 
of procedures as surgery for purposes of their performance in ASCs is 
best left to the expertise of the CPT Editorial Panel. We do not 
believe that services designated as radiology services by the CPT 
Editorial Panel are appropriately classified as covered surgical 
procedures in ASCs, facilities that specialize in the delivery of 
ambulatory surgical services. However, as discussed further in section 
IV.C.2. of this final rule, we do believe that it is appropriate to 
provide separate ASC payment for certain ancillary services that are 
integral to the covered surgical procedures. Thus, we will provide 
separate payment to ASCs under the revised payment system for radiology 
services that are integral to the performance of an ASC covered 
surgical procedure when that radiology procedure is one of those for 
which separate payment is made under the OPPS. That is, separate 
payment will be made for covered ancillary radiology services integral 
to covered surgical procedures that are provided in the ASC immediately 
before, during, or immediately following the surgical procedure.
    After consideration of the public comments we received, we are 
finalizing our proposal to define surgery as those procedures described 
by CPT codes within the surgical range of 10000 through 69999, without 
modification. In addition, we are including within our definition of a 
covered surgical procedure payable in the ASC setting those Level II 
HCPCS codes or Category III CPT codes that directly crosswalk or are 
clinically similar to procedures in the CPT surgical range that we have 
determined do not pose a significant safety risk, that we would not 
expect to require an overnight stay when performed in ASCs, and that 
are separately paid under the OPPS. An illustrative list of covered 
surgical procedures under the revised ASC payment system, including 
Category I and Category III CPT codes and Level II HCPCS codes, can be 
found in Addendum AA to this final rule. An illustrative list of 
radiology services and other covered ancillary services that are 
eligible for separate ASC payment when provided integral to an ASC 
covered surgical procedure on the same day is located in Addendum BB to 
this final rule.
2. Procedures Excluded From Payment Under the Revised ASC Payment 
System
    As stated above, in the August 2006 proposed rule for the revised 
ASC payment system, we proposed to allow payment to ASCs for all 
procedures described by CPT codes within the surgical range of 10000 
through 69999, or by Level II HCPCS codes or Category III CPT codes 
that directly crosswalk or are clinically similar to procedures in the 
CPT surgical range, that do not pose a significant safety risk to 
Medicare beneficiaries and that are not expected to require an 
overnight stay. Having established what we consider to be a ``surgical 
procedure,'' we next considered criteria that would enable us to 
identify procedures that could pose a significant safety risk when 
performed in an ASC or that we expect would require an overnight stay 
within the bounds of prevailing medical practice. We discuss in the 
next section how we proposed to identify procedures that could pose a 
significant safety risk.
a. Significant Safety Risk
    First, we proposed to exclude from ASC payment any procedure that 
is included on the current OPPS inpatient list, that is, those 
procedures designated as requiring inpatient care under Sec.  
419.22(n). (See Addendum E to the CY 2007 OPPS/ASC final rule with 
comment period (71 FR 68385 through 68398).) The procedures included on 
that list are typically performed in the hospital inpatient setting due 
to the nature of the procedure, the need for at least 24 hours of 
postoperative recovery time or monitoring before the patient can be 
safely discharged, or the underlying physical condition of the patient. 
We believed that any procedure for which we did not allow payment in 
the hospital outpatient setting due to safety concerns would not be 
safe to perform in an ASC.
    Second, we proposed to exclude from ASC payment procedures that the 
CY 2005 Part B Extract Summary System (BESS) data indicated were 
performed 80 percent or more of the time in the hospital inpatient 
setting, even if those procedures were not included on the OPPS 
inpatient list. We selected an 80-percent threshold because we believed 
that an 80-percent level of inpatient performance was a fair indicator 
that a procedure is most appropriately performed on an inpatient basis 
and, as such, would pose a significant safety risk for Medicare 
beneficiaries if performed in an ASC. We believed that procedures with 
inpatient utilization frequencies above the proposed threshold were 
complex and were likely to require a longer and more intensive level of 
care postoperatively than what is provided in a typical ASC. We also 
believed that performing these procedures in an ASC, where immediate 
access to the full resources of an acute care hospital is not the norm, 
would pose a significant safety risk for beneficiaries.
    Third, we proposed to retain some of the specific criteria for 
evaluating safety risks that are listed in Sec.  416.65(b)(3) of our 
existing regulations. Procedures that involve major blood vessels, 
major or prolonged invasion of body cavities, extensive blood loss, or 
are emergent or life-threatening in nature could, by definition, pose a 
significant safety risk. Therefore, we proposed to exclude from ASC 
payment surgical procedures that may be expected to involve any of 
these characteristics, based on evaluation by our medical advisors. We 
noted that most of the procedures that our medical advisors identified 
as involving any of the characteristics listed in Sec.  416.65(b)(3) 
also require overnight or

[[Page 42479]]

inpatient stays, reinforcing our belief that they should be excluded 
from ASC payment.
    Finally, we proposed not to continue applying under the proposed 
revised system the current time-based, prescriptive criteria at 
Sec. Sec.  416.65(b)(1) and (b)(2), which exclude from the ASC list 
procedures that exceed 90 minutes of operating time or 4 hours of 
recovery time or 90 minutes of anesthesia. We believed these criteria 
were no longer clinically appropriate for purposes of defining a 
significant safety risk for surgical procedures.
    We indicated that, in light of the proposed changes for evaluating 
procedures to identify those that pose a significant safety risk for 
beneficiaries when performed in ASCs, we believed that it would not be 
appropriate to apply the existing standard at Sec.  416.65(a)(1), which 
states that covered surgical procedures are those that are commonly 
performed on an inpatient basis but may be safely performed in an ASC, 
because this standard is no longer relevant to prevailing medical 
practice in the realm of ambulatory or outpatient surgery. Similarly, 
we believed that it would not be appropriate to continue applying the 
existing standard at Sec.  416.65(a)(2), which states that procedures 
performed in an ASC are not of a type that are commonly performed, or 
that may be performed, in a physician's office. This standard did not 
seem relevant within the context of the proposal only to exclude from 
ASC payment under the revised payment system those surgical procedures 
that pose a safety risk or are expected to require an overnight stay. 
We would expect the types of surgical procedures that are commonly 
performed or that may be performed in a physician's office to pose no 
significant safety risk and to require no overnight stay.
    We proposed to add new Subpart F to 42 CFR Part 416 to reflect 
coverage, scope, and payment for ASC services under the revised payment 
system. Included in the changes would be new Sec.  416.166 to reflect 
the changes that we proposed to our current policy for evaluating and 
identifying those procedures that would pose a significant safety risk 
for beneficiaries and would be excluded from our list of ASC covered 
surgical procedures beginning January 1, 2008. To set the provisions 
that are applicable to our existing ASC payment system apart from those 
that would apply to the revised ASC payment system, as we proposed, in 
the CY 2007 OPPS/ASC final rule with comment period, we revised the 
section headings of Subparts D and E of Part 416 to clearly denote the 
provisions that govern covered surgical procedures furnished before 
January 1, 2008. We also added Sec. Sec.  416.76 and 416.121 to clearly 
denote the effective dates of Subparts D and E (71 FR 68226).
    Comment: Commenters provided many recommendations regarding the 
proposed criteria for evaluating which procedures should be excluded 
from the ASC list of covered surgical procedures that varied greatly. 
At one end of the spectrum, some commenters recommended that CMS only 
exclude from ASC payment those procedures that are included on the 
``inpatient list'' used under the OPPS. They believed that all 
procedures not on the OPPS inpatient list are safe for performance in 
ASCs and that, by the specification of their payable status under the 
OPPS, they do not require an overnight stay.
    Some commenters suggested that CMS create the ASC exclusionary list 
by individually reviewing surgical procedures based upon data that 
demonstrate the risks, complications, and overall safety of a given 
procedure, rather than attempting to specifically apply the standards 
of the proposed criteria. They believed that health outcomes databases, 
including the National Surgical Quality Improvement Project and patient 
and device registries, could provide further information to refine an 
initial safety assessment based on the proposed criteria when certain 
procedures were identified as needing further consideration and 
evaluation. The commenters recommended this flexible and specific 
approach to allow for full consideration of the surgical aspects of 
each procedure, in order to make an appropriate determination regarding 
its safety for ASC performance. The commenters believed CMS could work 
with surgical professional associations and external surgical experts 
to facilitate a smooth and efficient clinical review process.
    In contrast, other commenters recommended that CMS implement more 
stringent review criteria than our criteria under the existing payment 
system for evaluating which procedures are unsafe for performance in 
ASCs. They believed that beneficiary safety could be better protected 
if CMS would adopt review criteria that would exclude more procedures 
from ASC performance than those criteria currently in place, while 
maintaining the existing limitations on operating and recovery room 
times.
    Response: We believe that both ends of the spectrum of public 
comments are inconsistent with our goal of only excluding those 
procedures from ASC payment that are unsafe for performance in ASCs or 
are expected to require an overnight stay. We agree with the 
perspective of most commenters that procedures on the OPPS inpatient 
list should also be excluded from ASC payment. However, while we 
strongly disagree with the contention by some commenters that all 
procedures performed in HOPDs are appropriate for performance in ASCs, 
we also believe that instituting criteria that are more restrictive 
than those currently in place would be inappropriate, because we do not 
have safety concerns regarding procedures that are already included on 
the ASC list of covered surgical procedures.
    Typically, HOPDs are able to provide much higher acuity care than 
ASCs. ASCs have neither patient safety standards consistent with those 
in place for hospitals, nor are they required to have the trained staff 
and equipment needed to provide the breadth and intensity of care that 
hospitals are required to maintain. According to current CMS standards, 
hospitals must meet numerous documentation, infection prevention, and 
patient assessment requirements that are not applied to ASCs. 
Therefore, there are some procedures that we believe may be 
appropriately provided in the HOPD setting that are unsafe for 
performance in ASCs. Thus, we are not adopting a final policy to 
exclude only those surgical procedures on the OPPS inpatient list from 
ASC payment under the revised payment system.
    Nonetheless, as stated in our August 2006 proposal and consistent 
with MedPAC recommendations, we are committed to revising the ASC list 
of covered surgical procedures so that it excludes only those surgical 
procedures that pose significant safety risks to beneficiaries or that 
are expected to require an overnight stay. We believe that adoption of 
a policy similar to that recommended by MedPAC would serve both to 
protect beneficiary safety and increase beneficiary access to surgical 
procedures in appropriate clinical settings. We also believe that this 
approach is most consistent with the PPAC's recommendation that we 
provide payment under the revised ASC payment system for all safe and 
appropriate services. Thus, we do not believe that it would be 
appropriate to implement more restrictive criteria for evaluating 
procedures for exclusion from ASC payment or even to maintain all of 
the current criteria that we use under the existing payment system to 
evaluate the appropriateness of including procedures on the ASC list. 
We continue to believe the current limitations on operating room and 
recovery room times for ASC procedures

[[Page 42480]]

are no longer clinically relevant to assessing the safety risk of 
surgical procedures. Our comprehensive review of all surgical 
procedures has convinced us that there are procedures in addition to 
those included on the CY 2007 ASC list of covered surgical procedures 
that may be safely performed in ASCs, and that increasing the number 
and types of procedures for which Medicare provides ASC payment is 
appropriate.
    Regarding our proposed overall approach to evaluating procedures 
for exclusion from the ASC list of covered surgical procedures, we 
believe that our evaluation process is generally consistent with the 
approach advised by some commenters that we apply the proposed criteria 
as part of an initial safety assessment, and then conduct procedure-
specific analyses of possible risks and complications of individual 
procedures based on available data. In preparing the proposal for the 
revised ASC payment system, we reviewed each surgical procedure that is 
separately payable under the OPPS and not already on the CY 2007 ASC 
list and with inpatient utilization of less than 80 percent against the 
proposed safety and overnight stay criteria and identified a subset of 
procedures for further assessment if we had concerns about their 
potential safety risk. We then used all of the information available to 
us to arrive at a preliminary determination regarding each procedure's 
suitability for payment in the ASC setting. These preliminary 
determinations constituted our proposed treatment of the procedures 
under the revised ASC payment system, and the status of the codes was 
open to public comment in the August 2006 proposed rule. We received 
detailed information and recommendations from many commenters, 
including hospitals, ASCs, device manufacturers, and physician 
specialty organizations, as well as physician experts, regarding the 
proposed treatment of many surgical procedure codes. Summaries of these 
comments and our responses follow later in this section of this final 
rule.
    Comment: A number of commenters expressed concerns about the safety 
implications of a greatly expanded list of surgical procedures to be 
performed in ASCs. They advocated implementation of specific additional 
measures for tightening and strengthening the criteria we proposed to 
use to evaluate the potential for beneficiary risk associated with 
surgical procedures. Included in the commenters' numerous 
recommendations were the following comments:
    (1) Make no changes to the current criteria until the ASC 
Conditions for Coverage are revised to ensure that patient protections 
comparable to those in place in hospitals are in place in ASCs.
    (2) Apply the existing and proposed criterion to exclude procedures 
from the ASC list that involve major blood vessels, by adopting a 
specific list of blood vessels that CMS defines as major blood vessels, 
in order to provide more certainty about which procedures would be 
excluded. Some commenters recommended that CMS adopt the definition of 
a major blood vessel advanced in a medical textbook, Essentials of 
Anatomy & Physiology, 6th Edition, by Seeley, Stephens and Tate. For 
procedures that involve blood vessels defined by Seeley, et al., as 
major, but that are already being performed safely in ASCs (for 
example, CPT code 36870, Thrombectomy, percutaneous, arteriovenous 
fistula, autogenous or nonautogenous graft (includes mechanical 
thrombus extraction and intra-graft thrombolysis)), the commenters 
suggested that CMS retain them as ASC covered surgical procedures, 
thereby allowing their continued payment when performed in ASCs.
    (3) Apply the existing and proposed criterion to exclude from ASC 
payment those procedures requiring major or prolonged invasion of body 
cavities, by defining ``prolonged'' invasion as referring to any 
procedure in which the patient is under anesthesia for 90 minutes or 
longer, and expand the definition of body cavity to include major blood 
vessels.
    (4) Exclude from ASC payment procedures that commonly require 
systemic thrombolytic therapy. Some commenters recommended that CMS 
exclude procedures that involve blood vessels that, if occluded, would 
require inpatient lytic therapy, while other commenters recommended 
more generally that CMS exclude procedures that may result in a 
patient's need for lytic therapy. Lytic or inpatient thrombolytic 
therapy as used in this context both refer to systemic thrombolytic 
therapy.
    (5) Disallow procedures that require puncturing of the femoral 
vessels for access. Some commenters recommended that this exclusion be 
for procedures accessing either the femoral artery or the femoral vein, 
while other commenters would have limited the exclusion to only those 
procedures requiring femoral arterial access.
    (6) Implement a quantitative measure (greater than or equal to 15 
percent of total blood volume) to define the existing and proposed 
criterion to exclude from the list procedures that generally result in 
extensive blood loss.
    (7) Use a 50-percent inpatient threshold for excluding procedures 
from the ASC list instead of the proposed 80-percent threshold. While 
some commenters recommended lowering the proposed threshold for 
exclusion of procedures from the ASC list from 80 percent to 50 
percent, several other commenters suggested that CMS should not apply a 
specific numerical threshold of inpatient utilization at all to its 
evaluation of procedure safety. They noted that this could have the 
unintended effect of automatically excluding some procedures from ASC 
payment simply because of limited data indicating their performance 
slightly more than 80 percent of the time in the inpatient setting, 
while data for clinically similar codes reflected inpatient performance 
slightly less than the 80-percent threshold. Instead, these commenters 
recommended that we evaluate each surgical procedure with respect to 
the other proposed criteria, based on the clinical characteristics of 
the procedure itself. The group of commenters recommending 
establishment of a lower threshold of 50 percent believed that this 
modified standard would better enable us to identify procedures that 
are typically clinically complex and have a higher risk of 
complications and extensive postoperative care. They suggested that 
setting the threshold at 50 percent would ensure that procedures 
performed the majority of time in the inpatient setting would be 
excluded from ASC payment.
    (8) Require that patients be assessed for comorbidities and 
anesthesia risk using the American Society of Anesthesiologists' tool, 
and those patients who are high risk, such as patients over age 85 or 
with morbid obesity, should be required to go to hospital settings for 
surgical procedures.
    (9) Identify and implement outcome and process measures to assess 
aspects of quality across care settings, including ASCs. To develop 
those measures, some commenters suggested that CMS work closely with 
the Hospital Quality Alliance (HQA) and the Ambulatory Quality Alliance 
(AQA) (formerly both organizations were known as the AQA). The HQA has 
already begun to include the measures of care used in the Surgical Care 
Improvement Project, and some commenters believed that the goal of 
preventing complications in the care of surgical patients provides an 
appropriate starting point for determining the correct measures for 
assessing important aspects of the safety

[[Page 42481]]

and quality of all types of ambulatory surgery.
    Response: We appreciate the commenters' concerns regarding 
beneficiary safety and gave consideration to each of the individual 
recommendations listed above. We respond to each of these individually 
as follows:
    (1) Maintain the current procedure review criteria until after the 
ASC Conditions for Coverage are revised.
    We do not believe that postponing revisions to our review criteria 
until after the ASC Conditions for Coverage are revised is warranted. 
We cannot predict when those revisions will be issued, and we are 
confident that the criteria we will use to evaluate procedures for 
exclusion from the list of covered surgical procedures under the 
revised ASC payment system are appropriate and serve to protect 
beneficiary safety in the current environment.
    (2) Specifically adopt a defined list of ``major blood vessels.''
    As we stated earlier, we believe it is important to maintain 
flexibility in our review of procedures for safe performance in the ASC 
setting, consistent with our past practice regarding this criterion. As 
noted by commenters requesting a specific definition of this criterion, 
there are some procedures already on the ASC list that are being safely 
performed in ASCs and that involve vessels that would be defined as 
major according to the recommendations of some commenters. We do not 
agree with these commenters that it would be logical or clinically 
consistent for us to adopt a specific definition of major blood vessels 
to evaluate procedures for exclusion from ASC payment, yet still 
continue to provide ASC payment for procedures that would otherwise be 
excluded, except for their history of safe performance in ASCs. We 
believe the involvement of major blood vessels is best considered in 
the context of the clinical characteristics of individual procedures, 
as recommended by other commenters, and see no need to adopt a defined 
list of major blood vessels.
    (3) Define prolonged invasion of a body cavity as any procedure in 
which the patient is under anesthesia for 90 minutes or longer, and 
expand the definition of body cavity to include major blood vessels. 
    We do not believe that considering major blood vessels to be 
included in the definition of a body cavity is clinically sensible, 
based on the general medical understanding of the terms. In addition, 
we already have a separate safety review criterion regarding major 
blood vessels, and we believe that evaluation of the safety of 
procedures involving major blood vessels will continue to be 
appropriately assessed using that criterion. We also do not believe 
that prolonged invasion should be defined as anesthesia for 90 minutes 
or longer. There are surgical procedures that require more than 90 
minutes that do not invade a major body cavity at all, and maintaining 
that time-based restriction would be contrary to the recommendations of 
MedPAC and current clinical practice. We believe the criterion 
regarding major or prolonged invasion of body cavities is most 
appropriately evaluated through a flexible review approach, consistent 
with our past practice, in which we consider the criterion and its 
relationship to each specific surgical procedure. Therefore, we are not 
expanding the current criterion regarding invasion of a body cavity to 
include the length of time the beneficiary will be under anesthesia or 
to incorporate major blood vessels.
    (4) Exclude from ASC payment procedures that commonly require 
systemic thrombolytic therapy.
    We agree with the commenters that systemic thrombolytic therapy is 
unsafe for performance in ASCs. Systemic thrombolytic therapy involves 
significant clinical risks and is not an appropriate procedure for 
initiation in ASCs if its use is anticipated. We have historically 
considered in our clinical evaluation of the safety of procedures for 
performance in ASCs the likely need for systemic thrombolytic therapy 
in association with a surgical procedure, but we have never previously 
made that an explicit safety review criterion. We agree with the 
commenters that it should be a specific criterion for evaluation of 
procedure safety. Therefore, we are making it explicit that the final 
criteria used to evaluate the safety of procedures for performance in 
ASCs at Sec.  416.166(c)(5) include the criterion that covered surgical 
procedures may not be of a type where systemic thrombolytic therapy 
would commonly be required.
    (5) Exclude procedures that require use of the femoral vessels for 
access.
    We do not agree with some commenters' position that excluding all 
procedures that involve the femoral vessels is reasonable or necessary 
to ensure the patient safety of surgical procedures performed in ASCs. 
Other commenters stated that there are instances in which the 
performance of procedures may require use of femoral vessels due to the 
beneficiary's particular physical condition. For example, a beneficiary 
who has experienced prolonged exposure to vascular sclerosing agents 
(such as chemotherapy) or has been on hemodialysis for many years may 
not have upper body peripheral blood vessels that are adequate even to 
support the basic intravenous access required during any surgical 
procedure performed under general anesthesia. In such a case, the 
surgeon may need to use the femoral vein just to provide routine 
intravenous access during surgery. In other cases, the use of the 
femoral vessels may be required for certain surgical procedures. For 
instance, the femoral blood vessels may be accessed to create an 
arteriovenous fistula for hemodialysis using a graft, as described by 
CPT code 36825 (Creation of arteriovenous fistula by other than direct 
arteriovenous anastomosis (separate procedure); autogenous graft) or 
CPT code 36830 (Creation of arteriovenous fistula by other than direct 
arteriovenous anastomosis (separate procedure); nonautogenous graft 
(e.g., biological collagen, thermoplastic graft)). Both of these 
procedures that may directly involve the femoral vessels have been on 
the list of covered ASC procedures since before July 2000, and we have 
no concerns about their safe performance in ASCs. We do not believe 
that it makes clinical sense to prohibit use of the femoral vessels in 
ASC procedures, knowing that they may be needed in any number of 
situations and that femoral access has been safely achieved in ASCs for 
years. We believe that our process for clinical review of individual 
procedures, during which our medical advisors consider the specific 
performance characteristics of a particular surgical procedure, is the 
most appropriate method for ensuring that procedures that pose a 
significant safety risk are excluded from ASC payment. As evidenced by 
the history of safe performance in ASCs of some procedures that utilize 
femoral access, we agree with the commenters who believe that it is the 
specific surgical procedure, rather than the method of vascular access, 
that must be fully evaluated to assess a procedure's safety in ASCs.
    (6) Adopt a quantitative definition of ``extensive blood loss.''
    We do not believe that the recommendation by some commenters that 
we revise the criteria used to evaluate procedures for exclusion from 
the ASC list by quantifying extensive blood loss is necessary or 
advisable. The existing and proposed criterion related to blood loss 
requires exclusion of procedures that ``generally result in extensive 
blood loss'' (42 CFR 416.65(b)(3)(i) and 42 CFR 416.166(c)(1),

[[Page 42482]]

respectively), and we have historically evaluated this criterion in 
considering surgical procedures for ASC payment. We do not believe that 
identifying a specific amount of blood loss that is considered by some 
to be ``extensive'' would improve our clinical review regarding 
procedural safety. For most surgical procedures, specific estimates of 
expected blood loss are not available, and we do not believe that a 
discussion of whether or not a procedure generally results in a loss of 
14 percent versus 16 percent of a beneficiary's blood volume would be 
clinically meaningful and contribute to our ability to evaluate a 
surgical procedure's potential for safe performance in ASCs.
    (7) Adopt a 50-percent inpatient utilization threshold for 
exclusion of procedures from the ASC list.
    We reexamined our proposal to exclude all procedures from ASC 
payment that are performed in the inpatient setting 80 percent or more 
of the time. Although the recommendations of some commenters advocated 
using a lower threshold to exclude more procedures from ASC payment, we 
confirmed that using any relatively arbitrary threshold resulted in 
unintended inconsistencies in the treatment of clinically similar 
procedures. There were several instances in which one procedure in a 
clinical family would be excluded from ASC payment based on its 
inpatient utilization of just slightly over 80 percent, whereas our 
clinical review of other members of the family indicated that those 
procedures were safe for performance in ASCs, with inpatient 
utilization of slightly less than 80 percent. For example, we proposed 
to exclude CPT codes 33207 (Insertion or replacement of permanent 
pacemaker with transvenous electrode(s); ventricular) and 33208 
(Insertion or replacement of permanent pacemaker with transvenous 
electrode(s); atrial and ventricular) from ASC payment under the 
revised payment system because the inpatient utilization for those 
procedures was higher than 80 percent and, therefore, we did not 
specifically review the procedures to assess their clinical safety or 
need for an overnight stay before proposing to exclude them. We did not 
propose to exclude CPT code 33206 (Insertion or replacement of 
permanent pacemaker with transvenous electrode(s); atrial), the other 
procedure in the same family of codes as CPT codes 33207 and 33208, 
because the inpatient utilization for that procedure was somewhat lower 
than 80 percent, and our clinical review, based on the other safety and 
overnight stay criteria proposed for the revised ASC payment system, 
led to our belief that it was appropriate for performance in ASCs. When 
we performed a clinical review of CPT codes 33207 and 33208 in order to 
respond to public comments, we determined that CPT codes 33207 and 
33208 do not pose a significant risk to beneficiary safety and are not 
expected to require an overnight stay, so they are appropriate for 
performance in ASCs, along with CPT code 33206. Therefore, we have 
removed both CPT codes 33207 and 33208 from the list of excluded 
procedures for the revised ASC payment system. We are also, as 
proposed, not excluding CPT code 33206 from eligibility for ASC 
payment. This more flexible approach, without application of a specific 
inpatient utilization threshold, allows us to treat the individual 
members of the same family of procedures consistently as a clinically 
coherent group, while considering them in the context of our final 
safety and overnight stay criteria for the revised ASC payment system.
    We also identified a number of surgical procedures with high 
Medicare inpatient utilization because, most of the time, the 
procedures are performed with other surgical procedures for 
beneficiaries who are hospital inpatients. Thus, although the data 
reflect high inpatient utilization, the procedures themselves are not 
unsafe for ASC performance, nor do they typically require an overnight 
stay. Specifically, commenters argued that the high inpatient 
utilization of CPT code 64447 (Injection, anesthetic agent; femoral 
nerve, single) was due to its frequent use during inpatient surgical 
procedures, whereas the injection may also be performed safely in ASCs 
on its own as an ambulatory pain management intervention. They believed 
that using the inpatient utilization as the basis for the exclusion of 
this procedure from ASC payment was unfair because we should evaluate 
the procedure itself specifically based upon its clinical 
characteristics, rather than based upon utilization data which could be 
misleading with respect to the procedure's potential for safe 
performance in the ASC setting. Our clinical review of CPT code 64447, 
in response to comments, convinced us that it would clearly not pose a 
significant safety risk or be expected to require an overnight stay 
when performed in ASCs and should not be excluded from the list of 
covered surgical procedures under the revised ASC payment system.
    Therefore, we concluded that, in the cases of CPT codes 33207, 
33208, and 64447, the utilization data alone could not be relied upon 
to support a decision to exclude these procedures from ASC payment and, 
as evidenced by our proposed list of excluded procedures, there were 
many procedures paid under the OPPS that were not performed more than 
80 percent of the time on an inpatient basis but that were proposed for 
exclusion from ASC payment because of their safety risk or expected 
need for an overnight stay. Therefore, for this final rule, we 
evaluated each of the procedures that we had proposed for exclusion 
from ASC payment based on inpatient utilization of 80 percent or more 
and made separate determinations about the safety and need for an 
overnight stay for each of those procedures using all available 
information, as we did for all other procedures in the surgical range 
of the CPT code set.
    Thus, while we proposed an 80-percent inpatient utilization 
threshold as one criterion for excluding surgical procedures from ASC 
payment, we now believe that we will reach more appropriate, clinically 
consistent decisions regarding procedures for exclusion from ASC 
payment by not adopting any specific numerical threshold for inpatient 
utilization that would automatically exclude surgical procedures from 
ASC payment. Rather than institute a definite threshold for inpatient 
utilization, we will examine all the clinical information regarding a 
surgical procedure, including its inpatient utilization, to determine 
whether or not a procedure would pose a significant risk to beneficiary 
safety or would be expected to require an overnight stay if performed 
in an ASC. We will not make final our proposal to exclude procedures 
from the ASC list of covered surgical procedures based solely on their 
inpatient utilization of 80 percent or more.
    (8) Require beneficiary assessment of individual surgical risk and 
do not permit high risk patients to receive ASC services.
    We do not believe that it would be appropriate to accept the 
commenters' recommendation that patients with certain specified 
demographic characteristics or comorbidities be automatically excluded 
from being considered for surgery within an ASC. The recommendation 
would require ASCs to deny services to individual beneficiaries who are 
found, based on an appraisal through a specific assessment tool, to 
have a high level of risk. Section 416.2 defines an ASC as providing 
surgical services to patients not requiring hospitalization. Thus, ASCs 
must ensure that each patient is assessed for relevant risk factors by 
the physician prior to performing the

[[Page 42483]]

surgical procedure, in order to screen out patients who are likely to 
require hospitalization in connection with the planned procedure. We 
require physicians to make these assessments as a part of their 
decisions regarding where to perform a surgical procedure for specific 
Medicare beneficiaries, prior to referring them to facilities for those 
surgical procedures. The ASC Conditions for Coverage specifically state 
in Sec.  416.42(a) that ``a physician must examine the patient 
immediately before surgery to evaluate the risk of anesthesia and of 
the procedure to be performed.'' In addition, we protect Medicare 
beneficiary safety through our process of excluding procedures from ASC 
payment that pose a significant safety risk for the typical Medicare 
patient. In summary, we do not believe that it is necessary or 
appropriate for CMS to mandate that ASCs use a specific assessment tool 
in conducting these required beneficiary assessments.
    (9) Identify and implement outcome and process measures in ASCs to 
assess quality of care.
    We will take into consideration for future action the 
recommendation by some commenters that we identify and implement 
outcome and process measures to assess aspects of quality of care 
across settings, including ASCs, taking into consideration our final 
policy for the CY 2009 OPPS that will require hospitals to meet quality 
reporting standards to receive the full OPPS update (71 FR 68189). We 
agree that this could be an appropriate next step and is consistent 
with CMS'' policies being implemented in other beneficiary care 
settings. In fact, section 109(b) of the Medicare Improvements and 
Extension Act under Division B of the Tax Relief and Health Care Act of 
2006, Public Law 109-432, enacted on December 20, 2006, specifies that 
the Secretary may require that in order to receive the full annual 
payment update, ASCs must report data on selected measures of quality. 
The provisions for ASC services are to apply in a manner similar to 
which they apply to hospital outpatient services, effective January 1, 
2009.
    After considering the public comments received, we are finalizing 
our proposal, with modification, to exclude from ASC payment all 
surgical procedures that could pose a significant safety risk to 
Medicare beneficiaries or are expected to require an overnight stay. 
The criteria to be used to identify procedures that could pose a 
significant safety risk when performed in an ASC include those surgical 
procedures that: generally result in extensive blood loss; require 
major or prolonged invasion of body cavities; directly involve major 
blood vessels; are emergent or life-threatening in nature; commonly 
require systemic thrombolytic therapy; are designated as requiring 
inpatient care under Sec.  419.22(n); can only be reported using a CPT 
unlisted surgical procedure code (see section III.B. of this final rule 
for further discussion); or are otherwise excluded under Sec.  411.15. 
We are not adopting the specific 80-percent inpatient utilization 
threshold that we proposed for exclusion of surgical procedures from 
ASC payment. The final revised policy regarding covered surgical 
procedures is set forth in Sec.  416.166 of this final rule, effective 
January 1, 2008.
b. Overnight Stay
    A longstanding criterion for determining which procedures are 
appropriate for inclusion on the ASC list of covered surgical 
procedures has been that the procedures on the list do not require an 
extended recovery time. Section 416.65(a)(3) of the regulations 
provides that ASC procedures ``[a]re limited to those requiring a 
dedicated operating room (or suite), and generally requiring a 
postoperative recovery room or short-term (not overnight) convalescent 
room.'' Under Sec.  416.65(b)(1)(ii), we have historically considered 
procedures that require more than 4 hours of recovery or convalescent 
time to be inappropriately performed in the ASC.
    We have heard many differing opinions of what constitutes an 
``overnight'' stay, ranging from ``more than 24 hours'' to time spent 
in recovery after sunset. After deliberation and consideration of 
several options, in the August 2006 proposed rule for the revised ASC 
payment system, we proposed to exclude from ASC payment any procedure 
for which prevailing medical practice dictates that the beneficiary 
would typically be expected to require active medical monitoring and 
care at midnight following the procedure (hereinafter ``overnight 
stay''). During the development of the August 2006 proposed rule, our 
clinical staff evaluated each surgical procedure using available claims 
and physician pricing data, as well as their clinical judgment, to 
determine which procedures would be expected to require monitoring at 
midnight of the day on which the surgical procedure was performed.
    We proposed to use midnight as the defining measure of an overnight 
stay for several reasons. First, a patient's location at midnight is a 
generally accepted standard for determining his or her status as a 
hospital inpatient or skilled nursing facility patient and as such, it 
seems reasonable to apply the same standard in the ASC setting. Second, 
overnight care is not within the scope of ASC services for which 
Medicare makes payment. The expectation is that surgical procedures 
performed in an ASC are ambulatory in nature; that is, patients 
undergoing a procedure in an ASC will recover from anesthesia and 
return home on the same day that they report to the ASC for a scheduled 
procedure. Finally, the expected need for monitoring at midnight is a 
straightforward and easily understood defining measure of ``overnight 
stay.'' We proposed to add the requirement that procedures will 
typically not be expected to require active medical monitoring and care 
at midnight following the procedure to proposed new Sec.  
416.166(c)(5).
    Comment: Some commenters recommended that CMS use ``less than 24 
hours'' as the definition of an overnight stay. Several of the 
commenters stated that the same 24-hour postoperative recovery standard 
that applies in HOPDs should apply in ASCs. One commenter stated that 
CMS' definition of overnight stay related to survey and certification 
for ASCs is a planned stay of over 24 hours and, that conversely, when 
the ``length of stay is less than 24 hours, it is not considered an 
overnight stay.'' Further, several commenters noted that a number of 
States allow ASCs to perform procedures that require stays of up to 23 
or 24 hours.
    One commenter group argued that the terms ``ambulatory'' and 
``outpatient'' surgery describe the same kind of care, and that the 
same 24-hour postoperative recovery standard should apply in both ASC 
and HOPD settings. Some commenters suggested that, if CMS allowed all 
procedures that are performed in HOPDs to be performed in ASCs, no 
specific definition of overnight stay would be required because any 
procedure paid under the OPPS would be presumed to require no overnight 
stay and that the same assumption should be applied to ASCs.
    A number of other commenters agreed with our proposal that 
procedures requiring an overnight stay should not be performed in an 
ASC and specifically endorsed our definition of overnight stay. They 
also believed that the proposed definition is consistent with other 
accepted definitions and standards of the term.
    Several commenters believed that our proposal, if adopted, would 
require ASCs performing and billing covered surgical procedures to 
transfer patients to other facilities if the recovery of

[[Page 42484]]

individual patients extended beyond midnight on the day of the 
procedure, in order to receive payment under the revised ASC payment 
system. Other commenters expressed concern that procedures performed 
later in the day in ASCs would be treated differently for purposes of 
ASC payment than those procedures that were performed in the morning, 
in terms of allowing for adequate recovery time.
    Response: We want to clarify our proposal to use the expected need 
for medical monitoring at midnight following the performance of a 
procedure as a consideration in determining whether a surgical 
procedure should be excluded from ASC payment. Our proposal does not 
affect the distinct care ASCs may provide in individual cases at 
various times of the day, nor does it alter the ASC payment for covered 
surgical procedures and covered ancillary services. As we explained in 
the August 2006 proposed rule, we proposed to exclude surgical 
procedures from ASC payment only based on their expected need for an 
overnight stay or the risk they pose to beneficiary safety. We 
identified the need for medical monitoring at midnight as a clinical 
measure that was meaningful to our clinical staff and advisors in their 
assessment, on a procedure-by-procedure basis, of the expected 
postoperative needs of the typical Medicare beneficiary, in order to 
determine whether a procedure was likely to require an overnight stay.
    We agree with some commenters that the criteria currently in place 
under the existing ASC payment system that limit covered surgical 
services to those that do not generally exceed a total of 90 minutes 
operating time and a total of 4 hours of recovery or convalescent time 
are both outdated and inconsistent with the proposed policy to base 
exclusion on the need for an overnight stay. We also agree with the 
commenters who recognized that the proposed revised measure to 
facilitate identification of those procedures requiring an overnight 
stay is considerably less restrictive than the current criteria and, at 
the same time, the use of midnight as a reference point is clinically 
meaningful and adequate to ensure beneficiary safety.
    As stated above, a beneficiary's location at midnight is a 
generally accepted standard for determining his or her status as a 
hospital inpatient or skilled nursing facility patient and, as such, it 
seems reasonable to apply the same standard in the ASC setting. Second, 
as defined at Sec.  416.2, ASC means ``any distinct entity that 
operates exclusively for the purpose of providing surgical services to 
patients not requiring hospitalization.'' Thus, ASCs are not certified 
by Medicare to provide overnight care, and there is longstanding policy 
to exclude from coverage in ASCs those surgical procedures that require 
overnight stays, as evidenced by our existing criterion at Sec.  
416.65(b)(1)(ii) that requires CMS to limit covered surgical procedures 
to those that do not generally exceed a total of 4 hours of recovery 
time following surgery. The expectation is that a beneficiary 
undergoing a procedure in an ASC will recover from anesthesia and 
return home on the same day that he or she reported to the ASC for a 
scheduled procedure. This expectation is inconsistent with a 24-hour 
postoperative recovery period as recommended by some commenters.
    The commenters' comparisons of ASCs to HOPDs are not persuasive for 
many reasons. Most importantly among these is the fact that HOPDs, 
unlike ASCs, have medical and nursing staff on duty 24 hours a day and 
all of the resources of the hospital to support the care requirements 
of beneficiaries in that setting.
    After consideration of the public comments we received, we continue 
to believe that it is appropriate to exclude from ASC payment any 
procedure for which standard medical practice dictates that the 
beneficiary would typically be expected to require active medical 
monitoring and care at midnight following the procedure. Therefore, we 
are finalizing, with editorial modification to include this requirement 
in the general standards for covered surgical procedures at Sec.  
416.166(b), our proposal to exclude these surgical procedures from ASC 
payment.

B. Treatment of Unlisted Procedure Codes and Procedures That Are Not 
Paid Separately Under the OPPS

    Unlisted procedure CPT codes are used to report services and 
procedures that are not accurately described by any other, more 
specific CPT codes. An example of an unlisted CPT code is 33999 
(Unlisted procedure, cardiac surgery). Within the surgical range of CPT 
codes, there are 91 such codes. None of the unlisted CPT codes in the 
surgical range is on the current ASC list of covered surgical 
procedures. Under the OPPS, we assign unlisted CPT codes to the lowest 
weighted APC in the relevant clinical group, regardless of the median 
cost for the unlisted procedure code, and we do not include the highly 
variable claims-based cost information for unlisted services in 
calculating APC median costs for purposes of establishing APC relative 
payment weights. Payment for procedures reported by unlisted CPT codes 
is made only at the discretion of the contractor under the MPFS.
    Because of concerns about the potential for safety risks when 
procedures that may only be reported with unlisted procedure CPT codes 
are performed, in the August 2006 proposed rule for the revised ASC 
payment system, we proposed to continue excluding CPT unlisted surgical 
procedure codes from ASC payment. For example, when CPT code 33999 is 
reported on a claim, we know only that some kind of cardiac surgery was 
performed. We have no other information about the procedure, and we 
have no way of knowing whether the procedure involved major blood 
vessels, major or prolonged invasion of body cavities, or extensive 
blood loss, or was emergent or life-threatening in nature.
    Prior to our evaluation of surgical procedure codes for their 
safety risk, we decided to propose that we would not make separate 
payment under the revised ASC payment system for CPT codes in the 
surgical range whose payments are packaged under the OPPS. Packaged CPT 
codes under the OPPS are identified by status indicator ``N'' in 
Addendum B of the CY 2007 OPPS/ASC final rule with comment period (71 
FR 68283 through 68384), and their OPPS payment is provided through 
payment for other separately payable services. We made this proposal 
for two reasons. First, we would not be able to establish an ASC 
payment rate for packaged surgical procedures using the same method we 
proposed for all other ASC procedures because packaged surgical codes 
have no relative payment weights under the OPPS upon which to base an 
ASC payment rate. Second, ASCs, just like hospitals, would receive 
payment for these packaged surgical procedures because their costs 
would already be included in the APC relative payment weights upon 
which the ASC payment rates would be based.
    Comment: A few commenters recommended that CMS not exclude all 
unlisted CPT codes from ASC payment as proposed. Some commenters 
believed that, because Medicare makes facility payments for unlisted 
CPT codes under the OPPS, CMS should provide the same treatment in 
ASCs. Other commenters suggested that, for groups of related CPT codes 
in which all codes but the related unlisted code are provided payment 
in ASCs, CMS should also include the unlisted code on the ASC list of 
covered surgical procedures. For example, all of the specific CPT codes 
in the surgical hysteroscopy

[[Page 42485]]

subsection of CPT (CPT codes 58558 through 58578) are currently on the 
ASC list. One commenter contended that because CMS had already 
determined that all of those specific hysteroscopy procedures are safe 
for performance in ASCs, the related unlisted hysteroscopy procedure 
(CPT code 58579, Unlisted hysteroscopy procedure, uterus) should also 
be deemed to pose no significant safety risk or require an overnight 
stay.
    Response: We appreciate the commenters' examples of unlisted codes 
in families where all of the other procedures in the CPT subsection are 
not excluded from ASC payment, in support of their recommendation that 
the related unlisted procedure code should be treated comparably. 
However, the fact remains that we do not know what specific procedure 
would be represented by an unlisted code. Our charge requires us to 
evaluate each surgical procedure for potential safety risk and the 
expected need for overnight monitoring and to exclude such procedures 
from ASC payment. It is not possible to evaluate procedures that would 
be reported by unlisted CPT codes according to these criteria.
    We continue to believe that because our final policy under the 
revised ASC payment system excludes from ASC payment those procedures 
that pose a significant safety risk in ASCs or would be expected to 
require an overnight stay, it would not be appropriate to provide ASC 
payment for unlisted CPT codes in the surgical range, even if payment 
may be provided under the OPPS. As discussed earlier, ASCs do not 
possess the breadth and intensity of services that hospitals must 
maintain to care for patients of higher acuity, and we would have no 
way of knowing what specific procedures reported by unlisted CPT codes 
were provided to patients, in order to ensure that they are safe for 
ASC performance. Therefore, we are finalizing in Sec.  416.166(c)(7) 
our proposal, without modification, to exclude from ASC payment under 
the revised ASC payment system all procedures reported by unlisted 
surgical procedure codes.
    Comment: A few commenters expressed concern that payments for 
certain surgical services that are packaged under the OPPS are 
frequently paid through the OPPS payments for more comprehensive 
services that we had proposed to define as nonsurgical because they are 
not classified by CPT within the surgical range of codes. Therefore, 
these packaged surgical services would not be paid under the revised 
ASC payment system. They pointed out that when ASCs perform these 
packaged surgical services as part of providing a more comprehensive 
nonsurgical service, the ASC would receive no payment for the surgical 
service. To illustrate the problem, commenters provided examples of the 
surgical codes that typically receive packaged payment under the OPPS 
through payment for radiology services. The minor packaged surgical 
procedures included numerous injection and catheter placement 
procedures in the surgical range of CPT codes that generally accompany 
radiology services for purposes of injecting contrast or facilitating 
another nonsurgical intervention. These commenters recommended that CMS 
expand the definition of surgical procedures to include invasive 
radiology services that have a surgical component, including those 
radiology procedures that are performed in association with a surgical 
procedure proposed for packaged payment under the revised ASC payment 
system, to enable ASCs to receive payment for the comprehensive 
service, including both the radiology service and the minor surgical 
procedure. Alternatively, several other commenters supported our 
proposal to package payment under the revised ASC payment system for 
the minor surgical procedures for which payment is also packaged under 
the OPPS, rather than paying for them separately.
    Response: We continue to believe that packaging payment for those 
surgical services that are packaged under the OPPS is appropriate under 
the revised ASC payment system. This policy is aligned with the 
recommendation of the PPAC to apply payment policies uniformly in the 
ASC and HOPD settings. It also maintains comparable payment bundles 
under the OPPS and the revised ASC payment system for these services, 
consistent with the recommendation of MedPAC to maintain consistent 
payment bundles under both payment systems.
    Packaged surgical services are minor procedures and are usually 
reported with a more comprehensive procedure that may itself be 
nonsurgical and, therefore, excluded from payment under the revised ASC 
payment system. See section III.A.1. of this final rule for a further 
discussion of the definition of surgical procedure under the revised 
ASC payment system. We believe that payment for these minor surgical 
procedures would be appropriately packaged into payment for 
comprehensive surgical procedures that are separately paid in the ASC 
setting, when those minor surgical procedures are provided in support 
of the comprehensive surgical procedures. In the circumstances referred 
to by the commenters, the minor surgical procedures are performed in 
support of comprehensive nonsurgical services and payment for the minor 
surgical procedures is packaged into payment for the nonsurgical 
services under the OPPS. Although the packaged procedures are surgical 
according to our definition for the revised ASC payment system, we do 
not believe it is reasonable or appropriate to assign a different 
packaging status for these procedures under the revised ASC payment 
system than is assigned under the OPPS. The minor surgical procedures 
are not separately paid in the OPPS and, thus, are not eligible for 
separate payment under the revised ASC payment system. In addition, if 
the procedures are only performed in conjunction with major services 
not payable in ASCs, Medicare also will make no packaged payment for 
these minor surgical procedures. As we discuss further in section 
III.A. of this final rule, Medicare pays ASCs for the performance of 
ambulatory surgical procedures, not for providing nonsurgical services. 
We do not agree that we should define surgical procedures under the 
revised ASC payment system to include other types of services, such as 
radiology services, just because they are provided in association with 
a minor surgical procedure in the CPT surgical range of codes. Instead, 
we continue to believe that the other types of services, including 
radiology services, are not appropriate for performance in ASCs unless 
they are integral to covered surgical procedures. We see no rationale 
for considering comprehensive radiology services to be integral to the 
minor surgical procedures.
    After considering all public comments received, we are finalizing, 
without modification, our proposal to provide packaged payment under 
the revised ASC payment system for all surgical procedures packaged 
under the OPPS for the same calendar year. Therefore, we will exclude 
these surgical procedures from separate payment in the ASC setting 
under the revised payment system, and they will not be included on the 
ASC list of covered surgical procedures. We believe that this approach 
will provide appropriate packaged payment for minor surgical procedures 
provided in association with significant ASC covered surgical 
procedures. When these minor surgical procedures are performed in 
support of comprehensive nonsurgical procedures, they are not 
appropriate for ASC payment because the more comprehensive service is 
not a surgical

[[Page 42486]]

procedure paid under the revised ASC payment system. HCPCS codes for 
surgical procedures for which payment will be packaged under the 
revised ASC payment system are identified in Addendum AA to this final 
rule with payment indicator ``N1'' (Packaged service/item; no separate 
payment made).

C. Treatment of Office-Based Procedures

    According to the general standard in Sec.  416.65(a)(2) of the 
existing regulations, procedures that ``are commonly performed, or that 
may be safely performed, in physicians' offices'' are excluded from the 
ASC list of covered surgical procedures. We did not propose to continue 
to apply this provision under the revised ASC payment system. Rather, 
in the August 2006 proposed rule for the revised ASC payment system, we 
proposed to allow ASC payment for surgical procedures that are commonly 
and safely performed in the office setting. We reasoned that the types 
of procedures performed in physicians' offices would neither pose a 
significant safety risk nor require an overnight stay when performed in 
an ASC. However, we expressed concerns that allowing payment for 
office-based procedures under the ASC benefit could create an incentive 
for physicians inappropriately to convert their offices into ASCs or to 
move all their office surgery to an ASC.
    To address this concern, we proposed to limit payment for office-
based procedures to neutralize any such incentive (see section IV.E. of 
this final rule). We also proposed in new Sec.  416.171(d) to set forth 
rules governing the payment of office-based procedures in ASCs. We 
specifically invited comment regarding the effect on the Medicare 
program, and on practice patterns for ambulatory surgery generally, of 
our proposal to allow ASC payment for office-based procedures that 
historically have been excluded from the ASC list of covered surgical 
procedures.
    As we discussed in the August 2006 proposed rule, we proposed to 
limit payment for office-based procedures in ASCs in an attempt to 
mitigate potentially inappropriate migration of services from the 
physician office setting to the ASC. Alternatively, we acknowledged 
that we could entirely exclude office-based procedures or procedures 
that require relatively inexpensive resources to perform from the ASC 
list of covered surgical procedures.
    Comment: Many commenters supported our proposal to not exclude from 
ASC payment those procedures that are performed most of the time in the 
physician's office setting. Numerous commenters requested that the 
payment rate for those procedures be set at a percentage of the OPPS 
amount, applying the same payment methodology under the revised ASC 
payment system as for all other surgical procedures not excluded from 
ASC payment. The commenters believed that the proposed treatment of 
office-based procedures is unfair because, when any of those procedures 
would be performed in the ASC setting, that facility site would be 
necessary due to an individual beneficiary's need for the higher acuity 
care setting. Therefore, the commenters concluded that the same level 
of payment, in relationship to OPPS payment for those procedures, 
should be made for office-based procedures as for other covered ASC 
procedures that are not office-based. Furthermore, commenters contended 
that there would be very little change in surgical practice patterns 
under the revised ASC payment system, and that procedures currently 
performed predominantly in physicians' offices would not move to ASC 
settings as a result of our proposal to provide payment for those 
procedures in ASCs.
    Response: We appreciate the commenters' support for our proposal to 
not exclude office-based surgical procedures from ASC payment under the 
revised ASC payment system. Based on both our final definition of 
surgical procedures and our final safety and overnight stay criteria to 
be used in evaluating procedures for exclusion from ASC payment, we see 
no reason to exclude surgical procedures that are currently commonly 
performed in physicians' offices from payment under the revised ASC 
payment system. We believe there are a variety of reasons that may 
contribute to the choice of a particular care setting for the treatment 
of an individual beneficiary, including the patient's surgical risk, 
the geographic location of the beneficiary and physician, individual 
physician practice patterns and preferences, the availability of 
specialty ASCs, and others. We do not believe that individuals 
receiving surgical procedures in ASCs routinely require care that is of 
such greater acuity than care provided in the office-based setting that 
the facility resources are significantly and systematically increased 
when those procedures that are primarily office-based are performed 
occasionally in ASCs. While it may be true that some more acute cases 
are treated in ASCs rather than in physicians' offices, we continue to 
believe that the structure of payments should not provide a financial 
incentive for treatment in the ASC facility setting. Furthermore, this 
policy is consistent with the averaging principle that is common to all 
prospective payment systems; payment is based on the resources that are 
required to treat the typical case, and payment for the treatment of a 
specific Medicare beneficiary may, therefore, be higher than the costs 
of treating less severe cases but lower than the costs of treating more 
acute cases.
    We believe that including these office-based procedures on the ASC 
list of covered surgical procedures will ensure Medicare beneficiary 
access to these services in the most appropriate ambulatory or 
outpatient setting. Our final payment policy for these procedures, 
along with public comments and our responses, is discussed in section 
IV.E. of this final rule, and the related payment rules are set forth 
in Sec.  416.171(d).
    After considering the public comments received, we are finalizing 
our proposal, without modification, to provide payment under the 
revised ASC payment system for surgical procedures that are currently 
performed predominantly in physicians' offices and that may be safety 
performed in ASCs, without requiring an overnight stay.

D. Specific Surgical Procedures Excluded From Payment under the Revised 
ASC Payment System

    In Tables 44 and 45 of the August 2006 proposed rule (71 FR 49640 
through 49646), we listed the HCPCS codes and short descriptors for 
surgical procedures that, in addition to those that comprised the OPPS 
inpatient list in Addendum E to the August 2006 proposed rule, we 
proposed to exclude from ASC payment on or after January 1, 2008, 
because they pose a significant safety risk or are expected to require 
an overnight stay. Table 44 included those surgical procedures proposed 
for exclusion from payment because at least 80 percent of Medicare 
cases are performed on an inpatient basis, while Table 45 listed those 
surgical procedures proposed for exclusion from payment because they 
require an overnight stay. In section III.A.2. of this final rule, we 
discuss our final rationale for excluding surgical procedures from ASC 
payment. We note that because our final policy, as discussed above, for 
the revised ASC payment system does not automatically exclude from 
payment those procedures for which at least 80 percent of Medicare 
cases are performed on an inpatient basis, all procedures listed in 
Table 44 of the August 2006

[[Page 42487]]

proposed rule were reviewed again for this final rule as described 
below, in the context of our final exclusionary patient safety and 
overnight stay criteria.
    For many of the procedures listed in Table 45 of the August 2006 
proposed rule, several disqualifying criteria could be applicable, such 
as ``requires inpatient stay'' or ``could potentially cause extensive 
blood loss'' or ``is emergent in nature.'' Rather than list multiple 
disqualifying criteria for individual codes in Table 45 of the August 
2006 proposed rule, we defaulted to the one characteristic that is 
common to all of the codes listed. That is, we believed that, at a 
minimum, prevailing medical practice would dictate the provision of 
overnight care following each of the procedures listed in Table 45 of 
the August 2006 proposed rule. We acknowledged that we had to exercise 
a degree of clinical judgment in identifying those procedures that we 
proposed to exclude from ASC payment. Therefore, we solicited comments 
on the appropriateness of excluding the procedures in Table 45 from 
payment under the revised payment system. We requested that commenters 
who disagreed with a specific procedure's proposed exclusion from 
payment submit clinical evidence that demonstrates that the criteria we 
proposed in proposed new Sec.  416.166 of the regulations are not 
factors when the procedure is performed in the majority of cases. We 
asked that commenters also provide data to support any assertion that 
the preponderance of Medicare beneficiaries upon whom the procedure is 
performed would not be expected to require overnight care or monitoring 
following the surgery. We noted in the proposed rule that simply 
asserting that the procedure could be safely performed in an ASC, 
without providing corroborative evidence and data, would not furnish us 
with sufficient information upon which to make an informed decision.
    Comment: Several commenters requested that, if CMS decided not to 
adopt less than 24 hours as its definition of an overnight stay, CMS 
should revise the list of proposed excluded procedures that were 
included in Table 45 of the August 2006 proposed rule on the basis of 
their overnight stay requirement. The commenters disagreed with CMS' 
determinations that all of those procedures required at least active 
medical monitoring at midnight following the procedure. Many commenters 
provided specific recommendations regarding surgical services that they 
believed should not be excluded from payment under the revised ASC 
payment system. In addition, several commenters identified a number of 
procedures not on the OPPS inpatient list that CMS proposed to exclude 
from ASC payment but that were not displayed in Table 44 or Table 45 of 
the proposed rule and for which CMS provided no rationale for their 
exclusion.
    Response: In response to these procedure-specific comments and to 
those comments that reflected the belief that all procedures not on the 
OPPS inpatient list should be payable under the revised ASC payment 
system, we reviewed a subset of all of the surgical procedures that we 
proposed to exclude from payment under the revised ASC payment system, 
identified as described below. This included reassessing the treatment 
of those codes that were proposed to be excluded but were inadvertently 
left out of Table 44 or Table 45 in the August 2006 proposed rule. To 
conduct this comprehensive review, we identified all codes within the 
surgical range of CPT codes that met all of the following criteria: (1) 
Not proposed for the CY 2008 list of ASC covered surgical procedures 
(Addendum BB to the August 2006 proposed rule); (2) not included on the 
CY 2007 OPPS inpatient list; (3) not packaged under the OPPS; (4) not 
CPT unlisted surgical procedure codes; and (5) recognized for separate 
payment under the OPPS. Elimination of all CPT codes not meeting these 
criteria yielded about 750 procedures designated for a second review by 
our medical advisors, in order to finalize their treatment under the CY 
2008 revised ASC payment system.
    Our clinical staff evaluated each of those procedures using all 
available claims and physician pricing data, as well as their clinical 
judgment and the public comments, to determine which procedures would 
be expected to require monitoring at midnight of the day on which the 
surgical procedure was performed or that otherwise would pose a 
significant safety risk to the typical Medicare beneficiary. Table 2 
below, which provides an illustrative list of all surgical procedures 
excluded from ASC payment under the revised ASC payment system, 
reflects the final outcome of that comprehensive review process. In 
all, we are not excluding 17 of the procedures that we had initially 
proposed for exclusion from payment under the revised ASC payment 
system. The procedures for which we made a different final 
determination than our proposal regarding the appropriateness of their 
performance in ASCs include procedures from virtually all specialty 
areas within the surgical range, from dermatology to gastroenterology 
to ophthalmology. In addition, we reviewed all Category III CPT codes 
and Level II HCPCS codes in the context of the public comments and our 
final policy for the revised ASC payment system and concluded that 29 
of these codes, in addition to those HCPCS codes on the CY 2007 ASC 
list of covered procedures, are appropriate for performance in ASCs 
under the revised payment system.
    Comment: A number of commenters requested that CMS exclude 
additional procedures from the ASC list of covered surgical procedures. 
Specifically, several commenters requested that CMS exclude the 
procedures listed in Table 1 below, because they believed that they 
pose significant safety risks to beneficiaries when performed in ASCs. 
They stated that all of the procedures listed in Table 1 would violate 
at least one of the proposed procedure review criteria by involving 
major blood vessels or prolonged invasion of body cavities. Further, 
one commenter suggested that some of the procedures (as listed, CPT 
codes 35473 through 37650) should be excluded, because they involve 
femoral access and could require thrombolytic therapy.

Table 1.--Specific Procedures That Commenters Requested Be Excluded From
                               ASC Payment
------------------------------------------------------------------------
            HCPCS code                        Short descriptor
------------------------------------------------------------------------
21215............................  Lower jaw bone graft.
32002............................  Treatment of collapsed lung.
33206............................  Insertion of heart pacemaker.
33214............................  Upgrade of pacemaker system.
33215............................  Reposition pacing-defib lead.
33216............................  Insert lead pace-defib, one.
33217............................  Insert lead pace-defib, dual.
33218............................  Repair lead pace-defib, once.
33220............................  Repair lead pace-defib, dual.
33222............................  Revise pocket, pacemaker.
33223............................  Revise pocket, pacing-defib.
33224............................  Insert pacing lead & connect.
33225............................  L ventric pacing lead add-on.
33226............................  Reposition L ventric lead.
33234............................  Removal of pacemaker system.
35473............................  Repair arterial blockage.
35474............................  Repair arterial blockage.
35475............................  Repair arterial blockage (non-
                                    dialysis).
35476............................  Repair venous blockage (non-
                                    dialysis).
35492............................  Artherectomy, perc.
35761............................  Exploration of artery/vein.
37205............................  Transcath IV stent, perc.
37206............................  Transcath IV stent/perc addl.
37250............................  IV U.S. first vessel add-on.
37251............................  IV U.S. each add vessel add-on.
37650............................  Revision of major vein.
40700............................  Repair cleft lip/nasal.
40701............................  Repair cleft lip/nasal.
42200............................  Reconstruct cleft palate.
42205............................  Reconstruct cleft palate.
42210............................  Reconstruct cleft palate.

[[Page 42488]]

 
42215............................  Reconstruct cleft palate.
42220............................  Reconstruct cleft palate.
G0297............................  Insrt 1 chamb dfib pulse generator.
------------------------------------------------------------------------

    Response: We appreciate the commenters' concerns and conducted a 
comprehensive review of each of the procedures presented. We agree with 
the commenters that the procedures reported by CPT codes 35475 
(Transluminal balloon angioplasty, percutaneous; brachiocephalic trunk 
or braches, each vessel); 37205 (Transcatheter placement of an 
intravascular stent(s), (except coronary, carotid, and vertebral 
vessel), percutaneous; initial vessel); and 37206 (Transcatheter 
placement of an intravascular stent(s), (except coronary, carotid, and 
vertebral vessel), each additional vessel) should be excluded from the 
ASC list of covered surgical procedures because they could pose a 
significant safety risk to beneficiaries in ASCs. We did not include 
CPT code 35475 in our proposed list of covered surgical procedures 
under the revised ASC payment system because we, like the commenters, 
believe that it poses a safety risk for beneficiaries if performed in 
ASCs. Although we did propose to add CPT codes 37205 and 37206 to the 
ASC list for CY 2007, we did not finalize that proposal for CY 2007 in 
response to comments and continue to agree with commenters that those 
procedures would likely require an overnight stay.
    With regard to the remaining procedures, three of them, 
specifically CPT codes 33222 (Revision or relocation of skin pocket for 
pacemaker); 33223 (Revision of skin pocket for single or dual chamber 
pacing cardioverter-defibrillator); and 37650 (Ligation of femoral 
vein), are on the current ASC list of covered surgical procedures and 
have been safely performed in ASCs for some time. We do not believe 
that they represent a significant safety risk or are likely to require 
an overnight stay.
    We did not propose to exclude any of the remaining procedures in 
Table 1 from the list of procedures for which ASCs may receive payment 
under the revised payment system because, based on our clinical review, 
we did not find that the procedures would be expected to require an 
overnight stay or pose a significant risk to beneficiary safety when 
performed in ASCs. Our review for this final rule, in consideration of 
the comments, did not alter our final opinion on the appropriate 
treatment of these other codes.
    Therefore, we are finalizing our proposal, with modification, 
regarding specific surgical procedures that are excluded from ASC 
payment under the revised ASC payment system. Table 2 provides an 
illustrative list of CPT codes that are payable under the OPPS but that 
are excluded from the ASC list of covered surgical procedures. This 
illustrative list does not include those procedures that are on the 
OPPS inpatient list, packaged under the OPPS, or only reportable by CPT 
unlisted surgical procedure codes. All of the procedures listed in 
Table 2 are excluded from the list of covered surgical procedures for 
which Medicare will provide ASC payment under the revised ASC payment 
system because we believe, based on our review of each procedure's 
clinical characteristics, utilization data reflected in physician 
claims, and prevailing medical practice as reflected in the valuation 
of the services by the AMA/Specialty Society Relative Value Scale 
Update Committee (RUC), and consideration of the judgment of our 
medical advisors and all public comments to the proposed rule, that 
these surgical procedures pose a significant risk to beneficiary safety 
or are expected to require an overnight stay.
    In this final rule, we are finalizing the addition of 793 new 
surgical procedures to the ASC list of covered surgical procedures for 
CY 2008, while we are excluding those procedures listed in Table 2 from 
ASC payment for CY 2008. This list will be updated for the CY 2008 
revised ASC payment system through the CY 2008 OPPS/ASC annual 
rulemaking cycle.

  Table 2.--Illustrative List of Surgical Procedures Payable Under the
  OPPS (Not on the OPPS Inpatient List, Not Packaged Under the OPPS and
Not Designated as CPT Unlisted Codes) That Are Excluded From ASC Payment
 Because They Pose a Significant Safety Risk or Are Expected to Require
                            an Overnight Stay
------------------------------------------------------------------------
            HCPCS code                        Short descriptor
------------------------------------------------------------------------
15170............................  Acell graft trunk/arms/legs.
15171............................  Acell graft t/arm/leg add-on.
15175............................  Acellular graft, f/n/hf/g.
15176............................  Acell graft, f/n/hf/g add-on.
19260............................  Removal of chest wall lesion.
19307............................  Mast, mod rad.
20100............................  Explore wound, neck.
20101............................  Explore wound, chest.
20102............................  Explore wound, abdomen.
21049............................  Excis uppr jaw cyst w/repair.
21175............................  Reconstruct orbit/forehead.
21195............................  Reconst lwr jaw w/o fixation.
21261............................  Revise eye sockets.
21263............................  Revise eye sockets.
21408............................  Treat eye socket fracture.
21470............................  Treat lower jaw fracture.
21742............................  Repair stern/nuss w/o scope.
21743............................  Repair sternum/nuss w/scope.
22100............................  Remove part of neck vertebra.
22101............................  Remove part, thorax vertebra.
22222............................  Revision of thorax spine.
22526............................  Idet, single level.
22527............................  Idet, 1 or more levels.
22612............................  Lumbar spine fusion.
22614............................  Spine fusion, extra segment.
22851............................  Apply spine prosth device.
23470............................  Reconstruct shoulder joint.
24150............................  Extensive humerus surgery.
24151............................  Extensive humerus surgery.
24935............................  Revision of amputation.
25170............................  Extensive forearm surgery.
26037............................  Decompress fingers/hand.
27216............................  Treat pelvic ring fracture.
27235............................  Treat thigh fracture.
27412............................  Autochondrocyte implant knee.
27415............................  Osteochondral knee allograft.
27446............................  Revision of knee joint.
27475............................  Surgery to stop leg growth.
27524............................  Treat kneecap fracture.
28360............................  Reconstruct cleft foot.
29866............................  Autgrft implnt, knee w/scope.
29867............................  Allgrft implnt, knee w/scope.
29868............................  Meniscal trnspl, knee w/scpe.
31292............................  Nasal/sinus endoscopy, surg.
31293............................  Nasal/sinus endoscopy, surg.
31294............................  Nasal/sinus endoscopy, surg.
31600............................  Incision of windpipe.
31601............................  Incision of windpipe.
31610............................  Incision of windpipe.
31785............................  Remove windpipe lesion.
32005............................  Treat lung lining chemically.
32020............................  Insertion of chest tube.
32201............................  Drain, percut, lung lesion.
32601............................  Thoracoscopy, diagnostic.
32602............................  Thoracoscopy, diagnostic.
32603............................  Thoracoscopy, diagnostic.
32604............................  Thoracoscopy, diagnostic.
32605............................  Thoracoscopy, diagnostic.
32606............................  Thoracoscopy, diagnostic.
32998............................  Perq rf ablate tx, pul tumor.
33244............................  Remove eltrd, transven.
34101............................  Removal of artery clot.
34111............................  Removal of arm artery clot.
34201............................  Removal of artery clot.
34203............................  Removal of leg artery clot.

[[Page 42489]]

 
34421............................  Removal of vein clot.
34471............................  Removal of vein clot.
34490............................  Removal of vein clot.
34501............................  Repair valve, femoral vein.
34510............................  Transposition of vein valve.
34520............................  Cross-over vein graft.
34530............................  Leg vein fusion.
35011............................  Repair defect of artery.
35180............................  Repair blood vessel lesion.
35184............................  Repair blood vessel lesion.
35190............................  Repair blood vessel lesion.
35201............................  Repair blood vessel lesion.
35206............................  Repair blood vessel lesion.
35226............................  Repair blood vessel lesion.
35231............................  Repair blood vessel lesion.
35236............................  Repair blood vessel lesion.
35256............................  Repair blood vessel lesion.
35261............................  Repair blood vessel lesion.
35266............................  Repair blood vessel lesion.
35286............................  Repair blood vessel lesion.
35321............................  Rechanneling of artery.
35458............................  Repair arterial blockage.
35459............................  Repair arterial blockage.
35460............................  Repair venous blockage.
35470............................  Repair arterial blockage.
35471............................  Repair arterial blockage.
35472............................  Repair arterial blockage.
35475............................  Repair arterial blockage.
35484............................  Atherectomy, open.
35485............................  Atherectomy, open.
35490............................  Atherectomy, percutaneous.
35491............................  Atherectomy, percutaneous.
35493............................  Atherectomy, percutaneous.
35494............................  Atherectomy, percutaneous.
35495............................  Atherectomy, percutaneous.
35500............................  Harvest vein for bypass.
35685............................  Bypass graft patency/patch.
35686............................  Bypass graft/av fist patency.
35860............................  Explore limb vessels.
35879............................  Revise graft w/vein.
35881............................  Revise graft w/vein.
35883............................  Revise graft w/nonauto graft.
35884............................  Revise graft w/vein.
35903............................  Excision, graft, extremity.
36838............................  Dist revas ligation, hemo.
37183............................  Remove hepatic shunt (tips).
37195............................  Thrombolytic therapy, stroke.
37201............................  Transcatheter therapy infuse.
37202............................  Transcatheter therapy infuse.
37204............................  Transcatheter occlusion.
37205............................  Transcath iv stent, precut.
37206............................  Transcath iv stent/perc addl.
37207............................  Transcath iv stent, open.
37208............................  Transcath iv stent/open addl.
37209............................  Change iv cath at thromb tx.
37210............................  Embolization uterine fibroid.
37565............................  Ligation of neck vein.
37600............................  Ligation of neck artery.
37605............................  Ligation of neck artery.
37606............................  Ligation of neck artery.
37615............................  Ligation of neck artery.
37620............................  Revision of major vein.
38120............................  Laparoscopy, splenectomy.
38240............................  Bone marrow/stem transplant.
38720............................  Removal of lymph nodes, neck.
39400............................  Visualization of chest.
42225............................  Reconstruct cleft palate.
42227............................  Lengthening of palate.
42842............................  Extensive surgery of throat.
42844............................  Extensive surgery of throat.
43020............................  Incision of esophagus.
43130............................  Removal of esophagus pouch.
43280............................  Laparoscopy, fundoplasty.
43510............................  Surgical opening of stomach.
43647............................  Lap impl electrode, antrum.
43648............................  Lap revise/remv eltrd antrum.
43651............................  Laparoscopy, vagus nerve
43652............................  Laparoscopy, vagus nerve.
43752............................  Nasal/orogastric w/stent.
43830............................  Place gastrostomy tube.
43831............................  Place gastrostomy tube.
44180............................  Lap, enterolysis.
44186............................  Lap, jejunostomy.
44206............................  Lap part colectomy w/stoma.
44207............................  Lcolectomy/coloproctostomy.
44208............................  Lcolectomy/coloproctostomy.
44213............................  Lap, mobil splenic fl add-on.
44500............................  Intro, gastrointestinal tube.
44901............................  Drain app abscess, precut.
44970............................  Laparoscopy, appendectomy.
45541............................  Correct rectal prolapse.
47011............................  Percut drain, liver lesion.
47370............................  Laparo ablate liver tumor rf.
47371............................  Laparo ablate liver cryosurg.
47490............................  Incision of gallbladder.
48511............................  Drain pancreatic pseudocyst.
49021............................  Drain abdominal abscess.
49041............................  Drain, percut, abdom abscess.
49061............................  Drain, percut, retroper absc.
49200............................  Removal of abdominal lesion.
49323............................  Laparo drain lymphocele.
49324............................  Lap insertion perm ip cath.
49325............................  Lap revision perm ip cath.
49326............................  Lap w/omentopexy add-on.
49435............................  Insert subq exten to ip cath.
49436............................  Embedded ip cath exit-site.
49491............................  Rpr hern preemie reduce.
49492............................  Rpr ing hern premie, blocked.
50020............................  Renal abscess, open drain.
50021............................  Renal abscess, percut drain.
50080............................  Removal of kidney stone.
50081............................  Removal of kidney stone.
50541............................  Laparo ablate renal cyst.
50542............................  Laparo ablate renal mass.
50543............................  Laparo partial nephrectomy.
50544............................  Laparoscopy, pyeloplasty.
50945............................  Laparoscopy, ureterolithotomy.
51990............................  Laparo urethral suspension.
53500............................  Urethrlys, transvag w/ scope.
57106............................  Remove vagina wall, partial.
57107............................  Remove vagina tissue, part.
57109............................  Vaginectomy partial w/nodes.
57120............................  Closure of vagina.
57282............................  Colpopexy, extraperitoneal.
57283............................  Colpopexy, intraperitoneal.
57284............................  Repair paravaginal defect.
57292............................  Construct vagina with graft.
57295............................  Change vaginal graft.
57310............................  Repair urethrovaginal lesion.
57330............................  Repair bladder-vagina lesion.
57335............................  Repair vagina.
57425............................  Laparoscopy, surg, colpopexy.
57555............................  Remove cervix/repair vagina.
58260............................  Vaginal hysterectomy.
58262............................  Vag hyst including t/o.
58263............................  Vag hyst w/t/o & vag repair.
58270............................  Vag hyst w/enterocele repair.
58290............................  Vag hyst complex.
58291............................  Vag hyst incl t/o, complex.
58292............................  Vag hyst t/o & repair, compl.
58294............................  Vag hyst w/enterocele, compl.
58541............................  Lsh, uterus 250 g or less.
58542............................  Lsh w/t/o ut 250 g or less.
58543............................  Lsh uterus above 250 g.
58544............................  Lsh w/t/o uterus above 250 g.
58553............................  Laparo-vag hyst, complex.
58554............................  Laparo-vag hyst w/t/o, compl.
58770............................  Create new tubal opening.
58823............................  Drain pelvic abscess, precut.
58920............................  Partial removal of ovary(s).
58925............................  Removal of ovarian cyst(s).
59030............................  Fetal scalp blood sample.
59074............................  Fetal fluid drainage w/us.
59409............................  Obstetrical care.
59612............................  Vbac delivery only.
60210............................  Partial thyroid excision.
60212............................  Partial thyroid excision.
60220............................  Partial removal of thyroid.
60225............................  Partial removal of thyroid.
60240............................  Removal of thyroid.
60252............................  Removal of thyroid.
60260............................  Repeat thyroid surgery.
60500............................  Explore parathyroid glands.
60502............................  Re-explore parathyroids.
60512............................  Autotransplant parathyroid.
60520............................  Removal of thymus gland.
61623............................  Endovasc tempory vessel occl.
61626............................  Transcath occlusion, non-cns.
61720............................  Incise skull/brain surgery.
62000............................  Treat skull fracture.
62160............................  Neuroendoscopy add-on.
62351............................  Implant spinal canal cath.
63001............................  Removal of spinal lamina.
63003............................  Removal of spinal lamina.
63005............................  Removal of spinal lamina.
63011............................  Removal of spinal lamina.
63012............................  Removal of spinal lamina.

[[Page 42490]]

 
63015............................  Removal of spinal lamina.
63016............................  Removal of spinal lamina.
63017............................  Removal of spinal lamina.
63020............................  Neck spine disk surgery.
63030............................  Low back disk surgery.
63035............................  Spinal disk surgery add-on.
63040............................  Laminotomy, single cervical.
63042............................  Laminotomy, single lumbar.
63045............................  Removal of spinal lamina.
63046............................  Removal of spinal lamina.
63047............................  Removal of spinal lamina.
63048............................  Remove spinal lamina add-on.
63055............................  Decompress spinal cord.
63056............................  Decompress spinal cord.
63057............................  Decompress spine cord add-on.
63064............................  Decompress spinal cord.
63066............................  Decompress spine cord add-on.
63075............................  Neck spine disk surgery.
63741............................  Install spinal shunt.
64448............................  Nblock inj fem, cont inf.
64449............................  Nblock inj, lumbar plexus.
64804............................  Remove sympathetic nerves.
64910............................  Nerve repair w/allograft.
64911............................  Neurorraphy w/vein autograft.
69725............................  Release facial nerve.
69955............................  Release facial nerve.
69960............................  Release inner ear canal.
------------------------------------------------------------------------

IV. Ratesetting Methodology for the Revised ASC Payment System

A. Overview of Current ASC Payment System

    Section 1833(i)(1) of the Act requires us to specify, in 
consultation with appropriate medical organizations, surgical 
procedures that are appropriately performed on an inpatient basis in a 
hospital but that also can be safely performed in an ASC and to review 
and update the list of procedures paid under the ASC payment system at 
least every 2 years.
    Under the existing ASC payment system, the ASC payment rate is a 
standard overhead amount established on the basis of our estimate of a 
fee that takes into account the costs incurred by ASCs generally in 
providing facility services in connection with performing a specific 
procedure. We refer readers to section I.B. of this final rule for 
further history regarding the establishment of standard overhead 
amounts for ASC payment. The standard overhead amounts under the 
existing ASC payment system for procedures on the ASC list of covered 
surgical procedures were last rebased in 1990 using data collected in a 
1986 survey of ASC costs. The process and methodology that we used to 
establish the payment system are explained in the February 8, 1990 
Federal Register (55 FR 4526).
    The existing ASC payment system consists of 9 standard overhead 
amounts ranging from $333 to $1,339, based on the data collected in the 
1986 survey of ASC costs. An ASC payment group currently consists of 
all the procedures assigned to a particular standard overhead amount. 
ASC payment groups are heterogeneous in terms of clinical 
characteristics, cutting across all body systems and types of surgery. 
Medicare pays a $150 allowance for IOLs that are inserted during or 
subsequent to cataract surgery and an additional $50 for IOLs that are 
included in active NTIOL classes. Medicare also makes separate payment 
for implantable prosthetic devices and implantable durable medical 
equipment (DME) that are surgically inserted at an ASC under the 
Durable Medical Equipment, Prosthetics, Orthotics, and Supplies 
(DMEPOS) fee schedule. Payment for all other facility services that are 
directly related to performing a surgical procedure is packaged into 
the prospectively determined ASC payment for the covered surgical 
procedure.
    Section 5103 of Public Law 109-171 requires us to substitute the 
OPPS payment amount for the ASC standard overhead amount for surgical 
procedures performed in an ASC on or after January 1, 2007, but prior 
to the revised ASC payment system, when the ASC standard overhead 
amount exceeds the OPPS payment amount for the procedure in that year. 
In Addendum AA to the CY 2007 OPPS/ASC final rule with comment period 
(71 FR 68243 through 68283), we identify the HCPCS codes on the CY 2007 
ASC list for which the CY 2007 ASC payments are capped at the OPPS 
payment amounts in accordance with the provisions of section 5103 of 
Public Law 109-171, based on a comparison of the final CY 2007 OPPS 
payment rates and the ASC standard overhead amounts that are effective 
in CY 2007.
    Except for screening flexible sigmoidoscopy and screening 
colonoscopy services, payment for ASC services is subject to the usual 
Medicare Part B deductible and coinsurance requirements and the amounts 
paid by Medicare must be 80 percent of the standard fee. As required by 
section 1834(d) of the Act, the coinsurance for screening flexible 
sigmoidoscopies and colonoscopies is 25 percent and the amounts paid by 
Medicare must be 75 percent of the standard fee.
    Medicare currently accounts for geographic wage variations when 
calculating individual ASC payments by applying the relevant inpatient 
prospective payment system (IPPS) wage index values and localities that 
were established under the IPPS prior to implementation of the new Core 
Based Statistical Areas (CBSAs) issued by the Office of Management and 
Budget (OMB) in June 2003 to 34.45 percent of the national ASC standard 
overhead amount. The 1986 ASC survey data are the basis for attributing 
34.45 percent of ASC facility costs to labor costs.
    Section 1833(i)(2)(C) of the Act requires the Secretary to update 
ASC payment rates using the CPI-U (U.S. city average) (CPI-U) if the 
Secretary has not otherwise updated the amounts under the revised ASC 
payment system. As amended by Public Law 108-173, section 1833(i)(2)(C) 
of the Act provides that if the Secretary is required to apply the CPI-
U increase, the CPI-U percentage increase is to be applied on a fiscal 
year basis beginning with FY 1986 through FY 2005 and on a calendar 
year basis beginning with 2006. Public Law 108-173 further amended 
section 1833(i)(2)(C) of the Act to require us in FY 2004, beginning 
April 1, 2004, to increase ASC payment rates using the CPI-U as 
estimated for the 12-month period ending March 31, 2003, minus 3.0 
percentage points. Public Law 108-173 also requires that the CPI-U 
adjustment factor equal zero percent in FY 2005, the last quarter of CY 
2005, and each of CYs 2006 through 2009.
    Section 141(b) of the Social Security Act Amendments of 1994, 
Public Law 103-432, requires us to establish a process for considering 
requests for review of the appropriateness of the payment amount 
provided under section 1833(i)(2)(A)(iii) of the Act for IOLs to ensure 
that the ASC payment for the insertion procedure is reasonable and 
related to the cost of acquiring a lens that belongs to a class of 
NTIOLs. In the CY 2007 OPPS/ASC proposed rule that was published August 
23, 2006 (71 FR 49631 through 49635), we proposed changes to the 
process for recognizing IOLs as belonging to a new NTIOL class. In the 
subsequent CY 2007 OPPS/ASC final rule with comment period (71 FR 68175 
through 68181), we finalized the proposed changes to that process, 
beginning with requests for review for establishing new NTIOL classes 
for CY 2008 payment.
    The revised ASC payment system that we are finalizing in this rule 
will implement requirements set forth in section 626 of Public Law 108-
173. The

[[Page 42491]]

revised payment system mandated by section 626(d) of Public Law 108-173 
requires us to take into account recommendations in a report to 
Congress prepared by the GAO. As mentioned earlier, that report (GAO-
07-86) was published on November 30, 2006. Its methodology, findings, 
and recommendations are summarized in section II.B. of this final rule. 
Specific ASC payment system issues considered in the GAO Report are 
discussed in the individual sections below under the related topic 
areas.

B. ASC Relative Payment Weights Based on APC Groups and Relative 
Payment Weights Established Under the OPPS

    As we stated in the August 2006 proposed rule for the revised ASC 
payment system (71 FR 49647), we considered several strategies and 
methodologies for setting ASC payment rates under a revised payment 
system. These options included requiring ASCs to submit modified cost 
reports as a basis for establishing ASC costs, expanding the number and 
payment range of the current ASC payment groups, basing payments to 
ASCs on the relative weights for surgical services established under 
the MPFS, basing payments to ASCs on the relative weights for surgical 
services established under the Medicare OPPS, as suggested in Public 
Law 108-173, or basing payments to ASCs on a flat percentage of the 
payment for the same services established under the OPPS, as advocated 
by representatives of several ASC associations.
    After reviewing the advantages and disadvantages of each of these 
approaches, in the August 2006 proposed rule we proposed, within the 
parameters of section 626 of Public Law 108-173, to use the APC groups 
and the relative payment weights for surgical procedures established 
under the OPPS as the basis of the payment groups and the relative 
payment weights for surgical procedures performed in ASCs. These 
payment weights would be multiplied by an ASC conversion factor in 
order to calculate the ASC payment rates. Several factors persuaded us 
to advance this proposal over the other approaches that we considered.
    First, in section 626(d) of Public Law 108-173, the Congress 
explicitly targets the OPPS for consideration by the GAO in its study 
of ASC payments. We believe it is reasonable to assume that Congress, 
by so doing, was highlighting the relative payment weights under the 
OPPS as a theoretical model for ASC relative payment weights under the 
revised payment system.
    Second, the ASC benefit provides payment for services associated 
with performing surgical procedures. The OPPS has equipped us with 
nearly a decade of experience in developing and refining a relative 
payment system for all services furnished in connection with outpatient 
surgical procedures.
    Third, Public Law 108-173 applies, for the first time, a budget 
neutrality requirement to the ASC benefit. That is, in the year the 
revised system is implemented, the system is to be designed to result 
in the same aggregate amount of expenditures that would be made if the 
revised payment system were not implemented. Because the OPPS is also a 
prospective payment system for facility services that is subject to 
budget neutrality requirements, it provides useful parallels for a 
ratesetting methodology based on relative facility payment weights for 
surgical services under the revised ASC payment system.
    Fourth, in our analysis of the APC groups to which surgical 
procedures are assigned for payment under the OPPS, we found that, of 
the 150 highest volume surgical procedures furnished in HOPDs, more 
than half (80) are also among the 150 highest volume procedures 
performed in ASCs.
    Finally, the ASC industry in numerous meetings with us over the 
past several years has frequently voiced its preference for a payment 
system that parallels the OPPS for the sake of promoting transparency 
across sites of service in the arena of outpatient surgery and to 
streamline and modernize how CMS sets payments and determines what is 
payable under the ASC benefit.
    We explained in the August 2006 proposed rule that the OPPS payment 
rates are based on relative payment weights, which are updated annually 
based on the most recent year of hospital outpatient claims data and 
hospitals' latest Medicare cost reports. APCs to which surgical 
procedures are assigned are generally homogeneous both in terms of 
clinical characteristics and resource requirements. The APCs have been 
continually refined over the past 6 years through the work of the 
Advisory Panel on Ambulatory Payment Classification Groups (APC Panel) 
and as a result of comments received during the OPPS annual rulemaking 
cycles.
    Moreover, we believed that the APC groups had matured with respect 
to their clinical and resource homogeneity, and the relativity in 
resource utilization among APCs containing surgical procedures had 
stabilized. Thus, we concluded in the proposed rule that the APC groups 
and their relative weights were reasonable and appropriate models for 
grouping outpatient surgical procedures and determining the relativity 
of the ASC payment weights under the revised payment system. For 
example, whether performed in an HOPD or in an ASC, we believed the 
time and facility resources required to perform a routine laparoscopic 
hernia repair described by CPT code 49650 (Laparoscopy, surgical; 
repair initial inguinal hernia), with a CY 2007 OPPS relative payment 
weight of 43.5488, were approximately 5 times higher than those 
required to perform a diagnostic colonoscopy described by CPT code 
45378 (Colonoscopy, flexible, proximal to splenic flexure; diagnostic, 
with or without collection of specimen(s) by brushing or washing, with 
or without colon decompression (separate procedure)), with a CY 2007 
OPPS relative payment weight of 8.7686. Thus, we believed that the 
relative payment weights established under the OPPS for procedures 
performed in the hospital outpatient setting reasonably reflected the 
relative facility resources required for such procedures and did so 
with sufficient coherence to be applicable to other ambulatory sites of 
service. Taking all these factors into account, we proposed to use the 
APCs as a ``grouper'' and the APC relative payment weights as the basis 
for ASC relative payment weights and for calculating ASC payment rates 
under the revised payment system. Accordingly, we proposed to establish 
provisions in proposed new Subpart F, Sec. Sec.  416.167 and 416.171, 
to reflect these proposed changes for calculating the ASC payment rates 
beginning January 1, 2008.
    As further discussed in section II.B. of this final rule, on 
November 30, 2006, the GAO published the report mandated by section 
626(d) of Public Law 108-173 (GAO-07-86), where it determined that the 
APC groups of the OPPS accurately reflect the relative costs of 
procedures performed in ASCs. It concluded that the APC groups in the 
OPPS reflect the relative costs of surgical procedures performed in 
ASCs in the same way that they reflect the relative costs of the same 
procedures when they are performed in HOPDs. Therefore, the GAO 
recommended that the APC groups could be applied to procedures 
performed in ASCs, and the OPPS could be used as the basis for an ASC 
payment system, thereby eliminating the need for ASC surveys and 
providing for an annual revision of the ASC payment groups. At its 
December 2006 meeting, the PPAC recommended that CMS apply any payment 
policies uniformly to both

[[Page 42492]]

ASCs and HOPDs as appropriate, confirming its belief that the OPPS and 
the revised ASC payment system could be closely linked.
    We received a number of comments on our proposal to use the OPPS 
relative payment weights as the basis for establishing relative payment 
weights under the revised ASC payment system. A summary of the comments 
and our responses follow.
    Comment: Many commenters agreed that using the OPPS APCs as a 
``grouper'' and the APC relative payment weights to establish ASC 
payment rates for surgical procedures paid under the revised ASC 
payment system is appropriate because a significant number of surgical 
procedures furnished in the hospital outpatient setting are also 
performed in ASCs. Some commenters argued that because ASCs provide 
many similar procedures that are also performed in HOPDs and often 
utilize the same equipment, supplies, and clinical labor in performing 
these procedures, the relative costs of performing the procedures 
should be similar, if not identical, in both settings. Moreover, the 
commenters generally agreed that creating an ASC payment system that 
parallels the OPPS would promote transparency across sites of service 
in the area of outpatient surgery and would also promote greater 
alignment and coordination between the OPPS and the revised ASC payment 
system, including providing for the annual updating of payment weights 
in the ASC payment system.
    Some commenters requested that CMS apply different conversion 
factors to the OPPS relative payment weights for specific types of 
procedures to calculate their ASC payment rates, because they suggested 
that the OPPS relativity was not correct for some services provided in 
single specialty ASCs (for example, gastroenterology and pain 
management procedures). They believed that the OPPS APC weights, based 
on all hospital services rather than just surgical services, may be 
flawed and that additional analyses of relative hospital and ASC costs 
are needed. They recommended that CMS develop firm data on the 
differences between hospital outpatient and ASC costs and the magnitude 
of those differences for numerous services before finalizing 
significant changes in ASC payments for procedures. One commenter 
specifically discussed a study commissioned by MedPAC in which RAND 
found that no single outpatient surgical setting, ASCs or HOPDs, had 
consistently higher rates of patient characteristics that would be 
expected to increase facility costs. Analyses by another commenter 
found that among a subset of gastrointestinal (GI) procedures, the 
majority of surgical CPT codes describing those procedures received 
OPPS payments that were less than hospitals' median costs for the 
individual procedures.
    Response: We appreciate the commenters' general support for basing 
the revised ASC payment system relative weights on the OPPS APC groups 
and their relative weights. As discussed in detail in section II.B. of 
this final rule, in its November 2006 report on ASC payment, the GAO 
found that the APC groups in the OPPS accurately reflect the relative 
costs of procedures performed in ASCs. The GAO analyses also 
demonstrated that there is less variation in the ASC setting between 
individual procedures' costs and the costs of their assigned APC groups 
than there is in the HOPD setting, and that when compared to the median 
cost of the same APC group, procedures performed in ASCs had 
substantially lower costs than those same procedures performed in 
HOPDs.
    The GAO findings were based upon data for all procedures performed 
in ASCs in CY 2004, as reported by those ASCs responding to the GAO 
survey. In view of the GAO's confirmation that the APC groups 
accurately reflect the relative costs of these procedures performed in 
ASCs in the same way that they reflect the relative costs of the same 
procedures when they are performed in HOPDs, substantiating a key 
assumption underlying our proposal for the revised ASC payment system, 
we do not believe there is a compelling rationale for using different 
ASC conversion factors to develop payment rates for various procedures 
under the revised ASC payment system. Applying more than one ASC 
conversion factor to different procedures would imply that we believe 
the OPPS APC payment weight relativity is not applicable to the ASC 
setting, contrary to our proposal and the GAO study results. APCs 
currently serve as a ``grouper'' for the OPPS and, as such, the payment 
for any given procedure under the OPPS does not specifically reflect 
the cost of that procedure in any one facility. Instead, the APC 
relative payment weights under the OPPS are developed based on the 
median cost of all single claims for all procedures assigned to each 
APC. Prospectively established APC payment rates provide an averaging 
effect on OPPS payments for individual services. With the significant 
expansion of covered surgical procedures eligible for ASC payment that 
we are finalizing in this final rule for the revised ASC payment system 
as discussed in section III. of this final rule, in many cases where 
one service in an APC is an ASC procedure, most of the other procedures 
assigned to the same APC will also be paid in the ASC setting. Thus, 
under the revised payment system, ASCs generally will have the 
potential to provide a mix of individual services assigned to those 
APCs that is similar to the mix of OPPS procedures attributable to 
certain APCs and, in many cases, all of the procedures assigned to 
certain APCs under the OPPS will also be ASC covered surgical 
procedures. We believe this uniform approach under the revised ASC 
payment system is fully consistent with the recommendation of the PPAC 
that we apply payment policies consistently to both ASCs and HOPDs, as 
appropriate. It also generally treats procedures performed in ASCs 
consistently for purposes of developing ASC payment rates under the 
revised ASC payment system, in accordance with the PPAC recommendation 
that we adopt a systematic and adaptable means of fairly reimbursing 
ASCs for their services.
    While information provided by the commenters clearly demonstrated 
that some specific groups of procedures would experience a significant 
decrease in payment under the revised ASC payment system as compared 
with the existing payment structure, we are not convinced that the 
information we received contradicts the premise of our proposal and the 
GAO findings that the relativity of costs observed in HOPDs could 
appropriately be used as the basis for the relative payment weights in 
the revised ASC payment system. We also continue to see no clinical 
basis that would support the differential relativity of costs for 
various procedures performed in the ASC or HOPD settings.
    While applying a single conversion factor to the OPPS relative 
weights may result in decreases to ASC payments for some services 
commonly provided in single specialty ASCs, we also believe that this 
approach should result in facilities receiving more appropriate 
payments for ASC services in general, where those payments more 
accurately reflect the facility resources required for their 
performance. As discussed further in section IV.J. of this final rule, 
our final policy of a 4-year transition to phase in the revised ASC 
payment system should mitigate the potential disruption in care that 
could be associated with significant increases or decreases in payments 
for specific surgical procedures under the revised payment system. 
Individual ASCs will have a longer period of time to evaluate and 
potentially modify the breadth of

[[Page 42493]]

surgical procedures they provide based on the expanded list of covered 
surgical procedures and the final policies of the revised ASC payment 
system. Further, our final ASC policies for payment of device=intensive 
procedures and covered ancillary services that more closely align the 
ASC and OPPS systems may moderate the magnitude of differences between 
current ASC payments and those under the revised payment system for 
individual surgical procedures. We do not believe that it would be 
appropriate to modulate changes in payment under the revised system by 
differentially adjusting the payment weights or the conversion factor 
for various types of services because, consistent with the GAO 
recommendation, we believe the OPPS relative payment weights upon which 
the revised ASC payment system is based appropriately reflect the 
relativity in ASC resource costs associated with different surgical 
procedures. We believe that the final payment policies for the revised 
payment system result in appropriate and equitable payments, and thus, 
we see no rationale for applying adjustments that are counter to the 
principles of a prospective payment system.
    After considering the public comments received, we are finalizing 
our proposal, without modification, to establish the relative payment 
weights under the revised ASC payment system for most covered surgical 
procedures based on their OPPS APC relative payment weights for the 
same calendar year, with application of a single ASC conversion factor 
to determine the national unadjusted ASC payment rates, as set forth in 
Sec. Sec.  416.167 and 416.171. Several exceptions to this general 
policy are discussed elsewhere in this final rule, specifically in 
sections IV.C. and IV.E. of this preamble.

C. Packaging Policy

1. General Policy
    Payment for a surgical procedure under both the current OPPS and 
ASC payment systems represents payment for a package of various items 
and services, all of which are directly related and required in order 
to perform the procedure. In both systems, we package into a single 
facility payment the payment for a bundle of direct and indirect costs 
incurred by the facility to perform the surgical procedure. These costs 
include, but are not limited to, use of the facility, including an 
operating suite or procedure room and recovery room; nursing, 
technician, and related services; administrative, recordkeeping, and 
housekeeping items and services; medical and surgical supplies and 
equipment; surgical dressings; and materials for anesthesia.
    CMS currently applies different rules under the ASC payment system 
and the OPPS for determining whether payment for other items and 
services directly related to a surgical procedure is packaged into the 
facility payment for the associated surgical procedure or paid for 
separately. These other items and services include drugs, biologicals, 
contrast agents, implantable devices, and diagnostic services such as 
imaging. Currently, CMS packages payment for the costs for all drugs, 
biologicals, and diagnostic services, including imaging, into the ASC 
standard overhead amount for the surgical procedure with which these 
items and services are associated. Under the OPPS, CMS pays separately 
for some of these items and services, in addition to paying for the 
surgical procedure.
    ASCs currently receive separate payment for prosthetic implants and 
implantable DME, as well as additional payment for NTIOLs. Laboratory 
services, physicians' services, and x-ray or diagnostic procedures may 
also be paid separately under other Medicare Part B fee schedules. 
Conversely, under the OPPS, payment for prosthetic implants and 
implantable DME is packaged into the OPPS payment for the surgical 
procedure performed to insert the implants. Payments for IOLs, 
anesthesia materials, and implantable surgical supplies, such as 
stents, mesh, guidewires, pins, and catheters, are packaged into the 
associated surgical procedure payment under both the OPPS and the ASC 
payment system.
    In developing the August 2006 proposed rule for the revised ASC 
payment system, we considered several packaging options. First, we 
considered making no change to the current policy regarding items and 
services for which payment is packaged into the ASC payment. That is, 
we would continue under the revised ASC payment system to package into 
the ASC payment all services listed at existing Sec.  416.61(a). In 
addition, we would continue to pay separately, sometimes under other 
fee schedules, for items and services such as: NTIOLs; prosthetic 
implants and implantable DME surgically inserted at an ASC (DMEPOS fee 
schedule); laboratory services (Clinical Diagnostic Laboratory Fee 
Schedule); physician services (MPFS); and x-ray or diagnostic 
procedures other than those directly related to performance of the 
surgical procedure (MPFS).
    We also considered proposing to apply the OPPS packaging rules to 
the ASC payment system and to pay under the revised ASC payment system 
the same way we pay under the OPPS for items and services directly 
related to a surgical procedure. If we adopted this option, payment for 
certain imaging procedures, drugs, biologicals, and contrast agents 
directly related to performing a covered surgical procedure would not 
be packaged into the ASC payment for the procedure but would, instead, 
be paid separately. Conversely, payment for most surgically implanted 
devices and implantable DME would be packaged.
    Each of the preceding two options has characteristics that are 
inconsistent with a fundamental principle of a prospective payment 
system, which is to base payment on large bundles of items and services 
so as to promote the efficient provision of services. To preserve as 
much as possible the elements of a prospective payment system within 
the revised ASC payment system, in the August 2006 proposed rule for 
the revised ASC payment system, we proposed a third option (71 FR 
49648). That is, we proposed to continue the current policy of 
packaging payment for all direct and indirect costs incurred by the 
facility to perform a covered surgical procedure into the ASC payment 
for the procedure. This would include payment for all drugs, 
biologicals, contrast agents, anesthesia materials, and imaging 
services, as well as the other items and services that were proposed 
for packaging into the ASC surgical procedure payment as listed in 
proposed Sec.  416.164(a). Proposed Sec.  416.164(a) addressed the 
services for which payment was proposed to be included in the ASC 
payment for the covered surgical procedures, and proposed Sec.  
416.164(b) addressed those services that were proposed not to be 
included in the ASC payment for the covered surgical procedures.
    In addition, we proposed to cease making separate payment for 
implantable prosthetic devices and implantable DME inserted surgically 
in an ASC. Instead, under the revised payment system, we proposed to 
package payment for implantable prosthetic devices and implantable DME 
when they are surgically inserted into the ASC payment for the 
associated covered surgical procedure, as we do under the OPPS.
    However, we proposed to continue excluding from ASC payment for 
covered surgical procedures the other services addressed in Sec.  
416.164(b). That is, payment for items and services for which payment 
is currently made under other Part B fee schedules, with the exception 
of implantable prosthetic devices and implantable DME, would

[[Page 42494]]

not be included in the ASC payment for the surgical procedure. Payment 
for items and services, such as physicians' professional services; 
laboratory, x-ray or diagnostic procedures (other than those directly 
related to performance of the surgical procedure); nonimplantable 
prosthetic devices; ambulance services; leg, arm, back and neck braces; 
artificial limbs; and DME for use in the patient's home would not be 
included in the ASC payment for the covered surgical procedure.
    We proposed this third option for a number of reasons. First, in 
the August 2006 proposed rule, we explained that this approach to 
packaging is most consistent with the principles of a prospective 
payment system. Second, we noted that we believe that ASCs generally 
treat a less complex and severely ill patient case-mix and, as a 
result, we believe that ASCs are less likely to provide, on a regular 
basis, many of the separately paid items and services that patients 
might receive more consistently in a hospital outpatient setting. Thus, 
in the August 2006 proposed rule, we concluded that we did not believe 
there is a need to pay for these services separately in ASCs, because 
that would unbundle some items and services that are currently packaged 
into the ASC facility services payment under the existing payment 
system, reduce incentives for cost-efficient delivery of services in 
ASCs, and increase the complexity of the revised ASC payment system.
    Moreover, after analysis of OPPS claims for surgical procedures, we 
were unable to identify ancillary items and services that are 
repeatedly and consistently reported separately in association with 
specific ambulatory surgical procedures. Rather, the OPPS claims for 
surgical procedures were of two types: one group showed a broad range 
of items and services that were provided on the same day that a 
surgical procedure was performed in the HOPD, only some of which were 
likely to be directly related to the surgical procedure; the second 
group of claims revealed that many surgical procedures are only 
infrequently associated with ancillary items and services paid 
separately under the OPPS.
    We sought comments in the August 2006 proposed rule (71 FR 49648) 
from ASC clinical and administrative staff, and from physicians who 
perform surgeries in ASCs, regarding nonsurgical ancillary services or 
items that are directly related to a surgical procedure that would be 
paid separately under the OPPS but that would be packaged under our 
proposal for the revised ASC payment system. We specifically requested 
that commenters provide data to indicate the frequency with which 
specific items and services are typically furnished in association with 
given procedures, the reasons why one patient might require the 
additional items and services whereas another patient would not, and 
the costs of those items and services relative to the other costs 
incurred to perform the associated surgery.
    At its December 2006 meeting, the PPAC recommended that CMS apply 
any payment policies uniformly to ASCs under the revised ASC payment 
system and HOPDs under the OPPS. In the GAO Report (GAO-07-86) 
published on November 30, 2006, based upon its study of the 20 most 
frequently performed ASC procedures in CY 2004, the GAO found that many 
additional services were billed with surgical procedures in both the 
ASC and HOPD settings, but few resulted in an additional payment in one 
setting but not the other. In general, HOPDs were paid separately for 
some of the related additional services they billed with the procedures 
and, in the ASC setting, other Part B suppliers usually billed Medicare 
for those services and received payment for them. Multiple surgical 
procedures performed in one session were typically paid separately in 
both settings, occurring in similar proportions of cases and subject to 
the same 50-percent reduction policy for the procedure with the lower 
payment rate. Laboratory services were paid under the OPPS according to 
the Clinical Diagnostic Laboratory Fee Schedule (CLFS) rates and were 
billed by another Medicare Part B supplier when provided in the context 
of a surgical procedure performed in an ASC. Similarly, some radiology 
services were paid separately under the OPPS, but when those radiology 
services were performed with procedures provided in the ASC setting, 
those services generally were furnished and billed by another Part B 
supplier. Anesthesia services in both settings were usually billed by 
another Part B supplier. While individual drugs were billed under the 
OPPS for most procedures, the GAO found that none of those individual 
drugs were separately payable in the HOPD setting, just as their 
payment was packaged in ASCs. Thus, the GAO concluded that there were 
many similarities in the additional services billed in the ASC or HOPD 
settings with the top 20 ASC procedures. Furthermore, the GAO found 
that, in the context of the existing ASC payment system, CMS generally 
made separate payment for similar additional services in both settings, 
although sometimes to other Part B suppliers than to the ASCs 
themselves.
    We also note that we proposed, consistent with section 141(b) of 
the Social Security Act Amendments of 1994, Public Law 103-432, to 
continue to provide adjustment to payment amounts for NTIOLs under the 
revised ASC payment system as set forth in Subpart G that we finalized 
in the CY 2007 OPPS/ASC final rule with comment period.
    We received numerous comments on our proposed packaging policies 
for the revised ASC payment system. The commenters submitted many 
suggestions regarding the various approaches that they believed CMS 
should follow when finalizing the packaging policies for certain items 
and services under the revised ASC payment system. A summary of the 
comments and our responses follow.
    Comment: In general, many of the commenters agreed with CMS' 
proposal to continue to package under the revised ASC payment system 
payment for various items and services that are currently packaged 
under the OPPS and the existing ASC payment system. They recommended 
that CMS adopt its proposal to provide packaged payment for the costs 
of many items and services that are directly related to the provision 
of surgical procedures, such as facility overhead, operating and 
recovery room use, nursing and technician services, administrative and 
housekeeping items and services, appliances and equipment, materials 
for anesthesia, IOLs, surgical dressings, supplies, splints, and casts. 
They acknowledged that the statute requires that payment to ASCs for 
IOLs (other than NTIOLs which receive a supplemental payment) must be 
packaged into the ASC payment for IOL insertion procedures. In 
addition, the commenters agreed that CMS should continue to exclude 
from payment as part of the ASC payment for covered surgical procedures 
some items and services that are paid under other Part B fee schedules, 
specifically the professional services of physicians and nonphysician 
practitioners paid under the MFPS and laboratory services paid under 
the CLFS. Further, the commenters agreed that CMS should continue to 
provide additional payment for NTIOLs.
    The commenters who supported continued packaging of the items and 
services described above generally provided those recommendations in 
the context of their broader recommendation to apply the same packaging 
policies under the revised ASC payment system as under the

[[Page 42495]]

OPPS, because the proposed payment rates under the revised ASC payment 
system were based upon the OPPS payment groups. They argued that 
parallel packaging policies were most consistent with promoting 
transparency between the two systems and minimizing any payment 
incentives to shift sites of service for various procedures. They also 
believed that this approach is the most appropriate, given the proposal 
to base the rates in the revised ASC payment system on the OPPS 
relative payment weights, with application of a single conversion 
factor. The commenters asserted that consistent packaging policies 
would ensure that some payment was made for the costs of all items and 
services used by facilities in performing surgical procedures, and that 
there was no duplicate payment for these items under either the OPPS or 
the revised ASC payment system.
    MedPAC supported the proposal to expand the ASC payment bundles in 
the revised payment system by packaging payment for implantable 
prosthetics and DME, but recommended that CMS make the payment bundles 
under the revised ASC payment system and the OPPS even more compatible 
by expanding the payment bundles in the OPPS. MedPAC noted that 
different bundling policies under the two payment systems may lead to 
different relative payment amounts in each setting, even if the base 
payment rates share the same relative values in both settings.
    Response: We appreciate the commenters' support for continuing to 
package payment under the revised ASC payment system for those items 
and services that also receive packaged payment under the OPPS. The 
commenters' recommendations are consistent with the PPAC recommendation 
that we apply payment policies uniformly across the two systems. We 
note that any changes to the OPPS payment bundles are outside the scope 
of this final rule for the revised ASC payment system. Such changes 
would have to be proposed and finalized through the OPPS annual 
rulemaking cycle, and we will keep MedPAC's recommendations in mind for 
future OPPS updates.
    As set forth in final Sec.  416.163, payment is made under the 
revised ASC payment system for ASC services furnished in connection 
with covered surgical procedures. As set forth in revised Sec.  416.2, 
ASC services include both facility services, which are defined as items 
and services that are furnished in connection with a covered surgical 
procedure performed in an ASC and for which payment is packaged into 
the ASC payment for the covered surgical procedure, and covered 
ancillary services, which are defined as those items and services that 
are integral to a covered surgical procedure and for which separate 
payment may be made under the revised ASC payment system.
    After considering all public comments received, we are finalizing, 
with modification, our proposal to provide packaged payment for ASC 
facility services into the ASC payment for covered surgical procedures 
under the revised ASC payment system. That is, we will continue to 
identify as within the scope of ASC facility services for which payment 
is packaged into the payment for covered surgical procedures as set 
forth in final Sec.  416.164(a) the following: nursing, technician, and 
related services; use of the facility where the surgical procedures are 
performed; laboratory testing performed under a Clinical Laboratory 
Improvement Amendments of 1988 (CLIA) certificate of waiver; drugs and 
biologicals for which separate payment is not allowed under the OPPS; 
medical and surgical supplies not on pass-through status under the 
OPPS; equipment; surgical dressings; implanted prosthetic devices and 
related accessories and supplies not on pass-through status under the 
OPPS, including IOLs; implanted DME and related accessories and 
supplies not on pass-through status under the OPPS; splints and casts 
and related devices; radiology services for which separate payment is 
not allowed under the OPPS and other diagnostic tests or interpretive 
services that are integral to a surgical procedure; administrative, 
recordkeeping, and housekeeping items and services; materials, 
including supplies and equipment for the administration and monitoring 
of anesthesia; and supervision of the services of an anesthetist by the 
operating surgeon. Under the revised ASC payment system, the above 
items and services fall within the scope of ASC facility services, and 
we will package payment for them into the ASC payment for the covered 
surgical procedure in order to promote efficient use of resources. We 
will continue to provide a payment adjustment for insertion of an IOL 
approved as belonging to a class of NTIOLs, for the 5-year period of 
time established for that class, as set forth in Subpart G and new 
Sec.  416.172(g) for the revised ASC payment system.
    As a modification to our proposal, under the final policy of the 
revised ASC payment system, covered ancillary services that are 
integral to a covered ASC surgical procedure will be allowed separate 
payment. These covered ancillary services, which are outside of the 
scope of ASC facility services defined at Sec.  416.2 and described at 
new Sec.  416.164(a) for which payment is packaged into the ASC payment 
for covered surgical procedures, are defined at Sec.  416.2 and 
described at new Sec.  416.164(b) as follows: brachytherapy sources; 
certain implantable items that have pass-through status under the OPPS; 
certain items and services that we designate as contractor-priced 
(payment rate is determined by the Medicare contractor) including, but 
not limited to, the procurement of corneal tissue; certain drugs and 
biologicals for which separate payment is allowed under the OPPS; and 
certain radiology services for which separate payment is allowed under 
the OPPS. Public comments on the proposed rule and our responses 
regarding these specific items and services are discussed later in this 
section.
    We will consider to be outside the scope of ASC services, as set 
forth in Sec.  416.164(c), the following items and services, including, 
but not limited to: physicians' services (including surgical procedures 
and all preoperative and postoperative services that are performed by a 
physician); anesthetists' services; radiology services (other than 
those integral to performance of a covered surgical procedure); 
diagnostic procedures (other than those directly related to performance 
of a covered surgical procedure); ambulance services; leg, arm, back, 
and neck braces other than those that serve the function of a cast or 
splint; artificial limbs; and nonimplantable prosthetic devices and 
DME.
2. Policies for Specific Items and Services
    Although in the August 2006 proposed rule we proposed to package 
payment for a broad array of items and services under the revised ASC 
payment system into the ASC payment for a covered surgical procedure as 
described earlier in this section, we solicited and received many 
public comments regarding our proposed treatment of those items or 
services that are directly related to a surgical procedure and that 
would be paid separately under the OPPS but that were proposed for 
packaging under the revised ASC payment system. We address those 
specific comments and provide our responses below.
    Comment: A number of commenters indicated that, if the goal of the 
revised ASC payment system is to create a payment system that is based 
on OPPS relative weights and payment rates, then the packaging policy 
for ASCs should be

[[Page 42496]]

based on the same inclusions as those found under the OPPS. They 
suggested that following the OPPS payment policies under the revised 
ASC payment system would promote parity in payments between HOPDs and 
ASCs and, thereby, eliminate inappropriate incentives to base care 
decisions on payment considerations. Specifically, a number of 
commenters were concerned about payment differences that could arise 
between HOPDs and ASCs when services outside the CPT surgical range 
were provided in an ASC in conjunction with a covered surgical 
procedure on the ASC list. They noted that when HOPDs provide some of 
these services and items, they generally receive separate payment for 
them.
    Response: Because we received numerous comments on various issues 
related to the proposed packaging of payment for specific items and 
services under the revised ASC payment system where the proposed 
packaging policy differs from the OPPS payment policy, we address them 
separately in the following sections:
a. Radiology Services
    Under the existing ASC payment system, we define a surgical 
procedure as any procedure described within the range of Category I CPT 
codes that the AMA defines as ``surgery'' (CPT codes 10000-69999). In 
the August 2006 proposed rule, we indicated that we would continue this 
standard (71 FR 49636). Because the HCPCS codes that describe radiology 
services are outside of the CPT surgical range, payment for radiology 
services that are directly related to surgical procedures has been 
packaged into the ASC payment for the covered surgical procedure under 
the existing ASC payment system. The current regulatory definition of 
an ASC does not allow the ASC and another entity to mix functions and 
operations in a common space during concurrent or overlapping hours of 
operation. That is, the two facilities must be separated by time 
(different hours of operation) or the other entity may operate in the 
ASC's space when the ASC is not operating in that space. Historically, 
we have made an exception to this rule when there is a need for imaging 
services during the course of a covered surgical procedure in progress 
in an ASC under the existing ASC payment system. In that case, an 
Independent Diagnostic Testing Facility (IDTF) sharing the space with 
the ASC (normally at a different time) may conduct the required 
radiology service outside of its normal business hours, as needed, and 
receive Medicare payment for those services. Specifically, under the 
existing ASC payment system if an ASC enrolls in the Medicare program 
as an IDTF and bills as that supplier when furnishing a radiology 
service that is reasonable and necessary and directly related to and 
furnished in conjunction with a covered surgical procedure, the IDTF 
may bill and receive payment under the MPFS for imaging and guidance 
services, even though they are being provided during the ASC's 
designated hours.
    The GAO Report on ASC payment released on November 30, 2006 
confirmed that separate payment is commonly made to another Part B 
supplier for these radiology services provided in association with 
surgical procedures in ASCs. Currently, radiology services provided in 
association with surgical procedures paid under the OPPS are either 
packaged or paid separately through an OPPS facility payment. We 
received a number of comments regarding our proposal to package payment 
for radiology services into payment for their associated surgical 
procedures under the revised ASC payment system. A summary of the 
comments and our responses follow.
    Comment: Numerous commenters opposed CMS' proposed policy of 
packaging payment for radiology services directly related to a surgical 
procedure into the ASC payment for the associated covered surgical 
procedure. Some commenters requested that CMS continue to follow the 
existing practice regarding separate payment for radiology services 
provided in association with surgical procedures under the current ASC 
payment system. That is, they recommended that CMS permit continued 
separate payments for such radiology services to IDTFs if the ASCs are 
enrolled as IDTFs and bill for the services as that type of supplier. 
On the other hand, other commenters believed that ASC enrollment as an 
IDTF supplier was unnecessarily administratively burdensome for those 
ASCs that only are providing radiology services necessary for the safe 
provision of surgical procedures. These commenters requested that CMS 
adopt the OPPS payment policy for radiology services under the revised 
ASC payment system, which either provides separate payment or packages 
their payment into the OPPS payment for the surgical procedure 
associated with the radiology services. They indicated that following 
the OPPS payment policy under the revised ASC payment system would 
promote parity in payments between HOPDs and ASCs, especially because 
the relative payment weights used in both payment systems were linked. 
In contrast, MedPAC recommended that CMS address the potentially 
inconsistent payment policies by creating larger payment bundles under 
the OPPS, consistent with CMS' proposal to package payment for 
radiology services directly related to a surgical procedure under the 
revised ASC payment system.
    Response: We believe that appropriate radiology services may be 
necessary for the safe performance of covered surgical procedures that 
are provided to Medicare beneficiaries in ASCs, and we realize that 
under the current system, payments for many of these services are made 
to other Part B suppliers even though the radiology services are 
integral to the surgical procedures provided by ASCs. We have come to 
believe that the most prudent method for providing accurate payment for 
the ancillary radiology services that are integral to, and required for 
the successful performance of, covered surgical procedures is to 
provide separate payment for certain radiology services under our final 
policy for the revised ASC payment system. Payment for the costs of 
radiology services that are separately paid under the OPPS is not 
included in the OPPS payment weights upon which the revised ASC payment 
system is based so, under our proposal, ASCs may not have received the 
most appropriate payment for the costs of these associated radiology 
services. We will, therefore, provide separate payment to ASCs for 
certain ancillary radiology services when they are integral to the 
performance of a covered surgical procedure billed by the ASC on the 
same day, provided that separate payment for the radiology service 
would be made under the OPPS.
    We specify that a radiology service is integral to the performance 
of a covered surgical procedure if it is required for the successful 
performance of the surgery and is performed in the ASC immediately 
preceding, during, or immediately following the covered surgical 
procedure. Based on our analysis of the OPPS data, we believe that, in 
most cases, a radiology service that is separately payable under the 
OPPS that is performed in the ASC on the same day as a covered surgical 
procedure will be provided integral to a covered surgical procedure, 
and the ASC will be able to receive separate payment for the service as 
a covered ancillary service. The separate ASC payments for these 
radiology services will be made at the lower of: (1) The amount 
calculated according to the standard methodology of the revised ASC 
payment system; or (2) the MPFS nonfacility practice expense amount for 
the service (specifically, for the

[[Page 42497]]

technical component (TC) if the service's HCPCS code is assigned a TC 
under the MPFS). This is similar to our final payment policy for 
covered office-based surgical procedures added to the ASC list in CY 
2008 or later years. Payment for the costs of the facility resources 
associated with the radiology service would have been made to IDTFs 
under the existing ASC payment system at the MPFS nonfacility practice 
expense amount. Therefore, we believe the revised payment system 
beginning January 1, 2008, will both ensure appropriate and equitable 
payment for covered ancillary radiology services integral to covered 
surgical procedures and not provide a payment incentive for migration 
of services from physicians' offices or IDTFs to ASCs.
    This final policy will not encourage the proliferation of ASCs 
enrolling as IDTF suppliers, a practice which could lead to even 
greater future increases in the volume of diagnostic imaging services 
than those recently observed for such services to Medicare 
beneficiaries. CMS defines an IDTF in Sec.  410.33 as an entity 
independent of a hospital or physician's office in which diagnostic 
tests are performed by licensed or certified nonphysician personnel 
under appropriate physician supervision. ASCs are distinct entities 
that operate exclusively for the purpose of providing surgical services 
to patients not requiring hospitalization (Sec.  416.2). As discussed 
earlier, an ASC that is also enrolled as an IDTF must maintain 
separate, exclusive hours of operation from those of the IDTF, and 
there may be no overlap in the hours of operation of the two entities.
    In order to bill for diagnostic tests, the IDTF must be enrolled as 
such with Medicare and meet specific requirements regarding its 
structure, ownership and, operation as set forth in Sec.  410.33. As 
stated in Sec.  416.49, an ASC is responsible for obtaining radiologic 
services from a Medicare approved facility to meet the needs of its 
patients and, as confirmed by the GAO in its report released on 
November 30, 2006, many ASCs currently provide those radiology services 
in association with covered surgical procedures through other Part B 
suppliers, specifically IDTFs.
    Under the revised payment system, there is no incentive for ASCs 
that provide only those radiology services that are integral to the 
performance of covered surgical procedures to also enroll as IDTFs. In 
contrast to current policy, under the revised system, payment will be 
made to the ASC for radiology services that are furnished integral to a 
covered surgical procedure. Payment will no longer be permitted to 
IDTFs for covered ancillary radiology services furnished integral to 
covered surgical procedures in ASCs. Because ASCs are distinct entities 
that operate exclusively to provide ambulatory surgical services, we 
would not expect that IDTFs sharing space with ASCs would be billing 
for any services for a patient receiving those services in an ASC on 
the date of a covered surgical procedure because all such services 
would be integral to the surgical procedure.
    Under the final policy, only the ASC can receive payment for the 
facility resources required to provide the ancillary radiology 
services. IDTFs would not be able to bill for radiology services 
integral to the performance of a covered surgical procedure, an 
existing practice which commenters claimed is unnecessarily 
administratively burdensome because it requires ASCs that are only 
providing radiology services related to the safe performance of 
surgical procedures also to enroll as IDTF suppliers under Medicare. As 
of January 1, 2008, we are no longer permitting the exception that has 
allowed billing by IDTFs for required radiology services provided in 
ASCs during the course of covered ASC surgical procedures. We are also 
not allowing any other suppliers to bill for the technical component of 
radiology services provided in ASCs that are integral to the 
performance of an ASC covered surgical procedure. Only ASCs will 
receive separate payment for the technical component of those radiology 
services that are separately payable under the OPPS to ensure that no 
duplicate payment is made. This policy will ensure that packaged or 
separate payment is made to ASCs for all radiology services integral to 
the performance of covered surgical procedures, thereby providing 
appropriate payment to ASCs for those radiology services that are 
essential to the delivery of safe, high quality surgical care.
    In summary, under the revised ASC payment system, we are adopting 
the OPPS payment status for radiology services and will pay separately, 
at the lower of the amount developed according to the standard 
methodology of the revised ASC payment system or the MPFS nonfacility 
practice expense amount, for ancillary radiology services designated as 
separately payable under the OPPS when those radiology services are 
integral to the performance of a covered surgical procedure provided on 
the same day and billed by the ASC. Similarly, we will package payment 
for those services that are designated as packaged under the OPPS into 
the payment for the covered surgical procedure. The separate national, 
unadjusted ASC payment for a covered ancillary radiology service would 
be based either upon the OPPS payment weight for the APC group of the 
radiology service, with application of the uniform ASC conversion 
factor, or upon the MPFS nonfacility practice expense relative value 
units (RVUs) for the service. Payment under the revised ASC payment 
system for these covered ancillary radiology services would be subject 
to geographic adjustment, like payment for covered surgical procedures. 
IDTFs would no longer be able to receive payment for ancillary 
radiology services that are integral to the performance of a covered 
surgical procedure for which the ASC is billing Medicare. This policy 
is consistent with the PPAC's request for uniform payment policies 
across the OPPS and the revised ASC payment system and is responsive to 
MedPAC's concern about creating different payment bundles for ASCs and 
HOPDs. Because the packaging status of radiology services under the 
revised ASC payment system will parallel their treatment under the 
OPPS, any changes to the packaging of radiology services under the OPPS 
that would alter the OPPS payment bundles would also occur under the 
revised ASC payment system. Therefore, we believe that this approach is 
fully consistent with the recommendations of MedPAC and the PPAC in 
applying payment policies consistently to both ASCs and HOPDs.
    Radiology services include all Category I CPT codes in the 
radiology range established by CPT, from 70000 to 79999, and Category 
III CPT codes and Level II HCPCS codes that describe radiology services 
that crosswalk or are clinically similar to procedures in the radiology 
range established by CPT. This revised ASC payment system policy for 
each calendar year will apply to all radiology services that are 
separately payable under the OPPS in that same calendar year. An 
illustrative listing that includes all radiology services that are 
separately payable under the CY 2007 OPPS, which will be proposed for 
updating and then finalized in the CY 2008 OPPS/ASC proposed and final 
rules, respectively, can be found in Addendum BB to this final rule. 
Covered ancillary radiology services are assigned to payment indicator 
``Z2'' (Radiology service paid separately when provided integral to a 
surgical procedure on ASC list; payment based on OPPS relative payment 
weight) or ``Z3'' (Radiology service paid separately when provided 
integral to a

[[Page 42498]]

surgical procedure on ASC list; payment based on MPFS nonfacility PE 
RVUs). ASC payment rates for these radiology services will be 
determined according to the standard methodology of the revised ASC 
payment system as discussed further in section V. of this final rule, 
or according to the MPFS nonfacility practice expense amount, whichever 
payment amount is lower. This final policy is set forth in Sec. Sec.  
416.171(d) and 416.167(b)(3).
    After consideration of all public comments received, we are 
finalizing a policy to provide separate payment under the revised ASC 
payment system for those ancillary radiology services separately paid 
under the OPPS that are integral to the performance of covered surgical 
procedures for which the ASC bills Medicare. This final policy 
contrasts with our proposal which would have provided packaged payment 
for all ancillary radiology services. Instead, under the revised ASC 
payment system, we will provide separate payment for those ancillary 
radiology services that are separately paid under the OPPS when they 
are provided on the same day as, and integral to, the performance of a 
covered surgical procedure in an ASC. Payment for ancillary radiology 
services that are packaged under the OPPS will be packaged under the 
revised ASC payment system, and these services are identified in 
Addendum BB to this final rule with payment indicator ``N1'' (Packaged 
service/item; no separate payment made).
    Separately paid radiology services are considered to be covered 
ancillary services. ASC payment for these radiology services will not 
be subject to the 4-year transition (see section IV.J. of this final 
rule) because the services have never received separate payment under 
the existing ASC payment system. The 4-year transition applies only to 
those services that receive separate payment under the existing CY 2007 
ASC payment system. We also are revising proposed Sec.  416.164(a) and 
(b) to reflect this final policy.
b. Brachytherapy Sources
    As we stated in the August 2006 proposed rule, under the existing 
ASC payment system, a single payment is made to an ASC for all facility 
services furnished by the ASC in connection with a covered surgical 
procedure. However, a number of services and related items covered 
under Medicare may be furnished in an ASC, where these items and 
services are not considered to be facility services and, therefore, are 
not paid through the ASC payment for the covered surgical procedure. 
These items and related services may be covered and paid to other Part 
B suppliers, such as physicians. Such is sometimes the case with 
payment for brachytherapy sources implanted in ASCs, where the needles 
and catheters to implant the sources are implanted during surgical 
procedures that are on the ASC list. Under the existing ASC payment 
system, while payment is not made for brachytherapy sources to ASCs, 
these sources may be separately paid at contractor-priced rates by 
Medicare contractors under the MPFS to physicians who may also be 
billing the CPT codes for application of the brachytherapy sources in 
ASCs. Contractor-priced rates are those payment rates for certain items 
or services that are individually established by each Medicare 
contractor for payment of claims submitted to them. Brachytherapy 
source application codes, which are included in the radiology section 
of the CPT code book, are not on the existing ASC list because they do 
not fall within the CPT surgical range and, therefore, are not defined 
as surgery for purposes of ASC payment. While we did not explicitly 
discuss payment for brachytherapy sources in the August 2006 proposed 
rule, we received a number of comments regarding payment for 
brachytherapy sources under the revised ASC payment system. A summary 
of the comments and our responses follow.
    Comment: Several commenters suggested that CMS pay separately for 
brachytherapy sources under the revised ASC payment system when they 
are implanted in ASCs. Other commenters recommended that CMS continue 
to pay separately under the MPFS for brachytherapy sources provided in 
ASCs. The commenters requested that CMS allow separate payment for 
brachytherapy sources to facilitate the treatment of cancer patients 
who have brachytherapy sources implanted in ASCs. As an example, they 
described a closely related sequence of procedures performed in the ASC 
setting for the brachytherapy treatment of patients with prostate 
cancer, including the placement of needles and catheters, reported with 
a CPT code on the ASC list; the application of brachytherapy sources, 
reported with a CPT code not on the ASC list; and the provision of 
numerous brachytherapy sources, reported with specific Level II HCPCS 
codes in the OPPS setting. The commenters noted that it would be 
appropriate to implant brachytherapy sources in ASCs for the treatment 
of prostate cancer, because the surgical procedure to insert the 
required needles and catheters is currently on the ASC list and, in the 
case of prostate cancer in particular, patients must have the sources 
implanted in the same session where the needles or catheters are 
placed. The commenters pointed out that each of these related items and 
services is separately paid under the OPPS, so the base OPPS payment 
weights for the surgical needle and catheter placement procedures do 
not provide payment for the brachytherapy source application or the 
sources themselves. They noted that all of these individual procedures 
and items are required to provide the full brachytherapy treatment.
    Response: Based on the comments received and our review of the 
issue, we have concluded that the most appropriate policy under the 
revised ASC payment system is to provide separate payment to ASCs for 
the brachytherapy sources as covered ancillary services implanted in 
conjunction with covered surgical procedures billed by ASCs. Further, 
as evidenced by our decisions regarding payment for other covered 
ancillary services under the CY 2008 revised ASC payment system, our 
intention is to maintain consistent payment and packaging policies 
across HOPD and ASC settings for covered ancillary services that are 
integral to covered surgical procedures performed in ASCs. Therefore, 
consistent with our policy to pay separately for some drugs, 
biologicals, and radiology services as covered ancillary services, we 
also believe that adopting a payment policy consistent with the OPPS 
for payment of brachytherapy sources is reasonable and appropriate to 
ensure that the comprehensive brachytherapy service can be provided by 
ASCs. The application of the brachytherapy sources is integrally 
related to the surgical procedures for insertion of brachytherapy 
needles and catheters, which are appropriate for performance in ASCs. 
There is a statutory requirement that the OPPS establish separate 
payment groups for brachytherapy sources related to their number, 
radioisotope, and radioactive intensity, as well as for stranded and 
non-stranded sources as of July 1, 2007, OPPS procedure payments do not 
include payment for brachytherapy sources. We agree with both MedPAC 
and the PPAC that consistent payment bundles between the two payment 
systems are desirable. Therefore, under the revised ASC payment system, 
we will pay ASCs separately for brachytherapy sources when they are 
provided in association with a surgical

[[Page 42499]]

procedure not excluded from ASC payment and billed by the ASC on the 
same day. The ASC brachytherapy source payment rate for a given 
calendar year will be the same as the OPPS payment rate for that year 
or, if specific OPPS prospective payment rates are unavailable, ASC 
payments for brachytherapy sources will be contractor-priced. The ASC 
brachytherapy source payment rate will be established at its OPPS 
payment rate, without application of the ASC budget neutrality 
adjustment factor to the OPPS conversion factor. In addition, 
consistent with the payment of brachytherapy sources under the OPPS, 
the ASC payment rates for brachytherapy sources will not be adjusted 
for geographic wage differences. Because brachytherapy sources are 
implantable devices with relatively fixed costs for which we would not 
expect efficiencies that would permit ASCs to acquire them at lower 
costs than HOPDs, we believe it is most appropriate to pay for the 
brachytherapy sources at the same rates as the OPPS if possible. A list 
of brachytherapy sources recognized under the CY 2007 OPPS, for which 
payment according to the statute is made at charges reduced to cost 
under the CY 2007 OPPS, is included in Table 3 below, as well as in 
Addendum BB to this final rule, specifically those codes assigned to 
payment indicator ``H7'' (Brachytherapy source paid separately when 
provided integral to a surgical procedure on ASC list; payment 
contractor-priced).
    An updated list will be proposed and finalized for CY 2008 in the 
CY 2008 OPPS/ASC proposed and final rules, respectively, as will the CY 
2008 OPPS payment rates for brachytherapy sources. We also may 
establish new brachytherapy source HCPCS codes, revise the existing 
HCPCS codes, or both, for separate payment on a quarterly basis under 
the revised ASC payment system, as we currently do under the OPPS, in 
order to keep the two payment systems aligned. In addition, we note 
that the CPT codes for the application of brachytherapy sources are 
radiology services in the radiology range of Category I CPT codes, so 
they would also be separately paid in ASCs under the revised ASC 
payment system if provided in association with a covered surgical 
procedure, as described in section IV.C.2.a. of this final rule.

