[Federal Register Volume 72, Number 227 (Tuesday, November 27, 2007)]
[Rules and Regulations]
[Pages 66580-67225]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 07-5507]



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Part III

Book 2 of 2 Books

Pages 66579-67226





Department of Health and Human Services





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Centers for Medicare & Medicaid Services



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42 CFR Parts 410, 411, 412, et al.



Medicare and Medicaid Programs; Interim and Final Rule

  Federal Register / Vol. 72, No. 227 / Tuesday, November 27, 2007 / 
Rules and Regulations  

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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Medicare & Medicaid Services

42 CFR Parts 410, 411, 412, 413, 414, 416, 419, 482, and 485

[CMS-1392-FC], [CMS-1533-F2], and [CMS-1531-IFC2]
RIN 0938-AO71, RIN 0938-AO70, and RIN 0938-AO35


Medicare Program: Changes to the Hospital Outpatient Prospective 
Payment System and CY 2008 Payment Rates, the Ambulatory Surgical 
Center Payment System and CY 2008 Payment Rates, the Hospital Inpatient 
Prospective Payment System and FY 2008 Payment Rates; and Payments for 
Graduate Medical Education for Affiliated Teaching Hospitals in Certain 
Emergency Situations Medicare and Medicaid Programs: Hospital 
Conditions of Participation; Necessary Provider Designations of 
Critical Access Hospitals

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

ACTION: Interim and final rule with comment period.

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SUMMARY: This final rule with comment period revises the Medicare 
hospital outpatient prospective payment system to implement applicable 
statutory requirements and changes arising from our continuing 
experience with this system. We describe the changes to the amounts and 
factors used to determine the payment rates for Medicare hospital 
outpatient services paid under the prospective payment system. These 
changes are applicable to services furnished on or after January 1, 
2008. In addition, the rule sets forth the applicable relative payment 
weights and amounts for services furnished in ASCs, specific HCPCS 
codes to which the final policies of the ASC payment system apply, and 
other pertinent rate setting information for the CY 2008 ASC payment 
system. Furthermore, this final rule with comment period will make 
changes to the policies relating to the necessary provider designations 
of critical access hospitals and changes to several of the current 
conditions of participation requirements.
    The attached document also incorporates the changes to the FY 2008 
hospital inpatient prospective payment system (IPPS) payment rates made 
as a result of the enactment of the TMA, Abstinence Education, and QI 
Programs Extension Act of 2007, Public Law 110-90. In addition, we are 
changing the provisions in our previously issued FY 2008 IPPS final 
rule and are establishing a new policy, retroactive to October 1, 2007, 
of not applying the documentation and coding adjustment to the FY 2008 
hospital-specific rates for Medicare-dependent, small rural hospitals 
(MDHs) and sole community hospitals (SCHs). In the interim final rule 
with comment period in this document, we are modifying our regulations 
relating to graduate medical education (GME) payments made to teaching 
hospitals that have Medicare affiliation agreements for certain 
emergency situations.

DATES: Effective Date: The provisions of this rule are effective on 
January 1, 2008.
    IPPS Payment Rates: The FY 2008 IPPS payment rates, provided in 
section XIX of the preamble of this document, became effective October 
1, 2007.
    Comment Period: We will consider comments on the payment 
classifications assigned to HCPCS codes identified in Addenda B, AA, 
and BB to this final rule with the ``NI'' comment indicator, and other 
areas specified throughout this rule, at the appropriate address, as 
provided below, no later than 5 p.m. EST on January 28, 2008. We will 
also consider comments relating to the Medicare GME teaching hospital 
affiliated agreement provisions, as provided below, no later than 5 
p.m. EST on January 28, 2008.
    Application Deadline--New Class of New Technology Intraocular Lens: 
Requests for review of applications for a new class of new technology 
intraocular lenses must be received by 5 p.m. EST on April 1, 2008.
    Deadline for Submission of Written Medicare GME Affiliation 
Agreements: Written Medicare GME affiliation agreements must be 
received by 5 p.m. EST on January 1, 2008.

ADDRESSES: In commenting, please refer to file codes CMS-1392-FC (for 
OPPS and ASC matters) or CMS-1531-IFC (for Medicare GME matters), as 
appropriate. Because of staff and resource limitations, we cannot 
accept comments by facsimile (FAX) transmission.
    You may submit comments in one of four ways (no duplicates, 
please):
    1. Electronically. You may submit electronic comments on specific 
issues in this regulation to http://www.cms.hhs.gov/eRulemaking. Click 
on the link ``Submit electronic comments on CMS regulations with an 
open comment period.'' (Attachments should be in Microsoft Word, 
WordPerfect, or Excel; however, we prefer Microsoft Word.)
    2. By regular mail. You may mail written comments (one original and 
two copies) to the following address ONLY: Centers for Medicare & 
Medicaid Services, Department of Health and Human Services, Attention: 
CMS-1392-FC (for OPPS and ASC matters), Attention: CMS-1531-IFC (for 
Medicare GME matters), P.O. Box 8013, Baltimore, MD 21244-1850.
    Please allow sufficient time for mailed comments to be received 
before the close of the comment period.
    3. By express or overnight mail. You may send written comments (one 
original and two copies) to the following address ONLY: Centers for 
Medicare & Medicaid Services, Department of Health and Human Services, 
Attention: CMS-1392-FC (for OPPS and ASC matters), Attention: CMS-1531-
IFC (for Medicare GME matters), Mail Stop C4-26-05, 7500 Security 
Boulevard, Baltimore, MD 21244-1850.
    4. By hand or courier. If you prefer, you may deliver (by hand or 
courier) your written comments (one original and two copies) before the 
close of the comment period to one of the following addresses: Room 
445-G, Hubert H. Humphrey Building, 200 Independence Avenue, SW., 
Washington, DC 20201; or 7500 Security Boulevard, Baltimore, MD 21244-
1850.
    If you intend to deliver your comments to the Baltimore address, 
please call telephone number (410) 786-9994 in advance to schedule your 
arrival with one of our staff members.
    (Because access to the interior of the Hubert H. Humphrey Building 
is not readily available to persons without Federal Government 
identification, commenters are encouraged to leave their comments in 
the CMS drop slots located in the main lobby of the building. A stamp-
in clock is available for persons who wish to retain proof of filing by 
stamping in and retain an extra copy of the comments being filed.)
    Comments mailed to the addresses indicated as appropriate for hand 
or courier delivery may be delayed and received after the comment 
period.
    For information on viewing public comments, see the beginning of 
the SUPPLEMENTARY INFORMATION section.
    Applications for a new class of new technology intraocular lenses: 
Requests for review of applications for a new class of new technology 
intraocular lenses must be sent by regular mail to:ASC/NTIOL, Division 
of Outpatient Care, Mailstop C4-05-17, Centers for Medicare and 
Medicaid Services,7500 Security Boulevard,Baltimore, MD 21244-1850.
    Submissions of written Medicare GME affiliation agreements: Written

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Medicare GME affiliation agreements must be sent by regular mail 
to:Centers for Medicare and Medicaid Services, Division of Acute Care, 
Attention: Elizabeth Troung or Renate Rockwell,Mailstop C4-08-06,7500 
Security Boulevard, Baltimore, MD 21244-1850.

FOR FURTHER INFORMATION CONTACT:
    Alberta Dwivedi, (410) 786-0378, Hospital outpatient prospective 
payment issues.
    Dana Burley, (410) 786-0378, Ambulatory surgical center issues.
    Suzanne Asplen, (410) 786-4558, Partial hospitalization and 
community mental health center issues.
    Sheila Blackstock, (410) 786-3502, Reporting of quality data 
issues.
    Mary Collins, (410) 786-3189, and Jeannie Miller, (410) 786-3164, 
Necessary provider designations for CAHs issues.
    Scott Cooper, (410) 786-9465, and Jeannie Miller, (410) 786-3164, 
Hospital conditions of participation issues.
    Miechal Lefkowitz, (410) 786-5316, Hospital inpatient prospective 
payment system issues.
    Tzvi Hefter, (410) 786-4487, Graduate medical education program 
issues.

SUPPLEMENTARY INFORMATION:
    Submitting Comments: We welcome comments from the public on the 
OPPS APC assignments and/or status indicators assigned to HCPCS codes 
identified in Addendum B to this final rule with comment period with 
comment indicator ``NI'' and on the ASC payment indicators assigned to 
HCPCS codes identified in Addenda AA and BB to this final rule with 
comment period with comment indicator ``NI'' in order to assist us in 
fully considering issues and developing OPPS and ASC payment policies 
for those services. You can assist us by referencing file code CMS-
1392-FC.
    We also welcome comments from the public on all issues set forth 
regarding the revised regulations regarding the Medicare GME 
affiliation agreements to assist us in fully considering issues and 
developing policies. You can assist us by referencing the file code 
CMS-1531-IFC2 and the specific ``issue identifier'' that precedes the 
section on which you choose to comment.
    Inspection of Public Comments: All comments received before the 
close of the comment period are available for viewing by the public, 
including any personally identifiable or confidential business 
information that is included in a comment. We post all comments 
received before the close of the comment period on the following Web 
site as soon as possible after they have been received: http://www.cms.hhs.gov/eRulemaking. Click on the link ``Electronic Comments on 
CMS Regulations'' on that Web site to view public comments.
    Comments received timely will also be available for public 
inspection as they are received, generally beginning approximately 3 
weeks after publication of a document, at the headquarters of the 
Centers for Medicare & Medicaid Services, 7500 Security Boulevard, 
Baltimore, MD 21244, on Monday through Friday of each week from 8:30 
a.m. to 4 p.m. To schedule an appointment to view public comments, 
phone 1-800-743-3951.

Electronic Access

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

Alphabetical List of Acronyms Appearing in This Final Rule With Comment 
Period

ACEP American College of Emergency Physicians
AHA American Hospital Association
AHIMA American Health Information Management Association
AMA American Medical Association
APC Ambulatory payment classification
AMP Average manufacturer price
ASC Ambulatory Surgical Center
ASP Average sales price
AWP Average wholesale price
BBA Balanced Budget Act of 1997, Pub. L. 105-33
BBRA Medicare, Medicaid, and SCHIP [State Children's Health 
Insurance Program] Balanced Budget Refinement Act of 1999, Pub. L. 
106-113
BCA Blue Cross Association
BCBSA Blue Cross and Blue Shield Association
BIPA Medicare, Medicaid, and SCHIP Benefits Improvement and 
Protection Act of 2000, Pub. L. 106-554
CAH Critical access hospital
CAP Competitive Acquisition Program
CBSA Core-Based Statistical Area
CCR Cost-to-charge ratio
CERT Comprehensive Error Rate Testing
CMHC Community mental health center
CMS Centers for Medicare & Medicaid Services
CoP [Hospital] Condition of participation
CORF Comprehensive outpatient rehabilitation facility
CPT [Physicians'] Current Procedural Terminology, Fourth Edition, 
2007, copyrighted by the American Medical Association
CRNA Certified registered nurse anesthetist
CY Calendar year
DMEPOS Durable medical equipment, prosthetics, orthotics, and 
supplies
DMERC Durable medical equipment regional carrier
DRA Deficit Reduction Act of 2005, Pub. L. 109-171
DSH Disproportionate share hospital
EACH Essential Access Community Hospital
E/M Evaluation and management
EPO Erythropoietin
ESRD End-stage renal disease
FACA Federal Advisory Committee Act, Pub. L. 92-463
FAR Federal Acquisition Regulations
FDA Food and Drug Administration
FFS Fee-for-service
FSS Federal Supply Schedule
FTE Full-time equivalent
FY Federal fiscal year
GAO Government Accountability Office
GME Graduate medical education
HCPCS Healthcare Common Procedure Coding System
HCRIS Hospital Cost Report Information System
HHA Home health agency
HIPAA Health Insurance Portability and Accountability Act of 1996, 
Pub. L. 104-191
HOPD Hospital outpatient department
HOP QDRP Hospital Outpatient Quality Data Reporting Program
ICD-9-CM International Classification of Diseases, Ninth Edition, 
Clinical Modification
IDE Investigational device exemption
IME Indirect medical education
IOL Intraocular lens
IPPS [Hospital] Inpatient prospective payment system
IVIG Intravenous immune globulin
MAC Medicare Administrative Contractors
MedPAC Medicare Payment Advisory Commission
MDH Medicare-dependent, small rural hospital
MIEA-TRHCA Medicare Improvements and Extension Act under Division B, 
Title I of the Tax Relief Health Care Act of 2006, Pub. L. 109-432
MMA Medicare Prescription Drug, Improvement, and Modernization Act 
of 2003, Pub. L. 108-173
MPFS Medicare Physician Fee Schedule
MSA Metropolitan Statistical Area
NCCI National Correct Coding Initiative
NCD National Coverage Determination
NTIOL New technology intraocular lens
OCE Outpatient Code Editor
OMB Office of Management and Budget
OPD [Hospital] Outpatient department
OPPS [Hospital] Outpatient prospective payment system
PHP Partial hospitalization program

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PM Program memorandum
PPI Producer Price Index
PPS Prospective payment system
PPV Pneumococcal pneumonia vaccine
PRA Paperwork Reduction Act
QIO Quality Improvement Organization
RFA Regulatory Flexibility Act
RHQDAPU Reporting Hospital Quality Data for Annual Payment Update 
[Program]
RHHI Regional home health intermediary
SBA Small Business Administration
SCH Sole community hospital
SDP Single Drug Pricer
SI Status indicator
TEFRA Tax Equity and Fiscal Responsibility Act of 1982, Pub. L. 97-
248
TOPS Transitional outpatient payments
USPDI United States Pharmacopoeia Drug Information
WAC Wholesale acquisition cost

    In this document, we address several payment systems under the 
Medicare program: The hospital outpatient prospective payment system 
(OPPS); the revised ambulatory surgical center (ASC) payment system; 
the hospital inpatient prospective payment system (IPPS); and payments 
for direct and indirect graduate medical education (GME). The 
provisions relating to the OPPS are included in sections I. through 
XV., XVII., XXI. through XXIV. of this final rule with comment period 
and in Addenda A, B, C (Addendum C is available on the Internet only; 
see section XXI. of this final rule with comment period), D1, D2, E, L, 
and M to this final rule with comment period. The provisions related to 
the revised ASC payment system are included in sections XVI., XVII., 
and XXI. through XXIV. of this final rule with comment period and in 
Addenda AA, BB, DD1, DD2, and EE (Addendum EE is available on the 
Internet only; see section XXI. of this final rule with comment period) 
to this final rule with comment period.
    The provisions relating to the IPPS payment rates are included in 
section XIX., XXIV., and XXV. of this document. The provisions relating 
to policy changes to the Medicare GME affiliation provisions for 
teaching hospitals in certain emergency situations are included in 
sections XX., XXIV., and XXV. of this document.

Table of Contents

I. Background for the OPPS
    A. Legislative and Regulatory Authority for the Hospital 
Outpatient Prospective Payment System
    B. Excluded OPPS Services and Hospitals
    C. Prior Rulemaking
    D. APC Advisory Panel
    1. Authority of the APC Panel
    2. Establishment of the APC Panel
    3. APC Panel Meetings and Organizational Structure
    E. Provisions of the Medicare Improvements and Extension Act 
under Division B, Title I of the Tax Relief and Health Care Act of 
2006
    F. Summary of the Major Contents of the CY 2008 OPPS/ASC 
Proposed Rule
    1. Updates Affecting OPPS Payments
    2. OPPS Ambulatory Payment Classification (APC) Group Policies
    3. OPPS Payment for Devices
    4. OPPS Payment for Drugs, Biologicals, and Radiopharmaceuticals
    5. Estimate of OPPS Transitional Pass-Through Spending for 
Drugs, Biologicals, and Devices
    6. OPPS Payment for Brachytherapy Sources
    7. OPPS Coding and Payment for Drug Administration Services
    8. OPPS Hospital Coding and Payment for Visits
    9. OPPS Payment for Blood and Blood Products
    10. OPPS Payment for Observation Services
    11. Procedures That Will Be Paid Only as Inpatient Services
    12. Nonrecurring Technical and Policy Changes
    13. OPPS Payment Status and Comment Indicators
    14. OPPS Policy and Payment Recommendations
    15. Update of the Revised ASC Payment System
    16. Quality Data for Annual Payment Updates
    17. Changes Affecting Necessary Provider Critical Access 
Hospitals (CAHs) and Hospital Conditions of Participation (CoPs)
    18. Regulatory Impact Analysis
    G. Public Comments Received in Response to the CY 2008 OPPS/ASC 
Proposed Rule
    H. Public Comments Received on the November 24, 2006 OPPS/ASC 
Final Rule with Comment Period
II. Updates Affecting OPPS Payments
    A. Recalibration of APC Relative Weights
    1. Database Construction
    a. Database Source and Methodology
    b. Use of Single and Multiple Procedure Claims
    (1) Use of Date of Service Stratification and a Bypass List to 
Increase the Amount of Data Used to Determine Medians
    (2) Exploration of Allocation of Packaged Costs to Separately 
Paid Procedure Codes
    c. Calculation of CCRs
    2. Calculation of Median Costs
    3. Calculation of OPPS Scaled Payment Weights
    4. Changes to Packaged Services
    a. Background
    b. Addressing Growth in OPPS Volume and Spending
    c. Packaging Approach
    (1) Guidance Services
    (2) Image Processing Services
    (3) Intraoperative Services
    (4) Imaging Supervision and Interpretation Services
    (5) Diagnostic Radiopharmaceuticals
    (6) Contrast Agents
    (7) Observation Services
    d. Development of Composite APCs
    (1) Background
    (2) Low Dose Rate (LDR) Prostate Brachytherapy Composite APC
    (a) Background
    (b) Payment for LDR Prostate Brachytherapy
    (3) Cardiac Electrophysiologic Evaluation and Ablation Composite 
APC
    (a) Background
    (b) Payment for Cardiac Electrophysiologic Evaluation and 
Ablation
    e. Service-Specific Packaging Issues
    B. Payment for Partial Hospitalization
    1. Background
    2. PHP APC Update
    3. Separate Threshold for Outlier Payments to CMHCs
    C. Conversion Factor Update
    D. Wage Index Changes
    E. Statewide Average Default CCRs
    F. OPPS Payments to Certain Rural Hospitals
    1. Hold Harmless Transitional Payment Changes Made by Pub. L. 
109-171 (DRA)
    2. Adjustment for Rural SCHs Implemented in CY 2006 Related to 
Pub. L. 108-173 (MMA)
    G. Hospital Outpatient Outlier Payments
    H. Calculation of an Adjusted Medicare Payment from the National 
Unadjusted Medicare Payment
    I. Beneficiary Copayments
    1. Background
    2. Copayment
    3. Calculation of an Adjusted Copayment Amount for an APC Group
III. OPPS Ambulatory Payment Classification (APC) Group Policies
    A. Treatment of New HCPCS and CPT Codes
    1. Treatment of New HCPCS Codes Included in the April and July 
Quarterly OPPS Updates for CY 2007
    a. Background
    b. Implantation of Interstitial Devices (APC 0156)
    c. Other New HCPCS Codes Implemented in April or July 2007
    2. Treatment of New Category I and III CPT Codes and Level II 
HCPCS Codes
    a. Establishment and Assignment of New Codes
    b. Electronic Brachytherapy (New Technology APC 1519)
    c. Other Mid-Year CPT Codes
    B. Variations within APCs
    1. Background
    2. Application of the 2 Times Rule
    3. Exceptions to the 2 Times Rule
    C. New Technology APCs
    1. Introduction
    2. Movement of Procedures from New Technology APCs to Clinical 
APCs
    a. Positron Emission Tomography (PET)/Computed Tomography (CT) 
Scans (APC 0308)
    b. IVIG Preadministration-Related Services (APC 0430)
    c. Other Services in New Technology APCs
    (1) Breast Brachytherapy Catheter Implantation (APC 0648)
    (2) Preoperative Services for Lung Volume Reduction Surgery 
(LVRS) (APCs 0209 and 0213)
    D. APC Specific Policies
    1. Cardiac Procedures

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    a. Cardiac Computed Tomography and Computed Tomographic 
Angiography (APCs 0282 and 0383)
    b. Coronary and Non-Coronary Angioplasty (PTCA/PTA)(APCs 0082, 
0083, and 0103)
    c. Implantation of Cardioverter-Defibrillators (APCs 0107 and 
0108)
    d. Removal of Patient-Activated Cardiac Event Recorder (APC 
0109)
    e. Stress Echocardiography (APC 0697)
    2. Gastrointestinal Procedures
    a. Computed Tomographic Colonography (APC 0332)
    b. Laparoscopic Neurostimulator Electrode Implantation (APC 
0130)
    c. Screening Colonoscopies and Screening Flexible 
Sigmoidoscopies (APCs 0158 and 0159)
    3. Genitourinary Procedures
    a. Cystoscopy with Stent (APC 0163)
    b. Percutaneous Renal Cryoablation (APC 0423)
    c. Prostatic Thermotherapy (APC 0163)
    d. Radiofrequency Ablation of Prostate (APC 0163)
    e. Ultrasound Ablation of Uterine Fibroids with Magnetic 
Resonance Guidance (MRgFUS) (APC 0067)
    f. Uterine Fibroid Embolization (APC 0202)
    4. Nervous System Procedures
    a. Chemodenervation (APC 0206)
    b. Implantation of Intrathecal or Epidural Catheter (APC 0224)
    c. Implantation of Spinal Neurostimulators (APC 0222)
    5. Nuclear Medicine and Radiation Oncology Procedures
    a. Adrenal Imaging (APC 0391)
    b. Injection for Sentinel Node Identification (APC 0389)
    c. Myocardial Positron Emission Tomography (PET) Scans (APC 
0307)
    d. Nonmyocardial Positron Emission Tomography (PET) Scans (APC 
0308)
    e. Proton Beam Therapy (APCs 0664 and 0667)
    6. Ocular and Ear, Nose and Throat Procedures
    a. Amniotic Membrane for Ocular Surface Reconstruction (APC 
0244)
    b. Keratoprosthesis (APC 0293)
    c. Palatal Implant (New Technology APC 1510)
    7. Orthopedic Procedures
    a. Arthroscopic Procedures (APCs 0041 and 0042)
    b. Closed Fracture Treatment (APC 0043)
    c. Insertion of Posterior Spinous Process Distraction Device 
(APC 0050)
    d. Intradiscal Annuloplasty (APC 0050)
    e. Kyphoplasty Procedures (APC 0052)
    8. Vascular Procedures
    a. Blood Transfusion (APC 0110)
    b. Endovenous Ablation (APC 0092)
    c. Insertion of Central Venous Access Device (APC 0625)
    d. Noninvasive Vascular Studies (APC 0267)
    9. Other Procedures
    a. Hyperbaric Oxygen Therapy (APC 0659)
    b. Skin Repair Procedures (APCs 0133, 0134, 0135, 0136, and 
0137)
    c. Stereotactic Radiosurgery (SRS) Treatment Delivery Services 
(APCs 0065, 0066, and 0067)
    10. Medical Services
    a. Single Allergy Tests (APC 0381)
    b. Continuous Glucose Monitoring (APC 0097)
    c. Home International Normalized Ratio (INR) Monitoring (APC 
0097)
    d. Mental Health Services (APC 0322, 0323, 0324, 0325)
IV. OPPS Payment for Devices
    A. Treatment of Device Dependent APCs
    1. Background
    2. Payment under the OPPS
    3. Payment When Devices Are Replaced with Partial Credit to the 
Hospital
    B. Pass-Through Payments for Devices
    1. Expiration of Transitional Pass Through Payments for Certain 
Devices
    a. Background
    b. Final Policy
    2. Provisions for Reducing Transitional Pass Through Payments to 
Offset Costs Packaged into APC Groups
    a. Background
    b. Final Policy
V. OPPS Payment Changes for Drugs, Biologicals, and 
Radiopharmaceuticals
    A. Transitional Pass-Through Payment for Additional Costs of 
Drugs and Biologicals
    1. Background
    2. Drugs and Biologicals with Expiring Pass-Through Status in CY 
2007
    3. Drugs and Biologicals with Pass-Through Status in CY 2008
    B. Payment for Drugs, Biologicals, and Radiopharmaceuticals 
without Pass Through Status
    1. Background
    2. Criteria for Packaging Payment for Drugs and Biologicals
    3. Payment for Drugs and Biologicals without Pass Through Status 
That Are Not Packaged
    a. Payment for Specified Covered Outpatient Drugs
    (1) Background
    (2) Payment Policy
    (3) Payment for Blood Clotting Factors
    (a) Background
    (b) Payment for Diagnostic Radiopharmaceuticals
    (c) Payment for Therapeutic Radiopharmaceuticals
    b. Payment for Nonpass-Through Drugs, Biologicals, and 
Radiopharmaceuticals with HCPCS Codes, But without OPPS Hospital 
Claims Data
VI. Estimate of OPPS Transitional Pass Through Spending for Drugs, 
Biologicals, Radiopharmaceuticals, and Devices
    A. Total Allowed Pass Through Spending
    B. Estimate of Pass Through Spending
VII. OPPS Payment for Brachytherapy Sources
    A. Background
    B. Payment for Brachytherapy Sources
VIII. OPPS Drug Administration Coding and Payment
    A. Background
    B. Coding and Payment for Drug Administration Services
IX. Hospital Coding and Payments for Visits
    A. Background
    B. Policies for Hospital Outpatient Visits
    1. Clinic Visits: New and Established Patient Visits and 
Consultations
    2. Emergency Department Visits
    C. Visit Reporting Guidelines
    1. Background
    2. CY 2007 Work on Visit Guidelines
    3. Visit Guidelines
X. OPPS Payment for Blood and Blood Products
    A. Background
    B. Payment for Blood and Blood Products
XI. OPPS Payment for Observation Services
    A. Observation Services (HCPCS Code G0378)
    B. Direct Admission to Observation (HCPCS Code G0379)
XII. Procedures That Will Be Paid Only as Inpatient Procedures
    A. Background
    B. Changes to the Inpatient List
XIII. Nonrecurring Technical and Policy Changes
    A. Outpatient Hospital Services and Supplies Incident to a 
Physician Service
    B. Interrupted Procedures
    C. Transitional Adjustments--Hold Harmless Provisions
    D. Reporting of Wound Care Services
    E. Reporting of Cardiac Rehabilitation Services
    F. Reporting of Bone Marrow and Stem Cell Processing Services
    G. Reporting of Alcohol and/or Substance Abuse Assessment and 
Intervention Services
XIV. OPPS Payment Status and Comment Indicators
    A. Payment Status Indicator Definitions
    1. Payment Status Indicators to Designate Services That Are Paid 
under the OPPS
    2. Payment Status Indicators to Designate Services That Are Paid 
under a Payment System Other Than the OPPS
    3. Payment Status Indicators to Designate Services That Are Not 
Recognized under the OPPS But That May Be Recognized by Other 
Institutional Providers
    4. Payment Status Indicators to Designate Services That Are Not 
Payable by Medicare
    B. Comment Indicator Definitions
XV. OPPS Policy and Payment Recommendations
    A. MedPAC Recommendations
    B. APC Panel Recommendations
XVI. Update of the Revised Ambulatory Surgical Center Payment System
    A. Legislative and Regulatory Authority for the ASC Payment 
System
    B. Rulemaking for the Revised ASC Payment System
    C. Revisions to the ASC Payment System Effective January 1, 2008
    1. Covered Surgical Procedures under the Revised ASC Payment 
System
    a. Definition of Surgical Procedure
    b. Identification of Surgical Procedures Eligible for Payment 
under the Revised ASC Payment System
    c. Payment for Covered Surgical Procedures under the Revised ASC 
Payment System
    (1) General Policies
    (2) Office-Based Procedures
    (3) Device-Intensive Procedures
    (4) Multiple and Interrupted Procedure Discounting
    (5) Transition to Revised ASC Payment Rates

[[Page 66584]]

    2. Covered Ancillary Services under the Revised ASC Payment 
System
    a. General Policies
    b. Payment Policies for Specific Items and Services
    (1) Radiology Services
    (2) Brachytherapy Sources
    3. General Payment Policies
    a. Adjustment for Geographic Wage Differences
    b. Beneficiary Coinsurance
    D. Treatment of New HCPCS Codes
    1. Treatment of New CY 2008 Category I and III CPT Codes and 
Level II HCPCS Codes
    2. Treatment of New Mid-Year Category III CPT Codes
    3. Treatment of Level II HCPCS Codes Released on a Quarterly 
Basis
    E. Updates to Covered Surgical Procedures and Covered Ancillary 
Services
    1. Identification of Covered Surgical Procedures
    a. General Policies
    b. Changes in Designation of Covered Surgical Procedures as 
Office-Based
    c. Changes in Designation of Covered Surgical Procedures as 
Device Intensive
    2. Changes in Identification of Covered Ancillary Services
    F. Payment for Covered Surgical Procedures and Covered Ancillary 
Services
    1. Payment for Covered Surgical Procedures
    a. Update to Payment Rates
    b. Payment Policies When Devices Are Replaced at No Cost or with 
Credit
    (1) Policy When Devices Are Replaced at No Cost or with Full 
Credit
    (2) Policy When Implantable Devices Are Replaced with Partial 
Credit
    2. Payment for Covered Ancillary Services
    G. Physician Payment for Procedures and Services Provided in ASC
    H. Changes to Definitions of ``Radiology and Certain Other 
Imaging Services'' and ``Outpatient Prescription Drugs''
    I. New Technology Intraocular Lenses (NTIOLs)
    1. Background
    2. Changes to the NTIOL Determination Process Finalized for CY 
2008
    3. NTIOL Application Process for CY 2008 Payment Adjustment
    4. Classes of NTIOLS Approved for Payment Adjustment
    5. Payment Adjustment
    6. CY 2008 ASC Payment for Insertion of IOLs
    J. ASC Payment and Comment Indicators
    K. ASC Policy and Payment Recommendations
    L. Calculation of the ASC Conversion Factor and ASC Payment 
Rates
XVII. Reporting Quality Data for Annual Payment Rate Updates
    A. Background
    1. Reporting Hospital Outpatient Quality Data for Annual Payment 
Update
    2. Reporting ASC Quality Data for Annual Payment Increase
    3. Reporting Hospital Inpatient Quality Data for Annual Payment 
Update
    B. Hospital Outpatient Measures
    C. Other Hospital Outpatient Measures
    D. Implementation of the HOP QDRP and Request for Additional 
Suggested Measures
    E. Requirements for HOP Quality Data Reporting for CY 2009 and 
Subsequent Calendar Years
    1. Administrative Requirements
    2. Data Collection and Submission Requirements
    3. HOP QDRP Validation Requirements
    F. Publication of HOP QDRP Data Collected
    G. Attestation Requirement for Future Payment Years
    H. HOP QDRP Reconsiderations
    I. Reporting of ASC Quality Data
    J. FY 2009 IPPS Quality Measures under the RHQDAPU Program
XVIII. Changes Affecting Critical Access Hospitals (CAHs) and 
Hospital Conditions of Participation (CoPs)
    A. Changes Affecting CAHs
    1. Background
    2. Co-Location of Necessary Provider CAHs
    3. Provider-Based Facilities of CAHs
    4. Termination of Provider Agreement
    5. Regulation Changes
    B. Revisions to Hospital CoPs
    1. Background
    2. Provisions of the Final Regulation
    a. Timeframes for Completion of the Medical History and Physical 
Examination
    b. Requirements for Preanesthesia and Postanesthesia Evaluations
    c. Technical Amendment to Nursing Services CoP
XIX. Changes to the FY 2008 Hospital Inpatient Prospective Payment 
System (IPPS) Payment Rates
    A. Background
    B. Revised IPPS Payment Rates
    1. MS-DRG Documentation and Coding Adjustment
    2. Application of the Documentation and Coding Adjustment to the 
Hospital Specific Rates
XX. Medicare Graduate Medical Education Affiliation Provisions for 
Teaching Hospitals in Certain Emergency Situations
    A. Background
    1. Legislative Authority
    2. Existing Medicare Direct GME and Indirect GME Policies
    3. Regulatory Changes Issued in 2006 to Address Certain 
Emergency Situations
    B. Additional Changes in This Interim Final Rule with Comment 
Period
    1. Summary of Regulatory Changes
    2. Discussion of Training in Nonhospital Settings
    C. Responses to Comments on the April 12, 2006 Interim Final 
Rule with Comment Period and This Interim Final Rule with Comment 
Period
XXI. Files Available to the Public Via the Internet
    A. Information in Addenda Related to the Revised CY 2008 
Hospital OPPS
    B. Information in Addenda Related to the Revised CY 2008 ASC 
Payment System
XXII. Collection of Information Requirements
XXIII. Response to Comments
XXIV. Regulatory Impact Analysis
    A. Overall Impact of Changes to the OPPS and ASC Payment Systems
    1. Executive Order 12866
    2. Regulatory Flexibility Act (RFA)
    3. Small Rural Hospitals
    4. Unfunded Mandates
    5. Federalism
    B. Effects of OPPS Changes in This Final Rule with Comment 
Period
    1. Alternatives Considered
    2. Limitation of Our Analysis
    3. Estimated Impact of This Final Rule with Comment Period on 
Hospitals and CMHCs
    4. Estimated Effect of This Final Rule with Comment Period on 
Beneficiaries
    5. Conclusion
    6. Accounting Statement
    C. Effects of ASC Payment System Changes in This Final Rule with 
Comment Period
    1. Alternatives Considered
    2. Limitations on Our Analysis
    3. Estimated Effects of This Final Rule with Comment Period on 
ASCs
    4. Estimated Effects of This Final Rule with Comment Period on 
Beneficiaries
    5. Conclusion
    6. Accounting Statement
    D. Effects of the Requirements for Reporting of Quality Data for 
Hospital Outpatient Settings
    E. Effects of the Policy on CAH Off-Campus and Co-Location 
Requirements
    F. Effects of the Policy Revisions to the Hospital CoPs
    G. Effects of the Changes to the Hospital Inpatient Prospective 
Payment System (IPPS) Payment Rates
    1. Overall Impact
    2. Objectives
    3. Limitations of Our Analysis
    4. Quantitative Effects of the IPPS Policy Changes on Operating 
Costs
    5. Analysis of Table I
    a. Effects of All Changes with CMI Adjustment Prior to Estimated 
Growth (Columns 2a and 2b)
    b. Effects of All Changes with CMI Adjustment and Estimated 
Growth (Column 3)
    6. Overall Conclusion
    7. Accounting Statement
    8. Executive order 12866
    H. Impact of the Policy Revisions to the Emergency Medicare GME 
Affiliated Groups for Hospitals in Certain Declared Emergency Areas
    1. Overall Impact
    2. RFA
    3. Small Rural Hospitals
    4. Unfunded Mandates
    5. Federalism
    6. Anticipated Effects
    7. Alternatives Considered
    8. Conclusion
    9. Executive Order 12866
XXV. Waiver of Proposed Rulemaking, Waiver of Delay in Effective 
Date, and Retroactive Effective Date
    A. Requirements for Waivers and Retroactive Rulemaking
    B. IPPS Payment Rate Policies
    C. Medicare GME Affiliation Agreement Provisions

Regulation Text

Addenda

Addendum A-OPPS APCs for CY 2008

[[Page 66585]]

Addendum AA-ASC Covered Surgical Procedures for CY 2008 (Including 
Surgical Procedures for Which Payment is Packaged)
Addendum B-OPPS Payment By HCPCS Code for CY 2008
Addendum BB-ASC Covered Ancillary Services Integral to Covered 
Surgical Procedures for CY 2008 (Including Ancillary Services for 
Which Payment Is Packaged)
Addendum D1-OPPS Payment Status Indicators
Addendum DD1-ASC Payment Indicators
Addendum D2-OPPS Comment Indicators
Addendum DD2-ASC Comment Indicators
Addendum E-HCPCS Codes That Would Be Paid Only as Inpatient 
Procedures for CY 2008
Addendum L-Out-Migration Adjustment
Addendum M-HCPCS Codes for Assignment to Composite APCs for CY 2008

I. Background for the OPPS

A. Legislative and Regulatory Authority for the Hospital Outpatient 
Prospective Payment System

    When the Medicare statute was originally enacted, Medicare payment 
for hospital outpatient services was based on hospital-specific costs. 
In an effort to ensure that Medicare and its beneficiaries pay 
appropriately for services and to encourage more efficient delivery of 
care, the Congress mandated replacement of the reasonable cost-based 
payment methodology with a prospective payment system (PPS). The 
Balanced Budget Act (BBA) of 1997 (Pub. L. 105-33) added section 
1833(t) to the Social Security Act (the Act) authorizing implementation 
of a PPS for hospital outpatient services.
    The Medicare, Medicaid, and SCHIP Balanced Budget Refinement Act 
(BBRA) of 1999 (Pub. L. 106-113) made major changes in the hospital 
outpatient prospective payment system (OPPS). The Medicare, Medicaid, 
and SCHIP Benefits Improvement and Protection Act (BIPA) of 2000 (Pub. 
L. 106-554) made further changes in the OPPS. Section 1833(t) of the 
Act was also amended by the Medicare Prescription Drug, Improvement, 
and Modernization Act (MMA) of 2003 (Pub. L. 108 173). The Deficit 
Reduction Act (DRA) of 2005 (Pub. L. 109-171), enacted on February 8, 
2006, also made additional changes in the OPPS. In addition, the 
Medicare Improvements and Extension Act under Division B of Title I of 
the Tax Relief and Health Care Act (MIEA-TRHCA) of 2006 (Pub. L. 109-
432), enacted on December 20, 2006, made further changes in the OPPS. A 
discussion of these changes is included in sections I.E., VII., and 
XVII. of this final rule with comment period.
    The OPPS was first implemented for services furnished on or after 
August 1, 2000. Implementing regulations for the OPPS are located at 42 
CFR part 419.
    Under the OPPS, we pay for hospital outpatient services on a rate-
per-service basis that varies according to the ambulatory payment 
classification (APC) group to which the service is assigned. We use the 
Healthcare Common Procedure Coding System (HCPCS) codes (which include 
certain Current Procedural Terminology (CPT) codes) and descriptors to 
identify and group the services within each APC group. The OPPS 
includes payment for most hospital outpatient services, except those 
identified in section I.B. of this final rule with comment period. 
Section 1833(t)(1)(B)(ii) of the Act provides for Medicare payment 
under the OPPS for hospital outpatient services designated by the 
Secretary (which includes partial hospitalization services furnished by 
community mental health centers (CMHCs)) and hospital outpatient 
services that are furnished to inpatients who have exhausted their Part 
A benefits, or who are otherwise not in a covered Part A stay. Section 
611 of Pub. L. 108-173 added provisions for Medicare coverage of an 
initial preventive physical examination, subject to the applicable 
deductible and coinsurance, as an outpatient department service, 
payable under the OPPS.
    The OPPS rate is an unadjusted national payment amount that 
includes the Medicare payment and the beneficiary copayment. This rate 
is divided into a labor-related amount and a nonlabor-related amount. 
The labor-related amount is adjusted for area wage differences using 
the hospital inpatient wage index value for the locality in which the 
hospital or CMHC is located.
    All services and items within an APC group are comparable 
clinically and with respect to resource use (section 1833(t)(2)(B) of 
the Act). In accordance with section 1833(t)(2) of the Act, subject to 
certain exceptions, services and items within an APC group cannot be 
considered comparable with respect to the use of resources if the 
highest median (or mean cost, if elected by the Secretary) for an item 
or service in the APC group is more than 2 times greater than the 
lowest median cost for an item or service within the same APC group 
(referred to as the ``2 times rule''). In implementing this provision, 
we generally use the median cost of the item or service assigned to an 
APC group.
    For new technology items and services, special payments under the 
OPPS may be made in one of two ways. Section 1833(t)(6) of the Act 
provides for temporary additional payments, which we refer to as 
``transitional pass through payments,'' for at least 2 but not more 
than 3 years for certain drugs, biological agents, brachytherapy 
devices used for the treatment of cancer, and categories of other 
medical devices. For new technology services that are not eligible for 
transitional pass through payments, and for which we lack sufficient 
data to appropriately assign them to a clinical APC group, we have 
established special APC groups based on costs, which we refer to as New 
Technology APCs. These New Technology APCs are designated by cost bands 
which allow us to provide appropriate and consistent payment for 
designated new procedures that are not yet reflected in our claims 
data. Similar to pass through payments, an assignment to a New 
Technology APC is temporary; that is, we retain a service within a New 
Technology APC until we acquire sufficient data to assign it to a 
clinically appropriate APC group.

B. Excluded OPPS Services and Hospitals

    Section 1833(t)(1)(B)(i) of the Act authorizes the Secretary to 
designate the hospital outpatient services that are paid under the 
OPPS. While most hospital outpatient services are payable under the 
OPPS, section 1833(t)(1)(B)(iv) of the Act excludes payment for 
ambulance, physical and occupational therapy, and speech-language 
pathology services, for which payment is made under a fee schedule. 
Section 614 of Pub. L. 108-173 amended section 1833(t)(1)(B)(iv) of the 
Act to exclude payment for screening and diagnostic mammography 
services from the OPPS. The Secretary exercised the authority granted 
under the statute to also exclude from the OPPS those services that are 
paid under fee schedules or other payment systems. Such excluded 
services include, for example, the professional services of physicians 
and nonphysician practitioners paid under the Medicare Physician Fee 
Schedule (MPFS); laboratory services paid under the clinical diagnostic 
laboratory fee schedule (CLFS); services for beneficiaries with end 
stage renal disease (ESRD) that are paid under the ESRD composite rate; 
and services and procedures that require an inpatient stay that are 
paid under the hospital inpatient prospective payment system (IPPS). We 
set forth the services that are excluded from payment under the OPPS in 
Sec.  419.22 of the regulations.
    Under Sec.  419.20(b) of the regulations, we specify the types of 
hospitals and entities that are excluded from payment under the OPPS. 
These excluded

[[Page 66586]]

entities include Maryland hospitals, but only for services that are 
paid under a cost containment waiver in accordance with section 
1814(b)(3) of the Act; critical access hospitals (CAHs); hospitals 
located outside of the 50 States, the District of Columbia, and Puerto 
Rico; and Indian Health Service hospitals.

C. Prior Rulemaking

    On April 7, 2000, we published in the Federal Register a final rule 
with comment period (65 FR 18434) to implement a prospective payment 
system for hospital outpatient services. The hospital OPPS was first 
implemented for services furnished on or after August 1, 2000. Section 
1833(t)(9) of the Act requires the Secretary to review certain 
components of the OPPS, not less often than annually, and to revise the 
groups, relative payment weights, and other adjustments that take into 
account changes in medical practices, changes in technologies, and the 
addition of new services, new cost data, and other relevant information 
and factors.
    Since initially implementing the OPPS, we have published final 
rules in the Federal Register annually to implement statutory 
requirements and changes arising from our continuing experience with 
this system. We published in the Federal Register on November 24, 2006 
the CY 2007 OPPS/ASC final rule with comment period (71 FR 67960). In 
that final rule with comment period, we revised the OPPS to update the 
payment weights and conversion factor for services payable under the CY 
2007 OPPS on the basis of claims data from January 1, 2005, through 
December 31, 2005, and to implement certain provisions of Pub. L. 108-
173 and Pub. L. 109-171. In addition, we responded to public comments 
received on the provisions of the November 10, 2005 final rule with 
comment period (70 FR 86516) pertaining to the APC assignment of HCPCS 
codes identified in Addendum B of that rule with the new interim (NI) 
comment indicator; and public comments received on the August 23, 2006 
OPPS/ASC proposed rule for CY 2007 (71 FR 49506).
    On August 2, 2007, we issued in the Federal Register (72 FR 42628) 
a proposed rule for the CY 2008 OPPS/ASC to implement statutory 
requirements and changes arising from our continuing experience with 
both systems. We received approximately 2,180 pieces of timely 
correspondence in response to the proposed rule. A summary of the 
public comments we received and our responses to those comments are 
included in the specific sections of this final rule with comment 
period.

D. APC Advisory Panel

1. Authority of the APC Panel
    Section 1833(t)(9)(A) of the Act, as amended by section 201(h) of 
the BBRA, and redesignated by section 202(a)(2) of the BBRA, requires 
that we consult with an outside panel of experts to review the clinical 
integrity of the payment groups and their weights under the OPPS. The 
Act further specifies that the panel will act in an advisory capacity.
    The Advisory Panel on Ambulatory Payment Classification (APC) 
Groups (the APC Panel), discussed under section I.D.2. of this final 
rule with comment period, fulfills these requirements. The APC Panel is 
not restricted to using data compiled by CMS, and may use data 
collected or developed by organizations outside the Department in 
conducting its review.
2. Establishment of the APC Panel
    On November 21, 2000, the Secretary signed the initial charter 
establishing the APC Panel. This expert panel, which may be composed of 
up to 15 representatives of providers subject to the OPPS (currently 
employed full-time, not as consultants, in their respective areas of 
expertise), reviews clinical data and advises CMS about the clinical 
integrity of the APC groups and their payment weights. For purposes of 
this Panel, consultants or independent contractors are not considered 
to be full-time employees. The APC Panel is technical in nature, and is 
governed by the provisions of the Federal Advisory Committee Act 
(FACA). Since its initial chartering, the Secretary has renewed the APC 
Panel's charter three times: On November 1, 2002; on November 1, 2004; 
and effective November 21, 2006. The current charter specifies, among 
other requirements, that the APC Panel continue to be technical in 
nature; be governed by the provisions of the FACA; may convene up to 
three meetings per year; has a Designated Federal Officer (DFO); and is 
chaired by a Federal official designated by the Secretary.
    The current APC Panel membership and other information pertaining 
to the APC Panel, including its charter, Federal Register notices, 
membership, meeting dates, agenda topics, and meeting reports can be 
viewed on the CMS Web site at: http://www.cms.hhs.gov/FACA/05--
AdvisoryPanelonAmbulatoryPaymentClassificationGroups.asp#TopOfPage.
3. APC Panel Meetings and Organizational Structure
    The APC Panel first met on February 27, February 28, and March 1, 
2001. Since the initial meeting, the APC Panel has held 12 subsequent 
meetings, with the last meeting taking place on September 5 and 6, 
2007. Prior to each meeting, we publish a notice in the Federal 
Register to announce the meeting, and when necessary, to solicit 
nominations for APC Panel membership, and to announce new members.
    The APC Panel has established an operational structure that, in 
part, includes the use of three subcommittees to facilitate its 
required APC review process. The three current subcommittees are the 
Data Subcommittee, the Observation and Visit Subcommittee, and the 
Packaging Subcommittee. The Data Subcommittee is responsible for 
studying the data issues confronting the APC Panel, and for 
recommending options for resolving them. The Observation and Visit 
Subcommittee reviews and makes recommendations to the APC Panel on all 
technical issues pertaining to observation services and hospital 
outpatient visits paid under the OPPS (for example, APC configurations 
and APC payment weights). The Packaging Subcommittee studies and makes 
recommendations on issues pertaining to services that are not 
separately payable under the OPPS, but whose payments are bundled or 
packaged into APC payments. Each of these subcommittees was established 
by a majority vote from the full APC Panel during a scheduled APC Panel 
meeting, and their continuation as subcommittees was last approved at 
the September 2007 APC Panel meetings. All subcommittee recommendations 
are discussed and voted upon by the full APC Panel.
    Discussions of the recommendations resulting from the APC Panel's 
March 2007 and September 2007 meetings are included in the sections of 
this final rule with comment period that are specific to each 
recommendation. For discussions of earlier APC Panel meetings and 
recommendations, we refer readers to previously published hospital OPPS 
final rules or the Web site mentioned earlier in this section.

E. Provisions of the Medicare Improvements and Extension Act under 
Division B of Title I of the Tax Relief and Health Care Act of 2006

    The Medicare Improvements and Extension Act under Division B of 
Title I of the Tax Relief and Health Care Act

[[Page 66587]]

(MIEA-TRHCA) of 2006, Pub. L. 109-432, enacted on December 20, 2006, 
included the following provisions affecting the OPPS:
    1. Section 107(a) of the MIEA-TRHCA amended section 1833(t)(16)(C) 
of the Act to extend the period for payment of brachytherapy devices 
based on the hospital's charges adjusted to cost for 1 additional year, 
through December 31, 2007.
    2. Section 107(b)(1) of the MIEA-TRHCA amended section 
1833(t)(2)(H) of the Act by adding stranded and non stranded devices 
furnished on or after July 1, 2007, as additional classifications of 
brachytherapy devices for which separate payment groups must be 
established for payment under the OPPS. Section 107(b)(2) of the MIEA 
TRCHA provides that the Secretary may implement the section 107(b)(1) 
amendment to section 1833(t)(2)(H) of the Act ``by program instruction 
or otherwise.''
    3. Section 109(a) of the MIEA-TRHCA added new paragraph (17) to 
section 1833(t) of the Act which authorizes the Secretary, beginning in 
2009 and each subsequent year, to reduce the OPPS full annual update by 
2.0 percentage points if a hospital paid under the OPPS fails to submit 
data as required by the Secretary in the form and manner specified on 
selected measures of quality of care, including medication errors. In 
accordance with this provision, the selected measures are those that 
are appropriate for the measurement of quality of care furnished by 
hospitals in the outpatient setting, that reflect consensus among 
affected parties and, to the extent feasible and practicable, that 
include measures set forth by one or more of the national consensus 
entities, and that may be the same as those required for reporting by 
hospitals paid under the IPPS. This provision specifies that a 
reduction for 1 year cannot be taken into account when computing the 
OPPS update for a subsequent year. In addition, this provision requires 
the Secretary to establish a process for making the submitted data 
available for public review.

F. Summary of the Major Contents of the CY 2008 OPPS/ASC Proposed Rule

    On August 2, 2007, we published a proposed rule in the Federal 
Register (72 FR 42628) that set forth proposed changes to the Medicare 
hospital OPPS for CY 2008 to implement statutory requirements and 
changes arising from our continuing experience with the system and to 
implement certain statutory provisions. In addition, we proposed 
changes to the revised Medicare ASC payment system for CY 2008 such as 
adding procedures to the list of covered surgical procedures and 
adjusting the ASC rates so that the revised ASC payment system is 
budget neutral. We also proposed to make changes to the policies 
relating to the necessary provider designations of CAHs that are being 
recertified when a CAH enters into a new co-location arrangement with 
another hospital or CAH or when the CAH creates or acquires an off-
campus location. Further, we proposed changes to several of the current 
conditions of participation that hospitals must meet to participate in 
the Medicare and Medicaid programs to require the completion and 
documentation in the medical record of medical histories and physical 
examinations of patients conducted after admission and prior to surgery 
or a procedure requiring anesthesia services and for postanesthesia 
evaluations of patients before discharge or transfer from the 
postanesthesia recovery area. Finally, we set forth proposed quality 
measures for a Hospital Outpatient Quality Data Reporting (HOP QDRP) 
program for reporting quality data for annual payment rate updates for 
CY 2009 and subsequent calendar years. We also briefly discussed the 
legislative provisions of the MIEA-TRHCA that give the Secretary 
authority to develop quality measures for reporting data by ASCs. The 
following is a summary of the major changes included in the CY 2008 
OPPS/ASC proposed rule:
1. Updates Affecting OPPS Payments
    In section II. of the proposed rule, we set forth--
     The methodology used to recalibrate the proposed APC 
relative payment weights.
     The proposed payment for partial hospitalization services, 
including the proposed separate threshold for outlier payments for 
CMHCs.
     The proposed update to the conversion factor used to 
determine payment rates under the OPPS.
     The proposed retention of our current policy to use the 
IPPS wage indices to adjust, for geographic wage differences, the 
portion of the OPPS payment rate and the copayment standardized amount 
attributable to labor related cost.
     The proposed update of statewide average default CCRs.
     The proposed application of hold harmless transitional 
outpatient payments (TOPs) for certain small rural hospitals.
     The proposed payment adjustment for rural SCHs.
     The proposed calculation of the hospital outpatient 
outlier payment.
     The calculation of the proposed national unadjusted 
Medicare OPPS payment.
     The proposed beneficiary copayments for OPPS services.
2. OPPS Ambulatory Payment Classification (APC) Group Policies
    In section III. of the proposed rule, we discussed the proposed 
additions of new procedure codes to the APCs; our proposal to establish 
a number of new APCs; and our analyses of Medicare claims data and 
certain recommendations of the APC Panel. We also discussed the 
application of the 2 times rule and proposed exceptions to it; proposed 
changes to specific APCs; and the proposed movement of procedures from 
New Technology APCs to clinical APCs.
3. OPPS Payment for Devices
    In section IV. of the proposed rule, we discussed proposed payment 
for device dependent APCs and pass-through payment for specific 
categories of devices.
4. OPPS Payment for Drugs, Biologicals, and Radiopharmaceuticals
    In section V. of the proposed rule, we discussed the proposed CY 
2008 OPPS payment for drugs, biologicals, and radiopharmaceuticals, 
including the proposed payment for drugs, biologicals, and 
radiopharmaceuticals with and without pass-through status.
5. Estimate of OPPS Transitional Pass-Through Spending for Drugs, 
Biologicals, and Devices
    In section VI. of the proposed rule, we discussed the estimate of 
CY 2008 OPPS transitional pass-through spending for drugs, biologicals, 
and devices.
6. OPPS Payment for Brachytherapy Sources
    In section VII. of the proposed rule, we discussed our proposal 
concerning coding and payment for brachytherapy sources.
7. OPPS Coding and Payment for Drug Administration Services
    In section VIII. of the proposed rule, we set forth our proposed 
policy concerning coding and payment for drug administration services.
8. OPPS Hospital Coding and Payments for Visits
    In section IX. of the proposed rule, we set forth our proposed 
policies for the coding and reporting of clinic and emergency 
department visits and

[[Page 66588]]

critical care services on claims paid under the OPPS.
9. OPPS Payment for Blood and Blood Products
    In section X. of the proposed rule, we discussed our proposed 
payment for blood and blood products.
10. Proposed OPPS Payment for Observation Services
    In section XI. of the proposed rule, we discussed the proposed 
payment policies for observation services furnished to patients on an 
outpatient basis.
11. Procedures That Will Be Paid Only as Inpatient Services
    In section XII. of the proposed rule, we discussed the procedures 
that we proposed to remove from the inpatient list and assign to APCs.
12. Nonrecurring Technical and Policy Changes
    In section XIII. of the proposed rule, we set forth our proposals 
for nonrecurring technical and policy changes and clarifications 
relating to outpatient services and supplies incident to physicians' 
services; payment for interrupted procedures prior to and after the 
administration of anesthesia; transitional adjustments to payments for 
covered outpatient services furnished by small rural hospitals and SCHs 
located in rural areas; and reporting requirements for wound care 
services, cardiac rehabilitation services, and bone marrow and stem 
cell processing services.
13. OPPS Payment Status and Comment Indicators
    In section XIV. of the proposed rule, we discussed proposed changes 
to the definitions of status indicators assigned to APCs and presented 
our proposed comment indicators for the OPPS/ASC final rule with 
comment period.
14. OPPS Policy and Payment Recommendations
    In section XV. of the proposed rule, we addressed recommendations 
made by the Medicare Payment Advisory Commission (MedPAC) in its March 
and June 2007 Reports to Congress and by the APC Panel regarding the 
OPPS for CY 2008.
15. Update of the Revised ASC Payment System
    In section XVI. of the proposed rule, we discussed the proposed 
update of the revised ASC payment system payment rates for CY 2008. We 
also discussed our proposed changes to our regulations at Sec. Sec.  
414.22(b)(5)(i)(A) and (B) regarding physician payment for performing 
excluded surgical procedures in ASCs. In addition, we set forth our 
proposal to revise the definitions of ``radiology and certain other 
imaging services'' and ``outpatient prescription drugs'' when provided 
integral to an ASC covered surgical procedure.
16. Reporting Quality Data for Annual Payment Rate Updates
    In section XVII. of the proposed rule, we discussed the proposed 
quality measures for reporting hospital outpatient quality data for CY 
2009 and subsequent years and set forth the requirements for data 
collection and submission for the annual payment update. We also 
briefly discussed the legislative provisions of the MIEA-TRHCA that 
give the Secretary authority to develop quality measures for reporting 
by ASCs. (We note that, as discussed in section XVII.J. of this final 
rule with comment period, we are also finalizing a proposal from the FY 
2008 IPPS proposed rule relating to the FY 2009 RHQDAPU quality 
measures. Specifically, we are finalizing the inclusion of SCIP 
Infection 4: Cardiac Surgery Patients with Controlled 6AM Postoperative 
Serum Glucose and SCIP Infection 6: Surgery Patients with Appropriate 
Hair Removal in the FY 2009 RHQDAPU measure set, bringing the total 
number of measures in that measure set to 30.)
17. Changes Affecting Necessary Provider Critical Access Hospitals 
(CAHs) and Hospital Conditions of Participation (CoPs)
    In section XVIII. of the proposed rule, we discussed our proposed 
changes affecting CAHs both when the CAH enters into a new co-location 
arrangement with another hospital or CAH and when the CAH creates or 
acquires a provider-based off campus location. We also discussed our 
proposed changes relating to several hospital CoPs to require the 
completion of physical examinations and medical histories and 
documentation in the medical records for patients after admission and 
prior to surgery or a procedure requiring anesthesia services, and for 
postanesthesia evaluations of patients after surgery or a procedure 
requiring anesthesia services but before discharge or transfer from the 
postanesthesia recovery area.
18. Regulatory Impact Analysis
    In section XXII. of the proposed rule, we set forth an analysis of 
the impact the proposed changes would have on affected entities and 
beneficiaries. (We note that this regulatory impact analysis section is 
redesignated as section XXIV. of this final rule with comment period.)

G. Public Comments Received in Response to the CY 2008 OPPS/ASC 
Proposed Rule

    We received approximately 2,180 timely pieces of correspondence 
containing multiple comments on the CY 2008 OPPS/ASC proposed rule. We 
note that we received some comments that were outside the scope of the 
CY 2008 OPS/ASC proposed rule. These comments are not addressed in this 
CY 2008 OPPS/ASC final rule with comment period. Summaries of the 
public comments that are within the scope of the proposals and our 
responses to those comments are set forth in the various sections of 
this final rule with comment period under the appropriate headings.

H. Public Comments Received on the November 24, 2006 OPPS/ASC Final 
Rule with Comment Period

    We received approximately 21 timely items of correspondence on the 
CY 2007 OPPS/ASC final rule with comment period, some of which 
contained multiple comments on the interim final APC assignments and/or 
status indicators of HCPCS codes identified with comment indicator 
``NI'' in Addendum B to that final rule with comment period. Summaries 
of those public comments and our responses to them are set forth in the 
various sections of this final rule with comment period under the 
appropriate headings.

II. Updates Affecting OPPS Payments

A. Recalibration of APC Relative Weights

1. Database Construction
a. Database Source and Methodology
    Section 1833(t)(9)(A) of the Act requires that the Secretary review 
and revise the relative payment weights for APCs at least annually. In 
the April 7, 2000 OPPS final rule with comment period (65 FR 18482), we 
explained in detail how we calculated the relative payment weights that 
were implemented on August 1, 2000 for each APC group. Except for some 
reweighting due to a small number of APC changes, these relative 
payment weights continued to be in effect for CY 2001. This policy is 
discussed in the November 13, 2000 interim final rule (65 FR 67824 
through 67827).
    In the CY 2008 OPPS/ASC proposed rule, we proposed to use the same 
basic methodology that we described in the

[[Page 66589]]

April 7, 2000 OPPS final rule with comment period to recalibrate the 
APC relative payment weights for services furnished on or after January 
1, 2008 and before January 1, 2009. That is, we proposed to recalibrate 
the relative payment weights for each APC based on claims and cost 
report data for outpatient services. We proposed to use the most recent 
available data to construct the database for calculating APC group 
weights. For the purpose of recalibrating the proposed APC relative 
payment weights for CY 2008, we used approximately 131 million final 
action claims for hospital outpatient department (HOPD) services 
furnished on or after January 1, 2006 and before January 1, 2007. (For 
exact counts of claims used, we refer readers to the claims accounting 
narrative under supporting documentation for the proposed rule on the 
CMS Web site at: http://www.cms.hhs.gov/HospitalOutpatientPPS/HORD/).
    Of the 141 million final action claims for services provided in 
hospital outpatient settings used to calculate the CY 2008 OPPS payment 
rates for this final rule with comment period, approximately 103 
million claims were of the type of bill potentially appropriate for use 
in setting rates for OPPS services (but did not necessarily contain 
services payable under the OPPS). Of the 103 million claims, 
approximately 45 million were not for services paid under the OPPS or 
were excluded as not appropriate for use (for example, erroneous cost-
to-charge ratios (CCRs) or no HCPCS codes reported on the claim). We 
were able to use approximately 54 million whole claims of the 
approximately 58 million claims that remained to set the OPPS APC 
relative weights for the CY 2008 OPPS. From the 54 million whole 
claims, we created approximately 97 million single records, of which 
approximately 65 million were ``pseudo'' single claims (created from 
multiple procedure claims using the process we discuss in this 
section). Approximately 926,000 claims trimmed out on cost or units in 
excess of +/-3 standard deviations from the geometric mean, yielding 
approximately 96 million single bills used for median setting. 
Ultimately, we were able to use for CY 2008 ratesetting some portion of 
93 ercent of the CY 2006 claims containing services payable under the 
OPPS. This is approximately the same percentage of CY 2005 claims where 
some portion could be used for CY 2007 ratesetting as described in the 
CY 2007 OPPS/ASC final rule with comment period (71 FR 67970).
    As proposed, the final APC relative weights and payments for CY 
2008 in Addenda A and B to this final rule with comment period were 
calculated using claims from this period that were processed before 
June 30, 2007, and continue to be based on the median hospital costs 
for services in the APC groups. We selected claims for services paid 
under the OPPS and matched these claims to the most recent cost report 
filed by the individual hospitals represented in our claims data. We 
continue to believe that it is appropriate to use the most current full 
calendar year claims data and the most recently submitted cost reports 
to calculate the median costs which we proposed to convert to relative 
payment weights for purposes of calculating the CY 2008 payment rates.
    We did not receive any comments on our proposal to base the CY 2008 
APC relative weights on the most currently available cost reports and 
on claims for services furnished in CY 2006. Therefore, we are 
finalizing our data source for the recalibration of the CY 2008 APC 
relative payment weights as proposed, without modification, as 
described in this section of this final rule with comment period.
b. Use of Single and Multiple Procedure Claims
    For CY 2008, in general, we proposed to continue to use single 
procedure claims to set the medians on which the APC relative payment 
weights would be based, with some exceptions as discussed below. We 
generally use single procedure claims to set the median costs for APCs 
because we believe that it is important that the OPPS relative weights 
on which payment rates are based be appropriate when one and only one 
procedure is furnished and because we are, so far, unable to ensure 
that packaged costs can be appropriately allocated across multiple 
procedures performed on the same date of service. We agree that, 
optimally, it is desirable to use the data from as many claims as 
possible to recalibrate the APC relative payment weights, including 
those claims for multiple procedures. We engaged in several efforts 
this year to improve our use of multiple procedure claims for 
ratesetting. As we have for several years, we continued to use date of 
service stratification and a list of codes to be bypassed to convert 
multiple procedure claims to ``pseudo'' single procedure claims. We 
also continued our internal efforts to better understand the patterns 
of services and costs from multiple bills toward the goal of using more 
multiple bill information by assessing the amount of packaging in the 
multiple bills and, specifically, by exploring the amount of packaging 
for drug administration services in the single and multiple bill 
claims. Moreover, in many cases, the packaging approach that we 
proposed for the CY 2008 OPPS also allows the use of more claims data 
by enabling us to treat claims with multiple procedure codes as single 
claims. We refer readers to section II.A.4. of the proposed rule for a 
full discussion of the packaging approach for CY 2008.
    We received several public comments on our proposed use of single 
bills to calculate the APC median costs for ratesetting under the CY 
2008 OPPS. A summary of the public comments and our responses follow.
    Comment: Some commenters supported the ``natural'' and ``pseudo'' 
single methodology but asked that CMS continue to refine the approach 
in order to improve the accuracy of the estimates because the medians 
are used to develop payment rates for services on both single and 
multiple procedure claims. Other commenters asserted that continued 
reliance on single procedure bills to establish the medians from which 
the rates were calculated failed to produce a statistically valid 
sample of services for ratesetting, in particular for brachytherapy 
services that are often provided in combination with one another in a 
single encounter. Other commenters requested that CMS explore 
additional revisions to the current methodology to ensure that OPPS 
payment would be based on a substantial number of accurate hospital 
claims.
    Response: We generally base median costs for services on single 
procedure claims to ensure that the median cost captures the full cost 
of a service when it is the only service furnished. We recognize that 
this approach has limitations and, in some cases, prevents us from 
using many of the claims for services that are most commonly furnished 
at the same time as other services. For this reason, we have developed 
a number of different strategies, such as date of service 
stratification and the use of the bypass list, that enable us to break 
multiple procedure claims into ``pseudo'' single procedure claims where 
we have confidence that the ``pseudo'' single claim contains the full 
cost of the service, including related packaged costs. In recent years, 
however, we have increasingly used multiple procedure claims to develop 
median costs for individual services or groups of services. We have 
developed these methodologies so that we can use more naturally 
occurring claims data in cases in which care is most commonly reported 
with multiple major procedure

[[Page 66590]]

codes on the same date, such as observation services, hyperbaric oxygen 
therapy (HBOT), and single allergy tests.
    Similarly, for CY 2008, we developed and proposed composite APCs 
for low dose rate prostate brachytherapy (APC 8001 (LDR Prostate 
Brachytherapy Composite)) and cardiac electrophysiology services (APC 
8000 (Cardiac Electrophysiologic Evaluation and Ablation Composite)). 
These APCs are designed to use multiple procedure claims to establish a 
median cost and APC payment for multiple major procedures when they are 
furnished together. As we discuss in section II.A.4.d. of this final 
rule with comment period, we intend to explore the creation of 
additional composite APCs for services that frequently are provided in 
the same HOPD encounter. We also plan to continue to develop and refine 
methods to increase the amount of claims data that we can use for 
setting OPPS payment rates in a manner that gives us the most 
confidence that the costs derived from these approaches are valid 
reflections of the costs of the services described by HCPCS codes or, 
in the case of composite APCs, described by the APCs. We anticipate 
that the Data Subcommittee of the APC Panel will continue to provide us 
with valuable advice regarding possible methodologies for increasing 
the OPPS use of multiple procedure claims for ratesetting.
    After consideration of the public comments received, we are 
finalizing our proposal, without modification, to calculate median 
costs for APCs using single and ``pseudo'' single procedure claims, 
except where otherwise specified.
(1) Use of Date of Service Stratification and a Bypass List To Increase 
the Amount of Data Used To Determine Medians
    Through bypassing specified codes that we believe do not have 
significant packaged costs, we are able to use more data from multiple 
procedure claims. In many cases, this enables us to create multiple 
``pseudo'' single claims from claims that, as submitted, contained 
numerous separately paid procedures reported on the same date on one 
claim. We refer to these newly created single procedure claims as 
``pseudo'' single claims because they were submitted by providers as 
multiple procedure claims. The history of our use of a bypass list to 
generate ``pseudo'' single claims is well documented, most recently in 
the CY 2007 OPPS/ASC final rule with comment period (71 FR 67969 
through 67970).
    The date of service stratification (sorting the lines by date of 
service and treating all lines with the same date of service as a 
separate claim) and bypass list process we used for the CY 2007 OPPS 
(combined with the packaging changes we proposed in section II.A.4. of 
the proposed rule) resulted in our being able to use some part of 
approximately 92 percent of the total claims that were eligible for use 
in the OPPS ratesetting and modeling for the proposed rule. This 
process enabled us to create, for the CY 2008 proposed rule, 
approximately 58 million ``pseudo'' singles and approximately 30 
million ``natural'' single bills. For the proposed rule, ``pseudo'' 
single procedure bills represented 66 percent of all single bills used 
to calculate median costs. This compared favorably to the CY 2007 OPPS 
final rule data in which ``pseudo'' single bills represented 68 percent 
of all single bills used to calculate the median costs on which the CY 
2007 OPPS payment rates were based. We believed that the reduction in 
the percent of ``pseudo'' single bills and the corresponding increase 
in the proportion of ``natural'' single bills observed for the CY 2008 
proposed rule occurred largely because of our proposal to increase 
packaging as discussed in section II.A.4. of the proposed rule. In many 
cases, the packaging proposal for CY 2008 enabled us to use claims that 
would otherwise have been considered to be multiple procedure claims 
and, absent the proposal for additional packaging, could have been used 
for ratesetting only if we had been able to create ``pseudo'' single 
claims from them.
    For CY 2008, we proposed to bypass 425 HCPCS codes that are 
identified in Table 1 of the proposed rule. We proposed to continue the 
use of the codes on the CY 2007 OPPS bypass list but to remove codes we 
proposed to package for CY 2008. We also proposed to remove codes that 
were on the CY 2007 bypass list that ceased to meet the empirical 
criteria under the proposed packaging changes when clinical review 
confirmed that their removal would be appropriate in the context of the 
full proposal for the CY 2008 OPPS. Since the inception of the bypass 
list, we have calculated the percent of ``natural'' single bills that 
contained packaging for each code and the amount of packaging in each 
``natural'' single bill for each code. We retained the codes on the 
previous year's bypass list and used the update year's data to 
determine whether it would be appropriate to add additional codes to 
the previous year's bypass list. The entire list (including the codes 
that remained on the bypass list from prior years) was open to public 
comment. For the CY 2008 proposed rule, we explicitly reviewed all 
``natural'' single bills against the empirical criteria for all codes 
on the CY 2007 bypass list because of the proposal for greater 
packaging discussed in section II.A.4. of the proposed rule, as this 
effort increased the packaging associated with some codes. We removed 
106 HCPCS codes from the CY 2007 bypass list for the CY 2008 proposal. 
In addition, we note that many of the codes we proposed to newly 
package for CY 2008 were on the bypass list used for setting the OPPS 
payment rates for CY 2007 and were not proposed for bypass because we 
also proposed to package them. We proposed to add to the bypass list 
HCPCS codes that, using the proposed rule data, met the same previously 
established empirical criteria for the bypass list that are reviewed 
below or which our clinicians believed would have little associated 
packaging if the services were coded correctly.
    The CY 2008 packaging proposal minimally reduced the percentage of 
total claims that we were able to use, in whole or in part, from 93 
percent for CY 2007 to 92 percent for the proposed rule. The proposed 
packaging approach increased the number of ``natural'' single bills, in 
spite of reducing the universe of codes requiring single bills for 
ratesetting, but reduced the number of ``pseudo'' single bills. More 
``natural'' single procedure bills can be created by the packaging of 
codes that always appear with another procedure because these dependent 
services are supportive of and ancillary to the primary independent 
procedures for which payment is being made. A claim containing two 
independent procedure codes on the same date of service and not on the 
bypass list previously could not be used for ratesetting, but packaging 
the cost of one of the codes on the claim frees the claim to be used to 
calculate the median cost of the procedure that is not packaged. On the 
other hand, our proposed packaging approach reduced the number of codes 
eligible for the bypass list because of the limitation on packaging set 
by our previously established empirical criteria. A smaller bypass list 
and the presence of greater packaging on claims reduced the final 
number of ``pseudo'' single claims. In prior years, roughly 68 percent 
of single bills were ``pseudo'' single bills, but based on the CY 2008 
proposed rule data, 66 percent of single bills were ``pseudo'' singles. 
Similarly, for this final rule with comment period,

[[Page 66591]]

66 percent of single bills were ``pseudo'' singles. Moreover, the 
numbers of ``natural'' single bills and ``pseudo'' single bills were 
reduced by the volume of services that we proposed to package. Hence, 
our CY 2008 proposal to package payment for some HCPCS codes with 
relatively high frequencies would eliminate for ratesetting the number 
of available ``natural'' and ``pseudo'' single bills attributable to 
the codes that we proposed to package.
    As in prior years, we proposed to use the following empirical 
criteria to determine the additional codes to add to the CY 2007 bypass 
list to create the CY 2008 bypass list. We assumed that the 
representation of packaging in the single claims for any given code was 
comparable to packaging for that code in the multiple claims:
     There are 100 or more single claims for the code. This 
number of single claims ensures that observed outcomes are sufficiently 
representative of packaging that might occur in the multiple claims.
     Five percent or fewer of the single claims for the code 
have packaged costs on that single claim for the code. This criterion 
results in limiting the amount of packaging being redistributed to the 
separately payable procedure remaining on the claim after the bypass 
code is removed and ensures that the costs associated with the bypass 
code represent the cost of the bypassed service.
     The median cost of packaging observed in the single claims 
is equal to or less than $50. This limits the amount of error in 
redistributed costs.
     The code is not a code for an unlisted service.
    In addition, we proposed to add to the bypass list codes that our 
clinicians believe have minimal associated packaging based on their 
clinical assessment of the complete CY 2008 OPPS proposal. As proposed, 
this list contained bypass codes that were appropriate to claims for 
services in CY 2006 and, therefore, included codes that were deleted 
for CY 2007. Moreover, there were codes on the proposed bypass list 
that were new for CY 2007 and which were appropriate additions to the 
bypass list in preparation for use of the CY 2007 claims for creation 
of the CY 2009 OPPS.
    We received a number of public comments on the use of the bypass 
list for creation of ``pseudo'' single procedure claims. A summary of 
the comments and our responses follow.
    Comment: Some commenters objected to the removal of HCPCS codes 
from the bypass list because the codes ceased to meet the criteria for 
the bypass list as a result of increased packaging in the ``natural'' 
single claims due to the proposed packaging approach. The commenters 
objected to the removal of codes from the bypass list for this reason 
because they asserted that it caused claims that would otherwise have 
become ``pseudo'' single claims to not be used and, thereby, reduced 
the number of single bills that were available for ratesetting for 
certain services.
    Response: We agree with the commenters, so we have reevaluated the 
bypass list for this final rule with comment period and restored a 
number of codes on the bypass list prior to the CY 2008 proposal to 
maximize the creation of single and ``pseudo'' single procedure bills. 
As we discuss later in this section and in section II.A.4. of this 
final rule with comment period, we have made changes to the data 
process to ensure that we capture as much data as possible for services 
assigned status indicator ``Q.'' Although we revised the process to 
apply the specific ``Q'' status indicator policies before assessment of 
the bypass list so that additional HCPCS codes could be considered for 
the bypass list without risk of losing their data regarding packaging, 
we determined that no codes with status indicator ``Q'' were 
appropriate for addition to the final CY 2008 bypass list because of 
their significant associated packaging.
    Comment: Several commenters asked that CMS add certain HCPCS codes 
to the bypass list so that more single bills would be available for 
median setting. Some commenters specifically objected to the removal of 
the following radiation oncology services that they indicated should 
seldom have any associated packaging: CPT codes 77280 (Therapeutic 
radiology simulation-aided field setting; simple); 77285 (Therapeutic 
radiology simulation-aided field setting; intermediate); 77290 
(Therapeutic radiology simulation-aided field setting; complex); 77295 
(Therapeutic radiology simulation-aided field setting; 3-dimensional); 
77332 (Treatment devices, design and construction; simple (simple 
block, simple bolus)); 77333 (Treatment devices, design and 
construction; intermediate (multiple blocks, stents, bite blocks, 
special bolus)); 77334 (Treatment devices, design and construction; 
complex (irregular blocks, special shields, compensators, wedges, molds 
or casts)); and 77417 (Therapeutic radiology port film(s)). One 
commenter explained that there was an interaction with the packaging of 
image guided radiation therapy codes that reduced the percentage of 
single bills for high dose rate (HDR) brachytherapy from 62 percent to 
48 percent of the total frequency. The commenter believed that the 
payment for APC 0313 (Brachytherapy) dropped from $789.70 in CY 2007 to 
$739.46 in the CY 2008 proposed rule because there were packaged costs 
on claims that could no longer be used because the multiple procedure 
claims included codes that were removed from the bypass list. The 
commenter asked that these codes be restored to the bypass list so that 
these claims could be used. Other commenters asked that CMS place CPT 
code 93017 (Cardiovascular stress test using maximal or submaximal 
treadmill or bicycle exercise, continuous electrocardiographic 
monitoring, and/or pharmacological stress; tracing only, without 
interpretation and report) on the bypass list because it is typically 
performed with single photon emission computed tomography (SPECT) 
procedures (CPT code 78465 (Myocardial perfusion imaging; tomographic 
(SPECT), multiple studies (including attenuation correction when 
performed), at rest and/or stress (exercise and/or pharmacologic) and 
redistribution and/or rest injection, without or without 
quantification)). These commenters believed that significant data from 
multiple procedure claims were lost because CPT code 93017 was not 
bypassed. Other commenters asked that CMS add the following drug 
administration CPT codes to the bypass list because doing so would 
enable use of more multiple procedure claims data to establish median 
costs for drug administration services: CPT codes 90767 (Intravenous 
infusion, for therapy, prophylaxis, or diagnosis (specify substance or 
drug); additional sequential infusion, up to 1 hour (List separately in 
addition to code for primary procedure)); 90768 (Intravenous infusion, 
for therapy, prophylaxis, or diagnosis (specify substance or drug); 
concurrent infusion (List separately in addition to code for primary 
procedure); 90775 (Therapeutic, prophylactic or diagnostic injection 
(specify substance or drug); each additional sequential intravenous 
push of a new substance/drug (List separately in addition to code for 
primary procedure)); 96411 (Chemotherapy administration; intravenous, 
push technique, each additional substance/drug (List separately in 
addition to code for primary procedure)); and 96417 (Chemotherapy 
administration, intravenous infusion technique; each additional 
sequential infusion (different substance/drug), up to 1 hour (List

[[Page 66592]]

separately in addition to code for primary procedure)). A commenter 
asked that we add HCPCS code 88307 (Level V Surgical pathology, gross 
and microscopic examination) because it is so similar to HCPCS codes 
88305 (Level III Surgical pathology, gross and microscopic examination) 
and 88306 (Level IV Surgical pathology, gross and microscopic 
examination) that were already included on the bypass list.
    Response: We have reviewed the requests to add these codes to the 
bypass list and we have made the following decisions for CY 2008 for 
the reasons stated below:
    We have added the radiation oncology services listed above, with 
the exception of CPT code 77417, to the bypass list because we agree 
that they are of the type that should not have packaging associated 
with them. We recognize that including them on the bypass list may 
yield significantly more single procedure bills and may also increase 
the number of claims that we can use for calculation of the low dose 
rate prostate brachytherapy composite APC (APC8001). We have not added 
CPT code 77417 to the CY 2008 bypass list because, based on its final 
CY 2008 unconditionally packaged status, the code would not be a 
candidate for the bypass list. Unconditionally packaged codes are not 
included on the bypass list because their presence on a claim does not 
make that claim a multiple procedure bill.
    We have added CPT code 93017 to the bypass list because we agree 
that it should not have significant associated packaging, and we 
recognize that including it on the bypass list may yield significantly 
more single procedure bills for median setting.
    We have not added the drug administration services listed above to 
the bypass list. Four of these five codes are for sequential drug 
infusion services or injections of additional drugs and, therefore, by 
definition, new drugs and medical supplies that are associated with 
these codes should be reported in all cases in which the services are 
furnished. We note that, beginning in CY 2007, we placed the CPT codes 
for additional hours of infusion on the bypass list, recognizing that 
all packaging related to these hours would be associated with the 
initial services on the claim. We proposed and finalized this approach 
for CY 2007, because we were unable to accurately assign representative 
portions of packaged costs to multiple different drug administration 
services. We expected that the packaging related to additional hours of 
infusion of drugs that spanned several hours would be appropriately 
assigned to the code for the first hour of infusion on the same claim. 
If we had not placed the codes for additional hours of infusion on the 
bypass list, we would have had a substantial set of drug administration 
multiple procedure claims that were unusable for ratesetting purposes. 
However, adding the sequential drug administration services to the 
bypass list too would force all of the costs of the associated 
additional drugs and supplies to be packaged into the payment for the 
initial drug administration service for another drug, which we do not 
believe is an appropriate allocation of packaging. While we understand 
the concerns of the commenters regarding the challenges associated with 
setting appropriate payment rates for these sequential services 
reported on multiple procedure claims, we have very little CY 2006 
claims data for the four codes because they were not recognized for 
payment under the CY 2006 OPPS. We will reconsider the treatment of 
these CPT codes for the CY 2009 OPPS update when CY 2007 data, where 
these codes were separately paid under the OPPS, are available. We have 
not added CPT code 90768 to the bypass list because our final CY 2008 
policy unconditionally packages payment for this service and, 
therefore, it is not a candidate for the bypass list.
    We agree that HCPCS code 88307 (which was on the proposed bypass 
list for the CY 2008 OPPS) is appropriate and we have added it to the 
final CY 2008 bypass list.
    In addition to these responses to comments, we have added six other 
HCPCS codes to the final CY 2008 bypass list that met the empirical 
criteria for inclusion using the final rule data, and we have also 
added three HCPCS codes for clinical consistency with codes that are 
already on the bypass list. New bypass codes for this final rule with 
comment period are identified in Table 1 with an asterisk.
    Comment: One commenter objected to the use of the bypass list to 
create ``pseudo'' single claims for median setting on the basis that it 
artificially lowers the median cost of the services on the bypass list 
by sending all packaging on the claim to the other major separately 
paid service on the claim. Specifically, the commenter believed that 
inclusion of CPT code 93880 (Duplex scan of extracranial arteries; 
complete bilateral study) on the bypass list resulted in the use of the 
cost data for the lowest cost services and, thereby, lowered the cost 
of this service. The commenter stated that CMS should work with 
stakeholders on use of the bypass list, its impact on median costs, and 
ways that CMS could use data that were more reflective of the real 
costs for these procedures. The commenter believed that the median cost 
of CPT code 93880 should be based on the cost of the typical patient 
and not the least expensive patient because the OPPS payment caps 
payment in the physician's office for the service. The commenter 
explained that using the bypass list to generate more ``pseudo'' single 
claims without any packaging resulted in stagnation in payment that 
encouraged hospitals to pressure physicians to order more expensive 
tests and threatened access to care for beneficiaries who would be 
served well by simpler tests that were being underpaid as a result of 
inclusion of CPT code 93880 on the bypass list.
    One commenter asked that CMS provide a code-specific analysis of 
the impact of bypassing each code on the bypass list because the 
commenter believed that removing and using the line item costs for the 
bypass codes to set the median costs for the APCs to which the bypass 
codes are assigned results in understatement of the median costs for 
those APCs.
    Response: The bypass list has been very effective in enabling us to 
use claims data that would not otherwise be available for median 
calculation. Since its origin for the CY 2004 OPPS, we have been very 
careful in determining the codes to be placed on the bypass list. As 
described above, we use a standard set of criteria to select claims 
that seldom have packaging (that is, fewer than 5 percent of 
``natural'' single bills); that have little packaging (that is, less 
than $50); for which we have at least 100 ``natural'' single bills; and 
that are not unlisted codes (for which there is no specified service). 
In addition to codes that pass these criteria, we also have added HCPCS 
codes to the bypass list that have been recommended to us by members of 
the public, including the specialty societies that are most familiar 
with them, as services with which packaging should be seldom, if ever, 
associated. Therefore, we believe that we have been very prudent with 
regard to our selection of the codes to be added to the bypass list and 
with our use of the list. Moreover, we open the criteria and the list 
to public comment each year and we respond to comments in the final 
rule for the update year.
    We also make available the claims data used to calculate the median 
costs on which the relative weights are based, and we provide an 
extensive narrative description of our data process. Hence, we provide 
commenters with the tools to conduct any further analyses they chose 
with regard to the codes on the

[[Page 66593]]

bypass list or otherwise. In the case of CPT code 93880, the median 
packaged cost on ``natural'' single procedure claims (of which there 
were 403,106) was $0 and the percent of natural single procedure claims 
on which there was any packaging was 0.47 percent (1,899 claims out of 
403,106 ). Therefore, the code meets the criteria for inclusion on the 
bypass list and will remain on it for CY 2008. We have no evidence that 
physicians or hospitals are billing more expensive tests as a result of 
the OPPS payment rate for CPT code 93880, and our data show there is 
very little packaging associated with the service in the typical case.
    In order to keep the established empirical criteria for the bypass 
list constant, we specifically solicited public comment on whether we 
should adjust the $50 packaging cost criterion for inflation each year 
and, if so, recommendations for the source of the adjustment. We 
believed that adding an inflation adjustment factor would ensure that 
the same amount of packaging associated with candidate codes for the 
bypass list was reviewed each year relative to nominal costs.
    We received one public comment on the appropriateness of updating 
the $50 packaging cost criteria for inclusion of a code on the bypass 
list to account for annual inflation. A summary of the comment and our 
response follow.
    Comment: One commenter stated that CMS should update the $50 
maximum ``natural'' single bill median packaging cost criterion for 
including HCPCS codes on the bypass list on the basis of empirical 
criteria. The commenter did not suggest a methodology we might use for 
the update.
    Response: We have not changed the $50 maximum ``natural'' bill 
median packaging cost criterion for this final rule with comment 
period. However, we will consider whether to update the criterion and, 
if so, what methodology would be used, as part of the development of 
the proposals for the CY 2009 OPPS.
    After consideration of the public comments received, we are 
adopting, as final, the proposed ``pseudo'' single claims process and 
the CY 2008 bypass codes listed in Table 1 below. This list has been 
modified from the CY 2008 proposed list, with the addition of HCPCS 
codes that meet the empirical criteria based on updated claims data and 
certain HCPCS codes recommended by commenters, as discussed above. As 
stated earlier, the new bypass codes for this final rule with comment 
period are identified in Table 1 with an asterisk.

   Table 1.--CY 2008 Final Bypass Codes for Creating ``Pseudo'' Single
                   Claims for Calculating Median Costs
------------------------------------------------------------------------
                                                              Added for
         HCPCS code                Short description         this final
                                                                rule
------------------------------------------------------------------------
11056......................  Trim skin lesions, 2 to 4....
11057......................  Trim skin lesions, over 4....
11300......................  Shave skin lesion............
11301......................  Shave skin lesion............
11719......................  Trim nail(s).................
11720......................  Debride nail, 1-5............
11721......................  Debride nail, 6 or more......
11954......................  Therapy for contour defects..
17003......................  Destruct premalg les, 2-14...
31231......................  Nasal endoscopy, dx..........
31579......................  Diagnostic laryngoscopy......
51798......................  Us urine capacity measure....
53661......................  Dilation of urethra..........            *
54240......................  Penis study..................
56820......................  Exam of vulva w/scope........
57150......................  Treat vagina infection.......            *
67820......................  Revise eyelashes.............
69210......................  Remove impacted ear wax......
69220......................  Clean out mastoid cavity.....
70030......................  X-ray eye for foreign body...
70100......................  X-ray exam of jaw............
70110......................  X-ray exam of jaw............
70120......................  X-ray exam of mastoids.......
70130......................  X-ray exam of mastoids.......
70140......................  X-ray exam of facial bones...
70150......................  X-ray exam of facial bones...
70160......................  X-ray exam of nasal bones....
70200......................  X-ray exam of eye sockets....
70210......................  X-ray exam of sinuses........
70220......................  X-ray exam of sinuses........
70250......................  X-ray exam of skull..........
70260......................  X-ray exam of skull..........
70328......................  X-ray exam of jaw joint......
70330......................  X-ray exam of jaw joints.....
70336......................  Magnetic image, jaw joint....
70355......................  Panoramic x-ray of jaws......
70360......................  X-ray exam of neck...........
70370......................  Throat x-ray & fluoroscopy...
70371......................  Speech evaluation, complex...
70450......................  Ct head/brain w/o dye........
70480......................  Ct orbit/ear/fossa w/o dye...
70486......................  Ct maxillofacial w/o dye.....
70490......................  Ct soft tissue neck w/o dye..
70544......................  Mr angiography head w/o dye..
70551......................  Mri brain w/o dye............
71010......................  Chest x-ray..................
71015......................  Chest x-ray..................
71020......................  Chest x-ray..................
71021......................  Chest x-ray..................
71022......................  Chest x-ray..................
71023......................  Chest x-ray and fluoroscopy..
71030......................  Chest x-ray..................
71034......................  Chest x-ray and fluoroscopy..
71035......................  Chest x-ray..................
71100......................  X-ray exam of ribs...........
71101......................  X-ray exam of ribs/chest.....
71110......................  X-ray exam of ribs...........
71111......................  X-ray exam of ribs/chest.....
71120......................  X-ray exam of breastbone.....
71130......................  X-ray exam of breastbone.....
71250......................  Ct thorax w/o dye............
72010......................  X-ray exam of spine..........
72020......................  X-ray exam of spine..........
72040......................  X-ray exam of neck spine.....
72050......................  X-ray exam of neck spine.....
72052......................  X-ray exam of neck spine.....
72069......................  X-ray exam of trunk spine....
72070......................  X-ray exam of thoracic spine.
72072......................  X-ray exam of thoracic spine.
72074......................  X-ray exam of thoracic spine.
72080......................  X-ray exam of trunk spine....
72090......................  X-ray exam of trunk spine....
72100......................  X-ray exam of lower spine....
72110......................  X-ray exam of lower spine....
72114......................  X-ray exam of lower spine....
72120......................  X-ray exam of lower spine....

[[Page 66594]]

 
72125......................  Ct neck spine w/o dye........
72128......................  Ct chest spine w/o dye.......
72131......................  Ct lumbar spine w/o dye......
72141......................  Mri neck spine w/o dye.......
72146......................  Mri chest spine w/o dye......
72148......................  Mri lumbar spine w/o dye.....
72170......................  X-ray exam of pelvis.........
72190......................  X-ray exam of pelvis.........
72192......................  Ct pelvis w/o dye............
72202......................  X-ray exam sacroiliac joints.
72220......................  X-ray exam of tailbone.......
73000......................  X-ray exam of collar bone....
73010......................  X-ray exam of shoulder blade.
73020......................  X-ray exam of shoulder.......
73030......................  X-ray exam of shoulder.......
73050......................  X-ray exam of shoulders......
73060......................  X-ray exam of humerus........
73070......................  X-ray exam of elbow..........
73080......................  X-ray exam of elbow..........
73090......................  X-ray exam of forearm........
73100......................  X-ray exam of wrist..........
73110......................  X-ray exam of wrist..........
73120......................  X-ray exam of hand...........
73130......................  X-ray exam of hand...........
73140......................  X-ray exam of finger(s)......
73200......................  Ct upper extremity w/o dye...
73218......................  Mri upper extremity w/o dye..
73221......................  Mri joint upr extrem w/o dye.
73510......................  X-ray exam of hip............
73520......................  X-ray exam of hips...........
73540......................  X-ray exam of pelvis & hips..
73550......................  X-ray exam of thigh..........
73560......................  X-ray exam of knee, 1 or 2...
73562......................  X-ray exam of knee, 3........
73564......................  X-ray exam, knee, 4 or more..
73565......................  X-ray exam of knees..........
73590......................  X-ray exam of lower leg......
73600......................  X-ray exam of ankle..........
73610......................  X-ray exam of ankle..........
73620......................  X-ray exam of foot...........
73630......................  X-ray exam of foot...........
73650......................  X-ray exam of heel...........
73660......................  X-ray exam of toe(s).........
73700......................  Ct lower extremity w/o dye...
73718......................  Mri lower extremity w/o dye..
73721......................  Mri jnt of lwr extre w/o dye.
74000......................  X-ray exam of abdomen........
74010......................  X-ray exam of abdomen........
74020......................  X-ray exam of abdomen........
74022......................  X-ray exam series, abdomen...
74150......................  Ct abdomen w/o dye...........
74210......................  Contrast x-ray exam of throat
74220......................  Contrast x-ray, esophagus....
74230......................  Cine/vid x-ray, throat/esoph.
74246......................  Contrast x-ray uppr gi tract.
74247......................  Contrst x-ray uppr gi tract..
74249......................  Contrst x-ray uppr gi tract..
76020......................  X-rays for bone age..........
76040......................  X-rays, bone evaluation......
76061......................  X-rays, bone survey..........
76062......................  X-rays, bone survey..........
76065......................  X-rays, bone evaluation......
76066......................  Joint survey, single view....
76070......................  Ct bone density, axial.......
76071......................  Ct bone density, peripheral..
76075......................  Dxa bone density, axial......
76076......................  Dxa bone density/peripheral..
76077......................  Dxa bone density/v-fracture..
76078......................  Radiographic absorptiometry..
76100......................  X-ray exam of body section...
76400......................  Magnetic image, bone marrow..
76510......................  Ophth us, b & quant a........
76511......................  Ophth us, quant a only.......
76512......................  Ophth us, b w/non-quant a....
76513......................  Echo exam of eye, water bath.
76514......................  Echo exam of eye, thickness..
76516......................  Echo exam of eye.............
76519......................  Echo exam of eye.............
76536......................  Us exam of head and neck.....
76645......................  Us exam, breast(s)...........
76700......................  Us exam, abdom, complete.....
76705......................  Echo exam of abdomen.........
76770......................  Us exam abdo back wall, comp.
76775......................  Us exam abdo back wall, lim..
76778......................  Us exam kidney transplant....
76801......................  Ob us < 14 wks, single fetus.
76805......................  Ob us >/= 14 wks, sngl fetus.
76811......................  Ob us, detailed, sngl fetus..
76816......................  Ob us, follow-up, per fetus..
76817......................  Transvaginal us, obstetric...
76830......................  Transvaginal us, non-ob......
76856......................  Us exam, pelvic, complete....
76857......................  Us exam, pelvic, limited.....
76870......................  Us exam, scrotum.............
76880......................  Us exam, extremity...........
76970......................  Ultrasound exam follow-up....
76977......................  Us bone density measure......
76999......................  Echo examination procedure...
77280......................  Set radiation therapy field..            *
77285......................  Set radiation therapy field..            *
77290......................  Set radiation therapy field..            *
77295......................  Set radiation therapy field..            *
77300......................  Radiation therapy dose plan..

[[Page 66595]]

 
77301......................  Radiotherapy dose plan, imrt.
77315......................  Teletx isodose plan complex..
77326......................  Brachytx isodose calc simp...
77327......................  Brachytx isodose calc interm.
77328......................  Brachytx isodose plan compl..
77331......................  Special radiation dosimetry..
77332......................  Radiation treatment aid(s)...            *
77333......................  Radiation treatment aid(s)...            *
77334......................  Radiation treatment aid(s)...            *
77336......................  Radiation physics consult....
77370......................  Radiation physics consult....
77401......................  Radiation treatment delivery.
77402......................  Radiation treatment delivery.
77403......................  Radiation treatment delivery.
77404......................  Radiation treatment delivery.
77407......................  Radiation treatment delivery.
77408......................  Radiation treatment delivery.
77409......................  Radiation treatment delivery.
77411......................  Radiation treatment delivery.
77412......................  Radiation treatment delivery.
77413......................  Radiation treatment delivery.
77414......................  Radiation treatment delivery.
77416......................  Radiation treatment delivery.
77418......................  Radiation tx delivery, imrt..
77470......................  Special radiation treatment..
77520......................  Proton trmt, simple w/o comp.
77523......................  Proton trmt, intermediate....
80500......................  Lab pathology consultation...
80502......................  Lab pathology consultation...
85097......................  Bone marrow interpretation...
86510......................  Histoplasmosis skin test.....
86850......................  RBC antibody screen..........
86870......................  RBC antibody identification..
86880......................  Coombs test, direct..........
86885......................  Coombs test, indirect, qual..
86886......................  Coombs test, indirect, titer.
86890......................  Autologous blood process.....
86900......................  Blood typing, ABO............
86901......................  Blood typing, Rh (D).........
86903......................  Blood typing, antigen screen.
86904......................  Blood typing, patient serum..
86905......................  Blood typing, RBC antigens...
86906......................  Blood typing, Rh phenotype...
86930......................  Frozen blood prep............
86970......................  RBC pretreatment.............
88104......................  Cytopath fl nongyn, smears...
88106......................  Cytopath fl nongyn, filter...
88107......................  Cytopath fl nongyn, sm/fltr..
88108......................  Cytopath, concentrate tech...
88112......................  Cytopath, cell enhance tech..
88160......................  Cytopath smear, other source.
88161......................  Cytopath smear, other source.
88162......................  Cytopath smear, other source.
88172......................  Cytopathology eval of fna....
88173......................  Cytopath eval, fna, report...
88182......................  Cell marker study............
88184......................  Flowcytometry/ tc, 1 marker..
88185......................  Flowcytometry/tc, add-on.....
88300......................  Surgical path, gross.........
88302......................  Tissue exam by pathologist...
88304......................  Tissue exam by pathologist...
88305......................  Tissue exam by pathologist...
88307......................  Tissue exam by pathologist...
88311......................  Decalcify tissue.............
88312......................  Special stains...............
88313......................  Special stains...............
88321......................  Microslide consultation......
88323......................  Microslide consultation......
88325......................  Comprehensive review of data.
88331......................  Path consult intraop, 1 bloc.
88342......................  Immunohistochemistry.........
88346......................  Immunofluorescent study......
88347......................  Immunofluorescent study......
88348......................  Electron microscopy..........
88358......................  Analysis, tumor..............
88360......................  Tumor immunohistochem/manual.
88361......................  Tumor immunohistochem/comput.            *
88365......................  Insitu hybridization (fish)..
88368......................  Insitu hybridization, manual.
88399......................  Surgical pathology procedure.
89049......................  Chct for mal hyperthermia....
89230......................  Collect sweat for test.......
89240......................  Pathology lab procedure......
90761......................  Hydrate iv infusion, add-on..
90761......................  Hydrate iv infusion, add-on..            *
90766......................  Ther/proph/dg iv inf, add-on.            *
90801......................  Psy dx interview.............
90802......................  Intac psy dx interview.......
90804......................  Psytx, office, 20-30 min.....
90805......................  Psytx, off, 20-30 min w/e&m..
90806......................  Psytx, off, 45-50 min........
90807......................  Psytx, off, 45-50 min w/e&m..
90808......................  Psytx, office, 75-80 min.....
90809......................  Psytx, off, 75-80, w/e&m.....
90810......................  Intac psytx, off, 20-30 min..
90812......................  Intac psytx, off, 45-50 min..
90816......................  Psytx, hosp, 20-30 min.......
90818......................  Psytx, hosp, 45-50 min.......
90826......................  Intac psytx, hosp, 45-50 min.            *
90845......................  Psychoanalysis...............
90846......................  Family psytx w/o patient.....
90847......................  Family psytx w/patient.......

[[Page 66596]]

 
90853......................  Group psychotherapy..........
90857......................  Intac group psytx............
90862......................  Medication management........
92002......................  Eye exam, new patient........
92004......................  Eye exam, new patient........
92012......................  Eye exam established pat.....
92014......................  Eye exam & treatment.........
92020......................  Special eye evaluation.......
92081......................  Visual field examination(s)..
92082......................  Visual field examination(s)..
92083......................  Visual field examination(s)..
92135......................  Ophth dx imaging post seg....
92136......................  Ophthalmic biometry..........
92225......................  Special eye exam, initial....
92226......................  Special eye exam, subsequent.
92230......................  Eye exam with photos.........
92240......................  Icg angiography..............
92250......................  Eye exam with photos.........
92275......................  Electroretinography..........
92285......................  Eye photography..............
92286......................  Internal eye photography.....
92520......................  Laryngeal function studies...
92541......................  Spontaneous nystagmus test...
92546......................  Sinusoidal rotational test...
92548......................  Posturography................
92552......................  Pure tone audiometry, air....
92553......................  Audiometry, air & bone.......
92555......................  Speech threshold audiometry..
92556......................  Speech audiometry, complete..
92557......................  Comprehensive hearing test...
92567......................  Tympanometry.................
92582......................  Conditioning play audiometry.
92585......................  Auditor evoke potent, compre.
92603......................  Cochlear implt f/up exam 7 >.
92604......................  Reprogram cochlear implt 7 >.
92626......................  Eval aud rehab status........
93005......................  Electrocardiogram, tracing...
93017......................  Cardiovascular stress test...            *
93225......................  ECG monitor/record, 24 hrs...
93226......................  ECG monitor/report, 24 hrs...
93231......................  Ecg monitor/record, 24 hrs...
93232......................  ECG monitor/report, 24 hrs...
93236......................  ECG monitor/report, 24 hrs...
93270......................  ECG recording................
93271......................  Ecg/monitoring and analysis..
93278......................  ECG/signal-averaged..........
93727......................  Analyze ilr system...........
93731......................  Analyze pacemaker system.....
93732......................  Analyze pacemaker system.....
93733......................  Telephone analy, pacemaker...
93734......................  Analyze pacemaker system.....
93735......................  Analyze pacemaker system.....
93736......................  Telephonic analy, pacemaker..
93741......................  Analyze ht pace device sngl..
93742......................  Analyze ht pace device sngl..
93743......................  Analyze ht pace device dual..
93744......................  Analyze ht pace device dual..
93786......................  Ambulatory BP recording......
93788......................  Ambulatory BP analysis.......
93797......................  Cardiac rehab................
93798......................  Cardiac rehab/monitor........
93875......................  Extracranial study...........
93880......................  Extracranial study...........
93882......................  Extracranial study...........
93886......................  Intracranial study...........
93888......................  Intracranial study...........
93922......................  Extremity study..............
93923......................  Extremity study..............
93924......................  Extremity study..............
93925......................  Lower extremity study........
93926......................  Lower extremity study........
93930......................  Upper extremity study........
93931......................  Upper extremity study........
93965......................  Extremity study..............
93970......................  Extremity study..............
93971......................  Extremity study..............
93975......................  Vascular study...............
93976......................  Vascular study...............
93978......................  Vascular study...............
93979......................  Vascular study...............
93990......................  Doppler flow testing.........
94015......................  Patient recorded spirometry..
94690......................  Exhaled air analysis.........
95115......................  Immunotherapy, one injection.
95117......................  Immunotherapy injections.....
95165......................  Antigen therapy services.....
95250......................  Glucose monitoring, cont.....            *
95805......................  Multiple sleep latency test..
95806......................  Sleep study, unattended......
95807......................  Sleep study, attended........
95808......................  Polysomnography, 1-3.........
95812......................  Eeg, 41-60 minutes...........
95813......................  Eeg, over 1 hour.............
95816......................  Eeg, awake and drowsy........
95819......................  Eeg, awake and asleep........
95822......................  Eeg, coma or sleep only......
95869......................  Muscle test, thor paraspinal.
95872......................  Muscle test, one fiber.......            *
95900......................  Motor nerve conduction test..
95921......................  Autonomic nerv function test.
95925......................  Somatosensory testing........
95926......................  Somatosensory testing........            *
95930......................  Visual evoked potential test.
95950......................  Ambulatory eeg monitoring....
95953......................  EEG monitoring/computer......
95970......................  Analyze neurostim, no prog...
95972......................  Analyze neurostim, complex...
95974......................  Cranial neurostim, complex...
95978......................  Analyze neurostim brain/1h...
96000......................  Motion analysis, video/3d....
96101......................  Psycho testing by psych/phys.

[[Page 66597]]

 
96111......................  Developmental test, extend...
96116......................  Neurobehavioral status exam..
96118......................  Neuropsych tst by psych/phys.
96119......................  Neuropsych testing by tec....
96150......................  Assess hlth/behave, init.....
96151......................  Assess hlth/behave, subseq...
96152......................  Intervene hlth/behave, indiv.
96153......................  Intervene hlth/behave, group.
96415......................  Chemo, iv infusion, addl hr..
96423......................  Chemo ia infuse each addl hr.
96900......................  Ultraviolet light therapy....
96910......................  Photochemotherapy with UV-B..
96912......................  Photochemotherapy with UV-A..
96913......................  Photochemotherapy, UV-A or B.
96920......................  Laser tx, skin < 250 sq cm...
98925......................  Osteopathic manipulation.....
98926......................  Osteopathic manipulation.....
98927......................  Osteopathic manipulation.....
98940......................  Chiropractic manipulation....
98941......................  Chiropractic manipulation....
98942......................  Chiropractic manipulation....
99204......................  Office/outpatient visit, new.
99212......................  Office/outpatient visit, est.
99213......................  Office/outpatient visit, est.
99214......................  Office/outpatient visit, est.
99241......................  Office consultation..........
99242......................  Office consultation..........
99243......................  Office consultation..........
99244......................  Office consultation..........
99245......................  Office consultation..........
0144T......................  CT heart wo dye; qual calc...
C8951......................  IV inf, tx/dx, each addl hr..
C8955......................  Chemotx adm, IV inf, addl hr.
G0008......................  Admin influenza virus vac....
G0101......................  CA screen; pelvic/breast exam
G0127......................  Trim nail(s).................
G0130......................  Single energy x-ray study....
G0166......................  Extrnl counterpulse, per tx..
G0175......................  OPPS Service,sched team conf.
G0332......................  Preadmin IV immunoglobulin...
G0340......................  Robt lin-radsurg fractx 2-5..
G0344......................  Initial preventive exam......
G0365......................  Vessel mapping hemo access...
G0367......................  EKG tracing for initial prev.
G0376......................  Smoke/tobacco counseling >10.
M0064......................  Visit for drug monitoring....
Q0091......................  Obtaining screen pap smear...
------------------------------------------------------------------------

(2) Exploration of Allocation of Packaged Costs to Separately Paid 
Procedure Codes
    During its August 23-24, 2006 meeting, the APC Panel recommended 
that CMS provide claims analysis of the contributions of packaged costs 
(including packaged revenue code charges and charges for packaged HCPCS 
codes) to the median cost of each drug administration service. (We 
refer readers to Recommendation 28 in the August 23-24, 2006 
meeting recommendation summary on the CMS Web site at: http://www.cms.hhs.gov/FACA/05--
AdvisoryPanelonAmbulatoryPaymentClassificationGroups.asp#TopOfPage.) In 
our continued effort to better understand the multiple claims in order 
to extract single bill information from them, we examined the extent to 
which the packaging in multiple procedure claims differs from the 
packaging in the single procedure claims on which we base the median 
costs both in general and more specifically for drug administration 
services. We performed this analysis using the claims data on which we 
based the CY 2007 OPPS/ASC final rule with comment period. We examined 
the amount of packaging in multiple procedure versus single procedure 
claims in general and in claims for drug administration services in 
particular. We conducted this analysis without taking into account the 
proposed packaging approach presented in the CY 2008 OPPS/ASC proposed 
rule. However, we did not expect the services newly proposed for 
packaged payment to commonly appear with a drug administration service. 
Therefore, we believed that the analysis conducted on the CY 2007 final 
rule with comment period data was sufficient to inform our development 
of the CY 2008 OPPS/ASC proposed rule.
    In general, we did not believe that the proportionate amount of 
packaged costs in the multiple bills relative to the number of primary 
services would be greater than that in the single bills. Our findings 
supported our hypothesis. The costs in uncoded revenue codes and HCPCS 
codes with a packaged status indicator accounted for 22 percent of 
observed costs in the universe of all CY 2005 claims that we used to 
model the CY 2007 OPPS (including both the single and multiple 
procedure bills). Similarly, the costs in uncoded revenue codes and 
HCPCS codes with a packaged status indicator accounted for 18 percent 
of the total cost in the subset of CY 2005 single bills that we used to 
calculate the median costs on which the relative weights were based.
    However, the bypass methodology creates a ``pseudo'' single bill 
for all claims for services or items on the bypass list, and these 
``pseudo'' single bills have no associated packaging, by definition of 
the application of the bypass list. Excluding the total cost associated 
with bypass codes, 28 percent of observed costs in the single bills 
were attributable to packaged services, and 29 percent of observed 
costs across all claims were attributable to packaged services. 
Therefore, we concluded that, in general, the extent of packaging in 
all bills was similar to the amount of packaging in the single 
procedure bills we used to set median costs for most APCs.
    In the CY 2008 proposed rule (72 FR 42640), we recognized that 
aggregate numbers do not address the packaging associated with single 
and multiple procedure claims for specific services. In past years, we 
received comments stating that the amount of packaging in the single 
bills for drug administration services was not representative of the 
typical packaged costs of these drug administration services, which 
were usually performed in combination with one another, because the 
single bills represented less complex and less resource-intensive 
services than the usual cases.
    We published a study in the CY 2007 OPPS/ASC final rule with 
comment period (71 FR 68120 through 68121) that discussed the amount of 
packaging on

[[Page 66598]]

the single bills for drug administration procedure codes, and we 
promised to replicate that study for the APC Panel. We discussed the 
results of this study with the APC Panel at its March 2007 meeting, in 
accordance with the APC Panel's August 2006 recommendation and also 
published the results in the CY 2008 OPPS/ASC proposed rule (72 FR 
42640 through 42641).
    As discussed in the proposed rule, we found that drug 
administration services demonstrated reasonable single bill 
representation in comparison with other OPPS services. Single bills for 
drug administration constituted, roughly, 30 percent of all observed 
occurrences of drug administration services, varying by code from 7 to 
55 percent. The study also demonstrated that packaged costs 
substantially contributed to median cost estimates for the majority of 
drug administration HCPCS codes (72 FR 42640 through 42641).
    For all single bills for CPT code 90780 (Intravenous infusion for 
therapy/diagnosis, administered by physician or under direct 
supervision of physician; up to one hour), on average, packaged costs 
were 31 percent of total cost (median 27 percent). For the same code, 
packaged drug and pharmacy costs comprised, on average, 23 percent of 
total costs (median 15 percent). Single bills made up 34 percent of all 
line-item occurrences of the service, suggesting that this single bill 
median cost was fairly robust and probably captured packaging 
adequately. On the other hand, CPT code 90784 (Therapeutic, 
prophylactic or diagnostic injection (specify material injected); 
subcutaneous or intramuscular) demonstrated limited packaging (median 0 
percent and mean 17 percent), and the median cost for the code was 
derived from only 7 percent of all occurrences of the code. Across all 
drug administration codes, over half showed significant median packaged 
costs largely attributable to packaged drug and pharmacy costs.
    By definition, we were unable to precisely assess the amount of 
packaging associated with drug administration codes in the multiple 
bills. As a proxy, we estimated packaging as a percent of total cost on 
each claim for two subsets of claims. Both analyses suggested the 
presence of moderate packaged costs, especially drug and pharmacy 
costs, associated with drug administration services in the multiple 
bills. We calculated measures of central tendency for packaging 
percentages in the multiple bills or portions of multiple bills 
remaining after ``pseudo'' singles were created. We referred to this 
group of the multiple bills as the ``hardcore'' multiple bills. For the 
first subset of ``hardcore'' multiple bills with only drug 
administration codes, that is, where multiple drug administration codes 
were the only separately paid procedure codes on the claim, we 
estimated that packaged costs were 22 percent of total costs (27 
percent, on average), where total costs consisted of costs for all 
payable codes. Costs for packaged drug HCPCS codes and pharmacy revenue 
codes comprised 13 percent of total cost at the median (19 percent, on 
average). For the second subset of ``hardcore'' multiple bills with any 
drug administration code, that is, where a drug administration code 
appeared with other payable codes (largely radiology services and 
visits), we estimated packaged costs were 13 percent of total cost at 
the median (19 percent, on average). Costs for packaged drugs and 
pharmacy revenue codes comprised 6 percent of total cost at the median 
(10 percent, on average). The amount of packaging in both proxy 
measures, but especially the first subset, closely resembled the 
packaged costs as a percentage of drug administration costs observed in 
the single bills for drug administration services. While finding a way 
to accurately use data from the ``hardcore'' multiple bills to estimate 
drug administration median costs undoubtedly would impact medians, 
these comparisons suggested that the multiple bill data probably would 
support current median estimates.
    In the CY 2008 OPPS/ASC proposed rule (72 FR 42641), we noted that 
we had received several comments over the past few years offering 
algorithms for packaging the costs associated with specific revenue 
codes or packaging drugs with certain drug administration codes. 
Because of the complexity of even routine OPPS claims, prior research 
suggested that such algorithms have limited power to generate 
additional single bill claims and do little to change median cost 
estimates. In the proposed rule (72 FR 42641), we explained that we 
continue to look for simple, but powerful, methodologies like the 
bypass list and packaging of HCPCS codes for additional ancillary and 
supportive services to assign packaged costs to all services within the 
``hardcore'' multiple bills. Ideally, these methodologies should be 
intuitive to the provider community, easily integrated into the 
complexity of OPPS median cost estimation, and simple to maintain from 
year to year. We specifically solicited methodologies for creation of 
single bills that meet these criteria.
    We received several public comments with regard to the use of data 
from single and multiple procedure claims for ratesetting. A summary of 
the public comments and our responses follow.
    Comment: Several commenters expressed appreciation for CMS' 
analysis of packaged costs included on single and multiple procedure 
claims for drug administration services. One commenter encouraged CMS 
to further analyze the total amount and percentage of packaged costs 
associated with all packaged HCPCS codes, as well as other packaged 
services reported by hospitals, and examine this information on single 
versus multiple procedure claims in order to increase hospitals' 
understanding of the actual packaged costs used in the ratesetting 
process. Once again, several commenters encouraged CMS to consider 
specific packaging algorithms to allocate packaged costs on multiple 
procedures claims, in order to create additional ``pseudo'' single 
claims for ratesetting.
    Response: The packaging of associated costs into payment for major 
procedures is a longstanding principle of the OPPS. The OPPS packages 
payment for the operating and capital-related costs that are directly 
related and integral to furnishing a service on an outpatient basis. 
These packaged costs have historically included costs related to use of 
an operating or treatment room, anesthesia, medical supplies, 
implantable devices, inexpensive drugs, etc. Our findings related to 
the packaged costs on single and multiple claims for drug 
administration services confirm that the packaging on the single bills 
used for ratesetting resembles the drug and pharmacy-related packaged 
costs on multiple procedure claims. The packaging associated with drug 
administration services on single and multiple claims has historically 
been of particular concern to the public, so we are reassured by this 
finding. We are not convinced that developing this information for all 
other HCPCS codes would provide further useful information to 
hospitals. Instead, we prefer to direct our analytic resources toward 
exploring additional approaches to using more cost data from multiple 
procedure claims for ratesetting. If we are eventually able to use all 
OPPS claims in developing median costs, then all packaged costs on 
claims would also be incorporated in ratesetting under the OPPS. We 
remind hospitals that they should continue to take into consideration 
all costs associated with providing HOPD services in establishing their 
charges for the services. In addition, hospitals should report packaged 
HCPCS codes and charges, consistent with all CPT, OPPS, and local

[[Page 66599]]

contractor instructions, whenever those services are provided to ensure 
that the associated costs are included in ratesetting for the major 
services.
    As we have stated previously regarding our exploration of specific 
packaging algorithms, we have found that these approaches, while 
resource-intensive on our part, have limited power to generate 
additional single bill claims and do little to change median cost 
estimates. We received no other specific suggestions for other 
approaches to allocating packaged costs on ``hardcore'' multiple bills 
that would be intuitive to the provider community, easily integrated 
into the complexity of OPPS median cost estimation, and simple to 
maintain from year to year. We will continue to explore these data 
challenges with the assistance of the Data Subcommittee of the APC 
Panel. We believe that further progression toward encounter-based or 
episode-based payment for commonly provided combinations of services 
could reduce the number of these multiple claims and incorporate 
additional claims data, as discussed in section II.A.4.d. of this final 
rule with comment period regarding low dose rate prostate brachytherapy 
and cardiac electrophysiologic evaluation and ablation procedures.
    After consideration of the public comments received, we are 
finalizing our CY 2008 proposal for the use of single and multiple 
procedure claims for ratesetting. We will continue to pursue additional 
methodologies that would allow use of cost data from ``hardcore'' 
multiple claims for ratesetting.
c. Calculation of CCRs
    We calculated hospital-specific overall CCRs and hospital-specific 
departmental CCRs for each hospital for which we had claims data in the 
period of claims being used to calculate the median costs that we 
converted to scaled relative weights for purposes of setting the OPPS 
payment rates. We applied the hospital-specific CCR to the hospital's 
charges at the most detailed level possible, based on a revenue code to 
cost center crosswalk that contains a hierarchy of CCRs used to 
estimate costs from charges for each revenue code. That crosswalk is 
available for review and continuous comment on the CMS Web site at: 
http://www.cms.hhs.gov/HospitalOutpatientPPS/03--
crosswalk.asp#TopOfPage. We calculated CCRs for the standard and 
nonstandard cost centers accepted by the electronic cost report 
database. In general, the most detailed level at which we calculated 
CCRs was the hospital-specific departmental level.
    Following the expiration of most medical devices from pass-through 
status in CY 2003, prior to which devices were paid at charges reduced 
to cost using the hospital's overall CCR, we received comments that our 
OPPS cost estimates for device implantation procedures systematically 
underestimate the cost of the devices included in the packaged payment 
for the procedures because hospitals routinely mark up charges for low 
cost items to a much greater extent than they mark up high cost items, 
and that these items are often combined in a single cost center on 
their Medicare cost report. This is commonly known as ``charge 
compression.''
    In CY 2006, the device industry commissioned a study to interpolate 
a device specific CCR from the medical supply CCR, using publicly 
available hospital claims and Medicare cost report data rather than 
proprietary data on device costs. After reviewing the device industry's 
data analysis and study model, CMS contracted with RTI International 
(RTI) to study the impact of charge compression on the cost-based 
weight methodology adopted in the FY 2007 IPPS final rule, to evaluate 
this model, and to propose solutions. For more information, interested 
individuals can view RTI's report on the CMS Web site at: http://www.cms.hhs.gov/reports/downloads/Dalton.pdf.
    Any study of cost estimation in general, and charge compression 
specifically, has obvious importance for both the OPPS and the IPPS. 
RTI's research explicitly focused on the IPPS for several reasons, 
which include greater Medicare expenditures under the IPPS, a desire to 
evaluate the model quickly given IPPS regulation deadlines, and a focus 
on other components of the new FY 2007 IPPS cost-based weight 
methodology (CMS Contract No. 500-00-0024-T012, ``A Study of Charge 
Compression in Calculating DRG Relative Weights,'' page 5). The study 
first addressed the possibility of cross-aggregation bias in the CCRs 
used to estimate costs under the IPPS created by the IPPS methodology 
of aggregating cost centers into larger departments before calculating 
CCRs. The report also addressed potential bias created by estimating 
costs using a CCR that reflects the combined costs and charges of 
services with wide variation in the amount of hospital markup. In its 
assessment of the latter, RTI targeted its attempt to identify the 
presence of charge compression to those cost centers presumably 
associated with revenue codes demonstrating significant IPPS 
expenditures and utilization. RTI assessed the correlation between cost 
report CCRs and the percent of charges in a cost center attributable to 
a set of similar services represented by a group of revenue codes. RTI 
did not examine the correlation between CCRs and revenue codes without 
significant IPPS expenditures or a demonstrated concentration in a 
specific Diagnosis Related Group (DRG). For example, RTI did not 
examine revenue code groups within the pharmacy cost center with low 
proportionate inpatient charges that might be important to the OPPS, 
such as ``Pharmacy Incident to Radiology.'' RTI states this limitation 
in its study and specifically recommends that disaggregated CCRs be 
reestimated for hospital outpatient charges.
    Cost report CCRs combine both inpatient and outpatient services. 
Ideally, RTI would be able to examine the correlation between CCRs for 
Medicare inpatient services and inpatient claim charges and the 
correlation between CCRs for Medicare outpatient services and 
outpatient claim charges. However, the comprehensive nature of the cost 
report CCR (which combines inpatient and outpatient services) argues 
for an analysis of the correlation between CCRs and combined inpatient 
and outpatient claim charges. As noted, the RTI study accepted some 
measurement error in its analysis by matching an ``all charges'' CCR to 
inpatient estimates of charges for groups of similar services 
represented by revenue codes because of short timelines and because 
inpatient costs dominate outpatient costs in many ancillary cost 
centers. We believe that CCR adjustments used to calculate payment 
should be based on the comparison of cost report CCRs to combined 
inpatient and outpatient charges. An ``all charges'' model would reduce 
measurement error and estimate adjustments to disaggregated CCRs that 
could be used in both hospital inpatient and outpatient payment 
systems.
    RTI made several short-term recommendations for improving the 
accuracy of DRG weight estimates from a cost-based methodology to 
address bias in combining cost centers and charge compression that 
could be considered in the context of OPPS policy. We discussed each 
recommendation within the context of the OPPS and provided our 
assessment of its application to the OPPS in the CY 2008 OPPS/ASC 
proposed rule (72 FR 42642). Of the four short term recommendations, we 
believe that only the recommendation to establish regression based 
estimates as a

[[Page 66600]]

temporary or permanent method for disaggregating national average CCRs 
for medical supplies, drugs, and radiology services under the IPPS has 
specific application to the OPPS (RTI study, pages 11 and 86). 
Moreover, with regard to radiology services, the OPPS already has 
partially implemented RTI's recommendation to use lower CCRs to 
estimate costs for those OPPS services allocated to MRI or CT Scan cost 
centers through its use of hospital-specific CCRs for nonstandard cost 
centers.
    For reasons discussed below and in more detail in the proposed rule 
(72 FR 42642 through 42643), we proposed to develop an all charges 
model that would compare variation in CCRs with variation in combined 
inpatient and outpatient charges for sets of similar services and 
establish disaggregated regression-based CCRs that could be applied to 
both inpatient and outpatient charges. We proposed to evaluate the 
results of that methodology for purposes of determining whether the 
resulting regression-based CCRs should be proposed for use in 
developing the CY 2009 OPPS payment rates. As noted in the proposed 
rule (72 FR 42642), the revised all charges model and resulting 
regression-based CCRs were not available in time for use in developing 
this final rule with comment period.
    Since publication of the proposed rule, we have contracted with RTI 
to determine whether the statistical model that RTI recommended in its 
January 2007 report for adjusting CCRs in inpatient cost computations 
can be expanded to include cost computations for significant categories 
of outpatient services that are paid under the OPPS and to assess the 
impact of any such changes on payment under the OPPS (HHSM 500-2005-
00029I Task Order 0008, ``Refining Cost-to-Charge Ratios for 
Calculating APC and DRG Relative Payment Weights''). Under this task 
order, RTI will assess the validity of the revenue code-to-cost center 
crosswalk used under the OPPS by comparing revenue code and cost center 
charges, make recommendations for changes to the crosswalk, and assess 
the OPPS use of nonstandard cost centers. RTI will estimate regression-
based CCRs using charge data from both inpatient and outpatient claims 
for hospital ancillary departments. RTI will extend its recommended 
models to estimate regression-based CCRs for cost centers that are 
particularly relevant to APCs, working with CMS staff to analyze the 
sensitivity of APC weights to proposed adjustments. RTI also will 
convene a technical expert panel to review analyses, as it did for its 
first study.
    There are several reasons why we did not propose to use the 
intradepartmental regression-based CCRs that RTI estimated using IPPS 
charges for the CY 2008 OPPS estimation of median costs. We agree with 
RTI that the intradepartmental CCRs calculated for the IPPS would not 
always be appropriate for application to the OPPS (RTI study, pages 34 
and 35). While RTI recommends that the model be recalibrated for 
outpatient charges before it is applied to the OPPS, we believed that 
the combined nature of the CCRs available from the cost report prevents 
an accurate outpatient recalibration that would be appropriate for the 
OPPS alone. Therefore, we believed that an all charges model examining 
an expanded subset of revenue codes would be the most appropriate, and 
that this model should be developed before we could apply the resulting 
regression based CCRs to the charges for supplies paid under the OPPS.
    Moreover, we were concerned that implementing the regression-based 
IPPS related CCRs in the OPPS that RTI estimated for CY 2008 could 
result in greater instability in relative payment weights for CY 2008 
than would otherwise occur, and that a subsequent change to application 
of the regression-based CCRs resulting from development of an all 
charges model might also result in significant fluctuations in median 
costs and increased instability in payments from CY 2008 to CY 2009. 
Therefore, these sequential changes could result in significant 
increases in median costs in one year and significant declines in 
median costs in the next year.
    Therefore, we did not propose to adopt the RTI regression-based 
CCRs under the CY 2008 OPPS. As indicated in the proposed rule (72 FR 
42643), we stated that we would consider whether it would be 
appropriate to adopt regression-based CCRs for the OPPS after we 
received RTI's comprehensive review of the OPPS cost estimation 
methodology and reviewed the results of the use of both inpatient and 
outpatient charges across all payers to reestimate regression-based 
CCRs.
    We received many public comments on the issue of application of the 
disaggregated CCRs that RTI estimated using regression analysis to 
calculate payments for the CY 2008 OPPS. A summary of the public 
comments and our responses follow.
    Comment: The commenters made a number of requests for the CY 2008 
OPPS. Some commenters asked specifically that CMS use the RTI 
regression-based CCRs to calculate the costs of devices, implants, and 
drugs under the CY 2008 OPPS. Other commenters urged CMS not to apply 
this charge compression adjustment methodology to diagnostic radiology 
services because the application of the methodology to these capital 
intensive procedures has not been fully validated and would benefit 
from additional analysis. The commenters who supported the application 
of the adjustment methodology for CY 2008 asserted that CMS should 
disregard the fact that the estimated regression-based CCRs were 
calculated using only inpatient charge data because the commenters had 
found that using inpatient or outpatient charges yielded similar CCR 
estimates for implantable devices and all other supplies. These 
commenters believed that CMS should accept the RTI findings that were 
based on inpatient charges alone and apply them to the calculation of 
median costs for all OPPS weights. They explained that CMS could 
consider further refinements to the methodology in future years, such 
as estimating the regression-based CCRs using either outpatient or 
combined charges, but that CMS should not delay implementing this 
important change as it evaluates an all charges model.
    Some commenters who supported the application of the adjustment for 
CY 2008 also stated that the most glaring cases of charge compression 
occur with high cost implantable devices that are reported by hospitals 
with low cost supplies in the same supply cost center. They asserted 
that the need for analysis of the extent of a problem in other cost 
centers should not stop CMS from applying the estimated regression-
based CCRs for CY 2008 to charges for medical supplies, drugs, and 
radiology services. One commenter submitted a set of revised weights 
for all APCs reflecting regression-based CCRs for implantable devices 
and all other supplies, as well as its assumptions in developing the 
weights, and asked that CMS review the results. Some commenters stated 
that if CMS decides not to implement the RTI recommendations for 
regression-based CCRs for CY 2008, it should ensure that an all charges 
model is implemented in both the IPPS and the OPPS for CY 2009 through 
a joint IPPS/OPPS task force. Some commenters believed that CMS should 
either implement the regression-based adjustments in CY 2008 or begin a 
transition to them over a period of 2 to 3 years.
    The MedPAC recommended that CMS use the RTI's estimated 
disaggregated, regression-based CCRs for medical supplies, drugs, and 
radiology as part of the OPPS ratesetting process for CY

[[Page 66601]]

2008. It stated that, although the application of the regression based 
CCR estimates is not a perfect solution to the problem of charge 
compression, the possibility of payment inaccuracies is sufficiently 
serious that CMS should implement this imperfect solution. The MedPAC 
also recommended that if CMS prefers to await the results of the all 
charges model and chooses not to correct for the effects of charge 
compression under the CY 2008 OPPS, CMS must do so for the CY 2009 
OPPS.
    Response: While the RTI recommendations for regression-based CCRs 
may have the potential to address issues of charge compression raised 
in the public comments about OPPS cost-based weights, we are not 
sufficiently convinced that we should adopt the regression-based CCR 
estimates for the CY 2008 OPPS from the January 2007 RTI short-term 
recommendations for several reasons. First, the focus of the RTI study 
on inpatient charges did more than just restrict the regression model 
dependent variables to inpatient percentages. The study also limited 
the cost centers addressed to those where the inpatient charges 
comprised a significant portion of the cost center charges and 
substantially contributed to the DRGs. The RTI analysis did not examine 
cost centers that have a much greater proportion of outpatient charges, 
and as such, are particularly important to APC weights, while also 
potentially having a residual import for DRG weight calculations as 
well.
    Second, adoption of regression-based CCRs in this final rule with 
comment period would produce significant changes to the proposed APC 
payment rates beyond those already introduced with our CY 2008 
packaging approach. The lengthy discussion of public comments to our 
proposed packaging approach in section II.A.4. of this final rule with 
comment period reflects the public concern raised by a modest change in 
the methodology for estimating APC relative weights. Disaggregating 
drug and supply cost centers clearly would redistribute hospitals' 
resource costs among relative weights for different APCs. Estimated APC 
median costs calculated using regression-based CCRs for implantable 
devices and all other supplies, which were furnished by one commenter, 
showed increases for some services of as high as 28 percent, such as 
APC 0418 (Insertion of Left Ventricular Lead). Others would decline by 
as much as 11 percent, including APC 0674 (Prostate Cryoablation) and 
APC 0086 (Level III Electrophysiologic Procedures). An adjusted ``all 
other supply'' CCR would reduce the median cost of any service with 
significant supply packaging. Adoption of regression-based CCRs could 
interact with other potential changes to the APC payment groups under 
the OPPS. Budget neutrality adjustments could further increase the 
magnitude of these observed differences. We believe that these 
significant redistributional effects would have to be confirmed through 
CMS analysis, modeled, and made available for public comment should CMS 
decide to adopt regression-based CCRs.
    Third, we anticipate overall changes to our cost estimation 
methodology in the future, including changes to the revenue code-to-
cost center crosswalk and use of nonstandard cost centers. We believe 
that a comprehensive review of cost estimation is an appropriate time 
to explore the potential use of disaggregated CCRs for the OPPS. For 
example, if we implemented only select regression-based CCRs or 
crosswalk refinements, we could inappropriately redistribute weight 
within the system.
    Finally, as noted in the FY 2008 IPPS final rule (72 FR 47192 
through 47200), despite commenters' support for the disaggregated CCRs 
developed from regression analysis, we remain concerned about the 
accuracy of using regression-based estimates to determine relative 
weights rather than the Medicare cost report. This is especially true 
for the OPPS, given the potential redistribution of resource costs 
among services. One commenter noted that poor capital allocation to MRI 
and CT Scan revenue code charges could explain the observed differences 
in CCRs for these services, and a regression-based adjustment based on 
incorrect capital allocation would be equally inaccurate. As discussed 
in the FY 2008 IPPS final rule (72 FR 47196), we fully support 
voluntary educational initiatives to improve uniformity in reporting 
costs and charges on the cost report. Participation in these 
educational initiatives by hospitals is voluntary. Hospitals are not 
required to change how they report costs and charges if their current 
cost reporting practices are consistent with rules and regulations and 
applicable instructions. However, both the IPPS and OPPS relative 
weight estimates will benefit from any steps taken to improve cost 
reporting. To the extent allowed under current regulations and cost 
report instructions, we encourage hospitals to report costs and charges 
consistently with how the data are used to determine relative weights. 
We believe this goal is of mutual benefit to both Medicare and 
hospitals.
    In conclusion, we believe that it is important that the initial RTI 
estimation of regression-based CCRs be replicated with the inclusion of 
hospital outpatient charges, that the study examine the current OPPS 
revenue code-to-cost center crosswalk and the use of nonstandard cost 
centers, and that the analysis focus on the cost centers that have 
significant hospital outpatient charges. Regression-based CCRs may have 
potential to address issues of charge compression under the OPPS and 
possible mismatches between how costs and charges are reported in the 
cost reports and on OPPS claims. However, given the potential resulting 
change in APC weights and redistributional impact, we believe we would 
need to apply regression-based CCRs in all areas eligible for an 
adjustment, as well as implement appropriate crosswalk refinements, in 
order to not under-or overvalue relative weights within the system. We 
continue to have concerns about premature adoption of regression-based 
CCRs without the benefit of knowing how they would interact with other 
APC changes. We further believe that such methodological changes would 
need to be proposed, including presentation of our assessment of the 
possible impact of the methodology and solicitation of public comment. 
Once we have received the results of RTI's evaluation, we will analyze 
the findings and then consider whether it could be appropriate to 
propose to use regression-based CCRs under the OPPS. Once we have 
completed our analysis, we will then examine whether the educational 
activities being undertaken by the hospital community to improve cost 
reporting accuracy under the IPPS would help to mitigate charge 
compression under the OPPS, either as an adjunct to the application of 
regression-based CCRs or in lieu of such an adjustment. After the 
conclusion of our analysis of the RTI evaluation and our review of 
hospital educational activities, we will then determine whether any 
refinements should be proposed.
    Comment: One commenter indicated that the standard hospital 
accounting methodology for treatment of high capital costs, including 
the costs of expensive nonmovable radiology equipment, results in CCRs 
for radiology services that understate the true costs of radiology 
services because the high capital costs are spread over all departments 
of the hospital on a square footage basis. The commenter argued that 
this understatement of the costs in the CCR for radiology-related

[[Page 66602]]

departments results in calculated costs for radiology services that are 
too low because flawed CCRs are applied to the charges for the services 
provided by the radiology department.
    Response: We will consider the issue as part of our assessment of 
CCRs over the upcoming year, in the context of the RTI study as 
described earlier and the ongoing work that the hospital industry is 
undertaking with respect to cost reporting.
2. Calculation of Median Costs
    In this section of this final rule with comment period, we discuss 
the use of claims to calculate the final OPPS payment rates for CY 
2008. The hospital OPPS page on the CMS Web site on which this final 
rule with comment period is posted provides an accounting of claims 
used in the development of the final rates on the CMS Web site at: 
http://www.cms.hhs.gov/HospitalOutpatientPPS. The accounting of claims 
used in the development of this final rule with comment period is 
included on the Web site under supplemental materials for the CY 2008 
final rule with comment period. That accounting provides additional 
detail regarding the number of claims derived at each stage of the 
process. In addition, below we discuss the files of claims that 
comprise the data sets that are available for purchase under a CMS data 
user contract. Our CMS Web site, http://www.cms.hhs.gov/
HospitalOutpatientPPS, includes information about purchasing the 
following two OPPS data files: ``OPPS Limited Data Set'' and ``OPPS 
Identifiable Data Set.'' These files are available for both the claims 
that were used to calculate the proposed payment rates for the CY 2008 
OPPS and also for the claims that were used to calculate the final 
payment rates for the CY 2008 OPPS.
    As proposed, we used the following methodology to establish the 
relative weights used in calculating the OPPS payment rates for CY 2008 
shown in Addenda A and B to this final rule with comment period. This 
methodology is as follows:
a. Claims Preparation
    We used hospital outpatient claims for the full CY 2006, processed 
before June 30, 2007, to set the final relative weights for CY 2008. To 
begin the calculation of the relative weights for CY 2008, we pulled 
all claims for outpatient services furnished in CY 2006 from the 
national claims history file. This is not the population of claims paid 
under the OPPS, but all outpatient claims (including, for example, CAH 
claims and hospital claims for clinical laboratory services for persons 
who are neither inpatients nor outpatients of the hospital).
    We then excluded claims with condition codes 04, 20, 21, and 77. 
These are claims that providers submitted to Medicare knowing that no 
payment would be made. For example, providers submit claims with a 
condition code 21 to elicit an official denial notice from Medicare and 
document that a service is not covered. We then excluded claims for 
services furnished in Maryland, Guam, the U.S. Virgin Islands, American 
Samoa, and the Northern Mariana Islands because hospitals in those 
geographic areas are not paid under the OPPS.
    We divided the remaining claims into the three groups shown below. 
Groups 2 and 3 comprise the 108 million claims that contain hospital 
bill types paid under the OPPS.
    1. Claims that were not bill types 12X, 13X, 14X (hospital bill 
types), or 76X (CMHC bill types). Other bill types are not paid under 
the OPPS and, therefore, these claims were not used to set OPPS 
payment.
    2. Claims that were bill types 12X, 13X, or 14X (hospital bill 
types). These claims are hospital outpatient claims.
    3. Claims that were bill type 76X (CMHC). (These claims are later 
combined with any claims in item 2 above with a condition code 41 to 
set the per diem partial hospitalization rate determined through a 
separate process.)
    For the CCR calculation process, we used the same general approach 
as we used in developing the final APC rates for CY 2007, using the 
revised CCR calculation which excluded the costs of paramedical 
education programs and weighted the outpatient charges by the volume of 
outpatient services furnished by the hospital. We refer readers to the 
CY 2007 OPPS/ASC final rule with comment period for more information 
(71 FR 67983 through 67985). We first limited the population of cost 
reports to only those for hospitals that filed outpatient claims in CY 
2006 before determining whether the CCRs for such hospitals were valid.
    We then calculated the CCRs for each cost center and the overall 
CCR for each hospital for which we had claims data. We did this using 
hospital-specific data from the Healthcare Cost Report Information 
System (HCRIS). We used the most recent available cost report data, in 
most cases, cost reports for CY 2005. As proposed, for this final rule 
with comment period, we used the most recently submitted cost reports 
to calculate the CCRs to be used to calculate median costs for the CY 
2008 OPPS rates. If the most recent available cost report was submitted 
but not settled, we looked at the last settled cost report to determine 
the ratio of submitted to settled cost using the overall CCR, and we 
then adjusted the most recent available submitted but not settled cost 
report using that ratio. We calculated both an overall CCR and cost 
center-specific CCRs for each hospital. We used the final overall CCR 
calculation discussed in section II.A.1.c. of this final rule with 
comment period for all purposes that required use of an overall CCR.
    We then flagged CAH claims, which are not paid under the OPPS, and 
claims from hospitals with invalid CCRs. The latter included claims 
from hospitals without a CCR; those from hospitals paid an all-
inclusive rate; those from hospitals with obviously erroneous CCRs 
(greater than 90 or less than .0001); and those from hospitals with 
overall CCRs that were identified as outliers (3 standard deviations 
from the geometric mean after removing error CCRs). In addition, we 
trimmed the CCRs at the cost center (that is, departmental) level by 
removing the CCRs for each cost center as outliers if they exceeded +/-
3 standard deviations from the geometric mean. We used a four tiered 
hierarchy of cost center CCRs to match a cost center to every possible 
revenue code appearing in the outpatient claims, with the top tier 
being the most common cost center and the last tier being the default 
CCR. If a hospital's cost center CCR was deleted by trimming, we set 
the CCR for that cost center to ``missing'' so that another cost center 
CCR in the revenue center hierarchy could apply. If no other cost 
center CCR could apply to the revenue code on the claim, we used the 
hospital's overall CCR for the revenue code in question. For example, 
if a visit was reported under the clinic revenue code, but the hospital 
did not have a clinic cost center, we mapped the hospital-specific 
overall CCR to the clinic revenue code. The hierarchy of CCRs is 
available for inspection and comment on the CMS Web site: http://www.cms.hhs.gov/HospitalOutpatientPPS. We then converted the charges to 
costs on each claim by applying the CCR that we believed was best 
suited to the revenue code indicated on the line with the charge. Table 
4 of the proposed rule contained a list of the revenue codes we 
proposed to package. Revenue codes not included in Table 4 were those 
not allowed under the OPPS because their services could not be paid 
under the OPPS (for example, inpatient room and

[[Page 66603]]

board charges), and thus charges with those revenue codes were not 
packaged for creation of the OPPS median costs. One exception is the 
calculation of median blood costs, as discussed in section X. of this 
final rule with comment period.
    Thus, we applied CCRs as described above to claims with bill types 
12X, 13X, or 14X, excluding all claims from CAHs and hospitals in 
Maryland, Guam, the U.S. Virgin Islands, American Samoa, and the 
Northern Mariana Islands and claims from all hospitals for which CCRs 
were flagged as invalid.
    We identified claims with condition code 41 as partial 
hospitalization services of hospitals and moved them to another file. 
These claims were combined with the 76X claims identified previously to 
calculate the partial hospitalization per diem rate.
    We then excluded claims without a HCPCS code. We moved to another 
file claims that contained nothing but influenza and pneumococcal 
pneumonia (``PPV'') vaccines. Influenza and PPV vaccines are paid at 
reasonable cost and, therefore, these claims are not used to set OPPS 
rates. We note that the separate file containing partial 
hospitalization claims is included in the files that are available for 
purchase as discussed above. Unlike years past, we did not create a 
separate file of claims containing observation services because we are 
packaging all observation care for the CY 2008 OPPS.
    We next copied line-item costs for drugs, blood, and brachytherapy 
sources (the lines stay on the claim, but are copied onto another file) 
to a separate file. No claims were deleted when we copied these lines 
onto another file. These line-items are used to calculate a per unit 
mean and median and a per day mean and median for drugs, 
radiopharmaceutical agents, blood and blood products, and brachytherapy 
sources, as well as other information used to set payment rates, such 
as a unit-to-day ratio for drugs.
b. Splitting Claims and Creation of ``Pseudo'' Single Claims.
    We then split the claims into five groups: single majors, multiple 
majors, single minors, multiple minors, and other claims. (Specific 
definitions of these groups follow below.) In years prior to the CY 
2007 OPPS, we made a determination about whether each HCPCS code was a 
major code or a minor code or a code other than a major or minor code. 
We used those code-specific determinations to sort claims into the five 
groups identified above. For the CY 2007 OPPS, we used status 
indicators to sort the claims into these groups. We defined major 
procedures as any procedure having a status indicator of ``S,'' ``T,'' 
``V,'' or ``X;'' defined minor procedures as any code having a status 
indicator of ``N;'' and classified ``other'' procedures as any code 
having a status indicator other than ``S,'' ``T,'' ``V,'' ``X,'' or 
``N.'' For the CY 2007 OPPS proposed rule limited data set and 
identifiable data set, these definitions excluded claims on which 
hospitals billed drugs and devices without also reporting separately 
paid procedure codes and, therefore, those public use files did not 
contain all claims used to calculate the drug and device frequencies 
and medians. We corrected this for the CY 2007 OPPS/ASC final rule with 
comment period limited data set and identifiable data set by extracting 
claims containing drugs and devices from the set of ``other'' claims 
and adding them to the public use files.
    At its March 2007 meeting, the APC Panel recommended that CMS edit 
and return for correction claims that contain a HCPCS code for a 
separately paid drug or device but that also do not contain a HCPCS 
code assigned to a procedural APC (that is, those not assigned status 
indicator ``S,'' ``T,'' ``V,'' or ``X''). The APC Panel stated that 
this edit should improve the claims data and may increase the number of 
single bills available for ratesetting. We noted that such an edit 
would be broader than the device-to-procedure code edits we implemented 
for CY 2007 for selected devices, and we solicited comments on the 
impact of establishing such edits on hospital billing processes and 
related potential improvements to claims data. In the CY 2008 proposed 
rule (72 FR 42645), we explained that in view of the prior public 
comments and our desire to ensure that the public data files contained 
all appropriate data, for the CY 2008 OPPS, we proposed to define 
majors as HCPCS codes that have a status indicator of ``S,'' ``T,'' 
``V,'' or ``X.'' We proposed to define minors as HCPCS codes that have 
a status indicator of ``F,'' ``G,'' ``H,'' ``K,'' ``L,'' or ``N'' but, 
as discussed above, to make single bills out of any claims for single 
procedures with a minor code that also has an APC assignment. This 
ensured that the claims that contained only HCPCS codes for drugs and 
biologicals or devices but that did not contain codes for procedures 
were included in the limited data set and the identifiable data set. It 
also ensured that conditionally packaged services proposed to receive 
separate payment only when they were billed without any other 
separately payable OPPS services would be treated appropriately for 
purposes of median cost calculations. We proposed to define ``other'' 
services as HCPCS codes that had a status indicator other than those 
defined as majors or minors.
    We received several public comments regarding our proposal to 
continue to process OPPS claims for a separately paid drug or device 
that did not also report a procedural HCPCS code with a status 
indicator of ``S,'' ``T,'' ``V,'' or ``X.'' A summary of the public 
comments and our responses follow.
    Comment: Several commenters requested that we adopt the 
recommendation of the APC Panel that CMS edit and return for correction 
claims that contained a HCPCS code for a separately paid drug or device 
but that did not also report a HCPCS code with a status indicator of 
``S,'' ``T,'' ``V,'' or ``X.'' These commenters believed that this 
process would generally improve hospitals' coding and charging 
practices. One commenter indicated that, under some circumstances, a 
hospital may bill for a diagnostic radiopharmaceutical that is 
administered on one day but may not report the associated nuclear 
medicine procedure on the same claim because the procedure would be 
provided several days later. In this case, the bill for the diagnostic 
radiopharmaceutical would include no other services with a status 
indicator of ``S,'' ``T,'' ``V,'' or ``X'' because the administration 
of the radiopharmaceutical would be considered to be a part of the 
nuclear medicine study.
    Response: We have accepted this recommendation in selective 
situations. We currently edit claims in the Outpatient Code Editor 
(OCE) for selected devices for which our data show that hospitals have 
a history of reporting the HCPCS device code but not reporting the 
HCPCS procedure code that is necessary for the device to have 
therapeutic benefit. See the device-to-procedure edits on the OPPS Web 
page at http://www.cms.hhs.gov/HospitalOutpatientPPS/. Moreover, as 
discussed in more detail in section II.A.4.c.(5) of this final rule 
with comment period, effective for dates of service on or after January 
1, 2008, we will implement OCE edits for diagnostic nuclear medicine 
services that will require that a HCPCS code for a diagnostic 
radiopharmaceutical must be on the claim for the claim to be processed 
to payment. Claims will be returned to the provider for correction if 
they contain a nuclear medicine service but the hospital does not also 
report a radiopharmaceutical on the same claim. We will continue to 
assess the need for OCE edits based upon the unique

[[Page 66604]]

circumstances of individual services or categories of services.
    In the CY 2008 proposed rule (72 FR 42645), we explained our 
continued belief that using status indicators, with the proposed 
changes, was an appropriate way to sort the claims into these groups 
and also to make our process more transparent to the public. We further 
believed that this proposed method of sorting claims would enhance the 
public's ability to derive useful information for analysis and public 
comment on the proposed rule.
    We used status indicator ``Q'' in Addendum B to the proposed rule 
to identify services that would receive separate HCPCS code-specific 
payment when specific criteria are met, and payment for the individual 
service would be packaged in all other circumstances. We proposed 
several different sets of criteria to determine whether separate 
payment would be made for specific services. For example, we proposed 
that HCPCS code G0379 (Direct admission of patient for hospital 
observation care) be assigned status indicator ``Q'' in Addendum B to 
the proposed rule because we proposed that it receive separate payment 
only if it is billed on the same date of service as HCPCS code G0378 
(Hospital observation service, per hour), without any services with 
status indicator ``T'' or ``V'' or Critical Care (APC 0617). We also 
proposed to assign the specific services in the proposed composite APCs 
discussed in section II.A.4.d. of the proposed rule status indicator 
``Q'' in Addendum B to the proposed rule because we proposed that their 
payment would be bundled into a single composite payment for a 
combination of major procedures under certain circumstances. As 
proposed, these services would only receive separate code-specific 
payment if certain criteria were met. The same is true for those less 
intensive outpatient mental health treatment services for which payment 
would be limited to the partial hospitalization per diem rate and which 
also were assigned status indicator ``Q'' in Addendum B to the proposed 
rule. According to longstanding OPPS payment policy (65 FR 18455), 
payment for these individual mental health services is bundled into a 
single payment, APC 0034 (Mental Health Services Composite), when the 
sum of the individual mental health service payments for all of those 
mental health services provided on the same day would exceed payment 
for a day of partial hospitalization services. However, the largest 
number of specific HCPCS codes identified by status indicator ``Q'' in 
Addendum B to the proposed rule were those codes that we identified as 
``special'' packaged codes, where we proposed that a hospital would 
receive separate payment for providing one unit of a service when the 
``special'' packaged code appears on the same day on a claim without 
another service that was assigned status indicator ``S,'' ``T,'' ``V,'' 
or ``X.'' We proposed to package payment for these HCPCS codes when the 
code appears on the same date of service on a claim with any other 
service that was assigned status indicator ``S,'' ``T,'' ``V,'' or 
``X.''
    In response to public comments as discussed in detail in section 
II.A.4. of this final rule with comment period, we refined the proposed 
methodology for paying claims that contain ``special'' packaged codes 
with status indicator ``Q'' when there is a major separately paid 
procedure on the claim for the same date and when there are multiple 
``special'' packaged codes with status indicator ``Q'' but no major 
procedure on the claim. This last and largest subset of conditionally 
packaged services, referred to as ``special'' packaged codes in the 
proposed rule, had to be integrated into the identification of single 
and multiple bills for ratesetting to ensure that the costs for these 
services were appropriately packaged when they appeared with any other 
separately paid service or paid separately when appearing by 
themselves.
    We handled these ``special'' packaged ``Q'' status codes in the 
data for this final rule with comment period by assigning the HCPCS 
code an APC and a data status indicator of ``N.'' This gives all 
special packaged codes an initial status of ``minor'' that is changed, 
when appropriate, through the split process. We identified two subsets 
of the ``special'' packaged codes for the purpose of payment and 
ratesetting. Imaging supervision and interpretation ``special'' 
packaged codes are now named ``T-packaged'' codes. All other 
``special'' packaged codes are referred to as ``STVX-packaged'' codes. 
When an ``STVX-packaged'' code appeared with a HCPCS code with a status 
indicator of ``S,'' ``T,'' ``V,'' or ``X'' on the same date of service, 
it retained its minor status and was treated as a packaged code and 
received a status indicator of ``N.'' The costs that appeared on the 
lines with these codes were packaged into the cost of the HCPCS code 
with a status indicator of ``S,'' ``T,'' ``V,'' or ``X'' in the single 
bills and contributed to the median cost for the primary service with 
which they appeared. When the ``STVX packaged'' code appeared by 
itself, without other special packaged codes on the same claim, and had 
a unit of one, we changed the status indicator on the line to the 
status indicator of the APC to which the code was assigned, converting 
the service from a single minor to a single major. This created 
``natural'' single bills for the ``STVX-packaged'' codes. In the case 
of multiple ``STVX-packaged'' codes reported on a claim on the same 
date of service but without a major separately paid procedure (that is, 
``S,'' ``T,'' ``V,'' or ``X''), we first identified the ``STVX-
packaged'' code with the highest CY 2007 OPPS payment weight. We then 
changed the status indicator on the line to the status indicator of the 
APC to which this particular code was assigned, converting the service 
from a single minor to a single major, and we forced the units to be 
one to conform with our policy of paying only one unit of a ``Q'' 
status service. We extracted these claims from the multiple minors to 
create ``pseudo'' single bills. We summed all costs on the claim and 
associated the resulting cost with the payable ``STVX-packaged'' code 
that had the highest CY 2007 OPPS payment weight. We used natural and 
``pseudo'' single procedure claims for ``STVX-packaged'' codes to set 
the median costs for the APCs to which the codes were assigned when 
they would be separately paid.
    We modified this methodology for the ``T-packaged'' codes (imaging 
supervision and interpretation services in CY 2008) because our final 
CY 2008 payment policy for these services differs from the policy for 
``STVX-packaged'' codes. Although we treated all ``special'' packaged 
codes as ``STVX-packaged'' codes in the proposed rule, in this final 
rule with comment period, ``T-packaged'' services are packaged only 
when they appear with a service with a status indicator of ``T'' on the 
same date; otherwise, ``T packaged'' services are paid separately. We 
assessed all claims for the presence of ``T packaged'' services and 
determined their final payment disposition, packaged or separately 
paid, prior to splitting the claims into single and multiple majors and 
minors. When a ``T-packaged'' code appeared with a HCPCS code with a 
status indicator of ``T'' on the same date of service, the ``T-
packaged'' code was treated as a packaged code and retained its minor 
status and a status indicator of ``N.'' Otherwise, we designated a ``T-
packaged'' service that would be separately paid by identifying the 
``T-packaged'' code on the date of service with the highest CY 2007 
payment weight. We changed the status indicator on the line of the ``T-
packaged'' code with the highest CY 2007 payment weight to the status 
indicator of the APC

[[Page 66605]]

to which the code was assigned, converting it from a single minor to a 
single major. We forced the units to be one to conform with our policy 
of paying only one unit of a service with a status indicator of ``Q.'' 
Any remaining ``T-packaged'' codes appearing on the same date of 
service retained their minor status and a status indicator of ``N.'' In 
the single and ``pseudo'' single bills, the costs that appeared on the 
lines with these codes were packaged into the cost of the HCPCS code 
with a status indicator of ``T.'' The remaining claims, ``T-packaged'' 
services on claims with another service with a status indicator of 
``S,'' ``V,'' or ``X'' on the same date, became multiple majors. The 
bypass process for breaking multiple major claims created additional 
``pseudo'' single bills for the ``T-packaged'' codes that had been 
converted to major status. When the ``T-packaged'' code appeared by 
itself with packaged services and one unit, we changed the status 
indicator on the line to the status indicator of the APC to which the 
code was assigned, converting the service to a single major procedure. 
In the case of multiple ``T-packaged'' codes reported on a claim on the 
same date of service but without a major separately paid procedure 
(``S,'' ``T,'' ``V,'' or ``X''), we summed all costs on the claim, 
associated the resulting cost with the ``T-packaged'' or ``STVX-
packaged'' code that had the highest 2007 OPPS payment weight, and 
forced the units to one. We extracted these claims from the multiple 
minors to created new single bills. These processes created ``natural'' 
and ``pseudo'' single bills for the ``T-packaged'' codes that were then 
used to set the median cost for each specific code and for the APCs to 
which the codes would be assigned when they were separately paid.
    We added the logic necessary to deal with these codes as part of 
the split of the claims into the five groups defined below and in our 
review of the multiple minor claims. We evaluated the ``T-packaged'' 
codes that had been on the bypass list to see if they might be eligible 
for continuation on the list, as these codes would appear with their 
final payment disposition in the multiple majors. However, we 
determined that none of these codes should be returned to the bypass 
list because their associated packaging under their CY 2008 ``Q'' 
payment status exceeded the empirical criteria designed to limit error 
in the allocation of packaged costs through the bypass process.
    Specifically, we divided the remaining claims into the following 
five groups:
    1. Single Major Claims: Claims with a single separately payable 
procedure (that is, status indicator ``S,'' ``T,'' ``V,'' or ``X''). 
Claims with one unit of a status indicator ``Q'' code that was an 
``STVX-packaged'' code or ``T-packaged'' code where there was no code 
on the claim with status indicator ``S,'' ``T,'' `` V,'' or ``X,'' or 
``T,'' respectively.
    2. Multiple Major Claims: Claims with more than one separately 
payable procedure (that is, status indicator ``S,'' ``T,'' ``V,'' or 
``X''), or multiple units of one payable procedure. As discussed below, 
some of these were used in median setting. These claims included those 
with a status indicator ``Q'' code that was a ``T-packaged'' code and 
no procedure with a status indicator ``T'' on the same date of service. 
We also included in this set claims that contained one unit of one code 
when the bilateral modifier was appended to the code and the code was 
conditionally or independently bilateral. In these cases, the claims 
represented more than one unit of the service described by the code, 
notwithstanding that only one unit was billed.
    3. Single Minor Claims: Claims with a single HCPCS code that was 
assigned status indicator ``F,'' ``G,'' ``H,'' ``K,'' ``L,'' or ``N'' 
and was not an ``STVX-packaged'' or ``T packaged code.''
    4. Multiple Minor Claims: Claims with multiple HCPCS codes that 
were assigned status indicator ``F,'' ``G,'' ``H,'' ``K,'' ``L,'' or 
``N.'' This set included ``STVX packaged'' and ``T-packaged'' codes 
with more than one unit of the code or more than one line of these 
codes on the same date of service. As noted above, we created 
``pseudo'' singles from some of these claims when we broke the claim by 
date, packaged the costs into the code with the highest CY 2007 payment 
weight, and forced the units to one to match our payment policy of 
paying one unit.
    5. Non-OPPS Claims: Claims that contained no services payable under 
the OPPS (that is, all status indicators other than those listed for 
major or minor status). These claims were excluded from the files used 
for the OPPS. Non-OPPS claims have codes paid under other fee 
schedules, for example, durable medical equipment or clinical 
laboratory tests, and do not contain either a code for a separately 
paid service or a code for a packaged service.
    The claims listed in numbers 1, 2, 3, and 4 above were included in 
the data files that can be purchased as described above. ``STVX-
packaged'' and ``T-packaged'' codes appear in the single major file, 
the multiple major file, and the multiple minor file.
    We set aside the single minor, multiple minor, and non-OPPS claims 
(numbers 3, 4, and 5 above) because we did not use these claims in 
calculating median costs of procedural APCs. We then used the bypass 
codes listed earlier in Table 1 and discussed in section II.A.1.b. of 
this final rule with comment period to remove separately payable 
procedures that we determined contained limited or no packaged costs or 
that were otherwise suitable for inclusion on the bypass list from a 
multiple procedure bill. When one of the two separately payable 
procedures on a multiple procedure claim was on the bypass list, we 
split the claim into two ``pseudo'' single procedure claim records. The 
single procedure claim record that contained the bypass code did not 
retain packaged services. The single procedure claim record that 
contained the other separately payable procedure (but no bypass code) 
retained the packaged revenue code charges and the packaged HCPCS code 
charges. We then examined the multiple major claims for dates of 
service to determine if we could break them into ``pseudo'' single 
procedure claims using the dates of service on all lines on the claim. 
If we could create claims with single major procedures by using dates 
of service, we created a single procedure claim record for each 
separately paid procedure on a different date of service (that is, a 
``pseudo'' single).
    We also removed lines that contained multiple units of codes on the 
bypass list and treated them as ``pseudo'' single claims by dividing 
the cost for the multiple units by the number of units on the line. 
Where one unit of a single, separately paid procedure code remained on 
the claim after removal of the multiple units of the bypass code, we 
created a ``pseudo'' single claim from that residual claim record, 
which retained the costs of packaged revenue codes and packaged HCPCS 
codes. This enabled us to use claims that would otherwise be multiple 
procedure claims and could not be used. We excluded those claims that 
we were not able to convert to single claims even after applying all of 
the techniques for creation of ``pseudo'' singles. Among those excluded 
were claims that contained codes that were viewed as independently or 
conditionally bilateral and that contained the bilateral modifier 
(Modifier 50 (Bilateral procedure)) because the line-item cost for the 
code represented the cost of two units of the procedure, 
notwithstanding that the code appeared with a unit of one. Therefore, 
the charge on the line

[[Page 66606]]

represented the charge for two services rather than a single service 
and using the line as reported would have overstated the cost of a 
single procedure.
c. Completion of Claim Records and Median Cost Calculations
    We then packaged the costs of packaged HCPCS codes (codes with 
status indicator ``N'' listed in Addendum B to the proposed rule and 
the costs of those lines for ``Q'' status services that retained status 
indicator ``N'' through the split process as described above) and 
packaged revenue codes into the cost of the single major procedure 
remaining on the claim.
    The final list of packaged revenue codes is shown in Table 2 below. 
At its March 2007 meeting, the APC Panel recommended that CMS review 
the final list of packaged revenue codes for consistency with OPPS 
policy and ensure that future versions of the OCE edit accordingly. We 
compared the packaged revenue codes in the OCE to the final list of 
packaged revenue codes for the CY 2007 OPPS (71 FR 67989 through 67990) 
that we used for packaging costs in median calculation. As a result of 
that analysis, we stated in the CY 2008 OPPS/ASC proposed rule (72 RF 
42646) that we accepted the APC Panel's recommendation and we proposed 
to change the list of packaged revenue codes for the CY 2008 OPPS in 
the following manner. First, we proposed to remove revenue codes 0274 
(Prosthetic/Orthotic devices) and 0290 (Durable Medical Equipment) from 
the list of packaged revenue codes because we do not permit hospitals 
to report implantable devices in these revenue codes (Internet Only 
Manual 100-4, Chapter 4, section 20.5.1.1). We also specifically 
proposed to add revenue code 0273 (Take Home Supplies) to the list of 
packaged revenue codes because we believed that the charges under this 
revenue code were for the incidental supplies that hospitals sometimes 
provided for patients who were discharged at a time when it was not 
possible to secure the supplies needed for a brief time at home. We 
proposed to conform the list of packaged revenue codes in the OCE to 
the OPPS for CY 2008. We made these changes in the calculation of the 
CY 2008 OPPS payment rates. The final CY 2008 packaged revenue codes 
are displayed in Table 2 below.
    We packaged the costs of the HCPCS codes that were shown with 
status indicator ``N'' into the cost of the independent service to 
which the packaged service was ancillary or supportive. We refer 
readers to section II.A.4. of this final rule with comment period for a 
more complete discussion of the final packaging changes for CY 2008.
    We also excluded (1) claims that had zero costs after summing all 
costs on the claim and (2) claims containing packaging flag number 3. 
Effective for services furnished on or after July 1, 2004, the OCE 
assigned packaging flag number 3 to claims on which hospitals submitted 
token charges for a service with status indicator ``S'' or ``T'' (a 
major separately paid service under the OPPS) for which the fiscal 
intermediary was required to allocate the sum of charges for services 
with a status indicator equaling ``S'' or ``T'' based on the weight of 
the APC to which each code was assigned. We did not believe that these 
charges, which were token charges as submitted by the hospital, were 
valid reflections of hospital resources. Therefore, we deleted these 
claims. We also deleted claims for which the charges equaled the 
revenue center payment (that is, the Medicare payment) on the 
assumption that where the charge equaled the payment, to apply a CCR to 
the charge would not yield a valid estimate of relative provider cost.
    For the remaining claims, we then standardized 60 percent of the 
costs of the claim (which we have previously determined to be the 
labor-related portion) for geographic differences in labor input costs. 
We made this adjustment by determining the wage index that applied to 
the hospital that furnished the service and dividing the cost for the 
separately paid HCPCS code furnished by the hospital by that wage 
index. As has been our policy since the inception of the OPPS, we used 
the pre reclassified wage indices for standardization because we 
believed that they better reflected the true costs of items and 
services in the area in which the hospital was located than the post 
reclassification wage indices and, therefore, would result in the most 
accurate unadjusted median costs.
    We also excluded claims that were outside 3 standard deviations 
from the geometric mean of units for each HCPCS code on the bypass list 
(because, as discussed above, we used claims that contain multiple 
units of the bypass codes).
    After removing claims for hospitals with error CCRs, claims without 
HCPCS codes, claims for immunizations not covered under the OPPS, and 
claims for services not paid under the OPPS, approximately 58 million 
claims were left for this final rule comment period. Of these 58 
million claims, we were able to use some portion of approximately 54 
million whole claims (93 percent of approximately 58 million 
potentially usable claims) to create approximately 97 million single 
and ``pseudo'' single claims, of which we used 96 million single bills 
(after trimming out just over 900,000 claims as discussed below) in the 
CY 2008 median development and ratesetting.
    We used the remaining claims to calculate the CY 2008 median costs 
for each separately payable HCPCS code and each APC. The comparison of 
HCPCS and APC medians determines the applicability of the ``2 times'' 
rule. Section 1833(t)(2) of the Act provides that, subject to certain 
exceptions, the items and services within an APC group cannot be 
considered comparable with respect to the use of resources if the 
highest median (or mean cost, if elected by the Secretary) for an item 
or service in the group is more than 2 times greater than the lowest 
median cost for an item or service within the same group (``the 2 times 
rule''). Finally, we reviewed the medians and reassigned HCPCS codes to 
different APCs where we believed that it was appropriate. Section III. 
of this final rule with comment period includes a discussion of certain 
HCPCS code assignment changes that resulted from examination of the 
medians and for other reasons. The APC medians were recalculated after 
we reassigned the affected HCPCS codes. Both the HCPCS medians and the 
APC medians were weighted to account for the inclusion of multiple 
units of the bypass codes in the creation of ``pseudo'' single bills.
    In the CY 2008 proposed rule (72 FR 42646), we explained that in 
our review of median costs for HCPCS codes and their assigned APCs, we 
had frequently noticed that some services were consistently rarely 
performed in the hospital outpatient setting for the Medicare 
population. In particular, there were a number of services, such as 
several procedures related to the care of pregnant women, that had 
annual Medicare claims volume of 100 or fewer occurrences. By 
definition, these services also had a small number of single bills from 
which to estimate median costs. In addition, in some cases, these codes 
had been historically assigned to clinical APCs where all the services 
were low volume. Therefore, the median costs for these services and 
APCs often fluctuated from year to year, in part due to the variability 
created by such a small number of claims. One of the benefits of basing 
payment on the median cost of many HCPCS codes with sufficient single 
bill representation in an APC is that such fluctuation would be 
moderated by the increased number of observations for similar services 
on

[[Page 66607]]

which the APC median cost was also based. We considered proposing a 
distinct methodology for calculation of the median cost of low total 
volume APCs in order to provide more stability in payment from year to 
year for these low total volume services. However, after examination of 
the low total volume OPPS services and their assigned APCs, we 
concluded that there were other clinical APCs with higher volumes of 
total claims to which these low total volume services could be 
reassigned, while ensuring the continued clinical and resource 
homogeneity of the clinical APCs to which they would be newly 
reassigned. Therefore, we believed that it would be more appropriate to 
reconfigure clinical APCs to eliminate most of the low total volume 
APCs. We observed that these low volume services differed from other 
OPPS services only because they were not often furnished to the 
Medicare population. Therefore, we proposed to reconfigure certain 
clinical APCs for CY 2008 as a way to promote stability and appropriate 
payment for the services assigned to them, including low total volume 
services. We believed that these proposed reconfigurations maintained 
APC clinical and resource homogeneity. We proposed these changes as an 
alternative to developing specific quantitative approaches to treating 
low total volume APCs differently for purposes of median calculation. 
Specifically, we proposed that 3 APCs (all of which are New Technology 
APCs) would have a total volume of services less than 100, and only 17 
APCs would have a total volume of less than 1,000, in comparison with 
CY 2007 where 9 APCs (including 3 New Technology APCs) had a total 
volume of less than 100 and 36 APCs had a total volume of less than 
1,000. In this final rule with comment period, 3 APCs (all New 
Technology APCs) have a total volume of less than 100 and 15 APCs have 
a total volume of less than 1,000.
    We received a number of public comments on our proposed process for 
calculating the median costs on which our payment rates are based. A 
summary of the pubic comments and our responses follow.
    Comment: Some commenters objected to the volatility of the OPPS 
rates from year to year. The commenters asserted that the absence of 
stability in the OPPS rates creates budgeting, planning, and operating 
problems for hospitals, and that as more care is provided on an 
outpatient, rather than inpatient basis, the need for stable payment 
rates from one year to the next becomes more important to hospitals. 
Some commenters asked that CMS permit no payment rate to change by more 
than 5 percent from one year to the next.
    Response: There are a number of factors pertinent to the OPPS that 
cause median costs to change from one year to the next. Some of these 
are a reflection of hospital behavior, and some of them are a 
reflection of fundamental characteristics of the OPPS as defined in 
statute. For example, the OPPS payment rates are based on hospital cost 
report and claims data. However, hospital costs and charges change each 
year and this results in both changes to the CCRs taken from the most 
currently available cost reports and also differences in the charges on 
the claims that are the basis of the calculation of the median costs on 
which OPPS rates are based. Similarly, hospitals adjust their mix of 
services from year to year by offering new services and ceasing to 
furnish services or changing the proportion of the various services 
they furnish, which has impact on the CCRs that we derive from their 
cost reports. CMS cannot stabilize these hospital-driven fundamental 
inputs to the calculation of OPPS payment rates. Moreover, there are 
other essential elements of the OPPS which contribute to the changes in 
relative weights each year. These include, but are not limited to, 
reassignments of HCPCS codes to APCs to rectify 2 times violations as 
required by the law, to address the costs of new services, and to 
respond to public comments. Moreover, for some services, we cannot 
avoid using small numbers of claims, either because the volume of 
services is naturally low or because the claims data do not facilitate 
the calculation of a median cost for a single service. Where there are 
small numbers of claims to be used in median calculation, there is more 
volatility in the median cost from one year to the next. Lastly, 
changes to OPPS payment policy (for example, changes to packaging) also 
contribute to some extent to the fluctuations in the OPPS payment rates 
for the same service from year to year.
    We cannot avoid the naturally occurring volatility in the cost 
report and claims data that hospitals submit and on which the payment 
rates are based. Moreover (with limited exceptions), we are required by 
law to reassign HCPCS codes to APCs where it is necessary to avoid 2 
times violations. However, we have made other changes to resolve some 
of the other potential reasons for instability from year to year. 
Specifically, we continue to seek ways to use more claims data so that 
we have fewer APCs for which there are small numbers of single bills 
used to set the APC median costs. Moreover, we have tried to eliminate 
APCs with very small numbers of single bills where we could do so. We 
received no public comments that objected to our proposal to eliminate 
a number of very low volume APCs; therefore, we are adopting these 
reconfigurations for CY 2008. We recognize that changes to payment 
policies, such as the packaging of payment for ancillary and supportive 
services and the implementation of composite APCs, may contribute to 
volatility in payment rates in the short term, but we believe that 
larger payment packages and bundles will help to stabilize payments in 
future years by enabling us to use more claims data and by establishing 
payments for larger groups of services.
    Comment: A commenter stated that CMS should crosswalk revenue code 
0278 (Other implants, under the Medical/Surgical Supplies category) to 
cost center 3540 (Prosthetic Devices), which generally represents 
higher cost technology, instead of crosswalking it to cost center 5500 
(Medical Supplies Charge to Patient), which often represents lower cost 
items. The commenter indicated that this change to the revenue code-to-
cost center crosswalk would result in improved estimates of the costs 
of the devices billed under revenue code 0278 and, therefore, would 
result in more accurate payments.
    Response: We will carefully examine the implications of making this 
change in the future. However, for CY 2008 this change would have a 
negligible effect on the median costs for services with charges 
reported under revenue code 0278. Only 20 providers out of 4,201 in the 
file of the 2005-2006 cost reports used cost center 3540.
    Comment: Some commenters asked that CMS provide an adjustment for 
medical education costs under the OPPS because so much of the costs of 
teaching services are being incurred in the HOPD as many of the 
services previously furnished only in the inpatient setting are now 
being furnished in the HOPD. The commenters stated that CMS indicated 
that it would study the costs and payment differential among different 
classes of providers in the April 7, 2000 OPPS final rule with comment 
period but has not done so. The commenters also asserted that section 
4523 of the BBA requires the Secretary to establish adjustments ``as 
determined to be necessary to ensure equitable payments * * * for 
certain classes of hospitals'' and, therefore, CMS should study whether 
the hospital outpatient costs of teaching hospitals are higher than the 
costs of other hospitals for purposes of determining whether there 
should be a teaching

[[Page 66608]]

hospital adjustment. The commenters explained that their internal 
analysis of 2004 Medicare cost reports showed that the average 
outpatient margins were -20.2 percent for major teaching hospitals, -
10.1 percent for other teaching hospitals, and -11.8 percent for non-
teaching hospitals. They believed these findings demonstrated that the 
hospital outpatient costs of major teaching hospitals are significantly 
greater than the costs of other hospitals. The commenters requested 
that CMS conduct its own analysis, and added that if that analysis 
shows such a difference, CMS should add a teaching adjustment to the 
OPPS.
    Response: Unlike payment under the IPPS, the law does not provide 
for payment for indirect medical education costs to be made through the 
OPPS. Section 1833(t)(2)(E) of the Act, as added by section 4523 of the 
BBA, states that the Secretary shall establish, in a budget neutral 
manner `` * * * other adjustments as determined to be necessary to 
ensure equitable payments, such as adjustments for certain classes of 
hospitals.'' We have not found such an adjustment to be necessary to 
ensure equitable payments to teaching hospitals and, therefore, have 
not developed such an adjustment. We do not believe an indirect medical 
education add-on payment is appropriate in a budget neutral payment 
system where such changes would result in reduced payments to all other 
hospitals. Furthermore, in this final rule with comment period, we have 
developed payment weights that we believe provide appropriate and 
adequate payment for the complex medical services, such as visits 
requiring prolonged observation, new technology services and device-
dependent procedures, which we understand are furnished largely by 
teaching hospitals. Teaching hospitals benefit from the recalibration 
of the APCs and the changes to packaging that are implemented in this 
final rule with comment period. The final CY 2008 impacts by class of 
hospital are displayed in Table 61 in section XXIV.B. of this final 
rule with comment period. Therefore, we do not believe that there is 
sufficient reason to develop an adjustment to the OPPS payment to 
teaching hospitals for the CY 2008 OPPS.
    Comment: The MedPAC commented that while CMS proposed to apply a 
multiple procedure reduction to imaging services for CY 2006, CMS did 
not adopt this proposal as final but stated that it would continue to 
study whether such a reduction was appropriate. The MedPAC asked that 
CMS continue to examine ways to improve payment accuracy for imaging 
services, including considering applying a multiple procedure reduction 
to these services.
    Response: The question of whether it would be appropriate to apply 
a multiple procedure reduction pertains only to those imaging services 
for which we make separate payment. It is not an issue for packaged 
imaging services, including the numerous imaging services that we are 
packaging for CY 2008 as part of our expanded payment bundles under the 
OPPS. The concern, therefore, is partially mitigated by our final CY 
2008 packaging policies. Commenters responding to the CY 2006 proposal 
OPPS indicated that, in contrast to the MPFS payment rates, the 
hospital cost data used by CMS to set payment rates for imaging 
services already reflects savings due to the efficiencies of performing 
multiple procedures during the same session and that the proposal to 
discount second and subsequent procedures would be tantamount to 
discounting those procedures twice (70 FR 68707). As we indicated in 
our response to that comment, we were unable to disprove commenters' 
contentions that there are already efficiencies included in hospitals' 
costs and, therefore, in their CCRs and in the median costs on which 
the OPPS payments are based (70 FR 68708). However, we believe it is 
possible that there may be a relationship between the extent to which 
efficiencies are incorporated into the median costs and the degree to 
which charge compression affects the median costs for imaging services. 
RTI's study of charge compression using inpatient charges found that 
use of regression adjusted CCRs would reduce the costs of magnetic 
resonance imaging and computed tomography services. This is one of the 
categories of hospital services that has high outpatient utilization. 
Over the coming year, as discussed earlier in this section of this 
final rule with comment period, we will explore through the RTI 
contract the results of including hospital outpatient charges to 
determine regression-adjusted CCRs for calculation of the median costs 
for imaging services. We believe that this information could be useful 
in the reassessment of whether it would be appropriate to apply a 
multiple procedure reduction to separately paid imaging services.
    A detailed discussion of the development of median costs for blood 
and blood products is included in section X. of this final rule with 
comment period. A discussion of the calculation of medians for APCs 
that require one or more implantable devices when the service is 
performed is provided in section IV.A. of this final rule with comment 
period. The methodology for developing the median costs for composite 
APCs is included below in section II.A.4.d. of this final rule with 
comment period. A description of the methodology for calculating the 
median cost for partial hospitalization services is presented below in 
section II.B. of this final rule with comment period.
    After consideration of the public comments received, we are 
finalizing our proposed CY 2008 methodology for calculating the median 
costs upon which the CY 2008 OPPS payment rates are based, with the 
modifications described earlier regarding the treatment of services 
which are assigned status indicator ``Q.''

                Table 2.--CY 2008 Packaged Revenue Codes
------------------------------------------------------------------------
           Revenue code                          Description
------------------------------------------------------------------------
0250..............................  PHARMACY.
0251..............................  GENERIC.
0252..............................  NONGENERIC.
0254..............................  PHARMACY INCIDENT TO OTHER
                                     DIAGNOSTIC.
0255..............................  PHARMACY INCIDENT TO RADIOLOGY.
0257..............................  NONPRESCRIPTION DRUGS.
0258..............................  IV SOLUTIONS.
0259..............................  OTHER PHARMACY.
0260..............................  IV THERAPY, GENERAL CLASS.
0262..............................  IV THERAPY/PHARMACY SERVICES.
0263..............................  SUPPLY/DELIVERY.

[[Page 66609]]

 
0264..............................  IV THERAPY/SUPPLIES.
0269..............................  OTHER IV THERAPY.
0270..............................  M&S SUPPLIES.
0271..............................  NONSTERILE SUPPLIES.
0272..............................  STERILE SUPPLIES.
0273..............................  TAKE HOME SUPPLIES.
0275..............................  PACEMAKER DRUG.
0276..............................  INTRAOCULAR LENS SOURCE DRUG.
0278..............................  OTHER IMPLANTS.
0279..............................  OTHER M&S SUPPLIES.
0280..............................  ONCOLOGY.
0289..............................  OTHER ONCOLOGY.
0343..............................  DIAGNOSTIC RADIOPHARMS.
0344..............................  THERAPEUTIC RADIOPHARMS.
0370..............................  ANESTHESIA.
0371..............................  ANESTHESIA INCIDENT TO RADIOLOGY.
0372..............................  ANESTHESIA INCIDENT TO OTHER
                                     DIAGNOSTIC.
0379..............................  OTHER ANESTHESIA.
0390..............................  BLOOD STORAGE AND PROCESSING.
0399..............................  OTHER BLOOD STORAGE AND PROCESSING.
0560..............................  MEDICAL SOCIAL SERVICES.
0569..............................  OTHER MEDICAL SOCIAL SERVICES.
0621..............................  SUPPLIES INCIDENT TO RADIOLOGY.
0622..............................  SUPPLIES INCIDENT TO OTHER
                                     DIAGNOSTIC.
0624..............................  INVESTIGATIONAL DEVICE (IDE).
0630..............................  DRUGS REQUIRING SPECIFIC
                                     IDENTIFICATION, GENERAL CLASS.
0631..............................  SINGLE SOURCE.
0632..............................  MULTIPLE.
0633..............................  RESTRICTIVE PRESCRIPTION.
0681..............................  TRAUMA RESPONSE, LEVEL I.
0682..............................  TRAUMA RESPONSE, LEVEL II.
0683..............................  TRAUMA RESPONSE, LEVEL III.
0684..............................  TRAUMA RESPONSE, LEVEL IV.
0689..............................  TRAUMA RESPONSE, OTHER.
0700..............................  CAST ROOM.
0709..............................  OTHER CAST ROOM.
0710..............................  RECOVERY ROOM.
0719..............................  OTHER RECOVERY ROOM.
0720..............................  LABOR ROOM.
0721..............................  LABOR.
0732..............................  TELEMETRY.
0762..............................  OBSERVATION ROOM.
0801..............................  HEMODIALYSIS.
0802..............................  PERITONEAL DIALYSIS.
0803..............................  CAPD.
0804..............................  CCPD.
0809..............................  OTHER INPATIENT DIALYSIS.
0810..............................  ORGAN ACQUISITION.
0819..............................  OTHER ORGAN ACQUISITION.
0821..............................  HEMODIALYSIS COMP OR OTHER RATE.
0824..............................  MAINTENANCE 100%.
0825..............................  SUPPORT SERVICES.
0829..............................  OTHER HEMO OUTPATIENT.
0942..............................  EDUCATION/TRAINING.
------------------------------------------------------------------------

3. Calculation of OPPS Scaled Payment Weights
    Using the median APC costs discussed previously, we calculated the 
final relative payment weights for each APC for CY 2008 shown in 
Addenda A and B to this final rule with comment period. In years prior 
to CY 2007, we standardized all the relative payment weights to APC 
0601 (Mid Level Clinic Visit) because it was one of the most frequently 
performed services in the hospital outpatient setting. We assigned APC 
0601 a relative payment weight of 1.00 and divided the median cost for 
each APC by the median cost for APC 0601 to derive the relative payment 
weight for each APC.
    Beginning with the CY 2007 OPPS, we standardized all of the 
relative payment weights to APC 0606 (Level 3 Clinic Visits) because we 
deleted APC 0601 as part of the reconfiguration of the visit APCs. We 
chose APC 0606 as the base because APC 0606 was the middle level clinic 
visit APC (that is, Level 3 of five levels). We had historically used 
the median cost of the middle level clinic visit APC (that is APC 0601 
through CY 2006) to calculate unscaled weights because mid-level clinic 
visits were among the most frequently performed services in the 
hospital outpatient setting. As proposed for CY 2008, to maintain 
consistency in using a median for calculating unscaled weights 
representing the median cost of some of the most frequently provided 
services, we continued to use the

[[Page 66610]]

median cost of the mid-level clinic APC, proposed APC 0606, to 
calculate unscaled weights. Following our standard methodology, but 
using the CY 2008 median for APC 0606, for CY 2008 we assigned APC 0606 
a relative payment weight of 1.00 and divided the median cost of each 
APC by the median cost for APC 0606 to derive the unscaled relative 
payment weight for each APC. The choice of the APC on which to base the 
relative weights for all other APCs does not affect the payments made 
under the OPPS because we scale the weights for budget neutrality.
    Section 1833(t)(9)(B) of the Act requires that APC reclassification 
and recalibration changes, wage index changes, and other adjustments be 
made in a manner that assures that aggregate payments under the OPPS 
for CY 2008 are neither greater than nor less than the aggregate 
payments that would have been made without the changes. To comply with 
this requirement concerning the APC changes, we compared aggregate 
payments using the CY 2007 relative weights to aggregate payments using 
the CY 2008 final relative weights. This year, we included payments to 
CMHCs in our comparison. Based on this comparison, we adjusted the 
relative weights for purposes of budget neutrality. The final unscaled 
relative payment weights were adjusted by a weight scaler of 1.3226 for 
budget neutrality. In addition to adjusting for increases and decreases 
in weight due to the recalibration of APC medians, the scaler also 
accounts for any change in the base, other than changes in volume which 
are not a factor in the weight scaler. The decline in the weight scaler 
compared to the proposed weight scaler of 1.3665 results largely from 
the refinement for this final rule with comment period of the proposed 
packaging policy to package imaging supervision and interpretation 
services only if they are reported on the same date of service as a 
HCPCS code that has a status indicator of ``T.'' This change both 
increased the median costs for these imaging supervision and 
interpretation services and added a significant number of units for 
these services that would be separately paid under the final CY 2008 
policy. The other factors that contributed to the decline of the scaler 
from the proposed rule to this final rule with comment period include 
the creation of the observation composite APCs and the increase in the 
final CY 2008 payment rate for partial hospitalization services 
compared to the proposed payment rate.
    The final relative payment weights listed in Addenda A and B to 
this final rule with comment period incorporate the recalibration 
adjustments discussed in sections II.A.1. and 2. of this final rule 
with comment period.
    Section 1833(t)(14)(H) of the Act, as added by section 621(a)(1) of 
Pub. L. 108-173, states that ``Additional expenditures resulting from 
this paragraph shall not be taken into account in establishing the 
conversion factor, weighting and other adjustment factors for 2004 and 
2005 under paragraph (9) but shall be taken into account for subsequent 
years.'' Section 1833(t)(14) of the Act provides the payment rates for 
certain ``specified covered outpatient drugs.'' Therefore, the cost of 
those specified covered outpatient drugs (as discussed in section V. of 
this final rule with comment period) is included in the budget 
neutrality calculations for the CY 2008 OPPS. We did not receive any 
public comments on the methodology for calculating scaled weights from 
the median costs for the CY 2008 OPPS. Therefore, we are finalizing our 
proposed methodology, without modification, including updating of the 
budget neutrality scaler for the final rule as proposed.
4. Changes to Packaged Services
a. Background
    When the Medicare program was first implemented, it paid for 
hospital services (inpatient and outpatient) based on hospital-specific 
reasonable costs attributable to furnishing services to Medicare 
beneficiaries. Later, the law was amended to limit payment to the 
lesser of the hospital's reasonable cost or customary charges for 
services furnished to Medicare beneficiaries. Specific service-based 
methodologies were then developed for certain types of services, such 
as clinical laboratory tests and durable medical equipment, while 
payments for outpatient surgical procedures and other diagnostic tests 
were based on a blend of the hospital's aggregate Medicare costs for 
these services and Medicare's payment for similar services in other 
ambulatory settings. While this mix of different payment methodologies 
was in use, hospital outpatient services were growing rapidly following 
the implementation of the IPPS in 1983. The brisk increase in hospital 
outpatient services led to an interest in creating payment incentives 
to promote more efficient delivery of hospital outpatient services 
through a Medicare prospective payment system for hospital outpatient 
services, and the final statutory requirements for the OPPS were 
established by the BBA and the BBRA. During the period of time when 
different approaches to prospective payment for hospital outpatient 
services were being considered, a variety of reports to Congress (June 
1988, September 1990, and March 1995) discussed three major issues 
related to defining the unit of payment for the payment system, 
specifically the extent to which clinically similar procedures should 
be grouped for payment purposes and the logic that should be used for 
the groupings; the extent to which payment for minor, ancillary 
services associated with a significant procedure should be packaged 
into a single payment for the procedure (which we refer to as 
``packaging''); and the extent to which payment for multiple 
significant procedures or multiple units of the same procedure related 
to an outpatient encounter or to an episode of care should be bundled 
into a single unit of payment (which we refer to as ``bundling''). Both 
packaging and bundling were presented as approaches to creating 
incentives for efficiency, with their potential policy disadvantages 
including inconsistency with other ambulatory fee schedules, reduced 
transparency of service-specific payment, and the potential for 
hospitals shifting the delivery of packaged or bundled services to 
delivery settings other than the hospital outpatient department (HOPD).
    The OPPS, like other prospective payment systems, relies on the 
concept of averaging, where the payment may be more or less than the 
estimated costs of providing a service or package of services for a 
particular patient, but with the exception of outlier cases, it is 
adequate to ensure access to appropriate care. Decisions about 
packaging and bundling payment involve a balance between ensuring some 
separate payment for individual services and establishing incentives 
for efficiency through larger units of payment. In many situations, the 
final payment rate for a package of services may do a better job of 
balancing variability in the relative costs of component services 
compared to individual rates covering a smaller unit of service without 
packaging or bundling. Packaging payments into larger payment bundles 
promotes the stability of payment for services over time, a 
characteristic that reportedly is very important to hospitals. Unlike 
packaged services, the costs of individual services typically show 
greater variation because the higher variability for some component 
items and services cannot be balanced with lower variability for others 
and because relative weights are typically estimated using a smaller 
set of claims.

[[Page 66611]]

When compared to service-specific payment, packaging or bundling 
payment for component services may change payment at the hospital level 
to the extent that there are systematic differences across hospitals in 
their performance of the services included in that unit of payment. 
Hospitals spending more per case than payment received would be 
encouraged to review their service patterns to ensure that they furnish 
services as efficiently as possible. Similarly, we believe that 
unpackaging services heightens the hospital's focus on pricing 
individual services, rather than the efficient delivery of those 
services. Over the past several years of the OPPS, greater unpackaging 
of payment has occurred simultaneously with continued tremendous growth 
in OPPS expenditures as a result of increasing volumes of individual 
services, as discussed in further detail below. Also discussed in 
further detail below, most recently in its comments to the CY 2007 
OPPS/ASC proposed rule and in the context of this rapid spending 
growth, MedPAC encouraged CMS to broaden the payment bundles under the 
OPPS to encourage providers to use resources efficiently.
    As permitted under section 1833(t)(2)(B) of the Act, the OPPS 
establishes groups of covered HOPD services, namely APC groups, and 
uses them as the basic unit of payment. During the evolution of the 
OPPS over the past 7 years, significant attention has been concentrated 
on service-specific payment for services furnished to particular 
patients, rather than on creating incentives for the efficient delivery 
of services through encounter or episode-of-care-based payment. Overall 
packaging included in the clinical APCs has decreased, and the 
procedure groupings have become smaller as the focus has shifted to 
refining service-level payment. Specifically, in the CY 2003 OPPS, 
there were 569 APCs, but by CY 2007, the number of APCs had grown to 
862, a 51 percent increase in 4 years. Similarly, the percentage of CPT 
codes for procedural services that receive packaged payment declined by 
over 10 percent between CY 2003 and CY 2007.
    Currently, the APC groups reflect a modest degree of packaging, 
including packaged payment for minor ancillary services, inexpensive 
drugs, medical supplies, implantable devices, capital-related costs, 
operating and recovery room use, and anesthesia services. Bundling 
payment for multiple significant services provided in the same hospital 
outpatient encounter or during an episode of care is not currently a 
common OPPS payment practice, because the APC groups generally reflect 
only the modest packaging associated with individual procedures or 
services. Unconditionally packaged services with HCPCS codes are 
identified by the status indicator ``N.'' Conditionally packaged 
services, specifically those services whose payment is packaged unless 
specific criteria for separate payment are met, are assigned status 
indicator ``Q.'' To the extent possible, hospitals may use HCPCS codes 
to report any packaged services that were performed, consistent with 
CPT or CMS coding guidelines, but packaged costs also may be uncoded 
and included in specific revenue code charges. Hospitals include 
charges for packaged services on their claims, and the costs associated 
with those packaged services are then added into the costs of 
separately payable procedures on the same claims in establishing 
payment rates for the separately payable services.
    Packaging and bundling payment for multiple interrelated services 
into a single payment create incentives for providers to furnish 
services in the most efficient way by enabling hospitals to manage 
their resources with maximum flexibility, thereby encouraging long-term 
cost containment. For example, where there are a variety of supplies 
that could be used to furnish a service, some of which are more 
expensive than others, packaging encourages hospitals to use the least 
expensive item that meets the patient's needs, rather than to routinely 
use a more expensive item. Packaging also encourages hospitals to 
negotiate carefully with manufacturers and suppliers to reduce the 
costs of purchased items and services or to explore alternative group 
purchasing arrangements, thereby encouraging the most economical health 
care. Similarly, packaging encourages hospitals to establish protocols 
that ensure that services are furnished only when they are important 
and to carefully scrutinize the services ordered by practitioners to 
maximize the efficient use of hospital resources. Finally, packaging 
payments into larger payment bundles promotes the stability of payment 
for services over time. Packaging and bundling also may reduce the 
importance of refining service-specific payment because there is more 
opportunity for hospitals to average payment across higher cost cases 
requiring many ancillary services and lower cost cases requiring fewer 
ancillary services.
b. Addressing Growth in OPPS Volume and Spending
    Creating additional incentives for providing only necessary 
services in the most efficient manner is of vital importance to 
Medicare today, in view of the recent explosion of growth in program 
expenditures for hospital outpatient services paid under the OPPS. As 
illustrated in Table 3 below, total spending has been growing at a rate 
of roughly 10 percent per year under the OPPS, and the Medicare 
Trustees project that total spending under the OPPS will increase by 
more than $3 billion from CY 2007 through CY 2008 to nearly $35 
billion. Implementation of the OPPS has not slowed outpatient spending 
growth over the past few years; in fact, double-digit spending growth 
has generally been occurring. We are greatly concerned with this rate 
of increase in program expenditures under the OPPS.

                                             Table 3.-Growth in Expenditures Under Opps From CY 2001-CY 2008
                                                [Projected expenditures for CY 2006-CY 2008 in billions]
--------------------------------------------------------------------------------------------------------------------------------------------------------
                       OPPS growth                          CY 2001     CY 2002     CY 2003     CY 2004     CY 2005     CY 2006     CY 2007     CY 2008
--------------------------------------------------------------------------------------------------------------------------------------------------------
Incurred Cost...........................................      17.702      19.561      21.156      23.866      26.572      29.741      32.714      36.072
Percent Increase........................................  ..........        10.5         8.2        12.8        11.3        11.9        10.1       10.26
--------------------------------------------------------------------------------------------------------------------------------------------------------
Based on the Midsession Review of the President's FY 2008 Budget.

    As with the other Medicare fee-for-service payment systems that are 
experiencing rapid spending growth, brisk growth in the intensity and 
utilization of services is the major reason for the current rates of 
growth in the OPPS, rather than general price or enrollment changes. 
Table 4 below illustrates the increases in the volume and intensity of 
hospital outpatient services over the past several years.

[[Page 66612]]



                                  Table 4.-Percentage Increase in Volume and Intensity of Hospital Outpatient Services
--------------------------------------------------------------------------------------------------------------------------------------------------------
                                                                                                                     CY 2006      CY 2007      CY 2008
                                                                 CY 2002      CY 2003      CY 2004      CY 2005       (Est.)       (Est.)       (Est.)
--------------------------------------------------------------------------------------------------------------------------------------------------------
Percent Increase.............................................         3.5          2.5          7.6          7.4         10.1          9.4          5.8
--------------------------------------------------------------------------------------------------------------------------------------------------------
Based on the Midsession Review of the President's FY 2008 Budget.