 Table 3.--Brachytherapy Sources Paid Separately Under the CY 2007 OPPS
                           as of April 1, 2007
------------------------------------------------------------------------
           HCPCS code                         Long descriptor
------------------------------------------------------------------------
A9527...........................  Iodine I-125, sodium iodide solution,
                                   therapeutic, per millicurie.
C1716...........................  Brachytherapy source, Gold-198, per
                                   source.
C1717...........................  Brachytherapy source, High Dose Rate
                                   Iridium-192, per source.
C1718...........................  Brachytherapy source, Iodine-125, per
                                   source.
C1719...........................  Brachytherapy source, Non-High Dose
                                   Rate Iridium-192, per source.
C1720...........................  Brachytherapy source, Palladium-103,
                                   per source.
C2616...........................  Brachytherapy source, Yttrium-90, per
                                   source.
C2633...........................  Brachytherapy source, Cesium-131, per
                                   source.
C2634...........................  Brachytherapy source, High Activity,
                                   Iodine-125, greater than 1.01 mCi
                                   (NIST), per source.
C2635...........................  Brachytherapy source, High Activity,
                                   Palladium-103, greater than 2.2 mCi
                                   (NIST), per source.
C2636...........................  Brachytherapy linear source, Palladium-
                                   103, per 1MM.
C2637...........................  Brachytherapy source, Ytterbium-169,
                                   per source.
------------------------------------------------------------------------

    After consideration of all public comments received, we are 
finalizing a policy to provide separate payment under the revised ASC 
payment system for ancillary brachytherapy sources implanted in 
association with the performance of a covered surgical procedure that 
is billed by the ASC to Medicare. Under our proposal, no payment would 
have been made to ASCs for the implantation of brachytherapy sources in 
conjunction with covered surgical procedures, although payment could 
have been made to other Part B suppliers. Under this final policy, ASC 
payment for brachytherapy sources as covered ancillary services in a 
calendar year will be made at the OPPS rates for that same year, or if 
OPPS rates are unavailable, ASC payment will be made at contractor-
priced rates. Payment rates for brachytherapy sources will not be 
developed through application of the uniform ASC conversion factor, and 
they will not be subject to the geographic adjustment. Accordingly, we 
are revising proposed Sec.  416.164(a) and (b) to reflect this final 
policy.
    We would also caution that we expect ASCs to follow all Federal, 
State, and local safety requirements regarding the proper handling and 
disposal of these radioactive substances. ASCs that cannot comply with 
those guidelines should not provide brachytherapy services. ASC 
policies for the proper handling and disposal of brachytherapy sources 
also should include accommodations for the appropriate disposal of 
sources that were not implanted.
c. Drugs and Biologicals
    In the August 2006 proposed rule, we indicated that under the 
existing ASC payment system, payment for all drugs and biologicals 
(whether packaged or separately payable under the OPPS) is packaged 
into the ASC payment for the covered surgical procedure. We proposed to 
continue that policy under the revised ASC payment system. Under the 
OPPS, CMS pays separately for all pass-through drugs and biologicals, 
while nonpass-through drugs and biologicals are either packaged or paid 
separately under the OPPS, depending on whether or not their cost is 
equal to or less than $55 per day or exceeds $55 per day, respectively, 
for CY 2007. We received a number of comments on our proposal to 
package payment for all drugs and biologicals into the payment for 
their associated surgical procedures under the revised ASC payment 
system. A summary of the comments and our responses follow.
    Comment: While the commenters generally agreed with CMS' proposal 
to package payment for inexpensive drugs into the ASC payment for the 
covered surgical procedure under the revised ASC payment system 
consistent with current practice, many commenters objected to CMS' 
proposed packaging of payment for expensive drugs and biologicals and 
urged CMS to pay separately for them. Moreover, several commenters 
requested that CMS adopt the OPPS payment policies for both pass-
through and nonpass-through drugs and biologicals under the revised ASC 
payment system. They indicated that following the OPPS payment policies 
under the revised ASC payment system would promote parity in

[[Page 42500]]

payments between HOPDs and ASCs and, thereby, eliminate inappropriate 
incentives to base care decisions on payment considerations. 
Specifically, a number of commenters were concerned about payment 
differences that could arise between HOPDs and ASCs when items were 
provided in an ASC in conjunction with a covered surgical procedure on 
the ASC list. They noted that when HOPDs provide pass-through and many 
nonpass-through drugs and biologicals, they generally receive separate 
payment for these items; therefore, the base OPPS payment rates contain 
no payment for these drugs and biologicals.
    Several commenters expressed particular concern regarding CMS' 
proposal to package payment for expensive biologicals into the 
associated surgical procedure's ASC payment. These commenters cited 
surgical procedures for the application of skin substitutes, newly 
proposed as additions for ASC payment in CY 2008, as examples of 
relatively inexpensive surgical procedures that require the use of 
costly biologicals, for which separate payment is made under the OPPS. 
They argued that the additions of the procedures to the ASC list would 
not provide meaningful access to those services in ASCs, given that the 
relatively low procedure payments proposed for the revised ASC payment 
system included no payment for those necessary biologicals. The 
commenters further added that not paying separately for expensive drugs 
and biologicals in ASCs could result in a shift of services from ASCs 
to HOPDs or physicians' offices, where they are separately paid, even 
though ASCs could be the most appropriate clinical setting for care. 
Some commenters suggested that CMS select specific drugs and 
biologicals for separate payment under the revised ASC payment system 
based on specific criteria such as their cost, required use, or 
association with specific surgical procedures not excluded from ASC 
payment.
    Response: After considering all the comments related to payment for 
drugs and biologicals, we agree with the commenters that the revised 
ASC payment system should provide separate payment for relatively 
costly drugs and biologicals that are integral to covered surgical 
procedures that are billed by ASCs and whose payments are not packaged 
into the base OPPS payment rates. Therefore, effective January 1, 2008, 
we will pay separately for all OPPS pass-through and nonpass-through 
drugs and biologicals that are separately paid under the OPPS, when 
they are provided in association with a covered surgical procedure that 
is billed by the ASC to Medicare.
    Based on the November 30, 2006 GAO Report on ASC payment, we 
recognize that historically common ASC procedures generally used drugs 
that are packaged under the OPPS, but we believe that the significant 
expansion of the procedures eligible for payment under the revised ASC 
payment system, in addition to evolving surgical practice, may 
necessitate the use of different drugs and biologicals in ASCs in the 
future. To ensure appropriate access to all surgical procedures that 
are safe for performance in ASCs, we believe it is prudent under the 
revised ASC payment system to provide separate payment in the ASC 
setting for drugs and biologicals that are integral to covered surgical 
procedures for which the ASC is billing, when the costs of those drugs 
and biologicals were not included in developing the base procedure 
payment weights under the OPPS. We do not believe it would be 
appropriate to select only a subset of these drugs and biologicals that 
are separately payable under the OPPS because we do not see a clear 
rationale for doing so.
    We specify that a drug or biological is integral to the performance 
of a covered surgical procedure if it is required for the successful 
performance of the surgery and is provided in the ASC immediately 
preceding, during, or immediately following the covered surgical 
procedure. Based on our analysis of OPPS data, we believe that, in most 
cases, a drug or biological that is separately payable under the OPPS 
that is provided in an ASC on the same day as a covered surgical 
procedure will be provided as integral to the covered surgical 
procedure, and the ASC will be able to receive separate payment for the 
drug or biological as a covered ancillary service.
    The payments for separately payable drugs and biologicals under the 
revised ASC payment system for a calendar year will be equal to the 
payment rates developed according to the payment methodology used in 
the OPPS for that same year, without the application of the ASC budget 
neutrality adjustment to the OPPS conversion factor. Because OPPS 
payment for separately paid drugs and biologicals is provided at the 
average hospital acquisition cost and is not based upon the application 
of the OPPS conversion factor to relative payment weights, we believe 
the OPPS rates should also reflect the typical acquisition cost of 
these products in the ASC facility setting as well. The OPPS currently 
relies on the average sales price (ASP) methodology to establish 
payment rates for many separately paid drugs and biologicals, and ASP 
data are based upon manufacturers' reports of all drug sales, including 
those to different types of facilities and physicians' offices. The ASP 
methodology is also utilized to establish the physician's office 
payment for drugs and biologicals. Therefore, we believe that aligning 
the ASC payment methodology with the OPPS payment for these covered 
ancillary services is a consistent and logical approach to setting 
their ASC payment rates, and we will not apply the ASC budget 
neutrality adjustment to establish the ASC payment rates. Comparable to 
their treatment under the OPPS, the ASC payment for separately paid 
drugs and biologicals will also not be subject to the geographic wage 
adjustment. In addition, ASC payment for drugs and biologicals that are 
not separately payable under the OPPS will be packaged into the 
payments for the covered surgical procedures with which they are 
administered, consistent with the current OPPS payment methodology.
    As noted above, under the CY 2007 OPPS, payment for separately 
payable nonpass-through drugs and biologicals is made according to the 
ASP methodology, and is generally equal to the ASP plus 6 percent in CY 
2007, the same as the physician's office payment. Payment for pass-
through drugs and biologicals is set at the rate under the Competitive 
Acquisition Program (CAP) for Part B drugs or, if the drug is not 
included in the CAP, at the rate established by the ASP methodology and 
generally equal to the ASP plus 6 percent. A list of the drugs and 
biologicals that are separately paid under the CY 2007 OPPS, along with 
their payment rates as of April 1, 2007, is included in Addendum BB to 
this final rule, specifically those codes assigned to payment indicator 
``K2'' (Drugs and biologicals paid separately when provided integral to 
a surgical procedure on ASC list; payment based on OPPS rate). Drugs 
and biologicals for which payment is packaged under the CY 2007 OPPS 
are also listed in Addendum BB, where they are assigned to payment 
indicator ``N1'' (Packaged service/item; no separate payment made).
    The CY 2008 payment status and payment rates for drugs and 
biologicals will be proposed and finalized in the CY 2008 OPPS/ASC 
proposed and final rules, respectively. We also may establish new HCPCS 
codes for separately payable drugs and plan to update payment rates for 
drugs and biologicals based on new ASP information on a quarterly basis 
under

[[Page 42501]]

the revised ASC payment system, as we currently do under the OPPS, in 
order to keep the two payment systems aligned. This final policy is 
consistent with the recommendation of the PPAC and the comments of 
MedPAC to align the payment bundles under the OPPS and ASC payment 
systems.
    In summary, after consideration of all public comments received, we 
are finalizing a policy to provide separate payment under the revised 
ASC payment system for drugs and biologicals that are separately paid 
under the OPPS, when those items are integral to the performance of a 
covered surgical procedure for which the ASC is billing. We proposed to 
provide packaged payment for all drugs and biologicals under the 
revised ASC payment system through the ASC payment for the covered 
surgical procedure. In contrast, this final policy will provide 
separate payment for those drugs and biologicals that are separately 
paid under the OPPS, when those items are provided on the same day as 
and integral to the performance of a covered surgical procedure in an 
ASC. Separate ASC payment for these drugs and biologicals will be made 
at the OPPS payment rate for the same calendar quarter. ASC payment for 
those drugs and biologicals that are integral to the performance of a 
covered surgical procedure and whose payment is packaged under the OPPS 
will receive packaged payment under the revised ASC payment system. 
Payment rates for drugs and biologicals will not be developed through 
application of the uniform ASC conversion factor, and they will not be 
subject to the geographic adjustment. We also are revising proposed 
Sec.  416.164(a) and (b) to reflect this final policy.
d. Implantable Devices With Pass-Through Status Under the OPPS
    In the August 2006 proposal for the revised ASC payment system, we 
proposed to pay for all implantable devices as part of the ASC payment 
for the covered surgical procedure, thereby packaging payment for all 
devices except for the additional ASC adjustment for NTIOLs. Under this 
proposal, payment for devices included in those device categories with 
pass-through status under the OPPS would also be packaged. In contrast, 
pass-through status under the OPPS provides payment for a device 
included in the pass-through device category on a claim-specific basis 
at the hospital's charges reduced to cost. That is, fiscal 
intermediaries apply the hospital's overall cost-to-charge ratio from 
the hospital's last submitted cost report to the submitted charges on 
the claim and pay the resulting amount on a claim-specific basis. A 
device offset amount is applied, if appropriate, to take into 
consideration the predecessor device payment already packaged into the 
OPPS payment for the associated implantation procedure, in order to 
ensure no duplicate payment. The predecessor device is the device that 
would have been used in the procedure if the pass-through device had 
not been implanted and for which the historical cost is packaged into 
the payment for the implantation procedure.
    Under the existing ASC payment system, payment for OPPS designated 
pass-through devices is either packaged into the ASC payment for the 
covered surgical procedure or, if the device is implantable DME or an 
implantable prosthetic, separately paid under the DMEPOS fee schedule, 
independent from the ASC payment for the associated surgical procedure. 
We received many comments regarding our proposal to package payment for 
devices with OPPS pass-through status into payment for their associated 
surgical procedures under the revised ASC payment system. A summary of 
the comments and our responses follow.
    Comment: Many commenters encouraged us to expand the OPPS pass-
through program to the revised ASC payment system, to provide separate 
payment for those devices whose payments, in whole or in part, were not 
packaged into the base OPPS payment weights upon which the revised ASC 
payment system would be based. These commenters questioned how ASCs 
would be paid appropriately for devices that are paid separately under 
the OPPS as pass-through devices at the hospital's charges reduced to 
cost by the hospital's overall cost-to-charge ratio. The commenters did 
not believe it would be appropriate to provide payment for devices with 
pass-through status under the OPPS packaged into the ASC payment for 
the associated surgical procedure, when there are either no costs 
associated with those devices packaged into the base OPPS procedure 
payment weights or inadequate costs associated only with predecessor 
devices packaged into the base OPPS weights.
    The commenters added that many of the OPPS designated pass-through 
devices that are implanted in ASCs are expensive, and their cost would 
not be adequately reflected in the ASC payment for the covered surgical 
procedure. They believed that the proposed policy would result in 
little access to these new technologies in the ASC setting, despite the 
fact that the associated surgical procedures for their implantation are 
appropriate for ASC payment. They pointed out that only devices that 
demonstrate significant clinical improvement are provided pass-through 
status under the OPPS; hence, Medicare beneficiaries would be unable to 
receive the most clinically beneficial procedures in ASCs.
    Several commenters requested that CMS not provide ASC payments for 
many surgical procedures that use implantable devices, generally for 
patient safety reasons, whether pass-through devices are used or not.
    Response: While the OPPS pass-through program is a statutory 
requirement of the OPPS under section 1833(t)(6) of the Act and, 
therefore, not specifically applicable to the revised ASC payment 
system, we agree with commenters that similar device payment policies 
for these devices under the OPPS and the revised ASC payment system are 
most appropriate to ensure access to procedures implanting these 
clinically beneficial devices in ASCs. Specifically in the case of OPPS 
pass-through devices, the costs of the devices are not fully packaged 
into the OPPS payment weights upon which the revised ASC payment system 
is based because the devices are separately paid under the OPPS. We 
agree with commenters that if payments to ASCs for the associated 
surgical implantation procedures are inadequate to cover the costs of 
these beneficial devices, then ASCs will not offer the procedures 
implanting these devices and beneficiary access to these effective 
devices will thereby be limited to other sites for the services.
    When we examined the three device categories that currently have 
pass-through status under the CY 2007 OPPS, specifically C1820 
(Generator, neurostimulator (implantable), with rechargeable battery 
and charging system), C1821 (Interspinous process distraction device 
(implantable)), and L8690 (Auditory osseointegrated device, includes 
all internal and external components), we noted that the surgical 
procedures associated with both C1820 and L8690 are currently payable 
in the ASC setting. We continue to believe that the procedures 
associated with these pass-through device categories are safe for ASC 
performance and, as such, the procedures will be paid under the revised 
ASC payment system. We remind the public that the list of device 
categories with pass-through status under the OPPS is updated 
quarterly, with the addition of new pass-through device categories, if 
applicable, and that the dates for the expiration of pass-through 
payment for device categories

[[Page 42502]]

are proposed and finalized during the OPPS annual rulemaking cycle. 
Only device categories C1821 and L8690 will continue with pass-through 
status under the CY 2008 OPPS, but there may be additional device 
categories established in the future that will have pass-through status 
during all or a portion of that calendar year. Under the OPPS, claim-
specific device pass-through payment is calculated based on the device 
charge reduced to cost by application of the overall hospital cost-to-
charge ratio and, if applicable, the resulting device cost is further 
subject to a payment reduction (device offset) that is equivalent to 
the device cost for predecessor devices already included in the APC 
median cost for the associated surgical procedure. This ensures that 
the OPPS does not provide duplicate payment for any portion of an 
implanted device with pass-through status. Of the three device 
categories currently with pass-through status under the OPPS, only one 
device category (C1820) has an associated device offset due to the 
costs of the predecessor nonrechargeable implantable neurostimulators 
already packaged into the base APC payment weights for neurostimulator 
implantation procedures.
    Commenters have persuaded us that, under the revised ASC payment 
system, it is appropriate to provide separate payment for devices that 
are included in device categories with pass-through status under the 
OPPS. A list of the OPPS pass-through device categories as of April 1, 
2007 is provided in Table 4 below, and their HCPCS codes are also 
included in Addendum BB to this final rule, where they are assigned to 
payment indicator ``J7'' (OPPS pass-through device paid separately when 
provided integral to a surgical procedure on ASC list; payment 
contractor-priced). Implantable devices that received packaged payment 
because they do not have OPPS pass-through status are also listed in 
Addendum BB to this final rule, where they are assigned to payment 
indicator ``N1'' (Packaged service/item; no separate payment made).

 Table 4.--Active OPPS Pass-Through Device Categories Under the CY 2007
                        OPPS as of April 1, 2007
------------------------------------------------------------------------
           HCPCS code                         Long descriptor
------------------------------------------------------------------------
C1820...........................  Generator, neurostimulator
                                   (implantable), with rechargeable
                                   battery and charging system.
C1821...........................  Interspinous process distraction
                                   device (implantable).
L8690...........................  Auditory osseointegrated device,
                                   includes all internal and external
                                   components.
------------------------------------------------------------------------

    It is not possible to pay for these devices using the specific OPPS 
payment methodology, because cost-to-charge ratios are not available 
for ASCs to convert ASC charges to cost in order to establish a claim-
specific device payment. Because these devices are new technology and 
the number of device categories with pass-through status under the OPPS 
has been limited over the past several years, we believe that 
contractor-priced rates are the most appropriate payment methodology 
for these devices under the revised ASC payment system since there 
would be little or no OPPS claims data available to establish 
prospective payment rates for these devices. Therefore, we will pay 
ASCs separately for devices with pass-through status under the OPPS in 
that same quarter of the calendar year at contractor-priced rates when 
they are implanted in ASCs during a covered surgical procedure that is 
billed by the ASC. As under the OPPS, ASC payment for these devices 
would not be subject to the geographic wage adjustment, nor would the 
uniform ASC conversion factor be applied because there is no OPPS 
payment weight available for these devices and there is little clinical 
labor associated with the device acquisition by the ASC. The associated 
nondevice facility resources for the device implantation procedures 
would be paid through an ASC surgical procedure service payment based 
upon the payment weight for the nondevice portion of the related OPPS 
APC payment weight, as described further below with respect to ASC 
payment for implantable devices without pass-through status under the 
OPPS. This policy, similar to the device offset policy under the OPPS, 
would ensure no duplicate device payment by removing, if applicable, 
the costs of related predecessor devices packaged into the base 
procedure's OPPS payment weight. Under this policy, we will pay 
separately in ASCs for new devices that result in significant clinical 
improvement, consistent with the pass-through policy under the OPPS. 
This similar treatment of devices included in device categories with 
OPPS pass-through status under both the OPPS and revised ASC payment 
systems will help to ensure that beneficiaries have access to the 
devices in both settings. We believe this approach is fully consistent 
with the recommendation of the PPAC to apply payment policies uniformly 
to both ASCs and HOPDs, and with the comments of MedPAC in support of 
comparable payment bundles in the two systems.
    As we have stated earlier in this final rule, we are firmly 
committed to ensuring that outpatient procedures are not limited to 
certain sites of service and that all surgical procedures that can 
safely be performed in ASCs and that are not expected to require an 
overnight stay are on the ASC list of covered surgical procedures so 
that Medicare beneficiaries have full access to surgical services in 
all appropriate settings. We believe that paying separately for those 
devices that are included in device categories with pass-through status 
under the OPPS and that are implanted during ASC covered surgical 
procedures under the revised ASC payment system will promote efficient 
resource use and ensure appropriate access to care.
    After considering all public comments received, we are finalizing a 
policy to provide separate payment under the revised ASC payment system 
for ancillary devices included in device categories with pass-through 
status under the OPPS in the same quarter of the same calendar year 
that the devices are implanted during a covered surgical procedure that 
is billed by the ASC. In contrast with our proposal which would have 
provided packaged payment for these devices, but consistent with their 
separate payment under the OPPS, this specific subset of implantable 
devices will receive separate payment under the revised ASC payment 
system as covered ancillary services. ASC payment will be made for the 
devices at contractor-priced rates and will not be subject to 
geographic wage adjustment, and payment for the associated surgical 
procedures will be made according to our standard methodology for the 
revised ASC payment system, based on only the service (nondevice) 
portion of the procedure's OPPS relative payment weight. Accordingly, 
we are revising proposed Sec.  416.164(a) and (b) to reflect this final 
policy.

[[Page 42503]]

e. Implantable Devices Without Pass-Through Status Under the OPPS
    Historically, separate payment for implantable DME and prosthetics 
provided in association with procedures on the ASC list of covered 
surgical procedures has been made to ASCs on the basis of the DMEPOS 
fee schedule. Payment for other devices that are not implantable DME or 
prosthetics, including some nonpass-through devices under the OPPS, has 
historically been made as part of the ASC payment for the covered 
surgical procedure because such items have been considered to be 
supplies.
    In the August 2006 proposed rule for the revised ASC payment 
system, we proposed to pay for nonpass-through devices as part of the 
ASC payment that would be based on the OPPS relative payment weight of 
the associated surgical procedure, thereby packaging payment for all 
nonpass-through devices, consistent with their treatment under the 
OPPS. We also proposed to apply an ASC budget neutrality adjustment of 
62 percent to the OPPS conversion factor to calculate the ASC payment 
rates for all covered surgical services, regardless of the specific 
nature of the surgical procedures. Therefore, payment for surgical 
procedures with high device costs, referred to as device-intensive 
procedures, would be calculated like payment for all other surgical 
procedures not excluded from ASC payment under the revised payment 
system. We received many comments on our proposed payment policy for 
devices without pass-through status under the OPPS. A summary of the 
comments and our responses follow.
    Comment: Many commenters objected to the packaging of payment for 
all devices as proposed, principally on the basis that, where the 
device cost exceeds 62 percent of the APC payment rate, the ASC would 
not be paid enough to cover the cost of the device, let alone the other 
service costs of the implantation procedure. Some commenters suggested 
that CMS continue to pay separately for devices for which it currently 
pays separately under the DMEPOS fee schedule and provide payment 
through the ASC payment for only the nondevice portion of the 
implantation procedure. They recommended that CMS apply the ASC 
conversion factor only to the nondevice portion of the APC payment 
weight to calculate the ASC service payment for the implantation 
procedure. Other commenters believed that CMS should not apply the ASC 
conversion factor to the device portion of the APC payment, but instead 
should pass the OPPS payment amount for the device through to the ASC 
payment system directly because ASCs would be unable to obtain the 
devices at lower cost than HOPDs. They argued that ASCs would see no 
efficiencies regarding the fixed device costs, so it would be 
inappropriate to apply the ASC conversion factor to develop this 
portion of the ASC procedure payment. These commenters suggested that 
CMS could then apply the ASC conversion factor to the nondevice portion 
of the APC payment to develop a service payment, and sum the two 
partial payments (for the device and the service) to calculate the full 
ASC payment for these device-intensive procedures under the revised ASC 
payment system. They concluded that, in this manner, the OPPS and the 
revised ASC payment system would be aligned, because both systems would 
provide packaged payment for devices without OPPS pass-through status.
    Several commenters requested that CMS not provide ASC payments for 
many procedures that use devices and that are currently paid under the 
OPPS, generally for patient safety reasons.
    Response: For purposes of the revised ASC payment system, we are 
defining device-intensive procedures as all those ASC covered surgical 
procedures in CY 2008 that are assigned to device-dependent APCs under 
the OPPS, where the APC device cost is greater than 50 percent of the 
median APC cost. There are 40 such procedures that fall into this group 
based on their CY 2007 APC assignments, 25 of which are on the CY 2007 
ASC list and 15 of which will be newly recognized for ASC payment 
beginning in CY 2008. They are listed in Tables 5 and 6, respectively, 
below. These procedures are also identified in Addendum AA to this 
final rule.
    Specific payment policies have been applied to device-dependent 
APCs under the OPPS over the past several years (71 FR 68063 through 
68070). There are about 194 OPPS device-dependent procedures, 
specifically those procedures that are assigned to the 42 OPPS device-
dependent APCs under the CY 2007 OPPS, and 89 of these device-dependent 
procedures are also paid in ASCs in CY 2007. However, only 25 of those 
89 procedures are assigned to APCs that have device costs that exceed 
50 percent of the APC median costs and would be subject to the payment 
policy applied to device-intensive procedures under the revised ASC 
payment system. Thus, as noted above, based on current data, there are 
40 device-intensive surgical procedures for which ASC payment will be 
made in CY 2008. ASC payments for these 40 device-intensive procedures 
will be made according to the policy described for device-intensive ASC 
procedures based on their assignments to 19 of the 42 device-dependent 
APCs under the OPPS for CY 2007.
    We do not agree with the commenters who believe that many device-
intensive procedures are unsafe for performance in ASCs because most of 
these device-intensive procedures have been on the ASC list of covered 
surgical procedures for several years and no safety concerns have 
arisen. In the context of developing this final rule, we have once 
again reviewed the clinical characteristics of all of these device-
intensive procedures based on the public comments and our final 
policies regarding surgical procedures for exclusion from ASC payment, 
as discussed in section III.A.2. of this final rule. We continue to 
believe that many device-intensive procedures are appropriate for 
performance in ASCs under the final policies of the revised ASC payment 
system.
    We also are persuaded that it would be inappropriate to continue to 
provide separate payment for some implantable prosthetics and DME under 
the DMEPOS fee schedule by maintaining the practice of the existing ASC 
payment system. Payment for these devices is already packaged into the 
base OPPS payment weights, and separate payment for devices under the 
ASC payment system could essentially pay twice for the device. Separate 
payment for devices under the revised ASC payment system would also be 
contrary to MedPAC's support for our proposal to increase the size of 
the ASC payment bundles and to create comparable payable bundles under 
the OPPS and the revised ASC payment system. Most importantly, separate 
payment for certain devices would not provide the incentives for 
efficiency that would occur through packaging device payment into 
payment for the associated surgical implantation procedure, because 
increased packaging through larger payment bundles would encourage ASCs 
to provide surgical services as cost-effectively as possible. In 
addition, there are some expensive implantable devices, such as ICDs, 
which are not currently paid under the DMEPOS fee schedule, but for 
which we will provide payment for their associated surgical 
implantation procedures in ASCs beginning in CY 2008. If the separate 
DMEPOS payment methodology were to be continued, ASCs would be 
significantly underpaid for such procedures because the device would 
not be separately paid if it were neither implantable DME nor an 
implantable prosthetic device. The

[[Page 42504]]

commenters who recommended continued separate payment for some devices 
under the DMEPOS fee schedule provided no suggestions for developing 
the appropriate ASC payment for expensive implantable devices that are 
neither implantable DME nor implantable prosthetics.
    We agree with the commenters who are concerned that our standard 
methodology for the revised ASC payment system that applies a uniform 
ASC conversion factor to the OPPS relative payment weights could 
provide inadequate payment for device-intensive procedures under the 
revised ASC payment system. The estimated budget neutrality adjustment 
for the revised ASC payment system was 62 percent of the OPPS 
conversion factor in the proposed rule, and it is currently 67 percent 
as discussed in section V. of this final rule (the final CY 2008 ASC 
budget neutrality adjustment will be proposed and finalized through the 
CY 2008 OPPS/ASC rulemaking cycle). Because of the expected magnitude 
of the difference between the estimated ASC procedure payments, 
calculated by application of the ASC conversion factor to the OPPS 
payment weights under the revised ASC payment system, and the OPPS 
payment rates for those same procedures, we are particularly concerned 
that under the revised ASC payment system device-intensive procedures 
would be underpaid if we paid for them as proposed.
    We would not expect that ASCs' device costs for expensive devices 
would differ significantly from the device costs of HOPDs because we do 
not believe that ASCs would realize more substantial efficiencies in 
their acquisition of devices in comparison with HOPDs. On the other 
hand, we believe that ASCs would experience significant efficiencies in 
comparison with HOPDs when performing the implantation procedures 
themselves, consistent with the findings of the GAO Report regarding 
the lower cost of procedures in ASCs in comparison with HOPDs. These 
lower ASC costs may be attributable to a variety of factors, including 
lower facility overhead costs due to ASCs' limited operating hours, 
lack of emergency departments, specialization of ASCs contributing to 
efficient delivery of services, and the characteristics of different 
patient populations treated in ASCs versus HOPDs. Therefore, we believe 
it would be most appropriate under the revised ASC payment system to 
apply a modified payment methodology to this group of device-intensive 
services. Accordingly, in developing the ASC payment rates under the 
revised payment system for device-intensive procedures, we will 
calculate the device portion of the ASC procedure payment separately 
from the service portion, in order to provide special consideration for 
the packaged device costs that are unlikely to vary significantly 
across different facility settings.
    Our final payment methodology for device-intensive procedures under 
the revised ASC payment system is as follows. We will apply the OPPS 
device offset percentage to the OPPS national unadjusted payment to 
acquire the device cost included in the OPPS payment rate for a device-
intensive ASC covered surgical procedure, which we will then set as 
equal to the device portion of the national unadjusted ASC payment rate 
for the procedure. The device offset percentage, which is used under 
the OPPS to remove the predecessor device cost from the device pass-
through payment when a pass-through device is paid at charges reduced 
to cost, so that the pass-through payment for the device only 
represents the incremental payment for the new device over the payment 
for predecessor devices already packaged into the APC payment is our 
best estimate of the amount of device cost included in an APC payment 
under the OPPS. We believe that use of the OPPS device offset 
percentage is appropriate to establish the device amount of payment 
when device-intensive procedures are furnished in an ASC under the 
revised ASC payment system. The OPPS device offset percentage is 
calculated for each OPPS device-dependent APC based upon the most 
recent year of hospital outpatient claims data available and represents 
the relative amount of device payment that we believe exists in the 
total APC payment. The device offset percentage is also applied to 
reduce the APC payment when a typically expensive device is provided to 
the hospital without cost or with full credit for the device being 
replaced and, therefore, the hospital incurs no device cost for 
implanting the replacement device. For more background on the 
calculation and use of the device offset percentage, we refer readers 
to the CY 2007 OPPS/ASC final rule with comment period (71 FR 68077 
through 68079).
    We will then calculate the service portion of the ASC payment for 
device-intensive procedures by applying the uniform ASC conversion 
factor as specified in new Sec.  416.171 to the service (nondevice) 
portion of the OPPS relative payment weight for the device-intensive 
procedure. Finally, we will sum the ASC device portion and ASC service 
portion to establish the full payment for the device-intensive 
procedure under the revised ASC payment system.
    Tables 5 and 6 include the most current device-intensive procedures 
that would be subject to this modified payment methodology under the 
revised ASC payment system. The device-intensive procedure lists for 
the CY 2008 revised ASC payment system will be proposed and finalized 
in conjunction with the OPPS treatment of these procedures in the CY 
2008 OPPS/ASC proposed and final rules, respectively. The device-
intensive procedures in Tables 5 and 6 are listed in Addendum AA to 
this final rule, where they are assigned to payment indicators ``H8'' 
(Device-intensive procedure on ASC list in CY 2007; paid at adjusted 
rate) and ``J8'' (Device-intensive procedure added to ASC list in CY 
2008 or later; paid at adjusted rate), respectively.

   Table 5.--Illustrative List of Device-Intensive Procedures on the CY 2007 ASC List Subject to the Modified
                  Payment Methodology Under the Revised ASC Payment System Beginning in CY 2008
----------------------------------------------------------------------------------------------------------------
                                                                                               CY 2007  device-
                HCPCS code                          Short descriptor           CY 2007 OPPS     dependent  APC
                                                                                    APC         offset percent
----------------------------------------------------------------------------------------------------------------
33212....................................  Insertion of pulse generator.....            0090               74.74
33213....................................  Insertion of pulse generator.....            0654               77.35
36566....................................  Insert tunneled cv cath..........            0625               57.56
53445....................................  Insert uro/ves nck sphincter.....            0386               61.16
53447....................................  Remove/replace ur sphincter......            0386               61.16
54401....................................  Insert self-contd prosthesis.....            0386               61.16
54405....................................  Insert multi-comp penis pros.....            0386               61.16
54410....................................  Remove/replace penis prosth......            0386               61.16

[[Page 42505]]

 
54416....................................  Remv/repl penis contain pros.....            0386               61.16
55873....................................  Cryoablate prostate..............            0674               53.78
61885....................................  Insrt/redo neurostim 1 array.....            0039               78.85
61886....................................  Implant neurostim arrays.........            0315               83.19
62361....................................  Implant spine infusion pump......            0227               80.27
62362....................................  Implant spine infusion pump......            0227               80.27
63650....................................  Implant neuroelectrodes..........            0040               54.06
63685....................................  Insrt/redo spine n generator.....            0222               77.65
64553....................................  Implant neuroelectrodes..........            0225               79.04
64561....................................  Implant neuroelectrodes..........            0040               54.06
64573....................................  Implant neuroelectrodes..........            0225               79.04
64575....................................  Implant neuroelectrodes..........            0061               60.06
64577....................................  Implant neuroelectrodes..........            0061               60.06
64580....................................  Implant neuroelectrodes..........            0061               60.06
64581....................................  Implant neuroelectrodes..........            0061               60.06
64590....................................  Insrt/redo pn/gastr stimul.......            0222               77.65
69930....................................  Implant cochlear device..........            0259               84.61
----------------------------------------------------------------------------------------------------------------


 Table 6.--Illustrative List of Device-Intensive Procedures New to the CY 2008 ASC List Subject to the Modified
                  Payment Methodology Under the Revised ASC Payment System Beginning in CY 2008
----------------------------------------------------------------------------------------------------------------
                                                                                               CY 2007  device-
                HCPCS code                          Short descriptor           CY 2007 OPPS     dependent  APC
                                                                                    APC         offset percent
----------------------------------------------------------------------------------------------------------------
33206....................................  Insertion of heart pacemaker.....            0089               77.11
33207....................................  Insertion of heart pacemaker.....            0089               77.11
33208....................................  Insertion of heart pacemaker.....            0655               76.59
33214....................................  Upgrade of pacemaker system......            0655               76.59
33224....................................  Insert pacing lead & connect.....            0418               87.32
33225....................................  Lventric pacing lead add-on......            0418               87.32
33282....................................  Implant pat-active ht record.....            0680               76.40
63655....................................  Implant neuroelectrodes..........            0061               60.06
64555....................................  Implant neuroelectrodes..........            0040               54.06
64560....................................  Implant neuroelectrodes..........            0040               54.06
64565....................................  Implant neuroelectrodes..........            0040               54.06
G0297....................................  Insert single chamber/cd.........            0107               90.44
G0298....................................  Insert dual chamber/cd...........            0107               90.44
G0299....................................  Inser/repos single icd+leads.....            0108               89.40
G0300....................................  Insert reposit lead dual+gen.....            0108               89.40
----------------------------------------------------------------------------------------------------------------

    Table 7 provides an example of how we will calculate the ASC 
payment for a device-intensive procedure. We use the example of 
insertion of a cochlear implant, CPT code 69930 (Cochlear device 
implantation, with or without mastoidectomy), that is included in Table 
5 above. For purposes of this illustration, we are using the CY 2007 
OPPS/ASC final rule with comment period device offset percentage and 
payment rate for APC 0259 (Level VI ENT Procedures), the APC to which 
CPT code 69930 is assigned under the CY 2007 OPPS. We also assume that 
the ASC budget neutrality adjustment remains at 0.67 under both the 
first transition year and full implementation scenarios, yielding an 
ASC conversion factor of $42.543 based on our current estimate of the 
CY 2008 OPPS conversion factor. The example includes the estimated ASC 
payment in the first year of the 4-year transition and the estimated 
payment under full implementation of the revised ASC payment system.

 Table 7.--Example of Calculation of ASC Payment for a Device-Intensive Covered Surgical Procedure According to
                       the Modified Payment Methodology of the Revised ASC Payment System
----------------------------------------------------------------------------------------------------------------
                                                                                Full implementation of revised
                                            First year of 4-year transition                 system
----------------------------------------------------------------------------------------------------------------
OPPS CY 2007 national unadjusted payment                          $25,499.72                          $25,499.72
 rate...................................
OPPS CY 2007 device offset percent......                              84.61%                              84.61%
OPPS/ASC device portion.................                          $21,575.31                          $21,575.31
                                                       ($25,499.72 x 0.8461)               ($25,499.72 x 0.8461)
OPPS service portion....................                           $3,924.41                           $3,924.41

[[Page 42506]]

 
OPPS relative payment weight                                         61.8047                             61.8047
 attributable to service (OPPS service                    ($3,924.41/63.497)                  ($3,924.41/63.497)
 portion divided by estimated CY 2008
 OPPS conversion factor)................
ASC service portion (OPPS relative                                 $2,629.36                           $2,629.36
 payment weight for service portion                      (61.8047 x $42.543)                 (61.8047 x $42.543)
 multiplied by estimated CY 2008 ASC
 conversion factor).....................
CY 2007 ASC payment (without device                                     $995                                 N/A
 payment)...............................
ASC service payment (see following                                 $1,403.59                           $2,629.36
 paragraph).............................  (0.25 x $2,629.36) + (0.75 x $995)
Estimated CY 2008 ASC total payment (sum                          $22,978.90                          $24,204.67
 of service payment and device payment).            ($1,403.59 + $21,575.31)            ($2,629.36 + $21,575.31)
----------------------------------------------------------------------------------------------------------------

    As discussed further in section IV.J. of this final rule and as 
shown in the example above, we will apply the transitional blend only 
to the service portion of the ASC procedure payment. Consistent with 
their treatment under the OPPS, we will apply the ASC geographic wage 
adjustment to payment for device-intensive procedures under the revised 
ASC payment system.
    Comment: Several commenters encouraged CMS to pay the same amount 
and apply the same payment policies regarding implantable devices in 
both ASCs and HOPDs. In particular, they recommended that ASCs be paid 
100 percent of the portion of the OPPS procedure payment that is 
device-related, when ASCs perform device-intensive procedures.
    Response: We agree with commenters that providing the same device 
payment amount for expensive devices under the revised ASC payment 
system as under the OPPS is appropriate, and our final payment 
methodology accomplishes that. As we discuss above, we will 
specifically calculate the amount of OPPS device payment in APCs that 
contain devices for which the device cost exceeds 50 percent of the APC 
median cost. We will then add the OPPS device payment amount to the ASC 
service payment for each device-intensive procedure that is a covered 
ASC surgical procedure, in order to determine the total payment for the 
device-intensive procedure when it is performed in an ASC.
    We also agree that the same payment policies that exist with regard 
to payment for costly devices under the OPPS should also apply to 
payment for devices implanted in ASCs. In particular, under the OPPS, 
beginning on January 1, 2007, when a device is replaced without cost to 
the hospital or with full credit for the cost of the device being 
replaced, CMS reduces the APC payment to the hospital by the amount 
that we estimate represents the cost of the device. The application of 
this same policy to ASC payment for certain device-intensive procedures 
is fully consistent with the comments that CMS should pay ASCs for 
expensive devices in the same manner that they are paid under the OPPS, 
and with the recommendation of the PPAC that CMS should apply payment 
policies uniformly under the OPPS and revised ASC payment systems. 
Therefore, in accordance with the OPPS policy implemented in CY 2007, 
beginning in CY 2008, we will reduce the amount of payment made to ASCs 
for device-intensive procedures assigned to certain OPPS APCs in those 
cases in which the necessary device is furnished without cost to the 
ASC or the beneficiary, or with a full credit for the cost of the 
device being replaced. We will provide the same amount of payment 
reduction that would apply under the OPPS for performance of those 
procedures under the same circumstances. Specifically, when an ASC 
performs a procedure that is listed in Table 8 below and the case 
involves implantation of a no cost or full credit device listed in 
Table 9, the ASC must report the HCPCS ``FB'' modifier on the line with 
the covered surgical procedure code to indicate that a major 
implantable device in Table 9 was furnished without cost. We expect 
that this scenario will occur most often in cases in which there is a 
recall, field action, or other activity that results in the ASC 
receiving a device from a device manufacturer, for which the facility 
has no obligation to pay. In these cases, this policy is necessary to 
be consistent with section 1862(a)(2) of the Act, which excludes from 
Medicare coverage items and services for which neither the beneficiary 
nor anyone on the beneficiary's behalf has an obligation to pay. This 
reduction policy is consistent with the modified payment methodology 
for device-intensive procedures under the revised ASC payment system 
that would generally provide the same device-related payment amount in 
HOPD and ASC settings, both in those cases where the facility bears the 
cost of the device and those situations where it does not. Tables 8 and 
9 list those specific procedures and implantable devices to which the 
reduction policy applies under the CY 2007 OPPS. The list of device-
dependent APCs and their associated procedures and implantable devices 
to which this policy will apply in CY 2008 will be proposed and 
finalized in the CY 2008 OPPS/ASC proposed and final rules, 
respectively. See the CY 2007 OPPS/ASC final rule with comment period 
(71 FR 68071 through 68077) for further discussion of this policy.
    When the ``FB'' modifier is reported with a procedure code that is 
listed in Table 8, the contractor will reduce the ASC payment for the 
procedure by the amount of payment that CMS attributed to the device 
when the ASC payment rate was calculated. The reduction of ASC payment 
in this circumstance is necessary to pay appropriately for the covered 
surgical procedure being furnished by the ASC.

[[Page 42507]]



 Table 8.--Illustrative List of Adjustments to Payments for ASC Covered Surgical Procedures in CY 2008 in Cases
                      of Devices Reported Without Cost or for Which Full Credit Is Received
----------------------------------------------------------------------------------------------------------------
                                                        CY 2007 OPPS                               CY 2007 OPPS
        HCPCS code               Short descriptor            APC            APC group title       offset percent
----------------------------------------------------------------------------------------------------------------
61885.....................  Insrt/redo neurostim 1               0039  Level I Implantation of             78.85
                             array.                                     Neurostimulator.
63650.....................  Implant neuroelectrodes..            0040  Percutaneous Implantation           54.06
64555.....................  Implant neuroelectrodes..                   of Neurostimulator
64560.....................  Implant neuroelectrodes..                   Electrodes, Excluding
64561.....................  Implant neuroelectrodes..                   Cranial Nerve.
64565.....................  Implant neuroelectrodes..
63655.....................  Implant neuroelectrodes..            0061  Laminectomy or Incision             60.06
64575.....................  Implant neuroelectrodes..                   for Implantation of
64577.....................  Implant neuroelectrodes..                   Neurostimulator
64580.....................  Implant neuroelectrodes..                   Electrodes, Excluding
64581.....................  Implant neuroelectrodes..                   Cranial Nerve.
33206.....................  Insertion of heart                    089  Insertion/Replacement of            77.11
33207.....................   pacemaker.                                 Permanent Pacemaker and
                            Insertion of heart                          Electrodes.
                             pacemaker..
33212.....................  Insertion of pulse                   0090  Insertion/Replacement of            74.74
                             generator.                                 Pacemaker Pulse
                                                                        Generator.
33210.....................  Insertion of heart                   0106  Insertion/Replacement/              41.88
33211.....................   electrode.                                 Repair of Pacemaker and/
33216.....................  Insertion of heart                          or Electrodes.
33217.....................   electrode..
                            Insert lead pace-defib,
                             one..
                            Insert lead pace-defib,
                             dual..
G0297.....................  Insert single chamber/cd.            0107  Insertion of Cardioverter-          90.44
G0298.....................  Insert dual chamber/cd...                   Defibrillator.
G0299.....................  Inser/repos single                   0108  Insertion/Replacement/              89.40
G0300.....................   icd+leads.                                 Repair of Cardioverter-
                            Insert reposit lead                         Defibrillator Leads.
                             dual+gen..
63685.....................  Insrt/redo spine n                   0222  Implantation of                     77.65
64590.....................   generator.                                 Neurological Device.
                            Insrt/redo perph n
                             generator..
64553.....................  Implant neuroelectrodes..            0225  Implantation of                     79.04
64573.....................  Implant neuroelectrodes..                   Neurostimulator
                                                                        Electrodes, Cranial
                                                                        Nerve.
62361.....................  Implant spine infusion               0227  Implantation of Drug                80.27
62362.....................   pump.                                      Infusion Device.
                            Implant spine infusion
                             pump..
69930.....................  Implant cochlear device..            0259  Level VI ENT Procedures..           84.61
61886.....................  Implant neurostim arrays.            0315  Level II Implantation of            83.19
                                                                        Neurostimulator.
53440.....................  Male sling procedure.....            0385  Level I Prosthetic                  46.86
53444.....................  Insert tandem cuff.......                   Urological Procedures.
54400.....................  Insert semi-rigid
                             prosthesis..
53445.....................  Insert uro/ves nck                   0386  Level II Prosthetic                 61.16
53447.....................   sphincter.                                 Urological Procedures.
54401.....................  Remove/replace ur
54405.....................   sphincter..
54410.....................  Insert self-contd
54416.....................   prosthesis..
                            Insert multi-comp penis
                             pros..
                            Remove/replace penis
                             prosth..
                            Remv/repl penis contain
                             pros..
33224.....................  Insert pacing lead &                 0418  Insertion of Left                   87.32
33225.....................   connect.                                   Ventricular Pacing Elect.
                            L ventric pacing lead add-
                             on..
33213.....................  Insertion of pulse                   0654  Insertion/Replacement of            77.35
                             generator.                                 a permanent dual chamber
                                                                        pacemaker.
33214.....................  Upgrade of pacemaker                 0655  Insertion/Replacement/              76.59
33208.....................   system.                                    Conversion of a
                            Insertion of heart                          permanent dual chamber
                             pacemaker..                                pacemaker.
33282.....................  Implant pat-active ht                0680  Insertion of Patient                76.40
                             record.                                    Activated Event
                                                                        Recorders.
----------------------------------------------------------------------------------------------------------------


  Table 9.--Illustrative List of Devices for Which the ``FB'' Modifier
 Must Be Reported With the Procedure Code When Furnished Without Cost or
                    for Which Full Credit Is Received
------------------------------------------------------------------------
                 Device                          Short descriptor
------------------------------------------------------------------------
C1721..................................  AICD, dual chamber.
C1722..................................  AICD, single chamber.
C1764..................................  Event recorder, cardiac.
C1767..................................  Generator, neurostim, imp.
C1771..................................  Rep dev, urinary, w/sling.
C1772..................................  Infusion pump, programmable.
C1776..................................  Joint device (implantable.
C1777..................................  Lead, AICD, endo single coil.
C1778..................................  Lead, neurostimulator.
C1779..................................  Lead, pmkr, transvenous VDD.
C1785..................................  Pmkr, dual, rate-resp.
C1786..................................  Pmkr, single, rate-resp.
C1813..................................  Prosthesis, penile, inflatab.
C1815..................................  Pros, urinary sph, imp.
C1820..................................  Generator, neuro rechg bat sys.
C1882..................................  AICD, other than sing/dual.
C1891..................................  Infusion pump, non-prog, perm.
C1895..................................  Lead, AICD, endo dual coil.
C1896..................................  Lead, AICD, non sing/dual.
C1897..................................  Lead, neurostim, test kit.
C1898..................................  Lead, pmkr, other than trans.
C1899..................................  Lead, pmkr/AICD combination.

[[Page 42508]]

 
C1900..................................  Lead coronary venous.
C2619..................................  Pmkr, dual, non rate-resp.
C2620..................................  Pmkr, single, non rate-resp.
C2621..................................  Pmkr, other than sing/dual.
C2622..................................  Prosthesis, penile, non-inf.
C2626..................................  Infusion pump, non-prog, temp.
C2631..................................  Rep dev, urinary, w/o sling.
L8614..................................  Cochlear device/system.
------------------------------------------------------------------------

    After considering all public comments received, while we are 
finalizing our proposed policy to package payment under the revised ASC 
payment system for all implantable devices without pass-through status 
under the OPPS into the ASC payment for the associated surgical 
implantation procedure, we are adopting a modified methodology to 
calculate the payment rates for device-intensive procedures under the 
revised ASC payment system. We proposed to pay for these devices and 
their associated implantation procedures according to the standard 
revised ASC payment system methodology, with application of the uniform 
ASC conversion factor to the applicable OPPS payment weight for the 
procedure. However, our final payment policy will apply a modified 
payment methodology to develop the ASC payment rates for device-
intensive covered surgical procedures, in order to provide the same 
payment amount to ASCs for the implantable devices as is made under the 
OPPS. This methodology will apply to ASC covered surgical procedures 
that are assigned to device-dependent APCs under the OPPS for the same 
calendar year, where those APCs have a device cost of greater than 50 
percent of the APC cost (device offset percentage greater than 50). 
While lists of device-intensive procedures under the revised ASC 
payment system to which this policy would apply based on their CY 2007 
OPPS status are included in Tables 5 and 6 of this final rule, the list 
of ASC procedures subject to this modified payment methodology will be 
proposed and finalized in the CY 2008 OPPS/ASC proposed and final 
rules, respectively.
    We will also reduce the ASC procedure payment for certain device-
intensive procedures when the necessary device is furnished to the ASC 
or the beneficiary at no cost or when a full credit for the device 
being replaced is provided to the ASC, by the same amount as the OPPS 
payment reduction for the same calendar year because neither the HOPD 
nor the ASC incur a device cost for the replaced device in such 
situations. Accordingly, we are adding new Sec.  416.179 to reflect 
this payment reduction policy.

D. Payment for Corneal Tissue Under the Revised ASC Payment System

    In a memorandum dated May 21, 1992, CMS (known at the time as the 
Health Care Financing Administration or ``HCFA'') notified Regional 
Administrators that carriers could pay corneal tissue acquisition costs 
when HCPCS code V2785 (Processing, preserving and transporting corneal 
tissue) is reported with corneal transplant procedures performed in an 
ASC. The memorandum indicated that payment for corneal tissue 
acquisition costs is subject to the usual coinsurance and deductible 
requirements, and could be paid as an add-on to either the ASC payment 
or the physician's fee for corneal transplant surgery performed at an 
ASC. In the June 12, 1998 proposed rule to revise the ASC ratesetting 
methodology and payment rates, we proposed to package the costs 
incurred by an ASC to procure corneal tissue into the payment for the 
associated corneal transplant procedure, rather than continue making 
separate payment for those costs (63 FR 32312 and 32313). We also 
proposed to package corneal tissue acquisition costs into the APC 
payment for corneal transplant procedures in the September 8, 1998 
proposed rule to implement the OPPS (63 FR 47760).
    We received numerous comments from physicians, eye banks, and 
health care associations opposing both proposals. In the April 7, 2000 
final rule with comment period, which implemented the OPPS, we 
summarized the comments that we received in response to the September 
8, 1998 proposal, and we determined that we would not implement our 
proposal to package payment under the OPPS for corneal tissue 
acquisition costs but would, instead, make separate payment based on 
hospitals' reasonable costs to procure corneal tissue (65 FR 18448 and 
18449). Because we never made final the changes in the ASC payment 
rates and ratesetting methodology that we proposed in the June 12, 1998 
Federal Register, the policy issued in the June 1992 memorandum remains 
in effect, which allows carriers (now MACs) to make separate payment 
for the costs incurred to procure corneal tissue for transplant at an 
ASC.
    In the August 2006 proposed rule to revise the ASC ratesetting 
methodology and payment rates beginning in CY 2008, we proposed to 
continue to pay ASCs separately, based on their invoiced costs, for the 
procurement of corneal tissue (71 FR 49648). We had no evidence to 
suggest that costs incurred to procure corneal tissue are any less 
variable now than they were in 1992, in 1998, or in 2000. We noted 
that, if we were to package payment for the procurement of corneal 
tissue into the APC payment for corneal transplant procedures, we 
believed the resulting payment rate would overpay those facilities that 
are able to acquire corneal tissue at little or no cost through 
philanthropic organizations and underpay those facilities that must pay 
for corneal tissue processing, testing, preservation, and 
transportation costs. We further proposed in the August 2006 proposed 
rule to exclude, through proposed new Sec.  416.164(b), the costs of 
procurement of corneal tissue furnished in an ASC on or after January 
1, 2008 from the scope of ASC facility services.
    We invited comments and submission of data that supported or 
challenged this proposal to continue paying ASCs separately for corneal 
tissue on an acquisition cost basis.
    Comment: Several commenters agreed with our proposal to continue to 
pay separately for the acquisition costs of corneal tissue under the 
revised ASC payment system, rather than package payment for corneal 
tissue costs into the payment for the associated corneal transplant 
procedure. The commenters indicated that this proposed methodology is 
consistent with the way physicians and HOPDs are currently paid for 
corneal tissue procurement. They believed that this policy of paying 
separately for the procurement of corneal tissue has been, and 
continues to be, the most appropriate payment policy for these services 
provided in ASC settings, because of the continuing significant 
variability in the costs of corneal tissue procurement. The commenters 
further reiterated that packaging these costs should not be considered, 
because such an option would result in overpayments to certain 
facilities that have been able to acquire corneal tissue at little or 
no cost through philanthropic organizations and would undoubtedly 
result in underpayments to other facilities that paid for the corneal 
tissue processing, testing, preservation, and transportation costs.
    Response: After consideration of the public comments we received, 
we are finalizing our proposed CY 2008 ASC corneal tissue procurement 
payment policy, with modification to clarify that

[[Page 42509]]

corneal tissue is a covered ancillary service within the scope of ASC 
services, but not within the scope of ASC facility services. Corneal 
tissue procurement will be included in the scope of ASC services as a 
covered ancillary service when it is integral to the performance of an 
ASC covered surgical procedure, but its payment will not be packaged 
into the ASC payment for the associated covered surgical procedure. 
Specifically, under the revised ASC payment system, we will continue to 
pay ASCs separately, based on their invoiced costs, for the acquisition 
costs of corneal tissue for transplant in an ASC. The HCPCS code for 
corneal tissue processing, V2785, is listed in Addendum BB to this 
final rule, where it is assigned to payment indicator ``F4'' (Corneal 
tissue processing; paid at reasonable cost). Accordingly, we are 
reflecting this final policy in revised proposed Sec. Sec.  
416.164(b)(3) and 416.171(b).

E. Payment for Office-Based Procedures

    Since the inception of the ASC benefit, procedures that are 
commonly performed or that can be safely performed in a physician's 
office have generally been excluded from the ASC list of covered 
surgical procedures. We refer to these procedures as ``office-based'' 
in this preamble discussion. Over the past 15 years, physicians and ASC 
associations have urged CMS to add office-based procedures to the ASC 
list of covered surgical procedures or to retain on the ASC list 
procedures that were originally performed most commonly in an 
institutional setting, but that have subsequently moved to an office 
setting as surgical techniques and technology have advanced. 
Representatives of the ASC industry have argued that although, for most 
patients, the office is an appropriate setting for most high volume 
office procedures, there are some patients for whom an ASC or another 
more resource-intensive setting is required. The physician may decide 
that a facility setting is necessary for individual patients for 
various clinical reasons, such as the need for more nursing staff, a 
sterile operating room, or a piece of equipment not typically available 
in the office setting. CPT code 52000 (Cystourethroscopy (separate 
procedure)) is a prime example of a high volume procedure that is 
performed more than 80 percent of the time in an office setting, but 
for which a small number of patients require resources usually 
available only in an ASC or a hospital. Representatives of the ASC 
industry have contended that unless we made an exception to the 
criteria that historically governed which procedures comprised the ASC 
list and allowed an office-based procedure to remain on the ASC list, 
as we have done with CPT code 52000, the hospital would be the only 
facility setting available as an alternative to the office setting. ASC 
industry commenters asserted in the past that this limitation was 
burdensome both to physicians and to beneficiaries and could, in some 
cases, limit beneficiary access to needed surgery.
    We generally interpret ``office-based'' or ``commonly performed in 
a physician's office'' to mean a surgical procedure that the most 
recent BESS data available indicate is performed more than 50 percent 
of the time in the physician's office setting. In the August 2006 
proposed rule for the revised ASC payment system and as discussed in 
section III.A.2. of this final rule, we proposed to expand the ASC list 
of covered surgical procedures to allow payment for all surgical 
procedures, except those procedures that pose a significant safety risk 
or would be expected to require an overnight stay. Because office-based 
surgical procedures typically do not pose a significant safety risk and 
do not require an overnight stay, we proposed not to exclude them from 
ASC payment under the revised ASC payment system. However, we were 
concerned that allowing payment to ASCs for office-based procedures 
based on OPPS relative payment weights could have a significant impact 
on Medicare program costs. Approximately two-thirds of the additional 
procedures which we proposed not to exclude from ASC payment beginning 
in CY 2008 are office-based, that is, they are performed in the 
physician's office more than 50 percent of the time. The practice 
expense payment for many of these procedures under the MPFS, when they 
are performed in the physician's office, would be lower than the 
payment for the same procedures under the OPPS or under the standard 
methodology of the revised ASC payment system as proposed. Therefore, 
we indicated that the proposed ASC payment rates based on the OPPS 
relative payment weights could result in a significant program cost if 
these high volume procedures were to shift from the office-based 
setting to the ASC setting.
    One reason why we were concerned about the possibility of a sizable 
shift of office-based procedures to ASCs is the impact that such a 
shift might have on ASC payments in light of the statutory requirements 
that the revised ASC payment system be designed to result in the same 
aggregate amount of expenditures that would be made if the revised 
payment system were not implemented. In the August 2006 proposed rule, 
we explained that, depending on the methodology for determining the 
requisite budget neutrality adjustment (71 FR 49657), an influx of 
high-volume, relatively low cost office-based surgical procedures into 
the ASC setting under the revised payment system could lower the 
payment amounts for other procedures made to ASCs due to the 
constraints of budget neutrality. In other words, we might have had to 
scale the ASC conversion factor downward in order for estimated 
aggregate expenditures under the revised system to not exceed what they 
would have been if the revised payment system were not implemented. 
Payment for procedures with relatively high payments would have to be 
reduced in order to offset increased aggregate costs resulting from an 
influx of relatively low cost, high volume office-based procedures 
shifting to ASCs. (See section V. of this final rule for a detailed 
discussion of our proposed and final policies regarding calculation of 
an ASC conversion factor.)
    In the August 2006 proposed rule, we explained that we are 
committed to refining Medicare payment systems wherever possible to 
prevent payment incentives from inappropriately driving decisions about 
where to perform a surgical procedure, when those decisions should 
properly be based on clinical considerations. Towards that end, we 
proposed to cap payment for office-based surgical procedures for which 
ASC payment would be newly allowed under the revised payment system as 
of January 1, 2008, at the lesser of the MPFS nonfacility practice 
expense amount or the ASC rate developed according to the standard 
methodology of the revised ASC payment system. We also proposed to 
exempt procedures that are on the ASC list as of January 1, 2007, and 
that meet our criterion for designation as office-based, from the 
payment limitation proposed for office-based procedures for which ASC 
payment would be allowed for the first time beginning January 1, 2008. 
Accordingly, we proposed to incorporate in proposed new Sec.  
416.171(e) the payment basis for these office-based procedures 
beginning January 1, 2008.
    When we started to identify the codes that we would propose to 
classify as office-based surgical procedures beginning in CY 2008, we 
encountered some anomalous cases that required further refinement of 
our office-based criterion beyond strict application of a

[[Page 42510]]

50-percent utilization threshold. For example, we identified some CPT 
codes that met the 50-percent office utilization threshold but for 
which a nonfacility practice expense amount had not been developed 
under the MPFS. We proposed to classify as office-based any surgical 
codes that our physicians' claims data indicated are performed more 
than 50 percent of the time in an office setting, even if the codes 
currently lack a nonfacility practice expense value under the MPFS. We 
further proposed to cap payment for these procedures, as appropriate, 
once a nonfacility practice expense amount is established. Until that 
time, we proposed to calculate payment for these office-based surgical 
CPT codes using the methodology we proposed for other surgical 
procedures under the revised ASC payment system. Similarly, until a 
national nonfacility practice expense amount is established for office-
based surgical CPT codes that are contractor-priced (that is, carriers 
typically determine the payment for a procedure for which there is no 
calculated national payment) under the MPFS, we proposed to calculate 
the ASC payment using the same methodology that we proposed for 
surgical procedures that are not office-based. Application of the cap 
to codes designated as office-based would be updated through rulemaking 
as part of the annual OPPS/ASC payment update.
    In applying the 50-percent threshold, we discovered some apparent 
contradictions in the BESS data that required us to further refine our 
definition of office-based procedures. For example, we noted instances 
in which seemingly similar procedures had inconsistent site-of-service 
utilization data. The BESS data showed high levels of office 
utilization for some complex procedures that we expected to be 
performed relatively infrequently in an office setting, whereas simpler 
but related procedures showed lower levels of office utilization.
    Therefore, we undertook another, more detailed level of review and 
identified groups of surgical CPT codes related to procedures that are 
performed 50 percent or more of the time in the office setting to 
determine if there was a logical correlation between procedure 
complexity within a group of related procedures and the frequency with 
which those procedures were performed in the office setting. For 
example, according to CPT coding, the following three codes are 
related:
     13120, Repair, complex, scalp arms and/or legs; 1.1 cm to 
2.5 cm.
     13121, Repair, complex, scalp arms and/or legs; 2.6 cm to 
7.5 cm.
     13122, Repair, complex, scalp arms and/or legs; each 
additional 5 cm or less.
    As is often the case for groups of related codes in the CPT coding 
system, the first of these codes is the least complex clinically and, 
in this example, the complexity of the procedure increases in 
proportion to the increase in the size of the area to be repaired. If 
utilization data indicated that CPT code 13122 was performed in the 
office 67 percent of the time in CY 2005, we would expect to find that 
both CPT codes 13120 and 13121 were also performed in the physician's 
office more than 50 percent of the time during that year. Because the 
most complex procedure was provided in the office most of the time, 
logically, it would seem that the less complex procedures would also 
have been performed frequently in that site of service. However, the 
BESS data showed that this was not always the case.
    Although our expectation was that the less complex procedures 
within a group of related procedure codes would typically be performed 
most often in the office and the more complex procedures less often in 
the office, there were instances in which the less complex procedures 
within the code group were billed more commonly in an ASC or HOPD, 
while the more complex procedures within the code group were billed 
more frequently in the office setting. Therefore, we believed it was 
prudent to consider the clinical characteristics and utilization data 
of related CPT codes in determining the codes to be proposed as office-
based, to supplement our consideration of data specific to the codes 
under review.
    In our analysis of the BESS site-of-service data, we also took into 
consideration the volume of cases represented in the data. There were a 
few instances in which we initially identified a procedure as office-
based because the data indicated that 100 percent of the cases were 
performed in the physician's office. However, closer inspection 
revealed that there was only one case reported for the procedure with a 
physician's office as the site of service. We were concerned about 
using such a low volume of procedure claims as the basis for 
identifying a procedure as office-based. Therefore, we also believed it 
was wise to consider the volume of claims for procedures in the context 
of our assessment of their utilization data, to determine those codes 
to propose as office-based for the revised ASC payment system.
    Because of the occasional unevenness and inconsistency of the data 
associated with some of the codes we initially classified as office-
based, we conducted a code-by-code analysis to buttress inconclusive 
data with the clinical judgment of our medical advisors. As a result, 
in our proposed rule, there were some procedures that met the 50-
percent office performance threshold when evaluated in isolation from 
other closely related codes, but that we did not propose to designate 
as office-based after more specific review.
    In the August 2006 proposed rule for the revised ASC payment 
system, we proposed to assess each year, based on the most recent 
available BESS and other data available to us and detailed clinical 
review, whether there are additional procedures that we would propose 
to newly classify as office-based, beginning in the update year. We 
would solicit comments on the proposed classification of additional 
codes as office-based as part of the annual OPPS/ASC rulemaking cycle. 
In addition, we proposed that once we identify a procedure as office-
based, that classification could not change in future updates of the 
ASC payment system. We reasoned that once a procedure becomes safe 
enough to be performed in more than 50 percent of cases in the office 
setting, it would be improbable for it to revert to an institutional 
setting.
    To summarize, the list of codes that we proposed as office-based 
took into account the most recent available volume and utilization data 
for each individual procedure code and/or, if appropriate, the clinical 
characteristics, utilization, and volume of related codes. We proposed 
to apply the office-based designation only to procedures that would no 
longer be excluded from ASC payment beginning in CY 2008 or later 
years. Moreover, we proposed to exempt all procedures on the CY 2007 
ASC list from application of the office-based classification. We 
believed that the resulting list accurately reflected Medicare practice 
patterns and was clinically coherent. The procedures that we proposed 
to designate as subject to the office-based payment limit were 
identified in Addendum BB to the proposed rule (71 FR 49845 through 
49948). Those procedures for which the CY 2008 payment would be based 
on the MPFS nonfacility practice expense RVUs according to our analysis 
for the August 2006 proposed rule were flagged in Addendum BB to that 
rule. The ASC relative payment weights shown for procedures in Addendum 
BB to the proposed rule that would be capped by the MPFS nonfacility 
practice expense RVUs were adjusted to reflect the capped payment 
amounts. We reminded readers in the August 2006 proposed rule that the 
ASC payment rates in

[[Page 42511]]

Addendum BB to that rule were based on the proposed CY 2007 OPPS 
relative payment weights and the proposed CY 2007 MPFS nonfacility 
practice expense RVUs. Similarly, the information in Addenda AA and BB 
to this final rule is also only illustrative, meaning that the Addenda 
provide examples of the results of applying the final policies of the 
revised ASC payment system, based on the final information available 
for CY 2007 and projected CY 2008 updates. As further discussed in 
sections V.E. and VI. of this final rule, we will propose the CY 2008 
relative payment weights, payment amounts, specific HCPCS codes to 
which the final policies of the revised ASC payment system would apply, 
and other pertinent ratesetting information for the CY 2008 revised ASC 
payment system in the proposed OPPS/ASC rule to update the payment 
systems for CY 2008 to be issued in mid-summer of CY 2007. We will then 
publish final relative payment weights, payment amounts, specific CY 
2008 HCPCS codes to which the final policies will apply, and other 
pertinent ratesetting information for the CY 2008 revised ASC payment 
system in the final OPPS/ASC rule to update the payment systems for CY 
2008.
    Comment: Several commenters suggested that instituting a cap on 
payment for office-based surgical procedures would result in payment 
levels that would make it economically infeasible for many ASCs to 
perform certain surgical procedures, forcing patients who could be 
treated safely and more cost effectively in an ASC to go to an HOPD for 
surgery. Other commenters suggested that there is no empirical evidence 
that payment of office-based procedures in ASCs would lead to 
overutilization of ASCs or result in physicians converting their 
offices into ASCs. The commenters pointed out that, in historical cases 
where CMS has made exceptions to allow ASC payment for procedures 
primarily performed in the office, there have not been significant 
shifts in the sites of service for these procedures. Several commenters 
suggested that imposing a cap on payment for these procedures would be 
tantamount to a penalty and an affirmative policy intended to 
discourage these procedures from performance in the ASC setting. The 
commenters strongly recommended that the best policy would be to allow 
physicians to select the site of service they believe is the most 
clinically appropriate for their patients, especially because sicker 
patients may require the additional infrastructure and safeguards of an 
ASC or a HOPD. Other commenters pointed out that CMS' proposal for the 
revised ASC payment system depends on the use of the relative payment 
weights for the OPPS that CMS argued in the proposed rule would be 
expected to reasonably reflect the relativity of ASC resources for 
surgical procedures. They stated that CMS has no evidence to suggest 
that the OPPS relativity of payment weights for office-based procedures 
does not reflect the relative resource use for the performance of these 
procedures in ASCs and, therefore, application of a payment limitation 
for these procedures is unwarranted.
    The commenters also expressed concern that the establishment of a 
payment cap for office-based procedures would be problematic and 
detrimental to CMS' desire to create a setting-neutral payment system. 
The commenters recommended that CMS exclude this provision from the 
final rule and pay all procedures using a single ASC conversion factor 
applied to the applicable OPPS relative payment weight. Several 
commenters suggested that CMS could follow trends in the sites of 
service for office-based procedures, and should CMS find significant 
and unwarranted migration of certain procedures to ASCs, implement the 
proposed policy at a later date.
    Response: We acknowledge the commenters' concerns regarding our 
proposal to cap payments for office-based surgical procedures performed 
in ASCs. Nevertheless, we continue to believe that capping the payment 
for office-based surgical procedures performed in ASCs would be the 
best approach to eliminating differential payment as a factor in site-
of-service decisions regarding minor surgical procedures. The combined 
ASC and physician payment exceeds the single payment the physician 
would receive for services performed in the office, even with the 
application of the proposed payment limitation for office-based 
procedures. Therefore, we are concerned that allowing payment for 
office-based procedures under the ASC benefit may create an incentive 
for physicians inappropriately to convert their offices into ASCs or to 
move all their office surgery to an ASC. As discussed further in 
section V. of this final rule, the final policy for the budget 
neutrality adjustment for the revised ASC payment system which would 
cap payment for office-based surgical procedures as we proposed takes 
into account the expected migration of 15 percent of the current office 
utilization of office-based procedures that will be newly paid in CY 
2008 under the revised ASC payment system over the first 4 years of the 
revised payment system. As commenters observed, a setting-neutral 
payment system is most consistent with the principle that physicians 
should be free to make site-of-service decisions on the basis of 
clinical and quality of care considerations alone. We strongly agree 
that the health of the patient should be the primary consideration. The 
proposed cap significantly reduces the payment differential that would 
otherwise exist when office-based surgical procedures are performed in 
ASCs and is, thus, more consistent with the principle of site-neutral 
payment.
    After consideration of the public comments we received, we are 
finalizing our proposal under Sec.  416.167(b)(3) and Sec.  416.171(d), 
without modification, to cap payment for office-based surgical 
procedures for which ASC payment would first be allowed under the 
revised payment system beginning in January 1, 2008, or later years at 
the lesser of the MPFS nonfacility practice expense amount or the ASC 
rate developed according to the standard methodology of the revised ASC 
payment system. For those office-based procedures for which there is no 
available MPFS nonfacility practice expense amount, we will implement 
the cap, as appropriate, once a MPFS nonfacility practice expense 
amount is available. Until that time, those procedures that are office-
based but for which there is no available MPFS nonfacility practice 
expense amount available for the comparison will be paid using the 
standard methodology for calculating ASC payment under the revised ASC 
payment system.
    The procedures that we are finalizing as office-based for CY 2008 
are identified in Addendum AA to this final rule, assigned to payment 
indicators of ``P2'' (Office-based surgical procedure added to ASC list 
in CY 2008 or later with MPFS nonfacility PE RVUs; payment based on 
OPPS relative payment weight); ``P3'' (Office-based surgical procedure 
added to ASC list in CY 2008 or later with MPFS nonfacility PE RVUs; 
payment based on MPFS nonfacility PE RVUs); and ``R2'' (Office-based 
surgical procedure added to ASC list in CY 2008 or later without MPFS 
nonfacility PE RVUs; payment based on OPPS relative payment weight). 
These payment indicators identify the office-based procedures' 
estimated payment status under the CY 2008 revised ASC payment system, 
based on the final CY 2007 information for the OPPS and the MPFS as 
discussed above, and their illustrative CY 2008 relative payment 
weights and payment rates reflect

[[Page 42512]]

application of the capped payment amounts for those procedures with a 
payment status indicator of ``P3.'' We note that the actual proposed 
and final ASC relative payment weights and payment amounts for CY 2008 
will be proposed and finalized through the CY 2008 OPPS/ASC proposed 
and final rules, respectively. We will continue to monitor the 
appropriateness of the payment cap for office-based surgical procedures 
performed in ASCs and explore other opportunities to promote site-
neutral payments as we gain experience under the revised ASC payment 
system.
    Comment: Several commenters expressed concern about the ``50-
percent rule'' we proposed to use to designate which procedures would 
be considered office-based. One commenter indicated that if a procedure 
is performed in an office 50 percent of the time, that means half the 
time the physician has determined that the office is not the 
appropriate setting for specific patients. Commenters further indicated 
that clinical circumstances dictate the site of service and not the 
physician's personal preference, as suggested by the policy proposed 
for the revised payment system. One commenter stated that surgeons 
often perform a procedure in the office when anesthesia is not required 
and perform the same procedure in an ASC when anesthesia is required 
due to the complexity of individual patient factors.
    The commenters offered several suggestions for modifying the 
specific proposal for designating procedures as office-based. In 
particular, one commenter requested that there be a reasonable, fair, 
and efficient mechanism for removing a procedure from the office-based 
list if the typical site of service for a procedure does change for a 
legitimate clinical reason. Other commenters recommended that CMS 
consider raising the threshold above 50 percent to a number that shows 
the clear majority of cases are performed in the physician's office or 
allow an exemption to the cap for procedures that are performed in ASCs 
because of the need for anesthesia. Another commenter suggested that 
CMS could implement this policy through the use of a modifier that 
indicates the surgeon selected the ASC over the physician's office as 
the site of service because of the necessity of anesthesia or patient 
factors, whereupon the payment limitation would not be applied.
    Response: As indicated in our proposed rule, office-based 
procedures are surgical procedures that the most recent BESS data 
available indicate are performed more than 50 percent of the time in 
the physician's office setting. We believe our ``50-percent rule'' 
proposed policy is the best option at this point in time. It is our 
current practice to consider procedures that are performed more than 50 
percent of the time in the physician's office setting as office-based 
procedures, and we will continue to monitor whether the 50-percent 
threshold is appropriate for this categorization. These office-based 
procedures, as categorized through application of the ``50-percent 
rule,'' are typically procedures that have transitioned from low volume 
in the office setting and high volume in the facility setting to higher 
volume in the office setting and lower volume in the facility setting. 
The 50-percent threshold marks the point in that transition at which a 
procedure comes to be performed more often in the office. Typically, 
procedures that come to be performed more frequently in offices than in 
the facility setting remain primarily office-based once that transition 
has taken place. Therefore, we continue to believe that the 50-percent 
threshold is an appropriate, objective measure for determining which 
procedures ought to be considered office-based. Moreover, a rigorous 
review of procedures that met the aforementioned threshold took into 
account the most recent available volume and utilization data for each 
individual procedure code and, if appropriate, the utilization and 
volume of related codes. In addition, we conducted a code-by-code 
analysis to bolster inconclusive data with the clinical judgment of our 
medical advisors.
    We will continue to assess each year, based on the most recent 
available BESS and other data available to us, whether there are 
additional procedures that we would propose to classify as office-
based. However, we note that we proposed that once we identify a 
procedure as office-based, that classification would not change in 
future updates of the ASC payment system, except in cases of new codes, 
where those initial determinations are temporary, as explained further 
in section V.E. of this final rule. As we have explained above, once a 
procedure becomes safe enough to be performed in more than 50 percent 
of cases in the office setting, it is unlikely to revert to a facility 
setting.
    The vast majority of procedures designated as office-based under 
the revised ASC payment system would require only either local 
anesthesia or at most moderate or ``conscious'' sedation, that is, 
sedation to achieve a medically controlled state of depressed 
consciousness while maintaining the patient's airway, protective 
reflexes, and ability to respond to stimulation or verbal commands. The 
use of general anesthesia for the performance of these office-based 
procedures would be expected to be highly unusual. In those cases where 
local anesthesia or ``conscious'' sedation are the typical types of 
anesthesia used in the performance of certain procedures, the 
procedure's MPFS nonfacility practice expense amount would have already 
been valued to include payment for the anesthesia typically used, so 
appropriate payment would be provided in the ASC setting if the 
procedure were subject to the office-based payment limitation. However, 
even when general anesthesia may be required because of uncommon 
patient-specific considerations, basing a surgical procedure's 
prospective payment rate on the typical case when anesthesia is not 
required and the procedure can be performed safely in the office is 
consistent with the averaging principle that is the basis for all our 
prospective payment systems, including the revised ASC payment system.
    Therefore, after considering all comments received, we are 
finalizing our proposal, without modification, to identify office-based 
surgical procedures for the revised ASC payment system as those 
surgical procedures no longer excluded from ASC payment beginning in CY 
2008 or later years that are performed more than 50 percent of the time 
in physicians' offices, taking into account the most recent available 
volume and utilization data for each individual procedure code and/or, 
if appropriate, the clinical characteristics, utilization, and volume 
of related codes. We will annually assess whether there are additional 
procedures that we would propose to classify as office-based as part of 
the annual OPPS/ASC rulemaking cycle. With the exception of new codes 
for which our determinations would remain preliminary until there are 
adequate physicians' claims data available to assess their predominant 
sites of service as discussed further in section V.E. of this final 
rule, the classification of a procedure as office-based would not 
change in future updates of the ASC payment system. Those procedures 
whose office-based designation for CY 2008 is temporary because they 
are new codes for which there is not yet adequate physicians' claims 
data are flagged with an asterisk (*) in Addendum AA to this final 
rule.
    Comment: One commenter indicated that code CPT 64555 (Percutaneous 
implantation of neurostimulator electrodes; peripheral nerve (excludes

[[Page 42513]]

sacral nerve)), should not be designated as an office-based procedure 
under the revised ASC payment system because not all of the procedures 
described by the code can be done in the physician's office. The 
commenter further stated that payment accuracy should be included as a 
goal of any new payment system, to avoid site-of-service decisions that 
are based on financial factors rather than clinical appropriateness. 
The commenter reasoned that the proposed payment method for procedures 
similarly identified as office-based would inappropriately impact site-
of-service decisions, because it would not be possible to provide the 
procedures in the ASC setting.
    Another commenter suggested that CPT code 15340 (Tissue cultured 
allogeneic skin substitute, first 25 sq cm or less) be removed from the 
proposed list of office-based procedures so as to ensure appropriate 
payment for the procedure in the ASC setting and thereby provide 
Medicare beneficiaries with increased access to the procedure. The 
commenter noted that this CPT code was new for CY 2006 and, therefore, 
there were no CY 2005 utilization data available for our review. They 
also explained that the predecessor CPT code was not performed in the 
physician's office more than 50 percent of the time, and they did not 
believe this new code would be determined to be office-based based on 
the 50-percent threshold when CY 2006 data were available.
    Response: We have identified CPT code 64555, newly proposed for ASC 
payment beginning in CY 2008, as a device-intensive procedure that is 
clinically similar to other CPT codes for implantation of 
neuroelectrodes that are not office-based procedures, although some of 
the other procedures are ASC covered surgical procedures prior to 
January 2008. The code is assigned to APC 0040 (Percutaneous 
Implantation of Neurostimulator Electrodes, Excluding Cranial Nerve) 
under the CY 2007 OPPS, where other neurostimatulor electrode 
implantation procedures reside. Therefore, we believe it is most 
appropriate to remove CPT code 64555 from the list of office-based 
procedures under the revised ASC payment system, so that it will be 
paid in the ASC setting according to the modified payment methodology 
we are adopting for device-intensive procedures. We refer readers to 
section IV.C.2.e. of this final rule for a detailed discussion of our 
proposed and final policies regarding ASC payment for procedures with 
significant device costs. In addition, we note that, while we had also 
proposed an office-based designation for CPT code 64565 (Percutaneous 
implantation of neurostimulator electrodes; neuromuscular) beginning 
with its initial ASC payment in CY 2008, under the OPPS this code is 
assigned to the same clinical APC as CPT code 64555, which it resembles 
from both clinical and facility resource perspectives. Therefore, we 
will also remove CPT code 64565 from the list of office-based 
procedures for the CY 2008 revised ASC payment system. Following the 
removal of these two codes from the list of office-based procedures, 
there are no ASC covered surgical procedures that are both device-
intensive and office-based for the CY 2008 revised ASC payment system.
    With respect to CPT code 15340, as the commenter pointed out, we 
have no utilization data from CY 2005 available for this procedure to 
review in developing this final rule. We note that we did not propose 
to designate the CPT add-on code for an additional area of application, 
15341 (Tissue cultured allogeneic skin substitute, each additional 25 
sq cm) as office-based under the revised ASC payment system. The 
proposed ASC treatment of CPT code 15340 was a temporary designation 
for the new code, subject to change in response to public comments and 
our examination of utilization data when available. At this time, we 
have decided to remove this CPT code from the office-based list 
because, after further review, we believe it is not likely to be 
performed more than 50 percent of the time in the physician's office 
setting. However, we will continue to evaluate the appropriateness of 
this action as new data become available and will annually reassess 
whether this code, or other procedures newly paid in ASCs in CY 2008 or 
later years that are not already designated as office-based or for 
which that classification is temporary, should be proposed as office-
based for ASC payment, in the context of each year's OPPS/ASC annual 
update. We note, specifically, that our treatment of CPT code 15340 in 
this CY 2008 ASC final rule is not a final determination for CY 2008, 
because we expect to have CY 2006 utilization data available for the CY 
2008 OPPS/ASC proposed rule, where we may propose that additional codes 
be classified as office-based for the CY 2008 revised ASC payment 
system.
    After considering all public comments received, we are finalizing 
our proposal, with modification, of the office-based list of covered 
surgical procedures under the CY 2008 revised ASC payment system. At 
this point, we are removing CPT codes 64555, 64565, and 15340 from the 
office-based list for the CY 2008 revised ASC payment system. As new 
data become available, we may propose that additional HCPCS codes newly 
paid in ASCs in CY 2008 be classified as office-based in the CY 2008 
OPPS/ASC proposed rule, and the final CY 2008 ASC list of covered 
office-based surgical procedures will be published in the CY 2008 OPPS/
ASC final rule.

F. Payment Policies for Multiple and Interrupted Procedures

1. Multiple Procedure Discounting Policy
    In the August 2006 proposed rule for the revised ASC payment 
system, we proposed to mirror the OPPS policy for discounting when a 
beneficiary has more than one surgical procedure performed on the same 
day at an ASC facility (71 FR 49651). The current policy for multiple 
procedure discounting in the ASC, as specified in Sec.  
416.120(c)(2)(ii) of our regulations, is based on a simple count of 
procedures performed on the same day. The most costly procedure is paid 
the full amount and all other procedures are discounted by half.
    Under the OPPS, certain surgical procedures are not subject to the 
discounting policy. Generally, the procedures that are exempted are 
those performed to implant costly devices. They are not discounted even 
when performed in association with other surgical procedures because 
the cost of the implantable device does not change; therefore, resource 
savings due to efficiencies would be minimal.
    Until now, there has been no reason to exempt any procedure from 
the multiple procedure discounting policy in ASCs because separate 
payments have been made for implantable devices. Although the ASC 
payment for the procedure may have been discounted, the cost of the 
device was paid outside of that rate and was unaffected by the multiple 
procedure discount methodology.
    Under the revised ASC payment system in the August 2006 proposed 
rule, we proposed to package payment for implantable devices into the 
procedure payment made to the ASC, as under the OPPS. Because we are 
trying wherever possible to implement parallel payment policies across 
both systems, we proposed to adopt the OPPS discounting policy that is 
applied to surgical procedures so that the costs of performing multiple 
procedures for the implantation of costly devices are taken into 
account. Thus, payment for the

[[Page 42514]]

same set of multiple procedures under the OPPS and the ASC payment 
system would be made using similar packaging and payment rules.
    For the revised ASC payment system, we proposed in Table 46 of the 
August 2006 proposed rule (71 FR 49652) a listing of the covered 
surgical procedures that would be exempt from multiple procedure 
discounting based on CY 2007 OPPS proposed procedure-specific 
discounting designations (71 FR 49652 through 49654). These exempt 
procedures were those surgical procedures proposed for ASC payment in 
CY 2008 that were also proposed for assignment to a status indicator 
other than ``T'' under the CY 2007 OPPS, indicating that a multiple 
surgical procedure reduction would not apply. We proposed to update 
this list annually in the OPPS/ASC proposed and final rules, and 
solicited comments on the list.
    We also proposed to incorporate our proposed policy on multiple 
procedure discounting in proposed new Sec.  416.172(e).
    Comment: Several commenters supported our proposal to apply the 
multiple procedure discounting policy of the OPPS to procedures 
provided under the revised ASC payment system. The commenters noted 
that this policy would ensure that payments for ASC covered surgical 
procedures with high fixed costs are not discounted, and that the full 
costs of procedures to implant expensive devices are taken into account 
when these device-intensive procedures are performed in conjunction 
with other surgical procedures. The commenters also suggested that 
adopting the OPPS multiple procedure discounting policy would provide 
parity in payments to both HOPDs and ASCs, as well as minimize any 
payment incentive to shift services between the two settings because of 
different policies. They believed that this consistency would result in 
appropriate and parallel policies for payment of multiple surgical 
procedures performed in a single operative session in both of these 
delivery settings where outpatient surgery is commonly performed.
    Response: We appreciate the commenters' support for the proposed 
ASC multiple procedure discounting policy. Specifically, when more than 
one covered surgical procedure is provided by an ASC in a single 
operative session to a Medicare beneficiary, the procedure with the 
highest ASC payment rate would be paid 100 percent of the ASC payment 
amount, and ASC payments for any other surgical procedures not 
expressly exempt from the discounting policy would be reduced by half. 
Certain ASC covered surgical procedures with relatively high fixed 
costs would be specifically exempt from the ASC multiple procedure 
discounting policy, consistent with the current OPPS multiple procedure 
discounting policy for those surgical procedures assigned to a status 
indicator other than ``T'' under the OPPS. We agree with the 
commenters' general reasoning and further believe that adopting an ASC 
policy that parallels the OPPS discounting policy would assist in 
timely and coordinated updates to the multiple procedure discounting 
status of services payable under both payment systems.
    Comment: Several commenters indicated that CMS inappropriately 
included only one of three similar CPT codes for the placement of 
breast brachytherapy catheters (specifically CPT code 19298 (Placement 
of radiotherapy after loading brachytherapy catheters (multiple tube 
and button type) into the breast for interstitial radioelement 
application following (at the time of or subsequent to) partial 
mastectomy, includes imaging guidance)) on the list of procedures 
proposed for exemption from multiple procedure discounting, which was 
provided as Table 46 in the CY 2008 ASC proposed rule (and which has 
been updated as Table 10 below based on the CY 2007 OPPS final 
procedure-specific discounting designations). These commenters 
explained that the general surgical approach and devices required to 
perform CPT code 19298 are similar to those used to provide CPT code 
19296 (Placement of radiotherapy after loading balloon catheter into 
the breast for interstitial radioelement application following partial 
mastectomy, includes imaging guidance; on date separate from partial 
mastectomy) and CPT code 19297 (Placement of radiotherapy after loading 
balloon catheter into the breast for interstitial radioelement 
application following partial mastectomy, includes imaging guidance; 
concurrent with partial mastectomy). Moreover, the commenters believed 
that, because all three CPT codes are assigned to status indicator 
``S'' under the OPPS, indicating that multiple procedure discounting 
does not apply to payment for their performance in the hospital 
outpatient setting, all of these codes should also be exempt from 
multiple procedure discounting under the revised ASC payment system.
    Response: While CPT code 19298 is assigned to status indicator 
``S'' under the CY 2007 OPPS, CPT codes 19296 and 19297 are assigned to 
status indicator ``T'' under the OPPS effective January 1, 2007. As 
discussed in the CY 2007 OPPS final rule with comment period (71 FR 
68028), CPT codes 19296 and 19297 were reassigned from New Technology 
APCs to a clinical APC effective January 1, 2007. Along with their APC 
reassignments, CPT codes 19296 and 19297 were also reassigned from 
status indicator ``S'' to ``T'' effective January 1, 2007. During the 
CY 2007 OPPS rulemaking cycle, in considering the public comments and 
finalizing the new assignments of CPT codes 19296 and 19297 to a 
clinical APC with status indicator ``T,'' the implications of the 
multiple procedure reduction to payment for CPT codes 19296 and 19297 
in various clinical scenarios were taken into consideration. Therefore, 
consistent with our proposed multiple procedure discounting policy for 
the revised ASC payment system, these two procedures were not included 
on the proposed list of procedures for exemption from multiple 
procedure discounting under the revised ASC payment system. Their OPPS 
payment status of ``T'' implies that the multiple procedure payment 
reduction would be appropriate, and the possibility of a 50-percent 
payment reduction has already specifically been evaluated with respect 
to the hospital outpatient resources required to perform the 
procedures. However, because CPT code 19298 is assigned to status 
indicator ``S'' under the CY 2007 OPPS, where it remains in its 
original New Technology APC while additional hospital cost data are 
being collected, we believe that CPT code 19298 would be appropriately 
exempted from multiple procedure discounting in both the ASC and HOPD 
settings, consistent with our overall proposal for discounting under 
the revised ASC payment system.
    After considering the public comments we received, we are 
finalizing our proposed payment policy for multiple surgical procedure 
discounting under the revised ASC payment system under Sec.  416.172(e) 
with only editorial modification. We will mirror the OPPS payment 
policy for discounting when a beneficiary has more than one covered 
surgical procedure performed in a single operative session in an ASC in 
CY 2008, by exempting those surgical procedures on the ASC list of 
covered surgical procedures that are assigned to a status indicator 
other than ``T'' under the CY 2008 OPPS from multiple procedure 
discounting under the revised ASC payment system. The discounting 
policy of the revised ASC payment system, like

[[Page 42515]]

the policy of the existing ASC payment system, will apply the multiple 
procedure reduction if the same procedure is performed bilaterally, 
consistent with the general discounting policy of the OPPS for payment 
of surgical procedures that are performed bilaterally. A procedure 
performed bilaterally in one operative session would be paid at 150 
percent of the single procedure payment under the revised ASC payment 
system. The multiple procedure discounting policy will only apply to 
ASC payment for covered surgical procedures. ASC payment for covered 
ancillary services, as discussed further in section IV.C.2. of this 
final rule, will not be subject to the multiple procedure discount.
    The specific multiple procedure discounting policy that applies to 
each ASC covered surgical procedure is identified in Addendum AA to 
this final rule. Table 10 provides an illustrative summary list of the 
CY 2007 HCPCS codes on the ASC list of covered surgical procedures for 
CY 2008, and their respective APCs as of January 1, 2007 under the 
OPPS, which will be exempt from multiple procedure discounting in ASCs 
effective January 1, 2008, if no changes are made to their OPPS 
discounting designation for CY 2008. We will update this list annually 
in the OPPS/ASC proposed and final rulemaking process, which includes 
the solicitation of public comments. The CY 2008 list of exemptions 
will be proposed and finalized for the CY 2008 revised ASC payment 
system through the OPPS/ASC rulemaking cycle for CY 2008.

     Table 10.--Illustrative List of Procedures Exempt From Multiple
  Procedure Discounting Under the Revised ASC Payment System in CY 2008
------------------------------------------------------------------------
          HCPCS code                   Short descriptor            APC
------------------------------------------------------------------------
11980........................  Implant hormone pellet(s).......     0340
11981........................  Insert drug implant device......     0340
11982........................  Remove drug implant device......     0340
11983........................  Remove/insert drug implant......     0340
15852........................  Dressing change not for burn....     0340
15860........................  Test for blood flow in graft....     0340
19295........................  Place breast clip, percut.......     0657
19298........................  Place breast rad tube/caths.....     1524
20665........................  Removal of fixation device......     0340
20975........................  Electrical bone stimulation.....     0340
20979........................  Us bone stimulation.............     0340
29010........................  Application of body cast........     0426
29015........................  Application of body cast........     0426
29020........................  Application of body cast........     0058
29025........................  Application of body cast........     0058
29035........................  Application of body cast........     0426
29040........................  Application of body cast........     0058
29044........................  Application of body cast........     0426
29049........................  Application of figure eight.....     0058
29055........................  Application of shoulder cast....     0426
29058........................  Application of shoulder cast....     0058
29065........................  Application of long arm cast....     0426
29075........................  Application of forearm cast.....     0426
29085........................  Apply hand/wrist cast...........     0058
29086........................  Apply finger cast...............     0058
29105........................  Apply long arm splint...........     0058
29125........................  Apply forearm splint............     0058
29126........................  Apply forearm splint............     0058
29130........................  Application of finger splint....     0058
29131........................  Application of finger splint....     0058
29200........................  Strapping of chest..............     0058
29220........................  Strapping of low back...........     0058
29240........................  Strapping of shoulder...........     0058
29260........................  Strapping of elbow or wrist.....     0058
29280........................  Strapping of hand or finger.....     0058
29305........................  Application of hip cast.........     0426
29325........................  Application of hip casts........     0426
29345........................  Application of long leg cast....     0426
29355........................  Application of long leg cast....     0426
29358........................  Apply long leg cast brace.......     0426
29365........................  Application of long leg cast....     0426
29405........................  Apply short leg cast............     0426
29425........................  Apply short leg cast............     0426
29435........................  Apply short leg cast............     0426
29440........................  Addition of walker to cast......     0058
29445........................  Apply rigid leg cast............     0426
29450........................  Application of leg cast.........     0058
29505........................  Application, long leg splint....     0058
29515........................  Application lower leg splint....     0058
29520........................  Strapping of hip................     0058
29530........................  Strapping of knee...............     0058
29540........................  Strapping of ankle and/or ft....     0058
29550........................  Strapping of toes...............     0058
29580........................  Application of paste boot.......     0058
29590........................  Application of foot splint......     0058
29700........................  Removal/revision of cast........     0058
29705........................  Removal/revision of cast........     0058
29710........................  Removal/revision of cast........     0426
29715........................  Removal/revision of cast........     0058
29720........................  Repair of body cast.............     0058
29730........................  Windowing of cast...............     0058
29740........................  Wedging of cast.................     0058
29750........................  Wedging of clubfoot cast........     0058
30300........................  Remove nasal foreign body.......     0340
31500........................  Insert emergency airway.........     0094
31620........................  Endobronchial us add-on.........     0670
33282........................  Implant pat-active ht record....     0680
36002........................  Pseudoaneurysm injection trt....     0267
36430........................  Blood transfusion service.......     0110
36440........................  Bl push transfuse, 2 yr or <....     0110
36450........................  Bl exchange/transfuse, nb.......     0110
36511........................  Apheresis wbc...................     0111
36512........................  Apheresis rbc...................     0111
36513........................  Apheresis platelets.............     0111
36514........................  Apheresis plasma................     0111
36515........................  Apheresis, adsorp/reinfuse......     0112
36516........................  Apheresis, selective............     0112
36522........................  Photopheresis...................     0112
36598........................  Inj w/fluor, eval cv device.....     0340
37250........................  Iv us first vessel add-on.......     0416
37251........................  Iv us each add vessel add-on....     0416
38205........................  Harvest allogenic stem cells....     0111
38206........................  Harvest auto stem cells.........     0111
38230........................  Bone marrow collection..........     0123
38241........................  Bone marrow/stem transplant.....     0123
38242........................  Lymphocyte infuse transplant....     0111
40804........................  Removal, foreign body, mouth....     0340
42809........................  Remove pharynx foreign body.....     0340
46600........................  Diagnostic anoscopy.............     0340
51701........................  Insert bladder catheter.........     0340
51702........................  Insert temp bladder cath........     0340
51798........................  Us urine capacity measure.......     0340
53440........................  Male sling procedure............     0385
53444........................  Insert tandem cuff..............     0385
53445........................  Insert uro/ves nck sphincter....     0386
53447........................  Remove/replace ur sphincter.....     0386

[[Page 42516]]

 
54400........................  Insert semi-rigid prosthesis....     0385
54401........................  Insert self-contd prosthesis....     0386
54405........................  Insert multi-comp penis pros....     0386
54410........................  Remove/replace penis prosth.....     0386
54416........................  Remv/repl penis contain pros....     0386
61795........................  Brain surgery using computer....     0302
61885........................  Insrt/redo neurostim 1 array....     0039
62252........................  Csf shunt reprogram.............     0691
62367........................  Analyze spine infusion pump.....     0691
62368........................  Analyze spine infusion pump.....     0691
63650........................  Implant neuroelectrodes.........     0040
63655........................  Implant neuroelectrodes.........     0061
64553........................  Implant neuroelectrodes.........     0225
64555........................  Implant neuroelectrodes.........     0040
64560........................  Implant neuroelectrodes.........     0040
64561........................  Implant neuroelectrodes.........     0040
64565........................  Implant neuroelectrodes.........     0040
64573........................  Implant neuroelectrodes.........     0225
64575........................  Implant neuroelectrodes.........     0061
64577........................  Implant neuroelectrodes.........     0061
64580........................  Implant neuroelectrodes.........     0061
64581........................  Implant neuroelectrodes.........     0061
65205........................  Remove foreign body from eye....     0698
65210........................  Remove foreign body from eye....     0698
65220........................  Remove foreign body from eye....     0698
65222........................  Remove foreign body from eye....     0698
65430........................  Corneal smear...................     0698
65450........................  Treatment of corneal lesion.....     0231
67500........................  Inject/treat eye socket.........     0231
67820........................  Revise eyelashes................     0698
67938........................  Remove eyelid foreign body......     0698
68040........................  Treatment of eyelid lesions.....     0698
68200........................  Treat eyelid by injection.......     0230
68760........................  Close tear duct opening.........     0231
68761........................  Close tear duct opening.........     0231
68801........................  Dilate tear duct opening........     0698
68810........................  Probe nasolacrimal duct.........     0231
68840........................  Explore/irrigate tear ducts.....     0698
69200........................  Clear outer ear canal...........     0340
69210........................  Remove impacted ear wax.........     0340
C9725........................  Place endorectal app............     1507
C9726........................  Rxt breast appl place/remov.....     1508
C9727........................  Insert palate implants..........     1510
G0104........................  CA screen; flexi sigmoidscope...     0159
------------------------------------------------------------------------

2. Interrupted Procedure Policies
    When a procedure requiring anesthesia is discontinued after the 
beneficiary is prepared for the procedure and taken to the room where 
it is to be performed, but before the administration of anesthesia, 
ASCs currently report modifier 73 (Discontinued outpatient procedure 
prior to anesthesia administration) appended to the discontinued 
procedure and receive 50 percent of the ASC payment for the planned 
surgical procedure. We believe that ASCs, like hospital outpatient 
facilities, realize significant savings when procedures for which 
anesthesia is to be used are discontinued prior to their initiation but 
after the beneficiary is taken to the procedure room. We believe that 
savings are recognized for the costs associated with a variety of 
facility resources, including treatment/operating room time, single use 
devices, drugs, equipment, supplies, and recovery room time. When a 
procedure is interrupted after its initiation or the administration of 
anesthesia, ASCs currently report these cases using modifier 74 
(Discontinued outpatient procedure after anesthesia administration) 
appended to the interrupted procedure, and the full ASC payment for the 
covered surgical procedure is made. Similar to hospital outpatient 
procedures that are discontinued after the administration of anesthesia 
or the initiation of the procedure, in cases where modifier 74 is 
reported by ASCs, we believe that the facility costs incurred for these 
discontinued procedures that were initiated to some degree are 
generally as significant to the ASC as those for a completed procedure, 
including resources for patient preparation, operating room use, and 
recovery room care. In the August 2006 proposed rule, we proposed no 
change to the existing ASC payment policy for procedures reported with 
modifier 73 or 74 under the revised ASC payment system, and note that 
the policy under the existing ASC payment system is the same as the 
OPPS policy in these circumstances.
    Under the existing ASC payment system, ASCs do not report modifier 
52 (Reduced services) for interrupted procedures, because most 
interrupted covered surgical procedures paid in ASCs would be 
appropriately reported with modifier 73 or 74 because they generally 
require anesthesia. Modifier 52 is appended to a service under the OPPS 
to signify that a service that did not require anesthesia was partially 
reduced or discontinued at the physician's discretion. Modifier 52 is 
reported under the OPPS for a variety of types of interrupted services, 
such as radiology services, and we believe that there are considerable 
resource savings to the facility under the circumstances where it is 
reported. Therefore, under the OPPS, we apply a 50 percent reduction to 
the facility payment for interrupted procedures and services reported 
with modifier 52.
    The PPAC recommended that we apply payment policies consistently 
under the revised ASC payment system and the OPPS. We received a number 
of public comments recommending consistency of payment policies between 
the two payment systems. Although not discussed in our proposed rule 
for the revised ASC payment system, we received comments on the 
application of the current interrupted procedure policies to the 
revised ASC payment system and respond to these comments below.
    Comment: Many commenters recommended that we establish consistent 
payment policies under the OPPS and the revised ASC payment system, 
because the hospital and ASC facilities provide many of the same 
services to similar patients. In particular, several commenters 
compared current payment policies that were similar between the 
existing ASC payment system and the OPPS, including the payment policy 
that reduces the payment for interrupted procedures reported with 
modifier 73 by 50 percent in both payment systems.
    Response: We agree with commenters that consistent policies between 
the revised ASC payment system and the OPPS are desirable whenever 
possible, because the revised ASC payment system will be based upon the 
OPPS relative payment weights. We also note that, with the significant 
expansion of procedures eligible for ASC payment under the revised ASC 
payment system, it is possible that some of the additional procedures 
payable in the ASC setting beginning in CY 2008 may not always require 
anesthesia. In addition, as further discussed in section IV.C.2. of 
this final rule, we will be providing separate payment for some 
ancillary radiology services that are integral to the performance of 
covered surgical procedures under the revised ASC payment system. 
Therefore, we believe that the revised ASC payment system should also 
allow ASCs to report interrupted services not requiring anesthesia with 
modifier 52, consistent with the OPPS reporting of these services. 
Because we expect ASCs to utilize fewer facility resources in such 
situations, similar to ASC procedures where modifier 73 is reported and 
to

[[Page 42517]]

HOPDs where modifier 73 or 52 is reported, we believe that it is 
appropriate to provide the same payment reduction of 50 percent under 
the revised ASC payment system as under the OPPS when modifier 52 is 
reported.
    After considering the public comments received, we are clarifying 
here the payment policies for interrupted procedures in ASCs. First, 
procedures requiring anesthesia that are terminated after the patient 
has been prepared for surgery and taken to the operating room but 
before the administration of anesthesia will be reported with modifier 
73, and the ASC payment for the covered surgical procedure will be 
reduced by 50 percent. Second, procedures and services not requiring 
anesthesia that are partially reduced or discontinued at the 
physician's discretion will be reported with modifier 52, and the ASC 
payment for the covered surgical procedure or covered ancillary service 
will be reduced by 50 percent. Third, procedures requiring anesthesia 
that are terminated after the administration of anesthesia or the 
initiation of the procedure will be reported with modifier 74, and the 
full ASC payment for the covered surgical procedure will be provided. 
We are adding new Sec.  416.172(f) to reflect this final policy.

G. Geographic Adjustment

    Currently, Medicare adjusts 34.45 percent of the national ASC 
payment rates using wage index values and localities that were 
established under the hospital IPPS prior to implementation of the new 
CBSAs issued by OMB in June 2003. Medicare currently adjusts 60 percent 
of national OPPS payment rates by the IPPS wage index value assigned to 
hospitals using the June 2003 OMB definitions for geographical 
statistical areas and wage adjustments required under Public Law 108-
173.
    Since 1990, ASC payments have been adjusted for regional wage 
variations using the IPPS wage index values. As we discussed in the 
August 2006 proposed rule, we believe that standardization continues to 
be appropriate in recognition of widely varying labor market costs tied 
to geographic localities. We also explained in the proposed rule that 
we believe it is advisable to maintain consistency in locality 
designations between ASCs and hospitals and acknowledge parity of labor 
costs between ASCs and HOPDs that are competing for staff in the same 
locality. Therefore, we proposed to apply to ASCs the IPPS pre-
reclassification wage index values associated with the June 2003 OMB 
geographic localities, as recognized under the IPPS and OPPS, to adjust 
national ASC payment rates for geographic wage differences under the 
revised payment system.
    Although we had not collected new data to identify whether the 
current labor-related share is correct, the results of a 1994 survey of 
ASC costs generally supported the current 34.45-percent labor 
adjustment factor, and we had received no complaints from the ASC 
community, prior to our proposal, about our continued use of the 34.45/
65.55 ratio of labor to nonlabor costs for purposes of adjusting 
payments for regional wage differences. Moreover, in the proposed rule, 
we stated our belief that it is reasonable to expect ASCs to have a 
lower labor adjustment factor than that of hospitals. For example, most 
OPPS HOPDs are staffed 24 hours per day to provide emergency department 
services and observation care, and these patterns of operation could 
lead to relatively higher labor costs for hospital services overall. 
Therefore, we proposed to continue using 34.45 percent as the labor 
adjustment factor for regional wage differences under the revised ASC 
payment system, beginning in CY 2008. We proposed to establish rules 
governing this proposal in new Sec.  416.172(c).
    Subsequent to the publication of the August 2006 proposed rule for 
the revised ASC payment system, the GAO issued the report, ``Medicare: 
Payment for Ambulatory Surgical Centers Should Be Based on the Hospital 
Outpatient Payment System,'' (GAO-07-86), which is discussed in further 
detail in section II.B. of this final rule. In this report, the GAO 
determined that based upon the 2004 ASC cost data from a geographically 
representative group of ASCs received in response to its ASC survey, 
the mean labor-related proportion of ASC costs was 50 percent.
    Comment: Several commenters agreed with CMS' proposal to use the 
IPPS pre-reclassification wage index values associated with the June 
2003 OMB geographic localities. However, many commenters indicated that 
the current 34.45-percent labor factor is based on old data and is too 
low, leading to their recommendation that the 60-percent OPPS labor 
factor would be more appropriate. Some commenters explained that it was 
difficult to assess the appropriateness of CMS' proposal in the absence 
of the GAO Report on the ASC payment system that was directed to 
address whether a geographic adjustment should be provided for payment 
of procedures furnished in ASCs and, if so, the labor and nonlabor 
shares of ASC payment. Other commenters recommended that CMS collect 
more recent data on the costs of delivering services in the ASC setting 
or suggested that ASCs be asked to submit cost reports to inform the 
development of an appropriate, contemporary labor factor reflecting 
current ASC costs.
    Response: For the reasons stated in the proposed rule and 
reiterated above, we agree with the commenters that we should use the 
IPPS pre-reclassification wage index values associated with the June 
2003 OMB geographic localities. While we share the concerns of 
commenters about the age of the survey data used for the current 34.45-
percent labor factor, we disagree that it would be appropriate to use 
the same 60-percent labor factor used under the OPPS. The commenters 
who indicated a preference for the OPPS labor factor did not address 
the fact that most OPPS HOPDs are staffed 24 hours per day to provide 
emergency department services and observation care. Other than their 
request for parity with the OPPS labor adjustment, they provided no 
specific data to support the appropriateness of a 60-percent labor 
factor based on current ASC costs for performing procedures.
    However, we agree with commenters that the 34.45 labor-related 
share that we proposed for the revised payment system is likely too low 
to accurately reflect the current proportion of ASCs' labor costs. The 
data used to develop the 34.45 labor-related share are 20 years old, 
and 1994 ASC survey cost data, which have never been used for ASC 
payment, showed a slightly higher labor-related share of 37.66 percent 
that we believe was likely reflective of a generally increasing 
proportion of ASC labor costs. ASCs and HOPDs operate in some of the 
same communities, using similar clinical staff to perform certain 
procedures, and ASC staff wages may be comparable to those of hospital 
staff. However, we have no data to indicate that ASCs and HOPDs have 
equivalent ratios of labor to nonlabor costs, on average, for all the 
services each type of facility provides. As discussed above, because 
ASCs only provide a subset of surgical procedures compared with the 
wide variety of OPPS services that we expect could be, overall, 
relatively more labor-intensive than ambulatory surgical procedures 
specifically, we believe that the most appropriate ASC labor-related 
share would be lower than the 60 percent used to adjust HOPD payment. 
The GAO Report determined, on the basis of the 2004 ASC cost data 
received from a geographically representative group of ASCs in response 
to its ASC survey, that the mean labor-related

[[Page 42518]]

proportion of costs was 50 percent. In addition, the GAO found that the 
range of the labor-related costs for the middle 50 percent of ASCs 
responding to the survey was relatively narrow, at 43 percent to 57 
percent of total costs.
    Therefore, in response to comments about the age of the historical 
data used for the existing and proposed revised ASC payment system 
labor factor, in addition to consideration of the GAO's determination 
based on the most recent ASC survey findings, we reviewed the labor-
related share indicated by the 1994 ASC survey cost data and assessed 
the clinical labor required to provide both ASC and OPPS services, in 
the context of the full facility resource costs associated with those 
services. Based on all of those considerations, we believe that it is 
not necessary to collect additional ASC cost data in order to determine 
the appropriate labor-related factor for use under the revised ASC 
payment system and that a 50-percent labor factor for the revised ASC 
payment system is most appropriate. Fifty percent is significantly 
higher than the current labor-related share (34.45 percent) that we 
proposed to maintain but is also lower than the OPPS labor-related 
share of 60 percent, a differential we believe is appropriate given the 
broader range of labor-intensive services provided in the HOPD setting. 
A 50-percent labor-related share is fully consistent with the GAO 
findings that we believe provide a more accurate representation of the 
present-day labor-related proportion of ASC costs than the data upon 
which we currently rely. In the future, if we believe that the 
collection of additional ASC cost data is important to providing 
appropriate payment to ASCs and such an activity is administratively 
feasible, we may consider gathering such information from ASCs.
    After considering the public comments received, we are finalizing 
our proposal to apply to ASC payments under the revised ASC payment 
system the IPPS pre-reclassification wage index values associated with 
the June 2003 OMB geographic localities, as recognized under the IPPS 
and OPPS, in order to adjust national ASC payment rates for geographic 
wage differences under the revised payment system. However, rather than 
adopting 34.45 percent as the labor adjustment factor as we proposed, 
we are adopting 50 percent as the labor-related proportion under the 
revised ASC payment system. The geographic adjustment policy of the 
revised ASC payment system is set forth in Sec.  416.172(c).