    For hospital outpatient services, the volume and intensity of 
services are estimated to have continued to increase significantly in 
recent years, at a rate of 10.1 percent between CY 2005 and CY 2006, 
the last two completed calendar years. As we discussed in the CY 2007 
OPPS/ASC final rule with comment period (71 FR 68189 through 68190), 
the rapid growth in utilization of services under the OPPS shows that 
Medicare is paying mainly for more services each year, regardless of 
their quality or impact on beneficiary health. In its March 2007 Report 
to Congress (pages 55 and 56), MedPAC confirmed that much of the growth 
in service volume from 2003 to 2005 resulted from increases in the 
number of services per beneficiary who received care, rather than from 
increases in the number of beneficiaries served. MedPAC found that 
while the rate of growth in service volume declined over that time 
period, the complexity of services, defined as the sum of the relative 
payment weights of all OPPS services divided by the volume of all 
services, increased, and that most of the growth was attributable to 
the insertion of devices and the provision of complex imaging services. 
MedPAC further found that regression analysis suggested that relatively 
complex hospital outpatient services may be more profitable for 
hospitals than less complex services. In addition, its analysis 
indicated that favorable payments for complex services give hospitals 
an incentive to provide more of those complex services rather than 
fewer basic services, which increases overall service complexity. 
MedPAC expressed concern about this relationship and concluded that the 
historically large increases in outpatient volume and service 
complexity suggest a need to recalibrate the OPPS. In the future, 
MedPAC plans to examine options for recalibrating the payment system to 
accurately match payments to the costs of individual services (Medicare 
Payment Advisory Commission Report to the Congress: Medicare Payment 
Policy, March 2007, pages 55 and 56).
    As proposed for the CY 2007 OPPS and finalized for the CY 2009 
OPPS, we developed a plan to promote higher quality services under the 
OPPS, so that Medicare spending would be directed toward those higher 
quality services (71 FR 68189 through 68197). We believe that Medicare 
payments should encourage physicians and other providers in their 
efforts to achieve better health outcomes for Medicare beneficiaries at 
a lower cost. In the CY 2007 OPPS/ASC final rule with comment period, 
we discussed the concept of ``value-based purchasing'' in the OPPS as 
well as in other Medicare payment systems. ``Value-based purchasing'' 
may use a range of budget-neutral incentives to achieve identified 
quality and efficiency goals, as a means of promoting better quality of 
care and more effective resource use in the Medicare payment systems. 
In developing the concept of value-based purchasing for Medicare, we 
have been working closely with stakeholder partners.
    We continue to believe that the collection and submission of 
performance data and the public reporting of comparative information 
are strong incentives for hospital accountability in general and 
quality improvement in particular, while encouraging the most efficient 
and effective care. Measurement and reporting can focus the attention 
of hospitals and consumers on specific goals and on hospitals' 
performance relative to those goals. Development and implementation of 
performance measurement and reporting by hospitals can thus produce 
quality improvement in health care delivery. Hospital performance 
measures may also provide a foundation for performance-based rather 
than volume-based payments.
    In the CY 2007 OPPS/ASC final rule with comment period, as a first 
step in the OPPS toward value-based purchasing, we finalized a policy 
that would employ our equitable adjustment authority under section 
1833(t)(2)(E) of the Act to establish an OPPS Reporting Hospital 
Quality Data for Annual Payment Update (RHQDAPU) program based on 
measures specifically developed to characterize the quality of 
outpatient care (71 FR 68197). We finalized implementation of the 
program for CY 2009, when we would implement a 2.0 point reduction to 
the OPPS conversion factor update for those hospitals that do not meet 
the specific requirements of the CY 2009 program. We described the CY 
2009 program, which would be based upon CY 2008 hospital reporting of 
appropriate measures of the quality of hospital outpatient care that 
have been carefully developed and evaluated, and endorsed as 
appropriate, with significant input from stakeholders. We reiterated 
our belief that ensuring that Medicare beneficiaries receive the care 
they need and that such services are of high quality are the necessary 
initial steps to incorporating value-based purchasing into the OPPS. We 
explained that we are specifically seeking to encourage care that is 
both efficient and of high quality in the HOPD.
    Subsequent to the publication of the CY 2007 OPPS/ASC final rule 
with comment period, section 109(a) of the MIEA-TRHCA, which added 
section 1833(t)(19) to the Act, specifies that in the case of a 
subsection (d) hospital (defined under section 1886(d)(1)(B) of the Act 
as hospitals that are located in the 50 States or the District of 
Columbia other than those categories of hospitals or hospital units 
that are specifically excluded from the IPPS, including psychiatric, 
rehabilitation, long-term care, children's, and cancer hospitals or 
hospital units) that does not submit to the Secretary the quality 
reporting data required for CY 2009 and each subsequent year, the OPPS 
annual update factor shall be reduced by 2.0 percentage points. The 
quality reporting program proposed for CY 2008 according to this 
provision is referred to as the Hospital Outpatient Quality Data 
Reporting Program (HOP QDRP) and is discussed in detail in section 
XVII. of this final rule with comment period.
    As the next step in our movement toward value-based purchasing 
under the OPPS and to complement the HOP QDRP for CY 2009, with measure 
reporting beginning in CY 2008, we believe it is important to initiate 
specific payment approaches to explicitly encourage efficiency in the 
hospital outpatient setting that we believe will control future growth 
in the volume of OPPS services. While the HOP QDRP will encourage the 
provision of higher quality hospital outpatient services that lead to 
improved health outcomes for Medicare beneficiaries, we believe that 
more targeted approaches are also necessary to encourage increased

[[Page 66613]]

hospital efficiency. Two alternatives we have considered that would be 
feasible under current law include establishing a methodology to 
measure the growth in volume and reduce OPPS payment rates to account 
for unnecessary increases in volume or developing payment incentives 
for hospitals to ensure that they provide necessary services as 
efficiently as possible.
    With respect to the first alternative, section 1833(t)(2)(F) of the 
Act requires us to establish a methodology for controlling unnecessary 
increases in the volume of covered OPPS services, and section 
1833(t)(9)(C) of the Act authorizes us to adjust the update to the 
conversion factor if, under section 1833(t)(2)(F) of the Act, we 
determine that there is growth in volume that exceeds established 
tolerances. As we indicated in the September 8, 1998 proposed rule 
proposing the establishment of the OPPS (63 FR 47585), we considered 
creating a system that mirrors the sustainable growth rate (SGR) 
methodology applied to the MPFS update to control unnecessary growth in 
service volume. However, implementing such a system could have the 
potentially undesirable effect of escalating service volume as payment 
rates stagnate and hospital costs rise, thus actually resulting in a 
growth in volume rather than providing an incentive to control volume. 
Therefore, this approach to addressing the volume growth under the OPPS 
could inadvertently result in the exact opposite of our desired 
outcome.
    The second alternative we considered is to expand the packaging of 
supportive ancillary services and ultimately bundle payment for 
multiple independent services into a single OPPS payment. We believe 
that this would create incentives for hospitals to monitor and adjust 
the volume and efficiency of services themselves, by enabling them to 
manage their resources with maximum flexibility. Instead of external 
controls on volume, we believe that it is preferable for the OPPS to 
create payment incentives for hospitals to carefully scrutinize their 
service patterns to ensure that they furnish only those services that 
are necessary for high quality care and to ensure that they provide 
care as efficiently as possible. Specifically, we believe that 
increased packaging and bundling are the most appropriate payment 
strategies to establish such incentives in a prospective payment 
system, and that this approach is clearly preferable to the 
establishment of an SGR or other methodology that seeks to control 
spending by addressing significant growth in volume and program 
spending with lower payments.
    In its October 6, 2006 letter of comment on the CY 2007 OPPS/ASC 
proposed rule, MedPAC urged us to establish broader payment bundles in 
both the revised ASC payment system and the OPPS to promote efficient 
resource use and better align the two payment systems. In particular, 
our proposal for the CY 2008 revised ASC payment system proposed to 
package payment for all items and services directly related to the 
provision of covered surgical procedures into the ASC facility payment 
for the associated surgical procedure (71 FR 49468). These other items 
and services included all drugs, biologicals, contrast agents, 
implantable devices, and diagnostic services such as imaging. Because a 
number of these items and services are separately paid under the OPPS 
and the proposal included the establishment of most ASC payment weights 
based on the procedures' corresponding OPPS payment weights, MedPAC 
encouraged us to align the payment bundles in the two payment systems 
by increasing the size of the payment bundles under the OPPS.
    Moreover, MedPAC staff indicated in testimony at the January 9, 
2007 MedPAC public meeting that the growth in OPPS spending and volume 
raises questions about whether the OPPS should be changed to encourage 
greater efficiency (page 390 of the January 9, 2007 MedPAC meeting 
transcript available at the Web site at: http://www.medpac.gov). MedPAC 
staff explained at that time that MedPAC intends to perform a long term 
assessment of the design of the OPPS, including considering the 
bundling of payments for procedures and visits furnished over a period 
of time into a single payment, assessing whether there should be an 
expenditure target for hospital outpatient services, evaluating whether 
payments for multiple imaging services provided in the same session 
should be discounted, and reviewing the methodology used by CMS to 
determine relative payment weights for hospital outpatient services. We 
welcome MedPAC's study of these areas, particularly with regard to how 
we might develop appropriate payment rates for larger bundles of 
services.
    Because we believe it is important that the OPPS create enhanced 
incentives for hospitals to provide only necessary, high quality care 
and to provide that care as efficiently as possible, we have given 
considerable thought to how we could increase packaging under the OPPS 
in a manner that would not place hospitals at substantial financial 
risk but which would create incentives for efficiency and volume 
control, while providing hospitals with flexibility to provide care in 
the most appropriate way for each Medicare beneficiary. We are 
considering the possibility of greater bundling of payment for major 
hospital outpatient services, which could result in establishing OPPS 
payments for episodes of care, and for this reason we particularly 
welcome MedPAC's exploration of how such an approach might be 
incorporated into the OPPS payment methodology. We are particularly 
concerned about the potential for shifting higher cost bundled services 
to other ambulatory settings. We are currently considering the complex 
policy issues related to the possible development and implementation of 
a bundled payment policy for hospital outpatient services that involves 
significant services provided over a period of time which could be paid 
through an episode-based payment methodology, but we consider this 
possible approach to be a long-term policy objective.
    We also are examining how we might possibly establish payments for 
same-day care encounters, building upon the current use of APCs for 
payment through greater packaging of supportive ancillary services. 
This could include conditional packaging of supportive ancillary 
services into payment for the procedure that is the reason for the OPPS 
encounter (for example, diagnostic tests performed on the day of a 
scheduled procedure). Another approach could include creation of 
composite APCs for frequently performed combinations of surgical 
procedures (for example, one APC payment for multiple cardiac 
electrophysiologic procedures performed on the same date). Not only 
could these encounter-based payment groups create enhanced incentives 
for efficiency, but they may also enable us to utilize for ratesetting 
many of the multiple procedure claims that are not now used in our 
establishment of OPPS rates for single procedures. (We refer readers to 
section II.A.1.b. of this final rule with comment period for a more 
detailed discussion of the treatment of multiple procedure claims in 
the ratesetting process.) In the CY 2008 OPPS/ASC proposed rule, we 
proposed two new composite APCs for CY 2008 payment of combinations of 
services in two clinical care areas, as discussed in section II.A.4.d. 
of this final rule with comment period. In that section, we summarize 
and respond to the public comments we received on this proposal

[[Page 66614]]

as we explore the possibility of moving toward basing OPPS payment on 
larger packages and bundles of services provided in a single hospital 
outpatient encounter.
    We intend to involve the APC Panel in our future exploration of how 
we can develop encounter-based and episode-based payment groups, and we 
look forward to the findings and recommendations of MedPAC in this 
area. This is a significant change in direction for the OPPS, and we 
specifically seek the recommendations of all stakeholders with regard 
to which ancillary services could be packaged and those combinations of 
services provided in a single encounter or over time that could be 
bundled together for payment. We are hopeful that expanded packaging 
and, ultimately, greater bundling under the OPPS may result in 
sufficient moderation of growth in volume and spending that further 
controls would not be needed. However, if spending were to continue to 
escalate at the current rates, even after we have exhausted our options 
for increased packaging and bundling, we are considering multiple 
options under our authority to address these issues.
c. Packaging Approach
    With the exception of the two composite APCs that we proposed for 
CY 2008 and discuss in detail in section II.A.4.d. of this final rule 
with comment period, we indicated in the CY 2008 OPPS/ASC proposed rule 
that we were not prepared to propose an episode-based or fully 
developed encounter-based payment methodology for CY 2008 as our next 
step in value-based purchasing for the OPPS. However, in reviewing our 
approach to revising payment packages and bundles for the proposed 
rule, we examined services currently provided under the OPPS, looking 
for categories of ancillary items and services for which we believed 
payment could be appropriately packaged into larger payment packages 
for the encounter. For this first step in creating larger payment 
groups, we examined the HCPCS code definitions (including CPT code 
descriptors) to see whether there were categories of codes for which 
packaging would be a logical expansion of the longstanding packaging 
policy that has been a part of the OPPS since its inception. In 
general, we have often packaged the costs of selected HCPCS codes into 
payment for services reported with other HCPCS codes where we believed 
that one code reported an item or service that was integral to the 
provision of care that was reported by another HCPCS code.
    As an example of a previous change in the OPPS packaging status for 
a HCPCS code that is ancillary and supportive, under the CY 2007 OPPS, 
we note that CPT code 93641 (Electrophysiologic evaluation of single or 
dual chamber pacing cardioverter defibrillator leads including 
defibrillation threshold evaluation (induction of arrhythmia, evaluate 
of sensing an pacing for arrhythmia termination) at the time of initial 
implantation or replacement; with testing of single chamber or dual 
chamber cardioverter defibrillator) went from separate to packaged 
payment. This service is only performed during the course of a surgical 
procedure for implantation or replacement of implantable cardioverter-
defibrillator (ICD) leads, and these surgical implantation procedures 
are currently assigned to APC 0106 (Insertion/Replacement/Repair of 
Pacemaker and/or Electrodes) and APC 0108 (Insertion/Replacement/Repair 
of Cardioverter-Defibrillator Leads). We considered the 
electrophysiologic evaluation service (CPT code 93641) to be an 
ancillary supportive service that may be performed only in the same 
operative session as a procedure that could otherwise be performed 
independently of the electrophysiologic evaluation service. In this 
particular case, the APC Panel recommended for CY 2007 that we package 
payment for this diagnostic test, and we adopted that recommendation 
for the CY 2007 OPPS. Making this payment change in this specific case 
resulted in the availability of significantly more claims data and, 
therefore, establishment of more valid and representative estimated 
median costs for the lead insertion and electrophysiologic evaluation 
services furnished in the single hospital encounter.
    In the case of much of the care furnished in the HOPD, we believe 
that it is appropriate to view a complete service as potentially being 
reported by a combination of two or more HCPCS codes, rather than a 
single code, and to establish payment policy that supports this view. 
Ideally, we would consider a complete HOPD service to be the totality 
of care furnished in a hospital outpatient encounter or in an episode 
of care. In general, we believe that it is particularly appropriate to 
package payment for those items and services that are typically 
ancillary and supportive into the payment for the primary diagnostic or 
therapeutic modalities in which they are used. As a significant first 
step towards creating payment units that represent larger units of 
service, in development of the proposed rule, we examined whether there 
were categories of HCPCS codes that are typically ancillary and 
supportive to diagnostic and therapeutic modalities.
    Specifically, as our initial substantial step toward creating 
larger payment groups for hospital outpatient care, in the CY 2008 
OPPS/ASC proposed rule (72 FR 42652), we proposed to package payment 
for items and services in the seven categories listed below into the 
payment for the primary diagnostic or therapeutic modality to which we 
believe these items and services are typically ancillary and 
supportive. We specifically chose these categories of HCPCS codes for 
packaging because we believe that the items and services described by 
the codes in these categories are the HCPCS codes that are typically 
ancillary and supportive to a primary diagnostic or therapeutic 
modality and, in those cases, are an integral part of the primary 
service they support. We proposed to assign status indicator ``N'' to 
those HCPCS codes that we believe are always integral to the 
performance of the primary modality and to package their costs into the 
costs of the separately paid primary services with which they are 
billed. We proposed to assign status indicator ``Q'' to those HCPCS 
codes that we believe are typically integral to the performance of the 
primary modality and to package payment for their costs into the costs 
of the separately paid primary services with which they are usually 
billed but to pay them separately in those uncommon cases in which no 
other separately paid primary service is furnished in the hospital 
outpatient encounter.
    For ease of reference in our subsequent discussion in each of the 
seven areas, we refer to the HCPCS codes for which we proposed to 
package (or conditionally package) payment as dependent services. We 
use the term ``independent service'' to refer to the HCPCS codes that 
represent the primary therapeutic or diagnostic modality into which we 
are proposing to package payment for the dependent service. We note 
that, in future years as we consider the development of larger payment 
groups that more broadly reflect services provided in an encounter or 
episode of care, it is possible that we might propose to bundle payment 
for a service that we now refer to as ``independent'' in this final 
rule with comment period.
    Specifically, we proposed to package the payment for HCPCS codes 
describing the dependent items and services in the following seven 
categories into the payment for the

[[Page 66615]]

independent services with which they are furnished:
     Guidance services
     Image processing services
     Intraoperative services
     Imaging supervision and interpretation services
     Diagnostic radiopharmaceuticals
     Contrast media
     Observation services
    In the proposed rule, we identified the HCPCS codes we proposed to 
package for CY 2008, explained our rationale for proposing to package 
the codes in these categories, provided examples of how HCPCS and APC 
median costs and payments would change under these proposals, and 
discussed the impact of these changes under each category, as follows:
    The median costs of services at the HCPCS level for many separately 
paid procedures changed as a result of our proposal because we proposed 
to change the composition of the payment packages associated with the 
HCPCS codes. Moreover, as a result of changes to the HCPCS median 
costs, we proposed to reassign some HCPCS codes to different clinical 
APCs for CY 2008 to avoid 2 times violations and to ensure continuing 
clinical and resource homogeneity of the APCs. Therefore, the proposed 
APC median costs changed not only as a result of the increased 
packaging itself but also as a result of the migration of HCPCS codes 
into and out of APCs through APC reconfiguration. The file of HCPCS 
code and APC median costs resulting from our proposal is found under 
supporting documentation for the proposed rule on the CMS Web site at 
http://www.cms.hhs.gov/HospitalOutpatientPPS/HORD/list.asp#TopOfPage.
    Review of the HCPCS median costs for the proposed rule indicated 
that, while the proposed median costs rise for some HCPCS codes as a 
result of increased packaging that expands the costs included in the 
payment packages, there are also cases in which the proposed median 
costs decline as a result of these proposed changes. While it seems 
intuitive to believe that the proposed median costs of the remaining 
separately paid services should rise when the costs of services 
previously paid separately are packaged into larger payment groups, it 
is more challenging to understand why the proposed median costs of 
separately paid services would not change or would decline when the 
costs of previously paid services are packaged.
    Medians are generally more stable than means because they are less 
sensitive to extreme observations, but medians typically do not reflect 
subtle changes in cost distributions. The OPPS' use of medians rather 
than means usually results in relative weight estimates being less 
sensitive to packaging decisions. Specifically, the median cost for a 
particular independent procedure generally will be higher as a result 
of added packaging, but also could change little or be lower because 
median costs typically do not reflect small distributional changes and 
also because changes to the packaged HCPCS codes affect both the number 
and composition of single bills and the mix of hospitals contributing 
those single bills. Such a decline, no change, or an increase in the 
median cost at the HCPCS code level could result from a change in the 
number of single bills used to set the median cost. With greater 
packaging, more ``natural'' single bills are created for some codes but 
fewer ``pseudo'' single bills are created. Thus, some APCs gain single 
bills and some lose single bills due to packaging changes, as well as 
to the reassignment of some codes to different APCs. When more claims 
from a different mix of providers are used to set the median cost for 
the HCPCS code, the median cost could move higher or lower within the 
array of per claim costs.
    Similarly, revisions to APC assignments that are necessary to 
resolve 2 times violations that could arise as a result of changes in 
the HCPCS median cost for one or more codes due to additional packaging 
may also result in increases or decreases to APC median costs and, 
therefore, to increases or decreases in the payments for HCPCS codes 
that would not be otherwise affected except for the CY 2008 proposed 
packaging approach for the seven categories of items and services.
    We examined the aggregate impact of making these proposed changes 
on payment for CY 2008 in the proposed rule. Because the OPPS is a 
budget neutral payment system in which the amount of payment weight in 
the system is annually adjusted for changes in expenditures created by 
changes in APC weights and codes (but is not currently adjusted based 
on estimated growth in service volume), the effects of the packaging 
changes we proposed resulted in changes to scaled weights and, 
therefore, to the proposed payment rates for all separately paid 
procedures. These changes resulted from both shifts in median costs as 
a result of increased packaging, changes in multiple procedure 
discounting patterns, and a higher weight scaler that was applied to 
all unscaled APC weights. (We refer readers to section II.A.3. of this 
final rule with comment period for an explanation of the weight 
scaler.) In a budget neutral system, the monies previously paid for 
services that were proposed to be packaged are not lost, but are 
redistributed to all other services. A higher weight scaler would 
increase payment rates relative to observed median costs for 
independent services by redistributing the lost weight of packaged 
items that historically have been paid separately and the lost weight 
when the median costs of independent services did not completely 
reflect the full incremental cost of the packaged services. The impact 
of the cumulative changes for the CY 2008 OPPS payments is discussed in 
section XXIV.B. of this final rule with comment period.
    We estimated that our CY 2008 packaging proposal would redistribute 
approximately 1.2 percent of the estimated CY 2007 base year 
expenditures under the OPPS. The monies associated with this 
redistribution were in addition to any increases that would otherwise 
occur due to a higher median cost for the APC as a result of the 
expanded payment package. If the relative weight for a particular APC 
decreased as a result of the proposed packaging approach, the increased 
weight scaler may or may not result in a relative weight that is equal 
to or greater than the relative weight that would occur without the 
proposed packaging approach. In general, the packaging that we proposed 
would have more effect on payment for some services than on payment for 
others because the dependent items and services that we proposed for 
packaging are furnished more often with some independent services than 
with others. However, because of the amount of payment weight that 
would be redistributed by our proposal, there would be some impact on 
payments for all OPPS services whose rates are set based on payment 
weights, and the impact on any given hospital would vary based on the 
mix of services furnished by the hospital.
    We received many, often widely diverging, public comments on the CY 
2008 proposed packaging approach. In many cases the comments were 
generally applicable to the totality of the packaging proposal and, in 
other cases, the same general comments were made but only with regard 
to a specific category or set of services of interest to the commenter. 
We have addressed all similar public comments in the discussion of 
general comments, whether they were made in general or for specific 
categories of services, because the same response applies

[[Page 66616]]

whether the comment was on packaging in general or on a specific 
service. We have limited the summary of public comments and our 
responses in the individual category discussions to issues that pertain 
only to the category or specific services within the category.
    During the September 2007 APC Panel meeting, the APC Panel 
supported packaging for contrast agents, image processing services, 
guidance (except for radiation oncology guidance procedures), 
diagnostic radiopharmaceuticals with a median per day cost of less than 
$200, and intraoperative testing other than possibly for CPT code 96020 
(Neurofunctional testing selection and administration during 
noninvasive imaging functional brain mapping, with test administered 
entirely by a physician or psychologist, with review of test results 
and report). The Panel recommended a delay in packaging for imaging 
supervision and interpretation services because of excessive payment 
reductions that the Panel believed would occur under the CMS proposal, 
particularly with regard to packaging payment for those supervision and 
interpretation services that already include packaged injection 
services. The Panel did not support packaging of observation services, 
although it suggested that if CMS were to package observation, it 
should instead create a composite APC (or a group of composite APCs) 
for observation and the related visit services, without restriction to 
specific clinical conditions. The APC Panel also recommended that CMS 
provide additional information in the CY 2008 final rule with comment 
period about packaging, including crosswalks and information clarifying 
how newly packaged services map back to primary procedures.
    Comment: MedPAC generally supported the proposed packaging because 
the services proposed for packaging are typically furnished on the same 
day as a separately paid service and there is little potential for them 
to be furnished on another date to avoid the effects of packaging. 
MedPAC explained that packaging of observation services is logical 
because currently 70 percent of observation care is packaged. MedPAC's 
principal concern about the proposed packaging of observation was that 
this approach could result in hospitals' costs being higher than OPPS 
payments in some cases, and thereby create an incentive for inpatient 
admissions. It encouraged CMS to carefully monitoring whether hospitals 
change their behavior with regard to inpatient admissions.
    Some commenters supported encounter-based or episode-based payment, 
but asked that this approach be based on single encounter only and not 
span a period of time, because they believed that it would be very 
difficult to set rates for periods of recurring services. The 
commenters supported use of multiple procedure claims and payment for 
combinations of services but encouraged CMS to carefully evaluate the 
overall impact of packaging on all hospitals. Other commenters 
suggested that CMS package only services that are low cost and 
furnished at a high frequency with the independent service. Several 
commenters stated that CMS should not finalize the proposed packaging 
approach because it would lead to inappropriate payment, including both 
overpayments and underpayments.
    Several commenters asked that CMS delay the packaging approach for 
at least a year because they believed the proposed rule did not furnish 
sufficient data analysis in support of the proposal. They asserted that 
the aggregate impact analysis provided no information that commenters 
could use to evaluate the individual codes proposed to be packaged, 
making it impossible for the public to determine how payment for 
services would be affected. Some commenters requested that CMS furnish 
the same level of impact discussion for each of the services in each of 
the categories as it did for the composite APCs. Other commenters asked 
CMS to identify the percent of charges for dependent services that were 
packaged into each independent procedure, identify all independent 
procedures into which cost was packaged from each packaged procedure, 
and identify the cost of each procedure code with and without the 
proposed packaging. They recommended that, before implementing the 
proposed packaging, CMS publish all HCPCS and revenue codes and the 
costs for each that enter into the consideration of packaging for every 
code proposed to be packaged. The commenters believed that the lack of 
transparency, together with late availability of a correct OPPS 
proposed rule claims data set, made it difficult to determine whether 
packaged costs were retained or lost in the median setting process.
    Other commenters suggested that CMS explicitly crosswalk packaged 
services to identified independent services, rather than packaging 
payment into the independent service with which the packaged services 
is billed on each claim. They asserted that no service should be 
packaged unless it is furnished the majority of the time with the 
specified independent service. The commenters stated that items and 
services should be packaged only where there are substitutable services 
that could be chosen by the hospital, and that no packaging should 
occur where there is only one dependent service that would be provided 
with the independent service.
    Some commenters contended that CMS should not implement the 
proposed packaging changes until after it implements an adjustment for 
charge compression because errors in the proposed rates as a result of 
charge compression would result in too little payment being packaged 
into the independent service and would create disincentives for 
hospital to furnish the packaged services, thus harming beneficiary 
access to advanced technologies.
    Some commenters requested that CMS develop and propose a set of 
criteria for packaging services that would be open to public comment 
and that would control whether and, if so, when CMS could package 
payment for a service. The commenters stated that the criteria in the 
proposed rule were too vague, undefined, and subjective to identify 
which codes should be packaged. The commenters provided criteria that 
they believe should govern whether a service should be packaged. The 
suggested criteria included, but were not limited to, requiring that 
packaging should only be adopted for high volume, low cost, minor and 
ancillary services that are very frequently performed with the 
specified independent service; no packaging of services that require 
specialized equipment or devices; no packaging of services that are 
only furnished in a small number of hospitals; no packaging of add-on 
services unless the service is furnished with its base code at least 50 
percent or 75 percent of the time; packaging only when a service is 
being packaged into a specified service and, therefore, no general 
packaging of services into the service with which it is performed; no 
packaging unless CMS has provided the public with a full data 
assessment of the effects of packaging each service; and no packaging 
if the median cost for the code exceeds an established amount.
    Other commenters suggested CMS not implement the proposed packaging 
because the 60-day comment period provided insufficient time for 
analysis and because the APC Panel recommendations and report were not 
posted on the Web site immediately after the meeting.
    Response: We have reviewed all of the public comments we received 
on the

[[Page 66617]]

proposed packaging approach, and we have decided to finalize our 
proposal with significant modifications and refinements to address some 
of the concerns raised by commenters on our proposal to package payment 
for diagnostic radiopharmaceuticals, imaging supervision and 
interpretation services, contrast agents, and observation services. We 
refer readers to sections II.A.4.c.(4), (5), (6), and (7) of this final 
rule with comment period for detailed discussion of these modifications 
and section II.A.2 of this final rule with comment period for 
discussion of the changes we made to the data process in this regard. 
We are finalizing our proposal for guidance, image processing, and 
intraoperative services without substantial modification. Table 10, 
which appears in section II.A.4., contains a comprehensive list of all 
codes in the final seven categories for which we will package payment 
either unconditionally (to which we assign status indicator ``N'') or 
conditionally, providing separate payment if certain criteria are met 
(to which we assign status indicator ``Q''). There is a category of 
conditionally packaged codes assigned status indicator ``Q,'' which we 
previously referred to as ``special'' packaged codes because their 
payment was packaged when provided on the same date as a service that 
was assigned status indicator ``S,'' ``T,'' ``V,'' or ``X.'' These 
``special'' packaged codes will now be referred to as ``STVX-packaged 
codes.'' We have identified a new category of conditionally packaged 
codes that are called ``T-packaged codes,'' whose payment is packaged 
when provided on the same date as another service that is assigned 
status indicator ``T.'' The rationale for these changes are discussed 
in detail below in section II.A.4.c.(4) of this final rule with comment 
period.
    We believe that it is appropriate and fully consistent with the 
principles of a prospective payment system to package payment for 
ancillary and supportive services into the payment for the independent 
service with which they are furnished as a means of making payment for 
a more comprehensive service package. Although separate payment will no 
longer be made for the packaged services, the payments for the 
independent services with which they are furnished will reflect the 
costs of the packaged services to the extent that the packaged services 
are provided with the independent service. We recognize that, in some 
cases, certain supportive and ancillary dependent services are 
furnished with only one independent service, and in other cases they 
are furnished with many independent services. Similarly, in some cases 
they are furnished frequently with independent services, and in some 
cases they are uncommonly furnished with independent services.
    We believe that packaging should reflect the reality of how the 
services are furnished and reported on claims by hospitals. We believe 
that nonspecific packaging (as opposed to selected code packaging) 
based on combinations of services observed on hospital claims is fully 
appropriate because of the myriad combinations of services that can be 
appropriately provided together. This approach to packaging payment has 
long existed in prospective payment systems, including the OPPS. For 
example, in the IPPS, Medicare's oldest prospective payment system, 
payment for all services furnished is packaged into a single payment 
for an entire hospital inpatient stay that is based on the diagnosis-
related group (DRG) into which the stay is categorized. The DRG payment 
packages together all payment for routine care, drugs, biologicals, 
medical supplies, diagnostic tests, and all other covered services that 
were provided to the patient, regardless of the extent to which 
different patients in the same DRG received somewhat different services 
during their stay. We believe that a similar approach to nonspecific 
packaging under the OPPS is likewise fully appropriate. We have used 
this packaging approach for ratesetting throughout the history of the 
OPPS, and note that payment for APC groups currently reflects 
significant nonspecific packaging in many cases. Similarly, we believe 
that it is appropriate to establish under the OPPS a single payment for 
multiple independent procedures that are frequently furnished together. 
For that reason, we are adopting five composite APCs for CY 2008 and 
intend to explore developing others.
    We do not agree with the commenters that we should not package a 
service unless it is a low cost ancillary and supportive service that 
appears frequently with an independent service. To establish that 
policy would negate the concept of averaging that is an underlying 
premise of a prospective payment system by packaging only services that 
will increase the payment for the independent service. To do that would 
also create incentives for hospitals to provide ancillary and dependent 
services that are higher cost or historically were infrequently 
furnished with an independent service and would remain separately paid. 
Similarly, we do not agree that we should not finalize the proposed 
packaging approach because it will ``overpay'' some services and 
``underpay'' others. Payment based on a measure of central tendency is 
also a principle of any prospective payment system. In some cases, 
payment in an individual case exceeds the average cost and in other 
cases payment is less than the average cost, but on balance, payment 
should approximate the relative cost of the average case, recognizing 
that the OPPS, as created in the statute, was not intended to pay the 
full cost of HOPD services.
    We also do not agree that it would be beneficial to delay the 
implementation of the proposed packaging approach for a year because 
that would delay the implementation of incentives under the OPPS for 
hospitals to look carefully at ways that they could provide care more 
efficiently. We recognize that, as with any payment policy, there will 
be affected parties that will ask for changes to the policy, and we are 
always willing to hear their concerns and to make changes if the 
changes are appropriate. Moreover, both APC and status indicator 
assignments are open to public comment each year in the proposed rule, 
and hence affected parties may provide their arguments for separate 
payment as part of that process in the future.
    We further disagree that we should delay or not finalize the 
proposed packaging approach pending provision of the extensive data 
that the commenters requested. We make available a considerable amount 
of data for public analysis each year and while we are not developing 
and providing the extensively detailed information that the commenters 
request, we provide the public use files of claims and a detailed 
narrative description of our data process that the public can use to 
perform any desired analyses. While we acknowledge that we needed to 
issue a second corrected file of claims data, the second file differed 
from the first only in that it deleted a relatively small number of 
duplicate claims for observation that would have been used to calculate 
an APC rate for separately payable observation, had we proposed to pay 
separately for observation, and hence we believe that the accidental 
inclusion of these duplicate claims for observation care should have 
had little or no effect on the majority of studies of the HCPCS codes 
we proposed to package.
    With regard to the request for extensive data on all HCPCS codes we 
proposed to package, it would not be possible for us to anticipate the 
specific combinations of services of interest to the public. In 
addition, we believe that

[[Page 66618]]

the commenters must examine the data themselves to develop the specific 
arguments to support their requests for changes to payments under the 
OPPS. We note that we pay hospitals under the OPPS, and we showed the 
impact of the CY 2008 packaging proposal on payment to different 
classes of hospitals in Table 67 of the proposed rule (72 FR 42822 
through 42824). We believe our estimate of the impact of these changes 
provided valuable information to the hospitals that would receive 
packaged payment for services that had been previously paid separately 
under the OPPS.
    With regard to the public comments that we should explicitly 
crosswalk packaged codes to the independent codes into which the costs 
would be packaged, we do not believe that this is feasible, given the 
myriad combinations of services that are furnished in the HOPD, nor is 
it consistent with the principles of a prospective payment system, 
which bases payment on real occurrences of services that are furnished 
by hospitals and reported on claims. Moreover, creation of such a 
crosswalk would undoubtedly result in omissions of appropriate 
packaging of services and would create a maintenance task that would 
not be sustainable, given the number of changes to HCPCS codes each 
year and the ever changing way in which services are furnished. 
Similarly, it is not consistent with the concept of packaging within a 
prospective payment system to package only those services for which 
there are substitutes that could be furnished. In contrast, it is fully 
consistent with the principles of a prospective payment system for 
groups of services to package items and services that are always 
furnished with an independent service and for which there are no 
substitutes.
    We also do not agree that we should delay creation of larger 
payment bundles through packaging until after there is adjustment for 
charge compression under the OPPS. As we discuss in section II.A.1.c. 
of this final rule with comment period, we will consider whether to use 
regression-adjusted CCRs to adjust for charge compression under the 
OPPS after RTI reviews the OPPS cost estimation process, including an 
assessment of the revenue code-to-cost center crosswalk and estimating 
regression-adjusted CCRs from a model that includes outpatient charges. 
There is no reason to delay the creation of incentives for encouraging 
cost-effective utilization and efficiency in the provision of HOPD 
services until a decision is made regarding the appropriateness of 
using regression-adjusted CCRs to estimate OPPS costs.
    We do not agree that we should develop and establish criteria with 
stakeholder input before we finalize the packaging proposal. Nor do we 
believe that the specific criteria the commenters recommended are 
appropriate for determining when services should be packaged. The 
criteria that the commenters provided are focused almost exclusively on 
preventing packaging, rather than on determining when packaging would 
be appropriate. We believe that packaging is appropriate when the 
nature of a service is such that it is supportive and ancillary to 
another service, whether the dependent service is frequently furnished 
with the independent service or not and regardless of the cost of the 
supportive ancillary service. This is largely a clinical decision based 
on the nature of the service being considered for packaging.
    Lastly, we do not agree that we should not implement the proposed 
changes because the commenters believed that the 60 day comment period 
was insufficient or because the APC Panel recommendations and report 
were not posted to the Web site immediately after the public meeting. 
The 60 day comment period is generally the standard comment period for 
the proposed rule process. The availability of updated claims and cost 
report data necessary to develop the proposed rule and issue the final 
rule for the OPPS precludes a longer period for comment. Moreover, we 
do not believe that the Web site posting of the APC Panel 
recommendations and report is necessary for the public to provide 
meaningful comments, in light of the fact that the APC Panel meeting is 
open to the public.
    We are not accepting the recommendation of the APC Panel to provide 
information in this final rule with comment period clarifying how newly 
packaged services map back to primary procedures because we would be 
unable to display in a meaningful way all of the many combinations of 
services that may be of interest to the public. Moreover, given the 
numerous new, refined, and interrelated payment policies finalized for 
CY 2008 involving APC reconfiguration, HCPCS migration, reduction in 
the numbers of low volume APCs, and others, to adopt the APC Panel's 
example of simulating median costs holding all other CY 2008 policies 
constant for HCPCS codes with and without the additional packaging of 
those services newly packaged for CY 2008 would not provide meaningful 
comparative information. Almost certainly, if we were not to adopt 
packaging of the additional services for CY 2008, the APC 
configurations, bypass list, single claims available for ratesetting, 
and other important features upon which the final median costs depend 
would differ in significant ways from those aspects under our final CY 
2008 policies.
    Comment: A number of commenters disagreed with the CMS estimate of 
the amount of payment that would be redistributed under the proposed 
rule. The commenters indicated that the services proposed to be newly 
packaged constitute 6 percent of the OPPS costs, although CMS estimated 
that the packaging proposal would redistribute 1.2 percent of the CY 
2008 expenditures under the OPPS. They attributed the difference in 
cost estimates to the methodology for applying status indicator ``Q.'' 
The commenters believed that the resulting impact analysis would be 
quite different from CMS' estimated impact displayed in the proposed 
rule and, therefore, the implications of the policy are not fully 
understood. They objected to packaging of observation services in 
particular, but recommended that CMS reevaluate the entire packaging 
proposal in light of methodological and data concerns.
    Response: In the proposed rule, we estimated that the proposed 
packaging approach would redistribute 1.2 percent of the CY 2007 base 
expenditures under the OPPS to other OPPS services as part of our 
budget neutrality adjustments for the proposed CY 2008 payment system. 
This 1.2 percent is the aggregate payment weight reduction from the 
packaging proposal, where the medians are marginally less than the 
costs for the individual services prior to packaging. This is not 
inconsistent with a finding that the total cost of services proposed to 
be packaged constitutes 6 percent of HOPD costs. These percentages 
measure different things. The first provides an estimate of money 
redistributed to other services and the second an estimate of the 
proportion of OPPS spending on services addressed by the policy. We 
understand, and intended, that the packaging proposal affect services 
responsible for significant OPPS spending, in order to provide 
hospitals with meaningful incentives to examine their patterns of care 
delivery and improve efficiency. The 1.2 percent reflects the 
difference in total weight with and without the packaging proposal 
relative to the CY 2007 total base weight. Whether or not the 1.2 
percent of redistributed dollars was entirely attributable to the 
proposed policy for estimating the median cost for ``Q'' status 
indicator services cannot be

[[Page 66619]]

determined. For this final rule with comment period, we made 
modifications to the policy governing the handling of many services 
assigned status indicator ``Q,'' as discussed in section II.A.4.c.(4) 
of this final rule with comment period, that resulted in use of more 
claims data and significant changes to the median costs for some 
services. We also accepted the public comments that recommended that we 
create a composite APC for observation services, as discussed in 
section II.A.4.c.(7) of this final rule with comment period.
    Comment: Some commenters stated that CMS must undertake provider 
education and claims monitoring because providers will cease to bill 
HCPCS codes and charges for packaged services, which will result in 
lower payment rates than would otherwise be made if they reported all 
codes and charges and thus the costs of packaged services would be lost 
to the payment system in future years. They indicated that this 
presents huge operational challenges to hospitals to ensure that they 
bill and charge for the packaged codes. Other commenters believed that 
the implementation of increased packaging will be particularly 
difficult in CY 2008 because CMS is simultaneously implementing 
Medicare-Severity DRGs (MS-DRGs) for IPPS payment, which also poses 
operational challenges for hospitals.
    Response: We do not believe that there will be a significant change 
in what hospitals charge and report for the services they furnish to 
Medicare beneficiaries and to others as a result of the increased 
packaging for the CY 2008 OPPS. Medicare cost reporting standards 
specify that hospitals must impose the same charges for Medicare 
patients as for other patients. We are often told by hospitals that 
many private payers pay based on a percentage of charges and that 
hospital chargemasters do not differentiate between the charges to 
Medicare patients and others. Therefore, we have no reason to believe 
that hospitals will cease to report charges and HCPCS codes for 
packaged services they provide to Medicare beneficiaries. We expect 
that hospitals, as other prudent businesses, will have a quality review 
process that ensures that they accurately and completely report the 
services they furnish, with the appropriate charges for those services 
to Medicare and all other payers. Therefore, we do not see either the 
need or the responsibility to undertake a special effort to educate 
providers to report and charge Medicare for the services they furnish, 
whether separately paid or packaged. According to our longstanding 
policy, we will continue to encourage hospitals to report the HCPCS 
codes and associated charges for all services they provide, taking into 
consideration all CPT, OPPS, and local contracture instructions, 
regardless of whether payment for those HCPCS codes is packaged or 
separately provided. Similarly, we do not believe that the 
implementation of MS-DRGs will create operational issues for hospitals 
that would be complicated by increased packaging under the OPPS.
    Comment: Some commenters asserted that increased packaging will 
create disincentives to provide certain services and that providers may 
stop furnishing these services to Medicare beneficiaries. The 
commenters stated that increased packaging would reduce expenditures, 
but the ultimate result would be reduced access to necessary care as 
the payment incentives to provide care are reduced. Other commenters 
believed that increased packaging will result in services being 
furnished on multiple days in order to maximize payment, which will 
increase, rather than decrease, volumes of services and provide a 
significant inconvenience to beneficiaries.
    Response: We also do not agree that beneficiary access to care will 
be harmed by increased packaging. We believe that packaging will create 
incentives for hospitals and their physician partners to work together 
to establish appropriate protocols that will eliminate unnecessary 
services where they exist and will institutionalize approaches to 
providing necessary services more efficiently. Where this review 
results in reductions in services that are only marginally beneficial, 
we believe that this could improve rather than harm the quality of care 
for beneficiaries because every service furnished in a hospital carries 
some level of risk to the patient. Similarly, where this review results 
in the concentration of some services in a reduced number of hospitals 
in the community, we believe that the quality of care and hospital 
efficiency may both be enhanced as a result. The medical literature 
shows that concentration of services in certain hospitals often results 
in both greater efficiency and higher quality of care for patients.
    Moreover, we do not believe that packaging will result in Medicare 
beneficiaries being treated differently from other patients with regard 
to the care they receive in the hospital. A hospital may have its 
provider agreement terminated by Medicare under 42 CFR 489.53(a)(2) if 
it places restrictions on the persons it accepts for treatment and 
either fails to exempt Medicare beneficiaries from those restrictions 
or apply them to Medicare beneficiaries the same as to all other 
persons seeking care. We do not believe that a hospital would risk 
termination of its provider agreement by Medicare by refusing to 
furnish a medically necessary service to a Medicare beneficiary, 
although it provides the same service to other patients for the same 
clinical indications.
    As we indicated in the proposed rule, we will examine our claims 
data for patterns of fragmented care and if we find a pattern in which 
a hospital appears to be fragmenting care across multiple days, we will 
refer it for investigation to the QIO or to the program safeguard 
contractor, as appropriate to the circumstances we find. However, we do 
not believe that, in general, hospitals would routinely, and for 
purposes of financial gain, require patients to return on multiple days 
to receive services that could have been furnished on the same day.
    Comment: One commenter objected to the implication in the proposed 
rule that hospitals provide whatever services they wish at whatever 
cost, with their only concern being payment for the services, and that 
payment rates could motivate hospitals to report services on separate 
claims or split the service among different hospitals in order to be 
paid more. The commenter stated that 42 CFR 411.15(m) requires that 
hospitals must furnish and bill for services necessary to complete an 
outpatient encounter and that, therefore, it would be a violation of 
CMS regulations for a hospital to deliver part of the service at one 
hospital and the rest at another hospital.
    Response: We believe that hospitals strive to provide the best care 
they can to the patients they serve. However, we are aware that there 
are financial pressures on hospitals that might motivate some of them 
to split services in such a way as to maximize payments. While we do 
not expect that hospitals would routinely change the way they furnish 
services or the way they bill in order to maximize payment, we do 
believe that it would be possible, and hence we offered the cautionary 
note in the proposed rule that we will consider that possibility as we 
review our claims data. Other commenters, as described in the preceding 
comment, stated that volumes of services and expenditures would 
increase because hospitals would provide services on multiple days to 
maximize payment.
    We note that 42 CFR 411.15(m) specifies exclusions from Medicare 
coverage in cases in which the hospital does not furnish a service 
directly or

[[Page 66620]]

under arrangements as defined in 42 CFR 409.3 and, therefore, would not 
prohibit a hospital from discharging a patient and sending that patient 
to another hospital for a service that would otherwise be packaged if 
furnished during the same encounter. However, as noted above, a 
hospital that does not make available the same services to Medicare 
beneficiaries as to its other hospital patients can be terminated from 
Medicare under 42 CFR 489.53(a)(2). Additionally, we remind hospitals 
that any business models or arrangements they make for the provision of 
services intended to be billed by that hospital must comply with all 
applicable laws and regulations, including, but not limited to, the 
Stark law and other anti-kickback laws, the provider-based rules at 42 
CFR 413.65, the ``incident-to'' rules at 42 CFR 410.27, and the 
conditions for outpatient diagnostic services at 42 CFR 410.28. In 
regard to hospital services provided under arrangements, as defined in 
42 CFR 409.3, we have specified in the Eligibility and Entitlement 
Manual that, ``In permitting providers to furnish services under 
arrangements, it was not intended that the provider merely serve as a 
billing mechanism for the other party. Accordingly, for services 
provided under arrangements to be covered, the provider must exercise 
professional responsibility over the arranged for services'' (Pub. 100-
1, Chapter 5, section 10.3). Therefore, we would not expect hospitals 
to send patients to a separate entity merely to avoid packaged payment, 
but, as stated above, we will consider that possibility as we review 
our claims data.
    Comment: Some commenters suggested that CMS work with and through 
the AMA process in making any packaging decisions and not make any 
arbitrary and single-sided bundling decisions that have not been fully 
reviewed and analyzed for impact by the stakeholders. They suggested 
that CMS discuss with the AMA CPT Editorial Panel the potential for 
unintended consequences of proposed packaging or bundling on the 
establishment of CPT codes. For example, one commenter believed that 
packaging add-on codes, which the commenter viewed as integral to 
maintaining flexibility of CPT coding, would likely discourage future 
consideration of creating add-on codes as a means to describe code-
specific procedures and resources. Other commenters objected to what 
they view as a ``codebook'' approach to determining what should be 
packaged. The commenters stated that CMS not rely on CPT and HCPCS code 
descriptors because the descriptors are complex and many do not 
accurately describe the services furnished. Some commenters argued that 
CMS should pay across settings in the same way and, therefore, should 
not package under the OPPS services that are paid separately under the 
MPFS.
    Response: Our general process for developing the OPPS, including 
making major payment policy decisions, is prescribed by the 
Administrative Procedure Act (APA) and the Federal Advisory Committee 
Act (FACA). As such, proposed payment rates and the attendant policies 
are open to public comment both through the Federal Register notice and 
comment rulemaking process and through the public meetings of the APC 
Panel, which is a Federal Advisory Committee chartered by the Secretary 
of Health and Human Services. Therefore, our proposed packaging for the 
CY 2008 OPPS and the decisions we are announcing in this final rule 
with comment period are neither arbitrary nor single-sided, as all 
stakeholders have had the opportunity to comment. In this final rule 
with comment period, we are responding to their comments. We note that 
the AMA, as a member of the public, has the same opportunity to comment 
on the packaging proposal in the proposed rule as any other member of 
the public.
    We believe that it is entirely appropriate to rely on the HCPCS 
descriptors, including the AMA's CPT descriptors, for the definition of 
the services furnished for purposes of the proposed packaging approach 
and other payment policies. The OPPS is based on the definitions of 
services reported with HCPCS codes, of which the CPT code set is a 
fundamental part. The HCPCS codes are the only means by which hospitals 
report the services they furnish and the charges for those services 
and, therefore, they are basis of the OPPS. For that reason, we look to 
the HCPCS definition of the service to determine whether a particular 
service is ancillary and supportive of another service. To the extent 
that there are changes to the HCPCS codes and, by extension, to the CPT 
code descriptors, we will reevaluate the decisions we make with regard 
to packaging payment. However, we do not believe that the AMA's CPT 
Editorial Board is influenced by OPPS payment policy in its 
deliberations, nor should it be influenced by OPPS payment policy in 
its creation of CPT codes.
    Moreover, we disagree that we should not package payment for 
ancillary and supportive services because the MPFS pays separately for 
them. The OPPS is not a fee schedule, but a prospective payment system 
based on relative weights derived from costs and charges. Packaging of 
payments into appropriate groups is a fundamental principle that 
distinguishes a prospective payment system from a fee schedule and we 
do not believe that we should refrain from packaging payment for 
ancillary and supportive services into payment for the independent 
services with which they are furnished because they may be treated 
differently in the MPFS or because of the unlikely possibility that 
this policy may have some influence on the AMA CPT Editorial Panel's 
decisions regarding creation of codes.
    Comment: One commenter stated that the concept of creating 
incentives for hospitals to negotiate better prices on goods and 
services through packaging is not applicable to small rural hospitals 
and, therefore, it should not apply to them. The commenter argued that 
smaller rural hospitals cannot negotiate for better prices on goods and 
services because they buy smaller amounts of products and lack the 
ability that large urban hospitals have to negotiate for better prices 
on goods and services.
    Response: We believe that the creation of incentives for hospitals 
to seek more efficient ways of furnishing services is applicable to all 
hospitals, including small rural hospitals. Small rural hospitals and 
their physician partners have the same capacity and capability as other 
hospitals to evaluate the appropriateness and efficiency of the 
packaged services they furnish. Moreover, small rural hospitals can 
join in cooperatives and group purchasing organizations that can 
achieve purchasing efficiencies that they could not achieve by 
themselves. We recognize that some costs are higher for certain 
categories of rural hospitals, therefore we have provided the 7.1 
percent rural adjustment for rural SCHs. Moreover, the law holds 
harmless rural hospitals with 100 or fewer beds. However, we also 
expect that small rural hospitals will be motivated by the packaging 
approach to seek ways of furnishing services as efficiently as possible 
and to eliminate services that are essential to the appropriate 
treatment of the patient in any clinical case.
    Comment: Some commenters contended that the proposed packaging 
approach has the potential for systemwide net savings and 
redistribution of payments away from hospitals that invested in high-
cost equipment and toward hospitals that do not have such costs. They 
believed that charge compression contributes to this

[[Page 66621]]

problem because hospitals are limited in what they can charge, and the 
allocation of radiology equipment capital costs exacerbates the 
problem. The commenters suggested that CMS not finalize the packaging 
proposal because packaging creates incentives for hospitals to divest 
themselves of important but expensive technologies because those 
technologies have ceased to be profitable.
    Response: We agree that there is the potential for systemwide 
redistribution of payments away from hospitals that invested in costly 
equipment for services for which payment will be packaged and toward 
hospitals that do not have such costs. However, to the extent that 
packaging payment for ancillary and supportive services reduces the 
amount of payment weight in the system for separately paid services, 
that amount will be redistributed to all hospitals across all services 
paid under the OPPS through the budget neutral weight scaler. Any 
reduction in the growth of OPPS expenditures will result from slower 
growth in hospital costs in future years as a result of hospitals 
reducing the volume of certain services or finding more efficient ways 
to provide care. That potential future savings is one of the purposes 
of this packaging initiative and the exploration of episode-based or 
encounter-based payments under the OPPS. Similarly, if increased 
packaging causes hospitals to be more cautious in their decision making 
regarding investing in new equipment or incurring other large capital 
expenditures, we view that as a positive result of the policy. 
Hospitals make decisions regarding the equipment they buy for general 
business reasons, of which payment under the OPPS is only one factor 
among many, including, but not limited to, utilization and payments 
from other payers and payments from Medicare for IPPS services, which 
is the dominant source of Medicare payment for hospital care.
    Comment: One commenter asserted that linking growth in volume to 
reduced payments is premature, inappropriate, and not supported by 
statutory authority. The commenter was particularly concerned about any 
methodology that would establish different update factors for different 
OPPS service categories, where the update factor is determined in a 
manner that takes into account utilization trends. Many commenters 
stated that HOPD utilization of services is only marginally within the 
control of hospitals. They explained that hospitals provide services 
ordered by their medical staff and community physicians, and it would 
be inappropriate to penalize hospitals for performing services whose 
utilization is not within their control. The commenters believed that 
innovation and best practices have increased utilization, not the 
provision of excessive services.
    Response: Section 1833(t)(2)(F) of the Act requires us to develop a 
method of controlling unnecessary increases in the volume of covered 
OPS services and section 1833(t)(9)(C) of the Act authorizes us to 
adjust the update to the conversion factor if under section 
1833(t)(2)(F) of the Act, we determine that there is growth in volume 
that exceeds established tolerances. As we indicated in our proposed 
rule, we prefer not to take the approach of creating an SGR-type 
mechanism that could result in a reduced conversion factor under the 
OPPS and that could inadvertently result in actually increasing the 
volume of services. We prefer to establish larger packages of services 
on which to base OPPS payment in order to create incentives for 
hospitals and their physician partners to make thoughtful decisions 
regarding what services are medically necessary for their patients and 
to continuously reassess how they might be able to provide care more 
efficiently. We recognize that decisions regarding the care provided in 
HOPDs are not made unilaterally by the hospital, nor are they made 
unilaterally by the physician who is ordering the care. While 
physicians, rather than hospital staff, may order specific services for 
patients, hospitals decide what HOPD services they will and will not 
furnish, what drugs and supplies they will or will not buy and from 
whom they will buy them, what investments in equipment they will or 
will not make, and what programs they will open or close. Certainly, 
they make these decisions with significant input from their medical 
staff, but it is the hospital administration that makes the final 
decisions in this regard. Moreover, hospitals control, to some extent, 
the physicians on their medical staff and increasingly employ 
physicians to provide services to patients and to supervise the 
provision of hospital services. Hence, we do not agree with the 
argument that hospitals have no control over the services they furnish 
or that they have no influence over the physicians who order the 
specific services furnished to their patients.
    Comment: Some commenters asked CMS to impose a payment floor to 
limit the amount of decline in any APC payment in at least the first 
year of implementation as a means of mitigating the effects of no 
longer paying separately for the packaged services.
    Response: We do not agree that we should impose a payment floor to 
limit the amount of decline in any APC payment as a means of mitigating 
the effects of no longer paying separately for the packaged services. 
The purpose of creating larger payment packages is to create incentives 
for hospitals to assess the services they are furnishing to ensure that 
they are furnishing only medically necessary services as efficiently as 
possible. To establish a payment floor that would artificially inflate 
payments for APCs that are declining would reduce what would otherwise 
be appropriate increases in payments for other APCs. We believe that 
this would be contrary to the stated goal of paying appropriately for 
all services through larger payment bundles that are intended to create 
incentives for efficiency.
    Comment: Several commenters objected to the proposed packaging 
approach because they believed that it would be more difficult for new 
services to be approved for payment under New Technology APCs. One 
commenter believed that it would be difficult for new guidance 
services, in particular, to be approved for assignment to a New 
Technology APC if CMS considers guidance to be a supportive and 
ancillary service rather than a separately paid complete service. 
Therefore, the commenter concluded that the proposed packaging not only 
packages existing services but creates the potential for new 
technologies to not be approved for New Technology APC payment.
    Response: We assess applications for New Technology APC placement 
on a case-by-case basis. The commenter is correct that, to qualify for 
New Technology APC placement, the service must be a complete service, 
by which we mean a comprehensive service that stands alone as a 
meaningful diagnostic or therapeutic service. To the extent that a 
service for which New Technology APC status is being requested is 
ancillary and supportive of another service, for example, a new 
intraoperative service or a new guidance service, we might not consider 
it to be a complete service because its value is as part of an 
independent service. However, if the entire, complete service, 
including the guidance component of the service, for example, is 
``truly new,'' as we explained that term at length in the November 30, 
2001 final rule (66 FR 59898) which set forth the criteria for 
eligibility for assignment of services to New Technology APCs, we would 
consider the new complete procedure for New Technology APC assignment.

[[Page 66622]]

As stated in the November 30, 2001 final rule, by way of examples 
provided, ``The use of a new expensive instrument for tissue 
debridement or a new, expensive wound dressing does not in and of 
itself warrant creation of a new HCPCS code to describe the instrument 
or dressing; rather, the existing wound repair code appropriately 
describes the service that is being furnished * * * '' (66 FR 59898). 
This example may hold for some new guidance technologies as well.
    The following discussions separately address each of the seven 
categories of items and services for which we proposed to package 
payment under the CY 2008 OPPS as part of our packaging proposal and 
which we are adopting in this final rule with comment period, with the 
modifications discussed under the applicable topic. Many codes that we 
proposed to package for CY 2008 could fit into more than one of those 
seven categories. For example, CPT code 93325 (Doppler echocardiography 
color flow velocity mapping (List separately in addition to codes for 
echocardiography)) could be included in both the intraoperative and 
image processing categories. Therefore, for organizational purposes, 
both to ensure that each code appears in only one category and to 
facilitate discussion of our CY 2008 proposed and final policy, we have 
created a hierarchy of categories that determines which category each 
code appropriately falls into. This hierarchy is organized from the 
most clinically specific to the most general type of category. The 
hierarchy of categories is as follows: guidance services; image 
processing services; intraoperative services; and imaging supervision 
and interpretation services. Therefore, while CPT code 93325 may 
logically be grouped with either image processing services or 
intraoperative services, it is treated as an image processing service 
because that group is more clinically specific and precedes 
intraoperative services in the hierarchy. We did not believe it was 
necessary to include diagnostic radiopharmaceuticals, contrast media, 
or observation categories in this list because those services generally 
map to only one of those categories. We note that there is no cost 
estimation or payment implications related to the assignment of a HCPCS 
code for purposes of discussion to any specific category.
    Each HCPCS code we discuss in this section has a status indicator 
of either ``N'' or ``Q.'' The payment for a HCPCS code with a status 
indicator of ``N'' is unconditionally packaged so that its payment is 
always incorporated into the payments for the separately paid services 
with which it is reported. Payment for a HCPCS code with a status 
indicator of ``Q'' is either packaged or separately paid, depending on 
the services with which it is reported. Payment for a HCPCS code with a 
status indicator of ``Q'' that is ``STVX-packaged'' is packaged unless 
the HCPCS code is not reported on the same day with a service that has 
a status indicator of ``S,'' ``T,'' ``V,'' or ``X,'' in which case it 
would be paid separately. Payment for a HCPCS code with a status 
indicator of ``Q'' that is ``T-packaged'' is packaged unless the HCPCS 
code is not reported on the same day with a service that has a status 
indicator of ``T,'' in which case it would be paid separately. Payment 
for a HCPCS code with a status indicator of ``Q'' that is assigned to a 
composite APC is packaged into the payment for the composite APC when 
the criteria for payment of the composite APC are met.
(1) Guidance Services
    We proposed to package payment for HCPCS guidance codes for CY 
2008, specifically those codes that are reported for supportive 
guidance services, such as ultrasound, fluoroscopic, and stereotactic 
navigation services, that aid the performance of an independent 
procedure. We performed a broad search for such services, relying upon 
the AMA's CY 2007 book of CPT codes and the CY 2007 book of Level II 
HCPCS codes, which identified specific HCPCS codes as guidance codes. 
Moreover, we performed a clinical review of all HCPCS codes to capture 
additional codes that are not necessarily identified as ``guidance'' 
services but describe services that provide directional information 
during the course of performing an independent procedure. For example, 
we proposed to package CPT code 61795 (Stereotactic computer-assisted 
volumetric (navigational) procedure, intracranial, extracranial, or 
spinal (List separately in addition to code for primary procedure)) 
because we consider it to be a guidance service that provides three-
dimensional information to direct the performance of intracranial or 
other diagnostic or therapeutic procedures. We also included HCPCS 
codes that existed in CY 2006 but were deleted and were replaced in CY 
2007. We included the CY 2006 HCPCS codes because we proposed to use 
the CY 2006 claims data to calculate the CY 2008 OPPS median costs on 
which the CY 2008 payment rates would be based. Many, although not all, 
of the CPT guidance codes we identified are designated in the CPT 
coding scheme as add-on codes that are to be reported in addition to 
the CPT code for the primary procedure. We also note that there are a 
number of CPT codes describing independent surgical procedures that 
have code descriptors that indicate that guidance is included in the 
code reported for the surgical procedure if it is used and, therefore, 
packaged payment is already made for the associated guidance service 
under the OPPS. For example, the independent procedure described by CPT 
code 55873 (Cryosurgical ablation of the prostate (includes ultrasonic 
guidance for interstitial cryosurgical probe placement)) already 
includes the ultrasound guidance that may be used. We believed 
packaging payment for every guidance service under the OPPS would 
provide consistently packaged payment for all these services that are 
used to direct independent procedures, even if they are currently 
separately reported.
    Because these dependent guidance procedures support the performance 
of an independent procedure and they are generally provided in the same 
operative session as the independent procedure, we believed that it 
would be appropriate to package their payment into the OPPS payment for 
the independent procedure performed. However, guidance services differ 
from some of the other categories of services that we proposed to 
package for CY 2008. Hospitals sometimes may have the option of 
choosing whether to perform a guidance service immediately preceding or 
during the main independent procedure, or not at all, unlike many of 
the imaging supervision and interpretation services, for example, which 
are generally always reported when the independent procedure is 
performed. Once a hospital decides that guidance is appropriate, the 
hospital may have several options regarding the type of guidance 
service that can be performed. For example, when inserting a central 
venous access device, hospitals have the option of using no guidance, 
ultrasound guidance, or fluoroscopic guidance, and the selection in any 
specific case will depend upon the specific clinical circumstances of 
the device insertion procedure. In fact, as we noted in the CY 2008 
proposed rule, the historical hospital claims data demonstrated that 
various guidance services for the insertion of these devices, which 
have historically received packaged payment under the OPPS, are used 
frequently for the insertion of vascular access devices.
    Thus, we recognized that hospitals have several options regarding 
the performance and types of guidance services they use. However, we 
believed

[[Page 66623]]

that hospitals utilize the most appropriate form of guidance for the 
specific procedure that is performed. We did not want to create payment 
incentives to use guidance for all independent procedures or to provide 
one form of guidance instead of another. Therefore, by proposing to 
package payment for all forms of guidance, we specifically encouraged 
hospitals to utilize the most cost effective and clinically 
advantageous method of guidance that is appropriate in each situation 
by providing them with the maximum flexibility associated with a single 
payment for the independent procedure. Similarly, hospitals may 
appropriately not utilize guidance services in certain situations based 
on clinical indications.
    Because guidance services can be appropriately reported in 
association with many independent procedures, under our proposed 
packaging of guidance services for CY 2008, the costs associated with 
guidance services would be mapped to a larger number of independent 
procedures than some other categories of codes that we proposed to 
package. For example, CPT code 76001 (Fluoroscopy, physician time more 
than one hour, assisting a non-radiologic physician (e.g., 
nephrostolithotomy, ERCP, bronchoscopy, transbronchial biopsy)) can be 
reported with a wide range of services. According to the CPT code 
descriptor, these procedures include nephrostolithotomy, which may be 
reported with CPT code 50080 (Percutaneous nephrostolithotomy or 
pyelostolithotomy, with or without dilation, endoscopy, lithotripsy, 
stenting, or basket extraction; up to 2 cm), and endoscopic retrograde 
cholangiopancreatography, which may be reported with CPT code 43260 
(Endoscopic retrograde cholangiopancreatography (ERCP); diagnostic, 
with or without collection of specimen(s) by brushing or washing 
(separate procedure)). Therefore, the cost of the fluoroscopic guidance 
would be reflected in the payment for each of these independent 
services, in addition to numerous other procedures, rather than in the 
payment for only one or two independent services, as is the case for 
some of the other categories of codes that we proposed to package for 
CY 2008.
    In addition, because independent procedures such as CPT code 20610 
(Arthrocentesis, aspiration and/or injection; major joint or bursa 
(e.g., shoulder, hip, knee joint, subacromial bursa)) may be reported 
with or without guidance, the cost for the guidance will be reflected 
in the median cost for the independent procedure as a function of the 
frequency that guidance is reported with that procedure. As we stated 
previously, the median cost for a particular independent procedure 
generally will be higher as a result of added packaging, but also could 
change little or be lower because median costs typically do not reflect 
small distributional changes and because changes to the packaged HCPCS 
codes affect both the number and composition of single bills and the 
mix of hospitals contributing those single bills. In fact, the CY 2007 
CPT book indicates that if guidance is performed with CPT code 20610, 
it may be appropriate to bill CPT code 76942 (Ultrasonic guidance for 
needle placement (e.g., biopsy, aspiration, injection, localization 
device), imaging supervision and interpretation); 77002 (Fluoroscopic 
guidance for needle placement (e.g., biopsy, aspiration, injection, 
localization device)); 77012 (Computed tomography guidance for needle 
placement (e.g., biopsy, aspiration, injection, localization device), 
radiological supervision and interpretation); or 77021 (Magnetic 
resonance guidance for needle placement (e.g., for biopsy, needle 
aspiration, injection, or placement of localization device) 
radiological supervision and interpretation). The CY 2007 CPT book also 
implies that it is not always clinically necessary to use guidance in 
performing an arthrocentesis described by CPT code 20610.
    The guidance procedures that we proposed to package for CY 2008 
vary in their resource costs. Resource cost was not a factor we 
considered when proposing to package guidance procedures. Notably, most 
of the guidance procedures are relatively low cost in comparison to the 
independent services they frequently accompany.
    The codes we proposed to identify as guidance codes for CY 2008 
that would receive packaged payment were listed in Table 8 of the CY 
2008 proposed rule (72 FR 42657). (Table 10 in this final rule with 
comment period contains a comprehensive list of all codes in the final 
seven categories for services that are packaged for CY 2008.)
    Several of these codes, including CPT code 76937 (Ultrasound 
guidance for vascular access requiring ultrasound evaluation of 
potential access sites, documentation of selected vessel patency, 
concurrent real time ultrasound visualization of vascular needle entry, 
with permanent recording and reporting (List separately in addition to 
code for primary procedure)), were already unconditionally (that is, 
always) packaged under the CY 2007 OPPS, where they have been assigned 
status indicator ``N.'' Payment for these services is currently made as 
part of the payment for the separately payable, independent services 
with which they are billed. No separate payment is made for services 
that we have assigned to status indicator ``N.'' We did not propose 
status indicator changes for the five guidance procedures that were 
unconditionally packaged for CY 2007.
    We proposed to change the status indicators for 31 guidance 
procedures from separately paid to unconditionally packaged (status 
indicator ``N'') for the CY 2008 OPPS. We believed that these services 
are always integral to and dependent upon the independent services that 
they support and, therefore, their payment would be appropriately 
packaged because they would generally be performed on the same date and 
in the same hospital as the independent services.
    We proposed to change the status indicator for one guidance 
procedure from separately paid to conditionally packaged (status 
indicator ``Q''), and to treat it as a ``special'' ``packaged code for 
the CY 2008 OPPS, specifically, CPT code 76000 (Fluoroscopy (separate 
procedure), up to 1 hour physician time, other than 71023 or 71034 
(e.g., cardiac fluoroscopy)). This code was discussed in the past with 
the Packaging Subcommittee of the APC Panel, which determined that, 
consistent with its code descriptor as a separate procedure, this 
procedure could sometimes be provided alone, without any other services 
on the claim. We believe that this procedure will usually be provided 
by a hospital as guidance in conjunction with another significant 
independent procedure on the same date of service but may occasionally 
be provided without another independent service. As a ``special'' 
packaged code, if the fluoroscopy service were billed without any other 
service assigned status indicator ``S,'' ``T,'' ``V,'' or ``X'' 
reported on the same date of service, under our proposal we would not 
treat the fluoroscopy procedure as a dependent service for purposes of 
payment. If we were to unconditionally package payment for this 
procedure, treating it as a dependent service, hospitals would receive 
no payment at all when providing this service alone, although the 
procedure would not be functioning as a guidance service in that case. 
However, according to our proposal, its conditionally packaged status 
with its designation as a ``special'' packaged code would allow payment 
to be provided for this ``Q'' status fluoroscopy

[[Page 66624]]

procedure, in which case it would be treated as an independent service 
under these limited circumstances. On the other hand, when the 
fluoroscopy service is furnished as a guidance procedure on the same 
day and in the same hospital as independent, separately paid services 
that are assigned status indicator ``S,'' ``T,'' ``V,'' or ``X,'' we 
proposed to package payment for it as a dependent service. In all 
cases, we proposed that hospitals that furnish independent services on 
the same date as dependent guidance services must bill them all on the 
same claim. We believed that when dependent guidance services and 
independent services are furnished on the same date and in the same 
facility, they are part of a single complete hospital outpatient 
service that is reported with more than one HCPCS code, and no separate 
payment should be made for the guidance service that supports the 
independent service.
    The estimated overall impact of these changes presented in section 
XXII.B. of the proposed rule (section XXIV.B. in this final rule with 
comment period) was based on the assumption that hospital behavior 
would not change with regard to when these dependent services are 
performed on the same date and by the same hospital that performs the 
independent services. To the extent that hospitals could change their 
behavior and perform the guidance services more or less frequently, on 
subsequent dates, or at settings outside of the hospital, the data 
would show such a change in practice in future years and that change 
would be reflected in future budget neutrality adjustments. However, 
with respect to guidance services in particular, we believe that 
hospitals are limited in the extent to which they could change their 
behavior with regard to how they furnish these services. By their 
definition, these guidance services generally must be furnished on the 
same date and at the same operative location as the independent 
procedure in order for the guidance service to meaningfully contribute 
to the treatment of the patient in directing the performance of the 
independent procedure. We do not believe the clinical characteristics 
of the guidance services will change in the immediate future.
    As we indicated earlier, in all cases, we proposed that hospitals 
that furnish the guidance service on the same date as the independent 
service must bill both services on the same claim. We indicated that we 
expected to carefully monitor any changes in billing practices on a 
service-specific and hospital-specific basis to determine whether there 
is reason to request that QIOs review the quality of care furnished or 
to request that Program Safeguard Contractors review the claims against 
the medical record.
    During the September 2007 APC Panel meeting, the Panel recommended 
that CMS finalize the proposal to package guidance services, with the 
exception of radiation oncology guidance procedures.
    We received many public comments on our proposal to package 
guidance services for CY 2008. A summary of the public comments and our 
responses follow.
    Comment: Many commenters requested that, if CMS elected to finalize 
the packaging status of the guidance codes proposed for packaging, CMS 
exclude radiation oncology guidance procedures, in accordance with the 
APC Panel recommendation. Specifically, many commenters requested that 
CMS pay separately for CPT codes 76950 (Ultrasonic guidance for 
placement of radiation therapy fields); 76965 (Ultrasonic guidance for 
interstitial radioelement application); 77014 (Computed tomography 
guidance for placement of radiation therapy fields); 77417 (Therapeutic 
radiology port film(s)); and 77421 (Stereoscopic X-ray guidance for 
localization of target volume for the delivery of radiation therapy). 
The commenters were concerned that packaging radiation oncology 
guidance procedures would encourage hospitals to decrease utilization 
of advanced technologies for localization used in radiation oncology 
treatment delivery. The commenters noted that packaging payment for 
radiation oncology guidance services offers a financial incentive to 
those hospitals that use little or no daily localization when providing 
radiation therapy. One commenter believed that packaging payment for 
these guidance services encourages hospitals to use older, less 
effective technologies, thereby discouraging development of new, more 
effective technologies. Another commenter noted that if hospitals are 
discouraged from using new technologies due to low payment rates, it 
will take many years to gather robust cost data that reflect these new 
technologies, likely even longer than New Technology APC and pass-
through payments are available for new technologies.
    Response: After reviewing these public comments, considering the 
recommendation of the APC Panel, and ensuring that CMS clinical staff 
analyzed the content of these comments, we have decided to finalize our 
proposal to package these guidance services, as proposed. These 
services are ancillary and dependent in relation to the radiation 
therapy services with which they are most commonly furnished. Moreover, 
there are no unique clinical aspects to these radiation oncology 
guidance services that would differentiate them from other guidance 
services. Consistent with the principles of a prospective payment 
system, in some cases, payment in an individual case exceeds the 
average costs, and in other cases payment is less than the average 
cost, but on balance, payment should approximate the relative cost of 
the average case. We do not believe that beneficiary access to care 
will be harmed by increased packaging. We believe that packaging will 
create incentives for hospitals and their physician partners to work 
together to establish appropriate protocols that will eliminate 
unnecessary services where they exist and institutionalize approaches 
to providing necessary services more efficiently. Therefore, we see no 
basis for treating radiation oncology services differently from other 
guidance services that are ancillary and dependent to the procedure 
that they facilitate.
    Comment: Many commenters were concerned with the proposal to 
package payment for electrodiagnostic guidance for chemodenervation 
procedures, specifically, CPT codes 95873 (Electrical stimulation for 
guidance in conjunction with chemodenervation (List separately in 
addition to code for primary procedure)), and 95874 (Needle 
electromyography for guidance in conjunction with chemodenervation 
(List separately in addition to code for primary procedure)). The 
commenters indicated that chemodenervation involves the injection of 
chemodenervation agents, such as botulinum toxin, to control the 
symptoms associated with dystonia and other disorders. According to the 
commenters, physicians often, but not always, use electromyography or 
electrical stimulation guidance to guide the needle to the most 
appropriate location. The commenters were concerned that the proposal 
to package payment for these guidance services may discourage 
utilization of this particular form of guidance, even when medically 
appropriate. Several commenters noted that the CY 2008 proposed payment 
rate for the injection and the associated guidance is a 15 percent 
decrease from the CY 2007 payment rate. Most commenters requested that 
CMS pay separately for electrodiagnostic guidance, several of whom 
specified that CMS assign the

[[Page 66625]]

three chemodenervation procedures to their own APC. The commenters 
noted that even if the median cost for the chemodenervation procedures 
increased, the payment rate would not increase because chemodenervation 
procedures are only a small proportion of all claims in their proposed 
APC 0204 (Level I Nervous System Injections). Several other commenters 
stated that the median costs for the chemodenervation procedures do not 
reflect the full cost of the guidance because the guidance is performed 
with the procedure infrequently.
    Response: We note that the cost of the chemodenervation guidance 
services will be reflected in the median cost for the independent HCPCS 
code as a function of the frequency that chemodenervation services are 
reported with that particular HCPCS code. As noted above, we recognize 
that, in some cases, supportive and ancillary dependent services are 
furnished at high frequency with independent services, and in other 
cases, they are furnished with independent services at a low frequency. 
We believe that packaging should reflect the reality of how services 
are furnished. While the commenters are correct that the 
chemodenervation procedures reflect only approximately 10 percent of 
the services that comprise APC 0204, we note that they appropriately 
map to this APC both clinically and in terms of resource use. If the 
median costs for the individual chemodenervation procedures were to 
change dramatically, based on resource cost data, we would review these 
services as part of our annual review process to determine if a 
different APC were more appropriate. We also note that if these three 
chemodenervation procedures were mapped to their own APC, the estimated 
median cost of the APC would be in the same general cost range as the 
current median cost for APC 0204. Therefore, it is unnecessary to map 
these three services to their own APC for CY 2008.
    Comment: Several commenters requested that CMS clarify how the DRA 
imaging cap for services paid under the MPFS would be applied to 
services that are packaged under the OPPS.
    Response: If an imaging service is packaged under the OPPS, the DRA 
cap on the technical component payment for that service under the MPFS 
is not applicable.
    Comment: Many commenters supported the proposal to package each of 
the guidance services that we identified in the proposed rule. The 
commenters also gave specific comments related to almost every guidance 
code that we proposed to package. In general, each commenter requested 
that we pay separately for several of the guidance codes that we 
proposed to package. The commenters expressed concern in several areas, 
specifically, that insufficient payment rates would discourage new 
technologies; that guidance services used infrequently with specific 
services contribute very little to the payment rates for those 
services; that the expected decrease in utilization for guidance 
services could ultimately lead to increased costs, as a result of worse 
patient outcomes; that packaged payment under the OPPS and separate 
payment under the MPFS leads to payment disparity; and, in general, 
that the lack of published crosswalks makes it difficult to analyze the 
specific effects of this policy.
    Response: We note that we did not receive any unique arguments 
specific to any particular code. We received many similar public 
comments regarding all the categories of codes that we proposed for 
packaged payment. Therefore, we have responded to these general 
comments above in section II.A.4.c. of this final rule with comment 
period. In light of the public comments we received, our clinical 
advisors reassessed every guidance code on the list to ensure that it 
was still appropriate for packaged payment.
    For CY 2008, we are finalizing the CY 2008 proposal, without 
modification, to package payment for all guidance services for CY 2008. 
We are partially accepting the APC Panel recommendation. Specifically, 
we are packaging all guidance services for CY 2008, including radiation 
oncology services. The guidance codes that are packaged for CY 2008 are 
identified and displayed in Table 10 of this final rule with comment 
period. These services are assigned status indicator ``N'' to indicate 
their unconditional packaging, with the exception of CPT code 76000, 
which is an ``STVX-packaged'' code assigned status indicator ``Q.''
(2) Image Processing Services
    We proposed to package payment for ``image processing'' HCPCS codes 
for CY 2008, specifically those codes that are reported as supportive 
dependent services to process and integrate diagnostic test data in the 
development of images, performed concurrently or after the independent 
service is complete. We performed a broad search for such services, 
relying upon the AMA's CY 2007 book of CPT codes and the CY 2007 book 
of Level II HCPCS codes, which identified specific codes as 
``processing'' codes. In addition, we performed a clinical review of 
all HCPCS codes to capture additional codes that we consider to be 
image processing. For example, we proposed to package payment for CPT 
code 93325 (Doppler echocardiography color flow velocity mapping (List 
separately in addition to codes for echocardiography)) because it is an 
image processing procedure, even though the code descriptor does not 
specifically indicate it as such.
    An image processing service processes and integrates diagnostic 
test data that were captured during another independent procedure, 
usually one that is separately payable under the OPPS. The image 
processing service is not necessarily provided on the same date of 
service as the independent procedure. In fact, several of the image 
processing services that we proposed to package for CY 2008 do not need 
to be provided face-to-face with the patient in the same encounter as 
the independent service. While this approach to service delivery may be 
administratively advantageous from a hospital's perspective, providing 
separate payment for each image processing service whenever it is 
performed is not consistent with encouraging value-based purchasing 
under the OPPS. We believed it was important to package payment for 
supportive dependent services that accompany independent services but 
that may not need to be provided face-to-face with the patient in the 
same encounter because the supportive services utilize data that were 
collected during the preceding independent services and packaging their 
payment encourages the most efficient use of hospital resources. We are 
particularly concerned with any continuance of current OPPS payment 
policies that could encourage certain inefficient and more costly 
service patterns. As stated above, packaging encourages hospitals to 
establish protocols that ensure that services are furnished only when 
they are medically necessary and to carefully scrutinize the services 
ordered by practitioners to minimize unnecessary use of hospital 
resources. Our standard methodology to calculate median costs packages 
the costs of dependent services with the costs of independent services 
on ``natural'' single claims across different dates of service, so we 
are confident that we would capture the costs of the supportive image 
processing services for ratesetting when they are packaged according to 
our CY 2008 proposal, even if they were provided on a different date 
than the independent procedure.
    We listed the image processing services that we proposed to be 
packaged for CY 2008 in Table 10 in the

[[Page 66626]]

CY 2008 proposed rule (72 FR 42659). As these services support the 
performance of an independent service, we believe it would be 
appropriate to package their payment into the OPPS payment for the 
independent service provided.
    As many independent services may be reported with or without image 
processing services, the cost of the image processing services will be 
reflected in the median cost for the independent HCPCS code as a 
function of the frequency that image processing services are reported 
with that particular HCPCS code. Again, while the median cost for a 
particular independent procedure generally will be higher as a result 
of added packaging, it could also change little or be lower because 
median costs typically do not reflect small distributional changes and 
because changes to the packaged HCPCS codes affect both the number and 
composition of single bills and the mix of hospitals contributing those 
single bills. For example, CPT code 70450 (Computed tomography, head or 
brain; without contrast material) may be provided alone or in 
conjunction with CPT code 76376 (3D rendering with interpretation and 
reporting of computed tomography, magnetic resource imaging, 
ultrasound, or other tomographic modality; not requiring image post-
processing on an independent workstation). In fact, CPT code 70450 was 
provided approximately 1.5 million times based on CY 2008 proposed rule 
claims data. CPT code 76376 was provided with CPT code 70450 less than 
2 percent of the total instances that CPT code 70450 was billed. 
Therefore, as the frequency of CPT code 76376 provided in conjunction 
with CPT code 70450 increases, the median cost for CPT code 70450 would 
be more likely to reflect that additional cost.
    The image processing services that we proposed to package vary in 
their hospital resource costs. Resource cost was not a factor we 
considered when we proposed to package supportive image processing 
services. Notably, the majority of image processing services that we 
proposed to package have modest median costs in relationship to the 
cost of the independent service that they typically accompany.
    Several of these codes, including CPT code 76350 (Subtraction in 
conjunction with contrast studies), are already unconditionally (that 
is, always) packaged under the CY 2007 OPPS, where they have been 
assigned status indicator ``N.'' Payment for these services is made as 
part of the payment for the separately payable, independent services 
with which they are billed. No separate payment is made for services 
that we have assigned status indicator ``N.'' We did not propose status 
indicator changes for the four image processing services that were 
unconditionally packaged for CY 2007.
    We proposed to change the status indicator for seven image 
processing services from separately paid to unconditionally packaged 
(status indicator ``N'') for the CY 2008 OPPS. We believe that these 
services are always integral to and dependent upon the independent 
service that they support and, therefore, their payment would be 
appropriately packaged.
    The estimated overall impact of these changes presented in section 
XXII.B. of the proposed rule (section XXIV.B. of this final rule with 
comment period) was based on the assumption that hospital behavior 
would not change with regard to when these dependent image processing 
services are performed on the same date and by the same hospital that 
performs the independent services. To the extent that hospitals could 
change their behavior and perform the image processing services more or 
less frequently, the data would show such a change in practice in 
future years and that change would be reflected in future budget 
neutrality adjustments.
    As we indicated earlier, in all cases, we provided that hospitals 
that furnish the image processing procedure in association with the 
independent service must bill both services on the same claim. We 
indicated that we expected to carefully monitor any changes in billing 
practices on a service-specific and hospital-specific basis to 
determine whether there is reason to request that QIOs review the 
quality of care furnished or to request that Program Safeguard 
Contractors review the claims against the medical record.
    The APC Panel recommended that all image processing services be 
packaged as proposed in the proposed rule.
    We received a number of public comments on our proposal to package 
image processing service for CY 2008. A summary of the public comments 
and our responses follow.
    Comment: Many commenters were concerned with the proposal to 
package payment for CPT code 93325 (Doppler echocardiography color flow 
velocity mapping (List separately in addition to codes for 
echocardiography)). The commenters noted that this service is often 
critical to decisionmaking and consumes significantly greater resources 
than the general echocardiography study process. Several commenters 
noted that the AMA is planning to revise this CPT code for CY 2009, and 
that changing the payment status of this code may confuse hospital 
coding staff. Some commenters requested that CMS make no changes to the 
payment status of this code until this code's descriptor has been 
revised by the AMA, while others requested that CMS instruct hospitals 
not to use the new CPT code that will be created by the AMA.
    Response: We acknowledge that this service may be an important 
clinical tool that is critical to decisionmaking. However, we continue 
to believe that packaged payment is appropriate for this dependent 
service that must, per the CY 2007 CPT book, be provided in conjunction 
with echocardiography. In fact, packaging the status of this code may 
make it easier to crosswalk the data from this code to the new CPT code 
that the AMA may create for CY 2009. We see no compelling reason to 
postpone packaging this service until CY 2009.
    Comment: One commenter requested that CMS pay separately for HCPCS 
code G0288 (Reconstruction, computed tomographic angiography of aorta 
for surgical planning for vascular surgery) because it is different 
than the other image processing codes proposed for packaged payment. 
The commenter stated that the service is often an out-sourced service 
purchased by the hospital. The commenter was particularly concerned 
that hospitals would no longer continue to purchase this service if 
insufficient payment was provided. Another commenter requested separate 
payment for CPT code 95957 (Digital analysis of electroencephalogram 
(EEG) (eg, for epileptic spike analysis)). The commenter stated that 
this service is often performed on a different day than the EEG and by 
a technologist other than the one who performed the EEG.
    Response: As noted above, we believe it is important to package 
payment for supportive dependent services that may not need to be 
provided face-to-face with the patient in the same encounter as the 
independent service. Packaging payment for supportive services that 
utilize data that were collected during the preceding independent 
services encourages the most efficient use of hospital resources. In 
fact, as part of our proposed CY 2008 packaging approach, we also 
proposed to unconditionally package payment in CY 2008 for several 
other image processing services that are not always performed face-to-
face, including CPT codes 0174T (Computer aided detection (CAD) 
(computer algorithm analysis of digital image data for lesion 
detection) with further physician review for interpretation and report, 
with or without digitization of

[[Page 66627]]

film radiographic images, chest radiograph(s), performed concurrent 
with primary interpretation); 0175T ((Computer aided detection (CAD) 
(computer algorithm analysis of digital image data for lesion 
detection) with further physician review for interpretation and report, 
with or without digitization of film radiographic images, chest 
radiograph(s), performed remote from primary interpretation); and CPT 
code 76377 (3D rendering with interpretation and reporting of computed 
tomography, magnetic resource imaging, ultrasound, or other tomographic 
modality; requiring image postprocessing on an independent 
workstation).
    We also believe it is likely that a hospital that performed the 
computed tomographic angiography diagnostic procedure but does not have 
the technology necessary to provide the preoperative image 
reconstruction would send the results to another hospital for 
performance of the reconstruction. In this situation, the second 
hospital would be providing the reconstruction under arrangement and, 
therefore, at least one service provided by the first hospital would be 
separately paid. We believe that packaged payment for image 
reconstruction under a prospective payment methodology for hospital 
outpatient services is most appropriate. The same situation occurs when 
hospitals provide the service described by CPT code 95957. We proposed 
to unconditionally package payment for HCPCS code G0288 and CPT code 
95957 for CY 2008, fully consistent with the packaging approach for the 
CY 2008 OPPS. Because HCPCS code G0288 and CPT code 95957 are 
supportive ancillary services that fit into the image processing 
category, and we proposed to package payment for all image processing 
services for CY 2008, we believe it is appropriate to unconditionally 
package payment associated with these codes. Specifically, we 
determined that these services are dependent services that are integral 
to independent services, in this case, the computed tomographic 
angiography and the EEG that we would expect to be provided. Even if 
the imaging process services were provided on another day than the 
independent services, our packaging methodology packages costs across 
dates of service on ``natural'' single claims, so that the costs of 
image process services would be captured.
    For CY 2008, we are finalizing the packaged status of HCPCS code 
G0288 and CPT code 95957, as listed in Table 10 of the proposed rule. 
We note an inadvertent error in Addendum B to the proposed rule. 
However, Table 10 of the proposed rule listed the accurate proposed 
payment status of HCPCS code G0288.
    Comment: Many commenters supported the proposal to package each of 
the image processing services that was identified in the proposed rule. 
Numerous other commenters requested that CMS postpone packaging all the 
packaged codes included in all categories of the proposal until 
additional data were provided to the public. These commenters also 
submitted specific comments related to almost every image processing 
code that CMS proposed to package. The commenters expressed concern in 
several areas, specifically, that what they considered to be 
insufficient payment rates would discourage new technologies; that 
image processing services used infrequently with specific services 
contribute very little to the payment rates for those services; that 
the expected decrease in utilization for image processing services 
could ultimately lead to increased costs, as a result of worse patient 
outcomes; and in general, that the lack of published crosswalks makes 
it difficult to analyze the specific effects of this policy.
    Several commenters requested a crosswalk that specified how the 
packaged costs were allocated from each dependent code to each 
independent code. Other commenters requested that CMS create edits to 
ensure that costs are appropriately mapped to independent codes. 
Several commenters requested that CMS consider resource cost when 
determining which codes to package. The commenters were concerned that 
what they considered to be insufficient payment would create a 
disincentive for hospitals to adopt new technology.
    Response: We note that we did not receive any unique arguments 
specific to any particular code. These comments are similar to those 
received for all the categories of codes that we proposed for packaged 
payment. Therefore, we have responded to these general comments above 
in section II.A.4.c. of this final rule with comment period. In light 
of the public comments we received, our clinical advisors reassessed 
every image processing code on the list to ensure that it was still 
appropriate for packaged payment.
    We received one comment related to CPT codes 0174T and 0175T. The 
comment summary and response related to those codes are located in 
section II.A.4.e. of this final rule with comment period.
    For CY 2008, we are finalizing our proposal, without modification, 
to unconditionally package the payment for all imaging processing codes 
listed in Table 10 of this final rule with comment period. We are 
accepting the APC Panel recommendation to package all image processing 
services. These services are assigned status indicator ``N'' to 
indicate their unconditional packaging.
(3) Intraoperative Services
    We proposed to package payment for ``intraoperative'' HCPCS codes 
for CY 2008, specifically those codes that are reported for supportive 
dependent diagnostic testing or other minor procedures performed during 
independent procedures. We performed a broad search for possible 
intraoperative HCPCS codes, relying upon the AMA's CY 2007 book of CPT 
codes and the CY 2007 book of Level II HCPCS codes, to identify 
specific codes as ``intraoperative'' codes. Furthermore, we performed a 
clinical review of all HCPCS codes to capture additional supportive 
diagnostic testing or other minor intraoperative or intraprocedural 
codes that are not necessarily identified as ``intraoperative'' codes. 
For example, we proposed to package payment for CPT code 95955 
(Electroencephalogram (EEG) during nonintracranial surgery (e.g., 
carotid surgery)) because it is a minor intraoperative diagnostic 
testing procedure even though the code descriptor does not indicate it 
as such. Although we use the term ``intraoperative'' to categorize 
these procedures, we also have included supportive dependent services 
in this group that are provided during an independent procedure, 
although that procedure may not necessarily be a surgical procedure. 
These dependent services clearly fit into this category because they 
are provided during, and are integral to, an independent procedure, 
like all the other intraoperative codes, but the independent procedure 
they accompany may not necessarily be a surgical procedure. For 
example, we proposed to package HCPCS code G0268 (Removal of impacted 
cerumen (one or both ears) by physician on same date of service as 
audiologic function testing). While specific audiologic function 
testing procedures are not surgical procedures performed in an 
operating room, they are independent procedures that are separately 
payable under the OPPS, and HCPCS code G0268 is a supportive dependent 
service always provided in association with one of these independent 
services. All references to ``intraoperative'' below refer to services 
that are usually or always provided during a surgical procedure or 
other independent procedure.

[[Page 66628]]

    By definition, a service that is performed intraoperatively is 
provided during and, therefore, on the same date of service as another 
procedure that is separately payable under the OPPS. Because these 
intraoperative services support the performance of an independent 
procedure and they are provided in the same operative session as the 
independent procedure, we believed it would be appropriate to package 
their payment into the OPPS payment for the independent procedure 
performed. Therefore, we did not propose to package payment for CY 2008 
for those diagnostic services, such as CPT code 93005 
(Electrocardiogram, routine ECG with at least 12 leads; tracing only, 
without interpretation and report) that are sometimes or only rarely 
performed and reported as supportive services in association with other 
independent procedures. Instead, we proposed to include those HCPCS 
codes that are usually or always performed intraoperatively, based upon 
our review of the codes described above. The intraoperative services 
that we proposed to package vary in hospital resource costs. Resource 
cost was not a factor we considered when determining which supportive 
intraoperative procedures to package.
    The codes we proposed to identify as intraoperative services for CY 
2008 that would receive packaged payment under the OPPS were listed in 
Table 12 of the proposed rule (72 FR 42661 through 42662).
    Several of these codes, including CPT code 93640 
(Electrophysiologic evaluation of single or dual chamber pacing 
cardioverter-defibrillator leads including defibrillation threshold 
evaluation (induction of arrhythmia, evaluation of sensing and pacing 
for arrhythmia termination) at the time of initial implantation or 
replacement), are already unconditionally (that is, always) packaged 
under the CY 2007 OPPS, where they have been assigned status indicator 
``N.'' Payment for these services is made through the payment for the 
separately payable, independent services with which they are billed. No 
separate payment is made for services that we have assigned status 
indicator ``N.'' We did not propose status indicator changes for the 
five diagnostic intraoperative services that were unconditionally 
packaged for CY 2007.
    We proposed to change the status indicator for 34 intraoperative 
services from separately paid to unconditionally packaged (status 
indicator ``N'') for the CY 2008 OPPS. As stated in the CY 2008 
proposed rule, we believe that these services are always integral to 
and dependent upon the independent services that they support and, 
therefore, their payment would be appropriately packaged because they 
would generally be performed on the same date and in the same hospital 
as the independent services.
    We also proposed to change the status indicator for one 
intraoperative procedure from unconditionally packaged to conditionally 
packaged (status indicator ``Q'') as a ``special'' packaged code for 
the CY 2008 OPPS, specifically, CPT code 0126T (Common carotid intima-
media thickness (IMT) study for evaluation of atherosclerotic burden or 
coronary heart disease risk factor assessment). This code was discussed 
in the past with the Packaging Subcommittee of the APC Panel, which 
determined that, consistent with its code descriptor as a separate 
procedure, this procedure could sometimes be provided alone, without 
any other OPPS services on the claim. We believed that this procedure 
would usually be provided by a hospital in conjunction with another 
independent procedure on the same date of service but may occasionally 
be provided without another independent service. As a ``special'' 
packaged code, if the study were billed without any other service 
assigned status indicator ``S,'' ``T,'' ``V,'' or ``X'' reported on the 
same date of service, under our proposal we proposed not to treat the 
IMT study as a dependent service for purposes of payment. If we were to 
continue to unconditionally package payment for this procedure, 
treating it as a dependent service, hospitals would receive no payment 
at all when providing this service alone, although the procedure would 
not be functioning as an intraoperative service in that case. However, 
according to our proposal, its conditionally packaged status as a 
``special'' packaged code would allow payment to be provided for this 
``Q'' status IMT study when provided alone, in which case it would be 
treated as an independent service under these limited circumstances. On 
the other hand, when this service is furnished as an intraoperative 
procedure on the same day and in the same hospital as independent, 
separately paid services that are assigned status indicator ``S,'' 
``T,'' ``V,'' or ``X,'' we proposed to package payment for it as a 
dependent service. In all cases, we proposed that hospitals that 
furnish independent services on the same date as this IMT procedure 
must bill them all on the same claim. We believed that when dependent 
and independent services are furnished on the same date and in the same 
facility, they are part of a single complete hospital outpatient 
service that is reported with more than one HCPCS code, and no separate 
payment should be made for the intraoperative procedure that supports 
the independent service.
    The estimated overall impact of these changes presented in section 
XXII.B. of the proposed rule (section XXIV.B. of this final rule with 
comment period) was based on the assumption that hospital behavior 
would not change with regard to when these intraoperative dependent 
services are performed on the same date and by the same hospital that 
performs the independent services. To the extent that hospitals could 
change their behavior and perform the intraoperative services more or 
less frequently, on subsequent dates, or at settings outside of the 
hospital, the data would show such a change in practice in future years 
and that change would be reflected in future budget neutrality 
adjustments. However, with respect to intraoperative services in 
particular, we believed that hospitals are limited in the extent to 
which they could change their behavior with regard to how they furnish 
these services. By their definition, these intraoperative services 
generally must be furnished on the same date and at the same operative 
location as the independent procedure in order to be considered 
intraoperative. For these codes, we assume that both the dependent and 
independent services would be furnished on the same date in the same 
hospital, and hospitals should bill them on the same claim with the 
same date of service.
    As we indicated earlier, in all cases we provided that hospitals 
that furnish the intraoperative procedure on the same date as the 
independent service must bill both services on the same claim. We 
expect to carefully monitor any changes in billing practices on a 
service-specific and hospital-specific basis to determine whether there 
is reason to request that QIOs review the quality of care furnished or 
to request that Program Safeguard Contractors review the claims against 
the medical record.
    During the September 2007 APC Panel meeting, the Panel recommended 
that CMS finalize the proposal to package intraoperative services and 
that CMS consider assigning status indicator ``Q'' to CPT code 96020 
(Neurofunctional testing selection and administration during 
noninvasive imaging functional brain mapping, with test administered 
entirely by a physician or psychologist, with review of test results 
and report).
    We received many public comments on our proposal to package

[[Page 66629]]

intraoperative services for CY 2008. A summary of the public comments 
and our responses follow.
    Comment: Several commenters requested that CMS change the status of 
CPT code 96020 to conditionally packaged or separately payable instead 
of finalizing the proposal to unconditionally package this code. 
According to the commenters, functional brain mapping is often 
performed prior to epilepsy surgery. The commenters noted that 
functional brain mapping is performed by staff other than the 
neurologist or neuropsychologist who performs the accompanying 
functional MRI, reported with CPT code 70555 (Magnetic resonance 
imaging, brain, functional MRI; requiring physician or psychologist 
administration of entire neurofunctional testing). One commenter 
clarified that functional MRI is more commonly performed without 
functional brain mapping. If CPT code 96020 were conditionally 
packaged, the commenter believed that separate payment should be made 
for CPT code 96020 when it was provided with the functional MRI. 
Another commenter stated that functional brain mapping is a separate 
service from the functional MRI, and therefore should not be packaged.
    Response: The AMA 2007 CPT book specifically states that CPT code 
70555 can only be reported if CPT code 96020 is also performed. CPT 
code 70555 is separately payable under the CY 2008 OPPS. Therefore, 
whenever CPT code 70555, the independent procedure, is billed with CPT 
code 96020, the dependent procedure, the payment associated with CPT 
code 96020 is appropriately packaged into the payment for CPT code 
70555. Even if CPT code 96020 were conditionally packaged, separate 
payment would not be made when it was billed with CPT code 70555. In 
addition, we believe that functional brain mapping is never provided to 
a patient as a sole service. Instead, it is always provided in 
conjunction with a functional MRI. Therefore, we continue to believe 
that unconditional packaging is appropriate for CPT code 96020.
    Comment: Many commenters requested that CMS continue to pay 
separately for intravascular ultrasound (IVUS), fractional flow reserve 
(FFR), and intracardiac echocardiography (ICE) reported with CPT codes 
37250 (Intravascular ultrasound (non-coronary vessel) during diagnostic 
evaluation and/or therapeutic intervention; initial vessel (List 
separately in addition to code for primary procedure)); 37251 
(Intravascular ultrasound (non-coronary vessel) during diagnostic 
evaluation and/or therapeutic intervention; each additional vessel 
(List separately in addition to code for primary procedure)); 75946 
(Intravascular ultrasound (non coronary vessel), radiological 
supervision and interpretation; each additional non-coronary vessel 
(List separately in addition to code for primary procedure)); 92978 
(Intravascular ultrasound (coronary vessel or graft) during diagnostic 
evaluation and/or therapeutic intervention including imaging 
supervision, interpretation and report; initial vessel (List separately 
in addition to code for primary procedure)); 92979 (Intravascular 
ultrasound (coronary vessel or graft) during diagnostic evaluation and/
or therapeutic intervention including imaging supervision, 
interpretation and report; each additional vessel (List separately in 
addition to code for primary procedure)); 93571 (Intravascular Doppler 
velocity and/or pressure derived coronary flow reserve measurement 
(coronary vessel or graft) during coronary angiography including 
pharmacologically induced stress; initial vessel (List separately in 
addition to code for primary procedure)); 93572 (Intravascular Doppler 
velocity and/or pressure derived coronary flow reserve measurement 
(coronary vessel or graft) during coronary angiography including 
pharmacologically induced stress; each additional vessel (List 
separately in addition to code for primary procedure)); and 93662 
(Intracardiac echocardiography during therapeutic/diagnostic 
intervention, including imaging supervision and interpretation (List 
separately in addition to code for primary procedure)).
    The commenters noted that, while use of these procedures often 
results in better patient outcomes and reduced need for subsequent 
procedures, they are only provided to a small proportion of patients 
who undergo stenting, angioplasty, and other related services. A number 
of commenters specified that IVUS is performed on 1 to 20 percent of 
patients who undergo a related diagnostic or therapeutic intervention, 
using Medicare claims and internal hospital assessments. Therefore, the 
commenters stated that the costs for IVUS, FFR, and ICE do not affect 
the payment rates for the independent procedures in a significant way, 
if at all. In addition, the commenters noted that IVUS, in particular, 
involves high resource costs because of expensive capital equipment, 
significant labor cost, and disposable supplies. Several commenters 
noted that the CY 2005 OPPS data included a median cost of $2,000 for 
IVUS, with approximately $800 of those costs related solely to the 
device component. One commenter stated that IVUS may be performed in 
conjunction with a diagnostic procedure that maps to an APC such as 
0080 (Diagnostic Cardiac Catheterization); 0267 (Level III Diagnostic 
and Screening Ultrasound); or 0280 (Level III Angiography and 
Venography), rather than a major therapeutic procedure such as stenting 
or angioplasty, resulting in a total payment of $150 to $2,500, which 
would not cover the hospital's costs. Other commenters elaborated on 
the costs associated with ICE, which is reported with the corresponding 
independent services described by CPT codes 93621 (Comprehensive 
electrophysiologic evaluation including insertion and repositioning of 
multiple electrode catheters with induction or attempted induction of 
arrhythmia; with left atrial pacing and recording from coronary sinus 
or left atrium (List separately in addition to code for primary 
procedure)); 93622 (Comprehensive electrophysiologic evaluation 
including insertion and repositioning of multiple electrode catheters 
with induction or attempted induction of arrhythmia; with left 
ventricular pacing and recording (List separately in addition to code 
for primary procedure)); 93651 (Intracardiac catheter ablation of 
arrhythmogenic focus; for treatment of supraventricular tachycardia by 
ablation of fast or slow atrioventricular pathways, accessory 
atrioventricular connections or other atrial foci, singly or in 
combination); and 93652 (Intracardiac catheter ablation of 
arrhythmogenic focus; for treatment of ventricular tachycardia), in 
only 5 percent of the claims involving the above procedures. The 
commenters also noted that only 14 percent of hospitals billed ICE with 
the CPT codes listed above, indicating that the impact of packaged 
payment will affect a subset of hospitals who invested in this capital 
equipment. One commenter noted that IVUS and ICE are clearly not 
integral to any independent procedure because they are used 
infrequently. Other commenters noted that costs will be improperly 
allocated to hospitals that perform the independent procedure, 
regardless of whether they purchased the equipment for the dependent 
procedure. One commenter disputed describing FFR services as 
``ancillary'' and stated that they are ``decisional'' and therefore 
should not be packaged. The commenters expressed concern that packaged 
payment will create a

[[Page 66630]]

significant financial disincentive to provide these services. The 
commenters also noted that these procedures should not be described as 
``intraoperative'' because they precede the independent procedure, and 
may even result in canceling the independent procedure. One commenter 
requested that CMS assign status indicator ``Q'' to CPT codes 93571 and 
93572. On the other hand, several commenters specified that these 
services are not stand alone procedures. One commenter stated that it 
is illegal under section 1833(t)(2)(G) of the Act to package payment 
for IVUS and FFR, which do not use contrast agents, into payment for 
coronary or peripheral angiography, which require contrast agents. 
Specifically, the commenter summarized the Act which states that CMS 
must create payment groups under the OPPS that ``classify separately 
those procedures that utilize contrast agents from those that do not.''
    Response: We appreciate the many thoughtful comments related to the 
packaged status of IVUS, FFR, and ICE services. We acknowledge that the 
costs associated with packaged services may contribute more or less to 
the median cost of the independent service, depending on how often the 
dependent service is billed with the independent service. It is our 
goal to adhere to the principles inherent in a prospective payment 
system and to encourage hospitals to utilize resources in a cost-
effective manner. In this case, hospitals must choose whether to 
utilize IVUS, FFR, and ICE, balancing the needs of the patient with the 
costs associated with the services.
    We continue to believe that IVUS, FFR, and ICE are dependent 
services that are always provided in association with independent 
services. This is different than stating that every angioplasty or 
other related independent procedure utilizes IVUS, FFR, or ICE. In 
fact, all of the codes about which we received comment are listed as 
add-on codes in the CY 2007 CPT book. While we agree that some of these 
services may contribute to decisionmaking, we still believe that these 
services are never provided without another independent service on the 
same day. Therefore, we do not believe it is appropriate to assign 
status indicator ``Q'' to CPT codes 93571 and 93572, or any of the 
other IVUS, FFR, or ICE services.
    While the statute requires us to establish separate APCs for those 
services that require contrast and those that do not require contrast, 
the statute does not state a similar requirement for the packaged 
services that are ancillary and supportive to the main independent 
procedure. In this case, IVUS, FFR, and ICE are not the services 
themselves that must be mapped to contrast or noncontrast APCs for 
payment. Instead, independent services must map to contrast or 
noncontrast APCs, as we have done. IVUS, FFR, and ICE are similar to 
other supportive packaged services, including drugs and anesthesia. 
Packaged codes never map to an APC, and, therefore, it is unnecessary 
to distinguish whether they require contrast agents or not. Instead, 
the independent procedure must map to a contrast or noncontrast APC.
    For the reasons stated above, we are finalizing our proposal to 
unconditionally package payment for IVUS, FFR, and ICE services for CY 
2008.
    Comment: One commenter requested that CMS conditionally package 
payment for CPT code 75898 (Angiography through existing catheter for 
follow-up study for transcatheter therapy, embolization or infusion), 
instead of finalizing the proposal to unconditionally package payment 
for this service. The commenter clarified that this is often the only 
service performed when a patient has lengthy thrombolytic therapy.
    Response: We agree with the commenter that this code should be 
conditionally packaged rather than unconditionally packaged, so that 
separate payment is made when this service is provided without any 
other separately payable services on the same date of service. We are 
changing the status indicator for CPT code 75898 to ``Q'' for CY 2008 
and including it as an ``STVX-packaged'' code. When provided on the 
same date of service as other separately payable services, payment for 
CPT code 75898 will be packaged into payment for the other services.
    Comment: One commenter requested that CMS continue to pay 
separately for CPT codes 67299 (Unlisted procedure, posterior segment) 
and 95999 (Unlisted neurological or neuromuscular diagnostic 
procedure). These codes describe unlisted procedures, and the commenter 
explained that it would be impossible to know whether the services they 
describe should be appropriately packaged or separately paid.
    Response: We agree with the commenter that CPT codes 67299 and 
95999 should not be packaged under the OPPS for CY 2008 because they 
are unlisted procedures. Therefore, we are finalizing a separately 
payable status indicator and APC assignment for them in Addendum B to 
this final rule with comment period.
    Comment: Many commenters supported the proposal to package payment 
for all intraoperative services and recommended that CMS finalize the 
proposal without modification. Several commenters requested that CMS 
pay separately for other intraoperative services that it proposed to 
package for CY 2008, but did not present unique arguments specific to 
any code.
    Response: We agree with commenters that packaging payment for 
intraoperative services is consistent with the principles of the OPPS 
and will help contain costs while creating an incentive for hospitals 
to utilize resources in a cost efficient manner. We understand that 
hospitals would prefer if certain intraoperative services were paid 
separately. In light of the public comments we received, our clinical 
advisors reassessed each intraoperative code on the list to ensure that 
it was still appropriate for packaged payment. However, we did not see 
any compelling reason to pay separately for any of the intraoperative 
services that were not already discussed and revised above.
    For CY 2008, we are finalizing our CY 2008 proposal, with 
modification, to package the payment for all intraoperative HCPCS codes 
with three exceptions. Specifically, we are finalizing all of the 
packaging changes we proposed, with the exception of conditionally 
packaging CPT code 75898 as an ``STVX-packaged'' code and paying 
separately for CPT codes 67299 and 95999. Except as otherwise specified 
above, we are fully adopting the APC Panel recommendation to package 
all intraoperative services and to review the status indicator of CPT 
code 96020. Table 10 of this final rule with comment period includes 
the final comprehensive list of all codes in the seven categories that 
are packaged for CY 2008.
(4) Imaging Supervision and Interpretation Services
    We proposed to change the packaging status of many imaging 
supervision and interpretation codes for CY 2008. We define ``imaging 
supervision and interpretation codes'' as HCPCS codes for services that 
are defined as ``radiological supervision and interpretation'' in the 
radiology series, 70000 through 79999, of the AMA CY 2007 book of CPT 
codes, with the addition of some services in other code ranges of CPT, 
Category III CPT tracking codes, or Level II HCPCS codes that are 
clinically similar or directly crosswalk to codes defined as 
radiological supervision and interpretation services in the CPT 
radiology range. We also

[[Page 66631]]

included HCPCS codes that existed in CY 2006 but were deleted and were 
replaced in CY 2007. We included the CY 2006 HCPCS codes because we 
proposed to use the CY 2006 claims data to calculate the CY 2008 OPPS 
median costs on which the CY 2008 payment rates would be based.
    In its discussion of ``radiological supervision and 
interpretation,'' CPT indicates that ``when a procedure is performed by 
two physicians, the radiologic portion of the procedure is designated 
as `radiological supervision and interpretation'.'' In addition, CPT 
guidance notes that, ``When a physician performs both the procedure and 
provides imaging supervision and interpretation, a combination of 
procedure codes outside the 70000 series and imaging supervision and 
interpretation codes are to be used.'' In the hospital outpatient 
setting, the concept of one or more than one physician performing 
related procedures does not apply to the reporting of these codes, but 
the radiological supervision and interpretation codes clearly are 
established for reporting in association with other procedural services 
outside the CPT 70000 series. Because these imaging supervision and 
interpretation codes are always reported for imaging services that 
support the performance of an independent procedure and they are, by 
definition, always provided in the same operative session as the 
independent procedure, we believe that it is appropriate to package 
their payment into the OPPS payment for the independent procedure 
performed.
    In addition to radiological supervision and interpretation codes in 
the radiology range of CPT codes, there are CPT codes in other series 
that describe similar procedures that we proposed to include in the 
group of imaging supervision and interpretation codes proposed for 
packaging under the CY 2008 OPPS. For example, CPT code 93555 (Imaging 
supervision, interpretation and report for injection procedure(s) 
during cardiac catheterization; ventricular and/or atrial angiography) 
whose payment under the OPPS is currently packaged, is commonly 
reported with an injection procedure code, such as CPT code 93543 
(Injection procedure during cardiac catheterization; for selective left 
ventricular or left atrial angiography), whose payment is also 
currently packaged under the OPPS, and a cardiac catheterization 
procedure code, such as CPT code 93526 (Combined right heart 
catheterization and retrograde left heart catheterization), that is 
separately paid. In the case of cardiac catheterization, CPT code 93555 
describes an imaging supervision and interpretation service in support 
of the cardiac catheterization procedure, and this dependent service is 
clinically quite similar to radiological supervision and interpretation 
codes in the radiology range of CPT. Payment for the cardiac 
catheterization imaging supervision and interpretation services has 
been packaged since the beginning of the OPPS. Therefore, in developing 
the proposal for the CY 2008 proposed rule, we conducted a 
comprehensive clinical review of all Category I and Category III CPT 
codes and Level II HCPCS codes to identify all codes that describe 
imaging supervision and interpretation services. The codes we proposed 
to identify as imaging supervision and interpretation codes for CY 2008 
that would receive packaged payment were listed in Table 14 of the 
proposed rule (72 FR 42665-42667).
    Several of these codes, including CPT code 93555 discussed above, 
are already unconditionally (that is, always) packaged under the CY 
2007 OPPS, where they have been assigned status indicator ``N.'' 
Payment for these services is made as part of the payment for the 
separately payable, independent services with which they are billed. No 
separate payment is made for services that we have assigned to status 
indicator ``N.'' We did not propose status indicator changes for the 
six imaging supervision and interpretation services that were 
unconditionally packaged for CY 2007.
    We proposed to change the status indicator for 33 imaging 
supervision and interpretation services from separately paid to 
unconditionally packaged (status indicator ``N'') for the CY 2008 OPPS. 
We believed that these services are always integral to and dependent 
upon the independent services that they support and, therefore, their 
payment would be appropriately packaged because they would generally be 
performed on the same date and in the same hospital as the independent 
services.
    We proposed to change the status indicator for 93 imaging 
supervision and interpretation services from separately paid to 
conditionally packaged (status indicator ``Q'') as ``special'' packaged 
codes for the CY 2008 OPPS. These services may occasionally be provided 
at the same time and at the same hospital with one or more other 
procedures for which payment is currently packaged under the OPPS, most 
commonly injection procedures, and in these cases we would not treat 
the imaging supervision and interpretation services as dependent 
services for purposes of payment. If we were to unconditionally package 
payment for these imaging supervision and interpretation services as 
dependent services, hospitals would receive no payment at all for 
providing the imaging supervision and interpretation service and the 
other minor procedure(s). However, according to our proposal, their 
conditional packaging status as ``special'' packaged codes would allow 
payment to be provided for these ``Q'' status imaging supervision and 
interpretation services as independent services in these limited 
circumstances, and for which payment for the accompanying minor 
procedure would be packaged. However, when these imaging supervision 
and interpretation dependent services are furnished on the same day and 
in the same hospital as independent separately paid services, 
specifically, any service assigned status indicator ``S,'' ``T,'' 
``V,'' or ``X,'' we proposed to package payment for them as dependent 
services. In all cases, we proposed that hospitals that furnish the 
independent services on the same date as the dependent services must 
bill them all on the same claim. We believe that when the dependent and 
independent services are furnished on the same date and in the same 
hospital, they are part of a single complete hospital outpatient 
service that is reported with more than one HCPCS code, and no separate 
payment should be made for the imaging supervision and interpretation 
service that supports the independent service.
    In the case of services for which we proposed conditional 
packaging, we indicated that we would expect that, although these 
services would always be performed in the same session as another 
procedure, in some cases that other procedure's payment would also be 
packaged. For example, CPT code 73525 (Radiological examination, hip, 
arthrography, radiological supervision and interpretation) and CPT code 
27093 (Injection procedure for hip arthrography; without anesthesia) 
could be provided in a single hospital outpatient encounter and 
reported as the only two services on a claim. In the case where only 
these two services were performed, the conditionally packaged status of 
CPT code 73525 would appropriately allow for its separate payment as an 
independent imaging supervision and interpretation arthrography 
service, into which payment for the dependent injection procedure would 
be packaged.
    The estimated overall impact of these changes presented in section 
XXII.B. of the proposed rule (section XXIV.B. of this final rule with 
comment period) was based on the assumption that

[[Page 66632]]

hospital behavior would not change with regard to when these dependent 
services are performed on the same date and by the same hospital that 
performs the independent services. To the extent that hospitals could 
change their behavior and perform the imaging supervision and 
interpretation services more or less frequently, on subsequent dates, 
or at settings outside of the hospital, the data would show such a 
change in practice in future years and that change would be reflected 
in future budget neutrality adjustments. However, with respect to the 
imaging supervision and interpretation services in particular, we 
believed that hospitals are limited in the extent to which they could 
change their behavior with regard to how they furnish these services. 
By their definition, these imaging and supervision services generally 
must be furnished on the same date and at the same operative location 
as the independent procedure in order for the imaging service to 
meaningfully contribute to the diagnosis or treatment of the patient. 
For those radiological supervision and interpretation codes in the 
radiology range of CPT in particular, if the same physician is able to 
perform both the procedure and the supervision and interpretation as 
stated by CPT, we assume that both the dependent and independent 
services would be furnished on the same date in the same hospital, and 
hospitals should bill them on the same claim with the same date of 
service.
    As we indicated earlier in this section, in all cases, we are 
providing that hospitals that furnish the imaging supervision and 
interpretation service on the same date as the independent service must 
bill both services on the same claim. We expect to carefully monitor 
any changes in billing practices on a service-specific and hospital-
specific basis to determine whether there is reason to request that 
QIOs review the quality of care furnished or to request that Program 
Safeguard Contractors review the claims against the medical record.
    During the September 2007 APC Panel meeting, the APC Panel 
recommended that CMS delay packaging the imaging supervision and 
interpretation services because of the reductions in payment that would 
occur for services that would only be paid separately if they occurred 
with other minor procedures that are already packaged. The Panel was 
concerned about the proposed reductions in payment for typical 
combinations of expensive imaging services. The Panel asked that CMS 
develop an alternative model for these services and present it at the 
next APC Panel meeting.
    We received many public comments on our proposal to package imaging 
supervision and interpretation services for CY 2008. A summary of the 
public comments and our response follows.
    Comment: Many commenters objected to the packaging of imaging 
supervision and interpretation services. They asserted that the 
proposal would, in many cases, excessively reduce payments because the 
proposal packaged the cost of the service into one or more services 
that are already packaged or would inappropriately package the cost of 
expensive imaging supervision and interpretation services into more 
minor services, like visits or minor diagnostic tests. The commenters 
believed that this would result in little or no payment being made for 
the more expensive services provided in an encounter. Other commenters 
suggested that CMS package only the 33 codes for which the associated 
surgical service is separately paid but not package the 93 codes 
proposed to be conditionally packaged because payments would be 
excessively reduced. As an alternative, one commenter suggested that 
CMS review claims data for the 93 imaging supervision and 
interpretation codes proposed to be assigned status indicator ``Q'' to 
identify high volume combinations of services and evaluate the 
combinations for creation of composite APCs. For example, the commenter 
suggested that CMS could create a composite APC for CPT codes 72265 
(Myelography, lumbosacral, radiological supervision and interpretation) 
and 72132 (Computed tomography lumbar spine, with contrast material) 
that would ensure that the full payment for CPT code 72265 would always 
be made when furnished with CPT code 72132. The commenter was concerned 
that CMS could ``overpay'' lumbar CT when no myelography was furnished 
but could ``underpay'' when myelography is performed without lumbar 
computed tomography (CT) but in addition to another minor services such 
as an emergency department visit or other radiological service. Like 
others, the commenter was concerned that, as proposed, if an expensive 
imaging supervision and interpretation service is billed on the same 
date as a visit, the visit would be paid and the expensive service 
would not be paid.
    Some commenters believed that the absence of consideration of how 
payment would be made when unrelated services or packaged services were 
the only other services on the claim demonstrated that the CMS proposal 
was not carefully or sufficiently analyzed prior to being proposed and 
should not be made final. The commenters cited several examples of 
packaging with minor services or packaged services that they view as 
common, which they believe illuminate the problems with packaging 
imaging supervision and interpretation services. The commenters 
asserted that CMS should ensure that no service is packaged into a 
service that is already packaged. Some commenters believed that the 
proposed policy would reduce payment for important interventional 
imaging services by 25 percent in the aggregate, would cause CMS to use 
fewer claims for ratesetting, and would result in access problems for 
patients. Some commenters stated that the methodology reduces the 
number of records that could be used to value these imaging codes for 
separate payment, thereby resulting in costs that would be much lower 
than would be the case if the medians were calculated with a higher 
number of claims.
    The commenters explained that some of the most common scenarios for 
the services that are assigned to APC 0280 (Level III Angiography and 
Venography) and are proposed for packaging are comparable to cardiac 
catheterization (APC 0080 (Diagnostic Cardiac Catheterization)) in 
time, equipment, supply, and labor but under the CMS proposal, the 
payment made under APC 0280 would be significantly less than the 
payment for APC 0080. Therefore, the commenters asked that the proposal 
to package services in APCs 0279 (Level II Angiography and Venography), 
280, and 668 (Level I Angiography and Venography) not be adopted in CY 
2008 because the packaging would result in payments that are much less 
than the cost of furnishing the services. One commenter added that it 
is methodologically circular and unreasonable to package payment for 
services that already include other packaged services.
    Response: We have carefully considered the comments of the APC 
Panel and the many thoughtful public comments we received on the 
proposal to package imaging supervision and interpretation services for 
the CY 2008 OPPS. We spent considerable time and effort in analysis of 
the data as we developed our proposed rule, and we appreciate the 
helpful comments we received on this issue. We have decided to finalize 
our proposal to package these services after refining our methodology 
for estimating the median cost of conditionally packaged codes assigned 
status indicator ``Q'' to address concerns that packaging significant 
services into services that either are already packaged

[[Page 66633]]

or are minor services leads to underpayment and concerns that the 
proposal reduced the number of claims available for setting APC medians 
for these services. We agree that we should not pay for a more minor 
service, such as a visit or minor diagnostic procedure, when the 
conditionally packaged imaging supervision and interpretation services 
require more resources. We have modified the conditionally packaged 
status of these services to be specific to surgical procedures and 
called them ``T-packaged services.'' The payment for these imaging 
supervision and interpretation codes will be packaged into the payment 
for services with a status indicator ``T'' when they appear on the same 
date as the surgical procedure. When these imaging supervision and 
interpretation services appear with other codes that have any other 
payable status indicator (``S,'' ''V,'' or ''X'') or with other 
services that have a status indicator ``Q'' on the same date, we would 
pay one unit of the ``T-packaged'' service with the highest relative 
payment weight. We discuss how we split the claims to acquire ``T-
packaged'' single bills that represent all of the resource costs 
associated with the conditionally packaged service in greater detail in 
section II.A.2. of this final rule with comment period. The ratesetting 
methodology specifically includes single bill claims for T-packed 
services that represent the costs of multiple services with status 
indicator ``Q'' and other packaged services. We believe that this 
resolves many of the payment concerns with regard to our proposal to 
treat the majority of supervision and interpretation codes as 
conditionally packaged codes. These refinements to our methodology 
significantly raised the median costs for a number of these services 
compared to the proposed rule median costs. Furthermore, the 
refinements, especially those creating single bills from multiple minor 
claims, allowed us to use many more claims to estimate a median cost 
for these conditionally packaged codes and, therefore, to develop an 
APC median cost estimate that better reflects the resources consumed by 
these services that are commonly performed in combination with one 
another.
    We believe that our changes have resulted in resolution of many of 
the concerns raised by the commenters and the APC Panel. There were a 
number of specific examples cited by the commenters to illustrate their 
concerns on this issue. We include the commenters' examples below, 
expanded to add the CY 2008 final rule payment. In the examples below, 
``pkg'' means payment is packaged; ``na'' means not applicable.