H. Adjustment for Inflation

    As noted above, section 1833(i)(2)(C)(iv) of the Act, as amended by 
section 626(a) of Public Law 108-173, requires the adjustment of ASC 
payment amounts for inflation for FY 2005, the last quarter of CY 2005, 
and each of CYs 2006 through 2009 to equal zero percent. Otherwise, 
section 1833(i)(2)(C)(i) of the Act provides that ASC payment amounts 
are to be adjusted by the percentage increase in the CPI-U during years 
when the ASC payment amounts are not updated.
    Although we are only required to increase the ASC payment rates by 
the percentage increase in the CPI-U during years in which we have not 
updated the ASC payment amounts, we proposed to update the ASC 
conversion factor annually using the CPI-U. For CY 2008 and CY 2009, 
the statute requires a zero percent CPI-U increase for ASC services. 
Beginning in CY 2010, in the August 2006 proposed rule for the revised 
ASC payment system, we proposed to update the ASC conversion factor by 
the percentage increase in the CPI-U (U.S. city average) as estimated 
for the 12-month period ending with the midpoint of the year involved. 
Accordingly, we proposed to establish rules in proposed new Sec. Sec.  
416.171 and 416.172 to reflect our proposed policy for applying an 
inflation adjustment under the proposed revised payment system 
beginning January 1, 2008. (These sections of the proposed regulations 
also included our proposed policies for calculating a conversion factor 
and standardizing labor-related costs, respectively, under the proposed 
revised payment system.)
    Comment: A number of commenters recommended that CMS use the 
hospital market basket as an update for inflation in the revised ASC 
payment system. The commenters generally indicated that the hospital 
market basket more appropriately reflects inflation in the costs of 
providing surgical services. These commenters pointed out that the CPI-
U is a measure of consumer inflation rather than health care provider 
inflation, and that the hospital market basket was specifically 
designed to measure the cost of hospital inflation. They concluded that 
the hospital market basket is, thus, a better proxy for the 
inflationary pressures faced by ASCs. One commenter presented data 
indicating that the cost of operating an ASC rose by an average of 13.4 
percent between 2003 and 2005 and that, during that same period, the 
CPI-U fell 36 percent short of meeting these increased costs.
    Some commenters expressed concern that the use of two different 
factors to update payments for ASCs and HOPDs would further increase 
the discrepancies between payments in the two settings. They further 
suggested that alignment with hospital updates and policies in general 
would achieve parity and transparency in the market and ensure that 
facility decisions are made based upon what is best for the patient. 
Other commenters suggested that CMS develop another method that would 
more closely approximate the rising cost of operating an ASC if the 
proposal to base the annual update of the ASC conversion factor on the 
CPI-U is finalized.
    Response: As we explained in the CY 2007 OPPS/ASC final rule with 
comment period (71 FR 68003), the OPPS conversion factor is updated 
annually using the hospital inpatient market basket percentage 
increase. The statute specifically required us to take into account the 
recommendations of a GAO Report studying the appropriateness of 
aligning a revised ASC payment system with the payment rates and 
relative weights established under the OPPS. However, the statute gives 
the Secretary broad authority in designing the specific features of the 
revised system. In particular, the statute gives the Secretary 
considerable discretion in determining an appropriate update mechanism 
for the revised ASC payment system. Section 1833(i)(2)(C)(i) of the Act 
requires that the Secretary update the payment amounts established 
under the revised system ``by the percentage increase in the Consumer 
Price Index for all urban consumers,'' but only if the Secretary has 
not otherwise ``updated amounts established'' under the revised system 
for that year. The statute, therefore, does not mandate the adoption of 
any particular update mechanism, but it does establish the CPI-U as the 
default update mechanism in the absence of any other update. In 
addition, section 1833(i)(2)(C)(iv) of the Act mandates a zero CPI-U 
adjustment in CY 2008 and CY 2009 for ASCs, the first 2 years under the 
revised payment system, suggesting that maintaining continuity in the 
update mechanism under the revised system may be appropriate. 
Therefore, we proposed, under the revised system beginning in CY 2010, 
to apply the CPI-U adjustment to update the ASC conversion factor for 
inflation on an annual basis. While we understand the arguments of 
commenters in favor of adopting the hospital market basket as the 
update mechanism under the revised ASC

[[Page 42519]]

payment system, we continue to believe that it is appropriate to adopt 
the default update mechanism designated by Congress for the revised 
system.
    Therefore, we are finalizing our proposal, beginning in CY 2010, to 
update the conversion factor by the percentage increase in the CPI-U 
(U.S. city average) as estimated for the 12-month period ending with 
the midpoint of the year involved. At the same time, we recognize that 
we continue to have flexibility under the statute to employ a different 
update mechanism under the revised ASC payment system. As one example, 
we do not intend for the revised ASC payment system to result in 
additional Medicare expenditures over time. We will be monitoring this 
issue closely in the coming years. Consequently, we will reconsider the 
ASC update if expenditures increase inappropriately in future years.
    Therefore, after consideration of all public comments received, we 
are finalizing our proposal under Sec.  416.171(a)(2), without 
modification, to apply the CPI-U to update the ASC conversion factor 
for inflation on an annual basis under the revised ASC payment system.

I. Beneficiary Coinsurance

    Payment for ASC services is subject to the Medicare Part B 
deductible and coinsurance requirements. Currently, Medicare pays 
participating ASCs 80 percent of a prospectively determined standard 
overhead amount, adjusted for regional wage variations for ASC covered 
surgical procedures, except for screening colonoscopies. The 
beneficiary deductible and coinsurance make up the other 20 percent of 
payment for ASC services, except for screening colonoscopies for which 
there is no deductible and for which the coinsurance is equal to 25 
percent. Section 1834(d) of the Act requires this higher coinsurance 
for screening colonoscopies and screening flexible sigmoidoscopies. 
However, only screening colonoscopies are on the CY 2007 ASC list of 
covered surgical procedures. In addition, effective January 1, 2007, a 
deductible is no longer applied for colorectal cancer screening tests, 
including screening flexible sigmoidoscopy and screening colonoscopy 
procedures performed in ASCs or other settings, as specified in section 
1833(b)(8) of the Act (as added by section 5113 of Public Law 109-171).
    Section 626(c) of Public Law 108-173 amended section 1833(a)(1) of 
the Act to provide that, beginning with the implementation date of the 
revised payment system, the Medicare program payment to ASCs shall 
equal 80 percent of the lesser of the actual charge for the services or 
the payment amount that we determine under the revised payment system 
for the services. This amendment, however, did not affect section 
1834(d) of the Act. Therefore, we proposed to make this change and to 
continue to maintain the beneficiary deductible and coinsurance at 20 
percent under the revised ASC payment system, except for screening 
colonoscopies and screening flexible sigmoidoscopies (which are both 
ASC covered surgical procedures in CY 2008) for which the statute 
requires 25 percent beneficiary coinsurance. In the August 2006 
proposed rule for the revised ASC payment system, we proposed to 
reflect the 20 percent beneficiary coinsurance in proposed new 
Sec. Sec.  416.172(b) and (d); however, the proposed regulation text 
did not address the statutory requirement of 25 percent coinsurance for 
screening flexible sigmoidoscopies and screening colonoscopies. 
Consistent with the provisions of section 1834(d) of the Act, we 
implemented the 25 percent coinsurance requirement for screening 
colonoscopies (screening flexible sigmoidoscopies are not on the CY 
2007 ASC list of covered surgical procedures) in ASCs, effective 
January 1, 2007, as finalized in Sec.  410.152(i) and discussed in the 
preamble to the CY 2007 OPPS/ASC final rule with comment period (71 FR 
68174).
    Comment: Many commenters supported our proposal to continue to 
apply the 20 percent coinsurance provision to payment for covered 
surgical procedures performed in ASCs and paid under the revised ASC 
payment system.
    Response: We appreciate the comments. The statute requires Medicare 
to pay 80 percent of the lesser of the actual charge for the service or 
the amount we determine under the revised payment system, other than 
for screening colonoscopy and screening flexible sigmoidoscopy 
procedures. Beneficiary coinsurance will remain at 20 percent for ASC 
services under the revised ASC payment system, except for screening 
flexible sigmoidoscopy and screening colonoscopy procedures. The 
coinsurance for screening colonoscopies and screening flexible 
sigmoidoscopies will be 25 percent, as required by section 1834(d) of 
the Act, with no deductible for those services under the revised ASC 
payment system. This requirement is reflected in our regulations at 
Sec. Sec.  416.172(b) and (d).

J. Phase-In of Full Implementation of Payment Rates Calculated Under 
the Revised ASC Payment System Methodology

    We discussed in section XXVII.D. of the preamble to the August 2006 
proposed rule for the revised ASC payment system (71 FR 49690 through 
49695), our analysis of the impact that the revised ASC payment system 
and estimated payment rates for implementation in CY 2008 could have on 
certain ASCs that specialize in or perform high volumes of procedures 
for which payment under the new system would decrease. We wanted to 
ensure that the revised payment system does not cause a sudden, 
unwarranted migration of services from ASCs to other ambulatory 
settings, or the reverse; that ASCs would have an opportunity to 
balance their Medicare case[pi]mix between procedures whose rates 
decrease and procedures whose rates increase; and that beneficiaries 
and their physicians would continue to have a robust choice of sites 
where important preventive and other surgical services are paid under 
Medicare.
    In the August 2006 proposed rule, we proposed to implement the 
revised ASC payment system in CY 2008 using transitional payment rates 
that would be based upon a 50/50 blend of the CY 2007 ASC payment rate 
for a procedure on the CY 2007 ASC list of covered surgical procedures 
and the final payment rate for that same procedure calculated under the 
revised payment system methodology described in the proposed rule and 
reflected in proposed new Sec.  416.171(c). We further proposed that, 
in CY 2009, we would fully implement the ASC payment rates calculated 
under the proposed payment methodology, discontinuing the blended 
transitional payment rates for services furnished beginning January 1, 
2009. This was proposed in new Sec.  416.171(d).
    Comment: Several commenters expressed concern that the proposed 2-
year transition period would threaten the viability of many ASCs. The 
commenters indicated that given the size of the payment cuts 
contemplated under the proposed rule for certain procedures and 
specialties, especially gastrointestinal, pain management, and 
ophthalmology services, 1 year would not provide adequate time for ASCs 
to adjust to the changes and that a 4-year phase-in would allow a more 
gradual and less disruptive transition to the new payment system. Many 
commenters urged CMS to implement policies to further address the 
decrease in payments for procedures whose rates would fall 
significantly during a

[[Page 42520]]

transition to the new payment system. One commenter suggested that CMS 
hold harmless procedures that were on the ASC list of covered surgical 
procedures prior to CY 2008 to prevent significant changes in payments 
during the transition. Some commenters expressed concern that if CMS 
revises both the payment system and the geographic localities used for 
wage adjustment at the same time, providers in certain areas could 
experience dramatic shifts in payment as a result of the cumulative 
effect of the wage index and other policy changes that were described 
in the proposed rule. These commenters encouraged CMS to consider the 
cumulative effects of the wage index and other policy changes on 
payments to ASCs under the revised ASC payment system and develop a 
transitional approach that protects providers from significant 
reductions in payment.
    A number of commenters supported the proposed 2-year phase-in of 
the ASC payment rates based on the final methodology of the revised ASC 
payment system. The commenters generally believed that the transition 
period as proposed would provide sufficient notice and time for ASCs to 
adapt to the revised payment system.
    Some commenters stated that the proposed transition does not 
appropriately address payment for device-intensive procedures that 
implant devices that are paid separately according to the DMEPOS fee 
schedule under the existing payment system during the transitional year 
of CY 2008. Some of these commenters urged CMS to devise a strategy 
that would accelerate full implementation of payment for device-
intensive procedures according to the proposed methodology for the 
revised ASC payment system. Alternatively, other commenters suggested 
that CMS develop a final transitional policy that does not exclude the 
payments for implanted devices now paid separately under the DMEPOS fee 
schedule in calculating the CY 2007 ASC payment contributions to the 
blended payment rates for device-intensive procedures for CY 2008.
    Response: After consideration of all of these public comments, we 
agree with the majority of the commenters who indicated that a 2-year 
transition may provide some ASCs with insufficient time to adapt to the 
revised payment system. During the transition to the revised system, we 
believe it is important to maintain appropriate Medicare beneficiary 
access to ASC services. In addition, we do not believe that the 
transition should be asymmetrical, meaning that procedures with 
decreasing payments under the revised payment system should be 
transitioned differently from those with increasing payments. We also 
do not believe that the transition should lead to increases or 
decreases in overall Medicare ASC expenditures.
    Therefore, in order to provide additional time for ASCs to adapt to 
the revised payment system and to facilitate Medicare beneficiary 
access to ambulatory surgical procedures at those ASCs that may not 
adjust as quickly as others to the revised payment system, we are 
extending the transition from our proposed 2 years to 4 years for all 
services on the CY 2007 ASC list of covered surgical procedures, as 
reflected in Sec.  416.171(c). We believe a transition period of 4 
years, comparable to transition periods provided under other payment 
systems (for example, the recent practice expense changes to the MPFS) 
and as suggested in comments concerning this issue, will provide a 
reasonable and balanced approach to implementation that addresses two 
important objectives, in particular offering sufficient notice and time 
for ASCs to adapt to the revised payment system and providing more 
accurate and appropriate ASC payments for covered surgical procedures. 
The contribution of CY 2007 ASC payment rates to the blended 
transitional rates will decrease by 25 percentage point increments each 
year of transitional payment, until CY 2011, when we will fully 
implement the ASC payment rates calculated under the final methodology 
of the revised payment system. Procedures new to ASC payment for CY 
2008 or later calendar years will receive payments determined according 
to the final methodology of the revised ASC payment system, as 
reflected in Sec.  416.171(a), without the need for a transition. ASC 
covered surgical procedures listed in Addendum AA to this final rule 
that are subject to the transition are assigned to payment indicators 
``A2'' (Surgical procedure on ASC list in CY 2007; payment based on 
OPPS relative payment weight) and ``H8'' (Device-intensive procedure on 
ASC list in CY 2007; paid at adjusted rate). ASC covered surgical 
procedures listed in Addendum AA to this final rule that are not 
subject to the transition are assigned to payment indicators ``G2'' 
(Non office-based surgical procedure added to ASC list in CY 2008 or 
later; payment based on OPPS relative payment weight); ``J8'' (Device-
intensive procedure added to ASC list in CY 2008 or later; paid at 
adjusted rate); ``P2'' (Office-based surgical procedure added to ASC 
list in CY 2008 or later with MPFS nonfacility PE RVUs; payment based 
on OPPS relative payment weight); ``P3'' (Office-based surgical 
procedure added to ASC list in CY 2008 or later with MPFS nonfacility 
PE RVUs; payment based on MPFS nonfacility PE RVUs); and ``R2'' 
(Office-based surgical procedure added to ASC list in CY 2008 or later 
without MPFS nonfacility PE RVUs; payment based on OPPS relative 
payment weight).
    In addition, we agree with commenters who indicated that an 
adjustment should be made during the transition period for certain 
procedures that implant devices that are separately payable under the 
existing ASC payment system. For device-intensive procedures utilizing 
separately payable devices of significant cost, ideally, we would 
adjust the CY 2007 base rates for the procedures to appropriately 
reflect the fact that associated devices may have been separately paid 
to ASCs in CY 2007 under the DMEPOS fee schedule, but beginning in CY 
2008 implantable device payment will be packaged into the ASC payment 
for the covered surgical procedure under the revised ASC payment 
system. This would require associating the current separately provided 
implantable device payments with specific covered surgical procedures, 
in order to determine an appropriate CY 2007 base payment rate for the 
transition for each procedure. However, due to the challenges in making 
these associations, including the common historical practice of payment 
at contractor-priced rates for some implantable devices that have been 
reported only under Level II HCPCS unlisted codes under the existing 
payment system, we cannot accurately allocate those device payments to 
covered surgical procedures using the ASC data.
    Under the final methodology of the revised ASC payment system for 
calculating payment for procedures with significant device costs as 
discussed in section IV.C.2.e. of this final rule, for device-intensive 
procedures on the CY 2007 ASC list of covered surgical procedures, we 
will separately determine both the device payment and service payment 
portions of the total ASC payment under the revised payment system. We 
will apply the ASC conversion factor only to the specially calculated 
OPPS relative payment weight for the service portion, while providing 
the same packaged payment for the device portion as would be made under 
the OPPS. That is, we will determine the payment amount attributable to 
the device, as currently determined under the OPPS, and

[[Page 42521]]

combine that payment amount with the adjusted ASC service payment, 
resulting in a total ``bundled'' ASC payment for the device-intensive 
procedure under the revised ASC payment system.
    Consistent with that approach, we also will apply our transition 
policy differentially to those portions of the total ASC payment. While 
we will not subject the device payment portion of the total ASC payment 
for the procedure under the revised ASC payment system to the 
transition policy, we will transition the service payment portion of 
the total ASC payment for the procedure over the 4-year phase-in 
period. Device-intensive procedures that are new to the ASC list of 
covered surgical procedures for CY 2008 or later years will be exempted 
from any transition period and will be paid at the fully implemented 
revised ASC payment system rates beginning in CY 2008 or the applicable 
update year, just like all other new ASC surgical procedures. During 
each of the transition years, when the CY 2007 ASC payment rate for a 
device-intensive procedure that did not previously include packaged ASC 
payment for the implantable device itself is blended with the payment 
developed under the methodology of the revised ASC payment system that 
would otherwise package the device payment, the full device payment 
amount will be paid to ASCs in the transition year, with blended 
payment determined only for the service portion of the ASC payment, for 
which a corresponding CY 2007 ASC payment rate exists. This methodology 
achieves an appropriate payment for costly, implantable devices, 
because it recognizes that, in general, the device costs are similar 
for ASCs and HOPDs. This specific transition approach for device-
intensive procedures ensures that ASCs receive appropriate packaged 
payment for implantable devices during the transition years, even 
though payment for such devices is generally not included in their base 
CY 2007 ASC payment rates under the existing ASC payment system.
    A full discussion of the calculation of the payment rates for these 
device-intensive procedures can be found in section IV.C.2.e. of this 
final rule, in the context of establishing payment weights for device-
intensive procedures under the revised ASC payment system. Tables 5 and 
6 above are illustrative of the device-intensive procedures likely to 
be subject to this special transitional policy for device-intensive 
procedures under the revised ASC payment system, pending updating of 
their OPPS status in CY 2008 and future years.
    After considering the public comments received, we are finalizing a 
policy to phase in implementation of the payment rates calculated under 
the revised ASC payment system over 4 years. For CYs 2008, 2009, and 
2010, payment will be made for each procedure on the CY 2007 ASC list 
of covered surgical procedures based on a 25/75, 50/50, and 75/25 
blend, respectively, of the CY 2007 payment rate for the procedure and 
the payment rate for that procedure calculated under the standard 
revised payment system methodology set forth in Sec.  416.171(a). 
Procedures that are newly approved for ASC payment in CY 2008 or later 
years are not subject to the transition policy. In CY 2011, we will 
fully implement the ASC payment rates calculated under the standard 
payment methodology of the revised ASC payment system. This final 
transition policy is set forth in Sec.  416.171(c).
    The service payment portion of the total ASC payment for device-
intensive procedures that are on the ASC list of covered surgical 
procedures in CY 2007 will be subject to the transition. The service 
payment portion calculated under the fully implemented revised ASC 
payment system methodology will be blended with the ASC payment for the 
procedure under the existing payment system. In contrast, the device 
payment portion of the total ASC payment for these procedures, where 
the device would generally have been paid separately according to the 
DMEPOS fee schedule under the existing ASC payment system, will not be 
subject to the transition. Rather, the contribution of the device 
payment portion to the total ASC payment during the transitional years 
will be calculated according to the methodology of the fully 
implemented revised ASC payment system. During the years of phase-in of 
the revised ASC payment system, the device payment portion will be 
summed with the blended service payment portion (that is, the 25/75, 
50/50, or 75/25 blend, as appropriate) to establish the total ASC 
payment for these device-intensive procedures for each year of the 
transition. Device-intensive procedures new to the ASC list of covered 
surgical procedures for CY 2008 or later years will be paid the fully 
implemented revised payment system rates.

V. Calculation of ASC Conversion Factor and ASC Payment Rates for CY 
2008

A. Overview

    As discussed in section IV.B. of this final rule, in the August 
2006 proposed rule, we proposed to base ASC relative payment weights 
and payment rates under the revised ASC payment system on APC groups 
and relative payment weights established under the OPPS. We also 
proposed to set the ASC relative payment weight for certain office-
based surgical procedures so that the national ASC payment rate does 
not exceed the MPFS unadjusted nonfacility practice expense amount. We 
explained that the proposed ASC payment weights would be multiplied by 
an ASC conversion factor to calculate the ASC payment rates. In the 
August 2006 proposed rule, our estimate for the CY 2008 budget neutral 
ASC conversion factor was $39.688. In this final rule, we estimate that 
the ASC conversion factor for CY 2008 will be approximately $42.543. 
This new estimate of the ASC conversion factor differs from the 
estimate in the August 2006 proposed rule for a number of reasons, 
including: (1) Use of the final OPPS relative payment weights for CY 
2007; (2) use of the final MPFS nonfacility practice expense payment 
amounts for CY 2007; (3) use of updated utilization data for the full 
year of CY 2005; (4) a 4-year instead of 2-year transition to the 
revised payment system rates, with a modified transition for device-
intensive procedures; (5) more recent estimates of the hospital market 
basket update and the MPFS conversion factor update for CY 2008; and 
(6) adoption of the with-migration approach to calculation of the 
budget neutrality adjustment using different time periods for the 
assumed migration of procedures from physicians' offices and HOPDs to 
ASCs under the revised ASC payment system. Specific details regarding 
our final methodology for estimating the revised ASC payment system 
conversion factor are discussed later in this section.
    We are not able to provide the final CY 2008 ASC conversion factor 
in this final rule for the revised ASC payment system because the final 
conversion factor will be based on the final OPPS relative payment 
weights for CY 2008, the final MPFS nonfacility practice expense 
payment amounts for CY 2008, and updated and complete CY 2006 
utilization data, all of which are unavailable at this time but will be 
available for the CY 2008 OPPS/ASC final rule. Therefore, in this final 
rule, we are finalizing the methodology for calculating the ASC 
conversion factor for the revised ASC payment system. When the 
necessary data are available, they will be used in the methodology 
described in this final rule, and we will provide the final CY 2008 ASC 
conversion factor and ASC relative

[[Page 42522]]

payment weights and rates in the CY 2008 OPPS/ASC final rule.

B. Budget Neutrality Requirement

    Section 626(b) of Public Law 108-173 amended section 1833(i)(2) of 
the Act by adding subparagraph (D) to require that in the year the 
revised ASC system is implemented:
    ``* * * [S]uch system shall be designed to result in the same 
aggregate amount of expenditures for such services as would be made if 
this subparagraph did not apply, as estimated by the Secretary. * * *''
    As discussed in the August 2006 proposed rule for the revised ASC 
payment system, the ASC conversion factor is calculated so that 
estimated total Medicare payments under the revised ASC payment system 
would be budget neutral to estimated total Medicare payments under the 
current ASC payment system as required by the statute. That is, 
application of the ASC conversion factor would be designed to result in 
aggregate expenditures under the revised ASC payment system in CY 2008 
equal to aggregate expenditures that would have occurred in CY 2008 in 
the absence of the revised system, taking into consideration the cap on 
payments in CY 2007 as required under section 5103 of Public Law 109-
171, which we discuss further in section IV.A. of this final rule.
    We note that, in the August 2006 proposed rule (71 FR 49656), we 
considered the term ``expenditures'' in the context of section 626(b) 
of the Public Law 108-173 budget neutrality requirement to mean 
expenditures from the Medicare Part B Trust Fund. We did not consider 
expenditures to include beneficiary coinsurance and copayments.

C. Calculation of the ASC Payment Rates for CY 2008

    1. Proposed Method for Calculation of the ASC Payment Rates for CY 
2008 in the August 2006 Proposed Rule
    In the August 2006 proposed rule, we proposed to calculate the ASC 
payment rates for CY 2008 as follows:
a. Estimated Medicare Program Payments (Excluding Beneficiary 
Coinsurance) Under the Current ASC Payment System in the August 2006 
Proposed Rule
    Step 1: To estimate the aggregate amount of expenditures that would 
be made in CY 2008 under the current ASC payment system, we first 
multiplied the estimated CY 2008 ASC volume for each HCPCS code on the 
CY 2007 ASC list of covered surgical procedures by the estimated CY 
2008 ASC payment rate for the HCPCS code under the existing ASC system, 
and then subtracted beneficiary coinsurance. In the August 2006 
proposed rule, the estimated CY 2008 ASC payment rates were based on 
the proposed CY 2007 ASC payment rates, which were listed in Addendum 
AA to the rule, taking into account the OPPS cap on ASC services at the 
OPPS rate as required by section 5103 of Public Law 109-171 and 
reflecting the zero percent CY 2008 update for ASC services mandated by 
section 1833(i)(2)(C)(iv) of the Act. Although we did not specify in 
the August 2006 proposed rule that we did so, we also estimated the 
amount the Medicare program would pay in CY 2008 for implantable 
prosthetic devices and implantable DME for which ASCs currently receive 
separate payment under the DMEPOS fee schedule. We then summed the 
estimated DMEPOS fee schedule total amount and all of the estimated 
procedure payment amounts for services on the CY 2007 ASC list of 
covered surgical procedures to estimate the aggregate amount of 
expenditures that would be made in CY 2008 under the policies of the 
current ASC payment system.
b. Estimated Medicare Program Payments (Excluding Beneficiary 
Coinsurance) Under the Proposed Revised ASC Payment System in the 
August 2006 Proposed Rule
    Step 2: To estimate the aggregate amount of expenditures that would 
be made in CY 2008, we used estimated CY 2008 OPPS payment amounts 
instead of estimated CY 2008 ASC payment amounts under the current 
system, and we multiplied the estimated CY 2008 ASC volume for each 
HCPCS code on the CY 2007 ASC list of covered surgical procedures by 
the estimated CY 2008 OPPS payment rate for the HCPCS code, and then 
subtracted beneficiary coinsurance. We summed the results for all 
services on that ASC list of covered surgical procedures.
c. Calculation of the Proposed CY 2008 Budget Neutrality Adjustment in 
the August 2006 Proposed Rule
    Step 3: To calculate the proposed CY 2008 ASC budget neutrality 
adjustment, we divided the total expenditures calculated in Step 1 by 
the total expenditures calculated in Step 2. We calibrated this 
estimate of the budget neutrality adjustment to take into account that, 
in CY 2008, the payment rate for procedures on the CY 2007 ASC list of 
covered surgical procedures was proposed to be 50 percent of the CY 
2007 ASC payment amount and 50 percent of the CY 2008 ASC payment rate 
calculated according to the proposed revised payment system methodology 
without the transition. The result of these calculations was a budget 
neutrality adjustment of 0.62.
d. Application of the Budget Neutrality Adjustment To Determine the 
Proposed CY 2008 ASC Conversion Factor in the August 2006 Proposed Rule
    Step 4: To determine the proposed CY 2008 ASC conversion factor, we 
multiplied the estimated CY 2008 OPPS conversion factor by the result 
of Step 3. The proposed estimated CY 2008 OPPS conversion factor was 
$64.013. Multiplying the estimated CY 2008 OPPS conversion factor by 
the 0.62 budget neutrality adjustment yielded our proposed CY 2008 ASC 
conversion factor of $39.688.
e. Calculation of the Proposed CY 2008 ASC Payment Rates Under the 
Revised ASC Payment System in the August 2006 Proposed Rule
    Step 5: To determine the proposed national ASC payment rates for 
covered surgical procedures under the revised payment system (including 
beneficiary coinsurance), we multiplied the ASC conversion factor from 
Step 4 by the ASC relative payment weight.
    The proposed ASC relative payment weights for covered surgical 
procedures were based on the relative payment weights for the APC 
groups established under the OPPS as described in section IV.B. of this 
final rule. However, as further discussed in section IV.E. of this 
final rule, the ASC relative payment weights for certain office-based 
surgical procedures were set so that the national ASC payment rate did 
not exceed the MPFS unadjusted nonfacility practice expense amount.
f. Calculation of the Proposed CY 2008 ASC Payment Rates Under the 
Transition in the August 2006 Proposed Rule
    Step 6: We proposed to fully implement the revised ASC payment 
rates through a 2-year transition to 100 percent implementation of the 
revised ASC payment rates for procedures included on the CY 2007 ASC 
list of covered surgical procedures. In the first year of the 
transition, the payment rate would be based on 50 percent of the final 
CY 2007 ASC payment rate under the existing ASC payment system and 50 
percent of the final CY 2008 ASC payment rate calculated under the 
proposed revised payment methodology. The CY 2008 payment for 
procedures not on the CY 2007 ASC list of covered surgical procedures, 
but for which we proposed to make payment

[[Page 42523]]

under the revised payment system beginning in CY 2008, would be made at 
the fully implemented revised ASC payment rates.
2. Alternative Option for Calculating the Proposed Budget Neutrality 
Adjustment in the August 2006 Proposed Rule
    In the August 2006 proposed rule, we presented an alternative 
approach to calculating the budget neutrality adjustment under the 
revised ASC payment system, which would take into account the effects 
of migration of procedures across ASCs, physicians' offices, and HOPDs 
that might be attributable to the revised ASC payment system (71 FR 
49657 through 49658). In the following discussion, the phrase ``new ASC 
procedure'' refers to a surgical procedure not on the CY 2007 ASC list 
of covered surgical procedures but for which we proposed to make 
payment under the revised ASC payment system beginning in CY 2008.
    Under this alternative, we assumed that 25 percent of the HOPD 
utilization for new ASC procedures would migrate to ASCs, and we also 
assumed that 15 percent of the physician's office utilization for new 
ASC procedures would migrate to ASCs in the first year of the revised 
ASC payment system. In the August 2006 proposed rule, we also noted our 
belief that our assumptions of 25 percent and 15 percent migration from 
HOPDs and physicians' offices to ASCs, respectively, were reasonable, 
given the general utilization relationships between those settings for 
services on the CY 2007 ASC list of covered surgical procedures. 
Services on the ASC list of covered surgical procedures that are 
predominantly performed in ASC and HOPD settings are, on average, 
performed 30 percent of the time in the ASC setting. Furthermore, 
services on the existing ASC list of covered surgical procedures that 
are mainly performed in ASC and physician's office settings are, on 
average, performed 17 percent of the time in the ASC setting. We 
assumed that new ASC procedures would migrate at slightly lower rates 
in the first year of the revised ASC payment system, yielding our 
migration assumptions to ASCs of 25 percent for the HOPD services and 
15 percent for the physician's office services.
    We also assumed that the net impact of migration of services on the 
existing CY 2007 ASC list of covered surgical procedures would be 
negligible. We noted that payment rates for the current highest volume 
ASC procedures would generally decrease under the proposed revised ASC 
payment system, and the lower volume ASC procedures would experience 
significant payment increases. We believed it was reasonable to assume 
that some of the higher volume services would migrate from ASCs to 
other settings, and some of the current lower volume procedures would 
migrate to the ASC setting as a result of the payment changes.
    In order to calculate the budget neutrality adjustment under this 
alternative option in the August 2006 proposed rule, first we estimated 
expenditures that would occur if we did not revise the ASC payment 
system. We estimated CY 2008 expenditures if the ASC payment rates were 
not revised and the ASC list of covered surgical procedures was not 
expanded, as described below.
a. Estimated Medicare Program Payments (Excluding Beneficiary 
Coinsurance) Under the Existing ASC Payment System in the August 2006 
Proposed Rule
    Step 1: Migration from HOPDs to ASCs was valued using estimated CY 
2008 OPPS payment rates.
    (a) We multiplied the estimated CY 2008 HOPD utilization for each 
new ASC procedure by 0.25, consistent with our assumption that 25 
percent of the HOPD utilization for new ASC procedures would migrate to 
the ASC.
    (b) For each new ASC procedure, we multiplied the results of Step 
1(a) by the estimated CY 2008 OPPS payment rate for the procedure, and 
then subtracted beneficiary coinsurance for the procedure.
    (c) We summed the results of Step 1(b) across all new ASC 
procedures.
    Step 2: Migration of procedures from physicians' offices to ASCs 
was valued using estimated CY 2008 MPFS physician in-office payment 
rates. ``Physician in-office payment rate'' was equal to the MPFS 
nonfacility practice expense RVUs multiplied by the estimated CY 2008 
MPFS conversion factor.
    (a) To estimate the payment associated with our assumption that 15 
percent of the physicians' office utilization for new ASC procedures 
would migrate to the ASC, we multiplied the projected CY 2008 
physicians' office utilization for each new ASC procedure by 0.15.
    (b) For each new ASC procedure, we multiplied the results of Step 
2(a) by the estimated CY 2008 physician in-office payment rate for the 
procedure, and then subtracted beneficiary coinsurance for the 
procedure.
    (c) We summed the results of Step 2(b) across all new ASC 
procedures.
    Step 3: CY 2007 ASC services valued using the estimated CY 2008 ASC 
payment rates under the current ASC system.
    This is described under Step 1 in the Estimated Payments under the 
Current ASC Payment System section, specifically section V.C.1.a. 
above.
    Step 4: The results of Steps 1-3 were summed.
b. Estimated Medicare Program Payments (Excluding Beneficiary 
Coinsurance) Under the Proposed Revised ASC Payment System in the 
August 2006 Proposed Rule
    Step 5: HOPD migration was valued using estimated CY 2008 OPPS 
payment rates.
    This step is the same as Step 1 in section V.C.2.a. above.
    Step 6: We identified new ASC procedures that were office-based (as 
discussed in section III.C. of this final rule).
    Step 7: Migration of new ASC office-based procedures from 
physicians' offices to ASCs was valued based on estimated CY 2008 OPPS 
payment rates capped at the estimated CY 2008 physician in-office 
payment rates, if appropriate.
    (a) For each new ASC procedure determined to be office-based, we 
multiplied the results of Step 2(a) from section V.C.2.a. above by the 
lesser of--
    (1) The estimated CY 2008 OPPS payment rate for the procedure; or
    (2) The estimated CY 2008 physician in-office payment rate for the 
procedure, and then subtracted beneficiary coinsurance for the 
procedure. (As noted in subsequent discussion in section V.C.3. of this 
final rule, we applied this adjustment for the capped office-based 
procedures after publication of the proposed rule and posted the 
results on our Web site.)
    (b) The results of Step 7(a) were summed across all new ASC 
procedures considered to be office-based.
    Step 8: Migration of new ASC procedures that were not determined to 
be office-based from physicians' offices to ASCs was valued using the 
estimated CY 2008 OPPS rates.
    (a) For each new ASC procedure not considered to be office-based, 
we multiplied the results of Step 2(a) from section V.C.2.a. above by 
the estimated CY 2008 OPPS rate for the procedure, and then subtracted 
beneficiary coinsurance for the procedure.
    (b) The results of Step 8(a) were summed across all new ASC 
procedures not considered to be office-based.
    Step 9: Migration of new ASC procedures from physicians' offices to 
ASCs was valued using the estimated CY 2008 MPFS physician out-of-
office payment rates. ``Physician out-of-office

[[Page 42524]]

payment rate'' was equal to the facility practice expense RVUs 
multiplied by the estimated CY 2008 MPFS conversion factor.
    (a) For each new ASC procedure, we multiplied the results of Step 
2(a) from section V.C.2.a. above by the estimated CY 2008 physician 
out-of-office payment rate for the procedure, and then subtracted 
beneficiary coinsurance for the procedure.
    (b) The results of Step 9(a) were summed across all new ASC 
procedures.
    Step 10: Current ASC services were valued using the estimated CY 
2008 OPPS payment rates.
    This is described under Step 2 in section V.C.1.b. above.
    Step 11: The results of Steps 5 and 7-10 were summed.
c. Calculation of the Proposed CY 2008 Budget Neutrality Adjustment in 
the August 2006 Proposed Rule
    Step 12: The result of Step 4 was divided by the result of Step 11.
    Step 13: The calculation of the budget neutrality adjustment in 
Step 12 was calibrated in a number of ways. The application of the cap 
at the estimated CY 2008 MPFS nonfacility practice expense amount that 
occurred in Step 7 was dependent on the ASC conversion factor. The ASC 
budget neutrality adjustment resulting from Step 12 was calibrated to 
take into account the effects of the physician's office payment cap on 
the ASC conversion factor. The ASC budget neutrality calculation was 
also calibrated to take into account the fact that the additional 
physician out-of-office payments under the revised ASC payment system 
calculated in Step 9 must be fully offset by the budget neutrality 
adjustment to ASC services under the revised payment system. 
Furthermore, the budget neutrality calculation was calibrated to take 
into account the CY 2008 transitional payment rates for procedures on 
the CY 2007 ASC list of covered surgical procedures.
    As reported in the August 2006 proposed rule (71 FR 49658), the 
budget neutrality adjustment calculated using this alternative option 
that incorporated CMS' migration assumptions was 0.62, indicating that 
under the migration assumptions described above there was no 
difference, rounded to the nearest hundredth, between our proposed 
budget neutrality adjustment without migration (0.62) and the 
alternative budget neutrality adjustment with migration (0.62).
d. Discussion of the Alternative Calculation of the Budget Neutrality 
Adjustment
    We chose to propose calculation of the budget neutrality adjustment 
based on the CY 2007 final ASC list of covered surgical procedures and 
the most recent available ASC utilization data because we believed this 
was the most appropriate approach to estimating expenditures to result 
in a budget neutral payment system in CY 2008. We believed that the 
data available to us did not enable us to precisely estimate the net 
potential migration of services between the ASC, outpatient hospital, 
and physician's office settings that might result from implementation 
of the revised ASC payment system. Moreover, basing our estimate of 
expenditures on current ASC utilization without including migration 
from other sites of service was consistent with how we estimate 
expenditures for purposes of establishing budget neutrality in other 
Medicare payment systems. However, we recognized, that significant 
service migration would not generally be expected to occur under these 
other payment systems and acknowledged that the potential for migration 
could be significantly greater under the revised ASC payment system, 
with a possible effect on Medicare expenditures. Our recognition of the 
uniqueness of the revised ASC payment system was the reason we 
presented the alternative with-migration budget neutrality adjustment 
calculation in the August 2006 proposed rule, so commenters would have 
the opportunity to fully examine this model, in addition to the 
traditional without-migration methodology that we proposed to use.
    Given that the revised ASC payment system includes a significant 
expansion of procedures for which ASC payment would be allowed, in 
addition to the expected service mix changes that result from the 
changes in payment incentives that accompany the introduction of any 
revised payment system, we expected that some commenters might believe 
that it would be more appropriate to estimate the ASC budget neutrality 
adjustment taking into account the potential migration of services 
between the ASC, hospital outpatient, and physician's office settings, 
consistent with the alternative with-migration model discussed in the 
August 2006 proposed rule. In that proposed rule, we explained that we 
would welcome data supporting the use of specific migration assumptions 
in the calculation of the ASC budget neutrality adjustment. We 
described the budget neutrality calculation under the alternative 
approach based on our best estimate of the potential migration of 
services between the different settings, hoping to facilitate and 
stimulate comment on migration that could occur and specifically to 
encourage the submission of pertinent quantitative evidence of service 
migration resulting from changes in payment rates. We welcomed data on 
all of the migration assumptions presented in the proposed rule 
discussion of the alternative approach. We noted that there was no 
difference between our proposed budget neutrality calculation without 
migration (0.62) and the alternative budget neutrality adjustment with 
migration (0.62), when rounded to the nearest hundredth.
    Comment: Many commenters recommended different interpretations of 
section 626(b) of Public Law 108-173. The commenters believed that CMS' 
interpretation of the law's requirement that CMS ensure the budget 
neutrality of the revised system was overly restrictive and that 
consequently, the proposed budget neutrality factor was not adequate to 
make fair ASC payments. According to the commenters' interpretations of 
the law, they believed that CMS has the clear legal authority to make 
assumptions regarding the migration of procedures between different 
sites of service, and that expenditures for all services covered by the 
ASC payment system, including beneficiary coinsurance, should be 
considered in the calculation of budget neutrality. Most of the 
commenters recommended that CMS include projected case migration across 
ASC, HOPD, and physician's office settings in its budget neutrality 
model and use total expenditures across all Medicare Part B sites of 
service, rather than limit the base solely to estimated CY 2008 
aggregate expenditures under the ASC payment system. Several commenters 
supported the use of the alternative option for calculating budget 
neutrality that incorporated the case migration assumptions as they 
were presented in the August 2006 proposed rule, with the stipulation 
that several technical corrections to fully account for the Medicare 
expenditures for all procedures that were assumed to migrate to the ASC 
would be made and that the resulting conversion factor would be 64.6 
percent. Most other commenters believed that case migration would 
certainly be one result of implementation of the revised ASC payment 
system, and that CMS' budget neutrality adjustment model should include 
recognition of those changes in sites of service and the related 
Medicare expenditures. They recommended that

[[Page 42525]]

CMS use a model like the alternative option for calculating budget 
neutrality presented in the August 2006 proposed rule and discussed 
above in this final rule, but that the specific assumptions CMS used 
should be revised as indicated in their comments.
    Response: As discussed in the August 2006 proposed rule, we were 
interested in comments from the public about our interpretation of 
budget neutrality and our proposed methodology for developing the 
budget neutrality adjustment factor for the revised ASC payment system. 
We will fully address each of the specific technical corrections (for 
example, that we account for differences in beneficiary coinsurance 
amounts in HOPD and ASC settings) and migration assumption 
modifications that were recommended by commenters in section V.C.3. of 
this final rule. At the more general level, we noted the strong 
preference among commenters for CMS to use the alternative, with-
migration methodology that would take into account the effects of 
assumed migration of cases across ambulatory sites of service that 
could result from the payment changes associated with the revised ASC 
payment system. The August 2006 proposal reflected our belief that 
adoption of the without-migration model was more appropriate than the 
alternative with-migration model that was also discussed. In the 
proposal, we explained that basing our estimate of expenditures on 
current utilization without including migration from other sites of 
services was consistent with how we estimate expenditures for purposes 
of maintaining budget neutrality in other Medicare payment systems. We 
realized that the influx of newly covered procedures was unique to our 
proposal for the revised ASC payment system, but because the budget 
neutrality adjustment that resulted from both models in the August 2006 
proposed rule was the same and data to determine estimates of potential 
case migration were limited, we adopted the without-migration model in 
our proposal, consistent with our previous modeling to ensure that our 
payment systems are budget neutral.
    We agree with commenters that the flexibility to include migration 
assumptions in our calculation of budget neutrality for the revised ASC 
payment system is provided by the statute. Furthermore, our review of 
the extensive comments on the August 2006 proposed rule led to our 
conclusion in this final rule that the significant expansion of ASC 
covered surgical procedures proposed as part of the revised system is 
not only a unique aspect of the revised ASC payment system, but that 
its effects on ASC expenditures may be substantial. An influx of new 
covered services has not been a factor in developing the budget 
neutrality adjustment factors for our other prospective payment 
systems. The scope of services in other payment systems does not change 
significantly from one year to the next, as does the ASC scope of 
services between CYs 2007 and 2008 in the context of our final policies 
for the revised ASC payment system, as discussed in sections III. and 
IV. of this final rule.
    In view of our belief that the revised ASC payment system is unique 
because of the significant expansion of covered surgical procedures and 
covered ancillary services to be paid under the revised ASC payment 
system, we conclude that including estimates of case migration of the 
new procedures, as well as the existing ASC covered surgical 
procedures, is the most accurate method for developing the budget 
neutrality adjustment in this case. After reviewing all of the public 
comments and reexamining the available data, we believe that there is 
sufficient evidence to indicate that adoption of a with-migration 
methodology for calculating the budget neutrality adjustment for the 
revised ASC payment system is appropriate. Thus, we have determined 
that it would be prudent, and more accurate, to adopt a with-migration 
budget neutrality estimation methodology, in order to take into account 
the effects of the migration of procedures between ASCs, physicians' 
offices, and HOPDs that might be attributable to the revised ASC 
payment system. While the budget neutrality estimation methodology that 
takes into account migration increases the complexity associated with 
establishing the budget neutrality adjustment, we believe that its 
application provides us with the most reasonable approach to 
establishing payment rates under the revised ASC payment system in 
order to assist in ensuring continued access to current ASC procedures 
and expanded access to new surgical procedures for Medicare 
beneficiaries in ASCs.
    Although we are convinced that the with-migration model is more 
appropriate for calculating the final budget neutrality adjustment 
factor for the revised ASC payment system, we calculated the budget 
neutrality adjustment for this final rule using both with-migration and 
without-migration models, as we had for the August 2006 proposed rule. 
However, in contrast to the results of our work for that proposed rule, 
where application of either model resulted in the same adjustment 
factor, the budget neutrality factors that resulted from application of 
the two methods for this final rule were different. The adjustment 
factor that resulted from application of our proposed model that did 
not consider migration was 0.64, while the with-migration model 
resulted in a 0.67 budget neutrality adjustment factor. For a full 
discussion of the calculation of the final budget neutrality adjustment 
factor, we refer readers to section V.C.3. of this final rule.
    Comment: Several commenters agreed with the use of a blended rate 
for CY 2008 to calculate budget neutrality for the revised ASC payment 
system, based on the proposal for a 2-year transition to the fully 
implemented revised payment system. They believed this use of 
discretion was an appropriate interpretation of the legislation and 
produced the most reasonable result. They believed that, because the 
proposed CY 2008 rates were a 50/50 blend of the CY 2007 ASC rate and 
the estimated CY 2008 ASC rate calculated according to the methodology 
of the proposed revised ASC payment system, the ASC payment system 
would have increased expenditures in CY 2009 unless migration patterns 
differed from the assumptions discussed in the proposed rule regarding 
the alternative calculation of the budget neutrality adjustment. These 
commenters concluded that the increased expenditures that would result 
from our adoption of their recommendation to utilize a modification of 
the alternative calculation of the proposed budget neutrality 
adjustment were expected, appropriate, and consistent with the budget 
neutrality provision of section 626(b) of Public Law 108-173 for the 
revised ASC payment system.
    Response: We agree with commenters that the migration assumptions 
influence the relationship between estimated expenditures under the 
current ASC system and the revised ASC payment system over time. As 
noted elsewhere in sections IV.J. and V.C.4 of this final rule, we have 
extended the transition period for payment of services on the CY 2007 
ASC list of covered surgical procedures and have also modified our 
migration assumptions to reflect migration over a more extended time 
period than was reflected in our discussion of the alternative option 
for calculating the budget neutrality adjustment in the August 2006 
proposed rule. As described in section X. of this final rule, we 
estimate that, over time, the expenditures under the revised ASC system 
using our final migration assumptions would be slightly less than

[[Page 42526]]

the expenditures that would occur if we did not revise the system.
3. Calculation of the Estimated CY 2008 Budget Neutrality Adjustment 
According to the Final Policy
    In the August 2006 proposed rule, and as discussed earlier in this 
section of the final rule, we described two methodologies for 
determining the budget neutrality adjustment under the revised ASC 
payment system that could then be used to establish the ASC conversion 
factor for CY 2008 (71 FR 49656 through 49658). We proposed that, under 
the standard methodology of the revised ASC payment system, the ASC 
conversion factor would be multiplied by the ASC payment weight for 
each covered surgical procedure to determine the procedure's CY 2008 
ASC payment rate. As discussed in detail in section IV.C. of this final 
rule, our final policy will also provide separate payment for covered 
ancillary services under the revised ASC payment system. While the 
payment rates for separately payable drugs and biologicals, 
brachytherapy sources, corneal tissue acquisition, and implantable 
devices with OPPS pass-through status that are covered ancillary 
services, along with the device portion of ASC payment for device-
intensive covered surgical procedures, will be determined without 
application of the ASC conversion factor, the final standard 
methodology of the revised ASC payment system will apply the ASC 
conversion factor to ASC payment weights to calculate the fully 
implemented payment rates for covered surgical procedures and covered 
ancillary radiology services. We received a number of general and 
specific comments on our proposal for calculating the CY 2008 ASC 
payment rates under the revised ASC payment system.
    Comment: There was general agreement among the commenters that, in 
the absence of cost data for surgical procedures performed in ASCs, 
CMS' proposal to base the revised ASC payment system on the OPPS APC 
groups and their relative payment weights was sound policy that could 
reasonably be expected to result in accurate ASC payments for most 
procedures. Further, the commenters generally agreed that ASC facility 
costs are lower than the HOPD costs for providing the same surgical 
services. The commenters gave specific examples of the reasons why 
higher costs are incurred by hospitals, including the requirement that 
HOPDs satisfy quality and safety standards that are not applied to 
ASCs; the fact that hospitals' resources are available 24 hours a day, 
7 days a week; Emergency Medical Treatment and Labor Act of 1986-
related (EMTALA-related) requirements; treatment of a more acutely ill 
population with greater comorbidities; and higher uncompensated care 
rates. Moreover, those commenters cited MedPAC's findings reported in 
2003 and 2004 that hospitals probably incur higher costs than ASCs for 
providing similar procedures, because HOPDs are subject to additional 
regulatory requirements which are likely to increase their overhead 
costs, and HOPDs also treat patients who are more medically complex.
    Beyond these points, the commenters diverged on their opinions 
about the accuracy and appropriateness of the proposed conversion 
factor, as discussed in detail below.
    Response: We appreciate the commenters' general support of our 
proposal to base payment under the revised ASC payment system on the 
OPPS relative payment weights and the APC groups. These comments were 
consistent with the recommendation of the GAO (GAO-07-86) that CMS 
should implement a payment system for procedures performed in ASCs 
based on the OPPS, taking into account the lower relative costs of 
procedures performed in ASCs compared to HOPDs. For further discussion 
of this subject, as well as a summary of additional public comments and 
our responses, we refer readers to section IV.B. of this final rule.
    Comment: Several commenters specifically recommended that CMS adopt 
75 percent as the multiplier to the OPPS conversion factor, so that 
payment rates under the revised ASC payment system would be 75 percent 
of the OPPS rates. They cited legislation that was introduced in the 
U.S. Senate in 2003 in which payments to ASCs were to have been 
provided at 75 percent of the OPPS rates. The proponents of that 
proposed legislation believed that, by using a 75 percent factor to 
reduce OPPS rates in order to provide payment for ASCs to perform 
procedures, Medicare would save 25 cents for every dollar spent for 
procedures performed in the ASC setting instead of the HOPD.
    Several commenters also believed that, because ASC rates have been 
frozen since 2003 while OPPS rates have been increased annually for 
inflation, an unfair differential in payments between the two payment 
systems has grown over the past several years. These commenters argued 
that by calculating budget neutrality for the revised ASC payment 
system using the static ASC rates in comparison with annually updated 
OPPS rates, CMS proposed an inappropriately low budget neutrality 
adjustment factor. They were convinced that, if CMS had implemented the 
revised ASC payment system immediately after Congress passed Public Law 
108-173 in 2003, before the differential between the payment rates for 
the two systems increased due to the continued freeze on ASC rates, the 
budget neutrality adjustment for the revised payment system would have 
been close to 85 percent, rather than 62 percent as CMS proposed for 
the revised payment system to be implemented in CY 2008. Other 
commenters, noting that Congress gave CMS the authority to implement 
the revised payment system between CY 2006 and CY 2008, expressed their 
belief that, had CMS implemented the revised ASC payment system in an 
earlier year, the budget neutrality adjustment would have been at least 
8 percent higher than the 62 percent that was proposed.
    Response: We see no rationale for estimating the budget neutrality 
adjustment by comparing existing ASC payment system rates with OPPS 
rates from an earlier calendar year, prior to implementation of the 
revised ASC payment system. Congress provided CMS with the latitude to 
implement the revised ASC payment system beginning on or after January 
1, 2006, and not later than January 1, 2008. We believe that the 
statute provides direction that the revised ASC payment system is to be 
budget neutral in its design in order to result in the same aggregate 
expenditures for services as would be made if the provisions of the 
revised ASC payment system did not apply, that the ASC conversion 
factor is not to be updated before CY 2010, and that implementation of 
the revised system by January 1, 2008 is timely. There is no evidence 
that Congress intended for CMS to attempt to maintain the relationship 
between OPPS payment rates and ASC payments that existed at the time of 
enactment of Public Law 108-173 (CY 2003) in the development of the 
revised ASC payment system. We also see no rationale for adopting an 
arbitrary multiplier, such as 75 percent of OPPS payment rates, that is 
not founded on explicit consideration of budget neutrality as required 
by the statute.
    We received many public comments in response to our proposed budget 
neutrality adjustment factor. A number of commenters included seven 
specific recommendations, three of which were related to the migration 
assumptions discussed as an alternative option for calculating the 
budget neutrality adjustment in the proposed rule. The

[[Page 42527]]

other four were technical in nature and related to our proposed budget 
neutrality model. A summary of the comments and our responses follow, 
beginning with the four recommended technical modifications to our 
proposed methodology, followed by the three migration assumption 
recommendations.
    Comment: One of the recommended technical modifications was that, 
instead of basing ASC payments on CY 2007 rates for all procedures on 
the CY 2007 ASC list of covered surgical procedures, CMS should use the 
payment amounts that would be made in CY 2008 in the absence of the 
revised payment system for those ASC procedures whose payments are 
capped in CY 2007 due to section 5103 of Public Law 109-171. The 
commenters believed that using the lower CY 2007 rates for ASC 
procedures capped by section 5103 of Public Law 109-171 was an unfair 
representation of estimated ASC payments under the existing payment 
system in CY 2008. Their rationale was that, if the revised ASC system 
were not implemented in CY 2008, the payments for those services under 
the policy of the existing ASC payment system would increase in CY 
2008, consistent with the overall projected increase in OPPS rates of 4 
percent. The commenters expected that incorporation of this adjustment 
would result in a 0.11 percentage point increase to the budget 
neutrality adjustment.
    Response: We do not agree that the ASC rates for these specific 
services would necessarily increase consistent with an overall increase 
in OPPS rates for CY 2008. Through the annual update of the OPPS, while 
the aggregate spending is generally projected to increase in the 
update, the specific payments for individual services may rise or fall 
from year to year based on a variety of factors, including APC 
recalibration. Because the ASC procedures that are capped at the OPPS 
rates in CY 2007 are a small subset of all OPPS services, we are unable 
to project that their rates would be subject to a 4 percent increase, 
or indeed any increase, as suggested by the commenters. In addition, we 
believe that Congress intended for the revised ASC payment system rates 
and budget neutrality to be related to the estimated aggregate 
expenditures for ASC services based on ASC payment rates from the year 
prior to implementation of the revised system. Congress mandated that 
the revised ASC system be budget neutral and be implemented by CY 2008. 
It also set ASC updates to zero percent for the calendar years through 
2009. We believe all of those actions, in combination, provide clear 
indication that Congress did not intend for estimates of aggregate 
expenditures under the existing ASC payment system to take into account 
updated ASC payment rates for CY 2008. The limitations on ASC payments 
prior to implementation of the revised ASC payment system, specifically 
both section 626 of Public Law 108-173 that specifies that ASC rates 
would not be updated before CY 2010 and, further, the limit on ASC 
payment at the lesser of the OPPS or ASC rate, as required in section 
5103 of Public Law 109-171 that extends until implementation of the 
revised ASC payment system, provide clear evidence that the CY 2007 ASC 
rates for covered procedures are to be used in developing the budget 
neutrality adjustment for the revised payment system. We continue to 
believe, for the purposes of this final rule, that the most appropriate 
course for calculation of the budget neutrality adjustment, consistent 
with our proposal, is to estimate that the CY 2008 rates for the ASC 
procedures subject to the cap set forth in section 5103 of Public Law 
109-171 in CY 2007 will be the same as their CY 2007 rates.
    Comment: Some commenters stated that, in CMS' calculation of 
estimated ASC payments under the existing ASC payment system for 
comparison to payments under the proposed methodology for the revised 
ASC payment system, CMS did not include payments for the costs of 
implantable prosthetic devices that are currently separately paid to 
ASCs under the DMEPOS fee schedule. The commenters recommended that CMS 
include the amount paid to ASCs to cover the costs of separately 
payable implantable prosthetics and DME under the DMEPOS fee schedule 
to avoid understating Medicare's current full cost related to the 
surgical implantation procedures. The commenters believed that 
inclusion of those payments would increase the budget neutrality 
adjustment by 0.41 percentage points.
    Response: We agree with the commenters that the payments to ASCs 
for the implantable prosthetic devices and DME should be included in 
estimating total ASC payments for CY 2008 under the policies of the 
existing ASC payment system. In fact, we did include those payments in 
our proposed budget neutrality adjustment calculation, but we failed to 
explicitly state that in our explanation in the August 2006 proposed 
rule. Therefore, the effect of including those payments was reflected 
in the budget neutrality adjustment that we proposed. We have also 
included these payments in our calculation of the budget neutrality 
adjustment for this final rule.
    Comment: Several commenters believed that, although CMS accounted 
for the 20 percent beneficiary coinsurance in ASCs by discounting by 20 
percent all of the payment rates used to estimate the CY 2008 payments 
under the existing ASC system and under the proposed methodology of the 
revised ASC payment system, CMS did not appropriately account for 
beneficiary coinsurance associated with the new ASC office-based 
procedures for which payment was proposed to be limited to the MPFS 
unadjusted nonfacility practice expense amount. They believed that CMS 
should apply the 20 percent discount to those procedures because that 
approach would more accurately and consistently reflect the Medicare 
program costs, and they concluded that this change would increase the 
budget neutrality adjustment by 0.43 percentage points.
    Response: While we did not apply this discount to payment rates for 
the capped office-based procedures newly proposed for ASC payment in CY 
2008 in our calculation of the proposed budget neutrality adjustment, 
we agree with this recommendation. Recognizing those lower costs to the 
Medicare program, consistent with our calculation of program costs 
under the existing ASC payment system and the standard methodology of 
the revised ASC payment system, would be more accurate. Soon after 
publication of the August 2006 proposed rule, we discovered this 
oversight, made the appropriate adjustments to the data, and posted the 
revised data on our Web site (http://www.cms.hhs.gov/ASCPayment).
    Comment: Commenters noted that CMS did not account for the variable 
copayment amounts associated with procedures under the OPPS for 
purposes of establishing the budget neutrality adjustment under the 
revised ASC payment system. The beneficiary copayment under the OPPS 
varies from 20 to 40 percent of the payment rate, depending on the 
procedure, whereas the coinsurance under the ASC payment system is 20 
percent for all procedures. The commenters believed that as a result of 
not considering the sometimes much higher copayments under the OPPS, 
CMS artificially inflated Medicare's estimated payments under the 
proposed methodology of the revised ASC payment system. They believed 
that accurately accounting for the OPPS copayments would increase the 
budget neutrality adjustment by 1.04 percentage points.
    Response: We agree with the commenters regarding this

[[Page 42528]]

recommendation. We did not apply the variable OPPS copayment amounts in 
the model that was proposed. However, soon after publication of the 
August 2006 proposed rule, we discovered this oversight, made the 
appropriate adjustments to the data, and posted the revised data on our 
Web site (http://www.cms.hhs.gov/ASCPayment).
    After considering the first four technical recommendations of many 
commenters and making the two technical adjustments as described above, 
the resulting increase in the proposed budget neutrality adjustment was 
approximately 2.6 percentage points. We have applied these same two 
technical adjustments in our calculation of the budget neutrality 
adjustment for this final rule. In addition, we made another technical 
change in this final rule by taking the multiple procedure discount 
into account in our estimates of ASC, OPPS, and MPFS expenditures both 
before and after implementation of the revised ASC payment system. We 
factored the multiple procedure discount into our estimates of ASC, 
OPPS, and MPFS spending under the existing and revised ASC payment 
systems. We assumed that the pattern of multiple surgical procedures 
furnished in ASCs and physicians' offices would be similar to the 
pattern in HOPDs. Based on claims data indicating the prevalence of 
multiple procedures in HOPDs, we estimated the percentage of discounted 
units to total units for each procedure and then reduced the volume for 
those procedures prior to estimating expenditures in each year. We 
incorporated this reduction into our estimates of Medicare expenditures 
under the ASC, OPPS, and MPFS payment systems both before and after 
implementation of the revised ASC payment system. We had not factored 
the multiple procedure discount into the August 2006 proposed rule 
estimates.
    The final three recommendations by commenters that were related to 
the migration assumptions used in the alternative option for 
calculating the budget neutrality adjustment presented in the August 
2006 proposed rule are discussed below.
    Comment: Many commenters believed that the alternative method for 
calculating the budget neutrality adjustment that CMS discussed in the 
August 2006 proposed rule described a preferable and superior method 
for developing the budget neutrality adjustment for the revised ASC 
payment system. They believed that developing and applying some 
assumptions to account for the migration of services and their payment 
across Medicare Part B sites of care would be the most appropriate 
method for ensuring budget neutrality. However, they recommended that 
CMS revise some of the assumptions regarding migration that were 
described in that proposed rule.
    The first of their recommendations in this regard was that CMS use 
a much lower migration assumption of 2 percent for new ASC procedures 
migrating from physicians' offices to ASCs. They were convinced that 
CMS' assumption in the proposed rule that 15 percent of the current 
office utilization of new ASC procedures would migrate to ASCs was far 
greater than would be possible. They stated that ASCs do not have the 
capacity to absorb that level of services. Furthermore, they explained 
that ASCs have found that, once physicians acquire the equipment and 
resources to provide a procedure in their offices, they prefer to 
perform it there. The commenters believed that physicians only 
typically perform procedures in an ASC or HOPD setting when there is a 
particular patient need that requires the facility setting. They argued 
that by allowing the new ASC procedures to receive payment in ASCs, CMS 
would realize savings because cases could be moved from the office to 
an ASC instead of to the more costly HOPD setting when the physician 
determines that relocation of the service is preferable for a 
particular beneficiary.
    Furthermore, the commenters stated that ASCs would not only be 
overwhelmed by the volume of cases CMS assumed would migrate to that 
setting, but that ASCs would not welcome the influx of low paying, 
minor procedures that could generally be performed in physicians' 
offices over the more complex, higher paying procedures that ASCs are 
accustomed to providing in the more efficient and intensive facility 
setting. The commenters believed that adjusting the assumption for 
migration of new ASC procedures from physicians' offices to ASCs to 2 
percent of the cases would be more appropriate and would result in a 
3.11 percentage point increase in the budget neutrality adjustment.
    In addition, the commenters believed that CMS did not accurately 
adjust for the likely negative migration of cases involving procedures 
paid under the existing ASC payment system out of ASCs and into more 
costly HOPDs under the proposal for the revised payment system. They 
developed a model that they believed would more correctly predict the 
migration of procedures out of ASCs and into HOPDs based on the 
magnitude of the procedure's proposed payment rate decrease. In that 
model, the commenters assumed that for every 10 percent decrease in a 
procedure's ASC payment rate from the existing to the revised payment 
system, 1.5 percent of the ASC volume would migrate to HOPDs. They 
believed that CMS' application of this adjustment would result in a 
0.51 percentage point decrease to the budget neutrality adjustment.
    They also recommended that CMS account for the positive migration 
of existing ASC covered procedures from HOPDs to ASCs by assuming that 
for every 10 percent increase in a procedure's ASC payment rate under 
the proposal for the revised ASC payment system, 1.5 percent of the 
HOPD volume would migrate to ASCs, up to a maximum of 25 percent of the 
procedure's current HOPD volume. Furthermore, commenters suggested that 
ASC capacity would limit movement of these procedures to no more than 
25 percent of each procedure's existing ASC volume. The commenters 
believed that, although ASCs have significant excess capacity, as 
confirmed by a CY 2006 industry study that showed that only about one 
quarter of ASCs were operating above 60 percent operating room 
capacity, they could not absorb more than 25 percent of the HOPD volume 
for all ASC procedures for which payment was expected to increase under 
the proposed revised payment system. They explained that application of 
their assumption would result in a 5.57 percentage point increase in 
the budget neutrality adjustment.
    Response: We appreciate the extensive comments we received 
regarding the appropriate migration assumptions to be applied in 
determining the budget neutrality adjustment for the revised ASC 
payment system. While commenters provided a number of suggestions 
regarding migration assumptions for both the procedures on the CY 2007 
ASC list of covered surgical procedures and new ASC procedures, they 
did not provide data supporting all of the specific assumptions 
regarding the relationship between expected service migration and 
changes in payment rates that they recommended we adopt along with 
their other migration assumptions. However, as stated above, we are 
adopting a with-migration model for calculation of the final budget 
neutrality adjustment factor because we believe that it is more 
accurate than the without-migration model that we proposed that does 
not consider the migration of new procedures across sites of service, 
but we did not adopt the assumptions recommended by some commenters.

[[Page 42529]]

    The CMS Office of the Actuary (OACT) developed the assumptions 
utilized in the final budget neutrality model. With respect to current 
ASC covered surgical procedures paid under the existing ASC payment 
system, we did not accept the recommendation by commenters that we 
should assume that negative migration, that is, movement of existing 
ASC covered procedures out of ASCs and into the higher cost HOPD 
setting, would have an effect on our budget neutrality adjustment that 
is not equal to the effect of positive migration of cases from other 
settings into ASCs. Rather, in this final rule, after reviewing 
information provided by commenters and reevaluating current site-of-
service utilization patterns for exiting and new ASC procedures, we are 
assuming that the effect on budget neutrality due to movement of cases 
involving existing ASC procedures out of ASCs will be balanced by 
movement of additional cases involving existing ASC procedures into 
ASCs. We believe that it is reasonable to assume that the payment 
increases for many currently low volume ASC procedures will result in 
higher ASC volumes for those procedures under the revised ASC payment 
system. Moreover, we believe that this anticipated positive migration 
of those procedures will balance the estimated negative migration of 
the high volume ASC procedures for which payment will decrease. Our 
actuaries project that the net budgetary effect of migration into and 
out of ASCs for procedures currently on the ASC list of covered 
surgical procedures will be negligible.
    Consistent with our assumption for the alternative budget 
neutrality adjustment model discussed in the August 2006 proposed rule, 
under the final methodology for the revised ASC payment system, we 
assume that 25 percent of the current HOPD volume of new ASC procedures 
would ultimately migrate from HOPDs to ASCs. However, taking into 
consideration the final, longer 4-year transition period to the fully 
implemented payment weights of the revised ASC payment system and the 
final modifications to several aspects of the proposed payment policy 
as discussed in this preamble, for this final rule, we assume that the 
25 percent case migration would occur more gradually, over the first 2 
years of the transition, instead of all in the first year. We believe 
the migration would occur over the first 2 years of the 4-year 
transition, as the ASC industry adapts to the revised ASC payment 
system and the significant expansion of covered surgical procedures 
described in this final rule. We agree with commenters that the level 
of migration in a single year, as discussed in our presentation of the 
with-migration budget neutrality adjustment model in the August 2006 
proposed rule, would be difficult for ASCs to accommodate in a single 
year, but we believe, based on current ASC and HOPD utilization and ASC 
industry information, that the 25 percent case migration over 2 years 
is most likely.
    We believe that our assumption of 25 percent migration of current 
HOPD volume for new ASC procedures is reasonable, given the general 
utilization relationships between ASCs and HOPDs for services as 
discussed in section V.C.2. above. We also note that commenters 
generally did not disagree with our proposed HOPD migration assumption 
for the new ASC procedures. As discussed in the August 2006 proposed 
rule (71 FR 49657), services on the ASC list of covered surgical 
procedures that are predominantly performed in ASC and HOPD settings 
are, on average, performed 30 percent of the time in the ASC setting. 
Thus, for calculation of the budget neutrality adjustment according to 
the final policy of this final rule, we assume that new ASC procedures 
would migrate at the slightly slower rate of 25 percent over the first 
2 years of the 4-year transition, reflecting their movement toward the 
general 30-percent site-of-service utilization pattern currently 
observed for ASC covered surgical procedures as ASCs transition to the 
revised ASC payment system.
    Our assumed 25 percent migration of new ASC procedures from HOPDs 
to ASCs differs considerably from the commenters' recommended positive 
migration assumptions, because the commenters' model included all 
current ASC procedures and applied a formula linking the magnitude of 
ASC payment changes under the revised ASC payment system to the 
expected volume of migration. Given that the commenters based their 
estimate for this assumption on existing ASC procedures, they used 25 
percent of current HOPD volume as the upper limit for migration from 
HOPDs to ASCs, the same assumption we used for the migration of new ASC 
procedures in CY 2008. However, because they believed that ASC capacity 
would ultimately limit procedure movement, they also limited the 
movement to 25 percent of the existing ASC volume for those procedures. 
Our actuaries determined migration assumptions separately for existing 
ASC covered procedures and new ASC procedures. As mentioned earlier, 
the net effect of migration of existing procedures into and out of ASCs 
is assumed to be negligible. For the new ASC procedures, it is assumed 
that 25 percent of the current HOPD volume will migrate to ASCs during 
the first 2 years of the revised ASC payment system.
    The commenters assumed some negative migration of existing ASC 
covered procedures from ASCs to HOPDs in response to price changes 
under the revised ASC payment system, based on a relationship between a 
procedure's decrease in ASC payment and its volume of migration. 
However, as discussed above, we also believe that we have adequately 
accounted for the expected migration of procedures currently covered in 
ASCs from the ASC to the HOPD setting under the revised ASC payment 
system.
    Finally, the commenters' recommendation that we assume much less 
migration from physicians' offices to ASCs for new ASC procedures due 
to ASC capacity limitations led us to reconsider our earlier assumption 
articulated in the August 2006 proposed rule for the alternative model 
to calculate the budget neutrality adjustment. Thus, for this final 
rule, although the actuaries' assumption is that 15 percent of the 
physicians' office volume of new ASC procedures may eventually be 
expected to move into ASCs, they did take into consideration the 
commenters' argument that such a level of migration could not be fully 
accommodated by ASCs in CY 2008. Therefore, in our final policy we 
assume that the migration of these currently office-based cases would 
occur more gradually, with an additional one quarter of the total 
migration occurring in each year of the full 4-year transition period. 
Thus, we expect that only 3.75 percent of the office utilization of new 
ASC procedures would migrate to ASCs in CY 2008, followed by an 
additional quarter of new cases in each subsequent year, reaching the 
full 15 percent by the end of the transition period to the fully 
implemented revised ASC payment rates. Given the current 17 percent ASC 
utilization of procedures that are predominantly performed in 
physicians' offices and ASCs that are on the existing ASC list of 
covered surgical procedures, we see no reason to assume that only 2 
percent of the current office volume for new ASC procedures would 
migrate to ASCs, as suggested by some commenters. Instead, we believe 
the eventual utilization data for those procedures would most likely 
resemble the site-of-service utilization for procedures predominantly 
performed in ASC and physician's office settings that are currently 
paid in ASCs. Our

[[Page 42530]]

assumption of 15 percent is slightly lower than the current pattern of 
17 percent ASC utilization, consistent with our expectation that 
migration of the broad array of new ASC procedures would result in 
slightly lower ASC utilization in 4 years than the currently observed 
pattern for procedures on the CY 2007 ASC list of covered surgical 
procedures that are predominantly performed in physicians' offices and 
ASCs.
    In addition, in the context of developing the budget neutrality 
adjustment for the revised ASC payment system under the with-migration 
model, the actuaries took into consideration the final payment policies 
of the revised ASC payment system. These include the final changes to 
the payment rate calculations for device-intensive procedures, as well 
as the separate payment for covered ancillary services. While specific 
current and projected ASC utilization of covered ancillary services is 
difficult to estimate, in establishing the final budget neutrality 
adjustment, the actuaries took into account the findings of the GAO 
that payment for many of these ancillary services is currently provided 
to other Medicare Part B suppliers under the existing ASC payment 
system, and that most drugs and biologicals utilized with current ASC 
procedures do not receive separate payment under the OPPS.
    In summary, since our discussion of the alternative model for 
calculating the budget neutrality adjustment presented in the August 
2006 proposed rule for the revised ASC payment system, the actuaries 
have continued to refine the assumptions and estimates related to the 
with-migration budget neutrality model to take into account policy 
decisions made in this final rule, additional research, information 
from industry experts, and public comments. Application of our final 
revised migration assumptions, along with changes to the OPPS rates, 
MPFS rates, and updated utilization data, as well as the final payment 
policies for the revised ASC payment system, taken together result in 
an estimated budget neutrality adjustment of 0.67. The estimated budget 
neutrality adjustment of 0.67 in this July 2007 final rule for the 
revised ASC payment system is based on the CY 2007 OPPS relative 
payment weights, with an estimated update factor for CY 2008, the CY 
2007 MPFS PE RVUs trended forward to CY 2008, and CY 2005 utilization 
data projected forward to CY 2008. It is important to note that the 
budget neutrality estimate in this final rule is illustrative only. The 
CY 2008 ASC budget neutrality adjustment will be proposed in the CY 
2008 OPPS/ASC proposed rule based on the methodology for calculating 
budget neutrality established in this final rule and incorporating the 
proposed CY 2008 OPPS relative payment weights, the proposed CY 2008 
MPFS PE RVUs, and CY 2006 utilization information projected forward to 
CY 2008. The final CY 2008 ASC budget neutrality adjustment will be 
established in the CY 2008 OPPS/ASC final rule with comment period. The 
final CY 2008 ASC budget neutrality factor will be calculated in that 
rule in accord with the methodology for calculating budget neutrality 
established in this July 2007 final rule and based on the final CY 2008 
OPPS relative payment weights, the final CY 2008 MPFS PE RVUs, and 
updated CY 2006 utilization data projected forward to CY 2008.
4. Final Calculation of the Estimated ASC Payment Rates for CY 2008
    The following is a step-by-step illustration of the final budget 
neutrality adjustment calculation.
a. Estimated CY 2008 Medicare Program Payments (Excluding Beneficiary 
Coinsurance) Under the Existing ASC Payment System
    Step 1: Migration from HOPDs to ASCs is valued using estimated CY 
2008 OPPS payment rates.
    (a) We multiply the estimated CY 2008 HOPD utilization for each new 
ASC procedure by 0.125, consistent with our assumption that 25 percent 
of the HOPD utilization for new ASC procedures will migrate to the ASC 
over the first 2 years of the revised ASC payment system, only half of 
which would be in CY 2008. In estimating HOPD utilization for CY 2008, 
we take into account the impact of the multiple procedure discount (as 
discussed in more detail in section V.C.3. of this final rule).
    (b) For each new ASC procedure, we multiply the results of Step 
1(a) by the estimated CY 2008 OPPS payment rate for the procedure, and 
then subtract beneficiary coinsurance for the procedure.
    (c) We sum the results of Step 1(b) across all new ASC procedures.
    Step 2: Migration of procedures from physicians' offices to ASCs is 
valued using estimated CY 2008 physician in-office payment rates. 
``Physician in-office payment rate'' is equal to the MPFS nonfacility 
practice expense RVUs multiplied by the estimated CY 2008 MPFS 
conversion factor.
    (a) We multiply the estimated physician office utilization for CY 
2008 for each new ASC procedure by 0.0375, consistent with our 
assumption that 15 percent of the physician's office utilization for 
new ASC procedures will migrate to the ASC over the full 4-year 
transition period.
    (b) For each new ASC procedure, we multiply the results of Step 
2(a) by the estimated CY 2008 physician in-office payment rate for the 
procedure, and then subtract beneficiary coinsurance for the procedure.
    (c) We sum the results of Step 2(b) across all new ASC procedures.
    Step 3: CY 2007 ASC services are valued using the estimated CY 2008 
ASC payment rates under the current ASC system.
    To estimate the aggregate expenditures that would be made in CY 
2008 under the existing ASC payment system:
    (a) We multiply the estimated CY 2008 ASC utilization for each 
HCPCS code on the CY 2007 ASC list by the estimated CY 2008 ASC payment 
rate for the HCPCS code under the existing ASC payment system, and then 
subtract beneficiary coinsurance for the procedure. The estimated CY 
2008 ASC payment rates are based on the CY 2007 ASC payment rates, 
which were listed in Addendum AA to the CY 2007 OPPS/ASC final rule 
with comment period and take into account the OPPS cap on payment for 
ASC services as required by section 5103 of Public Law 109-171 and 
reflect the zero percent CY 2008 update for ASC services mandated by 
section 1833(i)(2)(C) of the Act. In estimating ASC utilization for CY 
2008, we take into account the impact of the multiple procedure 
discount (as discussed in section V.C.3. of this final rule).
    (b) We estimate the amount the Medicare program would pay in CY 
2008 for implantable prosthetic devices and implantable DME for which 
ASCs currently receive separate payment under the DMEPOS fee schedule.
    (c) We sum the results of Steps 3(a) and 3(b) to estimate the 
aggregate amount of expenditures that would be made in CY 2008 for 
current covered surgical procedures under the existing ASC payment 
system.
    Step 4: Sum the results of Steps 1-3.
b. Estimated Medicare Program Payments (Excluding Beneficiary 
Coinsurance) Under the Revised ASC Payment System
    Step 5: HOPD migration is valued using estimated CY 2008 OPPS 
payment rates.
    This step is the same as Step 1, above.
    Step 6: We identify new ASC procedures that are office-based (as 
discussed in section III.C. of this final rule).

[[Page 42531]]

    Step 7: Migration of new ASC office-based procedures from 
physicians' offices to ASCs is valued based on estimated CY 2008 OPPS 
payment rates capped at the estimated CY 2008 physician in-office 
payment rates, if appropriate.
    (a) For each new ASC procedure determined to be office-based, we 
multiply the results of Step 2(a) above by the lesser of--
    (1) The estimated CY 2008 OPPS rate for the procedure; or
    (2) The estimated CY 2008 physician in-office payment rate for the 
procedure, and then subtract beneficiary coinsurance for the procedure.
    (b) The results of Step 7(a) are summed across all new ASC 
procedures considered to be office-based.
    Step 8: Migration of new ASC procedures not determined to be 
office-based from physicians' offices to ASCs is valued using the 
estimated CY 2008 OPPS rates.
    (a) For each new ASC procedure not considered to be office-based, 
we multiply the results of Step 2(a) above by the estimated CY 2008 
OPPS rate for the procedure, and then subtract beneficiary coinsurance 
for the procedure.
    (b) The results of Step 8(a) are summed across all new ASC 
procedures not considered to be office-based.
    Step 9: Migration of new ASC procedures from physicians' offices to 
ASCs is valued using the estimated CY 2008 MPFS physician out-of-office 
payment rate. ``Physician out-of-office payment rate'' is equal to the 
facility practice expense RVUs multiplied by the estimated CY 2008 MFPS 
conversion factor.
    (a) For each new ASC procedure, we multiply the results of Step 
2(a) from above by the estimated CY 2008 physician out-of-office 
payment rate for the procedure, and then subtract beneficiary 
coinsurance for the procedure.
    (b) The results of Step 9(a) are summed across all new ASC 
procedures.
    Step 10: Current ASC services are valued using the estimated CY 
2008 OPPS payment rates.
    To estimate the aggregate amount of expenditures that would be made 
in CY 2008, we use estimated CY 2008 OPPS payment amounts instead of 
estimated CY 2008 ASC payment amounts under the current system, and we 
multiply the estimated CY 2008 ASC volume for each HCPCS code on the CY 
2007 ASC list by the estimated CY 2008 OPPS payment rate for the HCPCS 
code, and then subtract beneficiary coinsurance for the procedure. We 
sum the results over all services on that ASC list.
    Step 11: The results of Steps 5 and 7-10 are summed.
c. Calculation of the Final Estimated CY 2008 Budget Neutrality 
Adjustment
    Step 12: The result of Step 4 is divided by the result of Step 11.
    Step 13: The application of the cap at the estimated CY 2008 
physician in-office payment rates that occurs in Step 7 is dependent on 
the ASC conversion factor. The ASC budget neutrality adjustment 
resulting from Step 12 is calibrated to take into account the 
interactive nature of the ASC conversion factor and the physician's 
office payment cap. The ASC budget neutrality calculation is also 
calibrated to take into account the fact that the additional physician 
out-of-office payment rates under the revised ASC payment system 
calculated in Step 9 must be fully offset by the budget neutrality 
adjustment to ASC services under the revised payment system. 
Furthermore, the budget neutrality calculation is calibrated to take 
into account the CY 2008 transitional payment rates for procedures on 
the CY 2007 ASC list of covered surgical procedures.
d. Calculation of the Final Estimated CY 2008 ASC Payment Rates
    As described earlier, the application of the methodology to the 
data available for this final rule results in an estimated budget 
neutrality adjustment of 0.67. The CY 2008 budget neutrality adjustment 
for the revised ASC payment system, based on the methodology outlined 
above, will be proposed in the CY 2008 OPPS/ASC proposed rule and 
finalized in the CY 2008 OPPS/ASC final rule with comment period, based 
on the methodology for calculating budget neutrality established in 
this July 2007 final rule.
    After developing the estimated CY 2008 budget neutrality adjustment 
of 0.67 according to the policies established in this final rule, in 
order to determine the estimated CY 2008 ASC conversion factor we 
multiply the estimated CY 2008 OPPS conversion factor by the budget 
neutrality adjustment. At this time, our estimate of the CY 2008 OPPS 
conversion factor is $63.497. Multiplying the estimated CY 2008 OPPS 
conversion factor by the 0.67 budget neutrality adjustment yields our 
estimated CY 2008 ASC conversion factor of $42.543 for this final rule. 
To determine the fully implemented ASC payment rates for this final 
rule, including beneficiary coinsurance, according to the final payment 
methodology that applies to covered surgical procedures and covered 
ancillary radiology services under the revised ASC payment system, we 
multiply the ASC conversion factor by the ASC relative payment weight 
for each procedure or service. As further discussed in sections IV.C. 
and IV.E. of this final rule, the ASC relative payment weights for 
certain office-based surgical procedures and covered ancillary 
radiology services are set so that the national unadjusted ASC payment 
rate does not exceed the MPFS unadjusted nonfacility practice expense 
amount. In addition, as discussed in section IV.C of this final rule, 
the ASC relative payment weights for device-intensive covered surgical 
procedures are set according to a modified payment methodology to 
ensure the same device payment under the revised ASC payment system as 
under the OPPS. We then calculate the estimated CY 2008 payment rate 
for procedures on the CY 2007 ASC list of covered surgical procedures 
using a blend of 75 percent of the final CY 2007 ASC payment rate and 
25 percent of the estimated revised ASC payment rate developed 
according to methodology of the revised ASC payment system, applying 
the special transition treatment to device-intensive procedures as 
discussed in section IV.J. of this final rule. See Addenda AA and BB to 
this final rule for the illustrative estimated CY 2008 ASC payment 
weights and payment rates for covered surgical procedures and covered 
ancillary services that are expected to be paid separately under the CY 
2008 revised ASC payment system.

D. Calculation of the ASC Payment Rates for CY 2009 and Future Years

1. Updating the ASC Relative Payment Weights
    In the August 2006 proposed rule, we proposed to update the ASC 
relative payment weights each year using the national OPPS relative 
payment weights for that calendar year, as well as the practice expense 
payment amounts under the MPFS schedule for that calendar year because 
some covered office-based surgical procedures and covered ancillary 
services will be paid according to MPFS amounts if those are less than 
the rates calculated under the standard methodology of the revised ASC 
payment system. We further proposed to uniformly scale the ASC relative 
payment weights for each update year so that estimated aggregate 
expenditures using updated ASC relative payment weights would be the 
same as estimated aggregate expenditures using the current year ASC

[[Page 42532]]

relative payment weights. That is, we proposed to make the relative 
payment weights budget neutral to ensure that changes in the relative 
payment weights from year to year would not cause the estimated amount 
of expenditures to ASCs to increase or decrease as a function of those 
changes. For example, we proposed to uniformly scale the ASC relative 
payment weights for CY 2009 so that estimated expenditures for CY 2009 
using the updated CY 2009 ASC relative payment weights would be the 
same as they would be using the CY 2008 ASC relative payment weights. 
Similarly, we proposed to uniformly scale the ASC relative payment 
weights for CY 2010 so that estimated expenditures for CY 2010 using 
the updated CY 2010 ASC relative payment weights would be the same as 
they would be using the CY 2009 ASC relative payment weights.
    We proposed to scale the relative payment weights annually because 
we believed that the purpose of using relative payment weights as part 
of the ratesetting methodology under the proposed revised ASC payment 
system was only to establish appropriate relativity among surgical 
procedures paid in ASCs. Changes in weights should not, in and of 
themselves, change aggregate payment levels under a prospective payment 
system. Scaling the relative payment weights each year would also serve 
as a buffer to protect ASCs from sudden changes that could occur under 
the OPPS. For example, by making the relative payment weights budget 
neutral under the revised ASC payment system, the ASC relative weights 
would not drop were there to be a sudden upsurge in costs associated 
with outpatient hospital emergency or clinic visits relative to 
outpatient hospital surgical costs. Moreover, making the ASC relative 
weights budget neutral would shield the ASC payment system from the 
inadvertent impact of unrelated aggregate changes in OPPS expenditures. 
We proposed to continue this methodology to update the revised ASC 
payment system in future years.
    Comment: Several commenters supported the proposal to annually 
update ASC relative payment weights using the national OPPS payment 
weights for the corresponding year; conversely, some commenters also 
expressed concern regarding our proposed policy of rescaling ASC 
relative weights. They were concerned that annual rescaling would cause 
divergence of the relative weights between the OPPS and the revised ASC 
payment system for individual procedures.
    Response: We appreciate commenters' support for annually updating 
ASC relative payment weights in coordination with the OPPS update, 
consistent with the proposed relationship between the two payment 
systems. We believe this process would provide more appropriate 
payments for surgical services under the revised ASC payment system 
that would reflect ongoing changes in the facility costs associated 
with different surgical procedures. We also acknowledge commenters' 
concerns about our proposed policy of rescaling ASC relative weights. 
However, we note that rescaling the relative payment weights in the ASC 
payment system would not cause divergence in the relativity of the 
weights of various services under the two payment systems. Rescaling of 
the weights would equally increase or decrease the relative payment 
weights of services under the revised ASC payment system in comparison 
to the relative weights of the same services under the OPPS, but only 
to the extent necessary to ensure that changes in the relative weights 
do not, in and of themselves, change aggregate payments to ASCs.
    Rescaling of relative weights or the application of a budget 
neutrality adjustment is a common feature of Medicare payment systems, 
designed to ensure that the estimated aggregate payments under a 
payment system for an upcoming year would be neither greater than nor 
less than the aggregate payments that would be made in the prior year, 
taking into consideration any changes or recalibrations for the 
upcoming year. For example, in CY 2006, as required by section 
1833(t)(9)(B) of the Act, we scaled relative weights under the OPPS by 
applying a budget neutrality adjustment to ensure that changes due to 
APC reclassification and recalibration changes, wage index changes, and 
other adjustments were made in a manner that ensured that estimated 
aggregate OPPS payments for CY 2006 would not exceed aggregate payments 
for CY 2005 (70 FR 68542). We continue to believe that this principle 
should apply as well in the revised ASC payment system. We note that 
while we do not currently have a provider-level dataset of ASC 
utilization that accurately identifies unique ASCs and their geographic 
information that would allow us to compare changes in geographic 
adjustment over time for budget neutrality purposes, we intend to take 
these changes into account in maintaining budget neutrality for the 
revised ASC payment system as soon as our provider-level ASC data 
permit.
    In addition to considerations that are common to many payment 
systems, there is another reason for adopting annual rescaling of the 
relative weights in the revised ASC payment system. Because we are 
finalizing our proposal to generally employ the relative payment 
weights developed under the OPPS in the revised ASC payment system as 
discussed earlier in section IV.B. of this final rule, aggregate 
payments to ASCs could, in the absence of rescaling, be affected by 
changes in the cost structure of HOPDs that ought to be relevant only 
under the OPPS. We provided an example of such a scenario in the August 
2006 proposed rule. A sudden increase in the costs of hospital 
outpatient emergency or clinic visits due, for instance, to an increase 
in the volume of cases, would have the effect of increasing the weights 
for these services relative to the weights for surgical procedures in 
the hospital outpatient setting. In the absence of rescaling, this 
change in the relative weights under the OPPS would result in a 
decrease in the relative weights for surgical procedures under the ASC 
payment system and, therefore, a decrease in aggregate ASC payments for 
these same procedures. Because ASCs principally receive payment for 
surgical procedures, aggregate payments to ASCs could decline; ASCs 
would receive lower payments for surgical procedures without realizing 
the benefits of the higher payments provided to HOPDs for emergency or 
clinic visits. As we explained in the August 2006 proposed rule (71 FR 
49657), we believe that changes in relative weights each year under the 
OPPS should not, in and of themselves, cause aggregate payments under 
the revised ASC payment system to increase or decrease. In fact, 
scaling the relative weights each year under the revised ASC payment 
system would serve as a buffer to protect ASCs from sudden changes that 
could occur under the OPPS.
    Rescaling of relative payment weights in a budget neutral manner 
under the revised ASC payment system would thus shield the ASC payment 
system from the inadvertent impact of unrelated aggregate changes in 
OPPS expenditures. It is important to note that the specific adjustment 
factor applied in the scaling process could be positive or negative in 
any particular year. Annual scaling would prevent both sudden decreases 
in aggregate payments to ASCs and sudden windfall payments due solely 
to changes in HOPD costs for nonsurgical services. In the example given 
above, the scaling adjustment would be positive, that is, scaling would 
increase the relative weights of all surgical procedures under the ASC 
payment system in order to maintain aggregate ASC payments for the

[[Page 42533]]

procedures at the same level, in the absence of other factors affecting 
the relative payment weights of hospital outpatient emergency or clinic 
visits and surgical procedures under the OPPS.
    After considering the public comments we received, we are 
finalizing our proposal, without modification, to update the ASC 
relative payment weights in the revised ASC payment system each year 
using the national OPPS relative payment weights for that same calendar 
year and to uniformly scale the ASC relative payment weights for each 
update year to make them budget neutral. For example, holding ASC 
utilization and the mix of services constant, for CY 2009, we will 
compare the total weight using the CY 2008 ASC relative payment weights 
under the 75/25 blend (of the CY 2007 payment rate and the revised 
payment rate) with the total weight using CY 2009 relative payment 
weights under the 50/50 blend (of the CY 2007 payment rate and the 
revised payment rate), taking into account the changes in the OPPS 
relative payment weights between CY 2008 and CY 2009. We will use the 
ratio of CY 2008 to CY 2009 total weight to scale the ASC relative 
payment weights for CY 2009. Scaling of ASC relative payment weights 
would apply to covered surgical procedures and covered ancillary 
radiology services whose payment rates are related to OPPS relative 
payment weights. Scaling would not apply in the case of ASC payment for 
other separately payable covered ancillary services that have a 
predetermined national payment amount (that is, their national payment 
amounts are not based on OPPS relative payment weights) such as drugs 
and biologicals that are separately paid under the OPPS. Any service 
with a predetermined national payment amount would be included in the 
budget neutrality comparison, but scaling of the relative payment 
weights would not apply to those services that have a predetermined 
payment amount. The ASC payment weights for those services without 
predetermined national payment amounts (that is, their national payment 
amounts would be based on OPPS relative payment weights if a payment 
limitation did not apply) would be scaled to eliminate any difference 
in the total payment weight between the current year and the update 
year.
2. Updating the ASC Conversion Factor
    Section 1833(i)(2)(C) of the Act requires that, if the Secretary 
has not updated the ASC payment amounts in a calendar year after CY 
2009, the payment amounts shall be increased by the percentage increase 
in the CPI-U as estimated by the Secretary for the 12-month period 
ending with the midpoint of the year involved. Therefore, in the August 
2006 proposed rule for the revised ASC payment system we proposed to 
update the ASC conversion factor using the CPI-U in order to adjust ASC 
payment rates for inflation.
    We received a number of comments regarding our proposal to use the 
CPI-U to adjust payments to ASCs for inflation, and these comments and 
our responses are discussed in section IV.H. of this final rule, which 
addresses the adjustment for inflation under the revised ASC payment 
system. We did not receive any public comments regarding our proposal 
to adjust ASC payments for inflation by applying the inflation 
adjustment to the conversion factor under the revised ASC payment 
system.
    As explained in section IV.H. of this final rule, after 
consideration of the public comments we received, we are finalizing our 
proposal under Sec. Sec.  416.171(a) and (b), without modification, to 
apply the CPI-U to adjust payments to ASCs for inflation. We will 
implement the annual update through an adjustment to the conversion 
factor under the revised ASC payment system, beginning in CY 2010 when 
the statutory requirement for a zero update no longer applies.

E. Annual Updates

    Currently, under the existing ASC payment system, we update the ASC 
list of covered surgical procedures every 2 years through the notice 
and comment regulation process. We make additions to and deletions from 
the ASC list of covered surgical procedures based on clinical judgment 
and data that are available regarding utilization of care settings. We 
last published an updated list of the ASC covered surgical procedures 
in the CY 2007 OPPS/ASC final rule with comment period (71 FR 67960).
    Under the revised ASC payment system, which will be implemented 
effective January 1, 2008, we proposed in the August 2006 proposed rule 
to update on an annual calendar year basis the ASC conversion factor, 
the relative payment weights and APC assignments, the ASC payment 
rates, and the list of procedures for which Medicare would not make 
payment of an ASC payment rate. To the extent possible under the rules 
and policies of the revised ASC payment system, we proposed to maintain 
consistency between the OPPS and the ASC payment system in the way we 
treat new and revised HCPCS and CPT codes for payment under the ASC 
payment system. We also proposed to invite comment as part of the 
annual update cycle to determine if there are procedures that we 
exclude from payment in the ASC setting that merit reconsideration as a 
result of changes in clinical practice or innovations in technology.
    We proposed to update the ASC list of covered surgical procedures 
and payment system as part of the annual proposed and final rulemaking 
cycle updating the hospital OPPS. We believed that including the ASC 
update as part of the OPPS rulemaking cycle would ensure that updates 
of the ASC payment rates and the list of covered surgical procedures 
for which Medicare makes payment to ASCs would be issued in a regular, 
predictable, and timely manner. Moreover, the ASC payment system would 
be updated concurrent with changes in the APC groups and the OPPS 
inpatient list, making it easier to predict changes in payment for 
particular services from year to year.
    In the August 2006 proposed rule for the revised ASC payment 
system, we proposed to issue a final rule in the first part of CY 2007 
in which we would respond to comments submitted timely regarding the 
proposals set forth in that proposed rule and make final the policy and 
regulations for the revised ASC payment system for implementation 
effective January 1, 2008. We also proposed to include the CY 2008 ASC 
payment rates for surgical procedures payable in an ASC as part of the 
proposed and final rules for the CY 2008 OPPS update.
    In addition, in the August 2006 proposed rule we proposed to 
evaluate each year all new HCPCS codes that describe surgical 
procedures to make preliminary determinations regarding whether or not 
they should be payable in the ASC setting and, if so, whether they are 
office-based procedures. In the absence of claims data that would 
indicate where procedures described by new codes are being performed 
and identify the facility resources required to perform them, we 
proposed to use other available information, including our clinical 
advisors' judgment, predecessor CPT and Level II HCPCS codes, 
information submitted by representatives of specialty societies and 
professional associations, and information submitted by commenters 
during the public comment period following publication of the final 
rule with comment period in the Federal Register. We would publish in 
the annual OPPS/ASC payment update final rule those interim 
determinations for

[[Page 42534]]

the new codes to be active January 1 of the update year. The ASC 
payment system treatment of those procedures would be open to comment 
on that final rule, and we would respond to comments about our interim 
determinations in the final rule for the following year, just as we 
currently respond to comments about our APC assignments for new codes 
in the OPPS final rule for the following year. After our review of 
public comments and in the absence of physicians' claims data, if our 
determination regarding a new code was that it should reside on the ASC 
list of covered surgical procedures as an office-based procedure 
subject to the payment limitation, this determination would remain 
preliminary until we were able to consider more recent volume and 
utilization data for each individual procedure code and/or, if 
appropriate, the clinical characteristics, utilization, and volume of 
related codes. Using that information, if we confirmed our 
determination that the new code was appropriately assigned to an 
office-based payment indicator, it would then be permanently assigned 
to the list of office-based procedures subject to the payment 
limitation.
    Accordingly, we proposed to reflect this annual rulemaking and 
publication of revised payment methodologies and payment rates in new 
Sec.  416.173 in proposed new Subpart F.
    Comment: Several commenters recommended that CMS continue to 
consider the input of interested parties submitting comments regarding 
the assignment of HCPCS codes to appropriate APCs, additions to and 
deletions from the ASC list of covered surgical procedures, and 
creation of payment mechanisms to account for new technology.
    Response: As stated in our August 2006 proposal for the annual 
update process, we intend to invite comments from interested parties as 
part of the consolidated annual update cycle for updating the hospital 
OPPS and revised ASC payment system. As always, the OPPS treatment, 
including APC assignments, of all HCPCS codes would be open to comment, 
and we proposed also to invite comment regarding whether there are 
procedures that we exclude from payment in the ASC setting that merit 
reconsideration as a result of changes in clinical practice or 
innovations in technology. This approach is consistent with the 
recommendation of the PPAC that we utilize a process for the revised 
ASC payment system to obtain input from national medical specialty 
societies and the ASC community in order to provide payment to ASCs for 
all safe and appropriate procedures and to allow for changes in 
technology and evolution in medical practice. Annual updating will 
provide for the adaptable methodology that the PPAC recommends for the 
revised ASC payment system.
    Comment: Some commenters supported our proposal for the annual 
updates, indicating that the proposed alignment of annual updates to 
the revised ASC payment system with the OPPS updates is appropriate and 
allows the industry to review and contemplate the changes in both 
payment systems simultaneously.
    Response: We appreciate the commenters' support and continue to 
believe that including the ASC update as part of the OPPS rulemaking 
cycle would ensure that updates of the ASC payment rates and the list 
of surgical procedures for which Medicare pays ASCs would be issued in 
a regular, predictable, and timely manner. Moreover, the ASC payment 
system would be updated concurrent with changes in the APC groups and 
the OPPS inpatient list, making it easier to predict changes in payment 
for particular services from year to year. We believe this approach is 
especially appropriate, given the final policy of the revised ASC 
payment system as discussed further in section IV.B. of this final 
rule, to use the APC groups and relative payment weights for surgical 
procedures established under the OPPS as the basis of the payment 
groups and the relative payment weights for surgical procedures paid in 
ASCs beginning in CY 2008. The annually updated OPPS device offset 
percents will be used to establish ASC payment rates for device-
intensive procedures. In addition, according to the final policies 
established in this final rule, the OPPS relative payment weights and 
rates will be used as the basis for the payment of most covered 
ancillary services under the revised ASC payment system, so coordinated 
annual updating of the OPPS and the revised ASC payment system is 
particularly important.
    Comment: A number of commenters indicated that many ASCs were 
interested in submitting bills to Medicare using the same claim form 
that is used by HOPDs, the CMS UB-92 (soon to be the UB-04), so that 
CMS would have additional information available for the annual ASC 
update under the revised ASC payment system. The commenters stated that 
the CMS-1500 billing form currently used by most Medicare Part B 
providers and suppliers, including ASCs, limits the amount of 
information that ASCs can report on claims. The commenters expressed 
concern that, as a result of having to use the CMS-1500, the true costs 
incurred by ASCs to provide services are not available to CMS and that, 
consequently, CMS cannot include actual ASC costs in its analyses to 
develop and update the revised payment system. They recommended that 
ASCs be allowed to report to CMS the same level of detail about the 
services they provide as do HOPDs. Further, the commenters stated that 
it would be less burdensome than the current Medicare billing policy 
because ASCs already use the UB-92 to submit bills to commercial 
payors. Thus, they concluded that allowing ASCs to use the UB-92 for 
Medicare Part B billing would be advantageous for both CMS and ASCs, 
because ASCs could provide more detailed cost information to CMS and 
this change would reduce the administrative burden on ASCs that 
currently are maintaining billing capabilities for both the CMS-1500 
and UB-92 formats.
    Response: For future ASC update years, we will explore the 
feasibility of adopting the ASC billing change recommended by 
commenters, but this is not a change that we can make by January 2008. 
We understand the commenters' concerns in this regard and investigated 
the possibility of implementing this recommendation as part of the 
revised payment system, effective January 2008. A policy change that 
requires ASCs to use a different billing format would have to 
incorporate adequate time for CMS and ASCs to make the necessary 
systems changes and for CMS to provide training for contractors and 
ASCs prior to implementing the new format. Although we will continue to 
explore this recommendation, not only is there insufficient time to 
make systems changes and provide training before implementation of the 
revised ASC payment system, but CMS is in the midst of a comprehensive 
reorganization of its contracting functions, making adoption of any 
significant billing change at this time even more challenging. During 
the next few years, Medicare Part A and B claims will be processed by 
reconfigured contracting entities, and we believe that allowing ASCs to 
bill using the same format as HOPDs should be explored as part of that 
larger contractor reform. We plan to pursue the feasibility of this 
option and to coordinate any possible change to ASC billing 
requirements with CMS' overall contracting transition. We welcome 
additional information from the public regarding recommendations for 
ASC billing

[[Page 42535]]

modifications or improvements that we should consider once the revised 
payment system is implemented. We note that, under our final annual 
update methodology for the revised ASC payment system, we would not 
require ASC information beyond that currently available to us through 
the CMS-1500 in order to annually update the ASC payment system.
    After consideration of the public comments we received, we are 
finalizing our proposal as reflected in Sec.  416.173, without 
modification, to annually update the ASC conversion factor, the 
relative payment weights and OPPS APC assignments of covered surgical 
procedures paid in ASCs, the ASC payment rates, and the list of 
surgical procedures for which Medicare would not make payment to ASCs 
as part of the annual proposed and final rulemaking cycle updating the 
hospital OPPS. In addition, we will annually update the list of covered 
ancillary services and their ASC payment rates. We also are finalizing 
our proposal, without modification, to evaluate each year all new HCPCS 
codes that describe surgical procedures to make preliminary 
determinations regarding whether they should be payable in the ASC 
setting and, if so, whether they are office-based procedures. The ASC 
treatment of these procedures would be open to comment in the final 
rule, and we would provide responses in the final rule for the 
following calendar year. Designations of new surgical procedure codes 
as office-based would remain preliminary until there are adequate 
physicians' claims data to assess their predominant sites of services, 
whereupon if we confirm their office-based nature, the codes would be 
permanently assigned to the list of office-based procedures subject to 
the ASC payment limitation.

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

    We include addenda to the preamble of proposed and final rules 
updating the ASC payment system to present national ASC unadjusted 
payment rates, by HCPCS code, and other factors that affect 
ratesetting. For example, in Addendum BB to the August 2006 proposed 
rule for the revised ASC payment system, we listed the HCPCS codes of 
surgical procedures for which we proposed to allow payment to ASCs in 
CY 2008, the short descriptors for those codes, and whether or not the 
code was proposed to be newly added to the list of covered surgical 
procedures. We also indicated for each HCPCS code: (1) Whether or not 
we proposed to designate it as office-based; (2) whether or not we 
proposed to cap it at the MPFS nonfacility practice expense rate; (3) 
the estimated proposed CY 2008 ASC relative payment weight; (4) the 
estimated proposed CY 2008 full payment and coinsurance amounts; and 
(5) the estimated proposed CY 2008 transitional payment and coinsurance 
amounts using a 50/50 blend of the current and proposed new rates. 
Addendum CC to the August 2006 proposed rule listed the specific subset 
of HCPCS codes and their short descriptors for procedures proposed for 
payment limitation at the MPFS nonfacility practice expense amount 
under the revised ASC payment system.
    We will continue to use addenda to summarize, as part of the annual 
proposed and final OPPS/ASC rules updating both payment systems, the 
annual update of the relative payment weights of ASC covered surgical 
procedures, the national unadjusted ASC payment amounts for those 
procedures, the procedures designated as office-based that are subject 
to payment limitation at the MPFS nonfacility practice expense amount, 
and other pertinent information that bears on the determination of the 
payment status and payment rates for services under the revised ASC 
payment system for the update year. We will also summarize in the 
addenda the covered ancillary services that will be separately paid 
under the revised ASC payment system if they are integral to the 
performance of a covered surgical procedure, including their updated 
relative payment weights as appropriate, the national unadjusted ASC 
payment amounts for those services, and other pertinent information.
    Although we are including addenda to this final rule, we emphasize 
that the information presented in these addenda is intended solely to 
demonstrate the payment rates that result from application of the 
revised ASC payment system methodology that we are finalizing in this 
final rule based on the most current data available. We caution readers 
that the illustrative relative payment weights, national payment 
amounts, and other information shown in the addenda to this final rule 
are neither the proposed nor final ASC rates for the CY 2008 revised 
ASC payment system. The information in the addenda to this final rule 
exemplifies the results of applying the revised ASC payment system 
methodology implemented in this final rule to the final or most 
recently updated CY 2007 OPPS information, with application of the 
estimated CY 2008 OPPS update, including the CY 2007 APC groupings and 
relative payment weights, the CY 2007 second quarter OPPS payment rates 
for drugs and biologicals, the CY 2007 OPPS payment methodology for 
brachytherapy sources, the specification of surgical procedures as 
subject to OPPS multiple procedure discounting, the designation of 
surgical procedures as inpatient only under the OPPS, the 
identification of surgical procedures for which payment is packaged 
under the OPPS rather than separately paid, and the CY 2007 OPPS 
device-dependent APCs and their respective device offset percents. The 
information is also based on the most recently available Part B 
utilization data derived from the full year of CY 2005 ASC and 
physicians' claims, and the CY 2008 estimated transitional nonfacility 
practice expense payment amounts for the CY 2008 MPFS, with application 
of the projected CY 2008 MPFS update.
    We reiterate that the information in the addenda to this final rule 
does not represent the rates that we will be proposing for 
implementation in CY 2008 under the revised ASC payment system, but 
merely serves to illustrate application of the final ratesetting 
methodology under the revised ASC payment system. All information 
included in Addendum AA and Addendum BB to this final rule is subject 
to change in the annual cycle of notice and comment rulemaking to 
update the OPPS/ASC payment rates for CY 2008, with the exception of 
the office-based designation of procedures whose designation is not 
marked as temporary. We note that we have also included in Addenda AA 
and BB to this final rule HCPCS codes for those surgical procedures, 
radiology services, implantable devices, and drugs and biologicals 
whose payment is packaged under the OPPS and which, therefore, would 
not be eligible for separate ASC payment as covered surgical procedures 
or covered ancillary services, in order to facilitate review of the ASC 
payment policies for these groups of services. Payment to ASCs under 
the revised ASC payment system for these services would also be 
packaged. We will propose the relative payment weights, payments rates, 
and other pertinent ratesetting information for the CY 2008 revised ASC 
payment system in the OPPS/ASC proposed rule to update both payment 
systems for CY 2008. This proposed rule will be issued in mid-summer of 
CY 2007. The relative payment weights and payment rates and other 
pertinent ratesetting information proposed for the revised ASC payment 
system in CY 2008 will be based on proposed CY 2008 OPPS payment 
weights and APC groups, proposed CY

[[Page 42536]]

2008 MPFS nonfacility practice expense payment amounts, CY 2007 second 
quarter OPPS payment rates for drugs and biologicals as established 
based on the ASP information for that quarter, and the most recent Part 
B utilization data available to us from CY 2006 claims.
    CMS will publish final relative payment weights and final payment 
rates and other pertinent ratesetting information for the CY 2008 
revised ASC payment system in the final OPPS/ASC rule that updates both 
payment systems for CY 2008.
    Changes in CY 2008 payments for physicians' services under the 
MPFS, in first quarter CY 2008 prices for drugs and biologicals based 
on the most recent available ASP data, and in CY 2008 HCPCS codes and 
pricing of OPPS services that may occur and that would affect the CY 
2008 revised ASC payment system between publication of the CY 2008 
OPPS/ASC final rule and release of the January 2008 OPPS PRICER and the 
ASC payment files will be reflected in updated addenda that we will 
post on the CMS Web site.
    We have created Addendum DD1 to this final rule to define ASC 
payment indicators that we will use in Addenda AA and BB to provide 
payment information regarding covered surgical procedures and covered 
ancillary services, respectively, under the revised ASC payment system. 
Analogous to the OPPS payment status indicators that we publish in 
Addendum D1 as part of the annual OPPS rulemaking cycle, the ASC 
payment indicators in Addendum DD1 are intended to capture policy-
relevant characteristics of HCPCS codes that may receive packaged or 
separate payment in ASCs, including their ASC payment status prior to 
CY 2008; their designation as device-intensive; their designation as 
office-based and the corresponding ASC payment methodology; and their 
classification as a separately payable radiology service, brachytherapy 
source, OPPS pass-through device, corneal tissue acquisition service, 
drug or biological, or NTIOL.

VII. ASC Regulatory Changes

    In the August 23, 2006 proposed rule, we proposed to modify 
applicable ASC regulations under 42 CFR Parts 410, 414, and 416 to 
incorporate the requirements and conditions for payments for ASC 
facility services under the revised payment system that was proposed 
for implementation beginning January 1, 2008.

A. Regulatory Changes That Were Finalized in the CY 2007 OPPS/ASC Final 
Rule With Comment Period

    In the August 23, 2006 proposed rule (71 FR 49631), we proposed the 
following regulatory changes which we finalized in the CY 2007 OPPS/ASC 
final rule with comment period (71 FR 68174).
     We proposed to revise the current regulations at Part 416, 
Subparts D and E, to ensure that the rules governing the current ASC 
payment system are clearly distinguishable from those that would apply 
to the revised system beginning January 1, 2008.
     We proposed to revise Subparts D and E to Part 416 to 
reflect the rules governing the ASC payment system prior to January 1, 
2008.
     We proposed to redesignate existing Subpart F as Subpart G 
under Part 416 to codify the rules governing the ASC payment adjustment 
for NTIOLs (71 FR 49631).
     We proposed several technical changes to Part 416 (71 FR 
49659).
     We proposed to revise existing Sec.  416.1 (Basis and 
scope) to remove the obsolete reference to ``a hospital outpatient 
department,'' and to add provisions of section 5103 of Public Law 109-
171 and applicable provisions of Public Law 108-173.
     We proposed to revise existing Sec.  416.65 (Covered 
surgical procedures) to modify the introductory text to clearly denote 
the section's application to covered surgical procedures furnished 
before January 1, 2008. In addition, we proposed to remove the obsolete 
cross-reference in paragraph (a)(4) to Sec.  405.310 and replace it 
with the correct cross-reference to Sec.  411.15.
     We proposed to revise Sec.  416.125 (ASC facility services 
payment rate) to incorporate the limitation on payment imposed by 
section 5103 of Public Law 109-171.
     We proposed to revise Sec.  488.1 (Definitions) to add 
ambulatory surgical centers to the definition of a supplier in 
conformance with section 1861(d) of the Act.
     We proposed to add new Sec.  416.76 and new Sec.  416.121 
to Subparts D and E, respectively, to clearly state that the provisions 
of Subparts D and E apply to services furnished before January 1, 2008.
    The bases for these proposed regulatory changes were discussed in 
detail throughout the preamble of the August 23, 2006 proposed rule. We 
did not receive any public comments on these proposed revisions. In the 
CY 2007 OPPS/ASC final rule with comment period, we made these 
provisions final as proposed, without modification (71 FR 68174).

B. Regulatory Changes Included in This Final Rule

    In the August 23, 2006 proposed rule (71 FR 49699), we proposed to 
add a new Subpart F to Part 416 entitled ``Subpart--Coverage, Scope of 
ASC Facility Services, and Prospective Payment System for Facility 
Services Furnished On or After January 1, 2008,'' which would include 
the following new sections:

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

    We also proposed a technical change to 42 CFR Part 414 to conform 
with changes we were proposing under Part 416, new Subpart F (71 FR 
49659), and we likewise proposed to revise Sec.  410.152(i) to make it 
consistent with provisions of the revised ASC payment system. The 
numerous public comments that we received regarding the revised ASC 
payment system we proposed to implement January 1, 2008, are addressed 
in detail throughout the preamble of this final rule.
    As a result of our review of the public comments, in this final 
rule, we have made a number of modifications to our proposals for the 
revised ASC payment system. These modifications, which are also 
discussed in detail in other sections of this final rule, have 
necessitated corresponding changes in the regulations that we proposed 
for the revised ASC payment system. The following is a summary of 
changes to 42 CFR 410 and 416 that reflect those modifications, which 
we are finalizing in this final rule.
     We added a new paragraph (i)(2) under Sec.  410.152 to 
specify the amount of payment the Medicare program makes for ASC 
services beginning January 1, 2008.
     We decided not to finalize the proposed revision of Sec.  
414.22(b)(5)(i)(B) in this final rule.
     In Sec.  416.2, we revised the definitions of ``ASC 
services,'' ``Covered surgical procedures,'' and ``Facility

[[Page 42537]]

services,'' and we added a definition of ``Covered ancillary 
services.''
     We added new Subpart F, as proposed, but modified the 
title to read ``Coverage, Scope of ASC Services, and Prospective 
Payment System for ASC Services Furnished on or after January 1, 
2008.'' We also modified certain proposed sections under Subpart F and 
added other provisions as outlined below.
     We revised the section headings of Sec. Sec.  416.161 and 
416.164 to read ``Applicability of this subpart'' and ``Scope of ASC 
services,'' respectively.
    We also revised the section heading of Sec.  416.171 to read 
``Determination of payment rates for ASC services.'' In addition, we 
added new Sec.  416.179 with a new section heading.
     We added Sec.  416.160(a)(4), which addresses payment 
rules for screening flexible sigmoidoscopy and screening colonoscopy 
services. Also, we reordered the paragraphs of Sec.  416.160.
     We revised Sec.  416.160(b) to conform the text with the 
changes to the definitions in Sec.  416.2.
     We made a technical change to Sec. Sec.  416.163(b) and 
(c) to specify that payment for anesthetists' services is made in 
accordance with 42 CFR part 414, in addition to editorial changes to 
Sec.  416.163(a) to reference ASC services rather than ASC facility 
services.
     We revised Sec.  416.164(a), ``Included facility 
services,'' and we renamed and revised Sec.  416.164(b) as ``Covered 
ancillary services,'' to reflect the policy regarding the packaging of 
services which is made final in section IV.C. of this final rule. 
Proposed Sec.  416.164(b) becomes final Sec.  416.164(c), ``Excluded 
services,'' where we revised anesthetists' services, which are paid 
under 42 CFR part 414 and where we changed x-ray procedures to 
radiology services and separated diagnostic procedures and radiology 
services into separate items. Also, ``Excluded services'' no longer 
includes costs incurred to procure corneal tissue.
     In Sec.  416.166(c), ``General exclusions,'' we deleted 
the phrase ``other medical procedures'' from the introductory sentence 
to conform with the definition of the type of procedures covered under 
the ASC benefit as discussed in section III. of this final rule. We 
moved the criterion proposed as paragraph (c)(5) (regarding the 
expected requirement for active medical monitoring and care at midnight 
following the procedure) to Sec.  416.166(b) as an element of the 
``General standards.'' We also added the following as new criteria for 
exclusion of a procedure from coverage when performed in an ASC: (1) 
Commonly require systemic thrombolytic therapy; (2) are designated as 
requiring inpatient care under Sec.  419.22(n); and (3) can only be 
reported using a CPT unlisted surgical procedure code.
     We made technical and editorial changes to Sec.  
416.167(a) and (b) to reference payment for ASC services and covered 
ancillary services.
     We revised Sec.  416.171 to reflect the modifications that 
we are making final in this final rule regarding separate payment for 
certain covered ancillary services and the extension of transitional 
payment rates from 1 to 3 years, as discussed in section IV. J. of this 
final rule.
     We revised Sec.  416.172 as follows: (1) Made minor 
changes to paragraphs (a), (b), (d), and (e) to reference ASC services 
and to clarify that the comparison for purposes of assessing the lesser 
of the actual charge or the prospective rate is to the geographically 
adjusted payment rate; and (2) revised paragraph (c) to exclude 
application of a geographic adjustment to payment rates for certain 
drugs, devices, and brachytherapy sources, as discussed in section IV. 
C. of this final rule. In addition, we added new paragraph (f) to 
reflect the payment adjustment when ASC services are interrupted due to 
circumstances that threaten the well-being of the beneficiary. We also 
added new paragraph (g) to reflect the payment adjustment for the 
insertion of NTIOLs.
     We made editorial changes to Sec.  416.173 and Sec.  
416.178.
     We added new Sec.  416.179, ``Payment and coinsurance 
reduction for devices replaced without cost or when full credit is 
received,'' as discussed in section IV.C. of this final rule.