                                                Example 1.--Myleography and Lumbosacral CT With Contrast
--------------------------------------------------------------------------------------------------------------------------------------------------------
                                                CY 2007                                     CY 2008 Proposed   CY 2008                    CY 2008 Final
       HCPCS Code              Descriptor         APC       CY 2007 SI     CY 2007 Payment       payment         APC       CY 2008 SI        payment
--------------------------------------------------------------------------------------------------------------------------------------------------------
72265...................  Contrast X-ray            0274  S.............  $157.01.........  pkg.............       0274  Q............  $481.46
                           lower spine.
72132...................  CT lumbar spine w/        0283  S.............  $250.94.........  $751.09.........       0283  S............  $277.48
                           dye.
                         -------------------------------------------------------------------------------------------------------------------------------
    Sum.................  ...................  .........  ..............  $407.95.........  $751.09.........  .........  .............  $758.94
--------------------------------------------------------------------------------------------------------------------------------------------------------


                                        Example 2.--Angiography, Carotid, Cervical, Vertebral and/or Intracranial
--------------------------------------------------------------------------------------------------------------------------------------------------------
                                                CY 2007                                     CY 2008 Proposed   CY 2008                    CY 2008 Final
       HCPCS Code              Descriptor         APC       CY 2007 SI     CY 2007 Payment       payment         APC       CY 2008 SI        payment
--------------------------------------------------------------------------------------------------------------------------------------------------------
36216...................  Place catheter in    .........  N.............  pkg.............  pkg.............         na  N............  pkg
                           artery.
36215...................  Place catheter in    .........  N.............  pkg.............  pkg.............         na  N............  pkg
                           artery.
36217...................  Place catheter in    .........  N.............  pkg.............  pkg.............         na  N............  pkg
                           artery.
36216-59................  Place catheter in    .........  N.............  pkg.............  pkg.............         na  N............  pkg
                           artery.
75671...................  Artery Xrays head         0280  S.............  $1,279.92.......  pkg.............       0280  Q............  $2,847.85
                           and neck.
75680...................  Artery Xrays, neck.       0280  S.............  $1,279.92.......  pkg.............       0279  Q............  pkg
75685X2.................  Artery Xrays, spine       0280  S.............  $2,559.84.......  $1,442.28.......       0279  Q............  pkg
                         -------------------------------------------------------------------------------------------------------------------------------
    Sum.................  ...................  .........  ..............  $5,119.68.......  $1,442.28.......  .........  .............  $2,847.85
--------------------------------------------------------------------------------------------------------------------------------------------------------
Note: Several commenters submitted this example or this example with minor variation. The final payment for this service in its entirety is similar to
  the payment for cardiac catheterization (APC 0080), to which the commenters compared this service.


                                           Example 3.--Evaluation and Percutaneous Revascularization of Graft
--------------------------------------------------------------------------------------------------------------------------------------------------------
                                                CY 2007                                     CY 2008 Proposed   CY 2008                    CY 2008 Final
       HCPCS Code              Descriptor         APC       CY 2007 SI     CY 2007 Payment       payment         APC       CY 2008 SI        payment
--------------------------------------------------------------------------------------------------------------------------------------------------------
36145X2.................  Place catheter in           na  N.............  pkg.............  pkg.............         na  N............  pkg
                           artery.
75790...................  Visualize A-V shunt       0279  S.............  $584.32.........  pkg.............       0668  Q............  pkg
G0393...................  A-V fistula or            0081  T.............  $2,639.19.......  $2,934.24.......       0083  T............  $2,890.72
                           graft venous.
75978X2.................  Repair venous             0668  S.............  $767.90.........  pkg.............       0083  Q............  pkg
                           blockage.
35476...................  Repair venous             0081  T.............  $1,319.60.......  $1,467.37.......       0083  T............  $1,445.36
                           blockage.
                         -------------------------------------------------------------------------------------------------------------------------------
    Sum.................  ...................  .........  ..............  $5,311.01.......  $4,401.61.......  .........  .............  $4,336.08
--------------------------------------------------------------------------------------------------------------------------------------------------------


[[Page 66634]]


                                Example 4.--Diagnostic Angiography With Balloon Angioplasty of Superficial Femoral Artery
--------------------------------------------------------------------------------------------------------------------------------------------------------
                                                CY 2007                                     CY 2008 Proposed   CY 2008                    CY 2008 Final
       HCPCS Code              Descriptor         APC       CY 2007 SI     CY 2007 Payment       payment         APC       CY 2008 SI        payment
--------------------------------------------------------------------------------------------------------------------------------------------------------
75625...................   Contrast Xray exam       0280  S.............  $1,279.92.......  pkg.............       0279  Q............  pkg
                           of aorta.
75716...................   Artery Xrays, arms/      0280  S.............  $1,279.92.......  pkg.............       0279  Q............  pkg
                           legs.
75774...................   Artery Xray, each        0279  S.............  $584.32.........  pkg.............         na  N............  pkg
                           vessel.
75774...................   Artery Xray, each        0279  S.............  $584.32.........  pkg.............         na  N............  pkg
                           vessel.
36247...................   Place catheter in   .........  N.............  pkg.............  pkg.............         na  N............  pkg
                           artery.
35474...................   Repair arterial          0081  T.............  $2,639.19.......  $2,934.24.......       0083  T............  $2,890.72
                           blockage.
35474...................  Repair arterial           0081  T.............  $1,319.60.......  $1,467.37.......       0083  T............  $1,445.36
                           blockage.
75962...................   Repair atrial            0668  S.............  $383.95.........  pkg.............       0083  Q............  pkg
                           blockage.
75964...................   Repair artery            0668  S.............  $383.95.........  pkg.............         na  N............  pkg
                           blockage, each.
                         -------------------------------------------------------------------------------------------------------------------------------
    Sum.................  ...................  .........  ..............  $8,455.17.......  $4,401.61.......  .........  .............  $4336.08
--------------------------------------------------------------------------------------------------------------------------------------------------------

    Comment: Some commenters believed that CMS should not package 
imaging supervision and interpretation services because CMS did not 
conduct a sufficiently thorough analysis of the many ways that CPT 
codes can be reported for services where there could be more than one 
surgical CPT code associated with a single imaging supervision and 
interpretation service. The commenters stated that these codes are 
created on a ``component'' basis to deal effectively with the huge 
variation in the combinations of services that could occur.
    Response: We disagree with the commenters. We acknowledge that the 
APC Panel and the commenters raised concerns about the packaging of 
these services that we did not fully anticipate in development of the 
proposed rule. However, the purpose of the APC Panel and the exposure 
of the proposal to public comment are to raise issues for our 
consideration as we develop final policies for the final rule. We 
appreciate the assistance of the APC Panel and the many thoughtful 
public comments we received on the proposal to package these codes. We 
recognize that the codes are created as they exist, in order to 
describe many different treatment scenarios through the use of multiple 
and varied combinations of codes. As we discuss above, we have 
developed a methodology that addresses the concerns raised by the 
commenters and, as such, continue to believe that it is appropriate to 
package these services for CY 2008.
    Comment: Some commenters believed that the revenue code to CCR 
mapping for these services is problematic because most are billed with 
revenue code 0361 and revenue code 0361 is mapped to the surgery cost 
center. However, as the commenters pointed out, most of these 
procedures are performed in the imaging department or the heart 
catheterization laboratory and, therefore, their median cost 
calculation is highly suspect.
    Response: We do not view the unknown amount of error that occurs as 
a result of a theoretical conflict between the revenue code reported 
for a service and the CCR used to reduce that charge to an estimated 
cost as justification to not package these services. The costs we 
calculate for purposes of establishing median costs for ratesetting are 
estimated costs and as such, in general, there is error in them to the 
extent that the charges are reported under a revenue code that maps to 
a cost center in which the costs for the services are not found. 
Hospitals select the revenue codes with which they report services to 
Medicare and other payers for a wide range of reasons over which CMS 
generally exercises no control. The CMS crosswalk of revenue codes to 
cost centers is available for inspection and comment at the CMS Web 
site at: http://www.cms.hhs.gov/HospitalOutpatientPPS/. Hospitals that 
want to ensure that the correct CCR is applied to a service could, if 
they chose, use this crosswalk to select either the revenue codes to 
report or the cost center to use for costs reported with a particular 
revenue code.
    Comment: Some commenters believed that implementation of the 
imaging and supervision packaging would present huge operational 
challenges for hospitals to ensure that codes and charges continue to 
be billed so that the data in future years will be acceptable as the 
basis for setting relative weights for the OPPS. The commenters stated 
that hospitals will cease to report the codes and charges for the 
services that are no longer separately paid and that the costs of the 
services will then be lost to the payment system and the median costs 
for the services that should carry the packaging will be 
inappropriately low.
    Response: The commenters did not articulate how implementation of 
the imaging supervision and interpretation packaging proposal would 
present huge operational challenges for hospitals to ensure that the 
codes and charges continue to be billed so that future claims will 
contain the necessary costs for setting relative weights for the OPPS. 
Hospitals need only continue to report the codes and charges for all of 
the services they furnish. There are no new billing requirements 
associated with this change in payment policy. Moreover, hospitals are 
required to charge the same amount to all payers for the same services. 
We understand that many private payers continue to pay a percent of 
charges, creating incentives for hospitals to report and charge for all 
services furnished to all patients.
    Comment: Some commenters suggested that CMS update the OPPS 
packaging policies to address newly added or deleted codes.
    Response: We routinely review all new or revised HCPCS codes each 
year to determine what status indicator to assign and whether other 
changes to our files are needed. We also indicate new codes with a 
change indicator in Addendum B to this final rule with comment period, 
and we solicit public comments on the interim APC placement and status 
indicator we assign to them for those HCPCS codes designated with 
comment indicator ``NI'' in the final rule with comment period. We do 
not review deleted codes because they naturally fall out of the system, 
beginning in the claims for the period in which they are deleted, 
although we continue to assign their claims data for ratesetting 
purposes.
    Comment: Some commenters expressed concerns with the treatment of 
the claims data for imaging supervision and interpretation codes with 
status indicator ``Q'' with regard to the impact on the number of 
multiple procedure claims. Some commenters stated that reporting 
packaged services

[[Page 66635]]

will create more multiple procedure bills that will not be used to set 
rates.
    Response: The reporting of packaged services will not result in 
more multiple procedure claims because the packaged service, which has 
a status indicator of ``N'' for data purposes, unless it is changed to 
be separately paid, will not by itself cause a claim to be viewed as a 
multiple major procedure claim. Moreover, if packaged services and 
their charges are not reported, the payment for the services into which 
their cost is packaged may be understated. Therefore, it is important 
that hospitals report all services furnished and the associated 
charges.
    Comment: Some commenters indicated that where there are multiple 
codes with status indicator ``Q'' on a claim and no separately paid 
services, they are assigned status indicator ``N'' and sent to multiple 
minors because the assignment of the status indicator ``N'' happens 
before the split. They suggested that if the assignment happened after 
the split and after the ``pseudo'' single creation, they could be used 
in the median calculation for the APC.
    Response: The commenter correctly describes how codes with status 
indicator ``Q'' were treated in this circumstance for the proposed rule 
data. We agree that claims with multiple occurrences of codes with 
status indicator ``Q'' should be used to estimate the APC median cost 
through which they will be separately paid. In response to the public 
comments we received, we have revised the data process in several 
places to address the estimation of costs for services with a status 
indicator of ``Q.'' (See section II.A.2.b. of this final rule with 
comment period for further discussion of the changes to the data 
process.) With regard to this particular comment, we continue to assign 
claims with multiple ``Q'' procedure or packaged services to the 
multiple minor file. We then create additional single bills from the 
multiple minor file by identifying which conditionally packaged code 
will be the prime code that will carry the packaging by selecting the 
conditionally packaged code with the highest payment for CY 2007 and 
packaging all costs of the other codes into the cost for that code. We 
also set the units to one for the prime code to reflect our policy of 
only paying one unit of a service for codes with a status indicator of 
``Q.'' That claim then becomes a single procedure claim assigned to the 
APC to which the prime code is assigned. These modifications have 
resulted in the use of many more claims than were used for the proposed 
rule to set APC medians where conditionally packaged codes are 
assigned.
    Comment: One commenter believed that the data for many single bills 
for the services with status indicator ``Q'' will be lost because CMS 
assesses the status of the status indicator ``Q'' code before applying 
the bypass list. The commenters stated that where there are three 
services on the claim, two of which are on the bypass list, the status 
indicator ``Q'' service will be changed to packaged before the bypass 
list is applied and the two bypass codes will leave the claim without 
packaging. The commenter added that there will then be no code to which 
to package the cost of the status indicator ``Q'' code and the data 
will neither be used nor packaged into anything (because nothing is 
left for it to be packaged with). The commenter believed that if CMS 
had made the assignment of the ``Q'' after the bypass codes were 
removed, the data could be used to set the APC median for the ``Q'' 
service and more claims could have been used.
    Response: The commenter accurately described the treatment of a 
code with status indicator ``Q'' if it is on the same claim with two 
codes that are on the bypass list. However, we disagree with the 
commenter's recommendation. First, by definition, codes on the bypass 
list do not have significant packaging. We specifically reassessed the 
codes included on the bypass list in light of this packaging proposal 
to ensure removal of any services with significant packaging. The 
circumstances where ``Q'' service data would remain on a claim as 
``packaging'' after removing the other two codes as bypass codes should 
be very limited. Second, we would not want to use that data to set the 
median cost for the ``Q'' status service because the final payment 
disposition of the code with status indicator ``Q'' on the claim would 
be packaged. Under this commenter's recommendation, we would be sending 
the data for the status indicator ``Q'' codes to the APC to which it is 
assigned even though, when the claim was processed, no separate payment 
would be made for the status indicator ``Q'' code.
    Comment: One commenter found that its calculation of median costs 
using proposed rule data for the imaging supervision and interpretation 
services to which CMS proposed to assign status indicator ``Q'' 
resulted in median costs for these codes and the APCs to which they 
were assigned that were significantly higher than the median costs 
calculated by CMS for these codes and their APCs. The commenter was 
concerned that CMS may have inadvertently failed to include the 
packaged costs in the calculation of the medians for these costs codes.
    Response: The commenter is correct in that we inadvertently erred 
and did not include the packaged costs of ``Q'' status procedures in 
the calculation of the medians for these codes and their related APCs 
in the proposed rule. We have packaged these costs with the ``Q'' 
procedures for this final rule with comment period, in addition to 
making the other modifications to the calculation of the median costs 
for these codes as discussed in detail above and in section II.A.2. of 
this final rule with comment period.
    For CY 2008, we are finalizing our proposal, with modification as 
discussed above, to unconditionally or conditionally packaged imaging 
supervision and interpretation services. These codes, with their 
assigned status indicator ``N'' as unconditionally packaged or ``Q'' as 
``T-packaged'' codes, are listed in Table 10 of this final rule with 
comment period. We are not accepting the APC Panel recommendation to 
delay packaging of these services and provide an alternative model at 
the next Panel meeting, because we are finalizing a modified model. We 
will review the final CY 2008 policy, including the ratesetting 
methodology, with the APC Panel at its 2008 winter meeting.
(5) Diagnostic Radiopharmaceuticals
    For CY 2008, we proposed to change the packaging status of 
diagnostic radiopharmaceuticals as part of our overall enhanced 
packaging approach for the CY 2008 OPPS. Packaging costs into a single 
aggregate payment for a service, encounter, or episode of care is a 
fundamental principle that distinguishes a prospective payment system 
from a fee schedule. In general, packaging the costs of supportive 
items and services into the payment for the independent procedure or 
service with which they are associated encourages hospital efficiencies 
and also enables hospitals to manage their resources with maximum 
flexibility. As we stated in the CY 2007 OPPS/ASC final rule with 
comment period, we believe that a policy to package payment for 
additional radiopharmaceuticals (other than those already packaged when 
their per day costs are below the packaging threshold for OPPS drugs, 
biologicals, and radiopharmaceuticals based on data for the update 
year) is consistent with OPPS packaging principles and would provide 
greater administrative simplicity for hospitals (71 FR 68094).
    All nuclear medicine procedures require the use of at least one 
radiopharmaceutical, and there are only

[[Page 66636]]

a small number of radiopharmaceuticals that may be appropriately billed 
with each diagnostic nuclear medicine procedure. While examining the CY 
2005 hospital claims data in preparation for the CY 2007 OPPS/ASC 
proposed rule, we identified a significant number of diagnostic nuclear 
medicine procedure claims that were missing HCPCS codes for the 
associated radiopharmaceutical. At that time, we believed that there 
could be two reasons for the presence of these claims in the data. One 
reason could be that the radiopharmaceutical used for the procedure was 
packaged under the OPPS and, therefore, some hospitals may have decided 
not to include the specific radiopharmaceutical HCPCS code and an 
associated charge on the claim. A second reason could be that the 
hospitals may have incorporated the cost of the radiopharmaceutical 
into the charges for the associated nuclear medicine procedures. A 
third possibility not offered in the CY 2007 OPPS/ASC proposed rule is 
that hospitals may have included the charges for radiopharmaceuticals 
on an uncoded revenue code line.
    In the CY 2007 OPPS/ASC proposed rule, we did not propose packaging 
payment for radiopharmaceuticals with per day costs above the $55 CY 
2007 packaging threshold because we indicated that we were concerned 
that payments for certain nuclear medicine procedures could potentially 
be less than the costs of some of the packaged radiopharmaceuticals, 
especially those that are relatively expensive. At the same time, we 
also noted the GAO's comment in reference to the CY 2006 OPPS proposed 
rule that stated a methodology that includes packaging all 
radiopharmaceutical costs into the payments for the nuclear medicine 
procedures may result in payments that exceed hospitals' acquisition 
costs for certain radiopharmaceuticals because there may be more than 
one radiopharmaceutical that may be used for a particular procedure. We 
also expressed concern that packaging payment for additional 
radiopharmaceuticals could provoke treatment decisions that may not 
reflect use of the most clinically appropriate radiopharmaceutical for 
a particular nuclear medicine procedure in any specific case (71 FR 
68094).
    After considering this issue further and examining our CY 2006 
claims data for the CY 2008 OPPS update, as we indicated in the CY 2008 
OPPS/ASC proposed rule, we believe that it is most appropriate to 
package payment for some radiopharmaceuticals, specifically diagnostic 
radiopharmaceuticals, into the payment for diagnostic nuclear medicine 
procedures for CY 2008. We expect that packaging would encourage 
hospitals to use the most cost efficient diagnostic radiopharmaceutical 
products that are clinically appropriate. We anticipate that hospitals 
would continue to provide care that is aligned with the best interests 
of the patient. Furthermore, we believe that it would be the intent of 
most hospitals to provide both the diagnostic radiopharmaceutical and 
the associated diagnostic nuclear medicine procedure at the time the 
diagnostic radiopharmaceutical is administered and not to send patients 
to a different provider for administration of the radiopharmaceutical. 
As we indicated in the proposed rule, we do not believe that our 
packaging proposal would limit beneficiaries' ability to receive 
clinically appropriate diagnostic procedures. Again, the OPPS is a 
system of averages, and payment in the aggregate is intended to be 
adequate, although payment for any one service may be higher or lower 
than a hospital's actual costs in that case.
    For CY 2008, we have separated radiopharmaceuticals into two 
groupings. The first group includes diagnostic radiopharmaceuticals, 
while the second group includes therapeutic radiopharmaceuticals. We 
identified all diagnostic radiopharmaceuticals as those Level II HCPCS 
codes that include the term ``diagnostic'' along with a 
radiopharmaceutical in their long code descriptors. Therefore, we were 
able to distinguish therapeutic radiopharmaceuticals from diagnostic 
radiopharmaceuticals as those Level II HCPCS codes that have the term 
``therapeutic'' along with a radiopharmaceutical in their long code 
descriptors. There currently are no HCPCS C-codes used to report 
radiopharmaceuticals under the OPPS. For CY 2008, we proposed to 
package payment for all diagnostic radiopharmaceuticals that are not 
otherwise packaged according to the CY 2008 packaging threshold for 
drugs, biologicals, and radiopharmaceuticals that we proposed. We 
proposed this packaging approach for diagnostic radiopharmaceuticals, 
while we proposed to continue to pay separately for therapeutic 
radiopharmaceuticals with an average per day cost of more than $60 as 
discussed in section V.B.3.a.(c) of this final rule with comment 
period. In that section, we review our reasons for treating diagnostic 
radiopharmaceuticals (as well as contrast media) differently from other 
types of specified covered outpatient drugs identified in section 
1833(t)(B) of the Act.
    Diagnostic radiopharmaceuticals are always intended to be used with 
a diagnostic nuclear medicine procedure. In examining our CY 2006 
claims data, we were able to match most diagnostic radiopharmaceuticals 
to their associated diagnostic procedures and most diagnostic nuclear 
medicine procedures to their associated diagnostic radiopharmaceuticals 
in the vast majority of single bills used for ratesetting. We estimate 
that less than 5 percent of all claims with a diagnostic 
radiopharmaceutical had no corresponding diagnostic nuclear medicine 
procedure. In addition, we found that only about 13 percent of all 
single bills with a diagnostic nuclear medicine procedure code had no 
corresponding diagnostic radiopharmaceutical billed. These statistics 
indicate that, in a majority of our single bills for diagnostic nuclear 
medicine procedures, a diagnostic radiopharmaceutical HCPCS code is 
included on the single bill. Table 15 in the proposed rule (72 FR 
42668) presented the top 20 diagnostic nuclear medicine procedures in 
terms of the overall frequency with which they are reported in the OPPS 
claims data. Among these high volume diagnostic nuclear medicine 
procedures, their single bills included a HCPCS code for a diagnostic 
radiopharmaceutical at least 84 percent of the time for 19 of the top 
20 procedures. More specifically, 84 to 86 percent of the single bills 
for 4 diagnostic nuclear medicine procedures included a diagnostic 
radiopharmaceutical, 87 to 89 percent of the single bills for 8 
diagnostic nuclear medicine procedures included a diagnostic 
radiopharmaceutical, and 90 percent or more of the single bills for 7 
diagnostic nuclear medicine procedures included a diagnostic 
radiopharmaceutical.
    Among the lower volume diagnostic nuclear medicine procedures 
(which were outside the top 20 in terms of volume), there was still 
good representation of diagnostic radiopharmaceutical HCPCS codes on 
the single bills for most procedures. About 40 percent of the low 
volume diagnostic nuclear medicine procedures had at least 80 percent 
of the single bills for that diagnostic procedure that included a 
diagnostic radiopharmaceutical HCPCS code; about 37 percent of the low 
volume diagnostic procedures had between 50 to 79 percent of the single 
bills that included a diagnostic radiopharmaceutical HCPCS code; and 
about 23 percent of the low volume diagnostic procedures

[[Page 66637]]

had less than 50 percent of the single bills that include a diagnostic 
radiopharmaceutical HCPCS code. For the few diagnostic nuclear medicine 
procedures where less than 50 percent of the single bills included a 
diagnostic radiopharmaceutical HCPCS code, we believed there could be 
several reasons why the percentage of single bills for the diagnostic 
nuclear medicine procedure with a diagnostic radiopharmaceutical HCPCS 
code was low.
    As noted earlier, it is possible that hospitals may have included 
the charge for the radiopharmaceutical in the charge for the diagnostic 
nuclear medicine procedure itself or on an uncoded revenue code line 
instead of reporting charges for a specific diagnostic 
radiopharmaceutical HCPCS code. We found that 24 percent of all single 
bills for a diagnostic nuclear medicine procedure but without a coded 
diagnostic radiopharmaceutical had uncoded costs in a revenue code that 
might contain diagnostic radiopharmaceutical costs, specifically, 
revenue codes 0254 (Drugs Incident to Other Diagnostic Services), 0255 
(Drugs Incident to Radiology), 0343 (Diagnostic Radiopharmaceuticals), 
0621 (Supplies Incident to Radiology), and 0622 (Supplies Incident to 
Other Diagnostic Services). In comparison, we found that only 2 percent 
of diagnostic nuclear medicine single bills with a nuclear medicine 
procedure and a coded diagnostic radiopharmaceutical had uncoded costs 
in these revenue codes. It is also possible that some of these 
procedures typically used a diagnostic radiopharmaceutical subject to 
packaged payment under the CY 2006 OPPS, and hospitals may have chosen 
not to report a separate charge for the diagnostic radiopharmaceutical. 
Payment for diagnostic radiopharmaceuticals commonly used with some 
diagnostic nuclear medicine procedures would already be packaged 
because these diagnostic radiopharmaceuticals' average per day costs 
were less than $50 in CY 2006. We stated in the proposed rule that the 
CY 2008 proposal to package additional diagnostic radiopharmaceuticals 
would have little impact on the payment for those diagnostic procedures 
that typically use inexpensive diagnostic radiopharmaceuticals that 
would be packaged under our proposed CY 2008 packaging threshold of 
$60, except to the extent that the budget neutrality adjustment due to 
the broader packaging proposal leads to an increase in the scaler and 
an increase in the payment for procedures in general.
    At its March 2007 meeting, the APC Panel recommended that CMS work 
with stakeholders on issues related to payment for 
radiopharmaceuticals, including evaluating claims data for different 
classes of radiopharmaceuticals and ensuring that a nuclear medicine 
procedure claim always includes at least one reported 
radiopharmaceutical agent. In the proposed rule, we noted that we 
planned to accept the APC Panel's recommendation, and we specifically 
welcomed public comment on the hospitals' burden involved should we 
require such precise reporting. We also sought public comment on the 
importance of such a requirement in light of our above discussion on 
the representation of diagnostic radiopharmaceuticals in the single 
bills for diagnostic nuclear medicine procedures, the presence of 
uncoded revenue code charges specific to diagnostic 
radiopharmaceuticals on claims without a coded diagnostic 
radiopharmaceutical, and our proposal to package payment for all 
diagnostic radiopharmaceuticals.
    As we indicated in the proposed rule, we are aware that several 
diagnostic radiopharmaceuticals may be used for multiple day studies; 
that is, a particular diagnostic radiopharmaceutical may be 
administered on one day and a related diagnostic nuclear medicine 
procedure may be performed on a subsequent day. While we understand 
that multiple day episodes for diagnostic radiopharmaceuticals and the 
related diagnostic nuclear medicine procedures occur, we expect that 
this would be a small proportion of all diagnostic nuclear medicine 
imaging procedures. We estimate that, roughly, 15 diagnostic 
radiopharmaceuticals have a half-life longer than one day such that 
they could support diagnostic nuclear medicine scans on different days. 
We believe these diagnostic radiopharmaceuticals would be concentrated 
in a specific set of diagnostic procedures. Excluding the 5 percent of 
diagnostic radiopharmaceutical claims with no matching diagnostic 
nuclear medicine scan for the same beneficiary, we found that a 
diagnostic nuclear medicine scan was reported on the same day as a 
coded diagnostic radiopharmaceutical 90 percent or more of the time for 
10 of these 15 diagnostic radiopharmaceuticals. Further, between 80 and 
90 percent single bills for each of the remaining 5 diagnostic 
radiopharmaceuticals had a diagnostic nuclear medicine scan on the same 
day. In the ``natural'' single bills we use for ratesetting, we package 
payment across dates of service. In light of such high percentages of 
extended half-life diagnostic radiopharmaceuticals with same day 
diagnostic nuclear medicine scans and the ability of ``natural'' 
singles to package costs across days, we indicated in the proposed rule 
that we believe that our standard OPPS ratesetting methodology of using 
median costs calculated from claims data would adequately capture the 
costs of diagnostic radiopharmaceuticals associated with diagnostic 
nuclear medicine procedures that are not provided on the same date of 
service.
    The packaging proposal we presented would have reduced the overall 
frequency of single bills for diagnostic nuclear medicine procedures, 
but the percent of single bills out of total claims remained robust for 
the majority of diagnostic nuclear medicine procedures. Typically, 
packaging more procedures should improve the number of single bill 
claims from which to derive median cost estimates because packaging 
reduces the number of separately paid procedures on a claim, thereby 
creating more single procedure bills. In the case of diagnostic nuclear 
medicine procedures, packaging diagnostic radiopharmaceuticals reduced 
the overall number of single bills available to calculate median costs 
by increasing packaged costs that previously were ignored in the bypass 
process. In prior years, we did not consider the costs of 
radiopharmaceuticals when we used our bypass methodology to extract 
``pseudo'' single claims because we assumed that the cost of 
radiopharmaceutical overhead and handling would be included in the 
line-item charge for the radiopharmaceutical, and the diagnostic 
radiopharmaceuticals were subject to potential separate payment if 
their mean per day cost fell above the packaging threshold. The bypass 
process sets empirical and clinical criteria for minimal packaging for 
a specific list of procedures and services in order to assign packaged 
costs to other procedures on a claim and is discussed at length in 
section II.A.1. of the proposed rule, and this final rule with comment 
period. Generally, we found that changing the status of diagnostic 
radiopharmaceuticals to packaged increased the packaging on each claim. 
This would make it both harder for nuclear medicine procedures to 
qualify for the bypass list and more difficult to assign packaging to 
individual diagnostic nuclear medicine procedures, resulting in a 
possible reduction of the number of ``pseudo'' singles that are 
produced by the bypass process. Notwithstanding this potentiality, 
diagnostic nuclear medicine procedures

[[Page 66638]]

continued to have good representation in the single bills. On average, 
single bills as a percent of total occurrences remained substantial at 
55 percent for individual procedures. We discuss our process for 
ratesetting, including the construction and use of single and multiple 
bills, in greater detail in section II.A.1. of this final rule with 
comment period.
    We indicated in the proposed rule that we believe our CY 2006 
claims data supported our CY 2008 proposal to package payment for all 
diagnostic radiopharmaceuticals and would lead to payment rates for 
diagnostic nuclear medicine procedures that appropriately reflect 
payment for the costs of the diagnostic radiopharmaceuticals that are 
administered to carry out those diagnostic nuclear medicine procedures. 
Among the top 20 high volume diagnostic nuclear medicine procedures, at 
least 84 percent of the single bills for almost every diagnostic 
nuclear medicine procedure included a diagnostic radiopharmaceutical 
HCPCS code. While a diagnostic radiopharmaceutical, by definition, 
would be anticipated to accompany 100 percent of the diagnostic nuclear 
medicine procedures, it is not unexpected that, while percentages in 
our claims data are high, they are less than 100 percent. As noted 
previously, we have heard anecdotal reports that some hospitals may 
include the charges for diagnostic radiopharmaceuticals in their charge 
for the diagnostic nuclear medicine procedure or on an uncoded revenue 
code line, rather than reporting a HCPCS code for the diagnostic 
radiopharmaceutical. Thus, it is likely that the frequency of 
diagnostic radiopharmaceutical costs reflected in our claims data were 
even higher than the percentages indicated. Furthermore, we note that 
the OPPS ratesetting methodology is based on medians, which are less 
sensitive to extremes than means and typically do not reflect subtle 
changes in cost distributions. Therefore, to the extent that the vast 
majority of single bills for a particular diagnostic nuclear medicine 
procedure included a diagnostic radiopharmaceutical HCPCS code, the 
fact that the percentage was somewhat less than 100 percent was likely 
to have minimal impact on the median cost of the procedure in most 
cases. Even in those few instances where we had a low total number of 
single bills, largely because of low overall volume, we had ample 
representation of diagnostic radiopharmaceutical HCPCS codes on the 
single bills for the majority of lower volume nuclear medicine 
procedures. We also continued to have reasonable representation of 
single bills out of total claims in general. Finally, as noted 
previously, to the extent that the diagnostic radiopharmaceuticals 
commonly used with a particular diagnostic nuclear medicine procedure 
were already packaged, the proposal to package additional diagnostic 
radiopharmaceuticals would have had little impact on the payment for 
these procedures.
    The estimated overall impact of these changes presented in section 
XXII.B. of the proposed rule (section XXIV.B. of this final rule with 
comment period) was based on the assumption that hospital behavior 
would not change with regard to whether the dependent diagnostic 
radiopharmaceuticals services are provided by the same hospital that 
performs the independent services. In order to provide diagnostic 
nuclear medicine procedures under this policy, hospitals would either 
need to administer the necessary diagnostic radiopharmaceuticals 
themselves or refer patients elsewhere for the administration of the 
diagnostic radiopharmaceuticals. In the latter case, claims data would 
show such a change in practice in future years and that change would be 
reflected in future ratesetting. However, with respect to diagnostic 
radiopharmaceuticals, we believe that hospitals are limited in the 
extent to which they could change their behavior with regard to how 
they furnish these items because diagnostic radiopharmaceuticals are 
typically provided on the same day as a diagnostic nuclear medicine 
procedure. It would be difficult for Hospital A to send patients to 
receive diagnostic radiopharmaceuticals from Hospital B and then have 
the patients return to Hospital A for the diagnostic nuclear medicine 
procedure in the appropriate timeframe (given the radiopharmaceutical's 
half-life) to perform a high quality study. We expect that hospitals 
would always bill the diagnostic radiopharmaceutical on the same claim 
as the other independent services for which the radiopharmaceutical was 
administered.
    The APC Panel recommended that CMS package radiopharmaceuticals 
with a median per day cost of less than $200 but pay separately for 
radiopharmaceuticals with a per day cost of $200 or more. The APC Panel 
also recommended that CMS should identify nuclear medicine procedure 
claims with and without radiopharmaceuticals and should present its 
findings to the Panel at the next meeting for consideration of whether 
an edit is needed to ensure that the cost of the radiopharmaceutical is 
packaged into the payment for the nuclear medicine service.
    We received many public comments on our proposal to package payment 
for diagnostic radiopharmaceuticals for CY 2008. A summary of the 
public comments and our responses follow.
    Comment: Some commenters recommended that CMS package 
radiopharmaceuticals with a per day cost less than $200 but pay 
separately for radiopharmaceuticals with a per day cost of $200 or 
more. Other commenters objected to packaging diagnostic 
radiopharmaceuticals and asked that CMS continue to pay separately for 
radiopharmaceuticals with per day costs that exceed the packaging 
threshold for drugs. These commenters explained that FDA views 
radiopharmaceuticals to be drugs, they are defined as drugs for 
purposes of pass-through payment under OPPS in sections 
1833(t)(6)(A)(iii) of the Act, and for purposes of payment as specified 
covered outpatient drugs (SCODs) and biologicals in section 
1833(t)(14)(B)(i)(l) of the Act. The commenters argued that CMS should, 
therefore, pay separately for radiopharmaceuticals with a per day cost 
in excess of $60, as it does for other drugs.
    The commenters believed that section 1833(t)(14)(B)(i)(l) of the 
Act requires CMS to treat radiopharmaceuticals no differently from 
other SCODs and, therefore, CMS must pay radiopharmaceuticals actual 
acquisition costs or, failing that, charges adjusted to costs. Some 
commenters believed that there is no authority for CMS to package drugs 
that are incidental or ancillary to a procedure and that by doing so, 
CMS is relying on a form of ``functional equivalence'' which is 
expressly limited by statute under section 1833(t)(6)(F) of the Act. 
The commenters argued that the proposal will create an incentive for 
hospitals to not use advanced technologies and will harm patient care. 
Some commenters believed that packaging diagnostic radiopharmaceuticals 
could discourage hospitals from using the most appropriate drug for 
each patient and encourage them to use less clinically effective 
radiopharmaceuticals when there is a choice of radiopharmaceutical. 
Some commenters added that the proposal ignores medical indications and 
focuses solely on cost reduction, which could result in constraints on 
medical decisionmaking and would compromise medical care.
    Response: After review of the public comments we received on this 
issue, we have decided to finalize our proposal to package payment for 
diagnostic

[[Page 66639]]

radiopharmaceuticals into the payment for the nuclear medicine services 
which cannot be performed without the administration of a 
radiopharmaceutical. We refer readers to section V.B.4.b. of this final 
rule with comment period for a discussion of the rationale to package 
payment for diagnostic radiopharmaceuticals as SCODs and our belief 
that the packaged payment provides payment at average acquisition cost 
for the products.
    We find the argument that we are creating functional equivalence by 
packaging the payment for diagnostic radiopharmaceuticals into the 
payment for the nuclear medicine services without which they cannot be 
performed to be unconvincing. We are not establishing an equivalent 
payment for different products based on their function. We are instead 
packaging the cost of radiopharmaceuticals, however differential those 
costs may be, into the payment for nuclear medicine services to create 
an appropriate payment for the nuclear medicine services that use these 
products, whether there is one product or multiple products that could 
be used to furnish the service. This is analogous to our longstanding 
practice of packaging of medical devices into the payment for the 
procedure in which they are used, notwithstanding that there may be 
different devices that could be used to furnish the service.
    Moreover, we do not agree with the argument that paying for 
radiopharmaceuticals as part of the payment for the nuclear medicine 
service to which they are essential will harm patient care. We believe 
that providing packaged payment for radiopharmaceuticals as part of the 
nuclear medicine service will cause hospitals and their physician 
partners to give even more careful consideration to the selection of 
the radiopharmaceutical that is the most appropriate for the patient 
whom they are treating.
    We are not accepting the APC Panel recommendation to pay separately 
for radiopharmaceuticals with a per day cost in excess of $200 because 
we could not determine an empirical basis for paying separately for 
radiopharmaceuticals with a per day cost in excess of $200.
    Comment: Many commenters stated that a diagnostic 
radiopharmaceutical is always needed to provide a nuclear medicine 
service and, therefore, CMS should use only claims in which both 
services were present to compute the median cost for the nuclear 
medicine procedure if CMS decides to package diagnostic 
radiopharmaceuticals. Some commenters suggested that CMS establish OCE 
edits that would require a charge be reported under the diagnostic 
radiopharmaceutical revenue code 0343 when there was a charge in 
revenue codes 0340 or 0341 for a nuclear medicine procedure. Other 
commenters recommended that CMS establish OCE edits that would require 
a HCPCS code for a diagnostic radiopharmaceutical be reported on a 
claim for a diagnostic nuclear medicine procedure. Some commenters were 
concerned that the actual cost of radiopharmaceuticals would be lost 
because hospitals would not report the charges on the claim unless CMS 
mandates and enforces their reporting.
    Response: We agree that it is important that the costs of 
radiopharmaceuticals be reported on the same claim with the nuclear 
medicine service so that we can have confidence that the payment for 
the nuclear medicine procedure reflects the cost of the 
radiopharmaceutical as well as the nuclear medicine service. Therefore, 
we have used only claims that contain a HCPCS code and charge for a 
diagnostic radiopharmaceutical to calculate the median costs of the 
nuclear medicine procedures for CY 2008. Moreover, effective for 
services furnished on and after January 1, 2008, the OCE will return 
for correction any claim for a nuclear medicine procedure that does not 
contain a HCPCS code and charge for a diagnostic radiopharmaceutical. 
These edits are similar to the edits we have had in place in the OCE 
since CY 2005 for medical devices. The significant difference, however, 
is that we recognize that, for some nuclear medicine procedures, there 
is a choice of radiopharmaceuticals that could be used and, therefore, 
the edits will not specify which radiopharmaceutical must be billed 
with any given nuclear medicine procedure. We also recognize that, in 
some cases, the radiopharmaceutical is administered several days before 
the nuclear medicine service is furnished. In these cases, the hospital 
will need to hold the claim until after the service is furnished so 
that the radiopharmaceutical can appear on the bill with the nuclear 
medicine procedure or the bill for the procedure will be returned for 
correction. We did not accept the comment that we should establish the 
edits using combinations of revenue codes because to do so would not 
provide specific information on the particular radiopharmaceutical 
being furnished and we could not be certain that the charges were for 
radiopharmaceuticals.
    Comment: Some commenters asserted that, based on survey data they 
gathered, claims data fail to capture hospital average acquisition 
costs for radiopharmaceuticals. The commenters, therefore, concluded 
that the costs of low volume, high cost radiopharmaceuticals are not 
captured in the claims data that is used to set the median costs on 
which the nuclear medicine services payment rates are based and the 
packaged payment for radiopharmaceuticals will be inadequate to pay for 
the cost of the drug. The commenters believed that these incorrectly 
priced products are unlikely to continue to be manufactured and thus 
will cease to be available. The commenters also stated that it is 
unlikely that the industry will develop new products for the market if 
they find that hospitals will not use them because of inadequate 
payment. The commenters believed that beneficiary care would suffer as 
hospitals ceased to furnish the service because payment would be 
inadequate to cover the cost. Some commenters explained that, while CMS 
implemented revenue codes for diagnostic and therapeutic 
radiopharmaceuticals in CY 2004, hospitals have not yet fully reflected 
these revenue codes in their billing practices and, therefore, the 
claims data are not correct or reliable and CMS should continue to pay 
separately for radiopharmaceuticals at charges adjusted to cost. Other 
commenters believed that the proposed changes would overestimate 
payments for some diagnostic radiopharmaceuticals, underestimate 
others, and create improper financial incentives for hospitals and 
physicians to select certain radiopharmaceuticals rather than others, 
potentially reducing the quality of care.
    Response: We believe that we have appropriately calculated the 
radiopharmaceutical costs that we are packaging into the nuclear 
medicine services by using only claims for nuclear medicine services 
that contain a radiopharmaceutical, as noted above. This is analogous 
to our process for ensuring that the costs of devices are packaged into 
the payment for the APC in which they are used, and we believe that 
using only these claims will negate any existing problems with the use 
or lack of use of the radiopharmaceutical revenue codes.
    With regard to the concern that packaging radiopharmaceuticals will 
result in overpayment in some cases and underpayment in others, we note 
that the most fundamental characteristic of a prospective payment 
system is that payment is to be set at an average for the service, 
which, by definition, means that some services are paid more or less 
than the average. However, the average

[[Page 66640]]

should provide adequate payment for the service, while creating 
incentives for hospitals to control costs and utilization of high cost 
services where it is appropriate to do so. We do not believe that 
either beneficiary access to care or the quality of care will be 
adversely affected because we pay for diagnostic radiopharmaceuticals 
as part of the payment for the procedure to which they are an integral 
part. With regard to the influence this may have on the development and 
production of radiopharmaceuticals, there are many aspects of the 
health care economy that influence what is developed and produced, of 
which Medicare payment under the OPPS is merely one.
    Comment: Some commenters stated that CMS has not provided adequate 
information for specialty societies and others to adequately review the 
matching of the drugs with the services to determine whether an 
appropriate radiopharmaceutical is packaged into the nuclear medicine 
services. The commenters indicated that CMS should provide data on the 
percent of nuclear medicine claims that were reported with and without 
a corresponding radiopharmaceutical so that the public can determine 
whether an edit is indicated for reporting these services either 
through OCE or backend rate setting and, if so, what edit would be 
appropriate.
    Response: We provided considerable information and data in support 
of our proposal. Moreover, we make available our claims data both for 
the proposed rule and the final rule so that the public can perform any 
analysis they choose. There are limits to our ability to provide 
specialized studies of interest. Therefore, we provide a narrative 
claims accounting that is intended to illuminate our data process for 
those who would like to use the claims data to explore alternatives.
    Comment: Some commenters believed that packaging diagnostic 
radiopharmaceuticals would undermine the clinical and resource 
homogeneity of the nuclear medicine APCs, especially the cardiac 
imaging APCs, resulting in 2 times violations. The commenters stated 
that the APC revision that is proposed as a result of the proposed 
packaging results in a lack of resource and clinical homogeneity within 
the APCs. Specifically, the commenters believed that, by packaging 
diagnostic radiopharmaceuticals, CMS created a 2 times violation in APC 
0408 because the median costs for the services assigned to the APC vary 
widely for the procedure code based on the radiopharmaceutical used.
    Response: We agree that packaging costs into the median for a 
service to which they are an integral part can change the median cost 
for that service and result in 2 times violations. As we noted in the 
proposed rule, there were a significant number of APC reassignments to 
eliminate 2 times violations that would otherwise have resulted from 
the proposed packaging approach. However, we disagree that we should 
refrain from packaging payment for necessary items into the payment for 
the service in which they are required in order to prevent 2 times 
violations from occurring. Instead, we believe that we should make the 
necessary reassignments to different APCs where necessary to resolve 2 
times violations where they occur. For example, to resolve 2 times 
violations that would otherwise have occurred when we used only those 
claims for nuclear medicine procedures reporting HCPCS code for 
diagnostic radiopharmaceuticals, we made the following APC 
reassignments for this final rule with comment period. We reassigned 
CPT code 78730 (Urinary bladder residual study (List separately in 
addition to code for primary procedure)) from APC 0340 (Minor Ancillary 
Procedures) to APC 0389 (Level I Non-Imaging Nuclear Medicine). We 
reassigned CPT code 78725 (Kidney function study, non-imaging 
radioisotopic study) from APC 0389 to APC 0392 (Level II Non-Imaging 
Nuclear Medicine). We reassigned CPT code 78006 (Thyroid imaging, with 
uptake; single determination) from APC 0390 (Level I Endocrine Imaging) 
to APC 0391 (Level II Endocrine Imaging). With regard to APC 0408 
(Level III Tumor/Infection Imaging), that APC contained only one code 
for the proposed rule, CPT code 78804 (Radiopharmaceutical localization 
of tumor or distribution of radiopharmaceutical agent(s); whole body, 
requiring two or more days imaging), and it had a proposed median of 
approximately $1,010. For this final rule with comment period, APC 0408 
contains 3 CPT codes: 78804 (Radiopharmaceutical localization of tumor 
or distribution of radiopharmaceutical agent(s); whole body, requiring 
two or more days imaging); 78075 (Adrenal Imaging, cortex and/or 
medulla); and 78803 (Radiopharmaceutical localization of tumor or 
distribution of radiopharmaceutical agent(t); tomographic (SPECT)). For 
this final rule with comment period, APC 408 has a median cost of 
approximately $969.
    Because we have traditionally paid for a service package under the 
OPPS as represented by a HCPCS code for the major procedure that is 
assigned to an APC group for payment, we assess the applicability of 
the 2 times rule to services at the HCPCS code level, not at a more 
specific level based on the individual diagnostic radiopharmaceuticals 
that may be utilized in a service reported with a single HCPCS code. If 
the use of a very expensive diagnostic radiopharmaceutical in a 
clinical scenario causes a specific procedure to be much more expensive 
for the hospital than the APC payment, we consider such a case to be 
the natural consequence of a prospective payment system that 
anticipates that some cases will be more costly and other less costly 
than the procedure payment. In addition, very high cost cases could be 
eligible for outlier payment. As we note elsewhere in this final rule 
with comment period, decisions about packaging and bundling payment 
involve a balance between ensuring some separate payment for individual 
services and establishing incentives for efficiency through larger 
units of payment. In the case of diagnostic radiopharmaceuticals, these 
products will be part of the OPPS payment package for the procedures in 
which they are used beginning in CY 2008.
    Comment: One commenter objected to packaging of diagnostic 
radiopharmaceuticals because the commenter believed that including the 
payment for the item in the payment for the procedure would improperly 
subject the portion of the payment that is attributable to the 
diagnostic radiopharmaceutical to wage adjustment. The commenter 
indicated that there should be no wage adjustment applied to the cost 
of a diagnostic radiopharmaceutical.
    Response: We disagree that we should not package the payment for a 
radiopharmaceutical into the payment for the procedure in which it is 
an integral part because part of the procedure payment will be wage 
adjusted. Since the inception of the OPPS, we have determined that, 
approximately 60 percent of the cost of an OPPS service is attributable 
to wage costs. That figure is an overall average percent that takes 
into account the extent to which there are costs in the OPPS payments 
that are not attributable to wages. We have a longstanding policy of 
wage adjusting 60 percent of the cost of the APC, regardless of whether 
it is an office visit (which is mostly wage costs) or an ICD 
replacement (in which most of the cost is a device), because our 
analysis shows that, overall, OPPS

[[Page 66641]]

services approximately 60 percent of the cost is attributable to wages.
    Comment: Some commenters stated that diagnostic 
radiopharmaceuticals are not interchangeable and carry high costs 
because, if the patient for whom the hospital secures a 
radiopharmaceutical cannot use the product, the hospital cannot bill 
for it and must absorb the loss. The commenters stated that hospitals 
have little or no flexibility in determining the diagnostic 
radiopharmaceutical that they purchase and have little ability to 
achieve efficiency.
    Response: We recognize that radiopharmaceuticals are specialized 
products that have unique costs associated with them. However, we 
believe that the costs should be reflected in the charges that 
hospitals set for them and in the cost report where the full costs of 
the services are carried. Therefore, the costs will be calculated like 
any other OPPS cost and packaged into the total cost of the nuclear 
medicine service to which they are an integral part and will be the 
basis for the payment rate for the nuclear medicine service in the same 
way that other packaged costs contribute to the payment rate for the 
services to which they are an integral part.
    Comment: Several commenters stated that HCPCS codes A9542 (Indium 
IN-111 ibritumomab tiuxetan, diagnostic, per study dose, up to 5 
millicuires) and A9544 (Iodine I-131 tositumomab, diagnostic, per study 
dose) are not diagnostic radiopharmaceuticals and should not be 
packaged. The commenters reported that they are not used to diagnose 
the patient's disease but instead are used to assess the 
biodistribution of radioimmunotherapy agents or to calculate the 
therapeutic dose of those agents. The commenters contended that, 
although packaging is intended to create incentives for using the most 
cost-effective product, in these cases there are no other products that 
are available, and hence these products should always be paid 
separately. The commenters concluded that the proposed payments for 
these services are so low that hospitals will not offer the treatments 
to Medicare beneficiaries.
    Response: We continue to believe that HCPCS codes A9542 and A9544 
are diagnostic radiopharmaceuticals. While they are not used to 
diagnose disease, they are used to determine whether future therapeutic 
services would be beneficial to the patient and to determine how to 
proceed with therapy. This is analogous to the use of positron emission 
tomography (PET) scanning for staging purposes when there has already 
been a diagnosis of disease but the physician is seeking information to 
use in planning a course of therapy. The scan is a diagnostic service, 
notwithstanding that the disease has previously been diagnosed and the 
diagnostic service is essential to planning therapy. While we recognize 
that these radiopharmaceuticals are sole source products, we do not 
believe that is sufficient to justify treating them differently from 
other diagnostic radiopharmaceuticals. Moreover, given that the 
Medicare population is such a dominant portion of the population to 
which these services are targeted, we do not believe that hospitals 
will cease to provide the service because the payment is packaged into 
the payment for the service to which the radiopharmaceutical is an 
integral part. We also note that, under 42 CFR 489.53(a)(2), CMS may 
terminate the provider agreement of any hospital that furnishes this or 
any other service to its patients but fails to also furnish it to 
Medicare patients who need it.
    Comment: Some commenters asked that CMS pay hospitals separately 
for diagnostic radiopharmaceuticals based on acquisition costs. The 
commenters had a variety of recommendations regarding how CMS should 
acquire acquisition cost data on which CMS could base separate payment 
for radiopharmaceuticals. Some commenters recommended that CMS conduct 
surveys of radiopharmaceutical costs or rely on the external data from 
surveys conducted by outside entities to obtain cost data. Some 
commenters recommended that CMS work with stakeholders to develop a 
standardized radiopharmaceutical reporting format and base separate 
payment for radiopharmaceuticals on a radiopharmaceutical average 
selling nuclear pharmacy price (ASNPP), average acquisition cost (ACC), 
or another voluntarily reported amount if furnished by manufacturers 
and nuclear pharmacies, instead of claims data charges adjusted to cost 
by departmental CCRs. Other commenters suggested that CMS require 
hospitals to report acquisition costs for radiopharmaceuticals, 
instruct contractors to collect periodic reports from hospitals of 
diagnostic radiopharmaceutical costs, and gather and summarize nuclear 
pharmacy invoice data through CY 2008 that would be used to set CY 2009 
rates. The commenters stated that separate payment of diagnostic 
radiopharmaceuticals for CY 2008 is critical to enable hospitals to 
account for the complex combinations of radiopharmaceuticals used to 
provide nuclear medicine procedures. Some commenters indicated that 
continuation of the current payment at charges reduced to cost by the 
overall CCR, while not ideal, is a reasonable temporary solution until 
CMS can implement a long term solution to pay acquisition costs for 
radiopharmaceuticals as required by law. Some commenters supported CMS' 
use of its claims data alone to set the CY 2008 payment rates, but only 
if no external data source is available to pay actual acquisition costs 
for radiopharmaceuticals.
    Response: As we previously stated, we have decided to package 
payment for diagnostic radiopharmaceuticals into the payment for 
nuclear medicine services. Therefore, proposals for gathering data on 
which separate payment could be based are not relevant. However, we 
note that when we proposed to acquire ASP data for radiopharmaceuticals 
for purposes of paying separately for them under the CY 2006 OPPS, 
commenters were virtually unanimous that the industry could not report 
valid sales price data on radiopharmaceuticals.
    After consideration of the public comments received, we are 
finalizing our CY 2008 proposal to provide packaged payment for 
diagnostic radiopharmaceuticals, with modification to calculate the 
median costs for the APCs for nuclear medicine studies that require a 
diagnostic radiopharmaceutical using only claims on which at least one 
diagnostic radiopharmaceutical is present. We will implement edits in 
the OCE for services furnished on and after January 1, 2008, that will 
return to providers any claim for a nuclear medicine study that does 
not also report a HCPCS code and charge for a diagnostic 
radiopharmaceutical. We are not accepting the APC Panel's 
recommendation to set a packaging threshold for diagnostic 
radiopharmaceuticals at a median cost of $200 per day. We are accepting 
the APC Panel's recommendation to provide information regarding claims 
for diagnostic radiopharmaceuticals reported with nuclear medicine 
procedures, and we will discuss that information with the Panel at the 
2008 winter meeting. Diagnostic radiopharmaceuticals assigned status 
indicator ``N'' that will be unconditionally packaged are listed in 
Table 10 of this final rule with comment period.
(6) Contrast Agents
    For CY 2008, we proposed to package payment for all contrast media 
into their

[[Page 66642]]

associated independent diagnostic and therapeutic procedures as part of 
our proposed packaging approach for the CY 2008 OPPS (72 FR 42672 
through 42674). As noted in section II.A.4.c. of the proposed rule and 
this final rule with comment period, packaging the costs of supportive 
items and services into the payment for the independent procedure or 
service with which they are associated encourages hospital efficiencies 
and also enables hospitals to manage their resources with maximum 
flexibility. As stated in the proposed rule (72 FR 42672), we believe 
that contrast agents are particularly well suited for packaging because 
they are always provided in support of an independent diagnostic or 
therapeutic procedure that involves imaging, and thus payment for 
contrast agents can be packaged into the payment for the associated 
separately payable procedures.
    Contrast agents are generally considered to be those substances 
introduced into or around a structure that, because of the differential 
absorption of x-rays, alteration of magnetic fields, or other effects 
of the contrast medium in comparison with surrounding tissues, permit 
visualization of the structure through an imaging modality. The use of 
certain contrast agents is generally associated with specific imaging 
modalities, including x-ray, computed tomography (CT), ultrasound, and 
magnetic resonance imaging (MRI), for purposes of diagnostic testing or 
treatment. They are most commonly administered through an oral or 
intravascular route in association with the performance of the 
independent procedures involving imaging that are the basis for their 
administration. Even in the absence of this proposal to package payment 
for all contrast agents, we indicated that we would propose to package 
the majority of HCPCS codes for contrast agents recognized under the 
OPPS in CY 2008. We consider contrast agents to be drugs under the 
OPPS, and as a result they are packaged if their estimated mean per day 
cost is equal to or less than $60 for CY 2008. (For more discussion of 
our drug packaging criteria, we refer readers to section V.B.2 of this 
final rule with comment period.) Seventy-five percent of contrast 
agents HCPCS codes have an estimated mean per day cost equal to or less 
than $60 based on our CY 2006 proposed rule claims data.
    At the time of the proposed rule, contrast agents were described by 
those Level II HCPCS codes in the range from Q9945 through Q9964. There 
were currently no HCPCS C-codes or other Level II HCPCS codes outside 
the range specified above used to report contrast agents under the 
OPPS. As shown in Table 19 of the proposed rule, in CY 2007 we packaged 
7 out of 20 of these contrast agent HCPCS codes based on the $55 
packaging threshold. For CY 2008, we proposed to package all drugs with 
a per day mean cost of $60 or less. For CY 2008, the vast majority of 
contrast agents would be packaged under the traditional OPPS packaging 
methodology using the $60 packaging threshold, based on the CY 2006 
claims data available for the proposed rule. In fact, of the 20 
contrast agent HCPCS codes we included in our proposed packaging 
approach, 15 would have been proposed to be packaged for CY 2008 under 
our drug packaging methodology. These 15 codes represent 94 percent of 
all occurrences of contrast agents billed under the OPPS, using 
proposed rule data. As stated in the proposed rule (72 FR 42672), we 
believe that this shift in the packaging status for several of these 
agents between CYs 2007 and 2008 may be because, in CY 2007, a number 
of the contrast agents exceeded the $55 threshold by only a small 
amount and, based on our latest claims data for CY 2008, a number of 
these products have now fallen below the proposed $60 threshold. Given 
that the vast majority of contrast agents billed would already be 
packaged under the OPPS in CY 2008, we stated in the proposed rule (72 
FR 42672) that we believe it would be desirable to package payment for 
the remaining contrast agents as it promotes efficiency and results in 
a consistent payment policy across products that may be used in many of 
the same independent procedures. We also noted in the proposed rule (72 
FR 42672) that the significant costs associated with these 15 contrast 
agents would already be reflected in the median costs for those 
independent procedures and, if we were to pay for the 5 remaining 
agents separately, we would be treating these 5 agents differently than 
the others. If the 5 agents remained separately payable, there would 
effectively be two payments for contrast agents when these 5 agents 
were billed--a separate payment and a payment for packaged contrast 
agents that was part of the procedure payment. This could potentially 
provide a payment incentive to administer certain contrast agents that 
might not be the most clinically appropriate or cost effective. 
Moreover, as noted previously, contrast agents are always provided with 
independent procedures and, under a consistent approach to packaging in 
keeping with our enhanced efforts to encourage hospital efficiency and 
promote value-based purchasing under the OPPS, their payment would be 
appropriately packaged for CY 2008.
    The estimated overall impact of these changes presented in section 
XXII.B. of the proposed rule (and section XXIV.B. of this final rule 
with comment period) was based on the assumption that hospital behavior 
would not change with regard to when these contrast agents are provided 
by the same hospital that performs the imaging procedure. Under this 
policy, in order to provide imaging procedures requiring contrast 
agents, hospitals will either need to administer the necessary contrast 
agent themselves or refer patients elsewhere for the administration of 
the contrast agent. In the latter case, claims data would show such a 
change in practice in future years and that change would be reflected 
in future ratesetting. However, with respect to contrast agents, we 
believe that hospitals are limited in the extent to which they could 
change their behavior with regard to how they furnish these services 
because contrast agents are typically provided on the same day 
immediately prior to an imaging procedure being performed. We expected 
that hospitals would always bill the contrast agent on the same claim 
as the other independent services for which the contrast agent was 
administered.
    As we indicated earlier, in all cases we are providing that 
hospitals that furnish the supportive contrast agent in association 
with independent procedures involving imaging must bill both services 
on the same claim so that the cost of the contrast agent can be 
appropriately packaged into payment for the significant independent 
procedure. As noted in the proposed rule (72 FR 42673), we expect to 
carefully monitor any changes in billing practices on a service-
specific and hospital-specific basis to determine whether there is 
reason to request that QIOs review the quality of care furnished or to 
request that Program Safeguard Contractors review the claims against 
the medical record.
    During its September 2007 APC Panel meeting, the Panel recommended 
that contrast agents be packaged as proposed.
    We received many public comments on the proposal to package payment 
for all contrast agents. A summary of the public comments and our 
responses follow.
    Comment: Many commenters supported our proposal to package all 
contrast agents, while others requested that we pay separately for all 
contrast agents in accordance with the Average

[[Page 66643]]

Sales Price (ASP) payment methodology. Many commenters requested that 
we treat contrast agents in the same manner as we treat other drugs 
under the OPPS, thereby continuing to apply the proposed $60 threshold 
to determine packaging status. One commenter expressed concern with the 
accuracy of CMS' cost data, and estimated that if contrast agents were 
packaged, hospitals would not receive any payment in addition to the 
payment for the procedure without contrast. Several commenters 
requested that CMS create edits to ensure that the costs for contrast 
agents are only packaged with appropriate procedures, rather than with 
any code that may appear on the claim. Other commenters requested that 
CMS implement edits to ensure that contrast agents are always billed 
with procedures that require contrast agents. Some commenters were 
concerned that CMS may not be accounting for the full cost of the 
contrast agent, because of the methodology used to determine the 
acquisition costs of the agents. One commenter noted that it is 
difficult for hospitals operationally to treat contrast agents as 
packaged, then separately payable the following year, and then packaged 
again. In addition, commenters were concerned that packaged status 
would encourage less coding accuracy, which would hinder the 
development of accurate future payment rates. One commenter expressed 
concern that patient access to more expensive contrast agents, such as 
gadolinium-based contrast agents, may be limited, if the proposal to 
package all contrast agents were finalized.
    Response: We have considered all of the comments on this issue and 
have concluded that it is appropriate to package all contrast agents 
into payment for the procedure in which they are used. Many contrast 
agents are packaged currently under the OPPS and have been packaged 
since the inception of the OPPS. We have no reason to believe that the 
cost data that we developed for contrast agents are insufficient to 
result in an appropriate median cost for the services in which the 
contrast agent is used. Moreover, we are not convinced that there are 
benefits to making separate payment that would outweigh the incentives 
for appropriate utilization and efficiency that are created by 
packaging the payment for the contrast agent into the payment for the 
service in which it is used.
    In addition, we do not believe it is necessary to create edits to 
ensure that contrast agents are billed in conjunction with services 
that require contrast agents. For example, we believe that the payment 
rates for CT with and without contrast are accurate, further bolstering 
our perspective that hospitals are correctly billing the charges for 
contrast agents for those services that require them. There is 
currently a significant cost differential that appears to be 
appropriate between CT scans with and without contrast, and we have no 
reason to believe that this cost differential is inaccurate. For 
example, the CY 2008 median cost for CPT code 72192 (Computer 
tomographic angiography, pelvis, without contrast material) is 
approximately $190. The CY 2008 median cost for CPT code 72193 
(Computer tomographic angiography, pelvis, with contrast material) the 
same procedure, with contrast, is approximately $249. The CY 2008 
median costs for the services in APC 0332 (Computed Tomography Without 
Contrast) range from approximately $164 to $227. The CY 2008 proposed 
median costs for the services in APC 0283 (Computed Tomography with 
Contrast) range from approximately $247 to $333, significantly higher 
than the median costs for the procedures that do not involve contrast 
media.
    Providers have several ways to report contrast agents, including 
uncoded charges on revenue code lines, including the charge for the 
contrast agent in the charge for the procedure, or reporting the 
appropriate HCPCS code for the contrast agent that was used. Prior to 
proposing to package payment for all contrast agents, we note that 
there were no concerns or complaints about the payment rates for 
imaging studies with and without contrast, when a number of the 
commonly used contrast agents were packaged. In addition, if we were to 
subset claims for procedures that require a contrast agent to use only 
those claims that included a coded contrast agent, we would be able to 
use many fewer claims, which would cause our median costs to be less 
accurate and representative.
    Most of the contrast media would have been packaged in the absence 
of this packaging proposal, because 75 percent of all contrast agents 
fall below the $60 threshold for CY 2008. However, we are interested to 
know whether the public thinks it would be beneficial from a 
ratesetting perspective to require hospitals to report contrast media 
by including HCPCS codes for contrast on all claims for procedures that 
use contrast. We are particularly concerned with unnecessarily 
burdening hospitals, and are seeking comments in this final rule with 
comment period related to how administratively burdensome this 
requirement would be for hospitals.
    In response to the commenter who found it difficult operationally 
to manage changes in the packaged status of contrast media, we note 
that we do not anticipate regular changes to the packaged status of 
contrast media, now that we are finalizing our proposal to package 
payment for all contrast media.
    In response to the commenter's concern about payment for expensive 
contrast agents like gadolinium-based contrast media, we note that the 
gadolinium-based contrast agents would be packaged under the $60 
packaging threshold, regardless of whether this proposal to package 
payment for all contrast media was finalized. Packaging payment for 
these products provides hospitals with an incentive to choose the most 
cost-effective contrast agent that meets the needs of the patient.
    Comment: Several commenters questioned whether we have the 
authority under the Social Security Act to package all contrast agents.
    Response: See section V.B.4.b. of this final rule with comment 
period for a discussion of the rationale to package payment for 
contrast agents as SCODs and our belief that the packaged payment 
provides payment at average acquisition cost for the products.
    Comment: Several commenters requested that contrast agents used for 
echocardiography imaging procedures remain separately paid in CY 2008. 
These commenters were concerned that echocardiography procedure codes 
do not distinguish between services provided with contrast and those 
provided without contrast, although section 1833(t)(2)(G) of the Act 
requires that contrast and noncontrast procedures be paid through 
separate APC groups. As echocardiography procedures are not usually 
performed with contrast, the commenters asserted that the packaged 
payment for contrast and echocardiography would be insufficient to 
cover both costs, and that physicians would therefore be limited in 
their ability to use contrast when necessary.
    Response: The commenters are correct; section 1833(t)(2)(G) of the 
Act requires us to create additional groups of services for procedures 
that use contrast agents. As contrast agents were eligible for separate 
payment in CY 2007 but subject to the OPPS drug packaging threshold, a 
distinction was made in payment between those procedures performed with 
contrast from those without contrast. However, as noted above, we are 
finalizing our proposal to package all contrast agents in CY 2008 
regardless of if they meet the OPPS drug packaging threshold.

[[Page 66644]]

    Because current CPT codes do not distinguish between 
echocardiography procedures performed without contrast from those 
performed with contrast, we calculated HCPCS-specific median costs for 
echocardiography procedures that were performed with contrast by 
isolating single and ``pseudo'' single claims with CPT codes 93303 
through 93350 where there was also a contrast agent on the claim. Our 
analysis indicated that median costs for echocardiography procedures 
performed with contrast are similar both clinically and in terms of 
resource use, as evidenced by similar HCPCS median costs. Therefore, 
pursuant to the statute, we have created APC 0128 (Echocardiogram With 
Contrast) to provide payment for echocardiography procedures that are 
performed with a contrast agent in CY 2008.
    In order for hospitals to report echocardiography procedures 
performed with contrast, as all contrast will be packaged in CY 2008, 
we have also created the eight new HCPCS codes shown in Table 3 below. 
We have assigned HCPCS codes C8921 through C8928 to the newly created 
APC 0128. Hospitals performing echocardiography procedures without 
contrast will continue to use the CPT codes indicated in Table 5, while 
echocardiography procedures performed with contrast will be reported 
with the newly developed C-codes also identified in Table 5. We will 
provide further instruction about reporting echocardiography procedures 
with and without contrast in the January 2007 OPPS update.

                                 Table 5.--CY 2008 Echocardiography HCPCS Codes for Procedures With and Without Contrast
--------------------------------------------------------------------------------------------------------------------------------------------------------
                         Echocardiography without contrast                                             Echocardiography with contrast
--------------------------------------------------------------------------------------------------------------------------------------------------------
                HCPCS                          Descriptor             SI      APC            HCPCS                    Descriptor             SI     APC
--------------------------------------------------------------------------------------------------------------------------------------------------------
93303...............................  Transthoracic                     S    0269   C8921..................  Transthoracic                     S    0128
                                       echocardiography for                                                   echocardiography with
                                       congenital cardiac                                                     contrast for congenital
                                       anomalies; complete.                                                   cardiac anomalies; complete.
93304...............................  Transthoracic                     S    0697   C8922..................  Transthoracic                     S    0128
                                       echocardiography for                                                   echocardiography with
                                       congenital cardiac                                                     contrast for congenital
                                       anomalies; follow-up or                                                cardiac anomalies; follow-
                                       limited study.                                                         up or limited study.
93307...............................  Echocardiography,                 S    0269   C8923..................  Transthoracic                     S    0128
                                       transthoracic, real-time                                               echocardiography with
                                       with image documentation                                               contrast, real-time with
                                       (2D) with or without M-mode                                            image documentation (2D)
                                       recording; complete.                                                   with or without M-mode
                                                                                                              recording; complete.
93308...............................  Echocardiography,                 S    0697   C8924..................  Transthoracic                     S    0128
                                       transthoracic, real-time                                               echocardiography with
                                       with image documentation                                               contrast, real-time with
                                       (2D) with or without M-mode                                            image documentation (2D)
                                       recording; follow-up or                                                with or without M-mode
                                       limited study.                                                         recording; follow-up or
                                                                                                              limited study.
93312...............................  Echocardiography,                 S    0270   C8925..................  Transesophageal                   S    0128
                                       transesophageal, real time                                             echocardiography (TEE) with
                                       with image documentation                                               contrast, real time with
                                       (2D) (with or without M-                                               image documentation (2D)
                                       mode recording); including                                             (with or without M-mode
                                       probe placement, image                                                 recording); including probe
                                       acquisition, interpretation                                            placement, image
                                       and report.                                                            acquisition, interpretation
                                                                                                              and report.
93313...............................  Echocardiography,                 S    0270                                                          ......  .....
                                       transesophageal, real time
                                       with image documentation
                                       (2D) (with or without M-
                                       mode recording); placement
                                       of transesophageal probe
                                       only.
93314...............................  Echocardiography,                 N   ......                                                         ......  .....
                                       transesophageal, real time
                                       with image documentation
                                       (2D) (with or without M-
                                       mode recording); image
                                       acquisition, interpretation
                                       and report only.
93315...............................  Transesophageal                   S    0270   C8926..................  Transesophageal                   S    0128
                                       echocardiography for                                                   echocardiography (TEE) with
                                       congenital cardiac                                                     contrast for congenital
                                       anomalies; including probe                                             cardiac anomalies;
                                       placement, image                                                       including probe placement,
                                       acquisition, interpretation                                            image acquisition,
                                       and report.                                                            interpretation and report.
93316...............................  Transesophageal                   S    0270                                                          ......  .....
                                       echocardiography for
                                       congenital cardiac
                                       anomalies; placement of
                                       transesophageal probe only.
93317...............................  Transesophageal                   N   ......                                                         ......  .....
                                       echocardiography for
                                       congenital cardiac
                                       anomalies; image
                                       acquisition, interpretation
                                       and report only.
93318...............................  Echocardiography,                 S    0270   C8927..................  Transesophageal                   S    0128
                                       transesophageal (TEE) for                                              echocardiography (TEE) with
                                       monitoring purposes,                                                   contrast for monitoring
                                       including probe placement,                                             purposes, including probe
                                       real time 2-dimensional                                                placement, real time 2-
                                       image acquisition and                                                  dimensional image
                                       interpretation leading to                                              acquisition and
                                       ongoing (continuous)                                                   interpretation leading to
                                       assessment of (dynamically                                             ongoing (continuous)
                                       changing) cardiac pumping                                              assessment of (dynamically
                                       function and to therapeutic                                            changing) cardiac pumping
                                       measures on an immediate                                               function and to therapeutic
                                       time basis.                                                            measures on an immediate
                                                                                                              time basis.

[[Page 66645]]

 
93320...............................  Doppler echocardiography,         N   ......                                                         ......  .....
                                       pulsed wave and/or
                                       continuous wave with
                                       spectral display (List
                                       separately in addition to
                                       codes for echocardiographic
                                       imaging); complete.
93321...............................  Doppler echocardiography,         N   ......                                                         ......  .....
                                       pulsed wave and/or
                                       continuous wave with
                                       spectral display (List
                                       separately in addition to
                                       codes for echocardiographic
                                       imaging); follow-up or
                                       limited study (List
                                       separately in addition to
                                       codes for echocardiographic
                                       imaging).
93325...............................  Doppler echocardiography          N   ......                                                         ......  .....
                                       color flow velocity mapping
                                       (List separately in
                                       addition to codes for
                                       echocardiography).
93350...............................  Echocardiography,                 S    0697   C8928..................  Transthoracic                     S    0128
                                       transthoracic, real-time                                               echocardiography with
                                       with image documentation                                               contrast, real-time with
                                       (2D), with or without M-                                               image documentation (2D),
                                       mode recording, during rest                                            with or without M-mode
                                       and cardiovascular stress                                              recording, during rest and
                                       test using treadmill,                                                  cardiovascular stress test
                                       bicycle exercise and/or                                                using treadmill, bicycle
                                       pharmacologically induced                                              exercise and/or
                                       stress, with interpretation                                            pharmacologically induced
                                       and report.                                                            stress, with interpretation
                                                                                                              and report.
--------------------------------------------------------------------------------------------------------------------------------------------------------

    In order to determine a payment rate for APC 0128 for CY 2008, we 
isolated single and ``pseudo'' single claims in our database that 
included those CPT codes in the range of 93303 through 93350 that 
correspond to the contrast studies described by the new C-codes. We 
created new C-codes for contrast studies only to parallel those CPT 
codes for procedures where we expected that the procedures could be 
provided with or without contrast. For claims where an echocardiography 
procedure was billed with a contrast agent, we packaged the payment for 
the contrast agent into the echocardiography procedure and then 
calculated the median cost for this subset of claims. This became the 
median for APC 0128. In addition, we recalculated the medians for APCs 
0269 (Level II Echocardiogram Without Contrast Except Transesophageal); 
0270 (Transesophageal Echocardiogram Without Contrast); and 0697 (Level 
I Echocardiogram Without Contrast Except Transesophageal), as we needed 
to remove the claims from the ratesetting process that included 
contrast because they were used to set the median cost for APC 0128. 
The resulting CY 2008 APC medians are shown in Table 6.

         Table 6.-CY 2008 Final Rule Echocardiogram APC Medians
------------------------------------------------------------------------
                                                        HCPCS
             APC                       Title            Codes    Median
------------------------------------------------------------------------
0269.........................  Level II                  93303      $401
                                Echocardiogram           93307
                                Without Contrast
                                Except
                                Transesophageal.
0270.........................  Transesophageal           93312      $517
                                Without Contrast         93313
                                Echocardiogram.          93315
                                                         93316
                                                         93318
0697.........................  Level I                   93304      $210
                                Echocardiogram           93308
                                Without Contrast         93350
                                Except
                                Transesophageal.
0128.........................  Echocardiogram With       C8921      $534
                                Contrast.                C8922
                                                         C8923
                                                         C8924
                                                         C8925
                                                         C8926
                                                         C8927
                                                         C8928
------------------------------------------------------------------------

    We believe that these medians accurately reflect hospital costs 
when performing echocardiography procedures, both with and without 
contrast. This final coding and payment methodology allows us to both 
adhere to the statutory requirement to create additional groups of 
services for procedures that use contrast agents and to package payment 
contrast agents in CY 2008. Therefore, we are finalizing our policy to 
assign HCPCS codes C8921

[[Page 66646]]

through C8928 to APC 0128 and will instruct hospitals to use these 
contrast-specific HCPCS codes when submitting an OPPS claim for 
echocardiography procedures performed with contrast.
    For CY 2008, we are finalizing our proposal to unconditionally 
packaged payment for all contrast agents, with modification as 
discussed above. We are fully adopting the APC Panel recommendation to 
package all contrast media for CY 2008. Consistent with the statute, we 
are also finalizing the creation of APC 0128, as well as eight Level II 
HCPCS codes that describe echocardiography procedures performed with 
contrast. Contrast agents that are packaged are assigned status 
indicator ``N'' and are listed in Table 10 of this final rule with 
comment period.
(7) Observation Services
    We proposed to package payment for all observation care, reported 
under HCPCS code G0378 (Hospital observation services, per hour) for CY 
2008. We proposed that payment for observation care would be packaged 
as part of the payment for the separately payable services with which 
it is billed. We have defined observation care as a well defined set of 
specific, clinically appropriate services that include ongoing short-
term treatment, assessment, and reassessment before a decision can be 
made regarding whether patients will require further treatment as 
hospital inpatients or if they are able to be discharged from the 
hospital. Observation status is commonly assigned to patients who 
present to the emergency department and who then require a significant 
period of treatment or monitoring before a decision is made concerning 
their next placement or to patients with unexpectedly prolonged 
recovery after surgery. Throughout the proposed rule and in this final 
rule with comment period, as well as in our manuals and guidance 
documents, we use both of the terms ``observation services'' and 
``observation care'' in reference to the services defined above.
    Payment for all observation care under the OPPS was packaged prior 
to CY 2002. Since CY 2002, separate payment of a single unit of an 
observation APC for an episode of observation care has been provided in 
limited circumstances. Effective for services furnished on or after 
April 1, 2002, separate payment for observation was made if the 
beneficiary had chest pain, asthma, or congestive heart failure and met 
additional criteria for diagnostic testing, minimum and maximum limits 
to observation care time, physician care, and documentation in the 
medical record (66 FR 59856, 59879). Payment for observation care that 
did not meet these specified criteria was packaged. Between CY 2003 and 
CY 2006, several more changes were made to the OPPS policy regarding 
separate payment for observation services, such as: clarification that 
observation is not separately payable when billed with ``T'' status 
procedures on the day of or day before observation care; development of 
specific Level II HCPCS codes for hospital observation services and 
direct admission to observation care; and removal of the initially 
established diagnostic testing requirements for separately payable 
observation (67 FR 66794, 69 FR 65828, and 70 FR 68688). Throughout 
this time period, we maintained separate payment for observation care 
only for the three specified medical conditions, and OPPS payment for 
observation for all other clinical conditions remained packaged.
    Since January 1, 2006, hospitals have reported observation services 
based on an hourly unit of care using HCPCS code G0378. This code has a 
status indicator of ``Q'' under the CY 2007 OPPS, meaning that the OPPS 
claims processing logic determines whether the observation is packaged 
or separately payable. The OCE's current logic determines whether 
observation services billed under HCPCS code G0378 are separately 
payable through APC 0339 (Observation) or whether payment for 
observation services will be packaged into the payment for other 
separately payable services provided by the hospital in the same 
encounter based on criteria discussed subsequently. (We note that if an 
HOPD directly admits a patient to observation, Medicare currently pays 
separately for that direct admission reported under HCPCS code G0379 
(Direct admission of patient for hospital observation care) in 
situations where payment for the actual observation care reported under 
HCPCS code G0378 is packaged.) For CY 2008, as discussed in more detail 
later in this final rule with comment period (section XI.), we proposed 
to continue the coding and payment methodology for direct admission to 
observation status, with the exception of the requirement that HCPCS 
code G0379 is only eligible for separate payment if observation care 
reported under HCPCS code G0378 does not qualify for separate payment. 
As noted in the proposed rule (72 FR 42674), this requirement would no 
longer be applicable under our proposal to package all observation 
services reported under HCPCS code G0378.
    For CY 2007, separate OPPS payment may be made for observation 
services reported under HCPCS code G0378 provided to a patient when all 
of the following requirements are met. The hospital would receive a 
single separate payment for an episode of observation care (APC 0339) 
when:
1. Diagnosis Requirements
    a. The beneficiary must have one of three medical conditions: 
congestive heart failure, chest pain, or asthma.
    b. Qualifying ICD-9-CM diagnosis codes must be reported in Form 
Locator (FL) 76, Patient Reason for Visit, or FL 67, principal 
diagnosis, or both in order for the hospital to receive separate 
payment for APC 0339. If a qualifying ICD-9-CM diagnosis code(s) is 
reported in the secondary diagnosis field, but is not reported in 
either the Patient Reason for Visit field (FL 76) or in the principal 
diagnosis field (FL 67), separate payment for APC 0339 is not allowed.
2. Observation Time
    a. Observation time must be documented in the medical record.
    b. A beneficiary's time in observation (and hospital billing) 
begins with the beneficiary's admission to an observation bed.
    c. A beneficiary's time in observation (and hospital billing) ends 
when all clinical or medical interventions have been completed, 
including follow-up care furnished by hospital staff and physicians 
that may take place after a physician has ordered the patient be 
released or admitted as an inpatient.
    d. The number of units reported with HCPCS code G0378 must equal or 
exceed 8 hours.
3. Additional Hospital Services
    a. The claim for observation services must include one of the 
following services in addition to the reported observation services. 
The additional services listed below must have a line-item date of 
service on the same day or the day before the date reported for 
observation:
     An emergency department visit (APC 0609, 0613, 0614, 0615, 
or 0616); or
     A clinic visit (APC 0604, 0605, 0606, 0607, or 0608); or
     Critical care (APC 0617); or
     Direct admission to observation reported with HCPCS code 
G0379 (APC 0604).
    b. No procedure with a ``T'' status indicator can be reported on 
the same day or day before observation care is provided.
4. Physician Evaluation
    a. The beneficiary must be in the care of a physician during the 
period of

[[Page 66647]]

observation, as documented in the medical record by admission, 
discharge, and other appropriate progress notes that are timed, 
written, and signed by the physician.
    b. The medical record must include documentation that the physician 
explicitly assessed patient risk to determine that the beneficiary 
would benefit from observation care.
    In the context of our proposed CY 2008 packaging approach, we 
indicated that we believed that it was appropriate to package payment 
for all observation services reported with HCPCS code G0378 under the 
CY 2008 OPPS. Primarily, observation services are ideal for packaging 
because they are always provided as a supportive service in conjunction 
with other independent separately payable hospital outpatient services 
such as an emergency department (ED) visit, surgical procedure, or 
another separately payable service, and thus observation costs can 
logically be packaged into OPPS payment for independent services. As 
discussed extensively in this section, packaging payment into larger 
payment bundles creates incentives for providers to furnish services in 
the most efficient way that meets the needs of the patient, encouraging 
long-term cost containment.
    As we discussed in the general overview of the CY 2008 packaging 
approach (section II.A.4.b. of this final rule with comment period), 
there has been substantial growth in program expenditures for hospital 
outpatient services under the OPPS in recent years. The primary reason 
for this upsurge is growth in the intensity and utilization of services 
rather than the general price of services or enrollment changes. This 
observed trend is notably reflected in the frequency and costs of 
separately payable observation care for the last few years. While 
median costs for an episode of observation care that would meet the 
criteria for separate payment have remained relatively stable between 
CYs 2003 and 2006, the frequency of claims for separately payable 
observation services has rapidly increased. Comparing claims data for 
separately payable observation care available for proposed rules 
spanning from CYs 2005 to 2008 (that is, claims data reflecting 
services furnished from CYs 2003 to 2006), we saw substantial growth in 
separately payable observation care billed under the OPPS over that 
time. In CY 2003, the first full year that observation care was 
separately payable, there were approximately 56,000 claims for 
separately payable observation care. In CY 2004, there were 
approximately 77,000 claims for separately payable observation care. By 
CY 2005, that number had increased to approximately 124,300 claims, 
representing an increase of approximately 61 percent over the previous 
calendar year. Based on the CY 2006 data available for issuance of the 
proposed rule, the frequency of claims for separately payable 
observation services increased to more than 271,200 claims which 
represents an increase of approximately 118 percent over CY 2005 and 
more than triple the number of claims for CY 2004. While it is not 
possible to discern the specific factors responsible for the growth in 
claims for separately payable observation services, as there have been 
minor changes in both the process and criteria for separate payment for 
these services over this time period, the substantial growth by itself 
is noteworthy.
    In the proposed rule (72 FR 42675), we indicated that we were also 
concerned that the current criteria for separate payment for 
observation services may provide disincentives for efficiency. For CY 
2007, in order for observation services to be separately payable, they 
must last at least 8 hours. While this criterion was put in place to 
ensure that separate payment is made only for observation services of a 
substantial duration, it may create a financial disincentive for an 
HOPD to make a timely determination regarding a patient's safe 
disposition after observation care ends. By packaging payment for all 
observation services, regardless of their duration, we would provide 
incentives for more efficient delivery of services and timely decision-
making. The current criterion also prohibits separate payment for 
observation services when a ``T'' status procedure (generally a 
surgical procedure) is provided on the same day or the previous day by 
the HOPD to the same Medicare beneficiary. Again, this may create a 
financial disincentive for hospitals to provide minor surgical 
procedures during a patient's observation stay, unless those procedures 
are essential to the patient's care during that time period, even if 
the most efficient and effective performance of those procedures could 
be during the single HOPD encounter.
    Currently, the OPPS pays separately for observation care for only 
the three original medical conditions designated in CY 2002, 
specifically chest pain, asthma, and congestive heart failure. As 
discussed in more detail in the observation section (section XI.) of 
this final rule with comment period, the APC Panel recommended at its 
March 2007 meeting that we consider expanding separate payment for 
observation services to include two additional diagnoses, syncope and 
dehydration. As mentioned previously, we have defined observation care 
as a well-defined set of specific, clinically appropriate services, 
which include ongoing, short term treatment, assessment, and 
reassessment, that are furnished while a decision is being made 
regarding whether a patient will require further treatment as a 
hospital inpatient or if the individual is able to be discharged from 
the hospital. Given the definition of observation services, it is clear 
that, in certain circumstances, observation care could be appropriate 
for patients with a range of diagnoses. Both the APC Panel and numerous 
commenters to prior OPPS proposed rules have confirmed their agreement 
with this perspective. In addition, the June 2006 Institute of Medicine 
(IOM) Report entitled, ``Hospital-Based Emergency Care: At the Breaking 
Point,'' encourages hospitals to apply tools to improve the flow of 
patients through emergency departments, including developing clinical 
decisions units where observation care is provided. The IOM's Committee 
on the Future of Emergency Care in the United States Health System 
recommended that CMS remove the current limitations on the medical 
conditions that are eligible for separate observation care payment in 
order to encourage the development of such observation units.
    We indicated in the proposed rule (72 FR 42676) that, as packaging 
payment provides desirable incentives for greater efficiency in the 
delivery of health care and provides hospitals with significant 
flexibility to manage their resources, we believed it was most 
appropriate to treat observation care for all diagnoses similarly by 
packaging its costs into payment for the separately payable independent 
services with which the observation is associated. We noted in the 
proposed rule (72 FR 42676) that this consistent payment methodology 
would provide hospitals with the flexibility to assess their approaches 
to patient care and patient flow and provide observation care for 
patients with a variety of clinical conditions when hospitals conclude 
that observation services would improve their treatment of those 
patients. Approximately 70 percent of the occurrences of observation 
care billed under the OPPS are currently packaged, and this expansion 
would extend the incentives for efficiency already present for the vast 
majority of observation services that are already packaged under the 
OPPS to the remaining 30 percent of

[[Page 66648]]

observation services for which we currently make separate payment.
    The estimated overall impact of these changes, presented in section 
XXII.B. of the proposed rule (and in section XXIV.B. of this final rule 
with comment period), was based on the assumption that hospital 
behavior would not change with regard to when the dependent observation 
care is provided in the same encounter and by the same hospital that 
performs the independent services. To the extent that hospitals could 
change their behavior and cease providing observation services, refer 
patients elsewhere for that care, or increase the frequency of 
observation services, the data would show such a change in practice in 
future years and that change would be reflected in future budget 
neutrality adjustments. However, with respect to observation care, we 
indicated that we believe that hospitals are limited in the extent to 
which they could change their behavior with regard to how they furnish 
these services because observation care, by definition, is short-term 
treatment, assessment, and reassessment before a decision can be made 
regarding whether patients will require further treatment as hospital 
inpatients or if they are able to be discharged from the hospital after 
receiving the independent services. We indicated that we believe it is 
unlikely that hospitals will cease providing medically necessary 
observation care or refer patients elsewhere for that care if they were 
unable to reach a decision that the patient could be safely discharged 
from the outpatient department. We stated in the proposed rule (72 FR 
42677) that we expect that hospitals would always bill the supportive 
observation services on the same claim as the other independent 
services provided in the single hospital encounter.
    As we indicated earlier, in all cases we proposed that hospitals 
that furnish the observation care in association with independent 
services must bill those services on the same claim so that the costs 
of the observation services can be appropriately packaged into payment 
for the independent services. We stated in the proposed rule (72 FR 
42677) that we expected to carefully monitor any changes in billing 
practices on a service-specific and hospital-specific basis to 
determine whether there is reason to request that QIOs review the 
quality of care furnished or to request that Program Safeguard 
Contractors review the claims against the medical record.
    During its September 2007 APC Panel meeting, the APC Panel 
recommended that CMS not package observation services as proposed, 
thereby maintaining the CY 2007 payment policy. However, the APC Panel 
indicated that if CMS were to package observation, CMS should create a 
composite emergency department/clinic and observation APC (or group of 
composite APCs) that would be paid only when both services were 
furnished; if the composite APC were paid, neither the emergency 
department nor the clinic visit would be paid separately. The APC Panel 
recommended that coding and service requirements currently applicable 
to separately paid observation would remain the same, with the 
exception that there would be no clinical condition (that is, 
diagnosis) restrictions on payment for the composte APC. The APC Panel 
noted that payment rates for this (these) composite APC(s) would need 
to be adjusted based on readily available historical visit and 
observation data.
    We received many public comments on our proposal to package payment 
for observation services into the payment for the services with which 
it is furnished. A summary of public comments and our responses follow.
    Comment: Several commenters, including MedPAC, requested that CMS 
finalize its policy to package payment for all observation care. MedPAC 
specifically stated that packaging of observation care is logical 
because currently 70 percent of observation care is packaged. However, 
most commenters addressing observation packaging requested that CMS 
finalize its proposal to package all of the categories of codes that it 
identified in the proposed rule, with the exception of observation 
care. Many of these commenters stated that observation care is often a 
significant service and is not supportive and integral to an 
independent service. These commenters recommended that CMS implement 
various policies, such as paying separately for all observation care 
regardless of diagnosis, expanding the diagnoses that would enable 
separate payment, postponing packaging observation services, or 
creating a composite APC to allow separate payment for observation care 
in certain circumstances.
    Response: Based on our review of the comments received, we continue 
to believe that observation services are usually ancillary and 
supportive to the other independent services that are provided to the 
patient on the same day. However, we accept the commenters' and the APC 
Panel's statements that observation care may sometimes rise to the 
level of a major component service, specifically, when it is provided 
for 8 hours or more in association with a high level clinic or ED 
visit, direct admission to observation, or critical care services and 
it is not provided in conjunction with a surgical procedure. In 
addition, based on our review of the clinical circumstances provided by 
many commenters, we recognize that observation care can be a major 
component service when provided to patients with clinical conditions 
other than congestive heart pain, chest pain, and asthma for which 
separate observation payment may currently by provided under the OPPS.
    Consistent with our statutory flexibility to define what 
constitutes a service under the OPPS, we proposed to view a service, in 
some cases, as the totality of care provided in a hospital outpatient 
encounter that would be reported with two or more HCPCS codes for 
component services with the proposal of composite APCs for low dose 
rate prostate brachytherapy and cardiac electrophysiological evaluation 
and ablation services. In general, we intend to request public comment 
on possible composite APCs in the annual OPPS proposed rulemaking 
cycle. This also includes creating composite APCs, as appropriate, in 
response to those public comments received during rulemaking.
    Therefore, we have decided to create two composite APCs that will 
provide payment to hospitals in certain circumstances when extended 
assessment and management of a patient occur. These composite APCs 
describe an extended encounter for care provided to a patient. 
Specifically, we are creating two new composite APCs for CY 2008, APCs 
8002 (Level I Extended Assessment and Management Composite) and 8003 
(Level II Extended Assessment and Management Composite). APC 8002 
describes an encounter for care provided to a patient that includes a 
high level (Level 5) clinic visit or direct admission to observation in 
conjunction with observation services of substantial duration. APC 8003 
describes an encounter for care provided to a patient that includes a 
high level (Level 4 or 5) emergency department visit or critical care 
services in conjunction with observation services of substantial 
duration. As with the other composite APCs that we proposed, we 
anticipate that assignment to and payment through one of these two new 
composite APCs will be transparent from a billing perspective. The OCE 
will evaluate every claim received to determine if payment through a 
composite APC is appropriate. If payment through a composite APC is 
inappropriate, the OCE in conjunction with the PRICER, will determine 
the appropriate status

[[Page 66649]]

indicator, APC, and payment for every code on a claim. The specific 
logic associated with the two Extended Assessment and Management 
Composite APCs is detailed below.
    APC 8002 will be assigned when 8 or more units of HCPCS code G0378 
(Hospital observation service, per hour) are billed--
     On the same day as HCPCS code G0379 (Direct admission of 
patient for hospital observation care); or
     On the same day or the day after--
    ++ CPT code 99205 (Office or other outpatient visit for the 
evaluation and management of a new patient (Level 5)); or
    ++ CPT code 99215 (Office or other outpatient visit for the 
evaluation and management of an established patient (Level 5)).
    If a hospital provides a service with status indicator ``T'' on the 
same date of service, or 1 day earlier than the date of service 
associated with HCPCS code G0378, the hospital will not be eligible for 
payment under APC 8002. There is no diagnosis requirement for purposes 
of this composite APC. Rather, patients with any diagnosis may trigger 
payment of APC 8002. If any of the criteria listed above are not met, 
payment would not be made through APC 8002. Instead, payment for any 
separately payable services, including the clinic visit, would be made 
through the usual associated APCs. Payment for a direct admission to 
observation would be made according to the usual HCPCS code G0379 
payment criteria and payment for HCPCS code G0378 would remain packaged 
because we consider the observation care to be supportive and ancillary 
to whichever service(s) it accompanies.
    APC 8003 will be assigned when eight or more units of HCPCS code 
G0378 (Hospital observation service, per hour) are billed on the same 
day or the day after CPT code 99284 (Emergency department visit for the 
evaluation and management of a patient (Level 4)), 99285 (Emergency 
department visit for the evaluation and management of a patient (Level 
5)); or 99291 (Critical care, evaluation and management of the 
critically ill or critically injured patient; first 30-74 minutes). The 
remaining criteria are identical to the criteria associated with 
composite APC 8002. If a hospital provides a service with status 
indicator ``T'' on the same date of service, or one day earlier than 
the date of service associated with HCPCS code G0378, the composite APC 
8003 would not apply. Instead, payment for the ED visit or critical 
care and any other separately payable services will be made through the 
usual associated APCs, and payment for HCPCS code G0378 for observation 
services will remain packaged because we consider the observation care 
to be supportive and ancillary to whichever service(s) it accompanies. 
There is no diagnosis requirement for purposes of this composite APC 
either. Instead, patients with any diagnosis may trigger payment of APC 
8003.
    We note that HCPCS code G0378 will continue to be assigned status 
indicator ``N,'' signifying that its payment is always packaged. As 
stated above, in most circumstances, observation services are 
supportive and ancillary to the other services provided to a patient. 
In the circumstances when observation care is elevated to a major 
component service in conjunction with a high level visit or direct 
admission that is an integral part of a patient's extended encounter 
for care, payment is made for the entire care encounter through APC 
8002 or 8003, as appropriate.
    We are retaining as general reporting requirements for all 
observation services those criteria related to physician order and 
evaluation, documentation, and observation beginning and ending time as 
listed in section XI. of this final rule with comment period. Those are 
more general requirements that encourage hospitals to provide medically 
reasonable and necessary care and help to ensure the proper reporting 
of observation services on correctly coded hospital claims that reflect 
the full charges associated with all hospital resources utilized to 
provide the reported services.
    The CY 2008 median cost for APC 8002 (Level I Extended Assessment 
and Management Composite) is approximately $347. The payment associated 
with APC 8002 is intended to pay the hospital for the costs associated 
with a single episode of extended assessment and management that 
includes a high level clinic visit or direct admission to the hospital 
for observation care, 8 hours or more of observation services, and any 
associated packaged services. We calculated this median cost using all 
CY 2006 single bill claims that met the criteria for APC 8002, as 
specified above. The CY 2008 median cost for APC 8003 (Level II 
Extended Assessment and Management Composite) is approximately $631. 
The payment associated with APC 8003 is intended to pay the hospital 
for the costs associated with a single episode of more intense extended 
assessment and management that includes a high level emergency 
department visit or critical care services, 8 hours or more of 
observation services, and any associated packaged services. We 
calculated this median cost using all CY 2006 single bill claims that 
met the criteria for APC 8003, as specified above.
    While analyzing CY 2006 claims data, the most current full year 
claims data available, we observed that applying CY 2008 criteria for 
composite APCs resulted in payment for 55 percent more instances of 
observation care through a composite APC than if we had applied the CY 
2007 criteria to those same claims. In addition, our CY 2006 claims 
data indicate that close to 30 percent of all observation care was paid 
separately. We estimate that roughly 90 percent of those instances of 
separately payable observation care reported in CY 2006 would be 
eligible for payment through composite APCs 8002 and 8003, using CY 
2008 criteria. Those separately payable observation services that would 
not be eligible for payment through a composite APC involve observation 
services that were associated with low level clinic or emergency 
department visits. In addition, some of the packaged observation care 
that was provided in CY 2006 would be eligible for payment through 
composite APCs 8002 and 8003 because we are eliminating the diagnosis 
requirement for CY 2008.
    As noted in detail in section IX.C of this final rule with comment 
period, we see a normal and stable distribution of clinic and ED visit 
levels. We do not expect this distribution to change due to the 
increase in claims for high level visits that may result from the new 
composite APCs. Depending on our CY 2008 claims data (which would be 
used for the CY 2010 OPPS), we may choose to modify the composite APCs 
that we are creating for CY 2008 or move to packaging observation care 
as we originally proposed to create further incentives for hospitals to 
operate in an efficient way.
    In summary, for CY 2008, payment for observation services will 
remain packaged with status indicator ``N.'' We are creating two 
composite APCs for extended assessment and management, of which 
observation care is a component major service. When criteria for 
payment of the composite APCs are met, separate payment will be made to 
the hospital through the composite APC. This composite APC payment 
methodology will contribute to our goal of providing payment under the 
OPPS for a larger bundle of component services provided in a single 
hospital outpatient encounter, creating additional hospital incentives 
for efficiency and cost containment, while providing hospitals with the 
most flexibility to manage their resources.

[[Page 66650]]

d. Development of Composite APCs
(1) Background
    As we discuss above in regard to our reasons for our packaging 
approach for the CY 2008 OPPS, we believe that it is crucial that the 
payment approach of the OPPS create incentives for hospitals to seek 
ways to provide services more efficiently than exist under the current 
OPPS structure and allow hospitals maximum flexibility to manage their 
resources. The current OPPS structure usually provides payment for 
individual services which are generally defined by individual HCPCS 
codes. We currently package the costs of some items and services (such 
as drugs and biologicals with an average per day cost of less than $55) 
into the payment for separately payable individual services. However, 
because the extent of packaging in the OPPS is currently modest, 
furnishing many individual separately payable services increases total 
payment to the hospital. We believe that this aspect of the current 
OPPS structure is a significant factor in the growth in volume and 
spending that we discuss in our general overview and provides a primary 
rationale for the packaging approach for services that we proposed for 
the CY 2008 OPPS. While packaging payment for supportive dependent 
services into the payment for the independent services which they 
accompany promotes greater efficiency and gives hospitals some 
flexibility to manage their resources, we believe that payment for 
larger bundles of major separately paid services that are commonly 
performed in the same hospital outpatient encounter or as part of a 
multi-day episode of care would create even more incentives for 
efficiency, as discussed earlier. Moreover, defining the ``service'' 
paid under the OPPS by combinations of HCPCS codes for component 
services that are commonly performed in the same encounter and that 
result in the provision of a complete service would enable us to use 
more claims data and to establish payment rates that we believe more 
appropriately capture the costs of services paid under the OPPS.
    Section 1833(t)(1)(B) of the Act permits us to define what 
constitutes a ``service'' for purposes of payment under the OPPS and is 
not restricted to defining a ``service'' as a single HCPCS code. For 
example, the OPPS currently packages payment for certain items and 
services reported with HCPCS codes into the payment for other 
separately payable services on the claim. Consistent with our statutory 
flexibility to define what constitutes a service under the OPPS, we 
proposed to view a service, in some cases, as not just the diagnostic 
or treatment modality identified by one individual HCPCS code but as 
the totality of care provided in a hospital outpatient encounter that 
would be reported with two or more HCPCS codes for component services.
    In view of this statutory flexibility to define what constitutes a 
``service'' for purposes of OPPS payment, our desire to encourage 
efficiency in HOPD care, our focus on value-based purchasing, and our 
desire to use as much claims data as possible to set payment rates 
under the OPPS, we examined our claims data to determine how we could 
best use the multiple procedure claims (``hardcore'' multiples) that 
are otherwise not available for ratesetting because they include 
multiple separately payable procedures furnished on the same date of 
service. As discussed in more detail in our discussion of single and 
multiple procedure claims in section II.A.1.b. of this final rule with 
comment period, we have focused in recent years on ways to convert 
multiple procedure claims to single procedure claims to maximize our 
use of the claims data in setting median costs for separately payable 
procedures. We have been successful in using the bypass list to 
generate ``pseudo'' single procedure claims for use in median setting, 
but this approach generally does not enable us to use the hardcore 
multiple claims that contain multiple separately payable procedures, 
all with associated packaging that cannot be split among them. We 
believe that we could use the data from many more multiple procedure 
claims by creating APCs for payment of those services defined as 
frequently occurring common combinations of HCPCS codes for component 
services that we see in correctly coded multiple procedure claims.
    Our examination of data for multiple procedure claims identified 
two specific sets of services that we believe are good candidates for 
payment based on the naturally occurring common combinations of 
component codes that we see on the multiple procedure claims. These are 
low dose rate (LDR) prostate brachytherapy and cardiac 
electrophysiologic evaluation and ablation services.
    Specifically, we have been told (and our data support) that claims 
for LDR prostate brachytherapy, when correctly coded, report at least 
two major separately payable procedure codes the majority of the time. 
For reasons discussed below, in the CY2008 OPPS/ASC proposed rule (72 
FR 42678 through 42679), we proposed to use these correctly coded 
claims that would otherwise be unusable hardcore multiples as the basis 
for an encounter-based composite APC that would make a single payment 
when both codes are reported with the same date of service. We also 
proposed to pay separately for these procedure codes in cases where 
only one of the two procedures is provided in a hospital encounter, 
through the APC associated with that component procedure code that is 
furnished.
    Similarly, we have been told (and our data support) that multiple 
cardiac electrophysiologic evaluation, mapping, and ablation services 
are typically furnished on the same date of service and that the 
correctly coded claims are typically the multiple procedure claims that 
include several component services and that we are unable to use in our 
current claims process. The CY 2007 CPT book introductory discussion in 
the section entitled ``Intracardiac Electrophysiological Procedures/
Studies'' notes that, in many circumstances, patients with arrhythmias 
are evaluated and treated at the same encounter. Therefore, as 
discussed in detail below, we also proposed to establish an encounter 
based composite APC for these services that would provide a single 
payment for certain common combinations of component cardiac 
electrophysiologic services that are reported on the same date of 
service.
    These composite APCs reflect an evolution in our approach to 
payment under the OPPS. Where the claims data show that combinations of 
services are commonly furnished together, in the future we will 
actively examine whether it would be more appropriate to establish a 
composite APC under which we would pay a single rate for the service 
reported with a combination of HCPCS codes on the same date of service 
(or different dates of service) than to continue to pay for these 
individual services under service-specific APCs. We proposed these 
specific encounter-based composite APCs for CY 2008 because we believe 
that this approach could move the OPPS toward possible payment based on 
an encounter or episode-of-care basis, enable us to use more valid and 
complete claims data, create hospital incentives for efficiency, and 
provide hospitals with significant flexibility to manage their 
resources that do not exist when we pay for services on a per service 
basis. As such, we indicated that these proposed composite APCs may 
serve as a prototype for future creation of more composite APCs, 
through which we could provide OPPS payment for other types of services 
in the future. We

[[Page 66651]]

noted that while these proposed composite APCs for CY 2008 are based on 
observed combinations of component HCPCS codes reported on the same 
date of service for a single encounter, we also would be exploring in 
the future how we could potentially set payments based on episodes of 
care involving services that extend beyond the same date but which are 
all supportive of a single, related course of treatment. While we did 
not propose to implement multiday episode-of-care APCs in CY 2008, we 
welcomed comments on the concept of developing these APCs to provide 
payment for such episodes in order to inform our future analyses in 
this area.
    While we have never previously used the term ``composite'' APC 
under the OPPS, we have one historical payment policy that resembles 
the CY 2008 proposed composite APC policy. Since the inception of the 
OPPS, CMS has limited the aggregate payment for specified less 
intensive mental health services furnished on the same date to the 
payment for a day of partial hospitalization, which we considered to be 
the most resource intensive of all outpatient mental health treatment 
(65 FR 18455). The costs associated with administering a partial 
hospitalization program represent the most resource intensive of all 
outpatient mental health treatment, and we do not believe that we 
should pay more for a day of individual mental health services under 
the OPPS. Through the OCE, when the payment for specified mental health 
services provided by one hospital to a single beneficiary on one date 
of service based on the payment rates associated with the APCs for the 
individual services would exceed the per diem partial hospitalization 
payment (listed as APC 0033 (Partial Hospitalization)), those specified 
mental health services are assigned to APC 0034, which has the same 
payment rate as APC 0033, and the hospital is paid one unit of APC 
0034. This longstanding policy regarding payment of APC 0034 for 
combinations of independent services provided in a single hospital 
encounter resembles the payment policy for composite APCs that we 
proposed for LDR prostate brachytherapy and cardiac electrophysiologic 
evaluation and ablation services for CY 2008. Similar to the logic for 
the proposed composite APCs, the OCE determines whether to pay these 
specified mental health services individually or to make a single 
payment at the same rate as the per diem rate for partial 
hospitalization for all of the specified mental health services 
furnished on that date of service. However, we note this established 
policy for payment of APC 0034 differs from the proposed policies for 
the new CY 2008 composite APCs because APC 0034 is only paid if the sum 
of the individual payment rates for the specified mental health 
services provided on one date of service exceeds the APC 0034 payment 
rate, which equals the per diem rate of APC 0033 for partial 
hospitalization.
    We did not propose to change this mental health services payment 
policy for CY 2008. However, we proposed to change the status indicator 
from ``S'' to ``Q'' for the HCPCS codes for the specified mental health 
services to which APC 0034 applies because those codes are 
conditionally packaged when the sum of the payment rates for the single 
code APCs to which they are assigned exceeds the per diem payment rate 
for partial hospitalization. While we have not published APC 0034 in 
Addendum A in the past, we are including it in Addendum A to this final 
rule with comment period entitled ``Mental Health Composite,'' 
consistent with our naming taxonomy and publication of the two other 
composite APCs. We are also including the mental health composite APC 
0034 and its member HCPCS codes in Addendum M to this final rule with 
comment period in the same way that we show the HCPCS codes to which 
the LDR Prostate Brachytherapy Composite APC and Cardiac 
Electrophysiologic Evaluation and Ablation Composite APC apply.
    We solicited public comments on the concept of composite APCs in 
general and, specifically, the two new proposed encounter-based 
composite APCs for CY 2008, and we expressed our hope of involving the 
public and the APC Panel in the creation of additional composite APCs. 
As stated in the proposed rule (72 FR 42679), our goal is to use the 
many naturally occurring multiple procedure claims that cannot 
currently be incorporated under the existing APC structure, regardless 
of whether the naturally occurring pattern of multiple procedure claims 
prevents the development of single bills for individual services.
    We received many comments on the concept of composite APCs in 
general and on the proposal to create the LDR Prostate Brachytherapy 
Composite and the Electrophysiologic Evaluation and Ablation Composite 
APC in particular. A summary of the comments and our responses follow.
    Comment: In general, most commenters supported the creation of the 
two composite APCs that were proposed for CY 2008: Cardiac 
Electrophysiologic Evaluation and Ablation Composite (APC 8000) and Low 
Dose Rate Prostate Brachytherapy Composite (APC 8001). Commenters, 
including MedPAC and the APC Panel, supported the implementation of the 
proposed composite APCs. Commenters stated that creation of these 
composites will enable use of more multiple claims data and enable the 
payment system to better reflect the reality of how services are 
commonly furnished. In particular, MedPAC indicated that it supports 
the proposed composite APCs because they will increase incentives for 
efficiency and can serve as a starting point for payment bundles that 
reflect encounters or episodes of care. MedPAC indicated that it will 
be exploring both packaging and bundling under the OPPS in its future 
work. Other commenters objected to the creation of composite APCs 
because they believed that they are dependent on proposed packaging 
changes that the commenters do not support. Other commenters supported 
the concept of composite APCS as long as a composite is limited to 
related services furnished on the same date of service. These 
commenters believed that the creation of composite APCs for 
discontinuous services that span multiple dates of service would 
present too many problems to be viable.
    Response: We appreciate the commenters' support for the creation of 
the two proposed composite APCs and we will implement the proposed new 
composite APCs 8000 and 8001 for services furnished on and after 
January 1, 2008. We also acknowledge that the viability of the 
composite APCs is dependent on packaging of the supportive and 
ancillary services. However, as discussed above, we are finalizing the 
proposed packaging approach, with modifications, and therefore, we 
believe that it is appropriate to finalize the creation of these two 
composite APCs for the CY 2008 OPPS. We will take the commenters' 
concerns with regard to the possible creation of composite APCs for 
discontinuous services that span multiple dates of service into account 
in development of future proposals for composite APCs.
    Comment: Some commenters asked that CMS provide a clear and 
transparent process for identifying and calculating payments for future 
composite APCs and asked that CMS evaluate closely the impact of the 
proposed composites on payment adequacy and access to care before 
expanding to other services. They asserted that any development of 
further composite APCs should include the views of all stakeholders.
    Response: We expect that in the future, we would identify possible

[[Page 66652]]

composite APCs using the same process that we used to identify the 
codes in composite APCs 8000 and 8001. As we described in the proposed 
rule, we examined the multiple procedure claims that we could not 
convert to single procedure claims to identify common combinations of 
services for which we had relatively few single procedure claims. We 
then performed a clinical assessment of the combinations that we 
identified to determine whether our findings were consistent with our 
understanding of the services furnished. After we defined the minimal 
combination of services for which we would pay under the composite APC, 
we then identified claims for which the only separately paid codes were 
members of the composite, and we calculated the median cost for the 
package of services, including the costs of the packaged services. We 
intend to proceed carefully in examining the potential for creation of 
more composite APCs. In general, we intend to follow this process for 
creation of composite APCs and to request public comment in the 
rulemaking cycle, which is our standard process for securing the views 
of stakeholders. See section II.A.4.c.(7). for our discussion of the 
composite APCs we created for this final rule with comment period, 
specifically APC 8002 (Level I Extended Assessment and Management 
Composite) and APC 8003 (Level II Extended Assessment and Management 
Composite).
    Comment: Some commenters asked that CMS ensure that all packaged 
costs are captured in the payment rate for the composite APC. Other 
commenters stated that there are many intraoperative services that we 
proposed to package that may or may not be done at the same time and 
whose costs, when packaged may not be fully accommodated in the 
composite payment and should therefore be paid separately in addition 
to the payment for the composite APCs. Some commenters identified 
services that CMS proposed to package for which they believed separate 
payment should be made outside of the composite APC payment. For 
example, one commenter asked that CPT code 93662 (Intracardiac 
echocardiography during therapeutic/diagnostic intervention, including 
imaging supervision and interpretation (List separately in addition to 
code for primary procedure)) continue to be paid separately and not as 
part of composite APC 8000 because its cost is high but the frequency 
of its use with the main procedures in APC 8000 is low.
    Response: We capture the packaged costs in the creation of the 
composite APC medians to the extent that the packaged services are 
reported on the claims that meet the criteria for composite payment. 
The effectiveness of the composite APCs is highly dependent upon the 
packaging of the ancillary and supportive services that are furnished 
at the same encounter with the services in the composite APC. By 
packaging guidance, imaging post processing, intraoperative, and 
imaging supervision and interpretation services we are able to identify 
many more services that contain only the separately paid procedures 
that are assigned to the composite APC that we can then use to 
calculate a median cost for the composite APC. Separate payment for 
guidance, imaging post processing, intraoperative, and imaging 
supervision and interpretation services would greatly reduce the number 
of claims that would be available for use in composite APCs because the 
HCPCS codes assigned to the composite APC would no longer be the only 
separately paid procedure codes on the claims and one of the benefits 
of using a composite APC (enabling use of more claims) would be lost. 
As with packaging of the costs of OPPS services in general, we package 
costs into the cost of the major separately paid service being 
furnished. In the case of the composite APCs, the costs of ancillary 
and dependent services are packaged into the payment for the composite 
APC to the extent that they are furnished with the services that are 
assigned to the composite APC. In general, the premise of the OPPS, 
like that of other claims-based prospective payment systems, is that 
hospitals report HCPCS codes and charges to reflect the reality of how 
they furnish services. In general, we believe we can rely on the claims 
data to be an accurate reflection of the services that were furnished 
to Medicare beneficiaries.
    Comment: A commenter stated that the composite APCs differ 
significantly in concept from the conditionally packaged services to 
which CMS also proposed to assign status indicator ``Q'' and urged CMS 
to assign a status indicator other than ``Q'' to composites so that 
they would be more easily distinguishable from a conditionally packaged 
service. Other commenters stated that the definition of the status 
indicator Q was ill defined and confusing.
    Response: For CY 2008, we will assign the status indicator ``Q'' to 
composite APCs, to codes that are packaged when billed on the same 
claim with a procedure that has status indicator ``S,'' ``T,'' ``V,'' 
or ``X,'' and to codes that are packaged only when billed on the same 
claim with a procedure that has a status indicator ``T.'' We will 
consider for CY 2009 whether it would be more appropriate to assign 
status indicators based on the particular packaging policy that applies 
to the code.
    We appreciate the comments on composite APCs. With respect to our 
treatment of mental health services, we are not making a change to the 
longstanding payment policy under which the OPPS pays one unit of APC 
0034 in cases in which the total payments for specified mental health 
services provided on the same date of service would otherwise exceed 
the payment rate for APC 0033. However, we are changing the status 
indicator to ``Q'' for the HCPCS codes for mental health services to 
which this policy applies and which comprise this existing composite 
APC, because payment for these services would be packaged unless the 
sum of the individual payments assigned to the codes would be less than 
the payment for APC 0034.
(2) Low Dose Rate (LDR) Prostate Brachytherapy Composite APC
(a) Background
    LDR prostate brachytherapy is a treatment for prostate cancer in 
which needles or catheters are inserted into the prostate, and then 
radioactive sources are permanently implanted into the prostate through 
the hollow needles or catheters. The needles or catheters are then 
removed from the body, leaving the radioactive sources in the prostate 
forever, where they slowly give off radiation to destroy the cancer 
cells until the sources are no longer radioactive. At least two CPT 
codes are used to report the composite treatment service because there 
are separate codes that describe placement of the needles or catheters 
and application of the brachytherapy sources. LDR prostate 
brachytherapy cannot be furnished without the services described by 
both of these codes. Generally, the component services represented by 
both codes occur in the same operative session in the same hospital on 
the same date of service. However, we have been told of uncommon cases 
in which they are furnished in different locations, with the patient 
being transported from one location to another for application of the 
sources. In addition, other services, commonly CPT code 76965 
(Ultrasonic guidance for interstitial radioelement application) and CPT 
code 77290 (Therapeutic radiology simulation-aided field setting; 
complex) are often provided in the same hospital encounter.
    CPT code 55875 (Transperineal placement of needles or catheters 
into

[[Page 66653]]

prostate for interstitial radioelement application, with or without 
cystoscopy) is used to report the placement of the needles or catheters 
for services furnished on or after January 1, 2007. Before this date, 
including in the claims for services furnished in CY 2006 that were 
used to develop the CY 2008 proposed rule, CPT code 55859 
(Transperineal placement of needles or catheters into prostate for 
interstitial radioelement application, with or without cystoscopy) 
reported this service. All of the claims for CPT code 55859 (as 
reported in the CY 2006 claims data) are for the placement of needles 
or catheters for prostate brachytherapy, although not all are related 
to permanent brachytherapy source application.
    CPT code 77778 (Interstitial radiation source application; complex) 
is used to report the application of brachytherapy sources and, when 
billed with CPT code 55859 (or CPT code 55875 after January 1, 2007) 
for the same encounter, reports placement of the sources in the 
prostate. We have been told that application of brachytherapy sources 
to the prostate is estimated to be about 85 percent of all occurrences 
of CPT code 77778 under the OPPS, consistent with our CY 2006 claims 
data used for CY 2008 ratesetting. CPT code 77778 is also used to 
report the application of sources of brachytherapy to body sites other 
than the prostate.
    Historical coding, APC assignments, and payment rates for CPT codes 
55859 (CPT code 55875 beginning in CY 2007) and 77778 are shown below 
in Table 7.

                            Table 7.--Historical Payment Rates for Complex Interstitial Application of Brachytherapy Sources
--------------------------------------------------------------------------------------------------------------------------------------------------------
                                                                           Payment                   Payment
                                                                           rate for     APC for      rate for     APC for
                 OPPS CY                          Combination APC          CPT code    HCPCS code   CPT codes    HCPCS code      Brachytherapy source
                                                                            77778        77778     55859/55875     55859
--------------------------------------------------------------------------------------------------------------------------------------------------------
2000.....................................  n/a.........................      $198.31     APC 0312      $848.04     APC 0162  Pass-through
2001.....................................  n/a.........................      $205.49     APC 0312      $878.72     APC 0162  Pass-through
2002.....................................  n/a.........................    $6,344.67     APC 0312    $2,068.23     APC 0163  Pass-through with pro rata
                                                                                                                              reduction
2003 (prostate brachytherapy with iodine   G0261, APC 648, $5,154.34...          n/a          n/a          n/a          n/a  Packaged
 sources).
2003 (prostate brachytherapy with          G0256, APC 649, $5,998.24...          n/a          n/a          n/a          n/a  Packaged
 palladium sources).
2003 (not prostate brachytherapy, not      N/A.........................    $2,853.58     APC 0651    $1,479.60     APC 0163  Separate payment based on
 including sources).                                                                                                          scaled median cost per
                                                                                                                              source
2004.....................................  N/A.........................      $558.24     APC 0651    $1,848.55     APC 0163  Cost
2005.....................................  N/A.........................    $1,248.93     APC 0651    $2,055.63     APC 0163  Cost
2006.....................................  N/A.........................      $666.21     APC 0651    $1,993.35     APC 0163  Cost
2007.....................................  N/A.........................    $1,035.50     APC 0651    $2,146.84     APC 0163  Cost
--------------------------------------------------------------------------------------------------------------------------------------------------------

    Payment rates for CPT code 77778, in particular, have fluctuated 
over the years. We have frequently been informed by the public that 
reliance on single procedure claims to set the median costs for these 
services results in use of only incorrectly coded claims for LDR 
prostate brachytherapy because, for application of brachytherapy 
sources to the prostate, a correctly coded claim is a multiple 
procedure claim. Specifically, we have been informed that a correctly 
coded claim for LDR prostate brachytherapy should include, for the same 
date of service, both CPT codes 55859 and 77778, brachytherapy sources 
reported with Level II HCPCS codes, and typically separately coded 
imaging and radiation therapy planning services, and that we should use 
correctly coded claims to set the median for APC 0651 (Complex 
Interstitial Radiation Source Application) in particular (where CPT 
code 77778 is assigned). In presentations to the APC Panel at its March 
2006 meeting, and in response to the CY 2006 OPPS proposed rule and CY 
2007 OPPS/ASC proposed rule, commenters urged us to set the payment 
rate for LDR prostate brachytherapy services using only multiple 
procedure claims. Specifically for CY 2007, they urged us to sum the 
costs on multiple procedure claims containing CPT codes 77778 and 55859 
(and no other separately payable services not on the bypass list) and, 
excluding the costs of sources, split the resulting aggregate median 
cost on the multiple procedure claim according to a preestablished 
attribution ratio between CPT codes 77778 and 55859. They indicated 
that any claim for a brachytherapy service that did not also report a 
brachytherapy source should be considered to be incorrectly coded and 
thus not reflective of the hospital's resources required for the 
interstitial source application procedure. The presenters to the APC 
Panel believed that claims that did not contain both brachytherapy 
source and source application codes should be excluded from use in 
establishing the median cost for APC 0651. They believed that hospitals 
that reported the brachytherapy sources on their claims were more 
likely to report complete charges for the associated brachytherapy 
source application procedure than hospitals that did not report the 
separately payable brachytherapy sources.
    As a result of those comments, for both CYs 2006 and 2007, we used 
multiple procedure claims containing both CPT codes 55859 and 77778 to 
determine a median cost for the totality of both services (with both 
packaging and bypassing of the other commonly furnished services). We 
compared the median calculated from this subset of claims reflecting 
the most common clinical scenario to the single bill median costs for 
CPT codes 55859 and 77778 as a method of determining whether the total 
payment to the hospital for both services furnished to provide LDR 
prostate brachytherapy would be reasonable. In both years, we found 
that the sum of the single bill medians was reasonably close to the 
median cost of both services from multiple claims when they were 
treated as a single procedure and the supporting services were either 
packaged or bypassed for purposes of calculating the

[[Page 66654]]

median for the combined pair of codes. (We refer readers to the CY 2006 
final rule with comment period (70 FR 68596) and the CY 2007 final rule 
with comment period (71 FR 68043) for specific discussion of these 
findings.) Hence, we concluded that the single bill median costs were 
reasonable and, for both the CYs 2006 and CY 2007 OPPS, we based 
payment for CPT codes 55859 and 77778 on single procedure claims.
(b) Payment for LDR Prostate Brachytherapy
    For the CY 2008 OPPS, we proposed to create a composite APC 8001, 
titled ``LDR Prostate Brachytherapy Composite,'' that would provide one 
bundled payment for LDR prostate brachytherapy when the hospital bills 
both CPT codes 55875 and 77778 as component services provided during 
the same hospital encounter. It is shown in Addendum A to this final 
rule with comment period as APC 8001 (LDR Prostate Brachytherapy 
Composite). As discussed in detail in section VII. of this final rule 
with comment period, as we proposed, we are continuing to pay sources 
of brachytherapy separately in accordance with the statute.
    In the CY 2006 claims used to calculate the proposed CY 2008 median 
costs, CPT code 55859 was reported 14,083 times. The proposed rule 
median cost for CPT code 55859, calculated from 2,232 single and 
``pseudo'' single bills, was approximately $2,329. The CY 2008 proposed 
rule median cost for APC 0163 (Level IV Cystourethroscopy and other 
Genitourinary Procedures) to which CPT code 55859 was assigned for CY 
2006 and to which CPT code 55875 is assigned for CY 2007 was 
approximately $2,322. In the set of claims used to calculate the median 
cost for APC 0651, to which CPT code 77778 is the only assigned 
service, CPT code 77778 was reported 11,850 times. The CY 2008 proposed 
rule median cost for APC 0651 (and, therefore, for CPT code 77778) 
based on 339 single and ``pseudo'' single procedure bills was 
approximately $970.
    In examining the claims data used to calculate the median costs for 
the proposed rule, we found 9,807 claims on which both CPT code 55859 
and CPT code 77778 were billed on the same date of service. These data 
suggest that LDR prostate brachytherapy constituted at least 70 percent 
of CY 2006 claims for CPT code 55859, with the remainder of claims 
representing the insertion of needles or catheters for high dose rate 
prostate brachytherapy or unusual clinical situations where the LDR 
sources were not applied in the same operative session as the insertion 
of the needles or catheters. These data are consistent with our 
understanding of current clinical practice for prostate brachytherapy, 
and we believe that those multiple claims are correctly coded claims 
for this common clinical scenario. Similarly, 83 percent of the claims 
for complex interstitial brachytherapy source application CPT code 
77778 also included the CPT code for inserting needles or catheters 
into the prostate, consistent with our understanding that the vast 
majority of cases of complex interstitial brachytherapy source 
application procedures are specifically for the treatment of prostate 
cancer, rather than other types of cancer.
    Using the proposed packaging approach for imaging supervision and 
interpretation services and guidance services for CY 2008, we were able 
to identify 1,343 claims, 14 percent of all OPPS claims that reported 
these two procedures on the same date, that contain both CPT codes 
55859 and 77778 on the same date of service and no other separately 
paid procedure code. We were not able to use more claims to develop 
this composite APC median cost because there are several radiation 
therapy planning codes that are commonly reported with CPT codes 55859 
and 77778 and that are both separately paid and not on the bypass list 
because the amount of their associated packaging exceeds the threshold 
for inclusion on the bypass list. A complete discussion of the bypass 
list under our CY 2008 packaging policy is provided in section II.A. of 
this final rule with comment period.
    We packaged the costs of packaged revenue codes and packaged HCPCS 
codes into the sum of the costs for CPT codes 55859 and 77778 to derive 
a total proposed median cost of approximately $3,127 for the composite 
LDR prostate brachytherapy service based upon the 1,343 claims that 
contained both CPT codes and no other separately paid procedure codes. 
This is reasonably comparable to $3,298, the sum of the CPT median 
costs we calculated using the single procedure bills for CPT codes 
55859 and 77778 (($2,329 plus $969). As stated in the proposed rule (72 
FR 42680), we believe that the difference between the composite APC 
median cost based upon those claims that contain both codes and the sum 
of the median costs for the APCs to which the two individual CPT codes 
map is minimal and may be attributable to efficiencies in furnishing 
the services together during a single encounter.
    In the proposed rule (72 FR 42681), we indicated our belief that 
creation of the composite APC for the payment of LDR prostate 
brachytherapy is consistent with the statute and with our desire to use 
more claims data for ratesetting, particularly data from correctly 
coded claims that reflect typical clinical practice, and to make 
payment for larger packages and bundles of services to provide enhanced 
incentives for efficiency and cost containment under the OPPS and to 
maximize hospital flexibility in managing resources.
    Under our proposal, hospitals that furnish LDR prostate 
brachytherapy would report CPT codes 55875 and 77778 and the codes for 
the applicable brachytherapy sources in the same manner that they 
currently report these items and services (in addition to reporting any 
other services provided), using the same HCPCS codes and reporting the 
same charges. We would require that hospitals report both CPT codes 
resulting in the composite APC payment on the same claim when they are 
furnished to a single Medicare beneficiary in the same facility on the 
same date of service, and we would make any necessary conforming 
changes to the billing instructions to ensure that they do not present 
an obstacle to correct reporting. We may implement edits to ensure that 
hospitals do not submit two separate claims for these two procedures 
when furnished on the same date in the same facility. When this 
combination of codes is reported, the OCE would assign the composite 
APC 8001 and the PRICER would pay based on the payment rate for the 
composite APC. The OCE would assign APC 0163 or APC 0651 only when both 
codes are not reported on the same claim with the same date of service, 
and we would expect this to be the atypical case. The composite APC 
would have a status indicator of ``T'' so that payment for other 
procedures also assigned to status indicator ``T'' with lower payment 
rates would be reduced by 50 percent when furnished on the same date of 
service as the composite service, in order to reflect the efficiency 
that occurs when multiple procedures are furnished to a Medicare 
beneficiary in a single operative session. We would not expect that the 
composite APC payment would be frequently reduced under the multiple 
procedure reduction policy because we believe that it is unlikely that 
a higher paid procedure would be performed on the same date.
    We proposed to continue to establish separate payment rates for APC 
0651 (to which only CPT code 77778 is assigned) and for APC 0163 (to 
which we proposed to continue to assign CPT code 55875). In some cases, 
CPT 55875

[[Page 66655]]

may be reported for the insertion of needles or catheters for high dose 
rate prostate brachytherapy, and the low dose rate brachytherapy source 
application procedure (CPT code 77778) would not be reported. In high 
dose rate prostate brachytherapy, the sources are applied temporarily 
several times over a few days while the needles or catheters remain in 
the prostate, and the needles or catheters are removed only after all 
the treatment fractions have been completed. We have also been told by 
hospitals that, even when LDR prostate brachytherapy is planned, there 
are occasions in which the needles or catheters are inserted in one 
facility and the patient is moved to another facility for the 
application of the sources. In those cases, we would need to be able to 
appropriately pay the hospital that inserted the needles or catheters 
before the patient was discharged prior to source application. 
Moreover, there are cases in which the needles or catheters are 
inserted but it is not possible to proceed to the application of the 
sources and, therefore, the hospital would correctly report only CPT 
code 55875. Similarly, more than 10 brachytherapy sources can be 
applied interstitially (as described by CPT code 77778) to sites other 
than the prostate and it is, therefore, necessary to have a separate 
payment rate for CPT code 77778. Hence, for CY 2008 we proposed to 
continue to pay for CPT code 55875 (the successor to CPT code 55859) 
through APC 0163 and to pay for CPT code 77778 through APC 0651 when 
the services are individually furnished other than on the same date of 
service in the same facility.
    Comment: One commenter supported the creation of the composite APC 
for LDR Prostate Brachytherapy (APC 8001) but was concerned about the 
assignment of status indicator ``T'' to APC 8001. The commenter asked 
which codes would be reduced when furnished with the composite as a 
result of the assignment of the status indicator ``T.''
    Response: We assigned status indicator ``T'' to APC 8001 because 
CPT code 55875 is a surgical service that has a status indicator ``T'' 
in APC 163. The multiple surgical reduction will apply only when other 
surgical procedures that have the status indicator of ``T'' are 
performed on the same date of service. Payment for the APC with the 
highest payment rate with status indicator ``T'' will not be reduced 
but payments for other codes on the same claim that also have a status 
indicator of ``T'' will be reduced by 50 percent under our standard 
multiple procedure reduction policy. Currently, when CPT code 55875 is 
reported with another procedure that has a status indicator of ``T,'' 
payment for the service with the lower payment rate would be reduced by 
50 percent. Similarly, when CPT code 55875 is paid as part of composite 
APC 8001 and another procedure that has a status indicator of ``T'' is 
also reported on the claim, payment for the composite APC or the other 
procedure would be reduced by 50 percent, depending on which payment 
rate was lower. This is the standard OPPS multiple surgical procedure 
payment reduction policy.
    As proposed, we are establishing a composite APC, shown in Addendum 
A as APC 8001, to provide payment for LDR prostate brachytherapy when 
the composite service, billed as CPT codes 55875 and 77778, is 
furnished in a single hospital encounter and to base the payment for 
the composite APC on the median cost derived from claims that contain 
both codes. These two CPT codes are assigned status indicator ``Q'' in 
Addendum B to this final rule with comment period to signify their 
conditionally packaged status, and their composite APC assignments are 
noted in Addendum M. This policy will permit us to base payment on 
claims for the most common clinical scenario for interstitial radiation 
source application to the prostate. We note that this payment bundle 
will also include payment for the commonly associated imaging guidance 
services, which will be newly packaged under our CY 2008 packaging 
approach. Most importantly, this composite APC payment methodology will 
contribute to our goal of providing payment under the OPPS for a larger 
bundle of component services provided in a single hospital outpatient 
encounter, creating additional hospital incentives for efficiency and 
cost containment, while providing hospitals with the most flexibility 
to manage their resources. In our final calculation of the median cost 
for this composite APC for CY 2008, we were able to use 7,870 claims 
that contained both CPT code 77778 and 55859 (the code in effect in 
2006) and the median cost on which payment is based is approximately 
$3,391. This compares favorably to the proposed rule in which we were 
able to us only 1,343 claims containing both codes and calculated a 
proposed median cost of approximately $3,127. We believe that the 
number of usable claims increased so greatly as the result of the 
addition of related procedure codes to the bypass list as a result of 
public comments. The CY 2008 composite median is slightly less than 
$3,410, the sum of the medians for APCs 163 and 651 ($2,270 + $1,140), 
which commenters have told us are unreliable because they are 
calculated from single bills although there should never be single 
bills for this procedure. Hence, we believe that the median cost for 
the composite APC of approximately $3,391, which is calculated from 
bills we believe to be correctly coded will result in a reasonable and 
appropriate payment rate for this service.
(3) Cardiac Electrophysiologic Evaluation and Ablation Composite APC
(a) Background
    During its March 2007 meeting, members of the APC Panel indicated 
that the reason we found so few single bills for procedures assigned to 
APC 0087 (Cardiac Electrophysiologic Recording/Mapping), specifically 
72 of 11,834 or 0.61 percent of all proposed rule CY 2006 claims, is 
that most of the services assigned to APCs 0085 (Level II 
Electrophysiologic Evaluation), 0086 (Ablate Heart Dysrhythm Focus), 
and 0087 are performed in varying combinations with one another. 
Therefore, correctly coded claims would most often include multiple 
codes for component services that are reported with different CPT codes 
and that are now paid separately through different APCs. There would 
never be many single bills and those that are reported as single bills 
would likely represent atypical cases or incorrectly coded claims.
    We examined the combinations of services observed in our claims 
data across these three APCs to see whether there was the potential for 
handling the data differently so that we could use more claims data to 
set the payment rates for these procedures, particularly those services 
assigned to APC 0087 where we have had a persistent concern regarding 
the limited and reportedly unrepresentative single bills available for 
use in calculating the median cost according to our standard OPPS 
methodology. We initially developed and examined frequency 
distributions of unique combinations of codes on claims which contained 
at least one unit of any code assigned to APC 0085, 0086, or 0087 and 
then broadened these analysis to any combination of an 
electrophysiologic evaluation and ablation code.
    Our initial frequency distributions supported the APC Panel 
members' description of their experiences. We identified and enumerated 
the most commonly appearing unique occurrences (either single 
procedures or combinations) of codes for services assigned to status 
indicator ``S,'' ``T,'' ``V,'' or ``X'' that contained at least one

[[Page 66656]]

code assigned to APC 0085, 0086, or 0087. There were 7,379 claims in 
the top 100 occurrence types. Table 8 shows the 10 most common unique 
occurrences from CY 2006 proposed rule claims data available at that 
time.

 Table 8.--Ten Most Frequently Occurring Unique Occurrences of Cardiac Electrophysiologic Evaluations, Mapping,
                          and Ablation Procedures and other Separately Payable Services
----------------------------------------------------------------------------------------------------------------
                                                                                              CY 2007   CY 2007
          Combination  No.             Frequency    HCPCS code        Short descriptor          APC        SI
----------------------------------------------------------------------------------------------------------------
1...................................          763        93620  Electrophysiology                0085         T
                                                                 evaluation.
2...................................          509        93609  Map tachycardia, add-on....      0087         T
                                                         93620  Electrophysiology                0085         T
                                                                 evaluation.
                                                         93621  Electrophysiology                0085         T
                                                                 evaluation.
                                                         93623  Stimulation, pacing heart..      0087         T
                                                         93651  Ablate heart dysrhythm           0086         T
                                                                 focus.
3...................................          398        93609  Map tachycardia, add-on....      0087         T
                                                         93620  Electrophysiology                0085         T
                                                                 evaluation.
                                                         93621  Electrophysiology                0085         T
                                                                 evaluation.
                                                         93651  Ablate heart dysrhythm           0086         T
                                                                 focus.
4...................................          381        93650  Ablate heart dysrhythm           0086         T
                                                                 focus.
5...................................          376        93620  Electrophysiology                0085         T
                                                                 evaluation.
                                                         93623  Stimulation, pacing heart..      0087         T
6...................................          248        93005  Electrocardiogram, tracing.      0099         S
                                                         93609  Map tachycardia, add-on....      0087         T
                                                         93620  Electrophysiology                0085         T
                                                                 evaluation.
                                                         93621  Electrophysiology                0085         T
                                                                 evaluation.
                                                         93623  Stimulation, pacing heart..      0087         T
                                                         93651  Ablate heart dysrhythm           0086         T
                                                                 focus.
7...................................          225        93005  Electrocardiogram, tracing.      0099         S
                                                         93609  Map tachycardia, add-on....      0087         T
                                                         93620  Electrophysiology                0085         T
                                                                 evaluation.
                                                         93621  Electrophysiology                0085         T
                                                                 evaluation.
                                                         93651  Ablate heart dysrhythm           0086         T
                                                                 focus.
8...................................          225        93613  Electrophys map 3d, add-on.      0087         T
                                                         93620  Electrophysiology                0085         T
                                                                 evaluation.
                                                         93621  Electrophysiology                0085         T
                                                                 evaluation.
                                                         93651  Ablate heart dysrhythm           0086         T
                                                                 focus.
9...................................          217        93005  Electrocardiogram, tracing.      0099         S
                                                         93620  Electrophysiology                0085         T
                                                                 evaluation.
10..................................          185        93613  Electrophys map 3d, add-on.      0087         T
                                                         93620  Electrophysiology                0085         T
                                                                 evaluation.
                                                         93621  Electrophysiology                0085         T
                                                                 evaluation.
                                                         93623  Stimulation, pacing heart..      0087         T
                                                         93651  Ablate heart dysrhythm           0086         T
                                                                 focus.
----------------------------------------------------------------------------------------------------------------

    Although the number of claims for each unique occurrence was 
modest, we were able to determine that there were certain combinations 
of codes that occurred most often together. Based on our review of the 
most frequently occurring combinations of codes on claims that also 
contained at least one code assigned to APC 0085, 0086 or 0087 and our 
clinical review of the codes, we proceeded to study combination claims 
that contained at least one code from group A for evaluation services 
and at least one code from group B for ablation services reported on 
the same date of service on an individual claim, as specified in Table 
9 below.

 Table 9.--Groups of Cardiac Electrophysiologic Evaluation and Ablation
              Procedures on Which We Base the Composite APC
------------------------------------------------------------------------
                                                           CY
  Codes Used in Combinations: At Least One in    HCPCS    2007   CY 2007
          Group A and One in Group B              code     APC      SI
------------------------------------------------------------------------
Group A
  Electrophysiology evaluation................    93619    0085       T
  Electrophysiology evaluation................    93620    0085       T
Group B
  Ablate heart dysrhythm focus................    93650    0086       T
  Ablate heart dysrhythm focus................    93651    0086       T
  Ablate heart dysrhythm focus................    93652    0086       T
------------------------------------------------------------------------

    When we studied proposed rule claims that contained a code in group 
A and also a code in group B, we found that there were 5,118 claims 
that met these criteria, and that of these 5,118 claims, 4,552 (89 
percent) contained both CPT code 93620 (Comprehensive 
electrophysiologic evaluation including insertion and repositioning of 
multiple electrode catheters with induction or attempted induction of 
arrhythmia; with right atrial pacing and recording, right ventricular 
pacing and recording, His bundle recording) from APC 0085 and CPT code 
93651 (Intracardiac catheter ablation of arrhythmogenic focus; for 
treatment of supraventricular tachycardia by ablation of fast or slow 
atrioventricular pathways, accessory atrioventricular connections or 
other atrial foci, singly or in combination) from APC 0086 with the 
same date of service. Given that CPT code 93651 had a total frequency 
of 8,091, this means that more than 55 percent of the claims for CPT 
code 93651 also contained CPT

[[Page 66657]]

code 93620. CPT code 93620 had a total frequency of 12,624, 
approximately 50 percent higher than the total frequency for CPT code 
93651, which is consistent with our expectations because CPT code 93620 
describes a diagnostic service and CPT code 93651 is a treatment 
service that may be provided based upon the findings of the evaluation 
described by CPT code 93620. In addition to the codes for group A and 
group B services, the combination claims also contained costs for 
packaged services that were reported under revenue codes without HCPCS 
codes and under packaged HCPCS codes. As we discuss in considerable 
detail above, we lack a methodology that could be used to allocate 
these packaged costs to major separately paid procedures in a manner 
which gives us confidence that the costs would be attributed correctly. 
We have explored and will continue to explore an alternative strategy 
that would enable us to use these correctly coded multiple procedure 
claims for ratesetting.
    In our review of these proposed rule claims, not only did we find a 
high number of claims on which there was one code from group A and one 
code from group B, but we also found that claims for procedures 
assigned to APC 0087 for CY 2007 usually appeared on claims that 
contained a code from APC 0085 or APC 0086, or both. The most 
frequently appearing CPT codes that were assigned to APC 0087 for CY 
2007 were, as shown above, 93609 (Intraventricular and/or intra-atrial 
mapping of tachycardia site(s), with catheter manipulation to record 
from multiple sites to identify origin of tachycardia (List separately 
in addition to code for primary procedure)), 93613 (Intracardiac 
electrophysiologic 3-dimensional mapping (List separately in addition 
to code for primary procedure)), 93621 (Comprehensive 
electrophysiologic evaluation including insertion and repositioning of 
multiple electrode catheters with induction or attempted induction of 
arrhythmia; with left atrial pacing and recording from coronary sinus 
or left atrium (List separately in addition to code for primary 
procedure)), 93622 (Comprehensive electrophysiologic evaluation 
including insertion and repositioning of multiple electrode catheters 
with induction or attempted induction of arrhythmia; with left 
ventricular pacing and recording (List separately in addition to code 
for primary procedure)), and 93623 (Programmed simulation and pacing 
after intravenous drug infusion (List separately in addition to code 
for primary procedure)). These codes are all CPT add-on codes that CPT 
indicates are to be reported in addition to the code for the primary 
procedure. Our clinical review of the services described by these five 
CPT codes determined that they are supportive dependent services that 
are provided most often as supplemental to procedures assigned to APCs 
0085 and 0086. The procedures in APCs 0085 and 0086 can be performed 
without these supportive add-on procedures, but these dependent 
services cannot be done except as a supplement to another 
electrophysiologic procedure. Therefore, we proposed to unconditionally 
package all of these five CPT codes under the grouping of 
intraoperative services for the CY 2008 OPPS. We discuss the packaging 
of intraoperative services in general, including these services, in 
section II.A.4.c.(3) above.
    However, packaging these supportive ancillary services that are so 
often reported with the cardiac electrophysiologic evaluation and 
ablation services did not, by itself, enable us to use many more claims 
because, as we noted previously, the claims on which these codes most 
commonly appeared typically also contained at least one separately paid 
code from APC 0085 and one code from APC 0086. Although the most common 
combination of codes from APCs 0085 and 0086 was the pair of CPT codes 
93620 and 93651, there are numerous other combinations of services from 
APCs 0085 and 0086 that were performed and, while not as frequent, 
these combinations were also reflected in the multiple claims.
    In order to use more claims and adequately reflect the varied, 
common combinations of electrophysiologic evaluation and ablation CPT 
codes, we calculated a composite median cost from all claims containing 
at least one code from group A and at least one code from group B as if 
they were a single service. We selected multiple procedure claims that 
contained at least one code in group A and one code in group B on the 
same date of service and calculated a median cost from the total costs 
on these claims. Some claims had more than one code from each group. 
Although the claim was required to contain at least one code from each 
group to be included, the claim could also contain any number of codes 
from either group and any number of units of those codes. In addition, 
the costs of the five supportive intraoperative services previously 
assigned to APC 0087 that we identify above were packaged, as well as 
the costs of the other items and services proposed to be packaged for 
the CY 2008 OPPS. This selection process yielded 5,118 claims to use 
for the calculation. The proposed composite median cost for these 
claims using the CY 2008 proposed rule data was approximately $8,529. 
We believe that this cost is attributable largely to the 4,552 claims 
that contain one unit each of CPT code 93620 and CPT code 93651 (and 
some unknown numbers and combinations of packaged services). In 
comparison, the sum of the CY 2008 proposed rule CPT code median costs 
for CPT code 93620 (which is $3,111) and CPT code 93651 (which is 
$5,644) is approximately $8,756. If the 50 percent multiple procedure 
discount is applied to the CPT code median cost for the lower cost 
procedure based on its assignment to an APC with a ``T'' status, the 
adjusted sum of the median costs is $7,200 ($5,644 + $1,556). These 
medians were calculated using only claims that contain correct devices 
and do not contain token charges or the ``FB'' modifier. We believe the 
significant positive difference between the composite and discounted 
costs still reflects efficiencies, as the sum of the discounted median 
costs does not take into account the cost of other procedures also 
provided that are assigned to APCs 0085 and 0086, while the composite 
median cost of $8,528.83 does, to some extent, reflect the cost of 
other multiple procedures in APCs 0085 and 0086 that were also reported 
on the claims used to develop the composite median cost. In addition, 
these two calculations are based upon two different sets of claims, 
single procedure claims in one case (which do not represent the way the 
service is typically furnished) and the specified subset of clinically 
common combination claims in the second case. Moreover, while the 50 
percent multiple procedure reduction is our best aggregate estimate of 
the overall degree of efficiency applicable to multiple surgeries, it 
may or may not be specifically appropriate to this particular 
combination of procedures.
    By selecting the multiple procedure claims that contained at least 
one code in each group, we were able to use many more claims than were 
available to establish the individual APC medians. The percents by CPT 
code for the composite configuration in Table 24 of the proposed rule 
(72 FR 42684) represented the sum of the frequency of single bills used 
to set the medians for APCs 0085 and 0086 with packaging of the five 
intraoperative services and the frequency of multiple bills used to set 
the medians for the composite claims containing at least one code from 
each group and with packaging of the costs

[[Page 66658]]

of the five intraoperative services, divided by the total frequency of 
each CPT code.
    Moreover, by packaging CPT codes 93609, 93613, 93621, 93622, and 
93623, we were able to use many more of the claims for these codes from 
the most common clinical scenarios than would otherwise be possible if 
the supportive intraoperative services were separately paid. Wherever 
any of these codes appears on a claim that could be used for median 
setting, the cost data for these codes are packaged in the calculation 
of the median cost for the separately paid services on the claim.
(b) Payment for Cardiac Electrophysiologic Evaluation and Ablation
    In view of our findings with regard to how often the codes in 
groups A and B appear together on the same claim, we proposed to 
establish one composite APC, shown in Addendum A of the proposed rule 
as APC 8000 (Cardiac Electrophysiologic Evaluation and Ablation 
Composite), for CY 2008 that would pay for a composite service made up 
of any number of services in groups A and B when at least one code from 
group A and at least one code from group B appear on the same claim 
with the same date of service. The five CPT codes involved in this 
composite APC are assigned to status indicator ``Q'' in Addendum B to 
the proposed rule to identify their conditionally packaged status, and 
their composite APC assignments were identified in Addendum M of the 
proposed rule. We proposed to use the composite median cost of 
approximately $8,529 as the basis for establishing the relative weight 
for this newly created APC for the composite electrophysiology 
evaluation and ablation service. Under this composite APC, unlike most 
other APCs, we proposed to make a single payment for all services 
reported in groups A and B. We proposed that hospitals would continue 
to code using CPT codes to report these services and that the OCE would 
recognize when the criteria for payment of the composite APC are met 
and would assign the composite APC instead of the single procedure APCs 
as currently occurs. The PRICER would make a single payment for the 
composite APC that would encompass the program payment for the code in 
group A, the code in group B, and any other codes reported in groups A 
or B, as well as the packaged services furnished on the same date of 
service. The proposed composite APC would have a status indicator of 
``T'' so that payment for other procedures also assigned to status 
indicator ``T'' with lower payment rates would be reduced by 50 percent 
when furnished on the same date of service as the composite service, in 
order to reflect the efficiency that occurs when multiple procedures 
are furnished to a Medicare beneficiary in a single operative session. 
We would not expect that the proposed composite APC payment would be 
commonly reduced because we believe that it is unlikely that a higher 
paid procedure would be performed on the same date. We proposed to 
continue to pay separately for other separately paid services that are 
not reported under the codes in groups A and B (such as chest x-rays 
and electrocardiograms).
    Moreover, where a service in group A is furnished on a date of 
service that is different from the date of service for a code in group 
B for the same beneficiary, we proposed that payments would be made 
under the single procedure APCs and the composite APC would not apply. 
Given our CY 2008 proposal to unconditionally package payment for five 
cardiac electrophysiologic CPT codes as members of the category of 
intraoperative services that were previously assigned to APCs 0085 and 
0087, we also proposed to reconfigure APCs 0084 through 0087, where 
many of the cardiac electrophysiologic procedures that will be 
separately paid when they are not paid according to the composite APC 
are assigned. Specifically, we proposed to discontinue APC 0087, and 
reconfigure APCs 0084, 0085, and 0086, with proposed titles and median 
costs of Level I Electrophysiologic Procedures (APC 0084) at 
approximately $603; Level II Electrophysiologic Procedures (APC 0085) 
at approximately $2,976; and Level III Electrophysiologic Procedures 
(APC 0086) at approximately $5,842, respectively. We refer readers to 
section IV.A.2. of this his final rule with comment period rule for a 
discussion of calculation of median costs for device-dependent APCs. We 
believe this reconfiguration improved the clinical and resource 
homogeneity of these APCs which would provide payment for cardiac 
electrophysiologic procedures that would be individually paid when they 
do not meet the criteria for payment of the composite APC.
    We believe that creation of the proposed composite APC for cardiac 
electrophysiology evaluation and ablation services is the most 
efficient and effective way to use the claims data for the majority of 
these services and best represents the hospital resources associated 
with performing the common combinations of these services that are 
clinically typical. We believe that the proposed ratesetting 
methodology results in an appropriate median cost for the composite 
service when at least one evaluation service in group A is furnished on 
the same date as at least one ablation service in group B. This 
approach creates incentives for efficiency by providing a single 
payment for a larger bundle of major procedures when they are performed 
together, in contrast to continued separate payment for each of the 
individual procedures. We expect to develop additional composite APCs 
in the future as we learn more about major currently separately paid 
services that are commonly furnished together during the same hospital 
outpatient encounter.
    We did not receive any public comments specific to the creation of 
the composite APC for cardiac electrophysiology evaluation and ablation 
other than those included in the general discussion of composite APCs 
above. Therefore, we are finalizing the creation of this APC as 
proposed. For this final rule with comment period, we recalculated the 
median cost of the APC as proposed. We were able to use 5,596 claims 
that met the criteria of having at least one code in group A and one 
code in group B, which had correct device codes, no token charges for 
devices and no FB modifiers on the claims. Using these 5,596 correctly 
coded claims from the final rule data, we calculated a median cost from 
the final rule data of approximately $8,438. We note that while the 
number of usable claims for the final rule date increased to 5,596 from 
the 5,118 claims used in the proposed rule, the median cost declined 
slightly (approximately 1 percent) to approximately $8,438 from the 
$8,529 median cost calculated from proposed rule data. However, we 
believe that the median cost for this composite APC is a valid 
reflection of the estimated relative cost of these services when 
furnished in combination with one another.
    After consideration of the public comments we received on the 
proposed composite APCs for LDR Prostate Brachytherapy and Cardiac 
Electrophysiology Evaluation and Ablation, we are finalizing our 
proposed policy regarding these composite APCs without modification.
    In conclusion, we are finalizing our proposed packaging approach 
with the modifications discussed above for the CY 2008 OPPS. Table 10 
in this final rule with comment period displays the list of packaged 
services in the categories of guidance, image processing, 
intraoperative services, radiopharmaceuticals, contrast media, imaging 
supervision and interpretation,

[[Page 66659]]

and observation services. Codes in composite APCs, including the two 
extended assessment and management APCs, are displayed in Addendum M. 
In Table 10, HCPCS codes with status indicator ``N'' are always 
packaged. HCPCS codes with status indicator ``Q'' are conditionally 
packaged. Codes with status indicator ``Q'' that are for imaging 
supervision and interpretation are packaged only when reported on the 
same claim on the same day as a procedure with status indicator ``T'' 
and are identified as ``T-packaged'' in the sixth column. Codes that 
are packaged when they are reported on the same claim with a code with 
status indicator ``S,'' ``T,'' ``V,'' or ``X'' on the same day are 
identified as ``STVX-packaged'' in the sixth column.

                                     Table 10.--CY 2008 Packaged HCPCS Codes Included in Seven Packaging Categories
--------------------------------------------------------------------------------------------------------------------------------------------------------
                                                                                Final    ``STVX-
                                                                 CY      CY      CY     packaged''    Final CY
      2008 HCPCS code                Short descriptor           2007    2007    2008     or ``T-      2008 APC                   Category
                                                                 SI      APC     SI     packaged''
(1)                         (2)..............................     (3)     (4)     (5)          (6)          (7)  (8)
--------------------------------------------------------------------------------------------------------------------------------------------------------
19295.....................  Place breast clip, percut........       S    0657       N          n/a          n/a  Guidance
20975.....................  Electrical bone stimulation......       X    0340       N          n/a          n/a  Intraoperative.
20985.....................  Cptr-asst dir ms px..............     n/a     n/a       N          n/a          n/a  Guidance.
20986.....................  Cptr-asst dir ms px io img.......     n/a     n/a       N          n/a          n/a  Guidance.
20987.....................  Cptr-asst dir ms px pre img......     n/a     n/a       N          n/a          n/a  Guidance.
31620.....................  Endobronchial us add-on..........       S    0670       N          n/a          n/a  Intraoperative.
37250.....................  Iv us first vessel add-on........       S    0416       N          n/a          n/a  Intraoperative.
37251.....................  Iv us each add vessel add-on.....       S    0416       N          n/a          n/a  Intraoperative.
58110.....................  Bx done w/colposcopy add-on......       T    0188       N          n/a          n/a  Intraoperative.
61795.....................  Brain surgery using computer.....       S    0302       N          n/a          n/a  Guidance.
62160.....................  Neuroendoscopy add-on............       T    0122       N          n/a          n/a  Guidance.
70010.....................  Contrast x-ray of brain..........       S    0274       Q            T         0274  Imaging S&I.
70015.....................  Contrast x-ray of brain..........       S    0274       Q            T         0274  Imaging S&I.
70170.....................  X-ray exam of tear duct..........       X    0264       Q            T         0317  Imaging S&I.
70332.....................  X-ray exam of jaw joint..........       S    0275       Q            T         0275  Imaging S&I.
70373.....................  Contrast x-ray of larynx.........       X    0263       Q            T         0263  Imaging S&I.
70390.....................  X-ray exam of salivary duct......       X    0263       Q            T         0263  Imaging S&I.
71040.....................  Contrast x-ray of bronchi........       X    0263       Q            T         0263  Imaging S&I.
71060.....................  Contrast x-ray of bronchi........       X    0263       Q            T         0317  Imaging S&I.
71090.....................  X-ray & pacemaker insertion......       X    0272       N          n/a          n/a  Imaging S&I.
72240.....................  Contrast x-ray of neck spine.....       S    0274       Q            T         0274  Imaging S&I.
72255.....................  Contrast x-ray, thorax spine.....       S    0274       Q            T         0274  Imaging S&I.
72265.....................  Contrast x-ray, lower spine......       S    0274       Q            T         0274  Imaging S&I.
72270.....................  Contrast x-ray, spine............       S    0274       Q            T         0274  Imaging S&I.
72275.....................  Epidurography....................       S    0274       N          n/a          n/a  Imaging S&I.
72285.....................  X-ray c/t spine disk.............       S    0388       Q            T         0388  Imaging S&I.
72291.....................  Perq vertebroplasty, fluor.......       S    0274       N          n/a          n/a  Imaging S&I.
72292.....................  Perq vertebroplasty, ct..........       S    0274       N          n/a          n/a  Imaging S&I.
72295.....................  X-ray of lower spine disk........       S    0388       Q            T         0388  Imaging S&I.
73040.....................  Contrast x-ray of shoulder.......       S    0275       Q            T         0275  Imaging S&I.
73085.....................  Contrast x-ray of elbow..........       S    0275       Q            T         0275  Imaging S&I.
73115.....................  Contrast x-ray of wrist..........       S    0275       Q            T         0275  Imaging S&I.
73525.....................  Contrast x-ray of hip............       S    0275       Q            T         0275  Imaging S&I.
73530.....................  X-ray exam of hip................       X    0261       N          n/a          n/a  Intraoperative.
73542.....................  X-ray exam, sacroiliac joint.....       S    0275       Q            T         0275  Imaging S&I.
73580.....................  Contrast x-ray of knee joint.....       S    0275       Q            T         0275  Imaging S&I.
73615.....................  Contrast x-ray of ankle..........       S    0275       Q            T         0275  Imaging S&I.
74190.....................  X-ray exam of peritoneum.........       S    0264       Q            T         0317  Imaging S&I.
74235.....................  Remove esophagus obstruction.....       S    0257       N          n/a          n/a  Imaging S&I.
74300.....................  X-ray bile ducts/pancreas........       X    0263       N          n/a          n/a  Intraoperative.
74301.....................  X-rays at surgery add-on.........       X    0263       N          n/a          n/a  Intraoperative.
74305.....................  X-ray bile ducts/pancreas........       X    0263       N          n/a          n/a  Imaging S&I.
74320.....................  Contrast x-ray of bile ducts.....       X    0264       Q            T         0317  Imaging S&I.
74327.....................  X-ray bile stone removal.........       S    0296       N          n/a          n/a  Imaging S&I.
74328.....................  X-ray bile duct endoscopy........       N     n/a       N          n/a          n/a  Imaging S&I.
74329.....................  X-ray for pancreas endoscopy.....       N     n/a       N          n/a          n/a  Imaging S&I.
74330.....................  X-ray bile/panc endoscopy........       N     n/a       N          n/a          n/a  Imaging S&I.
74340.....................  X-ray guide for GI tube..........       X    0272       N          n/a          n/a  Imaging S&I.
74355.....................  X-ray guide, intestinal tube.....       X    0263       N          n/a          n/a  Imaging S&I.
74360.....................  X-ray guide, GI dilation.........       S    0257       N          n/a          n/a  Imaging S&I.
74363.....................  X-ray, bile duct dilation........       S    0297       N          n/a          n/a  Imaging S&I.
74425.....................  Contrst x-ray, urinary tract.....       S    0278       Q            T         0278  Imaging S&I.
74430.....................  Contrast x-ray, bladder..........       S    0278       Q            T         0278  Imaging S&I.
74440.....................  X-ray, male genital tract........       S    0278       Q            T         0278  Imaging S&I.
74445.....................  X-ray exam of penis..............       S    0278       Q            T         0278  Imaging S&I.
74450.....................  X-ray, urethra/bladder...........       S    0278       Q            T         0278  Imaging S&I.
74455.....................  X-ray, urethra/bladder...........       S    0278       Q            T         0278  Imaging S&I.
74470.....................  X-ray exam of kidney lesion......       X    0263       Q            T         0263  Imaging S&I.
74475.....................  X-ray control, cath insert.......       S    0297       Q            T         0317  Imaging S&I.

[[Page 66660]]

 
74480.....................  X-ray control, cath insert.......       S    0296       Q            T         0317  Imaging S&I.
74485.....................  X-ray guide, GU dilation.........       S    0296       Q            T         0317  Imaging S&I.
74740.....................  X-ray, female genital tract......       X    0264       Q            T         0263  Imaging S&I.
74742.....................  X-ray, fallopian tube............       X    0264       N          n/a          n/a  Imaging S&I.
75600.....................  Contrast x-ray exam of aorta.....       S    0280       Q            T         0279  Imaging S&I.
75605.....................  Contrast x-ray exam of aorta.....       S    0280       Q            T         0279  Imaging S&I.
75625.....................  Contrast x-ray exam of aorta.....       S    0280       Q            T         0279  Imaging S&I.
75630.....................  X-ray aorta, leg arteries........       S    0280       Q            T         0279  Imaging S&I.
75635.....................  Ct angio abdominal arteries......       S    0662       Q            T         0662  Imaging S&I.
75650.....................  Artery x-rays, head & neck.......       S    0280       Q            T         0280  Imaging S&I.
75658.....................  Artery x-rays, arm...............       S    0279       Q            T         0279  Imaging S&I.
75660.....................  Artery x-rays, head & neck.......       S    0668       Q            T         0280  Imaging S&I.
75662.....................  Artery x-rays, head & neck.......       S    0280       Q            T         0280  Imaging S&I.
75665.....................  Artery x-rays, head & neck.......       S    0280       Q            T         0279  Imaging S&I.
75671.....................  Artery x-rays, head & neck.......       S    0280       Q            T         0280  Imaging S&I.
75676.....................  Artery x-rays, neck..............       S    0280       Q            T         0279  Imaging S&I.
75680.....................  Artery x-rays, neck..............       S    0280       Q            T         0279  Imaging S&I.
75685.....................  Artery x-rays, spine.............       S    0280       Q            T         0279  Imaging S&I.
75705.....................  Artery x-rays, spine.............       S    0668       Q            T         0279  Imaging S&I.
75710.....................  Artery x-rays, arm/leg...........       S    0280       Q            T         0279  Imaging S&I.
75716.....................  Artery x-rays, arms/legs.........       S    0280       Q            T         0279  Imaging S&I.
75722.....................  Artery x-rays, kidney............       S    0280       Q            T         0279  Imaging S&I.
75724.....................  Artery x-rays, kidneys...........       S    0280       Q            T         0279  Imaging S&I.
75726.....................  Artery x-rays, abdomen...........       S    0280       Q            T         0279  Imaging S&I.
75731.....................  Artery x-rays, adrenal gland.....       S    0280       Q            T         0279  Imaging S&I.
75733.....................  Artery x-rays, adrenals..........       S    0668       Q            T         0279  Imaging S&I.
75736.....................  Artery x-rays, pelvis............       S    0280       Q            T         0279  Imaging S&I.
75741.....................  Artery x-rays, lung..............       S    0279       Q            T         0279  Imaging S&I.
75743.....................  Artery x-rays, lungs.............       S    0280       Q            T         0279  Imaging S&I.
75746.....................  Artery x-rays, lung..............       S    0279       Q            T         0668  Imaging S&I.
75756.....................  Artery x-rays, chest.............       S    0279       Q            T         0668  Imaging S&I.
75774.....................  Artery x-ray, each vessel........       S    0279       N          n/a          n/a  Imaging S&I.
75790.....................  Visualize A-V shunt..............       S    0279       Q            T         0668  Imaging S&I.
75801.....................  Lymph vessel x-ray, arm/leg......       X    0264       Q            T         0317  Imaging S&I.
75803.....................  Lymph vessel x-ray, arms/legs....       X    0264       Q            T         0317  Imaging S&I.
75805.....................  Lymph vessel x-ray, trunk........       X    0264       Q            T         0317  Imaging S&I.
75807.....................  Lymph vessel x-ray, trunk........       X    0264       Q            T         0317  Imaging S&I.
75809.....................  Nonvascular shunt, x-ray.........       X    0263       Q            T         0263  Imaging S&I.
75810.....................  Vein x-ray, spleen/liver.........       S    0279       Q            T         0279  Imaging S&I.
75820.....................  Vein x-ray, arm/leg..............       S    0668       Q            T         0668  Imaging S&I.
75822.....................  Vein x-ray, arms/legs............       S    0668       Q            T         0668  Imaging S&I.
75825.....................  Vein x-ray, trunk................       S    0279       Q            T         0279  Imaging S&I.
75827.....................  Vein x-ray, chest................       S    0279       Q            T         0668  Imaging S&I.
75831.....................  Vein x-ray, kidney...............       S    0279       Q            T         0279  Imaging S&I.
75833.....................  Vein x-ray, kidneys..............       S    0279       Q            T         0279  Imaging S&I.
75840.....................  Vein x-ray, adrenal gland........       S    0280       Q            T         0279  Imaging S&I.
75842.....................  Vein x-ray, adrenal glands.......       S    0280       Q            T         0279  Imaging S&I.
75860.....................  Vein x-ray, neck.................       S    0668       Q            T         0668  Imaging S&I.
75870.....................  Vein x-ray, skull................       S    0668       Q            T         0668  Imaging S&I.
75872.....................  Vein x-ray, skull................       S    0279       Q            T         0668  Imaging S&I.
75880.....................  Vein x-ray, eye socket...........       S    0668       Q            T         0668  Imaging S&I.
75885.....................  Vein x-ray, liver................       S    0280       Q            T         0279  Imaging S&I.
75887.....................  Vein x-ray, liver................       S    0279       Q            T         0668  Imaging S&I.
75889.....................  Vein x-ray, liver................       S    0280       Q            T         0279  Imaging S&I.
75891.....................  Vein x-ray, liver................       S    0279       Q            T         0279  Imaging S&I.
75893.....................  Venous sampling by catheter......       Q    0668       Q            T         0279  Imaging S&I.
75894.....................  X-rays, transcath therapy........       S    0298       N          n/a          n/a  Imaging S&I.
75896.....................  X-rays, transcath therapy........       S    0263       N          n/a          n/a  Imaging S&I.
75898.....................  Follow-up angiography............       X    0263       Q         STVX         0263  Intraoperative.
75901.....................  Remove cva device obstruct.......       X    0263       N          n/a          n/a  Imaging S&I.
75902.....................  Remove cva lumen obstruct........       X    0263       N          n/a          n/a  Imaging S&I.
75940.....................  X-ray placement, vein filter.....       S    0298       N          n/a          n/a  Imaging S&I.
75945.....................  Intravascular us.................       S    0267       Q            T         0267  Imaging S&I.
75946.....................  Intravascular us add-on..........       S    0266       N          n/a          n/a  Imaging S&I.
75960.....................  Transcath iv stent rs&i..........       S    0668       N          n/a          n/a  Imaging S&I.
75961.....................  Retrieval, broken catheter.......       S    0668       N          n/a          n/a  Imaging S&I.
75962.....................  Repair arterial blockage.........       S    0668       Q            T         0083  Imaging S&I.

[[Page 66661]]

 
75964.....................  Repair artery blockage, each.....       S    0668       N          n/a          n/a  Imaging S&I.
75966.....................  Repair arterial blockage.........       S    0668       Q            T         0083  Imaging S&I.
75968.....................  Repair artery blockage, each.....       S    0668       N          n/a          n/a  Imaging S&I.
75970.....................  Vascular biopsy..................       S    0668       N          n/a          n/a  Imaging S&I.
75978.....................  Repair venous blockage...........       S    0668       Q            T         0083  Imaging S&I.
75980.....................  Contrast xray exam bile duct.....       S    0297       N          n/a          n/a  Imaging S&I.
75982.....................  Contrast xray exam bile duct.....       S    0297       N          n/a          n/a  Imaging S&I.
75984.....................  Xray control catheter change.....       X    0263       N          n/a          n/a  Imaging S&I.
75989.....................  Abscess drainage under x-ray.....       N  ......       N          n/a          n/a  Imaging S&I.
75992.....................  Atherectomy, x-ray exam..........       S    0668       N          n/a          n/a  Imaging S&I.
75993.....................  Atherectomy, x-ray exam..........       S    0668       N          n/a          n/a  Imaging S&I.
75994.....................  Atherectomy, x-ray exam..........       S    0668       N          n/a          n/a  Imaging S&I.
75995.....................  Atherectomy, x-ray exam..........       S    0668       N          n/a          n/a  Imaging S&I.
75996.....................  Atherectomy, x-ray exam..........       S    0668       N          n/a          n/a  Imaging S&I.
76000.....................  Fluoroscope examination..........       X    0272       Q         STVX         0272  Guidance.
76001.....................  Fluoroscope exam, extensive......       N     n/a       N          n/a          n/a  Guidance.
76080.....................  X-ray exam of fistula............       X    0263       Q            T         0263  Imaging S&I.
76125.....................  Cine/video x-rays add-on.........       X    0260       N          n/a          n/a  Image Processing.
76350.....................  Special x-ray contrast study.....       N     n/a       N          n/a          n/a  Image Processing.
76376.....................  3d render w/o postprocess........       X    0340       N          n/a          n/a  Image Processing.
76377.....................  3d rendering w/postprocess.......       S    0282       N          n/a          n/a  Image Processing.
76930.....................  Echo guide, cardiocentesis.......       S    0268       N          n/a          n/a  Guidance.
76932.....................  Echo guide for heart biopsy......       S    0309       N          n/a          n/a  Guidance.
76936.....................  Echo guide for artery repair.....       S    0309       N          n/a          n/a  Guidance.
76937.....................  Us guide, vascular access........       N     n/a       N          n/a          n/a  Guidance.
76940.....................  Us guide, tissue ablation........       S    0268       N          n/a          n/a  Guidance.
76941.....................  Echo guide for transfusion.......       S    0268       N          n/a          n/a  Guidance.
76942.....................  Echo guide for biopsy............       S    0268       N          n/a          n/a  Guidance.
76945.....................  Echo guide, villus sampling......       S    0268       N          n/a          n/a  Guidance.
76946.....................  Echo guide for amniocentesis.....       S    0268       N          n/a          n/a  Guidance.
76948.....................  Echo guide, ova aspiration.......       S    0309       N          n/a          n/a  Guidance.
76950.....................  Echo guidance radiotherapy.......       S    0268       N          n/a          n/a  Guidance.
76965.....................  Echo guidance radiotherapy.......       S    0308       N          n/a          n/a  Guidance.
76975.....................  GI endoscopic ultrasound.........       S    0266       Q            T         0267  Imaging S&I.
76998.....................  Us guide, intraop................       S    0266       N          n/a          n/a  Guidance.
77001.....................  Fluoro guide for vein device.....       N     n/a       N          n/a          n/a  Guidance.
77002.....................  Needle localization by xray......       N     n/a       N          n/a          n/a  Guidance.
77003.....................  Fluoroguide for spine inject.....       N     n/a       N          n/a          n/a  Guidance.
77011.....................  Ct scan for localization.........       S    0283       N          n/a          n/a  Guidance.
77012.....................  Ct scan for needle biopsy........       S    0283       N          n/a          n/a  Guidance.
77013.....................  Ct guide for tissue ablation.....       S    0333       N          n/a          n/a  Guidance.
77014.....................  Ct scan for therapy guide........       S    0282       N          n/a          n/a  Guidance.
77021.....................  Mr guidance for needle place.....       S    0335       N          n/a          n/a  Guidance.
77022.....................  Mri for tissue ablation..........       S    0335       N          n/a          n/a  Guidance.
77031.....................  Stereotact guide for brst bx.....       X    0264       N          n/a          n/a  Guidance.
77032.....................  Guidance for needle, breast......       X    0283       N          n/a          n/a  Guidance.
77053.....................  X-ray of mammary duct............       X    0263       Q            T         0263  Imaging S&I.
77054.....................  X-ray of mammary ducts...........       X    0263       Q            T         0263  Imaging S&I.
77417.....................  Radiology port film(s)...........       X    0260       N          n/a          n/a  Guidance.
77421.....................  Stereoscopic x-ray guidance......       S    0257       N          n/a          n/a  Guidance.
78020.....................  Thyroid met uptake...............       S    0399       N          n/a          n/a  Intraoperative.
78478.....................  Heart wall motion add-on.........       S    0399       N          n/a          n/a  Intraoperative.
78480.....................  Heart function add-on............       S    0399       N          n/a          n/a  Intraoperative.
78496.....................  Heart first pass add-on1.........       S    0399       N          n/a          n/a  Intraoperative.
92547.....................  Supplemental electrical test.....       X    0363       N          n/a          n/a  Intraoperative.
92978.....................  Intravasc us, heart add-on.......       S    0670       N          n/a          n/a  Intraoperative.
92979.....................  Intravasc us, heart add-on.......       S    0416       N          n/a          n/a  Intraoperative.
93320.....................  Doppler echo exam, heart.........       S    0697       N          n/a          n/a  Intraoperative.
93321.....................  Doppler echo exam, heart.........       S    0697       N          n/a          n/a  Intraoperative.
93325.....................  Doppler color flow add-on........       S    0697       N  ...........          n/a  Image Processing.
93555.....................  Imaging, cardiac cath............       N     n/a       N          n/a          n/a  Imaging S&I.
93556.....................  Imaging, cardiac cath............       N     n/a       N          n/a          n/a  Imaging S&I.
93571.....................  Heart flow reserve measure.......       S    0670       N          n/a          n/a  Intraoperative.
93572.....................  Heart flow reserve measure.......       S    0416       N          n/a          n/a  Intraoperative.
93609.....................  Map tachycardia, add-on..........       T    0087       N          n/a          n/a  Intraoperative.
93613.....................  Electrophys map 3d, add-on.......       T    0087       N          n/a          n/a  Image Processing.
93621.....................  Electrophysiology evaluation.....       T    0085       N          n/a          n/a  Intraoperative.

[[Page 66662]]

 
93622.....................  Electrophysiology evaluation.....       T    0085       N          n/a          n/a  Intraoperative.
93623.....................  Stimulation, pacing heart........       T    0087       N          n/a          n/a  Intraoperative.
93631.....................  Heart pacing, mapping............       T    0087       N          n/a          n/a  Intraoperative.
93640.....................  Evaluation heart device..........       N     n/a       N          n/a          n/a  Intraoperative.
93641.....................  Electrophysiology evaluation.....       N     n/a       N          n/a          n/a  Intraoperative.
93662.....................  Intracardiac ecg (ice)...........       S    0670       N          n/a          n/a  Intraoperative.
95829.....................  Surgery electrocorticogram.......       S    0214       N          n/a          n/a  Intraoperative.
95873.....................  Guide nerv destr, elec stim......       S    0215       N          n/a          n/a  Guidance.
95874.....................  Guide nerv destr, needle emg.....       S    0215       N          n/a          n/a  Guidance.
95920.....................  Intraop nerve test add-on........       S    0216       N          n/a          n/a  Intraoperative.
95955.....................  EEG during surgery...............       S    0213       N          n/a          n/a  Intraoperative.
95957.....................  EEG digital analysis.............       S    0214       N          n/a          n/a  Image Processing.
95980.....................  Io anal gast n-stim init.........     n/a     n/a       N          n/a          n/a  Intraoperative.
96020.....................  Functional brain mapping.........       X    0373       N          n/a          n/a  Intraoperative.
0126T.....................  Chd risk imt study...............       N     n/a       Q         STVX         0340  Intraoperative.
0159T.....................  Cad breast MRI...................       N     n/a       N          n/a          n/a  Image Processing.
0173T.....................  Iop monit io pressure............       N     n/a       N          n/a          n/a  Intraoperative.
0174T.....................  Cad cxr remote...................       N     n/a       N          n/a          n/a  Image Processing.
0175T.....................  Cad cxr with interp..............       N     n/a       N          n/a          n/a  Image Processing.
A4641.....................  Radiopharm dx agent noc..........       N     n/a       N          n/a          n/a  Diagnostic Radiopharmaceutical.
A4642.....................  In111 satumomab..................       H    0704       N          n/a          n/a  Diagnostic Radiopharmaceutical.
A9500.....................  Tc99m sestamibi..................       H    1600       N          n/a          n/a  Diagnostic Radiopharmaceutical.
A9501.....................  Technetium TC-99m teboroxime.....     n/a     n/a       N          n/a          n/a  Diagnostic Radiopharmaceutical.
A9502.....................  Tc99m tetrofosmin................       H    0705       N          n/a          n/a  Diagnostic Radiopharmaceutical.
A9503.....................  Tc99m medronate..................       N     n/a       N          n/a          n/a  Diagnostic Radiopharmaceutical.
A9504.....................  Tc99m apcitide...................       N     n/a       N          n/a          n/a  Diagnostic Radiopharmaceutical.
A9505.....................  TL201 thallium...................       H    1603       N          n/a          n/a  Diagnostic Radiopharmaceutical.
A9507.....................  In111 capromab...................       H    1604       N          n/a          n/a  Diagnostic Radiopharmaceutical.
A9508.....................  I131 iodobenguate, dx............       H    1045       N          n/a          n/a  Diagnostic Radiopharmaceutical.
A9509.....................  Iodine I-123 sod iodide mil......     n/a     n/a       N          n/a          n/a  Diagnostic Radiopharmaceutical.
A9510.....................  Tc99m disofenin..................       N     n/a       N          n/a          n/a  Diagnostic Radiopharmaceutical.
A9512.....................  Tc99m pertechnetate..............       N     n/a       N          n/a          n/a  Diagnostic Radiopharmaceutical.
A9516.....................  I123 iodide cap, dx..............       H    9148       N          n/a          n/a  Diagnostic Radiopharmaceutical.
A9521.....................  Tc99m exametazime................       H    1096       N          n/a          n/a  Diagnostic Radiopharmaceutical.
A9524.....................  I131 serum albumin, dx...........       H    9100       N          n/a          n/a  Diagnostic Radiopharmaceutical.
A9526.....................  Nitrogen N-13 ammonia............       H    0737       N          n/a          n/a  Diagnostic Radiopharmaceutical.
A9528.....................  Iodine I-131 iodide cap, dx......       H    1088       N          n/a          n/a  Diagnostic Radiopharmaceutical.
A9529.....................  I131 iodide sol, dx..............       N     n/a       N          n/a          n/a  Diagnostic Radiopharmaceutical.
A9531.....................  I131 max 100uCi..................       N     n/a       N          n/a          n/a  Diagnostic Radiopharmaceutical.
A9532.....................  I125 serum albumin, dx...........       N     n/a       N          n/a          n/a  Diagnostic Radiopharmaceutical.
A9536.....................  Tc99m depreotide.................       H    0739       N          n/a          n/a  Diagnostic Radiopharmaceutical.
A9537.....................  Tc99m mebrofenin.................       N     n/a       N          n/a          n/a  Diagnostic Radiopharmaceutical.
A9538.....................  Tc99m pyrophosphate..............       N     n/a       N          n/a          n/a  Diagnostic Radiopharmaceutical.

[[Page 66663]]

 
A9539.....................  Tc99m pentetate..................       H    0722       N          n/a          n/a  Diagnostic Radiopharmaceutical.
A9540.....................  Tc99m MAA........................       N     n/a       N          n/a          n/a  Diagnostic Radiopharmaceutical.
A9541.....................  Tc99m sulfur colloid.............       N     n/a       N          n/a          n/a  Diagnostic Radiopharmaceutical.
A9542.....................  In111 ibritumomab, dx............       H    1642       N          n/a          n/a  Diagnostic Radiopharmaceutical.
A9544.....................  I131 tositumomab, dx.............       H    1644       N          n/a          n/a  Diagnostic Radiopharmaceutical.
A9546.....................  Co57/58..........................       H    0723       N          n/a          n/a  Diagnostic Radiopharmaceutical.
A9547.....................  In111 oxyquinoline...............       H    1646       N          n/a          n/a  Diagnostic Radiopharmaceutical.
A9548.....................  In111 pentetate..................       H    1647       N          n/a          n/a  Diagnostic Radiopharmaceutical.
A9550.....................  Tc99m gluceptate.................       H    0740       N          n/a          n/a  Diagnostic Radiopharmaceutical.
A9551.....................  Tc99m succimer...................       H    1650       N          n/a          n/a  Diagnostic Radiopharmaceutical.
A9552.....................  F18 fdg..........................       H    1651       N          n/a          n/a  Diagnostic Radiopharmaceutical.
A9553.....................  Cr51 chromate....................       H    0741       N          n/a          n/a  Diagnostic Radiopharmaceutical.
A9554.....................  I125 iothalamate, dx.............       N     n/a       N          n/a          n/a  Diagnostic Radiopharmaceutical.
A9555.....................  Rb82 rubidium....................       H    1654       N          n/a          n/a  Diagnostic Radiopharmaceutical.
A9556.....................  Ga67 gallium.....................       H    1671       N          n/a          n/a  Diagnostic Radiopharmaceutical.
A9557.....................  Tc99m bicisate...................       H    1672       N          n/a          n/a  Diagnostic Radiopharmaceutical.
A9558.....................  Xe133 xenon 10mci................       N     n/a       N          n/a          n/a  Diagnostic Radiopharmaceutical.
A9559.....................  Co57 cyano.......................       H    0724       N          n/a          n/a  Diagnostic Radiopharmaceutical.
A9560.....................  Tc99m labeled rbc................       H    0742       N          n/a          n/a  Diagnostic Radiopharmaceutical.
A9561.....................  Tc99m oxidronate.................       N     n/a       N          n/a          n/a  Diagnostic Radiopharmaceutical.
A9562.....................  Tc99m mertiatide.................       H    0743       N          n/a          n/a  Diagnostic Radiopharmaceutical.
A9566.....................  Tc99m fanolesomab................       H    1678       N          n/a          n/a  Diagnostic Radiopharmaceutical.
A9567.....................  Technetium TC-99m aerosol........       H    0829       N          n/a          n/a  Diagnostic Radiopharmaceutical.
A9568.....................  Tc99m arcitumomab................       H    1648       N          n/a          n/a  Diagnostic Radiopharmaceutical.
A9569.....................  Technetium TC-99m auto WBC.......     n/a     n/a       N          n/a          n/a  Diagnostic Radiopharmaceutical.
A9570.....................  Indium In-111 auto WBC...........     n/a     n/a       N          n/a          n/a  Diagnostic Radiopharmaceutical.
A9571.....................  Indium In-111 auto platelet......     n/a     n/a       N          n/a          n/a  Diagnostic Radiopharmaceutical.
A9572.....................  Indium In-111 pentetreotide......     n/a     n/a       N          n/a          n/a  Diagnostic Radiopharmaceutical.
A9576.....................  Inj prohance multipack...........     n/a     n/a       N          n/a          n/a  Contrast Agent.
A9577.....................  Inj multihance...................     n/a     n/a       N          n/a          n/a  Contrast Agent.
A9578.....................  Inj multihance multipack.........     n/a     n/a       N          n/a          n/a  Contrast Agent.
A9579.....................  Gad-base MR contrast NOS, 1ml....     n/a     n/a       N          n/a          n/a  Contrast Agent.
G0268.....................  Removal of impacted wax md.......       X    0340       N          n/a          n/a  Intraoperative.
G0275.....................  Renal angio, cardiac cath........       N     n/a       N          n/a          n/a  Intraoperative.
G0278.....................  Iliac art angio,cardiac cath.....       N     n/a       N          n/a          n/a  Intraoperative.
G0288.....................  Recon, CTA for surg plan.........       S    0417       N          n/a          n/a  Image Processing.
G0378.....................  Hospital observation per hr......       Q     339       N          n/a          n/a  Observation.
Q9951.....................  LOCM >= 400 mg/ml iodine, 1ml....       K    9163       N          n/a          n/a  Contrast Agent.
Q9953.....................  Inj Fe-based MR contrast, 1ml....       K    1713       N          n/a          n/a  Contrast Agent.

[[Page 66664]]

 
Q9954.....................  Oral MR contrast, 100 ml.........       K    9165       N          n/a          n/a  Contrast Agent.
Q9955.....................  Inj perflexane lip micros, ml....       K    9203       N          n/a          n/a  Contrast Agent.
Q9956.....................  Inj octafluoropropane mic, ml....       K    9202       N          n/a          n/a  Contrast Agent.
Q9957.....................  Inj perflutren lip micros, ml....       K    9112       N          n/a          n/a  Contrast Agent.
Q9958.....................  HOCM <= 149 mg/ml iodine, 1ml....       N     n/a       N          n/a          n/a  Contrast Agent.
Q9959.....................  HOCM 150-199mg/ml iodine, 1ml....       N     n/a       N          n/a          n/a  Contrast Agent.
Q9960.....................  HOCM 200-249mg/ml iodine, 1ml....       N     n/a       N          n/a          n/a  Contrast Agent.
Q9961.....................  HOCM 250-299mg/ml iodine, 1ml....       N     n/a       N          n/a          n/a  Contrast Agent.
Q9962.....................  HOCM 300-349mg/ml iodine, 1ml....       N     n/a       N          n/a          n/a  Contrast Agent.
Q9963.....................  HOCM 350-399mg/ml iodine, 1ml....       N     n/a       N          n/a          n/a  Contrast Agent.
Q9964.....................  HOCM >= 400mg/ml iodine, 1ml.....       N     n/a       N          n/a          n/a  Contrast Agent.
Q9965.....................  LOCM 100-199mg/ml iodine, 1ml....     n/a     n/a       N          n/a          n/a  Contrast Agent.
Q9966.....................  LOCM 200-299mg/ml iodine, 1ml....     n/a     n/a       N          n/a          n/a  Contrast Agent.
Q9967.....................  LOCM 300-399mg/ml iodine, 1ml....     n/a     n/a       N          n/a          n/a  Contrast Agent.
--------------------------------------------------------------------------------------------------------------------------------------------------------

e. Service-Specific Packaging Issues
    As a result of requests from the public, a Packaging Subcommittee 
to the APC Panel was established to review all the procedural CPT codes 
with a status indicator of ``N.'' Commenters to past rules have 
suggested that certain packaged services could be provided alone, 
without any other separately payable services on the claim, and 
requested that these codes not be assigned status indicator ``N.'' In 
deciding whether to package a service or pay for a code separately, we 
have historically considered a variety of factors, including whether 
the service is normally provided separately or in conjunction with 
other services; how likely it is for the costs of the packaged code to 
be appropriately mapped to the separately payable codes with which it 
was performed; and whether the expected cost of the service is 
relatively low. As discussed above regarding our packaging approach for 
CY 2008, we have modified the historical considerations outlined above 
in developing our policy for the CY 2008 OPPS. The Packaging 
Subcommittee discussed many HCPCS codes during the March 2007 APC Panel 
meeting, prior to development of the packaging approach discussed 
above, and we have summarized and responded to the APC Panel's 
packaging-related recommendations below. Three of the codes reviewed by 
the Packaging Subcommittee at the March 2007 APC Panel meeting are 
included in the seven categories of services identified for packaging 
under the CY 2008 OPPS. For those three codes, we specifically applied 
the proposed CY 2008 criteria for determining whether a code should be 
proposed as packaged or separately payable for CY 2008. Specifically, 
we determined whether the service is a dependent service falling into 
one of the seven specified categories that is always or almost always 
provided integral to an independent service. For those four codes that 
were reviewed during the March 2007 APC Panel meeting but that do not 
fit into any of the seven categories of codes that are part of our CY 
2008 proposed packaging approach, we applied the packaging criteria 
described above that were historically used under the OPPS. Moreover, 
we took into consideration our interest in exploring the possibility of 
expanding the size of payment groups for component services to provide 
encounter-based and episode-of-care-based payment in the future in 
order to encourage hospital efficiency and provide hospitals with 
maximal flexibility to manage their resources.
    In accordance with a recommendation of the APC Panel, for the CY 
2007 OPPS, we implemented a new policy that designates certain codes as 
``special'' packaged codes, assigned to status indicator ``Q'' under 
the OPPS, where separate payment is provided if the code is reported 
without any other services that are separately payable under the OPPS 
on the same date of service. Otherwise, payment for the ``special'' 
packaged code is packaged into payment for the separately payable 
services provided by the hospital on the same date. We note that these 
``special'' packaged codes are a subset of those HCPCS codes that are 
assigned to status indicator ``Q,'' which means that their payment is 
conditionally packaged under the OPPS. We proposed to update our 
criteria to determine packaged versus separate payment for ``special'' 
packaged HCPCS codes assigned to status indicator ``Q'' for CY 2008. 
For CY 2008, payment for ``special'' packaged codes would be packaged 
when these HCPCS codes are billed on the same date of service as a code 
assigned to status indicator ``S,'' ``T,'' ``V,'' or ``X.'' When one of 
the ``special'' packaged codes assigned to status indicator ``Q'' is 
billed on a date of service without a code that is assigned to any of 
the four status indicators noted above, the ``special'' packaged code 
assigned to status indicator ``Q'' would be separately payable.
    The Packaging Subcommittee identified areas for change for some 
currently packaged CPT codes that it believed could frequently be 
provided to patients as the sole service on a given date and that 
required significant hospital resources as determined from hospital 
claims data. Based on the comments received, additional issues, and new 
data that we shared with the Packaging Subcommittee concerning the 
packaging status of codes for CY 2008, the Packaging Subcommittee 
reviewed the packaging status of numerous HCPCS codes and reported its 
findings to the APC Panel at its March 2007 meeting. The APC Panel 
accepted the report of the Packaging Subcommittee, heard several 
presentations on certain packaged services, discussed the deliberations 
of the Packaging Subcommittee, and recommended that--
    1. CMS place CPT code 76937 (Ultrasound guidance for vascular 
access requiring ultrasound evaluation of potential access sites, 
documentation of selected vessel patency, concurrent real-time 
ultrasound visualization of vascular needle entry, with permanent

[[Page 66665]]

recording and reporting (list separately in addition to code for 
primary procedure)) on the list of ``special'' packaged codes (status 
indicator ``Q''). (Recommendation 1)
    2. CMS evaluate providing separate payment for trauma activation 
when it is reported on a claim for an ED visit, regardless of the level 
of the emergency department visit. (Recommendation 2)
    3. CMS place CPT code 0175T (Computer aided detection (CAD) 
(computer algorithm analysis of digital image data for lesion 
detection) with further physician review for interpretation and report, 
with or without digitization of film radiographic images, chest 
radiograph(s), performed remote from primary interpretation) on the 
list of ``special'' packaged codes (status indicator ``Q''). 
(Recommendation 3)
    4. CMS place CPT code 0126T (Common carotid intima-media thickness 
(IMT) study for evaluation of atherosclerotic burden or coronary heart 
disease risk factor assessment) on the list of ``special'' packaged 
codes (status indicator ``Q'') and that CMS consider mapping the code 
to APC 340 (Minor Ancillary Procedures). (Recommendation 4)
    5. CMS place CPT code 0069T (Acoustic heart sound recording and 
computer analysis only) on the list of ``special'' packaged codes 
(status indicator ``Q'') and that CMS exclude APC 0096 (Non-Invasive 
Vascular Studies) as a potential placement for this CPT code. 
(Recommendation 5)
    6. CMS maintain the packaged status of HCPCS code A4306 (Disposable 
drug delivery system, flow rate of less than 50 ml per hour) and that 
CMS present additional data on this system to the APC Panel when 
available. (Recommendation 6)
    7. CMS reevaluate the packaged OPPS payment for CPT code 99186 
(Hypothermia; total body) based on current research and availability of 
new therapeutic modalities. (Recommendation 7)
    8. The Packaging Subcommittee remains active until the next APC 
Panel meeting. (Recommendation 8)
    In addition, the Packaging Subcommittee reported its findings to 
the APC Panel at its September 2007 meeting. The APC Panel accepted the 
report of the Packaging Subcommittee, heard presentations on certain 
packaged services, discussed the deliberations of the Packaging 
Subcommittee, and recommended that--
    9. CMS provide more data at the next APC Panel meeting on HCPCS 
code A4306 (Disposable drug delivery system, flow rate of less than 50 
mL per hour). (Recommendation 9)
    10. The Packaging Subcommittee remains active until the next APC 
Panel meeting. (Recommendation 10)
    We address each of these recommendations in turn in the discussion 
that follows.
Recommendation 1
    For CY 2008, we proposed to maintain CPT code 76937 as a packaged 
service. We are not adopting the APC Panel's recommendation to pay 
separately for this code in some circumstances as a ``special'' 
packaged code. In the CY 2006 OPPS final rule with comment period (70 
FR 68544 through 68545), in response to several public comments, we 
reviewed in detail the claims data related to CPT code 76937. During 
its March 2006 APC Panel meeting, after reviewing data pertinent to CPT 
code 76937, the APC Panel recommended that CMS maintain the packaged 
status of this code for CY 2007, and we accepted that recommendation. 
During the March 2007 APC Panel meeting, after reviewing current data 
and listening to a public presentation, the Panel recommended that we 
treat this code as a ``special'' packaged code for CY 2008, noting that 
certain uncommon clinical scenarios could occur where it would be 
possible to bill this service alone on a claim, without any other 
separately payable OPPS services.
    We proposed to maintain CPT code 76937 as an unconditionally 
packaged service for CY 2008, fully consistent with the proposed 
packaging approach for the CY 2008 OPPS, as discussed above. Because 
CPT code 76937 is a guidance procedure and we proposed to package 
payment for all guidance procedures for CY 2008, we believe it is still 
appropriate to maintain the unconditionally packaged status of this 
code, which is a CPT designated add-on procedure that we expected to be 
generally provided only in association with other independent services. 
We applied the updated criteria for determining whether this service 
should receive packaged or separately payment under the CY 2008 OPPS. 
Specifically, we determined that this service was a supportive 
ancillary service that was integral to an independent service, 
resulting in our CY 2008 proposal to packaged payment for the service.
    We discussed this code extensively in both the CY 2006 and CY 2007 
final rules with comment period (70 FR 68544 through 68545; 71 FR 67996 
through 67997). Our hospital claims data demonstrated that guidance 
services were used frequently for the insertion of vascular access 
devices, and we had no evidence that patients lacked appropriate access 
to guidance services necessary for the safe insertion of vascular 
access devices in the hospital outpatient setting. Because we believe 
that ultrasound guidance would almost always be provided with one or 
more separately payable independent procedures, its costs would be 
appropriately bundled with the handful of vascular access device 
insertion procedures with which it was most commonly performed. We 
further believe that hospital staff chose whether to use no guidance or 
fluoroscopic guidance or ultrasound guidance on an individual basis, 
depending on the clinical circumstances of the vascular access device 
insertion procedure.
    Therefore, we do not believe that CPT code 76937 is an appropriate 
candidate for designation as a ``special'' packaged code. The CY 2007 
CPT book indicates that this code is an add-on code and should be 
reported in addition to the code reported for the primary procedure. 
According to our CY 2006 claims data available for the proposed rule, 
this code was billed over 60,000 times, yet less than one-tenth of 1 
percent of all claims for the procedure were billed without any 
separately payable OPPS service on the claim. Because this code is 
provided alone only extremely rarely, we believe this code would not be 
appropriately treated as a ``special'' packaged code. Therefore, we 
proposed to continue to unconditionally package CPT code 76937 for CY 
2008.
    We received several comments that referenced CPT code 76937 in 
discussions related to the packaged status of guidance services in 
general. Those comments are summarized and responded to in section 
II.4.c.1 of this final rule with comment period. As noted in that 
section, we are finalizing our proposal, without modification, to 
unconditionally package CPT code 76937 for CY 2008.
Recommendation 2
    For CY 2008, we proposed to maintain the packaged status of revenue 
code 068x, trauma response, when the trauma response is provided 
without critical care services. During the August 2006 APC Panel 
meeting, the APC Panel encouraged CMS to pay differentially for 
critical care services provided with and without trauma activation. For 
CY 2007, as a result of the APC Panel's August 2006 discussion and our 
own data analysis, we finalized a policy to pay differentially for 
critical care provided with and without trauma activation. The CY 2007 
payment rate

[[Page 66666]]

for critical care unassociated with trauma activation is $405.04 (APC 
0617, Critical Care), while the payment rate for critical care 
associated with trauma activation is $899.58 (APC 0617 and APC 0618 
(Trauma Response with Critical Care)). During the March 2007 APC Panel 
meeting, a presenter requested that CMS also pay differentially for 
emergency department visits provided with and without trauma 
activation. Two organizations that submitted comment letters for the 
APC Panel's review specifically requested separate payment for revenue 
code 068x every time it appears on a claim, regardless of the other 
services that were billed on that claim. The APC Panel recommended that 
CMS evaluate providing separate payment for trauma activation when it 
is reported on a claim for an emergency department visit, regardless of 
the level of the emergency department visit.
    After accepting the APC Panel's recommendation and evaluating this 
issue, we continue to believe that, while it is currently appropriate 
to pay separately for trauma activation when billed in association with 
critical care services, it is also currently appropriate to maintain 
the packaged payment status of revenue code 068x when trauma response 
services are provided in association with both clinic and emergency 
department visits under the CY 2008 OPPS. As mentioned above, we are 
exploring the possibility of expanding the size of the payment groups 
under the OPPS to move toward encounter-based and episode-of-care-based 
payments in order to encourage maximum hospital efficiency with a focus 
on budget-neutral value-based purchasing. Because trauma activation in 
association with emergency department or clinic visits would always be 
provided in the same hospital outpatient encounter as the visit for 
care of the injured Medicare beneficiary, packaging payment for trauma 
activation when billed in association with both clinic and emergency 
department visits is most consistent with our proposed packaging 
approach. We are also concerned that unpackaging payment for trauma 
activation in those circumstances where the trauma response would be 
less likely to be essential to appropriately treating a Medicare 
beneficiary would reduce the incentive for hospitals to provide the 
most efficient and cost-effective care. We note that, while we proposed 
for CY 2008 to continue to provide separate payment for trauma 
activation in association with critical care services, we may 
reconsider this payment policy for future OPPS updates as we explore 
the possibility of developing encounter based and episode-of-care-based 
payment approaches.
    Furthermore, continued packaged payment for trauma activation when 
unassociated with critical care is consistent with the principles of 
the OPPS, where hospitals receive payment based on the median cost 
related to all of the hospital resources associated with the main 
service provided. In various situations, each hospital's costs may be 
higher or lower than the median cost used to set payment rates. In 
light of our packaging approach for the CY 2008 OPPS, we believe it is 
particularly important not to make any changes in our payment policies 
for other services that are not fully aligned with promoting efficient, 
judicious, and deliberate care decisions by hospitals that allow them 
maximum flexibility to manage their resources through encouraging the 
most cost-effective use of hospital resources in providing the care 
necessary for the treatment of Medicare beneficiaries. Packaging 
payment encourages hospitals to establish protocols that ensure that 
services are furnished only when they are medically necessary and to 
carefully scrutinize the services ordered by practitioners to minimize 
unnecessary use of hospital resources.
    Therefore, we are adopting the APC Panel's recommendation that we 
evaluate providing separate payment for revenue code 068x when provided 
in association with emergency department visits. For CY 2008, after our 
thorough assessment, we proposed to maintain the packaged status of 
revenue code 068x, except when revenue code 068x is billed in 
association with critical care services.
    We did not receive any comments on this proposal. Therefore, we are 
finalizing our proposal, without modification, to maintain the packaged 
status of revenue code 068x, trauma response, when the trauma response 
is provided without critical care services.
    We note that we do not anticipate that the new composite Extended 
Assessment and Management APCs, 8002 and 8003, will affect this policy 
in any way.
Recommendation 3
    For CY 2008, we proposed to maintain the unconditionally packaged 
status of CPT codes 0174T (Computer aided detection (CAD) (computer 
algorithm analysis of digital image data for lesion detection) with 
further physician review for interpretation and report, with or without 
digitization of film radiographic images, chest radiograph(s), 
performed concurrent with primary interpretation) and 0175T. These 
services involve the application of computer algorithms and 
classification technologies to chest x-ray images to acquire and 
display information regarding chest x-ray regions that may contain 
indications of cancer. CPT code 0152T (Computer aided detection 
(computer algorithm analysis of digital image data for lesion 
detection) with further physician review for interpretation, with or 
without digitization of film radiographic images; chest radiograph(s) 
(List separately in addition to code for primary procedure)), the 
predecessor code to CPT codes 0174T and 0175T, was indicated as an add-
on code to chest x-ray CPT codes for CY 2006, according to the AMA's CY 
2006 CPT book. However, on July 1, 2006, the AMA released to the public 
an update that deleted CPT codes 0152T and replaced it with the two new 
Category III CPT codes 0174T and 0175T.
    In its March 2006 presentation to the APC Panel, before the AMA had 
released the CY 2007 changes to CPT code 0152T, a presenter requested 
that we pay separately for this service and assign it to a New 
Technology APC with a payment rate of $15, based on its estimated cost, 
clinical considerations, and similarity to other image post-processing 
services that are paid separately. We proposed to accept the APC 
Panel's recommendation to package CPT code 0152T for CY 2007.
    In its August 2006 presentation to the APC Panel, after the AMA had 
released the CY 2007 code changes, the same presenter requested that we 
assign both of the two new codes to a New Technology APC with a payment 
rate of $15. The APC Panel members discussed these codes extensively. 
They considered the possibility of treating CPT code 0175T as a 
``special'' packaged code, thereby assigning payment to the code only 
when it was performed by a hospital without any other separately 
payable OPPS service also provided on the same day. They questioned the 
meaning of the word ``remote'' in the code descriptor for CPT code 
0175T, noting that was unclear as to whether remote referred to time, 
geography, or a specific provider. They believed it was likely that a 
hospital without a CAD system that performed a chest x-ray and sent the 
x-ray to another hospital for performance of the CAD would be providing 
the CAD service under arrangement and, therefore, would be providing at 
least one other service (chest x-ray) that would be separately paid. 
Thus, even in these cases, payment for the CAD service