VIII. Files Available to the Public Via the Internet

    Addenda AA, BB, and DD1 to this final rule provide various data 
pertaining to the CY 2008 ASC list of covered procedures and the 
covered ancillary services that will be separately paid to ASCs 
beginning in CY 2008 when provided by an ASC as integral to a covered 
surgical procedure on the same day as the procedure. All relative 
payment weights and payment rates are illustrative only, demonstrating 
the payment rates that result from application of the revised ASC 
payment system methodology that we are finalizing in this final rule 
based on the most current data available. They exemplify the results of 
applying the revised ASC payment system methodology implemented in this 
final rule to the final or most recently updated CY 2007 OPPS 
information as updated by the currently estimated CY 2008 OPPS update 
factor and to the CY 2008 estimated transitional nonfacility practice 
expense amounts for the CY 2008 MPFS, with application of the projected 
CY 2008 MPFS update.
    As further discussed in section VI. of this final rule, Addendum 
DD1 defines the payment indicators that are used in Addenda AA and BB 
of this final rule, while Addenda AA and BB provide payment information 
regarding covered surgical procedures and covered ancillary services 
under the revised ASC payment system.
    These addenda, as well as the final rule preamble tables and other 
supporting data files, are included on the CMS Web site at: http://www.cms.hhs.gov/ASCPayment/ in a format that can easily be downloaded 
and manipulated. Proposed and final ASC relative weights and payment 
rates for CY 2008 will be published in the proposed and final CY 2008 
OPPS/ASC rules, respectively, and related data files will be included 
on the CMS Web site as noted above. The OPPS data files are available 
to the public on the CMS Web site at: http://www.cms.hhs.gov/HospitalOutpatientPPS, and the MPFS data files are located at: http://www.cms.hhs.gov/PhysicianFeeSched.
    We are not including as addenda to this final rule reprints of the 
final FY 2007 IPPS wage indexes that were included in a notice 
published in the Federal Register on October 11, 2006 (71 FR 59886). 
Rather, we are providing a link on the CMS Web site at: http://www.cms.hhs.gov/AcuteInpatientPPS/WIFN to all of the final FY 2007 IPPS 
wage index related tables. The final CY 2008 ASC payment system will 
utilize the FY 2008 IPPS wage index related tables that will be 
proposed and finalized in the FY 2008 IPPS rulemaking cycle, and we 
will provide a link on the CMS Web site to those proposed and final 
wage index related tables in the CY 2008 OPPS/ASC proposed and final 
rules, respectively. For additional assistance, contact Gift Tee, (410) 
786-0378.

IX. Collection of Information Requirements

    This document does not impose any information collection and 
recordkeeping requirements. Consequently, it need not be reviewed by 
the Office of Management and Budget under the authority of the 
Paperwork Reduction Act of 1995 (44 U.S.C. 35).

[[Page 42538]]

X. Regulatory Impact Analysis

A. Overall Impact

    We have examined the impacts of this final rule as required by 
Executive Order 12866 (September 1993, Regulatory Planning and Review), 
the Regulatory Flexibility Act (RFA) (September 19, 1980, Pub. L. 96-
354), section 1102(b) of the Social Security Act, the Unfunded Mandates 
Reform Act of 1995 (Pub. L. 104-4), and Executive Order 13132.
1. Executive Order 12866
    Executive Order 12866 (as amended by Executive Order 13258, which 
merely reassigns responsibility of duties) directs agencies to assess 
all costs and benefits of available regulatory alternatives and, if 
regulation is necessary, to select regulatory approaches that maximize 
net benefits (including potential economic, environmental, public 
health and safety effects, distributive impacts, and equity). A 
regulatory impact analysis (RIA) must be prepared for major rules with 
economically significant effects ($100 million or more in any 1 year).
    We estimate that the revised ASC payment system and the expanded 
ASC list of covered surgical procedures that we are implementing in CY 
2008 will have no net effect on Medicare expenditures compared to the 
level of Medicare expenditures that would have occurred in CY 2008 in 
the absence of the revised payment system. A more detailed discussion 
of the effects of the changes to the ASC list of covered surgical 
procedures and the effects of the revisions to the ASC payment system 
in CY 2008 is provided in section X.B. below.
    While we estimate that there will be no net change in Medicare 
expenditures in CY 2008 as a result of the revised ASC payment system, 
we estimate that the revised system will result in savings of $240 
million over 5 years due to migration of new ASC covered surgical 
procedures from HOPDs and physicians' offices to ASCs over time. In 
addition, we note there will be a total increase in Medicare payments 
to ASCs for CY 2008 of approximately $270 million compared to Medicare 
expenditures that would have occurred in CY 2008 in the absence of the 
revised payment system. These additional payments to ASCs of 
approximately $270 million in CY 2008 will be fully offset by savings 
from reduced Medicare spending in HOPDs and physicians' offices on 
services that migrate from these settings to ASCs in CY 2008 (as 
discussed in detail in section V.C. of this final rule). Therefore, 
this final rule is an economically significant rule under Executive 
Order 12866 and a major rule under 5 U.S.C. 804(2).
2. Regulatory Flexibility Act
    The RFA requires agencies to determine whether a rule would have a 
significant economic impact on a substantial number of small entities. 
For purposes of the RFA, small entities include small businesses, 
nonprofit organizations, and small governmental jurisdictions. Most 
hospitals and most other providers and suppliers are small entities, 
either by nonprofit status or by having revenues of $9 million to $31.5 
million in any 1 year (65 FR 69432).
    For purposes of the RFA, we have determined that approximately 73 
percent of ASCs would be considered small businesses according to the 
Small Business Administration (SBA) size standards. Individuals and 
States are not included in the definition of a small entity. We 
anticipate that this final rule will have a significant impact on a 
substantial number of small entities.
3. Small Rural Hospitals
    In addition, section 1102(b) of the Act requires us to prepare a 
regulatory impact analysis if a rule may have a significant impact on 
the operations of a substantial number of small rural hospitals. This 
analysis must conform to the provisions of section 604 of the RFA. For 
purposes of section 1102(b) of the Act, we define a small rural 
hospital as a hospital with fewer than 100 beds that is located outside 
of a Metropolitan Statistical Area (MSA). The Secretary certifies that 
this final rule will not have a significant impact on the operations of 
a substantial number of small rural hospitals.
4. Unfunded Mandates
    Section 202 of the Unfunded Mandates Reform Act of 1995 (Pub. L. 
104-4) also requires that agencies assess anticipated costs and 
benefits before issuing any rule whose mandates require spending in any 
1 year of $100 million in 1995 dollars, updated annually for inflation. 
That threshold level is currently approximately $120 million. This 
final rule will not mandate any requirements for State, local, or 
tribal government, nor will it affect private sector costs.
5. Federalism
    Executive Order 13132 establishes certain requirements that an 
agency must meet when it publishes any rule (proposed or final) that 
imposes substantial direct costs on State and local governments, 
preempts State law, or otherwise has Federalism implications.
    We have examined this final rule in accordance with Executive Order 
13132, Federalism, and have determined that it would not have an impact 
on the rights, roles, and responsibilities of State, local or tribal 
governments. The changes related to payments to ASCs in CY 2008 will 
not affect payments to government hospitals.

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

    In CY 2008, we are implementing a revised Medicare ASC payment 
system that could have a far-reaching effect on the provision of 
outpatient surgical services for a number of years to come. First, we 
are greatly expanding the list of procedures that will be eligible for 
payment under the revised ASC payment system. Second, we are moving 
from a limited fee schedule based on nine disparate payment groups to a 
payment system incorporating relative payment weights for groups of 
procedures with similar clinical and resource characteristics, based on 
the APCs that are key elements of the OPPS.
    Implementation by January 1, 2008 of a revised ASC payment system 
designed to result in budget neutrality is mandated by section 626 of 
Public Law 108-173. To set ASC payment rates for CY 2008 under the 
revised payment system, we are multiplying ASC relative payment weights 
for surgical procedures by an ASC conversion factor that we calculate 
to result in the same amount of aggregate Medicare expenditures for 
those services in CY 2008 as we estimate would have been made if the 
revised payment system were not implemented.
    The effects of the expanded numbers and types of procedures for 
which an ASC payment may be made and other policy changes that affect 
the revised payment system, combined with significant changes in 
payment rates for covered surgical procedures, will vary across ASCs, 
depending on whether or not the ASC limits its services to those in a 
particular surgical specialty area, the volume of specific services 
provided by the ASC, the extent to which ASCs will offer different 
services, and the percentage of its patients that are Medicare 
beneficiaries.
    In this July 2007 final rule for the revised ASC payment system, we 
have estimated the CY 2008 ASC payment rates, budget neutrality factor, 
and impacts using the CY 2007 OPPS relative payment weights with an 
estimated update factor for CY 2008, the CY 2007 MPFS PE RVUs trended 
forward to CY 2008, and CY 2005

[[Page 42539]]

utilization data projected forward to CY 2008. We emphasize that the 
impact estimates in this final rule are illustrative only. The CY 2008 
ASC payment rates and budget neutrality factor will be proposed in the 
CY 2008 OPPS/ASC proposed rule based on the methodology for calculating 
budget neutrality established in this final rule and incorporating the 
proposed CY 2008 OPPS relative payment weights, the proposed CY 2008 
MPFS PE RVUs, and CY 2006 utilization information projected forward to 
CY 2008. The final CY 2008 ASC payment rates and budget neutrality 
factor will be established in the CY 2008 OPPS/ASC final rule with 
comment period, in accordance with the methodology for calculating 
budget neutrality established in this final rule and based on the final 
CY 2008 OPPS payment weights, the final CY 2008 MPFS RVUs, and updated 
CY 2006 utilization data projected forward to CY 2008.
    As discussed fully in section V.C. of this final rule, our final 
methodology for calculating the budget neutrality factor considers not 
only the effects of the new payment rates to be implemented under the 
revised payment system, but also the estimated net effect of migration 
of new ASC procedures across ambulatory care settings. The methodology 
for calculating the budget neutrality adjustment factor finalized in 
this rule assumes that over the first 2 years of the revised payment 
system, approximately 25 percent of the HOPD volume of new ASC 
procedures would migrate from the HOPD service setting to ASCs, and 
that over the 4-year transition period, approximately 15 percent of the 
physicians' office volume of new ASC procedures would migrate to ASCs.
    We estimate that the revised ASC payment system established in this 
final rule will result in neither savings nor costs to the Medicare 
program in CY 2008. That is, because it is designed to be budget 
neutral, in CY 2008, the revised ASC payment system will neither 
increase nor decrease expenditures under Part B of Medicare. We further 
estimate that beneficiaries will save approximately $20 million under 
the revised ASC payment system in CY 2008, because ASC payment rates 
will, in most cases, be lower than OPPS payment rates for the same 
services and, because, except for screening flexible sigmoidoscopy and 
screening colonoscopy procedures, beneficiary coinsurance for ASC 
services is 20 percent rather than 20 to 40 percent as is the case 
under the OPPS. (The only possible instance in which an ASC coinsurance 
amount could exceed the OPPS copayment amount would be when the 
coinsurance amount for a procedure under the revised ASC payment system 
exceeds the hospital inpatient deductible. Section 1833(t)(8)(C)(i) of 
the Act provides that the copayment amount for a procedure paid under 
the OPPS cannot exceed the inpatient deductible established for the 
year in which the procedure is performed, but there is no such 
requirement related to the ASC coinsurance amount.) Beneficiary 
coinsurance for services migrating from physicians' offices to ASCs may 
decrease or increase under the revised ASC payment system, depending on 
the particular service and whether the Medicare payment to the 
physician for providing that service in his or her office is higher or 
lower than the sum of the Medicare payment to the ASC for providing the 
facility portion of that service and the Medicare payment to the 
physician for providing that service in a facility (nonoffice) setting. 
As noted previously, the net effect of the revised ASC payment system 
on beneficiary coinsurance, taking into account the migration of 
services from HOPDs and physicians' offices, is estimated to be $20 
million in beneficiary savings in CY 2008.
1. Alternatives Considered
    We are issuing this final rule to meet a statutory requirement to 
implement, no later than January 1, 2008, a revised payment system for 
ASCs. We are implementing the revised ASC payment system through 
rulemaking in the Federal Register. Through the August 2006 proposed 
rule, we have afforded interested parties an opportunity to comment on 
revisions we proposed to make to the policies and rules for identifying 
surgical procedures that would be excluded from payment in ASCs, to the 
ASC ratesetting methodology and payment policies, and to the 
regulations for the revised ASC payment system.
    Throughout the preamble of this final rule, we discuss the various 
options we considered as we developed policies to redesign the ASC 
payment system in broad terms, and specific policies, such as those 
affecting payment for covered ancillary services integral to covered 
surgical procedures, the definition of a covered surgical procedure, 
criteria for identifying procedures that are not safely or 
appropriately performed in an ASC, and the payment methodology for 
device-intensive procedures, among others.
    Although we proposed to phase in the new ASC payment rates under 
the revised payment system over a 2-year period, we are finalizing a 
policy to phase in the ASC payment rates under the revised payment 
system over a 4-year period. As we discuss in section X.B.3. of this 
final rule, we believe that allowing a longer transition period is 
appropriate in light of the adverse financial impact that some ASCs 
could potentially experience if they perform a high volume of 
procedures whose rates would decrease significantly under the revised 
payment system. We believe the 4-year transition will give ASCs time to 
reconfigure their mix of services and make other needed adjustments so 
they can focus on achieving more efficient delivery of a broader range 
of surgical procedures.
2. Limitations of Our Analysis
    Presented here are the projected effects of the policy and 
statutory changes that will be effective for CY 2008 on aggregate ASC 
utilization and Medicare payments. One limitation of this analysis is 
that we could only infer the effects of the revised payment system on 
different types of ASCs, for example, single or multispecialty, high or 
low volume, and urban or nonurban ASCs, based on an overall comparison 
of procedure volumes and facility payments between the current and the 
revised payment system. At this time, we do not have a provider-level 
dataset of CY 2005 ASC utilization that accurately identifies unique 
ASCs and their geographic information that would allow us to compare 
estimated payments and geographic adjustment among classes of ASCs 
based on a provider-level analysis.
    A second limitation is our lack of information on ASC resource use. 
ASCs are not required to file Medicare cost reports and, therefore, we 
do not have cost information to evaluate whether or not the payments 
for ASC services coincide with the resources required by ASCs to 
provide those services.
    A third limitation is our inability to predict changes in service 
mix between CY 2005 and CY 2008. The aggregated impact tables below are 
based upon a methodology that assumes no changes in service-mix with 
respect to the CY 2005 ASC data used for this final rule. We believe 
that the net effect on Medicare expenditures of changes in service-mix 
for current ASC covered surgical procedures will be negligible, in the 
aggregate. Such changes may have differential effects across surgical 
specialty procedure groups as ASCs adjust to the revised payment 
system. However, we are unable to accurately project such changes at a 
disaggregated level. Clearly, individual ASCs will experience changes 
in payment that

[[Page 42540]]

differ from the aggregated estimated changes presented in the tables 
below.
    Because we do not have experience with ASC payment under the 
revised payment system, we have relied on comments and information from 
stakeholders in response to our August 2006 proposed rule for the 
revised ASC payment system to mitigate the limitations in the data 
available to us for analysis of the impact of the changes on specific 
procedures, on classes of specialty ASCs, and on beneficiaries.
3. Estimated Effect of This Final Rule on ASCs
    Some ASCs are multispecialty facilities that perform the gamut of 
surgical procedures, from excision of lesions to hernia repair to 
cataract extraction; others focus on a single specialty and perform 
only a limited range of surgical procedures, such as eye procedures, 
gastrointestinal procedures, or orthopedic surgery. The combined effect 
on an individual ASC of the CY 2008 revised payment system and the 
expanded ASC list of covered surgical procedures will depend on a 
number of factors, including, but not limited to, the mix of services 
the ASC provides, the volume of specific services provided by the ASC, 
the percentage of its patients who are Medicare beneficiaries, and the 
extent to which an ASC will choose to provide different services under 
the revised payment system. The following discussion presents two 
tables that provide estimates of the impact of the revised ASC payment 
system on Medicare payments to ASCs for current ASC services, assuming 
the same mix of services as offered by ASCs in our CY 2005 claims data. 
The first table depicts aggregate percent change in payment by surgical 
specialty group and the other compares payment for procedures estimated 
to receive the most payment in CY 2008 under the current payment 
system.
    In section IV.J. of this final rule, we finalize our policy of a 
transition of 4 years for the revised payment rates, rather than the 
proposed 2-year transition, where payments will generally be made using 
a blend of the rates based on the CY 2007 ASC payment rate and the 
revised ASC payment rate. In comparing estimated payment rates for CY 
2008 under the existing system with the estimated payment rates for CY 
2008 under the revised system, we noted the negative effect the 
estimated proposed payment rates would have on Medicare payments to 
ASCs for certain surgical procedures that currently are performed 
frequently in ASCs. We were concerned about the impact of the revised 
payment rates on ASCs that specialize in a limited number of surgical 
procedures for which payment would decrease under the revised system 
and wanted to encourage ASCs to continue to provide access to the high 
volume procedures that are currently performed there because, in all 
likelihood, the ASC has become an extremely efficient setting for those 
procedures, such as cataract extractions and colonoscopies. Moreover, 
we believe that a positive outcome of the revised ASC payment system 
could be to expand beneficiary and physician choice in selection of an 
appropriate site for ambulatory surgical services, as a consequence of 
the expansion of surgical procedures for which Medicare will make an 
ASC payment and the revised rates that will pay more appropriately for 
those services. We believe a 4-year transition will give ASCs 
additional time to reconfigure their mix of surgical services and make 
other needed adjustments so that they can focus on achieving more 
efficient delivery of a broader range of surgical procedures.
    In CY 2008, we will pay ASCs using a 75/25 blend, in which payment 
will be calculated by adding 75 percent of the CY 2007 ASC rate for a 
surgical procedure on the CY 2007 ASC list of covered surgical 
procedures and 25 percent of the revised CY 2008 ASC rate for the same 
procedure. For CYs 2009 and 2010, the blend will be transitioned first 
to 50/50 and then to a 25/75 blend of the CY 2007 ASC rate and the 
revised ASC payment rate. Beginning in CY 2011, payments will be made 
to ASCs for covered surgical procedures on the CY 2007 ASC list at the 
fully implemented revised ASC payment rates. Procedures that were not 
included on the ASC list of covered surgical procedures in CY 2007 will 
not be paid at the transitional rates for CYs 2008 through 2010 because 
they have no CY 2007 ASC payment rate. Those procedures will be paid at 
the fully implemented ASC rate, beginning in CY 2008.
    Table 11 shows the impact of the revised payment system at the 
surgical specialty group level. We have aggregated the surgical HCPCS 
codes by specialty group and estimated the effect on aggregated payment 
for surgical specialty groups, considering separately the CY 2008 
transitional rate and the fully implemented revised payment rate. The 
groups are sorted for display in descending order by estimated Medicare 
program payment to ASCs for CY 2008 in the absence of the revised ASC 
payment system. The following is an explanation of the information 
presented in Table 11:
     Column 1--Surgical Specialty Group indicates the surgical 
specialties into which ASC procedures are grouped. We used the CPT code 
range definitions and added the related Level II HCPCS codes and 
Category III CPT codes, as appropriate, to account for all surgical 
procedures to which the Medicare program payments are attributed.
     Column 2--Estimated CY 2008 ASC Payments in the absence of 
the revised ASC payment system were calculated by multiplying the CY 
2007 ASC payment rate by CY 2008 ASC utilization (which is based on CY 
2005 ASC utilization multiplied by a factor of 1.305 to take into 
account expected volume growth with volume adjustment, as appropriate, 
for the multiple procedure discount). The resulting amount was then 
multiplied by 0.8 to estimate the Medicare program's share of the total 
payments to the ASC. The payment amounts are expressed in millions of 
dollars.
     Column 3--Estimated CY 2008 Percent Change with Transition 
(75/25 Blend) is the aggregate percentage increase or decrease in 
Medicare program payment to ASCs for each surgical specialty group that 
is attributable to changes in the ASC payment rates for CY 2008 under 
the 75/25 blend of the CY 2007 ASC payment rate and the revised ASC 
payment rate.
     Column 4--Estimated CY 2008 Percent Change without 
Transition (Fully Implemented) is the aggregate percentage increase or 
decrease in Medicare program payment to ASCs for each surgical 
specialty group that is attributable to changes in the ASC payment 
rates for CY 2008 if there were no transition period to the revised 
payment rates. The percentages appearing in column 4 are presented as a 
comparison for the transition policy in column 3 and do not depict the 
impact of the fully implemented proposal in CY 2011.
    Table 11 reflects the changes for ASCs at the surgical specialty 
level and shows that for all but gastrointestinal procedures, if an ASC 
offers the same mix of services in CY 2008 that is reflected in our 
national CY 2005 claims data, Medicare payments to the ASC for services 
in that surgical specialty area would be estimated to increase under 
the revised payment system. If the revised payment system were fully 
implemented in CY 2008, we would expect all but gastrointestinal 
procedures and nervous system procedures to receive greater Medicare 
payment. In addition to the impacts on

[[Page 42541]]

Medicare payments for current ASC procedures shown in Table 11, it is 
important to note that overall CY 2008 payments to ASCs are estimated 
to increase by about $270 million as a result of the revised payment 
system. This increased spending in ASCs is projected to be fully offset 
by savings from reduced spending in HOPDs and physicians' offices due 
to service migration.

  Table 11.--Estimated CY 2008 Impact of the Revised ASC Payment System on Estimated Aggregate CY 2008 Medicare
     Program Payments Under the 75/25 Transition Blend and Without a Transition, by Surgical Specialty Group
----------------------------------------------------------------------------------------------------------------
                                                                                                   Estimated CY
                                                                   Estimated CY    Estimated CY    2008 percent
                                                                     2008 ASC      2008 percent   change without
                    Surgical specialty group                       payments (in     change with      transition
                                                                     millions)    transition (75/     (fully
                                                                                     25 blend)     implemented)
(1)                                                                          (2)             (3)             (4)
----------------------------------------------------------------------------------------------------------------
Eye and ocular adnexa...........................................          $1,365               1               5
Digestive system................................................             721              -4             -15
Nervous system..................................................             274               2              -5
Musculoskeletal system..........................................             167              24              97
Integumentary system............................................              85               4              15
Genitourinary system............................................              76              10              38
Respiratory system..............................................              23              16              65
Cardiovascular system...........................................               8              25              95
Auditory system.................................................               4              30              85
Hemic and lymphatic systems.....................................               2              28             110
Other systems...................................................             0.1              19              75
----------------------------------------------------------------------------------------------------------------

    Table 12 below shows the estimated impact of the revised payment 
system on aggregate ASC payments for selected procedures during the 
first year of implementation (CY 2008) with and without the 
transitional blended rate. The table displays 30 of the procedures 
receiving the highest estimated CY 2008 ASC payments under the existing 
Medicare payment system. The HCPCS codes are sorted in descending order 
by estimated CY 2008 ASC program payments in the absence of the revised 
ASC payment system.
     Column 1--HCPCS code.
     Column 2--Short Descriptor of the HCPCS code.
     Column 3--Estimated CY 2008 ASC Payments in the absence of 
the revised payment system were calculated by multiplying the CY 2007 
ASC payment rate by CY 2008 ASC utilization (which is based on CY 2005 
ASC utilization multiplied by a factor of 1.305 to take into account 
expected volume growth with volume adjustment, as appropriate, for the 
multiple procedure discount). The resulting amount was then multiplied 
by 0.8 to estimate the Medicare program's share of the total payments 
to the ASC. The payment amounts are expressed in millions of dollars.
     Column 4--CY 2008 Percent Change with Transition (75/25 
Blend) reflects the percent differences between the estimated ASC 
payment rates for CY 2008 under the current system and the estimated 
payment rates for CY 2008 under the revised system, incorporating a 75/
25 blend of the estimated ASC payment using the CY 2007 ASC payment 
rate and the revised ASC payment rate.
     Column 5--CY 2008 Percent Change without Transition (Fully 
Implemented) reflects the percent differences between the estimated ASC 
payment rates for CY 2008 under the current system and the estimated 
payment rates for CY 2008 under the revised payment system if there 
were no transition period to the revised payment rates. The percentages 
appearing in column 5 are presented as a comparison for the transition 
policy in column 4 and do not depict the impact of the fully 
implemented proposal in CY 2011.

 Table 12.--Estimated CY 2008 Impact of Revised ASC Payment System on Aggregate Payments for Procedures With the
                           Highest Estimated CY 2008 Payments Under the Current System
----------------------------------------------------------------------------------------------------------------
                                                                                                   Estimated CY
                                                                                                   2008 percent
                                                                   Estimated CY    Estimated CY       changes
          HCPCS code                    Short descriptor             2008 ASC      2008 percent       without
                                                                   payments (in    change (75/25    transition
                                                                     millions)        blend)          (fully
                                                                                                   implemented)
(1)                             (2).............................             (3)             (4)             (5)
----------------------------------------------------------------------------------------------------------------
66984.........................  Cataract surg w/iol, 1 stage....          $1,112               1               3
45378.........................  Diagnostic colonoscopy..........             153              -4             -16
43239.........................  Upper GI endoscopy, biopsy......             148              -5             -21
45380.........................  Colonoscopy and biopsy..........             114              -4             -16
66821.........................  After cataract laser surgery....             102              -8             -31
45385.........................  Lesion removal colonoscopy......              96              -4             -16
62311.........................  Inject spine l/s (cd)...........              81              -5             -19
45384.........................  Lesion remove colonoscopy.......              44              -4             -16

[[Page 42542]]

 
64483.........................  Inj foramen epidural l/s........              44              -5             -19
G0121.........................  Colon ca scrn not hi rsk ind....              37              -6             -25
15823.........................  Revision of upper eyelid........              35              -4             -17
66982.........................  Cataract surgery, complex.......              33               1               3
64476.........................  Inj paravertebral l/s add-on....              29              -7             -27
G0105.........................  Colorectal scrn; hi risk ind....              27              -6             -25
43235.........................  Uppr gi endoscopy, diagnosis....              25               2               6
52000.........................  Cystoscopy......................              24              -4             -17
64475.........................  Inj paravertebral l/s...........              24              -5             -19
67904.........................  Repair eyelid defect............              22               4              16
64721.........................  Carpal tunnel surgery...........              17              18              70
29881.........................  Knee arthroscopy/surgery........              16              23              93
43248.........................  Uppr gi endoscopy/guide wire....              15              -5             -21
62310.........................  Inject spine c/t................              14              -5             -19
29880.........................  Knee arthroscopy/surgery........              11              23              93
64484.........................  Inj foramen epidural add-on.....              11              -5             -19
28285.........................  Repair of hammertoe.............              10              18              70
67038.........................  Strip retinal membrane..........              10              31             122
29848.........................  Wrist endoscopy/surgery.........               9              -2              -9
64623.........................  Destr paravertebral n add-on....               9              -5             -19
45383.........................  Lesion removal colonoscopy......               9              -4             -16
26055.........................  Incise finger tendon sheath.....               9              14              54
----------------------------------------------------------------------------------------------------------------

    Over time, we believe that the current ASC payment system has 
served as an incentive to ASCs to focus on providing procedures for 
which they determine Medicare payments are adequate to support the 
ASC's continued operation. We would expect that, under the existing 
payment system, the ASC payment rates for many of the most frequently 
performed procedures in ASCs are similar to the OPPS payment rates for 
the same procedures. Conversely, we would expect that procedures with 
existing ASC payment rates that are substantially lower than the OPPS 
rates would be performed less often in ASCs. We believe the revised ASC 
payment system represents a major stride towards encouraging greater 
efficiency in ASCs and promoting a significant increase in the breadth 
of surgical procedures performed in ASCs, because it more appropriately 
distributes payments across the entire spectrum of covered surgical 
procedures, based on a coherent system of relative payment weights that 
are related to the clinical and facility resource characteristics of 
those procedures.
    Table 12 identifies a number of ASC procedures receiving the 
highest estimated CY 2008 payments under the current system and shows 
that most of them will experience payment decreases in CY 2008 under 
the revised ASC payment system. This contrasts with the estimated 
aggregate payment increases at the surgical specialty group level 
displayed in Table 11. In fact, Table 11 shows only one surgical 
specialty group of procedures for which the payments are expected to 
see a small decrease in the first year under the revised ASC payment 
system, and only two groups for which a decrease would be expected if 
there were no transition period to the revised payment rates. The 
increased payments at the full group level are due to the moderating 
effect of the payment increases for the less frequently performed 
procedures within the surgical specialty group. The exception to this 
is the surgical specialty group of eye and ocular adnexa where the 
aggregate increase in CY 2008 is driven by a small increase in payment 
for the highest volume procedure (CPT code 66984, Extracapsular 
cataract removal with insertion of intraocular lens prosthesis (one 
stage procedures), manual or mechanical technique (e.g., irrigation and 
aspiration or phacoemulsification)).
    As a result of the redistribution of payments across the expanded 
breadth of surgical procedures for which Medicare will provide an ASC 
payment, we believe that ASCs may change the mix of services they 
provide over the next several years. The revised ASC payment system 
should encourage ASCs to expand their service mix beyond the handful of 
the highest paying procedures which comprise the majority of ASC 
utilization under the existing ASC payment system. For example, 
although cystoscopy (CPT code 52000), the highest volume ASC 
genitourinary procedure, is expected to experience a 4 percent payment 
rate decrease in CY 2008, overall payment to ASCs for the group of 
genitourinary procedures currently performed in ASCs is expected to 
increase by 10 percent. Although a urology specialty ASC may currently 
perform far more cystoscopy procedures than any other genitourinary 
procedure, we believe that under the revised ASC payment system, the 
ASC has the opportunity to adapt to the payment decrease for its most 
frequently performed procedures by offering an increased breadth of 
procedures, still within the clinical specialty area, and receive 
payments that are adequate to support continued operations. Similarly, 
payments for all of the highest volume pain management injection 
procedures are expected to decrease in CY 2008, although payments for 
nervous system procedures overall

[[Page 42543]]

are expected to increase. However, if there were no transition for CY 
2008, payments would also decrease slightly for the nervous system 
surgical specialty group.
    For those procedures that will be paid a significantly lower amount 
under the revised payment system than they are currently paid, we 
believe that their current payment rates, which are closer to the OPPS 
payment rates than other ASC procedures, are likely to be generous 
relative to ASC costs, so ASCs would in all likelihood continue 
performing those procedures under the revised payment system. We also 
note that the majority of the most frequently performed ASC procedures 
specifically studied by the GAO, as described in the section II.B. of 
this final rule for the revised ASC payment system, appear in Table 12 
with estimated payment decreases under the revised ASC payment system. 
The GAO concluded that, for these procedures, the OPPS APC groups 
accurately reflect the relative costs of procedures performed at ASCs 
and that ASCs have substantially lower costs.
    Generally, the payment changes for individual surgical procedures 
are relatively small in the first year under the transition to the 
revised payment system. As displayed in Table 12, a 1 percent increase 
in payment for the most common cataract surgery, CPT code 66984, is 
expected and mirrors the effect of the revised payment system on 
payment for the eye and ocular adnexa surgical specialty group (Table 
11), even though payment for another relatively high volume eye 
procedure, CPT code 66821 (Discission of secondary membranous cataract 
(opacified posterior lens capsule and/or anterior hyaloid); laser 
surgery (e.g., YAG laser) (one or more stages)), is expected to 
decrease by 8 percent.
    For some procedures the estimated payment amounts in CY 2008 under 
the revised ASC payment system are much higher than the CY 2007 rates 
currently paid to ASCs. For example, payment for CPT code 67038 
(Vitrectomy, mechanical, pars plana approach; with epiretinal membrane 
stripping) increases by 31 percent compared to estimated CY 2008 
payments under the current system. Similarly, the estimated CY 2008 ASC 
payment for CPT code 29880 (Arthroscopy, knee, surgical; with 
meniscetomy (medial and lateral, including any meniscal shaving)) 
increases by 23 percent. For these two procedures and the other 
procedures with estimated payment increases greater than 10 percent, 
the increases are due to the comparatively higher OPPS rates which, 
when adjusted by the ASC budget neutrality factor and blended with the 
CY 2007 ASC payment amounts, generate CY 2008 ASC payment rates that 
are substantially above the current CY 2007 ASC payment rates.
    We estimate that payments for most of the highest volume 
colonoscopy and upper gastrointestinal endoscopy procedures will 
decrease under the revised payment system. In fact, payment decreases 
also are expected for the gastrointestinal surgical specialty group 
overall. We believe that decreased payments for so many of the 
gastrointestinal procedures are because current ASC payment rates are 
close to the OPPS rates. Procedures with current payment rates that are 
nearly as high as their OPPS rates are affected more negatively under 
the revised payment system than procedures for which ASC rates have 
historically been much lower than the comparable OPPS rates. The 
payment decreases expected in the first year under the revised ASC 
payment system for some of the high volume gastrointestinal procedures 
are not large (all less than 7 percent). We believe that ASCs can 
generally continue to cover their costs for these procedures, and that 
ASCs specializing in providing those services will be able to adapt 
their business practices and case-mix to manage declines for individual 
procedures.
    In CY 2008, we also are adding hundreds of surgical procedures to 
the already extensive list of procedures for which Medicare allows 
payment to ASCs, creating new opportunities for ASCs to expand their 
range of covered surgical procedures. For the first time, ASCs will be 
paid separately for covered ancillary services that are integral to 
covered surgical procedures, including certain radiology procedures, 
costly drugs and biologicals, devices with pass-through status under 
the OPPS, and brachytherapy sources. While separately paid radiology 
services will be paid based on their ASC relative payment weight 
calculated according to the standard ratesetting methodology of the 
revised ASC payment system or to the MPFS nonfacility practice expense 
amount, whichever is lower, the other items newly eligible for separate 
payment in ASCs will be paid comparably to their OPPS rates because we 
would not expect ASCs to experience efficiencies in providing them. 
Lastly, this final rule establishes a specific payment methodology for 
device-intensive procedures that provides the same packaged payment for 
the device as under the OPPS, while providing a reduced service payment 
that is subject to the 4-year transition if the device-intensive 
procedure is on the CY 2007 ASC list of covered surgical procedures. 
This final methodology should allow ASCs to continue to expand their 
provision of device-intensive services and to begin performing new 
device-intensive ASC procedures.
4. Estimated Effects of This Final Rule on Beneficiaries
    We estimate that the changes for CY 2008 will be positive for 
beneficiaries in at least two respects. Except for screening 
colonoscopy and flexible sigmoidoscopy procedures, the ASC coinsurance 
rate for all procedures is 20 percent. This contrasts with procedures 
performed in HOPDs where the beneficiary is responsible for copayments 
that range from 20 percent to 40 percent. In addition, ASC payment 
rates under the revised payment system are lower than payment rates for 
the same procedures under the OPPS, so the beneficiary coinsurance 
amount under the ASC payment system almost always will be less than the 
OPPS copayment amount for the same services. (The only exceptions will 
be when the ASC coinsurance amount exceeds the inpatient deductible. 
The statute requires that copayment amounts under the OPPS not exceed 
the inpatient deductible.) Beneficiary coinsurance for services 
migrating from physicians' offices to ASCs may decrease or increase 
under the revised ASC payment system, depending on the particular 
service and the relative payment amounts for that service in the 
physician's office compared with the ASC. As noted previously, the net 
effect of the revised ASC payment system on beneficiary coinsurance, 
taking into account the migration of services from HOPDs and 
physicians' offices, is estimated to be $20 million in beneficiary 
savings in CY 2008.
    In addition to the lower out-of-pocket expenses, we believe that 
beneficiaries also will have access to more services in ASCs as a 
result of the addition of 793 surgical procedures to the ASC list of 
covered surgical services eligible for Medicare payment. We expect that 
ASCs will provide a broader range of surgical services under the 
revised payment system and that beneficiaries will benefit from having 
access to a greater variety of surgical procedures in ASCs.
5. Conclusion
    The changes to the ASC payment system for CY 2008 will affect each 
of the more than 4,600 ASCs currently approved for participation in the 
Medicare program. The effect on an

[[Page 42544]]

individual ASC will depend on the ASC's mix of patients, the proportion 
of the ASC's patients that are Medicare beneficiaries, the degree to 
which the payments for the procedures offered by the ASC are changed 
under the revised payment system, and the degree to which the ASC 
chooses to provide a different set of procedures. The revised ASC 
payment system is designed to result in the same aggregate amount of 
Medicare expenditures in CY 2008 that would be made in the absence of 
the revised ASC payment system. As mentioned previously, we estimate 
that the revised ASC payment system and the expanded ASC list of 
covered surgical procedures that we are implementing in CY 2008 will 
have no net effect on Medicare expenditures compared to the level of 
Medicare expenditures that would have occurred in CY 2008 in the 
absence of the revised payment system. However, there will be a total 
increase in Medicare payments to ASCs for CY 2008 of approximately $270 
million as a result of the revised ASC payment system, which will be 
fully offset by savings from reduced Medicare spending in HOPDs and 
physicians' offices on services that migrate from these settings to 
ASCs (as discussed in detail in section V.C. of this final rule). 
Furthermore, we estimate that the revised ASC payment system will 
result in Medicare savings of $240 million over 5 years due to 
migration of new ASC services from HOPDs and physicians' offices to 
ASCs over time. We anticipate that this final rule will have a 
significant economic impact on a substantial number of small entities.
6. Accounting Statement
    As required by OMB Circular A-4 (available at http://www.whitehousegov/omb/circulars/a004/a-4.pdf), in Table 13 below, we 
have prepared an accounting statement showing the classification of the 
expenditures associated with the implementation of the CY 2008 revised 
ASC payment system, based on the provisions of this final rule. As 
explained above, we estimate that Medicare payments to ASCs in CY 2008 
will be about $270 million higher than they would otherwise be in the 
absence of the revised ASC payment system. This $270 million in 
additional payments to ASCs in CY 2008 will be fully offset by savings 
from reduced spending in HOPDs and physicians' offices on services that 
migrate from these settings to ASCs. This table provides our best 
estimate of Medicare payments to providers and suppliers as a result of 
the CY 2008 revised ASC payment system, as presented in this final 
rule. All expenditures are classified as transfers.

      Table 13.--Accounting Statement: Classification of Estimated
 Expenditures From CY 2007 to CY 2008 as a Result of the CY 2008 Revised
                           ASC Payment System
------------------------------------------------------------------------
                 Category                             Transfers
------------------------------------------------------------------------
Annualized Monetized Transfers............  $0 Million.
From Whom to Whom.........................  Federal Government to
                                             Medicare Providers and
                                             Suppliers.
Annualized Monetized Transfer.............  $0 Million.
From Whom to Whom.........................  Premium Payments from
                                             Beneficiaries to Federal
                                             Government.
                                           -----------------------------
    Total.................................  $0 Million.
------------------------------------------------------------------------

C. Executive Order 12866

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

List of Subjects

42 CFR Part 410

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

42 CFR Part 416

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

0
For reasons stated in the preamble of this final rule, the Centers for 
Medicare & Medicaid Services is amending 42 CFR Chapter IV as set forth 
below:

PART 410--SUPPLEMENTARY MEDICAL INSURANCE (SMI) BENEFITS

0
1. The authority citation for part 410 continues to read as follows:

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


0
2. Section 410.152 is amended by adding a new paragraph (i)(2) to read 
as follows:


Sec.  410.152  Amounts of payment.

* * * * *
    (i) * * *
    (2) For ASC services furnished on or after January 1, 2008, in 
connection with the covered surgical procedures specified in Sec.  
416.166 of this subchapter, except as provided in paragraphs (i)(2)(i) 
and (i)(2)(ii) of this section, Medicare Part B pays the lesser of 80 
percent of the actual charge or 80 percent of the prospective payment 
amount, geographically adjusted, if applicable, as determined under 
Subpart F of Part 416 of this subchapter. Part B coinsurance is 20 
percent of the actual charge or 20 percent of the prospective payment 
amount, geographically adjusted, if applicable.
    (i) If the limitation described in Sec.  416.167(b)(3) of this 
subchapter applies, Medicare pays 80 percent of the amount determined 
under Subpart B of Part 414 of this subchapter and Part B coinsurance 
is 20 percent of the applicable payment amount.
    (ii) Medicare Part B pays 75 percent of the applicable payment 
amount for screening flexible sigmoidoscopies and screening 
colonoscopies, and Part B coinsurance is 25 percent of the applicable 
payment amount.
* * * * *

PART 416--AMBULATORY SURGICAL SERVICES

0
3. The authority citation for part 416 continues to read as follows:

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


0
4. Section 416.2 is amended by--
0
a. Revising the definition of ``ASC services.''
0
b. Adding a definition of ``Covered ancillary services'' in 
alphabetical order.
0
c. Revising the definition of ``Covered surgical procedures.''
0
d. Revising the definition of ``Facility services.''
    The revisions and addition read as follows:


Sec.  416.2  Definitions.

* * * * *
    ASC services means, for the period before January 1, 2008, facility 
services that are furnished in an ASC, and beginning January 1, 2008, 
means the combined facility services and covered ancillary services 
that are furnished in an ASC in connection with covered surgical 
procedures.
    Covered ancillary services means items and services that are 
integral to a covered surgical procedure performed in an ASC as 
provided in Sec.  416.164(b), for which payment may be made under Sec.  
416.171 in addition to the payment for the facility services.
    Covered surgical procedures means those surgical procedures 
furnished before January 1, 2008, that meet the criteria specified in 
Sec.  416.65 and those surgical procedures furnished on or after 
January 1, 2008, that meet the criteria specified in Sec.  416.166.

[[Page 42545]]

    Facility services means for the period before January 1, 2008, 
services that are furnished in connection with covered surgical 
procedures performed in an ASC, and beginning January 1, 2008, means 
services that are furnished in connection with covered surgical 
procedures performed in an ASC as provided in Sec.  416.164(a) for 
which payment is included in the ASC payment established under Sec.  
416.171 for the covered surgical procedure.

0
5. A new Subpart F is added to read as follows:
Subpart F--Coverage, Scope of ASC Services, and Prospective Payment 
System for ASC Services Furnished on or After January 1, 2008
Sec.
416.160 Basis and scope
416.161 Applicability of this subpart
416.163 General rules
416.164 Scope of ASC services
416.166 Covered surgical procedures
416.167 Basis of payment
416.171 Determination of payment rates for ASC services
416.172 Adjustments to national payment rates
416.173 Publication of revised payment methodologies and payment 
rates
416.178 Limitations on administrative and judicial review
416.179 Payment and coinsurance reduction for devices replaced 
without cost or when full credit is received

Subpart F--Coverage, Scope of ASC Services, and Prospective Payment 
System for ASC Services Furnished on or After January 1, 2008


Sec.  416.160  Basis and scope.

    (a) Statutory basis. (1) Section 1833(i)(2)(D) of the Act requires 
the Secretary to implement a revised payment system for payment of 
surgical services furnished in ASCs. The statute requires that, in the 
year such system is implemented, the system shall be designed to result 
in the same amount of aggregate expenditures for such services as would 
be made if there was no requirement for a revised payment system. The 
revised payment system shall be implemented no earlier than January 1, 
2006, and no later than January 1, 2008. There shall be no 
administrative or judicial review under section 1869 of the Act, 
section 1878 of the Act, or otherwise of the classification system, the 
relative weights, payment amounts, and the geographic adjustment 
factor, if any, of the revised payment system.
    (2) Section 1833(a)(1)(G) of the Act provides that, beginning with 
the implementation date of a revised payment system for ASC facility 
services furnished in connection with a surgical procedure pursuant to 
section 1833(i)(1)(A) of the Act, the amount paid shall be 80 percent 
of the lesser of the actual charge for such services or the amount 
determined by the Secretary under the revised payment system.
    (3) Section 1833(i)(1)(A) of the Act requires the Secretary to 
specify the surgical procedures that can be performed safely on an 
ambulatory basis in an ASC.
    (4) Section 1834(d) of the Act specifies that, when screening 
colonoscopies or screening flexible sigmoidoscopies are performed in an 
ASC or hospital outpatient department, payment shall be based on the 
lesser of the amount under the fee schedule that would apply to such 
services if they were performed in a hospital outpatient department in 
an area or the amount under the fee schedule that would apply to such 
services if they were performed in an ambulatory surgical center in the 
same area. Section 1834(d) of the Act further specifies that the 
coinsurance for screening flexible sigmoidoscopy and screening 
colonoscopy procedures is 25 percent of the payment amount. Section 
1834(d) of the Act also specifies that, in the case of screening 
flexible sigmoidoscopy and screening colonoscopy services, their 
payment amounts must not exceed the payment rates established for the 
related diagnostic services. Section 1833(b)(8) of the Act specifies 
that the Part B deductible shall not apply with respect to colorectal 
screening tests as described in section 1861(pp)(1) of the Act, which 
include screening colonoscopies and screening flexible sigmoidoscopies.
    (b) Scope. This subpart sets forth--
    (1) The scope of ASC services and the criteria for determining the 
covered surgical procedures for which Medicare provides payment for the 
associated facility services and covered ancillary services;
    (2) The basis of payment for facility services and for covered 
ancillary services furnished in an ASC in connection with a covered 
surgical procedure;
    (3) The methodologies by which Medicare determines payment amounts 
for ASC services.


Sec.  416.161  Applicability of this subpart.

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


Sec.  416.163  General rules.

    (a) Payment is made under this subpart for ASC services specified 
in Sec. Sec.  416.164(a) and (b) furnished to Medicare beneficiaries by 
a participating ASC in connection with covered surgical procedures as 
determined by the Secretary in accordance with Sec.  416.166.
    (b) Payment for physicians' services and payment for anesthetists' 
services are made in accordance with Part 414 of this subchapter.
    (c) Payment for items and services other than physicians' and 
anesthetists' services, as specified in Sec.  416.164(c), is made in 
accordance with Sec.  410.152 of this subchapter.


Sec.  416.164  Scope of ASC services.

    (a) Included facility services. ASC services for which payment is 
packaged into the ASC payment for a covered surgical procedure under 
Sec.  416.166 include, but are not limited to--
    (1) Nursing, technician, and related services;
    (2) Use of the facility where the surgical procedures are 
performed;
    (3) Any laboratory testing performed under a Clinical Laboratory 
Improvement Amendments of 1988 (CLIA) certificate of waiver;
    (4) Drugs and biologicals for which separate payment is not allowed 
under the hospital outpatient prospective payment system (OPPS);
    (5) Medical and surgical supplies not on pass-through status under 
Subpart G of Part 419 of this subchapter;
    (6) Equipment;
    (7) Surgical dressings;
    (8) Implanted prosthetic devices, including intraocular lenses 
(IOLs), and related accessories and supplies not on pass-through status 
under Subpart G of Part 419 of this subchapter;
    (9) Implanted DME and related accessories and supplies not on pass-
through status under Subpart G of Part 419 of this subchapter;
    (10) Splints and casts and related devices;
    (11) Radiology services for which separate payment is not allowed 
under the OPPS, and other diagnostic tests or interpretive services 
that are integral to a surgical procedure;
    (12) Administrative, recordkeeping and housekeeping items and 
services;
    (13) Materials, including supplies and equipment for the 
administration and monitoring of anesthesia; and
    (14) Supervision of the services of an anesthetist by the operating 
surgeon.
    (b) Covered ancillary services. Ancillary items and services that 
are integral to a covered surgical procedure, as defined in Sec.  
416.166, and for which separate payment is allowed include:
    (1) Brachytherapy sources;
    (2) Certain implantable items that have pass-through status under 
the OPPS;
    (3) Certain items and services that CMS designates as contractor-
priced,

[[Page 42546]]

including, but not limited to, the procurement of corneal tissue;
    (4) Certain drugs and biologicals for which separate payment is 
allowed under the OPPS;
    (5) Certain radiology services for which separate payment is 
allowed under the OPPS.
    (c) Excluded services. ASC services do not include items and 
services outside the scope of ASC services for which payment may be 
made under Part 414 of this subchapter in accordance with Sec.  
410.152, including, but not limited to--
    (1) Physicians' services (including surgical procedures and all 
preoperative and postoperative services that are performed by a 
physician);
    (2) Anesthetists' services;
    (3) Radiology services (other than those integral to performance of 
a covered surgical procedure);
    (4) Diagnostic procedures (other than those directly related to 
performance of a covered surgical procedure);
    (5) Ambulance services;
    (6) Leg, arm, back, and neck braces other than those that serve the 
function of a cast or splint;
    (7) Artificial limbs;
    (8) Nonimplantable prosthetic devices and DME.


Sec.  416.166  Covered surgical procedures.

    (a) Covered surgical procedures. Effective for services furnished 
on or after January 1, 2008, covered surgical procedures are those 
procedures that meet the general standards described in paragraph (b) 
of this section (whether commonly furnished in an ASC or a physician's 
office) and are not excluded under paragraph (c) of this section.
    (b) General standards. Subject to the exclusions in paragraph (c) 
of this section, covered surgical procedures are surgical procedures 
specified by the Secretary and published in the Federal Register that 
are separately paid under the OPPS, that would not be expected to pose 
a significant safety risk to a Medicare beneficiary when performed in 
an ASC, and for which standard medical practice dictates that the 
beneficiary would not typically be expected to require active medical 
monitoring and care at midnight following the procedure.
    (c) General exclusions. Notwithstanding paragraph (b) of this 
section, covered surgical procedures do not include those surgical 
procedures that--
    (1) Generally result in extensive blood loss;
    (2) Require major or prolonged invasion of body cavities;
    (3) Directly involve major blood vessels;
    (4) Are generally emergent or life-threatening in nature;
    (5) Commonly require systemic thrombolytic therapy;
    (6) Are designated as requiring inpatient care under Sec.  
419.22(n) of this subchapter;
    (7) Can only be reported using a CPT unlisted surgical procedure 
code; or
    (8) Are otherwise excluded under Sec.  411.15 of this subchapter.


Sec.  416.167  Basis of payment.

    (a) Unit of payment. Under the ASC payment system, prospectively 
determined amounts are paid for ASC services furnished to Medicare 
beneficiaries in connection with covered surgical procedures. Covered 
surgical procedures and covered ancillary services are identified by 
codes established under the Healthcare Common Procedure Coding System 
(HCPCS). The unadjusted national payment rate is determined according 
to the methodology described in Sec.  416.171. The manner in which the 
Medicare payment amount and the beneficiary coinsurance amount for each 
ASC service is determined is described in Sec.  416.172.
    (b) Ambulatory payment classification (APC) groups and payment 
weights.
    (1) ASC covered surgical procedures are classified using the APC 
groups described in Sec.  419.31 of this subchapter.
    (2) For purposes of calculating ASC national payment rates under 
the methodology described in Sec.  416.171, except as specified in 
paragraph (b)(3) of this section, an ASC relative payment weight is 
determined based on the APC relative payment weight for each covered 
surgical procedure and covered ancillary service that has an applicable 
APC relative payment weight described in Sec.  419.31 of this 
subchapter.
    (3) Notwithstanding paragraph (b)(2) of this section, the relative 
payment weights for services paid in accordance with Sec.  416.171(d) 
are determined so that the national ASC payment rate does not exceed 
the unadjusted nonfacility practice expense amount paid under the 
Medicare physician fee schedule for such procedures under Subpart B of 
Part 414 of this subchapter.


Sec.  416.171  Determination of payment rates for ASC services.

    (a) Standard methodology. The standard methodology for determining 
the national unadjusted payment rate for ASC services is to calculate 
the product of the applicable conversion factor and the relative 
payment weight established under Sec.  416.167(b), unless otherwise 
indicated in this section.
    (1) Conversion factor for CY 2008. CMS calculates a conversion 
factor so that payment for ASC services furnished in CY 2008 would 
result in the same aggregate amount of expenditures as would be made if 
the provisions in this Subpart F did not apply, as estimated by CMS.
    (2) Conversion factor for CY 2009 and subsequent calendar years. 
The conversion factor for a calendar year is equal to the conversion 
factor calculated for the previous year, updated as follows:
    (i) For CY 2009, the update is equal to zero percent.
    (ii) For CY 2010 and subsequent calendar years, the update is the 
Consumer Price Index for All Urban Consumers (U.S. city average) as 
estimated by the Secretary for the 12-month period ending with the 
midpoint of the year involved.
    (b) Exception. The national ASC payment rates for the following 
items and services are not determined in accordance with paragraph (a) 
of this section but are paid an amount derived from the payment rate 
for the equivalent item or service set under the payment system 
established in Part 419 of this subchapter as updated annually in the 
Federal Register. If a payment rate is not available, the following 
items and services are designated as contractor-priced:
    (1) Covered ancillary services specified in Sec.  416.164(b), with 
the exception of radiology services as provided in Sec.  416.164(b)(5);
    (2) Device-intensive procedures assigned to device-dependent APCs 
under the OPPS with device costs greater than 50 percent of the APC 
cost;
    (3) Procedures using certain separately paid implantable devices 
that are approved for transitional pass-through payment in accordance 
with Sec.  419.66 of this subchapter.
    (c) Transitional payment rates. (1) ASC payment rates for CY 2008 
are a transitional blend of 75 percent of the CY 2007 ASC payment rate 
for a covered surgical procedure on the CY 2007 ASC list of surgical 
procedures and 25 percent of the payment rate for the procedure 
calculated under the methodology described in paragraph (a) of this 
section.
    (2) ASC payment rates for CY 2009 are a transitional blend of 50 
percent of the CY 2007 ASC payment rate for a covered surgical 
procedure on the CY 2007 ASC list of surgical procedures and 50 percent 
of the payment rate for the procedure calculated under the methodology 
described in paragraph (a) of this section.
    (3) ASC payment rates for CY 2010 are a transitional blend of 25 
percent of the CY 2007 ASC payment rate for a

[[Page 42547]]

covered surgical procedure on the CY 2007 ASC list of surgical 
procedures and 75 percent of the payment rate for the procedure 
calculated under the methodology described in paragraph (a) of this 
section.
    (4) The national ASC payment rate for CY 2011 and subsequent 
calendar years for a covered surgical procedure designated in 
accordance with Sec.  416.166 is the payment rates for the procedure 
calculated under the methodology described in paragraph (a) of this 
section.
    (5) Covered ancillary services described in Sec.  416.164(b) and 
surgical procedures identified as covered when performed in an ASC 
under Sec.  416.166 for the first time beginning on or after January 1, 
2008, are not subject to the transitional payment rates applicable in 
CYs 2008 through 2010 for ASC facility services.
    (d) Limitation on payment rates for office-based surgical 
procedures and covered ancillary radiology services. Notwithstanding 
the provisions of paragraph (a) of this section, for any covered 
surgical procedure under Sec.  416.166 that CMS determines is commonly 
performed in physicians' offices or for any covered ancillary radiology 
service, the national unadjusted ASC payment rates for these procedures 
and services will be the lesser of the amount determined under 
paragraph (a) of this section or the amount calculated at the 
nonfacility practice expense relative value units under Sec.  
414.22(b)(5)(i)(B) of this subchapter multiplied by the conversion 
factor described in Sec.  414.20(a)(3) of this subchapter.
    (e) Budget neutrality. (1) For CY 2008, CMS establishes the 
conversion factor to result in budget neutrality as estimated by CMS in 
accordance with paragraph (a)(1) of this section.
    (2) For CY 2009 and subsequent calendar years, CMS adjusts the ASC 
relative payment weights under Sec.  416.167(b)(2) as needed so that 
any updates and adjustments made under Sec.  419.50(a) of this 
subchapter are budget neutral as estimated by CMS.


Sec.  416.172  Adjustments to national payment rates.

    (a) General rule. Contractors adjust the payment rates established 
for ASC services to determine Medicare program payment and beneficiary 
coinsurance amounts in accordance with paragraphs (b) through (g) of 
this section.
    (b) Lesser of actual charge or geographically adjusted payment 
rate. Payments to ASCs equal 80 percent of the lesser of--
    (1) The actual charge for the service; or
    (2) The geographically adjusted payment rate determined under this 
subpart.
    (c) Geographic adjustment.--(1) General rule. Except as provided in 
paragraph (c)(2) of this section, the national ASC payment rates 
established under Sec.  416.171 for covered surgical procedures are 
adjusted for variations in ASC labor costs across geographic areas 
using wage index values, labor and nonlabor percentages, and localities 
specified by the Secretary.
    (2) Exception. The geographic adjustment is not applied to the 
payment rates set for drugs, biologicals, devices with OPPS 
transitional pass-through payment status, and brachytherapy sources.
    (d) Deductibles and coinsurance. Part B deductible and coinsurance 
amounts apply as specified in Sec. Sec.  410.152(a) and (i)(2) of this 
subchapter.
    (e) Payment reductions for multiple surgical procedures.--(1) 
General rule. Except as provided in paragraph (e)(2) of this section, 
when more than one covered surgical procedure for which payment is made 
under the ASC payment system is performed during an operative session, 
the Medicare program payment amount and the beneficiary coinsurance 
amount are based on--
    (i) 100 percent of the applicable ASC payment amount for the 
procedure with the highest national unadjusted ASC payment rate; and
    (ii) 50 percent of the applicable ASC payment amount for all other 
covered surgical procedures.
    (2) Exception: Procedures not subject to multiple procedure 
discounting. CMS may apply any policies or procedures used with respect 
to multiple procedures under the prospective payment system for 
hospital outpatient department services under Part 419 of this 
subchapter as may be consistent with the equitable and efficient 
administration of this part.
    (f) Interrupted procedures. When a covered surgical procedure or 
covered ancillary service is terminated prior to completion due to 
extenuating circumstances or circumstances that threaten the well-being 
of the patient, the Medicare program payment amount and the beneficiary 
coinsurance amount are based on one of the following--
    (1) The full program and beneficiary coinsurance amounts if the 
procedure for which anesthesia is planned is discontinued after the 
induction of anesthesia or after the procedure is started;
    (2) One-half of the full program and beneficiary coinsurance 
amounts if the procedure for which anesthesia is planned is 
discontinued after the patient is prepared for surgery and taken to the 
room where the procedure is to be performed but before the anesthesia 
is induced; or
    (3) One-half of the full program and beneficiary coinsurance 
amounts if a covered surgical procedure or covered ancillary service 
for which anesthesia is not planned is discontinued after the patient 
is prepared and taken to the room where the service is to be provided.
    (g) Payment adjustment for new technology intraocular lenses 
(NTIOLs). A payment adjustment will be made for insertion of an IOL 
approved as belonging to a class of NTIOLs as defined in Subpart G.


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

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


Sec.  416.178  Limitations on administrative and judicial review.

    There is no administrative or judicial review under section 1869 of 
the Act, section 1878 of the Act, or otherwise of the following:
    (a) The classification system;
    (b) Relative weights;
    (c) Payment amounts; and
    (d) Geographic adjustment factors.


Sec.  416.179  Payment and coinsurance reduction for devices replaced 
without cost or when full credit is received.

    (a) General rule. CMS reduces the amount of payment for a covered 
surgical procedure for which CMS determines that a significant portion 
of the payment is attributable to the cost of an implanted device not 
on pass-through status under Subpart G of Part 419 of this subchapter 
when one of the following situations occur:
    (1) The device is replaced without cost to the ASC or the 
beneficiary; or
    (2) The ASC receives full credit for the cost of a replaced device.
    (b) Amount of reduction to the ASC payment for the covered surgical 
procedure. The amount of the reduction to the ASC payment made under 
paragraph (a) of this section is calculated in the same manner as the 
device payment reduction that would be applied to the ASC payment for 
the covered surgical procedure in order to remove predecessor device 
costs so that

[[Page 42548]]

the ASC payment amount for a device with pass-through status under 
Sec.  419.66 of this subchapter represents the full cost of the device, 
and no packaged device payment is provided through the ASC payment for 
the covered surgical procedure.
    (c) Amount of beneficiary coinsurance. The beneficiary coinsurance 
is calculated based on the ASC payment for the covered surgical 
procedure after application of the reduction under paragraph (b) of 
this section.

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

    Dated: April 24, 2007.
Leslie Norwalk,
Acting Administrator, Centers for Medicare & Medicaid Services.
    Dated: May 31, 2007.
Michael O. Leavitt,
Secretary.

[[Page 42549]]







    --------------------
Note: The Medicare program payment is 80 percent of the total payment 
amount and beneficiary coinsurance is 20 percent of the total payment 
amount, except for screening flexible sigmoidoscopies and screening 
colonoscopies for which the program payment is 75 percent and the 
beneficiary coinsurance is 25 percent.



* Refers to codes designated as ``office-based'', whose designation as 
office-based is temporary because we have insufficient claims data. We 
will reconsider this designation when new claims data become available.

[[Page 42549]]



                     Addendum AA.--Illustrative ASC Covered Surgical Procedures for CY 2008
                          [Including surgical procedures for which payment is packaged]
----------------------------------------------------------------------------------------------------------------
                                                                                                      Estimated
                                  Subject to                                Estimated    Estimated     CY 2008
                    Short          multiple       Payment     CY 2007 ASC     fully       CY 2008       first
  HCPCS code      descriptor      procedure      indicator      payment    implemented     fully      transition
                                 discounting                      rate       payment    implemented      year
                                                                              weight       payment     payment
----------------------------------------------------------------------------------------------------------------
0016T........  Thermotx         Y............  R2...........  ...........       3.9333      $167.33      $167.33
                choroids vasc
                lesion.
0017T........  Photocoagulat    Y............  R2...........  ...........       3.9333      $167.33      $167.33
                macular drusen.
0027T........  Endoscopic       Y............  G2...........  ...........      17.8499      $759.39      $759.39
                epidural lysis.
0031T........  Speculoscopy...  .............  N1...........  ...........  ...........  ...........  ...........
0032T........  Speculoscopy w/  .............  N1...........  ...........  ...........  ...........  ...........
                direct sample.
0046T........  Cath lavage,     Y............  R2...........  ...........      15.1024      $642.50      $642.50
                mammary
                duct(s).
0047T........  Cath lavage,     Y............  R2...........  ...........      15.1024      $642.50      $642.50
                mammary
                duct(s).
0062T........  Rep intradisc    Y............  G2...........  ...........      25.1296    $1,069.09    $1,069.09
                annulus;1 lev.
0063T........  Rep intradisc    Y............  G2...........  ...........      25.1296    $1,069.09    $1,069.09
                annulus;>1lev.
0084T........  Temp prostate    Y............  G2...........  ...........       2.1393       $91.01       $91.01
                urethral stent.
0099T \*\....  Implant corneal  Y............  R2...........  ...........      15.2259      $647.76      $647.76
                ring.
0100T........  Prosth retina    Y............  G2...........  ...........      37.4290    $1,592.34    $1,592.34
                receive&gen.
0101T........  Extracorp        Y............  G2...........  ...........      25.1296    $1,069.09    $1,069.09
                shockwv tx,hi
                enrg.
0102T........  Extracorp        Y............  G2...........  ...........      25.1296    $1,069.09    $1,069.09
                shockwv
                tx,anesth.
0123T........  Scleral          Y............  G2...........  ...........      22.9970      $978.36      $978.36
                fistulization.
0124T \*\....  Conjunctival     Y............  R2...........  ...........       6.0673      $258.12      $258.12
                drug placement.
0133T........  Esophageal       Y............  G2...........  ...........      25.7552    $1,095.70    $1,095.70
                implant injexn.
0176T........  Aqu canal dilat  Y............  A2...........    $1,339.00      37.8967    $1,612.24    $1,407.31
                w/o retent.
0177T........  Aqu canal dilat  Y............  A2...........    $1,339.00      37.8967    $1,612.24    $1,407.31
                w retent.
10021........  Fna w/o image..  Y............  P2...........  ...........       1.0995       $46.78       $46.78
10022........  Fna w/image....  Y............  G2...........  ...........       2.0738       $88.23       $88.23
10040........  Acne surgery...  Y............  P2...........  ...........       0.4760       $20.25       $20.25
10060........  Drainage of      Y............  P3...........  ...........       1.0944       $46.56       $46.56
                skin abscess.
10061........  Drainage of      Y............  P2...........  ...........       1.4392       $61.23       $61.23
                skin abscess.
10080........  Drainage of      Y............  P2...........  ...........       1.4392       $61.23       $61.23
                pilonidal cyst.
10081........  Drainage of      Y............  P3...........  ...........       3.0339      $129.07      $129.07
                pilonidal cyst.
10120........  Remove foreign   Y............  P2...........  ...........       1.4392       $61.23       $61.23
                body.
10121........  Remove foreign   Y............  A2...........      $446.00      15.1024      $642.50      $495.13
                body.
10140........  Drainage of      Y............  P3...........  ...........       1.6174       $68.81       $68.81
                hematoma/fluid.
10160........  Puncture         Y............  P2...........  ...........       1.0259       $43.64       $43.64
                drainage of
                lesion.
10180........  Complex          Y............  A2...........      $446.00      17.5086      $744.87      $520.72
                drainage,
                wound.
11000........  Debride          Y............  P3...........  ...........       0.5312       $22.60       $22.60
                infected skin.
11001........  Debride          Y............  P3...........  ...........       0.1850        $7.87        $7.87
                infected skin
                add-on.
11010........  Debride skin,    Y............  A2...........      $251.52       4.0919      $174.08      $232.16
                fx.
11011........  Debride skin/    Y............  A2...........      $251.52       4.0919      $174.08      $232.16
                muscle, fx.
11012........  Debride skin/    Y............  A2...........      $251.52       4.0919      $174.08      $232.16
                muscle/bone,
                fx.
11040........  Debride skin,    Y............  P3...........  ...........       0.4828       $20.54       $20.54
                partial.
11041........  Debride skin,    Y............  P3...........  ...........       0.5632       $23.96       $23.96
                full.
11042........  Debride skin/    Y............  A2...........      $164.42       2.6749      $113.80      $151.77
                tissue.
11043........  Debride tissue/  Y............  A2...........      $164.42       2.6749      $113.80      $151.77
                muscle.
11044........  Debride tissue/  Y............  A2...........      $423.10       6.8832      $292.83      $390.53
                muscle/bone.
11055........  Trim skin        Y............  P3...........  ...........       0.5552       $23.62       $23.62
                lesion.
11056........  Trim skin        Y............  P3...........  ...........       0.6116       $26.02       $26.02
                lesions, 2 to
                4.
11057........  Trim skin        Y............  P3...........  ...........       0.7000       $29.78       $29.78
                lesions, over
                4.
11100........  Biopsy, skin     Y............  P2...........  ...........       1.0259       $43.64       $43.64
                lesion.
11101........  Biopsy, skin     Y............  P3...........  ...........       0.2978       $12.67       $12.67
                add-on.
11200........  Removal of skin  Y............  P3...........  ...........       0.9174       $39.03       $39.03
                tags.
11201........  Remove skin      Y............  P3...........  ...........       0.1288        $5.48        $5.48
                tags add-on.
11300........  Shave skin       Y............  P2...........  ...........       0.8432       $35.87       $35.87
                lesion.
11301........  Shave skin       Y............  P2...........  ...........       0.8432       $35.87       $35.87
                lesion.
11302........  Shave skin       Y............  P2...........  ...........       1.0918       $46.45       $46.45
                lesion.
11303........  Shave skin       Y............  P3...........  ...........       1.4484       $61.62       $61.62
                lesion.
11305........  Shave skin       Y............  P3...........  ...........       0.7726       $32.87       $32.87
                lesion.
11306........  Shave skin       Y............  P3...........  ...........       1.0140       $43.14       $43.14
                lesion.
11307........  Shave skin       Y............  P2...........  ...........       1.0918       $46.45       $46.45
                lesion.
11308........  Shave skin       Y............  P2...........  ...........       1.0918       $46.45       $46.45
                lesion.
11310........  Shave skin       Y............  P3...........  ...........       1.0058       $42.79       $42.79
                lesion.
11311........  Shave skin       Y............  P2...........  ...........       1.0918       $46.45       $46.45
                lesion.
11312........  Shave skin       Y............  P2...........  ...........       1.0918       $46.45       $46.45
                lesion.
11313........  Shave skin       Y............  P3...........  ...........       1.6094       $68.47       $68.47
                lesion.
11400........  Exc tr-ext       Y............  P3...........  ...........       1.5530       $66.07       $66.07
                b9+marg 0.5
                 4.0
                cm.
11420........  Exc h-f-nk-sp    Y............  P3...........  ...........       1.4484       $61.62       $61.62
                b9+marg 0.5<.
11421........  Exc h-f-nk-sp    Y............  P3...........  ...........       1.7220       $73.26       $73.26
                b9+marg 0.6-1.
11422........  Exc h-f-nk-sp    Y............  P3...........  ...........       1.8750       $79.77       $79.77
                b9+marg 1.1-2.
11423........  Exc h-f-nk-sp    Y............  P3...........  ...........       2.1085       $89.70       $89.70
                b9+marg 2.1-3.
11424........  Exc h-f-nk-sp    Y............  A2...........      $446.00      15.1024      $642.50      $495.13
                b9+marg 3.1-4.
11426........  Exc h-f-nk-sp    Y............  A2...........      $446.00      20.0656      $853.65      $547.91
                b9+marg > 4 cm.
11440........  Exc face-mm      Y............  P3...........  ...........       1.6898       $71.89       $71.89
                b9+marg 0.5 <
                cm.
11441........  Exc face-mm      Y............  P3...........  ...........       1.8993       $80.80       $80.80
                b9+marg 0.6-1
                cm.
11442........  Exc face-mm      Y............  P3...........  ...........       2.0763       $88.33       $88.33
                b9+marg 1.1-2
                cm.
11443........  Exc face-mm      Y............  P3...........  ...........       2.3256       $98.94       $98.94
                b9+marg 2.1-3
                cm.
11444........  Exc face-mm      Y............  A2...........      $333.00       6.8083      $289.65      $322.16
                b9+marg 3.1-4
                cm.
11446........  Exc face-mm      Y............  A2...........      $446.00      20.0656      $853.65      $547.91
                b9+marg > 4 cm.
11450........  Removal, sweat   Y............  A2...........      $446.00      20.0656      $853.65      $547.91
                gland lesion.
11451........  Removal, sweat   Y............  A2...........      $446.00      20.0656      $853.65      $547.91
                gland lesion.
11462........  Removal, sweat   Y............  A2...........      $446.00      20.0656      $853.65      $547.91
                gland lesion.
11463........  Removal, sweat   Y............  A2...........      $446.00      20.0656      $853.65      $547.91
                gland lesion.
11470........  Removal, sweat   Y............  A2...........      $446.00      20.0656      $853.65      $547.91
                gland lesion.
11471........  Removal, sweat   Y............  A2...........      $446.00      20.0656      $853.65      $547.91
                gland lesion.
11600........  Exc tr-ext       Y............  P3...........  ...........       2.1646       $92.09       $92.09
                mlg+marg 0.5 <
                cm.
11601........  Exc tr-ext       Y............  P3...........  ...........       2.4787      $105.45      $105.45
                mlg+marg 0.6-1
                cm.
11602........  Exc tr-ext       Y............  P3...........  ...........       2.6879      $114.35      $114.35
                mlg+marg 1.1-2
                cm.
11603........  Exc tr-ext       Y............  P3...........  ...........       2.8729      $122.22      $122.22
                mlg+marg 2.1-3
                cm.
11604........  Exc tr-ext       Y............  A2...........      $418.49       6.8083      $289.65      $386.28
                mlg+marg 3.1-4
                cm.
11606........  Exc tr-ext       Y............  A2...........      $446.00      15.1024      $642.50      $495.13
                mlg+marg > 4
                cm.
11620........  Exc h-f-nk-sp    Y............  P3...........  ...........       2.1888       $93.12       $93.12
                mlg+marg 0.5.
11621........  Exc h-f-nk-sp    Y............  P3...........  ...........       2.4947      $106.13      $106.13
                mlg+marg 0.6-1.
11622........  Exc h-f-nk-sp    Y............  P3...........  ...........       2.7683      $117.77      $117.77
                mlg+marg 1.1-2.
11623........  Exc h-f-nk-sp    Y............  P3...........  ...........       3.0017      $127.70      $127.70
                mlg+marg 2.1-3.
11624........  Exc h-f-nk-sp    Y............  A2...........      $446.00      15.1024      $642.50      $495.13
                mlg+marg 3.1-4.
11626........  Exc h-f-nk-sp    Y............  A2...........      $446.00      20.0656      $853.65      $547.91
                mlg+mar > 4 cm.
11640........  Exc face-mm      Y............  P3...........  ...........       2.2934       $97.57       $97.57
                malig+marg
                0.5<.
11641........  Exc face-mm      Y............  P3...........  ...........       2.6796      $114.00      $114.00
                malig+marg 0.6-
                1.
11642........  Exc face-mm      Y............  P3...........  ...........       2.9937      $127.36      $127.36
                malig+marg 1.1-
                2.
11643........  Exc face-mm      Y............  P3...........  ...........       3.2511      $138.31      $138.31
                malig+marg 2.1-
                3.
11644........  Exc face-mm      Y............  A2...........      $446.00      15.1024      $642.50      $495.13
                malig+marg 3.1-
                4.
11646........  Exc face-mm      Y............  A2...........      $446.00      20.0656      $853.65      $547.91
                mlg+marg > 4
                cm.
11719........  Trim nail(s)...  Y............  P3...........  ...........       0.2494       $10.61       $10.61
11720........  Debride nail, 1- Y............  P3...........  ...........       0.3218       $13.69       $13.69
                5.
11721........  Debride nail, 6  Y............  P3...........  ...........       0.4024       $17.12       $17.12
                or more.
11730........  Removal of nail  Y............  P3...........  ...........       0.9576       $40.74       $40.74
                plate.
11732........  Remove nail      Y............  P3...........  ...........       0.4024       $17.12       $17.12
                plate, add-on.
11740........  Drain blood      Y............  P3...........  ...........       0.5392       $22.94       $22.94
                from under
                nail.
11750........  Removal of nail  Y............  P3...........  ...........       2.0763       $88.33       $88.33
                bed.
11752........  Remove nail bed/ Y............  P3...........  ...........       2.8729      $122.22      $122.22
                finger tip.
11755........  Biopsy, nail     Y............  P3...........  ...........       1.4566       $61.97       $61.97
                unit.
11760........  Repair of nail   Y............  G2...........  ...........       1.4843       $63.15       $63.15
                bed.
11762........  Reconstruction   Y............  P2...........  ...........       1.4843       $63.15       $63.15
                of nail bed.
11765........  Excision of      Y............  P2...........  ...........       1.6241       $69.09       $69.09
                nail fold, toe.
11770........  Removal of       Y............  A2...........      $510.00      20.0656      $853.65      $595.91
                pilonidal
                lesion.
11771........  Removal of       Y............  A2...........      $510.00      20.0656      $853.65      $595.91
                pilonidal
                lesion.
11772........  Removal of       Y............  A2...........      $510.00      20.0656      $853.65      $595.91
                pilonidal
                lesion.
11900........  Injection into   Y............  P3...........  ...........       0.6358       $27.05       $27.05
                skin lesions.
11901........  Added skin       Y............  P3...........  ...........       0.6760       $28.76       $28.76
                lesions
                injection.
11920........  Correct skin     Y............  P2...........  ...........       1.4843       $63.15       $63.15
                color defects.
11921........  Correct skin     Y............  P2...........  ...........       1.4843       $63.15       $63.15
                color defects.
11922........  Correct skin     Y............  P3...........  ...........       0.8368       $35.60       $35.60
                color defects.
11950........  Therapy for      Y............  P3...........  ...........       0.8048       $34.24       $34.24
                contour
                defects.
11951........  Therapy for      Y............  P3...........  ...........       1.0784       $45.88       $45.88
                contour
                defects.
11952........  Therapy for      Y............  P3...........  ...........       1.4484       $61.62       $61.62
                contour
                defects.
11954........  Therapy for      Y............  P2...........  ...........       1.4843       $63.15       $63.15
                contour
                defects.

[[Page 42551]]

 
11960........  Insert tissue    Y............  A2...........      $446.00      21.4302      $911.71      $562.43
                expander(s).
11970........  Replace tissue   Y............  A2...........      $510.00      41.0893    $1,748.06      $819.52
                expander.
11971........  Remove tissue    Y............  A2...........      $333.00      20.0656      $853.65      $463.16
                expander(s).
11976........  Removal of       Y............  P3...........  ...........       1.3760       $58.54       $58.54
                contraceptive
                cap.
11980........  Implant hormone  N............  P2...........  ...........       0.6102       $25.96       $25.96
                pellet(s).
11981........  Insert drug      N............  P2...........  ...........       0.6102       $25.96       $25.96
                implant device.
11982........  Remove drug      N............  P2...........  ...........       0.6102       $25.96       $25.96
                implant device.
11983........  Remove/insert    N............  P2...........  ...........       0.6102       $25.96       $25.96
                drug implant.
12001........  Repair           Y............  P2...........  ...........       1.4843       $63.15       $63.15
                superficial
                wound(s).
12002........  Repair           Y............  P2...........  ...........       1.4843       $63.15       $63.15
                superficial
                wound(s).
12004........  Repair           Y............  P2...........  ...........       1.4843       $63.15       $63.15
                superficial
                wound(s).
12005........  Repair           Y............  A2...........       $91.24       1.4843       $63.15       $84.22
                superficial
                wound(s).
12006........  Repair           Y............  A2...........       $91.24       1.4843       $63.15       $84.22
                superficial
                wound(s).
12007........  Repair           Y............  A2...........       $91.24       1.4843       $63.15       $84.22
                superficial
                wound(s).
12011........  Repair           Y............  P2...........  ...........       1.4843       $63.15       $63.15
                superficial
                wound(s).
12013........  Repair           Y............  P2...........  ...........       1.4843       $63.15       $63.15
                superficial
                wound(s).
12014........  Repair           Y............  P2...........  ...........       1.4843       $63.15       $63.15
                superficial
                wound(s).
12015........  Repair           Y............  G2...........  ...........       1.4843       $63.15       $63.15
                superficial
                wound(s).
12016........  Repair           Y............  A2...........       $91.24       1.4843       $63.15       $84.22
                superficial
                wound(s).
12017........  Repair           Y............  A2...........       $91.24       1.4843       $63.15       $84.22
                superficial
                wound(s).
12018........  Repair           Y............  A2...........       $91.24       1.4843       $63.15       $84.22
                superficial
                wound(s).
12020........  Closure of       Y............  A2...........       $91.24       1.4843       $63.15       $84.22
                split wound.
12021........  Closure of       Y............  A2...........       $91.24       1.4843       $63.15       $84.22
                split wound.
12031........  Layer closure    Y............  P2...........  ...........       1.4843       $63.15       $63.15
                of wound(s).
12032........  Layer closure    Y............  P2...........  ...........       1.4843       $63.15       $63.15
                of wound(s).
12034........  Layer closure    Y............  A2...........       $91.24       1.4843       $63.15       $84.22
                of wound(s).
12035........  Layer closure    Y............  A2...........       $91.24       1.4843       $63.15       $84.22
                of wound(s).
12036........  Layer closure    Y............  A2...........       $91.24       1.4843       $63.15       $84.22
                of wound(s).
12037........  Layer closure    Y............  A2...........      $323.28       5.2594      $223.75      $298.40
                of wound(s).
12041........  Layer closure    Y............  P2...........  ...........       1.4843       $63.15       $63.15
                of wound(s).
12042........  Layer closure    Y............  P2...........  ...........       1.4843       $63.15       $63.15
                of wound(s).
12044........  Layer closure    Y............  A2...........       $91.24       1.4843       $63.15       $84.22
                of wound(s).
12045........  Layer closure    Y............  A2...........       $91.24       1.4843       $63.15       $84.22
                of wound(s).
12046........  Layer closure    Y............  A2...........       $91.24       1.4843       $63.15       $84.22
                of wound(s).
12047........  Layer closure    Y............  A2...........      $323.28       5.2594      $223.75      $298.40
                of wound(s).
12051........  Layer closure    Y............  P2...........  ...........       1.4843       $63.15       $63.15
                of wound(s).
12052........  Layer closure    Y............  P2...........  ...........       1.4843       $63.15       $63.15
                of wound(s).
12053........  Layer closure    Y............  P2...........  ...........       1.4843       $63.15       $63.15
                of wound(s).
12054........  Layer closure    Y............  A2...........       $91.24       1.4843       $63.15       $84.22
                of wound(s).
12055........  Layer closure    Y............  A2...........       $91.24       1.4843       $63.15       $84.22
                of wound(s).
12056........  Layer closure    Y............  A2...........       $91.24       1.4843       $63.15       $84.22
                of wound(s).
12057........  Layer closure    Y............  A2...........      $323.28       5.2594      $223.75      $298.40
                of wound(s).
13100........  Repair of wound  Y............  A2...........      $323.28       5.2594      $223.75      $298.40
                or lesion.
13101........  Repair of wound  Y............  A2...........      $323.28       5.2594      $223.75      $298.40
                or lesion.
13102........  Repair wound/    Y............  A2...........       $91.24       1.4843       $63.15       $84.22
                lesion add-on.
13120........  Repair of wound  Y............  A2...........       $91.24       1.4843       $63.15       $84.22
                or lesion.
13121........  Repair of wound  Y............  A2...........       $91.24       1.4843       $63.15       $84.22
                or lesion.
13122........  Repair wound/    Y............  A2...........       $91.24       1.4843       $63.15       $84.22
                lesion add-on.
13131........  Repair of wound  Y............  A2...........       $91.24       1.4843       $63.15       $84.22
                or lesion.
13132........  Repair of wound  Y............  A2...........       $91.24       1.4843       $63.15       $84.22
                or lesion.
13133........  Repair wound/    Y............  A2...........       $91.24       1.4843       $63.15       $84.22
                lesion add-on.
13150........  Repair of wound  Y............  A2...........      $323.28       5.2594      $223.75      $298.40
                or lesion.
13151........  Repair of wound  Y............  A2...........      $323.28       5.2594      $223.75      $298.40
                or lesion.
13152........  Repair of wound  Y............  A2...........      $323.28       5.2594      $223.75      $298.40
                or lesion.
13153........  Repair wound/    Y............  A2...........       $91.24       1.4843       $63.15       $84.22
                lesion add-on.
13160........  Late closure of  Y............  A2...........      $446.00      21.4302      $911.71      $562.43
                wound.
14000........  Skin tissue      Y............  A2...........      $446.00      14.0346      $597.07      $483.77
                rearrangement.
14001........  Skin tissue      Y............  A2...........      $510.00      21.4302      $911.71      $610.43
                rearrangement.
14020........  Skin tissue      Y............  A2...........      $510.00      14.0346      $597.07      $531.77
                rearrangement.
14021........  Skin tissue      Y............  A2...........      $510.00      14.0346      $597.07      $531.77
                rearrangement.
14040........  Skin tissue      Y............  A2...........      $446.00      14.0346      $597.07      $483.77
                rearrangement.
14041........  Skin tissue      Y............  A2...........      $510.00      14.0346      $597.07      $531.77
                rearrangement.
14060........  Skin tissue      Y............  A2...........      $510.00      14.0346      $597.07      $531.77
                rearrangement.

[[Page 42552]]

 
14061........  Skin tissue      Y............  A2...........      $510.00      14.0346      $597.07      $531.77
                rearrangement.
14300........  Skin tissue      Y............  A2...........      $630.00      21.4302      $911.71      $700.43
                rearrangement.
14350........  Skin tissue      Y............  A2...........      $510.00      21.4302      $911.71      $610.43
                rearrangement.
15002........  Wnd prep, ch/    Y............  A2...........      $323.28       5.2594      $223.75      $298.40
                inf, trk/arm/
                lg.
15003........  Wnd prep, ch/    Y............  A2...........      $323.28       5.2594      $223.75      $298.40
                inf addl 100
                cm.
15004........  Wnd prep ch/     Y............  A2...........      $323.28       5.2594      $223.75      $298.40
                inf, f/n/hf/g.
15005........  Wnd prep, f/n/   Y............  A2...........      $323.28       5.2594      $223.75      $298.40
                hf/g, addl cm.
15040........  Harvest          Y............  A2...........       $91.24       1.4843       $63.15       $84.22
                cultured skin
                graft.
15050........  Skin pinch       Y............  A2...........      $323.28       5.2594      $223.75      $298.40
                graft.
15100........  Skin splt grft,  Y............  A2...........      $446.00      21.4302      $911.71      $562.43
                trnk/arm/leg.
15101........  Skin splt grft   Y............  A2...........      $510.00      21.4302      $911.71      $610.43
                t/a/l, add-on.
15110........  Epidrm autogrft  Y............  A2...........      $446.00      21.4302      $911.71      $562.43
                trnk/arm/leg.
15111........  Epidrm autogrft  Y............  A2...........      $333.00      21.4302      $911.71      $477.68
                t/a/l add-on.
15115........  Epidrm a-grft    Y............  A2...........      $446.00      21.4302      $911.71      $562.43
                face/nck/hf/g.
15116........  Epidrm a-grft f/ Y............  A2...........      $333.00      21.4302      $911.71      $477.68
                n/hf/g addl.
15120........  Skn splt a-grft  Y............  A2...........      $446.00      21.4302      $911.71      $562.43
                fac/nck/hf/g.
15121........  Skn splt a-grft  Y............  A2...........      $510.00      21.4302      $911.71      $610.43
                f/n/hf/g add.
15130........  Derm autograft,  Y............  A2...........      $446.00      21.4302      $911.71      $562.43
                trnk/arm/leg.
15131........  Derm autograft   Y............  A2...........      $333.00      21.4302      $911.71      $477.68
                t/a/l add-on.
15135........  Derm autograft   Y............  A2...........      $446.00      21.4302      $911.71      $562.43
                face/nck/hf/g.
15136........  Derm autograft,  Y............  A2...........      $333.00      21.4302      $911.71      $477.68
                f/n/hf/g add.
15150........  Cult epiderm     Y............  A2...........      $446.00      21.4302      $911.71      $562.43
                grft t/arm/leg.
15151........  Cult epiderm     Y............  A2...........      $333.00      21.4302      $911.71      $477.68
                grft t/a/l
                addl.
15152........  Cult epiderm     Y............  A2...........      $333.00      21.4302      $911.71      $477.68
                graft t/a/l +%.
15155........  Cult epiderm     Y............  A2...........      $446.00      21.4302      $911.71      $562.43
                graft, f/n/hf/
                g.
15156........  Cult epidrm      Y............  A2...........      $333.00      21.4302      $911.71      $477.68
                grft f/n/hfg
                add.
15157........  Cult epiderm     Y............  A2...........      $333.00      21.4302      $911.71      $477.68
                grft f/n/hfg
                +%.
15200........  Skin full        Y............  A2...........      $510.00      14.0346      $597.07      $531.77
                graft, trunk.
15201........  Skin full graft  Y............  A2...........      $323.28       5.2594      $223.75      $298.40
                trunk add-on.
15220........  Skin full graft  Y............  A2...........      $446.00      14.0346      $597.07      $483.77
                sclp/arm/leg.
15221........  Skin full graft  Y............  A2...........      $323.28       5.2594      $223.75      $298.40
                add-on.
15240........  Skin full grft   Y............  A2...........      $510.00      14.0346      $597.07      $531.77
                face/genit/hf.
15241........  Skin full graft  Y............  A2...........      $323.28       5.2594      $223.75      $298.40
                add-on.
15260........  Skin full graft  Y............  A2...........      $446.00      14.0346      $597.07      $483.77
                een & lips.
15261........  Skin full graft  Y............  A2...........      $323.28       5.2594      $223.75      $298.40
                add-on.
15300........  Apply            Y............  A2...........      $323.28       5.2594      $223.75      $298.40
                skinallogrft,
                t/arm/lg.
15301........  Apply            Y............  A2...........      $323.28       5.2594      $223.75      $298.40
                sknallogrft t/
                a/l addl.
15320........  Apply skin       Y............  A2...........      $323.28       5.2594      $223.75      $298.40
                allogrft f/n/
                hf/g.
15321........  Aply             Y............  A2...........      $323.28       5.2594      $223.75      $298.40
                sknallogrft f/
                n/hfg add.
15330........  Aply acell       Y............  A2...........      $323.28       5.2594      $223.75      $298.40
                alogrft t/arm/
                leg.
15331........  Aply acell grft  Y............  A2...........      $323.28       5.2594      $223.75      $298.40
                t/a/l add-on.
15335........  Apply acell      Y............  A2...........      $323.28       5.2594      $223.75      $298.40
                graft, f/n/hf/
                g.
15336........  Aply acell grft  Y............  A2...........      $323.28       5.2594      $223.75      $298.40
                f/n/hf/g add.
15340........  Apply cult skin  Y............  P3...........  ...........       3.1385      $133.52      $133.52
                substitute.
15341........  Apply cult skin  Y............  G2...........  ...........       5.2594      $223.75      $223.75
                sub add-on.
15360........  Apply cult derm  Y............  G2...........  ...........       5.2594      $223.75      $223.75
                sub, t/a/l.
15361........  Aply cult derm   Y............  G2...........  ...........       5.2594      $223.75      $223.75
                sub t/a/l add.
15365........  Apply cult derm  Y............  G2...........  ...........       5.2594      $223.75      $223.75
                sub f/n/hf/g.
15366........  Apply cult derm  Y............  G2...........  ...........       5.2594      $223.75      $223.75
                f/hf/g add.
15400........  Apply skin       Y............  A2...........      $323.28       5.2594      $223.75      $298.40
                xenograft, t/a/
                l.
15401........  Apply skn        Y............  A2...........      $323.28       5.2594      $223.75      $298.40
                xenogrft t/a/l
                add.
15420........  Apply skin       Y............  A2...........      $323.28       5.2594      $223.75      $298.40
                xgraft, f/n/hf/
                g.
15421........  Apply skn xgrft  Y............  A2...........      $323.28       5.2594      $223.75      $298.40
                f/n/hf/g add.
15430........  Apply acellular  Y............  A2...........      $323.28       5.2594      $223.75      $298.40
                xenograft.
15431........  Apply acellular  Y............  A2...........      $323.28       5.2594      $223.75      $298.40
                xgraft add.
15570........  Form skin        Y............  A2...........      $510.00      21.4302      $911.71      $610.43
                pedicle flap.
15572........  Form skin        Y............  A2...........      $510.00      21.4302      $911.71      $610.43
                pedicle flap.
15574........  Form skin        Y............  A2...........      $510.00      21.4302      $911.71      $610.43
                pedicle flap.
15576........  Form skin        Y............  A2...........      $510.00      14.0346      $597.07      $531.77
                pedicle flap.
15600........  Skin graft.....  Y............  A2...........      $510.00      21.4302      $911.71      $610.43
15610........  Skin graft.....  Y............  A2...........      $510.00      21.4302      $911.71      $610.43
15620........  Skin graft.....  Y............  A2...........      $630.00      21.4302      $911.71      $700.43
15630........  Skin graft.....  Y............  A2...........      $510.00      21.4302      $911.71      $610.43

[[Page 42553]]

 
15650........  Transfer skin    Y............  A2...........      $717.00      21.4302      $911.71      $765.68
                pedicle flap.
15731........  Forehead flap w/ Y............  A2...........      $510.00      14.0346      $597.07      $531.77
                vasc pedicle.
15732........  Muscle-skin      Y............  A2...........      $510.00      21.4302      $911.71      $610.43
                graft, head/
                neck.
15734........  Muscle-skin      Y............  A2...........      $510.00      21.4302      $911.71      $610.43
                graft, trunk.
15736........  Muscle-skin      Y............  A2...........      $510.00      21.4302      $911.71      $610.43
                graft, arm.
15738........  Muscle-skin      Y............  A2...........      $510.00      21.4302      $911.71      $610.43
                graft, leg.
15740........  Island pedicle   Y............  A2...........      $446.00      14.0346      $597.07      $483.77
                flap graft.
15750........  Neurovascular    Y............  A2...........      $446.00      21.4302      $911.71      $562.43
                pedicle graft.
15760........  Composite skin   Y............  A2...........      $446.00      21.4302      $911.71      $562.43
                graft.
15770........  Derma-fat-       Y............  A2...........      $510.00      21.4302      $911.71      $610.43
                fascia graft.
15775........  Hair transplant  Y............  A2...........      $323.28       5.2594      $223.75      $298.40
                punch grafts.
15776........  Hair transplant  Y............  A2...........      $323.28       5.2594      $223.75      $298.40
                punch grafts.
15780........  Abrasion         Y............  P3...........  ...........       9.3992      $399.87      $399.87
                treatment of
                skin.
15781........  Abrasion         Y............  P2...........  ...........       4.0919      $174.08      $174.08
                treatment of
                skin.
15782........  Abrasion         Y............  P2...........  ...........       4.0919      $174.08      $174.08
                treatment of
                skin.
15783........  Abrasion         Y............  P2...........  ...........       2.6749      $113.80      $113.80
                treatment of
                skin.
15786........  Abrasion,        Y............  P2...........  ...........       1.0918       $46.45       $46.45
                lesion, single.
15787........  Abrasion,        Y............  P3...........  ...........       0.7726       $32.87       $32.87
                lesions, add-
                on.
15788........  Chemical peel,   Y............  P2...........  ...........       0.8432       $35.87       $35.87
                face, epiderm.
15789........  Chemical peel,   Y............  P2...........  ...........       1.6241       $69.09       $69.09
                face, dermal.
15792........  Chemical peel,   Y............  P2...........  ...........       1.0918       $46.45       $46.45
                nonfacial.
15793........  Chemical peel,   Y............  P2...........  ...........       0.8432       $35.87       $35.87
                nonfacial.
15819........  Plastic          Y............  G2...........  ...........       5.2594      $223.75      $223.75
                surgery, neck.
15820........  Revision of      Y............  A2...........      $510.00      21.4302      $911.71      $610.43
                lower eyelid.
15821........  Revision of      Y............  A2...........      $510.00      21.4302      $911.71      $610.43
                lower eyelid.
15822........  Revision of      Y............  A2...........      $510.00      21.4302      $911.71      $610.43
                upper eyelid.
15823........  Revision of      Y............  A2...........      $717.00      14.0346      $597.07      $687.02
                upper eyelid.
15824........  Removal of       Y............  A2...........      $510.00      21.4302      $911.71      $610.43
                forehead
                wrinkles.
15825........  Removal of neck  Y............  A2...........      $510.00      21.4302      $911.71      $610.43
                wrinkles.
15826........  Removal of brow  Y............  A2...........      $510.00      21.4302      $911.71      $610.43
                wrinkles.
15828........  Removal of face  Y............  A2...........      $510.00      21.4302      $911.71      $610.43
                wrinkles.
15829........  Removal of skin  Y............  A2...........      $717.00      21.4302      $911.71      $765.68
                wrinkles.
15830........  Exc skin abd...  Y............  A2...........      $510.00      20.0656      $853.65      $595.91
15832........  Excise           Y............  A2...........      $510.00      20.0656      $853.65      $595.91
                excessive skin
                tissue.
15833........  Excise           Y............  A2...........      $510.00      20.0656      $853.65      $595.91
                excessive skin
                tissue.
15834........  Excise           Y............  A2...........      $510.00      20.0656      $853.65      $595.91
                excessive skin
                tissue.
15835........  Excise           Y............  A2...........      $323.28       5.2594      $223.75      $298.40
                excessive skin
                tissue.
15836........  Excise           Y............  A2...........      $510.00      15.1024      $642.50      $543.13
                excessive skin
                tissue.
15837........  Excise           Y............  G2...........  ...........      15.1024      $642.50      $642.50
                excessive skin
                tissue.
15838........  Excise           Y............  G2...........  ...........      15.1024      $642.50      $642.50
                excessive skin
                tissue.
15839........  Excise           Y............  A2...........      $510.00      15.1024      $642.50      $543.13
                excessive skin
                tissue.
15840........  Graft for face   Y............  A2...........      $630.00      21.4302      $911.71      $700.43
                nerve palsy.
15841........  Graft for face   Y............  A2...........      $630.00      21.4302      $911.71      $700.43
                nerve palsy.
15842........  Flap for face    Y............  G2...........  ...........      14.0346      $597.07      $597.07
                nerve palsy.
15845........  Skin and muscle  Y............  A2...........      $630.00      21.4302      $911.71      $700.43
                repair, face.
15847........  Exc skin abd     Y............  A2...........      $510.00      20.0656      $853.65      $595.91
                add-on.
15850........  Removal of       Y............  G2...........  ...........       2.6749      $113.80      $113.80
                sutures.
15851........  Removal of       Y............  P3...........  ...........       1.2070       $51.35       $51.35
                sutures.
15852........  Dressing change  N............  G2...........  ...........       0.6102       $25.96       $25.96
                not for burn.
15860........  Test for blood   N............  G2...........  ...........       0.6102       $25.96       $25.96
                flow in graft.
15876........  Suction          Y............  A2...........      $510.00      21.4302      $911.71      $610.43
                assisted
                lipectomy.
15877........  Suction          Y............  A2...........      $510.00      21.4302      $911.71      $610.43
                assisted
                lipectomy.
15878........  Suction          Y............  A2...........      $510.00      14.0346      $597.07      $531.77
                assisted
                lipectomy.
15879........  Suction          Y............  A2...........      $510.00      21.4302      $911.71      $610.43
                assisted
                lipectomy.
15920........  Removal of tail  Y............  A2...........      $251.52       4.0919      $174.08      $232.16
                bone ulcer.
15922........  Removal of tail  Y............  A2...........      $630.00      21.4302      $911.71      $700.43
                bone ulcer.
15931........  Remove sacrum    Y............  A2...........      $510.00      20.0656      $853.65      $595.91
                pressure sore.
15933........  Remove sacrum    Y............  A2...........      $510.00      20.0656      $853.65      $595.91
                pressure sore.
15934........  Remove sacrum    Y............  A2...........      $510.00      21.4302      $911.71      $610.43
                pressure sore.
15935........  Remove sacrum    Y............  A2...........      $630.00      21.4302      $911.71      $700.43
                pressure sore.
15936........  Remove sacrum    Y............  A2...........      $630.00      21.4302      $911.71      $700.43
                pressure sore.
15937........  Remove sacrum    Y............  A2...........      $630.00      21.4302      $911.71      $700.43
                pressure sore.
15940........  Remove hip       Y............  A2...........      $510.00      20.0656      $853.65      $595.91
                pressure sore.

[[Page 42554]]

 
15941........  Remove hip       Y............  A2...........      $510.00      20.0656      $853.65      $595.91
                pressure sore.
15944........  Remove hip       Y............  A2...........      $510.00      21.4302      $911.71      $610.43
                pressure sore.
15945........  Remove hip       Y............  A2...........      $630.00      21.4302      $911.71      $700.43
                pressure sore.
15946........  Remove hip       Y............  A2...........      $630.00      21.4302      $911.71      $700.43
                pressure sore.
15950........  Remove thigh     Y............  A2...........      $510.00      20.0656      $853.65      $595.91
                pressure sore.
15951........  Remove thigh     Y............  A2...........      $630.00      20.0656      $853.65      $685.91
                pressure sore.
15952........  Remove thigh     Y............  A2...........      $510.00      21.4302      $911.71      $610.43
                pressure sore.
15953........  Remove thigh     Y............  A2...........      $630.00      21.4302      $911.71      $700.43
                pressure sore.
15956........  Remove thigh     Y............  A2...........      $510.00      21.4302      $911.71      $610.43
                pressure sore.
15958........  Remove thigh     Y............  A2...........      $630.00      21.4302      $911.71      $700.43
                pressure sore.
16000........  Initial          Y............  P3...........  ...........       0.6438       $27.39       $27.39
                treatment of
                burn(s).
16020........  Dress/debrid p-  Y............  P3...........  ...........       0.9656       $41.08       $41.08
                thick burn, s.
16025........  Dress/debrid p-  Y............  A2...........       $67.11       1.0918       $46.45       $61.95
                thick burn, m.
16030........  Dress/debrid p-  Y............  A2...........       $99.83       1.6241       $69.09       $92.15
                thick burn, l.
16035........  Incision of      Y............  G2...........  ...........       2.6749      $113.80      $113.80
                burn scab,
                initi.
17000........  Destruct         Y............  P2...........  ...........       0.4760       $20.25       $20.25
                premalg lesion.
17003........  Destruct         Y............  P3...........  ...........       0.0886        $3.77        $3.77
                premalg les, 2-
                14.
17004........  Destroy premlg   Y............  P3...........  ...........       1.8993       $80.80       $80.80
                lesions 15+.
17106........  Destruction of   Y............  P2...........  ...........       2.5665      $109.19      $109.19
                skin lesions.
17107........  Destruction of   Y............  P2...........  ...........       2.5665      $109.19      $109.19
                skin lesions.
17108........  Destruction of   Y............  P2...........  ...........       2.5665      $109.19      $109.19
                skin lesions.
17110........  Destruct b9      Y............  P2...........  ...........       0.8432       $35.87       $35.87
                lesion, 1-14.
17111........  Destruct         Y............  P2...........  ...........       1.0918       $46.45       $46.45
                lesion, 15 or
                more.
17250........  Chemical         Y............  P3...........  ...........       1.0220       $43.48       $43.48
                cautery,
                tissue.
17260........  Destruction of   Y............  P3...........  ...........       1.0944       $46.56       $46.56
                skin lesions.
17261........  Destruction of   Y............  P2...........  ...........       1.6241       $69.09       $69.09
                skin lesions.
17262........  Destruction of   Y............  P2...........  ...........       1.6241       $69.09       $69.09
                skin lesions.
17263........  Destruction of   Y............  P2...........  ...........       1.6241       $69.09       $69.09
                skin lesions.
17264........  Destruction of   Y............  P2...........  ...........       1.6241       $69.09       $69.09
                skin lesions.
17266........  Destruction of   Y............  P3...........  ...........       2.4382      $103.73      $103.73
                skin lesions.
17270........  Destruction of   Y............  P2...........  ...........       1.6241       $69.09       $69.09
                skin lesions.
17271........  Destruction of   Y............  P2...........  ...........       1.0918       $46.45       $46.45
                skin lesions.
17272........  Destruction of   Y............  P2...........  ...........       1.6241       $69.09       $69.09
                skin lesions.
17273........  Destruction of   Y............  P2...........  ...........       1.6241       $69.09       $69.09
                skin lesions.
17274........  Destruction of   Y............  P3...........  ...........       2.5026      $106.47      $106.47
                skin lesions.
17276........  Destruction of   Y............  P2...........  ...........       2.6749      $113.80      $113.80
                skin lesions.
17280........  Destruction of   Y............  P3...........  ...........       1.6014       $68.13       $68.13
                skin lesions.
17281........  Destruction of   Y............  P2...........  ...........       1.6241       $69.09       $69.09
                skin lesions.
17282........  Destruction of   Y............  P2...........  ...........       1.6241       $69.09       $69.09
                skin lesions.
17283........  Destruction of   Y............  P2...........  ...........       1.6241       $69.09       $69.09
                skin lesions.
17284........  Destruction of   Y............  P2...........  ...........       2.6749      $113.80      $113.80
                skin lesions.
17286........  Destruction of   Y............  P2...........  ...........       1.6241       $69.09       $69.09
                skin lesions.
17311........  Mohs, 1 stage,   Y............  P2...........  ...........       3.7292      $158.65      $158.65
                h/n/hf/g.
17312........  Mohs addl stage  Y............  P2...........  ...........       3.7292      $158.65      $158.65
17313........  Mohs, 1 stage,   Y............  P2...........  ...........       3.7292      $158.65      $158.65
                t/a/l.
17314........  Mohs, addl       Y............  P2...........  ...........       3.7292      $158.65      $158.65
                stage, t/a/l.
17315........  Mohs surg, addl  Y............  P3...........  ...........       0.9254       $39.37       $39.37
                block.
17340........  Cryotherapy of   Y............  P3...........  ...........       0.2816       $11.98       $11.98
                skin.
17360........  Skin peel        Y............  P2...........  ...........       1.0918       $46.45       $46.45
                therapy.
17380........  Hair removal by  Y............  R2...........  ...........       1.0918       $46.45       $46.45
                electrolysis.
19000........  Drainage of      Y............  P3...........  ...........       1.5290       $65.05       $65.05
                breast lesion.
19001........  Drain breast     Y............  P3...........  ...........       0.1932        $8.22        $8.22
                lesion add-on.
19020........  Incision of      Y............  A2...........      $446.00      17.5086      $744.87      $520.72
                breast lesion.
19030........  Injection for    .............  N1...........  ...........  ...........  ...........  ...........
                breast x-ray.
19100........  Bx breast        Y............  A2...........      $240.00       3.9045      $166.11      $221.53
                percut w/o
                image.
19101........  Biopsy of        Y............  A2...........      $446.00      19.2788      $820.18      $539.55
                breast, open.
19102........  Bx breast        Y............  A2...........      $240.00       3.9045      $166.11      $221.53
                percut w/image.
19103........  Bx breast        Y............  A2...........      $395.77       6.4387      $273.92      $365.31
                percut w/
                device.
19105........  Cryosurg ablate  Y............  G2...........  ...........      28.0166    $1,191.91    $1,191.91
                fa, each.
19110........  Nipple           Y............  A2...........      $446.00      19.2788      $820.18      $539.55
                exploration.
19112........  Excise breast    Y............  A2...........      $510.00      19.2788      $820.18      $587.55
                duct fistula.
19120........  Removal of       Y............  A2...........      $510.00      19.2788      $820.18      $587.55
                breast lesion.
19125........  Excision,        Y............  A2...........      $510.00      19.2788      $820.18      $587.55
                breast lesion.

[[Page 42555]]

 
19126........  Excision, addl   Y............  A2...........      $510.00      19.2788      $820.18      $587.55
                breast lesion.
19290........  Place needle     .............  N1...........      $333.00  ...........  ...........  ...........
                wire, breast.
19291........  Place needle     .............  N1...........      $333.00  ...........  ...........  ...........
                wire, breast.
19295........  Place breast     N............  A2...........      $106.76       1.7369       $73.89       $98.54
                clip, percut.
19296........  Place po breast  Y............  A2...........    $1,339.00      51.2269    $2,179.35    $1,549.09
                cath for rad.
19297........  Place breast     Y............  A2...........    $1,339.00      51.2269    $2,179.35    $1,549.09
                cath for rad.
19298........  Place breast     N............  A2...........    $1,339.00      52.8730    $2,249.38    $1,566.60
                rad tube/caths.
19300........  Removal of       Y............  A2...........      $630.00      19.2788      $820.18      $677.55
                breast tissue.
19301........  Partical         Y............  A2...........      $510.00      19.2788      $820.18      $587.55
                mastectomy.
19302........  P-mastectomy w/  Y............  A2...........      $995.00      36.9988    $1,574.04    $1,139.76
                ln removal.
19303........  Mast, simple,    Y............  A2...........      $630.00      28.0166    $1,191.91      $770.48
                complete.
19304........  Mast, subq.....  Y............  A2...........      $630.00      28.0166    $1,191.91      $770.48
19316........  Suspension of    Y............  A2...........      $630.00      28.0166    $1,191.91      $770.48
                breast.
19318........  Reduction of     Y............  A2...........      $630.00      36.9988    $1,574.04      $866.01
                large breast.
19324........  Enlarge breast.  Y............  A2...........      $630.00      36.9988    $1,574.04      $866.01
19325........  Enlarge breast   Y............  A2...........    $1,339.00      51.2269    $2,179.35    $1,549.09
                with implant.
19328........  Removal of       Y............  A2...........      $333.00      28.0166    $1,191.91      $547.73
                breast implant.
19330........  Removal of       Y............  A2...........      $333.00      28.0166    $1,191.91      $547.73
                implant
                material.
19340........  Immediate        Y............  A2...........      $446.00      37.8692    $1,611.07      $737.27
                breast
                prosthesis.
19342........  Delayed breast   Y............  A2...........      $510.00      51.2269    $2,179.35      $927.34
                prosthesis.
19350........  Breast           Y............  A2...........      $630.00      19.2788      $820.18      $677.55
                reconstruction.
19355........  Correct          Y............  A2...........      $630.00      28.0166    $1,191.91      $770.48
                inverted
                nipple(s).
19357........  Breast           Y............  A2...........      $717.00      51.2269    $2,179.35    $1,082.59
                reconstruction.
19366........  Breast           Y............  A2...........      $717.00      28.0166    $1,191.91      $835.73
                reconstruction.
19370........  Surgery of       Y............  A2...........      $630.00      28.0166    $1,191.91      $770.48
                breast capsule.
19371........  Removal of       Y............  A2...........      $630.00      28.0166    $1,191.91      $770.48
                breast capsule.
19380........  Revise breast    Y............  A2...........      $717.00      37.8692    $1,611.07      $940.52
                reconstruction.
19396........  Design custom    Y............  G2...........  ...........      28.0166    $1,191.91    $1,191.91
                breast implant.
20000........  Incision of      Y............  P2...........  ...........       1.4392       $61.23       $61.23
                abscess.
20005........  Incision of      Y............  A2...........      $446.00      20.8706      $887.90      $556.48
                deep abscess.
20103........  Explore wound,   Y............  G2...........  ...........       4.2212      $179.58      $179.58
                extremity.
20150........  Excise           Y............  G2...........  ...........      41.0893    $1,748.06    $1,748.06
                epiphyseal bar.
20200........  Muscle biopsy..  Y............  A2...........      $446.00      15.1024      $642.50      $495.13
20205........  Deep muscle      Y............  A2...........      $510.00      15.1024      $642.50      $543.13
                biopsy.
20206........  Needle biopsy,   Y............  A2...........      $240.00       3.9045      $166.11      $221.53
                muscle.
20220........  Bone biopsy,     Y............  A2...........      $251.52       4.0919      $174.08      $232.16
                trocar/needle.
20225........  Bone biopsy,     Y............  A2...........      $418.49       6.8083      $289.65      $386.28
                trocar/needle.
20240........  Bone biopsy,     Y............  A2...........      $446.00      20.0656      $853.65      $547.91
                excisional.
20245........  Bone biopsy,     Y............  A2...........      $510.00      20.0656      $853.65      $595.91
                excisional.
20250........  Open bone        Y............  A2...........      $510.00      20.8706      $887.90      $604.48
                biopsy.
20251........  Open bone        Y............  A2...........      $510.00      20.8706      $887.90      $604.48
                biopsy.
20500........  Injection of     Y............  P3...........  ...........       1.4162       $60.25       $60.25
                sinus tract.
20501........  Inject sinus     .............  N1...........  ...........  ...........  ...........  ...........
                tract for x-
                ray.
20520........  Removal of       Y............  P3...........  ...........       2.2131       $94.15       $94.15
                foreign body.
20525........  Removal of       Y............  A2...........      $510.00      20.0656      $853.65      $595.91
                foreign body.
20526........  Ther injection,  Y............  P3...........  ...........       0.7162       $30.47       $30.47
                carp tunnel.
20550........  Inj tendon       Y............  P3...........  ...........       0.5392       $22.94       $22.94
                sheath/
                ligament.
20551........  Inj tendon       Y............  P3...........  ...........       0.5312       $22.60       $22.60
                origin/
                insertion.
20552........  Inj trigger      Y............  P3...........  ...........       0.5230       $22.25       $22.25
                point, 1/2
                muscl.
20553........  Inject trigger   Y............  P3...........  ...........       0.5874       $24.99       $24.99
                points, =/> 3.
20600........  Drain/inject,    Y............  P3...........  ...........       0.5312       $22.60       $22.60
                joint/bursa.
20605........  Drain/inject,    Y............  P3...........  ...........       0.6036       $25.68       $25.68
                joint/bursa.
20610........  Drain/inject,    Y............  P3...........  ...........       0.8128       $34.58       $34.58
                joint/bursa.
20612........  Aspirate/inj     Y............  P3...........  ...........       0.5714       $24.31       $24.31
                ganglion cyst.
20615........  Treatment of     Y............  P2...........  ...........       2.0687       $88.01       $88.01
                bone cyst.
20650........  Insert and       Y............  A2...........      $510.00      20.8706      $887.90      $604.48
                remove bone
                pin.
20662........  Application of   Y............  R2...........  ...........      20.8706      $887.90      $887.90
                pelvis brace.
20663........  Application of   Y............  R2...........  ...........      20.8706      $887.90      $887.90
                thigh brace.
20665........  Removal of       N............  G2...........  ...........       0.6102       $25.96       $25.96
                fixation
                device.
20670........  Removal of       Y............  A2...........      $333.00      15.1024      $642.50      $410.38
                support
                implant.
20680........  Removal of       Y............  A2...........      $510.00      20.0656      $853.65      $595.91
                support
                implant.
20690........  Apply bone       Y............  A2...........      $446.00      25.1296    $1,069.09      $601.77
                fixation
                device.
20692........  Apply bone       Y............  A2...........      $510.00      25.1296    $1,069.09      $649.77
                fixation
                device.

[[Page 42556]]

 
20693........  Adjust bone      Y............  A2...........      $510.00      20.8706      $887.90      $604.48
                fixation
                device.
20694........  Remove bone      Y............  A2...........      $333.00      20.8706      $887.90      $471.73
                fixation
                device.
20822........  Replantation     Y............  G2...........  ...........      25.8758    $1,100.83    $1,100.83
                digit,
                complete.
20900........  Removal of bone  Y............  A2...........      $510.00      25.1296    $1,069.09      $649.77
                for graft.
20902........  Removal of bone  Y............  A2...........      $630.00      25.1296    $1,069.09      $739.77
                for graft.
20910........  Remove           Y............  A2...........      $510.00      21.4302      $911.71      $610.43
                cartilage for
                graft.
20912........  Remove           Y............  A2...........      $510.00      21.4302      $911.71      $610.43
                cartilage for
                graft.
20920........  Removal of       Y............  A2...........      $630.00      14.0346      $597.07      $621.77
                fascia for
                graft.
20922........  Removal of       Y............  A2...........      $510.00      21.4302      $911.71      $610.43
                fascia for
                graft.
20924........  Removal of       Y............  A2...........      $630.00      25.1296    $1,069.09      $739.77
                tendon for
                graft.
20926........  Removal of       Y............  A2...........      $630.00      14.0346      $597.07      $621.77
                tissue for
                graft.
20950........  Fluid pressure,  Y............  G2...........  ...........       1.4392       $61.23       $61.23
                muscle.
20972........  Bone/skin        Y............  G2...........  ...........      40.8559    $1,738.13    $1,738.13
                graft,
                metatarsal.
20973........  Bone/skin        Y............  R2...........  ...........      40.8559    $1,738.13    $1,738.13
                graft, great
                toe.
20975........  Electrical bone  N............  A2...........       $37.51       0.6102       $25.96       $34.62
                stimulation.
20979........  Us bone          N............  P3...........  ...........       0.5552       $23.62       $23.62
                stimulation.
20982........  Ablate, bone     Y............  G2...........  ...........      41.0893    $1,748.06    $1,748.06
                tumor(s) perq.
21010........  Incision of jaw  Y............  A2...........      $446.00      23.3299      $992.52      $582.63
                joint.
21015........  Resection of     Y............  A2...........      $510.00      16.4266      $698.84      $557.21
                facial tumor.
21025........  Excision of      Y............  A2...........      $446.00      38.1991    $1,625.10      $740.78
                bone, lower
                jaw.
21026........  Excision of      Y............  A2...........      $446.00      38.1991    $1,625.10      $740.78
                facial bone(s).
21029........  Contour of face  Y............  A2...........      $446.00      38.1991    $1,625.10      $740.78
                bone lesion.
21030........  Excise max/      Y............  P3...........  ...........       5.4479      $231.77      $231.77
                zygoma b9
                tumor.
21031........  Remove           Y............  P3...........  ...........       4.4823      $190.69      $190.69
                exostosis,
                mandible.
21032........  Remove           Y............  P3...........  ...........       4.5869      $195.14      $195.14
                exostosis,
                maxilla.
21034........  Excise max/      Y............  A2...........      $510.00      38.1991    $1,625.10      $788.78
                zygoma mlg
                tumor.
21040........  Excise mandible  Y............  A2...........      $446.00      23.3299      $992.52      $582.63
                lesion.
21044........  Removal of jaw   Y............  A2...........      $446.00      38.1991    $1,625.10      $740.78
                bone lesion.
21046........  Remove mandible  Y............  A2...........      $446.00      38.1991    $1,625.10      $740.78
                cyst complex.
21047........  Excise lwr jaw   Y............  A2...........      $446.00      38.1991    $1,625.10      $740.78
                cyst w/repair.
21048........  Remove maxilla   Y............  R2...........  ...........      38.1991    $1,625.10    $1,625.10
                cyst complex.
21050........  Removal of jaw   Y............  A2...........      $510.00      38.1991    $1,625.10      $788.78
                joint.
21060........  Remove jaw       Y............  A2...........      $446.00      38.1991    $1,625.10      $740.78
                joint
                cartilage.
21070........  Remove coronoid  Y............  A2...........      $510.00      38.1991    $1,625.10      $788.78
                process.
21076........  Prepare face/    Y............  P3...........  ...........       8.1760      $347.83      $347.83
                oral
                prosthesis.
21077........  Prepare face/    Y............  P3...........  ...........      20.1504      $857.26      $857.26
                oral
                prosthesis.
21079........  Prepare face/    Y............  P3...........  ...........      14.2437      $605.97      $605.97
                oral
                prosthesis.
21080........  Prepare face/    Y............  P3...........  ...........      16.3280      $694.64      $694.64
                oral
                prosthesis.
21081........  Prepare face/    Y............  P3...........  ...........      14.9437      $635.75      $635.75
                oral
                prosthesis.
21082........  Prepare face/    Y............  P3...........  ...........      13.8253      $588.17      $588.17
                oral
                prosthesis.
21083........  Prepare face/    Y............  P3...........  ...........      13.5113      $574.81      $574.81
                oral
                prosthesis.
21084........  Prepare face/    Y............  P3...........  ...........      15.6117      $664.17      $664.17
                oral
                prosthesis.
21085........  Prepare face/    Y............  P3...........  ...........       6.1079      $259.85      $259.85
                oral
                prosthesis.
21086........  Prepare face/    Y............  P3...........  ...........      14.7587      $627.88      $627.88
                oral
                prosthesis.
21087........  Prepare face/    Y............  P3...........  ...........      14.6621      $623.77      $623.77
                oral
                prosthesis.
21088........  Prepare face/    Y............  R2...........  ...........      38.1991    $1,625.10    $1,625.10
                oral
                prosthesis.
21100........  Maxillofacial    Y............  A2...........      $446.00      38.1991    $1,625.10      $740.78
                fixation.
21110........  Interdental      Y............  P2...........  ...........       7.5511      $321.25      $321.25
                fixation.
21116........  Injection, jaw   .............  N1...........  ...........  ...........  ...........  ...........
                joint x-ray.
21120........  Reconstruction   Y............  A2...........      $995.00      23.3299      $992.52      $994.38
                of chin.
21121........  Reconstruction   Y............  A2...........      $995.00      23.3299      $992.52      $994.38
                of chin.
21122........  Reconstruction   Y............  A2...........      $995.00      23.3299      $992.52      $994.38
                of chin.
21123........  Reconstruction   Y............  A2...........      $995.00      23.3299      $992.52      $994.38
                of chin.
21125........  Augmentation,    Y............  A2...........      $995.00      23.3299      $992.52      $994.38
                lower jaw bone.
21127........  Augmentation,    Y............  A2...........    $1,339.00      38.1991    $1,625.10    $1,410.53
                lower jaw bone.
21137........  Reduction of     Y............  G2...........  ...........      23.3299      $992.52      $992.52
                forehead.
21138........  Reduction of     Y............  G2...........  ...........      38.1991    $1,625.10    $1,625.10
                forehead.
21139........  Reduction of     Y............  G2...........  ...........      38.1991    $1,625.10    $1,625.10
                forehead.
21150........  Reconstruct      Y............  G2...........  ...........      38.1991    $1,625.10    $1,625.10
                midface,
                lefort.
21181........  Contour cranial  Y............  A2...........      $995.00      23.3299      $992.52      $994.38
                bone lesion.
21198........  Reconstr lwr     Y............  G2...........  ...........      38.1991    $1,625.10    $1,625.10
                jaw segment.
21199........  Reconstr lwr     Y............  G2...........  ...........      38.1991    $1,625.10    $1,625.10
                jaw w/advance.
21206........  Reconstruct      Y............  A2...........      $717.00      38.1991    $1,625.10      $944.03
                upper jaw bone.