[[Page 66667]]

could be appropriately packaged. After significant and lengthy 
deliberation, the APC Panel recommended that we package payment for 
both of the new CPT codes, 0174T and 0175T, for CY 2007.
    In its March 2007 presentation to the APC Panel, the same presenter 
requested that we pay separately for CPT codes 0174T and 0175T, mapping 
them to New Technology APC 1492, with a payment rate of $15. The 
presenter indicated that chest x-ray CAD is not a screening tool and 
should only be billed to Medicare when applied to chest x-rays 
suspicious for lung cancer. The presenter also explained that 
additional and distinct hospital resources are required for chest x-ray 
CAD that are not required for a standard chest x-ray. In addition, 
remote chest x-ray CAD described by CPT code 0175T can be performed at 
a different time or location or by a different provider than the chest 
x-ray service. The presenter expressed concern that if hospitals were 
not paid separately for this technology, hospitals would not be able to 
provide it, thereby limiting beneficiary access to chest x-ray CAD. The 
APC Panel recommended conditional packaging as a ``special'' packaged 
code for CPT code 0175T, but did not recommend a change to the 
unconditionally packaged status of CPT code 0174T. We are not adopting 
the APC Panel's recommendation for designation of CPT code 0175T as a 
``special'' packaged code under the CY 2008 OPPS.
    We believed and continue to believe that packaged payment for 
diagnostic chest x-ray CAD under a prospective payment methodology for 
outpatient hospital services is most appropriate. We proposed to 
maintain CPT codes 0174T and 0175T as unconditionally packaged services 
for CY 2008, fully consistent with the packaging approach for the CY 
2008 OPPS, as discussed above. Because CPT codes 0174T and 0175T are 
supportive ancillary services that fit into the ``image processing'' 
category, and we proposed to package payment for all image processing 
services for CY 2008, we believe it is appropriate to maintain the 
packaged status of these code. We applied the updated criteria for 
determining whether these two CAD services should receive packaged or 
separate payment. Specifically, we determined that this service is a 
dependent service that is integral to an independent service, in this 
case, the chest x-ray or other OPPS service that we would expect to be 
provided in addition to the CAD service.
    After hearing many public presentations and discussions regarding 
the use of chest x-ray CAD, we continue to believe that even the remote 
service would almost always be provided by a hospital either in 
conjunction with other separately payable services or under 
arrangement. For example, if a physician orders a chest x-ray and CAD 
service to be performed at hospital A and hospital A, which does not 
have the CAD technology, sends the chest x-ray to hospital B for the 
performance of chest x-ray CAD, hospital B could only provide the CAD 
service if it were provided under arrangement, to avoid the OPPS 
unbundling prohibition. Assuming that the CAD service was provided 
under arrangement, hospital A would bill for the chest x-ray CAD that 
was performed by hospital B and would pay hospital B for the service 
provided. In that case, hospital A would also bill the chest x-ray 
service that it provided. In another scenario that has been described 
to us, if a physician were to send a patient to a hospital clinic with 
the patient's chest x-ray for consultation, we believe that the patient 
would likely receive a visit service, in addition to the chest x-ray 
CAD. Therefore, in both of these circumstances, payment for the chest 
x-ray CAD would be appropriately packaged into payment for the 
separately payable services with which it was provided.
    We also do not believe that CPT code 0175T should be treated as a 
``special'' packaged code. As discussed earlier in this section with 
regard to our packaging approach for image processing services for CY 
2008, we are concerned with establishing payment policies that could 
encourage certain inefficient and more costly service patterns, 
particularly for those services that do not need to be provided as a 
face-to-face encounter with the patient. If we were to assign CPT code 
0175T to ``special'' packaged status, we would likely create an 
incentive for hospitals to perform chest x-ray CAD remotely, for 
example, several days after performance of the initial chest x-ray, 
rather than immediately following the chest x-ray on the same day, to 
enable the hospital to receive separate payment for the service. In CY 
2005, there were approximately 7.3 million claims for all chest x-ray 
services in the HOPD, so a payment policy that could induce such 
changes in service delivery would be problematic in light of our 
commitment to encouraging the most efficient and cost-effective care 
for Medicare beneficiaries. Creating such perverse payment incentives 
through conditional packaging is a particular problem for those 
services that do not need a face-to-face encounter with the patient. In 
fact, as part of our proposed CY 2008 packaging approach, we also 
proposed to unconditionally package payment in CY 2008 for several 
other image processing services that are not always performed face-to-
face, including HCPCS code G0288 (Reconstruction, computer tomographic 
angiography of aorta for surgical planning for vascular surgery) and 
CPT code 76377 (3D rendering with interpretation and reporting of 
computed tomography, magnetic resource imaging, ultrasound, or other 
tomographic modality; requiring image postprocessing on an independent 
workstation). As noted in section II.A.4.c.(2) of this final rule with 
comment period, we are finalizing our proposal for those codes and they 
will be unconditionally packaged for CY 2008.
    The proposed unconditionally packaged treatment of the two CPT 
codes for chest x-ray CAD is fully consistent with the packaging 
approach for the CY 2008 OPPS, as discussed above, and the principles 
and incentives for efficiency inherent in a prospective payment system 
based on groups of services. Packaging these services creates 
incentives for providers to furnish services in the most cost-effective 
way and provides them with the most flexibility to manage their 
resources. As stated above, packaging encourages hospitals to establish 
protocols that ensure that services are furnished only when they are 
medically necessary and to carefully scrutinize the services ordered by 
practitioners to minimize unnecessary use of hospital resources. 
Therefore, we proposed to continue to unconditionally package payment 
for CPT codes 0174T and 0175T for CY 2008.
    Comment: One commenter requested that CPT codes 0174T and 0175T, 
which were provided interim assignments in CY 2007 be assigned to 
status indicator ``S'' and be paid separately with a payment rate of 
$15. That commenter then requested conditional payment for both of 
these CPT codes, status indicator ``Q'' assignment, and a payment rate 
of $15. The commenter indicated that this technology is an important 
diagnostic test for lung cancer patients, and that insufficient payment 
will limit access to this cost-effective diagnostic tool.
    Response: As discussed extensively above, after thorough discussion 
with the APC Panel and repeated review by our clinical advisors, we 
continue to believe that these codes are appropriately unconditionally 
packaged.
    For CY 2008, we are finalizing our proposal without modification to 
unconditionally package CPT codes

[[Page 66668]]

0174T and 0175T for CY 2008. We note that these codes fall into the 
category of the image processing codes that are packaged for the CY 
2008 OPPS.
Recommendation 4
    For CY 2008, we adopted the APC Panel's recommendation and proposed 
to add CPT code 0126T to the list of ``special'' packaged codes and 
assign this code to APC 0340 (Minor Ancillary Procedures).
    This service describes an ultrasound procedure that measures common 
carotid intima-media thickness to evaluate a patient's degree of 
atherosclerosis. This code became effective January 1, 2006. We 
received a comment to the CY 2007 proposed rule requesting that this 
code become separately payable for CY 2007. At that point, we had no 
cost data for the service and, as discussed in the CY 2007 OPPS/ASC 
final rule with comment period (71 FR 67998), we reviewed this code 
with the Packaging Subcommittee, as is our standard procedure for codes 
that we are asked to review during the comment period. The APC Panel 
noted that this service could sometimes be provided to a patient 
without any other separately payable services. Therefore, the APC Panel 
recommended that we add this code to the list of ``special'' packaged 
codes and pay for it separately when it is provided without any other 
separately payable services on the same day. For circumstances when 
this code is paid separately, the APC Panel recommended that we 
consider assigning this code to APC 0340.
    While we continue to believe that this procedure would not commonly 
be provided alone, we adopted the APC Panel recommendation and proposed 
to treat this code as a ``special'' packaged code subject to 
conditional packaging, mapping to APC 0340 for CY 2008 when it would be 
separately paid. This is fully consistent with the packaging approach 
for the CY 2008 OPPS, as discussed above. Because CPT code 0126T is 
almost always performed during another procedure, and we proposed to 
package payment for all intraoperative procedures for CY 2008, we 
believe it is appropriate to designate this CPT code as a ``special'' 
packaged code. We applied the updated criteria for determining whether 
this service should receive packaged or separate payment. Specifically, 
we determined that this service is usually a dependent service that is 
integral to an independent service, but that it could sometimes be 
provided without an independent service.
    As with all ``special'' packaged codes, we will closely monitor 
cost data and frequency of separate payment for this procedure as soon 
as we have more claims data available.
    We did not receive any comments related to this proposal. 
Therefore, we are finalizing our proposal without modification to 
designate CPT code 0126T as a ``special'' packaged code for CY 2008. 
This code is an ``STVX-packaged'' code.
Recommendation 5
    For CY 2008, we proposed to maintain the packaged status of CPT 
code 0069T, and we are not adopting the APC Panel's recommendation to 
designate this service as a ``special'' packaged code. This service 
uses signal processing technology to detect, interpret, and document 
acoustical activities of the heart through special sensors applied to a 
patient's chest. This code was a new Category III CPT code implemented 
in the CY 2005 OPPS. CPT code 0069T was an add-on code to an 
electrocardiography (EKG) service for CYs 2005 and 2006. However, 
effective January 1, 2007, the AMA changed the code descriptor to 
remove the add-on code designation for CPT code 0069T. This code has 
been packaged under the OPPS since CY 2005.
    During the August 2005 APC Panel meeting, the APC Panel recommended 
packaging CPT code 0069T for CY 2005. In its March 2006 presentation to 
the APC Panel, a presenter requested that we pay separately for CPT 
code 0069T and assign it to APC 0099 (Electrocardiograms) based on its 
estimated cost and clinical characteristics. The presenter stated that 
the acoustic heart sound recording and analysis service may be provided 
with or without a separately reportable electrocardiogram. Members of 
the APC Panel engaged in extensive discussion of clinical scenarios as 
they considered whether CPT code 0069T could or could not be 
appropriately reported alone or in conjunction with several different 
procedure codes. Ultimately, the APC Panel recommended assigning this 
service to a separately payable status indicator. However, during the 
August 2006 meeting, the APC Panel further discussed CMS' proposal to 
package payment for CPT code 0069T for CY 2007 and considered the CY 
2007 code descriptor change, finally recommending that CMS continue to 
package this code for CY 2007.
    During the March 2007 APC Panel meeting, the same presenter 
requested that we pay separately for this service and assign it to APC 
0096 (Non-Invasive Vascular Studies) or to APC 0097 (Cardiac and 
Ambulatory Blood Pressure Monitoring), with CY 2007 payment rates of 
$94.06 and $62.85, respectively. The presenter stated that the 
estimated true cost of this service lies between $62 and $94. The 
presenter clarified that this service is usually provided with an EKG, 
but noted that the test is sometimes provided without an EKG, according 
to its revised code descriptor for CY 2007. The presenter agreed that 
it would be rare for the acoustic heart sound procedure to be performed 
alone without any other separately payable OPPS services. The APC Panel 
recommended that we place CPT code on the list of ``special'' packaged 
codes and that we exclude APC 0096 as a potential placement for this 
CPT code.
    Because this service does not fit into one of the seven identified 
categories of packaged codes proposed for the CY 2008 OPPS, we followed 
our historical packaging guidelines to determine whether to maintain 
the packaged status of this code or to pay for it separately. Based on 
the clinical uses that were described during the March 2007 and earlier 
APC Panel meetings, APC Panel discussions, and our claims data review, 
we continue to believe that it is highly unlikely that CPT code 0069T 
would be performed in the HOPD as a sole service without other 
separately payable OPPS services. In addition, our data indicate that 
this service is estimated to require only minimal hospital resources. 
Based on CY 2006 claims, we had only 8 single claims for CPT code 
0069T, with a median line-item cost of approximately $5, consistent 
with its low expected cost. Therefore, we believe that payment for CPT 
code 0069T is appropriately packaged because it would usually be 
closely linked to the performance of an EKG or other separately payable 
cardiac service, would rarely, if ever, be the only OPPS service 
provided to a patient in an encounter, and has a low estimated resource 
cost. The proposed packaged treatment of this code is consistent with 
the principles and incentives for efficiency inherent in a prospective 
payment system based on groups of services. Therefore, we proposed to 
continue to package payment for CPT code 0069T for CY 2008.
    We did not receive any comments related to this proposal. 
Therefore, we are finalizing our proposal, without modification, to 
continue to package payment for CPT code 0069T for CY 2008.
Recommendation 6
    For CY 2008, we proposed to adopt the APC Panel's recommendation 
and maintain the packaged status of HCPCS code A4306. We note that at 
its

[[Page 66669]]

September 2007 APC Panel meeting, the Panel recommended specifically 
that CMS provide more data at the next meeting on this code.
    HCPCS code A4306 describes a disposable drug delivery system with a 
flow rate of less than 50 ml per hour. As discussed during the March 
2007 APC Panel meeting, there is a particular disposable drug delivery 
system that is specifically used to treat postoperative pain. Since the 
implementation of the OPPS, this code was assigned to status indicator 
``A,'' indicating that it was payable according to another fee 
schedule, in this case, the Durable Medical Equipment (DME) fee 
schedule. There were discussions during CYs 2005 and 2006 between CMS 
and a manufacturer, and it was determined that this code should be 
removed from the DME fee schedule as this code does not describe DME. 
For CY 2007, HCPCS code A4306 is payable under the OPPS, with status 
indicator ``N'' indicating that its payment is unconditionally 
packaged.
    One presenter to the APC Panel requested that we pay separately for 
this supply under the OPPS. For CY 2007, we packaged payment for this 
code because it is considered to be a supply, and since the inception 
of the OPPS the established payment policy packages payment for 
supplies because they are directly related and integral to an 
independent service furnished under the OPPS.
    Our CY 2006 claims data indicate that HCPCS code A4306 was billed 
on OPPS claims 1,773 times, yielding a line-item median cost of 
approximately $3. The APC Panel and a presenter believe that this code 
may not always be appropriately billed by hospitals as the data also 
show that this code was billed together with computed tomography (CT) 
scans of the thorax, abdomen, and pelvis approximately 40 percent of 
the time that this supply was reported. The APC Panel speculated that 
this code may be currently reported when other types of drug delivery 
devices are utilized for nonsurgical procedures or for purposes other 
than the treatment of postoperative pain. Therefore, the APC Panel 
requested that we share additional data when available.
    In summary, because HCPCS code A4306 represents a supply and 
payment of supplies is packaged under the OPPS according to 
longstanding policy, we proposed to maintain the packaged status of 
HCPCS code A4306 for CY 2008.
    Comment: A commenter supported CMS' proposal to maintain the 
packaged status of HCPCS code A4306 for CY 2008. The commenter 
suspected that this code is misreported by hospitals and estimated that 
the true cost of the supply is between $20 and $60. The commenter 
requested that CMS provide instructions to hospitals on the appropriate 
revenue center for this supply and contact the AHA coding clinic 
regarding the need for better HCPCS code instructions for this supply.
    Response: In general, we give hospitals the flexibility to report 
charges under whichever revenue code the hospital believes is most 
appropriate. In addition, it is not our usual practice to refer codes 
to the AHA coding clinic for review. Instead, we encourage the 
commenter to submit any questions or requests for clarification to the 
AHA coding clinic, if appropriate.
    We are finalizing without modification our proposal to continue to 
package payment for HCPCS code A4306 for CY 2008. In addition, with 
respect to APC Panel Recommendation 9, we will provide the APC Panel 
with more cost data related to this code at its next meeting.
Recommendation 7
    For CY 2008, we proposed to maintain the packaged status of CPT 
code 99186, consistent with the APC Panel's recommendation that we 
reevaluate the packaged OPPS payment for CPT code 99186 based on 
current research and the availability of new therapeutic modalities. 
This service describes induced total body hypothermia that is performed 
on some post-cardiac arrest patients to avoid or lessen brain damage. 
The service has been packaged since the implementation of the OPPS. One 
presenter to the APC Panel at the March 2007 meeting requested that 
this code be assigned a separately payable status indicator under the 
OPPS. The presenter expressed concern that hospitals that provide this 
service and subsequently transfer the patient to another hospital prior 
to admission are not adequately paid for their services.
    Because this service does not fit into one of the seven identified 
categories of packaged codes proposed for the CY 2008 OPPS, we followed 
our historical packaging guidelines to determine whether to maintain 
the packaged status of this code or to pay for it separately. Claims 
data indicate that this code was billed 39 times under the OPPS in CY 
2006 and was never billed without another separately payable service on 
the same date. The proposed CY 2008 median cost for this code was 
approximately $35, with individual costs ranging from approximately $17 
to $69, likely reflecting the costs associated with traditional methods 
of inducing total body hypothermia, such as ice packs applied to the 
body. In fact, the presenter noted that a technologically advanced 
total body hypothermia system costs $30,000, with an additional cost of 
$1,600 per disposable body suit. As expected, our claims data showed 
that this service was provided most frequently with high level 
emergency department visits and critical care services.
    As we noted in the CY 2008 proposed rule, we believed that the 
circumstances in which total body hypothermia would be provided to a 
Medicare beneficiary and billed under the OPPS were extremely rare, as 
patients requiring this therapy would almost always be admitted as 
inpatients if they survive. Moreover, in the uncommon situation where a 
patient presents to one hospital and then is cooled and transported to 
another hospital without admission to the first hospital, payment for 
the hypothermia service would be most appropriately packaged into 
payment for the many other separately payable services that it most 
likely accompanied and that would be paid to the first hospital under 
the OPPS.
    In addition, consistent with the principles and incentives for 
efficiency inherent in a prospective payment system based on groups of 
services, packaging payment for this procedure that is highly 
integrated with other services provided in the hospital outpatient 
encounter creates incentives for providers to furnish services in the 
most cost-effective way. In situations where there are a variety of 
supplies that could be used to furnish a service, some of which are 
more expensive than others, packaging encourages hospitals to use the 
most cost-effective item that meets the patient's needs.
    This code was discussed by the APC Panel members during the 
September 2007 APC Panel meeting, but they made no official 
recommendation.
    We did not receive any comments related to our proposal. Therefore, 
we are finalizing our proposal to maintain the packaged status of CPT 
code 99186 for CY 2008.
Recommendation 8
    We note that the Packaging Subcommittee remains active. See 
Recommendation 10 below.
Recommendation 9
    As noted in Recommendation 6, in accordance with the APC Panel's 
recommendation, we will provide more cost data related to HCPCS code 
A4306 (Disposable drug delivery system, flow

[[Page 66670]]

rate of less than 50 mL per hour) for the APC Panel's review at its 
next meeting.
Recommendation 10
    In response to the APC Panel's recommendation for the Packaging 
Subcommittee to remain active until the next APC Panel meeting, we note 
that the APC Panel Packaging Subcommittee remains active, and 
additional issues and new data concerning the packaging status of codes 
will be shared for its consideration as information becomes available. 
We continue to encourage submission of common clinical scenarios 
involving currently packaged HCPCS codes to the Packaging Subcommittee 
for its ongoing review, and we also encourage recommendations of 
specific services or procedures whose payment would be most 
appropriately packaged under the OPPS. Additional detailed suggestions 
for the Packaging Subcommittee should be submitted to 
[email protected], with ``Packaging Subcommittee'' in the subject 
line.

B. Payment for Partial Hospitalization

1. Background
    Partial hospitalization is an intensive outpatient program of 
psychiatric services provided to patients as an alternative to 
inpatient psychiatric care for beneficiaries who have an acute mental 
illness. A partial hospitalization program (PHP) may be provided by a 
hospital to its outpatients or by a Medicare-certified community mental 
health center (CMHC). Section 1833(t)(1)(B)(i) of the Act provides the 
Secretary with the authority to designate the hospital outpatient 
services to be covered under the OPPS. The Medicare regulations at 
Sec.  419.21 that implement this provision specify that payments under 
the OPPS will be made for partial hospitalization services furnished by 
CMHCs as well as those furnished to hospital outpatients. Section 
1833(t)(2)(C) of the Act requires that we establish relative payment 
weights based on median (or mean, at the election of the Secretary) 
hospital costs determined by 1996 claims data and data from the most 
recent available cost reports. Payment to providers under the OPPS for 
PHPs represents the provider's overhead costs associated with the 
program. Because a day of care is the unit that defines the structure 
and scheduling of partial hospitalization services, we established a 
per diem payment methodology for the PHP APC, effective for services 
furnished on or after August 1, 2000. For a detailed discussion, which 
includes a discussion of the decision to base relative payment rates on 
median cost, we refer readers to the April 7, 2000 OPPS final rule with 
comment period (65 FR 18482).
    Historically, the median per diem cost for CMHCs greatly exceeded 
the median per diem cost for hospital-based PHPs and fluctuated 
significantly from year to year, while the median per diem cost for 
hospital-based PHPs remained relatively constant ($200-$225). We 
believe that CMHCs may have increased and decreased their charges in 
response to Medicare payment policies. As discussed in more detail in 
section II.B.2. of this final rule with comment period and in the CY 
2004 OPPS final rule with comment period (68 FR 63470), we also believe 
that some CMHCs manipulated their charges in order to inappropriately 
receive outlier payments.
    For CY 2005, the PHP per diem amount was based on 12 months of 
hospital and CMHC PHP claims data (for services furnished from January 
1, 2003, through December 31, 2003). We used data from all hospital 
bills reporting condition code 41, which identifies the claim as 
partial hospitalization, and all bills from CMHCs because CMHCs are 
Medicare providers only for the purpose of providing partial 
hospitalization services. We used CCRs from the most recently available 
hospital and CMHC cost reports to convert each provider's line-item 
charges as reported on bills to estimate the provider's cost for a day 
of PHP services. Per diem costs were then computed by summing the line-
item costs on each bill and dividing by the number of days on the bill.
    In the CY 2005 OPPS update, the CMHC median per diem cost was $310, 
the hospital-based PHP median per diem cost was $215, and the combined 
CMHC and hospital-based median per diem cost was $289. We believed that 
the reduction in the CY 2005 CMHC median per diem cost compared to 
prior years indicated that the use of updated CCRs had accounted for 
the previous increase in CMHC charges and represented a more accurate 
estimate of CMHC per diem costs for PHP.
    For the CY 2006 OPPS final rule with comment period, we analyzed 12 
months of the most current claims data available for hospital and CMHC 
PHP services furnished between January 1, 2004, and December 31, 2004. 
We also used the most currently available CCRs to estimate costs. The 
median per diem cost for CMHCs dropped to $154, while the median per 
diem cost for hospital-based PHPs was $201. Based on the CY 2004 claims 
data, the average charge per day for CMHCs was $760, considerably 
greater than hospital-based per day costs but significantly lower than 
what it was in CY 2003 ($1,184). We believed that a combination of 
reduced charges and slightly lower CCRs for CMHCs resulted in a 
significant decline in the CMHC median per diem cost between CY 2003 
and CY 2004.
    Following the methodology used for the CY 2005 OPPS update, the CY 
2006 OPPS updated combined hospital-based and CMHC median per diem cost 
was $161, a decrease of 44 percent compared to the CY 2005 combined 
median per diem amount.
    Due to concern that this amount may not cover the cost for PHPs, as 
stated in the CY 2006 OPPS final rule with comment period (70 FR 68548 
and 68549), we applied a 15-percent reduction to the combined hospital-
based and CMHC median per diem cost to establish the CY 2006 PHP APC. 
(We refer readers to the CY 2006 OPPS final rule with comment period 
for a full discussion of how we established the CY 2006 PHP rate (70 FR 
68548).) We stated our belief that a reduction in the CY 2005 median 
per diem cost would strike an appropriate balance between using the 
best available data and providing adequate payment for a program that 
often spans 5-6 hours a day. We stated that 15 percent was an 
appropriate reduction because it recognized decreases in median per 
diem costs in both the hospital data and the CMHC data, and also 
reduced the risk of any adverse impact on access to these services that 
might result from a large single-year rate reduction. However, we 
adopted this policy as a transitional measure, and stated in the CY 
2006 OPPS final rule with comment period that we would continue to 
monitor CMHC costs and charges for these services and work with CMHCs 
to improve their reporting so that payments could be calculated based 
on better empirical data (70 FR 68548). To apply this methodology for 
CY 2006, we reduced the CY 2005 combined unscaled hospital-based and 
CMHC median per diem cost of $289 by 15 percent, resulting in a 
combined median per diem cost of $245.65 for CY 2006.
    For the CY 2007 final rule with comment period, we analyzed 12 
months of more current data for hospital and CMHC PHP claims for 
services furnished between January 1, 2005, and December 31, 2005, and 
used the most currently available CCRs to estimate costs. Using these 
updated data, we recreated the analysis performed for the CY 2007 
proposed rule to determine if the significant factors we used in 
determining the proposed PHP rate had changed. The median per diem cost 
for CMHCs increased $8 to $173, while the

[[Page 66671]]

median per diem cost for hospital-based PHPs decreased $19 to $190. The 
CY 2005 average charge per day for CMHCs was $675, similar to the 
figure noted in the CY 2007 proposed rule ($673) but still 
significantly lower than what was noted as the average charge for CY 
2003 ($1,184).
    The combined hospital-based and CMHC median per diem cost would 
have been $175 for CY 2007. Rather than allowing the PHP median per 
diem cost to drop to this level, we proposed to reduce the PHP median 
cost by 15 percent, similar to the methodology used for the CY 2006 
update. However, after considering all public comments received 
concerning the proposed CY 2007 PHP per diem rate and results obtained 
using the more current data, we modified our proposal. We made a 5-
percent reduction to the CY 2006 median per diem rate to provide a 
transitional path to the per diem cost indicated by the data. This 
approach accounted for the downward direction of the data and addressed 
concerns raised by commenters about the magnitude of another 15-percent 
reduction in 1 year. Thus, to calculate the CY 2007 APC PHP per diem 
cost, we reduced $245.65 (the CY 2005 combined hospital-based and CMHC 
median per diem cost of $289 reduced by 15 percent) by 5 percent, which 
resulted in a combined per diem cost of $233.37.
2. PHP APC Update for CY 2008
    As noted in the CY 2008 OPPS/ASC proposed rule (72 FR 42691), for 
the past 2 years, we were concerned that we did not have sufficient 
evidence to support using the median per diem cost produced by the most 
current year's PHP data. After extensive analysis, we now believe the 
data reflects the level of cost for the type of services that are being 
provided. This analysis included an examination of revenue-to-cost 
center mapping, refinements to the per diem methodology, and an in-
depth analysis of the number of units of service per day.
    As stated in the CY 2008 proposed rule (72 FR 42691), the CY 2006 
and CY 2007 OPPS updates data have produced median costs that we 
believed were too low to cover the cost of a program that typically 
spans 5 to 6 hours per day. However, we continued to observe a clear 
downward trend in the data. We stated that if the data continued to 
reflect a low PHP per diem cost in CY 2008, we expected to continue the 
transition of decreasing the PHP median per diem cost to an amount that 
is more reflective of the data.
    We received a comment on the CY 2007 proposed rates that CMS 
understated the PHP median cost by not using a hospital-specific CCR 
for partial hospitalization. In our response to this comment in the CY 
2007 OPPS/ASC final rule with comment period (71 FR 68000), we noted 
that, although most hospitals do not have a cost center for partial 
hospitalization, we used the CCR as specific to PHP as possible. The 
following CMS Web site contains the revenue-code-to-cost-center 
crosswalk: http://www.cms.hhs.gov/HospitalOutpatientPPS/03--
crosswalk.asp#TopOfPage.
    As noted in the proposed rule (72 FR 42691), this crosswalk 
indicates how charges on a claim are mapped to a cost center for the 
purpose of converting charges to cost. One or more cost centers are 
listed for most revenue codes that are used in the OPPS median 
calculations, starting with the most specific, and ending with the most 
general. Typically, we map the revenue code to the most specific cost 
center with a provider-specific CCR. However, if the hospital does not 
have a CCR for any of the listed cost centers, we consider the overall 
hospital CCR as the default. For partial hospitalization, the revenue 
center codes billed by PHPs are mapped to Primary Cost Center 3550 
``Psychiatric/Psychological Services''. If that cost center is not 
available, they are mapped to the Secondary Cost Center 6000 
``Clinic.'' We use the overall facility CCR for CMHCs because PHPs are 
CMHCs' only Medicare cost, and CMHCs do not have the same cost 
structure as hospitals. Therefore, for CMHCs, we use the CCR from the 
outpatient provider-specific file.
    As indicated in the proposed rule (72 FR 42691), closer examination 
of the revenue-code-to-cost-center crosswalk revealed that 10 of the 
revenue center codes (shown in the table below) that are common among 
hospital-based PHP claims did not map to a Primary Cost Center 3550 
``Psychiatric/Psychological Services'' or a Secondary Cost Center of 
6000 ``Clinic.''

------------------------------------------------------------------------
       Revenue center code               Revenue center description
------------------------------------------------------------------------
0430.............................  Occupational Therapy.
0431.............................  Occupational Therapy: Visit charge.
0432.............................  Occupational Therapy: Hourly charge.
0433.............................  Occupational Therapy: Group rate.
0434.............................  Occupational Therapy: Evaluation/re-
                                    evaluation.
0439.............................  Occupational Therapy: Other
                                    occupational therapy.
0904.............................  Psychiatric/Psychological Treatment:
                                    Activity therapy.
0940.............................  Other Therapeutic Services.
0941.............................  Other Therapeutic Services:
                                    Recreation Rx.
0942.............................  Other Therapeutic Services: Education/
                                    training.
------------------------------------------------------------------------

    We believed these 10 revenue center codes did not map to either a 
Primary Cost Center 3550 ``Psychiatric/Psychological Services'' or a 
Secondary Cost Center 6000 ``Clinic'' because these codes may be used 
for services that are not PHP or psychiatric related. For example, the 
majority of Occupational Therapy services are not furnished to PHP 
patients and, therefore, these services should be appropriately mapped 
to a Primary Cost Center 5100 ``Occupation Therapy'' (the general 
Occupational Therapy Cost Center). Another example would be claims for 
Diabetes Education, which is also not furnished to PHP patients.
    For this final rule with comment period, we have updated this 
analysis using updated claims and CCR data for PHP claims. Again, we 
remapped the 10 revenue center codes described earlier in this section 
to a Primary Cost Center 3550 ``Psychiatric/Psychological Services'' or 
a Secondary Cost Center 6000 ``Clinic''. Once we remapped the codes, we 
computed an alternate cost for each line item of the CY 2006 hospital-
based PHP claims. There are a total of 723,749 line items in the CY 
2006 hospital-based PHP claims. Prior to remapping, there were 320,504 
line items where a default CCR was used to estimate costs. After the 
remapping, there were 160,351 line items left defaulting to the 
hospitals' overall CCR. While this remapping creates a more accurate 
estimate of PHP per diem costs for a significant number of claims, 
again there was not a large change in the resulting median per diem 
cost. The median per diem costs for hospital-based PHPs increased by $5 
(from $172 to $177). We note that, unlike the proposed rule, this final 
rule analysis was done using the revised methodology for computing per 
diem costs described below. We received no public comments in 
opposition to the proposed change in remapping revenue codes to 
alternate cost centers. Therefore, we are adopting this proposed change 
beginning in CY 2008.
    As part of our effort to produce the most accurate per diem cost 
estimate, we have reexamined our methodology for computing the PHP per 
diem cost. Section 1833(t)(2)(C) of the Act requires that we establish 
relative payment weights based on median (or mean, at

[[Page 66672]]

the election of the Secretary) hospital costs determined by 1996 claims 
data and data from the most recent available cost reports. As explained 
in section II.B.1. of this final rule with comment period, payment to 
providers under OPPS for PHP services represents the provider's 
overhead costs associated with the program. Because a day of care is 
the unit that defines the structure and scheduling of partial 
hospitalization services, we established a per diem payment methodology 
for the PHP APC. Other than being a per diem payment, we use the 
general OPPS ratesetting methodology for determining median cost.
    As we have described in prior Federal Register notices, our current 
method for computing per diem costs is as follows: We use data from all 
hospital bills reporting condition code 41, which identifies the claim 
as partial hospitalization, and all bills from CMHCs. We use CCRs from 
the most recently available hospital and CMHC cost reports to convert 
each provider's line-item charges as reported on bills to estimate the 
provider's cost for a day of PHP services. Per diem costs are then 
computed by summing the line-item costs on each bill and dividing by 
the number of days of PHP care provided on the bill. These computed per 
diem costs are arrayed from lowest to highest and the middle value of 
the array is the median per diem cost.
    As indicated in the proposed rule (72 FR 42692), we have developed 
an alternate way to determine median cost by computing a separate per 
diem cost for each day rather than for each bill. Under this method, a 
cost is computed separately for each day of PHP care. When there are 
multiple days of care entered on a claim, a unique cost is computed for 
each day of care. All of these costs are then arrayed from lowest to 
highest and the middle value of the array would be the median per diem 
cost.
    We proposed to adopt this alternative method of computing PHP per 
diem median cost because we believe it produces a more accurate 
estimate because each day gets an equal weight towards computing the 
median. In light of the stabilizing trend in the data, and the 
robustness of recent data analysis, we believe it is now appropriate to 
adopt this method. We believe this method for computing a PHP per diem 
median cost more accurately reflects the costs of a PHP and uses all 
available PHP data. We received no public comments in opposition to the 
revised method for computing per diem cost, although we did receive a 
few public comments critical of our current method of computing per 
diem costs. (These public comments and our response are addressed 
below.) Therefore, we are adopting this proposed change beginning in CY 
2008.
    As noted previously, for the past 2 years, the data have produced 
median costs that we believed were too low to cover the cost of a 
program that typically spans 5 to 6 hours per day. This length of day 
would include five or six services with a break for lunch. We looked at 
the number of units of service being provided in a day of care, as a 
possible explanation for the low per diem cost for PHP. Our analysis 
revealed that both hospital based and CMHC PHPs have a significant 
number of days where fewer than 4 units of service were provided.
    Using updated data from the CY 2008 proposed rule, specifically, 64 
percent of the days that CMHCs were paid were for days where 3 or less 
units of services were provided, and 31 percent of the days that 
hospital-based PHPs were paid were for days where 3 or less units of 
service were provided. We continue to believe these findings are 
significant because they may explain a lower per diem cost. Based on 
these updated findings, we computed median per diem costs in two 
categories:
    (a) All days.
    (b) Days with 4 units of service or more (removing days with 3 
services or less).
    These updated median per diem costs were computed separately for 
CMHCs and hospital based PHPs and are shown in the table below:

------------------------------------------------------------------------
                                                 Hospital-
                                      CMHCs      based PHPs    Combined
------------------------------------------------------------------------
All Days.........................         $172         $177         $172
Days with 4 units or more........          192          189          192
------------------------------------------------------------------------

    As expected, excluding the low unit days resulted in a higher 
median per diem cost estimate. However, if the programs have many ``low 
unit days,'' their cost and Medicare payment should reflect this level 
of service. It would not be appropriate to set the PHP rate to exclude 
the ``low unit days'' because these days are covered PHP days. We 
believe the analysis of the number of units of service per day supports 
a lower per diem cost. Therefore, including all days supports the data 
trend towards a lower per diem cost and we believe more accurately 
reflects the costs of providing PHP services.
    Although the minimum number of PHP services required in a PHP day 
is three, it was never our intention that this represented the number 
of services to be provided in a typical PHP day. Our intention was to 
cover days that consisted of only three services, generally because a 
patient was transitioning towards discharge (or a patient who is 
transitioning at the beginning of their PHP stay). Rather than set 
separate rates for half-days and full-days, we believed it was 
appropriate to set one rate that would be paid for all PHP days, 
including those for patients transitioning towards discharge (or 
admission). We intended that the PHP benefit is for a full day, with 
shorter days only occurring while a patient transitions into or out of 
the PHP.
    However, as indicated in the data, many programs have these ``low 
unit days,'' and we believe their cost and Medicare payment should 
reflect this level of service. It would not be appropriate to set the 
PHP rate excluding the low unit days because these days are covered. 
Again, we believe the data support the estimated per diem cost under 
$200 that we have observed.
    We believed the most appropriate payment rate for PHPs is computed 
using both hospital-based and CMHC PHP data, including the remapped 
data for all days, resulting in a median per diem cost of $178. 
Therefore, we proposed a CY 2008 APC PHP per diem cost of $178.
    We received a large number of public comments on our proposal. A 
summary of the public comments received and our responses follow.
    Comment: A number of commenters expressed concern about the 
magnitude of the PHP per diem rate reduction, particularly in light of 
the reductions over the past few years. Many commenters believe that 
such a reduction would reduce the financial viability and possibly lead 
to the closure of many PHPs, thus affecting access to this crucial 
service that serves vulnerable populations. Many commenters stated that 
PHPs are an

[[Page 66673]]

integral part of the continuum of care, and if programs were forced to 
close, there would be an increase in the length and number of more 
costly inpatient hospital stays. In addition, because hospital 
outpatient mental health services paid under the OPPS are capped at the 
PHP per diem rate, many commenters were concerned about overall access 
to outpatient mental health treatment. The majority of commenters 
requested that CMS freeze the PHP per diem rate at the CY 2007 level, 
and some suggested inflating this rate each year by the consumer price 
index or market basket update. In addition, several patients were 
concerned that the proposed 24-percent reduction in payment would 
negatively impact their ability to continue therapy. One commenter 
requested that CMS limit the annual reduction to 5 percent, phasing in 
the reduction over several years if necessary.
    Response: For this CY 2008 final rule with comment period, we 
analyzed 12 months of more current data for hospital and CMHC PHP 
claims for PHP services furnished between January 1, 2006 and December 
31, 2006. These claims data are more current than the CY 2008 proposed 
rule claims data because the data include claims paid through June 30, 
2007. We also used the most currently available CCRs to estimate costs. 
Using these updated data, we recreated the analysis performed for the 
proposed rule to determine if the significant factors we used in 
determining the proposed PHP rate had changed. The median per diem cost 
for CMHCs decreased $6 to $172, while the median per diem cost for 
hospital based PHPs decreased $9 to $177. The combined median per diem 
cost, which is computed from both hospital-based and CMHC PHP data, 
decreased $6 to $172. The CY 2006 average charge per day for CMHCs was 
$615, similar to the figure noted in the CY 2007 proposed rule ($613) 
and slightly lower than the average charge per day for hospital-based 
PHPs ($631).
    The data in this area have been volatile in the past and CMS must 
establish a payment amount that reflects the intensity of the PHP, and 
that also considers that costs for providing PHP services are 
declining. We proposed two refinements to the methodology for computing 
the PHP median, however, these refinements did not appreciably impact 
the median per diem cost. We received no public comments in opposition 
to these refinements and, therefore, we are adopting them in this final 
rule with comment period. Thus, for CY 2008, we remapped the revenue 
codes to the most appropriate cost centers and computed the median 
using a per day methodology (as described earlier in this section).
    In addition, based on our data analysis, we have determined that 
CMHCs (and hospital-based PHPs to a lesser extent) are furnishing a 
substantial number of low unit days. Although these are all covered 
days in the context of existing Medicare guidelines, PHPs are furnished 
in lieu of psychiatric hospitalization and are intended to be more 
intensive than a half-day program. While the guidelines have allowed a 
minimum of three services per day, this was intended to be a floor, not 
the norm.
    We conducted extensive data analysis, which included unit analysis, 
revenue code and HCPCS/CPT frequency analysis, and we have learned that 
PHPs often use the least costly staff and may not offer the full range 
of PHP services contemplated in section 1861(ff) of the Act. However, 
we believe the data accurately represent the level of service provided.
    Because partial hospitalization is provided in lieu of inpatient 
care, it should be a highly structured and clinically-intensive 
program, usually lasting most of the day. Our goal is to improve the 
level of service furnished in a PHP day. We are concerned that the 
proposed decrease in PHP payment may not reflect the mix and quantity 
of services that should be provided under such an intensive program. In 
an effort to ensure access to this needed service to vulnerable 
populations, we are mitigating the reduction to 50 percent of the 
difference between the current APC amount ($233) and the computed 
amount based on the PHP data ($172), resulting in an APC median cost of 
$203. We believe this payment amount will give the providers an 
opportunity to increase the intensity of their programs and maintain 
partial hospitalization as part of the continuum of mental health care.
    We reiterate our expectation that hospitals and CMHCs will provide 
a comprehensive program consistent with the statutory intent. We intend 
to explore the changes to our regulations and claims processing systems 
in order to deny payment for low intensity days and we specifically 
invite public comment on the most appropriate threshold.
    Comment: A few commenters disagreed with the CMS approach to 
establishing the median per diem cost by summarizing the line-item 
costs on each bill and dividing by the number of days on the bills. The 
commenters indicated that this calculation can severely dilute the rate 
and penalize providers. The commenters stated that all programs are 
strongly encouraged by the fiscal intermediaries to submit all PHP 
service days on claims, even when the patient receives less than three 
services. They further stated that programs must report these days to 
be able to meet the 57 percent attendance threshold and avoid potential 
delays in the claim payment. The commenters were concerned that 
programs are only paid their per diem when three or more qualified 
services are presented for a day of service. The commenters stated that 
if only one or two services are assigned a cost and the day is divided 
into the aggregate data, the cost per day is significantly compromised 
and diluted. They claimed that even days that are paid but only have 
three services dilute the cost factors on the calculations.
    Response: As discussed earlier in this section, we have refined our 
methodology for computing per diem costs. We have developed an 
alternate way to determine median cost by computing a separate per diem 
cost for each day rather than for each bill. Under this method, a cost 
is computed separately for each day of PHP care. When there are 
multiple days of care entered on a claim, a unique cost is computed for 
each day of care. We only assign costs for line items on days when a 
payment is made. All of these costs are then arrayed from lowest to 
highest and the middle value of the array would be the median per diem 
cost.
    We adopted this alternative method of computing PHP per diem median 
cost because we believe it produces a more accurate estimate because 
each day gets an equal weight towards computing the median. This method 
for computing a PHP per diem median cost more accurately reflects the 
costs of a PHP and uses all available PHP data. Additionally, if a 
provider has charges on a bill for which the provider does not receive 
payment, this will be reflected in that provider's CCRs. This lower CCR 
will be applied to the larger charges and will result in the 
appropriate cost per diem.
    To gauge the effect that days with one or two services had on the 
per diem cost, we trimmed all days with less than three services, and 
the recalculated median per diem cost only changed by $2.00. As such, 
we do not believe the calculations are adversely affected by the 
inclusion of these days.
    Comment: One commenter suggested that CMS set the PHP median per 
diem cost based on days when four or more services are provided and 
then pay a low-utilization payment adjustment amount for days when 
three or fewer

[[Page 66674]]

services are provided. The commenter also suggested that CMS establish 
frequency constraints for billing three or fewer services to prevent 
the bulk of days furnished by a provider from becoming low utilization 
days. The commenter urged CMS to further research this suggestion as a 
possible payment restructuring for CY 2009. Several commenters urged 
CMS to reevaluate the PHP payment methodology and to either refine the 
APC structure for PHP to reflect different service levels or to exclude 
the low-volume days from the calculation of the PHP rate and develop an 
alternate payment policy for low-volume days.
    Response: The structure of partial hospitalization is a full day of 
treatment. We are concerned about providing an incentive for providers 
to structure their PHPs on a half-day basis. As discussed earlier in 
this section, in an effort to ensure access to this needed service to 
vulnerable populations, we are mitigating the reduction to the PHP rate 
for CY 2008. We think establishing a half-day rate is inconsistent with 
this policy. Therefore, we are not prepared to establish a half day 
rate at this time. However, we are willing to explore how we could 
utilize frequency controls to maintain the overall intensity of the 
partial hospitalization benefit.
    Comment: One commenter noted that CMS did not respond to previous 
statements from commenters that the industry would welcome 
accreditation rules and/or stricter policies for PHPs.
    Response: For the CY 2009 OPPS update, we are exploring proposing 
conditions of participation for CMHCs to establish minimum standards 
for patient rights, physical environment, staffing, and documentation 
requirements. In addition, we are considering changes that are 
necessary to our regulations and claims processing systems to deny 
payment for low intensity days. We specifically invite public comment 
on the most appropriate threshold.
    Comment: Many commenters requested that the CMHC cost report data 
be included in the HCRIS so that the industry can review and analyze 
CMHC cost data.
    Response: We understand the commenters' need to have CMHC data 
available through the HCRIS system and are working to accomplish this 
task.
    Comment: With respect to the methodology used to establish the PHP 
APC amount, commenters were concerned that data from settled cost 
reports do not include costs reversed on appeal. The commenters stated 
that there are inherent problems in using claims data from a time 
period that is different from that for the CCRs from settled cost 
reports. The commenters indicated this methodology would artificially 
lower the computed median costs, and that the data used to calculate 
the PHP rate should be revised to include costs that were subsequently 
allowed. The commenters also stated that CMS uses costs that are at 
least 1 to 3 years old to project rates 2 years forward and that this 
approach does not accurately reflect the true costs of the providers.
    Response: We use the best available data in computing the APCs. On 
January 17, 2003, we issued Program Memorandum No. A-03-004 that 
directed fiscal intermediaries to update the CCRs on an on going basis 
whenever a more recent full year settled or tentatively settled cost 
report is available. In this way, we minimize the time lag between the 
CCRs and claims data and continue to use the best available data for 
ratesetting purposes.
    Comment: Several commenters summed the payment rate for four Group 
Therapy sessions (APC 0325) and requested that amount as the minimum 
for a day of PHP (that is, 4 x $64.45=$257.80). Another commenter 
presented two different typical days using proposed CY 2008 rates. 
Typical Day 1 included three Group Therapy sessions (CPT code 90853, 
APC 0325, 3 x $64.45) and one Individual Psychotherapy session (CPT 
code 90818, APC 0323, $106.49). The commenter priced Typical Day 1 at 
$299.84. Typical Day 2 included one Group Therapy session (CPT code 
90853, APC 0325, $64.45), one Individual Psychotherapy session (CPT 
code 90818, APC 0323, $106.49), and one Family Therapy session (CPT 
code 90847, APC 0324, $141.61). The commenter priced Typical Day 2 at 
$312.55. Based on the commenter's presented material, the commenter 
stated that the typical days yield an average componentized rate of 
$306. The commenter questioned how CMS can set rates for APCs 0322 
through 0325, but is unable to determine a payment rate for a day that 
is comprised of a minimum of three to four of those services. Other 
commenters stated that while CMS requires a minimum of four treatments 
per day to qualify for a day of PHP, the proposed per diem rate of 
$179.88 for PHP is less than what CMS would pay for four Group Therapy 
sessions.
    Response: We do not believe this is an appropriate comparison. The 
commenter does not use the payment rate for the PHP APC, that is, APC 
0033, in the calculations. The payment rates for APC services cited by 
the commenter (APC 0323, APC 0324 and APC 0325) are not computed from 
PHP bills. As stated earlier, we used data from PHP programs (both 
hospitals and CMHCs) to determine the median cost of a day of PHP. PHP 
is a program of services where savings can be realized by hospitals and 
CMHCs over delivering individual psychotherapy services.
    We structured the PHP APC (APC 0033) as a per diem methodology in 
which the day of care is the unit that reflects the structure and 
scheduling of PHPs and the composition of the PHP APC consists of the 
cost of all services provided each day. Although we require that each 
PHP day include a psychotherapy service, we do not specify the specific 
mix of other services provided and our payment methodology reflects the 
cost per day rather than the cost of each service furnished within the 
day.
    CMS examined both CMHC and hospital-based PHP program data to 
determine what services these programs are providing to their patients. 
An important finding was that the days cited by the commenter are not 
typical days for most CMHCs. For CMHCs, 60 percent of services are 
Group Psychotherapy (CPTs 90853 and 90857), 26 percent of services are 
Training and Education (HCPCS G0177), 12 percent are Activity Therapy 
(HCPCS G0176), and only 1 percent of PHP days included Individual 
Therapy (Brief or Extended, CPTs 90816 or 90818)).
    The days cited by the commenter are not typical days for hospital-
based PHPs either. For hospital-based PHPs, 47 percent of services are 
Group Psychotherapy (CPT codes 90853 and 90857), 27 percent of services 
are Training and Education (HCPCS code G0177), 16 percent are Activity 
Therapy (HCPCS code G0176), 3 percent are Occupational Therapy (HCPCS 
code G0129), 2 percent of PHP days include Brief Individual 
Psychotherapy (CPT code 90816), and only 1 percent of PHP days include 
Extended Individual Therapy (CPT code 90818).
    We note that the APCs for Training and Education (HCPCS code 
G0177), Activity Therapy (HCPCS code G0176), and Occupational Therapy 
(HCPCS code G0129) are not separately payable under the OPPS. They are 
packaged services and only payable as part of a PHP day of care. In 
CMHCs, Training and Education (HCPCS code G0177) and Activity Therapy 
(HCPCS code G0176), account for 38 percent of PHP services. In 
hospital-based PHPs, Training and Education and Activity Therapy 
account for 43 percent of PHP services. In addition to not being 
separately payable, these services may be provided to

[[Page 66675]]

patients by less costly staff than staff that provide Psychotherapy and 
Occupational Therapy. Based on the mix of services provided on the 
majority of PHP days, we believe the data used for setting the PHP 
payment appropriately reflect the typical PHP day.
    Comment: One commenter asked CMS to consider implementing a 
reimbursement level for intensive outpatient program (IOP) services 
because the commenter's State requires 3 hours of service for such 
programs.
    Response: While some private insurers and some State Medicaid 
programs recognize IOP as a distinct benefit (like PHP), Medicare does 
not. However, hospitals that provide IOP services may bill Medicare 
under the OPPS for individual mental health services that are otherwise 
covered and billable under the OPPS.
    Comment: Several commenters claimed that the costs of CMHCs are 
higher because ``hospitals can share and spread their costs to other 
departments.'' The commenters believed that the CMHC patient acuity 
level is more intense than that for hospital patients because hospital 
outpatient departments need only provide one or two therapies, yet 
still receive the full PHP per diem.
    Response: CMHCs are required to furnish an array of outpatient 
services including specialized outpatient services for children, the 
elderly, individuals with a serious mental illness, and residents of 
its service area who have been discharged from inpatient treatment. 
Accordingly, CMHCs have the same ability as hospitals to share costs 
among its programs as needed. Further, we believe hospital costs in 
some areas, for example, capital and 24-hour maintenance costs, greatly 
exceed comparable CMHC costs. Notably, we believe patient acuity across 
hospital-based and CMHC PHPs should be the same, that is, the patients 
would otherwise require inpatient psychiatric care regardless of 
setting (see sections 1861(ff) and 1835(a)(2)(F) of the Act).
    Comment: A few commenters expressed concern that the current 
methodology used to calculate the daily rate does not capture all 
relevant data nor does it reflect the actual cost to providers to 
deliver these services. The commenters asked that CMS analyze the 
mapping of revenue-codes-to-cost centers for CMHCs similar to the 
analysis CMS completed for hospital-based programs and discussed in the 
CY 2007 OPPS/ASC final rule with comment period (71 FR 68000). The 
commenters indicated that CMHC PHP services have higher cost-to-charge 
ratios than the overall CMHC cost-to-charge ratios.
    Response: We are unable to conduct a revenue code mapping analysis 
for CMHCs because PHP is the CMHCs' only Medicare cost and CMHCs do not 
have the same cost centers as hospitals. Therefore, for CMHCs, we use 
the overall facility CCR from the outpatient provider-specific file.
    Comment: Several commenters expressed concern that cost report data 
frequently do not reflect bad debt expense for the entire year. The 
commenters are concerned that these costs are not being considered in 
the CMS data and severely short change the rate calculations.
    Response: While, the bad debt policy is outside the scope of this 
rule, we refer the commenter to Sec.  413.89 and the Provider 
Reimbursement Manual Part I (PRM), Chapter 3, concerning our bad debt 
requirements.
    Comment: One commenter stated that administrative costs for CMHCs 
continue to be a major impediment to operating PHPs for Medicare 
beneficiaries. The commenter was concerned that Medicare does not cover 
the cost of meals and transportation to and from programs. The 
commenter stated that almost all programs offer transportation because 
in most cases Medicare beneficiaries with serious mental illnesses 
would not be able to access these programs without the transportation.
    Response: The services that are covered as part of a PHP are 
specified in section 1861(ff) of the Act. Meals and transportation are 
specifically excluded under section 1861(ff)(2)(I) of the Act.
    Comment: One commenter requested that the same provisions given to 
rural HOPDs also be given to rural CMHCs. Several commenters urged CMS 
to reconsider the changes in funding for these programs, especially the 
programs in rural areas.
    Response: We believe the commenter may be referring to the 
statutory hold harmless provisions. Section 1833(t)(7)(D) of the Act 
authorizes such payments, on a permanent basis, for children's 
hospitals and cancer hospitals and, through CY 2005, for rural 
hospitals having 100 or fewer beds and SCHs in rural areas. Section 
1866(t)(7)(D) of the Act does not authorize hold harmless payments to 
CMHCs. In addition, although section 411 of Pub. L. 108-173 required 
CMS to determine the appropriateness of additional payments for certain 
rural hospitals, that authority also does not extend to CMHCs.
    Comment: A few commenters stated that hospitals that offer partial 
hospitalization services should not be penalized for the instability in 
data reporting of CMHCs. Many commenters requested that CMS require 
that CMHCs improve their reporting or have that provider group face 
economic consequences.
    Response: As described earlier in this section, after extensive 
analysis, we now believe we have determined the appropriate level of 
cost for the type of services that are being provided by PHPs. This 
analysis included an examination of revenue-to-cost center mapping, 
refinements to the per diem methodology, and an in-depth analysis of 
the number of units of service per day. We note that for CY 2006, the 
hospital-based PHPs per diem median cost is $177 and for CMHCs, the per 
diem median cost is $172. We have observed a stabilizing trend in CMHC 
data and similar per diem costs between hospital-based and CMHC PHPs.
    Comment: Two national behavioral health care organizations 
expressed concern that contrary to congressional intent, the most 
intensive provider settings are being penalized. The commenters pointed 
out that CMS data show that PHP programs providing four or more units 
of service per day (programs that are highly intensive) have a 
substantially higher median cost for those days than the overall median 
cost per day. The commenters pointed out that hospital-based programs 
(66 percent of their days have 4 or more units of service) have a 
median cost of $218 versus a median cost of $186 for all days 
regardless of the number of units of service. They noted that CMS' use 
of the overall median cost per day understates the degree to which 
hospital-based programs are structured around four or more units of 
services, but acknowledge that on some days a patient may only get 
three services (due to leaving early for illness, transitioning out of 
the program, or other reasons). Similarly, according to one commenter, 
CMHCs have a median cost of $191 for those days with 4 or more units of 
service provided versus a median cost of $178 for all days. The 
commenter stated that CMHCs have 36 percent of their days with 4 or 
more units of service provided. The commenter indicated that its 
State's Medicaid program requires a minimum of four hours to qualify 
for a day of PHP and believed the CMS payment methodology is in 
conflict with its State's laws.
    Several commenters stated that the CMS data, when it combines those 
programs that offer 3 units with those that offer 4 or more units, 
clearly

[[Page 66676]]

penalizes the programs that routinely offer 4 or more units.
    Response: We refer the commenter to the table presented earlier in 
this section that provides updated figures to the ones cited by the 
commenter. We recognize that by definition, 50 percent of PHP days will 
have per diem costs higher than the median per diem cost, while 50 
percent will have costs lower than the median per diem cost. It is 
likely that the programs providing 4 units of service are on the high 
side of the median per diem cost. In addition, we note that the final 
rate of $203 is well above the combined median per diem cost for days 
with 4 units of service of more ($192). Days where four services are 
provided are certainly within this amount.
    Comment: One commenter asked that CMS change the Medicare lifetime 
maximum of 190 mental health days of stay in a psychiatric hospital, to 
unlimited. The commenter asserted that if a person is diagnosed with a 
mental health illness of various kinds the individual will need 
``maintenance'' throughout his or her entire life.
    Response: The 190-day lifetime limit on inpatient psychiatric care 
is statutory, and established in section 1812(b)(3) of the Act.
    Comment: Many commenters, including a national behavioral health 
association, recommended that PHP be removed from the APC codes and 
created under an independent status using home health and hospice as 
examples. The commenters are concerned that the current methodology is 
not conducive to this APC code and asserted that there is precedent in 
other CMS OPPS service industries to exclude the service from the APC 
code listing and treat it independently.
    Response: Section 1833(t)(1)(B)(i) of the Act provides the 
Secretary with the authority to designate the hospital outpatient 
services to be covered under the OPPS. The Medicare regulations at 42 
CFR 419.21 that implement this provision specify that payments under 
the OPPS will be made for partial hospitalization services furnished by 
CMHCs as well as those furnished to hospital outpatients and thus, PHP 
is paid under the OPPS. However, it would require a statutory change to 
establish an independent payment system for partial hospitalization 
programs outside the OPPS. The statute provides specific separate and 
distinct payment systems for both home health and hospice services, 
which are also separate and distinct benefit categories.
    Comment: One commenter asked why there are no CMHCs shown in the 
impact statements in the annual OPPS updating documents published in 
the Federal Register. The commenter asked if this is required by 
regulation.
    Response: CMHCs do not share the same characteristics as hospitals 
and do not fit into the traditional impact categories (like bed size). 
Therefore, we have not included them in the impact chart. As PHP is the 
only Medicare service CMHCs provide, the impact is the percentage 
change in the APC amount from year to year. Assuming that the number of 
PHP days provided by CMHCs stays the same as it was in CY 2006, the 
estimated impact on CMHCs as a result of the CY 2008 PHP payment rate 
compared to the CY 2007 PHP payment rate is a 13-percent decrease. In 
this year's impact table we have included CMHCs in the total count of 
providers, but they are not shown separately. (For additional 
information, see section XXIV, ``Regulatory Impact Analysis'' of this 
final rule with comment period.)
    Comment: Several commenters suggested establishing a PHP rate 
calculation task force to develop a new rate methodology that captures 
all relevant data and reflects the actual costs to providers to deliver 
PHP services. The commenter recommended that the ratesetting task force 
be composed of CMS staff and a diverse group of stakeholder that 
include front-line providers of PHP services and representatives from 
national industry organizations. Other commenters requested that CMS 
further study the possibility of differentiating payment based on the 
intensity of services provided during a day of PHP services for CY 
2009. These commenters also recommended that CMS establish quality 
criteria to judge performance and that would influence future rate 
reimbursement.
    Response: We agree that the payment rate for PHP needs to be 
accurate and appropriate to sustain access to care. While we believe we 
provide an accurate and appropriate approach to payment for PHP, as 
changes to the current methodology are considered, input from the 
industry is an important part of that process. Therefore, we welcome 
any input and information that the industry can provide about the costs 
of their programs and encourage providers to submit information on 
their costs. We would also find information about the status of quality 
criteria useful and would encourage providers to submit that 
information as well.
    Comment: A few commenters stated that the wage index adjustment 
does not accurately reflect the cost of labor in areas affected by 
Hurricanes Katrina and Rita. The commenters also pointed out that the 
proposed wage index in Louisiana has decreased post-hurricane instead 
of increasing, which has resulted in a much lower payment rate in 
Louisiana. The commenters further stated that the time lag for wage 
indexing is a huge factor for Hurricane Zone providers and that the 
wage index decrease makes the assumption that the cost of labor has 
actually decreased since the hurricanes. Some commenters noted that the 
lack of facilities, trained professionals and inadequate reimbursement 
will make Louisiana worse off now than prior to Hurricanes Katrina and 
Rita. A few commenters asked that CMS freeze the 2005 level rates to 
maintain the Hurricane Zones at status quo until a realistic impact 
study can be commissioned.
    Response: The hospital wage data used to compute the IPPS FY 2008 
hospital wage index is from the FY 2004 hospital cost reports for all 
hospitals. This is the standard lag timeframe in determining the 
hospital wage index. It will be another year before FY 2005 data will 
be reflected in the IPPS FY 2009 hospital wage index. However, we note 
that the wage index is a relative measure of differences in area hourly 
wage levels. It compares a labor market's average hourly wage to the 
national average hourly wage. To the extent that post-hurricane 
hospital labor costs are higher relative to the national average, the 
wage index will reflect the higher relative labor cost beginning when 
the FY 2005 data will be used in the FY 2009 IPPS hospital wage index 
(which will be applied to the CY 2009 OPPS rate year). In addition, the 
statutory authority for the OPPS wage index policy in section 
1833(t)(2)(D) of the Act requires that the wage adjustments be made in 
a budget neutral manner. Therefore, we cannot raise one wage area and 
still maintain budget neutrality. Finally, it should be noted that 
CMHCs located in Federal Emergency Management Agency (FEMA) designated 
disaster areas were provided with relief funds by the Department of 
Health and Human Services in 2007.
3. Separate Threshold for Outlier Payments to CMHCs
    In the November 7, 2003 final rule with comment period (68 FR 
63469), we indicated that, given the difference in PHP charges between 
hospitals and CMHCs, we did not believe it was appropriate to make 
outlier payments to CMHCs using the outlier percentage target amount 
and threshold established for hospitals. There was a significant 
difference in the amount of outlier payments made to hospitals and 
CMHCs

[[Page 66677]]

for PHP. In addition, further analysis indicated that using the same 
OPPS outlier threshold for both hospitals and CMHCs did not limit 
outlier payments to high cost cases and resulted in excessive outlier 
payments to CMHCs. Therefore, beginning in CY 2004, we established a 
separate outlier threshold for CMHCs. For CYs 2004 and 2005, we 
designated a portion of the estimated 2.0 percent outlier target amount 
specifically for CMHCs, consistent with the percentage of projected 
payments to CMHCs under the OPPS in each of those years, excluding 
outlier payments. For CY 2006, we set the estimated outlier target at 
1.0 percent and allocated a portion of that 1.0 percent, 0.6 percent 
(or 0.006 percent of total OPPS payments), to CMHCs for PHP services. 
For CY 2007, we set the estimated outlier target at 1.0 percent and 
allocated a portion of that 1.0 percent, an amount equal to 0.15 
percent of outlier payments and 0.0015 percent of total OPPS payments 
to CMHCS for PHP service outliers. The CY 2007 CMHC outlier threshold 
is met when the cost of furnishing services by a CMHC exceeds 3.40 
times the PHP APC payment amount. The CY 2007 OPPS outlier payment 
percentage is 50 percent of the amount of costs in excess of the 
threshold.
    The separate outlier threshold for CMHCs became effective January 
1, 2004, and has resulted in more commensurate outlier payments. In CY 
2004, the separate outlier threshold for CMHCs resulted in $1.8 million 
in outlier payments to CMHCs. In CY 2005, the separate outlier 
threshold for CMHCs resulted in $0.5 million in outlier payments to 
CMHCs. In contrast, in CY 2003, more than $30 million was paid to CMHCs 
in outlier payments. We believe this difference in outlier payments 
indicates that the separate outlier threshold for CMHCs has been 
successful in keeping outlier payments to CMHCs in line with the 
percentage of OPPS payments made to CMHCs.
    As noted in section II.G. of this final rule with comment period, 
for CY 2008, we proposed to continue our policy of setting aside 1.0 
percent of the aggregate total payments under the OPPS for outlier 
payments. We proposed that a portion of that 1.0 percent, an amount 
equal to 0.03 percent of outlier payments and 0.0003 percent of total 
OPPS payments, would be allocated to CMHCs for PHP service outliers. As 
discussed in section II.G. of this final rule with comment period, we 
again proposed to set a dollar threshold in addition to an APC 
multiplier threshold for OPPS outlier payments. However, because the 
PHP is the only APC for which CMHCs may receive payment under the OPPS, 
we would not expect to redirect outlier payments by imposing a dollar 
threshold. Therefore, we did not propose to set a dollar threshold for 
CMHC outliers. As noted above, we proposed to set the outlier threshold 
for CMHCs for CY 2008 at 3.40 times the APC payment amount and the CY 
2008 outlier payment percentage applicable to costs in excess of the 
threshold at 50 percent.
    We received no public comments on our proposal. As discussed in 
section II.G. of this final rule with comment period, using more recent 
data for this final rule with comment period, we set the target for 
hospital outpatient outlier payments at 1.0 percent of total OPPS 
payments. We allocate a portion of that 1.0 percent, an amount equal to 
0.02 percent of outlier payments and 0.0002 percent of total OPPS 
payments to CMHCs for PHP service outliers. For CY 2008, we set the 
outlier threshold for CMHCs for CY 2008 at 3.40 times the APC payment 
amount and the CY 2008 outlier percentage applicable to costs in excess 
of the threshold at 50 percent.

C. Conversion Factor Update

    Section 1833(t)(3)(C)(ii) of the Act requires us to update the 
conversion factor used to determine payment rates under the OPPS on an 
annual basis. Section 1833(t)(3)(C)(iv) of the Act provides that, for 
CY 2008, the update is equal to the hospital inpatient market basket 
percentage increase applicable to hospital discharges under section 
1886(b)(3)(B)(iii) of the Act.
    The final hospital market basket increase for FY 2008 published in 
the IPPS final rule with comment period on August 22, 2007 is 3.3 
percent (72 FR 48173), the same as the forecast published in the FY 
2008 IPPS proposed rule on May 3, 2007 (72 FR 24787). To set the OPPS 
conversion factor for CY 2008, we increased the CY 2007 conversion 
factor of $61.468, as specified in the CY 2007 OPPS/ASC final rule with 
comment period (71 FR 68003), by 3.3 percent.
    In accordance with section 1833(t)(9)(B) of the Act, we further 
adjusted the conversion factor for CY 2007 to ensure that the revisions 
we are making to our updates for a revised wage index and rural 
adjustment are made on a budget neutral basis. We calculated an overall 
budget neutrality factor of 1.0019 for wage index changes by comparing 
total payments from our simulation model using the FY 2008 IPPS final 
wage index values as finalized to those payments using the current (FY 
2007) IPPS wage index values. This adjustment reflected an adjustment 
of 1.0001 for changes to the wage index and an additional 1.0018 to 
accommodate the IPPS budget neutrality adjustment for inclusion of the 
rural floor. As discussed further in section II.D. of this final rule 
with comment period, for the first time, the final FY 2008 IPPS wage 
indices included a blanket budget neutrality adjustment for including 
the rural floor provision, which previously had been applied to the 
IPPS standardized amount. For further discussion of this policy in its 
entirety, we refer readers to the FY 2008 IPPS proposed rule (72 FR 
24787 through 24792) and the FY 2008 IPPS final rule with comment 
period (72 FR 47325 through 47330). This adjustment is specific to the 
IPPS. For the OPPS, we are increasing the conversion factor by the 
proportional amount of the rural floor budget neutrality adjustment to 
accommodate this change.
    For this final rule with comment period, we estimated the rural 
adjustment for CY 2008 to reflect the extension of the adjustment to 
payment for brachytherapy sources as discussed in section II.F.2. of 
this final rule with comment period, but as the impact of the extension 
was negligible, we did not change the rural adjustment. Therefore, we 
calculated a budget neutrality factor of 1.000 for the rural 
adjustment. For CY 2008, in this final rule with comment period, we 
estimated that allowed pass through spending for both drugs and devices 
would equal approximately $32 million, which represents 0.09 percent of 
total OPPS projected spending for CY 2008. The conversion factor was 
also adjusted by the difference between the 0.21 percent pass through 
dollars set aside in CY 2007 and the 0.09 percent estimate for CY 2008 
pass through spending. Finally, estimated payments for outliers remain 
at 1.0 percent of total payments for CY 2008.
    The market basket increase update factor of 3.3 percent for CY 
2008, the required wage index and rural budget neutrality adjustment of 
approximately 1.0019, and the adjustment of 0.12 percent for the 
difference in the pass-through set aside resulted in a final standard 
OPPS conversion factor for CY 2008 of $63.694.
    We received one public comment on our proposed conversion factor 
update for CY 2008. A summary of the public comment and our response 
follow.
    Comment: A commenter objected to the proposed market basket 
increase of 3.3 percent. The commenter stated that the average 
outpatient cost of service is projected to increase by at least 5 
percent for CY 2008 due to increases in salaries and medical supply 
costs for services to Medicare beneficiaries. The

[[Page 66678]]

commenter recommended that the average payment to hospitals for 
outpatient services be increased by 5 percent, the actual amount by 
which the commenter believed costs would increase for CY 2008.
    Response: Section 1833(t)(3)(C)(iv) of the Act requires that CMS 
update the conversion factor annually using an OPD fee schedule 
increase factor specific to the PPS year. However, the statute gives 
CMS the discretion to use the hospital inpatient update factor, the 
hospital inpatient operating market basket, as an appropriate 
substitute for the OPD fee schedule increase for purposes of the annual 
percentage increase specific to covered OPD services. The statute 
permits, and we continue to believe, that the hospital inpatient 
operating market basket is an appropriate measure of change in hospital 
input prices for goods and services required to provide hospital care, 
including that in the outpatient setting. Hospitals use similar 
resources in their hospital inpatient and outpatient departments. The 
hospital market basket is carefully estimated for each PPS year, and 
periodically rebased and revised. For these reasons, we have specified 
in the regulations governing the annual OPPS update at Sec.  419.32 
(b)(iv) that, for years beginning after CY 2003, the update factor for 
the OPPS equals the update factor for the IPPS. We disagree that the 
update factor for the CY 2008 OPPS should be 5 percent. For FY 2008, 
the IPPS update factor is the hospital market basket of 3.3 percent 
and, therefore, we have used this update factor in the establishment of 
the conversion factor for the CY 2008 OPPS.
    After consideration of the public comment received, we are 
finalizing our CY 2008 proposal, without modification, to update the 
conversion factor by the FY 2008 IPPS market basket increase update 
factor of 3.3 percent, resulting in a final conversion factor of 
$63.694.

D. Wage Index Changes

    Section 1833(t)(2)(D) of the Act requires the Secretary to 
determine a wage adjustment factor to adjust, for geographic wage 
differences, the portion of the OPPS payment rate, which includes the 
copayment standardized amount, that is attributable to labor and labor 
related cost. Since the inception of the OPPS, CMS policy has been to 
wage adjust 60 percent of the OPPS payment, based on a regression 
analysis that determined that approximately 60 percent of the costs of 
services paid under the OPPS were attributable to wage costs. We 
confirmed that this labor-related share for outpatient services is 
still appropriate during our regression analysis for the payment 
adjustment for rural hospitals in the CY 2006 OPPS final rule with 
comment period (70 FR 68553). Therefore, we did not propose to revise 
this policy for the CY 2008 OPPS. We refer readers to section II.H. of 
this final rule with comment period for a description and example of 
how the wage index for a particular hospital is used to determine the 
payment for the hospital. This adjustment must be made in a budget 
neutral manner. As we have done in prior years, we proposed to adopt 
the final IPPS wage indices for the OPPS and to extend these wage 
indices to hospitals that participate in the OPPS but not the IPPS 
(referred to in this section as ``non-IPPS'' hospitals).
    As discussed in section II.A. of this final rule with comment 
period, we standardize 60 percent of estimated costs as labor-related 
costs for geographic area wage variation using the IPPS pre-
reclassified wage indices in order to remove the effects of differences 
in area wage levels in determining the national unadjusted OPPS payment 
rate and the copayment amount.
    As published in the original OPPS April 7, 2000 final rule with 
comment period (65 FR 18545), the OPPS has consistently adopted the 
final IPPS wage indices as the wage indices for adjusting the OPPS 
standard payment amounts for labor market differences. Thus, the wage 
index that applies to a particular hospital under the IPPS will also 
apply to that hospital under the OPPS. As initially explained in the 
September 8, 1998 OPPS proposed rule, we believed and continue to 
believe that using the IPPS wage index as the source of an adjustment 
factor for the OPPS is reasonable and logical, given the inseparable, 
subordinate status of the hospital outpatient department within the 
hospital overall. In accordance with section 1886(d)(3)(E) of the Act, 
the IPPS wage index is updated annually. In accordance with our 
established policy, we proposed to use the final FY 2008 final version 
of these wage indices to determine the wage adjustments for the OPPS 
payment rate and copayment standardized amount that would be published 
in our final rule with comment period for CY 2008.
    We note that the FY 2008 IPPS wage indices continue to reflect a 
number of changes implemented over the past few years as a result of 
the revised Office of Management and Budget (OMB) standards for 
defining geographic statistical areas, the implementation of an 
occupational mix adjustment as part of the wage index, wage adjustments 
provided for under Pub. L. 105-33 and Pub. L. 108-173, and 
clarification of our policy for multicampus hospitals. The following is 
a brief summary of the components of the FY 2008 IPPS wage indices and 
any adjustments that we are applying to the OPPS for CY 2008. We refer 
the reader to the FY 2008 IPPS final rule with comment period (72 FR 
47308 through 47345) for a detailed discussion of the changes to the 
wage indices. In this final rule with comment period, we are not 
reprinting the final FY 2008 IPPS wage indices referenced in the 
discussion below, with the exception of the out migration wage 
adjustment table (Addendum L to this final rule with comment period), 
which includes non-IPPS providers paid under the OPPS. We also refer 
readers to the CMS Web site for the OPPS at: http://www.cms.hhs.gov/
providers/hopps. At this link, the reader will find a link to the final 
FY 2008 IPPS wage indices tables.
    1. The continued use of the Core Based Statistical Areas (CBSAs) 
issued by the OMB as revised standards for designating geographical 
statistical areas based on the 2000 Census data, to define labor market 
areas for hospitals for purposes of the IPPS wage index. The OMB 
revised standards were published in the Federal Register on December 
27, 2000 (65 FR 82235), and OMB announced the new CBSAs on June 6, 
2003, through an OMB bulletin. In the FY 2005 IPPS final rule, CMS 
adopted the new OMB definitions for wage index purposes. In the FY 2008 
IPPS final rule with comment period, we again stated that hospitals 
located in Metropolitan Statistical Areas (MSAs) will be urban and 
hospitals that are located in Micropolitan Areas or outside CBSAs will 
be rural. We also reiterated our policy that when an MSA is divided 
into one or more Metropolitan Divisions, we use the Metropolitan 
Division for purposes of defining the boundaries of a particular labor 
market area. To help alleviate the decreased payments for previously 
urban hospitals that became rural under the new geographical 
definitions, we allowed these hospitals to maintain for the 3-year 
period from FY 2005 through FY 2007, the wage index of the MSA where 
they previously had been located. This hold harmless provision expired 
after FY 2007. We adopted the same policy for the OPPS, but because the 
OPPS operates on a calendar year, wage index policies are in effect 
through December 31, 2007. To be consistent with the IPPS, as finalized 
in the FY 2008 IPPS final rule with comment period, beginning in CY 
2008 (January 1, 2008)

[[Page 66679]]

under the OPPS, these hospitals will receive their statewide rural wage 
index. Hospitals paid under the IPPS are eligible to apply for 
reclassification in FY 2008.
    As noted above, for purposes of estimating an adjustment for the 
OPPS payment rates to accommodate geographic differences in labor costs 
in this final rule with comment period, we have used the wage indices 
identified in the FY 2008 IPPS final rule with comment period (and as 
corrected in the September 28, 2007 second FY 2008 IPPS correction 
notice that was printed in the October 10, 2007 Federal Register (72 FR 
57634) that are fully adjusted for differences in occupational mix 
using the entire 6-month survey data collected in 2006.
    2. The reclassifications of hospitals to geographic areas for 
purposes of the wage index. For purposes of the OPPS wage index, we 
proposed to adopt all of the IPPS reclassifications for FY 2008, 
including reclassifications that the Medicare Geographic Classification 
Review Board (MGCRB) approved. We note that reclassifications under 
section 508 of Pub. L. 108-173 were set to terminate March 31, 2007. 
However, section 106(a) of the MIEA-TRHCA extended any geographic 
reclassifications of hospitals that were made under section 508 and 
that would expire on March 31, 2007 until September 30, 2007. On March 
23, 2007, we published a notice in the Federal Register (72 FR 13799) 
that indicated how we are implementing section 106 of the MIEA-TRHCA 
through September 30, 2007. Because the section 508 provision expired 
on September 30, 2007, the OPPS wage index will not include any 
reclassifications under section 508 for CY 2008.
    3. The out-migration wage adjustment to the wage index. In the FY 
2008 IPPS final rule with comment period (72 FR 473398 through 47341), 
we discussed the out migration adjustment under section 505 of Pub. L. 
108-173 for counties under this adjustment. Hospitals paid under the 
IPPS located in the qualifying section 505 ``out migration'' counties 
receive a wage index increase unless they have already been otherwise 
reclassified. We note that in the FY 2008 IPPS final rule with comment 
period, we finalized our proposal to use the post-reclassified, rather 
than the pre-reclassified, wage indices in calculating the out-
migration adjustment. (See the FY 2008 IPPS final rule with comment 
period and the second FY 2008 IPPS correction notice for further 
information on the out migration adjustment.) For OPPS purposes, we 
proposed to continue our policy in CY 2008 to allow-non IPPS hospitals 
paid under the OPPS to qualify for the out-migration adjustment if they 
are located in a section 505 out migration county. Because non-IPPS 
hospitals cannot reclassify, they are eligible for the out-migration 
wage adjustment. Table 4J published in the Addendum to the FY 2008 IPPS 
final rule with comment period (and corrected in the second FY 2008 
IPPS correction notice) identifies counties eligible for the out-
migration adjustment and providers receiving the adjustment. As stated 
earlier, we are reprinting the final version of Table 4J, as corrected, 
in this final rule with comment period as Addendum L.
    4. Wage Index for Multicampus Hospitals. As indicated in the CY 
2008 OPPS/ASC proposed rule (72 FR 42695), we also wish to clarify that 
the IPPS policy for multicampus wage index payments also applies to the 
OPPS. As a result of the new labor market areas introduced in FY 2005, 
there are hospitals with multiple campuses previously located in a 
single MSA that are now in more than one CBSA. A multicampus hospital 
is an integrated institution. For this reason, the multicampus hospital 
has one CMS certification number (CCN) and submits a single cost report 
that combines the total wages and hours of each of its campuses in the 
manner described in the FY 2008 IPPS final rule with comment period (72 
FR 47317).
    In the FY 2008 IPPS final rule with comment period, we finalized 
our proposal to apportion wages and hours across multiple campuses 
using full-time equivalent (FTE) staff data or Medicare discharge data 
in order to include wage data for the individual campuses of a 
multicampus hospital in its local wage index calculation. We indicated 
our intent to collect campus locations and numbers of FTE staff by 
location by adding lines to Worksheet S-2 of the Medicare cost report 
submitted by hospitals. We stated that we would continue to use either 
Medicare discharge data or self-reported FTE data to apportion wage 
data by campus until revisions are made to Worksheet S-2 of the 
Medicare cost report to require reporting of FTE data by campus and 
until such data in the cost report can be used to calculate the wage 
index, at which time the wage data of a multicampus hospital will be 
allocated among its campuses based only on FTE counts by campus 
reported in the Medicare cost report. We stated that the effective date 
of the revised cost report is not expected until FY 2009. Therefore the 
FTE data reported by multicampus hospitals in the revised Medicare cost 
report could not be used to allocate wages and hours to each labor 
market by FTEs until at least the FY 2013 wage index. As part of this 
policy, we would fully expect that an HOPD that is part of a 
multicampus hospital system would receive a wage index based on the 
geographic location of the inpatient campus with which it is 
associated. This would include cases where one inpatient campus 
reclassified. Affiliated outpatient facilities would receive the 
reclassified wage index of the inpatient campus. For further discussion 
of the FY 2008 IPPS final multicampus hospital policy in its entirety, 
we refer readers to the FY 2008 IPPS final rule with comment period (72 
FR 47317 through 47319).
    5. Rural Floor Provision. Section 4410 of Pub. L. 105-33 provides 
that the area wage index applicable to any hospital that is located in 
an urban area of a State may not be less than the area wage index 
applicable to hospitals located in rural areas of the State (``the 
rural floor''). Table 4A in the FY 2008 IPPS final rule with comment 
period (72 FR 47503) (and as corrected in the September 28, 2007 second 
correction notice for the FY 2008 IPPS final rule, which appeared in 
the October 10, 2007 issue of the Federal Register) identifies urban 
areas where hospitals located in those areas are assigned the rural 
floor (noted by a superscript ``2''). For CY 2008 under the OPPS, we 
proposed to continue our policy to allow non-IPPS hospitals paid under 
the OPPS to receive the rural floor wage index, when applicable under 
the IPPS for FY 2008. For the first time, the final FY 2008 IPPS wage 
indices include a blanket budget neutrality adjustment for including 
the rural floor provision, which previously had been applied to the 
IPPS standardized amount. For further discussion of this final policy 
in its entirety, we refer readers to the FY 2008 IPPS final rule with 
comment period (72 FR 47325 through 47330) and the second FY 2008 IPPS 
correction notice (72 FR 57634).
    We note that all changes to the wage index resulting from 
geographic labor market area reclassifications or other adjustments 
must be incorporated in a budget neutral manner. Accordingly, in 
calculating the OPPS budget neutrality estimates for CY 2008 in this 
final rule with comment period, we have included the wage index changes 
that would result from the MGCRB reclassifications, implementation of 
sections 4410 of Pub. L. 105-33 and 505 of Pub. L. 108-173, and other 
refinements adopted in the FY 2008 IPPS final rule with comment period. 
For the CY 2008 OPPS, we proposed to use the final FY 2008 IPPS

[[Page 66680]]

wage indices, including the budget neutrality adjustment for the rural 
floor, for calculating OPPS payment in CY 2008. We discuss how the OPPS 
conversion factor would compensate for the inclusion of this budget 
neutrality adjustment in the wage indices in section II.C. of this 
final rule with comment period relating to the conversion factor 
update.
    Comment: Commenters supported the CMS proposal for CY 2008 to 
extend the IPPS wage indices to the OPPS as we had done in previous 
years. One commenter agreed with the proposal to adopt the IPPS wage 
index but suggested that it would be logical to adopt the same labor 
component percentage as applied under the IPPS. The commenter argued 
that the labor component is derived from hospital cost report 
information that does not separate inpatient from outpatient services 
for labor-related and nonlabor-related costs, and thus the labor 
component utilized in the IPPS is based on a combination of inpatient 
and outpatient costs. The commenter also suggested that the 60 percent 
labor-related share used in the OPPS was derived nearly 10 years ago 
and has never been supported by analysis. The commenter recommended 
that CMS revise the labor-related share from 60 percent to 69.731 
percent to be consistent with the IPPS.
    Response: We appreciate the support expressed by commenters 
concerning our proposed wage index policies for CY 2008. In response to 
the comment concerning the OPPS labor-related share, we do not believe 
that such a change to adopt the IPPS labor related share is 
appropriate. The current IPPS labor-related share of 69.731 percent was 
calculated by summing the relative weights for labor components in the 
IPPS operating market basket (70 FR 2339). The IPPS estimates a labor-
related share that is specific to inpatient services; the OPPS 
estimates a labor-related share that is specific to outpatient 
services. The OPPS labor-related share was determined through 
regression analyses conducted for the initial OPPS proposed rule (63 FR 
47581). Those analyses examined the extent of variability in hospital 
outpatient cost per unit explained by variability in the wage index, 
holding outpatient service mix under the proposed system, geographic 
location, volume, and other variables constant. The unit cost dependent 
variable in these analyses was derived by applying the CCRs for 
ancillary cost centers to charges, and those ancillary CCRs should 
reflect the proportional labor costs for ancillary services. The wage 
index provides a measure of the wage level faced by a hospital relative 
to the national average, which should be roughly the same for the 
institution across inpatient and outpatient settings. Those initial 
analyses identified 60 percent as the appropriate labor-related share 
for outpatient services. We confirmed that this labor-related share is 
still appropriate during our regression analysis for the payment 
adjustment for rural hospitals, as discussed in the CY 2006 OPPS final 
rule with comment period (70 FR 68556). Further, we would expect 
services delivered in the HOPD to require proportionately less labor 
than more acute inpatient services that require greater nursing care 
and an extended stay. We believe that the 60 percent labor-related 
share for the OPPS compares favorably to the hospital inpatient labor-
related share of 69.731 percent.
    We are finalizing our proposal, without modification, to use the 
final IPPS FY 2008 wage indices to adjust the OPPS standard payment 
amounts for labor market differences under the CY 2008 OPPS.

E. Statewide Average Default CCRs

    CMS uses CCRs to determine outlier payments, payments for pass-
through devices, and monthly interim transitional corridor payments 
under the OPPS. Some hospitals do not have a valid CCR. These hospitals 
include, but are not limited to, hospitals that are new and have not 
yet submitted a cost report, hospitals that have a CCR that falls 
outside predetermined floor and ceiling thresholds for a valid CCR, or 
hospitals that have recently given up their all-inclusive rate status. 
Last year, we updated the default urban and rural CCRs for CY 2007 in 
our final rule with comment period (71 FR 68006 through 68009). As we 
proposed, in this final rule with comment period we have updated the 
default ratios for CY 2008 using the most recent cost report data.
    We calculated the statewide default CCRs using the same overall 
CCRs that we use to adjust charges to costs on claims data. Table 25 
published in the CY 2008 OPPS/ASC proposed rule listed the proposed CY 
2008 default urban and rural CCRs by State and compared them to last 
year's default CCRs. These CCRs are the ratio of total costs to total 
charges from each provider's most recently submitted cost report, for 
those cost centers relevant to outpatient services weighted by Medicare 
Part B charges. We also adjusted ratios from submitted cost reports to 
reflect final settled status by applying the differential between 
settled to submitted costs and charges from the most recent pair of 
final settled and submitted cost reports.
    For the proposed rule, approximately 78 percent of the submitted 
cost reports represented data for CY 2005. We have since updated the 
cost report data we use to calculate CCRs with additional submitted 
cost reports for CY 2006. For this final rule with comment period, 47 
percent of the submitted cost reports utilized in the default ratio 
calculation were for CY 2005 and 49 percent were for CY 2006. We only 
used valid CCRs to calculate these default ratios. That is, we removed 
the CCRs for all-inclusive hospitals, CAHs, and hospitals in Guam, and 
the U.S. Virgin Islands, American Samoa, and the Northern Mariana 
Islands because these entities are not paid under the OPPS, or in the 
case of all inclusive hospitals, because their CCRs are suspect. We 
further identified and removed any obvious error CCRs and trimmed any 
outliers. We limited the hospitals used in the calculation of the 
default CCRs to those hospitals that billed for services under the OPPS 
during CY 2006.
    Finally, we calculated an overall average CCR, weighted by a 
measure of volume for CY 2006, for each State except Maryland. This 
measure of volume is the total lines on claims and is the same one that 
we use in our impact tables. For Maryland, we used an overall weighted 
average CCR for all hospitals in the nation as a substitute for 
Maryland CCRs. Few providers in Maryland are eligible to receive 
payment under the OPPS, which limits the data available to calculate an 
accurate and representative CCR. The observed differences between last 
year's and this year's default statewide CCRs largely reflect a general 
decline in the ratio between costs and charges widely observed in the 
cost report data. However, observed increases in some areas suggest 
that the decline in CCRs is moderating. Further, the addition of 
weighting by Medicare Part B charges to the overall CCR in CY 2007 
slightly increases the variability of the overall CCR calculation.
    As stated above, CMS uses default statewide CCRs for several groups 
of hospitals, including, but not limited to, hospitals that are new and 
have not yet submitted a cost report, hospitals that have a CCR that 
falls outside predetermined floor and ceiling thresholds for a valid 
CCR, and hospitals that have recently given up their all-inclusive rate 
status.
    Prior to CY 2007, OPPS policy required hospitals that experienced a 
change of ownership, but that did not accept assignment of the previous 
hospital's provider agreement, to use the

[[Page 66681]]

previous provider's CCR. However, in CY 2007 we revised this policy and 
finalized our proposal to use default statewide CCRs for entities that 
had not accepted assignment of an existing hospital's provider 
agreement in accordance with Sec.  489.18 and that had not yet 
submitted its first Medicare cost report. For CY 2008, we proposed to 
continue to apply this treatment of using the default statewide CCR, to 
include an entity that has not accepted assignment of an existing 
hospital's provider agreement in accordance with Sec.  489.18 and that 
has not yet submitted its first Medicare cost report. This policy is 
effective for hospitals experiencing a change of ownership on or after 
January 1, 2007. As stated in the CY 2007 OPPS/ASC final rule with 
comment period (71 FR 68006), we believed that a hospital that has not 
accepted assignment of an existing hospital's provider agreement is 
similar to a new hospital that will establish its own costs and 
charges. We also believed that the hospital that has chosen not to 
accept assignment may have different costs and charges than the 
existing hospital. Furthermore, we believed that the hospital should be 
provided time to establish its own costs and charges. Therefore, we 
proposed to use the default statewide CCR to determine cost-based 
payments until the hospital has submitted its first Medicare cost 
report.
    We did not receive any public comments concerning this issue. 
Therefore, we are finalizing the statewide average default CCRs as 
shown in Table 11 below for OPPS services furnished on or after January 
1, 2008, without modification.

                                    Table 11.--CY 2008 Statewide Average CCRs
----------------------------------------------------------------------------------------------------------------
                                                                                                     Previous
                                                                                      CY 2008       default CCR
                   State                                 Rural/urban                default CCR    (CY 2007 OPPS
                                                                                                    final rule)
----------------------------------------------------------------------------------------------------------------
ALASKA.....................................  RURAL..............................           0.537           0.534
ALASKA.....................................  URBAN..............................           0.351           0.383
ALABAMA....................................  RURAL..............................           0.228           0.232
ALABAMA....................................  URBAN..............................           0.213           0.223
ARKANSAS...................................  RURAL..............................           0.266           0.264
ARKANSAS...................................  URBAN..............................           0.270           0.275
ARIZONA....................................  RURAL..............................           0.264           0.282
ARIZONA....................................  URBAN..............................           0.232           0.232
CALIFORNIA.................................  RURAL..............................           0.232           0.246
CALIFORNIA.................................  URBAN..............................           0.218           0.232
COLORADO...................................  RURAL..............................           0.355           0.370
COLORADO...................................  URBAN..............................           0.254           0.267
CONNECTICUT................................  RURAL..............................           0.391           0.389
CONNECTICUT................................  URBAN..............................           0.339           0.349
DISTRICT OF COLUMBIA.......................  URBAN..............................           0.346           0.339
DELAWARE...................................  RURAL..............................           0.302           0.323
DELAWARE...................................  URBAN..............................           0.400           0.395
FLORIDA....................................  RURAL..............................           0.219           0.219
FLORIDA....................................  URBAN..............................           0.198           0.199
GEORGIA....................................  RURAL..............................           0.279           0.285
GEORGIA....................................  URBAN..............................           0.269           0.289
HAWAII.....................................  RURAL..............................           0.373           0.357
HAWAII.....................................  URBAN..............................           0.317           0.320
IOWA.......................................  RURAL..............................           0.349           0.349
IOWA.......................................  URBAN..............................           0.325           0.343
IDAHO......................................  RURAL..............................           0.445           0.436
IDAHO......................................  URBAN..............................           0.414           0.416
ILLINOIS...................................  RURAL..............................           0.286           0.308
ILLINOIS...................................  URBAN..............................           0.271           0.288
INDIANA....................................  RURAL..............................           0.313           0.316
INDIANA....................................  URBAN..............................           0.301           0.320
KANSAS.....................................  RURAL..............................           0.318           0.320
KANSAS.....................................  URBAN..............................           0.240           0.252
KENTUCKY...................................  RURAL..............................           0.244           0.251
KENTUCKY...................................  URBAN..............................           0.262           0.270
LOUISIANA..................................  RURAL..............................           0.271           0.281
LOUISIANA..................................  URBAN..............................           0.277           0.273
MARYLAND...................................  RURAL..............................           0.308           0.318
MARYLAND...................................  URBAN..............................           0.284           0.298
MASSACHUSETTS..............................  URBAN..............................           0.338           0.349
MAINE......................................  RURAL..............................           0.433           0.457
MAINE......................................  URBAN..............................           0.424           0.429
MICHIGAN...................................  RURAL..............................           0.331           0.346
MICHIGAN...................................  URBAN..............................           0.318           0.329
MINNESOTA..................................  RURAL..............................           0.499           0.508
MINNESOTA..................................  URBAN..............................           0.342           0.338
MISSOURI...................................  RURAL..............................           0.289           0.294
MISSOURI...................................  URBAN..............................           0.292           0.303
MISSISSIPPI................................  RURAL..............................           0.267           0.284
MISSISSIPPI................................  URBAN..............................           0.217           0.231
MONTANA....................................  RURAL..............................           0.453           0.439

[[Page 66682]]

 
MONTANA....................................  URBAN..............................           0.450           0.463
NORTH CAROLINA.............................  RURAL..............................           0.286           0.305
NORTH CAROLINA.............................  URBAN..............................           0.321           0.370
NORTH DAKOTA...............................  RURAL..............................           0.379           0.367
NORTH DAKOTA...............................  URBAN..............................           0.378           0.395
NEBRASKA...................................  RURAL..............................           0.347           0.376
NEBRASKA...................................  URBAN..............................           0.290           0.290
NEW HAMPSHIRE..............................  RURAL..............................           0.375           0.370
NEW HAMPSHIRE..............................  URBAN..............................           0.337           0.325
NEW JERSEY.................................  URBAN..............................           0.276           0.297
NEW MEXICO.................................  RURAL..............................           0.275           0.274
NEW MEXICO.................................  URBAN..............................           0.353           0.398
NEVADA.....................................  RURAL..............................           0.329           0.335
NEVADA.....................................  URBAN..............................           0.200           0.214
NEW YORK...................................  RURAL..............................           0.417           0.445
NEW YORK...................................  URBAN..............................           0.402           0.427
OHIO.......................................  RURAL..............................           0.354           0.369
OHIO.......................................  URBAN..............................           0.268           0.283
OKLAHOMA...................................  RURAL..............................           0.288           0.295
OKLAHOMA...................................  URBAN..............................           0.245           0.261
OREGON.....................................  RURAL..............................           0.321           0.344
OREGON.....................................  URBAN..............................           0.366           0.405
PENNSYLVANIA...............................  RURAL..............................           0.298           0.305
PENNSYLVANIA...............................  URBAN..............................           0.241           0.252
PUERTO RICO................................  URBAN..............................           0.474           0.469
RHODE ISLAND...............................  URBAN..............................           0.308           0.309
SOUTH CAROLINA.............................  RURAL..............................           0.258           0.255
SOUTH CAROLINA.............................  URBAN..............................           0.244           0.248
SOUTH DAKOTA...............................  RURAL..............................           0.334           0.348
SOUTH DAKOTA...............................  URBAN..............................           0.289           0.304
TENNESSEE..................................  RURAL..............................           0.256           0.265
TENNESSEE..................................  URBAN..............................           0.241           0.249
TEXAS......................................  RURAL..............................           0.271           0.289
TEXAS......................................  URBAN..............................           0.242           0.258
UTAH.......................................  RURAL..............................           0.416           0.441
UTAH.......................................  URBAN..............................           0.406           0.416
VIRGINIA...................................  RURAL..............................           0.268           0.282
VIRGINIA...................................  URBAN..............................           0.275           0.280
VERMONT....................................  RURAL..............................           0.416           0.432
VERMONT....................................  URBAN..............................           0.340           0.338
WASHINGTON.................................  RURAL..............................           0.358           0.374
WASHINGTON.................................  URBAN..............................           0.368           0.372
WISCONSIN..................................  RURAL..............................           0.384           0.367
WISCONSIN..................................  URBAN..............................           0.362           0.364
WEST VIRGINIA..............................  RURAL..............................           0.298           0.316
WEST VIRGINIA..............................  URBAN..............................           0.360           0.369
WYOMING....................................  RURAL..............................           0.449           0.471
WYOMING....................................  URBAN..............................           0.351           0.352
----------------------------------------------------------------------------------------------------------------

F. OPPS Payments to Certain Rural Hospitals

1. Hold Harmless Transitional Payment Changes Made by Pub. L. 109-171 
(DRA)
    When the OPPS was implemented, every provider was eligible to 
receive an additional payment adjustment (called either transitional 
corridor payment or transitional outpatient payment) if the payments it 
received for covered outpatient department (OPD) services under the 
OPPS were less than the payments it would have received for the same 
services under the prior reasonable cost-based system. Section 
1833(t)(7) of the Act provides that the transitional corridor payments 
are temporary payments for most providers to ease their transition from 
the prior reasonable cost-based payment system to the OPPS system. 
There are two exceptions, cancer hospitals and children's hospitals, to 
this provision and those hospitals receive the transitional corridor 
payments on a permanent basis. Section 1833(t)(7)(D)(i) of the Act 
originally provided for transitional corridor payments to rural 
hospitals with 100 or fewer beds for covered OPD services furnished 
before January 1, 2004. However, section 411 of Pub. L. 108-173 amended 
section 1833(t)(7)(D)(i) of the Act to extend these payments through 
December 31, 2005, for rural hospitals with 100 or fewer beds. Section 
411 also extended the transitional corridor payments to SCHs located in 
rural areas for services furnished during the period that begins with 
the provider's first cost reporting period beginning on or after 
January 1, 2004, and ended on December 31, 2005. Accordingly, the 
authority for making transitional corridor payments under

[[Page 66683]]

section 1833(t)(7)(D)(i) of the Act, as amended by section 411 of Pub. 
L. 108-173, for rural hospitals having 100 or fewer beds and SCHs 
located in rural areas expired on December 31, 2005.
    Section 5105 of Pub. L. 109-171 reinstituted the hold harmless 
transitional outpatient payments (TOPs) for covered OPD services 
furnished on or after January 1, 2006, and before January 1, 2009, for 
rural hospitals having 100 or fewer beds that are not SCHs. When the 
OPPS payment is less than the payment the provider would have received 
under the previous reasonable cost-based system, the amount of payment 
is increased by 95 percent of the amount of the difference between the 
two payment systems for CY 2006, by 90 percent of the amount of that 
difference for CY 2007, and by 85 percent of the amount of that 
difference for CY 2008.
    For CY 2006, we implemented section 5105 of Pub. L. 109-171 through 
Transmittal 877, issued on February 24, 2006. We did not specifically 
address whether TOPs apply to essential access community hospitals 
(EACHs), which are considered to be SCHs under section 
1886(d)(5)(D)(iii)(III) of the Act. Accordingly, under the statute, 
EACHs are treated as SCHs. Therefore, we believed and continue to 
believe that EACHs are not currently eligible for TOPs under Pub. L. 
109-171. However, they are eligible for the adjustment for rural SCHs. 
In the CY 2007 OPPS/ASC final rule with comment period, we updated 
Sec.  419.70(d) to reflect the requirements of Pub. L. 109-171 (71 FR 
68010 and 68228).
2. Adjustment for Rural SCHs Implemented in CY 2006 Related to Pub. L. 
108-173 (MMA)
    In the CY 2006 OPPS final rule with comment period (70 FR 68556), 
we finalized a payment increase for rural SCHs of 7.1 percent for all 
services and procedures paid under the OPPS, excluding drugs, 
biologicals, brachytherapy seeds, and services paid under pass-through 
payment policy in accordance with section 1833(t)(13)(B) of the Act, as 
added by section 411 of Pub. L. 108-173. Section 411 gave the Secretary 
the authority to make an adjustment to OPPS payments for rural 
hospitals, effective January 1, 2006, if justified by a study of the 
difference in costs by APC between hospitals in rural and urban areas. 
Our analysis showed a difference in costs for rural SCHs. Therefore, we 
implemented a payment adjustment for only those hospitals beginning 
January 1, 2006.
    Last year, we became aware that we did not specifically address 
whether the adjustment applies to EACHs, which are considered to be 
SCHs under section 1886(d)(5)(D)(iii)(III) of the Act. Thus, under the 
statute, EACHs are treated as SCHs. Therefore, in the CY 2007 OPPS/ASC 
final rule with comment period, for purposes of receiving this rural 
adjustment, we revised Sec.  419.43(g) to clarify that EACHs are also 
eligible to receive the rural SCH adjustment, assuming these entities 
otherwise meet the rural adjustment criteria (71 FR 68010 and 68227). 
Currently, fewer than 10 hospitals are classified as EACHs and as of CY 
1998, under section 4201(c) of Pub. L. 105-33, a hospital can no longer 
become newly classified as an EACH.
    This adjustment for rural SCHs is budget neutral and applied before 
calculating outliers and copayment. As stated in the CY 2006 OPPS final 
rule with comment period (70 FR 68560), we would not reestablish the 
adjustment amount on an annual basis, but we note that we may review 
the adjustment in the future and, if appropriate, would revise the 
adjustment.
    For CY 2008, we proposed to continue our current policy of a budget 
neutral 7.1 percent payment increase for rural SCHs, including EACHs, 
for all services and procedures paid under the OPPS, excluding drugs, 
biologicals, and services paid under the pass-through payment policy in 
accordance with section 1833(t)(13)(B) of the Act. This adjustment is 
in accordance with section 411 of the MMA, which gave the Secretary the 
authority to make an adjustment to OPPS payments for rural hospitals, 
if justified by a study of the difference in costs by APC between 
hospitals in rural and urban areas. Our analysis showed a difference in 
costs only for rural SCHs, and we implemented a payment adjustment for 
those hospitals beginning January 1, 2006. For CY 2008, we also 
proposed to include brachytherapy sources in the group of services 
eligible for the 7.1 percent payment increase because we proposed to 
pay them at prospective rates based on their median costs as calculated 
from historical claims data. Consequently, we proposed to revise Sec.  
419.43 to reflect our proposal to make brachytherapy sources eligible 
for the 7.1 percent payment increase for rural SCHs. As indicated in 
our proposed rule (72 FR 42698), we intend to reassess the 7.1 percent 
adjustment in the near future by examining differences between urban 
and rural costs using updated claims, cost, and provider information. 
In that process, we will include brachytherapy sources in each 
hospital's mix of services.
    Comment: Several commenters supported our proposals to continue our 
current policy of a budget neutral 7.1 percent payment increase for 
rural SCHs, including EACHs, for all services and procedures paid under 
the OPPS, excluding drugs, biologicals, and services paid under the 
pass-through payment policy, and to make brachytherapy sources eligible 
for the 7.1 percent payment increase for rural SCHs.
    Response: We appreciate the commenters' support of the policy.
    After consideration of the public comments received, we are 
finalizing, without modification, our policy to continue a payment 
adjustment for rural SCHs, including EACHs, of 7.1 percent for CY 2008. 
We also are finalizing our proposed revision of Sec.  419.43 to make 
brachytherapy sources eligible for the 7.1 percent payment increase for 
rural SCHs, including EACHs, without modification.

G. Hospital Outpatient Outlier Payments

1. Background
    Currently, the OPPS pays outlier payments on a service-by-service 
basis. For CY 2007, the outlier threshold is met when the cost of 
furnishing a service or procedure by a hospital exceeds 1.75 times the 
APC payment amount and exceeds the APC payment rate plus a $1,825 
fixed-dollar threshold. We introduced a fixed-dollar threshold in CY 
2005 in addition to the traditional multiple threshold in order to 
better target outliers to those high cost and complex procedures where 
a very costly service could present a hospital with significant 
financial loss. If a provider meets both of these conditions, the 
multiple threshold and the fixed-dollar threshold, the outlier payment 
is calculated as 50 percent of the amount by which the cost of 
furnishing the service exceeds 1.75 times the APC payment rate.
    As explained in the CY 2007 OPPS/ASC final rule with comment period 
(71 FR 68011 through 68012), we set our projected target for aggregate 
outlier payments at 1.0 percent of aggregate total payments under the 
OPPS for CY 2007. The outlier thresholds were set so that estimated CY 
2007 aggregate outlier payments would equal 1.0 percent of aggregate 
total payments under the OPPS. In that final rule with comment period 
(71 FR 68010) we also published total outlier payments as a percent of 
total expenditures for CY 2005. In the past, we have received comments 
asking us to publish estimated outlier payments to provide a context 
for the proposed outlier thresholds for the update year. In the CY 2008 
OPPS/ASC

[[Page 66684]]

proposed rule (72 FR 42698), we estimated, using available CY 2006 
claims, that the outlier payments for CY 2006 would be approximately 
1.1 percent of total CY 2006 OPPS payment. In the final CY 2006 claims, 
aggregated outlier payments were 1.1 percent of aggregated total OPPS 
payments. For CY 2006, the estimated outlier payments were set at 1.0 
percent of the total aggregated OPPS payments. Therefore, for CY 2006 
we paid 0.1 percent in excess of the CY 2006 outlier target of 1.0 
percent of total aggregated OPPS payments. Using the final CY 2006 
claims and CY 2007 payment rates, we currently estimate that outlier 
payments for CY 2007 would be approximately 0.7 percent of total CY 
2007 OPPS payments and the difference between 1.0 percent and 0.7 
percent is reflected in the regulatory impact analysis in section 
XXIV.B. of this final rule with comment period. We will not know the 
final amount of outlier payments as a percent of total payments until 
we have final CY 2007 claims. We note that we provide estimated CY 2008 
outlier payments by hospital for hospitals with claims included in the 
claims data that we used to model impacts on the CMS Web site in the 
Hospital--Specific Impacts--Provider-Specific Data file on the CMS Web 
site at: http://www.cms.hhs.gov/HospitalOutpatientPPS/.
2. Proposed Outlier Calculation
    For CY 2008, we proposed to continue our policy of setting aside 
1.0 percent of aggregate total payments under the OPPS for outlier 
payments. We proposed that a portion of that 1.0 percent, 0.03 percent, 
would be allocated to CMHCs for partial hospitalization program service 
outliers. This amount is the amount of estimated outlier payments 
resulting from the proposed CMHC outlier threshold of 3.4 times the APC 
payment rate, as a proportion of all payments dedicated to outlier 
payments. For this final rule, we estimate that 0.02 percent of total 
outlier payments would be allocated to CMHC's for partial 
hospitalization program service outliers. For further discussion of 
CMHC outliers, we refer readers to section II.B.3. of this final rule 
with comment period.
    In order to ensure that estimated CY 2008 aggregate outlier 
payments would equal 1.0 percent of estimated aggregate total payments 
under the OPPS, we proposed that the outlier threshold be set so that 
outlier payments would be triggered when the cost of furnishing a 
service or procedure by a hospital exceeds 1.75 times the APC payment 
amount and exceeds the APC payment rate plus a $2,000 fixed-dollar 
threshold. This proposed threshold reflected minor changes to the 
methodology discussed below as well as APC recalibration, including 
changes due in part to the CY 2008 packaging approach discussed in 
section II.A.4.c. of this final rule with comment period.
    We calculated the fixed-dollar threshold for the CY 2008 proposed 
rule using largely the same methodology as we did in CY 2007, except 
that we proposed to adjust the overall CCRs to reflect the anticipated 
annual decline in overall CCRs, discussed below, and to use CCRs from 
the most recent update to the Outpatient Provider-Specific File (OPSF), 
rather than CCRs we calculate internally for ratesetting. As noted in 
the CY 2008 OPPS/ASC proposed rule (72 FR 42699), in November 2006 we 
issued Transmittal 1030, ``Policy Changes to the Fiscal Intermediary 
(FI) Calculation of Hospital Outpatient Payment System (OPPS) and 
Community Mental Health Center (CMHC) Cost to Charge Ratios (CCRs),'' 
instructing fiscal intermediaries (or, if applicable, MACs) to update 
the overall CCR calculation for outlier and other cost-based payments 
using the CCR calculation methodology that we finalized for CY 2007. As 
discussed in the CY 2007 OPPS/ASC proposed rule and final rule with 
comment period, this methodology aligned the fiscal intermediary's CCR 
calculation and the CCR calculation we previously used to model outlier 
thresholds by removing allied and nursing health costs for those 
hospitals with paramedical education programs from the fiscal 
intermediary's CCR calculation and weighting our ``traditional'' CCR 
calculation by total Medicare Part B charges. We believe that the OPSF 
best estimates the CCRs that fiscal intermediaries (or, if applicable, 
MACs) would use to determine outlier payments in CY 2008. For the 
proposed rule, we used the April update to the OPSF. We supplemented a 
CCR calculated internally for the handful of providers with claims in 
our claims dataset that were not listed in the April update to the 
OPSF.
    The claims that we use to model each OPPS update lag by 2 years. 
For the proposed rule, we used CY 2006 claims to model the CY 2008 
OPPS. In order to estimate CY 2008 outlier payments for the proposed 
rule, we inflated the charges on the CY 2006 claims using the same 
inflation factor of 1.1504 that we used to estimate the IPPS fixed-
dollar outlier threshold for the FY 2008 IPPS proposed rule. For 1 
year, the inflation factor is 1.0726. The methodology for determining 
this charge inflation factor was discussed in the FY 2008 IPPS proposed 
rule (72 FR 24837) and in the FY 2008 IPPS final rule with comment 
period (72 FR 47417). As we stated in the CY 2005 OPPS final rule with 
comment period, we believe that the use of this charge inflation factor 
is appropriate for the OPPS because, with the exception of the routine 
service cost centers, hospitals use the same cost centers to capture 
costs and charges across inpatient and outpatient services (69 FR 
65845).
    In comments on the CY 2007 OPPS/ASC proposed rule, a commenter 
asked that CMS modify the charge methodology used to set the OPPS 
outlier threshold to account for the change in CCRs over time in a 
manner similar to that used for the FY 2007 IPPS. The commenter 
indicated that it would be appropriate to apply an inflation adjustment 
factor so that the CCRs that CMS uses to simulate OPPS outlier payments 
would more closely reflect the CCRs that would be used in CY 2007 to 
determine actual outlier payment. In the CY 2007 OPPS/ASC final rule 
with comment period, we expressed concern that cost increases between 
inpatient and outpatient departments could be different and indicated 
that we would study the issue and address any changes to the outlier 
methodology through future rulemaking (71 FR 68012).
    In assessing the possibility of utilizing a cost inflation 
adjustment for the OPPS, we determined that we could not calculate an 
OPPS-specific reliable cost per unit, comparable to the cost per 
discharge component of the IPPS calculation, because of variability in 
definition of an OPPS unit of service across calendar years. However, 
we also believed that the costs and charges reported under the 
applicable cost centers largely are commingled inpatient and outpatient 
costs and charges. We did not want to systematically overestimate the 
OPPS outlier threshold as could occur if we did not apply a CCR 
inflation adjustment factor. Therefore, we proposed to apply the CCR 
adjustment factor that was proposed to be applied for IPPS outlier 
calculation to the CCRs used to simulate the CY 2008 OPPS outlier 
payments that determined the fixed-dollar threshold. Specifically, for 
CY 2008, we proposed to apply an adjustment of 0.9912 to the CCRs that 
are currently on the OPSF to trend them forward from CY 2007 to CY 
2008. The methodology for calculating this adjustment is discussed in 
the FY 2008 IPPS proposed rule (72 FR 24837) and the FY 2008 IPPS final 
rule with comment period (72 FR 47417).

[[Page 66685]]

    Therefore, for the CY 2008 proposed rule, we applied the overall 
CCRs from the April 2007 OPSF file after adjustment to approximate CY 
2008 CCRs (using the proposed CCR inflation adjustment factor of 
0.9912) to charges on CY 2006 claims that were adjusted to approximate 
CY 2008 charges (using the proposed charge inflation factor of 1.1504). 
We simulated aggregated CY 2008 outlier payments using these costs for 
several different fixed-dollar thresholds, holding the 1.75 multiple 
constant and assuming that outlier payment would continue to be made at 
50 percent of the amount by which the cost of furnishing the service 
would exceed 1.75 times the APC payment amount, until the total outlier 
payments equaled 1.0 percent of aggregated estimated total CY 2008 OPPS 
payments. We estimated that a proposed fixed-dollar threshold of 
$2,000, combined with the proposed multiple threshold of 1.75 times the 
APC payment rate, would allocate 1.0 percent of aggregated total OPPS 
payments to outlier payments. We proposed to continue to make an 
outlier payment that equals 50 percent of the amount by which the cost 
of furnishing the service exceeds 1.75 times the APC payment amount 
when both the 1.75 multiple threshold and the fixed-dollar $2,000 
threshold are met. For CMHCs, if a CMHC provider's cost for partial 
hospitalization exceeds 3.4 times the payment rate for APC 0033, the 
outlier payment is calculated as 50 percent of the amount by which the 
cost exceeds 3.4 times the APC payment rate.
    We received several public comments related to this proposal. A 
summary of the public comments and our responses follow.
    Comment: Several commenters requested that CMS publish annual 
outlier payments as a percentage of total OPPS payment.
    Response: We currently publish the total outlier payments as a 
percent of total payment for past years in the annual OPPS/ASC proposed 
and final rules. We have projected outlier payments to be 1.1 percent 
of total OPPS payments for CY 2006, the most complete set of full year 
claims data that currently exists. We plan to continue to publish these 
numbers for future years, after we have full year cost data. For CY 
2008, we estimate that outlier payments will be 1.0 percent of total 
payment.
    Comment: One commenter agreed with our proposal to raise the fixed 
dollar outlier threshold accordingly so that the 1.0 percent target for 
outlier payments is met. Other commenters requested that CMS lower the 
fixed dollar threshold so that a greater number of services would be 
eligible for outlier payments. One commenter noted that the proposed 
increased fixed dollar threshold significantly reduced the number of 
services that would be eligible for outlier payments. Another commenter 
expressed concern that increased OPPS packaging would cause CMS to pay 
less in outlier payments than in the past. Other commenters were 
concerned that the fixed dollar outlier threshold that CMS proposed was 
set too high and would result in CMS spending less money than allocated 
for the projected 1.0 percent outlier target. These commenters argued 
that the estimated outlier target amount has historically been greater 
than the actual need, and they asked that CMS either reduce the set-
aside amount and retain that money in the base OPPS rates or reduce the 
threshold for qualification so that the outlier expenditures would be 
at a zero balance at the end of each year. Several commenters asked 
that CMS limit the increase in the outlier threshold to the amount of 
the market basket update each year, which would mean, for CY 2008, that 
the CY 2008 threshold would be increased by only 3.3 percent. Other 
commenters suggested that the outlier payment be increased from 50 
percent to 80 percent of the difference between the APC payment and the 
cost of the service. They believed that this would more appropriately 
account for the additional cost of the service and make the outlier 
payment policy consistent with IPPS policy.
    Response: Consistent with the views of most commenters, we are 
reducing the proposed fixed dollar outlier threshold based on our 
updated analysis for this final rule with comment period, where we use 
the most current claims and cost report data and final payment policies 
to estimate the threshold that would allow us to pay CY 2008 outlier 
payments of 1.0 percent of total CY 2008 OPPS payment.
    In CY 2008, the OPPS outlier outlay is projected to be 1.0 percent 
of total payments. We note that our projections for CY 2008 outlier 
payments take into account the final packaging policies, as well as all 
other final payment policies, of the OPPS. We acknowledge that outlier 
payments are an integral component of the OPPS and could be 
particularly important as the APC payment bundles grow larger and 
hospitals potentially experience financially greater risk associated 
with individual patient encounters. In a movement toward encounter-
based or episode-based payment, multiple service payments for a claim 
could become less common, and OPPS outlier payments could come to be 
increasingly targeted toward clinical cases rather than individual 
services, consistent with the customary role of outlier payment in a 
prospective payment system. We prospectively set the outlier thresholds 
so that we will pay 1.0 percent of projected payment based on our best 
inflation assumptions and model of final payment policies. The final 
policy to increase packaging for the CY 2008 OPPS should not result in 
less aggregate outlier payment in CY 2008 than other years, although 
the distribution of payment across APCs will change.
    We believe that the estimated total CY 2008 outlier payments will 
meet the target of 1.0 percent of total OPPS payments. In CY 2006, 
aggregated outlier payments were 1.1 percent of aggregated total 
spending, while the target was set at 1.0. As we indicated in the CY 
2007 OPPS/ASC final rule with comment period (71 FR 68010), in the 
final set of CY 2005 OPPS claims, aggregated outlier payments were 2.39 
percent of aggregated total OPPS payments, while the target was set at 
2.0 percent. Similarly, using the final set of CY 2004 OPPS claims, 
aggregated outlier payments were 2.5 percent of total OPPS payments, 
while the target was set at 2 percent. Hence, our historic estimation 
of outlier payments has resulted in outlier payments that exceeded our 
target. As noted above, we currently estimate that we will pay 0.7 
percent of total payments in outlier payments in CY 2007. We believe 
that our proposed methodology that applies charge and CCR inflation 
factors to updated CY 2006 claims and overall CCRs from the most recent 
OPSF file to approximate CY 2008 values yields an outlier threshold 
that will result in more accurate aggregate program outlier payments.
    We did not increase the CY 2008 outlier threshold by the market 
basket update of 3.3 percent because our calculations are intended to 
best approximate the outlier target of 1.0 percent of CY 2008 OPPS 
expenditures. We continue to believe that an outlier target of 1.0 
percent of total OPPS payment is appropriate for the OPPS. However, we 
will monitor outlier payments distributed during CY 2008 to determine 
whether a different outlier target would be more appropriate.
    Similarly, we do not believe it is appropriate to increase the 
payment percentage to 80 percent of the difference between the APC 
payment and the cost of the service in order to align it with the IPPS 
outlier policy. In a budget neutral system with a specified payment 
target, the payment percentage

[[Page 66686]]

and fixed-dollar threshold have an inverse relationship. Raising the 
payment percentage would require us to significantly increase the fixed 
dollar threshold to ensure that the outlier target is not exceeded. We 
agree with most commenters that a relatively lower fixed-dollar 
threshold is more desirable for the OPPS than a higher fixed-dollar 
threshold, given the current size of the OPPS payment bundles.
    After consideration of the public comments received, we are 
finalizing our CY 2008 proposal, without modification, for the outlier 
calculation as outlined below.
3. Final Outlier Calculation
    For CY 2008, we are applying the overall CCRs from the July 2007 
OPSF file with a CCR adjustment factor of 1.0027 to approximate CY 2008 
CCRs to charges on the final CY 2006 claims that were adjusted to 
approximate CY 2008 charges (using the final charge inflation factor of 
1.1278). These are the same CCR adjustment and charge inflation factors 
that we used to set the IPPS fixed-dollar threshold for FY 2008 (72 FR 
47418). We simulated aggregated CY 2008 outlier payments using these 
costs for several different fixed-dollar thresholds, holding the 1.75 
multiple constant and assuming that outlier payment would continue to 
be made at 50 percent of the amount by which the cost of furnishing the 
service would exceed 1.75 times the APC payment amount, until the total 
outlier payments equaled 1.0 percent of aggregated estimated total CY 
2008 OPPS payments. We estimate that a fixed-dollar threshold of 
$1,575, combined with the multiple threshold of 1.75 times the APC 
payment rate, will allocate 1.0 percent of aggregated total OPPS 
payments to outlier payments.
    In summary, for CY 2008 we will continue to make an outlier payment 
that equals 50 percent of the amount by which the cost of furnishing 
the service exceeds 1.75 times the APC payment amount when both the 
1.75 multiple threshold and the fixed-dollar $1,575 threshold are met. 
As discussed in section VII.B. of this final rule with comment period, 
brachytherapy sources will be eligible for outlier payment beginning in 
CY 2008. In addition, the costs of diagnostic radiopharmaceuticals and 
contrast media for which CY 2008 payment is packaged into the APC 
payments for nuclear medicine and other imaging procedures under the 
final packaging approach will contribute to a claim's eligibility for 
outlier payment in CY 2008. For CMHCs, if a CMHC provider's cost for 
partial hospitalization exceeds 3.4 times the payment rate for APC 
0033, the outlier payment is calculated as 50 percent of the amount by 
which the cost exceeds 3.4 times the APC payment rate.

H. Calculation of an Adjusted Medicare Payment From the National 
Unadjusted Medicare Payment

    (We note that the title of this section has been changed from that 
used in the CY 2008 OPPS/ASC proposed rule. In that rule this section 
was entitled, ``Proposed Calculation of the National Unadjusted 
Medicare Payment.'')
    The basic methodology for determining prospective payment rates for 
HOPD services under the OPPS is set forth in existing regulations at 
Sec.  419.31 and Sec.  419.32, and Sec.  419.43 and Sec.  419.44. The 
payment rate for services and procedures for which payment is made 
under the OPPS is the product of the conversion factor calculated in 
accordance with section II.C. of this final rule with comment period 
and the relative weight determined under section II.A. of this final 
rule with comment period. Therefore, the national unadjusted payment 
rate for each APC contained in Addendum A to this final rule with 
comment period and for HCPCS codes to which separate payment under the 
OPPS has been assigned in Addendum B to this final rule with comment 
period (Addendum B is provided as a convenience for readers) was 
calculated by multiplying the final CY 2008 scaled weight for the APC 
by the final CY 2008 conversion factor.
    However, to determine the payment that will be made in a calendar 
year under the OPPS to a specific hospital for an APC for a service 
that has any of the status indicator assignments ``S,'' ``T,'' ``V,'' 
or ``X,'' as defined in Addendum D1 of this final rule with comment 
period, in a circumstance in which the multiple procedure discount does 
not apply and the procedure is not bilateral or discontinued, we take 
the following steps:
    Step 1. Calculate 60 percent (the labor-related portion) of the 
national unadjusted payment rate. Since the initial implementation of 
the OPPS, we have used 60 percent to represent our estimate of that 
portion of costs attributable, on average, to labor. (We refer readers 
to the April 7, 2000 final rule with comment period (65 FR 18496 
through 18497) for a detailed discussion of how we derived this 
percentage.) We confirmed that this labor-related share for hospital 
outpatient services is still appropriate during our regression analysis 
for the payment adjustment for rural hospitals in the CY 2006 OPPS 
final rule with comment period (70 FR 68553).
    Individual providers interested in calculating the final payment 
amount that they will receive for a specific service from the national 
payment rates presented in Addenda A and B to this final rule with 
comment period should follow the formulas presented in the following 
steps. The formula below is a mathematical representation of step 1 
discussed above and identifies the labor-related portion of a specific 
payment rate for the specific service.

x--Labor-related portion of the national unadjusted payment rate

x = .60 * (national unadjusted payment rate)

    Step 2. Determine the wage index area in which the hospital is 
located and identify the wage index level that applies to the specific 
hospital. The wage index values assigned to each area reflect the new 
geographic statistical areas as a result of revised OMB standards 
(urban and rural) to which hospitals are assigned for FY 2008 under the 
IPPS, reclassifications through the MCGRB, section 1886(d)(8)(B) 
``Lugar'' hospitals, and section 401 of Pub. L. 108-173. We note that 
the reclassifications of hospitals under the one-time appeals process 
under section 508 of Pub. L. 108-173 expired on September 30, 2007, and 
is no longer applicable in this determination of appropriate wage 
values for the CY 2008 OPPS. The wage index values include the 
occupational mix adjustment described in section II.D. of this final 
rule with comment period that was developed for the final FY 2008 IPPS 
payment rates published in the Federal Register on August 22, 2007 (72 
FR 47309 through 47315) and corrected in the correction notice to the 
FY 2008 IPPS final rule with comment period published in the Federal 
Register on October 10, 2007 (72 FR 57634 through 57738).
    Step 3. Adjust the wage index of hospitals located in certain 
qualifying counties that have a relatively high percentage of hospital 
employees who reside in the county, but who work in a different county 
with a higher wage index, in accordance with section 505 of Pub. L. 
108-173. Addendum L to this final rule with comment period contains the 
qualifying counties and the final wage index increase developed for the 
FY 2008 IPPS published in the FY 2008 IPPS final rule with comment 
period (72 FR 47339) and corrected in the correction notice to the FY 
2008 IPPS final rule with comment period published in the Federal 
Register on October 10, 2007 (72 FR 57634 through 57738). This step is 
to be followed only

[[Page 66687]]

if the hospital has chosen not to accept reclassification under Step 2 
above.
    Step 4. Multiply the applicable wage index determined under Steps 2 
and 3 by the amount determined under Step 1 that represents the labor-
related portion of the national unadjusted payment rate.
    The formula below is a mathematical representation of step 4 
discussed above and adjusts the labor-related portion of the national 
payment rate for the specific service by the wage index.

xa--Labor-related portion of the national unadjusted 
payment rate (wage adjusted
xa = 60 * (national unadjusted payment rate) * applicable 
wage index.

    Step 5. Calculate 40 percent (the nonlabor-related portion) of the 
national unadjusted payment rate and add that amount to the resulting 
product of Step 4. The result is the wage index adjusted payment rate 
for the relevant wage index area.The formula below is a mathematical 
representation of step 5 discussed above and calculates the remaining 
portion of the national payment rate, the amount not attributable to 
labor, and the adjusted payment for the specific service.

y--Nonlabor-related portion of the national unadjusted payment rate
y = .40 * (national unadjusted payment rate)
Adjusted Medicare Payment = y + xa

    Step 6. If a provider is a SCH, as defined in Sec.  412.92, or an 
EACH, which is considered to be a SCH under section 
1886(d)(5)(D)(iii)(III) of the Act, and located in a rural area, as 
defined in Sec.  412.64(b), or is treated as being located in a rural 
area under Sec.  412.103, multiply the wage index adjusted payment rate 
by 1.071 to calculate the total payment.
    The formula below is a mathematical representation of step 6 
discussed above and applies the rural adjustment for rural SCHs.

Adjusted Medicare Payment (SCH or EACH) = Adjusted Medicare Payment 
* 1.071

    We did not receive any public comments on our proposed methodology 
for calculating an adjusted payment from the national unadjusted 
Medicare payment amount for CY 2008. Therefore, we are finalizing our 
methodology as proposed for CY 2008, without modification.

I. Beneficiary Copayments

1. Background
    Section 1833(t)(3)(B) of the Act requires the Secretary to set 
rules for determining copayment amounts to be paid by beneficiaries for 
covered OPD services. Section 1833(t)(8)(C)(ii) of the Act specifies 
that the Secretary must reduce the national unadjusted copayment amount 
for a covered OPD service (or group of such services) furnished in a 
year in a manner so that the effective copayment rate (determined on a 
national unadjusted basis) for that service in the year does not exceed 
a specified percentage. For all services paid under the OPPS in CY 
2008, and in calendar years thereafter, the specified percentage is 40 
percent of the APC payment rate (section 1833(t)(8)(C)(ii)(V) of the 
Act). Section 1833(t)(3)(B)(ii) of the Act provides that, for a covered 
OPD service (or group of such services) furnished in a year, the 
national unadjusted copayment amount cannot be less than 20 percent of 
the OPD fee schedule amount. Sections 1834(d)(2)(C)(ii) and 
(d)(3)(C)(ii) of the Act further require that the copayment for 
screening flexible sigmoidoscopies and screening colonoscopies be equal 
to 25 percent of the payment amount. We have applied the 25-percent 
copayment to screening flexible sigmoidoscopies and screening 
colonoscopies since the beginning of the OPPS.
2. Copayment
    For CY 2008, we proposed to determine copayment amounts for new and 
revised APCs using the same methodology that we implemented for CY 
2004. (We refer readers to the November 7, 2003 OPPS final rule with 
comment period (68 FR 63458).) The unadjusted copayment amounts for 
services payable under the OPPS that will be effective January 1, 2008, 
are shown in Addendum A and Addendum B to this final rule with comment 
period.
    We have historically used standard rounding principles to establish 
a 20 percent copayment for those few circumstances where the copayment 
rate was between 19.5 and 20 percent using our established copayment 
rules. For example, the CY 2008 proposed payment and copayment amounts 
for APC 9228 (Tigecycline injection) were $0.91 and $0.18, 
respectively. Twenty percent of $0.91 is $0.182. Because it would be 
impossible to set a copayment rate at exactly 20 percent in this case, 
that is, $0.182, we proposed to round the amount, using standard 
rounding principles, to $0.18. Also using standard rounding principles, 
19.78 percent ($0.18 as a percentage of $0.91) rounds to 20 percent and 
meets the statutory requirement of a copayment amount of at least 20 
percent. For CY 2008, APC 9046 (Iron Sucrose Injection) had a proposed 
payment amount and copayment amount of $0.37 and $0.08, respectively. 
Using our established copayment rules, 20 percent of $0.37 is $0.074. 
Normally, we would apply standard rounding principles to achieve an 
amount that is payable, here $0.07 rather than $0.074. However, if we 
were to set a copayment amount of $0.07, which is 18.9 percent of 
$0.37, we would not be setting a copayment rate that is at least 20 
percent of the OPPS payment rate. As proposed, we continue to believe 
that section 1833(t)(3)(B) of the Act requires us to set a copayment 
amount that is at least 20 percent of the OPPS payment amount, not less 
than 20 percent. Therefore, we proposed to set the copayment rate for 
APC 9046 at $0.08. Eight cents represents the lowest amount that we 
could set that would bring the copayment rate to 20 percent or, in this 
case, just above 20 percent. We proposed to apply this same methodology 
in the future to instances where the application of our standard 
copayment methodology would result in a copayment amount that is under 
20 percent and cannot be rounded, under standard rounding principles, 
to 20 percent.
    We did not receive any public comments on this proposal, and, 
therefore, we are adopting it as final, without modification.
3. Calculation of an Adjusted Copayment Amount for an APC Group
    To calculate the OPPS adjusted copayment amount for an APC group, 
take the following steps:
    Step 1. Calculate the beneficiary payment percentage for the APC by 
dividing the APC's national unadjusted copayment by its payment rate. 
For example, using APC 0001, $7.00 is 23 percent of $30.61.
    Individuals interested in calculating the their final copayment 
liability for a given service from the national copayment rates 
presented in Addenda A and B should follow the formulas presented in 
the following steps. The formula below is a mathematical representation 
of step 1 discussed above and calculates national copayment as a 
percentage of national payment for a given service.

b--Beneficiary payment percentage
b = national unadjusted copayment for APC / national unadjusted 
payment rate for APC

    Step 2. Calculate the wage adjusted payment rate for the APC, for 
the provider in question, as indicated in section II.H. of this final 
rule with comment period. Calculate the rural adjustment for eligible 
providers as indicated in section II.H. of this final rule with comment 
period.
    Step 3. Multiply the percentage calculated in Step 1 by the payment 
rate calculated in Step 2. The result is the wage-adjusted copayment 
amount for the APC.

[[Page 66688]]

    The formula below is a mathematical representation of step 3 
discussed above and applies the beneficiary percentage to the adjusted 
payment rate for a service calculated under II.H. above, with and 
without the rural adjustment, to calculate the final adjusted 
beneficiary copayment for a given service.

Wage-adjusted copayment amount for the APC = Adjusted Medicare 
Payment * b
Wage-adjusted copayment amount for the APC (SCH or EACH) = (Adjusted 
Medicare Payment * 1.071)* b

    The unadjusted copayments for services payable under the OPPS that 
will be effective January 1, 2008, are shown in Addenda A and B to this 
final rule with comment period.
    We did not receive any public comments concerning the proposed 
methodology for calculating the unadjusted copayment amount for CY 
2008. Therefore, we are finalizing our proposal without modification.

III. OPPS Ambulatory Payment Classification (APC) Group Policies

A. Treatment of New HCPCS and CPT Codes

1. Treatment of New HCPCS Codes Included in the April and July 
Quarterly OPPS Updates for CY 2007
a. Background
    For the July quarter of CY 2007, we created a total of 16 new Level 
II HCPCS codes, specifically C2638, C2639, C2640, C2641, C2642, C2643, 
C2698, C2699, C9728, Q4087, Q4088, Q4089, Q4090, Q4091, Q4092, and 
Q4095 that were not addressed in the CY 2007 OPPS/ASC final rule with 
comment period that updated the CY 2007 OPPS. We designated the payment 
status of these codes and added them through the July 2007 update 
(Change Request 5623, Transmittal 1259, dated June 1, 2007). There were 
no new Level II HCPCS codes for the April 2007 update. In the CY 2008 
OPPS/ASC proposed rule, we also solicited public comment on the status 
indicators, APC assignments, and payment rates of these codes, which 
were listed in Table 26A and Table 26B of that proposed rule, and now 
appear in Tables 10 and 11, respectively, of this final rule with 
comment period. Because of the timing of the proposed rule, the codes 
implemented through the July 2007 OPPS update were not included in 
Addendum B to that rule. In the CY 2008 OPPS/ASC proposed rule, we 
proposed to assign the new HCPCS codes for CY 2008 to APCs with the 
proposed rates as displayed in Tables 26A and 26B and incorporate them 
into Addendum B of this final rule with comment period for CY 2008, 
which is consistent with our annual APC updating policy. As noted in 
Table 13 of this final rule with comment period, HCPCS codes Q4087, 
Q4088, Q4089, Q4090, Q4091, Q4092, and Q4095 will be deleted on 
December 31, 2007 and replaced with HCPCS J-codes effective January 1, 
2008. Readers should refer to Table 13 for their replacement codes.
b. Implantation of Interstitial Devices (APC 0156)
    Effective January 1, 2007, CPT code 55876 (Placement of 
interstitial device(s) for radiation therapy guidance (e.g., fiducial 
markers, dosimeter), prostate (via needle, any approach), single or 
multiple) was implemented. We assigned this code to APC 0156 (Level III 
Urinary and Anal Procedures) for CY 2007 on an interim final basis. We 
then created a new Level II HCPCS code for a similar interstitial 
device implantation service for non-prostate sites, C9728 (Placement of 
interstitial device(s) for radiation therapy/surgery guidance (e.g., 
fiducial markers, dosimeter), other than prostate (any approach), 
single or multiple). We implemented HCPCS code C9728 effective July 1, 
2007 via Program Transmittal 1259 dated June 1, 2007, as a result of 
information we received during our evaluation of an application for 
assignment of the implantation of a radiation dose verification system 
to a New Technology APC. We assigned HCPCS code C9728 to APC 0156 
because we believed it was similar to CPT code 55876 from both clinical 
and resource perspectives. We proposed to maintain both CPT code 55876 
and HCPCS code C9728 in APC 0156 for CY 2008, with a proposed payment 
rate of approximately $195.
    We received a number of comments on the APC assignments of these 
codes, both on the CY 2007 OPPS/ASC final rule with comment period and 
on the CY 2008 proposed rule. A summary of the comments and our 
response follow.
    Comment: A few commenters expressed concern about CMS' interim 
final placement of CPT code 55876 in APC 0156 for CY 2007 as shown in 
Addendum B to the CY 2007 final rule with comment period. Several 
commenters expressed similar concern regarding the proposed CY 2008 APC 
assignment for this code. The commenters recommended that the payment 
rate for implanting the interstitial devices not incorporate the cost 
of the devices, because such items have a range of costs. Several 
commenters claimed that the costs of these devices range widely, from 
approximately $200 for gold markers, to $900 for implantable 
dosimeters, to $1200 for electromagnetic transponders, which they 
believed justified separate payment for the various types of 
interstitial devices.
    Some commenters also expressed concern about the proposed CY 2008 
APC placement of a new code that CMS created for non-prostate 
applications, specifically HCPCS code C9728 which was assigned to APC 
0156, effective July 1, 2007, because it is similar to CPT code 55876. 
Several commenters asserted that the payment for HCPCS code C9728 
should include the costs of dosimeter sensors, which they believed are 
currently excluded. These commenters also noted that payment for CPT 
code 55876 excludes the cost of dosimeter sensors. They recommended 
that CMS develop Level II HCPCS codes that permit hospitals to report 
the specific technologies associated with HCPCS code C9728 and CPT code 
55876 in each clinical case and receive appropriate payment for the 
specific interstitial device implanted.
    Several commenters pointed out that the CPT coding instructions for 
CPT code 55876 instruct coders to report the supply of devices for the 
implantation procedure separately from CPT code 55876. These commenters 
claimed that when the CPT Editorial Panel established the code, it did 
not include the implantable interstitial device and the imaging 
guidance for the implantation procedure in the code, and, therefore, 
both device costs and imaging guidance costs were excluded from the 
proposed CY 2008 APC payment for CPT code 55876. Because a dosimeter 
sensor could be implanted with CPT code 55876 for prostate 
applications, the commenters asserted that its costs are not reflected 
in that service. The commenters claimed that, unlike the instructions 
for CPT code 55876, the descriptor for HCPCS code C9728 does not direct 
coders to report the device separately. These commenters recommended 
that CMS assign the DVS[reg] Dosimeter device for any body site to New 
Technology APC 1514 (New Technology--Level XIV ($1200-$1300)), with a 
payment rate of $1250 for the device for CY 2008. Alternatively, they 
suggested that CMS package payment for all of the items and services 
needed to implant the dosimeter into payment for a single code which 
they recommended be assigned to New Technology APC 1522 (New 
Technology--Level XXII ($2000-$2500)). One commenter further claimed 
that CMS was required to set the APC assignment for the DVS[reg] device 
based on the cost estimate

[[Page 66689]]

included in its New Technology APC application.
    Response: Many procedures paid under the OPPS include payment for 
various implantable devices, where the procedure cost in an individual 
case would vary by the type of device. Our long-standing policy is to 
package the costs of implantable devices into payment for the 
procedures in which they are used, unless those devices are paid 
separately for a limited period of 2 to 3 years based on their 
transitional pass-through status. Payment for OPPS services includes 
payment for all costs that are directly related and integral to 
performing a procedure or furnishing a service on an outpatient basis, 
as set forth in Sec.  419.2.
    According to our usual practice, when we originally evaluated CPT 
code 55876 for APC assignment for CY 2007, we took into consideration 
all information available to us about the particular service, as well 
as other OPPS services for which we have claims-based cost data. In 
particular, we considered the probable utilization of the various 
devices, including fiducial markers and dosimeters, whose implantation 
could be reported with the CPT code, as well as possible implantation 
approaches, recognizing that a prospective payment system is based on 
principles of averaging. For established services paid under the OPPS, 
payment is generally based on the median cost of the service from 
claims data. Although CPT instructions state that the supply of the 
implantable device is to be reported separately, we considered the 
device costs associated with CPT code 55876, which would be packaged 
into payment for the implantation procedure under the OPPS even if the 
device were separately reported, when we assigned the CPT code to APC 
0156. A previous pass-through device category, C1879 (Tissue marker 
(implantable)) for a device that we believe could be reported with CPT 
code 55876, was active from August 2000 through December 2002. After 
its expiration, the cost of tissue markers has been packaged into the 
OPPS payment for the procedures in which they are used. We note that 
the line-item CY 2006 median cost for HCPCS code C1879 for an 
implantable tissue marker was $88 based on approximately 18,600 units 
of this device. Although there was no specific HCPCS device code for a 
dosimeter in CY 2007, we would consider payment for the dosimeter 
packaged under the OPPS into the implantation procedure and would have 
no need to establish a specific HCPCS code for the dosimeter for OPPS 
payment purposes. There may be other devices whose implantation would 
also be reported with CPT code 55876 and, similarly, we would package 
their payment under the OPPS. We note that the CMS HCPCS Workgroup has 
created two related supply codes for CY 2008, specifically A4648 
(Tissue marker, implantable, any type, each) and A4650 (Implantable 
radiation dosimeter, each), which will be packaged under the OPPS for 
CY 2008 and which could also be reported in association with CPT code 
55876. Therefore, any of these HCPCS codes for devices or supplies, 
A4648, A4650 or C1879, are reportable with service codes 55876 or 
C9728.
    In response to public comments on the CY 2007 OPPS/ASC final rule 
with comment period and on the CY 2008 proposed rule on the proposed 
assignment of CPT code 55876 for CY 2008, we once again examined 
information available to us regarding procedures that could be reported 
with the CPT code, along with updated claims data for other OPPS 
services. We continue to believe that APC 0156 is the most appropriate 
APC assignment for CPT code 55876, based on the expected median cost 
and utilization of all of the services that would be reported with the 
code under the OPPS. We will first have claims data for CPT code 55876 
for the CY 2009 OPPS update, which we will review in the context of our 
CY 2009 update proposals.
    We note that during CY 2007, we evaluated a New Technology APC 
application submitted by the manufacturer of the DVS[reg] System for a 
service the applicant entitled ``Implantation of the DVS[reg] 
Dosimeter.'' We did not approve an item or service for payment 
specifically for the DVS[reg] Dosimeter. However, we approved creation 
of a new code for a service for non-prostate placement of interstitial 
device(s) for radiation therapy or surgical guidance, using such 
devices as fiducial markers or dosimeters. As explained by the 
commenters, and similar to CPT code 55876, this procedure could implant 
devices with a wide range of costs, including dosimeters that 
commenters claimed ranged from $900 to $1200. Our general policy in 
creating a new service code under the OPPS, whether we assign it to a 
clinical or New Technology APC, is to develop a general service code so 
that it may be reported for a range of technologies, rather than only 
for a single proprietary service. This reduces potential barriers to 
payment under the OPPS for related new services and is consistent with 
the general coding practices of the CPT Editorial Panel and the CMS 
HCPCS Workgroup. When we approve a new service for assignment to a New 
Technology APC, we are not required to set the payment rate based on 
the cost data presented in the New Technology APC application alone, as 
we have stated in our final rule published in the Federal Register on 
November 30, 2001. In that rule, we specifically explained that we do 
not limit our determination of the cost of a service to information 
submitted by the applicant. We obtain information on costs from other 
appropriate sources before making a determination of the cost of the 
procedure to hospitals (66 FR 59900). In addition, we note that only 
complete services are currently assigned to New Technology APCs, not 
items, such as drugs or devices.
    In response to comments to the CY 2008 proposed rule on the 
proposed assignment of HCPCS code C9728, we examined all information 
available to us on procedures that could be reported with the code, as 
well as updated cost data from claims regarding other OPPS services. We 
continue to believe that the resources and utilization associated with 
HCPCS code C9728, including the cost of the various possible 
implantable devices that may be implanted in the service and the 
different approaches to the implantation, resemble those associated 
with CPT code 55876. Therefore, we will maintain HCPCS code C9728 in 
APC 0156 for CY 2008. We will first have data for HCPCS code C9728 for 
the CY 2009 OPPS update, which we will review in the context of our CY 
2009 update proposals. We expect that these data will reflect the costs 
of the implantable devices utilized and, the extent that more costly 
devices, such as implantable dosimeters and electromagnetic 
transponders, are increasingly reported with this procedure, the cost 
of these devices will gradually be reflected in the median cost of 
HCPCS code C9728.
c. Other New HCPCS Codes Implemented in April or July 2007
    While we received public comments on the proposed CY 2008 OPPS 
treatment of HCPCS code C9728 as discussed above and HCPCS codes C2638, 
C2639, C2640, C2641, C2642, C2643, C2698, and C2699 as discussed in 
section VII. of this final rule with comment period, we did not receive 
any public comments on the proposed APC assignments and status 
indicators for HCPCS codes Q4087, Q4088, Q4089, Q4090, Q4091, Q4092, 
and Q4095 that were implemented in July 2007. However, for CY 2008, the 
CMS HCPCS Workgroup decided to delete the drug codes described by Q-
codes on December 31, 2007 and replace them with permanent J-codes 
effective

[[Page 66690]]

January 1, 2008. Consistent with our general policy of using permanent 
HCPCS codes for the reporting of drugs under the OPPS in order to 
streamline coding, we are displaying the J-codes in Table 13 that will 
replace the seven Q-codes, effective January 1, 2008. We note that Q 
codes are temporary national HCPCS codes. To avoid duplication, 
temporary national HCPCS codes, such as ``C-,'' ``G-,'' ``K-,'' and 
``Q-codes,'' are generally deleted once permanent national HCPCS codes 
are created that describe the same item, service, or procedure. The J-
codes describe the same drugs and the same dosages as the Q-codes that 
will be deleted December 31, 2007. Because we did not receive any 
public comments on the proposed CY 2008 APC and status indicator 
assignments for the new HCPCS codes, with the exception of HCPCS code 
C9728, that were implemented in July 2007, we are adopting our proposal 
as final, without modification, and are assigning the replacement HCPCS 
J codes to the same status indicators and APCs that were proposed for 
the predecessor Q-codes, as shown in Addendum B to this final rule with 
comment period.

                          Table 12.--New Non-Drug Hcpcs Codes Implemented in July 2007
----------------------------------------------------------------------------------------------------------------
                                                                                                       Final CY
        HCPCS code                  Long descriptor             Final CY 2008 status      Final CY   2008 median
                                                                     indicator            2008 APC       cost
----------------------------------------------------------------------------------------------------------------
C2638....................   Brachytherapy source, stranded,  K........................         2638          $45
                            iodine-125, per source.
C2639....................  Brachytherapy source, non-        K........................         2639           32
                            stranded, iodine-125, per
                            source.
C2640....................  Brachytherapy source, stranded,   K........................         2640           65
                            palladium-103, per source.
C2641....................  Brachytherapy source, non-        K........................         2641           51
                            stranded, palladium-103, per
                            source.
C2642....................  Brachytherapy source, stranded,   K........................         2642           97
                            cesium-131, per source.
C2643....................  Brachytherapy source, non         K........................         2643           63
                            stranded, cesium-131, per
                            source.
C2698....................  Brachytherapy source, stranded,   K........................         2698           45
                            not otherwise specified, per
                            source.
C2699....................  Brachytherapy source, non-        K........................         2699           31
                            stranded, not otherwise
                            specified, per source.
C9728....................  Placement of interstitial         T........................         0156          192
                            device(s) for radiation therapy/
                            surgery guidance (eg, fiducial
                            markers, dosimeter), other than
                            prostate (any approach) single
                            or multiple.
----------------------------------------------------------------------------------------------------------------


                            Table 13.--New Drug Hcpcs Codes Implemented in July 2007
----------------------------------------------------------------------------------------------------------------
                                                                                        Final CY
   New HCPCS J-code effective      HCPCS Q-               Long descriptor             2008 status    Final CY
        January 1, 2008              code                                              indicator     2008 APC
---------------------------------------------------------------------------------------------------------------
J1568..........................        Q4087  Injection, immune globulin, (Octogam),            K         0943
                                               intravenous, non-lyophilized, (e.g.
                                               liquid), 500 mg.
J1569..........................        Q4088  Injection, immune globulin,                       K         0944
                                               (Gammagard), intravenous, non-
                                               lyophilized, (e.g. liquid), 500 mg.
J2791..........................        Q4089  Injection, rho(d) immune globulin                 K         0945
                                               (human), (Rhophylac), intravenous,
                                               100 iu.
J1571..........................        Q4090  Injection, hepatitis b immune globulin            K         0946
                                               (Hepagam B), intramuscular, 0.5 ml.
J1572..........................        Q4091  Injection, immune globulin,                       K         0947
                                               (Flebogamma), intravenous, non-
                                               lyophilized, (e.g. liquid), 500 mg.
J1561..........................        Q4092  Injection, immune globulin, (Gamunex),            K         0948
                                               intravenous, non-lyophilized, (e.g.
                                               liquid), 500 mg.
J3488..........................        Q4095  Injection, zoledronic acid (Reclast),             K         0951
                                               1 mg.
----------------------------------------------------------------------------------------------------------------

2. Treatment of New Category I and III CPT Codes and Level II HCPCS 
Codes

a. Establishment and Assignment of New Codes
    As has been our practice in the past, we implement new Category I 
and III CPT codes and new Level II HCPCS codes through program 
transmittals, which are released in the summer through the fall of each 
year for annual updating, effective January 1, in the final rule 
updating the OPPS for the following calendar year. These codes are 
flagged with comment indicator ``NI'' in Addendum B to the OPPS/ASC 
final rule with comment period to indicate that we are assigning them 
an interim payment status which is subject to public comment following 
publication of the final rule that implements the annual OPPS update. 
(We refer readers to the discussion immediately below concerning our 
policy for implementing new Category I and III mid-year CPT codes.) In 
the CY 2008 OPPS/ASC proposed rule, we proposed to continue this 
recognition and process for CY 2008. Therefore, new Category I and III 
CPT codes and new Level II HCPCS codes, effective January 1, 2008, are 
listed in Addendum B to this final rule with comment period and 
designated using comment indicator ``NI.'' The status indicator, the 
APC assignment, or both, for all such codes flagged with comment 
indicator ``NI'' is open to public comment in this final rule with 
comment period. As indicated in the CY 2008 OPPS/ASC proposed rule, we 
will respond to all comments received concerning these codes in a 
subsequent final rule for the next calendar year's OPPS/ASC update.
    We did not receive any public comments on our proposal to assign a 
comment indicator of ``NI'' in Addendum B of the OPPS final rule with 
comment period to the new codes that are open to public comment. 
Therefore, we are finalizing our proposed treatment of new CY 2008 
Category I and III CPT codes, as well as the Level II HCPCS codes, 
without modification.
    We received some comments to the CY 2008 proposed rule regarding 
individual new HCPCS codes that commenters expected to be implemented 
for the first time in the CY 2008 OPPS. We could not discuss the CY 
2008 codes, including their APC

[[Page 66691]]

and/or status indicator assignments, because the codes were not 
available when we developed and issued the proposed rule. For those new 
Category I CPT codes whose descriptors were not officially available 
during the comment period and development of the CY 2008 final rule 
with comment period, we do not specifically respond to those comments 
in this final rule with comment period. For those new Category III CPT 
codes that were released on July 1, 2007, for implementation January 1, 
2008, we respond to those comments in this final rule with comment 
period because those codes were publicly available during the comment 
period to the proposed rule and the development of this final rule with 
comment period. Both of these groups of codes are flagged with comment 
indicator ``NI'' in this final rule with comment period, as discussed 
above, to signal that they are open to public comment.
    Effective for January 1, 2008, we have created eight HCPCS C-codes 
that describe transthoracic echocardiography with contrast and 
transesophageal echocardiography with contrast to enable facilities to 
appropriately report contrast-enhanced echocardiography services. (See 
section II.A.4.c(6) of this final rule with comment period for further 
discussion of these codes). Effective January 1, 2008, these C-codes 
will be used by HOPDs to report contrast echocardiography services. 
These codes are assigned comment indicator ``NI'' in Addendum B to this 
final rule with comment period.
    In the CY 2008 OPPS/ASC proposed rule, we also proposed to continue 
our policy of the last 2 years of recognizing new mid-year CPT codes, 
generally Category III CPT codes, that the AMA releases in January for 
implementation the following July through the OPPS quarterly update 
process. Therefore, for CY 2008, we proposed to include in Addendum B 
to the CY 2008 OPPS/ASC final rule with comment period the new Category 
III CPT codes released in January 2007 for implementation on July 1, 
2007 (through the OPPS quarterly update process), and the new Category 
III codes released in July 2007 for implementation on January 1, 2008. 
However, as proposed, only those new Category III CPT codes implemented 
effective January 1, 2008, are flagged with comment indicator ``NI'' in 
Addendum B to this final rule with comment period, to indicate that we 
have assigned them an interim payment status which is subject to public 
comment. Category III CPT codes implemented in July 2007, which 
appeared in Table 27 of the proposed rule and are displayed in Table 14 
of this final rule with comment period, were subject to comment in the 
proposed rule, and we proposed to finalize their status in this final 
rule with comment period.
b. Electronic Brachytherapy Services (New Technology APC 1519)
    The AMA's CPT Editorial Panel created a new Category III code, 
0182T (High dose rate (HDR) electronic brachytherapy, per fraction), as 
of July 1, 2007. We assigned CPT code 0182T to New Technology APC 1519 
(New Technology--Level IXX ($1700-$1800)), with a payment rate of 
$1750, as of July 1, 2007 (via Program Transmittal 1259, Change Request 
5623).
    We received a wide variety of comments regarding the proposed 
assignment of CPT code 0182T to New Technology APC 1519. A summary of 
the comments and our response follows.
    Comment: Some commenters thought the proposed assignment provided a 
payment that was too high, some believed the proposed payment was too 
low, while others agreed with the proposed APC assignment. A number of 
commenters believed that placement of CPT code 0182T into APC 1519 
resulted in a payment amount much higher relative to existing APCs for 
application of brachytherapy sources, specifically, APCs 0312 
(Radioelement Applications), 0313 (Brachytherapy), and 0651 (Complex 
Interstitial Radiation Source Application), with proposed CY 2008 
payment rates of $534.48, $739.46, and $981.88, respectively. One 
commenter indicated that only a very small number of patients would be 
treated using electronic brachytherapy. Another commenter expressed 
appreciation of CMS's prompt assignment of new technologies to APCs, 
while some commenters were concerned that the proposed payment for CPT 
code 0182T as a new technology service was between two and three times 
the payment rate for the other conventional brachytherapy service APCs 
cited above. These commenters believed that the proposed payment for 
electronic brachytherapy was excessive and, given that the risks of the 
treatment have yet to be clearly established, such conditions would 
encourage the early and possibly inappropriate adoption of this 
service. Some commenters recommended that CMS consult with specialty 
organizations regarding the pricing of new technology services prior to 
assigning them to APCs. Other commenters supported the proposed 
assignment of CPT code 0182T and recommended that the service reside in 
that New Technology APC for at least 2 years.
    Another commenter expressed concern that the payment level was too 
low for a single fraction treatment of electronic brachytherapy. The 
commenter pointed out that two applications for New Technology APCs 
were submitted to CMS for electronic brachytherapy with the following 
descriptions: (a) HDR electronic brachytherapy, complete course as a 
single fraction, and (b) HDR electronic brachytherapy, per fraction. 
The commenter claimed that the two forms of HDR electronic 
brachytherapy are each unique and should not be classified into the 
same APC. The commenter requested that a new HCPCS code for HDR 
electronic brachytherapy, complete course as a single fraction, be 
developed and assigned to APC 1529 (New Technology--Level XXIX ($5,500-
$6,000)) for CY 2008.
    Response: The CY 2008 proposed APC assignment of CPT code 0182T 
maintained our initial placement of HDR electronic brachytherapy. 
Consistent with our recent OPPS practice for Category III CPT codes 
that are implemented mid-year by the AMA, we recognized CPT code 0182T 
under the OPPS in July 2007. This recognition ensures timely collection 
of data pertinent to the service described by the code, ensures patient 
access to the service, and eliminates potential redundancy between 
Category III CPT codes and Level II HCPCS codes that are created by us 
in response to applications for new technology services.
    Commenters did not provide analyses regarding the costs of the 
service; however, we received cost estimates from two manufacturers in 
their respective New Technology APC applications over the course of an 
extensive evaluation period. As is our customary practice, we also used 
claims data for related services and other sources of information to 
supplement information included in the New Technology APC applications 
in order to provide an APC assignment we believed to be appropriate at 
this time. Regarding the comments on potential complications or risks 
of the new service that has a higher payment rate than conventional 
brachytherapy procedures, we note that the APC assignment of a service 
based on its estimated cost is our usual practice for new services 
under the OPPS, which generally pays for services based on estimated 
hospital resources. In the absence of cost data from hospital claims, 
we believe that comparisons of OPPS payment for electronic

[[Page 66692]]

brachytherapy to payment for conventional brachytherapy services that 
are assigned to APCs 0312, 0313, and 0651 and that implant radioactive 
sources are not appropriate. The law specifically requires separate 
payment for the brachytherapy sources, and, therefore, these costs are 
not included in the procedure payment for conventional brachytherapy 
services that are reported for implanting the sources. We define 
brachytherapy sources as containing a radioactive isotope so, by 
definition, in the case of electronic brachytherapy treatment the New 
Technology APC payment for the procedure would include payment for the 
costs of the radiation actually delivered to the patient. Thus, it is 
not appropriate to compare the costs of conventional and electronic 
brachytherapy treatments based on a comparison of the treatment 
procedure costs alone.
    In light of the commenters' concerns regarding safety of the new 
procedures, we reiterate that even though a service is assigned a HCPCS 
code and a payment rate under the OPPS, it does not imply coverage by 
the Medicare program but indicates only how the service may be paid if 
covered by the program. Unless CMS has issued a national coverage 
determination (NCD), local contractors determine whether a service 
meets all program requirements for coverage. While we do not 
specifically consult with specialty organizations during the New 
Technology APC application evaluation process that may result in an 
initial APC assignment for a service, the APC assignments of new 
technology services, like all other OPPS services, are open to comment 
in the annual OPPS update, and we welcome public comments.
    We will not create a new Level II HCPCS code for HDR electronic 
brachytherapy, complete course as a single fraction, and assign it to a 
different New Technology APC. We evaluated both New Technology APC 
applications at length and received input from both applicants. We 
believe that the two forms of HDR electronic brachytherapy, whether 
provided in a single fraction or multiple fractions depending on the 
technology, are both described by CPT code 0182T that is appropriately 
assigned to a single APC. We note that the payment is per fraction, and 
that would include a single fraction treatment as well.
    After reviewing the public comments received and all current 
information available to us regarding HDR electronic brachytherapy and 
other hospital outpatient services, we continue to believe that New 
Technology APC 1519, with a payment rate of $1750, is the most 
appropriate assignment for CPT code 0182T. Therefore, we are finalizing 
our proposal, without modification, to maintain the assignment of CPT 
code 0182T to New Technology APC 1519, with a payment rate of $1750 for 
CY 2008.
c. Other Mid-Year CPT Codes
    We did not receive any comments on the proposed CY 2008 APC and 
status indicator assignments of Category III CPT codes first 
implemented in July 2007 for services other than CPT code 0182T. After 
considering the public comments received on CPT code 0182T, we are 
finalizing our general proposal for the treatment of new mid-year CPT 
codes, including our proposed APC assignments for CPT code 0182T and 
other Category III CPT codes as displayed Table 14.

                           Table 14.--Category III CPT Codes Implemented in July 2007
----------------------------------------------------------------------------------------------------------------
                                                           Final CY 2008 status
        CPT code                 Long descriptor                indicator                Final CY 2008 APC
----------------------------------------------------------------------------------------------------------------
0178T..................  Electrocardiogram, 64 leads or  B......................  Not applicable.
                          greater, with graphic
                          presentation and analysis;
                          with interpretation and
                          report.
0179T..................  Electrocardiogram, 64 leads or  X......................  0100
                          greater, with graphic
                          presentation and analysis;
                          tracing and graphics only,
                          without interpretation and
                          report.
0180T..................  Electrocardiogram, 64 leads or  B......................  Not applicable.
                          greater, with graphic
                          presentation and analysis;
                          interpretation and report
                          only.
0181T..................  Corneal hysteresis              S......................  0230
                          determination, by air impulse
                          stimulation, bilateral, with
                          interpretation and report.
0182T..................  High dose rate electronic       S......................  1519
                          brachytherapy, per fraction.
----------------------------------------------------------------------------------------------------------------

B. Variations Within APCs

1. Background
    Section 1833(t)(2)(A) of the Act requires the Secretary to develop 
a classification system for covered hospital outpatient services. 
Section 1833(t)(2)(B) of the Act provides that this classification 
system may be composed of groups of services, so that services within 
each group are comparable clinically and with respect to the use of 
resources. In accordance with these provisions, we developed a grouping 
classification system, referred to as APCs, as set forth in Sec.  
419.31 of the regulations. We use Level I and Level II HCPCS codes and 
descriptors to identify and group the services within each APC. The 
APCs are organized such that each group is homogeneous both clinically 
and in terms of resource use. Using this classification system, we have 
established distinct groups of similar services, as well as medical 
visits. We also have developed separate APC groups for certain medical 
devices, drugs, biologicals, radiopharmaceuticals, and brachytherapy 
devices.
    We have packaged into payment for each procedure or service within 
an APC group the costs associated with those items or services that are 
directly related to and supportive of performing the main procedures or 
furnishing services. Therefore, we do not make separate payment for 
packaged items or services. For example, packaged items and services 
include: (1) Use of an operating, treatment, or procedure room; (2) use 
of a recovery room; (3) most observation services; (4) anesthesia; (5) 
medical/surgical supplies; (6) pharmaceuticals (other than those for 
which separate payment may be allowed under the provisions discussed in 
section V. of this final rule with comment period); and (7) incidental 
services such as venipuncture. Our final packaging methodology for 
ancillary and supportive services is discussed in section II.A.4.c. of 
this final rule with comment period.
    Under the OPPS, we pay for hospital outpatient services on a rate-
per-service basis, where the service may be reported with one or more 
HCPCS codes. Payment varies according to the APC group to which the 
independent service

[[Page 66693]]

or combination of services is assigned. Each APC weight represents the 
hospital median cost of the services included in that APC relative to 
the hospital median cost of the services included in APC 0606. The APC 
weights are scaled to APC 0606 because it is the middle level clinic 
visit APC (that is, where the Level 3 Clinic Visit HCPCS code of five 
levels of clinic visits is assigned), and because middle level clinic 
visits are among the most frequently furnished services in the hospital 
outpatient setting.
    Section 1833(t)(9)(A) of the Act requires the Secretary to review 
the components of the OPPS not less than annually and to revise the 
groups and relative payment weights and make other adjustments to take 
into account changes in medical practice, changes in technology, and 
the addition of new services, new cost data, and other relevant 
information and factors. Section 1833(t)(9)(A) of the Act, as amended 
by section 201(h) of the BBRA of 1999, also requires the Secretary, 
beginning in CY 2001, to consult with an outside panel of experts to 
review the APC groups and the relative payment weights (the APC Panel 
recommendations for specific services for the CY 2008 OPPS and our 
responses to them are discussed in the relevant specific sections 
throughout this final rule with comment period).
    Finally, as discussed earlier, section 1833(t)(2) of the Act 
provides that, subject to certain exceptions, the items and services 
within an APC group cannot be considered comparable with respect to the 
use of resources if the highest median for an item or service in the 
group is more than 2 times greater than the lowest median cost for an 
item or service within the same group (referred to as the ``2 times 
rule''). We use the median cost of the item or service in implementing 
this provision. The statute authorizes the Secretary to make exceptions 
to the 2 times rule in unusual cases, such as low-volume items and 
services.
2. Application of the 2 Times Rule
    In accordance with section 1833(t)(2) of the Act and Sec.  419.31 
of the regulations, we annually review the items and services within an 
APC group to determine, with respect to comparability of the use of 
resources, if the median of the highest cost item or service within an 
APC group is more than 2 times greater than the median of the lowest 
cost item or service within that same group (``2 times rule''). We make 
exceptions to this limit on the variation of costs within each APC 
group in unusual cases such as low volume items and services.
    During the APC Panel's March 2007 meeting, we presented median cost 
and utilization data for services furnished during the period of 
January 1, 2006, through September 30, 2006, about which we had 
concerns or about which the public had raised concerns regarding their 
APC assignments, status indicator assignments, or payment rates. The 
discussions of most service-specific issues, the APC Panel 
recommendations if any, and our proposals for CY 2008 are contained 
principally in sections III.C. and III.D. of this final rule with 
comment period.
    In addition to the assignment of specific services to APCs that we 
discussed with the APC Panel, we also identified APCs with 2 times 
violations that were not specifically discussed with the APC Panel but 
for which we proposed changes to their HCPCS codes' APC assignments in 
Addendum B to the proposed rule. In these cases, to eliminate a 2 times 
violation or to improve clinical and resource homogeneity, we proposed 
to reassign the codes to APCs that contained services that were similar 
with regard to both their clinical and resource characteristics. We 
also proposed to rename existing APCs, discontinue existing APCs, or 
create new clinical APCs to complement proposed HCPCS code 
reassignments. In many cases, the proposed HCPCS code reassignments and 
associated APC reconfigurations for CY 2008 included in the proposed 
rule were related to changes in median costs of services and APCs 
resulting from our proposed bundling approach for CY 2008, as discussed 
in section II.A.4.c. of the proposed rule. We also proposed changes to 
the status indicators for some codes that were not specifically and 
separately discussed in the proposed rule. In these cases, we proposed 
to change the status indicators for some codes because we believed that 
another status indicator more accurately described their payment status 
from an OPPS perspective based on the policies that we proposed for CY 
2008.
    Addendum B to the proposed rule identified with a comment indicator 
``CH'' those HCPCS codes for which we proposed a change to the APC 
assignment or status indicator as assigned in the April 2007 Addendum B 
update (via Change Request 5544, Transmittal 1209, dated March 21, 
2007). Addendum B to this final rule with comment period identifies 
with the ``CH'' comment indicator the final CY 2008 changes compared to 
the codes' status as reflected in the October 2007 Addendum B update 
(via Change Request 5718, Transmittal 1336, dated September 14, 2007).
    We received many public comments regarding the proposed APC and 
status indicator assignments for CY 2008 for specific HCPCS codes. 
These are discussed mainly in sections III.C. and III.D. of this final 
rule with comment period, and the final action for CY 2008 related to 
each HCPCS code is noted in those sections. We also received a number 
of specific comments about some of the procedures assigned to APCs that 
may have violated the 2 times rule. These comments are addressed 
elsewhere in the final rule with comment period, primarily in sections 
related to the types of procedures that were the subject of the 
comments.
3. Exceptions to the 2 Times Rule
    As discussed earlier, we may make exceptions to the 2 times limit 
on the variation of costs within each APC group in unusual cases such 
as low- volume items and services. Taking into account the APC changes 
that we proposed for CY 2008 based on the APC Panel recommendations 
discussed mainly in sections III.C. and III.D. of this final rule with 
comment period, the proposed changes to status indicators and APC 
assignments as identified in Addendum B to the proposed rule, and the 
use of CY 2006 claims data to calculate the median costs of procedures 
classified in the APCs, we reviewed all the APCs to determine which 
APCs would not satisfy the 2 times rule. We used the following criteria 
to decide whether to propose exceptions to the 2 times rule for 
affected APCs:
     Resource homogeneity
     Clinical homogeneity
     Hospital concentration
     Frequency of service (volume)
     Opportunity for upcoding and code fragments
    For a detailed discussion of these criteria, we refer readers to 
the April 7, 2000 OPPS final rule with comment period (65 FR 18457).
    Table 28 of the proposed rule listed the APCs that we proposed to 
exempt from the 2 times rule for CY 2008 based on the criteria cited 
above. For cases in which a recommendation by the APC Panel appeared to 
result in or allow a violation of the 2 times rule, we generally 
accepted the APC Panel's recommendation because those recommendations 
were based on explicit consideration of resource use, clinical 
homogeneity, hospital specialization, and the quality of the data used 
to determine the APC payment rates that we proposed for CY 2008. The 
median costs for hospital outpatient services for these and all other 
APCs that were used in the development of the proposed rule can

[[Page 66694]]

be found on the CMS Web site at: http://www.cms.hhs.gov.
    We did not receive any general public comments related to the list 
of proposed exceptions to the 2 times rule, specifically those listed 
in Table 28 of the proposed rule. For the proposed rule, the list of 
APCs excepted from the 2 times rule were based on data from January 1, 
2006, through September 30, 2006. For this final rule with comment 
period, we used data from January 1, 2006 through December 1, 2006. 
Thus, after responding to all of the comments on the proposed rule and 
making changes to APC assignments based on the comments received, we 
analyzed the full CY 2006 data to identify APCs with 2 times rule 
violations. In contrast to previous years, for CY 2008 we have 
calculated a significant number of APC medians through customized 
methodologies, such as device-dependent APC, APCs to which nuclear 
medicine procedures are assigned, and Visit APCs, that are impacted by 
the Extended Assessment and Management Composite APCs. Therefore, for 
this final rule with comment period we assessed the HCPCS code-specific 
median costs for HCPCS codes that are part of these customized APC 
median cost calculations to accurately identify 2 times violations. We 
also have some APCs where the concept of a 2 times violation is not 
relevant, typically those set based on multiple claims, such as APC 
0381 for single allergy tests and APC 0375 for ancillary services when 
a hospital outpatient dies. Table 15 below has been revised relative to 
prior years to remove APCs where a 2 times violation is not a relevant 
concept and to identify final APCs, including those with customized 
median cost methodologies, with 2 times violations.
    Based on our final data, we found that there were 21 APCs with 2 
times rule violations. We applied the criteria as described earlier to 
finalize the APCs that are exceptions to the 2 times rule for CY 2008. 
After consideration of all public comments received on the proposed 
rule and the careful review of the CY 2006 claims data for the full 
year, we are finalizing the list of APCs exempted from the 2 times 
rule. The final list of APCs that are exceptions to the 2 times rule 
for CY 2008 is displayed in Table 15 below.

     Table 15.--Final APC Exceptions to the 2 Times Rule for CY 2008
------------------------------------------------------------------------
               APC                               APC title
------------------------------------------------------------------------
0043............................  Closed Treatment Fracture Finger/Toe/
                                   Trunk.
0058............................  Level I Strapping and Cast
                                   Application.
0060............................  Manipulation Therapy.
0080............................  Diagnostic Cardiac Catheterization.
0093............................  Vascular Reconstruction/Fistula Repair
                                   Without Device.
0105............................  Repair/Revision/Removal of Pacemakers,
                                   AICDs, or Vascular Devices.
0106............................  Insertion/Replacement of Pacemaker
                                   Leads and/or Electrodes.
0141............................  Level I Upper GI Procedures.
0235............................  Level I Posterior Segment Eye
                                   Procedures.
0251............................  Level I ENT Procedures.
0256............................  Level V ENT Procedures.
0260............................  Level I Plain Film Except Teeth.
0303............................  Treatment Device Construction.
0323............................  Extended Individual Psychotherapy.
0330............................  Dental Procedures.
0409............................  Red Blood Cell Tests.
0432............................  Health and Behavior Services.
0437............................  Level II Drug Administration.
0438............................  Level III Drug Administration.
0604............................  Level 1 Hospital Clinic Visits.
0688............................  Revision/Removal of Neurostimulator
                                   Pulse Generator Receiver.
------------------------------------------------------------------------

C. New Technology APCs

1. Introduction
    In the November 30, 2001 final rule (66 FR 59903), we finalized 
changes to the time period a service was eligible for payment under a 
New Technology APC. Beginning in CY 2002, we retain services within New 
Technology APC groups until we gather sufficient claims data to enable 
us to assign the service to a clinically appropriate APC. This policy 
allows us to move a service from a New Technology APC in less than 2 
years if sufficient data are available. It also allows us to retain a 
service in a New Technology APC for more than 3 years if sufficient 
data upon which to base a decision for reassignment have not been 
collected.
    We note that the cost bands for New Technology APCs range from $0 
to $50 in increments of $10, from $50 to $100 in increments of $50, 
from $100 through $2,000 in increments of $100, and from $2,000 through 
$10,000 in increments of $500. These increments, which are in two 
parallel sets of New Technology APCs, one with status indicator ``S'' 
and the other with status indicator ``T,'' allow us to price new 
technology services more appropriately and consistently.
2. Movement of Procedures From New Technology APCs to Clinical APCs
    As we explained in the November 30, 2001 final rule (66 FR 59897), 
we generally keep a procedure in the New Technology APC to which it is 
initially assigned until we have collected data sufficient to enable us 
to move the procedure to a clinically appropriate APC. However, in 
cases where we find that our original New Technology APC assignment was 
based on inaccurate or inadequate information, or where the New 
Technology APCs are restructured, we may, based on more recent resource 
utilization information (including claims data) or the availability of 
refined New Technology APC cost bands, reassign the procedure or 
service to a different New Technology APC that most appropriately 
reflects its cost.
    At its March 2007 meeting, the APC Panel recommended that CMS keep 
services in New Technology APCs until sufficient data are available to 
assign them to clinical APCs, but for no longer than 2 years. We note 
that because of the potential for quarterly assignment of new services 
to New Technology APCs and the 2-year time lag in claims data for an 
OPPS update (that is, CY 2006 data are utilized for this CY 2008 OPPS 
rulemaking cycle), if we were to accept the APC Panel's recommendation, 
we would always reassign services from New Technology to clinical APCs 
based on 1 year or less of claims data. For example, if a new service 
was first assigned to a New Technology APC in July 2006, we would have 
6 months of data for purposes of CY 2008 rulemaking but, in order to 
ensure that the service was in a New Technology APC for no longer than 
2 years, we would need to move the service to a clinical APC for CY 
2008. While we might have sufficient claims data from 6 months of CY 
2006 to support a proposal for such a reassignment for CY 2008, we are 
not confident that this would always be the case for all new services, 
given our understanding of the dissemination of new technology 
procedures into medical practice and the diverse characteristics of new 
technology services that treat different clinical conditions. 
Therefore, we did not accept the APC Panel's recommendation for CY 2008 
because we believed that accepting the recommendation would limit our 
ability to individually assess the OPPS treatment of each new 
technology service in the context of available hospital claims data. We 
are particularly concerned about continuing to provide appropriate 
payment for low volume new technology services that may be

[[Page 66695]]

expected to continue to be low volume under the OPPS due to the 
prevalence of the target conditions in the Medicare population. We 
appreciate the APC Panel's thoughtful discussion of new technology 
services, and we agree with the APC Panel that it should be our 
priority to regularly reassign services from New Technology APCs to 
clinical APCs under the OPPS, so that they are treated like most other 
OPPS services for purposes of ratesetting once hospitals have had 
sufficient experience with providing and reporting the new services. 
Rather, consistent with our current policy, for CY 2008 we proposed to 
retain services within New Technology APC groups until we gather 
sufficient claims data to enable us to assign the service to a 
clinically appropriate APC. The flexibility associated with this policy 
allows us to move a service from a New Technology APC in less than 2 
years if sufficient data are available. It also allows us to retain a 
service in a New Technology APC for more than 2 years if sufficient 
hospital claims data upon which to base a decision for reassignment 
have not been collected.
    We received a number of public comments on our OPPS treatment of 
New Technology services. A summary of the public comments and our 
responses follow.
    Comment: Several commenters requested that CMS reconsider 
maintaining a new service in a New Technology APC for a minimum of at 
least 2 years, to ensure sufficient claims data, before assigning it to 
a clinical APC. These commenters were concerned that reassigning a new 
service from a New Technology APC to a clinical APC in less than 2 
years may result in the collection of inaccurate claims data because 
integration of new technologies can be slow and hospitals need time to 
update their chargemasters to appropriately include charges that are 
related to the actual costs of the new service. Other commenters 
reported that while a new technology service may increase hospital 
outpatient costs, it could ultimately replace more invasive inpatient 
procedures that are more costly for the Medicare program.
    In addition, several commenters recommended that CMS place all new 
HCPCS codes for new services in New Technology APCs, rather than 
assigning them directly to clinical APCs, until claims data are 
available in order to ensure access to these services. Some commenters 
also recommended that CMS consider alternatives to moving procedures 
from New Technology APCs to clinical APCs that would prevent excessive 
reductions in payment, including moving procedures to different APCs, 
utilizing external data for ratesetting, or maintaining procedures in 
their current New Technology APCs.
    Response: As we have stated previously, we generally keep a 
procedure in the New Technology APC to which it is initially assigned 
until we have collected sufficient claims data to enable us to move the 
procedure to a clinically appropriate APC. However, in cases where we 
find that our original New Technology APC assignment was based on 
inaccurate or inadequate information, or where the New Technology APCs 
are restructured, we may, based on more recent resource utilization 
information (including claims data) or the availability of refined New 
Technology APC bands, reassign the procedure or service to a different 
New Technology APC that most appropriately reflects its cost. This 
policy would allow us to retain a service in a New Technology APC for 
more than 3 years if sufficient data upon which to base a decision for 
reassignment have not been collected, and also allows us to move a 
service from a New Technology APC in less than 2 years if sufficient 
claims data are available. To retain a new service under a New 
Technology APC for a minimum of at least two years, especially for a 
service for which we have significant claims data, may result in 
inappropriate payment of the service. We want to ensure appropriate 
allocation of Medicare expenditures, and for a service that has been 
placed in a New Technology APC with significant claims data, we believe 
it is in the best interest of both the Medicare program and the 
beneficiary to reassign the service to an appropriate clinical APC 
based on clinical coherence and resource similarity.
    In response to the different suggestions for transitioning new 
technology services from New Technology APCs to clinical APCs to 
prevent excessive reductions in payment, because we generally move new 
services from New Technology APCs to clinical APCs only when we have 
adequate data upon which to base a decision, we do not believe a 
transition would commonly be necessary in order to provide appropriate 
payment for the services based on their hospital costs. We have no need 
to utilize external data in these cases where we believe our claims 
data, developed according to the standard OPPS ratesetting methodology, 
are adequate to reassign the new services to clinical APCs. In a few 
past situations, we have moved services from one New Technology APC to 
another New Technology APC with a lower payment rate if we believed 
that our data were not fully developed to support a final clinical APC 
assignment, but we expect these cases to continue to be rare. In 
addition, all reassignments of services out of New Technology APCs are 
proposed during the annual rulemaking cycle, allowing the opportunity 
for public comment prior to their movement.
    When evaluating new services for payment under the OPPS, we use all 
information available to us regarding the clinical characteristics of 
the procedures and the expected hospital resource costs. We reserve New 
Technology APC assignments for those services where we do not believe 
there is an appropriate clinical APC for the new service. In many 
cases, new HCPCS codes describe services that are similar to existing 
services that are paid under the OPPS and for which we have robust cost 
data from hospital claims. We continue to believe that it is 
appropriate to assign similar new and existing services to the same 
clinical APC in such cases. We follow the claims data closely and 
carefully review the New Technology and clinical APC assignments of 
relatively new OPPS services for each update year when new claims data 
become available. In addition, the OPPS treatment of all new services 
is open to public comment in the annual OPPS/ASC rule (either proposed 
or final with comment period) that follows the service's implementation 
under the OPPS.
    After consideration of all public comments received, we are 
finalizing our CY 2008 proposal, without modification, to maintain a 
new service in a New Technology APC until we gather sufficient claims 
data to assign the service to a clinically appropriate APC. Thus, a 
service can be assigned to a New Technology APC for more than 3 years 
if we have insufficient claims data to reassign the service to a 
clinical APC, or it could be reassigned to a clinical APC in less than 
2 years if we have adequate claims data. We will continue to assess new 
services for potential assignment to clinical APCs before assigning 
them to New Technology APCs.
    The procedures presented below in sections III.C.2.a., III.C.2.b., 
and III.C.2.c. represent services assigned to New Technology APCs for 
CY 2007 for which we stated in the CY 2008 proposed rule that we 
believed we had sufficient data to propose their reassignment to 
clinically appropriate APCs for CY 2008.

[[Page 66696]]

a. Positron Emission Tomography (PET)/Computed Tomography (CT) Scans 
(APC 0308)
    From August 2000 through April 2005, we paid separately for PET and 
CT scans. In CY 2004, the payment rate for nonmyocardial PET scans was 
$1,450, while it was $193 for typical diagnostic CT scans. Prior to CY 
2005, nonmyocardial PET and the PET portion of PET/CT scans were 
described by G-codes for billing to Medicare. Several commenters to the 
November 15, 2004 final rule with comment period (69 FR 65682) urged 
that we replace the G-codes for nonmyocardial PET and PET/CT scan 
procedures with the established CPT codes. These commenters stated that 
movement to the established CPT codes would greatly reduce the burden 
on hospitals of tracking and billing the G-codes which were not 
recognized by other payers and would allow for more uniform hospital 
billing of these scans. We agreed with the commenters that movement 
from the G-codes to the established CPT codes for nonmyocardial PET and 
PET/CT scans would allow for more uniform billing of these scans. As a 
result of a Medicare national coverage determination (Publication 100-
3, Medicare Claims Processing Manual section 220.6) that was made 
effective January 28, 2005, we discontinued numerous G-codes that 
described myocardial PET and nonmyocardial PET procedures and replaced 
them with the established CPT codes. The CY 2005 payment rate for 
concurrent PET/CT scans using the CPT codes 78814 (Tumor imaging, 
positron emission tomography (PET) with concurrently acquired computed 
tomography (CT) for attenuation correction and anatomical localization; 
limited area (eg, chest, head/neck)); 78815 (Tumor imaging, positron 
emission tomography (PET) with concurrently acquired computed 
tomography (CT) for attenuation correction and anatomical localization; 
skull base to mid-thigh); and 78816 (Tumor imaging, positron emission 
tomography (PET) with concurrently acquired computed tomography (CT) 
for attenuation correction and anatomical localization; whole body) was 
$1,250, which was $100 higher than the payment rate for PET scans 
alone. These PET/CT CPT codes were placed in New Technology APC 1514 
(New Technology--Level XIV ($1,200-$1,300)) for CY 2005.
    We continued with these coding and payment methodologies in CY 
2006. For CY 2007, while we proposed to reassign both PET and PET/CT 
scans to the same new clinical APC, we finalized a policy that 
reassigned conventional PET procedures to APC 0308 (Non-Myocardial 
Positron Emission Tomography (PET) Imaging) with a final median cost of 
approximately $850. We also reassigned PET/CT services to a different 
New Technology APC for CY 2007, specifically New Technology APC 1511 
(New Technology--Level XI ($900-$1000)), thereby maintaining the 
historical payment differential of about $100 between PET and PET/CT 
procedures. Furthermore, we stated in the CY 2007 OPPS/ASC final rule 
with comment period (71 FR 68022) that we would wait for a full year of 
CPT-coded claims data prior to assigning the PET/CT services to a 
clinical APC and that maintaining a modest payment differential between 
PET and PET/CT procedures was warranted for CY 2007.
    For CY 2008, we proposed the reassignment of concurrent PET/CT 
scans, specifically CPT codes 78814, 78815, and 78816, to a clinical 
APC because we believed we had adequate claims data from CY 2006 upon 
which to determine the median cost of performing these procedures. 
Based on our proposed rule analysis of approximately 117,000 CY 2006 
single claims, the median cost of PET/CT scans was approximately 
$1,094. We then examined approximately 34,000 single claims from CY 
2006 for nonmyocardial PET scans, as described by CPT codes 78608, 
78811, 78812, and 78813, and found that the median cost was also 
approximately $1,094. In the proposed rule, we noted that a comparison 
of the median cost of PET/CT scans with the median cost of 
nonmyocardial PET scans, as derived from CY 2006 claims data, 
demonstrated that these costs were almost the same, thereby reflecting 
significant hospital resource equivalency between the two types of 
services. This result was not unexpected because many newer PET 
scanners also have the capability of rapidly acquiring CT images for 
attenuation correction and anatomical localization, sometimes with 
simultaneous image acquisition. The median costs for both PET and PET/
CT scans were significantly higher for CY 2008 than for CY 2007 due to 
our CY 2008 proposal to package payment for all diagnostic 
radiopharmaceuticals as described in section II.A.4.c.(5) of this final 
rule with comment period that would package payment for the costs of 
the radiopharmaceuticals utilized similarly into the payment for both 
PET and PET/CT scans. As stated in the proposed rule (72 FR 42705), we 
believe that our claims data accurately reflected the comparable 
hospital resources required to provide nonmyocardial PET and PET/CT 
procedures, and that the scans had obvious clinical similarity as well. 
Therefore, for CY 2008 we proposed to reassign the CPT codes for PET/CT 
scans to the clinical APC where nonmyocardial PET scans were also 
assigned, specifically APC 0308, with a proposed median cost of 
approximately $1,094.
    We noted in the proposed rule (72 FR 42705) that we had been paying 
separately for fluorodeoxyglucose (FDG), the radiopharmaceutical 
described by HCPCS code A9552 (F18 fdg), that is commonly administered 
during nonmyocardial PET and PET/CT procedures. For CY 2008, consistent 
with the proposed packaging approach as discussed in section 
II.A.4.c.(5) of the proposed rule, we proposed to package payment for 
the diagnostic radiopharmaceutical FDG into payment for the associated 
PET and PET/CT procedures. Because FDG was the most commonly used 
radiopharmaceutical for both PET and PET/CT scans and our single claims 
for these procedures included FDG more than 80 percent of the time, the 
packaging of this radiopharmaceutical fully maintained the clinical and 
resource homogeneity of the reconfigured APC 0308 that we proposed.
    We received a number of public comments concerning our proposed 
reassignment of concurrent PET/CT scans for CY 2008. A summary of the 
public comments and our response follow.
    Comment: Several commenters thanked CMS for proposing to increase 
the payment rate for concurrent PET/CT scans from the CY 2007 payment 
of approximately $950 to approximately $1,107 for CY 2008 and ensuring 
that these scans are assigned to a clinical APC with other services 
with similar median costs. However, these commenters were concerned 
that the proposed payment rate for the PET/CT scans for CY 2008 would 
be inadequate if the payment for the diagnostic radiopharmaceutical 
used in these procedures, specifically FDG, was packaged into the 
payment for the scans. Other commenters questioned the validity of the 
claims used to set the proposed payment rate for the concurrent PET/CT 
scan procedures. They indicated that the proposal to assign concurrent 
PET/CT scans from a New Technology APC to clinical APC 0308 was 
inappropriate and unsupported by reliable data. They believed that CMS 
did not have sufficient or accurate claims data to justify movement of 
the concurrent PET/CT services from New Technology APC 1514 to clinical 
APC 0308. Several

[[Page 66697]]

commenters suspected that the claims used to set the proposed payment 
rate were flawed because they believed that many hospitals had not yet 
updated their chargemasters to distinguish charges for the conventional 
nonmyocardial PET scans from charges for concurrent PET/CT scans. One 
commenter indicated that if CMS were to blend its own external data 
from the refined direct cost inputs used to establish the practice 
expense relative value units under the MPFS with OPPS claims data to 
establish a payment rate for PET/CT, the payment rate would be 
significantly higher than the proposed payment. Several commenters 
claimed that that proposed payment rate for the concurrent PET/CT 
procedures failed to recognize the differences in technology between 
the conventional nonmyocardial PET procedures and the concurrent PET/CT 
scans. They indicated that concurrent PET/CT scans used more advanced 
technology, resulting in greater capital equipment costs. Many 
commenters recommended that CMS continue to assign these PET/CT scans 
to a New Technology APC for one more year while CMS collects additional 
data on the cost of these procedures. Conversely, several commenters 
strongly urged CMS to assign the concurrent PET/CT scans to a separate 
clinical APC, distinct from the APC for conventional PET scans, to 
better reflect the incremental cost differences associated with this 
technology.
    Response: As stated above, CPT codes 78814, 78815, and 78816 were 
new codes in CY 2005 and were assigned to New Technology APC 1514 with 
a payment rate of $1,250. We continued with this same APC assignment in 
CY 2006. In CY 2007, we assigned these services to a different New 
Technology APC, specifically New Technology APC 1511, with a payment 
rate of $950 in order to maintain the historical payment differential 
of about $100 between the conventional PET and concurrent PET/CT 
procedures. For CY 2007 ratesetting, we had only 9 months of claims 
data and public commenters were concerned that these data did not yet 
reflect updated and appropriate hospital charges specifically for PET/
CT scans. Therefore, concurrent PET/CT scan procedures have been 
assigned to a New Technology APC under the OPPS since CY 2005, a period 
of almost 3 years.
    As we have stated in other sections of this final rule with comment 
period, such as in section III.D., comparisons between the MPFS and 
OPPS payments for services are not appropriate because the MPFS applies 
a very different methodology for establishing the payment for the 
physician's office practice expenses associated with a procedure, based 
on direct cost inputs. Consequently, the application of the different 
methodologies results in different payment amounts in the two settings.
    As noted previously, under the OPPS, we retain services within New 
Technology APC groups where they are assigned according to our 
estimates of their costs until we gather sufficient claims data to 
enable us to assign the services to clinically appropriate APCs based 
on hospital resource costs as calculated from claims. We disagree with 
the commenters' argument that we have insufficient claims data to 
justify movement of concurrent PET/CT scans from New Technology APC 
1511 to clinical APC 0308. For this final rule with comment period, our 
updated claims data for concurrent PET/CT scans showed a total of over 
149,000 services performed, with about 126,000 single claims available 
for ratesetting. The median cost for PET/CT scans alone was 
approximately $1,076. Similarly, we had over 40,000 total claims for 
conventional PET scans, with approximately 35,000 single claims 
available for ratesetting. The median cost for conventional PET scans 
alone was approximately $1,029, very close to the median cost of PET/CT 
scans. Based on their common clinical characteristics and the hospital 
resource similarity observed in our claims data for conventional PET 
and concurrent PET/CT scans, we believe that our claims data are 
sufficiently robust to support reassignment of PET/CT scans to the same 
clinical APC as conventional PET scans. The final median cost of APC 
0308 of approximately $1,044 appropriately reflects the similar costs 
of both conventional PET and concurrent PET/CT scans.
    After consideration of the public comments received, we are 
finalizing our CY 2008 proposal, without modification, to assign 
concurrent PET/CT scan procedures described by CPT codes 78814, 78815, 
and 78816 to clinical APC 0308, with a CY 2008 median cost of 
approximately $1,044, which includes packaged costs for diagnostic 
radiopharmaceuticals used in the scans. For further discussion of our 
final CY 2008 payment policy for diagnostic radiopharmaceuticals, refer 
to section II.A.4.c.(5) of this final rule with comment period.
b. IVIG Preadministration-Related Services (APC 0430)
    In CY 2006, we created the temporary HCPCS code G0332 (Services for 
intravenous infusion of immunoglobulin prior to administration (this 
service is to be billed in conjunction with administration of 
immunoglobulin)). Based on our estimate of the costs of this service in 
comparison with other services, HCPCS code G0332 was assigned to New 
Technology APC 1502 (New Technology--Level II, $50-$100), with a 
payment rate of $75 effective January 1, 2006. In the CY 2007 OPPS/ASC 
final rule with comment period, we indicated our belief that it was 
appropriate to continue the temporary IVIG preadministration-related 
services payment through HCPCS code G0332 and its continued assignment 
to New Technology APC 1502 for CY 2007, in order to help ensure 
continued patient access to IVIG (71 FR 68092).
    For CY 2008, we proposed to continue to provide separate payment 
for IVIG preadministration-related services through the assignment of 
HCPCS code G0332 to a clinical APC. This service has been assigned to a 
New Technology APC under the OPPS for 2-full years. As noted 
previously, under the OPPS, we retain services within New Technology 
APC groups where they are assigned according to our estimates of their 
costs until we gather sufficient claims data to enable us to assign the 
services to clinically appropriate APCs based on hospital resource 
costs as calculated from claims. According to our analysis of the 
hospital outpatient claims data, we noted we had adequate claims data 
from CY 2006 upon which to determine the median cost of performing IVIG 
preadministration related services and to reassign HCPCS code G0332 to 
an appropriate clinical APC for CY 2008. For the CY 2008 OPPS/ASC 
proposed rule, our claims data for this high volume service showed a 
total of over 49,000 services performed, with about 48,000 single 
claims available for ratesetting. Therefore, we proposed to reassign 
HCPCS code G0332 to new clinical APC 0430 (Drug Preadministration--
Related Services) for CY 2008, with a proposed median cost of 
approximately $39, where it would be the only service assigned to the 
APC at this time.
    As noted in the proposed rule (72 FR 42705), IVIG 
preadministration-related services are always provided in conjunction 
with other separately payable services such as drug administration 
services, and thus are well suited for packaging into the payment for 
the separately payable services. While we did not make a determination 
about the appropriateness of continuing separate OPPS payment for HCPCS 
code G0332 after CY 2008, we stated in the proposed rule (72 FR

[[Page 66698]]

42705) that we would consider packaging payment for HCPCS code G0332 in 
future years if we determined that separate payment was no longer 
warranted. We intend to reevaluate the appropriateness of separate 
payment for IVIG preadministration-related services for the CY 2009 
OPPS rulemaking cycle, especially as we explore the potential for 
greater packaging and possible encounter-based or episode-based OPPS 
payment approaches.
    We received a number of public comments on our CY 2008 proposed 
payment for IVIG preadministration-related services. A summary of the 
public comments and our response follow.
    Comment: Many commenters questioned the accuracy and reliability of 
the CY 2006 hospital outpatient claims data that were used to set the 
proposed payment rate for HCPCS code G0332. Some commenters indicated 
that because HCPCS code G0332 was a new code for CY 2006, it was 
clearly not well understood by many hospitals, and as a result, it took 
some time for hospitals to appropriately determine the cost and the 
reported charge for the service. Many commenters stated that the 
proposed payment rate of $39 was likely based on flawed data, and as 
such, the data should not be used as a basis for reassigning HCPCS code 
G0332 from New Technology APC 1502 to APC 0430. These commenters 
believed that the low payment rate was due to underreporting of this 
service because their findings revealed that hospitals reported HCPCS 
code G0332 on only 49 percent of the claims for IVIG administration. 
One commenter believed that, based on an analysis of its hospital 
system's claims data for HCPCS code G0332, that claims data were 
distorted due to a number of factors, including revenue code selections 
by hospitals, differences in the CCRs mapped to those revenue codes, 
and the actual dollar charges reported by hospitals for this service. 
Several commenters explained that hospitals set widely varying charges 
for HCPCS code G0332, and some of these commenters believed that it 
would be appropriate to exclude from the ratesetting process claims 
where the reported charge is equal to or less than the $75 payment 
rate.
    Many commenters believed that reducing this add-on payment would 
have a negative impact on patient access to care, considering the short 
supply and high costs of acquiring IVIG. Several commenters suggested 
that CMS should maintain the $75 add-on payment for HCPCS code G0332 to 
maintain parity with the proposed $71 MPFS payment rate for this 
service. These commenters asserted that establishing a difference in 
payment for HCPCS code G0332 across systems could drive patients from 
one site of service to another. They further believed that maintaining 
payment parity for the service at comparable levels across these sites 
of service would mitigate potential disruptions to the sites of service 
where patients are now receiving care and would also allow the choice 
of site of care to be dictated by particular patient circumstances. 
Several commenters commended CMS for continued support in extending the 
add-on payment for HCPCS code G0332; however, they recommended that the 
$75 separate payment under New Technology APC 1502 be continued for 
another year. Alternatively, several commenters requested that CMS 
reassign HCPCS code G0332 to a clinical APC whose payment rate is 
equivalent to $75 to ensure that hospitals would continue to be paid 
appropriately for the full range of costs incurred in furnishing IVIG 
to their patients and to help mitigate the possible adverse financial 
impact on hospitals acquiring IVIG that could result from a lower 
payment for preadministration-related services.
    Response: Just as our payment rates are updated annually, so too 
are billing codes (that is, ICD-9-CM, Level II HCPCS, and CPT). Annual 
updates to the HCPCS coding system (whether through addition of a new 
code, revision of a code descriptor, or deletion of a code), are a 
well-established and predictable process that has been in place for 
some time. Hospitals are well aware of this practice because they have 
successfully implemented these changes each year.
    The MPFS applies a distinct methodology for establishing the 
payment for the physician's office practice expenses associated with a 
procedure that differs significantly from the OPPS methodology which 
generally pays based on relative payment weights calculated from 
hospitals' costs as determined from claims data. The application of the 
different methodologies results in different payment amounts in the two 
settings. Therefore, comparisons between OPPS and MPFS payments are not 
appropriate.
    In determining the CY 2008 final rule median cost of approximately 
$37 for HCPCS code G0332, we used the most recent claims data available 
under the OPPS, specifically CY 2006 claims. According to our standard 
OPPS methodology as described in section II.A.2. of this final rule 
with comment period, we excluded claims for HCPCS code G0332 where the 
line-item charge was exactly equal to the CY 2006 payment rate, a 
process we followed for all OPPS services. We did not remove claims 
whose charges were less than $75 because hospitals are free to set 
their own charges for individual services based on their own judgment.
    Under the OPPS, the current payment methodology for IVIG treatments 
consists of three components, which include payment for the drug itself 
(described by a HCPCS J code), administration of the IVIG product 
(described by one or more CPT codes), and the preadministration-related 
services (HCPCS code G0332). As stated previously, this service has 
been assigned to New Technology APC 1502 under the OPPS for 2 full 
years. Under the OPPS, we retain services within New Technology APC 
groups where they are assigned according to our estimates of their 
costs until we gather sufficient claims data to enable us to assign the 
services to clinically appropriate APCs based on hospital resource 
costs as calculated from claims. We do not agree with the commenters' 
argument that underreporting of this service in CY 2006 is a compelling 
rationale for delaying reassignment to a clinical APC. Our CY 2006 
claims data include approximately 59,000 total claims for HCPCPS code 
G0332, and we have no reason to believe those claims do not accurately 
represent the costs to hospitals of providing the service in CY 2006. 
We believe that the approximately 57,000 single claims used to set the 
CY 2008 median cost of IVIG preadministration-related services at 
approximately $37 accurately reflect hospitals' costs for the service 
and that the final CY 2008 payment rate for HCPCS code G0332 is 
adequate to ensure access to IVIG therapy.
    After consideration of the public comments received, we are 
finalizing our CY 2008 proposal, without modification, to assign HCPCS 
code G0332 to APC 0430, with a median cost of approximately $37. As we 
stated previously, we will consider packaging payment for HCPCS code 
G0332 in future years if we determine separate payment is no longer 
warranted. We intend to reevaluate the appropriateness of separate 
payment for IVIG preadministration-related services for the CY 2009 
OPPS rulemaking cycle, especially as we explore the potential for 
greater packaging and possible encounter-based or episode-based OPPS 
payment approaches.

[[Page 66699]]

c. Other Services in New Technology APCs
    Other than the concurrent PET/CT and IVIG preadministration-related 
new technology services discussed in sections III.C.2.a. and III.C.2.b. 
of this final rule with comment period, there are five procedures 
currently assigned to New Technology APCs for CY 2007 for which we 
believed we also had data that were adequate to support their 
reassignment to clinical APCs. For CY 2008, we proposed to reassign 
these procedures to clinically appropriate APCs, applying their CY 2006 
claims data to develop their clinical APC median costs upon which 
payments would be based. These procedures and their proposed APC 
assignments were displayed in Table 29 of the proposed rule. This table 
has been reproduced as Table 16 at the end of this section and updated 
with the final status indicators, APC assignments, and median costs of 
these services.
(1) Breast Brachytherapy Catheter Implantation (APC 0648)
    For CY 2008, we proposed to reassign CPT code 19298 (Placement of 
radiotherapy afterloading 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) from New Technology APC 1524 (New 
Technology--Level XXIV ($3,000-$3,500)) to APC 0648 (Level IV Breast 
Surgery), with a proposed median cost of approximately $3,417.
    We received several public comments concerning the proposed 
reassignment of CPT code 19298. A summary of the public comments and 
our response follow.
    Comment: Several commenters agreed with CMS's proposal to reassign 
CPT code 19298 to APC 0648. They acknowledged that this proposed 
reassignment of CPT code 19298 would place the three surgical codes for 
the placement of catheters for breast brachytherapy in the same APC, 
that is, CPT codes 19296 (Placement of radiotherapy afterloading 
balloon catheter into the breast for interstitial radioelement 
application following partial mastectomy, includes imaging guidance; on 
date separate from partial mastectomy); 19297 (Placement of 
radiotherapy afterloading balloon catheter into the breast for 
interstitial radioelement application following partial mastectomy, 
includes imaging guidance; concurrent with partial mastectomy (List 
separately in addition to code for primary procedure)); and 19298.
    Response: We thank the commenters for their input and support. 
Because of its clinical and resource characteristics similar to those 
other procedures also assigned to APC 0648, we are finalizing our CY 
2008 proposal, without modification, to reassign CPT code 19298 to APC 
0648, with a median cost of approximately $3,560.
(2) Preoperative Services for Lung Volume Reduction Surgery (LVRS) 
(APCs 0209 and 0213)
    As illustrated in Table 16 below, CY 2008, we proposed to reassign 
HCPCS codes G0302 (Pre operative pulmonary surgery services for 
preparation for LVRS, complete course of services, to include a minimum 
of 16 days of services) and G0303 (Pre-operative pulmonary surgery 
services for preparation for LVRS, 10 to 15 days of services) to APC 
0209 (Level II Extended EEG and Sleep Studies). For CY 2008, we also 
proposed to reassign HCPCS codes G0304 (Pre-operative pulmonary surgery 
services for preparation for LVRS, 1 to 9 days of services) and G0305 
(Post-discharge pulmonary surgery services after LVRS, minimum of 6 
days of services) to APC 0213 (Level I Extended EEG and Sleep Studies).
    We did not receive any public comments on these two proposals and, 
therefore, we are finalizing our CY 2008 proposals for HCPCS codes 
G0302, G0303, G0304, and G0305 without modification. Specifically, 
HCPCS codes G0302 and G0303 are assigned to APC 0209, with a CY 2008 
median cost of approximately $710. HCPCS codes G0304 and G0305 are 
assigned to APC 0213, with a CY 2008 median cost of approximately $145.