[[Page 42557]]

 
21208........  Augmentation of  Y............  A2...........      $995.00      38.1991    $1,625.10    $1,152.53
                facial bones.
21209........  Reduction of     Y............  A2...........      $717.00      38.1991    $1,625.10      $944.03
                facial bones.
21210........  Face bone graft  Y............  A2...........      $995.00      38.1991    $1,625.10    $1,152.53
21215........  Lower jaw bone   Y............  A2...........      $995.00      38.1991    $1,625.10    $1,152.53
                graft.
21230........  Rib cartilage    Y............  A2...........      $995.00      38.1991    $1,625.10    $1,152.53
                graft.
21235........  Ear cartilage    Y............  A2...........      $995.00      23.3299      $992.52      $994.38
                graft.
21240........  Reconstruction   Y............  A2...........      $630.00      38.1991    $1,625.10      $878.78
                of jaw joint.
21242........  Reconstruction   Y............  A2...........      $717.00      38.1991    $1,625.10      $944.03
                of jaw joint.
21243........  Reconstruction   Y............  A2...........      $717.00      38.1991    $1,625.10      $944.03
                of jaw joint.
21244........  Reconstruction   Y............  A2...........      $995.00      38.1991    $1,625.10    $1,152.53
                of lower jaw.
21245........  Reconstruction   Y............  A2...........      $995.00      38.1991    $1,625.10    $1,152.53
                of jaw.
21246........  Reconstruction   Y............  A2...........      $995.00      38.1991    $1,625.10    $1,152.53
                of jaw.
21248........  Reconstruction   Y............  A2...........      $995.00      38.1991    $1,625.10    $1,152.53
                of jaw.
21249........  Reconstruction   Y............  A2...........      $995.00      38.1991    $1,625.10    $1,152.53
                of jaw.
21260........  Revise eye       Y............  G2...........  ...........      38.1991    $1,625.10    $1,625.10
                sockets.
21267........  Revise eye       Y............  A2...........      $995.00      38.1991    $1,625.10    $1,152.53
                sockets.
21270........  Augmentation,    Y............  A2...........      $717.00      38.1991    $1,625.10      $944.03
                cheek bone.
21275........  Revision,        Y............  A2...........      $995.00      38.1991    $1,625.10    $1,152.53
                orbitofacial
                bones.
21280........  Revision of      Y............  A2...........      $717.00      38.1991    $1,625.10      $944.03
                eyelid.
21282........  Revision of      Y............  A2...........      $717.00      16.4266      $698.84      $712.46
                eyelid.
21295........  Revision of jaw  Y............  A2...........      $333.00       7.5511      $321.25      $330.06
                muscle/bone.
21296........  Revision of jaw  Y............  A2...........      $333.00      23.3299      $992.52      $497.88
                muscle/bone.
21310........  Treatment of     Y............  A2...........      $150.72       2.4520      $104.32      $139.12
                nose fracture.
21315........  Treatment of     Y............  A2...........      $150.72       2.4520      $104.32      $139.12
                nose fracture.
21320........  Treatment of     Y............  A2...........      $446.00       7.5511      $321.25      $414.81
                nose fracture.
21325........  Treatment of     Y............  A2...........      $630.00      23.3299      $992.52      $720.63
                nose fracture.
21330........  Treatment of     Y............  A2...........      $717.00      23.3299      $992.52      $785.88
                nose fracture.
21335........  Treatment of     Y............  A2...........      $995.00      23.3299      $992.52      $994.38
                nose fracture.
21336........  Treat nasal      Y............  A2...........      $630.00      37.5382    $1,596.99      $871.75
                septal
                fracture.
21337........  Treat nasal      Y............  A2...........      $446.00      16.4266      $698.84      $509.21
                septal
                fracture.
21338........  Treat            Y............  A2...........      $630.00      23.3299      $992.52      $720.63
                nasoethmoid
                fracture.
21339........  Treat            Y............  A2...........      $717.00      23.3299      $992.52      $785.88
                nasoethmoid
                fracture.
21340........  Treatment of     Y............  A2...........      $630.00      38.1991    $1,625.10      $878.78
                nose fracture.
21345........  Treat nose/jaw   Y............  A2...........      $995.00      23.3299      $992.52      $994.38
                fracture.
21355........  Treat cheek      Y............  A2...........      $510.00      38.1991    $1,625.10      $788.78
                bone fracture.
21356........  Treat cheek      Y............  A2...........      $510.00      23.3299      $992.52      $630.63
                bone fracture.
21390........  Treat eye        Y............  G2...........  ...........      38.1991    $1,625.10    $1,625.10
                socket
                fracture.
21400........  Treat eye        Y............  A2...........      $446.00       7.5511      $321.25      $414.81
                socket
                fracture.
21401........  Treat eye        Y............  A2...........      $510.00      16.4266      $698.84      $557.21
                socket
                fracture.
21406........  Treat eye        Y............  G2...........  ...........      38.1991    $1,625.10    $1,625.10
                socket
                fracture.
21407........  Treat eye        Y............  G2...........  ...........      38.1991    $1,625.10    $1,625.10
                socket
                fracture.
21421........  Treat mouth      Y............  A2...........      $630.00      23.3299      $992.52      $720.63
                roof fracture.
21440........  Treat dental     Y............  P3...........  ...........       7.0012      $297.85      $297.85
                ridge fracture.
21445........  Treat dental     Y............  A2...........      $630.00      23.3299      $992.52      $720.63
                ridge fracture.
21450........  Treat lower jaw  Y............  A2...........      $150.72       2.4520      $104.32      $139.12
                fracture.
21451........  Treat lower jaw  Y............  A2...........      $464.15       7.5511      $321.25      $428.43
                fracture.
21452........  Treat lower jaw  Y............  A2...........      $446.00      16.4266      $698.84      $509.21
                fracture.
21453........  Treat lower jaw  Y............  A2...........      $510.00      38.1991    $1,625.10      $788.78
                fracture.
21454........  Treat lower jaw  Y............  A2...........      $717.00      23.3299      $992.52      $785.88
                fracture.
21461........  Treat lower jaw  Y............  A2...........      $630.00      38.1991    $1,625.10      $878.78
                fracture.
21462........  Treat lower jaw  Y............  A2...........      $717.00      38.1991    $1,625.10      $944.03
                fracture.
21465........  Treat lower jaw  Y............  A2...........      $630.00      38.1991    $1,625.10      $878.78
                fracture.
21480........  Reset            Y............  A2...........      $150.72       2.4520      $104.32      $139.12
                dislocated jaw.
21485........  Reset            Y............  A2...........      $446.00      16.4266      $698.84      $509.21
                dislocated jaw.
21490........  Repair           Y............  A2...........      $510.00      38.1991    $1,625.10      $788.78
                dislocated jaw.
21495........  Treat hyoid      Y............  G2...........  ...........      16.4266      $698.84      $698.84
                bone fracture.
21497........  Interdental      Y............  A2...........      $446.00      16.4266      $698.84      $509.21
                wiring.
21501........  Drain neck/      Y............  A2...........      $446.00      17.5086      $744.87      $520.72
                chest lesion.
21502........  Drain chest      Y............  A2...........      $446.00      20.8706      $887.90      $556.48
                lesion.
21550........  Biopsy of neck/  Y............  G2...........  ...........       6.8083      $289.65      $289.65
                chest.
21555........  Remove lesion,   Y............  A2...........      $446.00      20.0656      $853.65      $547.91
                neck/chest.
21556........  Remove lesion,   Y............  A2...........      $446.00      20.0656      $853.65      $547.91
                neck/chest.
21557........  Remove tumor,    Y............  G2...........  ...........      20.0656      $853.65      $853.65
                neck/chest.

[[Page 42558]]

 
21600........  Partial removal  Y............  A2...........      $446.00      25.1296    $1,069.09      $601.77
                of rib.
21610........  Partial removal  Y............  A2...........      $446.00      25.1296    $1,069.09      $601.77
                of rib.
21685........  Hyoid myotomy &  Y............  G2...........  ...........       7.5511      $321.25      $321.25
                suspension.
21700........  Revision of      Y............  A2...........      $446.00      20.8706      $887.90      $556.48
                neck muscle.
21720........  Revision of      Y............  A2...........      $510.00      20.8706      $887.90      $604.48
                neck muscle.
21725........  Revision of      Y............  A2...........       $88.46       1.4392       $61.23       $81.65
                neck muscle.
21800........  Treatment of     Y............  A2...........      $103.62       1.6857       $71.71       $95.64
                rib fracture.
21805........  Treatment of     Y............  A2...........      $446.00      25.5264    $1,085.97      $605.99
                rib fracture.
21820........  Treat sternum    Y............  A2...........      $103.62       1.6857       $71.71       $95.64
                fracture.
21920........  Biopsy soft      Y............  P3...........  ...........       3.0983      $131.81      $131.81
                tissue of back.
21925........  Biopsy soft      Y............  A2...........      $446.00      20.0656      $853.65      $547.91
                tissue of back.
21930........  Remove lesion,   Y............  A2...........      $446.00      20.0656      $853.65      $547.91
                back or flank.
21935........  Remove tumor,    Y............  A2...........      $510.00      20.0656      $853.65      $595.91
                back.
22102........  Remove part,     Y............  G2...........  ...........      44.1489    $1,878.23    $1,878.23
                lumbar
                vertebra.
22103........  Remove extra     Y............  G2...........  ...........      44.1489    $1,878.23    $1,878.23
                spine segment.
22305........  Treat spine      Y............  A2...........      $103.62       1.6857       $71.71       $95.64
                process
                fracture.
22310........  Treat spine      Y............  A2...........      $103.62       1.6857       $71.71       $95.64
                fracture.
22315........  Treat spine      Y............  A2...........      $103.62       1.6857       $71.71       $95.64
                fracture.
22505........  Manipulation of  Y............  A2...........      $446.00      14.5947      $620.90      $489.73
                spine.
22520........  Percut           Y............  A2...........    $1,339.00      25.1296    $1,069.09    $1,271.52
                vertebroplasty
                thor.
22521........  Percut           Y............  A2...........    $1,339.00      25.1296    $1,069.09    $1,271.52
                vertebroplasty
                lumb.
22522........  Percut           Y............  A2...........    $1,339.00      25.1296    $1,069.09    $1,271.52
                vertebroplasty
                add-on.
22523........  Percut           Y............  G2...........  ...........      66.5800    $2,832.51    $2,832.51
                kyphoplasty,
                thor.
22524........  Percut           Y............  G2...........  ...........      66.5800    $2,832.51    $2,832.51
                kyphoplasty,
                lumbar.
22525........  Percut           Y............  G2...........  ...........      66.5800    $2,832.51    $2,832.51
                kyphoplasty,
                add-on.
22900........  Remove           Y............  A2...........      $630.00      20.0656      $853.65      $685.91
                abdominal wall
                lesion.
23000........  Removal of       Y............  A2...........      $446.00      15.1024      $642.50      $495.13
                calcium
                deposits.
23020........  Release          Y............  A2...........      $446.00      41.0893    $1,748.06      $771.52
                shoulder joint.
23030........  Drain shoulder   Y............  A2...........      $333.00      17.5086      $744.87      $435.97
                lesion.
23031........  Drain shoulder   Y............  A2...........      $510.00      17.5086      $744.87      $568.72
                bursa.
23035........  Drain shoulder   Y............  A2...........      $510.00      20.8706      $887.90      $604.48
                bone lesion.
23040........  Exploratory      Y............  A2...........      $510.00      25.1296    $1,069.09      $649.77
                shoulder
                surgery.
23044........  Exploratory      Y............  A2...........      $630.00      25.1296    $1,069.09      $739.77
                shoulder
                surgery.
23065........  Biopsy shoulder  Y............  P3...........  ...........       2.1888       $93.12       $93.12
                tissues.
23066........  Biopsy shoulder  Y............  A2...........      $446.00      20.0656      $853.65      $547.91
                tissues.
23075........  Removal of       Y............  A2...........      $446.00      15.1024      $642.50      $495.13
                shoulder
                lesion.
23076........  Removal of       Y............  A2...........      $446.00      20.0656      $853.65      $547.91
                shoulder
                lesion.
23077........  Remove tumor of  Y............  A2...........      $510.00      20.0656      $853.65      $595.91
                shoulder.
23100........  Biopsy of        Y............  A2...........      $446.00      20.8706      $887.90      $556.48
                shoulder joint.
23101........  Shoulder joint   Y............  A2...........      $995.00      25.1296    $1,069.09    $1,013.52
                surgery.
23105........  Remove shoulder  Y............  A2...........      $630.00      25.1296    $1,069.09      $739.77
                joint lining.
23106........  Incision of      Y............  A2...........      $630.00      25.1296    $1,069.09      $739.77
                collarbone
                joint.
23107........  Explore treat    Y............  A2...........      $630.00      25.1296    $1,069.09      $739.77
                shoulder joint.
23120........  Partial          Y............  A2...........      $717.00      41.0893    $1,748.06      $974.77
                removal,
                collar bone.
23125........  Removal of       Y............  A2...........      $717.00      41.0893    $1,748.06      $974.77
                collar bone.
23130........  Remove shoulder  Y............  A2...........      $717.00      41.0893    $1,748.06      $974.77
                bone, part.
23140........  Removal of bone  Y............  A2...........      $630.00      20.8706      $887.90      $694.48
                lesion.
23145........  Removal of bone  Y............  A2...........      $717.00      25.1296    $1,069.09      $805.02
                lesion.
23146........  Removal of bone  Y............  A2...........      $717.00      25.1296    $1,069.09      $805.02
                lesion.
23150........  Removal of       Y............  A2...........      $630.00      25.1296    $1,069.09      $739.77
                humerus lesion.
23155........  Removal of       Y............  A2...........      $717.00      25.1296    $1,069.09      $805.02
                humerus lesion.
23156........  Removal of       Y............  A2...........      $717.00      25.1296    $1,069.09      $805.02
                humerus lesion.
23170........  Remove collar    Y............  A2...........      $446.00      25.1296    $1,069.09      $601.77
                bone lesion.
23172........  Remove shoulder  Y............  A2...........      $446.00      25.1296    $1,069.09      $601.77
                blade lesion.
23174........  Remove humerus   Y............  A2...........      $446.00      25.1296    $1,069.09      $601.77
                lesion.
23180........  Remove collar    Y............  A2...........      $630.00      25.1296    $1,069.09      $739.77
                bone lesion.
23182........  Remove shoulder  Y............  A2...........      $630.00      25.1296    $1,069.09      $739.77
                blade lesion.
23184........  Remove humerus   Y............  A2...........      $630.00      25.1296    $1,069.09      $739.77
                lesion.
23190........  Partial removal  Y............  A2...........      $630.00      25.1296    $1,069.09      $739.77
                of scapula.
23195........  Removal of head  Y............  A2...........      $717.00      25.1296    $1,069.09      $805.02
                of humerus.
23330........  Remove shoulder  Y............  A2...........      $333.00       6.8083      $289.65      $322.16
                foreign body.
23331........  Remove shoulder  Y............  A2...........      $333.00      20.0656      $853.65      $463.16
                foreign body.
23350........  Injection for    .............  N1...........  ...........  ...........  ...........  ...........
                shoulder x-ray.

[[Page 42559]]

 
23395........  Muscle           Y............  A2...........      $717.00      41.0893    $1,748.06      $974.77
                transfer,shoul
                der/arm.
23397........  Muscle           Y............  A2...........      $995.00      66.5800    $2,832.51    $1,454.38
                transfers.
23400........  Fixation of      Y............  A2...........      $995.00      25.1296    $1,069.09    $1,013.52
                shoulder blade.
23405........  Incision of      Y............  A2...........      $446.00      25.1296    $1,069.09      $601.77
                tendon &
                muscle.
23406........  Incise           Y............  A2...........      $446.00      25.1296    $1,069.09      $601.77
                tendon(s) &
                muscle(s).
23410........  Repair rotator   Y............  A2...........      $717.00      41.0893    $1,748.06      $974.77
                cuff, acute.
23412........  Repair rotator   Y............  A2...........      $995.00      41.0893    $1,748.06    $1,183.27
                cuff, chronic.
23415........  Release of       Y............  A2...........      $717.00      41.0893    $1,748.06      $974.77
                shoulder
                ligament.
23420........  Repair of        Y............  A2...........      $995.00      41.0893    $1,748.06    $1,183.27
                shoulder.
23430........  Repair biceps    Y............  A2...........      $630.00      41.0893    $1,748.06      $909.52
                tendon.
23440........  Remove/          Y............  A2...........      $630.00      41.0893    $1,748.06      $909.52
                transplant
                tendon.
23450........  Repair shoulder  Y............  A2...........      $717.00      66.5800    $2,832.51    $1,245.88
                capsule.
23455........  Repair shoulder  Y............  A2...........      $995.00      66.5800    $2,832.51    $1,454.38
                capsule.
23460........  Repair shoulder  Y............  A2...........      $717.00      66.5800    $2,832.51    $1,245.88
                capsule.
23462........  Repair shoulder  Y............  A2...........      $995.00      41.0893    $1,748.06    $1,183.27
                capsule.
23465........  Repair shoulder  Y............  A2...........      $717.00      66.5800    $2,832.51    $1,245.88
                capsule.
23466........  Repair shoulder  Y............  A2...........      $995.00      41.0893    $1,748.06    $1,183.27
                capsule.
23480........  Revision of      Y............  A2...........      $630.00      41.0893    $1,748.06      $909.52
                collar bone.
23485........  Revision of      Y............  A2...........      $995.00      66.5800    $2,832.51    $1,454.38
                collar bone.
23490........  Reinforce        Y............  A2...........      $510.00      41.0893    $1,748.06      $819.52
                clavicle.
23491........  Reinforce        Y............  A2...........      $510.00      66.5800    $2,832.51    $1,090.63
                shoulder bones.
23500........  Treat clavicle   Y............  A2...........      $103.62       1.6857       $71.71       $95.64
                fracture.
23505........  Treat clavicle   Y............  A2...........      $103.62       1.6857       $71.71       $95.64
                fracture.
23515........  Treat clavicle   Y............  A2...........      $510.00      57.2172    $2,434.19      $991.05
                fracture.
23520........  Treat clavicle   Y............  A2...........      $103.62       1.6857       $71.71       $95.64
                dislocation.
23525........  Treat clavicle   Y............  A2...........      $103.62       1.6857       $71.71       $95.64
                dislocation.
23530........  Treat clavicle   Y............  A2...........      $510.00      37.5382    $1,596.99      $781.75
                dislocation.
23532........  Treat clavicle   Y............  A2...........      $630.00      25.5264    $1,085.97      $743.99
                dislocation.
23540........  Treat clavicle   Y............  A2...........      $103.62       1.6857       $71.71       $95.64
                dislocation.
23545........  Treat clavicle   Y............  A2...........      $103.62       1.6857       $71.71       $95.64
                dislocation.
23550........  Treat clavicle   Y............  A2...........      $510.00      37.5382    $1,596.99      $781.75
                dislocation.
23552........  Treat clavicle   Y............  A2...........      $630.00      37.5382    $1,596.99      $871.75
                dislocation.
23570........  Treat shoulder   Y............  A2...........      $103.62       1.6857       $71.71       $95.64
                blade fx.
23575........  Treat shoulder   Y............  A2...........      $103.62       1.6857       $71.71       $95.64
                blade fx.
23585........  Treat scapula    Y............  A2...........      $510.00      57.2172    $2,434.19      $991.05
                fracture.
23600........  Treat humerus    Y............  P2...........  ...........       1.6857       $71.71       $71.71
                fracture.
23605........  Treat humerus    Y............  A2...........      $103.62       1.6857       $71.71       $95.64
                fracture.
23615........  Treat humerus    Y............  A2...........      $630.00      57.2172    $2,434.19    $1,081.05
                fracture.
23616........  Treat humerus    Y............  A2...........      $630.00      57.2172    $2,434.19    $1,081.05
                fracture.
23620........  Treat humerus    Y............  P2...........  ...........       1.6857       $71.71       $71.71
                fracture.
23625........  Treat humerus    Y............  A2...........      $103.62       1.6857       $71.71       $95.64
                fracture.
23630........  Treat humerus    Y............  A2...........      $717.00      57.2172    $2,434.19    $1,146.30
                fracture.
23650........  Treat shoulder   Y............  A2...........      $103.62       1.6857       $71.71       $95.64
                dislocation.
23655........  Treat shoulder   Y............  A2...........      $333.00      14.5947      $620.90      $404.98
                dislocation.
23660........  Treat shoulder   Y............  A2...........      $510.00      37.5382    $1,596.99      $781.75
                dislocation.
23665........  Treat            Y............  A2...........      $103.62       1.6857       $71.71       $95.64
                dislocation/
                fracture.
23670........  Treat            Y............  A2...........      $510.00      57.2172    $2,434.19      $991.05
                dislocation/
                fracture.
23675........  Treat            Y............  A2...........      $103.62       1.6857       $71.71       $95.64
                dislocation/
                fracture.
23680........  Treat            Y............  A2...........      $510.00      37.5382    $1,596.99      $781.75
                dislocation/
                fracture.
23700........  Fixation of      Y............  A2...........      $333.00      14.5947      $620.90      $404.98
                shoulder.
23800........  Fusion of        Y............  A2...........      $630.00      66.5800    $2,832.51    $1,180.63
                shoulder joint.
23802........  Fusion of        Y............  A2...........      $995.00      41.0893    $1,748.06    $1,183.27
                shoulder joint.
23921........  Amputation       Y............  A2...........      $323.28       5.2594      $223.75      $298.40
                follow-up
                surgery.
23930........  Drainage of arm  Y............  A2...........      $333.00      17.5086      $744.87      $435.97
                lesion.
23931........  Drainage of arm  Y............  A2...........      $446.00      17.5086      $744.87      $520.72
                bursa.
23935........  Drain arm/elbow  Y............  A2...........      $446.00      20.8706      $887.90      $556.48
                bone lesion.
24000........  Exploratory      Y............  A2...........      $630.00      25.1296    $1,069.09      $739.77
                elbow surgery.
24006........  Release elbow    Y............  A2...........      $630.00      25.1296    $1,069.09      $739.77
                joint.
24065........  Biopsy arm/      Y............  P3...........  ...........       2.9695      $126.33      $126.33
                elbow soft
                tissue.
24066........  Biopsy arm/      Y............  A2...........      $446.00      15.1024      $642.50      $495.13
                elbow soft
                tissue.
24075........  Remove arm/      Y............  A2...........      $446.00      15.1024      $642.50      $495.13
                elbow lesion.
24076........  Remove arm/      Y............  A2...........      $446.00      20.0656      $853.65      $547.91
                elbow lesion.
24077........  Remove tumor of  Y............  A2...........      $510.00      20.0656      $853.65      $595.91
                arm/elbow.

[[Page 42560]]

 
24100........  Biopsy elbow     Y............  A2...........      $333.00      20.8706      $887.90      $471.73
                joint lining.
24101........  Explore/treat    Y............  A2...........      $630.00      25.1296    $1,069.09      $739.77
                elbow joint.
24102........  Remove elbow     Y............  A2...........      $630.00      25.1296    $1,069.09      $739.77
                joint lining.
24105........  Removal of       Y............  A2...........      $510.00      20.8706      $887.90      $604.48
                elbow bursa.
24110........  Remove humerus   Y............  A2...........      $446.00      20.8706      $887.90      $556.48
                lesion.
24115........  Remove/graft     Y............  A2...........      $510.00      25.1296    $1,069.09      $649.77
                bone lesion.
24116........  Remove/graft     Y............  A2...........      $510.00      25.1296    $1,069.09      $649.77
                bone lesion.
24120........  Remove elbow     Y............  A2...........      $510.00      20.8706      $887.90      $604.48
                lesion.
24125........  Remove/graft     Y............  A2...........      $510.00      25.1296    $1,069.09      $649.77
                bone lesion.
24126........  Remove/graft     Y............  A2...........      $510.00      25.1296    $1,069.09      $649.77
                bone lesion.
24130........  Removal of head  Y............  A2...........      $510.00      25.1296    $1,069.09      $649.77
                of radius.
24134........  Removal of arm   Y............  A2...........      $446.00      25.1296    $1,069.09      $601.77
                bone lesion.
24136........  Remove radius    Y............  A2...........      $446.00      25.1296    $1,069.09      $601.77
                bone lesion.
24138........  Remove elbow     Y............  A2...........      $446.00      25.1296    $1,069.09      $601.77
                bone lesion.
24140........  Partial removal  Y............  A2...........      $510.00      25.1296    $1,069.09      $649.77
                of arm bone.
24145........  Partial removal  Y............  A2...........      $510.00      25.1296    $1,069.09      $649.77
                of radius.
24147........  Partial removal  Y............  A2...........      $446.00      25.1296    $1,069.09      $601.77
                of elbow.
24149........  Radical          Y............  G2...........  ...........      25.1296    $1,069.09    $1,069.09
                resection of
                elbow.
24152........  Extensive        Y............  G2...........  ...........      41.0893    $1,748.06    $1,748.06
                radius surgery.
24153........  Extensive        Y............  G2...........  ...........      66.5800    $2,832.51    $2,832.51
                radius surgery.
24155........  Removal of       Y............  A2...........      $510.00      41.0893    $1,748.06      $819.52
                elbow joint.
24160........  Remove elbow     Y............  A2...........      $446.00      25.1296    $1,069.09      $601.77
                joint implant.
24164........  Remove radius    Y............  A2...........      $510.00      25.1296    $1,069.09      $649.77
                head implant.
24200........  Removal of arm   Y............  P3...........  ...........       2.4867      $105.79      $105.79
                foreign body.
24201........  Removal of arm   Y............  A2...........      $446.00      15.1024      $642.50      $495.13
                foreign body.
24220........  Injection for    .............  N1...........  ...........  ...........  ...........  ...........
                elbow x-ray.
24300........  Manipulate       Y............  G2...........  ...........      14.5947      $620.90      $620.90
                elbow w/anesth.
24301........  Muscle/tendon    Y............  A2...........      $630.00      25.1296    $1,069.09      $739.77
                transfer.
24305........  Arm tendon       Y............  A2...........      $630.00      25.1296    $1,069.09      $739.77
                lengthening.
24310........  Revision of arm  Y............  A2...........      $510.00      20.8706      $887.90      $604.48
                tendon.
24320........  Repair of arm    Y............  A2...........      $510.00      41.0893    $1,748.06      $819.52
                tendon.
24330........  Revision of arm  Y............  A2...........      $510.00      66.5800    $2,832.51    $1,090.63
                muscles.
24331........  Revision of arm  Y............  A2...........      $510.00      41.0893    $1,748.06      $819.52
                muscles.
24332........  Tenolysis,       Y............  G2...........  ...........      20.8706      $887.90      $887.90
                triceps.
24340........  Repair of        Y............  A2...........      $510.00      41.0893    $1,748.06      $819.52
                biceps tendon.
24341........  Repair arm       Y............  A2...........      $510.00      41.0893    $1,748.06      $819.52
                tendon/muscle.
24342........  Repair of        Y............  A2...........      $510.00      41.0893    $1,748.06      $819.52
                ruptured
                tendon.
24343........  Repr elbow lat   Y............  G2...........  ...........      25.1296    $1,069.09    $1,069.09
                ligmnt w/tiss.
24344........  Reconstruct      Y............  G2...........  ...........      66.5800    $2,832.51    $2,832.51
                elbow lat
                ligmnt.
24345........  Repr elbw med    Y............  A2...........      $446.00      25.1296    $1,069.09      $601.77
                ligmnt w/tissu.
24346........  Reconstruct      Y............  G2...........  ...........      41.0893    $1,748.06    $1,748.06
                elbow med
                ligmnt.
24350........  Repair of        Y............  A2...........      $510.00      25.1296    $1,069.09      $649.77
                tennis elbow.
24351........  Repair of        Y............  A2...........      $510.00      25.1296    $1,069.09      $649.77
                tennis elbow.
24352........  Repair of        Y............  A2...........      $510.00      25.1296    $1,069.09      $649.77
                tennis elbow.
24354........  Repair of        Y............  A2...........      $510.00      25.1296    $1,069.09      $649.77
                tennis elbow.
24356........  Revision of      Y............  A2...........      $510.00      25.1296    $1,069.09      $649.77
                tennis elbow.
24360........  Reconstruct      Y............  A2...........      $717.00      33.4505    $1,423.08      $893.52
                elbow joint.
24361........  Reconstruct      Y............  A2...........      $717.00     107.1942    $4,560.36    $1,677.84
                elbow joint.
24362........  Reconstruct      Y............  A2...........      $717.00      47.4378    $2,018.15    $1,042.29
                elbow joint.
24363........  Replace elbow    Y............  A2...........      $995.00     107.1942    $4,560.36    $1,886.34
                joint.
24365........  Reconstruct      Y............  A2...........      $717.00      33.4505    $1,423.08      $893.52
                head of radius.
24366........  Reconstruct      Y............  A2...........      $717.00     107.1942    $4,560.36    $1,677.84
                head of radius.
24400........  Revision of      Y............  A2...........      $630.00      25.1296    $1,069.09      $739.77
                humerus.
24410........  Revision of      Y............  A2...........      $630.00      25.1296    $1,069.09      $739.77
                humerus.
24420........  Revision of      Y............  A2...........      $510.00      41.0893    $1,748.06      $819.52
                humerus.
24430........  Repair of        Y............  A2...........      $510.00      66.5800    $2,832.51    $1,090.63
                humerus.
24435........  Repair humerus   Y............  A2...........      $630.00      66.5800    $2,832.51    $1,180.63
                with graft.
24470........  Revision of      Y............  A2...........      $510.00      41.0893    $1,748.06      $819.52
                elbow joint.
24495........  Decompression    Y............  A2...........      $446.00      25.1296    $1,069.09      $601.77
                of forearm.
24498........  Reinforce        Y............  A2...........      $510.00      66.5800    $2,832.51    $1,090.63
                humerus.
24500........  Treat humerus    Y............  A2...........      $103.62       1.6857       $71.71       $95.64
                fracture.
24505........  Treat humerus    Y............  A2...........      $103.62       1.6857       $71.71       $95.64
                fracture.
24515........  Treat humerus    Y............  A2...........      $630.00      57.2172    $2,434.19    $1,081.05
                fracture.

[[Page 42561]]

 
24516........  Treat humerus    Y............  A2...........      $630.00      57.2172    $2,434.19    $1,081.05
                fracture.
24530........  Treat humerus    Y............  A2...........      $103.62       1.6857       $71.71       $95.64
                fracture.
24535........  Treat humerus    Y............  A2...........      $103.62       1.6857       $71.71       $95.64
                fracture.
24538........  Treat humerus    Y............  A2...........      $446.00      25.5264    $1,085.97      $605.99
                fracture.
24545........  Treat humerus    Y............  A2...........      $630.00      57.2172    $2,434.19    $1,081.05
                fracture.
24546........  Treat humerus    Y............  A2...........      $717.00      57.2172    $2,434.19    $1,146.30
                fracture.
24560........  Treat humerus    Y............  A2...........      $103.62       1.6857       $71.71       $95.64
                fracture.
24565........  Treat humerus    Y............  A2...........      $103.62       1.6857       $71.71       $95.64
                fracture.
24566........  Treat humerus    Y............  A2...........      $446.00      25.5264    $1,085.97      $605.99
                fracture.
24575........  Treat humerus    Y............  A2...........      $510.00      57.2172    $2,434.19      $991.05
                fracture.
24576........  Treat humerus    Y............  A2...........      $103.62       1.6857       $71.71       $95.64
                fracture.
24577........  Treat humerus    Y............  A2...........      $103.62       1.6857       $71.71       $95.64
                fracture.
24579........  Treat humerus    Y............  A2...........      $510.00      57.2172    $2,434.19      $991.05
                fracture.
24582........  Treat humerus    Y............  A2...........      $446.00      25.5264    $1,085.97      $605.99
                fracture.
24586........  Treat elbow      Y............  A2...........      $630.00      57.2172    $2,434.19    $1,081.05
                fracture.
24587........  Treat elbow      Y............  A2...........      $717.00      57.2172    $2,434.19    $1,146.30
                fracture.
24600........  Treat elbow      Y............  A2...........      $103.62       1.6857       $71.71       $95.64
                dislocation.
24605........  Treat elbow      Y............  A2...........      $446.00      14.5947      $620.90      $489.73
                dislocation.
24615........  Treat elbow      Y............  A2...........      $510.00      57.2172    $2,434.19      $991.05
                dislocation.
24620........  Treat elbow      Y............  A2...........      $103.62       1.6857       $71.71       $95.64
                fracture.
24635........  Treat elbow      Y............  A2...........      $510.00      57.2172    $2,434.19      $991.05
                fracture.
24640........  Treat elbow      Y............  G2...........  ...........       1.6857       $71.71       $71.71
                dislocation.
24650........  Treat radius     Y............  P2...........  ...........       1.6857       $71.71       $71.71
                fracture.
24655........  Treat radius     Y............  A2...........      $103.62       1.6857       $71.71       $95.64
                fracture.
24665........  Treat radius     Y............  A2...........      $630.00      37.5382    $1,596.99      $871.75
                fracture.
24666........  Treat radius     Y............  A2...........      $630.00      57.2172    $2,434.19    $1,081.05
                fracture.
24670........  Treat ulnar      Y............  A2...........      $103.62       1.6857       $71.71       $95.64
                fracture.
24675........  Treat ulnar      Y............  A2...........      $103.62       1.6857       $71.71       $95.64
                fracture.
24685........  Treat ulnar      Y............  A2...........      $510.00      37.5382    $1,596.99      $781.75
                fracture.
24800........  Fusion of elbow  Y............  A2...........      $630.00      41.0893    $1,748.06      $909.52
                joint.
24802........  Fusion/graft of  Y............  A2...........      $717.00      41.0893    $1,748.06      $974.77
                elbow joint.
24925........  Amputation       Y............  A2...........      $510.00      20.8706      $887.90      $604.48
                follow-up
                surgery.
25000........  Incision of      Y............  A2...........      $510.00      20.8706      $887.90      $604.48
                tendon sheath.
25001........  Incise flexor    Y............  G2...........  ...........      20.8706      $887.90      $887.90
                carpi radialis.
25020........  Decompress       Y............  A2...........      $510.00      20.8706      $887.90      $604.48
                forearm 1
                space.
25023........  Decompress       Y............  A2...........      $510.00      25.1296    $1,069.09      $649.77
                forearm 1
                space.
25024........  Decompress       Y............  A2...........      $510.00      25.1296    $1,069.09      $649.77
                forearm 2
                spaces.
25025........  Decompress       Y............  A2...........      $510.00      25.1296    $1,069.09      $649.77
                forearm 2
                spaces.
25028........  Drainage of      Y............  A2...........      $333.00      20.8706      $887.90      $471.73
                forearm lesion.
25031........  Drainage of      Y............  A2...........      $446.00      20.8706      $887.90      $556.48
                forearm bursa.
25035........  Treat forearm    Y............  A2...........      $446.00      20.8706      $887.90      $556.48
                bone lesion.
25040........  Explore/treat    Y............  A2...........      $717.00      25.1296    $1,069.09      $805.02
                wrist joint.
25065........  Biopsy forearm   Y............  P3...........  ...........       3.0259      $128.73      $128.73
                soft tissues.
25066........  Biopsy forearm   Y............  A2...........      $446.00      20.0656      $853.65      $547.91
                soft tissues.
25075........  Removal forearm  Y............  A2...........      $446.00      15.1024      $642.50      $495.13
                lesion subcu.
25076........  Removal forearm  Y............  A2...........      $510.00      20.0656      $853.65      $595.91
                lesion deep.
25077........  Remove tumor,    Y............  A2...........      $510.00      20.0656      $853.65      $595.91
                forearm/wrist.
25085........  Incision of      Y............  A2...........      $510.00      20.8706      $887.90      $604.48
                wrist capsule.
25100........  Biopsy of wrist  Y............  A2...........      $446.00      20.8706      $887.90      $556.48
                joint.
25101........  Explore/treat    Y............  A2...........      $510.00      25.1296    $1,069.09      $649.77
                wrist joint.
25105........  Remove wrist     Y............  A2...........      $630.00      25.1296    $1,069.09      $739.77
                joint lining.
25107........  Remove wrist     Y............  A2...........      $510.00      25.1296    $1,069.09      $649.77
                joint
                cartilage.
25109........  Excise tendon    Y............  G2...........  ...........      20.8706      $887.90      $887.90
                forearm/wrist.
25110........  Remove wrist     Y............  A2...........      $510.00      20.8706      $887.90      $604.48
                tendon lesion.
25111........  Remove wrist     Y............  A2...........      $510.00      16.1540      $687.24      $554.31
                tendon lesion.
25112........  Reremove wrist   Y............  A2...........      $630.00      16.1540      $687.24      $644.31
                tendon lesion.
25115........  Remove wrist/    Y............  A2...........      $630.00      20.8706      $887.90      $694.48
                forearm lesion.
25116........  Remove wrist/    Y............  A2...........      $630.00      20.8706      $887.90      $694.48
                forearm lesion.
25118........  Excise wrist     Y............  A2...........      $446.00      25.1296    $1,069.09      $601.77
                tendon sheath.
25119........  Partial removal  Y............  A2...........      $510.00      25.1296    $1,069.09      $649.77
                of ulna.
25120........  Removal of       Y............  A2...........      $510.00      25.1296    $1,069.09      $649.77
                forearm lesion.
25125........  Remove/graft     Y............  A2...........      $510.00      25.1296    $1,069.09      $649.77
                forearm lesion.
25126........  Remove/graft     Y............  A2...........      $510.00      25.1296    $1,069.09      $649.77
                forearm lesion.

[[Page 42562]]

 
25130........  Removal of       Y............  A2...........      $510.00      25.1296    $1,069.09      $649.77
                wrist lesion.
25135........  Remove & graft   Y............  A2...........      $510.00      25.1296    $1,069.09      $649.77
                wrist lesion.
25136........  Remove & graft   Y............  A2...........      $510.00      25.1296    $1,069.09      $649.77
                wrist lesion.
25145........  Remove forearm   Y............  A2...........      $446.00      25.1296    $1,069.09      $601.77
                bone lesion.
25150........  Partial removal  Y............  A2...........      $446.00      25.1296    $1,069.09      $601.77
                of ulna.
25151........  Partial removal  Y............  A2...........      $446.00      25.1296    $1,069.09      $601.77
                of radius.
25210........  Removal of       Y............  A2...........      $510.00      25.8758    $1,100.83      $657.71
                wrist bone.
25215........  Removal of       Y............  A2...........      $630.00      25.8758    $1,100.83      $747.71
                wrist bones.
25230........  Partial removal  Y............  A2...........      $630.00      25.1296    $1,069.09      $739.77
                of radius.
25240........  Partial removal  Y............  A2...........      $630.00      25.1296    $1,069.09      $739.77
                of ulna.
25246........  Injection for    .............  N1...........  ...........  ...........  ...........  ...........
                wrist x-ray.
25248........  Remove forearm   Y............  A2...........      $446.00      20.8706      $887.90      $556.48
                foreign body.
25250........  Removal of       Y............  A2...........      $333.00      25.1296    $1,069.09      $517.02
                wrist
                prosthesis.
25251........  Removal of       Y............  A2...........      $333.00      25.1296    $1,069.09      $517.02
                wrist
                prosthesis.
25259........  Manipulate       Y............  G2...........  ...........       1.6857       $71.71       $71.71
                wrist w/
                anesthes.
25260........  Repair forearm   Y............  A2...........      $630.00      25.1296    $1,069.09      $739.77
                tendon/muscle.
25263........  Repair forearm   Y............  A2...........      $446.00      25.1296    $1,069.09      $601.77
                tendon/muscle.
25265........  Repair forearm   Y............  A2...........      $510.00      25.1296    $1,069.09      $649.77
                tendon/muscle.
25270........  Repair forearm   Y............  A2...........      $630.00      25.1296    $1,069.09      $739.77
                tendon/muscle.
25272........  Repair forearm   Y............  A2...........      $510.00      25.1296    $1,069.09      $649.77
                tendon/muscle.
25274........  Repair forearm   Y............  A2...........      $630.00      25.1296    $1,069.09      $739.77
                tendon/muscle.
25275........  Repair forearm   Y............  A2...........      $630.00      25.1296    $1,069.09      $739.77
                tendon sheath.
25280........  Revise wrist/    Y............  A2...........      $630.00      25.1296    $1,069.09      $739.77
                forearm tendon.
25290........  Incise wrist/    Y............  A2...........      $510.00      25.1296    $1,069.09      $649.77
                forearm tendon.
25295........  Release wrist/   Y............  A2...........      $510.00      20.8706      $887.90      $604.48
                forearm tendon.
25300........  Fusion of        Y............  A2...........      $510.00      25.1296    $1,069.09      $649.77
                tendons at
                wrist.
25301........  Fusion of        Y............  A2...........      $510.00      25.1296    $1,069.09      $649.77
                tendons at
                wrist.
25310........  Transplant       Y............  A2...........      $510.00      41.0893    $1,748.06      $819.52
                forearm tendon.
25312........  Transplant       Y............  A2...........      $630.00      41.0893    $1,748.06      $909.52
                forearm tendon.
25315........  Revise palsy     Y............  A2...........      $510.00      41.0893    $1,748.06      $819.52
                hand tendon(s).
25316........  Revise palsy     Y............  A2...........      $510.00      66.5800    $2,832.51    $1,090.63
                hand tendon(s).
25320........  Repair/revise    Y............  A2...........      $510.00      41.0893    $1,748.06      $819.52
                wrist joint.
25332........  Revise wrist     Y............  A2...........      $717.00      33.4505    $1,423.08      $893.52
                joint.
25335........  Realignment of   Y............  A2...........      $510.00      41.0893    $1,748.06      $819.52
                hand.
25337........  Reconstruct      Y............  A2...........      $717.00      41.0893    $1,748.06      $974.77
                ulna/
                radioulnar.
25350........  Revision of      Y............  A2...........      $510.00      66.5800    $2,832.51    $1,090.63
                radius.
25355........  Revision of      Y............  A2...........      $510.00      41.0893    $1,748.06      $819.52
                radius.
25360........  Revision of      Y............  A2...........      $510.00      25.1296    $1,069.09      $649.77
                ulna.
25365........  Revise radius &  Y............  A2...........      $510.00      25.1296    $1,069.09      $649.77
                ulna.
25370........  Revise radius    Y............  A2...........      $510.00      41.0893    $1,748.06      $819.52
                or ulna.
25375........  Revise radius &  Y............  A2...........      $630.00      41.0893    $1,748.06      $909.52
                ulna.
25390........  Shorten radius   Y............  A2...........      $510.00      25.1296    $1,069.09      $649.77
                or ulna.
25391........  Lengthen radius  Y............  A2...........      $630.00      41.0893    $1,748.06      $909.52
                or ulna.
25392........  Shorten radius   Y............  A2...........      $510.00      25.1296    $1,069.09      $649.77
                & ulna.
25393........  Lengthen radius  Y............  A2...........      $630.00      41.0893    $1,748.06      $909.52
                & ulna.
25394........  Repair carpal    Y............  G2...........  ...........      16.1540      $687.24      $687.24
                bone, shorten.
25400........  Repair radius    Y............  A2...........      $510.00      25.1296    $1,069.09      $649.77
                or ulna.
25405........  Repair/graft     Y............  A2...........      $630.00      25.1296    $1,069.09      $739.77
                radius or ulna.
25415........  Repair radius &  Y............  A2...........      $510.00      25.1296    $1,069.09      $649.77
                ulna.
25420........  Repair/graft     Y............  A2...........      $630.00      66.5800    $2,832.51    $1,180.63
                radius & ulna.
25425........  Repair/graft     Y............  A2...........      $510.00      41.0893    $1,748.06      $819.52
                radius or ulna.
25426........  Repair/graft     Y............  A2...........      $630.00      41.0893    $1,748.06      $909.52
                radius & ulna.
25430........  Vasc graft into  Y............  G2...........  ...........      25.8758    $1,100.83    $1,100.83
                carpal bone.
25431........  Repair nonunion  Y............  G2...........  ...........      25.8758    $1,100.83    $1,100.83
                carpal bone.
25440........  Repair/graft     Y............  A2...........      $630.00      66.5800    $2,832.51    $1,180.63
                wrist bone.
25441........  Reconstruct      Y............  A2...........      $717.00     107.1942    $4,560.36    $1,677.84
                wrist joint.
25442........  Reconstruct      Y............  A2...........      $717.00     107.1942    $4,560.36    $1,677.84
                wrist joint.
25443........  Reconstruct      Y............  A2...........      $717.00      47.4378    $2,018.15    $1,042.29
                wrist joint.
25444........  Reconstruct      Y............  A2...........      $717.00      47.4378    $2,018.15    $1,042.29
                wrist joint.
25445........  Reconstruct      Y............  A2...........      $717.00      47.4378    $2,018.15    $1,042.29
                wrist joint.
25446........  Wrist            Y............  A2...........      $995.00     107.1942    $4,560.36    $1,886.34
                replacement.
25447........  Repair wrist     Y............  A2...........      $717.00      33.4505    $1,423.08      $893.52
                joint(s).
25449........  Remove wrist     Y............  A2...........      $717.00      33.4505    $1,423.08      $893.52
                joint implant.

[[Page 42563]]

 
25450........  Revision of      Y............  A2...........      $510.00      41.0893    $1,748.06      $819.52
                wrist joint.
25455........  Revision of      Y............  A2...........      $510.00      41.0893    $1,748.06      $819.52
                wrist joint.
25490........  Reinforce        Y............  A2...........      $510.00      41.0893    $1,748.06      $819.52
                radius.
25491........  Reinforce ulna.  Y............  A2...........      $510.00      41.0893    $1,748.06      $819.52
25492........  Reinforce        Y............  A2...........      $510.00      41.0893    $1,748.06      $819.52
                radius and
                ulna.
25500........  Treat fracture   Y............  P2...........  ...........       1.6857       $71.71       $71.71
                of radius.
25505........  Treat fracture   Y............  A2...........      $103.62       1.6857       $71.71       $95.64
                of radius.
25515........  Treat fracture   Y............  A2...........      $510.00      37.5382    $1,596.99      $781.75
                of radius.
25520........  Treat fracture   Y............  A2...........      $103.62       1.6857       $71.71       $95.64
                of radius.
25525........  Treat fracture   Y............  A2...........      $630.00      37.5382    $1,596.99      $871.75
                of radius.
25526........  Treat fracture   Y............  A2...........      $717.00      37.5382    $1,596.99      $937.00
                of radius.
25530........  Treat fracture   Y............  P2...........  ...........       1.6857       $71.71       $71.71
                of ulna.
25535........  Treat fracture   Y............  A2...........      $103.62       1.6857       $71.71       $95.64
                of ulna.
25545........  Treat fracture   Y............  A2...........      $510.00      37.5382    $1,596.99      $781.75
                of ulna.
25560........  Treat fracture   Y............  P2...........  ...........       1.6857       $71.71       $71.71
                radius & ulna.
25565........  Treat fracture   Y............  A2...........      $103.62       1.6857       $71.71       $95.64
                radius & ulna.
25574........  Treat fracture   Y............  A2...........      $510.00      57.2172    $2,434.19      $991.05
                radius & ulna.
25575........  Treat fracture   Y............  A2...........      $510.00      57.2172    $2,434.19      $991.05
                radius/ulna.
25600........  Treat fracture   Y............  P2...........  ...........       1.6857       $71.71       $71.71
                radius/ulna.
25605........  Treat fracture   Y............  A2...........      $103.62       1.6857       $71.71       $95.64
                radius/ulna.
25606........  Treat fx distal  Y............  A2...........      $510.00      25.5264    $1,085.97      $653.99
                radial.
25607........  Treat fx rad     Y............  A2...........      $717.00      57.2172    $2,434.19    $1,146.30
                extra-articul.
25608........  Treat fx rad     Y............  A2...........      $717.00      57.2172    $2,434.19    $1,146.30
                intra-articul.
25609........  Treat fx radial  Y............  A2...........      $717.00      57.2172    $2,434.19    $1,146.30
                3+ frag.
25622........  Treat wrist      Y............  P2...........  ...........       1.6857       $71.71       $71.71
                bone fracture.
25624........  Treat wrist      Y............  A2...........      $103.62       1.6857       $71.71       $95.64
                bone fracture.
25628........  Treat wrist      Y............  A2...........      $510.00      37.5382    $1,596.99      $781.75
                bone fracture.
25630........  Treat wrist      Y............  P2...........  ...........       1.6857       $71.71       $71.71
                bone fracture.
25635........  Treat wrist      Y............  A2...........      $103.62       1.6857       $71.71       $95.64
                bone fracture.
25645........  Treat wrist      Y............  A2...........      $510.00      37.5382    $1,596.99      $781.75
                bone fracture.
25650........  Treat wrist      Y............  P2...........  ...........       1.6857       $71.71       $71.71
                bone fracture.
25651........  Pin ulnar        Y............  G2...........  ...........      25.5264    $1,085.97    $1,085.97
                styloid
                fracture.
25652........  Treat fracture   Y............  G2...........  ...........      37.5382    $1,596.99    $1,596.99
                ulnar styloid.
25660........  Treat wrist      Y............  A2...........      $103.62       1.6857       $71.71       $95.64
                dislocation.
25670........  Treat wrist      Y............  A2...........      $510.00      25.5264    $1,085.97      $653.99
                dislocation.
25671........  Pin radioulnar   Y............  A2...........      $333.00      25.5264    $1,085.97      $521.24
                dislocation.
25675........  Treat wrist      Y............  A2...........      $103.62       1.6857       $71.71       $95.64
                dislocation.
25676........  Treat wrist      Y............  A2...........      $446.00      25.5264    $1,085.97      $605.99
                dislocation.
25680........  Treat wrist      Y............  A2...........      $103.62       1.6857       $71.71       $95.64
                fracture.
25685........  Treat wrist      Y............  A2...........      $510.00      25.5264    $1,085.97      $653.99
                fracture.
25690........  Treat wrist      Y............  A2...........      $103.62       1.6857       $71.71       $95.64
                dislocation.
25695........  Treat wrist      Y............  A2...........      $446.00      25.5264    $1,085.97      $605.99
                dislocation.
25800........  Fusion of wrist  Y............  A2...........      $630.00      66.5800    $2,832.51    $1,180.63
                joint.
25805........  Fusion/graft of  Y............  A2...........      $717.00      41.0893    $1,748.06      $974.77
                wrist joint.
25810........  Fusion/graft of  Y............  A2...........      $717.00      66.5800    $2,832.51    $1,245.88
                wrist joint.
25820........  Fusion of hand   Y............  A2...........      $630.00      16.1540      $687.24      $644.31
                bones.
25825........  Fuse hand bones  Y............  A2...........      $717.00      25.8758    $1,100.83      $812.96
                with graft.
25830........  Fusion,          Y............  A2...........      $717.00      66.5800    $2,832.51    $1,245.88
                radioulnar jnt/
                ulna.
25907........  Amputation       Y............  A2...........      $510.00      20.8706      $887.90      $604.48
                follow-up
                surgery.
25922........  Amputate hand    Y............  A2...........      $510.00      20.8706      $887.90      $604.48
                at wrist.
25929........  Amputation       Y............  A2...........      $510.00      14.0346      $597.07      $531.77
                follow-up
                surgery.
26010........  Drainage of      Y............  P2...........  ...........       1.4392       $61.23       $61.23
                finger abscess.
26011........  Drainage of      Y............  A2...........      $333.00      11.1535      $474.50      $368.38
                finger abscess.
26020........  Drain hand       Y............  A2...........      $446.00      16.1540      $687.24      $506.31
                tendon sheath.
26025........  Drainage of      Y............  A2...........      $333.00      16.1540      $687.24      $421.56
                palm bursa.
26030........  Drainage of      Y............  A2...........      $446.00      16.1540      $687.24      $506.31
                palm bursa(s).
26034........  Treat hand bone  Y............  A2...........      $446.00      16.1540      $687.24      $506.31
                lesion.
26035........  Decompress       Y............  G2...........  ...........      16.1540      $687.24      $687.24
                fingers/hand.
26040........  Release palm     Y............  A2...........      $630.00      25.8758    $1,100.83      $747.71
                contracture.
26045........  Release palm     Y............  A2...........      $510.00      25.8758    $1,100.83      $657.71
                contracture.
26055........  Incise finger    Y............  A2...........      $446.00      16.1540      $687.24      $506.31
                tendon sheath.
26060........  Incision of      Y............  A2...........      $446.00      16.1540      $687.24      $506.31
                finger tendon.
26070........  Explore/treat    Y............  A2...........      $446.00      16.1540      $687.24      $506.31
                hand joint.

[[Page 42564]]

 
26075........  Explore/treat    Y............  A2...........      $630.00      16.1540      $687.24      $644.31
                finger joint.
26080........  Explore/treat    Y............  A2...........      $630.00      16.1540      $687.24      $644.31
                finger joint.
26100........  Biopsy hand      Y............  A2...........      $446.00      16.1540      $687.24      $506.31
                joint lining.
26105........  Biopsy finger    Y............  A2...........      $333.00      16.1540      $687.24      $421.56
                joint lining.
26110........  Biopsy finger    Y............  A2...........      $333.00      16.1540      $687.24      $421.56
                joint lining.
26115........  Removal hand     Y............  A2...........      $446.00      20.0656      $853.65      $547.91
                lesion subcut.
26116........  Removal hand     Y............  A2...........      $446.00      20.0656      $853.65      $547.91
                lesion, deep.
26117........  Remove tumor,    Y............  A2...........      $510.00      20.0656      $853.65      $595.91
                hand/finger.
26121........  Release palm     Y............  A2...........      $630.00      25.8758    $1,100.83      $747.71
                contracture.
26123........  Release palm     Y............  A2...........      $630.00      25.8758    $1,100.83      $747.71
                contracture.
26125........  Release palm     Y............  A2...........      $630.00      16.1540      $687.24      $644.31
                contracture.
26130........  Remove wrist     Y............  A2...........      $510.00      16.1540      $687.24      $554.31
                joint lining.
26135........  Revise finger    Y............  A2...........      $630.00      25.8758    $1,100.83      $747.71
                joint, each.
26140........  Revise finger    Y............  A2...........      $446.00      16.1540      $687.24      $506.31
                joint, each.
26145........  Tendon           Y............  A2...........      $510.00      16.1540      $687.24      $554.31
                excision, palm/
                finger.
26160........  Remove tendon    Y............  A2...........      $510.00      16.1540      $687.24      $554.31
                sheath lesion.
26170........  Removal of palm  Y............  A2...........      $510.00      16.1540      $687.24      $554.31
                tendon, each.
26180........  Removal of       Y............  A2...........      $510.00      16.1540      $687.24      $554.31
                finger tendon.
26185........  Remove finger    Y............  A2...........      $630.00      16.1540      $687.24      $644.31
                bone.
26200........  Remove hand      Y............  A2...........      $446.00      16.1540      $687.24      $506.31
                bone lesion.
26205........  Remove/graft     Y............  A2...........      $510.00      25.8758    $1,100.83      $657.71
                bone lesion.
26210........  Removal of       Y............  A2...........      $446.00      16.1540      $687.24      $506.31
                finger lesion.
26215........  Remove/graft     Y............  A2...........      $510.00      16.1540      $687.24      $554.31
                finger lesion.
26230........  Partial removal  Y............  A2...........      $992.95      16.1540      $687.24      $916.52
                of hand bone.
26235........  Partial          Y............  A2...........      $510.00      16.1540      $687.24      $554.31
                removal,
                finger bone.
26236........  Partial          Y............  A2...........      $510.00      16.1540      $687.24      $554.31
                removal,
                finger bone.
26250........  Extensive hand   Y............  A2...........      $510.00      16.1540      $687.24      $554.31
                surgery.
26255........  Extensive hand   Y............  A2...........      $510.00      25.8758    $1,100.83      $657.71
                surgery.
26260........  Extensive        Y............  A2...........      $510.00      16.1540      $687.24      $554.31
                finger surgery.
26261........  Extensive        Y............  A2...........      $510.00      16.1540      $687.24      $554.31
                finger surgery.
26262........  Partial removal  Y............  A2...........      $446.00      16.1540      $687.24      $506.31
                of finger.
26320........  Removal of       Y............  A2...........      $446.00      15.1024      $642.50      $495.13
                implant from
                hand.
26340........  Manipulate       Y............  G2...........  ...........       1.6857       $71.71       $71.71
                finger w/
                anesth.
26350........  Repair finger/   Y............  A2...........      $333.00      25.8758    $1,100.83      $524.96
                hand tendon.
26352........  Repair/graft     Y............  A2...........      $630.00      25.8758    $1,100.83      $747.71
                hand tendon.
26356........  Repair finger/   Y............  A2...........      $630.00      25.8758    $1,100.83      $747.71
                hand tendon.
26357........  Repair finger/   Y............  A2...........      $630.00      25.8758    $1,100.83      $747.71
                hand tendon.
26358........  Repair/graft     Y............  A2...........      $630.00      25.8758    $1,100.83      $747.71
                hand tendon.
26370........  Repair finger/   Y............  A2...........      $630.00      25.8758    $1,100.83      $747.71
                hand tendon.
26372........  Repair/graft     Y............  A2...........      $630.00      25.8758    $1,100.83      $747.71
                hand tendon.
26373........  Repair finger/   Y............  A2...........      $510.00      25.8758    $1,100.83      $657.71
                hand tendon.
26390........  Revise hand/     Y............  A2...........      $630.00      25.8758    $1,100.83      $747.71
                finger tendon.
26392........  Repair/graft     Y............  A2...........      $510.00      25.8758    $1,100.83      $657.71
                hand tendon.
26410........  Repair hand      Y............  A2...........      $510.00      16.1540      $687.24      $554.31
                tendon.
26412........  Repair/graft     Y............  A2...........      $510.00      25.8758    $1,100.83      $657.71
                hand tendon.
26415........  Excision, hand/  Y............  A2...........      $630.00      25.8758    $1,100.83      $747.71
                finger tendon.
26416........  Graft hand or    Y............  A2...........      $510.00      25.8758    $1,100.83      $657.71
                finger tendon.
26418........  Repair finger    Y............  A2...........      $630.00      16.1540      $687.24      $644.31
                tendon.
26420........  Repair/graft     Y............  A2...........      $630.00      25.8758    $1,100.83      $747.71
                finger tendon.
26426........  Repair finger/   Y............  A2...........      $510.00      25.8758    $1,100.83      $657.71
                hand tendon.
26428........  Repair/graft     Y............  A2...........      $510.00      25.8758    $1,100.83      $657.71
                finger tendon.
26432........  Repair finger    Y............  A2...........      $510.00      16.1540      $687.24      $554.31
                tendon.
26433........  Repair finger    Y............  A2...........      $510.00      16.1540      $687.24      $554.31
                tendon.
26434........  Repair/graft     Y............  A2...........      $510.00      25.8758    $1,100.83      $657.71
                finger tendon.
26437........  Realignment of   Y............  A2...........      $510.00      16.1540      $687.24      $554.31
                tendons.
26440........  Release palm/    Y............  A2...........      $510.00      16.1540      $687.24      $554.31
                finger tendon.
26442........  Release palm &   Y............  A2...........      $510.00      25.8758    $1,100.83      $657.71
                finger tendon.
26445........  Release hand/    Y............  A2...........      $510.00      16.1540      $687.24      $554.31
                finger tendon.
26449........  Release forearm/ Y............  A2...........      $510.00      25.8758    $1,100.83      $657.71
                hand tendon.
26450........  Incision of      Y............  A2...........      $510.00      16.1540      $687.24      $554.31
                palm tendon.
26455........  Incision of      Y............  A2...........      $510.00      16.1540      $687.24      $554.31
                finger tendon.
26460........  Incise hand/     Y............  A2...........      $510.00      16.1540      $687.24      $554.31
                finger tendon.
26471........  Fusion of        Y............  A2...........      $446.00      16.1540      $687.24      $506.31
                finger tendons.

[[Page 42565]]

 
26474........  Fusion of        Y............  A2...........      $446.00      16.1540      $687.24      $506.31
                finger tendons.
26476........  Tendon           Y............  A2...........      $333.00      16.1540      $687.24      $421.56
                lengthening.
26477........  Tendon           Y............  A2...........      $333.00      16.1540      $687.24      $421.56
                shortening.
26478........  Lengthening of   Y............  A2...........      $333.00      16.1540      $687.24      $421.56
                hand tendon.
26479........  Shortening of    Y............  A2...........      $333.00      16.1540      $687.24      $421.56
                hand tendon.
26480........  Transplant hand  Y............  A2...........      $510.00      25.8758    $1,100.83      $657.71
                tendon.
26483........  Transplant/      Y............  A2...........      $510.00      25.8758    $1,100.83      $657.71
                graft hand
                tendon.
26485........  Transplant palm  Y............  A2...........      $446.00      25.8758    $1,100.83      $609.71
                tendon.
26489........  Transplant/      Y............  A2...........      $510.00      25.8758    $1,100.83      $657.71
                graft palm
                tendon.
26490........  Revise thumb     Y............  A2...........      $510.00      25.8758    $1,100.83      $657.71
                tendon.
26492........  Tendon transfer  Y............  A2...........      $510.00      25.8758    $1,100.83      $657.71
                with graft.
26494........  Hand tendon/     Y............  A2...........      $510.00      25.8758    $1,100.83      $657.71
                muscle
                transfer.
26496........  Revise thumb     Y............  A2...........      $510.00      25.8758    $1,100.83      $657.71
                tendon.
26497........  Finger tendon    Y............  A2...........      $510.00      25.8758    $1,100.83      $657.71
                transfer.
26498........  Finger tendon    Y............  A2...........      $630.00      25.8758    $1,100.83      $747.71
                transfer.
26499........  Revision of      Y............  A2...........      $510.00      25.8758    $1,100.83      $657.71
                finger.
26500........  Hand tendon      Y............  A2...........      $630.00      16.1540      $687.24      $644.31
                reconstruction.
26502........  Hand tendon      Y............  A2...........      $630.00      25.8758    $1,100.83      $747.71
                reconstruction.
26508........  Release thumb    Y............  A2...........      $510.00      16.1540      $687.24      $554.31
                contracture.
26510........  Thumb tendon     Y............  A2...........      $510.00      25.8758    $1,100.83      $657.71
                transfer.
26516........  Fusion of        Y............  A2...........      $333.00      25.8758    $1,100.83      $524.96
                knuckle joint.
26517........  Fusion of        Y............  A2...........      $510.00      25.8758    $1,100.83      $657.71
                knuckle joints.
26518........  Fusion of        Y............  A2...........      $510.00      25.8758    $1,100.83      $657.71
                knuckle joints.
26520........  Release knuckle  Y............  A2...........      $510.00      16.1540      $687.24      $554.31
                contracture.
26525........  Release finger   Y............  A2...........      $510.00      16.1540      $687.24      $554.31
                contracture.
26530........  Revise knuckle   Y............  A2...........      $510.00      33.4505    $1,423.08      $738.27
                joint.
26531........  Revise knuckle   Y............  A2...........      $995.00      47.4378    $2,018.15    $1,250.79
                with implant.
26535........  Revise finger    Y............  A2...........      $717.00      33.4505    $1,423.08      $893.52
                joint.
26536........  Revise/implant   Y............  A2...........      $717.00      47.4378    $2,018.15    $1,042.29
                finger joint.
26540........  Repair hand      Y............  A2...........      $630.00      16.1540      $687.24      $644.31
                joint.
26541........  Repair hand      Y............  A2...........      $995.00      25.8758    $1,100.83    $1,021.46
                joint with
                graft.
26542........  Repair hand      Y............  A2...........      $630.00      16.1540      $687.24      $644.31
                joint with
                graft.
26545........  Reconstruct      Y............  A2...........      $630.00      25.8758    $1,100.83      $747.71
                finger joint.
26546........  Repair nonunion  Y............  A2...........      $630.00      25.8758    $1,100.83      $747.71
                hand.
26548........  Reconstruct      Y............  A2...........      $630.00      25.8758    $1,100.83      $747.71
                finger joint.
26550........  Construct thumb  Y............  A2...........      $446.00      25.8758    $1,100.83      $609.71
                replacement.
26555........  Positional       Y............  A2...........      $510.00      25.8758    $1,100.83      $657.71
                change of
                finger.
26560........  Repair of web    Y............  A2...........      $446.00      16.1540      $687.24      $506.31
                finger.
26561........  Repair of web    Y............  A2...........      $510.00      25.8758    $1,100.83      $657.71
                finger.
26562........  Repair of web    Y............  A2...........      $630.00      25.8758    $1,100.83      $747.71
                finger.
26565........  Correct          Y............  A2...........      $717.00      25.8758    $1,100.83      $812.96
                metacarpal
                flaw.
26567........  Correct finger   Y............  A2...........      $717.00      25.8758    $1,100.83      $812.96
                deformity.
26568........  Lengthen         Y............  A2...........      $510.00      25.8758    $1,100.83      $657.71
                metacarpal/
                finger.
26580........  Repair hand      Y............  A2...........      $717.00      16.1540      $687.24      $709.56
                deformity.
26587........  Reconstruct      Y............  A2...........      $717.00      16.1540      $687.24      $709.56
                extra finger.
26590........  Repair finger    Y............  A2...........      $717.00      16.1540      $687.24      $709.56
                deformity.
26591........  Repair muscles   Y............  A2...........      $510.00      25.8758    $1,100.83      $657.71
                of hand.
26593........  Release muscles  Y............  A2...........      $510.00      16.1540      $687.24      $554.31
                of hand.
26596........  Excision         Y............  A2...........      $446.00      16.1540      $687.24      $506.31
                constricting
                tissue.
26600........  Treat            Y............  P2...........  ...........       1.6857       $71.71       $71.71
                metacarpal
                fracture.
26605........  Treat            Y............  A2...........      $103.62       1.6857       $71.71       $95.64
                metacarpal
                fracture.
26607........  Treat            Y............  A2...........      $103.62       1.6857       $71.71       $95.64
                metacarpal
                fracture.
26608........  Treat            Y............  A2...........      $630.00      25.5264    $1,085.97      $743.99
                metacarpal
                fracture.
26615........  Treat            Y............  A2...........      $630.00      37.5382    $1,596.99      $871.75
                metacarpal
                fracture.
26641........  Treat thumb      Y............  G2...........  ...........       1.6857       $71.71       $71.71
                dislocation.
26645........  Treat thumb      Y............  A2...........      $103.62       1.6857       $71.71       $95.64
                fracture.
26650........  Treat thumb      Y............  A2...........      $446.00      25.5264    $1,085.97      $605.99
                fracture.
26665........  Treat thumb      Y............  A2...........      $630.00      37.5382    $1,596.99      $871.75
                fracture.
26670........  Treat hand       Y............  G2...........  ...........       1.6857       $71.71       $71.71
                dislocation.
26675........  Treat hand       Y............  A2...........      $103.62       1.6857       $71.71       $95.64
                dislocation.
26676........  Pin hand         Y............  A2...........      $446.00      25.5264    $1,085.97      $605.99
                dislocation.
26685........  Treat hand       Y............  A2...........      $510.00      37.5382    $1,596.99      $781.75
                dislocation.
26686........  Treat hand       Y............  A2...........      $510.00      57.2172    $2,434.19      $991.05
                dislocation.

[[Page 42566]]

 
26700........  Treat knuckle    Y............  G2...........  ...........       1.6857       $71.71       $71.71
                dislocation.
26705........  Treat knuckle    Y............  A2...........      $103.62       1.6857       $71.71       $95.64
                dislocation.
26706........  Pin knuckle      Y............  A2...........      $103.62       1.6857       $71.71       $95.64
                dislocation.
26715........  Treat knuckle    Y............  A2...........      $630.00      37.5382    $1,596.99      $871.75
                dislocation.
26720........  Treat finger     Y............  P2...........  ...........       1.6857       $71.71       $71.71
                fracture, each.
26725........  Treat finger     Y............  P2...........  ...........       1.6857       $71.71       $71.71
                fracture, each.
26727........  Treat finger     Y............  A2...........      $995.00      25.5264    $1,085.97    $1,017.74
                fracture, each.
26735........  Treat finger     Y............  A2...........      $630.00      37.5382    $1,596.99      $871.75
                fracture, each.
26740........  Treat finger     Y............  P2...........  ...........       1.6857       $71.71       $71.71
                fracture, each.
26742........  Treat finger     Y............  A2...........      $103.62       1.6857       $71.71       $95.64
                fracture, each.
26746........  Treat finger     Y............  A2...........      $717.00      37.5382    $1,596.99      $937.00
                fracture, each.
26750........  Treat finger     Y............  P2...........  ...........       1.6857       $71.71       $71.71
                fracture, each.
26755........  Treat finger     Y............  G2...........  ...........       1.6857       $71.71       $71.71
                fracture, each.
26756........  Pin finger       Y............  A2...........      $446.00      25.5264    $1,085.97      $605.99
                fracture, each.
26765........  Treat finger     Y............  A2...........      $630.00      37.5382    $1,596.99      $871.75
                fracture, each.
26770........  Treat finger     Y............  G2...........  ...........       1.6857       $71.71       $71.71
                dislocation.
26775........  Treat finger     Y............  G2...........  ...........      14.5947      $620.90      $620.90
                dislocation.
26776........  Pin finger       Y............  A2...........      $446.00      25.5264    $1,085.97      $605.99
                dislocation.
26785........  Treat finger     Y............  A2...........      $446.00      25.5264    $1,085.97      $605.99
                dislocation.
26820........  Thumb fusion     Y............  A2...........      $717.00      25.8758    $1,100.83      $812.96
                with graft.
26841........  Fusion of thumb  Y............  A2...........      $630.00      25.8758    $1,100.83      $747.71
26842........  Thumb fusion     Y............  A2...........      $630.00      25.8758    $1,100.83      $747.71
                with graft.
26843........  Fusion of hand   Y............  A2...........      $510.00      25.8758    $1,100.83      $657.71
                joint.
26844........  Fusion/graft of  Y............  A2...........      $510.00      25.8758    $1,100.83      $657.71
                hand joint.
26850........  Fusion of        Y............  A2...........      $630.00      25.8758    $1,100.83      $747.71
                knuckle.
26852........  Fusion of        Y............  A2...........      $630.00      25.8758    $1,100.83      $747.71
                knuckle with
                graft.
26860........  Fusion of        Y............  A2...........      $510.00      25.8758    $1,100.83      $657.71
                finger joint.
26861........  Fusion of        Y............  A2...........      $446.00      25.8758    $1,100.83      $609.71
                finger jnt,
                add-on.
26862........  Fusion/graft of  Y............  A2...........      $630.00      25.8758    $1,100.83      $747.71
                finger joint.
26863........  Fuse/graft       Y............  A2...........      $510.00      25.8758    $1,100.83      $657.71
                added joint.
26910........  Amputate         Y............  A2...........      $510.00      25.8758    $1,100.83      $657.71
                metacarpal
                bone.
26951........  Amputation of    Y............  A2...........      $446.00      16.1540      $687.24      $506.31
                finger/thumb.
26952........  Amputation of    Y............  A2...........      $630.00      16.1540      $687.24      $644.31
                finger/thumb.
26990........  Drainage of      Y............  A2...........      $333.00      20.8706      $887.90      $471.73
                pelvis lesion.
26991........  Drainage of      Y............  A2...........      $333.00      20.8706      $887.90      $471.73
                pelvis bursa.
27000........  Incision of hip  Y............  A2...........      $446.00      20.8706      $887.90      $556.48
                tendon.
27001........  Incision of hip  Y............  A2...........      $510.00      25.1296    $1,069.09      $649.77
                tendon.
27003........  Incision of hip  Y............  A2...........      $510.00      25.1296    $1,069.09      $649.77
                tendon.
27033........  Exploration of   Y............  A2...........      $510.00      41.0893    $1,748.06      $819.52
                hip joint.
27035........  Denervation of   Y............  A2...........      $630.00      41.0893    $1,748.06      $909.52
                hip joint.
27040........  Biopsy of soft   Y............  A2...........      $333.00       6.8083      $289.65      $322.16
                tissues.
27041........  Biopsy of soft   Y............  A2...........      $418.49       6.8083      $289.65      $386.28
                tissues.
27047........  Remove hip/      Y............  A2...........      $446.00      20.0656      $853.65      $547.91
                pelvis lesion.
27048........  Remove hip/      Y............  A2...........      $510.00      20.0656      $853.65      $595.91
                pelvis lesion.
27049........  Remove tumor,    Y............  A2...........      $510.00      20.0656      $853.65      $595.91
                hip/pelvis.
27050........  Biopsy of        Y............  A2...........      $510.00      20.8706      $887.90      $604.48
                sacroiliac
                joint.
27052........  Biopsy of hip    Y............  A2...........      $510.00      20.8706      $887.90      $604.48
                joint.
27060........  Removal of       Y............  A2...........      $717.00      20.8706      $887.90      $759.73
                ischial bursa.
27062........  Remove femur     Y............  A2...........      $717.00      20.8706      $887.90      $759.73
                lesion/bursa.
27065........  Removal of hip   Y............  A2...........      $717.00      20.8706      $887.90      $759.73
                bone lesion.
27066........  Removal of hip   Y............  A2...........      $717.00      25.1296    $1,069.09      $805.02
                bone lesion.
27067........  Remove/graft     Y............  A2...........      $717.00      25.1296    $1,069.09      $805.02
                hip bone
                lesion.
27080........  Removal of tail  Y............  A2...........      $446.00      25.1296    $1,069.09      $601.77
                bone.
27086........  Remove hip       Y............  A2...........      $333.00       6.8083      $289.65      $322.16
                foreign body.
27087........  Remove hip       Y............  A2...........      $510.00      20.8706      $887.90      $604.48
                foreign body.
27093........  Injection for    .............  N1...........  ...........  ...........  ...........  ...........
                hip x-ray.
27095........  Injection for    .............  N1...........  ...........  ...........  ...........  ...........
                hip x-ray.
27097........  Revision of hip  Y............  A2...........      $510.00      25.1296    $1,069.09      $649.77
                tendon.
27098........  Transfer tendon  Y............  A2...........      $510.00      25.1296    $1,069.09      $649.77
                to pelvis.
27100........  Transfer of      Y............  A2...........      $630.00      41.0893    $1,748.06      $909.52
                abdominal
                muscle.
27105........  Transfer of      Y............  A2...........      $630.00      41.0893    $1,748.06      $909.52
                spinal muscle.
27110........  Transfer of      Y............  A2...........      $630.00      41.0893    $1,748.06      $909.52
                iliopsoas
                muscle.
27111........  Transfer of      Y............  A2...........      $630.00      41.0893    $1,748.06      $909.52
                iliopsoas
                muscle.

[[Page 42567]]

 
27193........  Treat pelvic     Y............  A2...........      $103.62       1.6857       $71.71       $95.64
                ring fracture.
27194........  Treat pelvic     Y............  A2...........      $446.00      14.5947      $620.90      $489.73
                ring fracture.
27200........  Treat tail bone  Y............  P2...........  ...........       1.6857       $71.71       $71.71
                fracture.
27202........  Treat tail bone  Y............  A2...........      $446.00      37.5382    $1,596.99      $733.75
                fracture.
27220........  Treat hip        Y............  G2...........  ...........       1.6857       $71.71       $71.71
                socket
                fracture.
27230........  Treat thigh      Y............  A2...........      $103.62       1.6857       $71.71       $95.64
                fracture.
27238........  Treat thigh      Y............  A2...........      $103.62       1.6857       $71.71       $95.64
                fracture.
27246........  Treat thigh      Y............  A2...........      $103.62       1.6857       $71.71       $95.64
                fracture.
27250........  Treat hip        Y............  A2...........      $103.62       1.6857       $71.71       $95.64
                dislocation.
27252........  Treat hip        Y............  A2...........      $446.00      14.5947      $620.90      $489.73
                dislocation.
27256........  Treat hip        Y............  G2...........  ...........       1.6857       $71.71       $71.71
                dislocation.
27257........  Treat hip        Y............  A2...........      $510.00      14.5947      $620.90      $537.73
                dislocation.
27265........  Treat hip        Y............  A2...........      $103.62       1.6857       $71.71       $95.64
                dislocation.
27266........  Treat hip        Y............  A2...........      $446.00      14.5947      $620.90      $489.73
                dislocation.
27275........  Manipulation of  Y............  A2...........      $446.00      14.5947      $620.90      $489.73
                hip joint.
27301........  Drain thigh/     Y............  A2...........      $510.00      17.5086      $744.87      $568.72
                knee lesion.
27305........  Incise thigh     Y............  A2...........      $446.00      20.8706      $887.90      $556.48
                tendon &
                fascia.
27306........  Incision of      Y............  A2...........      $510.00      20.8706      $887.90      $604.48
                thigh tendon.
27307........  Incision of      Y............  A2...........      $510.00      20.8706      $887.90      $604.48
                thigh tendons.
27310........  Exploration of   Y............  A2...........      $630.00      25.1296    $1,069.09      $739.77
                knee joint.
27323........  Biopsy, thigh    Y............  A2...........      $333.00       6.8083      $289.65      $322.16
                soft tissues.
27324........  Biopsy, thigh    Y............  A2...........      $333.00      20.0656      $853.65      $463.16
                soft tissues.
27325........  Neurectomy,      Y............  A2...........      $446.00      17.8499      $759.39      $524.35
                hamstring.
27326........  Neurectomy,      Y............  A2...........      $446.00      17.8499      $759.39      $524.35
                popliteal.
27327........  Removal of       Y............  A2...........      $446.00      20.0656      $853.65      $547.91
                thigh lesion.
27328........  Removal of       Y............  A2...........      $510.00      20.0656      $853.65      $595.91
                thigh lesion.
27329........  Remove tumor,    Y............  A2...........      $630.00      20.0656      $853.65      $685.91
                thigh/knee.
27330........  Biopsy, knee     Y............  A2...........      $630.00      25.1296    $1,069.09      $739.77
                joint lining.
27331........  Explore/treat    Y............  A2...........      $630.00      25.1296    $1,069.09      $739.77
                knee joint.
27332........  Removal of knee  Y............  A2...........      $630.00      25.1296    $1,069.09      $739.77
                cartilage.
27333........  Removal of knee  Y............  A2...........      $630.00      25.1296    $1,069.09      $739.77
                cartilage.
27334........  Remove knee      Y............  A2...........      $630.00      25.1296    $1,069.09      $739.77
                joint lining.
27335........  Remove knee      Y............  A2...........      $630.00      25.1296    $1,069.09      $739.77
                joint lining.
27340........  Removal of       Y............  A2...........      $510.00      20.8706      $887.90      $604.48
                kneecap bursa.
27345........  Removal of knee  Y............  A2...........      $630.00      20.8706      $887.90      $694.48
                cyst.
27347........  Remove knee      Y............  A2...........      $630.00      20.8706      $887.90      $694.48
                cyst.
27350........  Removal of       Y............  A2...........      $630.00      25.1296    $1,069.09      $739.77
                kneecap.
27355........  Remove femur     Y............  A2...........      $510.00      25.1296    $1,069.09      $649.77
                lesion.
27356........  Remove femur     Y............  A2...........      $630.00      25.1296    $1,069.09      $739.77
                lesion/graft.
27357........  Remove femur     Y............  A2...........      $717.00      25.1296    $1,069.09      $805.02
                lesion/graft.
27358........  Remove femur     Y............  A2...........      $717.00      25.1296    $1,069.09      $805.02
                lesion/
                fixation.
27360........  Partial          Y............  A2...........      $717.00      25.1296    $1,069.09      $805.02
                removal, leg
                bone(s).
27370........  Injection for    .............  N1...........  ...........  ...........  ...........  ...........
                knee x-ray.
27372........  Removal of       Y............  A2...........      $995.00      20.0656      $853.65      $959.66
                foreign body.
27380........  Repair of        Y............  A2...........      $333.00      20.8706      $887.90      $471.73
                kneecap tendon.
27381........  Repair/graft     Y............  A2...........      $510.00      20.8706      $887.90      $604.48
                kneecap tendon.
27385........  Repair of thigh  Y............  A2...........      $510.00      20.8706      $887.90      $604.48
                muscle.
27386........  Repair/graft of  Y............  A2...........      $510.00      20.8706      $887.90      $604.48
                thigh muscle.
27390........  Incision of      Y............  A2...........      $333.00      20.8706      $887.90      $471.73
                thigh tendon.
27391........  Incision of      Y............  A2...........      $446.00      20.8706      $887.90      $556.48
                thigh tendons.
27392........  Incision of      Y............  A2...........      $510.00      20.8706      $887.90      $604.48
                thigh tendons.
27393........  Lengthening of   Y............  A2...........      $446.00      25.1296    $1,069.09      $601.77
                thigh tendon.
27394........  Lengthening of   Y............  A2...........      $510.00      25.1296    $1,069.09      $649.77
                thigh tendons.
27395........  Lengthening of   Y............  A2...........      $510.00      41.0893    $1,748.06      $819.52
                thigh tendons.
27396........  Transplant of    Y............  A2...........      $510.00      25.1296    $1,069.09      $649.77
                thigh tendon.
27397........  Transplants of   Y............  A2...........      $510.00      41.0893    $1,748.06      $819.52
                thigh tendons.
27400........  Revise thigh     Y............  A2...........      $510.00      41.0893    $1,748.06      $819.52
                muscles/
                tendons.
27403........  Repair of knee   Y............  A2...........      $630.00      25.1296    $1,069.09      $739.77
                cartilage.
27405........  Repair of knee   Y............  A2...........      $630.00      41.0893    $1,748.06      $909.52
                ligament.
27407........  Repair of knee   Y............  A2...........      $630.00      66.5800    $2,832.51    $1,180.63
                ligament.
27409........  Repair of knee   Y............  A2...........      $630.00      41.0893    $1,748.06      $909.52
                ligaments.
27418........  Repair           Y............  A2...........      $510.00      41.0893    $1,748.06      $819.52
                degenerated
                kneecap.
27420........  Revision of      Y............  A2...........      $510.00      41.0893    $1,748.06      $819.52
                unstable
                kneecap.

[[Page 42568]]

 
27422........  Revision of      Y............  A2...........      $995.00      41.0893    $1,748.06    $1,183.27
                unstable
                kneecap.
27424........  Revision/        Y............  A2...........      $510.00      41.0893    $1,748.06      $819.52
                removal of
                kneecap.
27425........  Lat retinacular  Y............  A2...........      $995.00      25.1296    $1,069.09    $1,013.52
                release open.
27427........  Reconstruction,  Y............  A2...........      $510.00      41.0893    $1,748.06      $819.52
                knee.
27428........  Reconstruction,  Y............  A2...........      $630.00      66.5800    $2,832.51    $1,180.63
                knee.
27429........  Reconstruction,  Y............  A2...........      $630.00      66.5800    $2,832.51    $1,180.63
                knee.
27430........  Revision of      Y............  A2...........      $630.00      41.0893    $1,748.06      $909.52
                thigh muscles.
27435........  Incision of      Y............  A2...........      $630.00      41.0893    $1,748.06      $909.52
                knee joint.
27437........  Revise kneecap.  Y............  A2...........      $630.00      33.4505    $1,423.08      $828.27
27438........  Revise kneecap   Y............  A2...........      $717.00      47.4378    $2,018.15    $1,042.29
                with implant.
27440........  Revision of      Y............  G2...........  ...........      33.4505    $1,423.08    $1,423.08
                knee joint.
27441........  Revision of      Y............  A2...........      $717.00      33.4505    $1,423.08      $893.52
                knee joint.
27442........  Revision of      Y............  A2...........      $717.00      33.4505    $1,423.08      $893.52
                knee joint.
27443........  Revision of      Y............  A2...........      $717.00      33.4505    $1,423.08      $893.52
                knee joint.
27446........  Revision of      Y............  G2...........  ...........     205.6815    $8,750.31    $8,750.31
                knee joint.
27496........  Decompression    Y............  A2...........      $717.00      20.8706      $887.90      $759.73
                of thigh/knee.
27497........  Decompression    Y............  A2...........      $510.00      20.8706      $887.90      $604.48
                of thigh/knee.
27498........  Decompression    Y............  A2...........      $510.00      20.8706      $887.90      $604.48
                of thigh/knee.
27499........  Decompression    Y............  A2...........      $510.00      20.8706      $887.90      $604.48
                of thigh/knee.
27500........  Treatment of     Y............  A2...........      $103.62       1.6857       $71.71       $95.64
                thigh fracture.
27501........  Treatment of     Y............  A2...........      $103.62       1.6857       $71.71       $95.64
                thigh fracture.
27502........  Treatment of     Y............  A2...........      $103.62       1.6857       $71.71       $95.64
                thigh fracture.
27503........  Treatment of     Y............  A2...........      $103.62       1.6857       $71.71       $95.64
                thigh fracture.
27508........  Treatment of     Y............  A2...........      $103.62       1.6857       $71.71       $95.64
                thigh fracture.
27509........  Treatment of     Y............  A2...........      $510.00      25.5264    $1,085.97      $653.99
                thigh fracture.
27510........  Treatment of     Y............  A2...........      $103.62       1.6857       $71.71       $95.64
                thigh fracture.
27516........  Treat thigh fx   Y............  A2...........      $103.62       1.6857       $71.71       $95.64
                growth plate.
27517........  Treat thigh fx   Y............  A2...........      $103.62       1.6857       $71.71       $95.64
                growth plate.
27520........  Treat kneecap    Y............  A2...........      $103.62       1.6857       $71.71       $95.64
                fracture.
27530........  Treat knee       Y............  A2...........      $103.62       1.6857       $71.71       $95.64
                fracture.
27532........  Treat knee       Y............  A2...........      $103.62       1.6857       $71.71       $95.64
                fracture.
27538........  Treat knee       Y............  A2...........      $103.62       1.6857       $71.71       $95.64
                fracture(s).
27550........  Treat knee       Y............  A2...........      $103.62       1.6857       $71.71       $95.64
                dislocation.
27552........  Treat knee       Y............  A2...........      $333.00      14.5947      $620.90      $404.98
                dislocation.
27560........  Treat kneecap    Y............  A2...........      $103.62       1.6857       $71.71       $95.64
                dislocation.
27562........  Treat kneecap    Y............  A2...........      $333.00      14.5947      $620.90      $404.98
                dislocation.
27566........  Treat kneecap    Y............  A2...........      $446.00      37.5382    $1,596.99      $733.75
                dislocation.
27570........  Fixation of      Y............  A2...........      $333.00      14.5947      $620.90      $404.98
                knee joint.
27594........  Amputation       Y............  A2...........      $510.00      20.8706      $887.90      $604.48
                follow-up
                surgery.
27600........  Decompression    Y............  A2...........      $510.00      20.8706      $887.90      $604.48
                of lower leg.
27601........  Decompression    Y............  A2...........      $510.00      20.8706      $887.90      $604.48
                of lower leg.
27602........  Decompression    Y............  A2...........      $510.00      20.8706      $887.90      $604.48
                of lower leg.
27603........  Drain lower leg  Y............  A2...........      $446.00      17.5086      $744.87      $520.72
                lesion.
27604........  Drain lower leg  Y............  A2...........      $446.00      20.8706      $887.90      $556.48
                bursa.
27605........  Incision of      Y............  A2...........      $333.00      20.4263      $869.00      $467.00
                achilles
                tendon.
27606........  Incision of      Y............  A2...........      $333.00      20.8706      $887.90      $471.73
                achilles
                tendon.
27607........  Treat lower leg  Y............  A2...........      $446.00      20.8706      $887.90      $556.48
                bone lesion.
27610........  Explore/treat    Y............  A2...........      $446.00      25.1296    $1,069.09      $601.77
                ankle joint.
27612........  Exploration of   Y............  A2...........      $510.00      25.1296    $1,069.09      $649.77
                ankle joint.
27613........  Biopsy lower     Y............  P3...........  ...........       2.8569      $121.54      $121.54
                leg soft
                tissue.
27614........  Biopsy lower     Y............  A2...........      $446.00      20.0656      $853.65      $547.91
                leg soft
                tissue.
27615........  Remove tumor,    Y............  A2...........      $510.00      25.1296    $1,069.09      $649.77
                lower leg.
27618........  Remove lower     Y............  A2...........      $446.00      15.1024      $642.50      $495.13
                leg lesion.
27619........  Remove lower     Y............  A2...........      $510.00      20.0656      $853.65      $595.91
                leg lesion.
27620........  Explore/treat    Y............  A2...........      $630.00      25.1296    $1,069.09      $739.77
                ankle joint.
27625........  Remove ankle     Y............  A2...........      $630.00      25.1296    $1,069.09      $739.77
                joint lining.
27626........  Remove ankle     Y............  A2...........      $630.00      25.1296    $1,069.09      $739.77
                joint lining.
27630........  Removal of       Y............  A2...........      $510.00      20.8706      $887.90      $604.48
                tendon lesion.
27635........  Remove lower     Y............  A2...........      $510.00      25.1296    $1,069.09      $649.77
                leg bone
                lesion.
27637........  Remove/graft     Y............  A2...........      $510.00      25.1296    $1,069.09      $649.77
                leg bone
                lesion.
27638........  Remove/graft     Y............  A2...........      $510.00      25.1296    $1,069.09      $649.77
                leg bone
                lesion.
27640........  Partial removal  Y............  A2...........      $446.00      41.0893    $1,748.06      $771.52
                of tibia.
27641........  Partial removal  Y............  A2...........      $446.00      25.1296    $1,069.09      $601.77
                of fibula.

[[Page 42569]]

 
27647........  Extensive ankle/ Y............  A2...........      $510.00      41.0893    $1,748.06      $819.52
                heel surgery.
27648........  Injection for    .............  N1...........  ...........  ...........  ...........  ...........
                ankle x-ray.
27650........  Repair achilles  Y............  A2...........      $510.00      41.0893    $1,748.06      $819.52
                tendon.
27652........  Repair/graft     Y............  A2...........      $510.00      66.5800    $2,832.51    $1,090.63
                achilles
                tendon.
27654........  Repair of        Y............  A2...........      $510.00      41.0893    $1,748.06      $819.52
                achilles
                tendon.
27656........  Repair leg       Y............  A2...........      $446.00      20.8706      $887.90      $556.48
                fascia defect.
27658........  Repair of leg    Y............  A2...........      $333.00      20.8706      $887.90      $471.73
                tendon, each.
27659........  Repair of leg    Y............  A2...........      $446.00      20.8706      $887.90      $556.48
                tendon, each.
27664........  Repair of leg    Y............  A2...........      $446.00      20.8706      $887.90      $556.48
                tendon, each.
27665........  Repair of leg    Y............  A2...........      $446.00      25.1296    $1,069.09      $601.77
                tendon, each.
27675........  Repair lower     Y............  A2...........      $446.00      20.8706      $887.90      $556.48
                leg tendons.
27676........  Repair lower     Y............  A2...........      $510.00      25.1296    $1,069.09      $649.77
                leg tendons.
27680........  Release of       Y............  A2...........      $510.00      25.1296    $1,069.09      $649.77
                lower leg
                tendon.
27681........  Release of       Y............  A2...........      $446.00      25.1296    $1,069.09      $601.77
                lower leg
                tendons.
27685........  Revision of      Y............  A2...........      $510.00      25.1296    $1,069.09      $649.77
                lower leg
                tendon.
27686........  Revise lower     Y............  A2...........      $510.00      25.1296    $1,069.09      $649.77
                leg tendons.
27687........  Revision of      Y............  A2...........      $510.00      25.1296    $1,069.09      $649.77
                calf tendon.
27690........  Revise lower     Y............  A2...........      $630.00      41.0893    $1,748.06      $909.52
                leg tendon.
27691........  Revise lower     Y............  A2...........      $630.00      41.0893    $1,748.06      $909.52
                leg tendon.
27692........  Revise           Y............  A2...........      $510.00      41.0893    $1,748.06      $819.52
                additional leg
                tendon.
27695........  Repair of ankle  Y............  A2...........      $446.00      25.1296    $1,069.09      $601.77
                ligament.
27696........  Repair of ankle  Y............  A2...........      $446.00      25.1296    $1,069.09      $601.77
                ligaments.
27698........  Repair of ankle  Y............  A2...........      $446.00      25.1296    $1,069.09      $601.77
                ligament.
27700........  Revision of      Y............  A2...........      $717.00      33.4505    $1,423.08      $893.52
                ankle joint.
27704........  Removal of       Y............  A2...........      $446.00      20.8706      $887.90      $556.48
                ankle implant.
27705........  Incision of      Y............  A2...........      $446.00      41.0893    $1,748.06      $771.52
                tibia.
27707........  Incision of      Y............  A2...........      $446.00      20.8706      $887.90      $556.48
                fibula.
27709........  Incision of      Y............  A2...........      $446.00      25.1296    $1,069.09      $601.77
                tibia & fibula.
27730........  Repair of tibia  Y............  A2...........      $446.00      25.1296    $1,069.09      $601.77
                epiphysis.
27732........  Repair of        Y............  A2...........      $446.00      25.1296    $1,069.09      $601.77
                fibula
                epiphysis.
27734........  Repair lower     Y............  A2...........      $446.00      25.1296    $1,069.09      $601.77
                leg epiphyses.
27740........  Repair of leg    Y............  A2...........      $446.00      25.1296    $1,069.09      $601.77
                epiphyses.
27742........  Repair of leg    Y............  A2...........      $446.00      41.0893    $1,748.06      $771.52
                epiphyses.
27745........  Reinforce tibia  Y............  A2...........      $510.00      66.5800    $2,832.51    $1,090.63
27750........  Treatment of     Y............  A2...........      $103.62       1.6857       $71.71       $95.64
                tibia fracture.
27752........  Treatment of     Y............  A2...........      $103.62       1.6857       $71.71       $95.64
                tibia fracture.
27756........  Treatment of     Y............  A2...........      $510.00      25.5264    $1,085.97      $653.99
                tibia fracture.
27758........  Treatment of     Y............  A2...........      $630.00      37.5382    $1,596.99      $871.75
                tibia fracture.
27759........  Treatment of     Y............  A2...........      $630.00      57.2172    $2,434.19    $1,081.05
                tibia fracture.
27760........  Treatment of     Y............  A2...........      $103.62       1.6857       $71.71       $95.64
                ankle fracture.
27762........  Treatment of     Y............  A2...........      $103.62       1.6857       $71.71       $95.64
                ankle fracture.
27766........  Treatment of     Y............  A2...........      $510.00      37.5382    $1,596.99      $781.75
                ankle fracture.
27780........  Treatment of     Y............  A2...........      $103.62       1.6857       $71.71       $95.64
                fibula
                fracture.
27781........  Treatment of     Y............  A2...........      $103.62       1.6857       $71.71       $95.64
                fibula
                fracture.
27784........  Treatment of     Y............  A2...........      $510.00      37.5382    $1,596.99      $781.75
                fibula
                fracture.
27786........  Treatment of     Y............  A2...........      $103.62       1.6857       $71.71       $95.64
                ankle fracture.
27788........  Treatment of     Y............  A2...........      $103.62       1.6857       $71.71       $95.64
                ankle fracture.
27792........  Treatment of     Y............  A2...........      $510.00      37.5382    $1,596.99      $781.75
                ankle fracture.
27808........  Treatment of     Y............  A2...........      $103.62       1.6857       $71.71       $95.64
                ankle fracture.
27810........  Treatment of     Y............  A2...........      $103.62       1.6857       $71.71       $95.64
                ankle fracture.
27814........  Treatment of     Y............  A2...........      $510.00      37.5382    $1,596.99      $781.75
                ankle fracture.
27816........  Treatment of     Y............  A2...........      $103.62       1.6857       $71.71       $95.64
                ankle fracture.
27818........  Treatment of     Y............  A2...........      $103.62       1.6857       $71.71       $95.64
                ankle fracture.
27822........  Treatment of     Y............  A2...........      $510.00      37.5382    $1,596.99      $781.75
                ankle fracture.
27823........  Treatment of     Y............  A2...........      $510.00      57.2172    $2,434.19      $991.05
                ankle fracture.
27824........  Treat lower leg  Y............  A2...........      $103.62       1.6857       $71.71       $95.64
                fracture.
27825........  Treat lower leg  Y............  A2...........      $103.62       1.6857       $71.71       $95.64
                fracture.
27826........  Treat lower leg  Y............  A2...........      $510.00      37.5382    $1,596.99      $781.75
                fracture.
27827........  Treat lower leg  Y............  A2...........      $510.00      57.2172    $2,434.19      $991.05
                fracture.
27828........  Treat lower leg  Y............  A2...........      $630.00      57.2172    $2,434.19    $1,081.05
                fracture.
27829........  Treat lower leg  Y............  A2...........      $446.00      37.5382    $1,596.99      $733.75
                joint.
27830........  Treat lower leg  Y............  A2...........      $103.62       1.6857       $71.71       $95.64
                dislocation.
27831........  Treat lower leg  Y............  A2...........      $103.62       1.6857       $71.71       $95.64
                dislocation.

[[Page 42570]]

 
27832........  Treat lower leg  Y............  A2...........      $446.00      37.5382    $1,596.99      $733.75
                dislocation.
27840........  Treat ankle      Y............  A2...........      $103.62       1.6857       $71.71       $95.64
                dislocation.
27842........  Treat ankle      Y............  A2...........      $333.00      14.5947      $620.90      $404.98
                dislocation.
27846........  Treat ankle      Y............  A2...........      $510.00      37.5382    $1,596.99      $781.75
                dislocation.
27848........  Treat ankle      Y............  A2...........      $510.00      37.5382    $1,596.99      $781.75
                dislocation.
27860........  Fixation of      Y............  A2...........      $333.00      14.5947      $620.90      $404.98
                ankle joint.
27870........  Fusion of ankle  Y............  A2...........      $630.00      66.5800    $2,832.51    $1,180.63
                joint, open.
27871........  Fusion of        Y............  A2...........      $630.00      66.5800    $2,832.51    $1,180.63
                tibiofibular
                joint.
27884........  Amputation       Y............  A2...........      $510.00      20.8706      $887.90      $604.48
                follow-up
                surgery.
27889........  Amputation of    Y............  A2...........      $510.00      25.1296    $1,069.09      $649.77
                foot at ankle.
27892........  Decompression    Y............  A2...........      $510.00      20.8706      $887.90      $604.48
                of leg.
27893........  Decompression    Y............  A2...........      $510.00      20.8706      $887.90      $604.48
                of leg.
27894........  Decompression    Y............  A2...........      $510.00      20.8706      $887.90      $604.48
                of leg.
28001........  Drainage of      Y............  P3...........  ...........       2.8327      $120.51      $120.51
                bursa of foot.
28002........  Treatment of     Y............  A2...........      $510.00      20.8706      $887.90      $604.48
                foot infection.
28003........  Treatment of     Y............  A2...........      $510.00      20.8706      $887.90      $604.48
                foot infection.
28005........  Treat foot bone  Y............  A2...........      $510.00      20.4263      $869.00      $599.75
                lesion.
28008........  Incision of      Y............  A2...........      $510.00      20.4263      $869.00      $599.75
                foot fascia.
28010........  Incision of toe  Y............  P3...........  ...........       2.1164       $90.04       $90.04
                tendon.
28011........  Incision of toe  Y............  A2...........      $510.00      20.4263      $869.00      $599.75
                tendons.
28020........  Exploration of   Y............  A2...........      $446.00      20.4263      $869.00      $551.75
                foot joint.
28022........  Exploration of   Y............  A2...........      $446.00      20.4263      $869.00      $551.75
                foot joint.
28024........  Exploration of   Y............  A2...........      $446.00      20.4263      $869.00      $551.75
                toe joint.
28035........  Decompression    Y............  A2...........      $630.00      17.8499      $759.39      $662.35
                of tibia nerve.
28043........  Excision of      Y............  A2...........      $446.00      20.0656      $853.65      $547.91
                foot lesion.
28045........  Excision of      Y............  A2...........      $510.00      20.4263      $869.00      $599.75
                foot lesion.
28046........  Resection of     Y............  A2...........      $510.00      20.4263      $869.00      $599.75
                tumor, foot.
28050........  Biopsy of foot   Y............  A2...........      $446.00      20.4263      $869.00      $551.75
                joint lining.
28052........  Biopsy of foot   Y............  A2...........      $446.00      20.4263      $869.00      $551.75
                joint lining.
28054........  Biopsy of toe    Y............  A2...........      $446.00      20.4263      $869.00      $551.75
                joint lining.
28055........  Neurectomy,      Y............  A2...........      $630.00      17.8499      $759.39      $662.35
                foot.
28060........  Partial          Y............  A2...........      $446.00      20.4263      $869.00      $551.75
                removal, foot
                fascia.
28062........  Removal of foot  Y............  A2...........      $510.00      20.4263      $869.00      $599.75
                fascia.
28070........  Removal of foot  Y............  A2...........      $510.00      20.4263      $869.00      $599.75
                joint lining.
28072........  Removal of foot  Y............  A2...........      $510.00      20.4263      $869.00      $599.75
                joint lining.
28080........  Removal of foot  Y............  A2...........      $510.00      20.4263      $869.00      $599.75
                lesion.
28086........  Excise foot      Y............  A2...........      $446.00      20.4263      $869.00      $551.75
                tendon sheath.
28088........  Excise foot      Y............  A2...........      $446.00      20.4263      $869.00      $551.75
                tendon sheath.
28090........  Removal of foot  Y............  A2...........      $510.00      20.4263      $869.00      $599.75
                lesion.
28092........  Removal of toe   Y............  A2...........      $510.00      20.4263      $869.00      $599.75
                lesions.
28100........  Removal of       Y............  A2...........      $446.00      20.4263      $869.00      $551.75
                ankle/heel
                lesion.
28102........  Remove/graft     Y............  A2...........      $510.00      40.8559    $1,738.13      $817.03
                foot lesion.
28103........  Remove/graft     Y............  A2...........      $510.00      40.8559    $1,738.13      $817.03
                foot lesion.
28104........  Removal of foot  Y............  A2...........      $446.00      20.4263      $869.00      $551.75
                lesion.
28106........  Remove/graft     Y............  A2...........      $510.00      40.8559    $1,738.13      $817.03
                foot lesion.
28107........  Remove/graft     Y............  A2...........      $510.00      40.8559    $1,738.13      $817.03
                foot lesion.
28108........  Removal of toe   Y............  A2...........      $446.00      20.4263      $869.00      $551.75
                lesions.
28110........  Part removal of  Y............  A2...........      $510.00      20.4263      $869.00      $599.75
                metatarsal.
28111........  Part removal of  Y............  A2...........      $510.00      20.4263      $869.00      $599.75
                metatarsal.
28112........  Part removal of  Y............  A2...........      $510.00      20.4263      $869.00      $599.75
                metatarsal.
28113........  Part removal of  Y............  A2...........      $510.00      20.4263      $869.00      $599.75
                metatarsal.
28114........  Removal of       Y............  A2...........      $510.00      20.4263      $869.00      $599.75
                metatarsal
                heads.
28116........  Revision of      Y............  A2...........      $510.00      20.4263      $869.00      $599.75
                foot.
28118........  Removal of heel  Y............  A2...........      $630.00      20.4263      $869.00      $689.75
                bone.
28119........  Removal of heel  Y............  A2...........      $630.00      20.4263      $869.00      $689.75
                spur.
28120........  Part removal of  Y............  A2...........      $995.00      20.4263      $869.00      $963.50
                ankle/heel.
28122........  Partial removal  Y............  A2...........      $510.00      20.4263      $869.00      $599.75
                of foot bone.
28124........  Partial removal  Y............  P3...........  ...........       4.7639      $202.67      $202.67
                of toe.
28126........  Partial removal  Y............  A2...........      $510.00      20.4263      $869.00      $599.75
                of toe.
28130........  Removal of       Y............  A2...........      $510.00      20.4263      $869.00      $599.75
                ankle bone.
28140........  Removal of       Y............  A2...........      $510.00      20.4263      $869.00      $599.75
                metatarsal.
28150........  Removal of toe.  Y............  A2...........      $510.00      20.4263      $869.00      $599.75
28153........  Partial removal  Y............  A2...........      $510.00      20.4263      $869.00      $599.75
                of toe.

[[Page 42571]]

 
28160........  Partial removal  Y............  A2...........      $510.00      20.4263      $869.00      $599.75
                of toe.
28171........  Extensive foot   Y............  A2...........      $510.00      20.4263      $869.00      $599.75
                surgery.
28173........  Extensive foot   Y............  A2...........      $510.00      20.4263      $869.00      $599.75
                surgery.
28175........  Extensive foot   Y............  A2...........      $510.00      20.4263      $869.00      $599.75
                surgery.
28190........  Removal of foot  Y............  P3...........  ...........       2.9855      $127.01      $127.01
                foreign body.
28192........  Removal of foot  Y............  A2...........      $446.00      15.1024      $642.50      $495.13
                foreign body.
28193........  Removal of foot  Y............  A2...........      $418.49       6.8083      $289.65      $386.28
                foreign body.
28200........  Repair of foot   Y............  A2...........      $510.00      20.4263      $869.00      $599.75
                tendon.
28202........  Repair/graft of  Y............  A2...........      $510.00      20.4263      $869.00      $599.75
                foot tendon.
28208........  Repair of foot   Y............  A2...........      $510.00      20.4263      $869.00      $599.75
                tendon.
28210........  Repair/graft of  Y............  A2...........      $510.00      40.8559    $1,738.13      $817.03
                foot tendon.
28220........  Release of foot  Y............  P3...........  ...........       4.4823      $190.69      $190.69
                tendon.
28222........  Release of foot  Y............  A2...........      $333.00      20.4263      $869.00      $467.00
                tendons.
28225........  Release of foot  Y............  A2...........      $333.00      20.4263      $869.00      $467.00
                tendon.
28226........  Release of foot  Y............  A2...........      $333.00      20.4263      $869.00      $467.00
                tendons.
28230........  Incision of      Y............  P3...........  ...........       4.4341      $188.64      $188.64
                foot tendon(s).
28232........  Incision of toe  Y............  P3...........  ...........       4.2329      $180.08      $180.08
                tendon.
28234........  Incision of      Y............  A2...........      $446.00      20.4263      $869.00      $551.75
                foot tendon.
28238........  Revision of      Y............  A2...........      $510.00      40.8559    $1,738.13      $817.03
                foot tendon.
28240........  Release of big   Y............  A2...........      $446.00      20.4263      $869.00      $551.75
                toe.
28250........  Revision of      Y............  A2...........      $510.00      20.4263      $869.00      $599.75
                foot fascia.
28260........  Release of       Y............  A2...........      $510.00      20.4263      $869.00      $599.75
                midfoot joint.
28261........  Revision of      Y............  A2...........      $510.00      20.4263      $869.00      $599.75
                foot tendon.
28262........  Revision of      Y............  A2...........      $630.00      20.4263      $869.00      $689.75
                foot and ankle.
28264........  Release of       Y............  A2...........      $333.00      40.8559    $1,738.13      $684.28
                midfoot joint.
28270........  Release of foot  Y............  A2...........      $510.00      20.4263      $869.00      $599.75
                contracture.
28272........  Release of toe   Y............  P3...........  ...........       4.0559      $172.55      $172.55
                joint, each.
28280........  Fusion of toes.  Y............  A2...........      $446.00      20.4263      $869.00      $551.75
28285........  Repair of        Y............  A2...........      $510.00      20.4263      $869.00      $599.75
                hammertoe.
28286........  Repair of        Y............  A2...........      $630.00      20.4263      $869.00      $689.75
                hammertoe.
28288........  Partial removal  Y............  A2...........      $510.00      20.4263      $869.00      $599.75
                of foot bone.
28289........  Repair hallux    Y............  A2...........      $510.00      20.4263      $869.00      $599.75
                rigidus.
28290........  Correction of    Y............  A2...........      $446.00      28.2349    $1,201.20      $634.80
                bunion.
28292........  Correction of    Y............  A2...........      $446.00      28.2349    $1,201.20      $634.80
                bunion.
28293........  Correction of    Y............  A2...........      $510.00      28.2349    $1,201.20      $682.80
                bunion.
28294........  Correction of    Y............  A2...........      $510.00      28.2349    $1,201.20      $682.80
                bunion.
28296........  Correction of    Y............  A2...........      $510.00      28.2349    $1,201.20      $682.80
                bunion.
28297........  Correction of    Y............  A2...........      $510.00      28.2349    $1,201.20      $682.80
                bunion.
28298........  Correction of    Y............  A2...........      $510.00      28.2349    $1,201.20      $682.80
                bunion.
28299........  Correction of    Y............  A2...........      $717.00      28.2349    $1,201.20      $838.05
                bunion.
28300........  Incision of      Y............  A2...........      $446.00      40.8559    $1,738.13      $769.03
                heel bone.
28302........  Incision of      Y............  A2...........      $446.00      20.4263      $869.00      $551.75
                ankle bone.
28304........  Incision of      Y............  A2...........      $446.00      40.8559    $1,738.13      $769.03
                midfoot bones.
28305........  Incise/graft     Y............  A2...........      $510.00      40.8559    $1,738.13      $817.03
                midfoot bones.
28306........  Incision of      Y............  A2...........      $630.00      20.4263      $869.00      $689.75
                metatarsal.
28307........  Incision of      Y............  A2...........      $630.00      20.4263      $869.00      $689.75
                metatarsal.
28308........  Incision of      Y............  A2...........      $446.00      20.4263      $869.00      $551.75
                metatarsal.
28309........  Incision of      Y............  A2...........      $630.00      40.8559    $1,738.13      $907.03
                metatarsals.
28310........  Revision of big  Y............  A2...........      $510.00      20.4263      $869.00      $599.75
                toe.
28312........  Revision of toe  Y............  A2...........      $510.00      20.4263      $869.00      $599.75
28313........  Repair           Y............  A2...........      $446.00      20.4263      $869.00      $551.75
                deformity of
                toe.
28315........  Removal of       Y............  A2...........      $630.00      20.4263      $869.00      $689.75
                sesamoid bone.
28320........  Repair of foot   Y............  A2...........      $630.00      40.8559    $1,738.13      $907.03
                bones.
28322........  Repair of        Y............  A2...........      $630.00      40.8559    $1,738.13      $907.03
                metatarsals.
28340........  Resect enlarged  Y............  A2...........      $630.00      20.4263      $869.00      $689.75
                toe tissue.
28341........  Resect enlarged  Y............  A2...........      $630.00      20.4263      $869.00      $689.75
                toe.
28344........  Repair extra     Y............  A2...........      $630.00      20.4263      $869.00      $689.75
                toe(s).
28345........  Repair webbed    Y............  A2...........      $630.00      20.4263      $869.00      $689.75
                toe(s).
28400........  Treatment of     Y............  A2...........      $103.62       1.6857       $71.71       $95.64
                heel fracture.
28405........  Treatment of     Y............  A2...........      $103.62       1.6857       $71.71       $95.64
                heel fracture.
28406........  Treatment of     Y............  A2...........      $446.00      25.5264    $1,085.97      $605.99
                heel fracture.
28415........  Treat heel       Y............  A2...........      $510.00      37.5382    $1,596.99      $781.75
                fracture.
28420........  Treat/graft      Y............  A2...........      $630.00      37.5382    $1,596.99      $871.75
                heel fracture.

[[Page 42572]]

 
28430........  Treatment of     Y............  P2...........  ...........       1.6857       $71.71       $71.71
                ankle fracture.
28435........  Treatment of     Y............  A2...........      $103.62       1.6857       $71.71       $95.64
                ankle fracture.
28436........  Treatment of     Y............  A2...........      $446.00      25.5264    $1,085.97      $605.99
                ankle fracture.
28445........  Treat ankle      Y............  A2...........      $510.00      37.5382    $1,596.99      $781.75
                fracture.
28450........  Treat midfoot    Y............  P2...........  ...........       1.6857       $71.71       $71.71
                fracture, each.
28455........  Treat midfoot    Y............  P2...........  ...........       1.6857       $71.71       $71.71
                fracture, each.
28456........  Treat midfoot    Y............  A2...........      $446.00      25.5264    $1,085.97      $605.99
                fracture.
28465........  Treat midfoot    Y............  A2...........      $510.00      37.5382    $1,596.99      $781.75
                fracture, each.
28470........  Treat            Y............  P2...........  ...........       1.6857       $71.71       $71.71
                metatarsal
                fracture.
28475........  Treat            Y............  P2...........  ...........       1.6857       $71.71       $71.71
                metatarsal
                fracture.
28476........  Treat            Y............  A2...........      $446.00      25.5264    $1,085.97      $605.99
                metatarsal
                fracture.
28485........  Treat            Y............  A2...........      $630.00      37.5382    $1,596.99      $871.75
                metatarsal
                fracture.
28490........  Treat big toe    Y............  P3...........  ...........       1.6579       $70.53       $70.53
                fracture.
28495........  Treat big toe    Y............  P2...........  ...........       1.6857       $71.71       $71.71
                fracture.
28496........  Treat big toe    Y............  A2...........      $446.00      25.5264    $1,085.97      $605.99
                fracture.
28505........  Treat big toe    Y............  A2...........      $510.00      37.5382    $1,596.99      $781.75
                fracture.
28510........  Treatment of     Y............  P3...........  ...........       1.2956       $55.12       $55.12
                toe fracture.
28515........  Treatment of     Y............  P3...........  ...........       1.6658       $70.87       $70.87
                toe fracture.
28525........  Treat toe        Y............  A2...........      $510.00      37.5382    $1,596.99      $781.75
                fracture.
28530........  Treat sesamoid   Y............  P3...........  ...........       1.2392       $52.72       $52.72
                bone fracture.
28531........  Treat sesamoid   Y............  A2...........      $510.00      37.5382    $1,596.99      $781.75
                bone fracture.
28540........  Treat foot       Y............  P2...........  ...........       1.6857       $71.71       $71.71
                dislocation.
28545........  Treat foot       Y............  A2...........      $333.00      25.5264    $1,085.97      $521.24
                dislocation.
28546........  Treat foot       Y............  A2...........      $446.00      25.5264    $1,085.97      $605.99
                dislocation.
28555........  Repair foot      Y............  A2...........      $446.00      37.5382    $1,596.99      $733.75
                dislocation.
28570........  Treat foot       Y............  P2...........  ...........       1.6857       $71.71       $71.71
                dislocation.
28575........  Treat foot       Y............  A2...........      $103.62       1.6857       $71.71       $95.64
                dislocation.
28576........  Treat foot       Y............  A2...........      $510.00      25.5264    $1,085.97      $653.99
                dislocation.
28585........  Repair foot      Y............  A2...........      $510.00      37.5382    $1,596.99      $781.75
                dislocation.
28600........  Treat foot       Y............  P2...........  ...........       1.6857       $71.71       $71.71
                dislocation.
28605........  Treat foot       Y............  A2...........      $103.62       1.6857       $71.71       $95.64
                dislocation.
28606........  Treat foot       Y............  A2...........      $446.00      25.5264    $1,085.97      $605.99
                dislocation.
28615........  Repair foot      Y............  A2...........      $510.00      37.5382    $1,596.99      $781.75
                dislocation.
28630........  Treat toe        Y............  G2...........  ...........       1.6857       $71.71       $71.71
                dislocation.
28635........  Treat toe        Y............  A2...........      $333.00      14.5947      $620.90      $404.98
                dislocation.
28636........  Treat toe        Y............  A2...........      $510.00      25.5264    $1,085.97      $653.99
                dislocation.
28645........  Repair toe       Y............  A2...........      $510.00      37.5382    $1,596.99      $781.75
                dislocation.
28660........  Treat toe        Y............  G2...........  ...........       1.6857       $71.71       $71.71
                dislocation.
28665........  Treat toe        Y............  A2...........      $333.00      14.5947      $620.90      $404.98
                dislocation.
28666........  Treat toe        Y............  A2...........      $510.00      25.5264    $1,085.97      $653.99
                dislocation.
28675........  Repair of toe    Y............  A2...........      $510.00      37.5382    $1,596.99      $781.75
                dislocation.
28705........  Fusion of foot   Y............  A2...........      $630.00      40.8559    $1,738.13      $907.03
                bones.
28715........  Fusion of foot   Y............  A2...........      $630.00      40.8559    $1,738.13      $907.03
                bones.
28725........  Fusion of foot   Y............  A2...........      $630.00      40.8559    $1,738.13      $907.03
                bones.
28730........  Fusion of foot   Y............  A2...........      $630.00      40.8559    $1,738.13      $907.03
                bones.
28735........  Fusion of foot   Y............  A2...........      $630.00      40.8559    $1,738.13      $907.03
                bones.
28737........  Revision of      Y............  A2...........      $717.00      40.8559    $1,738.13      $972.28
                foot bones.
28740........  Fusion of foot   Y............  A2...........      $630.00      40.8559    $1,738.13      $907.03
                bones.
28750........  Fusion of big    Y............  A2...........      $630.00      40.8559    $1,738.13      $907.03
                toe joint.
28755........  Fusion of big    Y............  A2...........      $630.00      20.4263      $869.00      $689.75
                toe joint.
28760........  Fusion of big    Y............  A2...........      $630.00      40.8559    $1,738.13      $907.03
                toe joint.
28810........  Amputation toe   Y............  A2...........      $446.00      20.4263      $869.00      $551.75
                & metatarsal.
28820........  Amputation of    Y............  A2...........      $446.00      20.4263      $869.00      $551.75
                toe.
28825........  Partial          Y............  A2...........      $446.00      20.4263      $869.00      $551.75
                amputation of
                toe.
28890........  High energy      Y............  G2...........  ...........      25.1296    $1,069.09    $1,069.09
                eswt, plantar
                f.
29000........  Application of   N............  G2...........  ...........       1.0607       $45.13       $45.13
                body cast.
29010........  Application of   N............  P2...........  ...........       2.2777       $96.90       $96.90
                body cast.
29015........  Application of   N............  P2...........  ...........       2.2777       $96.90       $96.90
                body cast.
29020........  Application of   N............  G2...........  ...........       1.0607       $45.13       $45.13
                body cast.
29025........  Application of   N............  P2...........  ...........       1.0607       $45.13       $45.13
                body cast.
29035........  Application of   N............  G2...........  ...........       2.2777       $96.90       $96.90
                body cast.
29040........  Application of   N............  G2...........  ...........       1.0607       $45.13       $45.13
                body cast.
29044........  Application of   N............  P2...........  ...........       2.2777       $96.90       $96.90
                body cast.

[[Page 42573]]

 
29046........  Application of   N............  G2...........  ...........       2.2777       $96.90       $96.90
                body cast.
29049........  Application of   N............  P3...........  ...........       0.9736       $41.42       $41.42
                figure eight.
29055........  Application of   N............  P2...........  ...........       2.2777       $96.90       $96.90
                shoulder cast.
29058........  Application of   N............  P2...........  ...........       1.0607       $45.13       $45.13
                shoulder cast.
29065........  Application of   N............  P3...........  ...........       1.0462       $44.51       $44.51
                long arm cast.
29075........  Application of   N............  P3...........  ...........       0.9978       $42.45       $42.45
                forearm cast.
29085........  Apply hand/      N............  P3...........  ...........       1.0220       $43.48       $43.48
                wrist cast.
29086........  Apply finger     N............  P3...........  ...........       0.8048       $34.24       $34.24
                cast.
29105........  Apply long arm   N............  P3...........  ...........       0.9334       $39.71       $39.71
                splint.
29125........  Apply forearm    N............  P3...........  ...........       0.7966       $33.89       $33.89
                splint.
29126........  Apply forearm    N............  P3...........  ...........       0.8932       $38.00       $38.00
                splint.
29130........  Application of   N............  P3...........  ...........       0.3622       $15.41       $15.41
                finger splint.
29131........  Application of   N............  P3...........  ...........       0.5472       $23.28       $23.28
                finger splint.
29200........  Strapping of     N............  P3...........  ...........       0.5312       $22.60       $22.60
                chest.
29220........  Strapping of     N............  P3...........  ...........       0.5312       $22.60       $22.60
                low back.
29240........  Strapping of     N............  P3...........  ...........       0.6116       $26.02       $26.02
                shoulder.
29260........  Strapping of     N............  P3...........  ...........       0.5632       $23.96       $23.96
                elbow or wrist.
29280........  Strapping of     N............  P3...........  ...........       0.5874       $24.99       $24.99
                hand or finger.
29305........  Application of   N............  G2...........  ...........       2.2777       $96.90       $96.90
                hip cast.
29325........  Application of   N............  G2...........  ...........       2.2777       $96.90       $96.90
                hip casts.
29345........  Application of   N............  P3...........  ...........       1.3760       $58.54       $58.54
                long leg cast.
29355........  Application of   N............  P3...........  ...........       1.3438       $57.17       $57.17
                long leg cast.
29358........  Apply long leg   N............  P3...........  ...........       1.6496       $70.18       $70.18
                cast brace.
29365........  Application of   N............  P3...........  ...........       1.3036       $55.46       $55.46
                long leg cast.
29405........  Apply short leg  N............  P3...........  ...........       0.9736       $41.42       $41.42
                cast.
29425........  Apply short leg  N............  P3...........  ...........       0.9898       $42.11       $42.11
                cast.
29435........  Apply short leg  N............  P3...........  ...........       1.2392       $52.72       $52.72
                cast.
29440........  Addition of      N............  P3...........  ...........       0.5230       $22.25       $22.25
                walker to cast.
29445........  Apply rigid leg  N............  P3...........  ...........       1.3760       $58.54       $58.54
                cast.
29450........  Application of   N............  P2...........  ...........       1.0607       $45.13       $45.13
                leg cast.
29505........  Application,     N............  G2...........  ...........       1.0607       $45.13       $45.13
                long leg
                splint.
29515........  Application      N............  G2...........  ...........       1.0607       $45.13       $45.13
                lower leg
                splint.
29520........  Strapping of     N............  P3...........  ...........       0.6116       $26.02       $26.02
                hip.
29530........  Strapping of     N............  P3...........  ...........       0.5714       $24.31       $24.31
                knee.
29540........  Strapping of     N............  P3...........  ...........       0.3862       $16.43       $16.43
                ankle and/or
                ft.
29550........  Strapping of     N............  P3...........  ...........       0.4024       $17.12       $17.12
                toes.
29580........  Application of   N............  P3...........  ...........       0.5552       $23.62       $23.62
                paste boot.
29590........  Application of   N............  P3...........  ...........       0.4506       $19.17       $19.17
                foot splint.
29700........  Removal/         N............  P3...........  ...........       0.7484       $31.84       $31.84
                revision of
                cast.
29705........  Removal/         N............  P3...........  ...........       0.6438       $27.39       $27.39
                revision of
                cast.
29710........  Removal/         N............  P3...........  ...........       1.1990       $51.01       $51.01
                revision of
                cast.
29715........  Removal/         N............  P3...........  ...........       0.9254       $39.37       $39.37
                revision of
                cast.
29720........  Repair of body   N............  P3...........  ...........       0.9254       $39.37       $39.37
                cast.
29730........  Windowing of     N............  P3...........  ...........       0.6276       $26.70       $26.70
                cast.
29740........  Wedging of cast  N............  P3...........  ...........       0.8852       $37.66       $37.66
29750........  Wedging of       N............  P3...........  ...........       0.7966       $33.89       $33.89
                clubfoot cast.
29800........  Jaw arthroscopy/ Y............  A2...........      $510.00      28.6245    $1,217.77      $686.94
                surgery.
29804........  Jaw arthroscopy/ Y............  A2...........      $510.00      28.6245    $1,217.77      $686.94
                surgery.
29805........  Shoulder         Y............  A2...........      $510.00      28.6245    $1,217.77      $686.94
                arthroscopy,
                dx.
29806........  Shoulder         Y............  A2...........      $510.00      45.5027    $1,935.82      $866.46
                arthroscopy/
                surgery.
29807........  Shoulder         Y............  A2...........      $510.00      45.5027    $1,935.82      $866.46
                arthroscopy/
                surgery.
29819........  Shoulder         Y............  A2...........      $510.00      28.6245    $1,217.77      $686.94
                arthroscopy/
                surgery.
29820........  Shoulder         Y............  A2...........      $510.00      28.6245    $1,217.77      $686.94
                arthroscopy/
                surgery.
29821........  Shoulder         Y............  A2...........      $510.00      28.6245    $1,217.77      $686.94
                arthroscopy/
                surgery.
29822........  Shoulder         Y............  A2...........      $510.00      28.6245    $1,217.77      $686.94
                arthroscopy/
                surgery.
29823........  Shoulder         Y............  A2...........      $510.00      28.6245    $1,217.77      $686.94
                arthroscopy/
                surgery.
29824........  Shoulder         Y............  A2...........      $717.00      28.6245    $1,217.77      $842.19
                arthroscopy/
                surgery.
29825........  Shoulder         Y............  A2...........      $510.00      28.6245    $1,217.77      $686.94
                arthroscopy/
                surgery.
29826........  Shoulder         Y............  A2...........      $510.00      45.5027    $1,935.82      $866.46
                arthroscopy/
                surgery.
29827........  Arthroscop       Y............  A2...........      $717.00      45.5027    $1,935.82    $1,021.71
                rotator cuff
                repr.
29830........  Elbow            Y............  A2...........      $510.00      28.6245    $1,217.77      $686.94
                arthroscopy.
29834........  Elbow            Y............  A2...........      $510.00      28.6245    $1,217.77      $686.94
                arthroscopy/
                surgery.
29835........  Elbow            Y............  A2...........      $510.00      28.6245    $1,217.77      $686.94
                arthroscopy/
                surgery.

[[Page 42574]]

 
29836........  Elbow            Y............  A2...........      $510.00      28.6245    $1,217.77      $686.94
                arthroscopy/
                surgery.
29837........  Elbow            Y............  A2...........      $510.00      28.6245    $1,217.77      $686.94
                arthroscopy/
                surgery.
29838........  Elbow            Y............  A2...........      $510.00      28.6245    $1,217.77      $686.94
                arthroscopy/
                surgery.
29840........  Wrist            Y............  A2...........      $510.00      28.6245    $1,217.77      $686.94
                arthroscopy.
29843........  Wrist            Y............  A2...........      $510.00      28.6245    $1,217.77      $686.94
                arthroscopy/
                surgery.
29844........  Wrist            Y............  A2...........      $510.00      28.6245    $1,217.77      $686.94
                arthroscopy/
                surgery.
29845........  Wrist            Y............  A2...........      $510.00      28.6245    $1,217.77      $686.94
                arthroscopy/
                surgery.
29846........  Wrist            Y............  A2...........      $510.00      28.6245    $1,217.77      $686.94
                arthroscopy/
                surgery.
29847........  Wrist            Y............  A2...........      $510.00      28.6245    $1,217.77      $686.94
                arthroscopy/
                surgery.
29848........  Wrist endoscopy/ Y............  A2...........    $1,339.00      28.6245    $1,217.77    $1,308.69
                surgery.
29850........  Knee             Y............  A2...........      $630.00      28.6245    $1,217.77      $776.94
                arthroscopy/
                surgery.
29851........  Knee             Y............  A2...........      $630.00      45.5027    $1,935.82      $956.46
                arthroscopy/
                surgery.
29855........  Tibial           Y............  A2...........      $630.00      45.5027    $1,935.82      $956.46
                arthroscopy/
                surgery.
29856........  Tibial           Y............  A2...........      $630.00      28.6245    $1,217.77      $776.94
                arthroscopy/
                surgery.
29860........  Hip              Y............  A2...........      $630.00      28.6245    $1,217.77      $776.94
                arthroscopy,
                dx.
29861........  Hip arthroscopy/ Y............  A2...........      $630.00      28.6245    $1,217.77      $776.94
                surgery.
29862........  Hip arthroscopy/ Y............  A2...........    $1,339.00      45.5027    $1,935.82    $1,488.21
                surgery.
29863........  Hip arthroscopy/ Y............  A2...........      $630.00      45.5027    $1,935.82      $956.46
                surgery.
29870........  Knee             Y............  A2...........      $510.00      28.6245    $1,217.77      $686.94
                arthroscopy,
                dx.
29871........  Knee             Y............  A2...........      $510.00      28.6245    $1,217.77      $686.94
                arthroscopy/
                drainage.
29873........  Knee             Y............  A2...........      $510.00      28.6245    $1,217.77      $686.94
                arthroscopy/
                surgery.
29874........  Knee             Y............  A2...........      $510.00      28.6245    $1,217.77      $686.94
                arthroscopy/
                surgery.
29875........  Knee             Y............  A2...........      $630.00      28.6245    $1,217.77      $776.94
                arthroscopy/
                surgery.
29876........  Knee             Y............  A2...........      $630.00      28.6245    $1,217.77      $776.94
                arthroscopy/
                surgery.
29877........  Knee             Y............  A2...........      $630.00      28.6245    $1,217.77      $776.94
                arthroscopy/
                surgery.
29879........  Knee             Y............  A2...........      $510.00      28.6245    $1,217.77      $686.94
                arthroscopy/
                surgery.
29880........  Knee             Y............  A2...........      $630.00      28.6245    $1,217.77      $776.94
                arthroscopy/
                surgery.
29881........  Knee             Y............  A2...........      $630.00      28.6245    $1,217.77      $776.94
                arthroscopy/
                surgery.
29882........  Knee             Y............  A2...........      $510.00      28.6245    $1,217.77      $686.94
                arthroscopy/
                surgery.
29883........  Knee             Y............  A2...........      $510.00      28.6245    $1,217.77      $686.94
                arthroscopy/
                surgery.
29884........  Knee             Y............  A2...........      $510.00      28.6245    $1,217.77      $686.94
                arthroscopy/
                surgery.
29885........  Knee             Y............  A2...........      $510.00      45.5027    $1,935.82      $866.46
                arthroscopy/
                surgery.
29886........  Knee             Y............  A2...........      $510.00      28.6245    $1,217.77      $686.94
                arthroscopy/
                surgery.
29887........  Knee             Y............  A2...........      $510.00      28.6245    $1,217.77      $686.94
                arthroscopy/
                surgery.
29888........  Knee             Y............  A2...........      $510.00      45.5027    $1,935.82      $866.46
                arthroscopy/
                surgery.
29889........  Knee             Y............  A2...........      $510.00      45.5027    $1,935.82      $866.46
                arthroscopy/
                surgery.
29891........  Ankle            Y............  A2...........      $510.00      28.6245    $1,217.77      $686.94
                arthroscopy/
                surgery.
29892........  Ankle            Y............  A2...........      $510.00      28.6245    $1,217.77      $686.94
                arthroscopy/
                surgery.
29893........  Scope, plantar   Y............  A2...........    $1,255.56      20.4263      $869.00    $1,158.92
                fasciotomy.
29894........  Ankle            Y............  A2...........      $510.00      28.6245    $1,217.77      $686.94
                arthroscopy/
                surgery.
29895........  Ankle            Y............  A2...........      $510.00      28.6245    $1,217.77      $686.94
                arthroscopy/
                surgery.
29897........  Ankle            Y............  A2...........      $510.00      28.6245    $1,217.77      $686.94
                arthroscopy/
                surgery.
29898........  Ankle            Y............  A2...........      $510.00      28.6245    $1,217.77      $686.94
                arthroscopy/
                surgery.
29899........  Ankle            Y............  A2...........      $510.00      45.5027    $1,935.82      $866.46
                arthroscopy/
                surgery.
29900........  Mcp joint        Y............  A2...........      $510.00      16.1540      $687.24      $554.31
                arthroscopy,
                dx.
29901........  Mcp joint        Y............  A2...........      $510.00      16.1540      $687.24      $554.31
                arthroscopy,
                surg.
29902........  Mcp joint        Y............  A2...........      $510.00      16.1540      $687.24      $554.31
                arthroscopy,
                surg.
30000........  Drainage of      Y............  P2...........  ...........       2.4520      $104.32      $104.32
                nose lesion.
30020........  Drainage of      Y............  P2...........  ...........       2.4520      $104.32      $104.32
                nose lesion.
30100........  Intranasal       Y............  P3...........  ...........       1.7625       $74.98       $74.98
                biopsy.
30110........  Removal of nose  Y............  P3...........  ...........       2.7683      $117.77      $117.77
                polyp(s).
30115........  Removal of nose  Y............  A2...........      $446.00      16.4266      $698.84      $509.21
                polyp(s).
30117........  Removal of       Y............  A2...........      $510.00      16.4266      $698.84      $557.21
                intranasal
                lesion.
30118........  Removal of       Y............  A2...........      $510.00      23.3299      $992.52      $630.63
                intranasal
                lesion.
30120........  Revision of      Y............  A2...........      $333.00      16.4266      $698.84      $424.46
                nose.
30124........  Removal of nose  Y............  R2...........  ...........       7.5511      $321.25      $321.25
                lesion.
30125........  Removal of nose  Y............  A2...........      $446.00      38.1991    $1,625.10      $740.78
                lesion.
30130........  Excise inferior  Y............  A2...........      $510.00      16.4266      $698.84      $557.21
                turbinate.
30140........  Resect inferior  Y............  A2...........      $446.00      23.3299      $992.52      $582.63
                turbinate.
30150........  Partial removal  Y............  A2...........      $510.00      38.1991    $1,625.10      $788.78
                of nose.
30160........  Removal of nose  Y............  A2...........      $630.00      38.1991    $1,625.10      $878.78
30200........  Injection        Y............  P3...........  ...........       1.4082       $59.91       $59.91
                treatment of
                nose.
30210........  Nasal sinus      Y............  P3...........  ...........       1.7784       $75.66       $75.66
                therapy.

[[Page 42575]]

 
30220........  Insert nasal     Y............  A2...........      $464.15       7.5511      $321.25      $428.43
                septal button.
30300........  Remove nasal     N............  P2...........  ...........       0.6102       $25.96       $25.96
                foreign body.
30310........  Remove nasal     Y............  A2...........      $333.00      16.4266      $698.84      $424.46
                foreign body.
30320........  Remove nasal     Y............  A2...........      $446.00      16.4266      $698.84      $509.21
                foreign body.
30400........  Reconstruction   Y............  A2...........      $630.00      38.1991    $1,625.10      $878.78
                of nose.
30410........  Reconstruction   Y............  A2...........      $717.00      38.1991    $1,625.10      $944.03
                of nose.
30420........  Reconstruction   Y............  A2...........      $717.00      38.1991    $1,625.10      $944.03
                of nose.
30430........  Revision of      Y............  A2...........      $510.00      23.3299      $992.52      $630.63
                nose.
30435........  Revision of      Y............  A2...........      $717.00      38.1991    $1,625.10      $944.03
                nose.
30450........  Revision of      Y............  A2...........      $995.00      38.1991    $1,625.10    $1,152.53
                nose.
30460........  Revision of      Y............  A2...........      $995.00      38.1991    $1,625.10    $1,152.53
                nose.
30462........  Revision of      Y............  A2...........    $1,339.00      38.1991    $1,625.10    $1,410.53
                nose.
30465........  Repair nasal     Y............  A2...........    $1,339.00      38.1991    $1,625.10    $1,410.53
                stenosis.
30520........  Repair of nasal  Y............  A2...........      $630.00      23.3299      $992.52      $720.63
                septum.
30540........  Repair nasal     Y............  A2...........      $717.00      38.1991    $1,625.10      $944.03
                defect.
30545........  Repair nasal     Y............  A2...........      $717.00      38.1991    $1,625.10      $944.03
                defect.
30560........  Release of       Y............  A2...........      $150.72       2.4520      $104.32      $139.12
                nasal
                adhesions.
30580........  Repair upper     Y............  A2...........      $630.00      38.1991    $1,625.10      $878.78
                jaw fistula.
30600........  Repair mouth/    Y............  A2...........      $630.00      38.1991    $1,625.10      $878.78
                nose fistula.
30620........  Intranasal       Y............  A2...........      $995.00      38.1991    $1,625.10    $1,152.53
                reconstruction.
30630........  Repair nasal     Y............  A2...........      $995.00      23.3299      $992.52      $994.38
                septum defect.
30801........  Ablate inf       Y............  A2...........      $333.00       7.5511      $321.25      $330.06
                turbinate,
                superf.
30802........  Cauterization,   Y............  A2...........      $333.00       7.5511      $321.25      $330.06
                inner nose.
30901........  Control of       Y............  P3...........  ...........       1.0300       $43.82       $43.82
                nosebleed.
30903........  Control of       Y............  A2...........       $72.48       1.1791       $50.16       $66.90
                nosebleed.
30905........  Control of       Y............  A2...........       $72.48       1.1791       $50.16       $66.90
                nosebleed.
30906........  Repeat control   Y............  A2...........       $72.48       1.1791       $50.16       $66.90
                of nosebleed.
30915........  Ligation, nasal  Y............  A2...........      $446.00      24.8809    $1,058.51      $599.13
                sinus artery.
30920........  Ligation, upper  Y............  A2...........      $510.00      24.8809    $1,058.51      $647.13
                jaw artery.
30930........  Ther fx, nasal   Y............  A2...........      $630.00      16.4266      $698.84      $647.21
                inf turbinate.
31000........  Irrigation,      Y............  P3...........  ...........       2.3499       $99.97       $99.97
                maxillary
                sinus.
31002........  Irrigation,      Y............  R2...........  ...........       7.5511      $321.25      $321.25
                sphenoid sinus.
31020........  Exploration,     Y............  A2...........      $446.00      23.3299      $992.52      $582.63
                maxillary
                sinus.
31030........  Exploration,     Y............  A2...........      $510.00      38.1991    $1,625.10      $788.78
                maxillary
                sinus.
31032........  Explore sinus,   Y............  A2...........      $630.00      38.1991    $1,625.10      $878.78
                remove polyps.
31040........  Exploration      Y............  R2...........  ...........      23.3299      $992.52      $992.52
                behind upper
                jaw.
31050........  Exploration,     Y............  A2...........      $446.00      38.1991    $1,625.10      $740.78
                sphenoid sinus.
31051........  Sphenoid sinus   Y............  A2...........      $630.00      38.1991    $1,625.10      $878.78
                surgery.
31070........  Exploration of   Y............  A2...........      $446.00      23.3299      $992.52      $582.63
                frontal sinus.
31075........  Exploration of   Y............  A2...........      $630.00      38.1991    $1,625.10      $878.78
                frontal sinus.
31080........  Removal of       Y............  A2...........      $630.00      38.1991    $1,625.10      $878.78
                frontal sinus.
31081........  Removal of       Y............  A2...........      $630.00      38.1991    $1,625.10      $878.78
                frontal sinus.
31084........  Removal of       Y............  A2...........      $630.00      38.1991    $1,625.10      $878.78
                frontal sinus.
31085........  Removal of       Y............  A2...........      $630.00      38.1991    $1,625.10      $878.78
                frontal sinus.
31086........  Removal of       Y............  A2...........      $630.00      38.1991    $1,625.10      $878.78
                frontal sinus.
31087........  Removal of       Y............  A2...........      $630.00      38.1991    $1,625.10      $878.78
                frontal sinus.
31090........  Exploration of   Y............  A2...........      $717.00      38.1991    $1,625.10      $944.03
                sinuses.
31200........  Removal of       Y............  A2...........      $446.00      38.1991    $1,625.10      $740.78
                ethmoid sinus.
31201........  Removal of       Y............  A2...........      $717.00      38.1991    $1,625.10      $944.03
                ethmoid sinus.
31205........  Removal of       Y............  A2...........      $510.00      38.1991    $1,625.10      $788.78
                ethmoid sinus.
31231........  Nasal            Y............  P2...........  ...........       1.4054       $59.79       $59.79
                endoscopy, dx.
31233........  Nasal/sinus      Y............  A2...........       $86.39       1.4054       $59.79       $79.74
                endoscopy, dx.
31235........  Nasal/sinus      Y............  A2...........      $333.00      14.7928      $629.33      $407.08
                endoscopy, dx.
31237........  Nasal/sinus      Y............  A2...........      $446.00      14.7928      $629.33      $491.83
                endoscopy,
                surg.
31238........  Nasal/sinus      Y............  A2...........      $333.00      14.7928      $629.33      $407.08
                endoscopy,
                surg.
31239........  Nasal/sinus      Y............  A2...........      $630.00      21.9512      $933.87      $705.97
                endoscopy,
                surg.
31240........  Nasal/sinus      Y............  A2...........      $446.00      14.7928      $629.33      $491.83
                endoscopy,
                surg.
31254........  Revision of      Y............  A2...........      $510.00      21.9512      $933.87      $615.97
                ethmoid sinus.
31255........  Removal of       Y............  A2...........      $717.00      21.9512      $933.87      $771.22
                ethmoid sinus.
31256........  Exploration      Y............  A2...........      $510.00      21.9512      $933.87      $615.97
                maxillary
                sinus.
31267........  Endoscopy,       Y............  A2...........      $510.00      21.9512      $933.87      $615.97
                maxillary
                sinus.
31276........  Sinus            Y............  A2...........      $510.00      21.9512      $933.87      $615.97
                endoscopy,
                surgical.
31287........  Nasal/sinus      Y............  A2...........      $510.00      21.9512      $933.87      $615.97
                endoscopy,
                surg.

[[Page 42576]]

 
31288........  Nasal/sinus      Y............  A2...........      $510.00      21.9512      $933.87      $615.97
                endoscopy,
                surg.
31300........  Removal of       Y............  A2...........      $717.00      23.3299      $992.52      $785.88
                larynx lesion.
31320........  Diagnostic       Y............  A2...........      $446.00      38.1991    $1,625.10      $740.78
                incision,
                larynx.
31400........  Revision of      Y............  A2...........      $446.00      38.1991    $1,625.10      $740.78
                larynx.
31420........  Removal of       Y............  A2...........      $446.00      38.1991    $1,625.10      $740.78
                epiglottis.
31500........  Insert           N............  G2...........  ...........       2.4233      $103.09      $103.09
                emergency
                airway.
31502........  Change of        Y............  G2...........  ...........       2.3587      $100.35      $100.35
                windpipe
                airway.
31505........  Diagnostic       Y............  P2...........  ...........       0.7698       $32.75       $32.75
                laryngoscopy.
31510........  Laryngoscopy     Y............  A2...........      $446.00      14.7928      $629.33      $491.83
                with biopsy.
31511........  Remove foreign   Y............  A2...........       $86.39       1.4054       $59.79       $79.74
                body, larynx.
31512........  Removal of       Y............  A2...........      $446.00      14.7928      $629.33      $491.83
                larynx lesion.
31513........  Injection into   Y............  A2...........       $86.39       1.4054       $59.79       $79.74
                vocal cord.
31515........  Laryngoscopy     Y............  A2...........      $333.00      14.7928      $629.33      $407.08
                for aspiration.
31520........  Dx               Y............  G2...........  ...........       1.4054       $59.79       $59.79
                laryngoscopy,
                newborn.
31525........  Dx laryngoscopy  Y............  A2...........      $333.00      14.7928      $629.33      $407.08
                excl nb.
31526........  Dx laryngoscopy  Y............  A2...........      $446.00      21.9512      $933.87      $567.97
                w/oper scope.
31527........  Laryngoscopy     Y............  A2...........      $333.00      21.9512      $933.87      $483.22
                for treatment.
31528........  Laryngoscopy     Y............  A2...........      $446.00      14.7928      $629.33      $491.83
                and dilation.
31529........  Laryngoscopy     Y............  A2...........      $446.00      14.7928      $629.33      $491.83
                and dilation.
31530........  Laryngoscopy w/  Y............  A2...........      $446.00      21.9512      $933.87      $567.97
                fb removal.
31531........  Laryngoscopy w/  Y............  A2...........      $510.00      21.9512      $933.87      $615.97
                fb & op scope.
31535........  Laryngoscopy w/  Y............  A2...........      $446.00      21.9512      $933.87      $567.97
                biopsy.
31536........  Laryngoscopy w/  Y............  A2...........      $510.00      21.9512      $933.87      $615.97
                bx & op scope.
31540........  Laryngoscopy w/  Y............  A2...........      $510.00      21.9512      $933.87      $615.97
                exc of tumor.
31541........  Larynscop w/     Y............  A2...........      $630.00      21.9512      $933.87      $705.97
                tumr exc +
                scope.
31545........  Remove vc        Y............  A2...........      $630.00      21.9512      $933.87      $705.97
                lesion w/scope.
31546........  Remove vc        Y............  A2...........      $630.00      21.9512      $933.87      $705.97
                lesion scope/
                graft.
31560........  Laryngoscop w/   Y............  A2...........      $717.00      21.9512      $933.87      $771.22
                arytenoidectom.
31561........  Larynscop,       Y............  A2...........      $717.00      21.9512      $933.87      $771.22
                remve cart +
                scop.
31570........  Laryngoscope w/  Y............  A2...........      $446.00      14.7928      $629.33      $491.83
                vc inj.
31571........  Laryngoscop w/   Y............  A2...........      $446.00      21.9512      $933.87      $567.97
                vc inj + scope.
31575........  Diagnostic       Y............  P3...........  ...........       1.4002       $59.57       $59.57
                laryngoscopy.
31576........  Laryngoscopy     Y............  A2...........      $446.00      21.9512      $933.87      $567.97
                with biopsy.
31577........  Remove foreign   Y............  A2...........      $236.42       3.8463      $163.63      $218.22
                body, larynx.
31578........  Removal of       Y............  A2...........      $446.00      21.9512      $933.87      $567.97
                larynx lesion.
31579........  Diagnostic       Y............  P3...........  ...........       2.5833      $109.90      $109.90
                laryngoscopy.
31580........  Revision of      Y............  A2...........      $717.00      38.1991    $1,625.10      $944.03
                larynx.
31582........  Revision of      Y............  A2...........      $717.00      38.1991    $1,625.10      $944.03
                larynx.
31588........  Revision of      Y............  A2...........      $717.00      38.1991    $1,625.10      $944.03
                larynx.
31590........  Reinnervate      Y............  A2...........      $717.00      38.1991    $1,625.10      $944.03
                larynx.
31595........  Larynx nerve     Y............  A2...........      $446.00      38.1991    $1,625.10      $740.78
                surgery.
31603........  Incision of      Y............  A2...........      $333.00       7.5511      $321.25      $330.06
                windpipe.
31605........  Incision of      Y............  G2...........  ...........       7.5511      $321.25      $321.25
                windpipe.
31611........  Surgery/speech   Y............  A2...........      $510.00      23.3299      $992.52      $630.63
                prosthesis.
31612........  Puncture/clear   Y............  A2...........      $333.00      23.3299      $992.52      $497.88
                windpipe.
31613........  Repair windpipe  Y............  A2...........      $446.00      23.3299      $992.52      $582.63
                opening.
31614........  Repair windpipe  Y............  A2...........      $446.00      38.1991    $1,625.10      $740.78
                opening.
31615........  Visualization    Y............  A2...........      $333.00       9.5228      $405.13      $351.03
                of windpipe.
31620........  Endobronchial    N............  A2...........      $333.00      32.2854    $1,373.52      $593.13
                us add-on.
31622........  Dx bronchoscope/ Y............  A2...........      $333.00       9.5228      $405.13      $351.03
                wash.
31623........  Dx bronchoscope/ Y............  A2...........      $446.00       9.5228      $405.13      $435.78
                brush.
31624........  Dx bronchoscope/ Y............  A2...........      $446.00       9.5228      $405.13      $435.78
                lavage.
31625........  Bronchoscopy w/  Y............  A2...........      $446.00       9.5228      $405.13      $435.78
                biopsy(s).
31628........  Bronchoscopy/    Y............  A2...........      $446.00       9.5228      $405.13      $435.78
                lung bx, each.
31629........  Bronchoscopy/    Y............  A2...........      $446.00       9.5228      $405.13      $435.78
                needle bx,
                each.
31630........  Bronchoscopy     Y............  A2...........      $446.00      22.0099      $936.37      $568.59
                dilate/fx repr.
31631........  Bronchoscopy,    Y............  A2...........      $446.00      22.0099      $936.37      $568.59
                dilate w/stent.
31632........  Bronchoscopy/    Y............  G2...........  ...........       9.5228      $405.13      $405.13
                lung bx, add'l.
31633........  Bronchoscopy/    Y............  G2...........  ...........       9.5228      $405.13      $405.13
                needle bx
                add'l.
31635........  Bronchoscopy w/  Y............  A2...........      $446.00       9.5228      $405.13      $435.78
                fb removal.
31636........  Bronchoscopy,    Y............  A2...........      $446.00      22.0099      $936.37      $568.59
                bronch stents.
31637........  Bronchoscopy,    Y............  A2...........      $333.00       9.5228      $405.13      $351.03
                stent add-on.
31638........  Bronchoscopy,    Y............  A2...........      $446.00      22.0099      $936.37      $568.59
                revise stent.

[[Page 42577]]

 
31640........  Bronchoscopy w/  Y............  A2...........      $446.00      22.0099      $936.37      $568.59
                tumor excise.
31641........  Bronchoscopy,    Y............  A2...........      $446.00      22.0099      $936.37      $568.59
                treat blockage.
31643........  Diag             Y............  A2...........      $446.00       9.5228      $405.13      $435.78
                bronchoscope/
                catheter.
31645........  Bronchoscopy,    Y............  A2...........      $333.00       9.5228      $405.13      $351.03
                clear airways.
31646........  Bronchoscopy,    Y............  A2...........      $333.00       9.5228      $405.13      $351.03
                reclear airway.
31656........  Bronchoscopy,    Y............  A2...........      $333.00       9.5228      $405.13      $351.03
                inj for x-ray.
31715........  Injection for    .............  N1...........  ...........  ...........  ...........  ...........
                bronchus x-ray.
31717........  Bronchial brush  Y............  A2...........      $236.42       3.8463      $163.63      $218.22
                biopsy.
31720........  Clearance of     Y............  A2...........       $47.32       0.7698       $32.75       $43.68
                airways.
31730........  Intro, windpipe  Y............  A2...........      $236.42       3.8463      $163.63      $218.22
                wire/tube.
31750........  Repair of        Y............  A2...........      $717.00      38.1991    $1,625.10      $944.03
                windpipe.
31755........  Repair of        Y............  A2...........      $446.00      38.1991    $1,625.10      $740.78
                windpipe.
31820........  Closure of       Y............  A2...........      $333.00      16.4266      $698.84      $424.46
                windpipe
                lesion.
31825........  Repair of        Y............  A2...........      $446.00      23.3299      $992.52      $582.63
                windpipe
                defect.
31830........  Revise windpipe  Y............  A2...........      $446.00      23.3299      $992.52      $582.63
                scar.
32000........  Drainage of      Y............  A2...........      $222.78       3.6244      $154.19      $205.63
                chest.
32002........  Treatment of     Y............  G2...........  ...........       3.6244      $154.19      $154.19
                collapsed lung.
32019........  Insert pleural   Y............  G2...........  ...........      29.5416    $1,256.79    $1,256.79
                catheter.
32400........  Needle biopsy    Y............  A2...........      $333.00       6.1384      $261.15      $315.04
                chest lining.
32405........  Biopsy, lung or  Y............  A2...........      $333.00       6.1384      $261.15      $315.04
                mediastinum.
32420........  Puncture/clear   Y............  A2...........      $222.78       3.6244      $154.19      $205.63
                lung.
32960........  Therapeutic      Y............  G2...........  ...........       3.6244      $154.19      $154.19
                pneumothorax.
33010........  Drainage of      Y............  A2...........      $222.78       3.6244      $154.19      $205.63
                heart sac.
33011........  Repeat drainage  Y............  A2...........      $222.78       3.6244      $154.19      $205.63
                of heart sac.
33206........  Insertion of     Y............  J8...........  ...........     170.6370    $7,259.41    $7,259.41
                heart
                pacemaker.
33207........  Insertion of     Y............  J8...........  ...........     170.6370    $7,259.41    $7,259.41
                heart
                pacemaker.
33208........  Insertion of     Y............  J8...........  ...........     210.2184    $8,943.32    $8,943.32
                heart
                pacemaker.
33210........  Insertion of     Y............  G2...........  ...........      58.8594    $2,504.06    $2,504.06
                heart
                electrode.
33211........  Insertion of     Y............  G2...........  ...........      58.8594    $2,504.06    $2,504.06
                heart
                electrode.
33212........  Insertion of     Y............  H8...........      $510.00     134.4886    $5,721.55    $5,311.76
                pulse
                generator.
33213........  Insertion of     Y............  H8...........      $510.00     155.7342    $6,625.40    $6,192.90
                pulse
                generator.
33214........  Upgrade of       Y............  J8...........  ...........     210.2184    $8,943.32    $8,943.32
                pacemaker
                system.
33215........  Reposition       Y............  G2...........  ...........      25.6142    $1,089.70    $1,089.70
                pacing-defib
                lead.
33216........  Insert lead      Y............  G2...........  ...........      58.8594    $2,504.06    $2,504.06
                pace-defib,
                one.
33217........  Insert lead      Y............  G2...........  ...........      58.8594    $2,504.06    $2,504.06
                pace-defib,
                dual.
33218........  Repair lead      Y............  G2...........  ...........      25.6142    $1,089.70    $1,089.70
                pace-defib,
                one.
33220........  Repair lead      Y............  G2...........  ...........      25.6142    $1,089.70    $1,089.70
                pace-defib,
                dual.
33222........  Revise pocket,   Y............  A2...........      $446.00      21.4302      $911.71      $562.43
                pacemaker.
33223........  Revise pocket,   Y............  A2...........      $446.00      21.4302      $911.71      $562.43
                pacing-defib.
33224........  Insert pacing    Y............  J8...........  ...........     439.4366   $18,694.95   $18,694.95
                lead & connect.
33225........  Lventric pacing  Y............  J8...........  ...........     439.4366   $18,694.95   $18,694.95
                lead add-on.
33226........  Reposition 1     Y............  G2...........  ...........      25.6142    $1,089.70    $1,089.70
                ventric lead.
33233........  Removal of       Y............  A2...........      $446.00      25.6142    $1,089.70      $606.93
                pacemaker
                system.
33234........  Removal of       Y............  G2...........  ...........      25.6142    $1,089.70    $1,089.70
                pacemaker
                system.
33235........  Removal          Y............  G2...........  ...........      25.6142    $1,089.70    $1,089.70
                pacemaker
                electrode.
33241........  Remove pulse     Y............  G2...........  ...........      25.6142    $1,089.70    $1,089.70
                generator.
33282........  Implant pat-     N............  J8...........  ...........      99.9215    $4,250.96    $4,250.96
                active ht
                record.
33284........  Remove pat-      Y............  G2...........  ...........      10.9918      $467.62      $467.62
                active ht
                record.
33508........  Endoscopic vein  .............  N1...........  ...........  ...........  ...........  ...........
                harvest.
35188........  Repair blood     Y............  A2...........      $630.00      37.7391    $1,605.53      $873.88
                vessel lesion.
35207........  Repair blood     Y............  A2...........      $630.00      37.7391    $1,605.53      $873.88
                vessel lesion.
35473........  Repair arterial  Y............  G2...........  ...........      42.9360    $1,826.63    $1,826.63
                blockage.
35474........  Repair arterial  Y............  G2...........  ...........      42.9360    $1,826.63    $1,826.63
                blockage.
35476........  Repair venous    Y............  G2...........  ...........      42.9360    $1,826.63    $1,826.63
                blockage.
35492........  Atherectomy,     Y............  G2...........  ...........      42.9360    $1,826.63    $1,826.63
                percutaneous.
35572........  Harvest          .............  N1...........  ...........  ...........  ...........  ...........
                femoropoplitea
                l vein.
35761........  Exploration of   Y............  G2...........  ...........      29.2133    $1,242.82    $1,242.82
                artery/vein.
35875........  Removal of clot  Y............  A2...........    $1,339.00      37.7391    $1,605.53    $1,405.63
                in graft.
35876........  Removal of clot  Y............  A2...........    $1,339.00      37.7391    $1,605.53    $1,405.63
                in graft.
36000........  Place needle in  .............  N1...........  ...........  ...........  ...........  ...........
                vein.
36002........  Pseudoaneurysm   N............  G2...........  ...........       2.4606      $104.68      $104.68
                injection trt.
36005........  Injection ext    .............  N1...........  ...........  ...........  ...........  ...........
                venography.
36010........  Place catheter   .............  N1...........  ...........  ...........  ...........  ...........
                in vein.

[[Page 42578]]

 
36011........  Place catheter   .............  N1...........  ...........  ...........  ...........  ...........
                in vein.
36012........  Place catheter   .............  N1...........  ...........  ...........  ...........  ...........
                in vein.
36013........  Place catheter   .............  N1...........  ...........  ...........  ...........  ...........
                in artery.
36014........  Place catheter   .............  N1...........  ...........  ...........  ...........  ...........
                in artery.
36015........  Place catheter   .............  N1...........  ...........  ...........  ...........  ...........
                in artery.
36100........  Establish        .............  N1...........  ...........  ...........  ...........  ...........
                access to
                artery.
36120........  Establish        .............  N1...........  ...........  ...........  ...........  ...........
                access to
                artery.
36140........  Establish        .............  N1...........  ...........  ...........  ...........  ...........
                access to
                artery.
36145........  Artery to vein   .............  N1...........  ...........  ...........  ...........  ...........
                shunt.
36160........  Establish        .............  N1...........  ...........  ...........  ...........  ...........
                access to
                aorta.
36200........  Place catheter   .............  N1...........  ...........  ...........  ...........  ...........
                in aorta.
36215........  Place catheter   .............  N1...........  ...........  ...........  ...........  ...........
                in artery.
36216........  Place catheter   .............  N1...........  ...........  ...........  ...........  ...........
                in artery.
36217........  Place catheter   .............  N1...........  ...........  ...........  ...........  ...........
                in artery.
36218........  Place catheter   .............  N1...........  ...........  ...........  ...........  ...........
                in artery.
36245........  Place catheter   .............  N1...........  ...........  ...........  ...........  ...........
                in artery.
36246........  Place catheter   .............  N1...........  ...........  ...........  ...........  ...........
                in artery.
36247........  Place catheter   .............  N1...........  ...........  ...........  ...........  ...........
                in artery.
36248........  Place catheter   .............  N1...........  ...........  ...........  ...........  ...........
                in artery.
36260........  Insertion of     Y............  A2...........      $510.00      28.5032    $1,212.61      $685.65
                infusion pump.
36261........  Revision of      Y............  A2...........      $446.00      28.5032    $1,212.61      $637.65
                infusion pump.
36262........  Removal of       Y............  A2...........      $333.00      22.6665      $964.30      $490.83
                infusion pump.
36400........  Bl draw <3 yrs   .............  N1...........  ...........  ...........  ...........  ...........
                fem/jugular.
36405........  Bl draw <3 yrs   .............  N1...........  ...........  ...........  ...........  ...........
                scalp vein.
36406........  Bl draw <3 yrs   .............  N1...........  ...........  ...........  ...........  ...........
                other vein.
36410........  Non-routine bl   .............  N1...........  ...........  ...........  ...........  ...........
                draw >3 yrs.
36416........  Capillary blood  .............  N1...........  ...........  ...........  ...........  ...........
                draw.
36420........  Vein access      Y............  G2...........  ...........       0.1999        $8.50        $8.50
                cutdown <1 yr.
36425........  Vein access      Y............  R2...........  ...........       0.1999        $8.50        $8.50
                cutdown >1 yr.
36430........  Blood            N............  P3...........  ...........       0.7806       $33.21       $33.21
                transfusion
                service.
36440........  Bl push          N............  R2...........  ...........       3.4584      $147.13      $147.13
                transfuse, 2
                yr or <.
36450........  Bl exchange/     N............  R2...........  ...........       3.4584      $147.13      $147.13
                transfuse, nb.
36468........  Injection(s),    Y............  R2...........  ...........       1.0798       $45.94       $45.94
                spider veins.
36469........  Injection(s),    Y............  G2...........  ...........       1.0798       $45.94       $45.94
                spider veins.
36470........  Injection        Y............  P2...........  ...........       1.0798       $45.94       $45.94
                therapy of
                vein.
36471........  Injection        Y............  P2...........  ...........       1.0798       $45.94       $45.94
                therapy of
                veins.
36475........  Endovenous rf,   Y............  A2...........    $1,339.00      34.7288    $1,477.47    $1,373.62
                1st vein.
36476........  Endovenous rf,   Y............  A2...........    $1,339.00      34.7288    $1,477.47    $1,373.62
                vein add-on.
36478........  Endovenous       Y............  A2...........    $1,339.00      24.8809    $1,058.51    $1,268.88
                laser, 1st
                vein.
36479........  Endovenous       Y............  A2...........    $1,339.00      24.8809    $1,058.51    $1,268.88
                laser vein
                addon.
36481........  Insertion of     .............  N1...........  ...........  ...........  ...........  ...........
                catheter, vein.
36500........  Insertion of     .............  N1...........  ...........  ...........  ...........  ...........
                catheter, vein.
36510........  Insertion of     .............  N1...........  ...........  ...........  ...........  ...........
                catheter, vein.
36511........  Apheresis wbc..  N............  G2...........  ...........      11.7134      $498.32      $498.32
36512........  Apheresis rbc..  N............  G2...........  ...........      11.7134      $498.32      $498.32
36513........  Apheresis        N............  G2...........  ...........      11.7134      $498.32      $498.32
                platelets.
36514........  Apheresis        N............  G2...........  ...........      11.7134      $498.32      $498.32
                plasma.
36515........  Apheresis,       N............  G2...........  ...........      30.2231    $1,285.78    $1,285.78
                adsorp/
                reinfuse.
36516........  Apheresis,       N............  G2...........  ...........      30.2231    $1,285.78    $1,285.78
                selective.
36522........  Photopheresis..  N............  G2...........  ...........      30.2231    $1,285.78    $1,285.78
36540........  Collect blood    .............  N1...........  ...........  ...........  ...........  ...........
                venous device.
36550........  Declot vascular  Y............  P3...........  ...........       0.2816       $11.98       $11.98
                device.
36555........  Insert non-      Y............  A2...........      $333.00       8.7846      $373.72      $343.18
                tunnel cv cath.
36556........  Insert non-      Y............  A2...........      $333.00       8.7846      $373.72      $343.18
                tunnel cv cath.
36557........  Insert tunneled  Y............  A2...........      $446.00      22.6665      $964.30      $575.58
                cv cath.
36558........  Insert tunneled  Y............  A2...........      $446.00      22.6665      $964.30      $575.58
                cv cath.
36560........  Insert tunneled  Y............  A2...........      $510.00      28.5032    $1,212.61      $685.65
                cv cath.
36561........  Insert tunneled  Y............  A2...........      $510.00      28.5032    $1,212.61      $685.65
                cv cath.
36563........  Insert tunneled  Y............  A2...........      $510.00      28.5032    $1,212.61      $685.65
                cv cath.
36565........  Insert tunneled  Y............  A2...........      $510.00      28.5032    $1,212.61      $685.65
                cv cath.
36566........  Insert tunneled  Y............  H8...........      $510.00     107.1217    $4,557.28    $3,809.60
                cv cath.
36568........  Insert picc      Y............  A2...........      $333.00       8.7846      $373.72      $343.18
                cath.
36569........  Insert picc      Y............  A2...........      $333.00       8.7846      $373.72      $343.18
                cath.

[[Page 42579]]

 
36570........  Insert picvad    Y............  A2...........      $510.00      22.6665      $964.30      $623.58
                cath.
36571........  Insert picvad    Y............  A2...........      $510.00      22.6665      $964.30      $623.58
                cath.
36575........  Repair tunneled  Y............  A2...........      $446.00       8.7846      $373.72      $427.93
                cv cath.
36576........  Repair tunneled  Y............  A2...........      $446.00       8.7846      $373.72      $427.93
                cv cath.
36578........  Replace          Y............  A2...........      $446.00      22.6665      $964.30      $575.58
                tunneled cv
                cath.
36580........  Replace cvad     Y............  A2...........      $333.00       8.7846      $373.72      $343.18
                cath.
36581........  Replace          Y............  A2...........      $446.00      22.6665      $964.30      $575.58
                tunneled cv
                cath.
36582........  Replace          Y............  A2...........      $510.00      28.5032    $1,212.61      $685.65
                tunneled cv
                cath.
36583........  Replace          Y............  A2...........      $510.00      28.5032    $1,212.61      $685.65
                tunneled cv
                cath.
36584........  Replace picc     Y............  A2...........      $333.00       8.7846      $373.72      $343.18
                cath.
36585........  Replace picvad   Y............  A2...........      $510.00      22.6665      $964.30      $623.58
                cath.
36589........  Removal          Y............  A2...........      $333.00       8.7846      $373.72      $343.18
                tunneled cv
                cath.
36590........  Removal          Y............  A2...........      $333.00       8.7846      $373.72      $343.18
                tunneled cv
                cath.
36595........  Mech remov       Y............  G2...........  ...........      22.6665      $964.30      $964.30
                tunneled cv
                cath.
36596........  Mech remov       Y............  G2...........  ...........       8.7846      $373.72      $373.72
                tunneled cv
                cath.
36597........  Reposition       Y............  G2...........  ...........       8.7846      $373.72      $373.72
                venous
                catheter.
36598 \*\....  Inj w/fluor,     N............  P2...........  ...........       0.6102       $25.96       $25.96
                eval cv device.
36600........  Withdrawal of    .............  N1...........  ...........  ...........  ...........  ...........
                arterial blood.
36620........  Insertion        .............  N1...........  ...........  ...........  ...........  ...........
                catheter,
                artery.
36625........  Insertion        .............  N1...........  ...........  ...........  ...........  ...........
                catheter,
                artery.
36640........  Insertion        Y............  A2...........      $333.00      28.5032    $1,212.61      $552.90
                catheter,
                artery.
36680........  Insert needle,   Y............  G2...........  ...........       1.0995       $46.78       $46.78
                bone cavity.
36800........  Insertion of     Y............  A2...........      $510.00      29.2133    $1,242.82      $693.21
                cannula.
36810........  Insertion of     Y............  A2...........      $510.00      29.2133    $1,242.82      $693.21
                cannula.
36815........  Insertion of     Y............  A2...........      $510.00      29.2133    $1,242.82      $693.21
                cannula.
36818........  Av fuse, uppr    Y............  A2...........      $510.00      37.7391    $1,605.53      $783.88
                arm, cephalic.
36819........  Av fuse, uppr    Y............  A2...........      $510.00      37.7391    $1,605.53      $783.88
                arm, basilic.
36820........  Av fusion/       Y............  A2...........      $510.00      37.7391    $1,605.53      $783.88
                forearm vein.
36821........  Av fusion        Y............  A2...........      $510.00      37.7391    $1,605.53      $783.88
                direct any
                site.
36825........  Artery-vein      Y............  A2...........      $630.00      37.7391    $1,605.53      $873.88
                autograft.
36830........  Artery-vein      Y............  A2...........      $630.00      37.7391    $1,605.53      $873.88
                nonautograft.
36831........  Open thrombect   Y............  A2...........    $1,339.00      37.7391    $1,605.53    $1,405.63
                av fistula.
36832........  Av fistula       Y............  A2...........      $630.00      37.7391    $1,605.53      $873.88
                revision, open.
36833........  Av fistula       Y............  A2...........      $630.00      37.7391    $1,605.53      $873.88
                revision.
36834........  Repair A-V       Y............  A2...........      $510.00      37.7391    $1,605.53      $783.88
                aneurysm.
36835........  Artery to vein   Y............  A2...........      $630.00      29.2133    $1,242.82      $783.21
                shunt.
36860........  External         Y............  A2...........      $127.40       2.0726       $88.17      $117.59
                cannula
                declotting.
36861........  Cannula          Y............  A2...........      $510.00      29.2133    $1,242.82      $693.21
                declotting.
36870........  Percut           Y............  A2...........    $1,339.00      32.3818    $1,377.62    $1,348.66
                thrombect av
                fistula.
37184........  Prim art mech    Y............  G2...........  ...........      37.7391    $1,605.53    $1,605.53
                thrombectomy.
37185........  Prim art m-      Y............  G2...........  ...........      37.7391    $1,605.53    $1,605.53
                thrombect add-
                on.
37186........  Sec art m-       Y............  G2...........  ...........      37.7391    $1,605.53    $1,605.53
                thrombect add-
                on.
37187........  Venous mech      Y............  G2...........  ...........      37.7391    $1,605.53    $1,605.53
                thrombectomy.
37188........  Venous m-        Y............  G2...........  ...........      37.7391    $1,605.53    $1,605.53
                thrombectomy
                add-on.
37200........  Transcatheter    Y............  G2...........  ...........       6.1384      $261.15      $261.15
                biopsy.
37203........  Transcatheter    Y............  G2...........  ...........      16.2375      $690.79      $690.79
                retrieval.
37250........  Iv us first      N............  G2...........  ...........      32.5472    $1,384.66    $1,384.66
                vessel add-on.
37251........  Iv us each add   N............  G2...........  ...........      32.5472    $1,384.66    $1,384.66
                vessel add-on.
37500........  Endoscopy        Y............  A2...........      $510.00      34.7288    $1,477.47      $751.87
                ligate perf
                veins.
37607........  Ligation of a-v  Y............  A2...........      $510.00      24.8809    $1,058.51      $647.13
                fistula.
37609........  Temporal artery  Y............  A2...........      $446.00      15.1024      $642.50      $495.13
                procedure.
37650........  Revision of      Y............  A2...........      $446.00      24.8809    $1,058.51      $599.13
                major vein.
37700........  Revise leg vein  Y............  A2...........      $446.00      34.7288    $1,477.47      $703.87
37718........  Ligate/strip     Y............  A2...........      $510.00      34.7288    $1,477.47      $751.87
                short leg vein.
37722........  Ligate/strip     Y............  A2...........      $510.00      34.7288    $1,477.47      $751.87
                long leg vein.
37735........  Removal of leg   Y............  A2...........      $510.00      34.7288    $1,477.47      $751.87
                veins/lesion.
37760........  Ligation, leg    Y............  A2...........      $510.00      24.8809    $1,058.51      $647.13
                veins, open.
37765........  Phleb veins -    Y............  R2...........  ...........      24.8809    $1,058.51    $1,058.51
                extrem - to 20.
37766........  Phleb veins -    Y............  R2...........  ...........      24.8809    $1,058.51    $1,058.51
                extrem 20+.
37780........  Revision of leg  Y............  A2...........      $510.00      24.8809    $1,058.51      $647.13
                vein.
37785........  Ligate/divide/   Y............  A2...........      $510.00      24.8809    $1,058.51      $647.13
                excise vein.
37790........  Penile venous    Y............  A2...........      $510.00      32.9873    $1,403.38      $733.35
                occlusion.
38200........  Injection for    .............  N1...........  ...........  ...........  ...........  ...........
                spleen x-ray.

[[Page 42580]]

 
38204........  Bl donor search  .............  N1...........  ...........  ...........  ...........  ...........
                management.
38205........  Harvest          N............  G2...........  ...........      11.7134      $498.32      $498.32
                allogenic stem
                cells.
38206........  Harvest auto     N............  G2...........  ...........      11.7134      $498.32      $498.32
                stem cells.
38220........  Bone marrow      Y............  P2...........  ...........       2.4011      $102.15      $102.15
                aspiration.
38221........  Bone marrow      Y............  P2...........  ...........       2.4011      $102.15      $102.15
                biopsy.
38230........  Bone marrow      N............  G2...........  ...........      20.3582      $866.10      $866.10
                collection.
38241........  Bone marrow/     N............  G2...........  ...........      20.3582      $866.10      $866.10
                stem
                transplant.
38242........  Lymphocyte       N............  R2...........  ...........      11.7134      $498.32      $498.32
                infuse
                transplant.
38300........  Drainage, lymph  Y............  A2...........      $333.00      11.1535      $474.50      $368.38
                node lesion.
38305........  Drainage, lymph  Y............  A2...........      $446.00      17.5086      $744.87      $520.72
                node lesion.
38308........  Incision of      Y............  A2...........      $446.00      21.2621      $904.55      $560.64
                lymph channels.
38500........  Biopsy/removal,  Y............  A2...........      $446.00      21.2621      $904.55      $560.64
                lymph nodes.
38505........  Needle biopsy,   Y............  A2...........      $240.00       3.9045      $166.11      $221.53
                lymph nodes.
38510........  Biopsy/removal,  Y............  A2...........      $446.00      21.2621      $904.55      $560.64
                lymph nodes.
38520........  Biopsy/removal,  Y............  A2...........      $446.00      21.2621      $904.55      $560.64
                lymph nodes.
38525........  Biopsy/removal,  Y............  A2...........      $446.00      21.2621      $904.55      $560.64
                lymph nodes.
38530........  Biopsy/removal,  Y............  A2...........      $446.00      21.2621      $904.55      $560.64
                lymph nodes.
38542........  Explore deep     Y............  A2...........      $446.00      37.7224    $1,604.82      $735.71
                node(s), neck.
38550........  Removal, neck/   Y............  A2...........      $510.00      21.2621      $904.55      $608.64
                armpit lesion.
38555........  Removal, neck/   Y............  A2...........      $630.00      21.2621      $904.55      $698.64
                armpit lesion.
38570........  Laparoscopy,     Y............  A2...........    $1,339.00      43.5488    $1,852.70    $1,467.43
                lymph node
                biop.
38571........  Laparoscopy,     Y............  A2...........    $1,339.00      70.5066    $2,999.56    $1,754.14
                lymphadenectom
                y.
38572........  Laparoscopy,     Y............  A2...........    $1,339.00      43.5488    $1,852.70    $1,467.43
                lymphadenectom
                y.
38700........  Removal of       Y............  G2...........  ...........      21.2621      $904.55      $904.55
                lymph nodes,
                neck.
38740........  Remove armpit    Y............  A2...........      $446.00      37.7224    $1,604.82      $735.71
                lymph nodes.
38745........  Remove armpit    Y............  A2...........      $630.00      37.7224    $1,604.82      $873.71
                lymph nodes.
38760........  Remove groin     Y............  A2...........      $446.00      21.2621      $904.55      $560.64
                lymph nodes.
38790........  Inject for       .............  N1...........  ...........  ...........  ...........  ...........
                lymphatic x-
                ray.
38792........  Identify         .............  N1...........  ...........  ...........  ...........  ...........
                sentinel node.
38794........  Access thoracic  .............  N1...........  ...........  ...........  ...........  ...........
                lymph duct.
40490........  Biopsy of lip..  Y............  P3...........  ...........       1.4968       $63.68       $63.68
40500........  Partial          Y............  A2...........      $446.00      16.4266      $698.84      $509.21
                excision of
                lip.
40510........  Partial          Y............  A2...........      $446.00      23.3299      $992.52      $582.63
                excision of
                lip.
40520........  Partial          Y............  A2...........      $446.00      16.4266      $698.84      $509.21
                excision of
                lip.
40525........  Reconstruct lip  Y............  A2...........      $446.00      23.3299      $992.52      $582.63
                with flap.
40527........  Reconstruct lip  Y............  A2...........      $446.00      23.3299      $992.52      $582.63
                with flap.
40530........  Partial removal  Y............  A2...........      $446.00      23.3299      $992.52      $582.63
                of lip.
40650........  Repair lip.....  Y............  A2...........      $464.15       7.5511      $321.25      $428.43
40652........  Repair lip.....  Y............  A2...........      $464.15       7.5511      $321.25      $428.43
40654........  Repair lip.....  Y............  A2...........      $464.15       7.5511      $321.25      $428.43
40700........  Repair cleft     Y............  A2...........      $995.00      38.1991    $1,625.10    $1,152.53
                lip/nasal.
40701........  Repair cleft     Y............  A2...........      $995.00      38.1991    $1,625.10    $1,152.53
                lip/nasal.
40702........  Repair cleft     Y............  R2...........  ...........      38.1991    $1,625.10    $1,625.10
                lip/nasal.
40720........  Repair cleft     Y............  A2...........      $995.00      38.1991    $1,625.10    $1,152.53
                lip/nasal.
40761........  Repair cleft     Y............  A2...........      $510.00      38.1991    $1,625.10      $788.78
                lip/nasal.
40800........  Drainage of      Y............  P2...........  ...........       1.4392       $61.23       $61.23
                mouth lesion.
40801........  Drainage of      Y............  A2...........      $446.00       7.5511      $321.25      $414.81
                mouth lesion.
40804........  Removal,         N............  P2...........  ...........       0.6102       $25.96       $25.96
                foreign body,
                mouth.
40805........  Removal,         Y............  P3...........  ...........       3.8385      $163.30      $163.30
                foreign body,
                mouth.
40806........  Incision of lip  Y............  P3...........  ...........       1.6898       $71.89       $71.89
                fold.
40808........  Biopsy of mouth  Y............  P2...........  ...........       2.4520      $104.32      $104.32
                lesion.
40810........  Excision of      Y............  P3...........  ...........       2.5913      $110.24      $110.24
                mouth lesion.
40812........  Excise/repair    Y............  P3...........  ...........       3.3155      $141.05      $141.05
                mouth lesion.
40814........  Excise/repair    Y............  A2...........      $446.00      16.4266      $698.84      $509.21
                mouth lesion.
40816........  Excision of      Y............  A2...........      $446.00      23.3299      $992.52      $582.63
                mouth lesion.
40818........  Excise oral      Y............  A2...........      $150.72       2.4520      $104.32      $139.12
                mucosa for
                graft.
40819........  Excise lip or    Y............  A2...........      $333.00       7.5511      $321.25      $330.06
                cheek fold.
40820........  Treatment of     Y............  P3...........  ...........       3.6455      $155.09      $155.09
                mouth lesion.
40830........  Repair mouth     Y............  G2...........  ...........       2.4520      $104.32      $104.32
                laceration.
40831........  Repair mouth     Y............  A2...........      $333.00       7.5511      $321.25      $330.06
                laceration.
40840........  Reconstruction   Y............  A2...........      $446.00      23.3299      $992.52      $582.63
                of mouth.
40842........  Reconstruction   Y............  A2...........      $510.00      23.3299      $992.52      $630.63
                of mouth.
40843........  Reconstruction   Y............  A2...........      $510.00      23.3299      $992.52      $630.63
                of mouth.

[[Page 42581]]

 
40844........  Reconstruction   Y............  A2...........      $717.00      38.1991    $1,625.10      $944.03
                of mouth.
40845........  Reconstruction   Y............  A2...........      $717.00      38.1991    $1,625.10      $944.03
                of mouth.
41000........  Drainage of      Y............  P3...........  ...........       1.9394       $82.51       $82.51
                mouth lesion.
41005........  Drainage of      Y............  A2...........      $150.72       2.4520      $104.32      $139.12
                mouth lesion.
41006........  Drainage of      Y............  A2...........      $333.00      23.3299      $992.52      $497.88
                mouth lesion.
41007........  Drainage of      Y............  A2...........      $333.00      16.4266      $698.84      $424.46
                mouth lesion.
41008........  Drainage of      Y............  A2...........      $333.00      16.4266      $698.84      $424.46
                mouth lesion.
41009........  Drainage of      Y............  A2...........      $150.72       2.4520      $104.32      $139.12
                mouth lesion.
41010........  Incision of      Y............  A2...........      $333.00       7.5511      $321.25      $330.06
                tongue fold.
41015........  Drainage of      Y............  A2...........      $150.72       2.4520      $104.32      $139.12
                mouth lesion.
41016........  Drainage of      Y............  A2...........      $333.00       7.5511      $321.25      $330.06
                mouth lesion.
41017........  Drainage of      Y............  A2...........      $333.00       7.5511      $321.25      $330.06
                mouth lesion.
41018........  Drainage of      Y............  A2...........      $333.00       7.5511      $321.25      $330.06
                mouth lesion.
41100........  Biopsy of        Y............  P3...........  ...........       2.0118       $85.59       $85.59
                tongue.
41105........  Biopsy of        Y............  P3...........  ...........       1.9634       $83.53       $83.53
                tongue.
41108........  Biopsy of floor  Y............  P3...........  ...........       1.7947       $76.35       $76.35
                of mouth.
41110........  Excision of      Y............  P3...........  ...........       2.5913      $110.24      $110.24
                tongue lesion.
41112........  Excision of      Y............  A2...........      $446.00      16.4266      $698.84      $509.21
                tongue lesion.
41113........  Excision of      Y............  A2...........      $446.00      16.4266      $698.84      $509.21
                tongue lesion.
41114........  Excision of      Y............  A2...........      $446.00      23.3299      $992.52      $582.63
                tongue lesion.
41115........  Excision of      Y............  P3...........  ...........       3.0339      $129.07      $129.07
                tongue fold.
41116........  Excision of      Y............  A2...........      $333.00      16.4266      $698.84      $424.46
                mouth lesion.
41120........  Partial removal  Y............  A2...........      $717.00      23.3299      $992.52      $785.88
                of tongue.
41250........  Repair tongue    Y............  A2...........      $150.72       2.4520      $104.32      $139.12
                laceration.
41251........  Repair tongue    Y............  A2...........      $150.72       2.4520      $104.32      $139.12
                laceration.
41252........  Repair tongue    Y............  A2...........      $446.00       7.5511      $321.25      $414.81
                laceration.
41500........  Fixation of      Y............  A2...........      $333.00      23.3299      $992.52      $497.88
                tongue.
41510........  Tongue to lip    Y............  A2...........      $333.00      16.4266      $698.84      $424.46
                surgery.
41520........  Reconstruction,  Y............  A2...........      $446.00       7.5511      $321.25      $414.81
                tongue fold.
41800........  Drainage of gum  Y............  A2...........       $88.46       1.4392       $61.23       $81.65
                lesion.
41805........  Removal of       Y............  P3...........  ...........       2.9695      $126.33      $126.33
                foreign body,
                gum.
41806........  Removal of       Y............  P3...........  ...........       3.8145      $162.28      $162.28
                foreign body,
                jawbone.
41820........  Excision, gum,   Y............  R2...........  ...........       7.5511      $321.25      $321.25
                each quadrant.
41821........  Excision of gum  Y............  G2...........  ...........       7.5511      $321.25      $321.25
                flap.
41822........  Excision of gum  Y............  P3...........  ...........       3.4363      $146.19      $146.19
                lesion.
41823........  Excision of gum  Y............  P3...........  ...........       4.8525      $206.44      $206.44
                lesion.
41825........  Excision of gum  Y............  P3...........  ...........       2.6879      $114.35      $114.35
                lesion.
41826........  Excision of gum  Y............  P3...........  ...........       3.0339      $129.07      $129.07
                lesion.
41827........  Excision of gum  Y............  A2...........      $446.00      23.3299      $992.52      $582.63
                lesion.
41828........  Excision of gum  Y............  P3...........  ...........       3.1867      $135.57      $135.57
                lesion.
41830........  Removal of gum   Y............  P3...........  ...........       4.4261      $188.30      $188.30
                tissue.
41850........  Treatment of     Y............  R2...........  ...........      16.4266      $698.84      $698.84
                gum lesion.
41870........  Gum graft......  Y............  G2...........  ...........      23.3299      $992.52      $992.52
41872........  Repair gum.....  Y............  P3...........  ...........       4.3939      $186.93      $186.93
41874........  Repair tooth     Y............  P3...........  ...........       4.2651      $181.45      $181.45
                socket.
42000........  Drainage mouth   Y............  A2...........      $150.72       2.4520      $104.32      $139.12
                roof lesion.
42100........  Biopsy roof of   Y............  P3...........  ...........       1.7220       $73.26       $73.26
                mouth.
42104........  Excision         Y............  P3...........  ...........       2.3980      $102.02      $102.02
                lesion, mouth
                roof.
42106........  Excision         Y............  P3...........  ...........       3.0741      $130.78      $130.78
                lesion, mouth
                roof.
42107........  Excision         Y............  A2...........      $446.00      23.3299      $992.52      $582.63
                lesion, mouth
                roof.
42120........  Remove palate/   Y............  A2...........      $630.00      38.1991    $1,625.10      $878.78
                lesion.
42140........  Excision of      Y............  A2...........      $446.00       7.5511      $321.25      $414.81
                uvula.
42145........  Repair palate,   Y............  A2...........      $717.00      23.3299      $992.52      $785.88
                pharynx/uvula.
42160........  Treatment mouth  Y............  P3...........  ...........       3.1707      $134.89      $134.89
                roof lesion.
42180........  Repair palate..  Y............  A2...........      $150.72       2.4520      $104.32      $139.12
42182........  Repair palate..  Y............  A2...........      $446.00      38.1991    $1,625.10      $740.78
42200........  Reconstruct      Y............  A2...........      $717.00      38.1991    $1,625.10      $944.03
                cleft palate.
42205........  Reconstruct      Y............  A2...........      $717.00      38.1991    $1,625.10      $944.03
                cleft palate.
42210........  Reconstruct      Y............  A2...........      $717.00      38.1991    $1,625.10      $944.03
                cleft palate.
42215........  Reconstruct      Y............  A2...........      $995.00      38.1991    $1,625.10    $1,152.53
                cleft palate.
42220........  Reconstruct      Y............  A2...........      $717.00      38.1991    $1,625.10      $944.03
                cleft palate.
42226........  Lengthening of   Y............  A2...........      $717.00      38.1991    $1,625.10      $944.03
                palate.
42235........  Repair palate..  Y............  A2...........      $717.00      16.4266      $698.84      $712.46

[[Page 42582]]

 
42260........  Repair nose to   Y............  A2...........      $630.00      23.3299      $992.52      $720.63
                lip fistula.
42280........  Preparation,     Y............  P3...........  ...........       1.6898       $71.89       $71.89
                palate mold.
42281........  Insertion,       Y............  G2...........  ...........      16.4266      $698.84      $698.84
                palate
                prosthesis.
42300........  Drainage of      Y............  A2...........      $333.00      16.4266      $698.84      $424.46
                salivary gland.
42305........  Drainage of      Y............  A2...........      $446.00      16.4266      $698.84      $509.21
                salivary gland.
42310........  Drainage of      Y............  A2...........      $150.72       2.4520      $104.32      $139.12
                salivary gland.
42320........  Drainage of      Y............  A2...........      $150.72       2.4520      $104.32      $139.12
                salivary gland.
42330........  Removal of       Y............  P3...........  ...........       2.5511      $108.53      $108.53
                salivary stone.
42335........  Removal of       Y............  P3...........  ...........       4.1685      $177.34      $177.34
                salivary stone.
42340........  Removal of       Y............  A2...........      $446.00      16.4266      $698.84      $509.21
                salivary stone.
42400........  Biopsy of        Y............  P3...........  ...........       1.4244       $60.60       $60.60
                salivary gland.
42405........  Biopsy of        Y............  A2...........      $446.00      16.4266      $698.84      $509.21
                salivary gland.
42408........  Excision of      Y............  A2...........      $510.00      16.4266      $698.84      $557.21
                salivary cyst.
42409........  Drainage of      Y............  A2...........      $510.00      16.4266      $698.84      $557.21
                salivary cyst.
42410........  Excise parotid   Y............  A2...........      $510.00      38.1991    $1,625.10      $788.78
                gland/lesion.
42415........  Excise parotid   Y............  A2...........      $995.00      38.1991    $1,625.10    $1,152.53
                gland/lesion.
42420........  Excise parotid   Y............  A2...........      $995.00      38.1991    $1,625.10    $1,152.53
                gland/lesion.
42425........  Excise parotid   Y............  A2...........      $995.00      38.1991    $1,625.10    $1,152.53
                gland/lesion.
42440........  Excise           Y............  A2...........      $510.00      38.1991    $1,625.10      $788.78
                submaxillary
                gland.
42450........  Excise           Y............  A2...........      $446.00      23.3299      $992.52      $582.63
                sublingual
                gland.
42500........  Repair salivary  Y............  A2...........      $510.00      23.3299      $992.52      $630.63
                duct.
42505........  Repair salivary  Y............  A2...........      $630.00      38.1991    $1,625.10      $878.78
                duct.
42507........  Parotid duct     Y............  A2...........      $510.00      38.1991    $1,625.10      $788.78
                diversion.
42508........  Parotid duct     Y............  A2...........      $630.00      38.1991    $1,625.10      $878.78
                diversion.
42509........  Parotid duct     Y............  A2...........      $630.00      38.1991    $1,625.10      $878.78
                diversion.
42510........  Parotid duct     Y............  A2...........      $630.00      38.1991    $1,625.10      $878.78
                diversion.
42550........  Injection for    .............  N1...........  ...........  ...........  ...........  ...........
                salivary x-ray.
42600........  Closure of       Y............  A2...........      $333.00      16.4266      $698.84      $424.46
                salivary
                fistula.
42650........  Dilation of      Y............  P3...........  ...........       0.9254       $39.37       $39.37
                salivary duct.
42660........  Dilation of      Y............  P3...........  ...........       1.1186       $47.59       $47.59
                salivary duct.
42665........  Ligation of      Y............  A2...........      $995.00      23.3299      $992.52      $994.38
                salivary duct.
42700........  Drainage of      Y............  A2...........      $150.72       2.4520      $104.32      $139.12
                tonsil abscess.
42720........  Drainage of      Y............  A2...........      $333.00      16.4266      $698.84      $424.46
                throat abscess.
42725........  Drainage of      Y............  A2...........      $446.00      38.1991    $1,625.10      $740.78
                throat abscess.
42800........  Biopsy of        Y............  P3...........  ...........       1.7947       $76.35       $76.35
                throat.
42802........  Biopsy of        Y............  A2...........      $333.00      16.4266      $698.84      $424.46
                throat.
42804........  Biopsy of upper  Y............  A2...........      $333.00      16.4266      $698.84      $424.46
                nose/throat.
42806........  Biopsy of upper  Y............  A2...........      $446.00      23.3299      $992.52      $582.63
                nose/throat.
42808........  Excise pharynx   Y............  A2...........      $446.00      16.4266      $698.84      $509.21
                lesion.
42809........  Remove pharynx   N............  G2...........  ...........       0.6102       $25.96       $25.96
                foreign body.
42810........  Excision of      Y............  A2...........      $510.00      23.3299      $992.52      $630.63
                neck cyst.
42815........  Excision of      Y............  A2...........      $717.00      38.1991    $1,625.10      $944.03
                neck cyst.
42820........  Remove tonsils   Y............  A2...........      $510.00      22.1165      $940.90      $617.73
                and adenoids.
42821........  Remove tonsils   Y............  A2...........      $717.00      22.1165      $940.90      $772.98
                and adenoids.
42825........  Removal of       Y............  A2...........      $630.00      22.1165      $940.90      $707.73
                tonsils.
42826........  Removal of       Y............  A2...........      $630.00      22.1165      $940.90      $707.73
                tonsils.
42830........  Removal of       Y............  A2...........      $630.00      22.1165      $940.90      $707.73
                adenoids.
42831........  Removal of       Y............  A2...........      $630.00      22.1165      $940.90      $707.73
                adenoids.
42835........  Removal of       Y............  A2...........      $630.00      22.1165      $940.90      $707.73
                adenoids.
42836........  Removal of       Y............  A2...........      $630.00      22.1165      $940.90      $707.73
                adenoids.
42860........  Excision of      Y............  A2...........      $510.00      22.1165      $940.90      $617.73
                tonsil tags.
42870........  Excision of      Y............  A2...........      $510.00      22.1165      $940.90      $617.73
                lingual tonsil.
42890........  Partial removal  Y............  A2...........      $995.00      38.1991    $1,625.10    $1,152.53
                of pharynx.
42892........  Revision of      Y............  A2...........      $995.00      38.1991    $1,625.10    $1,152.53
                pharyngeal
                walls.
42900........  Repair throat    Y............  A2...........      $333.00       7.5511      $321.25      $330.06
                wound.
42950........  Reconstruction   Y............  A2...........      $446.00      23.3299      $992.52      $582.63
                of throat.
42955........  Surgical         Y............  A2...........      $446.00      23.3299      $992.52      $582.63
                opening of
                throat.
42960........  Control throat   Y............  A2...........       $72.48       1.1791       $50.16       $66.90
                bleeding.
42962........  Control throat   Y............  A2...........      $446.00      38.1991    $1,625.10      $740.78
                bleeding.
42970........  Control nose/    Y............  R2...........  ...........       1.1791       $50.16       $50.16
                throat
                bleeding.
42972........  Control nose/    Y............  A2...........      $510.00      16.4266      $698.84      $557.21
                throat
                bleeding.
43030........  Throat muscle    Y............  G2...........  ...........      16.4266      $698.84      $698.84
                surgery.
43200........  Esophagus        Y............  A2...........      $333.00       8.3175      $353.85      $338.21
                endoscopy.

[[Page 42583]]

 
43201........  Esoph scope w/   Y............  A2...........      $333.00       8.3175      $353.85      $338.21
                submucous inj.
43202........  Esophagus        Y............  A2...........      $333.00       8.3175      $353.85      $338.21
                endoscopy,
                biopsy.
43204........  Esoph scope w/   Y............  A2...........      $333.00       8.3175      $353.85      $338.21
                sclerosis inj.
43205........  Esophagus        Y............  A2...........      $333.00       8.3175      $353.85      $338.21
                endoscopy/
                ligation.
43215........  Esophagus        Y............  A2...........      $333.00       8.3175      $353.85      $338.21
                endoscopy.
43216........  Esophagus        Y............  A2...........      $333.00       8.3175      $353.85      $338.21
                endoscopy/
                lesion.
43217........  Esophagus        Y............  A2...........      $333.00       8.3175      $353.85      $338.21
                endoscopy.
43219........  Esophagus        Y............  A2...........      $333.00      22.9475      $976.26      $493.82
                endoscopy.
43220........  Esoph            Y............  A2...........      $333.00       8.3175      $353.85      $338.21
                endoscopy,
                dilation.
43226........  Esoph            Y............  A2...........      $333.00       8.3175      $353.85      $338.21
                endoscopy,
                dilation.
43227........  Esoph            Y............  A2...........      $446.00       8.3175      $353.85      $422.96
                endoscopy,
                repair.
43228........  Esoph            Y............  A2...........      $446.00      25.7552    $1,095.70      $608.43
                endoscopy,
                ablation.
43231........  Esoph endoscopy  Y............  A2...........      $446.00       8.3175      $353.85      $422.96
                w/us exam.
43232........  Esoph endoscopy  Y............  A2...........      $446.00       8.3175      $353.85      $422.96
                w/us fn bx.
43234........  Upper GI         Y............  A2...........      $333.00       8.3175      $353.85      $338.21
                endoscopy,
                exam.
43235........  Uppr gi          Y............  A2...........      $333.00       8.3175      $353.85      $338.21
                endoscopy,
                diagnosis.
43236........  Uppr gi scope w/ Y............  A2...........      $446.00       8.3175      $353.85      $422.96
                submuc inj.
43237........  Endoscopic us    Y............  A2...........      $446.00       8.3175      $353.85      $422.96
                exam, esoph.
43238........  Uppr gi          Y............  A2...........      $446.00       8.3175      $353.85      $422.96
                endoscopy w/us
                fn bx.
43239........  Upper GI         Y............  A2...........      $446.00       8.3175      $353.85      $422.96
                endoscopy,
                biopsy.
43240........  Esoph endoscope  Y............  A2...........      $446.00       8.3175      $353.85      $422.96
                w/drain cyst.
43241........  Upper GI         Y............  A2...........      $446.00       8.3175      $353.85      $422.96
                endoscopy with
                tube.
43242........  Uppr gi          Y............  A2...........      $446.00       8.3175      $353.85      $422.96
                endoscopy w/us
                fn bx.
43243........  Upper gi         Y............  A2...........      $446.00       8.3175      $353.85      $422.96
                endoscopy &
                inject.
43244........  Upper GI         Y............  A2...........      $446.00       8.3175      $353.85      $422.96
                endoscopy/
                ligation.
43245........  Uppr gi scope    Y............  A2...........      $446.00       8.3175      $353.85      $422.96
                dilate strictr.
43246........  Place            Y............  A2...........      $446.00       8.3175      $353.85      $422.96
                gastrostomy
                tube.
43247........  Operative upper  Y............  A2...........      $446.00       8.3175      $353.85      $422.96
                GI endoscopy.
43248........  Uppr gi          Y............  A2...........      $446.00       8.3175      $353.85      $422.96
                endoscopy/
                guide wire.
43249........  Esoph            Y............  A2...........      $446.00       8.3175      $353.85      $422.96
                endoscopy,
                dilation.
43250........  Upper GI         Y............  A2...........      $446.00       8.3175      $353.85      $422.96
                endoscopy/
                tumor.
43251........  Operative upper  Y............  A2...........      $446.00       8.3175      $353.85      $422.96
                GI endoscopy.
43255........  Operative upper  Y............  A2...........      $446.00       8.3175      $353.85      $422.96
                GI endoscopy.
43256........  Uppr gi          Y............  A2...........      $510.00      22.9475      $976.26      $626.57
                endoscopy w/
                stent.
43257........  Uppr gi scope w/ Y............  A2...........      $510.00      25.7552    $1,095.70      $656.43
                thrml txmnt.
43258........  Operative upper  Y............  A2...........      $510.00       8.3175      $353.85      $470.96
                GI endoscopy.
43259........  Endoscopic       Y............  A2...........      $510.00       8.3175      $353.85      $470.96
                ultrasound
                exam.
43260........  Endo             Y............  A2...........      $446.00      19.8381      $843.97      $545.49
                cholangiopancr
                eatograph.
43261........  Endo             Y............  A2...........      $446.00      19.8381      $843.97      $545.49
                cholangiopancr
                eatograph.
43262........  Endo             Y............  A2...........      $446.00      19.8381      $843.97      $545.49
                cholangiopancr
                eatograph.
43263........  Endo             Y............  A2...........      $446.00      19.8381      $843.97      $545.49
                cholangiopancr
                eatograph.
43264........  Endo             Y............  A2...........      $446.00      19.8381      $843.97      $545.49
                cholangiopancr
                eatograph.
43265........  Endo             Y............  A2...........      $446.00      19.8381      $843.97      $545.49
                cholangiopancr
                eatograph.
43267........  Endo             Y............  A2...........      $446.00      19.8381      $843.97      $545.49
                cholangiopancr
                eatograph.
43268........  Endo             Y............  A2...........      $446.00      22.9475      $976.26      $578.57
                cholangiopancr
                eatograph.
43269........  Endo             Y............  A2...........      $446.00      22.9475      $976.26      $578.57
                cholangiopancr
                eatograph.
43271........  Endo             Y............  A2...........      $446.00      19.8381      $843.97      $545.49
                cholangiopancr
                eatograph.
43272........  Endo             Y............  A2...........      $446.00      19.8381      $843.97      $545.49
                cholangiopancr
                eatograph.
43450........  Dilate           Y............  A2...........      $333.00       5.4566      $232.14      $307.79
                esophagus.
43453........  Dilate           Y............  A2...........      $333.00       5.4566      $232.14      $307.79
                esophagus.
43456........  Dilate           Y............  A2...........      $335.41       5.4566      $232.14      $309.59
                esophagus.
43458........  Dilate           Y............  A2...........      $335.41       5.4566      $232.14      $309.59
                esophagus.
43600........  Biopsy of        Y............  A2...........      $333.00       8.3175      $353.85      $338.21
                stomach.
43653........  Laparoscopy,     Y............  A2...........    $1,339.00      43.5488    $1,852.70    $1,467.43
                gastrostomy.
43750........  Place            Y............  A2...........      $446.00       8.3175      $353.85      $422.96
                gastrostomy
                tube.
43760........  Change           Y............  A2...........      $144.98       2.3587      $100.35      $133.82
                gastrostomy
                tube.
43761........  Reposition       Y............  A2...........      $333.00       7.4800      $318.22      $329.31
                gastrostomy
                tube.
43870........  Repair stomach   Y............  A2...........      $333.00       8.3175      $353.85      $338.21
                opening.
43886........  Revise gastric   Y............  G2...........  ...........       5.2594      $223.75      $223.75
                port, open.
43887........  Remove gastric   Y............  G2...........  ...........       5.2594      $223.75      $223.75
                port, open.
43888........  Change gastric   Y............  G2...........  ...........      14.0346      $597.07      $597.07
                port, open.
44100........  Biopsy of bowel  Y............  A2...........      $333.00       8.3175      $353.85      $338.21
44312........  Revision of      Y............  A2...........      $333.00      21.4302      $911.71      $477.68
                ileostomy.

[[Page 42584]]

 
44340........  Revision of      Y............  A2...........      $510.00      21.4302      $911.71      $610.43
                colostomy.
44360........  Small bowel      Y............  A2...........      $446.00       9.4946      $403.93      $435.48
                endoscopy.
44361........  Small bowel      Y............  A2...........      $446.00       9.4946      $403.93      $435.48
                endoscopy/
                biopsy.
44363........  Small bowel      Y............  A2...........      $446.00       9.4946      $403.93      $435.48
                endoscopy.
44364........  Small bowel      Y............  A2...........      $446.00       9.4946      $403.93      $435.48
                endoscopy.
44365........  Small bowel      Y............  A2...........      $446.00       9.4946      $403.93      $435.48
                endoscopy.
44366........  Small bowel      Y............  A2...........      $446.00       9.4946      $403.93      $435.48
                endoscopy.
44369........  Small bowel      Y............  A2...........      $446.00       9.4946      $403.93      $435.48
                endoscopy.
44370........  Small bowel      Y............  A2...........    $1,339.00      22.9475      $976.26    $1,248.32
                endoscopy/
                stent.
44372........  Small bowel      Y............  A2...........      $446.00       9.4946      $403.93      $435.48
                endoscopy.
44373........  Small bowel      Y............  A2...........      $446.00       9.4946      $403.93      $435.48
                endoscopy.
44376........  Small bowel      Y............  A2...........      $446.00       9.4946      $403.93      $435.48
                endoscopy.
44377........  Small bowel      Y............  A2...........      $446.00       9.4946      $403.93      $435.48
                endoscopy/
                biopsy.
44378........  Small bowel      Y............  A2...........      $446.00       9.4946      $403.93      $435.48
                endoscopy.
44379........  Sbowel           Y............  A2...........    $1,339.00      22.9475      $976.26    $1,248.32
                endoscope w/
                stent.
44380........  Small bowel      Y............  A2...........      $333.00       9.4946      $403.93      $350.73
                endoscopy.
44382........  Small bowel      Y............  A2...........      $333.00       9.4946      $403.93      $350.73
                endoscopy.
44383........  Ileoscopy w/     Y............  A2...........    $1,339.00      22.9475      $976.26    $1,248.32
                stent.
44385........  Endoscopy of     Y............  A2...........      $333.00       8.7686      $373.04      $343.01
                bowel pouch.
44386........  Endoscopy,       Y............  A2...........      $333.00       8.7686      $373.04      $343.01
                bowel pouch/
                biop.
44388........  Colonoscopy....  Y............  A2...........      $333.00       8.7686      $373.04      $343.01
44389........  Colonoscopy      Y............  A2...........      $333.00       8.7686      $373.04      $343.01
                with biopsy.
44390........  Colonoscopy for  Y............  A2...........      $333.00       8.7686      $373.04      $343.01
                foreign body.
44391........  Colonoscopy for  Y............  A2...........      $333.00       8.7686      $373.04      $343.01
                bleeding.
44392........  Colonoscopy &    Y............  A2...........      $333.00       8.7686      $373.04      $343.01
                polypectomy.
44393........  Colonoscopy,     Y............  A2...........      $333.00       8.7686      $373.04      $343.01
                lesion removal.
44394........  Colonoscopy w/   Y............  A2...........      $333.00       8.7686      $373.04      $343.01
                snare.
44397........  Colonoscopy w/   Y............  A2...........      $333.00      22.9475      $976.26      $493.82
                stent.
44701........  Intraop colon    .............  N1...........  ...........  ...........  ...........  ...........
                lavage add-on.
45000........  Drainage of      Y............  A2...........      $312.07       5.0770      $215.99      $288.05
                pelvic abscess.
45005........  Drainage of      Y............  A2...........      $446.00      12.7389      $541.95      $469.99
                rectal abscess.
45020........  Drainage of      Y............  A2...........      $446.00      12.7389      $541.95      $469.99
                rectal abscess.
45100........  Biopsy of        Y............  A2...........      $333.00      22.2682      $947.36      $486.59
                rectum.
45108........  Removal of       Y............  A2...........      $446.00      22.2682      $947.36      $571.34
                anorectal
                lesion.
45150........  Excision of      Y............  A2...........      $446.00      22.2682      $947.36      $571.34
                rectal
                stricture.
45160........  Excision of      Y............  A2...........      $446.00      22.2682      $947.36      $571.34
                rectal lesion.
45170........  Excision of      Y............  A2...........      $446.00      22.2682      $947.36      $571.34
                rectal lesion.
45190........  Destruction,     Y............  A2...........    $1,339.00      22.2682      $947.36    $1,241.09
                rectal tumor.
45300........  Proctosigmoidos  Y............  P3...........  ...........       1.3922       $59.23       $59.23
                copy dx.
45303........  Proctosigmoidos  Y............  P2...........  ...........       8.5477      $363.64      $363.64
                copy dilate.
45305........  Proctosigmoidos  Y............  A2...........      $333.00       8.5477      $363.64      $340.66
                copy w/bx.
45307........  Proctosigmoidos  Y............  A2...........      $333.00      20.6375      $877.98      $469.25
                copy fb.
45308........  Proctosigmoidos  Y............  A2...........      $333.00       8.5477      $363.64      $340.66
                copy removal.
45309........  Proctosigmoidos  Y............  A2...........      $333.00       8.5477      $363.64      $340.66
                copy removal.
45315........  Proctosigmoidos  Y............  A2...........      $333.00       8.5477      $363.64      $340.66
                copy removal.
45317........  Proctosigmoidos  Y............  A2...........      $333.00       8.5477      $363.64      $340.66
                copy bleed.
45320........  Proctosigmoidos  Y............  A2...........      $333.00      20.6375      $877.98      $469.25
                copy ablate.
45321........  Proctosigmoidos  Y............  A2...........      $333.00      20.6375      $877.98      $469.25
                copy volvul.
45327........  Proctosigmoidos  Y............  A2...........      $333.00      22.9475      $976.26      $493.82
                copy w/stent.
45330........  Diagnostic       Y............  P3...........  ...........       1.9152       $81.48       $81.48
                sigmoidoscopy.
45331........  Sigmoidoscopy    Y............  A2...........      $299.24       4.8683      $207.11      $276.21
                and biopsy.
45332........  Sigmoidoscopy w/ Y............  A2...........      $299.24       4.8683      $207.11      $276.21
                fb removal.
45333........  Sigmoidoscopy &  Y............  A2...........      $333.00       8.5477      $363.64      $340.66
                polypectomy.
45334........  Sigmoidoscopy    Y............  A2...........      $333.00       8.5477      $363.64      $340.66
                for bleeding.
45335........  Sigmoidoscopy w/ Y............  A2...........      $299.24       4.8683      $207.11      $276.21
                submuc inj.
45337........  Sigmoidoscopy &  Y............  A2...........      $299.24       4.8683      $207.11      $276.21
                decompress.
45338........  Sigmoidoscopy w/ Y............  A2...........      $333.00       8.5477      $363.64      $340.66
                tumr remove.
45339........  Sigmoidoscopy w/ Y............  A2...........      $333.00       8.5477      $363.64      $340.66
                ablate tumr.
45340........  Sig w/balloon    Y............  A2...........      $333.00       8.5477      $363.64      $340.66
                dilation.
45341........  Sigmoidoscopy w/ Y............  A2...........      $333.00       8.5477      $363.64      $340.66
                ultrasound.
45342........  Sigmoidoscopy w/ Y............  A2...........      $333.00       8.5477      $363.64      $340.66
                us guide bx.
45345........  Sigmoidoscopy w/ Y............  A2...........      $333.00      22.9475      $976.26      $493.82
                stent.
45355........  Surgical         Y............  A2...........      $333.00       8.7686      $373.04      $343.01
                colonoscopy.

[[Page 42585]]

 
45378........  Diagnostic       Y............  A2...........      $446.00       8.7686      $373.04      $427.76
                colonoscopy.
45379........  Colonoscopy w/   Y............  A2...........      $446.00       8.7686      $373.04      $427.76
                fb removal.
45380........  Colonoscopy and  Y............  A2...........      $446.00       8.7686      $373.04      $427.76
                biopsy.
45381........  Colonoscopy,     Y............  A2...........      $446.00       8.7686      $373.04      $427.76
                submucous inj.
45382........  Colonoscopy/     Y............  A2...........      $446.00       8.7686      $373.04      $427.76
                control
                bleeding.
45383........  Lesion removal   Y............  A2...........      $446.00       8.7686      $373.04      $427.76
                colonoscopy.
45384........  Lesion remove    Y............  A2...........      $446.00       8.7686      $373.04      $427.76
                colonoscopy.
45385........  Lesion removal   Y............  A2...........      $446.00       8.7686      $373.04      $427.76
                colonoscopy.
45386........  Colonoscopy      Y............  A2...........      $446.00       8.7686      $373.04      $427.76
                dilate
                stricture.
45387........  Colonoscopy w/   Y............  A2...........      $333.00      22.9475      $976.26      $493.82
                stent.
45391........  Colonoscopy w/   Y............  A2...........      $446.00       8.7686      $373.04      $427.76
                endoscope us.
45392........  Colonoscopy w/   Y............  A2...........      $446.00       8.7686      $373.04      $427.76
                endoscopic fnb.
45500........  Repair of        Y............  A2...........      $446.00      22.2682      $947.36      $571.34
                rectum.
45505........  Repair of        Y............  A2...........      $446.00      29.6189    $1,260.08      $649.52
                rectum.
45520........  Treatment of     Y............  P2...........  ...........       1.0798       $45.94       $45.94
                rectal
                prolapse.
45560........  Repair of        Y............  A2...........      $446.00      29.6189    $1,260.08      $649.52
                rectocele.
45900........  Reduction of     Y............  A2...........      $312.07       5.0770      $215.99      $288.05
                rectal
                prolapse.
45905........  Dilation of      Y............  A2...........      $333.00      22.2682      $947.36      $486.59
                anal sphincter.
45910........  Dilation of      Y............  A2...........      $333.00      22.2682      $947.36      $486.59
                rectal
                narrowing.
45915........  Remove rectal    Y............  A2...........      $312.07       5.0770      $215.99      $288.05
                obstruction.
45990........  Surg dx exam,    Y............  A2...........      $312.07       5.0770      $215.99      $288.05
                anorectal.
46020........  Placement of     Y............  A2...........      $510.00      22.2682      $947.36      $619.34
                seton.
46030........  Removal of       Y............  A2...........      $312.07       5.0770      $215.99      $288.05
                rectal marker.
46040........  Incision of      Y............  A2...........      $510.00      22.2682      $947.36      $619.34
                rectal abscess.
46045........  Incision of      Y............  A2...........      $446.00      22.2682      $947.36      $571.34
                rectal abscess.
46050........  Incision of      Y............  A2...........      $312.07       5.0770      $215.99      $288.05
                anal abscess.
46060........  Incision of      Y............  A2...........      $446.00      22.2682      $947.36      $571.34
                rectal abscess.
46070........  Incision of      Y............  G2...........  ...........      12.7389      $541.95      $541.95
                anal septum.
46080........  Incision of      Y............  A2...........      $510.00      22.2682      $947.36      $619.34
                anal sphincter.
46083........  Incise external  Y............  P3...........  ...........       1.9554       $83.19       $83.19
                hemorrhoid.
46200........  Removal of anal  Y............  A2...........      $446.00      22.2682      $947.36      $571.34
                fissure.
46210........  Removal of anal  Y............  A2...........      $446.00      22.2682      $947.36      $571.34
                crypt.
46211........  Removal of anal  Y............  A2...........      $446.00      22.2682      $947.36      $571.34
                crypts.
46220........  Removal of anal  Y............  A2...........      $333.00      22.2682      $947.36      $486.59
                tag.
46221........  Ligation of      Y............  P3...........  ...........       2.5591      $108.87      $108.87
                hemorrhoid(s).
46230........  Removal of anal  Y............  A2...........      $333.00      22.2682      $947.36      $486.59
                tags.
46250........  Hemorrhoidectom  Y............  A2...........      $510.00      22.2682      $947.36      $619.34
                y.
46255........  Hemorrhoidectom  Y............  A2...........      $510.00      22.2682      $947.36      $619.34
                y.
46257........  Remove           Y............  A2...........      $510.00      22.2682      $947.36      $619.34
                hemorrhoids &
                fissure.
46258........  Remove           Y............  A2...........      $510.00      22.2682      $947.36      $619.34
                hemorrhoids &
                fistula.
46260........  Hemorrhoidectom  Y............  A2...........      $510.00      22.2682      $947.36      $619.34
                y.
46261........  Remove           Y............  A2...........      $630.00      22.2682      $947.36      $709.34
                hemorrhoids &
                fissure.
46262........  Remove           Y............  A2...........      $630.00      22.2682      $947.36      $709.34
                hemorrhoids &
                fistula.
46270........  Removal of anal  Y............  A2...........      $510.00      22.2682      $947.36      $619.34
                fistula.
46275........  Removal of anal  Y............  A2...........      $510.00      22.2682      $947.36      $619.34
                fistula.
46280........  Removal of anal  Y............  A2...........      $630.00      22.2682      $947.36      $709.34
                fistula.
46285........  Removal of anal  Y............  A2...........      $333.00      22.2682      $947.36      $486.59
                fistula.
46288........  Repair anal      Y............  A2...........      $630.00      22.2682      $947.36      $709.34
                fistula.
46320........  Removal of       Y............  P3...........  ...........       1.8186       $77.37       $77.37
                hemorrhoid
                clot.
46500........  Injection into   Y............  P3...........  ...........       2.2934       $97.57       $97.57
                hemorrhoid(s).
46505........  Chemodenervatio  Y............  G2...........  ...........       5.0770      $215.99      $215.99
                n anal musc.
46600........  Diagnostic       N............  P2...........  ...........       0.6102       $25.96       $25.96
                anoscopy.
46604........  Anoscopy and     Y............  P2...........  ...........       8.5477      $363.64      $363.64
                dilation.
46606........  Anoscopy and     Y............  P3...........  ...........       3.0821      $131.12      $131.12
                biopsy.
46608........  Anoscopy,        Y............  A2...........      $333.00       8.5477      $363.64      $340.66
                remove for
                body.
46610........  Anoscopy,        Y............  A2...........      $333.00      20.6375      $877.98      $469.25
                remove lesion.
46611........  Anoscopy.......  Y............  A2...........      $333.00       8.5477      $363.64      $340.66
46612........  Anoscopy,        Y............  A2...........      $333.00      20.6375      $877.98      $469.25
                remove lesions.
46614........  Anoscopy,        Y............  P3...........  ...........       1.9634       $83.53       $83.53
                control
                bleeding.
46615........  Anoscopy.......  Y............  A2...........      $446.00      20.6375      $877.98      $554.00
46700........  Repair of anal   Y............  A2...........      $510.00      22.2682      $947.36      $619.34
                stricture.
46706........  Repr of anal     Y............  A2...........      $333.00      29.6189    $1,260.08      $564.77
                fistula w/glue.
46750........  Repair of anal   Y............  A2...........      $510.00      37.8991    $1,612.34      $785.59
                sphincter.

[[Page 42586]]

 
46753........  Reconstruction   Y............  A2...........      $510.00      22.2682      $947.36      $619.34
                of anus.
46754........  Removal of       Y............  A2...........      $446.00      22.2682      $947.36      $571.34
                suture from
                anus.
46760........  Repair of anal   Y............  A2...........      $446.00      37.8991    $1,612.34      $737.59
                sphincter.
46761........  Repair of anal   Y............  A2...........      $510.00      37.8991    $1,612.34      $785.59
                sphincter.
46762........  Implant          Y............  A2...........      $995.00      37.8991    $1,612.34    $1,149.34
                artificial
                sphincter.
46900........  Destruction,     Y............  P3...........  ...........       2.4947      $106.13      $106.13
                anal lesion(s).
46910........  Destruction,     Y............  P3...........  ...........       2.7281      $116.06      $116.06
                anal lesion(s).
46916........  Cryosurgery,     Y............  P2...........  ...........       1.0918       $46.45       $46.45
                anal lesion(s).
46917........  Laser surgery,   Y............  A2...........      $333.00      20.4276      $869.05      $467.01
                anal lesions.
46922........  Excision of      Y............  A2...........      $333.00      20.4276      $869.05      $467.01
                anal lesion(s).
46924........  Destruction,     Y............  A2...........      $333.00      20.4276      $869.05      $467.01
                anal lesion(s).
46934........  Destruction of   Y............  P3...........  ...........       4.2087      $179.05      $179.05
                hemorrhoids.
46935........  Destruction of   Y............  P3...........  ...........       2.8729      $122.22      $122.22
                hemorrhoids.
46936........  Destruction of   Y............  P3...........  ...........       4.4341      $188.64      $188.64
                hemorrhoids.
46937........  Cryotherapy of   Y............  A2...........      $446.00      22.2682      $947.36      $571.34
                rectal lesion.
46938........  Cryotherapy of   Y............  A2...........      $446.00      29.6189    $1,260.08      $649.52
                rectal lesion.
46940........  Treatment of     Y............  P3...........  ...........       1.9394       $82.51       $82.51
                anal fissure.
46942........  Treatment of     Y............  P3...........  ...........       1.8588       $79.08       $79.08
                anal fissure.
46945........  Ligation of      Y............  P3...........  ...........       3.2511      $138.31      $138.31
                hemorrhoids.
46946........  Ligation of      Y............  A2...........      $333.00      12.7389      $541.95      $385.24
                hemorrhoids.
46947........  Hemorrhoidopexy  Y............  A2...........      $995.00      29.6189    $1,260.08    $1,061.27
                by stapling.
47000........  Needle biopsy    Y............  A2...........      $333.00       6.1384      $261.15      $315.04
                of liver.
47001........  Needle biopsy,   .............  N1...........  ...........  ...........  ...........  ...........
                liver add-on.
47382........  Percut ablate    Y............  G2...........  ...........      37.3604    $1,589.42    $1,589.42
                liver rf.
47500........  Injection for    .............  N1...........  ...........  ...........  ...........  ...........
                liver x-rays.
47505........  Injection for    .............  N1...........  ...........  ...........  ...........  ...........
                liver x-rays.
47510........  Insert           Y............  A2...........      $446.00      20.2682      $862.27      $550.07
                catheter, bile
                duct.
47511........  Insert bile      Y............  A2...........    $1,245.85      20.2682      $862.27    $1,149.96
                duct drain.
47525........  Change bile      Y............  A2...........      $333.00      11.6575      $495.95      $373.74
                duct catheter.
47530........  Revise/reinsert  Y............  A2...........      $333.00      11.6575      $495.95      $373.74
                bile tube.
47552........  Biliary          Y............  A2...........      $446.00      20.2682      $862.27      $550.07
                endoscopy thru
                skin.
47553........  Biliary          Y............  A2...........      $510.00      20.2682      $862.27      $598.07
                endoscopy thru
                skin.
47554........  Biliary          Y............  A2...........      $510.00      20.2682      $862.27      $598.07
                endoscopy thru
                skin.
47555........  Biliary          Y............  A2...........      $510.00      20.2682      $862.27      $598.07
                endoscopy thru
                skin.
47556........  Biliary          Y............  A2...........    $1,245.85      20.2682      $862.27    $1,149.96
                endoscopy thru
                skin.
47560........  Laparoscopy w/   Y............  A2...........      $510.00      32.1241    $1,366.66      $724.17
                cholangio.
47561........  Laparo w/        Y............  A2...........      $510.00      32.1241    $1,366.66      $724.17
                cholangio/
                biopsy.
47562........  Laparoscopic     Y............  G2...........  ...........      43.5488    $1,852.70    $1,852.70
                cholecystectom
                y.
47563........  Laparo           Y............  G2...........  ...........      43.5488    $1,852.70    $1,852.70
                cholecystectom
                y/graph.
47564........  Laparo           Y............  G2...........  ...........      43.5488    $1,852.70    $1,852.70
                cholecystectom
                y/explr.
47630........  Remove bile      Y............  A2...........      $510.00      20.2682      $862.27      $598.07
                duct stone.
48102........  Needle biopsy,   Y............  A2...........      $333.00       6.1384      $261.15      $315.04
                pancreas.
49080........  Puncture,        Y............  A2...........      $222.78       3.6244      $154.19      $205.63
                peritoneal
                cavity.
49081........  Removal of       Y............  A2...........      $222.78       3.6244      $154.19      $205.63
                abdominal
                fluid.
49180........  Biopsy,          Y............  A2...........      $333.00       6.1384      $261.15      $315.04
                abdominal mass.
49250........  Excision of      Y............  A2...........      $630.00      22.0832      $939.49      $707.37
                umbilicus.
49320........  Diag laparo      Y............  A2...........      $510.00      32.1241    $1,366.66      $724.17
                separate proc.
49321........  Laparoscopy,     Y............  A2...........      $630.00      32.1241    $1,366.66      $814.17
                biopsy.
49322........  Laparoscopy,     Y............  A2...........      $630.00      32.1241    $1,366.66      $814.17
                aspiration.
49400........  Air injection    .............  N1...........  ...........  ...........  ...........  ...........
                into abdomen.
49402........  Remove foreign   Y............  A2...........      $446.00      22.0832      $939.49      $569.37
                body, adbomen.
49419........  Insrt abdom      Y............  A2...........      $333.00      29.2133    $1,242.82      $560.46
                cath for
                chemotx.
49420........  Insert abdom     Y............  A2...........      $333.00      29.5416    $1,256.79      $563.95
                drain, temp.
49421........  Insert abdom     Y............  A2...........      $333.00      29.5416    $1,256.79      $563.95
                drain, perm.
49422........  Remove perm      Y............  A2...........      $333.00      25.6142    $1,089.70      $522.18
                cannula/
                catheter.
49423........  Exchange         Y............  G2...........  ...........      11.6575      $495.95      $495.95
                drainage
                catheter.
49424........  Assess cyst,     .............  N1...........  ...........  ...........  ...........  ...........
                contrast
                inject.
49426........  Revise abdomen-  Y............  A2...........      $446.00      22.0832      $939.49      $569.37
                venous shunt.
49427........  Injection,       .............  N1...........  ...........  ...........  ...........  ...........
                abdominal
                shunt.
49429........  Removal of       Y............  G2...........  ...........      25.6142    $1,089.70    $1,089.70
                shunt.
49495........  Rpr ing hernia   Y............  A2...........      $630.00      29.2182    $1,243.03      $783.26
                baby, reduc.
49496........  Rpr ing hernia   Y............  A2...........      $630.00      29.2182    $1,243.03      $783.26
                baby, blocked.
49500........  Rpr ing hernia,  Y............  A2...........      $630.00      29.2182    $1,243.03      $783.26
                init, reduce.

[[Page 42587]]

 
49501........  Rpr ing hernia,  Y............  A2...........    $1,339.00      29.2182    $1,243.03    $1,315.01
                init blocked.
49505........  Prp i/hern init  Y............  A2...........      $630.00      29.2182    $1,243.03      $783.26
                reduc > 5 yr.
49507........  Prp i/hern init  Y............  A2...........    $1,339.00      29.2182    $1,243.03    $1,315.01
                block > 5 yr.
49520........  Rerepair ing     Y............  A2...........      $995.00      29.2182    $1,243.03    $1,057.01
                hernia, reduce.
49521........  Rerepair ing     Y............  A2...........    $1,339.00      29.2182    $1,243.03    $1,315.01
                hernia,
                blocked.
49525........  Repair ing       Y............  A2...........      $630.00      29.2182    $1,243.03      $783.26
                hernia,
                sliding.
49540........  Repair lumbar    Y............  A2...........      $446.00      29.2182    $1,243.03      $645.26
                hernia.
49550........  Rpr rem hernia,  Y............  A2...........      $717.00      29.2182    $1,243.03      $848.51
                init, reduce.
49553........  Rpr fem hernia,  Y............  A2...........    $1,339.00      29.2182    $1,243.03    $1,315.01
                init blocked.
49555........  Rerepair fem     Y............  A2...........      $717.00      29.2182    $1,243.03      $848.51
                hernia, reduce.
49557........  Rerepair fem     Y............  A2...........    $1,339.00      29.2182    $1,243.03    $1,315.01
                hernia,
                blocked.
49560........  Rpr ventral      Y............  A2...........      $630.00      29.2182    $1,243.03      $783.26
                hern init,
                reduc.
49561........  Rpr ventral      Y............  A2...........    $1,339.00      29.2182    $1,243.03    $1,315.01
                hern init,
                block.
49565........  Rerepair ventrl  Y............  A2...........      $630.00      29.2182    $1,243.03      $783.26
                hern, reduce.
49566........  Rerepair ventrl  Y............  A2...........    $1,339.00      29.2182    $1,243.03    $1,315.01
                hern, block.
49568........  Hernia repair w/ Y............  A2...........      $995.00      29.2182    $1,243.03    $1,057.01
                mesh.
49570........  Rpr epigastric   Y............  A2...........      $630.00      29.2182    $1,243.03      $783.26
                hern, reduce.
49572........  Rpr epigastric   Y............  A2...........    $1,339.00      29.2182    $1,243.03    $1,315.01
                hern, blocked.
49580........  Rpr umbil hern,  Y............  A2...........      $630.00      29.2182    $1,243.03      $783.26
                reduc < 5 yr.
49582........  Rpr umbil hern,  Y............  A2...........    $1,339.00      29.2182    $1,243.03    $1,315.01
                block < 5 yr.
49585........  Rpr umbil hern,  Y............  A2...........      $630.00      29.2182    $1,243.03      $783.26
                reduc > 5 yr.
49587........  Rpr umbil hern,  Y............  A2...........    $1,339.00      29.2182    $1,243.03    $1,315.01
                block > 5 yr.
49590........  Repair           Y............  A2...........      $510.00      29.2182    $1,243.03      $693.26
                spigelian
                hernia.
49600........  Repair           Y............  A2...........      $630.00      29.2182    $1,243.03      $783.26
                umbilical
                lesion.
49650........  Laparo hernia    Y............  A2...........      $630.00      43.5488    $1,852.70      $935.68
                repair initial.
49651........  Laparo hernia    Y............  A2...........      $995.00      43.5488    $1,852.70    $1,209.43
                repair recur.
50200........  Biopsy of        Y............  A2...........      $333.00       6.1384      $261.15      $315.04
                kidney.
50382........  Change ureter    Y............  G2...........  ...........      19.2251      $817.89      $817.89
                stent, percut.
50384........  Remove ureter    Y............  G2...........  ...........      19.2251      $817.89      $817.89
                stent, percut.
50387........  Change ext/int   Y............  G2...........  ...........       7.4800      $318.22      $318.22
                ureter stent.
50389........  Remove renal     Y............  G2...........  ...........       3.4079      $144.98      $144.98
                tube w/fluoro.
50390........  Drainage of      Y............  A2...........      $333.00       6.1384      $261.15      $315.04
                kidney lesion.
50391........  Instll rx agnt   Y............  P2...........  ...........       1.0887       $46.32       $46.32
                into rnal tub.
50392........  Insert kidney    Y............  A2...........      $333.00      19.2251      $817.89      $454.22
                drain.
50393........  Insert ureteral  Y............  A2...........      $333.00      19.2251      $817.89      $454.22
                tube.
50394........  Injection for    .............  N1...........  ...........  ...........  ...........  ...........
                kidney x-ray.
50395........  Create passage   Y............  A2...........      $333.00      19.2251      $817.89      $454.22
                to kidney.
50396........  Measure kidney   Y............  A2...........      $131.50       2.1393       $91.01      $121.38
                pressure.
50398........  Change kidney    Y............  A2...........      $333.00       7.4800      $318.22      $329.31
                tube.
50551........  Kidney           Y............  A2...........      $333.00       6.4951      $276.32      $318.83
                endoscopy.
50553........  Kidney           Y............  A2...........      $333.00      19.2251      $817.89      $454.22
                endoscopy.
50555........  Kidney           Y............  A2...........      $333.00       6.4951      $276.32      $318.83
                endoscopy &
                biopsy.
50557........  Kidney           Y............  A2...........      $333.00      23.8700    $1,015.50      $503.63
                endoscopy &
                treatment.
50561........  Kidney           Y............  A2...........      $333.00      19.2251      $817.89      $454.22
                endoscopy &
                treatment.
50562........  Renal scope w/   Y............  G2...........  ...........       6.4951      $276.32      $276.32
                tumor resect.
50570........  Kidney           Y............  G2...........  ...........       6.4951      $276.32      $276.32
                endoscopy.
50572........  Kidney           Y............  G2...........  ...........       6.4951      $276.32      $276.32
                endoscopy.
50574........  Kidney           Y............  G2...........  ...........       6.4951      $276.32      $276.32
                endoscopy &
                biopsy.
50575........  Kidney           Y............  G2...........  ...........      34.9261    $1,485.86    $1,485.86
                endoscopy.
50576........  Kidney           Y............  G2...........  ...........      19.2251      $817.89      $817.89
                endoscopy &
                treatment.
50590........  Fragmenting of   Y............  G2...........  ...........      43.5398    $1,852.31    $1,852.31
                kidney stone.
50592........  Perc rf ablate   Y............  G2...........  ...........      37.3604    $1,589.42    $1,589.42
                renal tumor.
50684........  Injection for    .............  N1...........  ...........  ...........  ...........  ...........
                ureter x-ray.
50686........  Measure ureter   Y............  P2...........  ...........       1.0887       $46.32       $46.32
                pressure.
50688........  Change of        Y............  A2...........      $333.00       7.4800      $318.22      $329.31
                ureter tube/
                stent.
50690........  Injection for    .............  N1...........  ...........  ...........  ...........  ...........
                ureter x-ray.
50947........  Laparo new       Y............  A2...........    $1,339.00      43.5488    $1,852.70    $1,467.43
                ureter/bladder.
50948........  Laparo new       Y............  A2...........    $1,339.00      43.5488    $1,852.70    $1,467.43
                ureter/bladder.
50951........  Endoscopy of     Y............  A2...........      $333.00       6.4951      $276.32      $318.83
                ureter.
50953........  Endoscopy of     Y............  A2...........      $333.00       6.4951      $276.32      $318.83
                ureter.
50955........  Ureter           Y............  A2...........      $333.00      19.2251      $817.89      $454.22
                endoscopy &
                biopsy.
50957........  Ureter           Y............  A2...........      $333.00      19.2251      $817.89      $454.22
                endoscopy &
                treatment.
50961........  Ureter           Y............  A2...........      $333.00      19.2251      $817.89      $454.22
                endoscopy &
                treatment.

[[Page 42588]]

 
50970........  Ureter           Y............  A2...........      $333.00       6.4951      $276.32      $318.83
                endoscopy.
50972........  Ureter           Y............  A2...........      $333.00       6.4951      $276.32      $318.83
                endoscopy &
                catheter.
50974........  Ureter           Y............  A2...........      $333.00      19.2251      $817.89      $454.22
                endoscopy &
                biopsy.
50976........  Ureter           Y............  A2...........      $333.00      19.2251      $817.89      $454.22
                endoscopy &
                treatment.
50980........  Ureter           Y............  A2...........      $333.00      19.2251      $817.89      $454.22
                endoscopy &
                treatment.
51000........  Drainage of      Y............  P3...........  ...........       1.1588       $49.30       $49.30
                bladder.
51005........  Drainage of      Y............  P2...........  ...........       1.0887       $46.32       $46.32
                bladder.
51010........  Drainage of      Y............  A2...........      $333.00      18.1679      $772.92      $442.98
                bladder.
51020........  Incise & treat   Y............  A2...........      $630.00      23.8700    $1,015.50      $726.38
                bladder.
51030........  Incise & treat   Y............  A2...........      $630.00      23.8700    $1,015.50      $726.38
                bladder.
51040........  Incise & drain   Y............  A2...........      $630.00      23.8700    $1,015.50      $726.38
                bladder.
51045........  Incise bladder/  Y............  A2...........      $399.24       6.4951      $276.32      $368.51
                drain ureter.
51050........  Removal of       Y............  A2...........      $630.00      23.8700    $1,015.50      $726.38
                bladder stone.
51065........  Remove ureter    Y............  A2...........      $630.00      23.8700    $1,015.50      $726.38
                calculus.
51080........  Drainage of      Y............  A2...........      $333.00      17.5086      $744.87      $435.97
                bladder
                abscess.
51500........  Removal of       Y............  A2...........      $630.00      29.2182    $1,243.03      $783.26
                bladder cyst.
51520........  Removal of       Y............  A2...........      $630.00      23.8700    $1,015.50      $726.38
                bladder lesion.
51600........  Injection for    .............  N1...........  ...........  ...........  ...........  ...........
                bladder x-ray.
51605........  Preparation for  .............  N1...........  ...........  ...........  ...........  ...........
                bladder xray.
51610........  Injection for    .............  N1...........  ...........  ...........  ...........  ...........
                bladder x-ray.
51700........  Irrigation of    Y............  P3...........  ...........       1.2554       $53.41       $53.41
                bladder.
51701........  Insert bladder   N............  P2...........  ...........       0.6102       $25.96       $25.96
                catheter.
51702........  Insert temp      N............  P2...........  ...........       0.6102       $25.96       $25.96
                bladder cath.
51703........  Insert bladder   Y............  P2...........  ...........       1.0887       $46.32       $46.32
                cath, complex.
51705........  Change of        Y............  P3...........  ...........       1.7302       $73.61       $73.61
                bladder tube.
51710........  Change of        Y............  A2...........      $333.00       7.4800      $318.22      $329.31
                bladder tube.
51715........  Endoscopic       Y............  A2...........      $510.00      29.0253    $1,234.82      $691.21
                injection/
                implant.
51720........  Treatment of     Y............  P3...........  ...........       1.3600       $57.86       $57.86
                bladder lesion.
51725........  Simple           Y............  P2...........  ...........       2.1393       $91.01       $91.01
                cystometrogram.
51726........  Complex          Y............  A2...........      $209.48       3.4079      $144.98      $193.36
                cystometrogram.
51736........  Urine flow       Y............  P3...........  ...........       0.4264       $18.14       $18.14
                measurement.
51741........  Electro-         Y............  P3...........  ...........       0.4990       $21.23       $21.23
                uroflowmetry,
                first.
51772........  Urethra          Y............  A2...........      $131.50       2.1393       $91.01      $121.38
                pressure
                profile.
51784........  Anal/urinary     Y............  P2...........  ...........       1.0887       $46.32       $46.32
                muscle study.
51785........  Anal/urinary     Y............  A2...........       $66.92       1.0887       $46.32       $61.77
                muscle study.
51792........  Urinary reflex   Y............  P2...........  ...........       1.0887       $46.32       $46.32
                study.
51795........  Urine voiding    Y............  P2...........  ...........       2.1393       $91.01       $91.01
                pressure study.
51797........  Intraabdominal   Y............  P2...........  ...........       2.1393       $91.01       $91.01
                pressure test.
51798........  Us urine         N............  P3...........  ...........       0.3702       $15.75       $15.75
                capacity
                measure.
51880........  Repair of        Y............  A2...........      $333.00      23.8700    $1,015.50      $503.63
                bladder
                opening.
51992........  Laparo sling     Y............  A2...........      $717.00      43.5488    $1,852.70    $1,000.93
                operation.
52000........  Cystoscopy.....  Y............  A2...........      $333.00       6.4951      $276.32      $318.83
52001........  Cystoscopy,      Y............  A2...........      $399.24       6.4951      $276.32      $368.51
                removal of
                clots.
52005........  Cystoscopy &     Y............  A2...........      $446.00      19.2251      $817.89      $538.97
                ureter
                catheter.
52007........  Cystoscopy and   Y............  A2...........      $446.00      19.2251      $817.89      $538.97
                biopsy.
52010........  Cystoscopy &     Y............  A2...........      $399.24       6.4951      $276.32      $368.51
                duct catheter.
52204........  Cystoscopy w/    Y............  A2...........      $446.00      19.2251      $817.89      $538.97
                biopsy(s).
52214........  Cystoscopy and   Y............  A2...........      $446.00      23.8700    $1,015.50      $588.38
                treatment.
52224........  Cystoscopy and   Y............  A2...........      $446.00      23.8700    $1,015.50      $588.38
                treatment.
52234........  Cystoscopy and   Y............  A2...........      $446.00      23.8700    $1,015.50      $588.38
                treatment.
52235........  Cystoscopy and   Y............  A2...........      $510.00      23.8700    $1,015.50      $636.38
                treatment.
52240........  Cystoscopy and   Y............  A2...........      $510.00      23.8700    $1,015.50      $636.38
                treatment.
52250........  Cystoscopy and   Y............  A2...........      $630.00      23.8700    $1,015.50      $726.38
                radiotracer.
52260........  Cystoscopy and   Y............  A2...........      $446.00      19.2251      $817.89      $538.97
                treatment.
52265........  Cystoscopy and   Y............  P2...........  ...........       6.4951      $276.32      $276.32
                treatment.
52270........  Cystoscopy &     Y............  A2...........      $446.00      19.2251      $817.89      $538.97
                revise urethra.
52275........  Cystoscopy &     Y............  A2...........      $446.00      19.2251      $817.89      $538.97
                revise urethra.
52276........  Cystoscopy and   Y............  A2...........      $510.00      19.2251      $817.89      $586.97
                treatment.
52277........  Cystoscopy and   Y............  A2...........      $446.00      23.8700    $1,015.50      $588.38
                treatment.
52281........  Cystoscopy and   Y............  A2...........      $446.00      19.2251      $817.89      $538.97
                treatment.
52282........  Cystoscopy,      Y............  A2...........    $1,339.00      34.9261    $1,485.86    $1,375.72
                implant stent.
52283........  Cystoscopy and   Y............  A2...........      $446.00      19.2251      $817.89      $538.97
                treatment.
52285........  Cystoscopy and   Y............  A2...........      $446.00      19.2251      $817.89      $538.97
                treatment.

[[Page 42589]]

 
52290........  Cystoscopy and   Y............  A2...........      $446.00      19.2251      $817.89      $538.97
                treatment.
52300........  Cystoscopy and   Y............  A2...........      $446.00      19.2251      $817.89      $538.97
                treatment.
52301........  Cystoscopy and   Y............  A2...........      $510.00      19.2251      $817.89      $586.97
                treatment.
52305........  Cystoscopy and   Y............  A2...........      $446.00      19.2251      $817.89      $538.97
                treatment.
52310........  Cystoscopy and   Y............  A2...........      $399.24       6.4951      $276.32      $368.51
                treatment.
52315........  Cystoscopy and   Y............  A2...........      $446.00      19.2251      $817.89      $538.97
                treatment.
52317........  Remove bladder   Y............  A2...........      $333.00      23.8700    $1,015.50      $503.63
                stone.
52318........  Remove bladder   Y............  A2...........      $446.00      23.8700    $1,015.50      $588.38
                stone.
52320........  Cystoscopy and   Y............  A2...........      $717.00      23.8700    $1,015.50      $791.63
                treatment.
52325........  Cystoscopy,      Y............  A2...........      $630.00      23.8700    $1,015.50      $726.38
                stone removal.
52327........  Cystoscopy,      Y............  A2...........      $446.00      23.8700    $1,015.50      $588.38
                inject
                material.
52330........  Cystoscopy and   Y............  A2...........      $446.00      23.8700    $1,015.50      $588.38
                treatment.
52332........  Cystoscopy and   Y............  A2...........      $446.00      23.8700    $1,015.50      $588.38
                treatment.
52334........  Create passage   Y............  A2...........      $510.00      23.8700    $1,015.50      $636.38
                to kidney.
52341........  Cysto w/ureter   Y............  A2...........      $510.00      23.8700    $1,015.50      $636.38
                stricture tx.
52342........  Cysto w/up       Y............  A2...........      $510.00      23.8700    $1,015.50      $636.38
                stricture tx.
52343........  Cysto w/renal    Y............  A2...........      $510.00      23.8700    $1,015.50      $636.38
                stricture tx.
52344........  Cysto/uretero,   Y............  A2...........      $510.00      23.8700    $1,015.50      $636.38
                stricture tx.
52345........  Cysto/uretero w/ Y............  A2...........      $510.00      23.8700    $1,015.50      $636.38
                up stricture.
52346........  Cystouretero w/  Y............  A2...........      $510.00      23.8700    $1,015.50      $636.38
                renal strict.
52351........  Cystouretero &   Y............  A2...........      $510.00      19.2251      $817.89      $586.97
                or pyeloscope.
52352........  Cystouretero w/  Y............  A2...........      $630.00      23.8700    $1,015.50      $726.38
                stone remove.
52353........  Cystouretero w/  Y............  A2...........      $630.00      34.9261    $1,485.86      $843.97
                lithotripsy.
52354........  Cystouretero w/  Y............  A2...........      $630.00      23.8700    $1,015.50      $726.38
                biopsy.
52355........  Cystouretero w/  Y............  A2...........      $630.00      23.8700    $1,015.50      $726.38
                excise tumor.
52400........  Cystouretero w/  Y............  A2...........      $510.00      23.8700    $1,015.50      $636.38
                congen repr.
52402........  Cystourethro     Y............  A2...........      $510.00      23.8700    $1,015.50      $636.38
                cut ejacul
                duct.
52450........  Incision of      Y............  A2...........      $510.00      23.8700    $1,015.50      $636.38
                prostate.
52500........  Revision of      Y............  A2...........      $510.00      23.8700    $1,015.50      $636.38
                bladder neck.
52510........  Dilation         Y............  A2...........      $510.00      19.2251      $817.89      $586.97
                prostatic
                urethra.
52601........  Prostatectomy    Y............  A2...........      $630.00      34.9261    $1,485.86      $843.97
                (TURP).
52606........  Control postop   Y............  A2...........      $333.00      23.8700    $1,015.50      $503.63
                bleeding.
52612........  Prostatectomy,   Y............  A2...........      $446.00      34.9261    $1,485.86      $705.97
                first stage.
52614........  Prostatectomy,   Y............  A2...........      $333.00      34.9261    $1,485.86      $621.22
                second stage.
52620........  Remove residual  Y............  A2...........      $333.00      34.9261    $1,485.86      $621.22
                prostate.
52630........  Remove prostate  Y............  A2...........      $446.00      34.9261    $1,485.86      $705.97
                regrowth.
52640........  Relieve bladder  Y............  A2...........      $446.00      23.8700    $1,015.50      $588.38
                contracture.
52647........  Laser surgery    Y............  A2...........    $1,339.00      43.1004    $1,833.62    $1,462.66
                of prostate.
52648........  Laser surgery    Y............  A2...........    $1,339.00      43.1004    $1,833.62    $1,462.66
                of prostate.
52700........  Drainage of      Y............  A2...........      $446.00      23.8700    $1,015.50      $588.38
                prostate
                abscess.
53000........  Incision of      Y............  A2...........      $333.00      18.3960      $782.62      $445.41
                urethra.
53010........  Incision of      Y............  A2...........      $333.00      18.3960      $782.62      $445.41
                urethra.
53020........  Incision of      Y............  A2...........      $333.00      18.3960      $782.62      $445.41
                urethra.
53025........  Incision of      Y............  R2...........  ...........      18.3960      $782.62      $782.62
                urethra.
53040........  Drainage of      Y............  A2...........      $446.00      18.3960      $782.62      $530.16
                urethra
                abscess.
53060........  Drainage of      Y............  P3...........  ...........       1.6416       $69.84       $69.84
                urethra
                abscess.
53080........  Drainage of      Y............  A2...........      $510.00      18.3960      $782.62      $578.16
                urinary
                leakage.
53085........  Drainage of      Y............  G2...........  ...........      18.3960      $782.62      $782.62
                urinary
                leakage.
53200........  Biopsy of        Y............  A2...........      $333.00      18.3960      $782.62      $445.41
                urethra.
53210........  Removal of       Y............  A2...........      $717.00      29.0253    $1,234.82      $846.46
                urethra.
53215........  Removal of       Y............  A2...........      $717.00      18.3960      $782.62      $733.41
                urethra.
53220........  Treatment of     Y............  A2...........      $446.00      29.0253    $1,234.82      $643.21
                urethra lesion.
53230........  Removal of       Y............  A2...........      $446.00      29.0253    $1,234.82      $643.21
                urethra lesion.
53235........  Removal of       Y............  A2...........      $510.00      18.3960      $782.62      $578.16
                urethra lesion.
53240........  Surgery for      Y............  A2...........      $446.00      29.0253    $1,234.82      $643.21
                urethra pouch.
53250........  Removal of       Y............  A2...........      $446.00      18.3960      $782.62      $530.16
                urethra gland.
53260........  Treatment of     Y............  A2...........      $446.00      18.3960      $782.62      $530.16
                urethra lesion.
53265........  Treatment of     Y............  A2...........      $446.00      18.3960      $782.62      $530.16
                urethra lesion.
53270........  Removal of       Y............  A2...........      $446.00      18.3960      $782.62      $530.16
                urethra gland.
53275........  Repair of        Y............  A2...........      $446.00      18.3960      $782.62      $530.16
                urethra defect.
53400........  Revise urethra,  Y............  A2...........      $510.00      29.0253    $1,234.82      $691.21
                stage 1.
53405........  Revise urethra,  Y............  A2...........      $446.00      29.0253    $1,234.82      $643.21
                stage 2.
53410........  Reconstruction   Y............  A2...........      $446.00      29.0253    $1,234.82      $643.21
                of urethra.

[[Page 42590]]

 
53420........  Reconstruct      Y............  A2...........      $510.00      29.0253    $1,234.82      $691.21
                urethra, stage
                1.
53425........  Reconstruct      Y............  A2...........      $446.00      29.0253    $1,234.82      $643.21
                urethra, stage
                2.
53430........  Reconstruction   Y............  A2...........      $446.00      29.0253    $1,234.82      $643.21
                of urethra.
53431........  Reconstruct      Y............  A2...........      $446.00      29.0253    $1,234.82      $643.21
                urethra/
                bladder.
53440........  Male sling       N............  A2...........      $446.00      79.2092    $3,369.80    $1,176.95
                procedure.
53442........  Remove/revise    Y............  A2...........      $333.00      29.0253    $1,234.82      $558.46
                male sling.
53444........  Insert tandem    N............  A2...........      $446.00      79.2092    $3,369.80    $1,176.95
                cuff.
53445........  Insert uro/ves   N............  H8...........      $333.00     178.7754    $7,605.64    $6,152.75
                nck sphincter.
53446........  Remove uro       Y............  A2...........      $333.00      29.0253    $1,234.82      $558.46
                sphincter.
53447........  Remove/replace   N............  H8...........      $333.00     178.7754    $7,605.64    $6,152.75
                ur sphincter.
53449........  Repair uro       Y............  A2...........      $333.00      29.0253    $1,234.82      $558.46
                sphincter.
53450........  Revision of      Y............  A2...........      $333.00      29.0253    $1,234.82      $558.46
                urethra.
53460........  Revision of      Y............  A2...........      $333.00      18.3960      $782.62      $445.41
                urethra.
53502........  Repair of        Y............  A2...........      $446.00      18.3960      $782.62      $530.16
                urethra injury.
53505........  Repair of        Y............  A2...........      $446.00      29.0253    $1,234.82      $643.21
                urethra injury.
53510........  Repair of        Y............  A2...........      $446.00      18.3960      $782.62      $530.16
                urethra injury.
53515........  Repair of        Y............  A2...........      $446.00      29.0253    $1,234.82      $643.21
                urethra injury.
53520........  Repair of        Y............  A2...........      $446.00      29.0253    $1,234.82      $643.21
                urethra defect.
53600........  Dilate urethra   Y............  P3...........  ...........       0.9254       $39.37       $39.37
                stricture.
53601........  Dilate urethra   Y............  P3...........  ...........       1.0702       $45.53       $45.53
                stricture.
53605........  Dilate urethra   Y............  A2...........      $446.00      19.2251      $817.89      $538.97
                stricture.
53620........  Dilate urethra   Y............  P3...........  ...........       1.4888       $63.34       $63.34
                stricture.
53621........  Dilate urethra   Y............  P3...........  ...........       1.5692       $66.76       $66.76
                stricture.
53660........  Dilation of      Y............  P3...........  ...........       1.0542       $44.85       $44.85
                urethra.
53661........  Dilation of      Y............  P3...........  ...........       1.0462       $44.51       $44.51
                urethra.
53665........  Dilation of      Y............  A2...........      $333.00      18.3960      $782.62      $445.41
                urethra.
53850........  Prostatic        Y............  P2...........  ...........      41.1375    $1,750.11    $1,750.11
                microwave
                thermotx.
53852........  Prostatic rf     Y............  P2...........  ...........      41.1375    $1,750.11    $1,750.11
                thermotx.
53853........  Prostatic water  Y............  P2...........  ...........      23.8700    $1,015.50    $1,015.50
                thermother.
54000........  Slitting of      Y............  A2...........      $446.00      18.3960      $782.62      $530.16
                prepuce.
54001........  Slitting of      Y............  A2...........      $446.00      18.3960      $782.62      $530.16
                prepuce.
54015........  Drain penis      Y............  A2...........      $630.00      17.5086      $744.87      $658.72
                lesion.
54050........  Destruction,     Y............  P2...........  ...........       1.0918       $46.45       $46.45
                penis
                lesion(s).
54055........  Destruction,     Y............  P3...........  ...........       1.4404       $61.28       $61.28
                penis
                lesion(s).
54056........  Cryosurgery,     Y............  P2...........  ...........       0.8432       $35.87       $35.87
                penis
                lesion(s).
54057........  Laser surg,      Y............  A2...........      $333.00      17.4423      $742.05      $435.26
                penis
                lesion(s).
54060........  Excision of      Y............  A2...........      $333.00      17.4423      $742.05      $435.26
                penis
                lesion(s).
54065........  Destruction,     Y............  A2...........      $333.00      20.4276      $869.05      $467.01
                penis
                lesion(s).
54100........  Biopsy of penis  Y............  A2...........      $333.00      15.1024      $642.50      $410.38
54105........  Biopsy of penis  Y............  A2...........      $333.00      20.0656      $853.65      $463.16
54110........  Treatment of     Y............  A2...........      $446.00      32.9873    $1,403.38      $685.35
                penis lesion.
54111........  Treat penis      Y............  A2...........      $446.00      32.9873    $1,403.38      $685.35
                lesion, graft.
54112........  Treat penis      Y............  A2...........      $446.00      32.9873    $1,403.38      $685.35
                lesion, graft.
54115........  Treatment of     Y............  A2...........      $333.00      17.5086      $744.87      $435.97
                penis lesion.
54120........  Partial removal  Y............  A2...........      $446.00      32.9873    $1,403.38      $685.35
                of penis.
54150........  Circumcision w/  Y............  A2...........      $333.00      20.5513      $874.31      $468.33
                regionl block.
54160........  Circumcision,    Y............  A2...........      $446.00      20.5513      $874.31      $553.08
                neonate.
54161........  Circum 28 days   Y............  A2...........      $446.00      20.5513      $874.31      $553.08
                or older.
54162........  Lysis penil      Y............  A2...........      $446.00      20.5513      $874.31      $553.08
                circumic
                lesion.
54163........  Repair of        Y............  A2...........      $446.00      20.5513      $874.31      $553.08
                circumcision.
54164........  Frenulotomy of   Y............  A2...........      $446.00      20.5513      $874.31      $553.08
                penis.
54200........  Treatment of     Y............  P3...........  ...........       1.5370       $65.39       $65.39
                penis lesion.
54205........  Treatment of     Y............  A2...........      $630.00      32.9873    $1,403.38      $823.35
                penis lesion.
54220........  Treatment of     Y............  A2...........      $131.50       2.1393       $91.01      $121.38
                penis lesion.
54230........  Prepare penis    .............  N1...........  ...........  ...........  ...........  ...........
                study.
54231........  Dynamic          Y............  P3...........  ...........       1.3036       $55.46       $55.46
                cavernosometry.
54235........  Penile           Y............  P3...........  ...........       0.9496       $40.40       $40.40
                injection.
54240........  Penis study....  Y............  P3...........  ...........       0.6518       $27.73       $27.73
54250........  Penis study....  Y............  P3...........  ...........       0.2254        $9.59        $9.59
54300........  Revision of      Y............  A2...........      $510.00      32.9873    $1,403.38      $733.35
                penis.
54304........  Revision of      Y............  A2...........      $510.00      32.9873    $1,403.38      $733.35
                penis.
54308........  Reconstruction   Y............  A2...........      $510.00      32.9873    $1,403.38      $733.35
                of urethra.
54312........  Reconstruction   Y............  A2...........      $510.00      32.9873    $1,403.38      $733.35
                of urethra.

[[Page 42591]]

 
54316........  Reconstruction   Y............  A2...........      $510.00      32.9873    $1,403.38      $733.35
                of urethra.
54318........  Reconstruction   Y............  A2...........      $510.00      32.9873    $1,403.38      $733.35
                of urethra.
54322........  Reconstruction   Y............  A2...........      $510.00      32.9873    $1,403.38      $733.35
                of urethra.
54324........  Reconstruction   Y............  A2...........      $510.00      32.9873    $1,403.38      $733.35
                of urethra.
54326........  Reconstruction   Y............  A2...........      $510.00      32.9873    $1,403.38      $733.35
                of urethra.
54328........  Revise penis/    Y............  A2...........      $510.00      32.9873    $1,403.38      $733.35
                urethra.
54340........  Secondary        Y............  A2...........      $510.00      32.9873    $1,403.38      $733.35
                urethral
                surgery.
54344........  Secondary        Y............  A2...........      $510.00      32.9873    $1,403.38      $733.35
                urethral
                surgery.
54348........  Secondary        Y............  A2...........      $510.00      32.9873    $1,403.38      $733.35
                urethral
                surgery.
54352........  Reconstruct      Y............  A2...........      $510.00      32.9873    $1,403.38      $733.35
                urethra/penis.
54360........  Penis plastic    Y............  A2...........      $510.00      32.9873    $1,403.38      $733.35
                surgery.
54380........  Repair penis...  Y............  A2...........      $510.00      32.9873    $1,403.38      $733.35
54385........  Repair penis...  Y............  A2...........      $510.00      32.9873    $1,403.38      $733.35
54400........  Insert semi-     N............  A2...........      $510.00      79.2092    $3,369.80    $1,224.95
                rigid
                prosthesis.
54401........  Insert self-     N............  H8...........      $510.00     178.7754    $7,605.64    $6,285.50
                contd
                prosthesis.
54405........  Insert multi-    N............  H8...........      $510.00     178.7754    $7,605.64    $6,285.50
                comp penis
                pros.
54406........  Remove muti-     Y............  A2...........      $510.00      32.9873    $1,403.38      $733.35
                comp penis
                pros.
54408........  Repair multi-    Y............  A2...........      $510.00      32.9873    $1,403.38      $733.35
                comp penis
                pros.
54410........  Remove/replace   N............  H8...........      $510.00     178.7754    $7,605.64    $6,285.50
                penis prosth.
54415........  Remove self-     Y............  A2...........      $510.00      32.9873    $1,403.38      $733.35
                contd penis
                pros.
54416........  Remv/repl penis  N............  H8...........      $510.00     178.7754    $7,605.64    $6,285.50
                contain pros.
54420........  Revision of      Y............  A2...........      $630.00      32.9873    $1,403.38      $823.35
                penis.
54435........  Revision of      Y............  A2...........      $630.00      32.9873    $1,403.38      $823.35
                penis.
54440........  Repair of penis  Y............  A2...........      $630.00      32.9873    $1,403.38      $823.35
54450........  Preputial        Y............  A2...........      $209.48       3.4079      $144.98      $193.36
                stretching.
54500........  Biopsy of        Y............  A2...........      $333.00      10.2655      $436.73      $358.93
                testis.
54505........  Biopsy of        Y............  A2...........      $333.00      23.5310    $1,001.08      $500.02
                testis.
54512........  Excise lesion    Y............  A2...........      $446.00      23.5310    $1,001.08      $584.77
                testis.
54520........  Removal of       Y............  A2...........      $510.00      23.5310    $1,001.08      $632.77
                testis.
54522........  Orchiectomy,     Y............  A2...........      $510.00      23.5310    $1,001.08      $632.77
                partial.
54530........  Removal of       Y............  A2...........      $630.00      29.2182    $1,243.03      $783.26
                testis.
54550........  Exploration for  Y............  A2...........      $630.00      29.2182    $1,243.03      $783.26
                testis.
54560........  Exploration for  Y............  G2...........  ...........      23.5310    $1,001.08    $1,001.08
                testis.
54600........  Reduce testis    Y............  A2...........      $630.00      23.5310    $1,001.08      $722.77
                torsion.
54620........  Suspension of    Y............  A2...........      $510.00      23.5310    $1,001.08      $632.77
                testis.
54640........  Suspension of    Y............  A2...........      $630.00      29.2182    $1,243.03      $783.26
                testis.
54660........  Revision of      Y............  A2...........      $446.00      23.5310    $1,001.08      $584.77
                testis.
54670........  Repair testis    Y............  A2...........      $510.00      23.5310    $1,001.08      $632.77
                injury.
54680........  Relocation of    Y............  A2...........      $510.00      23.5310    $1,001.08      $632.77
                testis(es).
54690........  Laparoscopy,     Y............  A2...........    $1,339.00      43.5488    $1,852.70    $1,467.43
                orchiectomy.
54692........  Laparoscopy,     Y............  G2...........  ...........      70.5066    $2,999.56    $2,999.56
                orchiopexy.
54700........  Drainage of      Y............  A2...........      $446.00      23.5310    $1,001.08      $584.77
                scrotum.
54800........  Biopsy of        Y............  A2...........      $127.16       2.0687       $88.01      $117.37
                epididymis.
54830........  Remove           Y............  A2...........      $510.00      23.5310    $1,001.08      $632.77
                epididymis
                lesion.
54840........  Remove           Y............  A2...........      $630.00      23.5310    $1,001.08      $722.77
                epididymis
                lesion.
54860........  Removal of       Y............  A2...........      $510.00      23.5310    $1,001.08      $632.77
                epididymis.
54861........  Removal of       Y............  A2...........      $630.00      23.5310    $1,001.08      $722.77
                epididymis.
54865........  Explore          Y............  A2...........      $333.00      23.5310    $1,001.08      $500.02
                epididymis.
54900........  Fusion of        Y............  A2...........      $630.00      23.5310    $1,001.08      $722.77
                spermatic
                ducts.
54901........  Fusion of        Y............  A2...........      $630.00      23.5310    $1,001.08      $722.77
                spermatic
                ducts.
55000........  Drainage of      Y............  P3...........  ...........       1.5772       $67.10       $67.10
                hydrocele.
55040........  Removal of       Y............  A2...........      $510.00      29.2182    $1,243.03      $693.26
                hydrocele.
55041........  Removal of       Y............  A2...........      $717.00      29.2182    $1,243.03      $848.51
                hydroceles.
55060........  Repair of        Y............  A2...........      $630.00      23.5310    $1,001.08      $722.77
                hydrocele.
55100........  Drainage of      Y............  A2...........      $333.00      11.1535      $474.50      $368.38
                scrotum
                abscess.
55110........  Explore scrotum  Y............  A2...........      $446.00      23.5310    $1,001.08      $584.77
55120........  Removal of       Y............  A2...........      $446.00      23.5310    $1,001.08      $584.77
                scrotum lesion.
55150........  Removal of       Y............  A2...........      $333.00      23.5310    $1,001.08      $500.02
                scrotum.
55175........  Revision of      Y............  A2...........      $333.00      23.5310    $1,001.08      $500.02
                scrotum.
55180........  Revision of      Y............  A2...........      $446.00      23.5310    $1,001.08      $584.77
                scrotum.
55200........  Incision of      Y............  A2...........      $446.00      23.5310    $1,001.08      $584.77
                sperm duct.
55250........  Removal of       Y............  A2...........      $446.00      23.5310    $1,001.08      $584.77
                sperm duct(s).
55300........  Prepare, sperm   .............  N1...........  ...........  ...........  ...........  ...........
                duct x-ray.

[[Page 42592]]

 
55400........  Repair of sperm  Y............  A2...........      $333.00      23.5310    $1,001.08      $500.02
                duct.
55450........  Ligation of      Y............  P3...........  ...........       5.2227      $222.19      $222.19
                sperm duct.
55500........  Removal of       Y............  A2...........      $510.00      23.5310    $1,001.08      $632.77
                hydrocele.
55520........  Removal of       Y............  A2...........      $630.00      23.5310    $1,001.08      $722.77
                sperm cord
                lesion.
55530........  Revise           Y............  A2...........      $630.00      23.5310    $1,001.08      $722.77
                spermatic cord
                veins.
55535........  Revise           Y............  A2...........      $630.00      29.2182    $1,243.03      $783.26
                spermatic cord
                veins.
55540........  Revise hernia &  Y............  A2...........      $717.00      29.2182    $1,243.03      $848.51
                sperm veins.
55550........  Laparo ligate    Y............  A2...........    $1,339.00      43.5488    $1,852.70    $1,467.43
                spermatic vein.
55600........  Incise sperm     Y............  R2...........  ...........      23.5310    $1,001.08    $1,001.08
                duct pouch.
55680........  Remove sperm     Y............  A2...........      $333.00      23.5310    $1,001.08      $500.02
                pouch lesion.
55700........  Biopsy of        Y............  A2...........      $345.83       5.6262      $239.36      $319.21
                prostate.
55705........  Biopsy of        Y............  A2...........      $345.83       5.6262      $239.36      $319.21
                prostate.
55720........  Drainage of      Y............  A2...........      $333.00      23.8700    $1,015.50      $503.63
                prostate
                abscess.
55725........  Drainage of      Y............  A2...........      $446.00      23.8700    $1,015.50      $588.38
                prostate
                abscess.
55860........  Surgical         Y............  G2...........  ...........      18.1679      $772.92      $772.92
                exposure,
                prostate.
55870........  Electroejaculat  Y............  P3...........  ...........       1.6094       $68.47       $68.47
                ion.
55873........  Cryoablate       Y............  H8...........    $1,339.00     137.5639    $5,852.38    $5,252.74
                prostate.
55875........  Transperi        Y............  A2...........    $1,339.00      34.9261    $1,485.86    $1,375.72
                needle place,
                pros.
55876 \*\....  Place rt device/ Y............  P3...........  ...........       1.6416       $69.84       $69.84
                marker, pros.
56405........  I & D of vulva/  Y............  P3...........  ...........       1.0058       $42.79       $42.79
                perineum.
56420........  Drainage of      Y............  P2...........  ...........       1.2900       $54.88       $54.88
                gland abscess.
56440........  Surgery for      Y............  A2...........      $446.00      20.5081      $872.48      $552.62
                vulva lesion.
56441........  Lysis of labial  Y............  A2...........      $333.00      14.8489      $631.72      $407.68
                lesion(s).
56442........  Hymenotomy.....  Y............  A2...........      $333.00      14.8489      $631.72      $407.68
56501........  Destroy, vulva   Y............  P3...........  ...........       1.3680       $58.20       $58.20
                lesions, sim.
56515........  Destroy vulva    Y............  A2...........      $510.00      20.4276      $869.05      $599.76
                lesion/s compl.
56605........  Biopsy of vulva/ Y............  P3...........  ...........       0.7966       $33.89       $33.89
                perineum.
56606........  Biopsy of vulva/ Y............  P3...........  ...........       0.3460       $14.72       $14.72
                perineum.
56620........  Partial removal  Y............  A2...........      $717.00      28.5095    $1,212.88      $840.97
                of vulva.
56625........  Complete         Y............  A2...........      $995.00      28.5095    $1,212.88    $1,049.47
                removal of
                vulva.
56700........  Partial removal  Y............  A2...........      $333.00      20.5081      $872.48      $467.87
                of hymen.
56740........  Remove vagina    Y............  A2...........      $510.00      20.5081      $872.48      $600.62
                gland lesion.
56800........  Repair of        Y............  A2...........      $510.00      20.5081      $872.48      $600.62
                vagina.
56805........  Repair clitoris  Y............  G2...........  ...........      14.8489      $631.72      $631.72
56810........  Repair of        Y............  A2...........      $717.00      20.5081      $872.48      $755.87
                perineum.
56820........  Exam of vulva w/ Y............  P3...........  ...........       1.0058       $42.79       $42.79
                scope.
56821........  Exam/biopsy of   Y............  P3...........  ...........       1.3116       $55.80       $55.80
                vulva w/scope.
57000........  Exploration of   Y............  A2...........      $333.00      14.8489      $631.72      $407.68
                vagina.
57010........  Drainage of      Y............  A2...........      $446.00      14.8489      $631.72      $492.43
                pelvic abscess.
57020........  Drainage of      Y............  A2...........      $409.33       6.6592      $283.30      $377.82
                pelvic fluid.
57022........  I & d vaginal    Y............  G2...........  ...........      11.1535      $474.50      $474.50
                hematoma, pp.
57023........  I & d vag        Y............  A2...........      $333.00      17.5086      $744.87      $435.97
                hematoma, non-
                ob.
57061........  Destroy vag      Y............  P3...........  ...........       1.2634       $53.75       $53.75
                lesions,
                simple.
57065........  Destroy vag      Y............  A2...........      $333.00      20.5081      $872.48      $467.87
                lesions,
                complex.
57100........  Biopsy of        Y............  P3...........  ...........       0.8048       $34.24       $34.24
                vagina.
57105........  Biopsy of        Y............  A2...........      $446.00      20.5081      $872.48      $552.62
                vagina.
57130........  Remove vagina    Y............  A2...........      $446.00      20.5081      $872.48      $552.62
                lesion.
57135........  Remove vagina    Y............  A2...........      $446.00      20.5081      $872.48      $552.62
                lesion.
57150........  Treat vagina     Y............  P2...........  ...........       0.1468        $6.25        $6.25
                infection.
57155........  Insert uteri     Y............  A2...........      $409.33       6.6592      $283.30      $377.82
                tandems/ovoids.
57160........  Insert pessary/  Y............  P3...........  ...........       0.8208       $34.92       $34.92
                other device.
57170........  Fitting of       Y............  P2...........  ...........       0.1468        $6.25        $6.25
                diaphragm/cap.
57180........  Treat vaginal    Y............  A2...........      $178.05       2.8966      $123.23      $164.35
                bleeding.
57200........  Repair of        Y............  A2...........      $333.00      20.5081      $872.48      $467.87
                vagina.
57210........  Repair vagina/   Y............  A2...........      $446.00      20.5081      $872.48      $552.62
                perineum.
57220........  Revision of      Y............  A2...........      $510.00      42.9896    $1,828.91      $839.73
                urethra.
57230........  Repair of        Y............  A2...........      $510.00      28.5095    $1,212.88      $685.72
                urethral
                lesion.
57240........  Repair bladder   Y............  A2...........      $717.00      28.5095    $1,212.88      $840.97
                & vagina.
57250........  Repair rectum &  Y............  A2...........      $717.00      28.5095    $1,212.88      $840.97
                vagina.
57260........  Repair of        Y............  A2...........      $717.00      28.5095    $1,212.88      $840.97
                vagina.
57265........  Extensive        Y............  A2...........      $995.00      42.9896    $1,828.91    $1,203.48
                repair of
                vagina.
57267........  Insert mesh/     Y............  A2...........      $995.00      28.5095    $1,212.88    $1,049.47
                pelvic flr
                addon.
57268........  Repair of bowel  Y............  A2...........      $510.00      28.5095    $1,212.88      $685.72
                bulge.

[[Page 42593]]

 
57287........  Revise/remove    Y............  G2...........  ...........      28.5095    $1,212.88    $1,212.88
                sling repair.
57288........  Repair bladder   Y............  A2...........      $717.00      42.9896    $1,828.91      $994.98
                defect.
57289........  Repair bladder   Y............  A2...........      $717.00      28.5095    $1,212.88      $840.97
                & vagina.
57291........  Construction of  Y............  A2...........      $717.00      28.5095    $1,212.88      $840.97
                vagina.
57300........  Repair rectum-   Y............  A2...........      $510.00      28.5095    $1,212.88      $685.72
                vagina fistula.
57320........  Repair bladder-  Y............  G2...........  ...........      28.5095    $1,212.88    $1,212.88
                vagina lesion.
57400........  Dilation of      Y............  A2...........      $446.00      20.5081      $872.48      $552.62
                vagina.
57410........  Pelvic           Y............  A2...........      $446.00      14.8489      $631.72      $492.43
                examination.
57415........  Remove vaginal   Y............  A2...........      $446.00      20.5081      $872.48      $552.62
                foreign body.
57420........  Exam of vagina   Y............  P3...........  ...........       1.0380       $44.16       $44.16
                w/scope.
57421........  Exam/biopsy of   Y............  P3...........  ...........       1.3842       $58.89       $58.89
                vag w/scope.
57452........  Exam of cervix   Y............  P3...........  ...........       0.9818       $41.77       $41.77
                w/scope.
57454........  Bx/curett of     Y............  P3...........  ...........       1.2232       $52.04       $52.04
                cervix w/scope.
57455........  Biopsy of        Y............  P3...........  ...........       1.2876       $54.78       $54.78
                cervix w/scope.
57456........  Endocerv         Y............  P3...........  ...........       1.2474       $53.07       $53.07
                curettage w/
                scope.
57460........  Bx of cervix w/  Y............  P3...........  ...........       4.0639      $172.89      $172.89
                scope, leep.
57461........  Conz of cervix   Y............  P3...........  ...........       4.2811      $182.13      $182.13
                w/scope, leep.
57500........  Biopsy of        Y............  P3...........  ...........       1.8186       $77.37       $77.37
                cervix.
57505........  Endocervical     Y............  P3...........  ...........       1.1104       $47.24       $47.24
                curettage.
57510........  Cauterization    Y............  P3...........  ...........       1.1508       $48.96       $48.96
                of cervix.
57511........  Cryocautery of   Y............  P2...........  ...........       1.2900       $54.88       $54.88
                cervix.
57513........  Laser surgery    Y............  A2...........      $446.00      14.8489      $631.72      $492.43
                of cervix.
57520........  Conization of    Y............  A2...........      $446.00      20.5081      $872.48      $552.62
                cervix.
57522........  Conization of    Y............  A2...........      $446.00      28.5095    $1,212.88      $637.72
                cervix.
57530........  Removal of       Y............  A2...........      $510.00      28.5095    $1,212.88      $685.72
                cervix.
57550........  Removal of       Y............  A2...........      $510.00      28.5095    $1,212.88      $685.72
                residual
                cervix.
57556........  Remove cervix,   Y............  A2...........      $717.00      42.9896    $1,828.91      $994.98
                repair bowel.
57558........  D&c of cervical  Y............  A2...........      $510.00      17.7499      $755.13      $571.28
                stump.
57700........  Revision of      Y............  A2...........      $333.00      20.5081      $872.48      $467.87
                cervix.
57720........  Revision of      Y............  A2...........      $510.00      20.5081      $872.48      $600.62
                cervix.
57800........  Dilation of      Y............  P3...........  ...........       0.5874       $24.99       $24.99
                cervical canal.
58100........  Biopsy of        Y............  P3...........  ...........       0.9818       $41.77       $41.77
                uterus lining.
58110 \*\....  Bx done w/       Y............  P3...........  ...........       0.3782       $16.09       $16.09
                colposcopy add-
                on.
58120........  Dilation and     Y............  A2...........      $446.00      17.7499      $755.13      $523.28
                curettage.
58145........  Myomectomy vag   Y............  A2...........      $717.00      28.5095    $1,212.88      $840.97
                method.
58301........  Remove           Y............  P3...........  ...........       0.9496       $40.40       $40.40
                intrauterine
                device.
58321........  Artificial       Y............  P3...........  ...........       0.8450       $35.95       $35.95
                insemination.
58322........  Artificial       Y............  P3...........  ...........       0.9012       $38.34       $38.34
                insemination.
58323........  Sperm washing..  Y............  P3...........  ...........       0.2736       $11.64       $11.64
58340........  Catheter for     .............  N1...........  ...........  ...........  ...........  ...........
                hysterography.
58345........  Reopen           Y............  R2...........  ...........      14.8489      $631.72      $631.72
                fallopian tube.
58346........  Insert heyman    Y............  A2...........      $446.00      14.8489      $631.72      $492.43
                uteri capsule.
58350........  Reopen           Y............  A2...........      $510.00      28.5095    $1,212.88      $685.72
                fallopian tube.
58353........  Endometr         Y............  A2...........      $995.00      28.5095    $1,212.88    $1,049.47
                ablate,
                thermal.
58356........  Endometrial      Y............  P3...........  ...........      41.9827    $1,786.07    $1,786.07
                cryoablation.
58545........  Laparoscopic     Y............  A2...........    $1,339.00      32.1241    $1,366.66    $1,345.92
                myomectomy.
58546........  Laparo-          Y............  A2...........    $1,339.00      43.5488    $1,852.70    $1,467.43
                myomectomy,
                complex.
58550........  Laparo-asst vag  Y............  A2...........    $1,339.00      70.5066    $2,999.56    $1,754.14
                hysterectomy.
58552........  Laparo-vag hyst  Y............  G2...........  ...........      43.5488    $1,852.70    $1,852.70
                incl t/o.
58555........  Hysteroscopy,    Y............  A2...........      $333.00      21.3586      $908.66      $476.92
                dx, sep proc.
58558........  Hysteroscopy,    Y............  A2...........      $510.00      21.3586      $908.66      $609.67
                biopsy.
58559........  Hysteroscopy,    Y............  A2...........      $446.00      21.3586      $908.66      $561.67
                lysis.
58560........  Hysteroscopy,    Y............  A2...........      $510.00      34.0155    $1,447.12      $744.28
                resect septum.
58561........  Hysteroscopy,    Y............  A2...........      $510.00      34.0155    $1,447.12      $744.28
                remove myoma.
58562........  Hysteroscopy,    Y............  A2...........      $510.00      21.3586      $908.66      $609.67
                remove fb.
58563........  Hysteroscopy,    Y............  A2...........    $1,339.00      34.0155    $1,447.12    $1,366.03
                ablation.
58565........  Hysteroscopy,    Y............  A2...........    $1,339.00      42.9896    $1,828.91    $1,461.48
                sterilization.
58600........  Division of      Y............  G2...........  ...........      28.5095    $1,212.88    $1,212.88
                fallopian tube.
58615........  Occlude          Y............  G2...........  ...........      20.5081      $872.48      $872.48
                fallopian
                tube(s).
58660........  Laparoscopy,     Y............  A2...........      $717.00      43.5488    $1,852.70    $1,000.93
                lysis.
58661........  Laparoscopy,     Y............  A2...........      $717.00      43.5488    $1,852.70    $1,000.93
                remove adnexa.
58662........  Laparoscopy,     Y............  A2...........      $717.00      43.5488    $1,852.70    $1,000.93
                excise lesions.
58670........  Laparoscopy,     Y............  A2...........      $510.00      43.5488    $1,852.70      $845.68
                tubal cautery.

[[Page 42594]]

 
58671........  Laparoscopy,     Y............  A2...........      $510.00      43.5488    $1,852.70      $845.68
                tubal block.
58672........  Laparoscopy,     Y............  A2...........      $717.00      43.5488    $1,852.70    $1,000.93
                fimbrioplasty.
58673........  Laparoscopy,     Y............  A2...........      $717.00      43.5488    $1,852.70    $1,000.93
                salpingostomy.
58800........  Drainage of      Y............  A2...........      $510.00      14.8489      $631.72      $540.43
                ovarian
                cyst(s).
58820........  Drain ovary      Y............  A2...........      $510.00      28.5095    $1,212.88      $685.72
                abscess, open.
58900........  Biopsy of        Y............  A2...........      $510.00      14.8489      $631.72      $540.43
                ovary(s).
58970........  Retrieval of     Y............  A2...........      $245.92       4.0007      $170.20      $226.99
                oocyte.
58974........  Transfer of      Y............  A2...........      $245.92       4.0007      $170.20      $226.99
                embryo.
58976........  Transfer of      Y............  A2...........      $245.92       4.0007      $170.20      $226.99
                embryo.
59000........  Amniocentesis,   Y............  P2...........  ...........       1.4222       $60.50       $60.50
                diagnostic.
59001........  Amniocentesis,   Y............  R2...........  ...........       6.6592      $283.30      $283.30
                therapeutic.
59012........  Fetal cord       Y............  G2...........  ...........       1.4222       $60.50       $60.50
                puncture,
                prenatal.
59015........  Chorion biopsy.  Y............  P3...........  ...........       1.1910       $50.67       $50.67
59020........  Fetal contract   Y............  P3...........  ...........       0.5632       $23.96       $23.96
                stress test.
59025........  Fetal non-       Y............  P3...........  ...........       0.2816       $11.98       $11.98
                stress test.
59070........  Transabdom       Y............  G2...........  ...........       1.4222       $60.50       $60.50
                amnioinfus w/
                us.
59072........  Umbilical cord   Y............  G2...........  ...........       1.4222       $60.50       $60.50
                occlud w/us.
59076........  Fetal shunt      Y............  G2...........  ...........       1.4222       $60.50       $60.50
                placement, w/
                us.
59100........  Remove uterus    Y............  R2...........  ...........      28.5095    $1,212.88    $1,212.88
                lesion.
59150........  Treat ectopic    Y............  G2...........  ...........      43.5488    $1,852.70    $1,852.70
                pregnancy.
59151........  Treat ectopic    Y............  G2...........  ...........      43.5488    $1,852.70    $1,852.70
                pregnancy.
59160........  D& c after       Y............  A2...........      $510.00      17.7499      $755.13      $571.28
                delivery.
59200........  Insert cervical  Y............  P3...........  ...........       0.8530       $36.29       $36.29
                dilator.
59300........  Episiotomy or    Y............  P3...........  ...........       1.7542       $74.63       $74.63
                vaginal repair.
59320........  Revision of      Y............  A2...........      $333.00      20.5081      $872.48      $467.87
                cervix.
59412........  Antepartum       Y............  G2...........  ...........       2.3864      $101.52      $101.52
                manipulation.
59414........  Deliver          Y............  G2...........  ...........      14.8489      $631.72      $631.72
                placenta.
59812........  Treatment of     Y............  A2...........      $717.00      18.5201      $787.90      $734.73
                miscarriage.
59820........  Care of          Y............  A2...........      $717.00      18.5201      $787.90      $734.73
                miscarriage.
59821........  Treatment of     Y............  A2...........      $717.00      18.5201      $787.90      $734.73
                miscarriage.
59840........  Abortion.......  Y............  A2...........      $717.00      16.9328      $720.37      $717.84
59841........  Abortion.......  Y............  A2...........      $717.00      16.9328      $720.37      $717.84
59866........  Abortion (mpr).  Y............  G2...........  ...........       1.4222       $60.50       $60.50
59870........  Evacuate mole    Y............  A2...........      $717.00      18.5201      $787.90      $734.73
                of uterus.
59871........  Remove cerclage  Y............  A2...........      $717.00      20.5081      $872.48      $755.87
                suture.
60000........  Drain thyroid/   Y............  A2...........      $333.00       7.5511      $321.25      $330.06
                tongue cyst.
60001........  Aspirate/inject  Y............  P3...........  ...........       1.3116       $55.80       $55.80
                thyriod cyst.
60100........  Biopsy of        Y............  P3...........  ...........       1.0462       $44.51       $44.51
                thyroid.
60200........  Remove thyroid   Y............  A2...........      $446.00      37.7224    $1,604.82      $735.71
                lesion.
60280........  Remove thyroid   Y............  A2...........      $630.00      37.7224    $1,604.82      $873.71
                duct lesion.
60281........  Remove thyroid   Y............  A2...........      $630.00      37.7224    $1,604.82      $873.71
                duct lesion.
61000........  Remove cranial   Y............  R2...........  ...........       2.9907      $127.23      $127.23
                cavity fluid.
61001........  Remove cranial   Y............  R2...........  ...........       2.9907      $127.23      $127.23
                cavity fluid.
61020........  Remove brain     Y............  A2...........      $183.83       2.9907      $127.23      $169.68
                cavity fluid.
61026........  Injection into   Y............  A2...........      $183.83       2.9907      $127.23      $169.68
                brain canal.
61050........  Remove brain     Y............  A2...........      $183.83       2.9907      $127.23      $169.68
                canal fluid.
61055........  Injection into   Y............  A2...........      $183.83       2.9907      $127.23      $169.68
                brain canal.
61070........  Brain canal      Y............  A2...........      $183.83       2.9907      $127.23      $169.68
                shunt
                procedure.
61215........  Insert brain-    Y............  A2...........      $510.00      47.0342    $2,000.98      $882.75
                fluid device.
61330........  Decompress eye   Y............  G2...........  ...........      38.1991    $1,625.10    $1,625.10
                socket.
61334........  Explore orbit/   Y............  G2...........  ...........      38.1991    $1,625.10    $1,625.10
                remove object.
61790........  Treat            Y............  A2...........      $510.00      17.8499      $759.39      $572.35
                trigeminal
                nerve.
61791........  Treat            Y............  A2...........      $351.92       5.7253      $243.57      $324.83
                trigeminal
                tract.
61795........  Brain surgery    N............  A2...........      $302.04       4.9138      $209.05      $278.79
                using computer.
61880........  Revise/remove    Y............  G2...........  ...........      17.8334      $758.69      $758.69
                neuroelectrode.
61885........  Insrt/redo       N............  H8...........      $446.00     260.1530   $11,067.69   $10,137.66
                neurostim 1
                array.
61886........  Implant          Y............  H8...........      $510.00     342.4747   $14,569.90   $13,649.39
                neurostim
                arrays.
61888........  Revise/remove    Y............  A2...........      $333.00      35.5702    $1,513.26      $628.07
                neuroreceiver.
62194........  Replace/         Y............  A2...........      $333.00      11.6575      $495.95      $373.74
                irrigate
                catheter.
62225........  Replace/         Y............  A2...........      $333.00      11.6575      $495.95      $373.74
                irrigate
                catheter.
62230........  Replace/revise   Y............  A2...........      $446.00      47.0342    $2,000.98      $834.75
                brain shunt.
62252........  Csf shunt        N............  P3...........  ...........       1.0462       $44.51       $44.51
                reprogram.
62263........  Epidural lysis   Y............  A2...........      $333.00      12.1702      $517.76      $379.19
                mult sessions.

[[Page 42595]]

 
62264........  Epidural lysis   Y............  A2...........      $333.00      12.1702      $517.76      $379.19
                on single day.
62268........  Drain spinal     Y............  A2...........      $183.83       2.9907      $127.23      $169.68
                cord cyst.
62269........  Needle biopsy,   Y............  A2...........      $333.00       6.1384      $261.15      $315.04
                spinal cord.
62270........  Spinal fluid     Y............  A2...........      $139.00       2.2614       $96.21      $128.30
                tap,
                diagnostic.
62272........  Drain cerebro    Y............  A2...........      $139.00       2.2614       $96.21      $128.30
                spinal fluid.
62273........  Inject epidural  Y............  A2...........      $333.00       5.7253      $243.57      $310.64
                patch.
62280........  Treat spinal     Y............  A2...........      $333.00       6.3603      $270.59      $317.40
                cord lesion.
62281........  Treat spinal     Y............  A2...........      $333.00       6.3603      $270.59      $317.40
                cord lesion.
62282........  Treat spinal     Y............  A2...........      $333.00       6.3603      $270.59      $317.40
                canal lesion.
62284........  Injection for    .............  N1...........  ...........  ...........  ...........  ...........
                myelogram.
62287........  Percutaneous     Y............  A2...........    $1,339.00      33.1520    $1,410.39    $1,356.85
                diskectomy.
62290........  Inject for       .............  N1...........  ...........  ...........  ...........  ...........
                spine disk x-
                ray.
62291........  Inject for       .............  N1...........  ...........  ...........  ...........  ...........
                spine disk x-
                ray.
62292........  Injection into   Y............  G2...........  ...........       2.9907      $127.23      $127.23
                disk lesion.
62294........  Injection into   Y............  A2...........      $183.83       2.9907      $127.23      $169.68
                spinal artery.
62310........  Inject spine c/  Y............  A2...........      $333.00       6.3603      $270.59      $317.40
                t.
62311........  Inject spine l/  Y............  A2...........      $333.00       6.3603      $270.59      $317.40
                s (cd).
62318........  Inject spine w/  Y............  A2...........      $333.00       6.3603      $270.59      $317.40
                cath, c/t.
62319........  Inject spine w/  Y............  A2...........      $333.00       6.3603      $270.59      $317.40
                cath l/s (cd).
62350........  Implant spinal   Y............  A2...........      $446.00      30.8394    $1,312.00      $662.50
                canal cath.
62355........  Remove spinal    Y............  A2...........      $446.00      12.1702      $517.76      $463.94
                canal catheter.
62360........  Insert spine     Y............  A2...........      $446.00     112.6322    $4,791.71    $1,532.43
                infusion
                device.
62361........  Implant spine    Y............  H8...........      $446.00     243.3568   $10,353.13    $9,589.69
                infusion pump.
62362........  Implant spine    Y............  H8...........      $446.00     243.3568   $10,353.13    $9,589.69
                infusion pump.
62365........  Remove spine     Y............  A2...........      $446.00      33.1520    $1,410.39      $687.10
                infusion
                device.
62367........  Analyze spine    N............  P3...........  ...........       0.4104       $17.46       $17.46
                infusion pump.
62368........  Analyze spine    N............  P3...........  ...........       0.5150       $21.91       $21.91
                infusion pump.
63600........  Remove spinal    Y............  A2...........      $446.00      17.8499      $759.39      $524.35
                cord lesion.
63610........  Stimulation of   Y............  A2...........      $333.00      17.8499      $759.39      $439.60
                spinal cord.
63615........  Remove lesion    Y............  R2...........  ...........      17.8499      $759.39      $759.39
                of spinal cord.
63650........  Implant          N............  H8...........      $446.00      71.6329    $3,047.48    $2,552.76
                neuroelectrode
                s.
63655........  Implant          N............  J8...........  ...........     109.1028    $4,641.56    $4,641.56
                neuroelectrode
                s.
63660........  Revise/remove    Y............  A2...........      $333.00      17.8334      $758.69      $439.42
                neuroelectrode.
63685........  Insrt/redo       Y............  H8...........      $446.00     251.0862   $10,681.96    $9,721.25
                spine n
                generator.
63688........  Revise/remove    Y............  A2...........      $333.00      35.5702    $1,513.26      $628.07
                neuroreceiver.
63744........  Revision of      Y............  A2...........      $510.00      39.2633    $1,670.38      $800.10
                spinal shunt.
63746........  Removal of       Y............  A2...........      $446.00      10.9918      $467.62      $451.41
                spinal shunt.
64400........  Nblock inj,      Y............  P3...........  ...........       1.3198       $56.15       $56.15
                trigeminal.
64402........  Nblock inj,      Y............  P3...........  ...........       1.2312       $52.38       $52.38
                facial.
64405........  Nblock inj,      Y............  P3...........  ...........       1.0542       $44.85       $44.85
                occipital.
64408........  Nblock inj,      Y............  P3...........  ...........       1.2232       $52.04       $52.04
                vagus.
64410........  Nblock inj,      Y............  A2...........      $333.00       5.7253      $243.57      $310.64
                phrenic.
64412........  Nblock inj,      Y............  P3...........  ...........       1.8830       $80.11       $80.11
                spinal
                accessor.
64413........  Nblock inj,      Y............  P3...........  ...........       1.2554       $53.41       $53.41
                cervical
                plexus.
64415........  Nblock inj,      Y............  A2...........      $139.00       2.2614       $96.21      $128.30
                brachial
                plexus.
64416........  Nblock cont      Y............  G2...........  ...........       2.2614       $96.21       $96.21
                infuse, b plex.
64417........  Nblock inj,      Y............  A2...........      $139.00       2.2614       $96.21      $128.30
                axillary.
64418........  Nblock inj,      Y............  P3...........  ...........       1.8026       $76.69       $76.69
                suprascapular.
64420........  Nblock inj,      Y............  A2...........      $139.00       2.2614       $96.21      $128.30
                intercost, sng.
64421........  Nblock inj,      Y............  A2...........      $333.00       5.7253      $243.57      $310.64
                intercost, mlt.
64425........  Nblock inj,      Y............  P3...........  ...........       1.1990       $51.01       $51.01
                ilio-ing/
                hypogi.
64430........  Nblock inj,      Y............  A2...........      $139.00       2.2614       $96.21      $128.30
                pudendal.
64435........  Nblock inj,      Y............  P3...........  ...........       1.8026       $76.69       $76.69
                paracervical.
64445........  Nblock inj,      Y............  P3...........  ...........       1.7382       $73.95       $73.95
                sciatic, sng.
64446........  Nblk inj,        Y............  G2...........  ...........       5.7253      $243.57      $243.57
                sciatic, cont
                inf.
64447........  Nblock inj fem,  Y............  G2...........  ...........       2.2614       $96.21       $96.21
                single.
64450........  Nblock, other    Y............  P3...........  ...........       1.0140       $43.14       $43.14
                peripheral.
64470........  Inj              Y............  A2...........      $333.00       6.3603      $270.59      $317.40
                paravertebral
                c/t.
64472........  Inj              Y............  A2...........      $333.00       5.7253      $243.57      $310.64
                paravertebral
                c/t add-on.
64475........  Inj              Y............  A2...........      $333.00       6.3603      $270.59      $317.40
                paravertebral
                l/s.
64476........  Inj              Y............  A2...........      $333.00       5.7253      $243.57      $310.64
                paravertebral
                l/s add-on.
64479........  Inj foramen      Y............  A2...........      $333.00       6.3603      $270.59      $317.40
                epidural c/t.
64480........  Inj foramen      Y............  A2...........      $333.00       6.3603      $270.59      $317.40
                epidural add-
                on.

[[Page 42596]]

 
64483........  Inj foramen      Y............  A2...........      $333.00       6.3603      $270.59      $317.40
                epidural l/s.
64484........  Inj foramen      Y............  A2...........      $333.00       6.3603      $270.59      $317.40
                epidural add-
                on.
64505........  Nblock,          Y............  P3...........  ...........       0.9416       $40.06       $40.06
                spenopalatine
                gangl.
64508........  Nblock, carotid  Y............  P3...........  ...........       2.0922       $89.01       $89.01
                sinus s/p.
64510........  Nblock,          Y............  A2...........      $333.00       6.3603      $270.59      $317.40
                stellate
                ganglion.
64517........  Nblock inj,      Y............  A2...........      $139.00       2.2614       $96.21      $128.30
                hypogas plxs.
64520........  Nblock, lumbar/  Y............  A2...........      $333.00       6.3603      $270.59      $317.40
                thoracic.
64530........  Nblock inj,      Y............  A2...........      $333.00       6.3603      $270.59      $317.40
                celiac pelus.
64553........  Implant          N............  H8...........      $333.00     307.2433   $13,071.05   $11,841.79
                neuroelectrode
                s.
64555........  Implant          N............  J8...........  ...........      71.6329    $3,047.48    $3,047.48
                neuroelectrode
                s.
64560........  Implant          N............  J8...........  ...........      71.6329    $3,047.48    $3,047.48
                neuroelectrode
                s.
64561........  Implant          N............  H8...........      $510.00      71.6329    $3,047.48    $2,600.76
                neuroelectrode
                s.
64565........  Implant          N............  J8...........  ...........      71.6329    $3,047.48    $3,047.48
                neuroelectrode
                s.
64573........  Implant          N............  H8...........      $333.00     307.2433   $13,071.05   $11,841.79
                neuroelectrode
                s.
64575........  Implant          N............  H8...........      $333.00     109.1028    $4,641.56    $3,818.33
                neuroelectrode
                s.
64577........  Implant          N............  H8...........      $333.00     109.1028    $4,641.56    $3,818.33
                neuroelectrode
                s.
64580........  Implant          N............  H8...........      $333.00     109.1028    $4,641.56    $3,818.33
                neuroelectrode
                s.
64581........  Implant          N............  H8...........      $510.00     109.1028    $4,641.56    $3,951.08
                neuroelectrode
                s.
64585........  Revise/remove    Y............  A2...........      $333.00      17.8334      $758.69      $439.42
                neuroelectrode.
64590........  Insrt/redo pn/   Y............  H8...........      $446.00     251.0862   $10,681.96    $9,721.25
                gastr stimul.
64595........  Revise/rmv pn/   Y............  A2...........      $333.00      35.5702    $1,513.26      $628.07
                gastr stimul.
64600........  Injection        Y............  A2...........      $333.00      12.1702      $517.76      $379.19
                treatment of
                nerve.
64605........  Injection        Y............  A2...........      $333.00      12.1702      $517.76      $379.19
                treatment of
                nerve.
64610........  Injection        Y............  A2...........      $333.00      12.1702      $517.76      $379.19
                treatment of
                nerve.
64612........  Destroy nerve,   Y............  P3...........  ...........       1.6579       $70.53       $70.53
                face muscle.
64613........  Destroy nerve,   Y............  P3...........  ...........       1.7302       $73.61       $73.61
                neck muscle.
64614........  Destroy nerve,   Y............  P3...........  ...........       1.9474       $82.85       $82.85
                extrem musc.
64620........  Injection        Y............  A2...........      $333.00      12.1702      $517.76      $379.19
                treatment of
                nerve.
64622........  Destr            Y............  A2...........      $333.00      12.1702      $517.76      $379.19
                paravertebrl
                nerve l/s.
64623........  Destr            Y............  A2...........      $333.00       6.3603      $270.59      $317.40
                paravertebral
                n add-on.
64626........  Destr            Y............  A2...........      $333.00      12.1702      $517.76      $379.19
                paravertebrl
                nerve c/t.
64627........  Destr            Y............  A2...........      $333.00       6.3603      $270.59      $317.40
                paravertebral
                n add-on.
64630........  Injection        Y............  A2...........      $351.92       5.7253      $243.57      $324.83
                treatment of
                nerve.
64640........  Injection        Y............  P3...........  ...........       2.6716      $113.66      $113.66
                treatment of
                nerve.
64650........  Chemodenerv      Y............  G2...........  ...........       2.2614       $96.21       $96.21
                eccrine glands.
64653........  Chemodenerv      Y............  G2...........  ...........       2.2614       $96.21       $96.21
                eccrine glands.
64680........  Injection        Y............  A2...........      $390.95       6.3603      $270.59      $360.86
                treatment of
                nerve.
64681........  Injection        Y............  A2...........      $446.00      12.1702      $517.76      $463.94
                treatment of
                nerve.
64702........  Revise finger/   Y............  A2...........      $333.00      17.8499      $759.39      $439.60
                toe nerve.
64704........  Revise hand/     Y............  A2...........      $333.00      17.8499      $759.39      $439.60
                foot nerve.
64708........  Revise arm/leg   Y............  A2...........      $446.00      17.8499      $759.39      $524.35
                nerve.
64712........  Revision of      Y............  A2...........      $446.00      17.8499      $759.39      $524.35
                sciatic nerve.
64713........  Revision of arm  Y............  A2...........      $446.00      17.8499      $759.39      $524.35
                nerve(s).
64714........  Revise low back  Y............  A2...........      $446.00      17.8499      $759.39      $524.35
                nerve(s).
64716........  Revision of      Y............  A2...........      $510.00      17.8499      $759.39      $572.35
                cranial nerve.
64718........  Revise ulnar     Y............  A2...........      $446.00      17.8499      $759.39      $524.35
                nerve at elbow.
64719........  Revise ulnar     Y............  A2...........      $446.00      17.8499      $759.39      $524.35
                nerve at wrist.
64721........  Carpal tunnel    Y............  A2...........      $446.00      17.8499      $759.39      $524.35
                surgery.
64722........  Relieve          Y............  A2...........      $333.00      17.8499      $759.39      $439.60
                pressure on
                nerve(s).
64726........  Release foot/    Y............  A2...........      $333.00      17.8499      $759.39      $439.60
                toe nerve.
64727........  Internal nerve   Y............  A2...........      $333.00      17.8499      $759.39      $439.60
                revision.
64732........  Incision of      Y............  A2...........      $446.00      17.8499      $759.39      $524.35
                brow nerve.
64734........  Incision of      Y............  A2...........      $446.00      17.8499      $759.39      $524.35
                cheek nerve.
64736........  Incision of      Y............  A2...........      $446.00      17.8499      $759.39      $524.35
                chin nerve.
64738........  Incision of jaw  Y............  A2...........      $446.00      17.8499      $759.39      $524.35
                nerve.
64740........  Incision of      Y............  A2...........      $446.00      17.8499      $759.39      $524.35
                tongue nerve.
64742........  Incision of      Y............  A2...........      $446.00      17.8499      $759.39      $524.35
                facial nerve.
64744........  Incise nerve,    Y............  A2...........      $446.00      17.8499      $759.39      $524.35
                back of head.
64746........  Incise           Y............  A2...........      $446.00      17.8499      $759.39      $524.35
                diaphragm
                nerve.
64761........  Incision of      Y............  G2...........  ...........      17.8499      $759.39      $759.39
                pelvis nerve.
64763........  Incise hip/      Y............  G2...........  ...........      17.8499      $759.39      $759.39
                thigh nerve.
64766........  Incise hip/      Y............  G2...........  ...........      33.1520    $1,410.39    $1,410.39
                thigh nerve.
64771........  Sever cranial    Y............  A2...........      $446.00      17.8499      $759.39      $524.35
                nerve.

[[Page 42597]]

 
64772........  Incision of      Y............  A2...........      $446.00      17.8499      $759.39      $524.35
                spinal nerve.
64774........  Remove skin      Y............  A2...........      $446.00      17.8499      $759.39      $524.35
                nerve lesion.
64776........  Remove digit     Y............  A2...........      $510.00      17.8499      $759.39      $572.35
                nerve lesion.
64778........  Digit nerve      Y............  A2...........      $446.00      17.8499      $759.39      $524.35
                surgery add-on.
64782........  Remove limb      Y............  A2...........      $510.00      17.8499      $759.39      $572.35
                nerve lesion.
64783........  Limb nerve       Y............  A2...........      $446.00      17.8499      $759.39      $524.35
                surgery add-on.
64784........  Remove nerve     Y............  A2...........      $510.00      17.8499      $759.39      $572.35
                lesion.
64786........  Remove sciatic   Y............  A2...........      $510.00      33.1520    $1,410.39      $735.10
                nerve lesion.
64787........  Implant nerve    Y............  A2...........      $446.00      17.8499      $759.39      $524.35
                end.
64788........  Remove skin      Y............  A2...........      $510.00      17.8499      $759.39      $572.35
                nerve lesion.
64790........  Removal of       Y............  A2...........      $510.00      17.8499      $759.39      $572.35
                nerve lesion.
64792........  Removal of       Y............  A2...........      $510.00      33.1520    $1,410.39      $735.10
                nerve lesion.
64795........  Biopsy of nerve  Y............  A2...........      $446.00      17.8499      $759.39      $524.35
64802........  Remove           Y............  A2...........      $446.00      17.8499      $759.39      $524.35
                sympathetic
                nerves.
64820........  Remove           Y............  G2...........  ...........      17.8499      $759.39      $759.39
                sympathetic
                nerves.
64821........  Remove           Y............  A2...........      $630.00      25.8758    $1,100.83      $747.71
                sympathetic
                nerves.
64822........  Remove           Y............  G2...........  ...........      25.8758    $1,100.83    $1,100.83
                sympathetic
                nerves.
64823........  Remove           Y............  G2...........  ...........      25.8758    $1,100.83    $1,100.83
                sympathetic
                nerves.
64831........  Repair of digit  Y............  A2...........      $630.00      33.1520    $1,410.39      $825.10
                nerve.
64832........  Repair nerve     Y............  A2...........      $333.00      33.1520    $1,410.39      $602.35
                add-on.
64834........  Repair of hand   Y............  A2...........      $446.00      33.1520    $1,410.39      $687.10
                or foot nerve.
64835........  Repair of hand   Y............  A2...........      $510.00      33.1520    $1,410.39      $735.10
                or foot nerve.
64836........  Repair of hand   Y............  A2...........      $510.00      33.1520    $1,410.39      $735.10
                or foot nerve.
64837........  Repair nerve     Y............  A2...........      $333.00      33.1520    $1,410.39      $602.35
                add-on.
64840........  Repair of leg    Y............  A2...........      $446.00      33.1520    $1,410.39      $687.10
                nerve.
64856........  Repair/          Y............  A2...........      $446.00      33.1520    $1,410.39      $687.10
                transpose
                nerve.
64857........  Repair arm/leg   Y............  A2...........      $446.00      33.1520    $1,410.39      $687.10
                nerve.
64858........  Repair sciatic   Y............  A2...........      $446.00      33.1520    $1,410.39      $687.10
                nerve.
64859........  Nerve surgery..  Y............  A2...........      $333.00      33.1520    $1,410.39      $602.35
64861........  Repair of arm    Y............  A2...........      $510.00      33.1520    $1,410.39      $735.10
                nerves.
64862........  Repair of low    Y............  A2...........      $510.00      33.1520    $1,410.39      $735.10
                back nerves.
64864........  Repair of        Y............  A2...........      $510.00      33.1520    $1,410.39      $735.10
                facial nerve.
64865........  Repair of        Y............  A2...........      $630.00      33.1520    $1,410.39      $825.10
                facial nerve.
64870........  Fusion of        Y............  A2...........      $630.00      33.1520    $1,410.39      $825.10
                facial/other
                nerve.
64872........  Subsequent       Y............  A2...........      $446.00      33.1520    $1,410.39      $687.10
                repair of
                nerve.
64874........  Repair & revise  Y............  A2...........      $510.00      33.1520    $1,410.39      $735.10
                nerve add-on.
64876........  Repair nerve/    Y............  A2...........      $510.00      33.1520    $1,410.39      $735.10
                shorten bone.
64885........  Nerve graft,     Y............  A2...........      $446.00      33.1520    $1,410.39      $687.10
                head or neck.
64886........  Nerve graft,     Y............  A2...........      $446.00      33.1520    $1,410.39      $687.10
                head or neck.
64890........  Nerve graft,     Y............  A2...........      $446.00      33.1520    $1,410.39      $687.10
                hand or foot.
64891........  Nerve graft,     Y............  A2...........      $446.00      33.1520    $1,410.39      $687.10
                hand or foot.
64892........  Nerve graft,     Y............  A2...........      $446.00      33.1520    $1,410.39      $687.10
                arm or leg.
64893........  Nerve graft,     Y............  A2...........      $446.00      33.1520    $1,410.39      $687.10
                arm or leg.
64895........  Nerve graft,     Y............  A2...........      $510.00      33.1520    $1,410.39      $735.10
                hand or foot.
64896........  Nerve graft,     Y............  A2...........      $510.00      33.1520    $1,410.39      $735.10
                hand or foot.
64897........  Nerve graft,     Y............  A2...........      $510.00      33.1520    $1,410.39      $735.10
                arm or leg.
64898........  Nerve graft,     Y............  A2...........      $510.00      33.1520    $1,410.39      $735.10
                arm or leg.
64901........  Nerve graft add- Y............  A2...........      $446.00      33.1520    $1,410.39      $687.10
                on.
64902........  Nerve graft add- Y............  A2...........      $446.00      33.1520    $1,410.39      $687.10
                on.
64905........  Nerve pedicle    Y............  A2...........      $446.00      33.1520    $1,410.39      $687.10
                transfer.
64907........  Nerve pedicle    Y............  A2...........      $333.00      33.1520    $1,410.39      $602.35
                transfer.
65091........  Revise eye.....  Y............  A2...........      $510.00      35.2292    $1,498.76      $757.19
65093........  Revise eye with  Y............  A2...........      $510.00      35.2292    $1,498.76      $757.19
                implant.
65101........  Removal of eye.  Y............  A2...........      $510.00      35.2292    $1,498.76      $757.19
65103........  Remove eye/      Y............  A2...........      $510.00      35.2292    $1,498.76      $757.19
                insert implant.
65105........  Remove eye/      Y............  A2...........      $630.00      35.2292    $1,498.76      $847.19
                attach implant.
65110........  Removal of eye.  Y............  A2...........      $717.00      35.2292    $1,498.76      $912.44
65112........  Remove eye/      Y............  A2...........      $995.00      35.2292    $1,498.76    $1,120.94
                revise socket.
65114........  Remove eye/      Y............  A2...........      $995.00      35.2292    $1,498.76    $1,120.94
                revise socket.
65125........  Revise ocular    Y............  G2...........  ...........      17.1243      $728.52      $728.52
                implant.
65130........  Insert ocular    Y............  A2...........      $510.00      25.2550    $1,074.42      $651.11
                implant.
65135........  Insert ocular    Y............  A2...........      $446.00      25.2550    $1,074.42      $603.11
                implant.
65140........  Attach ocular    Y............  A2...........      $510.00      35.2292    $1,498.76      $757.19
                implant.

[[Page 42598]]

 
65150........  Revise ocular    Y............  A2...........      $446.00      25.2550    $1,074.42      $603.11
                implant.
65155........  Reinsert ocular  Y............  A2...........      $510.00      35.2292    $1,498.76      $757.19
                implant.
65175........  Removal of       Y............  A2...........      $333.00      17.1243      $728.52      $431.88
                ocular implant.
65205........  Remove foreign   N............  P3...........  ...........       0.4990       $21.23       $21.23
                body from eye.
65210........  Remove foreign   N............  P3...........  ...........       0.6196       $26.36       $26.36
                body from eye.
65220........  Remove foreign   N............  G2...........  ...........       1.1607       $49.38       $49.38
                body from eye.
65222........  Remove foreign   N............  P3...........  ...........       0.6840       $29.10       $29.10
                body from eye.
65235........  Remove foreign   Y............  A2...........      $446.00      15.2259      $647.76      $496.44
                body from eye.
65260........  Remove foreign   Y............  A2...........      $510.00      16.5239      $702.98      $558.25
                body from eye.
65265........  Remove foreign   Y............  A2...........      $630.00      27.6020    $1,174.27      $766.07
                body from eye.
65270........  Repair of eye    Y............  A2...........      $446.00      17.1243      $728.52      $516.63
                wound.
65272........  Repair of eye    Y............  A2...........      $446.00      22.9970      $978.36      $579.09
                wound.
65275........  Repair of eye    Y............  A2...........      $630.00      22.9970      $978.36      $717.09
                wound.
65280........  Repair of eye    Y............  A2...........      $630.00      16.5239      $702.98      $648.25
                wound.
65285........  Repair of eye    Y............  A2...........      $630.00      37.4290    $1,592.34      $870.59
                wound.
65286........  Repair of eye    Y............  P2...........  ...........       6.0673      $258.12      $258.12
                wound.
65290........  Repair of eye    Y............  A2...........      $510.00      21.2801      $905.32      $608.83
                socket wound.
65400........  Removal of eye   Y............  A2...........      $333.00      15.2259      $647.76      $411.69
                lesion.
65410........  Biopsy of        Y............  A2...........      $446.00      15.2259      $647.76      $496.44
                cornea.
65420........  Removal of eye   Y............  A2...........      $446.00      15.2259      $647.76      $496.44
                lesion.
65426........  Removal of eye   Y............  A2...........      $717.00      22.9970      $978.36      $782.34
                lesion.
65430........  Corneal smear..  N............  P3...........  ...........       0.9736       $41.42       $41.42
65435........  Curette/treat    Y............  P3...........  ...........       0.7564       $32.18       $32.18
                cornea.
65436........  Curette/treat    Y............  G2...........  ...........      15.2259      $647.76      $647.76
                cornea.
65450........  Treatment of     N............  G2...........  ...........       2.1451       $91.26       $91.26
                corneal lesion.
65600........  Revision of      Y............  P3...........  ...........       3.8707      $164.67      $164.67
                cornea.
65710........  Corneal          Y............  A2...........      $995.00      38.2707    $1,628.15    $1,153.29
                transplant.
65730........  Corneal          Y............  A2...........      $995.00      38.2707    $1,628.15    $1,153.29
                transplant.
65750........  Corneal          Y............  A2...........      $995.00      38.2707    $1,628.15    $1,153.29
                transplant.
65755........  Corneal          Y............  A2...........      $995.00      38.2707    $1,628.15    $1,153.29
                transplant.
65770........  Revise cornea    Y............  A2...........      $995.00      51.9894    $2,211.78    $1,299.20
                with implant.
65772........  Correction of    Y............  A2...........      $630.00      15.2259      $647.76      $634.44
                astigmatism.
65775........  Correction of    Y............  A2...........      $630.00      15.2259      $647.76      $634.44
                astigmatism.
65780........  Ocular reconst,  Y............  A2...........      $717.00      38.2707    $1,628.15      $944.79
                transplant.
65781........  Ocular reconst,  Y............  A2...........      $717.00      38.2707    $1,628.15      $944.79
                transplant.
65782........  Ocular reconst,  Y............  A2...........      $717.00      38.2707    $1,628.15      $944.79
                transplant.
65800........  Drainage of eye  Y............  A2...........      $333.00      15.2259      $647.76      $411.69
65805........  Drainage of eye  Y............  A2...........      $333.00      15.2259      $647.76      $411.69
65810........  Drainage of eye  Y............  A2...........      $510.00      22.9970      $978.36      $627.09
65815........  Drainage of eye  Y............  A2...........      $446.00      22.9970      $978.36      $579.09
65820........  Relieve inner    Y............  A2...........      $333.00       6.0673      $258.12      $314.28
                eye pressure.
65850........  Incision of eye  Y............  A2...........      $630.00      22.9970      $978.36      $717.09
65855........  Laser surgery    Y............  P3...........  ...........       3.1947      $135.91      $135.91
                of eye.
65860........  Incise inner     Y............  P3...........  ...........       2.9855      $127.01      $127.01
                eye adhesions.
65865........  Incise inner     Y............  A2...........      $333.00      15.2259      $647.76      $411.69
                eye adhesions.
65870........  Incise inner     Y............  A2...........      $630.00      22.9970      $978.36      $717.09
                eye adhesions.
65875........  Incise inner     Y............  A2...........      $630.00      22.9970      $978.36      $717.09
                eye adhesions.
65880........  Incise inner     Y............  A2...........      $630.00      15.2259      $647.76      $634.44
                eye adhesions.
65900........  Remove eye       Y............  A2...........      $717.00      15.2259      $647.76      $699.69
                lesion.
65920........  Remove implant   Y............  A2...........      $995.00      22.9970      $978.36      $990.84
                of eye.
65930........  Remove blood     Y............  A2...........      $717.00      22.9970      $978.36      $782.34
                clot from eye.
66020........  Injection        Y............  A2...........      $333.00      15.2259      $647.76      $411.69
                treatment of
                eye.
66030........  Injection        Y............  A2...........      $333.00       6.0673      $258.12      $314.28
                treatment of
                eye.
66130........  Remove eye       Y............  A2...........      $995.00      22.9970      $978.36      $990.84
                lesion.
66150........  Glaucoma         Y............  A2...........      $630.00      22.9970      $978.36      $717.09
                surgery.
66155........  Glaucoma         Y............  A2...........      $630.00      22.9970      $978.36      $717.09
                surgery.
66160........  Glaucoma         Y............  A2...........      $446.00      22.9970      $978.36      $579.09
                surgery.
66165........  Glaucoma         Y............  A2...........      $630.00      22.9970      $978.36      $717.09
                surgery.
66170........  Glaucoma         Y............  A2...........      $630.00      22.9970      $978.36      $717.09
                surgery.
66172........  Incision of eye  Y............  A2...........      $630.00      22.9970      $978.36      $717.09
66180........  Implant eye      Y............  A2...........      $717.00      37.8967    $1,612.24      $940.81
                shunt.
66185........  Revise eye       Y............  A2...........      $446.00      37.8967    $1,612.24      $737.56
                shunt.
66220........  Repair eye       Y............  A2...........      $510.00      37.4290    $1,592.34      $780.59
                lesion.

[[Page 42599]]

 
66225........  Repair/graft     Y............  A2...........      $630.00      37.8967    $1,612.24      $875.56
                eye lesion.
66250........  Follow-up        Y............  A2...........      $446.00      15.2259      $647.76      $496.44
                surgery of eye.
66500........  Incision of      Y............  A2...........      $333.00       6.0673      $258.12      $314.28
                iris.
66505........  Incision of      Y............  A2...........      $333.00       6.0673      $258.12      $314.28
                iris.
66600........  Remove iris and  Y............  A2...........      $510.00      22.9970      $978.36      $627.09
                lesion.
66605........  Removal of iris  Y............  A2...........      $510.00      22.9970      $978.36      $627.09
66625........  Removal of iris  Y............  A2...........      $372.94       6.0673      $258.12      $344.24
66630........  Removal of iris  Y............  A2...........      $510.00      22.9970      $978.36      $627.09
66635........  Removal of iris  Y............  A2...........      $510.00      22.9970      $978.36      $627.09
66680........  Repair iris &    Y............  A2...........      $510.00      22.9970      $978.36      $627.09
                ciliary body.
66682........  Repair iris &    Y............  A2...........      $446.00      22.9970      $978.36      $579.09
                ciliary body.
66700........  Destruction,     Y............  A2...........      $446.00      15.2259      $647.76      $496.44
                ciliary body.
66710........  Ciliary          Y............  A2...........      $446.00      15.2259      $647.76      $496.44
                transsleral
                therapy.
66711........  Ciliary          Y............  A2...........      $446.00      15.2259      $647.76      $496.44
                endoscopic
                ablation.
66720........  Destruction,     Y............  A2...........      $446.00      15.2259      $647.76      $496.44
                ciliary body.
66740........  Destruction,     Y............  A2...........      $446.00      22.9970      $978.36      $579.09
                ciliary body.
66761........  Revision of      Y............  P3...........  ...........       4.3375      $184.53      $184.53
                iris.
66762........  Revision of      Y............  P3...........  ...........       4.4019      $187.27      $187.27
                iris.
66770........  Removal of       Y............  P3...........  ...........       4.7639      $202.67      $202.67
                inner eye
                lesion.
66820........  Incision,        Y............  G2...........  ...........       6.0673      $258.12      $258.12
                secondary
                cataract.
66821........  After cataract   Y............  A2...........      $312.50       5.0839      $216.28      $288.45
                laser surgery.
66825........  Reposition       Y............  A2...........      $630.00      22.9970      $978.36      $717.09
                intraocular
                lens.
66830........  Removal of lens  Y............  A2...........      $372.94       6.0673      $258.12      $344.24
                lesion.
66840........  Removal of lens  Y............  A2...........      $630.00      14.8702      $632.62      $630.66
                material.
66850........  Removal of lens  Y............  A2...........      $995.00      29.2281    $1,243.45    $1,057.11
                material.
66852........  Removal of lens  Y............  A2...........      $630.00      29.2281    $1,243.45      $783.36
                material.
66920........  Extraction of    Y............  A2...........      $630.00      29.2281    $1,243.45      $783.36
                lens.
66930........  Extraction of    Y............  A2...........      $717.00      29.2281    $1,243.45      $848.61
                lens.
66940........  Extraction of    Y............  A2...........      $717.00      14.8702      $632.62      $695.91
                lens.
66982........  Cataract         Y............  A2...........      $973.00      23.6313    $1,005.35      $981.09
                surgery,
                complex.
66983........  Cataract surg w/ Y............  A2...........      $973.00      23.6313    $1,005.35      $981.09
                iol, 1 stage.
66984........  Cataract surg w/ Y............  A2...........      $973.00      23.6313    $1,005.35      $981.09
                iol, 1 stage.
66985........  Insert lens      Y............  A2...........      $826.00      23.6313    $1,005.35      $870.84
                prosthesis.
66986........  Exchange lens    Y............  A2...........      $826.00      23.6313    $1,005.35      $870.84
                prosthesis.
66990........  Ophthalmic       .............  N1...........  ...........  ...........  ...........  ...........
                endoscope add-
                on.
67005........  Partial removal  Y............  A2...........      $630.00      27.6020    $1,174.27      $766.07
                of eye fluid.
67010........  Partial removal  Y............  A2...........      $630.00      27.6020    $1,174.27      $766.07
                of eye fluid.
67015........  Release of eye   Y............  A2...........      $333.00      27.6020    $1,174.27      $543.32
                fluid.
67025........  Replace eye      Y............  A2...........      $333.00      27.6020    $1,174.27      $543.32
                fluid.
67027........  Implant eye      Y............  A2...........      $630.00      37.4290    $1,592.34      $870.59
                drug system.
67028........  Injection eye    Y............  P3...........  ...........       1.9876       $84.56       $84.56
                drug.
67030........  Incise inner     Y............  A2...........      $333.00      16.5239      $702.98      $425.50
                eye strands.
67031........  Laser surgery,   Y............  A2...........      $312.50       5.0839      $216.28      $288.45
                eye strands.
67036........  Removal of       Y............  A2...........      $630.00      37.4290    $1,592.34      $870.59
                inner eye
                fluid.
67038........  Strip retinal    Y............  A2...........      $717.00      37.4290    $1,592.34      $935.84
                membrane.
67039........  Laser treatment  Y............  A2...........      $995.00      37.4290    $1,592.34    $1,144.34
                of retina.
67040........  Laser treatment  Y............  A2...........      $995.00      37.4290    $1,592.34    $1,144.34
                of retina.
67101........  Repair detached  Y............  P3...........  ...........       7.2104      $306.75      $306.75
                retina.
67105........  Repair detached  Y............  P2...........  ...........       5.0841      $216.29      $216.29
                retina.
67107........  Repair detached  Y............  A2...........      $717.00      37.4290    $1,592.34      $935.84
                retina.
67108........  Repair detached  Y............  A2...........      $995.00      37.4290    $1,592.34    $1,144.34
                retina.
67110........  Repair detached  Y............  P3...........  ...........       7.8462      $333.80      $333.80
                retina.
67112........  Rerepair         Y............  A2...........      $995.00      37.4290    $1,592.34    $1,144.34
                detached
                retina.
67115........  Release          Y............  A2...........      $446.00      16.5239      $702.98      $510.25
                encircling
                material.
67120........  Remove eye       Y............  A2...........      $446.00      16.5239      $702.98      $510.25
                implant
                material.
67121........  Remove eye       Y............  A2...........      $446.00      27.6020    $1,174.27      $628.07
                implant
                material.
67141........  Treatment of     Y............  A2...........      $241.77       3.9333      $167.33      $223.16
                retina.
67145........  Treatment of     Y............  P3...........  ...........       4.5387      $193.09      $193.09
                retina.
67208........  Treatment of     Y............  P3...........  ...........       4.8283      $205.41      $205.41
                retinal lesion.
67210........  Treatment of     Y............  P2...........  ...........       5.0841      $216.29      $216.29
                retinal lesion.
67218........  Treatment of     Y............  A2...........      $717.00      16.5239      $702.98      $713.50
                retinal lesion.
67220........  Treatment of     Y............  P2...........  ...........       3.9333      $167.33      $167.33
                choroid lesion.
67221........  Ocular           Y............  P3...........  ...........       2.9695      $126.33      $126.33
                photodynamic
                ther.

[[Page 42600]]

 
67225........  Eye              Y............  P3...........  ...........       0.2012        $8.56        $8.56
                photodynamic
                ther add-on.
67227........  Treatment of     Y............  A2...........      $333.00      27.6020    $1,174.27      $543.32
                retinal lesion.
67228........  Treatment of     Y............  P2...........  ...........       5.0841      $216.29      $216.29
                retinal lesion.
67250........  Reinforce eye    Y............  A2...........      $510.00      17.1243      $728.52      $564.63
                wall.
67255........  Reinforce/graft  Y............  A2...........      $510.00      27.6020    $1,174.27      $676.07
                eye wall.
67311........  Revise eye       Y............  A2...........      $510.00      21.2801      $905.32      $608.83
                muscle.
67312........  Revise two eye   Y............  A2...........      $630.00      21.2801      $905.32      $698.83
                muscles.
67314........  Revise eye       Y............  A2...........      $630.00      21.2801      $905.32      $698.83
                muscle.
67316........  Revise two eye   Y............  A2...........      $630.00      21.2801      $905.32      $698.83
                muscles.
67318........  Revise eye       Y............  A2...........      $630.00      21.2801      $905.32      $698.83
                muscle(s).
67320........  Revise eye       Y............  A2...........      $630.00      21.2801      $905.32      $698.83
                muscle(s) add-
                on.
67331........  Eye surgery      Y............  A2...........      $630.00      21.2801      $905.32      $698.83
                follow-up add-
                on.
67332........  Rerevise eye     Y............  A2...........      $630.00      21.2801      $905.32      $698.83
                muscles add-on.
67334........  Revise eye       Y............  A2...........      $630.00      21.2801      $905.32      $698.83
                muscle w/
                suture.
67335........  Eye suture       Y............  A2...........      $630.00      21.2801      $905.32      $698.83
                during surgery.
67340........  Revise eye       Y............  A2...........      $630.00      21.2801      $905.32      $698.83
                muscle add-on.
67343........  Release eye      Y............  A2...........      $995.00      21.2801      $905.32      $972.58
                tissue.
67345........  Destroy nerve    Y............  P3...........  ...........       1.9634       $83.53       $83.53
                of eye muscle.
67346........  Biopsy, eye      Y............  A2...........      $333.00      14.3845      $611.96      $402.74
                muscle.
67400........  Explore/biopsy   Y............  A2...........      $510.00      25.2550    $1,074.42      $651.11
                eye socket.
67405........  Explore/drain    Y............  A2...........      $630.00      25.2550    $1,074.42      $741.11
                eye socket.
67412........  Explore/treat    Y............  A2...........      $717.00      25.2550    $1,074.42      $806.36
                eye socket.
67413........  Explore/treat    Y............  A2...........      $717.00      25.2550    $1,074.42      $806.36
                eye socket.
67414........  Explr/           Y............  G2...........  ...........      35.2292    $1,498.76    $1,498.76
                decompress eye
                socket.
67415........  Aspiration,      Y............  A2...........      $333.00      17.1243      $728.52      $431.88
                orbital
                contents.
67420........  Explore/treat    Y............  A2...........      $717.00      35.2292    $1,498.76      $912.44
                eye socket.
67430........  Explore/treat    Y............  A2...........      $717.00      35.2292    $1,498.76      $912.44
                eye socket.
67440........  Explore/drain    Y............  A2...........      $717.00      35.2292    $1,498.76      $912.44
                eye socket.
67445........  Explr/           Y............  A2...........      $717.00      35.2292    $1,498.76      $912.44
                decompress eye
                socket.
67450........  Explore/biopsy   Y............  A2...........      $717.00      35.2292    $1,498.76      $912.44
                eye socket.
67500........  Inject/treat     N............  G2...........  ...........       2.1451       $91.26       $91.26
                eye socket.
67505........  Inject/treat     Y............  G2...........  ...........       2.8954      $123.18      $123.18
                eye socket.
67515........  Inject/treat     Y............  P3...........  ...........       0.5714       $24.31       $24.31
                eye socket.
67550........  Insert eye       Y............  A2...........      $630.00      35.2292    $1,498.76      $847.19
                socket implant.
67560........  Revise eye       Y............  A2...........      $446.00      25.2550    $1,074.42      $603.11
                socket implant.
67570........  Decompress       Y............  A2...........      $630.00      35.2292    $1,498.76      $847.19
                optic nerve.
67700........  Drainage of      Y............  P2...........  ...........       2.8954      $123.18      $123.18
                eyelid abscess.
67710........  Incision of      Y............  P3...........  ...........       3.6777      $156.46      $156.46
                eyelid.
67715........  Incision of      Y............  A2...........      $333.00      17.1243      $728.52      $431.88
                eyelid fold.
67800........  Remove eyelid    Y............  P3...........  ...........       1.2312       $52.38       $52.38
                lesion.
67801........  Remove eyelid    Y............  P3...........  ...........       1.4888       $63.34       $63.34
                lesions.
67805........  Remove eyelid    Y............  P3...........  ...........       1.9232       $81.82       $81.82
                lesions.
67808........  Remove eyelid    Y............  A2...........      $446.00      17.1243      $728.52      $516.63
                lesion(s).
67810........  Biopsy of        Y............  P2...........  ...........       2.8954      $123.18      $123.18
                eyelid.
67820........  Revise           N............  P3...........  ...........       0.4264       $18.14       $18.14
                eyelashes.
67825........  Revise           Y............  P3...........  ...........       1.2794       $54.43       $54.43
                eyelashes.
67830........  Revise           Y............  A2...........      $446.00       7.2819      $309.79      $411.95
                eyelashes.
67835........  Revise           Y............  A2...........      $446.00      17.1243      $728.52      $516.63
                eyelashes.
67840........  Remove eyelid    Y............  P3...........  ...........       3.8063      $161.93      $161.93
                lesion.
67850........  Treat eyelid     Y............  P3...........  ...........       2.6879      $114.35      $114.35
                lesion.
67875........  Closure of       Y............  G2...........  ...........       7.2819      $309.79      $309.79
                eyelid by
                suture.
67880........  Revision of      Y............  A2...........      $510.00      15.2259      $647.76      $544.44
                eyelid.
67882........  Revision of      Y............  A2...........      $510.00      17.1243      $728.52      $564.63
                eyelid.
67900........  Repair brow      Y............  A2...........      $630.00      17.1243      $728.52      $654.63
                defect.
67901........  Repair eyelid    Y............  A2...........      $717.00      17.1243      $728.52      $719.88
                defect.
67902........  Repair eyelid    Y............  A2...........      $717.00      17.1243      $728.52      $719.88
                defect.
67903........  Repair eyelid    Y............  A2...........      $630.00      17.1243      $728.52      $654.63
                defect.
67904........  Repair eyelid    Y............  A2...........      $630.00      17.1243      $728.52      $654.63
                defect.
67906........  Repair eyelid    Y............  A2...........      $717.00      17.1243      $728.52      $719.88
                defect.
67908........  Repair eyelid    Y............  A2...........      $630.00      17.1243      $728.52      $654.63
                defect.
67909........  Revise eyelid    Y............  A2...........      $630.00      17.1243      $728.52      $654.63
                defect.
67911........  Revise eyelid    Y............  A2...........      $510.00      17.1243      $728.52      $564.63
                defect.
67912........  Correction       Y............  A2...........      $510.00      17.1243      $728.52      $564.63
                eyelid w/
                implant.

[[Page 42601]]

 
67914........  Repair eyelid    Y............  A2...........      $510.00      17.1243      $728.52      $564.63
                defect.
67915........  Repair eyelid    Y............  P3...........  ...........       4.2329      $180.08      $180.08
                defect.
67916........  Repair eyelid    Y............  A2...........      $630.00      17.1243      $728.52      $654.63
                defect.
67917........  Repair eyelid    Y............  A2...........      $630.00      17.1243      $728.52      $654.63
                defect.
67921........  Repair eyelid    Y............  A2...........      $510.00      17.1243      $728.52      $564.63
                defect.
67922........  Repair eyelid    Y............  P3...........  ...........       4.1685      $177.34      $177.34
                defect.
67923........  Repair eyelid    Y............  A2...........      $630.00      17.1243      $728.52      $654.63
                defect.
67924........  Repair eyelid    Y............  A2...........      $630.00      17.1243      $728.52      $654.63
                defect.
67930........  Repair eyelid    Y............  P3...........  ...........       4.1121      $174.94      $174.94
                wound.
67935........  Repair eyelid    Y............  A2...........      $446.00      17.1243      $728.52      $516.63
                wound.
67938........  Remove eyelid    N............  P2...........  ...........       1.1607       $49.38       $49.38
                foreign body.
67950........  Revision of      Y............  A2...........      $446.00      17.1243      $728.52      $516.63
                eyelid.
67961........  Revision of      Y............  A2...........      $510.00      17.1243      $728.52      $564.63
                eyelid.
67966........  Revision of      Y............  A2...........      $510.00      17.1243      $728.52      $564.63
                eyelid.
67971........  Reconstruction   Y............  A2...........      $510.00      25.2550    $1,074.42      $651.11
                of eyelid.
67973........  Reconstruction   Y............  A2...........      $510.00      25.2550    $1,074.42      $651.11
                of eyelid.
67974........  Reconstruction   Y............  A2...........      $510.00      25.2550    $1,074.42      $651.11
                of eyelid.
67975........  Reconstruction   Y............  A2...........      $510.00      17.1243      $728.52      $564.63
                of eyelid.
68020........  Incise/drain     Y............  P3...........  ...........       1.0864       $46.22       $46.22
                eyelid lining.
68040........  Treatment of     N............  P3...........  ...........       0.5392       $22.94       $22.94
                eyelid lesions.
68100........  Biopsy of        Y............  P3...........  ...........       2.2775       $96.89       $96.89
                eyelid lining.
68110........  Remove eyelid    Y............  P3...........  ...........       2.9131      $123.93      $123.93
                lining lesion.
68115........  Remove eyelid    Y............  A2...........      $446.00      17.1243      $728.52      $516.63
                lining lesion.
68130........  Remove eyelid    Y............  A2...........      $446.00      15.2259      $647.76      $496.44
                lining lesion.
68135........  Remove eyelid    Y............  P3...........  ...........       1.3922       $59.23       $59.23
                lining lesion.
68200........  Treat eyelid by  N............  P3...........  ...........       0.4024       $17.12       $17.12
                injection.
68320........  Revise/graft     Y............  A2...........      $630.00      17.1243      $728.52      $654.63
                eyelid lining.
68325........  Revise/graft     Y............  A2...........      $630.00      25.2550    $1,074.42      $741.11
                eyelid lining.
68326........  Revise/graft     Y............  A2...........      $630.00      25.2550    $1,074.42      $741.11
                eyelid lining.
68328........  Revise/graft     Y............  A2...........      $630.00      25.2550    $1,074.42      $741.11
                eyelid lining.
68330........  Revise eyelid    Y............  A2...........      $630.00      22.9970      $978.36      $717.09
                lining.
68335........  Revise/graft     Y............  A2...........      $630.00      25.2550    $1,074.42      $741.11
                eyelid lining.
68340........  Separate eyelid  Y............  A2...........      $630.00      17.1243      $728.52      $654.63
                adhesions.
68360........  Revise eyelid    Y............  A2...........      $446.00      22.9970      $978.36      $579.09
                lining.
68362........  Revise eyelid    Y............  A2...........      $446.00      22.9970      $978.36      $579.09
                lining.
68371........  Harvest eye      Y............  A2...........      $446.00      15.2259      $647.76      $496.44
                tissue,
                alograft.
68400........  Incise/drain     Y............  P2...........  ...........       2.8954      $123.18      $123.18
                tear gland.
68420........  Incise/drain     Y............  P3...........  ...........       4.3777      $186.24      $186.24
                tear sac.
68440........  Incise tear      Y............  P3...........  ...........       1.3520       $57.52       $57.52
                duct opening.
68500........  Removal of tear  Y............  A2...........      $510.00      25.2550    $1,074.42      $651.11
                gland.
68505........  Partial          Y............  A2...........      $510.00      25.2550    $1,074.42      $651.11
                removal, tear
                gland.
68510........  Biopsy of tear   Y............  A2...........      $333.00      17.1243      $728.52      $431.88
                gland.
68520........  Removal of tear  Y............  A2...........      $510.00      25.2550    $1,074.42      $651.11
                sac.
68525........  Biopsy of tear   Y............  A2...........      $333.00      17.1243      $728.52      $431.88
                sac.
68530........  Clearance of     Y............  P3...........  ...........       5.5929      $237.94      $237.94
                tear duct.
68540........  Remove tear      Y............  A2...........      $510.00      25.2550    $1,074.42      $651.11
                gland lesion.
68550........  Remove tear      Y............  A2...........      $510.00      25.2550    $1,074.42      $651.11
                gland lesion.
68700........  Repair tear      Y............  A2...........      $446.00      25.2550    $1,074.42      $603.11
                ducts.
68705........  Revise tear      Y............  P2...........  ...........       2.8954      $123.18      $123.18
                duct opening.
68720........  Create tear sac  Y............  A2...........      $630.00      25.2550    $1,074.42      $741.11
                drain.
68745........  Create tear      Y............  A2...........      $630.00      25.2550    $1,074.42      $741.11
                duct drain.
68750........  Create tear      Y............  A2...........      $630.00      25.2550    $1,074.42      $741.11
                duct drain.
68760........  Close tear duct  N............  P2...........  ...........       2.1451       $91.26       $91.26
                opening.
68761........  Close tear duct  N............  P3...........  ...........       1.6658       $70.87       $70.87
                opening.
68770........  Close tear       Y............  A2...........      $630.00      17.1243      $728.52      $654.63
                system fistula.
68801........  Dilate tear      N............  P2...........  ...........       1.1607       $49.38       $49.38
                duct opening.
68810........  Probe            N............  A2...........      $131.86       2.1451       $91.26      $121.71
                nasolacrimal
                duct.
68811........  Probe            Y............  A2...........      $446.00      17.1243      $728.52      $516.63
                nasolacrimal
                duct.
68815........  Probe            Y............  A2...........      $446.00      17.1243      $728.52      $516.63
                nasolacrimal
                duct.
68840........  Explore/         N............  P2...........  ...........       1.1607       $49.38       $49.38
                irrigate tear
                ducts.
68850........  Injection for    .............  N1...........  ...........  ...........  ...........  ...........
                tear sac x-ray.
69000........  Drain external   Y............  P2...........  ...........       1.4392       $61.23       $61.23
                ear lesion.
69005........  Drain external   Y............  P3...........  ...........       2.2934       $97.57       $97.57
                ear lesion.

[[Page 42602]]

 
69020........  Drain outer ear  Y............  P2...........  ...........       1.4392       $61.23       $61.23
                canal lesion.
69100........  Biopsy of        Y............  P3...........  ...........       1.4404       $61.28       $61.28
                external ear.
69105........  Biopsy of        Y............  P3...........  ...........       1.9474       $82.85       $82.85
                external ear
                canal.
69110........  Remove external  Y............  A2...........      $333.00      15.1024      $642.50      $410.38
                ear, partial.
69120........  Removal of       Y............  A2...........      $446.00      23.3299      $992.52      $582.63
                external ear.
69140........  Remove ear       Y............  A2...........      $446.00      23.3299      $992.52      $582.63
                canal
                lesion(s).
69145........  Remove ear       Y............  A2...........      $446.00      15.1024      $642.50      $495.13
                canal
                lesion(s).
69150........  Extensive ear    Y............  A2...........      $464.15       7.5511      $321.25      $428.43
                canal surgery.
69200........  Clear outer ear  N............  P2...........  ...........       0.6102       $25.96       $25.96
                canal.
69205........  Clear outer ear  Y............  A2...........      $333.00      20.0656      $853.65      $463.16
                canal.
69210........  Remove impacted  N............  P3...........  ...........       0.4748       $20.20       $20.20
                ear wax.
69220........  Clean out        Y............  P2...........  ...........       0.8432       $35.87       $35.87
                mastoid cavity.
69222........  Clean out        Y............  P3...........  ...........       3.0339      $129.07      $129.07
                mastoid cavity.
69300........  Revise external  Y............  A2...........      $510.00      23.3299      $992.52      $630.63
                ear.
69310........  Rebuild outer    Y............  A2...........      $510.00      38.1991    $1,625.10      $788.78
                ear canal.
69320........  Rebuild outer    Y............  A2...........      $995.00      38.1991    $1,625.10    $1,152.53
                ear canal.
69400........  Inflate middle   Y............  P3...........  ...........       1.9152       $81.48       $81.48
                ear canal.
69401........  Inflate middle   Y............  P3...........  ...........       1.0944       $46.56       $46.56
                ear canal.
69405........  Catheterize      Y............  P3...........  ...........       2.7842      $118.45      $118.45
                middle ear
                canal.
69420........  Incision of      Y............  P2...........  ...........       2.4520      $104.32      $104.32
                eardrum.
69421........  Incision of      Y............  A2...........      $510.00      16.4266      $698.84      $557.21
                eardrum.
69424........  Remove           Y............  P3...........  ...........       1.7542       $74.63       $74.63
                ventilating
                tube.
69433........  Create eardrum   Y............  P3...........  ...........       2.4787      $105.45      $105.45
                opening.
69436........  Create eardrum   Y............  A2...........      $510.00      16.4266      $698.84      $557.21
                opening.
69440........  Exploration of   Y............  A2...........      $510.00      23.3299      $992.52      $630.63
                middle ear.
69450........  Eardrum          Y............  A2...........      $333.00      38.1991    $1,625.10      $656.03
                revision.
69501........  Mastoidectomy..  Y............  A2...........      $995.00      38.1991    $1,625.10    $1,152.53
69502........  Mastoidectomy..  Y............  A2...........      $995.00      23.3299      $992.52      $994.38
69505........  Remove mastoid   Y............  A2...........      $995.00      38.1991    $1,625.10    $1,152.53
                structures.
69511........  Extensive        Y............  A2...........      $995.00      38.1991    $1,625.10    $1,152.53
                mastoid
                surgery.
69530........  Extensive        Y............  A2...........      $995.00      38.1991    $1,625.10    $1,152.53
                mastoid
                surgery.
69540........  Remove ear       Y............  P3...........  ...........       2.9615      $125.99      $125.99
                lesion.
69550........  Remove ear       Y............  A2...........      $717.00      38.1991    $1,625.10      $944.03
                lesion.
69552........  Remove ear       Y............  A2...........      $995.00      38.1991    $1,625.10    $1,152.53
                lesion.
69601........  Mastoid surgery  Y............  A2...........      $995.00      38.1991    $1,625.10    $1,152.53
                revision.
69602........  Mastoid surgery  Y............  A2...........      $995.00      38.1991    $1,625.10    $1,152.53
                revision.
69603........  Mastoid surgery  Y............  A2...........      $995.00      38.1991    $1,625.10    $1,152.53
                revision.
69604........  Mastoid surgery  Y............  A2...........      $995.00      38.1991    $1,625.10    $1,152.53
                revision.
69605........  Mastoid surgery  Y............  A2...........      $995.00      38.1991    $1,625.10    $1,152.53
                revision.
69610........  Repair of        Y............  P3...........  ...........       4.0477      $172.20      $172.20
                eardrum.
69620........  Repair of        Y............  A2...........      $446.00      23.3299      $992.52      $582.63
                eardrum.
69631........  Repair eardrum   Y............  A2...........      $717.00      38.1991    $1,625.10      $944.03
                structures.
69632........  Rebuild eardrum  Y............  A2...........      $717.00      38.1991    $1,625.10      $944.03
                structures.
69633........  Rebuild eardrum  Y............  A2...........      $717.00      38.1991    $1,625.10      $944.03
                structures.
69635........  Repair eardrum   Y............  A2...........      $995.00      38.1991    $1,625.10    $1,152.53
                structures.
69636........  Rebuild eardrum  Y............  A2...........      $995.00      38.1991    $1,625.10    $1,152.53
                structures.
69637........  Rebuild eardrum  Y............  A2...........      $995.00      38.1991    $1,625.10    $1,152.53
                structures.
69641........  Revise middle    Y............  A2...........      $995.00      38.1991    $1,625.10    $1,152.53
                ear & mastoid.
69642........  Revise middle    Y............  A2...........      $995.00      38.1991    $1,625.10    $1,152.53
                ear & mastoid.
69643........  Revise middle    Y............  A2...........      $995.00      38.1991    $1,625.10    $1,152.53
                ear & mastoid.
69644........  Revise middle    Y............  A2...........      $995.00      38.1991    $1,625.10    $1,152.53
                ear & mastoid.
69645........  Revise middle    Y............  A2...........      $995.00      38.1991    $1,625.10    $1,152.53
                ear & mastoid.
69646........  Revise middle    Y............  A2...........      $995.00      38.1991    $1,625.10    $1,152.53
                ear & mastoid.
69650........  Release middle   Y............  A2...........      $995.00      23.3299      $992.52      $994.38
                ear bone.
69660........  Revise middle    Y............  A2...........      $717.00      38.1991    $1,625.10      $944.03
                ear bone.
69661........  Revise middle    Y............  A2...........      $717.00      38.1991    $1,625.10      $944.03
                ear bone.
69662........  Revise middle    Y............  A2...........      $717.00      38.1991    $1,625.10      $944.03
                ear bone.
69666........  Repair middle    Y............  A2...........      $630.00      38.1991    $1,625.10      $878.78
                ear structures.
69667........  Repair middle    Y............  A2...........      $630.00      38.1991    $1,625.10      $878.78
                ear structures.
69670........  Remove mastoid   Y............  A2...........      $510.00      38.1991    $1,625.10      $788.78
                air cells.
69676........  Remove middle    Y............  A2...........      $510.00      38.1991    $1,625.10      $788.78
                ear nerve.
69700........  Close mastoid    Y............  A2...........      $510.00      38.1991    $1,625.10      $788.78
                fistula.
69711........  Remove/repair    Y............  A2...........      $333.00      38.1991    $1,625.10      $656.03
                hearing aid.

[[Page 42603]]

 
69714........  Implant temple   Y............  A2...........    $1,339.00      38.1991    $1,625.10    $1,410.53
                bone w/stimul.
69715........  Temple bne       Y............  A2...........    $1,339.00      38.1991    $1,625.10    $1,410.53
                implnt w/
                stimulat.
69717........  Temple bone      Y............  A2...........    $1,339.00      38.1991    $1,625.10    $1,410.53
                implant
                revision.
69718........  Revise temple    Y............  A2...........    $1,339.00      38.1991    $1,625.10    $1,410.53
                bone implant.
69720........  Release facial   Y............  A2...........      $717.00      38.1991    $1,625.10      $944.03
                nerve.
69740........  Repair facial    Y............  A2...........      $717.00      38.1991    $1,625.10      $944.03
                nerve.
69745........  Repair facial    Y............  A2...........      $717.00      38.1991    $1,625.10      $944.03
                nerve.
69801........  Incise inner     Y............  A2...........      $717.00      38.1991    $1,625.10      $944.03
                ear.
69802........  Incise inner     Y............  A2...........      $995.00      38.1991    $1,625.10    $1,152.53
                ear.
69805........  Explore inner    Y............  A2...........      $995.00      38.1991    $1,625.10    $1,152.53
                ear.
69806........  Explore inner    Y............  A2...........      $995.00      38.1991    $1,625.10    $1,152.53
                ear.
69820........  Establish inner  Y............  A2...........      $717.00      38.1991    $1,625.10      $944.03
                ear window.
69840........  Revise inner     Y............  A2...........      $717.00      38.1991    $1,625.10      $944.03
                ear window.
69905........  Remove inner     Y............  A2...........      $995.00      38.1991    $1,625.10    $1,152.53
                ear.
69910........  Remove inner     Y............  A2...........      $995.00      38.1991    $1,625.10    $1,152.53
                ear & mastoid.
69915........  Incise inner     Y............  A2...........      $995.00      38.1991    $1,625.10    $1,152.53
                ear nerve.
69930........  Implant          Y............  H8...........      $995.00     587.7216   $25,003.44   $23,712.58
                cochlear
                device.
69990........  Microsurgery     .............  N1...........  ...........  ...........  ...........  ...........
                add-on.
C9716........  Radiofrequency   Y............  G2...........  ...........      29.6189    $1,260.08    $1,260.08
                energy to anu.
C9724........  EPS gast cardia  Y............  G2...........  ...........      25.7552    $1,095.70    $1,095.70
                plic.
C9725........  Place            N............  G2...........  ...........       8.9477      $380.66      $380.66
                endorectal app.
C9726........  Rxt breast appl  N............  G2...........  ...........      10.5746      $449.88      $449.88
                place/remov.
C9727........  Insert palate    N............  G2...........  ...........      13.8283      $588.30      $588.30
                implants.
G0104........  CA screen;flexi  N............  P3...........  ...........       1.9152       $81.48       $81.48
                sigmoidscope.
G0105........  Colorectal       Y............  A2...........      $446.00       7.8492      $333.93      $417.98
                scrn; hi risk
                ind.
G0121........  Colon ca scrn    Y............  A2...........      $446.00       7.8492      $333.93      $417.98
                not hi rsk ind.
G0127........  Trim nail(s)...  Y............  P3...........  ...........       0.2494       $10.61       $10.61
G0186........  Dstry eye        Y............  R2...........  ...........       3.9333      $167.33      $167.33
                lesn,fdr vssl
                tech.
G0247........  Routine          Y............  P3...........  ...........       0.4828       $20.54       $20.54
                footcare pt w
                lops.
G0259........  Inject for       .............  N1...........  ...........  ...........  ...........  ...........
                sacroiliac
                joint.
G0260........  Inj for          Y............  A2...........      $333.00       5.7253      $243.57      $310.64
                sacroiliac jt
                anesth.
G0268........  Removal of       N............  P3...........  ...........       0.4990       $21.23       $21.23
                impacted wax
                md.
G0269........  Occlusive        .............  N1...........  ...........  ...........  ...........  ...........
                device in vein
                art.
G0289........  Arthro, loose    .............  N1...........  ...........  ...........  ...........  ...........
                body + chondro.
G0297........  Insert single    Y............  J8...........  ...........     440.1206   $18,724.05   $18,724.05
                chamber/cd.
G0298........  Insert dual      Y............  J8...........  ...........     440.1206   $18,724.05   $18,724.05
                chamber/cd.
G0299........  Inser/repos      Y............  J8...........  ...........     546.9370   $23,268.34   $23,268.34
                single
                icd+leads.
G0300........  Insert reposit   Y............  J8...........  ...........     546.9370   $23,268.34   $23,268.34
                lead dual+gen.
G0364........  Bone marrow      Y............  P3...........  ...........       0.1208        $5.14        $5.14
                aspirate &
                biopsy.
G0392........  AV fistula or    Y............  A2...........    $1,339.00      42.9360    $1,826.63    $1,460.91
                graft arterial.
G0393........  AV fistula or    Y............  A2...........    $1,339.00      42.9360    $1,826.63    $1,460.91
                graft venous.
----------------------------------------------------------------------------------------------------------------
Note: The Medicare program payment is 80 percent of the total payment amount and beneficiary coinsurance is 20
  percent of the total payment amount, except for screening flexible sigmoidoscopies and screening colonoscopies
  for which the program payment is 75 percent and the beneficiary coinsurance is 25 percent.
* Refers to codes designated as ``office-based,'' whose designation as office-based is temporary because we have
  insufficient claims data. We will reconsider this designation when new claims data become available.








  Federal Register / Vol. 72, No. 148 / Thursday, August 2, 2007 / 
Rules and Regulations  

[[Page 42603]]




[[Page 42604]]







    --------------------
Note: The Medicare program payment is 80 percent of the total payment 
amount and beneficiary coinsurance is 20 percent of the total payment 
amount, except for screening flexible sigmoidoscopies and screening 
colonoscopies for which the program payment is 75 percent and the 
beneficiary coinsurance is 25 percent.

[[Page 42604]]



  Addendum BB.--Illustrative ASC Covered Ancillary Services Integral to
  Covered Surgical Procedures for CY 2008 (Including Ancillary Services
                     for Which Payment is Packaged)
------------------------------------------------------------------------
                                                 Estimated
                     Short          Payment       CY 2008     Estimated
  HCPCS code       descriptor      indicator      payment      CY 2008
                                                  weights      payment
------------------------------------------------------------------------
0028T.........  Dexa body        N1...........  ...........  ...........
                 composition
                 study.
0042T.........  Ct perfusion w/  N1...........  ...........  ...........
                 contrast, cbf.
0054T.........  Bone surgery     Z2...........       4.9138      $209.05
                 using computer.
0055T.........  Bone surgery     Z2...........       4.9138      $209.05
                 using computer.
0056T.........  Bone surgery     Z2...........       4.9138      $209.05
                 using computer.
0067T.........  Ct               Z2...........       4.8405      $205.93
                 colonography;d
                 x.
0071T.........  U/s leiomyomata  Z2...........      28.5095    $1,212.88
                 ablate <200.
0072T.........  U/s leiomyomata  Z2...........      42.9896    $1,828.91
                 ablate >200.
0073T.........  Delivery, comp   Z2...........       5.4731      $232.84
                 imrt.
0126T.........  Chd risk imt     N1...........  ...........  ...........
                 study.
0144T.........  CT heart wo      Z2...........       4.1265      $175.55
                 dye; qual calc.
0145T.........  CT heart w/wo    Z2...........       4.9832      $212.00
                 dye funct.
0146T.........  CCTA w/wo dye..  Z2...........       4.9832      $212.00
0147T.........  CCTA w/wo, quan  Z2...........       4.9832      $212.00
                 calcium.
0148T.........  CCTA w/wo,       Z2...........       6.5012      $276.58
                 strxr.
0149T.........  CCTA w/wo,       Z2...........       6.5012      $276.58
                 strxr quan
                 calc.
0150T.........  CCTA w/wo,       Z2...........       4.1265      $175.55
                 disease strxr.
0151T.........  CT heart funct   Z2...........       1.5379       $65.43
                 add-on.
0159T.........  Cad breast mri.  N1...........  ...........  ...........
0174T.........  Cad cxr with     N1...........  ...........  ...........
                 interp.
0175T.........  Cad cxr remote.  N1...........  ...........  ...........
70010.........  Contrast x-ray   Z2...........       2.5544      $108.67
                 of brain.
70015.........  Contrast x-ray   Z3...........       1.4806       $62.99
                 of brain.
70030.........  X-ray eye for    Z3...........       0.3782       $16.09
                 foreign body.
70100.........  X-ray exam of    Z3...........       0.4346       $18.49
                 jaw.
70110.........  X-ray exam of    Z3...........       0.5230       $22.25
                 jaw.
70120.........  X-ray exam of    Z3...........       0.4990       $21.23
                 mastoids.
70130.........  X-ray exam of    Z2...........       0.7093       $30.18
                 mastoids.
70134.........  X-ray exam of    Z3...........       0.6036       $25.68
                 middle ear.
70140.........  X-ray exam of    Z3...........       0.4346       $18.49
                 facial bones.
70150.........  X-ray exam of    Z3...........       0.6116       $26.02
                 facial bones.
70160.........  X-ray exam of    Z3...........       0.4506       $19.17
                 nasal bones.
70170.........  X-ray exam of    Z2...........       2.9586      $125.87
                 tear duct.
70190.........  X-ray exam of    Z3...........       0.4990       $21.23
                 eye sockets.
70200.........  X-ray exam of    Z3...........       0.6116       $26.02
                 eye sockets.
70210.........  X-ray exam of    Z3...........       0.4506       $19.17
                 sinuses.
70220.........  X-ray exam of    Z3...........       0.5632       $23.96
                 sinuses.
70240.........  X-ray exam,      Z3...........       0.3862       $16.43
                 pituitary
                 saddle.
70250.........  X-ray exam of    Z3...........       0.4908       $20.88
                 skull.
70260.........  X-ray exam of    Z3...........       0.6518       $27.73
                 skull.
70300.........  X-ray exam of    Z3...........       0.1932        $8.22
                 teeth.
70310.........  X-ray exam of    Z3...........       0.4828       $20.54
                 teeth.
70320.........  Full mouth x-    Z2...........       0.6550       $27.87
                 ray of teeth.
70328.........  X-ray exam of    Z3...........       0.4104       $17.46
                 jaw joint.
70330.........  X-ray exam of    Z3...........       0.6920       $29.44
                 jaw joints.
70332.........  X-ray exam of    Z3...........       1.3520       $57.52
                 jaw joint.
70336.........  Magnetic image,  Z2...........       4.5523      $193.67
                 jaw joint.
70350.........  X-ray head for   Z3...........       0.2576       $10.96
                 orthodontia.
70355.........  Panoramic x-ray  Z3...........       0.3218       $13.69
                 of jaws.
70360.........  X-ray exam of    Z3...........       0.3622       $15.41
                 neck.
70370.........  Throat x-ray &   Z3...........       1.1346       $48.27
                 fluoroscopy.
70371.........  Speech           Z2...........       1.2908       $54.91
                 evaluation,
                 complex.
70373.........  Contrast x-ray   Z3...........       1.3036       $55.46
                 of larynx.
70380.........  X-ray exam of    Z3...........       0.5714       $24.31
                 salivary gland.
70390.........  X-ray exam of    Z3...........       1.5612       $66.42
                 salivary duct.
70450.........  Ct head/brain w/ Z2...........       3.0908      $131.49
                 o dye.
70460.........  Ct head/brain w/ Z2...........       4.0825      $173.68
                 dye.
70470.........  Ct head/brain w/ Z2...........       4.8405      $205.93
                 o & w/dye.
70480.........  Ct orbit/ear/    Z2...........       3.0908      $131.49
                 fossa w/o dye.
70481.........  Ct orbit/ear/    Z2...........       4.0825      $173.68
                 fossa w/dye.
70482.........  Ct orbit/ear/    Z2...........       4.8405      $205.93
                 fossa w/o & w/
                 dye.
70486.........  Ct               Z2...........       3.0908      $131.49
                 maxillofacial
                 w/o dye.
70487.........  Ct               Z2...........       4.0825      $173.68
                 maxillofacial
                 w/dye.
70488.........  Ct               Z2...........       4.8405      $205.93
                 maxillofacial
                 w/o & w/dye.

[[Page 42605]]

 
70490.........  Ct soft tissue   Z2...........       3.0908      $131.49
                 neck w/o dye.
70491.........  Ct soft tissue   Z2...........       4.0825      $173.68
                 neck w/dye.
70492.........  Ct sft tsue nck  Z2...........       4.8405      $205.93
                 w/o & w/dye.
70496.........  Ct angiography,  Z2...........       4.8552      $206.55
                 head.
70498.........  Ct angiography,  Z2...........       4.8552      $206.55
                 neck.
70540.........  Mri orbit/face/  Z2...........       5.6745      $241.41
                 neck w/o dye.
70542.........  Mri orbit/face/  Z2...........       6.1231      $260.50
                 neck w/dye.
70543.........  Mri orbt/fac/    Z2...........       8.1155      $345.26
                 nck w/o & w/
                 dye.
70544.........  Mr angiography   Z2...........       5.6745      $241.41
                 head w/o dye.
70545.........  Mr angiography   Z2...........       6.1231      $260.50
                 head w/dye.
70546.........  Mr angiograph    Z2...........       8.1155      $345.26
                 head w/o & w/
                 dye.
70547.........  Mr angiography   Z2...........       5.6745      $241.41
                 neck w/o dye.
70548.........  Mr angiography   Z2...........       6.1231      $260.50
                 neck w/dye.
70549.........  Mr angiograph    Z2...........       8.1155      $345.26
                 neck w/o & w/
                 dye.
70551.........  Mri brain w/o    Z2...........       5.6745      $241.41
                 dye.
70552.........  Mri brain w/dye  Z2...........       6.1231      $260.50
70553.........  Mri brain w/o &  Z2...........       8.1155      $345.26
                 w/dye.
70554.........  Fmri brain by    Z2...........       5.6745      $241.41
                 tech.
70555.........  Fmri brain by    Z2...........       5.6745      $241.41
                 phys/psych.
70557.........  Mri brain w/o    Z2...........       5.6745      $241.41
                 dye.
70558.........  Mri brain w/dye  Z2...........       6.1231      $260.50
70559.........  Mri brain w/o &  Z2...........       8.1155      $345.26
                 w/dye.
71010.........  Chest x-ray....  Z3...........       0.3300       $14.04
71015.........  Chest x-ray....  Z3...........       0.4024       $17.12
71020.........  Chest x-ray....  Z3...........       0.4426       $18.83
71021.........  Chest x-ray....  Z3...........       0.5392       $22.94
71022.........  Chest x-ray....  Z3...........       0.6036       $25.68
71023.........  Chest x-ray and  Z3...........       0.8690       $36.97
                 fluoroscopy.
71030.........  Chest x-ray....  Z3...........       0.6276       $26.70
71034.........  Chest x-ray and  Z2...........       1.2908       $54.91
                 fluoroscopy.
71035.........  Chest x-ray....  Z3...........       0.4828       $20.54
71040.........  Contrast x-ray   Z3...........       1.3278       $56.49
                 of bronchi.
71060.........  Contrast x-ray   Z2...........       1.6956       $72.14
                 of bronchi.
71090.........  X-ray &          Z2...........       1.2908       $54.91
                 pacemaker
                 insertion.
71100.........  X-ray exam of    Z3...........       0.4426       $18.83
                 ribs.
71101.........  X-ray exam of    Z3...........       0.5230       $22.25
                 ribs/chest.
71110.........  X-ray exam of    Z3...........       0.5794       $24.65
                 ribs.
71111.........  X-ray exam of    Z3...........       0.7322       $31.15
                 ribs/chest.
71120.........  X-ray exam of    Z3...........       0.4748       $20.20
                 breastbone.
71130.........  X-ray exam of    Z3...........       0.5472       $23.28
                 breastbone.
71250.........  Ct thorax w/o    Z2...........       3.0908      $131.49
                 dye.
71260.........  Ct thorax w/dye  Z2...........       4.0825      $173.68
71270.........  Ct thorax w/o &  Z2...........       4.8405      $205.93
                 w/dye.
71275.........  Ct angiography,  Z2...........       4.8552      $206.55
                 chest.
71550.........  Mri chest w/o    Z2...........       5.6745      $241.41
                 dye.
71551.........  Mri chest w/dye  Z2...........       6.1231      $260.50
71552.........  Mri chest w/o &  Z2...........       8.1155      $345.26
                 w/dye.
72010.........  X-ray exam of    Z2...........       0.7093       $30.18
                 spine.
72020.........  X-ray exam of    Z3...........       0.3218       $13.69
                 spine.
72040.........  X-ray exam of    Z3...........       0.5150       $21.91
                 neck spine.
72050.........  X-ray exam of    Z3...........       0.7322       $31.15
                 neck spine.
72052.........  X-ray exam of    Z3...........       0.9416       $40.06
                 neck spine.
72069.........  X-ray exam of    Z3...........       0.4586       $19.51
                 trunk spine.
72070.........  X-ray exam of    Z3...........       0.4748       $20.20
                 thoracic spine.
72072.........  X-ray exam of    Z3...........       0.5552       $23.62
                 thoracic spine.
72074.........  X-ray exam of    Z3...........       0.7000       $29.78
                 thoracic spine.
72080.........  X-ray exam of    Z3...........       0.5070       $21.57
                 trunk spine.
72090.........  X-ray exam of    Z3...........       0.6196       $26.36
                 trunk spine.
72100.........  X-ray exam of    Z3...........       0.5552       $23.62
                 lower spine.
72110.........  X-ray exam of    Z3...........       0.7644       $32.52
                 lower spine.
72114.........  X-ray exam of    Z3...........       1.0380       $44.16
                 lower spine.
72120.........  X-ray exam of    Z3...........       0.7484       $31.84
                 lower spine.
72125.........  Ct neck spine w/ Z2...........       3.0908      $131.49
                 o dye.
72126.........  Ct neck spine w/ Z2...........       4.0825      $173.68
                 dye.

[[Page 42606]]

 
72127.........  Ct neck spine w/ Z2...........       4.8405      $205.93
                 o & w/dye.
72128.........  Ct chest spine   Z2...........       3.0908      $131.49
                 w/o dye.
72129.........  Ct chest spine   Z2...........       4.0825      $173.68
                 w/dye.
72130.........  Ct chest spine   Z2...........       4.8405      $205.93
                 w/o & w/dye.
72131.........  Ct lumbar spine  Z2...........       3.0908      $131.49
                 w/o dye.
72132.........  Ct lumbar spine  Z2...........       4.0825      $173.68
                 w/dye.
72133.........  Ct lumbar spine  Z2...........       4.8405      $205.93
                 w/o & w/dye.
72141.........  Mri neck spine   Z2...........       5.6745      $241.41
                 w/o dye.
72142.........  Mri neck spine   Z2...........       6.1231      $260.50
                 w/dye.
72146.........  Mri chest spine  Z2...........       5.6745      $241.41
                 w/o dye.
72147.........  Mri chest spine  Z2...........       6.1231      $260.50
                 w/dye.
72148.........  Mri lumbar       Z2...........       5.6745      $241.41
                 spine w/o dye.
72149.........  Mri lumbar       Z2...........       6.1231      $260.50
                 spine w/dye.
72156.........  Mri neck spine   Z2...........       8.1155      $345.26
                 w/o & w/dye.
72157.........  Mri chest spine  Z2...........       8.1155      $345.26
                 w/o & w/dye.
72158.........  Mri lumbar       Z2...........       8.1155      $345.26
                 spine w/o & w/
                 dye.
72170.........  X-ray exam of    Z3...........       0.3782       $16.09
                 pelvis.
72190.........  X-ray exam of    Z3...........       0.5714       $24.31
                 pelvis.
72191.........  Ct angiograph    Z2...........       4.8552      $206.55
                 pelv w/o & w/
                 dye.
72192.........  Ct pelvis w/o    Z2...........       3.0908      $131.49
                 dye.
72193.........  Ct pelvis w/dye  Z2...........       4.0825      $173.68
72194.........  Ct pelvis w/o &  Z2...........       4.8405      $205.93
                 w/dye.
72195.........  Mri pelvis w/o   Z2...........       5.6745      $241.41
                 dye.
72196.........  Mri pelvis w/    Z2...........       6.1231      $260.50
                 dye.
72197.........  Mri pelvis w/o   Z2...........       8.1155      $345.26
                 & w/dye.
72200.........  X-ray exam       Z3...........       0.4184       $17.80
                 sacroiliac
                 joints.
72202.........  X-ray exam       Z3...........       0.5070       $21.57
                 sacroiliac
                 joints.
72220.........  X-ray exam of    Z3...........       0.4264       $18.14
                 tailbone.
72240.........  Contrast x-ray   Z2...........       2.5544      $108.67
                 of neck spine.
72255.........  Contrast x-ray,  Z3...........       2.5026      $106.47
                 thorax spine.
72265.........  Contrast x-ray,  Z3...........       2.4867      $105.79
                 lower spine.
72270.........  Contrast x-ray,  Z2...........       2.5544      $108.67
                 spine.
72275.........  Epidurography..  Z3...........       1.4404       $61.28
72285.........  X-ray c/t spine  Z3...........       3.8145      $162.28
                 disk.
72291.........  Perq             Z2...........       2.5544      $108.67
                 vertebroplasty
                 , fluor.
72292.........  Perq             Z2...........       2.5544      $108.67
                 vertebroplasty
                 , ct.
72295.........  X-ray of lower   Z3...........       3.6213      $154.06
                 spine disk.
73000.........  X-ray exam of    Z3...........       0.4024       $17.12
                 collar bone.
73010.........  X-ray exam of    Z3...........       0.4184       $17.80
                 shoulder blade.
73020.........  X-ray exam of    Z3...........       0.3460       $14.72
                 shoulder.
73030.........  X-ray exam of    Z3...........       0.4264       $18.14
                 shoulder.
73040.........  Contrast x-ray   Z3...........       1.6256       $69.16
                 of shoulder.
73050.........  X-ray exam of    Z3...........       0.5230       $22.25
                 shoulders.
73060.........  X-ray exam of    Z3...........       0.4264       $18.14
                 humerus.
73070.........  X-ray exam of    Z3...........       0.4024       $17.12
                 elbow.
73080.........  X-ray exam of    Z3...........       0.4990       $21.23
                 elbow.
73085.........  Contrast x-ray   Z3...........       1.4806       $62.99
                 of elbow.
73090.........  X-ray exam of    Z3...........       0.4024       $17.12
                 forearm.
73092.........  X-ray exam of    Z3...........       0.4024       $17.12
                 arm, infant.
73100.........  X-ray exam of    Z3...........       0.4104       $17.46
                 wrist.
73110.........  X-ray exam of    Z3...........       0.4908       $20.88
                 wrist.
73115.........  Contrast x-ray   Z3...........       1.4806       $62.99
                 of wrist.
73120.........  X-ray exam of    Z3...........       0.3944       $16.78
                 hand.
73130.........  X-ray exam of    Z3...........       0.4426       $18.83
                 hand.
73140.........  X-ray exam of    Z3...........       0.4184       $17.80
                 finger(s).
73200.........  Ct upper         Z2...........       3.0908      $131.49
                 extremity w/o
                 dye.
73201.........  Ct upper         Z2...........       4.0825      $173.68
                 extremity w/
                 dye.
73202.........  Ct uppr          Z2...........       4.8405      $205.93
                 extremity w/o
                 & w/dye.
73206.........  Ct angio upr     Z2...........       4.8552      $206.55
                 extrm w/o & w/
                 dye.
73218.........  Mri upper        Z2...........       5.6745      $241.41
                 extremity w/o
                 dye.
73219.........  Mri upper        Z2...........       6.1231      $260.50
                 extremity w/
                 dye.
73220.........  Mri uppr         Z2...........       8.1155      $345.26
                 extremity w/o
                 & w/dye.
73221.........  Mri joint upr    Z2...........       5.6745      $241.41
                 extrem w/o dye.
73222.........  Mri joint upr    Z2...........       6.1231      $260.50
                 extrem w/dye.

[[Page 42607]]

 
73223.........  Mri joint upr    Z2...........       8.1155      $345.26
                 extr w/o & w/
                 dye.
73500.........  X-ray exam of    Z3...........       0.3540       $15.06
                 hip.
73510.........  X-ray exam of    Z3...........       0.5070       $21.57
                 hip.
73520.........  X-ray exam of    Z3...........       0.5392       $22.94
                 hips.
73525.........  Contrast x-ray   Z3...........       1.4726       $62.65
                 of hip.
73530.........  X-ray exam of    Z2...........       1.2224       $52.00
                 hip.
73540.........  X-ray exam of    Z3...........       0.5150       $21.91
                 pelvis & hips.
73542.........  X-ray exam,      Z3...........       1.2312       $52.38
                 sacroiliac
                 joint.
73550.........  X-ray exam of    Z3...........       0.4184       $17.80
                 thigh.
73560.........  X-ray exam of    Z3...........       0.4184       $17.80
                 knee, 1 or 2.
73562.........  X-ray exam of    Z3...........       0.4908       $20.88
                 knee, 3.
73564.........  X-ray exam,      Z3...........       0.5552       $23.62
                 knee, 4 or
                 more.
73565.........  X-ray exam of    Z3...........       0.4264       $18.14
                 knees.
73580.........  Contrast x-ray   Z3...........       1.9152       $81.48
                 of knee joint.
73590.........  X-ray exam of    Z3...........       0.3944       $16.78
                 lower leg.
73592.........  X-ray exam of    Z3...........       0.4104       $17.46
                 leg, infant.
73600.........  X-ray exam of    Z3...........       0.3944       $16.78
                 ankle.
73610.........  X-ray exam of    Z3...........       0.4506       $19.17
                 ankle.
73615.........  Contrast x-ray   Z3...........       1.5128       $64.36
                 of ankle.
73620.........  X-ray exam of    Z3...........       0.3944       $16.78
                 foot.
73630.........  X-ray exam of    Z3...........       0.4426       $18.83
                 foot.
73650.........  X-ray exam of    Z3...........       0.3862       $16.43
                 heel.
73660.........  X-ray exam of    Z3...........       0.4024       $17.12
                 toe(s).
73700.........  Ct lower         Z2...........       3.0908      $131.49
                 extremity w/o
                 dye.
73701.........  Ct lower         Z2...........       4.0825      $173.68
                 extremity w/
                 dye.
73702.........  Ct lwr           Z2...........       4.8405      $205.93
                 extremity w/o
                 & w/dye.
73706.........  Ct angio lwr     Z2...........       4.8552      $206.55
                 extr w/o & w/
                 dye.
73718.........  Mri lower        Z2...........       5.6745      $241.41
                 extremity w/o
                 dye.
73719.........  Mri lower        Z2...........       6.1231      $260.50
                 extremity w/
                 dye.
73720.........  Mri lwr          Z2...........       8.1155      $345.26
                 extremity w/o
                 & w/dye.
73721.........  Mri jnt of lwr   Z2...........       5.6745      $241.41
                 extre w/o dye.
73722.........  Mri joint of     Z2...........       6.1231      $260.50
                 lwr extr w/dye.
73723.........  Mri joint lwr    Z2...........       8.1155      $345.26
                 extr w/o & w/
                 dye.
74000.........  X-ray exam of    Z3...........       0.3622       $15.41
                 abdomen.
74010.........  X-ray exam of    Z3...........       0.5070       $21.57
                 abdomen.
74020.........  X-ray exam of    Z3...........       0.5150       $21.91
                 abdomen.
74022.........  X-ray exam       Z3...........       0.6196       $26.36
                 series,
                 abdomen.
74150.........  Ct abdomen w/o   Z2...........       3.0908      $131.49
                 dye.
74160.........  Ct abdomen w/    Z2...........       4.0825      $173.68
                 dye.
74170.........  Ct abdomen w/o   Z2...........       4.8405      $205.93
                 & w/dye.
74175.........  Ct angio abdom   Z2...........       4.8552      $206.55
                 w/o & w/dye.
74181.........  Mri abdomen w/o  Z2...........       5.6745      $241.41
                 dye.
74182.........  Mri abdomen w/   Z2...........       6.1231      $260.50
                 dye.
74183.........  Mri abdomen w/o  Z2...........       8.1155      $345.26
                 & w/dye.
74190.........  X-ray exam of    Z2...........       2.9586      $125.87
                 peritoneum.
74210.........  Contrst x-ray    Z3...........       1.1024       $46.90
                 exam of throat.
74220.........  Contrast x-ray,  Z3...........       1.1830       $50.33
                 esophagus.
74230.........  Cine/vid x-ray,  Z3...........       1.1990       $51.01
                 throat/esoph.
74235.........  Remove           Z2...........       1.0974       $46.69
                 esophagus
                 obstruction.
74240.........  X-ray exam,      Z3...........       1.3680       $58.20
                 upper gi tract.
74241.........  X-ray exam,      Z2...........       1.4294       $60.81
                 upper gi tract.
74245.........  X-ray exam,      Z2...........       2.2176       $94.34
                 upper gi tract.
74246.........  Contrst x-ray    Z2...........       1.4294       $60.81
                 uppr gi tract.
74247.........  Contrst x-ray    Z2...........       1.4294       $60.81
                 uppr gi tract.
74249.........  Contrst x-ray    Z2...........       2.2176       $94.34
                 uppr gi tract.
74250.........  X-ray exam of    Z3...........       1.4082       $59.91
                 small bowel.
74251.........  X-ray exam of    Z2...........       2.2176       $94.34
                 small bowel.
74260.........  X-ray exam of    Z2...........       1.4294       $60.81
                 small bowel.
74270.........  Contrast x-ray   Z2...........       1.4294       $60.81
                 exam of colon.
74280.........  Contrast x-ray   Z2...........       2.2176       $94.34
                 exam of colon.
74283.........  Contrast x-ray   Z2...........       1.4294       $60.81
                 exam of colon.
74290.........  Contrast x-ray,  Z3...........       0.8450       $35.95
                 gallbladder.
74291.........  Contrast x-      Z3...........       0.7726       $32.87
                 rays,
                 gallbladder.
74300.........  X-ray bile       Z2...........       1.6956       $72.14
                 ducts/pancreas.

[[Page 42608]]

 
74301.........  X-rays at        Z2...........       1.6956       $72.14
                 surgery add-on.
74305.........  X-ray bile       Z2...........       1.6956       $72.14
                 ducts/pancreas.
74320.........  Contrast x-ray   Z3...........       2.0039       $85.25
                 of bile ducts.
74327.........  X-ray bile       Z3...........       1.7462       $74.29
                 stone removal.
74328.........  X-ray bile duct  N1...........  ...........  ...........
                 endoscopy.
74329.........  X-ray for        N1...........  ...........  ...........
                 pancreas
                 endoscopy.
74330.........  X-ray bile/panc  N1...........  ...........  ...........
                 endoscopy.
74340.........  X-ray guide for  Z2...........       1.2908       $54.91
                 GI tube.
74350.........  X-ray guide,     Z2...........       1.6956       $72.14
                 stomach tube.
74355.........  X-ray guide,     Z2...........       1.6956      $ 72.14
                 intestinal
                 tube.
74360.........  X-ray guide, GI  Z2...........       1.0974       $46.69
                 dilation.
74363.........  X-ray, bile      Z2...........       3.6392      $154.82
                 duct dilation.
74400.........  Contrst x-ray,   Z3...........       1.6094       $68.47
                 urinary tract.
74410.........  Contrst x-ray,   Z3...........       1.7625       $74.98
                 urinary tract.
74415.........  Contrst x-ray,   Z3...........       2.0440       $86.96
                 urinary tract.
74420.........  Contrst x-ray,   Z2...........       2.4159      $102.78
                 urinary tract.
74425.........  Contrst x-ray,   Z2...........       2.4159      $102.78
                 urinary tract.
74430.........  Contrast x-ray,  Z3...........       1.1346       $48.27
                 bladder.
74440.........  X-ray, male      Z3...........       1.2634       $53.75
                 genital tract.
74445.........  X-ray exam of    Z2...........       2.4159      $102.78
                 penis.
74450.........  X-ray, urethra/  Z2...........       2.4159      $102.78
                 bladder.
74455.........  X-ray, urethra/  Z3...........       1.4324       $60.94
                 bladder.
74470.........  X-ray exam of    Z2...........       1.6956       $72.14
                 kidney lesion.
74475.........  X-ray control,   Z3...........       2.3738      $100.99
                 cath insert.
74480.........  X-ray control,   Z3...........       2.3738      $100.99
                 cath insert.
74485.........  X-ray guide, GU  Z3...........       2.0683       $87.99
                 dilation.
74710.........  X-ray            Z3...........       0.6276       $26.70
                 measurement of
                 pelvis.
74740.........  X-ray, female    Z3...........       1.1508       $48.96
                 genital tract.
74742.........  X-ray,           Z2...........       2.9586      $125.87
                 fallopian tube.
74775.........  X-ray exam of    Z2...........       2.4159      $102.78
                 perineum.
75552.........  Heart mri for    Z2...........       5.6745      $241.41
                 morph w/o dye.
75553.........  Heart mri for    Z2...........       6.1231      $260.50
                 morph w/dye.
75554.........  Cardiac MRI/     Z2...........       5.6745      $241.41
                 function.
75555.........  Cardiac MRI/     Z2...........       5.6745      $241.41
                 limited study.
75600.........  Contrast x-ray   Z3...........       7.5404      $320.79
                 exam of aorta.
75605.........  Contrast x-ray   Z3...........       6.2929      $267.72
                 exam of aorta.
75625.........  Contrast x-ray   Z3...........       6.2125      $264.30
                 exam of aorta.
75630.........  X-ray aorta,     Z3...........       6.4941      $276.28
                 leg arteries.
75635.........  Ct angio         Z2...........       4.8552      $206.55
                 abdominal
                 arteries.
75650.........  Artery x-rays,   Z3...........       6.2125      $264.30
                 head & neck.
75658.........  Artery x-rays,   Z3...........       6.3815      $271.49
                 arm.
75660.........  Artery x-rays,   Z2...........       6.2463      $265.74
                 head & neck.
75662.........  Artery x-rays,   Z3...........       6.7840      $288.61
                 head & neck.
75665.........  Artery x-rays,   Z3...........       6.4699      $275.25
                 head & neck.
75671.........  Artery x-rays,   Z3...........       6.7920      $288.95
                 head & neck.
75676.........  Artery x-rays,   Z3...........       6.3815      $271.49
                 neck.
75680.........  Artery x-rays,   Z3...........       6.5987      $280.73
                 neck.
75685.........  Artery x-rays,   Z3...........       6.3736      $271.15
                 spine.
75705.........  Artery x-rays,   Z2...........       6.2463      $265.74
                 spine.
75710.........  Artery x-rays,   Z3...........       6.4619      $274.91
                 arm/leg.
75716.........  Artery x-rays,   Z3...........       6.7920      $288.95
                 arms/legs.
75722.........  Artery x-rays,   Z3...........       6.4055      $272.51
                 kidney.
75724.........  Artery x-rays,   Z3...........       6.8242      $290.32
                 kidneys.
75726.........  Artery x-rays,   Z3...........       6.3413      $269.78
                 abdomen.
75731.........  Artery x-rays,   Z3...........       6.4055      $272.51
                 adrenal gland.
75733.........  Artery x-rays,   Z2...........       6.2463      $265.74
                 adrenals.
75736.........  Artery x-rays,   Z3...........       6.3975      $272.17
                 pelvis.
75741.........  Artery x-rays,   Z3...........       6.0999      $259.51
                 lung.
75743.........  Artery x-rays,   Z3...........       6.1963      $263.61
                 lungs.
75746.........  Artery x-rays,   Z3...........       6.2607      $266.35
                 lung.
75756.........  Artery x-rays,   Z3...........       6.5828      $280.05
                 chest.
75774.........  Artery x-ray,    Z3...........       6.0033      $255.40
                 each vessel.
75790.........  Visualize A-V    Z3...........       1.5210       $64.71
                 shunt.
75801.........  Lymph vessel x-  Z2...........       2.9586      $125.87
                 ray, arm/leg.

[[Page 42609]]

 
75803.........  Lymph vessel x-  Z2...........       2.9586      $125.87
                 ray, arms/legs.
75805.........  Lymph vessel x-  Z2...........       2.9586      $125.87
                 ray, trunk.
75807.........  Lymph vessel x-  Z2...........       2.9586      $125.87
                 ray, trunk.
75809.........  Nonvascular      Z3...........       1.0864       $46.22
                 shunt, x-ray.
75810.........  Vein x-ray,      Z2...........       9.5061      $404.42
                 spleen/liver.
75820.........  Vein x-ray, arm/ Z3...........       1.4484       $61.62
                 leg.
75822.........  Vein x-ray,      Z3...........       1.6738       $71.21
                 arms/legs.
75825.........  Vein x-ray,      Z3...........       6.0515      $257.45
                 trunk.
75827.........  Vein x-ray,      Z3...........       6.0677      $258.14
                 chest.
75831.........  Vein x-ray,      Z3...........       6.0999      $259.51
                 kidney.
75833.........  Vein x-ray,      Z3...........       6.3009      $268.06
                 kidneys.
75840.........  Vein x-ray,      Z3...........       6.1723      $262.59
                 adrenal gland.
75842.........  Vein x-ray,      Z3...........       6.2769      $267.04
                 adrenal glands.
75860.........  Vein x-ray,      Z3...........       6.2285      $264.98
                 neck.
75870.........  Vein x-ray,      Z3...........       6.1641      $262.24
                 skull.
75872.........  Vein x-ray,      Z3...........       6.4459      $274.23
                 skull.
75880.........  Vein x-ray, eye  Z3...........       1.4484       $61.62
                 socket.
75885.........  Vein x-ray,      Z3...........       6.0837      $258.82
                 liver.
75887.........  Vein x-ray,      Z3...........       6.1561      $261.90
                 liver.
75889.........  Vein x-ray,      Z3...........       6.0837      $258.82
                 liver.
75891.........  Vein x-ray,      Z3...........       6.0837      $258.82
                 liver.
75893.........  Venous sampling  N1...........  ...........  ...........
                 by catheter.
75894.........  X-rays,          Z2...........       8.3906      $356.96
                 transcath
                 therapy.
75896.........  X-rays,          Z2...........       8.3906      $356.96
                 transcath
                 therapy.
75898.........  Follow-up        Z2...........       1.6956       $72.14
                 angiography.
75901.........  Remove cva       Z2...........       1.6956       $72.14
                 device
                 obstruct.
75902.........  Remove cva       Z3...........       1.1024       $46.90
                 lumen obstruct.
75940.........  X-ray            Z2...........       8.3906      $356.96
                 placement,
                 vein filter.
75945.........  Intravascular    Z2...........       2.4606      $104.68
                 us.
75946.........  Intravascular    Z2...........       1.5607       $66.40
                 us add-on.
75960.........  Transcath iv     Z2...........       6.2463      $265.74
                 stent rs&i.
75961.........  Retrieval,       Z3...........       5.4399      $231.43
                 broken
                 catheter.
75962.........  Repair arterial  Z2...........       6.2463      $265.74
                 blockage.
75964.........  Repair artery    Z3...........       4.2571      $181.11
                 blockage, each.
75966.........  Repair arterial  Z2...........       6.2463      $265.74
                 blockage.
75968.........  Repair artery    Z3...........       4.2731      $181.79
                 blockage, each.
75970.........  Vascular biopsy  Z2...........       6.2463      $265.74
75978.........  Repair venous    Z2...........       6.2463      $265.74
                 blockage.
75980.........  Contrast xray    Z2...........       3.6392      $154.82
                 exam bile duct.
75982.........  Contrast xray    Z2...........       3.6392      $154.82
                 exam bile duct.
75984.........  Xray control     Z3...........       1.5692       $66.76
                 catheter
                 change.
75989.........  Abscess          N1...........  ...........  ...........
                 drainage under
                 x-ray.
75992.........  Atherectomy, x-  Z2...........       6.2463      $265.74
                 ray exam.
75993.........  Atherectomy, x-  Z2...........       6.2463      $265.74
                 ray exam.
75994.........  Atherectomy, x-  Z2...........       6.2463      $265.74
                 ray exam.
75995.........  Atherectomy, x-  Z2...........       6.2463      $265.74
                 ray exam.
75996.........  Atherectomy, x-  Z2...........       6.2463      $265.74
                 ray exam.
76000.........  Fluoroscope      Z2...........       1.2908       $54.91
                 examination.
76001.........  Fluoroscope      N1...........  ...........  ...........
                 exam,
                 extensive.
76010.........  X-ray, nose to   Z3...........       0.3944       $16.78
                 rectum.
76080.........  X-ray exam of    Z3...........       0.7644       $32.52
                 fistula.
76098.........  X-ray exam,      Z3...........       0.2736       $11.64
                 breast
                 specimen.
76100.........  X-ray exam of    Z2...........       1.2224       $52.00
                 body section.
76101.........  Complex body     Z2...........       1.6956       $72.14
                 section x-ray.
76102.........  Complex body     Z2...........       2.9586      $125.87
                 section x-rays.
76120.........  Cine/video x-    Z3...........       1.1024       $46.90
                 rays.
76125.........  Cine/video x-    Z2...........       0.7093       $30.18
                 rays add-on.
76150.........  X-ray exam, dry  Z3...........       0.4346       $18.49
                 process.
76350.........  Special x-ray    N1...........  ...........  ...........
                 contrast study.
76376.........  3d render w/o    Z2...........       0.6102       $25.96
                 postprocess.
76377.........  3d rendering w/  Z2...........       1.5379       $65.43
                 postprocess.
76380.........  CAT scan follow- Z2...........       1.5379       $65.43
                 up study.
76496.........  Fluoroscopic     Z2...........       1.2908       $54.91
                 procedure.
76497.........  Ct procedure...  Z2...........       1.5379       $65.43

[[Page 42610]]

 
76498.........  Mri procedure..  Z2...........       4.5523      $193.67
76499.........  Radiographic     Z2...........       0.7093       $30.18
                 procedure.
76506.........  Echo exam of     Z2...........       0.9923       $42.22
                 head.
76510.........  Ophth us, b &    Z2...........       1.5607       $66.40
                 quant a.
76511.........  Ophth us, quant  Z3...........       1.2312       $52.38
                 a only.
76512.........  Ophth us, b w/   Z3...........       1.0702       $45.53
                 non-quant a.
76513.........  Echo exam of     Z3...........       1.1426       $48.61
                 eye, water
                 bath.
76514.........  Echo exam of     Z3...........       0.0644        $2.74
                 eye, thickness.
76516.........  Echo exam of     Z3...........       0.8852       $37.66
                 eye.
76519.........  Echo exam of     Z3...........       0.9736       $41.42
                 eye.
76529.........  Echo exam of     Z3...........       0.8450       $35.95
                 eye.
76536.........  Us exam of head  Z3...........       1.5290       $65.05
                 and neck.
76604.........  Us exam, chest.  Z2...........       0.9923       $42.22
76645.........  Us exam,         Z2...........       0.9923       $42.22
                 breast(s).
76700.........  Us exam, abdom,  Z2...........       1.5607       $66.40
                 complete.
76705.........  Echo exam of     Z3...........       1.3922       $59.23
                 abdomen.
76770.........  Us exam abdo     Z2...........       1.5607       $66.40
                 back wall,
                 comp.
76775.........  Us exam abdo     Z3...........       1.4002       $59.57
                 back wall, lim.
76776.........  Us exam k        Z2...........       1.5607       $66.40
                 transpl w/
                 doppler.
76800.........  Us exam, spinal  Z3...........       1.3680       $58.20
                 canal.
76801.........  Ob us < 14 wks,  Z2...........       1.5607       $66.40
                 single fetus.
76802.........  Ob us < 14 wks,  Z3...........       0.7000       $29.78
                 add'l fetus.
76805.........  Ob us >/= 14     Z2...........       1.5607       $66.40
                 wks, sngl
                 fetus.
76810.........  Ob us >/= 14     Z3...........       0.9576       $40.74
                 wks, addl
                 fetus.
76811.........  Ob us,           Z3...........       2.4060      $102.36
                 detailed, sngl
                 fetus.
76812.........  Ob us,           Z2...........       0.9923       $42.22
                 detailed, addl
                 fetus.
76813.........  Ob us nuchal     Z3...........       1.3922       $59.23
                 meas, 1 gest.
76814.........  Ob us nuchal     Z3...........       0.6760       $28.76
                 meas, add-on.
76815.........  Ob us, limited,  Z2...........       0.9923       $42.22
                 fetus(s).
76816.........  Ob us, follow-   Z2...........       0.9923       $42.22
                 up, per fetus.
76817.........  Transvaginal     Z2...........       0.9923       $42.22
                 us, obstetric.
76818.........  Fetal biophys    Z3...........       1.3922       $59.23
                 profile w/nst.
76819.........  Fetal biophys    Z3...........       1.1990       $51.01
                 profil w/o nst.
76820.........  Umbilical        Z3...........       0.8128       $34.58
                 artery echo.
76821.........  Middle cerebral  Z3...........       1.3036       $55.46
                 artery echo.
76825.........  Echo exam of     Z2...........       1.5973       $67.95
                 fetal heart.
76826.........  Echo exam of     Z3...........       1.2794       $54.43
                 fetal heart.
76827.........  Echo exam of     Z3...........       1.0462       $44.51
                 fetal heart.
76828.........  Echo exam of     Z3...........       0.6358       $27.05
                 fetal heart.
76830.........  Transvaginal     Z2...........       1.5607       $66.40
                 us, non-ob.
76831.........  Echo exam,       Z3...........       1.6094       $68.47
                 uterus.
76856.........  Us exam,         Z2...........       1.5607       $66.40
                 pelvic,
                 complete.
76857.........  Us exam,         Z2...........       0.9923       $42.22
                 pelvic,
                 limited.
76870.........  Us exam,         Z2...........       1.5607       $66.40
                 scrotum.
76872.........  Us, transrectal  Z2...........       1.5607       $66.40
76873.........  Echograp trans   Z2...........       1.5607       $66.40
                 r, pros study.
76880.........  Us exam,         Z2...........       1.5607       $66.40
                 extremity.
76885.........  Us exam infant   Z2...........       0.9923       $42.22
                 hips, dynamic.
76886.........  Us exam infant   Z2...........       0.9923       $42.22
                 hips, static.
76930.........  Echo guide,      Z2...........       1.1882       $50.55
                 cardiocentesis.
76932.........  Echo guide for   Z2...........       2.1012       $89.39
                 heart biopsy.
76936.........  Echo guide for   Z2...........       2.1012       $89.39
                 artery repair.
76937.........  Us guide,        N1...........  ...........  ...........
                 vascular
                 access.
76940.........  Us guide,        Z2...........       1.1882       $50.55
                 tissue
                 ablation.
76941.........  Echo guide for   Z2...........       1.1882       $50.55
                 transfusion.
76942.........  Echo guide for   Z2...........       1.1882       $50.55
                 biopsy.
76945.........  Echo guide,      Z2...........       1.1882       $50.55
                 villus
                 sampling.
76946.........  Echo guide for   Z3...........       0.7404       $31.50
                 amniocentesis.
76948.........  Echo guide, ova  Z3...........       0.7404       $31.50
                 aspiration.
76950.........  Echo guidance    Z3...........       0.9416       $40.06
                 radiotherapy.
76965.........  Echo guidance    Z2...........       2.1012       $89.39
                 radiotherapy.
76970.........  Ultrasound exam  Z2...........       0.9923       $42.22
                 follow-up.
76975.........  GI endoscopic    Z2...........       1.5607       $66.40
                 ultrasound.
76977.........  Us bone density  Z3...........       0.3702       $15.75
                 measure.

[[Page 42611]]

 
76998.........  Us guide,        Z2...........       1.5607       $66.40
                 intraop.
76999.........  Echo             Z2...........       0.9923       $42.22
                 examination
                 procedure.
77001.........  Fluoroguide for  N1...........  ...........  ...........
                 vein device.
77002.........  Needle           N1...........  ...........  ...........
                 localization
                 by xray.
77003.........  Fluoroguide for  N1...........  ...........  ...........
                 spine inject.
77011.........  Ct scan for      Z2...........       4.0825      $173.68
                 localization.
77012.........  Ct scan for      Z3...........       4.0559      $172.55
                 needle biopsy.
77013.........  Ct guide for     Z2...........       4.8405      $205.93
                 tissue
                 ablation.
77014.........  Ct scan for      Z2...........       1.5379       $65.43
                 therapy guide.
77021.........  Mr guidance for  Z2...........       4.5523      $193.67
                 needle place.
77022.........  Mri for tissue   Z2...........       4.5523      $193.67
                 ablation.
77031.........  Stereotact       Z2...........       2.9586      $125.87
                 guide for brst
                 bx.
77032.........  Guidance for     Z3...........       0.6840       $29.10
                 needle, breast.
77053.........  X-ray of         Z3...........       1.2554       $53.41
                 mammary duct.
77054.........  X-ray of         Z2...........       1.6956       $72.14
                 mammary ducts.
77071.........  X-ray stress     Z3...........       0.3782       $16.09
                 view.
77072.........  X-rays for bone  Z3...........       0.2736       $11.64
                 age.
77073.........  X-rays, bone     Z3...........       0.5312       $22.60
                 length studies.
77074.........  X-rays, bone     Z3...........       0.8852       $37.66
                 survey,
                 limited.
77075.........  X-rays, bone     Z2...........       1.2224       $52.00
                 survey
                 complete.
77076.........  X-rays, bone     Z2...........       0.7093       $30.18
                 survey, infant.
77077.........  Joint survey,    Z3...........       0.6598       $28.07
                 single view.
77078.........  Ct bone          Z2...........       1.1755       $50.01
                 density, axial.
77079.........  Ct bone          Z3...........       1.4566       $61.97
                 density,
                 peripheral.
77080.........  Dxa bone         Z2...........       1.1755       $50.01
                 density, axial.
77081.........  Dxa bone         Z2...........       0.5497       $23.39
                 density/
                 peripheral.
77082.........  Dxa bone         Z3...........       0.4426       $18.83
                 density, vert
                 fx.
77083.........  Radiographic     Z3...........       0.4264       $18.14
                 absorptiometry.
77084.........  Magnetic image,  Z2...........       4.5523      $193.67
                 bone marrow.
77280.........  Sbrt management  Z2...........       1.5735       $66.94
77285.........  Set radiation    Z2...........       3.9723      $168.99
                 therapy field.
77290.........  Set radiation    Z2...........       3.9723      $168.99
                 therapy field.
77295.........  Set radiation    Z3...........      13.6401      $580.29
                 therapy field.
77299.........  Radiation        Z2...........       1.5735       $66.94
                 therapy
                 planning.
77300.........  Radiation        Z3...........       0.9334       $39.71
                 therapy dose
                 plan.
77301.........  Radiotherapy     Z2...........      13.8081      $587.44
                 dose plan,
                 imrt.
77305.........  Teletx isodose   Z3...........       1.0140       $43.14
                 plan simple.
77310.........  Teletx isodose   Z3...........       1.3036       $55.46
                 plan intermed.
77315.........  Teletx isodose   Z3...........       1.7060       $72.58
                 plan complex.
77321.........  Special teletx   Z3...........       2.1085       $89.70
                 port plan.
77326.........  Brachytx         Z2...........       1.5735       $66.94
                 isodose calc
                 simp.
77327.........  Brachytx         Z3...........       2.8649      $121.88
                 isodose calc
                 interm.
77328.........  Brachytx         Z3...........       3.8305      $162.96
                 isodose plan
                 compl.
77331.........  Special          Z3...........       0.4104       $17.46
                 radiation
                 dosimetry.
77332.........  Radiation        Z3...........       1.0944       $46.56
                 treatment
                 aid(s).
77333.........  Radiation        Z3...........       0.8610       $36.63
                 treatment
                 aid(s).
77334.........  Radiation        Z3...........       2.2453       $95.52
                 treatment
                 aid(s).
77336.........  Radiation        Z2...........       1.5735       $66.94
                 physics
                 consult.
77370.........  Radiation        Z2...........       1.5735       $66.94
                 physics
                 consult.
77371.........  Srs,             Z3...........      24.3429    $1,035.62
                 multisource.
77399.........  External         Z2...........       1.5735       $66.94
                 radiation
                 dosimetry.
77401.........  Radiation        Z3...........       0.9094       $38.69
                 treatment
                 delivery.
77402.........  Radiation        Z2...........       1.4826       $63.07
                 treatment
                 delivery.
77403.........  Radiation        Z2...........       1.4826       $63.07
                 treatment
                 delivery.
77404.........  Radiation        Z2...........       1.4826       $63.07
                 treatment
                 delivery.
77406.........  Radiation        Z2...........       1.4826       $63.07
                 treatment
                 delivery.
77407.........  Radiation        Z2...........       1.4826       $63.07
                 treatment
                 delivery.
77408.........  Radiation        Z2...........       1.4826       $63.07
                 treatment
                 delivery.
77409.........  Radiation        Z2...........       1.4826       $63.07
                 treatment
                 delivery.
77411.........  Radiation        Z2...........       2.2295       $94.85
                 treatment
                 delivery.
77412.........  Radiation        Z2...........       2.2295       $94.85
                 treatment
                 delivery.
77413.........  Radiation        Z2...........       2.2295       $94.85
                 treatment
                 delivery.
77414.........  Radiation        Z2...........       2.2295       $94.85
                 treatment
                 delivery.
77416.........  Radiation        Z2...........       2.2295       $94.85
                 treatment
                 delivery.

[[Page 42612]]

 
77417.........  Radiology port   Z3...........       0.3782       $16.09
                 film(s).
77418.........  Radiation tx     Z2...........       5.4731      $232.84
                 delivery, imrt.
77421.........  Stereoscopic x-  Z2...........       1.0974       $46.69
                 ray guidance.
77422.........  Neutron beam     Z2...........       2.2295       $94.85
                 tx, simple.
77423.........  Neutron beam     Z2...........       2.2295       $94.85
                 tx, complex.
77435.........  Sbrt management  N1...........  ...........  ...........
77470.........  Special          Z3...........       4.9813      $211.92
                 radiation
                 treatment.
77520.........  Proton trmt,     Z2...........      18.8926      $803.75
                 simple w/o
                 comp.
77522.........  Proton trmt,     Z2...........      18.8926      $803.75
                 simple w/comp.
77523.........  Proton trmt,     Z2...........      22.6031      $961.60
                 intermediate.
77525.........  Proton           Z2...........      22.6031      $961.60
                 treatment,
                 complex.
77600.........  Hyperthermia     Z2...........       3.3461      $142.35
                 treatment.
77605.........  Hyperthermia     Z2...........       3.3461      $142.35
                 treatment.
77610.........  Hyperthermia     Z2...........       3.3461      $142.35
                 treatment.
77615.........  Hyperthermia     Z2...........       3.3461      $142.35
                 treatment.
77620.........  Hyperthermia     Z2...........       3.3461      $142.35
                 treatment.
77750.........  Infuse           Z3...........       1.7140       $72.92
                 radioactive
                 materials.
77761.........  Apply intrcav    Z3...........       3.0419      $129.41
                 radiat simple.
77762.........  Apply intrcav    Z3...........       3.7741      $160.56
                 radiat interm.
77763.........  Apply intrcav    Z3...........       4.8283      $205.41
                 radiat compl.
77776.........  Apply interstit  Z3...........       3.2109      $136.60
                 radiat simpl.
77777.........  Apply interstit  Z3...........       3.8707      $164.67
                 radiat inter.
77778.........  Apply interstit  Z3...........       5.1261      $218.08
                 radiat compl.
77781.........  High intensity   Z3...........       9.7854      $416.30
                 brachytherapy.
77782.........  High intensity   Z2...........      12.8473      $546.56
                 brachytherapy.
77783.........  High intensity   Z2...........      12.8473      $546.56
                 brachytherapy.
77784.........  High intensity   Z2...........      12.8473      $546.56
                 brachytherapy.
77789.........  Apply surface    Z3...........       0.8530       $36.29
                 radiation.
77790.........  Radiation        N1...........  ...........  ...........
                 handling.
77799.........  Radium/          Z2...........       4.8569      $206.63
                 radioisotope
                 therapy.
78000.........  Thyroid, single  Z3...........       1.0622       $45.19
                 uptake.
78001.........  Thyroid,         Z3...........       1.3520       $57.52
                 multiple
                 uptakes.
78003.........  Thyroid          Z3...........       1.0622       $45.19
                 suppress/
                 stimul.
78006.........  Thyroid imaging  Z2...........       2.3432       $99.69
                 with uptake.
78007.........  Thyroid image,   Z3...........       2.1085       $89.70
                 mult uptakes.
78010.........  Thyroid imaging  Z3...........       2.2692       $96.54
78011.........  Thyroid imaging  Z2...........       2.3432       $99.69
                 with flow.
78015.........  Thyroid met      Z3...........       3.0097      $128.04
                 imaging.
78016.........  Thyroid met      Z2...........       3.9934      $169.89
                 imaging/
                 studies.
78018.........  Thyroid met      Z2...........       3.9934      $169.89
                 imaging, body.
78020.........  Thyroid met      Z3...........       1.1346       $48.27
                 uptake.
78070.........  Parathyroid      Z2...........       2.7146      $115.49
                 nuclear
                 imaging.
78075.........  Adrenal nuclear  Z2...........       2.7146      $115.49
                 imaging.
78099.........  Endocrine        Z2...........       2.3432       $99.69
                 nuclear
                 procedure.
78102.........  Bone marrow      Z3...........       2.3336       $99.28
                 imaging, ltd.
78103.........  Bone marrow      Z3...........       3.2431      $137.97
                 imaging, mult.
78104.........  Bone marrow      Z2...........       3.9073      $166.23
                 imaging, body.
78110.........  Plasma volume,   Z3...........       1.1830       $50.33
                 single.
78111.........  Plasma volume,   Z3...........       1.8266       $77.71
                 multiple.
78120.........  Red cell mass,   Z3...........       1.4566       $61.97
                 single.
78121.........  Red cell mass,   Z3...........       1.9634       $83.53
                 multiple.
78122.........  Blood volume...  Z3...........       2.6394      $112.29
78130.........  Red cell         Z3...........       2.4060      $102.36
                 survival study.
78135.........  Red cell         Z2...........       3.7562      $159.80
                 survival
                 kinetics.
78140.........  Red cell         Z3...........       2.5913      $110.24
                 sequestration.
78185.........  Spleen imaging.  Z3...........       2.8808      $122.56
78190.........  Platelet         Z2...........       2.0057       $85.33
                 survival,
                 kinetics.
78191.........  Platelet         Z2...........       2.0057       $85.33
                 survival.
78195.........  Lymph system     Z2...........       3.9073      $166.23
                 imaging.
78199.........  Blood/lymph      Z2...........       3.9073      $166.23
                 nuclear exam.
78201.........  Liver imaging..  Z3...........       2.7039      $115.03
78202.........  Liver imaging    Z3...........       3.1385      $133.52
                 with flow.
78205.........  Liver imaging    Z3...........       4.2811      $182.13
                 (3D).
78206.........  Liver image      Z2...........       4.3774      $186.23
                 (3d) with flow.

[[Page 42613]]

 
78215.........  Liver and        Z3...........       2.9453      $125.30
                 spleen imaging.
78216.........  Liver & spleen   Z3...........       2.3980      $102.02
                 image/flow.
78220.........  Liver function   Z3...........       2.5833      $109.90
                 study.
78223.........  Hepatobiliary    Z2...........       4.3774      $186.23
                 imaging.
78230.........  Salivary gland   Z3...........       2.3980      $102.02
                 imaging.
78231.........  Serial salivary  Z3...........       2.2775       $96.89
                 imaging.
78232.........  Salivary gland   Z3...........       2.4143      $102.71
                 function exam.
78258.........  Esophageal       Z3...........       3.2995      $140.37
                 motility study.
78261.........  Gastric mucosa   Z2...........       3.6526      $155.39
                 imaging.
78262.........  Gastroesophagea  Z2...........       3.6526      $155.39
                 l reflux exam.
78264.........  Gastric          Z2...........       3.6526      $155.39
                 emptying study.
78270.........  Vit B-12         Z3...........       1.3278       $56.49
                 absorption
                 exam.
78271.........  Vit B-12 absrp   Z3...........       1.3760       $58.54
                 exam, int fac.
78272.........  Vit B-12         Z3...........       1.6898       $71.89
                 absorp,
                 combined.
78278.........  Acute GI blood   Z2...........       3.6526      $155.39
                 loss imaging.
78282.........  GI protein loss  Z2...........       3.6526      $155.39
                 exam.
78290.........  Meckel's divert  Z2...........       3.6526      $155.39
                 exam.
78291.........  Leveen/shunt     Z3...........       3.4765      $147.90
                 patency exam.
78299.........  GI nuclear       Z2...........       3.6526      $155.39
                 procedure.
78300.........  Bone imaging,    Z3...........       2.5106      $106.81
                 limited area.
78305.........  Bone imaging,    Z3...........       3.4443      $146.53
                 multiple areas.
78306.........  Bone imaging,    Z3...........       3.9029      $166.04
                 whole body.
78315.........  Bone imaging, 3  Z2...........       3.9174      $166.66
                 phase.
78320.........  Bone imaging     Z2...........       3.9174      $166.66
                 (3D).
78399.........  Musculoskeletal  Z2...........       3.9174      $166.66
                 nuclear exam.
78414.........  Non-imaging      Z2...........       4.1265      $175.55
                 heart function.
78428.........  Cardiac shunt    Z3...........       2.8729      $122.22
                 imaging.
78445.........  Vascular flow    Z2...........       2.4204      $102.97
                 imaging.
78456.........  Acute venous     Z2...........       2.4204      $102.97
                 thrombus image.
78457.........  Venous           Z2...........       2.4204      $102.97
                 thrombosis
                 imaging.
78458.........  Ven thrombosis   Z2...........       2.4204      $102.97
                 images, bilat.
78459.........  Heart muscle     Z2...........      11.8963      $506.10
                 imaging (PET).
78460.........  Heart muscle     Z3...........       2.6235      $111.61
                 blood, single.
78461.........  Heart muscle     Z3...........       3.2673      $139.00
                 blood,
                 multiple.
78464.........  Heart image      Z2...........       4.1265      $175.55
                 (3d), single.
78465.........  Heart image      Z2...........       6.5012      $276.58
                 (3d), multiple.
78466.........  Heart infarct    Z3...........       2.7039      $115.03
                 image.
78468.........  Heart infarct    Z3...........       3.7099      $157.83
                 image (ef).
78469.........  Heart infarct    Z2...........       4.1265      $175.55
                 image (3D).
78472.........  Gated heart,     Z2...........       4.1265      $175.55
                 planar, single.
78473.........  Gated heart,     Z2...........       4.9832      $212.00
                 multiple.
78478.........  Heart wall       Z3...........       0.8530       $36.29
                 motion add-on.
78480.........  Heart function   Z3...........       0.8530       $36.29
                 add-on.
78481.........  Heart first      Z3...........       3.9431      $167.75
                 pass, single.
78483.........  Heart first      Z2...........       4.9832      $212.00
                 pass, multiple.
78491.........  Heart image      Z2...........      11.8963      $506.10
                 (pet), single.
78492.........  Heart image      Z2...........      11.8963      $506.10
                 (pet),
                 multiple.
78494.........  Heart image,     Z2...........       4.1265      $175.55
                 spect.
78496.........  Heart first      Z2...........       1.5054       $64.04
                 pass add-on.
78499.........  Cardiovascular   Z2...........       4.1265      $175.55
                 nuclear exam.
78580.........  Lung perfusion   Z2...........       3.1802      $135.30
                 imaging.
78584.........  Lung V/Q image   Z3...........       2.2775       $96.89
                 single breath.
78585.........  Lung V/Q         Z2...........       5.0975      $216.86
                 imaging.
78586.........  Aerosol lung     Z3...........       2.5670      $109.21
                 image, single.
78587.........  Aerosol lung     Z3...........       3.1305      $133.18
                 image,
                 multiple.
78588.........  Perfusion lung   Z3...........       4.4261      $188.30
                 image.
78591.........  Vent image, 1    Z3...........       2.6637      $113.32
                 breath, 1 proj.
78593.........  Vent image, 1    Z3...........       3.1465      $133.86
                 proj, gas.
78594.........  Vent image,      Z2...........       3.1802      $135.30
                 mult proj, gas.
78596.........  Lung             Z2...........       5.0975      $216.86
                 differential
                 function.
78599.........  Respiratory      Z2...........       3.1802      $135.30
                 nuclear exam.
78600.........  Brain imaging,   Z3...........       3.8627      $164.33
                 ltd static.
78601.........  Brain imaging,   Z3...........       3.3315      $141.73
                 ltd w/flow.
78605.........  Brain imaging,   Z3...........       3.1063      $132.15
                 complete.

[[Page 42614]]

 
78606.........  Brain imaging,   Z2...........       4.6418      $197.48
                 compl w/flow.
78607.........  Brain imaging    Z2...........       4.6418      $197.48
                 (3D).
78608.........  Brain imaging    Z2...........      13.9166      $592.05
                 (PET).
78610.........  Brain flow       Z3...........       2.2855       $97.23
                 imaging only.
78615.........  Cerebral         Z3...........       3.5327      $150.29
                 vascular flow
                 image.
78630.........  Cerebrospinal    Z2...........       3.4923      $148.57
                 fluid scan.
78635.........  CSF              Z2...........       3.4923      $148.57
                 ventriculograp
                 hy.
78645.........  CSF shunt        Z2...........       3.4923      $148.57
                 evaluation.
78647.........  Cerebrospinal    Z2...........       3.4923      $148.57
                 fluid scan.
78650.........  CSF leakage      Z2...........       3.4923      $148.57
                 imaging.
78660.........  Nuclear exam of  Z3...........       2.4143      $102.71
                 tear flow.
78699.........  Nervous system   Z2...........       4.6418      $197.48
                 nuclear exam.
78700.........  Kidney imaging,  Z3...........       2.8891      $122.91
                 morphol.
78701.........  Kidney imaging   Z3...........       3.4041      $144.82
                 with flow.
78707.........  Kflow/funct      Z2...........       3.4209      $145.54
                 image w/o drug.
78708.........  Kflow/funct      Z3...........       2.9373      $124.96
                 image w/drug.
78709.........  Kflow/funct      Z2...........       4.0378      $171.78
                 image,
                 multiple.
78710.........  Kidney imaging   Z2...........       3.4209      $145.54
                 (3D).
78725.........  Kidney function  Z2...........       1.3754       $58.51
                 study.
78730.........  Urinary bladder  Z2...........       0.6102       $25.96
                 retention.
78740.........  Ureteral reflux  Z3...........       2.8649      $121.88
                 study.
78761.........  Testicular       Z3...........       3.0499      $129.75
                 imaging w/flow.
78799.........  Genitourinary    Z2...........       3.4209      $145.54
                 nuclear exam.
78800.........  Tumor imaging,   Z3...........       2.9293      $124.62
                 limited area.
78801.........  Tumor imaging,   Z3...........       3.9271      $167.07
                 mult areas.
78802.........  Tumor imaging,   Z2...........       3.9934      $169.89
                 whole body.
78803.........  Tumor imaging    Z2...........       3.9934      $169.89
                 (3D).
78804.........  Tumor imaging,   Z2...........       5.9245      $252.05
                 whole body.
78805.........  Abscess          Z3...........       2.8729      $122.22
                 imaging, ltd
                 area.
78806.........  Abscess          Z2...........       3.9934      $169.89
                 imaging, whole
                 body.
78807.........  Nuclear          Z2...........       3.9934      $169.89
                 localization/
                 abscess.
78811.........  Tumor imaging    Z2...........      13.9166      $592.05
                 (pet), limited.
78812.........  Tumor image      Z2...........      13.9166      $592.05
                 (pet)/skul-
                 thigh.
78813.........  Tumor image      Z2...........      13.9166      $592.05
                 (pet) full
                 body.
78814.........  Tumor image pet/ Z2...........      15.4552      $657.51
                 ct, limited.
78815.........  Tumorimage pet/  Z2...........      15.4552      $657.51
                 ct skul-thigh.
78816.........  Tumor image pet/ Z2...........      15.4552      $657.51
                 ct full body.
78890.........  Nuclear          N1...........  ...........  ...........
                 medicine data
                 proc.
78891.........  Nuclear med      N1...........  ...........  ...........
                 data proc.
78999.........  Nuclear          Z2...........       1.3754       $58.51
                 diagnostic
                 exam.
79005.........  Nuclear rx,      Z3...........       1.5370       $65.39
                 oral admin.
79101.........  Nuclear rx, iv   Z3...........       1.6094       $68.47
                 admin.
79200.........  Nuclear rx,      Z3...........       1.6738       $71.21
                 intracav admin.
79300.........  Nuclr rx,        Z2...........       3.1779      $135.20
                 interstit
                 colloid.
79403.........  Hematopoietic    Z3...........       2.5591      $108.87
                 nuclear tx.
79440.........  Nuclear rx,      Z3...........       1.4968       $63.68
                 intra-
                 articular.
79445.........  Nuclear rx,      Z2...........       3.1779      $135.20
                 intra-arterial.
79999.........  Nuclear          Z2...........       3.1779      $135.20
                 medicine
                 therapy.
90371.........  Hep b ig, im...  K2...........  ...........      $133.69
90375.........  Rabies ig, im/   K2...........  ...........       $65.44
                 sc.
90376.........  Rabies ig, heat  K2...........  ...........       $70.06
                 treated.
90396.........  Varicella-       K2...........  ...........      $122.74
                 zoster ig, im.
90585.........  Bcg vaccine,     K2...........  ...........      $113.63
                 precut.
90675.........  Rabies vaccine,  K2...........  ...........      $146.91
                 im.
90676.........  Rabies vaccine,  K2...........  ...........      $119.86
                 id.
90708.........  Measles-rubella  K2...........  ...........       $45.53
                 vaccine, sc.
90720.........  Dtp/hib          K2...........  ...........       $58.70
                 vaccine, im.
90727.........  Plague vaccine,  K2...........  ...........        $7.13
                 im.
90733.........  Meningococcal    K2...........  ...........       $89.43
                 vaccine, sc.
90734.........  Meningococcal    K2...........  ...........       $82.00
                 vaccine, im.
90735.........  Encephalitis     K2...........  ...........       $99.11
                 vaccine, sc.
A4218.........  Sterile saline   N1...........  ...........  ...........
                 or water.
A4220.........  Infusion pump    N1...........  ...........  ...........
                 refill kit.
A4248.........  Chlorhexidine    N1...........  ...........  ...........
                 antisept.

[[Page 42615]]

 
A4262.........  Temporary tear   N1...........  ...........  ...........
                 duct plug.
A4263.........  Permanent tear   N1...........  ...........  ...........
                 duct plug.
A4270.........  Disposable       N1...........  ...........  ...........
                 endoscope
                 sheath.
A4300.........  Cath impl vasc   N1...........  ...........  ...........
                 access portal.
A4301.........  Implantable      N1...........  ...........  ...........
                 access syst
                 perc.
A4305.........  Drug delivery    N1...........  ...........  ...........
                 system [gE]50
                 ML.
A4306.........  Drug delivery    N1...........  ...........  ...........
                 system [lE]50
                 ml.
A9527.........  Iodine I-125     H7...........  ...........  ...........
                 sodium iodide.
A9698.........  Non-rad          N1...........  ...........  ...........
                 contrast
                 materialNOC.
C1713.........  Anchor/screw bn/ N1...........  ...........  ...........
                 bn,tis/bn.
C1714.........  Cath, trans      N1...........  ...........  ...........
                 atherectomy,
                 dir.
C1715.........  Brachytherapy    N1...........  ...........  ...........
                 needle.
C1716.........  Brachytx         H7...........  ...........  ...........
                 source, Gold
                 198.
C1717.........  Brachytx         H7...........  ...........  ...........
                 source, HDR Ir-
                 192.
C1718.........  Brachytx         H7...........  ...........  ...........
                 source, Iodine
                 125.
C1719.........  Brachytx sour,   H7...........  ...........  ...........
                 Non-HDR Ir-192.
C1720.........  Brachytx sour,   H7...........  ...........  ...........
                 Palladium 103.
C1721.........  AICD, dual       N1...........  ...........  ...........
                 chamber.
C1722.........  AICD, single     N1...........  ...........  ...........
                 chamber.
C1724.........  Cath, trans      N1...........  ...........  ...........
                 atherec,
                 rotation.
C1725.........  Cath,            N1...........  ...........  ...........
                 translumin non-
                 laser.
C1726.........  Cath, bal dil,   N1...........  ...........  ...........
                 non-vascular.
C1727.........  Cath, bal tis    N1...........  ...........  ...........
                 dis, non-vas.
C1728.........  Cath, brachytx   N1...........  ...........  ...........
                 seed adm.
C1729.........  Cath, drainage.  N1...........  ...........  ...........
C1730.........  Cath, EP, 19 or  N1...........  ...........  ...........
                 few elect.
C1731.........  Cath, EP, 20 or  N1...........  ...........  ...........
                 more elec.
C1732.........  Cath, EP, diag/  N1...........  ...........  ...........
                 abl, 3D/vect.
C1733.........  Cath, EP, othr   N1...........  ...........  ...........
                 than cool-tip.
C1750.........  Cath,            N1...........  ...........  ...........
                 hemodialysis,
                 long-term.
C1751.........  Cath, inf, per/  N1...........  ...........  ...........
                 cent/midline.
C1752.........  Cath,            N1...........  ...........  ...........
                 hemodialysis,
                 short-term.
C1753.........  Cath, intravas   N1...........  ...........  ...........
                 ultrasound.
C1754.........  Catheter,        N1...........  ...........  ...........
                 intradiscal.
C1755.........  Catheter,        N1...........  ...........  ...........
                 intraspinal.
C1756.........  Cath, pacing,    N1...........  ...........  ...........
                 transesoph.
C1757.........  Cath,            N1...........  ...........  ...........
                 thrombectomy/
                 embolect.
C1758.........  Catheter,        N1...........  ...........  ...........
                 ureteral.
C1759.........  Cath, intra      N1...........  ...........  ...........
                 echocardiograp
                 hy.
C1760.........  Closure dev,     N1...........  ...........  ...........
                 vasc.
C1762.........  Conn tiss,       N1...........  ...........  ...........
                 human (inc
                 fascia).
C1763.........  Conn tiss, non-  N1...........  ...........  ...........
                 human.
C1764.........  Event recorder,  N1...........  ...........  ...........
                 cardiac.
C1765.........  Adhesion         N1...........  ...........  ...........
                 barrier.
C1766.........  Intro/sheath,    N1...........  ...........  ...........
                 strble, non-
                 peel.
C1767.........  Generator,       N1...........  ...........  ...........
                 neuro non-
                 recharg.
C1768.........  Graft, vascular  N1...........  ...........  ...........
C1769.........  Guide wire.....  N1...........  ...........  ...........
C1770.........  Imaging coil,    N1...........  ...........  ...........
                 MR, insertable.
C1771.........  Rep dev,         N1...........  ...........  ...........
                 urinary, w/
                 sling.
C1772.........  Infusion pump,   N1...........  ...........  ...........
                 programmable.
C1773.........  Ret dev,         N1...........  ...........  ...........
                 insertable.
C1776.........  Joint device     N1...........  ...........  ...........
                 (implantable).
C1777.........  Lead, AICD,      N1...........  ...........  ...........
                 endo single
                 coil.
C1778.........  Lead,            N1...........  ...........  ...........
                 neurostimulato
                 r.
C1779.........  Lead, pmkr,      N1...........  ...........  ...........
                 transvenous
                 VDD.
C1780.........  Lens,            N1...........  ...........  ...........
                 intraocular
                 (new tech).
C1781.........  Mesh             N1...........  ...........  ...........
                 (implantable).
C1782.........  Morcellator....  N1...........  ...........  ...........
C1783.........  Ocular imp,      N1...........  ...........  ...........
                 aqueous drain
                 de.
C1784.........  Ocular dev,      N1...........  ...........  ...........
                 intraop, det
                 ret.
C1785.........  Pmkr, dual,      N1...........  ...........  ...........
                 rate-resp.
C1786.........  Pmkr, single,    N1...........  ...........  ...........
                 rate-resp.
C1787.........  Patient progr,   N1...........  ...........  ...........
                 neurostim.

[[Page 42616]]

 
C1788.........  Port,            N1...........  ...........  ...........
                 indwelling,
                 imp.
C1789.........  Prosthesis,      N1...........  ...........  ...........
                 breast, imp.
C1813.........  Prosthesis,      N1...........  ...........  ...........
                 penile,
                 inflatab.
C1814.........  Retinal tamp,    N1...........  ...........  ...........
                 silicone oil.
C1815.........  Pros, urinary    N1...........  ...........  ...........
                 sph, imp.
C1816.........  Receiver/        N1...........  ...........  ...........
                 transmitter,
                 neuro.
C1817.........  Septal defect    N1...........  ...........  ...........
                 imp sys.
C1818.........  Integrated       N1...........  ...........  ...........
                 keratoprosthes
                 is.
C1819.........  Tissue           N1...........  ...........  ...........
                 localization-
                 excision.
C1820.........  Generator neuro  J7...........  ...........  ...........
                 rechg bat sy.
C1821.........  Interspinous     J7...........  ...........  ...........
                 implant.
C1874.........  Stent, coated/   N1...........  ...........  ...........
                 cov w/del sys.
C1875.........  Stent, coated/   N1...........  ...........  ...........
                 cov w/o del sy.
C1876.........  Stent, non-coa/  N1...........  ...........  ...........
                 non-cov w/del.
C1877.........  Stent, non-coat/ N1...........  ...........  ...........
                 cov w/o del.
C1878.........  Matrl for vocal  N1...........  ...........  ...........
                 cord.
C1879.........  Tissue marker,   N1...........  ...........  ...........
                 implantable.
C1880.........  Vena cava        N1...........  ...........  ...........
                 filter.
C1881.........  Dialysis access  N1...........  ...........  ...........
                 system.
C1882.........  AICD, other      N1...........  ...........  ...........
                 than sing/dual.
C1883.........  Adapt/ext,       N1...........  ...........  ...........
                 pacing/neuro
                 lead.
C1884.........  Embolization     N1...........  ...........  ...........
                 Protect syst.
C1885.........  Cath,            N1...........  ...........  ...........
                 translumin
                 angio laser.
C1887.........  Catheter,        N1...........  ...........  ...........
                 guiding.
C1888.........  Endovas non-     N1...........  ...........  ...........
                 cardiac abl
                 cath.
C1891.........  Infusion pump,   N1...........  ...........  ...........
                 non-prog, perm.
C1892.........  Intro/sheath,    N1...........  ...........  ...........
                 fixed, peel-
                 away.
C1893.........  Intro/sheath,    N1...........  ...........  ...........
                 fixed, non-
                 peel.
C1894.........  Intro/sheath,    N1...........  ...........  ...........
                 non-laser.
C1895.........  Lead, AICD,      N1...........  ...........  ...........
                 endo dual coil.
C1896.........  Lead, AICD, non  N1...........  ...........  ...........
                 sing/dual.
C1897.........  Lead, neurostim  N1...........  ...........  ...........
                 test kit.
C1898.........  Lead, pmkr,      N1...........  ...........  ...........
                 other than
                 trans.
C1899.........  Lead, pmkr/AICD  N1...........  ...........  ...........
                 combination.
C1900.........  Lead, coronary   N1...........  ...........  ...........
                 venous.
C2614.........  Probe, perc      N1...........  ...........  ...........
                 lumb disc.
C2615.........  Sealant,         N1...........  ...........  ...........
                 pulmonary,
                 liquid.
C2616.........  Brachytx         H7...........  ...........  ...........
                 source,
                 Yttrium-90.
C2617.........  Stent, non-cor,  N1...........  ...........  ...........
                 tem w/o del.
C2618.........  Probe,           N1...........  ...........  ...........
                 cryoablation.
C2619.........  Pmkr, dual, non  N1...........  ...........  ...........
                 rate-resp.
C2620.........  Pmkr, single,    N1...........  ...........  ...........
                 non rate-resp.
C2621.........  Pmkr, other      N1...........  ...........  ...........
                 than sing/dual.
C2622.........  Prosthesis,      N1...........  ...........  ...........
                 penile, non-
                 inf.
C2625.........  Stent, non-cor,  N1...........  ...........  ...........
                 tem w/del sy.
C2626.........  Infusion pump,   N1...........  ...........  ...........
                 non-prog, temp.
C2627.........  Cath,            N1...........  ...........  ...........
                 suprapubic/
                 cystoscopic.
C2628.........  Catheter,        N1...........  ...........  ...........
                 occlusion.
C2629.........  Intro/sheath,    N1...........  ...........  ...........
                 laser.
C2630.........  Cath, EP, cool-  N1...........  ...........  ...........
                 tip.
C2631.........  Rep dev,         N1...........  ...........  ...........
                 urinary, w/o
                 sling.
C2633.........  Brachytx         H7...........  ...........  ...........
                 source, Cesium-
                 131.
C2634.........  Brachytx         H7...........  ...........  ...........
                 source, HA, I-
                 125.
C2635.........  Brachytx         H7...........  ...........  ...........
                 source, HA, P-
                 103.
C2636.........  Brachytx linear  H7...........  ...........  ...........
                 source, P-103.
C2637.........  Brachytx,        H7...........  ...........  ...........
                 Ytterbium-169.
C8900.........  MRA w/cont, abd  Z2...........       6.1231      $260.50
C8901.........  MRA w/o cont,    Z2...........       5.6745      $241.41
                 abd.
C8902.........  MRA w/o fol w/   Z2...........       8.1155      $345.26
                 cont, abd.
C8903.........  MRI w/cont,      Z2...........       6.1231      $260.50
                 breast, uni.
C8904.........  MRI w/o cont,    Z2...........       5.6745      $241.41
                 breast, uni.
C8905.........  MRI w/o fol w/   Z2...........       8.1155      $345.26
                 cont, brst, un.
C8906.........  MRI w/cont,      Z2...........       6.1231      $260.50
                 breast, bi.
C8907.........  MRI w/o cont,    Z2...........       5.6745      $241.41
                 breast, bi.

[[Page 42617]]

 
C8908.........  MRI w/o fol w/   Z2...........       8.1155      $345.26
                 cont, breast,.
C8909.........  MRA w/cont,      Z2...........       6.1231      $260.50
                 chest.
C8910.........  MRA w/o cont,    Z2...........       5.6745      $241.41
                 chest.
C8911.........  MRA w/o fol w/   Z2...........       8.1155      $345.26
                 cont, chest.
C8912.........  MRA w/cont, lwr  Z2...........       6.1231      $260.50
                 ext.
C8913.........  MRA w/o cont,    Z2...........       5.6745      $241.41
                 lwr ext.
C8914.........  MRA w/o fol w/   Z2...........       8.1155      $345.26
                 cont, lwr ext.
C8918.........  MRA w/cont,      Z2...........       6.1231      $260.50
                 pelvis.
C8919.........  MRA w/o cont,    Z2...........       5.6745      $241.41
                 pelvis.
C8920.........  MRA w/o fol w/   Z2...........       8.1155      $345.26
                 cont, pelvis.
C9003.........  Palivizumab,     K2...........  ...........      $684.43
                 per 50 mg.
C9113.........  Inj              N1...........  ...........  ...........
                 pantoprazole
                 sodium, via.
C9121.........  Injection,       K2...........  ...........       $18.04
                 argatroban.
C9232.........  Injection,       K2...........  ...........      $455.03
                 idursulfase.
C9233.........  Injection,       K2...........  ...........    $2,030.92
                 ranibizumab.
C9234.........  Inj,             K2...........  ...........      $127.20
                 alglucosidase
                 alfa.
C9235.........  Injection,       K2...........  ...........       $84.80
                 panitumumab.
C9350.........  Porous collagen  K2...........  ...........      $485.91
                 tube per cm.
C9351.........  Acellular derm   K2...........  ...........       $41.59
                 tissue percm2.
C9399.........  Unclassified     K7...........  ...........  ...........
                 drugs or
                 biolog.
E0616.........  Cardiac event    N1...........  ...........  ...........
                 recorder.
E0749.........  Elec osteogen    N1...........  ...........  ...........
                 stim implanted.
E0782.........  Non-programble   N1...........  ...........  ...........
                 infusion pump.
E0783.........  Programmable     N1...........  ...........  ...........
                 infusion pump.
E0785.........  Replacement      N1...........  ...........  ...........
                 impl pump
                 cathet.
E0786.........  Implantable      N1...........  ...........  ...........
                 pump
                 replacement.
G0130.........  Single energy x- Z3...........       0.5150       $21.91
                 ray study.
G0173.........  Linear acc       Z2...........      63.3759    $2,696.20
                 stereo radsur
                 com.
G0251.........  Linear acc       Z2...........      20.3224      $864.58
                 based stero
                 radio.
G0288.........  Recon, CTA for   Z2...........       3.2393      $137.81
                 surg plan.
G0339.........  Robot lin-       Z2...........      63.3759    $2,696.20
                 radsurg com,
                 first.
G0340.........  Robt lin-        Z2...........      43.0297    $1,830.61
                 radsurg fractx
                 2-5.
J0120.........  Tetracyclin      N1...........  ...........  ...........
                 injection.
J0128.........  Abarelix         K2...........  ...........       $68.62
                 injection.
J0129.........  Abatacept        K2...........  ...........       $18.69
                 injection.
J0130.........  Abciximab        K2...........  ...........      $413.16
                 injection.
J0132.........  Acetylcysteine   K2...........  ...........        $1.95
                 injection.
J0133.........  Acyclovir        N1...........  ...........  ...........
                 injection.
J0135.........  Adalimumab       K2...........  ...........      $319.03
                 injection.
J0150.........  Injection        K2...........  ...........       $22.86
                 adenosine 6 MG.
J0152.........  Adenosine        K2...........  ...........       $69.16
                 injection.
J0170.........  Adrenalin        N1...........  ...........  ...........
                 epinephrin
                 inject.
J0180.........  Agalsidase beta  K2...........  ...........      $127.20
                 injection.
J0190.........  Inj biperiden    K2...........  ...........       $88.15
                 lactate/5 mg.
J0200.........  Alatrofloxacin   N1...........  ...........  ...........
                 mesylate.
J0205.........  Alglucerase      K2...........  ...........       $39.22
                 injection.
J0207.........  Amifostine.....  K2...........  ...........      $480.64
J0210.........  Methyldopate     K2...........  ...........       $10.11
                 hcl injection.
J0215.........  Alefacept......  K2...........  ...........       $26.07
J0256.........  Alpha 1          K2...........  ...........        $3.28
                 proteinase
                 inhibitor.
J0278.........  Amikacin         N1...........  ...........  ...........
                 sulfate
                 injection.
J0280.........  Aminophyllin     N1...........  ...........  ...........
                 250 MG inj.
J0282.........  Amiodarone HCl.  N1...........  ...........  ...........
J0285.........  Amphotericin B.  N1...........  ...........  ...........
J0287.........  Amphotericin b   K2...........  ...........       $10.38
                 lipid complex.
J0288.........  Ampho b          K2...........  ...........       $12.00
                 cholesteryl
                 sulfate.
J0289.........  Amphotericin b   K2...........  ...........       $17.24
                 liposome inj.
J0290.........  Ampicillin 500   N1...........  ...........  ...........
                 MG inj.
J0295.........  Ampicillin       N1...........  ...........  ...........
                 sodium per 1.5
                 gm.
J0300.........  Amobarbital 125  N1...........  ...........  ...........
                 MG inj.
J0330.........  Succinycholine   N1...........  ...........  ...........
                 chloride inj.
J0348.........  Anadulafungin    K2...........  ...........        $1.91
                 injection.
J0350.........  Injection        K2...........  ...........    $2,693.80
                 anistreplase
                 30 u.
J0360.........  Hydralazine hcl  N1...........  ...........  ...........
                 injection.

[[Page 42618]]

 
J0364.........  Apomorphine      K2...........  ...........        $2.99
                 hydrochloride.
J0365.........  Aprotonin,       K2...........  ...........        $2.52
                 10,000 kiu.
J0380.........  Inj metaraminol  K2...........  ...........       $15.67
                 bitartrate.
J0390.........  Chloroquine      N1...........  ...........  ...........
                 injection.
J0395.........  Arbutamine HCl   K2...........  ...........      $182.40
                 injection.
J0456.........  Azithromycin...  N1...........  ...........  ...........
J0460.........  Atropine         N1...........  ...........  ...........
                 sulfate
                 injection.
J0470.........  Dimecaprol       N1...........  ...........  ...........
                 injection.
J0475.........  Baclofen 10 MG   K2...........  ...........      $197.04
                 injection.
J0476.........  Baclofen         K2...........  ...........       $71.59
                 intrathecal
                 trial.
J0480.........  Basiliximab....  K2...........  ...........    $1,359.97
J0500.........  Dicyclomine      N1...........  ...........  ...........
                 injection.
J0515.........  Inj benztropine  N1...........  ...........  ...........
                 mesylate.
J0520.........  Bethanechol      N1...........  ...........  ...........
                 chloride
                 inject.
J0530.........  Penicillin g     N1...........  ...........  ...........
                 benzathine inj.
J0540.........  Penicillin g     N1...........  ...........  ...........
                 benzathine inj.
J0550.........  Penicillin g     N1...........  ...........  ...........
                 benzathine inj.
J0560.........  Penicillin g     N1...........  ...........  ...........
                 benzathine inj.
J0570.........  Penicillin g     N1...........  ...........  ...........
                 benzathine inj.
J0580.........  Penicillin g     N1...........  ...........  ...........
                 benzathine inj.
J0583.........  Bivalirudin....  K2...........  ...........        $1.74
J0585.........  Botulinum toxin  K2...........  ...........        $5.10
                 a per unit.
J0587.........  Botulinum toxin  K2...........  ...........        $8.37
                 type B.
J0592.........  Buprenorphine    N1...........  ...........  ...........
                 hydrochloride.
J0594.........  Busulfan         K2...........  ...........        $8.89
                 injection.
J0595.........  Butorphanol      N1...........  ...........  ...........
                 tartrate 1 mg.
J0600.........  Edetate calcium  K2...........  ...........       $40.19
                 disodium inj.
J0610.........  Calcium          N1...........  ...........  ...........
                 gluconate
                 injection.
J0620.........  Calcium glycer   N1...........  ...........  ...........
                 & lact/10 ML.
J0630.........  Calcitonin       N1...........  ...........  ...........
                 salmon
                 injection.
J0636.........  Inj calcitriol   N1...........  ...........  ...........
                 per 0.1 mcg.
J0637.........  Caspofungin      K2...........  ...........       $30.35
                 acetate.
J0640.........  Leucovorin       N1...........  ...........  ...........
                 calcium
                 injection.
J0670.........  Inj mepivacaine  N1...........  ...........  ...........
                 HCL/10 ml.
J0690.........  Cefazolin        N1...........  ...........  ...........
                 sodium
                 injection.
J0692.........  Cefepime HCl     N1...........  ...........  ...........
                 for injection.
J0694.........  Cefoxitin        N1...........  ...........  ...........
                 sodium
                 injection.
J0696.........  Ceftriaxone      N1...........  ...........  ...........
                 sodium
                 injection.
J0697.........  Sterile          N1...........  ...........  ...........
                 cefuroxime
                 injection.
J0698.........  Cefotaxime       N1...........  ...........  ...........
                 sodium
                 injection.
J0702.........  Betamethasone    N1...........  ...........  ...........
                 acet&sod phosp.
J0704.........  Betamethasone    N1...........  ...........  ...........
                 sod phosp/4 MG.
J0706.........  Caffeine         K2...........  ...........        $3.36
                 citrate
                 injection.
J0710.........  Cephapirin       N1...........  ...........  ...........
                 sodium
                 injection.
J0713.........  Inj ceftazidime  N1...........  ...........  ...........
                 per 500 mg.
J0715.........  Ceftizoxime      N1...........  ...........  ...........
                 sodium/500 MG.
J0720.........  Chloramphenicol  N1...........  ...........  ...........
                 sodium injec.
J0725.........  Chorionic        N1...........  ...........  ...........
                 gonadotropin/
                 1000u.
J0735.........  Clonidine        K2...........  ...........       $63.46
                 hydrochloride.
J0740.........  Cidofovir        K2...........  ...........      $761.81
                 injection.
J0743.........  Cilastatin       N1...........  ...........  ...........
                 sodium
                 injection.
J0744.........  Ciprofloxacin    N1...........  ...........  ...........
                 iv.
J0745.........  Inj codeine      N1...........  ...........  ...........
                 phosphate /30
                 MG.
J0760.........  Colchicine       N1...........  ...........  ...........
                 injection.
J0770.........  Colistimethate   N1...........  ...........  ...........
                 sodium inj.
J0780.........  Prochlorperazin  N1...........  ...........  ...........
                 e injection.
J0795.........  Corticorelin     K2...........  ...........        $4.31
                 ovine
                 triflutal.
J0800.........  Corticotropin    K2...........  ...........      $127.73
                 injection.
J0835.........  Inj cosyntropin  K2...........  ...........       $63.85
                 per 0.25 MG.
J0850.........  Cytomegalovirus  K2...........  ...........      $868.05
                 imm IV /vial.
J0878.........  Daptomycin       K2...........  ...........        $0.33
                 injection.
J0881.........  Darbepoetin      K2...........  ...........        $3.14
                 alfa, non-esrd.
J0885.........  Epoetin alfa,    K2...........  ...........        $9.45
                 non-esrd.
J0894.........  Decitabine       K2...........  ...........       $26.48
                 injection.

[[Page 42619]]

 
J0895.........  Deferoxamine     K2...........  ...........       $14.52
                 mesylate inj.
J0900.........  Testosterone     N1...........  ...........  ...........
                 enanthate inj.
J0945.........  Brompheniramine  N1...........  ...........  ...........
                 maleate inj.
J0970.........  Estradiol        N1...........  ...........  ...........
                 valerate
                 injection.
J1000.........  Depo-estradiol   N1...........  ...........  ...........
                 cypionate inj.
J1020.........  Methylprednisol  N1...........  ...........  ...........
                 one 20 MG inj.
J1030.........  Methylprednisol  N1...........  ...........  ...........
                 one 40 MG inj.
J1040.........  Methylprednisol  N1...........  ...........  ...........
                 one 80 MG inj.
J1051.........  Medroxyprogeste  N1...........  ...........  ...........
                 rone inj.
J1060.........  Testosterone     N1...........  ...........  ...........
                 cypionate 1 ML.
J1070.........  Testosterone     N1...........  ...........  ...........
                 cypionat 100
                 MG.
J1080.........  Testosterone     N1...........  ...........  ...........
                 cypionat 200
                 MG.
J1094.........  Inj              N1...........  ...........  ...........
                 dexamethasone
                 acetate.
J1100.........  Dexamethasone    N1...........  ...........  ...........
                 sodium phos.
J1110.........  Inj              N1...........  ...........  ...........
                 dihydroergotam
                 ine mesylt.
J1120.........  Acetazolamid     N1...........  ...........  ...........
                 sodium
                 injectio.
J1160.........  Digoxin          N1...........  ...........  ...........
                 injection.
J1162.........  Digoxin immune   K2...........  ...........      $516.35
                 fab (ovine).
J1165.........  Phenytoin        N1...........  ...........  ...........
                 sodium
                 injection.
J1170.........  Hydromorphone    N1...........  ...........  ...........
                 injection.
J1180.........  Dyphylline       N1...........  ...........  ...........
                 injection.
J1190.........  Dexrazoxane HCl  K2...........  ...........      $174.07
                 injection.
J1200.........  Diphenhydramine  N1...........  ...........  ...........
                 hcl injectio.
J1205.........  Chlorothiazide   K2...........  ...........      $123.84
                 sodium inj.
J1212.........  Dimethyl         N1...........  ...........  ...........
                 sulfoxide 50%
                 50 ML.
J1230.........  Methadone        N1...........  ...........  ...........
                 injection.
J1240.........  Dimenhydrinate   N1...........  ...........  ...........
                 injection.
J1245.........  Dipyridamole     N1...........  ...........  ...........
                 injection.
J1250.........  Inj dobutamine   N1...........  ...........  ...........
                 HCL/250 mg.
J1260.........  Dolasetron       K2...........  ...........        $6.11
                 mesylate.
J1265.........  Dopamine         N1...........  ...........  ...........
                 injection.
J1270.........  Injection,       N1...........  ...........  ...........
                 doxercalcifero
                 l.
J1320.........  Amitriptyline    N1...........  ...........  ...........
                 injection.
J1324.........  Enfuvirtide      K2...........  ...........       $22.91
                 injection.
J1325.........  Epoprostenol     N1...........  ...........  ...........
                 injection.
J1327.........  Eptifibatide     K2...........  ...........       $16.05
                 injection.
J1330.........  Ergonovine       K2...........  ...........        $4.00
                 maleate
                 injection.
J1335.........  Ertapenem        N1...........  ...........  ...........
                 injection.
J1364.........  Erythro          N1...........  ...........  ...........
                 lactobionate /
                 500 MG.
J1380.........  Estradiol        N1...........  ...........  ...........
                 valerate 10 MG
                 inj.
J1390.........  Estradiol        N1...........  ...........  ...........
                 valerate 20 MG
                 inj.
J1410.........  Inj estrogen     K2...........  ...........       $60.90
                 conjugate 25
                 MG.
J1430.........  Ethanolamine     K2...........  ...........       $79.01
                 oleate 100 mg.
J1435.........  Injection        N1...........  ...........  ...........
                 estrone per 1
                 MG.
J1436.........  Etidronate       K2...........  ...........       $71.41
                 disodium inj.
J1438.........  Etanercept       K2...........  ...........      $161.55
                 injection.
J1440.........  Filgrastim 300   K2...........  ...........      $189.47
                 mcg injection.
J1441.........  Filgrastim 480   K2...........  ...........      $300.58
                 mcg injection.
J1450.........  Fluconazole....  N1...........  ...........  ...........
J1451.........  Fomepizole, 15   K2...........  ...........       $12.39
                 mg.
J1452.........  Intraocular      K2...........  ...........      $237.50
                 Fomivirsen na.
J1455.........  Foscarnet        K2...........  ...........       $10.20
                 sodium
                 injection.
J1457.........  Gallium nitrate  N1...........  ...........  ...........
                 injection.
J1458.........  Galsulfase       K2...........  ...........      $299.92
                 injection.
J1460.........  Gamma globulin   K2...........  ...........       $11.42
                 1 CC inj.
J1562.........  Immune globulin  K2...........  ...........       $12.72
                 subcutaneous.
J1565.........  RSV-ivig.......  K2...........  ...........       $16.18
J1566.........  Immune           K2...........  ...........       $25.72
                 globulin,
                 powder.
J1567.........  Immune           K2...........  ...........       $30.57
                 globulin,
                 liquid.
J1570.........  Ganciclovir      N1...........  ...........  ...........
                 sodium
                 injection.
J1580.........  Garamycin        N1...........  ...........  ...........
                 gentamicin inj.
J1590.........  Gatifloxacin     N1...........  ...........  ...........
                 injection.
J1595.........  Injection        N1...........  ...........  ...........
                 glatiramer
                 acetate.
J1600.........  Gold sodium      N1...........  ...........  ...........
                 thiomaleate
                 inj.

[[Page 42620]]

 
J1610.........  Glucagon         K2...........  ...........       $66.27
                 hydrochloride/
                 1 MG.
J1620.........  Gonadorelin      K2...........  ...........      $180.30
                 hydroch/ 100
                 mcg.
J1626.........  Granisetron HCl  K2...........  ...........        $7.50
                 injection.
J1630.........  Haloperidol      N1...........  ...........  ...........
                 injection.
J1631.........  Haloperidol      N1...........  ...........  ...........
                 decanoate inj.
J1640.........  Hemin, 1 mg....  K2...........  ...........        $6.80
J1642.........  Inj heparin      N1...........  ...........  ...........
                 sodium per 10
                 u.
J1644.........  Inj heparin      N1...........  ...........  ...........
                 sodium per
                 1000u.
J1645.........  Dalteparin       N1...........  ...........  ...........
                 sodium.
J1650.........  Inj enoxaparin   N1...........  ...........  ...........
                 sodium.
J1652.........  Fondaparinux     N1...........  ...........  ...........
                 sodium.
J1655.........  Tinzaparin       K2...........  ...........        $2.45
                 sodium
                 injection.
J1670.........  Tetanus immune   K2...........  ...........       $97.26
                 globulin inj.
J1700.........  Hydrocortisone   N1...........  ...........  ...........
                 acetate inj.
J1710.........  Hydrocortisone   N1...........  ...........  ...........
                 sodium ph inj.
J1720.........  Hydrocortisone   N1...........  ...........  ...........
                 sodium succ i.
J1730.........  Diazoxide        K2...........  ...........      $114.32
                 injection.
J1740.........  Ibandronate      K2...........  ...........      $138.71
                 sodium
                 injection.
J1742.........  Ibutilide        K2...........  ...........      $266.92
                 fumarate
                 injection.
J1745.........  Infliximab       K2...........  ...........       $53.76
                 injection.
J1751.........  Iron dextran     K2...........  ...........       $11.72
                 165 injection.
J1752.........  Iron dextran     K2...........  ...........       $10.42
                 267 injection.
J1756.........  Iron sucrose     K2...........  ...........        $0.37
                 injection.
J1785.........  Injection        K2...........  ...........        $3.92
                 imiglucerase /
                 unit.
J1790.........  Droperidol       N1...........  ...........  ...........
                 injection.
J1800.........  Propranolol      N1...........  ...........  ...........
                 injection.
J1815.........  Insulin          N1...........  ...........  ...........
                 injection.
J1817.........  Insulin for      N1...........  ...........  ...........
                 insulin pump
                 use.
J1830.........  Interferon beta- K2...........  ...........       $84.92
                 1b /.25 MG.
J1835.........  Itraconazole     K2...........  ...........       $38.41
                 injection.
J1840.........  Kanamycin        N1...........  ...........  ...........
                 sulfate 500 MG
                 inj.
J1850.........  Kanamycin        N1...........  ...........  ...........
                 sulfate 75 MG
                 inj.
J1885.........  Ketorolac        N1...........  ...........  ...........
                 tromethamine
                 inj.
J1890.........  Cephalothin      N1...........  ...........  ...........
                 sodium
                 injection.
J1931.........  Laronidase       K2...........  ...........       $23.87
                 injection.
J1940.........  Furosemide       N1...........  ...........  ...........
                 injection.
J1945.........  Lepirudin......  K2...........  ...........      $154.89
J1950.........  Leuprolide       K2...........  ...........      $433.92
                 acetate /3.75
                 MG.
J1956.........  Levofloxacin     N1...........  ...........  ...........
                 injection.
J1960.........  Levorphanol      N1...........  ...........  ...........
                 tartrate inj.
J1980.........  Hyoscyamine      N1...........  ...........  ...........
                 sulfate inj.
J1990.........  Chlordiazepoxid  N1...........  ...........  ...........
                 e injection.
J2001.........  Lidocaine        N1...........  ...........  ...........
                 injection.
J2010.........  Lincomycin       N1...........  ...........  ...........
                 injection.
J2020.........  Linezolid        K2...........  ...........       $25.17
                 injection.
J2060.........  Lorazepam        N1...........  ...........  ...........
                 injection.
J2150.........  Mannitol         N1...........  ...........  ...........
                 injection.
J2170.........  Mecasermin       K2...........  ...........       $11.93
                 injection.
J2175.........  Meperidine       N1...........  ...........  ...........
                 hydrochl /100
                 MG.
J2180.........  Meperidine/      N1...........  ...........  ...........
                 promethazine
                 inj.
J2185.........  Meropenem......  K2...........  ...........        $3.71
J2210.........  Methylergonovin  N1...........  ...........  ...........
                 maleate inj.
J2248.........  Micafungin       K2...........  ...........        $1.71
                 sodium
                 injection.
J2250.........  Inj midazolam    N1...........  ...........  ...........
                 hydrochloride.
J2260.........  Inj milrinone    N1...........  ...........  ...........
                 lactate/5 MG.
J2270.........  Morphine         N1...........  ...........  ...........
                 sulfate
                 injection.
J2271.........  Morphine so4     N1...........  ...........  ...........
                 injection 100
                 mg.
J2275.........  Morphine         N1...........  ...........  ...........
                 sulfate
                 injection.
J2278.........  Ziconotide       K2...........  ...........        $6.52
                 injection.
J2280.........  Inj,             N1...........  ...........  ...........
                 moxifloxacin
                 100 mg.
J2300.........  Inj nalbuphine   N1...........  ...........  ...........
                 hydrochloride.
J2310.........  Inj naloxone     N1...........  ...........  ...........
                 hydrochloride.
J2315.........  Naltrexone,      K2...........  ...........        $1.90
                 depot form.
J2320.........  Nandrolone       N1...........  ...........  ...........
                 decanoate 50
                 MG.

[[Page 42621]]

 
J2321.........  Nandrolone       N1...........  ...........  ...........
                 decanoate 100
                 MG.
J2322.........  Nandrolone       N1...........  ...........  ...........
                 decanoate 200
                 MG.
J2325.........  Nesiritide       K2...........  ...........       $31.66
                 injection.
J2353.........  Octreotide       K2...........  ...........       $96.77
                 injection,
                 depot.
J2354.........  Octreotide inj,  N1...........  ...........  ...........
                 non-depot.
J2355.........  Oprelvekin       K2...........  ...........      $247.31
                 injection.
J2357.........  Omalizumab       K2...........  ...........       $16.95
                 injection.
J2360.........  Orphenadrine     N1...........  ...........  ...........
                 injection.
J2370.........  Phenylephrine    N1...........  ...........  ...........
                 hcl injection.
J2400.........  Chloroprocaine   N1...........  ...........  ...........
                 hcl injection.
J2405.........  Ondansetron hcl  K2...........  ...........        $3.40
                 injection.
J2410.........  Oxymorphone hcl  N1...........  ...........  ...........
                 injection.
J2425.........  Palifermin       K2...........  ...........       $11.43
                 injection.
J2430.........  Pamidronate      K2...........  ...........       $30.78
                 disodium/30 MG.
J2440.........  Papaverin hcl    N1...........  ...........  ...........
                 injection.
J2460.........  Oxytetracycline  N1...........  ...........  ...........
                 injection.
J2469.........  Palonosetron     K2...........  ...........       $16.00
                 HCl.
J2501.........  Paricalcitol...  N1...........  ...........  ...........
J2503.........  Pegaptanib       K2...........  ...........    $1,054.70
                 sodium
                 injection.
J2504.........  Pegademase       K2...........  ...........      $177.83
                 bovine, 25 iu.
J2505.........  Injection,       K2...........  ...........    $2,163.33
                 pegfilgrastim
                 6mg.
J2510.........  Penicillin g     N1...........  ...........  ...........
                 procaine inj.
J2513.........  Pentastarch 10%  N1...........  ...........  ...........
                 solution.
J2515.........  Pentobarbital    N1...........  ...........  ...........
                 sodium inj.
J2540.........  Penicillin g     N1...........  ...........  ...........
                 potassium inj.
J2543.........  Piperacillin/    N1...........  ...........  ...........
                 tazobactam.
J2550.........  Promethazine     N1...........  ...........  ...........
                 hcl injection.
J2560.........  Phenobarbital    N1...........  ...........  ...........
                 sodium inj.
J2590.........  Oxytocin         N1...........  ...........  ...........
                 injection.
J2597.........  Inj              N1...........  ...........  ...........
                 desmopressin
                 acetate.
J2650.........  Prednisolone     N1...........  ...........  ...........
                 acetate inj.
J2670.........  Totazoline hcl   N1...........  ...........  ...........
                 injection.
J2675.........  Inj              N1...........  ...........  ...........
                 progesterone
                 per 50 MG.
J2680.........  Fluphenazine     N1...........  ...........  ...........
                 decanoate 25
                 MG.
J2690.........  Procainamide     N1...........  ...........  ...........
                 hcl injection.
J2700.........  Oxacillin        N1...........  ...........  ...........
                 sodium
                 injection.
J2710.........  Neostigmine      N1...........  ...........  ...........
                 methylslfte
                 inj.
J2720.........  Inj protamine    N1...........  ...........  ...........
                 sulfate/10 MG.
J2725.........  Inj protirelin   N1...........  ...........  ...........
                 per 250 mcg.
J2730.........  Pralidoxime      N1...........  ...........  ...........
                 chloride inj.
J2760.........  Phentolaine      N1...........  ...........  ...........
                 mesylate inj.
J2765.........  Metoclopramide   N1...........  ...........  ...........
                 hcl injection.
J2770.........  Quinupristin/    K2...........  ...........      $117.81
                 dalfopristin.
J2780.........  Ranitidine       N1...........  ...........  ...........
                 hydrochloride
                 inj.
J2783.........  Rasburicase....  K2...........  ...........      $132.53
J2788.........  Rho d immune     K2...........  ...........       $26.66
                 globulin 50
                 mcg.
J2790.........  Rho d immune     K2...........  ...........       $81.48
                 globulin inj.
J2792.........  Rho(D) immune    K2...........  ...........       $15.91
                 globulin h, sd.
J2794.........  Risperidone,     K2...........  ...........        $4.85
                 long acting.
J2795.........  Ropivacaine HCl  N1...........  ...........  ...........
                 injection.
J2800.........  Methocarbamol    N1...........  ...........  ...........
                 injection.
J2805.........  Sincalide        N1...........  ...........  ...........
                 injection.
J2810.........  Inj              N1...........  ...........  ...........
                 theophylline
                 per 40 MG.
J2820.........  Sargramostim     K2...........  ...........       $25.31
                 injection.
J2850.........  Inj secretin     K2...........  ...........       $20.31
                 synthetic
                 human.
J2910.........  Aurothioglucose  N1...........  ...........  ...........
                 injection.
J2916.........  Na ferric        N1...........  ...........  ...........
                 gluconate
                 complex.
J2920.........  Methylprednisol  N1...........  ...........  ...........
                 one injection.
J2930.........  Methylprednisol  N1...........  ...........  ...........
                 one injection.
J2940.........  Somatrem         K2...........  ...........      $168.90
                 injection.
J2941.........  Somatropin       K2...........  ...........       $47.19
                 injection.
J2950.........  Promazine hcl    N1...........  ...........  ...........
                 injection.
J2993.........  Reteplase        K2...........  ...........      $899.51
                 injection.
J2995.........  Inj              K2...........  ...........      $129.75
                 streptokinase /
                 250000 IU.

[[Page 42622]]

 
J2997.........  Alteplase        K2...........  ...........       $32.79
                 recombinant.
J3000.........  Streptomycin     N1...........  ...........  ...........
                 injection.
J3010.........  Fentanyl         N1...........  ...........  ...........
                 citrate
                 injeciton.
J3030.........  Sumatriptan      K2...........  ...........       $59.38
                 succinate / 6
                 MG.
J3070.........  Pentazocine      N1...........  ...........  ...........
                 injection.
J3100.........  Tenecteplase     K2...........  ...........    $2,043.40
                 injection.
J3105.........  Terbutaline      N1...........  ...........  ...........
                 sulfate inj.
J3120.........  Testosterone     N1...........  ...........  ...........
                 enanthate inj.
J3130.........  Testosterone     N1...........  ...........  ...........
                 enanthate inj.
J3140.........  Testosterone     N1...........  ...........  ...........
                 suspension inj.
J3150.........  Testosterone     N1...........  ...........  ...........
                 propionate inj.
J3230.........  Chlorpromazine   N1...........  ...........  ...........
                 hcl injection.
J3240.........  Thyrotropin      K2...........  ...........      $765.38
                 injection.
J3243.........  Tigecycline      K2...........  ...........        $0.91
                 injection.
J3246.........  Tirofiban HCl..  K2...........  ...........        $7.73
J3250.........  Trimethobenzami  N1...........  ...........  ...........
                 de hcl inj.
J3260.........  Tobramycin       N1...........  ...........  ...........
                 sulfate
                 injection.
J3265.........  Injection        N1...........  ...........  ...........
                 torsemide 10
                 mg/ml.
J3280.........  Thiethylperazin  N1...........  ...........  ...........
                 e maleate inj.
J3285.........  Treprostinil     K2...........  ...........       $55.89
                 injection.
J3301.........  Triamcinolone    N1...........  ...........  ...........
                 acetonide inj.
J3302.........  Triamcinolone    N1...........  ...........  ...........
                 diacetate inj.
J3303.........  Triamcinolone    N1...........  ...........  ...........
                 hexacetonl inj.
J3305.........  Inj              K2...........  ...........      $145.26
                 trimetrexate
                 glucoronate.
J3310.........  Perphenazine     N1...........  ...........  ...........
                 injection.
J3315.........  Triptorelin      K2...........  ...........      $155.44
                 pamoate.
J3320.........  Spectinomycn di- K2...........  ...........       $30.08
                 hcl inj.
J3350.........  Urea injection.  K2...........  ...........       $74.16
J3355.........  Urofollitropin,  K2...........  ...........       $50.70
                 75 iu.
J3360.........  Diazepam         N1...........  ...........  ...........
                 injection.
J3364.........  Urokinase 5000   N1...........  ...........  ...........
                 IU injection.
J3365.........  Urokinase        K2...........  ...........      $457.73
                 250,000 IU inj.
J3370.........  Vancomycin hcl   N1...........  ...........  ...........
                 injection.
J3396.........  Verteporfin      K2...........  ...........        $8.92
                 injection.
J3400.........  Triflupromazine  N1...........  ...........  ...........
                 hcl inj.
J3410.........  Hydroxyzine hcl  N1...........  ...........  ...........
                 injection.
J3411.........  Thiamine hcl     N1...........  ...........  ...........
                 100 mg.
J3415.........  Pyridoxine hcl   N1...........  ...........  ...........
                 100 mg.
J3420.........  Vitamin b12      N1...........  ...........  ...........
                 injection.
J3430.........  Vitamin k        N1...........  ...........  ...........
                 phytonadione
                 inj.
J3465.........  Injection,       K2...........  ...........        $4.99
                 voriconazole.
J3470.........  Hyaluronidase    N1...........  ...........  ...........
                 injection.
J3471.........  Ovine, up to     N1...........  ...........  ...........
                 999 USP units.
J3472.........  Ovine, 1000 USP  K2...........  ...........      $135.04
                 units.
J3473.........  Hyaluronidase    K2...........  ...........        $0.40
                 recombinant.
J3475.........  Inj magnesium    N1...........  ...........  ...........
                 sulfate.
J3480.........  Inj potassium    N1...........  ...........  ...........
                 chloride.
J3485.........  Zidovudine.....  N1...........  ...........  ...........
J3486.........  Ziprasidone      N1...........  ...........  ...........
                 mesylate.
J3487.........  Zoledronic acid  K2...........  ...........      $206.04
J3490.........  Drugs            N1...........  ...........  ...........
                 unclassified
                 injection.
J3530.........  Nasal vaccine    N1...........  ...........  ...........
                 inhalation.
J3590.........  Unclassified     N1...........  ...........  ...........
                 biologics.
J7030.........  Normal saline    N1...........  ...........  ...........
                 solution infus.
J7040.........  Normal saline    N1...........  ...........  ...........
                 solution infus.
J7042.........  5% dextrose/     N1...........  ...........  ...........
                 normal saline.
J7050.........  Normal saline    N1...........  ...........  ...........
                 solution infus.
J7060.........  5% dextrose/     N1...........  ...........  ...........
                 water.
J7070.........  D5w infusion...  N1...........  ...........  ...........
J7100.........  Dextran 40       N1...........  ...........  ...........
                 infusion.
J7110.........  Dextran 75       N1...........  ...........  ...........
                 infusion.
J7120.........  Ringers lactate  N1...........  ...........  ...........
                 infusion.
J7130.........  Hypertonic       N1...........  ...........  ...........
                 saline
                 solution.
J7187.........  Inj              K2...........  ...........        $0.88
                 Vonwillebrand
                 factor IU.

[[Page 42623]]

 
J7189.........  Factor viia....  K2...........  ...........        $1.12
J7190.........  Factor viii....  K2...........  ...........        $0.70
J7191.........  Factor VIII      K2...........  ...........        $0.75
                 (porcine).
J7192.........  Factor viii      K2...........  ...........        $1.07
                 recombinant.
J7193.........  Factor IX non-   K2...........  ...........        $0.89
                 recombinant.
J7194.........  Factor ix        K2...........  ...........        $0.75
                 complex.
J7195.........  Factor IX        K2...........  ...........        $0.99
                 recombinant.
J7197.........  Antithrombin     K2...........  ...........        $1.64
                 iii injection.
J7198.........  Anti-inhibitor.  K2...........  ...........        $1.36
J7308.........  Aminolevulinic   K2...........  ...........      $105.43
                 acid hcl top.
J7310.........  Ganciclovir      K2...........  ...........    $4,752.26
                 long act
                 implant.
J7311.........  Fluocinolone     K2...........  ...........   $19,345.00
                 acetonide
                 implt.
J7340.........  Metabolic        K2...........  ...........       $28.78
                 active D/E
                 tissue.
J7341.........  Non-human,       K2...........  ...........        $1.82
                 metabolic
                 tissue.
J7342.........  Metabolically    K2...........  ...........       $31.66
                 active tissue.
J7343.........  Nonmetabolic     K2...........  ...........       $18.30
                 act d/e tissue.
J7344.........  Nonmetabolic     K2...........  ...........       $89.21
                 active tissue.
J7345.........  Non-human, non-  K2...........  ...........       $36.10
                 metab tissue.
J7346.........  Injectable       K2...........  ...........      $735.38
                 human tissue.
J7500.........  Azathioprine     N1...........  ...........  ...........
                 oral 50 mg.
J7501.........  Azathioprine     K2...........  ...........       $48.44
                 parenteral.
J7502.........  Cyclosporine     K2...........  ...........        $3.60
                 oral 100 mg.
J7504.........  Lymphocyte       K2...........  ...........      $317.18
                 immune
                 globulin.
J7505.........  Monoclonal       K2...........  ...........      $895.15
                 antibodies.
J7506.........  Prednisone oral  N1...........  ...........  ...........
J7507.........  Tacrolimus oral  K2...........  ...........        $3.66
                 per 1 MG.
J7509.........  Methylprednisol  N1...........  ...........  ...........
                 one oral.
J7510.........  Prednisolone     N1...........  ...........  ...........
                 oral per 5 mg.
J7511.........  Antithymocyte    K2...........  ...........      $327.75
                 globuln rabbit.
J7513.........  Daclizumab,      K2...........  ...........      $299.86
                 parenteral.
J7515.........  Cyclosporine     N1...........  ...........  ...........
                 oral 25 mg.
J7516.........  Cyclosporin      N1...........  ...........  ...........
                 parenteral 250
                 mg.
J7517.........  Mycophenolate    K2...........  ...........        $2.62
                 mofetil oral.
J7518.........  Mycophenolic     K2...........  ...........        $2.27
                 acid.
J7520.........  Sirolimus, oral  K2...........  ...........        $7.22
J7525.........  Tacrolimus       K2...........  ...........      $140.44
                 injection.
J7599.........  Immunosuppressi  N1...........  ...........  ...........
                 ve drug noc.
J7674.........  Methacholine     N1...........  ...........  ...........
                 chloride, neb.
J7799.........  Non-inhalation   N1...........  ...........  ...........
                 drug for DME.
J8501.........  Oral aprepitant  K2...........  ...........        $5.07
J8510.........  Oral busulfan..  K2...........  ...........        $2.14
J8520.........  Capecitabine,    K2...........  ...........        $3.97
                 oral, 150 mg.
J8530.........  Cyclophosphamid  N1...........  ...........  ...........
                 e oral 25 MG.
J8540.........  Oral             N1...........  ...........  ...........
                 dexamethasone.
J8560.........  Etoposide oral   K2...........  ...........       $29.60
                 50 MG.
J8597.........  Antiemetic drug  N1...........  ...........  ...........
                 oral NOS.
J8600.........  Melphalan oral   N1...........  ...........  ...........
                 2 MG.
J8610.........  Methotrexate     N1...........  ...........  ...........
                 oral 2.5 MG.
J8650.........  Nabilone oral..  K2...........  ...........       $16.96
J8700.........  Temozolomide...  K2...........  ...........        $7.41
J9000.........  Doxorubic hcl    K2...........  ...........        $6.31
                 10 MG vl chemo.
J9001.........  Doxorubicin hcl  K2...........  ...........      $389.48
                 liposome inj.
J9010.........  Alemtuzumab      K2...........  ...........      $541.20
                 injection.
J9015.........  Aldesleukin/     K2...........  ...........      $762.98
                 single use
                 vial.
J9017.........  Arsenic          K2...........  ...........       $34.17
                 trioxide.
J9020.........  Asparaginase     K2...........  ...........       $54.72
                 injection.
J9025.........  Azacitidine      K2...........  ...........        $4.30
                 injection.
J9027.........  Clofarabine      K2...........  ...........      $116.75
                 injection.
J9031.........  Bcg live         K2...........  ...........      $110.67
                 intravesical
                 vac.
J9035.........  Bevacizumab      K2...........  ...........       $57.53
                 injection.
J9040.........  Bleomycin        K2...........  ...........       $35.85
                 sulfate
                 injection.
J9041.........  Bortezomib       K2...........  ...........       $32.68
                 injection.
J9045.........  Carboplatin      K2...........  ...........        $8.46
                 injection.
J9050.........  Carmus bischl    K2...........  ...........      $139.84
                 nitro inj.

[[Page 42624]]

 
J9055.........  Cetuximab        K2...........  ...........       $49.81
                 injection.
J9060.........  Cisplatin 10 MG  N1...........  ...........  ...........
                 injection.
J9065.........  Inj cladribine   K2...........  ...........       $36.12
                 per 1 MG.
J9070.........  Cyclophosphamid  N1...........  ...........  ...........
                 e 100 MG inj.
J9093.........  Cyclophosphamid  K2...........  ...........        $1.99
                 e lyophilized.
J9098.........  Cytarabine       K2...........  ...........      $395.04
                 liposome.
J9100.........  Cytarabine hcl   N1...........  ...........  ...........
                 100 MG inj.
J9120.........  Dactinomycin     K2...........  ...........      $493.43
                 actinomycin d.
J9130.........  Dacarbazine 100  K2...........  ...........        $5.25
                 mg inj.
J9150.........  Daunorubicin...  K2...........  ...........       $20.47
J9151.........  Daunorubicin     K2...........  ...........       $55.92
                 citrate
                 liposom.
J9160.........  Denileukin       K2...........  ...........    $1,406.59
                 diftitox, 300
                 mcg.
J9165.........  Diethylstilbest  N1...........  ...........  ...........
                 rol injection.
J9170.........  Docetaxel......  K2...........  ...........      $306.81
J9175.........  Elliotts b       N1...........  ...........  ...........
                 solution per
                 ml.
J9178.........  Inj, epirubicin  K2...........  ...........       $21.21
                 hcl, 2 mg.
J9181.........  Etoposide 10 MG  N1...........  ...........  ...........
                 inj.
J9185.........  Fludarabine      K2...........  ...........      $236.44
                 phosphate inj.
J9190.........  Fluorouracil     N1...........  ...........  ...........
                 injection.
J9200.........  Floxuridine      K2...........  ...........       $51.31
                 injection.
J9201.........  Gemcitabine HCl  K2...........  ...........      $125.16
J9202.........  Goserelin        K2...........  ...........      $198.68
                 acetate
                 implant.
J9206.........  Irinotecan       K2...........  ...........      $126.00
                 injection.
J9208.........  Ifosfomide       K2...........  ...........       $46.59
                 injection.
J9209.........  Mesna injection  K2...........  ...........        $8.97
J9211.........  Idarubicin hcl   K2...........  ...........      $304.61
                 injection.
J9212.........  Interferon       K2...........  ...........        $4.65
                 alfacon-1.
J9213.........  Interferon alfa- K2...........  ...........       $37.89
                 2a inj.
J9214.........  Interferon alfa- K2...........  ...........       $13.88
                 2b inj.
J9215.........  Interferon alfa- K2...........  ...........        $9.12
                 n3 inj.
J9216.........  Interferon       K2...........  ...........      $289.87
                 gamma 1-b inj.
J9217.........  Leuprolide       K2...........  ...........      $229.50
                 acetate
                 suspnsion.
J9218.........  Leuprolide       K2...........  ...........        $8.88
                 acetate
                 injeciton.
J9219.........  Leuprolide       K2...........  ...........    $1,713.12
                 acetate
                 implant.
J9225.........  Histrelin        K2...........  ...........    $1,460.77
                 implant.
J9230.........  Mechlorethamine  K2...........  ...........      $141.61
                 hcl inj.
J9245.........  Inj melphalan    K2...........  ...........    $1,284.12
                 hydrochl 50 MG.
J9250.........  Methotrexate     N1...........  ...........  ...........
                 sodium inj.
J9261.........  Nelarabine       K2...........  ...........       $83.33
                 injection.
J9263.........  Oxaliplatin....  K2...........  ...........        $8.97
J9264.........  Paclitaxel       K2...........  ...........        $8.73
                 protein bound.
J9265.........  Paclitaxel       K2...........  ...........       $12.59
                 injection.
J9266.........  Pegaspargase/    K2...........  ...........    $1,683.49
                 singl dose
                 vial.
J9268.........  Pentostatin      K2...........  ...........    $1,934.91
                 injection.
J9270.........  Plicamycin       K2...........  ...........      $172.41
                 (mithramycin)
                 inj.
J9280.........  Mitomycin 5 MG   K2...........  ...........       $16.13
                 inj.
J9293.........  Mitoxantrone     K2...........  ...........      $168.23
                 hydrochl / 5
                 MG.
J9300.........  Gemtuzumab       K2...........  ...........    $2,356.98
                 ozogamicin.
J9305.........  Pemetrexed       K2...........  ...........       $43.79
                 injection.
J9310.........  Rituximab        K2...........  ...........      $496.22
                 cancer
                 treatment.
J9320.........  Streptozocin     K2...........  ...........      $153.73
                 injection.
J9340.........  Thiotepa         K2...........  ...........       $40.70
                 injection.
J9350.........  Topotecan......  K2...........  ...........      $830.74
J9355.........  Trastuzumab....  K2...........  ...........       $57.87
J9357.........  Valrubicin, 200  K2...........  ...........       $77.96
                 mg.
J9360.........  Vinblastine      N1...........  ...........  ...........
                 sulfate inj.
J9370.........  Vincristine      N1...........  ...........  ...........
                 sulfate 1 MG
                 inj.
J9390.........  Vinorelbine      K2...........  ...........       $20.07
                 tartrate/10 mg.
J9395.........  Injection,       K2...........  ...........       $80.56
                 Fulvestrant.
J9600.........  Porfimer sodium  K2...........  ...........    $2,563.31
J9999.........  Chemotherapy     N1...........  ...........  ...........
                 drug.
L8600.........  Implant breast   N1...........  ...........  ...........
                 silicone/eq.
L8603.........  Collagen imp     N1...........  ...........  ...........
                 urinary 2.5 ml.
L8606.........  Synthetic        N1...........  ...........  ...........
                 implnt urinary
                 1ml.

[[Page 42625]]

 
L8609.........  Artificial       N1...........  ...........  ...........
                 cornea.
L8610.........  Ocular implant.  N1...........  ...........  ...........
L8612.........  Aqueous shunt    N1...........  ...........  ...........
                 prosthesis.
L8613.........  Ossicular        N1...........  ...........  ...........
                 implant.
L8614.........  Cochlear device  N1...........  ...........  ...........
L8630.........  Metacarpophalan  N1...........  ...........  ...........
                 geal implant.
L8631.........  MCP joint repl   N1...........  ...........  ...........
                 2 pc or more.
L8641.........  Metatarsal       N1...........  ...........  ...........
                 joint implant.
L8642.........  Hallux implant.  N1...........  ...........  ...........
L8658.........  Interphalangeal  N1...........  ...........  ...........
                 joint spacer.
L8659.........  Interphalangeal  N1...........  ...........  ...........
                 joint repl.
L8670.........  Vascular graft,  N1...........  ...........  ...........
                 synthetic.
L8682.........  Implt neurostim  N1...........  ...........  ...........
                 radiofq rec.
L8690.........  Aud osseo dev,   J7...........  ...........  ...........
                 int/ext comp.
L8699.........  Prosthetic       N1...........  ...........  ...........
                 implant NOS.
Q0163.........  Diphenhydramine  N1...........  ...........  ...........
                 HCl 50mg.
Q0164.........  Prochlorperazin  N1...........  ...........  ...........
                 e maleate 5mg.
Q0166.........  Granisetron HCl  K2...........  ...........       $44.87
                 1 mg oral.
Q0167.........  Dronabinol 2.5   N1...........  ...........  ...........
                 mg oral.
Q0169.........  Promethazine     N1...........  ...........  ...........
                 HCl 12.5 mg
                 oral.
Q0171.........  Chlorpromazine   N1...........  ...........  ...........
                 HCl 10 mg oral.
Q0173.........  Trimethobenzami  N1...........  ...........  ...........
                 de HCl 250 mg.
Q0174.........  Thiethylperazin  N1...........  ...........  ...........
                 e maleate 10
                 mg.
Q0175.........  Perphenazine 4   N1...........  ...........  ...........
                 mg oral.
Q0177.........  Hydroxyzine      N1...........  ...........  ...........
                 pamoate 25 mg.
Q0179.........  Ondansetron HCl  K2...........  ...........       $36.55
                 8 mg oral.
Q0180.........  Dolasetron       K2...........  ...........       $47.52
                 mesylate oral.
Q0515.........  Sermorelin       K2...........  ...........        $1.75
                 acetate
                 injection.
Q1003.........  Ntiol category   L6...........  ...........       $50.00
                 3.
Q2004.........  Bladder calculi  N1...........  ...........  ...........
                 irrig sol.
Q2009.........  Fosphenytoin,    K2...........  ...........        $5.66
                 50 mg.
Q2017.........  Teniposide, 50   K2...........  ...........      $264.09
                 mg.
Q3025.........  IM inj           K2...........  ...........      $114.57
                 interferon
                 beta 1-a.
Q4079.........  Natalizumab      K2...........  ...........        $7.52
                 injection.
Q4083.........  Hyalgan/supartz  K2...........  ...........      $104.85
                 inj per dose.
Q4084.........  Synvisc inj per  K2...........  ...........      $186.66
                 dose.
Q4085.........  Euflexxa inj     K2...........  ...........      $115.16
                 per dose.
Q4086.........  Orthovisc inj    K2...........  ...........      $198.34
                 per dose.
Q9945.........  LOCM [lE]149 mg/ K2...........  ...........        $0.42
                 ml iodine, 1
                 ml.
Q9946.........  LOCM 150-199 mg/ K2...........  ...........        $1.95
                 ml iodine,1 ml.
Q9947.........  LOCM 200-249 mg/ K2...........  ...........        $1.33
                 ml iodine,1 ml.
Q9948.........  LOCM 250-299 mg/ K2...........  ...........        $0.36
                 ml iodine,1 ml.
Q9949.........  LOCM 300-349 mg/ K2...........  ...........        $0.37
                 ml iodine,1 ml.
Q9950.........  LOCM 350-399 mg/ K2...........  ...........        $0.22
                 ml iodine,1 ml.
Q9951.........  LOCM [gE] 400    K2...........  ...........        $0.22
                 mg/ml iodine,1
                 ml.
Q9952.........  Inj Gad-base MR  K2...........  ...........        $2.82
                 contrast,1 ml.
Q9953.........  Inj Fe-based MR  K2...........  ...........       $30.41
                 contrast,1 ml.
Q9954.........  Oral MR          K2...........  ...........        $8.82
                 contrast, 100
                 ml.
Q9955.........  Inj perflexane   K2...........  ...........       $12.96
                 lip micros, ml.
Q9956.........  Inj              K2...........  ...........       $49.61
                 octafluoroprop
                 ane mic, ml.
Q9957.........  Inj perflutren   K2...........  ...........       $61.55
                 lip micros, ml.
Q9958.........  HOCM [lE]149 mg/ N1...........  ...........  ...........
                 ml iodine, 1ml.
Q9959.........  HOCM 150-199 mg/ N1...........  ...........  ...........
                 ml iodine, 1ml.
Q9960.........  HOCM 200-249 mg/ N1...........  ...........  ...........
                 ml iodine, 1
                 ml.
Q9961.........  HOCM 250-299 mg/ N1...........  ...........  ...........
                 ml iodine, 1ml.
Q9962.........  HOCM 300-349 mg/ N1...........  ...........  ...........
                 ml iodine, 1
                 ml.
Q9963.........  HOCM 350-399 mg/ N1...........  ...........  ...........
                 ml iodine, 1ml.
Q9964.........  HOCM[gE] 400 mg/ N1...........  ...........  ...........
                 ml iodine, 1
                 ml.
V2630.........  Anter chamber    N1...........  ...........  ...........
                 intraocul lens.
V2631.........  Iris support     N1...........  ...........  ...........
                 intraoclr lens.
V2632.........  Post chmbr       N1...........  ...........  ...........
                 intraocular
                 lens.
V2785.........  Corneal tissue   F4...........  ...........  ...........
                 processing.

[[Page 42626]]

 
V2790.........  Amniotic         N1...........  ...........  ...........
                 membrane.
------------------------------------------------------------------------
Note: The Medicare program payment is 80 percent of the total payment
  amount and beneficiary coinsurance is 20 percent of the total payment
  amount, except for screening flexible sigmoidoscopies and screening
  colonoscopies for which the program payment is 75 percent and the
  beneficiary coinsurance is 25 percent.




  Federal Register / Vol. 72, No. 148 / Thursday, August 2, 2007 / 
Rules and Regulations  

[[Page 42626]]




           Addendum DD1.--Illustrative ASC Payment Indicators
------------------------------------------------------------------------
       Indicator                  Payment indicator definition
------------------------------------------------------------------------
A2....................  Surgical procedure on ASC list in CY 2007;
                         payment based on OPPS relative payment weight.
F4....................  Corneal tissue acquisition; paid at reasonable
                         cost.
G2....................  Non office-based surgical procedure added to ASC
                         list in CY 2008 or later; payment based on OPPS
                         relative payment weight.
H7....................  Brachytherapy source paid separately when
                         provided integral to a surgical procedure on
                         ASC list; payment contractor-priced.
H8....................  Device-intensive procedure on ASC list in CY
                         2007; paid at adjusted rate.
J7....................  OPPS pass-through device paid separately when
                         provided integral to a surgical procedure on
                         ASC list; payment contractor-priced.
J8....................  Device-intensive procedure added to ASC list in
                         CY 2008 or later; paid at adjusted rate.
K2....................  Drugs and biologicals paid separately when
                         provided integral to a surgical procedure on
                         ASC list; payment based on OPPS rate.
K7....................  Unclassified drugs and biologicals; payment
                         contractor-priced.
L6....................  New Technology Intraocular Lens (NTIOL); special
                         payment.
N1....................  Packaged procedure/item; no separate payment
                         made.
P2....................  Office-based surgical procedure added to ASC
                         list in CY 2008 or later with MPFS nonfacility
                         PE RVUs; payment based on OPPS relative payment
                         weight.
P3....................  Office-based surgical procedure added to ASC
                         list in CY 2008 or later with MPFS nonfacility
                         PE RVUs; payment based on MPFS nonfacility PE
                         RVUs.
R2....................  Office-based surgical procedure added to ASC
                         list in CY 2008 or later without MPFS
                         nonfacility PE RVUs; payment based on OPPS
                         relative payment weight.
Z2....................  Radiology service paid separately when provided
                         integral to a surgical procedure on ASC list;
                         payment based on OPPS relative payment weight.
Z3....................  Radiology service paid separately when provided
                         integral to a surgical procedure on ASC list;
                         payment based on MPFS nonfacility PE RVUs.
------------------------------------------------------------------------

[FR Doc. 07-3490 Filed 7-16-07; 4:00 pm]
BILLING CODE 4120-01-P