         Table 16.--Final CY 2008 APC Reassignments of Other New Technology Procedures to Clinical APCs
----------------------------------------------------------------------------------------------------------------
                                                             CY 2007 APC                               Final CY
   HCPCS code     Short descriptor  CY 2007 SI  CY 2007 APC    payment      Final CY      Final CY     2008 APC
                                                                 rate        2008 SI      2008 APC   median cost
----------------------------------------------------------------------------------------------------------------
19298..........  Place breast rad   S.........         1524       $3,250  T...........         0648       $3,560
                  tube/caths.
G0302..........  Pre-op service     S.........         1509          750  S...........         0209          710
                  LVRS complete.
G0303..........  Pre-op service     S.........         1507          550  S...........         0209          710
                  LVRS 10-15 dos.
G0304..........  Pre-op service     S.........         1504          250  S...........         0213          145
                  LVRS 1-9 dos.
G0305..........  Post op service    S.........         1504          250  S...........         0213          145
                  LVRS min 6.
----------------------------------------------------------------------------------------------------------------

D. APC-Specific Policies

1. Cardiac Procedures
a. Cardiac Computed Tomography and Computed Tomographic 
Angiography(APCs 0282 and 0383)
    Cardiac computed tomography (CCT) and cardiac computed tomography 
angiography (CCTA) are noninvasive diagnostic procedures that assist 
physicians in obtaining detailed images of coronary blood vessels. The 
data obtained from these procedures can be used for further diagnostic 
evaluations and/or appropriate therapy for coronary patients.
    Currently, there are eight Category III CPT codes that describe CCT 
and CCTA procedures. The CPT codes, which were shown in Table 31 of the 
proposed rule, are 0144T through 0151T. These codes were new for CY 
2006. In the CY 2006 OPPS final rule with comment period, we assigned 
the CCT and CCTA procedure codes to interim APCs, which were subject to 
public comment. In CY 2006, the CCT and CCTA procedure codes were 
assigned to four APCs, specifically, APC 0282 (Miscellaneous 
Computerized Axial Tomography), APC 0376 (Level II Cardiac Imaging), 
APC 0377 (Level III Cardiac Imaging), and APC 0398 (Level I Cardiac 
Imaging). We did not receive any public comments on the interim APC 
assignments.
    In the CY 2007 OPPS/ASC proposed rule, we proposed to retain the 
existing APC assignments for the CCT and CCTA procedure codes. We 
received several public comments on the proposed APCs assignments, 
which we addressed in the CY 2007 OPPS/ASC final rule with comment 
period (71 FR 68038 and 68039). Several of the commenters requested 
that we either not assign the CCT and CCTA procedures to any APCs or 
assign them to appropriate New Technology APCs. In addition, some 
commenters were also concerned that CCT and CCTA procedures were not

[[Page 66700]]

clinically homogeneous with other procedures assigned to APCs 0282, 
0376, 0377, and 0398, noting that the last three APCs previously 
contained only nuclear medicine cardiac imaging procedures.
    In the CY 2007 OPPS/ASC final rule with comment period (71 FR 
68038), we indicated our belief that the clinical characteristics and 
expected resource use associated with the CCT and CCTA procedures were 
sufficiently similar to the other procedures assigned to APCs 0282, 
0376, 0377, and 0398 that we believed those APC assignments were 
appropriate. While several of those APCs also contained nuclear 
medicine imaging procedures, we had never designated those APCs as 
specific to nuclear medicine procedures. Therefore, for CY 2007, we 
continued with the CY 2006 APC assignments for CPT codes 0144T through 
0151T. We did not agree with the commenters that use of CT and CTA for 
cardiac studies was a new technology for which we had no relevant OPPS 
cost information that could be used to estimate hospital resources for 
these procedures. We also believed these services could be potentially 
covered hospital outpatient services, so that it would not be 
appropriate for us to depart from our standard OPPS policy and not 
assign them to APCs. As we indicated in our CY 2007 OPPS/ASC proposed 
rule (71 FR 49549), some Category III CPT codes describe services that 
we have determined to be similar in clinical characteristics and 
resource use to HCPCS codes assigned to existing clinical APCs. In 
these instances, we may assign the Category III CPT code to the 
appropriate clinical APC. Other Category III CPT codes describe 
services that we have determined are not compatible with an existing 
clinical APC, yet are appropriately provided in the hospital outpatient 
setting. In these cases, we may assign the Category III CPT code to 
what we estimate is an appropriately priced New Technology APC. In 
other cases, we may assign a Category III CPT code to one of several 
nonseparately payable status indicators, including ``N,'' ``C,'' ``B,'' 
or ``E,'' which we believe is appropriate for the specific code. As we 
noted in the CY 2007 OPPS/ASC final rule with comment period, we 
believed that CCT and CCTA procedures were appropriate for separate 
payment under the OPPS should local contractors provide coverage for 
these procedures and, therefore, they warranted status indicator and 
APC assignments that would provide separate payment under the OPPS (71 
FR 68038).
    At its March 2007 meeting, the APC Panel recommended that CMS work 
with stakeholders to determine more appropriate APC placements for CCT 
and CCTA procedures. The APC Panel made no specific recommendations 
regarding the appropriate APC assignments for these services, although 
several different clinical APC configurations were discussed, along 
with the alternative of assigning these procedures to New Technology 
APCs.
    We note that we generally meet with interested organizations 
concerning their views about OPPS payment policy issues with respect to 
specific technologies or services. Following the publication of the CY 
2007 OPPS/ASC final rule with comment period, we received such 
information from interested individuals and organizations regarding the 
clinical and facility resource characteristics of CCT and CCTA 
procedures. In the CY 2008 OPPS/ASC proposed rule (72 FR 42711), we 
reiterated that we would consider the input of any individual or 
organization to the extent allowed by Federal law, including the 
Administrative Procedure Act (APA) and the FACA. We explained that we 
establish the OPPS payment rates for services through regulations, 
during our annual rulemaking cycle. We are required to consider the 
timely comments of interested organizations, establish the payment 
policies for the forthcoming year, and respond to the timely comments 
of all public commenters in the final rule in which we establish the 
payments for the forthcoming year.
    During the development of the CY 2008 proposed rule, we noted that 
analysis of our hospital data for claims submitted for CY 2006 
indicated that CCT and CCTA procedures were performed relatively 
frequently on Medicare patients. Our claims data showed a total of over 
16,000 procedures performed, with about 11,000 single claims available 
for ratesetting. Based on our analysis of the robust hospital 
outpatient claims data at that time, we believed we had adequate claims 
data from CY 2006 upon which to determine the median costs of 
performing these procedures and to assign them to appropriate clinical 
APCs. We saw no rationale for reassigning these procedures to New 
Technology APCs in CY 2008, when we had claims-based cost information 
regarding these procedures, and they were clinically similar to other 
procedures paid under the OPPS.
    We acknowledged the concerns that had been expressed to us 
regarding the clinical homogeneity of APCs 0376, 0377, and 0398, where 
some of the CCT and CCTA were assigned for CY 2007 along with nuclear 
medicine cardiac imaging procedures. Because we proposed to package 
payment for diagnostic radiopharmaceuticals into payment for diagnostic 
nuclear medicine procedures in CY 2008 as discussed in detail in 
section II.A.4.c.(5) of this final rule with comment period, we 
believed that to ensure the clinical and resource homogeneity of APCs 
0376, 0377, and 0398 in CY 2008, it would be most appropriate to 
reassign the CCT and CCTA services currently residing in those APCs to 
other clinical APCs for CY 2008.
    Therefore, for CY 2008, we proposed to assign the CCT and CCTA 
procedures to two clinical APCs, specifically new clinical APC 0383 
(Cardiac Computed Tomographic Imaging) and APC 0282, as shown in Table 
17 below. The proposed median cost of approximately $314 for APC 0383 
was based entirely on claims data for CPT codes 0145T, 0146T, 0147T, 
0148T, 0149T, and 0150T that described CCT and CCTA services, a 
clinically homogeneous grouping of services. In addition, the 
individual median costs of these services ranged from a low of 
approximately $277 to a high of $437, reflecting their hospital 
resource similarity as well. We proposed to reassign the two other CCT 
CPT codes, specifically CPT codes 0144T and 0151T, to APC 0282. The 
inclusion of these two codes in APC 0282 resulted in a CY 2008 proposed 
APC median cost of about $105.
    We received a number of public comments concerning our CY 2008 
proposals for CCT and CCTA procedures. A summary of the public comments 
and our responses follow.
    Comment: While several commenters expressed appreciation for the 
proposed reassignment of CCT and CCTA procedures into their own 
clinically homogenous APC groups, many commenters disagreed with the 
proposal to reassign these services from APCs 0282, 0376, 0377, and 
0398 to APCs 0282 and 0383 for CY 2008. These commenters were 
especially concerned with the proposed payment rates for these 
procedures and asserted that the proposed median costs of $105 for APC 
0282 and $314 for APC 0383 were inadequate because they were based on 
limited data, thereby undervaluing these new technology services. The 
commenters further believed that the CY 2008 proposed payment rates of 
$107 for APC 0282 and $318 for APC 0383 were unreasonably low based on 
only 16,000 total procedures, with about 11,000 single claims used for 
ratesetting. Some commenters pointed out that the

[[Page 66701]]

first year in which the new procedures were specifically reported by 
hospitals was CY 2006. They argued that because it takes time for 
hospitals to completely capture and report the full costs associated 
with new procedures in their charges, hospitals could not have reported 
these services accurately in CY 2006. One commenter believed that 
because most hospitals do not specifically allocate capital costs to 
the cost centers involved, the CCRs used to convert charges to costs 
for CCT and CCTA procedures were likely understated.
    Many commenters expressed concern that there had not been 
sufficient time to develop accurate and reliable claims data for these 
new procedures and that additional measures were necessary to ensure 
appropriate payments. Some commenters recommended that CMS delay the 
implementation of the CY 2008 median costs until a full year of claims 
data were available from both multiple and single claims and suggested 
that CMS continue with the CY 2007 APC assignments for CCT and CCTA 
procedures. They argued that inadequate payment rates would 
unintentionally encourage the use of more expensive and invasive 
diagnostic procedures for Medicare beneficiaries. Some commenters 
further requested that CMS consult with stakeholders and utilize 
external data to determine the degree to which OPPS claims data 
accurately reflected the relative resource costs of these procedures 
and to make appropriate adjustments to the payment rates, especially 
for APC 0383. Other commenters requested that CMS reassign the CCT and 
CCTA procedures to appropriate New Technology APCs for CY 2008.
    Some commenters requested that CMS reconsider the reassignment of 
CPT codes 0144T and 0151T whose median costs varied significantly, from 
$86 and $144, respectively, because these services did not appear to be 
clinically appropriate when compared to the other procedures assigned 
to APC 0282.
    Response: While we acknowledge that the CPT codes for CCT and CCTA 
procedures were new for January 2006, we disagree with the commenters' 
argument that our claims data are inadequate to support the 
reassignment of CCT and CCTA procedures to clinical APCs for CY 2008 
based on hospital costs derived from claims. We used the approximately 
12,000 single bills available for this final rule with comment period 
in determining the median costs for the CCT and CCTA procedures because 
the single bills provide us with the most accurate costs that are the 
foundation of our standard OPPS ratesetting methodology. As we discuss 
in section II.A.1.b. of this final rule with comment period, we are 
unable to appropriately allocate packaged costs on multiple procedure 
claims so we generally are not able to use them in setting payment 
rates. As we also discuss in that section, we are continuing to work on 
additional methodologies that would allow us to use claims data from 
more OPPS claims. While we recognize that reliance on single procedure 
claims may result in the use of fewer claims for some services than for 
others, in the case of CCT and CCTA procedures, in particular, we were 
able to use about two-thirds of all approximately 18,000 claims for 
ratesetting. These services were reported by many hospitals in CY 2006, 
and we have no reason to believe that costs based upon this large 
percentage of all claims do not accurately reflect the resource costs 
of these services to hospitals. Our standard OPPS methodology 
determines the relative costs of services from claims, with a specific 
focus on relative costs and not absolute costs, and we do not believe 
there is any need for us to utilize external data to determine the 
costs of these services. Additionally, we do not agree with the 
commenters' suggestion to place the CCT and CCTA procedures in New 
Technology APCs. We believe that, based on the clinical characteristics 
and resource use calculated from CY 2006 claims for CCT and CCTA 
procedures, our proposal would assign them to appropriate clinical APCs 
for CY 2008. In fact, several commenters acknowledged that the proposed 
APC assignments of these procedures were appropriate based on explicit 
consideration of clinical homogeneity.
    Further, in the case of CPT codes 0144T and 0151T, the commenters 
mistakenly believed that the CY 2008 OPPS median costs for these 
procedures were $86 and $144, respectively. The CY 2008 proposed rule 
median cost for CPT code 0144T was approximately $68 and approximately 
$43 for CPT code 0151T, and their final rule median costs are 
approximately $68 and $54, respectively. The $86 and $144 figures 
reported by some commenters were based on the procedures' mean costs, 
not the median costs which are used for ratesetting under the OPPS. We 
believe that CPT codes 0144T and 0151T are appropriately assigned to 
APC 0282 as their median costs fall within the range of costs of other 
procedures also assigned to the APC, which has a final median cost of 
approximately $100.
    Comment: Some commenters were uncertain as to whether the costs of 
the contrast agents used in conjunction with CCT and CCTA procedures 
were included in the proposed payment rate calculations for APCs 0282 
and 0383. They requested that CMS address this issue in this final rule 
with comment period. The commenters requested that CMS increase the 
payment rates for APCs 0282 and 0383 if the costs of the contrast 
agents were not included in the proposed payment rates.
    Response: The proposed payment rates for APCs 0282 and 0383 
included the costs of the contrast agents, because, as discussed 
further in section II.A.4.c.(6) of this final rule with comment period, 
we proposed to package payment for all contrast agents for CY 2008. Our 
final CY 2008 policy packages payment for all contrast agents and, 
therefore, the final payment rates for CCT and CCTA procedures include 
these costs.
    After consideration of the public comments received, we are 
finalizing our CY 2008 proposal, without modification, to assign CCT 
and CCTA procedures to APCs 0282 and 0383, with CY 2008 median costs of 
approximately $100 and approximately $296, respectively. The final CY 
2008 APC assignments and APC median costs for the specific CCT and CCTA 
procedures are displayed in Table 17.

                       Table 17.--Final CY 2008 APC Assignments of CCT and CCTA Procedures
----------------------------------------------------------------------------------------------------------------
                                                                                                       Final CY
   HCPCS code    Short descriptor   CY 2007 SI   CY 2007   CY 2007 APC   Final CY 2008    Final CY     2008 APC
                                                   APC     median cost        SI          2008 APC   median cost
----------------------------------------------------------------------------------------------------------------
0144T..........  CT heart wo dye;  S..........       0398         $252  S.............         0282         $100
                  qual calc.
0145T..........  CT heart w/wo     S..........       0376          305  S.............         0383          296
                  dye funct.
0146T..........  CCTA w/wo dye...  S..........       0376          305  S.............         0383          296
0147T..........  CCTA w/wo, quan   S..........       0376          305  S.............         0383          296
                  calcium.
0148T..........  CCTA w/wo, strxr  S..........       0377          397  S.............         0383          296

[[Page 66702]]

 
0149T..........  CCTA w/wo, strxr  S..........       0377          397  S.............         0383          296
                  quan calc.
0150T..........  CCTA w/wo,        S..........       0398          252  S.............         0383          296
                  disease strxr.
0151T..........  CT heart funct    S..........       0282           94  S.............         0282          100
                  add-on.
----------------------------------------------------------------------------------------------------------------

b. Coronary and Non-Coronary Angioplasty (PTCA/PTA) (APCs 0082, 0083, 
and 0103)
    For CY 2008, we proposed to delete APC 0081 (Noncoronary 
Angioplasty or Atherectomy) as a result of the effects of the proposed 
CY 2008 packaging approach on median costs (see section II.A.4.c. of 
this final rule with comment period for more discussion of our 
packaging approach). We proposed to reassign the procedures that mapped 
to this APC in CY 2007 to APCs that would be homogeneous with respect 
to clinical characteristics and resource use in CY 2008, specifically 
APCs 0082 (Coronary or Non-Coronary Atherectomy), 0083 (Coronary or 
Non-Coronary Angioplasty and Percutaneous Valvuloplasty), and 0103 
(Miscellaneous Vascular Procedures). The CY 2008 proposed payment rates 
for these APCs were approximately $5,654, $2,934, and $972, 
respectively. The CY 2007 payment rate for APC 0081 was approximately 
$2,639.
    We received one public comment on our CY 2008 proposal to delete 
APC 0081 and reassign the procedures that mapped to this APC to APCs 
0082 and 0083. A summary of the public comment and our response follow.
    Comment: One commenter stated that the proposed reassignment of 
some of the angioplasty procedures assigned to APC 0081 in CY 2007 to 
APC 0083 in CY 2008 fails to recognize the differences in median costs 
associated with the use of specialty balloons in certain coronary and 
non-coronary angioplasty (PTCA/PTA) procedures. According to the 
commenter, specialty balloons are defined as balloons that can be used 
for purposes other than inflation and deflation (eg, cutting balloons 
and cold therapy balloons). The commenter estimated from an analysis of 
the CY 2006 Medicare claims data that the median costs for PTCA/PTA 
procedures involving specialty balloons are approximately 55 percent 
higher than the median costs of all PTCA/PTA procedures in APC 0083, 
and represent approximately 4 percent of the cases. The commenter 
expressed concern that inadequate payment for PTCA/PTA procedures 
involving specialty balloons could reduce beneficiary access to this 
technology.
    The commenter urged CMS to reconsider its proposal to reassign all 
PTCA/PTA procedures to APC 0083. Specifically, the commenter requested 
that CMS establish a HCPCS Level II G-code to differentiate coronary 
and noncoronary PTCA/PTA procedures using specialty balloons from those 
PTCA/PTA procedures using standard, nonspecialty balloons, defining 
specialty balloons as those which have a median reported cost of more 
than $800 based on CY 2006 hospital claims containing the Level II 
HCPCS C-code for PTCA/PTA balloons, C1725 (Catheter, transluminal 
angioplasty, non-laser). The commenter stated that nonspecialty 
balloons cost approximately $200 to $400. According to the commenter's 
suggestion, the new G-code would map to a new APC for coronary and 
noncoronary angioplasty procedures using specialty balloons, the 
payment for which would be based upon the median cost of procedures 
performed using specialty balloons, as indicated on CY 2006 claims by 
the reporting of C1725 where the reported catheter cost is more than 
$800.
    Response: We believe that the proposed reassignment of the 
procedures assigned to APC 0081 in CY 2007 to APC 0083 in CY 2008 is 
appropriate, both in terms of the clinical similarities and resource 
costs of the procedures involved. The HCPCS-specific median costs of 
significant procedures assigned to APC 0083 range from approximately 
$2,621 to $4,339. Even considering the information provided by the 
commenter about the expected differential cost between specialty and 
non-specialty balloons of $400 to $600, we would not expect Medicare 
beneficiaries to have problems with access to procedures with specialty 
balloons, when the APC 0083 CY 2008 median cost is approximately 
$2,855. Packaging payment for the variety of implantable devices that 
are used in specific procedures is a well-established principle of the 
OPPS, and we expect that hospitals will carefully consider the clinical 
benefits and costs of all technologies when performing procedures on 
patients. Therefore, we also believe that a policy to provide different 
payments for PTCA/PTA procedures involving specialty balloons would not 
be consistent with our overall strategy to encourage hospitals to use 
resources more efficiently by increasing the size of the payment 
bundles. If the use of a very expensive device in a clinical scenario, 
such as a specialty balloon, caused a specific procedure to be much 
more expensive for the hospital than the APC payment, we consider such 
a case to be the natural consequence of a prospective payment system 
that anticipates that some cases will be more costly and others less 
costly than the procedure payment. We will continue to monitor the 
costs of PTCA/PTA procedures over time based on the evolution of 
clinical practice and will consider proposing future modifications to 
the configuration of APC 0083 as necessary.
    After consideration of the public comment received, we are 
finalizing our CY 2008 proposal, without modification, to reassign 
angioplasty procedures assigned to APC 0081 in CY 2007 to APC 0083 in 
CY 2008. The median cost of APC 0083 is approximately $2,855.
c. Implantation of Cardioverter-Defibrillators (APCs 0107 and 0108)
    In CY 2003, we created four Level II HCPCS codes for implantation 
of single and dual chamber cardioverter-defibrillators (ICDs) with and 
without leads because, for the CY 2004 OPPS, we deleted the device 
HCPCS codes and there was no other way of determining whether the 
device being implanted was a single chamber or dual chamber device. We 
were concerned that the costs of inserting single versus dual chamber 
ICDs could be sufficiently different due to the two types of devices 
implanted such that separate APC assignments for the insertion 
procedures could be appropriate in the future. The HCPCS codes are 
G0297 (Insertion of single chamber pacing cardioverter defibrillator 
pulse generator); G0298 (Insertion of dual chamber pacing cardioverter 
defibrillator pulse generator); G0299 (Insertion or repositioning of 
electrode lead for single chamber pacing cardioverter

[[Page 66703]]

defibrillator and insertion of pulse generator); and G0300 (Insertion 
or repositioning of electrode lead for dual chamber pacing cardioverter 
defibrillator and insertion of pulse generator). The pairs of codes 
were assigned to two different clinical APCs, depending on whether or 
not they included the possibility of electrode insertion, specifically 
APC 0107 (Insertion of Cardioverter-Defibrillator) and APC 0108 
(Insertion/Replacement/Repair of Cardioverter-Defibrillator Leads).
    In the same year, the OPPS ceased to recognize for payment the two 
CPT codes for insertion of ICDs with or without ICD leads. These CPT 
codes are 33240 (Insertion of single or dual chamber pacing 
cardioverter-defibrillator pulse generator) and 33249 (Insertion or 
repositioning of electrode lead(s) for single or dual chamber pacing 
cardioverter-defibrillator and insertion of pulse generator).
    We reinstated the device category HCPCS codes on January 1, 2005. 
Moreover, since January 1, 2005, hospitals have been required to report 
devices they use or implant when there is a device code that describes 
the device. We began to edit to ensure that hospitals are correctly 
billing devices required for certain procedures in April 2005 and 
implemented the second phase of device edits on October 1, 2005. 
Therefore, we no longer need different procedural Level II HCPCS codes 
to identify whether hospitals inserted a single or dual chamber ICD 
device.
    At its March 2007 meeting, the APC Panel recommended that CMS 
delete the Level II HCPCS codes for implantation of cardioverter-
defibrillator pulse generators with or without repositioning or 
implantation of electrode lead(s) for CY 2008 and authorize hospitals 
to report the CPT codes. The APC Panel indicated that the requirement 
for reporting device codes would enable CMS to continue to identify 
costs when different types of devices are implanted if that were to be 
necessary.
    We analyzed the median cost data associated with APCs 0107 and 0108 
as part of our preparation for the APC Panel discussion. While there 
was a difference in the median cost when a single chamber versus a dual 
chamber device is implanted, the difference has never been great enough 
to justify differential APC assignments for the procedures. Table 34 
included in the CY 2008 OPPS/ASC proposed rule presented a historical 
summary of all single claim median costs. (For purposes of this 
analysis, we displayed the median costs for all single claims without 
regard to adjustment or to whether the claims met various selection 
criteria; these were not the median costs on which proposed payments 
were based.)
    Hospitals have consistently indicated that they would prefer to 
report services furnished using the CPT codes that describe them, 
rather than the Level II HCPCS G-codes, because many private payers 
require that they bill the CPT codes. We also prefer to recognize CPT 
codes for procedures under the OPPS, when possible, to minimize the 
administrative coding burden on hospitals.
    In the CY 2008 OPPS/ASC proposed rule (72 FR 42715), we stated our 
belief that the differences between the median costs for the two Level 
II HCPCS codes assigned to each APC (that is, G0297 and G0298 for APC 
0107 and G0299 and G0300 for APC 0108) do not currently support 
differential APC assignments for single and dual chamber ICD insertion 
procedures. The required device coding would allow us to continue to 
follow the different costs over time by examining subsets of ICD 
implantation procedure claims based on the type of device reported on 
the claims. Moreover, we are sensitive to the benefits of minimizing 
the reporting burden on hospitals. Therefore, for CY 2008, we proposed 
to delete the Level II HCPCS codes for ICD insertion procedures and 
require hospitals to bill the appropriate CPT codes, along with the 
applicable device C-codes, for payment under the OPPS.
    We received a number of public comments on our CY 2008 proposal for 
reporting ICD implantation procedures under the OPPS. A summary of the 
public comments and our responses follow.
    Comment: Several commenters supported implementing the policy as 
proposed. One commenter favored the elimination of the Level II HCPCS 
codes for ICD implantation, citing the administrative burden these pose 
for hospitals, but remained concerned about the potential negative 
impact to hospitals when the more expensive dual chamber device is used 
for Medicare beneficiaries. The commenter suggested that CMS should 
consider creation of composite APCs for device-dependent procedures, 
such as ICD implantation, where the device costs can vary significantly 
based on the type of device used. The commenter suggested that payment 
for these composite APCs would be based on the combination of the 
device implantation CPT code and the existing Level II HCPCS code for 
the particular device. According to the commenter, this would minimize 
the administrative burden for providers, allow coding to remain 
consistent across payers, and enable more appropriate payment for 
procedures with varying device costs.
    Response: Composite APCs provide a single payment for two or more 
major procedures that are commonly performed together, in order to 
promote efficiency by increasing the size of the payment bundle. We do 
not agree that the payment methodology outlined by one commenter, to 
base payment for ICDs on the combination of the ICD implantation CPT 
code and the existing device code, is consistent with the concept of 
composite APCs as described in the proposed rule and as finalized in 
section II.A.4.d. of this final rule with comment period. The scenario 
described by the commenter largely describes the current packaging of 
device payment into the payment for the procedure, except that we 
generally base payment on all of the devices associated with a 
procedure as a mechanism to promote the efficient utilization of 
resources. The recommended approach could actually reduce packaging 
under the OPPS by creating small and more specific payment bundles, 
rather than increasing the size of the payment bundles to provide 
hospitals with the flexibility to manage their resources as they 
control costs. To establish a separate APC for each combination of a 
procedure and a particular device used, as described by the commenter, 
would create incentives for the use of the most expensive device rather 
than creating incentives for efficiency and therefore is contrary to 
the principles of a prospective payment system. As described above, we 
believe that the payment for the procedures and associated devices 
included in APCs 0107 and 0108 is appropriate, as the differences 
between the median costs for the two Level II HCPCS codes currently 
assigned to each APC do not currently support differential APC 
assignments for single and dual chamber ICD insertion procedures.
    After consideration of the public comments received, we are 
adopting the March 2007 APC Panel recommendation and finalizing our CY 
2008 proposal, without modification, to delete the Level II HCPCS codes 
(G0297, G0298, G0299, and G0300) for ICD insertion procedures and 
require hospitals to bill the appropriate CPT codes for ICD insertion, 
specifically CPT code 33240 or CPT code 33249, as appropriate, along 
with the applicable device C-codes, for payment under the OPPS in CY 
2008.

[[Page 66704]]

d. Removal of Patient-Activated Cardiac Event Recorder (APC 0109)
    In the CY 2008 OPPS/ASC proposed rule, we proposed to continue our 
CY 2007 assignment of CPT code 33284 (Removal of an implantable, 
patient-activated cardiac event recorder) to APC 0109 (Removal/Repair 
of Implanted Devices), with a proposed CY 2008 payment rate of 
approximately $389. The CY 2007 payment rate for this service is 
approximately $676.
    We received one public comment on the CY 2008 proposed 
reconfiguration of APC 0109. A summary of the public comment and our 
response follow.
    Comment: One commenter requested that CMS reexamine its proposed 
assignment of CPT code 33284 to APC 0109 in light of the proposed 
reassignment of CPT codes 36575 (Repair of tunneled or non-tunneled 
central venous access catheter, without subcutaneous port or pump, 
central or peripheral insertion site) and 36589 (Removal of tunneled 
central venous catheter, without subcutaneous port or pump) from APC 
0621 (Level I Vascular Access Procedures) to APC 0109 for CY 2008. The 
commenter asserted that the proposed inclusion of CPT codes 36575 and 
36589 in APC 0109 significantly altered the proposed median cost of APC 
0109, to the extent that it was no longer representative of the 
resource requirements of CPT code 33284. The commenter requested that 
CMS create a separate APC for CPT code 33284 if CMS finalizes its 
proposal to reassign CPT codes 36575 and 36589 to APC 0109.
    Response: We agree with the commenter that the change in 
composition of APC 0109 may no longer most accurately reflect the 
resource characteristics of CPT code 33284. CPT codes 36575 and 36589 
have median costs of approximately $319 and $357, respectively, while 
CPT code 33284 has a median cost of approximately $682. While we 
appreciate the commenter's suggestion for a new APC for CPT code 33284, 
we believe that an existing clinical APC may sufficiently account for 
the clinical and resource characteristics of the procedure described by 
CPT code 33284. The clinical characteristics of CPT code 33284 are 
similar to those procedures in APC 0020 (Level II Excision/Biopsy). CPT 
code 33284 and the other procedures assigned to APC 0020 generally 
require surgical incisions, local anesthesia, and suturing. In 
addition, we believe that APC 0020, with an APC median cost of 
approximately $546, more closely aligns with the resources of CPT code 
33284, rather than its proposed assignment to APC 0109, with an APC 
median cost of approximately $356.
    After consideration of the public comment received, we are not 
finalizing our CY 2008 proposal to assign CPT code 33284 to APC 0109. 
Instead, we are reassigning CPT code 33284 to APC 0020 for CY 2008, 
with a median cost of approximately $546.
e. Stress Echocardiography (APC 0697)
    In the CY 2008 OPPS/ASC proposed rule, we proposed to assign CPT 
code 93350 (Echocardiography, transthoracic, real-time with image 
documentation (2D), with or without M-mode recording, during rest and 
cardiovascular stress test using treadmill, bicycle exercise and/or 
pharmacologically induced stress, with interpretation and report) to 
APC 0697 (Level I Echocardiogram, Except Transesophageal), with a 
proposed payment rate of approximately $306. Currently, this service is 
assigned to APC 0269 (Level II Echocardiogram Except Transesophageal), 
with a payment rate of approximately $198 for CY 2007. The proposed 
packaging approach for CY 2008, as described further in section 
II.A.4.c. of this final rule with comment period, proposed to package 
significant additional costs for ancillary and supportive services into 
the CY 2008 payment for CPT code 93350.
    We received a few public comments concerning our CY 2008 proposed 
reassignment of CPT code 93350 to APC 0697. A summary of the public 
comments and our response follow.
    Comment: A few commenters requested that we continue to assign CPT 
code 93350 to APC 0269, instead of reassigning this procedure to APC 
0697 as proposed. The commenters stated that the Level II APC is a more 
appropriate placement, as the procedure is comparable in clinical and 
resource characteristics to CPT code 93307 (Echocardiography, 
transthoracic, real-time with image documentation (2D) with or without 
M-mode recoding; complete) that CMS proposed to retain in APC 0269.
    Response: We have a significantly greater number of single and 
``pseudo'' single claims available for CPT code 93350 for this final 
rule with comment period than we had for the proposed rule because, in 
response to the request of commenters, we added CPT code 93017 
(Cardiovascular stress test using maximal or submaximal treadmill or 
bicycle exercise, continuous electrocardiographic monitoring, and/or 
pharmacological stress; tracing only, without interpretation or report) 
to the final CY 2008 bypass list, as described in section II.A.1.b. of 
this final rule with comment period. By adding CPT code 93017 to the CY 
2008 bypass list, we did not attribute any packaged services that may 
be on the claim to this procedure, and we were therefore able to create 
single and ``pseudo'' single claims from claims that would have 
otherwise been considered multiple procedure claims. The availability 
of additional claims for ratesetting and our final policy for paying 
for contrast and nonconstrast echocardiography through different APCs 
also contribute to the differences between the final rule median costs 
and the proposed rule median costs for echocardiography CPT codes.
    For CY 2008, we are establishing a new APC for echocardiograms with 
contrast as described in section II.A.4.c.(6) of this final rule with 
comment period, specifically APC 0128 (Echocardiogram with Contrast). 
The median cost of CPT code 93350 for contrast studies is approximately 
$527, while the median cost of CPT code 93307 for contrast studies is 
approximately $545. When these studies are performed with contrast in 
CY 2008, they will be reported with HCPCS codes C8928 (Transthoracic 
echocardiography with contrast, real-time with image documentation 
(2D), with or without M-mode recording, during rest and cardiovascular 
stress test using treadmill, bicycle exercise and/or pharmacologically 
induced stress, with interpretation and report); and C8923 
(Transthoracic echocardiography with contrast, real-time with image 
documentation (2D) with or without M-mode recording; complete), 
respectively. Both of these C-codes are assigned to new APC 0128 based 
on their clinical and resource comparability, with a CY 2008 median 
cost of approximately $534.
    For this final rule with comment period, we have over 88,000 single 
bills for noncontrast studies reported with CPT code 93350 that have an 
updated median cost of approximately $374. This median cost is quite 
close to the final rule median cost of CPT code 93307 for noncontrast 
studies of approximately $404. We agree with the commenters that CPT 
code 93350 for noncontrast studies is more appropriately placed in the 
Level II noncontrast APC that has a median cost of approximately $401, 
and where CPT code 93307 is also assigned. The two procedures are 
clinically similar, both representing comprehensive transthoracic 
echocardiography services.
    Therefore, after consideration of the public comments received, we 
are not

[[Page 66705]]

finalizing our proposal to assign noncontrast studies reported with CPT 
code 93350 to APC 0697, which has the new APC title of ``Level I 
Echocardiogram Without Contrast Except Esophageal''. Instead, we are 
retaining the assignment of CPT code 93350 for noncontrast studies to 
APC 0269, which has the new APC title of ``Level II Echocardiogram 
Without Contrast Except Transesophageal,'' because we believe this 
procedure is clinically similar to other procedures in the Level II APC 
and the median costs indicate that the noncontrast studies in this APC 
require similar hospital resources as well. Contrast studies reported 
with the corresponding C-code to CPT code 93350, specifically C8928, 
are assigned to APC 0128, with a CY 2008 median cost of approximately 
$534.
f. Coronary or Non-Coronary Atherectomy (APC 0082)
    Currently, APC 0082 is titled ``Coronary Atherectomy'' and contains 
only two CPT codes: 92995 (Percutaneous transluminal coronary 
atherectomy, by mechanical or other method, with or without balloon 
angioplasty; single vessel) and 92996 (Percutaneous transluminal 
coronary atherectomy, by mechanical or other method, with or without 
balloon angioplasty; each additional vessel (List separately in 
addition to code for primary procedure)). We proposed to reconfigure 
APC 0082 for the CY 2008 OPPS by adding 11 CPT codes, most of which 
were for percutaneous atherectomy procedures, and to change its title 
to ``Coronary or Non-Coronary Atherectomy'', as shown in Addendum A to 
the proposed rule (72 FR 42838), to better reflect the composition of 
procedures that we proposed to assign to this APC. The CY 2008 proposed 
payment rate for APC 0082 was approximately $5,654, while its CY 2007 
payment rate is approximately $4,438.
    We received one public comment on the CY 2008 proposed 
reconfiguration of APC 0082. A summary of the public comment and our 
response follow.
    Comment: A commenter objected to the proposed composition of APC 
0082 on the basis that it includes both coronary and noncoronary 
atherectomy procedures, as a result of the proposed packaging of 
imaging supervision and interpretation CPT codes. The commenter stated 
that, as proposed, APC 0082 no longer contains services that are 
comparable clinically and with respect to resource use and, therefore, 
believed that the coronary and noncoronary services should not be 
assigned to the same APC. The commenter indicated that treatment of 
peripheral vascular disease is more diffuse, requires a different 
approach, and utilizes different resources than treatment of coronary 
disease. The commenter noted that it could not determine if the 
proposed payment rate for APC 0082 is appropriate, due to the proposed 
packaging of imaging supervision and interpretation codes for the 
noncoronary atherectomy procedures, and questioned whether the claims 
data could accurately reflect the costs associated with these different 
procedures.
    Response: We believe that there is sufficient clinical homogeneity 
among all the services that we proposed to assign to APC 0082 for the 
CY 2008 OPPS and that the resources that those services require are 
sufficiently similar to justify assigning coronary and noncoronary 
atherectomy procedures to the same clinical APC. The CY 2006 claims 
data show that CPT codes 92995 and 92996 are very uncommon services in 
the HOPD, as they have a total combined frequency of 159 services for 
CY 2006. Moreover, the median costs for these codes (approximately 
$5,696 for CPT code 92995 and $3,924 for CPT code 92996) are very 
comparable to the median costs for the two highest volume noncoronary 
atherectomy codes in APC 0082: CPT code 35493 (Transluminal peripheral 
atherectomy, percutaneous; femoral-popliteal), which has a total 
frequency of 8,473 and a median cost of approximately $5,956; and CPT 
code 37204 (Transcatheter occlusion or embolization (e.g., for tumor 
destruction, to achieve hemostasis, to occlude a vascular 
malformation), percutaneous, any method, non-central nervous system, 
non-head or neck), which has a total frequency of 5,789 and a median 
cost of approximately $4,867. The CY 2008 OPPS median cost for APC 0082 
(with correct devices, no token claims, and no claims with the ``FB'' 
modifier) is approximately $5,506 and the total frequency of services 
in the APC is 18,357.
    There are no HCPCS codes in APC 0082, as proposed, that would cause 
the APC to violate the 2 times rule. We believe that it is appropriate 
to reassign the noncoronary atherectomy procedures to APC 0082 because 
we believe that the clinical characteristics and resource costs are 
sufficiently similar to warrant their placement in the same APC with 
coronary atherectomy procedures. We recognize that the similar resource 
costs may result, to some extent, from the packaging of guidance and 
imaging supervision and interpretation services under the CY 2008 OPPS. 
However, even absent our proposal to increase packaging for the CY 2008 
OPPS, the median cost of virtually all codes for procedural services 
contains some costs for packaged services. Moreover, the movement of 
codes from one APC to another occurs for a variety of reasons, 
including changes in packaging from one year to another. In addition, 
as discussed further in section II.A.2. of this final rule with comment 
period, we proposed to reconfigure certain clinical APCs for CY 2008 as 
a way to promote stability and appropriate payment for the services 
assigned to them, including low total volume APCs, with a particular 
focus on APCs with total frequencies of less than 1,000. APC 0082, as 
configured for CY 2007, includes only 232 services. Therefore, the 
reconfiguration of APC 0082 for CY 2008, as a result of increased costs 
that occur with more packaging and our effort to minimize the number of 
low volume APCs, among other reasons, is a normal occurrence in the 
course of updating the OPPS from one year to another.
    After consideration of the public comment received, we are 
finalizing our CY 2008 proposal, without modification, to reconfigure 
APC 0082 as proposed, with a median cost of approximately $5,506.
2. Gastrointestinal Procedures
a. Computed Tomographic Colonography (APC 0332)
    For CY 2008, we proposed to reassign diagnostic computed 
tomographic colonography, specifically described by CPT code 0067T 
(Computed tomographic (CT) colonography (i.e., virtual colonoscopy); 
diagnostic), from APC 0333 (Computed Tomography without Contrast 
followed by Contrast) to APC 0332 (Computed Tomography without 
Contrast), with a proposed payment rate of approximately $201.
    We received several public comments concerning this proposal. A 
summary of the public comments and our response follow.
    Comment: Several commenters requested that CMS continue the CY 2007 
APC assignment for CPT code 0067T, specifically APC 0333, rather than 
reassign it to APC 0332 for CY 2008 as proposed.
    Response: CPT code 0067T was implemented on January 1, 2005, and 
initially assigned to APC 0332. As part of our annual APC review 
process, we subsequently reassigned CPT code 0067T to APC 0333 in CY 
2006 and continued this APC assignment in CY 2007. Based on analysis of 
the CY 2006

[[Page 66706]]

hospital outpatient claims data, we proposed to reassign CPT code 0067T 
to APC 0332 for CY 2008 based on clinical homogeneity and resource 
considerations. Specifically, our hospital outpatient claims data from 
CY 2006 showed a median cost of approximately $164 for CPT code 0067T 
based on 1,421 single claims (of 1,904 total claims). Based on the 
median costs of the significant procedures assigned to APC 0332 for CY 
2008, which range from $164 to $227, we believe that CPT code 0067T 
most closely resembles other noncontrast CT procedures also assigned to 
APC 0332. We do not agree with the commenters' recommendation that APC 
0333 is the most appropriate APC assignment for CPT code 0067T because 
the median cost of approximately $322 for APC 0333, which contains 
significant procedures with HCPCS-specific median costs ranging from 
about $272 to $359, is much higher than the median cost of CPT code 
0067T. In addition, as discussed in section II.A.4.c. of this final 
rule with comment period, we are finalizing our proposal to package 
payment for all contrasts agents in CY 2008. Because the CT scans 
assigned to APC 0333 for CY 2008 all include the administration of 
contrast and CT colonography is a noncontrast study, we believe 0067T 
is most appropriately assigned to APC 0332, where other noncontrast CT 
scans reside.
    After consideration of the public comments received, we are 
finalizing, without modification, the proposed assignment of CPT code 
0067T to APC 0332, with a median cost of about $189 for CY 2008.
b. Laparoscopic Neurostimulator Electrode Implantation (APC 0130)
    In the CY 2008 OPPS/ASC proposed rule, we proposed to continue our 
CY 2007 assignment of CPT code 43647 (Laparoscopy, surgical; 
implantation or replacement of gastric neurostimulators electrodes, 
antrum) to APC 0130 (Level I Laparoscopy), with a proposed payment rate 
of approximately $2,217. CPT code 43647 was a new code for CY 2007, so 
it received an interim final CY 2007 assignment to APC 0130, with a 
payment rate of approximately $1,975. In addition, during the September 
2007 meeting of the APC Panel, the Panel recommended that CMS 
reevaluate its decision to assign the device-dependent procedure 
described by CPT code 43647 to APC 0130 because the procedure requires 
a device and APC 0130 is not a device-dependent APC. We accepted the 
APC Panel recommendation and reassessed the proposed CY 2008 APC 
assignment of CPT code 43647 for this final rule with comment period. 
We respond to this recommendation below.
    We received a number of public comments on our interim final CY 
2007 and proposed CY 2008 assignments of CPT code 43647 to APC 0130, 
both on the CY 2007 OPPS/ASC final rule with comment period and on the 
CY 2008 OPPS/ASC proposed rule. A summary of the public comments and 
our response follow.
    Comment: A few commenters objected to our assignment of CPT code 
43647 to APC 0130, stating that APC 0130 does not accurately reflect 
the clinical and cost characteristics of CPT code 43647. The commenters 
noted that APC 0130 includes procedures for implanting minor devices 
that have modest costs, while the laparoscopic implantation of gastric 
neurostimulator electrodes is an invasive procedure that is comparable 
to the surgical implantation of neurostimulator electrodes via incision 
or laminectomy procedures that are assigned to APC 0061 (Laminectomy or 
Incision for Implantation of Neurostimulator Electrodes, Excluding 
Cranial Nerve). The commenters requested that we assign CPT code 43647 
to APC 0061, which they believed more accurately reflects the clinical 
and resource aspects of this procedure. In addition, the commenters 
noted that if CPT code 43647 is reassigned to APC 0061, then all 
peripheral neurostimulator lead implantations would be assigned to the 
same APC.
    Response: We have no hospital claims data for CPT code 43647 
because the code was new for CY 2007. However, we agree with the 
commenters that CPT code 43647 would be expected to have device costs 
that are similar to other procedures assigned to APC 0061 for CY 2007 
because all of these procedures implant neurostimulator electrodes. In 
particular, the device percentage of device-dependent APC 0061 is about 
60 percent, so that assignment of CPT code 43647 to an APC in the 
laparoscopic APC series as proposed may not provide the most 
appropriate payment for the procedure. While CPT code 43647 involves a 
different surgical approach to neurostimulator electrode implantation, 
in comparison with the potentially more invasive procedures currently 
assigned to APC 0061, we still believe the procedure's clinical 
characteristics more closely resemble the other procedures assigned to 
APC 0061 than the minimally invasive percutaneous neurostimulator 
electrode implantation procedures assigned to APC 0040 (Percutaneous 
Implantation of Neurostimulator Electrodes, Excluding Cranial Nerve). 
Therefore, we agree with commenters that APC 0061 would be an 
appropriate APC assignment for CPT code 43647 for CY 2008, taking into 
account the procedure's clinical characteristics and expected hospital 
resource costs. We will reassign CPT code 43647 to APC 0061 for CY 
2008, while we await the opportunity to review its CY 2007 claims data 
in preparation for the CY 2009 rulemaking cycle.
    After consideration of the public comments received, we are not 
finalizing our CY 2008 proposal to assign CPT code 43647 to APC 0130. 
Instead, we will reassign CPT code 43647 to APC 0061, with a median 
cost of approximately $5,213. In addition, we are changing the title of 
APC 0061 to ``Laminectomy, Laparoscopy, or Incision for Implantation of 
Neurostimulator Electrodes, Excluding Cranial Nerve'' to better reflect 
all of the procedures assigned to the APC for CY 2008.
c. Screening Colonoscopies and Screening Flexible Sigmoidoscopies (APCs 
0158 and 0159)
    Since the implementation of the OPPS in August 2000, screening 
colonoscopies and screening flexible sigmoidoscopies have been paid 
separately. In the CY 2007 OPPS/ASC final rule with comment period (71 
FR 68013), we implemented certain changes associated with colorectal 
cancer screening services provided in HOPDs. First, section 5113 of 
Pub. L. 109-171 amended section 1833(b) of the Act to add colorectal 
cancer screening to the list of services for which the beneficiary 
deductible no longer applies. This provision applies to services 
furnished on or after January 1, 2007. Second, sections 1834(d)(2) and 
(d)(3) of the Act require Medicare to pay the lesser of the ASC or OPPS 
payment amount for screening flexible sigmoidoscopies and screening 
colonoscopies. For CY 2007, the OPPS payment for screening 
colonoscopies, HCPCS codes G0105 (Colorectal cancer screening; 
colonoscopy on individual at risk) and G0121 (Colorectal cancer 
screening; colonoscopy on individual not meeting criteria for high 
risk), developed in accordance with our standard OPPS ratesetting 
methodology, would have slightly exceeded the CY 2007 ASC payment of 
$446 for these procedures. Consistent with the requirements set forth 
in sections 1834(d)(2) and (d)(3) of the Act, the OPPS payment rates 
for HCPCS codes G0105 and G0121 were set equal to the CY 2007 ASC rate 
of $446 effective January 1, 2007. This requirement did not impact the 
OPPS payment rate for

[[Page 66707]]

screening flexible sigmoidoscopies (G0104, Colorectal cancer screening; 
flexible sigmoidoscopy) because Medicare did not make payment to ASCs 
for screening flexible sigmoidoscopies in CY 2007, so there was no 
payment comparison to be made for those services.
    According to the policy for the revised ASC payment system as 
described in the August 2007 final rule for the revised ASC payment 
system (72 FR 42493), ASCs will be paid for screening colonoscopies 
based on their ASC payment weights derived from the related OPPS APC 
payment weights and multiplied by the final ASC conversion factor (the 
product of the OPPS conversion factor and the ASC budget neutrality 
adjustment). As an office-based procedure added to the ASC list of 
covered surgical procedures for CY 2008, ASC payment for screening 
flexible sigmoidoscopies will be capped at the CY 2008 MPFS nonfacility 
practice expense amount (72 FR 42511). Sections 1834(d)(2) and (d)(3) 
of the Act would then require that the CY 2008 OPPS payment rates for 
these procedures be set equal to their significantly lower ASC payment 
rates.
    However, for CY 2008, we proposed to use the equitable adjustment 
authority of section 1833(t)(2)(E) of the Act to adjust the OPPS 
payment rates for screening colonoscopies and screening flexible 
sigmoidoscopies. Section 1833(t)(2)E) of the Act provides that the 
Secretary shall establish adjustments, in a budget neutral manner, as 
determined to be necessary to ensure equitable payments under the OPPS. 
Sections 1834(d)(2) and (d)(3) of the Act regarding payment for 
screening flexible sigmoidoscopies and screening colonoscopies under 
the OPPS and ASC payment systems were established by Congress in 1997, 
many years prior to the CY 2008 initial implementation of the revised 
ASC payment system. The payment policies of the revised ASC payment 
system, as summarized in section XVI.C. of this final rule with comment 
period, make fundamental changes to the methodology for developing ASC 
payment rates based on certain principles, specifically that the OPPS 
payment weight relativity is applicable to ASC procedures and that ASC 
costs are lower than HOPD costs for providing the same procedures, that 
contradict the original assumptions underlying these provisions. 
According to the findings of the GAO in its report, released on 
November 30, 2006 and entitled ``Medicare: Payment for Ambulatory 
Surgical Centers Should Be Based on the Hospital Outpatient Payment 
System'' (GAO-07-86), the payment groups of the OPPS accurately reflect 
the relative costs of procedures performed in ASCs just as well as they 
reflect the relative costs of the same procedures provided in HOPDs. 
Screening colonoscopies were among the top 20 ASC procedures in terms 
of volume whose costs were specifically studied by the GAO in its work 
that led to this conclusion. We see no clinical or hospital resource 
explanation why the OPPS relative costs from CY 2006 OPPS claims data 
for screening flexible sigmoidoscopies and screening colonoscopies 
would not provide an appropriate basis for establishing their payment 
rates under both the OPPS and the revised ASC payment system, according 
to the standard ratesetting methodologies of each payment system for CY 
2008. If we were to pay for these screening procedures under the OPPS 
according to their ASC rates in CY 2008, we would significantly distort 
their payment relativity in comparison with other OPPS services. We 
believed and continue to believe it would be inequitable to pay these 
screening services in HOPDs at their ASC rates for CY 2008, thereby 
ignoring the relativity of their costs in comparison with other OPPS 
services which have similar or different clinical and resource 
characteristics. Therefore, for CY 2008 when we will be paying for 
screening colonoscopies and screening flexible sigmoidoscopies 
performed in ASCs based upon their standard revised ASC payment rates, 
we proposed to adjust the payment rates under the OPPS to pay for the 
procedures according to the standard OPPS payment rates. We believed 
that the application of sections 1834(d)(2) and (d)(3) of the Act 
produces inequitable results because of the revised ASC payment system 
to be implemented in CY 2008. We believed this proposal would provide 
the most appropriate payment for these procedures in the context of the 
contemporary payment policies of the OPPS and the revised ASC payment 
system.
    We received several public commenters concerning this proposal. A 
summary of the public comments and our response follow.
    Comment: Several commenters agreed that it would be inequitable to 
pay for screening colonoscopies and screening flexible sigmoidoscopies 
services in the HOPD at their lower ASC payment rate. They supported 
CMS's use of the equitable adjustment authority to adjust the OPPS 
payment rates for these services.
    Response: We appreciate commenters' support of our proposal. We 
acknowledge that sections 1834(d)(2) and (d)(3) of the Act would 
otherwise require that the CY 2008 OPPS payment rates for screening 
colonoscopies and screening flexible sigmoidoscopies be set equal to 
their significantly lower ASC payment rates. However, we continue to 
believe it is necessary to invoke the equitable adjustment authority 
provided by section 1833(t)(2)(E) of the Act to adjust the OPPS payment 
rates for these procedures in order to establish the most appropriate 
payment for these procedures in the context of the contemporary payment 
policies of the OPPS and the revised ASC payment system.
    After consideration of the public comments received, we are 
finalizing our CY 2008 proposal, without modification, to pay for 
screening colonoscopies and screening flexible sigmoidoscopies under 
the OPPS at payment rates developed according to the standard OPPS 
ratesetting methodology.
3. Genitourinary Procedures
a. Cystoscopy With Stent (APC 0163)
    For CY 2008, we proposed to continue assignment of CPT code 52282 
(Cystourethroscopy, with insertion of urethral stent) to APC 0163 
(Level IV Cystourethroscopy and other Genitourinary Procedures), with a 
proposed payment rate of approximately $2,351. Payment for APC 0163 in 
CY 2007 is approximately $2,147.
    We received one public comment on our CY 2008 proposed assignment 
of CPT code 52282 to APC 0163. A summary of the public comment and our 
response follow.
    Comment: One commenter indicated that the procedure described by 
CPT code 52282 is inappropriately assigned to APC 0163, and that it 
should be reassigned to a new device-dependent APC for CY 2008. 
According to the commenter, the procedure described by CPT code 52282 
is dissimilar to the other procedures that map to APC 0163, both 
clinically and in terms of cost. The commenter stated that this 
procedure is the only procedure in APC 0163 that involves an implant. 
In addition, the commenter asserted that the APC's CY 2008 proposed 
payment of approximately $2,351 is inadequate to cover hospitals' costs 
for performing this procedure, and that as a result, hospitals may 
limit beneficiary access to this treatment. According to the commenter, 
the urethral stent that is placed during these procedures is 
approximately $4,200. The commenter also noted that other stent 
placement procedures have device-dependent

[[Page 66708]]

status so that adequate costs can be tracked. The commenter recommended 
that CMS create a new device-dependent APC for CPT code 52282 with a 
payment rate of at least $4,000.
    Response: In response to the concerns raised by the commenter, we 
reviewed the clinical characteristics and hospital costs from CY 2006 
claims data for all procedures proposed for CY 2008 assignment to APC 
0163. The APC median cost is approximately $2,270, while CPT code 52282 
has a median cost of approximately $2,016, based on 291 single claims 
out of a total of 900 claims for the procedure. Because of the 
commenter's concern about whether the stent costs were appropriately 
reflected in the procedure's median cost, we compared the median costs 
of CY 2006 claims that include both CPT code 52282 for cystoscopy with 
implant of a stent and a Level II HCPCS C code for a stent, to CY 2006 
claims that include CPT code 52282 but do not include a device C-code 
for a stent. While a stent is always necessary for the procedure and we 
require that hospitals report device HCPCS codes whenever they implant 
a device that is described by an available device code, we found that 
hospitals did not always report a stent HCPCS code with CPT code 52282. 
This is similar to our findings in other cases of device-related 
procedures. We believe, however, that hospitals are usually otherwise 
accounting for the device cost in their charges on claims for CPT code 
52282, either by incorporating the charge into the charge for the 
procedure or reporting a charge on an uncoded revenue code line. We 
found only a small difference in median costs of approximately $500 for 
procedures reported with and without a device C-code. This difference 
in costs is well within an appropriate range for the APC group. 
Furthermore, the median cost for the claims billed with CPT code 52282 
and a stent C-code was approximately $2,369, very close to the CY 2008 
median cost of APC 0163 of approximately $2,270. We also believe that 
CPT code 52282 clinically resembles the other cystourethroscopic 
procedures also assigned to APC 0163. Therefore, we do not believe that 
there are sufficient differences in clinical characteristics or 
resources required to perform the procedure described by CPT code 52282 
relative to the other procedures assigned to APC 0163 to warrant 
reassignment of CPT code 52282 to a new, device-dependent APC as the 
commenter suggested.
    After consideration of the public comment received, we are 
finalizing our proposal, without modification, to assign CPT code 52282 
to APC 0163, with a CY 2008 median cost of approximately $2,270.
b. Percutaneous Renal Cryoablation (APC 0423)
    For CY 2008, we proposed to assign CPT code 0135T (Ablation renal 
tumor(s), unilateral, percutaneous, cryotherapy) to APC 0423 (Level II 
Percutaneous Abdominal and Biliary Procedures), with a proposed payment 
rate of approximately $2,810. This code was new in CY 2006, when it was 
assigned to APC 0163 (Level IV Cystourethroscopy and other 
Genitourinary Procedures) on an interim final basis, with a payment 
rate of $1,999. In CY 2007, based on the APC Panel's recommendation 
made at the March 2006 APC Panel meeting, we reassigned CPT code 0135T 
from APC 0163 to APC 0423 with a payment rate of approximately $2,297. 
We expected hospitals, when billing CPT code 0135T, to also report the 
device HCPCS code, C2618 (Probe, cryoablation), associated with the 
procedure.
    We received several public comments concerning this proposal. A 
summary of the public comments and our responses follow.
    Comment: Several commenters disagreed with our proposed APC 
assignment for CPT code 0135T. They indicated that the proposed payment 
rate for APC 0423 does not cover the cost hospitals incur for the 
cryoprobes used in the procedure. One commenter reported that the 
average cost of one probe is about $1,000, while several commenters 
indicated that a single procedure, on the average, uses about 2.5 
probes but may involve up to 4 probes depending on the size of the 
tumor and the probe needle selected. Other commenters argued that CPT 
code 0135T requires more resources than the other procedures currently 
assigned to APC 0423, specifically CPT codes 47382 (Ablation, one or 
more liver tumor(s), percutaneous, radiofrequency) and 50592 (Ablation, 
one or more renal tumor(s), percutaneous, unilateral, radiofrequency). 
Several commenters highlighted the variance in the use of probes used 
for the procedures assigned to APC 0423. Specifically, these commenters 
asserted that CPT code 0135T requires the use of multiple probes while 
the radiofrequency ablation procedures require only a single probe in a 
procedure. Further, the commenters highlighted the various median costs 
associated with the procedures assigned to APC 0423. That is, they 
pointed out that the proposed median cost of about $3,520 for CPT code 
0135T was 30 to 32 percent more than the median cost for CPT code 
47382, which had a proposed median cost of about $2,706, or CPT code 
50592, which had a proposed median cost of about $2,658. The commenters 
urged CMS to reevaluate the proposed payment rate for APC 0423 and use 
acquisition cost data provided by manufacturers, as many of the claims 
used to set the payment rate do not contain the required device. 
Alternatively, some commenters requested that CMS consider creating a 
unique clinical APC for renal cryoablation that would be designated as 
device-dependent to appropriately distinguish the resource costs 
associated with renal cryoablation from radiofrequency ablation 
procedures.
    Response: Based on our comprehensive review of the procedures 
assigned to APC 0423, public comments, and the CY 2006 recommendation 
of the APC Panel regarding renal cryoablation, we believe that we have 
appropriately assigned CPT code 0135T to APC 0423 for CY 2008 based on 
clinical and resource considerations. We disagree with the commenters' 
argument regarding the clinical dissimilarity of the renal cryoablation 
procedure from the radiofrequency ablation procedures in APC 0423. The 
commenters to the CY 2007 OPPS proposed rule (71 FR 68049) acknowledged 
that cryoablation and radiofrequency percutaneous ablation procedures 
for renal tumors are clinically similar. We continue to believe that 
CPT code 0135T is appropriately assigned to APC 0423 because it is 
placed with other procedures that share its clinical and resource 
characteristics. If hospitals use more than one probe in performing the 
renal cryoablation procedure, we expect hospitals to report this 
information on the claim and adjust their charges accordingly. 
Hospitals should report the number of cryoablation probes used to 
perform CPT code 0135T as the units of HCPCS code C2618 which describes 
these devices, with their charges for the probes. Since CY 2005, we 
have required hospitals to report device HCPCS codes for all devices 
used in procedures if there are appropriate HCPCS codes available. In 
this way, we can be confident that hospitals have included charges on 
their claims for costly devices used in procedures when they submit 
claims for those procedures.
    Comment: Several commenters informed us that the hospital claims 
data that we used to set the proposed payment rate for CPT code 0135T 
do not accurately capture the full costs related to this procedure. 
They believed that the omission on the claims for the device C-code, 
specifically HCPCS code C2618,

[[Page 66709]]

for the cryoprobes leads to omission of cryoprobe cost information and 
undervaluation of the cost of the procedure. Some commenters reported 
the results of their study of our hospital outpatient claims data which 
revealed that of the 110 Medicare claims submitted for CPT code 0135T, 
only 44 single claims included the device HCPCS C-code (C2618) on the 
claims. Because the procedure cannot be performed without the cryoprobe 
device, these commenters strongly urged CMS to designate the renal 
cryoablation procedure as a ``device-dependent'' procedure and require 
hospitals to submit claims with the appropriate HCPCS C-code. One 
commenter who acknowledged its experience with hospital billing 
reported that hospitals are not motivated to report the cost of the 
devices on the claim form unless a HCPCS C-code is required by a code 
edit for claim submission. Several commenters requested that CMS 
designate CPT code 0135T as a ``device-dependent'' procedure to ensure 
that future claims data more accurately reflect the total cost of the 
procedure.
    Response: We acknowledge the concerns raised by the commenters 
regarding the hospitals' failure to report the device HCPCS code C2618 
with the procedure. We further examined our CY 2006 hospital outpatient 
claims data to determine the frequency of billing CPT code 0135T with 
and without HCPCS code C2618. Our analysis revealed that the final rule 
median cost of approximately $3,446 based on 48 single bills used for 
ratesetting falls within the range for those procedures billed with and 
without the device HCPCS code C2618. Specifically, our data showed a 
median cost of about $4,402 based on 17 single bills for procedures 
billed with the device HCPCS code C2618 and a median cost of about 
$2,834 based on 31 single bills for those procedures billed without the 
device C-code. Even considering only those claims for CPT code 0135T 
with the device HCPCS code and higher median cost, CPT code 0135T would 
be appropriately assigned to APC 0423 based on that cost.
    Further, we do not believe that we should create a claims 
processing edit in this instance. We create device edits, when 
appropriate, for procedures assigned to device-dependent APCs, where 
those APCs have been historically identified under the OPPS as having 
very high device costs. Because APC 0423 is not a device-dependent APC 
and the costs of the procedure with and without HCPCS code C2618 are 
reasonably similar, we will not create edits. We remind hospitals that 
they must report all of the HCPCS codes that appropriately describe the 
items used to provide services, regardless of whether the HCPCS codes 
are packaged or paid separately.
    After further analysis of our CY 2006 hospital outpatient claims 
data, the APC Panel recommendation from the March 2006 meeting, and 
consideration of the public comments received, we are finalizing our 
proposal, without modification, to assign CPT code 0135T to APC 0423 
for CY 2008 with a median cost of approximately $2,705.
    For CY 2008, the CPT Editorial Panel decided to delete CPT code 
0135T on December 31, 2007, and replace it with CPT code 50593 
(Ablation, renal tumor(s), unilateral, percutaneous, cryotherapy). The 
replacement CPT code 50593 will be assigned to APC 0423 effective 
January 1, 2008. Similar to its predecessor code, we expect hospitals 
to report both the device HCPCS code C2618 and CPT code 50593 to 
appropriately report the renal cryoablation procedure.
c. Prostatic Thermotherapy (APC 0163)
    For CY 2008, we proposed to reconfigure certain clinical APCs to 
eliminate most of the low total volume APCs as an alternative to 
developing specific quantitative approaches to treating low total 
volume APCs differently for purposes of median calculation. We further 
concluded that there were other clinical APCs with higher volumes of 
total claims to which these low total volume services could be 
reassigned, while maintaining the continued clinical and resource 
homogeneity of the clinical APCs to which they would be newly 
reassigned. As a result, we eliminated certain APCs and reassigned the 
procedures associated with these APCs to other clinical APCs with 
higher volumes of claims. Prostatic thermotherapy procedures were 
assigned to APC 0675 (Prostatic Thermotherapy) for CY 2007, with a 
payment rate of approximately $2,529. For CY 2008, we proposed to 
reassign CPT codes 53850 (Transurethral destruction of prostate tissue; 
by microwave thermotherapy) and 53852 (Transurethral destruction of 
prostate tissue; by radiofrequency thermotherapy) from APC 0675 to APC 
0163 (Level IV Cystourethroscopy and other Genitourinary Procedures), 
with a proposed payment rate of approximately $2,351. We proposed to 
eliminate APC 0675, which would otherwise have included only 
approximately 550 total services based on CY 2006 claims.
    We received some public comments on the proposed deletion of APC 
0675 and the reassignment of the prostatic thermotherapy procedures in 
APC 0675 to APC 0163. A summary of the public comments and our response 
follow.
    Comment: Specifically, some commenters requested clarification from 
CMS on the reassignment of CPT codes 53850 and 53852 from APC 0675 to 
APC 0163, as reflected in Addendum B of the CY 2008 OPPS proposed rule. 
One commenter urged CMS to investigate whether these procedures were 
correctly assigned to APC 0163 as the procedures described by CPT codes 
53850 and 53852 seemed more appropriate, in terms of clinical 
characteristics and resource costs, for assignment to APC 0429 (Level V 
Cystourethroscopy and other Genitourinary Procedures). The commenter 
recommended that the APC Panel discuss this issue at its next meeting 
to further review the data before the proposed change is finalized.
    Response: As part of our annual review, we examine the APC 
assignments for all items and services under the OPPS for appropriate 
placements in the context of our proposed policies for the update year. 
This review involves careful and extensive analysis of our hospital 
outpatient claims data, as well as input from our medical advisors and 
the APC Panel and recommendations from the public. Based on our 
analysis of the hospital outpatient claims from CY 2006, the final 
median cost for CPT code 53850 is approximately $2,482 based on 199 
single claims (223 total), and the final median cost for CPT code 53852 
is approximately $2,894 based on 195 single claims (315 total). We 
agree with the commenter who recommended reassignment of these CPT 
codes to APC 0429, which has a median cost of approximately $2,844 for 
CY 2008 and includes several other procedures to destroy prostate 
tissue. We believe that APC 0429 is the most appropriate assignment for 
both CPT codes based on clinical and resource considerations.
    After consideration of the public comments received, we are 
modifying our proposal and finalizing the CY 2008 assignments of CPT 
codes 53850 and 53852 to APC 0429, with a median cost of approximately 
$2,844.
d. Radiofrequency Ablation of Prostate (APC 0163)
    For CY 2008, we proposed to delete APC 0675 (Prostatic 
Thermotherapy) and reassign the two CPT codes that mapped to this APC 
in CY 2007, CPT code 53850 (Transurethral destruction of prostate 
tissue; by microwave thermotherapy) and CPT code 53852

[[Page 66710]]

(Transurethral destruction of prostate tissue; by radiofrequency 
thermotherapy) to APC 0163 (Level IV Cystourethroscopy and other 
Genitourinary Procedures). The CY 2007 payment rate for APC 0675 is 
approximately $2,529, and the CY 2008 proposed payment rate for APC 
0163 was approximately $2,351.
    Comment: One commenter asserted that the proposed reassignment of 
CPT code 53852 to APC 0163 is not clinically appropriate or consistent 
with the resource costs of other procedures assigned to APC 0163. The 
commenter suggested that CMS reassign CPT code 53852 to APC 0429 (Level 
V Cystourethroscopy and other Genitourinary Procedures), with a CY 2008 
proposed payment rate of approximately $2,924. According to the 
commenter, CMS cost data showed that the median cost of CPT code 53852 
is 26 percent higher than the median cost of the APC 0163 to which CMS 
proposed to reassign the procedure. The commenter stated that the 
clinical characteristics of the procedure described by CPT code 53852 
are more similar to the procedure described by CPT code 52647 (Laser 
coagulation of the prostate, including control of postoperative 
bleeding, complete (vasectomy, meatotomy, cystourethroscopy, urethral 
calibration and/or dilation, and internal urethrotomy are included if 
performed)), which maps to APC 0429, than the procedures that are 
included in APC 0163. Specifically, the commenter stated that both 
procedures can be done under direct visualization, placement of the 
energies are customized, and there is no incision or cutting of the 
tissues involved. The commenter also argued that CMS data on 
intraservice procedure times and the direct costs of clinical labor, 
supplies, and equipment indicate that CPT code 53852 should be 
reassigned to APC 0429 rather than to APC 0163.
    Response: We examined the clinical characteristics and claims-based 
resource costs of all procedures proposed for assignment to APC 0163 
and APC 0429 for CY 2008. We agree with the commenter that APC 0429 
would be an appropriate assignment for CPT code 53852 for CY 2008. CPT 
code 53852 appears to be more closely related, both in terms of 
clinical characteristics and resource costs, to the laser surgery 
procedures assigned to APC 0429 than to many of the cystourethroscopy 
and transurethral resection procedures assigned to APC 0163. CPT code 
53852, like some other procedures assigned to APC 0429, is a minimally 
invasive procedure for the destruction of prostate tissue, and we 
believe the procedure room time and recovery period for the services 
would be relatively comparable.
    After consideration of the public comments received, we are 
modifying our CY 2008 proposal and will reassign CPT code 53852 to APC 
0429, with a median cost of approximately $2,844.
e. Ultrasound Ablation of Uterine Fibroids With Magnetic Resonance 
Guidance (MRgFUS) (APC 0067)
    Magnetic resonance guided focused ultrasound (MRgFUS) is a 
noninvasive surgical procedure that uses high intensity focused 
ultrasound waves to destroy tissue in combination with magnetic 
resonance imaging (MRI) guidance. Currently, the two Category III CPT 
codes for this procedure are 0071T (Focused ultrasound ablation of 
uterine leiomyomata, including MR guidance; total leiomyomata volume 
less than 200 cc of tissue) and 0072T (Focused ultrasound ablation of 
uterine leiomyomata, including MR guidance; total leiomyomata volume 
greater or equal to 200 cc of tissue), which were implemented on 
January 1, 2005.
    In the CY 2006 OPPS proposed rule, we proposed to continue to 
assign both codes to APC 0193 (Level V Female Reproductive Proc). 
However, at the August 2005 APC Panel meeting, the APC Panel 
recommended that CMS work with stakeholders to assign CPT codes 0071T 
and 0072T to appropriate New Technology APCs. Based on our review of 
several factors, which included information presented at the August 
2005 APC Panel meeting, the public comments received on the CY 2006 
OPPS proposed rule, and our analysis of OPPS claims data for different 
procedures, we reassigned CPT code 0071T from APC 0193 to APC 0195 
(Level IX Female Reproductive Proc) and CPT code 0072T from APC 0193 to 
APC 0202 (Level X Female Reproductive Proc) effective January 1, 2006, 
to reflect the higher level of resources we estimated were required 
when performing the MRgFUS procedures.
    In the CY 2007 OPPS/ASC proposed rule, we proposed to continue to 
assign CPT code 0071T to APC 0195 and CPT code 0072T to APC 0202. We 
received comments on the CY 2007 proposed APC assignments recommending 
that we revise the APC assignments for CPT codes 0071T and 0072T. The 
commenters indicated that, while MRgFUS treats anatomical sites that 
are similar to other procedures assigned to APCs 0195 and 0202, the 
resources utilized differed dramatically. Several commenters 
recommended that the most appropriate APC assignment for the MRgFUS 
procedures would be APC 0127 (Level IV Stereotactic Radiosurgery), 
based on their analyses of the procedures' resource use and clinical 
characteristics.
    As we stated in both the CY 2006 OPPS final rule with comment 
period and the CY 2007 OPPS/ASC final rule with comment period, we 
believe that MRgFUS treatment bears a significant relationship to 
technologies already in use in HOPDs (70 FR 68600 and 71 FR 68050, 
respectively). The use of focused ultrasound for thermal tissue 
ablation has been in development for decades, and the recent 
application of MRI to focused ultrasound therapy provides monitoring 
capabilities that may make the therapy more clinically useful. We 
continue to believe that, although MRgFUS therapy is relatively new, it 
is an integrated application of existing technologies (MRI and 
ultrasound), and its technology resembles other OPPS services that are 
assigned to clinical APCs for which we have significant OPPS claims 
data. In the CY 2007 OPPS/ASC final rule with comment period (71 FR 
68050), we explained our belief that retaining MRgFUS procedures in 
clinical APCs with other female reproductive procedures would enable us 
both to set accurate payment rates and to maintain appropriate clinical 
homogeneity of the APCs. Furthermore, we did not agree with commenters 
that MRgFUS procedures shared sufficient clinical and resource 
characteristics with cobalt-based stereotactic radiosurgery (SRS) to 
reassign them to that particular clinical APC 0127, where only the 
single specific SRS procedure was assigned for CY 2007 and which had a 
CY 2007 APC median cost of approximately $8,461. Consequently, in the 
CY 2007 OPPS/ASC final rule with comment period (71 FR 68051), we 
finalized payment for these procedures in APCs 0195 and 0202 as 
proposed.
    Analysis of our hospital outpatient data for claims submitted for 
CY 2006 during the development of the proposed rule indicated that 
MRgFUS procedures were rarely performed on Medicare patients. As we 
stated in the CY 2006 OPPS final rule with comment period and the CY 
2007 OPPS/ASC final rule with comment period, because treatment of 
uterine fibroids is most common among women younger than 65 years of 
age, we did not expect that there ever would be many Medicare claims 
for the MRgFUS procedures (70 FR 68600 and 71 FR 68050, respectively). 
For OPPS claims submitted from CY 2005 through CY 2006, our claims data 
showed that there

[[Page 66711]]

were only two claims submitted for CPT code 0071T in CY 2005 and one in 
CY 2006. We had no hospital claims for CPT code 0072T from either of 
those years.
    At its March 2007 meeting, the APC Panel recommended that, for CY 
2008, CMS reassign CPT codes 0071T and 0072T from APCs 0195 and 0202 to 
APC 0067 (Level III Stereotactic Radiosurgery, MRgFUS, and MEG), which 
had a proposed APC median cost of approximately $3,870 for CY 2008. The 
APC Panel discussed its general belief that while the MRgFUS procedures 
might not be performed frequently on Medicare patients, CMS should pay 
appropriately for the procedures to ensure access for Medicare 
beneficiaries. In addition, following discussion of the potential for 
reassignment of the CPT codes to New Technology APCs, the APC Panel 
specifically recommended that the procedures be assigned to a clinical 
APC at this point in their adoption into clinical practice, instead of 
a New Technology APC. Furthermore, following publication of the CY 2007 
OPPS/ASC final rule with comment period, we received input from 
interested individuals and organizations regarding the clinical and 
resource characteristics of MRgFUS procedures. Based on our 
consideration of all information available to us regarding the 
necessary hospital resources for the MRgFUS procedures in comparison 
with other procedures for which we have historical hospital claims 
data, for CY 2008 we proposed to accept the APC Panel's recommendation 
to reassign these services to clinical APC 0067, an APC that currently 
contains two linear accelerator-based stereotactic radiosurgery (SRS) 
procedures. We agreed with the APC Panel that these SRS procedures 
share sufficient clinical and resource similarity with the MRgFUS 
services, including reliance on image guidance in a single treatment 
session to ablate abnormal tissue, to justify their assignment to the 
same clinical APC. Unlike the cobalt-based SRS service that we 
concluded in the CY 2007 OPPS/ASC final rule with comment period was 
not similar to MRgFUS procedures based on clinical and resource 
considerations, these linear accelerator-based SRS procedures are not 
performed solely on intracranial lesions and generally do not require 
immobilization of the patient's head in a frame that is screwed into 
the skull, thereby exhibiting characteristics more consistent with 
MRgFUS treatments. In addition, based on our understanding of the 
MRgFUS procedures described by the two CPT codes which differ only in 
the volume of uterine leiomyomata treated, we believed it would be most 
appropriate to assign both of these procedures to the same clinical 
APC, as recommended by the APC Panel. Therefore, for CY 2008 we 
proposed to reassign CPT codes 0071T and 0072T to APC 0067, with a 
proposed APC median cost of approximately $3,870, which was reflected 
in Table 32 of the proposed rule (72 FR 42713).
    We received several public comments on our CY 2008 proposal 
concerning MRgFUS procedures. A summary of the public comments and our 
responses follow.
    Comment: Several commenters agreed with CMS's proposal to assign 
the MRgFUS procedures, specifically CPT codes 0071T and 0072T, to APC 
0067 because the services share similarities, both clinically and with 
regard to resource costs, with other procedures also assigned to APC 
0067. However, many commenters disagreed with the proposed payment rate 
of approximately $3,918 for APC 0067. They recommended that MRgFUS be 
placed in APC 0127 (Level IV Stereotactic Radiosurgery, MRgFUS, and 
MEG), which had a proposed payment rate of approximately $7,864, as 
they believed that this APC accurately reflected the hospital charges 
and costs for this procedure. The commenters believed that the proposed 
payment rate for APC 0067 was far below the costs incurred to provide 
MRgFUS procedures and did not accurately reflect the treatment planning 
component that is part of the MRgFUS procedure. Other commenters 
disagreed with the placement of MRgFUS services in an APC that 
historically had contained only SRS procedures. These same commenters 
argued that the MRgFUS procedure is not similar to SRS treatment 
delivery services based on clinical coherence and resource utilization. 
Some commenters suggested that CMS reassign these procedures, as 
previously done in CY 2007, to a female reproductive procedure APC.
    Response: As we stated in the CY 2006 OPPS final rule with comment 
period and the CY 2007 OPPS/ASC final rule with comment period, because 
treatment of uterine fibroids is most common among women younger than 
65 years of age, we did not expect that there ever would be many 
Medicare claims for the MRgFUS procedures (70 FR 68600 and 71 FR 68050, 
respectively). Analysis of hospital outpatient data for claims 
submitted for CY 2006 indicates that MRgFUS procedures were rarely 
performed on Medicare patients. For OPPS claims submitted from CY 2005 
through CY 2006, our claims data showed that there were only two claims 
submitted for CPT code 0071T in CY 2005 and one in CY 2006. We had no 
hospital claims for CPT code 0072T from either of those years. While we 
have no information from hospital claims regarding the costs of MRgFUS 
procedures, we continue to believe that the clinical and expected 
resource characteristics of MRgFUS procedures resemble the first or 
complete session LINAC-based SRS treatment delivery services that are 
also assigned to APC 0067. The APC Panel also recommended that MRgFUS 
procedures be assigned to that clinical APC, instead of a New 
Technology APC. While commenters pointed to specific differences in the 
technologies utilized for MRgFUS and SRS procedures, both services are 
noninvasive and utilize specialized equipment and image guidance in the 
targeted ablation of abnormal tissue during a lengthy treatment 
session. Therefore, we believe that the services are sufficiently 
similar to reside in the same clinical APC.
    After consideration of the public comments received and the APC 
Panel recommendation at its March 2007 meeting, we are finalizing our 
proposal, without modification, to assign CPT codes 0071T and 0072T to 
APC 0067, with a CY 2008 median cost of approximately $3,882. Table 18 
lists the final APC median costs for the MRgFUS CPT codes.

                          Table 18.--Final CY 2008 APC Assignments of MRgFUS Procedures
----------------------------------------------------------------------------------------------------------------
                                                                                                       Final CY
   HCPCS code     Short descriptor  CY 2007 SI   CY 2007   CY 2007 APC   Final CY 2008    Final CY     2008 APC
                                                   APC     median cost        SI          2008 APC   median cost
----------------------------------------------------------------------------------------------------------------
0071T..........  U/s leiomyomata    T.........       0195       $1,742  S.............         0067       $3,882
                  ablate <200.
0072T..........  U/s leiomyomata    T.........       0202       $2,534  S.............         0067       $3,882
                  ablate >200.
----------------------------------------------------------------------------------------------------------------


[[Page 66712]]

f. Uterine Fibroid Embolization (APC 0202)
    Prior to January 1, 2007, a specific CPT code did not exist to 
describe uterine fibroid embolization. CPT guidance suggests that 
hospitals previously reported this procedure using CPT codes 37204 
(Transcatheter occlusion or embolization (eg, for tumor destruction, to 
achieve hemostasis, to occlude a vascular malformation), percutaneous, 
any method, non-central nervous system, non-head or neck) and 75894 
(Transcatheter therapy, embolization, any method, radiological 
supervision and interpretation). In CY 2006, the combined APC payment 
for these two procedures was approximately $2,504. Effective January 1, 
2007, the CPT Editorial Panel created CPT code 37210 (Uterine fibroid 
embolization (UFE, embolization of the uterine arteries to treat 
uterine fibroids, leiomyomata), percutaneous approach inclusive of 
vascular access, vessel selection, embolization, and all radiological 
supervision and interpretation, intraprocedural roadmapping, and image 
guidance necessary to complete the procedure) to describe this 
procedure. In the CY 2007 OPPS/ASC final rule with comment period (71 
FR 68317), we provided an interim final assignment of CPT code 37210 to 
APC 0202 (Level VII Female Reproductive Procedures), with a CY 2007 
payment rate of approximately $2,642. For CY 2008, we proposed 
continued assignment of CPT code 37210 to APC 202 (72 FR 42936), with a 
proposed payment rate of approximately $2,753. Because this is a new 
code for CY 2007, the CY 2006 claims data, upon which we set CY 2008 
payment rates, do not reflect use of this code.
    At the September 2007 meeting of the APC Panel, the Panel 
recommended that CMS consider moving CPT code 37210 to another APC, 
such as APC 0067 (Level III Stereotactic Radiosurgery), with a CY 2008 
proposed payment rate of approximately $3,918, or APC 0229 
(Transcatheter Placement of Intravascular Shunts), with a CY 2008 
proposed payment rate of approximately $5,713, to improve the clinical 
and resource homogeneity of the procedure within its assigned APC.
    We received several public comments on the CY 2007 OPPS/ASC final 
rule with comment period and the CY 2008 OPPS/ASC proposed rule 
regarding the placement of CPT code 37210 in APC 0202. A summary of the 
public comments and our response follow.
    Comment: Several commenters requested that CMS consider the APC 
Panel's recommendation to reassign CPT code 37210 to a different APC. 
The commenters argued that the uterine fibroid embolization procedure 
is clinically dissimilar to the other procedures assigned to APC 0202, 
which do not require the implantation of a device and do not utilize 
imaging resources. The commenters suggested that CMS create a new APC 
for CPT code 37210 or reassign it to APC 0229. The commenters stated 
that the uterine fibroid embolization procedure is similar to the other 
vascular procedures included in APC 0229, both clinically and in terms 
of resource utilization. Specifically, the commenters noted that the 
uterine fibroid embolization procedure is similar to the revision of 
transvenous intrahepatic portosystemic shunts, described by CPT code 
37183 (Revision of transvenous intrahepatic portosystemic shunt(s) 
(TIPS) (includes venous access, hepatic and portal vein 
catheterization, portography with hemodynamic evaluation, intrahepatic 
tract recanulization/dilatation, stent placement and all associated 
imaging guidance and documentation)), which maps to APC 0229. According 
to the commenters, both uterine fibroid embolization and the revision 
of transvenous intrahepatic portosystemic shunts involve device 
implantation, selective catheterization, and radiological supervision 
and interpretation. The commenters stated that the hospital resource 
consumption related to the devices used in uterine fibroid embolization 
are also similar to other procedures in APC 0229, including those 
described by CPT code 37205 (Transcatheter placement of an 
intravascular stent(s) (except coronary, carotid, and vertebral 
vessel), percutaneous; initial vessel) and CPT code 37206 
(Transcatheter placement of an intravascular stent(s) (except coronary, 
carotid, and vertebral vessel), percutaneous; each additional vessel).
    Response: We reviewed the clinical characteristics and claims-based 
costs of all procedures also proposed for assignment to APC 0202 for CY 
2008, as well as the recommendation of the APC Panel from its September 
2007 meeting. We do not believe that the procedure described by CPT 
code 37210 sufficiently resembles the services assigned to APC 0067, 
one of the possibilities recommended by the APC Panel, for that 
clinical APC to be an appropriate assignment. The stereotactic 
radiosurgery, magnetic resonance-guided focused ultrasound ablation, 
and magnetoencephalography services assigned to APC 0067 all are 
noninvasive procedures that do not require vascular catheterization or 
the use of implantable devices. We examined the clinical 
characteristics and resource costs of procedures assigned to APC 0229 
and agree with some of the commenters that this APC would be an 
appropriate assignment for CPT code 37210 for CY 2008 while we await 
claims data that will be available for the CY 2009 OPPS update. CPT 
code 37210, like other procedures assigned to APC 0229, requires the 
targeted use of intravascular catheters, imaging guidance, and 
implantable devices, and we believe the procedure room time and 
recovery period for the services would be relatively comparable. CPT 
code 37210 appears to be more closely related, both in terms of 
clinical characteristics and resource costs, to the minimally invasive 
interventional procedures assigned to APC 0229 than to many of the open 
surgical repair procedures of the female reproductive system assigned 
to APC 0202. We are unable to assign CPT code 37210 to a new clinical 
APC for CY 2008 because we would have no claims data for the procedure 
upon which to base the payment rate for that APC. Therefore, we have 
adopted the recommendation of the APC Panel to consider moving CPT code 
37210 to APC 0229 and will reassign the procedure to that APC for CY 
2008.
    After consideration of the public comments received, we are 
modifying our CY 2008 proposal and will reassign CPT code 37210 for 
uterine fibroid embolization to APC 0229, with a median cost of 
approximately $5,570.
4. Nervous System Procedures
a. Chemodenervation (APC 0206)
    For CY 2008, we proposed to reassign two chemodenervation 
procedures, specifically those described by CPT codes 64650 
(Chemodenervation of eccrine glands; both axillae) and 64653 
(Chemodenervation of eccrine glands; other area(s) (eg, scalp, face, 
neck), per day) to APC 0206 (Level II Nerve Injections), with a 
proposed payment rate of approximately $265. These services are 
currently assigned to APC 0204 (Level I Nerve Injections) for CY 2007, 
with a payment rate of approximately $139.
    We received one public comment on our CY 2008 proposed assignment 
of chemodenervation procedures to APC 0206. A summary of the public 
comment and our response follow.
    Comment: One commenter was concerned that CMS proposed to reassign 
CPT codes 64650 and 64653 to APC 0206 for CY 2008, but retained other 
chemodenervation procedures in

[[Page 66713]]

APC 0204, specifically CPT codes 64612 (Chemodenervation of muscle(s); 
muscle(s) innervated by facial nerve (eg, for blepharospasm, hemifacial 
spasm); 64613 (Chemodenervation of muscle(s); cervical spinal muscle(s) 
(eg, for spasmodic torticollis); and 64614 (Chemodenervation of 
muscle(s); extremity(s) and/or trunk muscle(s) (eg, for dystonia, 
cerebral palsy, multiple sclerosis). The commenter believed that CPT 
codes 64650 and 64653 for chemodenervation of eccrine glands should be 
grouped with the other three cited chemodenervation codes based on 
clinical and resource considerations. Of note, many commenters stated 
that if CMS proceeded with the packaging of electrodiagnostic guidance 
for chemodenervation procedures, a new distinct APC should be 
established for CPT codes 64612, 64613, and 64614, but CPT codes 64650 
and 64653 were not included in that request.
    Response: CPT codes 64650 and 64653 were new codes in CY 2006, 
which were initially assigned to APC 0204 on an interim final basis, 
and subsequently retained in that APC for CY 2007. For CY 2008, we 
proposed to reassign them to APC 0206 based on analysis of our first 
limited claims data from CY 2006. The final rule median cost for APC 
0204 is approximately $146 and for APC 0206 is approximately $258. Our 
claims data showed a median cost of approximately $221 for CPT code 
64650 and a median cost of approximately $235 for CPT code 64653 based 
on only 7 claims (of 11 total claims) and 15 claims (of 22 total 
claims), respectively. We agree with the commenter that these two 
chemodenervation procedures are clinically similar to the three 
procedures reported for chemodenervation of the muscles. Given the 
final CY 2008 packaging policy as discussed section II.A.4.c.(1) of 
this final rule with comment period that will package payment for the 
electrodiagnostic guidance for chemodenervation services, we would 
expect that the hospital resources required for CPT codes 64612 through 
64614, where this guidance is sometimes used, would be at least as 
great as those required for chemodenervation of eccrine glands. In view 
of the limited claims for CY 2006 for CPT codes 64650 and 64653, we 
agree with the commenters that these two CPT codes should be assigned 
to the same APC as the other three chemodenervation procedures, 
specifically CPT codes 64612 through 64614, whose median costs of 
approximately $125 through $187 are within the range of costs for other 
significant services also assigned to APC 0204, where these muscle 
chemodenervation procedures were proposed for assignment in CY 2008. We 
do not see any need to establish a new APC for CPT codes 64612 through 
64614 for CY 2008 based on clinical and resource considerations. 
Therefore, we believe that CPT codes 64650 and 65653 should remain in 
APC 0204 for CY 2008. As we accumulate additional claims data for these 
procedures we will reassess their resource utilization and APC 
placement.
    After consideration of the public comment received, we are 
modifying the CY 2008 proposed assignments of CPT codes 64650 and 64653 
and retaining these two CPT codes in APC 0204, with a median cost of 
approximately $146, rather than reassigning them to APC 0206 as 
proposed.
b. Implantation of Intrathecal or Epidural Catheter (APC 0224)
    For CY 2008, we proposed to delete APC 0223 (Implantation or 
Revision of Pain Management Catheter) and reassign CPT code 62350 
(Implantation, revision, or repositioning of tunneled intrathecal or 
epidural catheter, for long-term medication administration via an 
external pump or implantable reservoir/infusion pump; without 
laminectomy) to APC 0224 (Implantation of catheter/reservoir/shunt). 
The procedure described by CPT code 62350 is the only procedure 
assigned to APC 0223 in CY 2007, with a payment rate of approximately 
$1,896. The CY 2008 proposed payment for APC 0224 was approximately 
$2,364.
    We received one public comment on our CY 2008 proposal to reassign 
CPT code 62350 to APC 0224. A summary of the public comment and our 
response follow.
    Comment: One commenter supported the proposal to delete APC 0223 
and reassign CPT code 62350 to APC 0224. According to the commenter, 
this policy would increase resource homogeneity and clinical coherence.
    Response: We appreciate the commenter's support and agree that the 
deletion of APC 0223 and the reassignment of CPT code 62350 to APC 0224 
would increase resource homogeneity and clinical coherence of the 
resulting APC configuration by assigning multiple similar procedures 
for the implantation of nervous system shunts and catheters to the same 
clinical APC. We also believe this proposal is consistent with our 
overall strategy to encourage hospitals to use resources more 
efficiently by increasing the size of the payment bundles, and by 
eliminating, whenever possible, APCs comprised of few procedures.
    Therefore, we are finalizing our proposal, without modification, to 
delete APC 0223 and reassign CPT code 62350 to APC 0224, with a median 
cost of approximately $2,282.
c. Implantation of Spinal Neurostimulators (APC 0222)
    The CPT code for insertion of a spinal neurostimulator (63685, 
Insertion or replacement of spinal neurostimulator pulse generator or 
receiver, direct or inductive coupling), which is currently assigned to 
APC 0222 (Implantation of Neurological Device), is reported for both 
the insertion of a nonrechargeable neurostimulator and a rechargeable 
neurostimulator. The costs of a nonrechargeable neurostimulator from 
the CY 2005 claims are packaged into the payment for APC 0222 in CY 
2007. We believe rechargeable neurostimulators are currently most 
commonly implanted for spinal neurostimulation, consistent with the 
information provided during our consideration of the device for pass-
through designation. However, in response to hospital requests, in CY 
2007 we expanded our procedure-to-device edits to allow device category 
code C1820 (Generator, neurostimulator (implantable), with rechargeable 
battery and charging system) to be reported with two other procedures. 
These procedures are CPT code 64590 (Insertion or replacement of 
peripheral or gastric neurostimulator pulse generator or receiver, 
direct or inductive coupling), assigned to APC 0222, and CPT code 61885 
(Insertion or replacement of cranial neurostimulator pulse generator or 
receiver, direct or inductive coupling; with connection to a single 
electrode array), assigned to APC 0039 (Level I Implantation of 
Neurostimulator).
    The rechargeable neurostimulator reported as device category code 
C1820 has received pass-through payment since January 1, 2006, and its 
pass-through status will expire on January 1, 2008, as discussed 
further in section IV.B. of this final rule with comment period. During 
the 2 years of pass-through payment when device category code C1820 has 
been paid at a hospital's charges reduced to cost using the overall 
hospital CCR, we have applied a device offset when device category code 
C1820 is reported with a CPT code assigned to APCs 0039 or 0222 in 
order to remove the costs of the predecessor nonrechargeable device 
from the payment for APCs 0039 and 0222. This device offset ensures 
that no duplicate

[[Page 66714]]

device payment is made. As a general policy, under the OPPS we package 
payment for the costs of devices into the payment for the procedure in 
which they are used.
    Because we traditionally have paid for a service package under the 
OPPS as represented by a HCPCS code for the major procedure that is 
assigned to an APC group for payment, we assess the applicability of 
the 2 times rule to services at the HCPCS code level, not at a more 
specific level based on the individual devices that may be utilized in 
a service reported with a single HCPCS code. If the use of a very 
expensive device in a clinical scenario causes a specific procedure to 
be much more expensive for the hospital than the APC payment, we 
consider such a case to be the natural consequence of a prospective 
payment system that anticipates that some cases will be more costly and 
others less costly than the procedure payment. In addition, very high 
cost cases could be eligible for outlier payment. As we note in section 
II.A.4. of this final rule with comment period, decisions about 
packaging and bundling payment involve a balance between ensuring some 
separate payment for individual services and establishing incentives 
for efficiency through larger units of payment. In the case of 
implantable nonpass-through devices, these devices are part of the OPPS 
payment package for the procedures in which they are used.
    Stakeholders encouraged us to deem as two distinct procedures 
neurostimulator implantation involving rechargeable and nonrechargeable 
devices, so in the CY 2008 proposed rule we conducted a review of our 
CY 2006 claims data for APC 0222. This examination showed that the 
median costs of the associated neurostimulator implantation procedures 
are higher for rechargeable neurostimulator implantation than for 
nonrechargeable neurostimulator implantation, as shown in Table 35 of 
the proposed rule (72 FR 42716). However, the difference in costs 
(approximately $6,500 based on proposed rule data) was not so great 
that retaining the procedures for the implantation of both types of 
devices for spinal or peripheral neurostimulation in APC 0222 would 
cause a 2 times violation, even if we were to consider them to be 
distinct procedures. The data did not justify creating a new clinical 
APC. In addition, to pay differentially would require us to establish 
one or more Level II HCPCS codes for reporting under the OPPS, because 
the three CPT codes for which device category code C1820 is currently 
an allowed device do not differentiate among the device implantation 
procedures based on the specific device used. The creation of special 
Level II HCPCS codes for OPPS reporting is generally undesirable, 
unless absolutely essential, because it increases hospital 
administrative burden as the codes may not be accepted by other payers. 
Establishing separate coding and payment would reduce the size of the 
APC payment groups in a year in which we proposed to increase packaging 
under the OPPS through expanded payment groups.
    Therefore, for CY 2008 we proposed to package the costs of 
rechargeable neurostimulators into the payment for the CPT codes that 
describe the services furnished. Our proposed median cost for APC 0222 
was approximately $12,162. We thought this approach to be the most 
administratively simple, consistent with the OPPS packaging principles, 
and supportive of encouraging hospital efficiency, while also providing 
appropriate packaged payment for implantable neurostimulators. In the 
proposed rule (72 FR 42716), we specifically requested that commenters 
submit comments that address how this specific device implantation 
situation differed from many other scenarios under the OPPS, where 
relatively general HCPCS codes describe procedures that may utilize a 
variety of devices with different costs, and payment for those devices 
is packaged into the payment for the associated procedures.
    We received many public comments in response to this proposal. A 
summary of the public comments and our response follow.
    Comment: The commenters urged CMS to pay differentially for 
rechargeable and nonrechargeable neurostimulators by creating separate 
APCs for the implantation procedures. They argued that the 2 times rule 
is a sufficient but not necessary condition for splitting APCs, and 
they identified other factors apart from the 2 times rule that should 
be taken into consideration in determining APC assignments. The 
commenters argued that the resources required to implant rechargeable 
versus nonrechargeable neurostimulators vary substantially, and that a 
combined APC for these procedures would result in a payment that is 
inequitable for both technologies and may lead to incentives for 
facilities to furnish only the less costly technology, even when the 
more expensive technology is clinically indicated for a particular 
patient. The commenters stated that the prospect of hospitals limiting 
patient access to rechargeable neurostimulators is particularly 
troubling because this technology represents a substantial clinical 
improvement for select patients and is more cost-effective compared to 
nonrechargeable neurostimulators. The commenters argued that paying 
more initially for rechargeable neurostimulators would save the 
Medicare program and beneficiaries money in the long term, and improve 
overall patient care and satisfaction. The commenters also pointed to 
provider concentration as an additional factor that should be 
considered in APC assignments. In the case of neurostimulators, 
commenters provided data that showed only 27 percent of the total 
number of hospitals that implant nonrechargeable neurostimulators also 
implant rechargeable neurostimulators, and stated that an APC payment 
that combines payment for rechargeable and nonrechargeable 
neurostimulator implantation procedures may bias the payment system 
against those hospitals.
    The commenters disagreed with the assertion in the proposed rule 
that creating a new APC dedicated solely to rechargeable 
neurostimulator implantation procedures would be inconsistent with OPPS 
packaging principles. According to the commenters, distinct treatment 
of rechargeable and nonrechargeable neurostimulators is not an issue of 
packaging, because the technologies are not ancillary services or 
products. Instead, the commenters characterized them as alternative 
treatments depending on patient needs, and indicated that neither 
rechargeable nor nonrechargeable neurostimulators represent 
subordinate, supportive, or optional services relative to the other. 
The commenters also disagreed that as rechargeable neurostimulators 
become the dominant device implanted for neurostimulation, the median 
costs of APC 0222 would increase to reflect the costs of the 
technology. According to their analysis of claims data, approximately 
60 percent of the CY 2006 single procedure claims for APC 0222 were for 
implantation of gastric, sacral, or other types of peripheral nerve 
neurostimulator devices, all of which utilize and are indicated for 
nonrechargeable technologies only. Therefore, the commenters claimed 
that the median costs for APC 0222 would continue to be dominated by 
nonrechargeable neurostimulator implantation procedures, even as the 
utilization of rechargeable neurostimulators grows.
    The commenters responded to the proposed rule request to describe 
how this specific device implantation situation differed from many 
other scenarios under the OPPS, where relatively general HCPCS codes 
describe

[[Page 66715]]

procedures that may utilize a variety of devices with different costs, 
and payment for those devices is packaged into the payment for the 
associated procedures. The commenters stated that they were unaware of 
other APCs that include devices where the magnitude of the cost 
difference among packaged services is as substantial as proposed for 
neurostimulators. They also asserted that, unlike other OPPS services, 
rechargeable neurostimulators can reduce long-term costs. Rather than 
promoting efficiency, they argued, the CMS proposal to group payment 
for rechargeable neurostimulator implantation procedures with 
procedures involving nonrechargeable neurostimulators would discourage 
efficient resource utilization. They submitted economic models 
presented at special society meetings that concluded rechargeable 
spinal neurostimulators should reduce the number of reimplantation 
procedures due to battery depletion as well as reduce the number of 
complications associated with reimplantation procedures, and ultimately 
result in cost savings to payers and the health system.
    The commenters offered various coding mechanisms that would enable 
the creation of unique APCs for rechargeable and nonrechargeable 
neurostimulator implantation procedures. Some commenters urged CMS to 
create new Level II HCPCS codes to differentiate between 
neurostimulator implantation procedures involving nonrechargeable and 
rechargeable devices, assign those HCPCS codes to separate APCs, and 
discontinue the use of CPT codes describing these procedures for OPPS 
payment purposes. These commenters stated that any administrative 
burden posed by new Level II HCPCS codes would be outweighed by the 
higher payment the hospital would receive for rechargeable 
neurostimulators, and that this methodology is consistent with previous 
CMS actions to identify and allow specific payment for services of 
importance to Medicare. Other commenters, however, supported the CMS 
proposal not to implement new Level II HCPCS codes, arguing that it is 
too much of an administrative burden for hospitals to follow coding 
rules for Medicare patients that are inconsistent with CPT coding 
guidelines. They suggested that neurostimulator implantation procedures 
that contain the existing C-code for the rechargeable device (C1820) 
map to a new APC with a higher payment rate, while claims for 
neurostimulator implantation procedures with the existing C-code for 
the nonrechargeable device (C1767) continue to map to APC 0222. Other 
commenters requested that CMS pursue new CPT codes through the AMA 
rather than create new Level II HCPCS codes.
    Response: After consideration of the comments received on this 
issue, we have decided to reconfigure the APC assignments of procedures 
involving implantation of neurostimulators in order to improve the 
resource homogeneity of these APCs and ensure appropriate payment for 
both rechargeable and nonrechargeable neurostimulators. Effective 
January 1, 2008, CMS will implement a revised APC configuration for 
neurostimulator implantation procedures that groups payment for certain 
procedures mainly involving nonrechargeable neurostimulator technology 
(that is, cranial, sacral, gastric, or other peripheral 
neurostimulators) into two clinical APCs (APCs 0039 and 0315), while 
establishing a single APC for spinal neurostimulator implantation, 
which may commonly utilize either rechargeable or nonrechargeable 
technologies (APC 0222). Specifically, CMS will reassign CPT code 64590 
for implantation of peripheral neurostimulators from APC 0222 to APC 
0039, which already includes CPT code 61885 for implantation of single 
array cranial neurostimulators. CPT code 63685 for the implantation of 
spinal neurostimulators will be the only code remaining in APC 0222. By 
moving CPT code 64590 to APC 0039, all procedures that generally use 
nonrechargeable technologies only will be removed from ratesetting for 
spinal neurostimulator implantation, for which both rechargeable and 
nonrechargeable neurostimulators are indicated and commonly utilized. 
This APC reconfiguration will not affect CPT code assignment to APC 
0315 (Level II Implantation of Neurostimulators), which will continue 
to include only CPT code 61886 (Insertion or replacement of cranial 
neurostimulator pulse generator or receiver, direct or inductive 
coupling; with connection to two or more electrode arrays), although we 
will rename all three APCs to accommodate this new configuration. The 
revised APC configuration and naming convention for neurostimulator 
implantation APCs are summarized in Table 19 below. We note that this 
approach does not require hospitals to alter their coding practices in 
any way to conform to the new payment policy.
    We agree with commenters that there are other important factors we 
consider when deciding on APC assignments besides the 2 times rule. In 
our CY 2001 final rule, we recognized that resource homogeneity is a 
fundamental criterion for evaluating changes to APC assignments. We 
wrote in the CY 2001 final rule that ``if the procedures within an APC 
require widely varying resources, it would be difficult to develop 
equitable payment rates. Aggregated payments to a facility that 
performed a disproportionate share of either the expensive or 
inexpensive procedures within an APC would be distorted. Further, the 
facility might be encouraged to furnish only the less costly procedures 
within the APC, resulting in a potential access problem for the more 
costly services'' (65 FR 18457). In the case of the neurostimulator 
implantation APC configuration that we are adopting for CY 2008, two of 
the APCs contain only one procedure and one APC contains only two CPT 
codes, with very close CPT code-specific median costs, so these three 
APCs reflect great resource homogeneity. We do not consider the 
implantation of rechargeable and nonrechargeable neurostimulators to be 
different procedures, so we see no need to adopt differential coding 
and/or payment for procedures that depend on the device implanted. We 
believe our final APC configuration will provide appropriate payment 
for neurostimulator implantation procedures that ensures access to the 
appropriate neurostimulator technologies under the OPPS for Medicare 
beneficiaries.
    Just as we do not want to provide incentives for the 
underutilization of rechargeable neurostimulators, we also do not want 
to provide incentives for the overutilization of this expensive 
technology. According to information provided by the manufacturers of 
rechargeable neurostimulators, these devices are clinically indicated 
in only a subset of patients for whom spinal neurostimulation is a 
treatment option. They estimate that approximately 35 percent of these 
patients are candidates for rechargeable spinal neurostimulators, 
although this proportion may be higher. Our claims data from CY 2006, 
the first year of device pass-through for the rechargeable devices, 
already indicate that rechargeable neurostimulators are being implanted 
in about one-third of the spinal neurostimulator implantation cases. We 
received comments from many providers, however, who stated that they 
use or wish to use the rechargeable technology in all of their 
patients. We believe that creating a separate APC for rechargeable 
neurostimulator implantation, as was recommended by commenters, could

[[Page 66716]]

create incentives for hospitals to use the more expensive rechargeable 
technology, even when the more expensive technology is not clinically 
indicated. In contrast to the commenters' perspective, we believe that 
packaging payment for implantable devices into the related procedures 
is an important packaging principle that contributes to the size of the 
OPPS payment bundles. Although our CY 2008 proposal was to newly 
package payment for certain ancillary and supportive services, many 
other items and types of services that are fundamental to a procedure's 
therapeutic effect have been historically packaged under the payment 
system and will remain packaged for CY 2008. A policy to provide 
different payments for procedures according to the devices implanted 
would not be consistent with our overall strategy to encourage 
hospitals to use resources more efficiently by increasing the size of 
the payment bundles. However, we believe that the revised 
neurostimulator APC configuration that we are adopting for CY 2008 will 
allow us to calculate payment rates for procedures involving spinal 
neurostimulators that reflect changes in surgical practice based on 
clinical, rather than financial, considerations. To the extent that 
rechargeable neurostimulators may become the dominant device implanted 
for spinal neurostimulation over time based on the evolution of 
clinical practice, the median costs for the spinal neurostimulator 
implantation APC may increase to reflect contemporary utilization 
patterns.
    In summary, for CY 2008, we are finalizing our proposal, with 
modification, for payment of neurostimulator implantation procedures. 
We will implement a revised APC configuration for neurostimulator 
implantation procedures that packages payment for procedures involving 
mainly nonrechargeable neurostimulator technology (i.e., cranial, 
sacral, gastric, or other peripheral neurostimulators) into two APCs 
(APCs 0039 and 0315), while establishing a single APC for spinal 
neurostimulator implantation, which commonly utilizes either 
rechargeable or nonrechargeable technologies (APC 0222). We believe 
that this revised APC configuration best serves the principles of a 
prospective payment system by following our standard practice of 
retaining a single CPT code for neurostimulator implantation procedures 
that does not distinguish between the implantation of rechargeable and 
nonrechargeable neurostimulators, into which the costs of both types of 
devices are packaged in relationship to their OPPS utilization. We also 
believe the revised APC configuration is both consistent with our 
standard ratesetting practice for technologies coming off pass-through 
status, and reflective of the clinical and resource considerations 
presented by commenters. Because no new codes or coding practices will 
be required, hospitals will not experience any change in the 
administrative burden associated with reporting neurostimulator 
implantation procedures.

              Table 19.--CY 2008 APC Configuration for Payment of Rechargeable and Nonrechargeable Neurostimulator Implantation Procedures
--------------------------------------------------------------------------------------------------------------------------------------------------------
                                                                                            HCPCS codes                              CY 2008    CY 2008
                                                                                            included in                              CPT code     APC
                APC                  Revised title for CY 2008        Previous title          CY 2008         HCPCS descriptor        median     median
                                                                                            median cost                                cost       cost
--------------------------------------------------------------------------------------------------------------------------------------------------------
0039..............................  Level I Implantation of     Level I Implantation of           61885  Insertion or replacement     $12,799    $11,732
                                     Neurostimulator.            Neurostimulator.                         of cranial
                                                                                                          neurostimulator pulse
                                                                                                          generator or receiver,
                                                                                                          direct or inductive
                                                                                                          coupling; with
                                                                                                          connection to a single
                                                                                                          electrode array.
                                                                                                  64590  Insertion or replacement     $10,954    $11,732
                                                                                                          of peripheral
                                                                                                          neurostimulator pulse
                                                                                                          generator or receiver,
                                                                                                          direct or inductive
                                                                                                          coupling.
0222..............................  Level II Implantation of    Implantation of                   63685  Insertion or replacement     $15,150    $15,150
                                     Neurostimulator.            Neurological Device.                     of spinal
                                                                                                          neurostimulator pulse
                                                                                                          generation or receiver,
                                                                                                          direct or inductive
                                                                                                          coupling.
0315..............................  Level III Implantation of   Level II Implantation of          61886  Insertion or replacement     $16,988    $16,988
                                     Neurostimulator.            Neurostimulator.                         of cranial
                                                                                                          neurostimulator pulse
                                                                                                          generator or receiver,
                                                                                                          direct or inductive
                                                                                                          coupling; with
                                                                                                          connection to two or
                                                                                                          more electrode arrays.
--------------------------------------------------------------------------------------------------------------------------------------------------------

5. Nuclear Medicine and Radiation Oncology Procedures
a. Adrenal Imaging (APC 0391)
    For CY 2008, we proposed to assign CPT code 78075 (Adrenal imaging, 
cortex and/or medulla) to APC 0391 (Level II Endocrine Imaging), with a 
proposed payment rate of about $233. Currently, this procedure is 
assigned to the same clinical APC for CY 2007.
    We received several public comments concerning this proposal. A 
summary of the public comments and our response follow.
    Comment: Some commenters requested that CMS recognize this code as 
a high intensity multiday imaging procedure and reassign CPT code 78075 
to APC 0408 (Level III Tumor/Infection Imaging), along with another 
multiday tumor imaging procedure code CPT code 78804 
(Radiopharmaceutical localization of tumor or distribution of 
radiopharmaceutical agent(s); whole body, requiring two or more days 
imaging).
    Response: Based on our review of the costs and clinical 
characteristics of CPT code 78075, we agree with the commenters that 
this procedure is similar to CPT code 78804, in terms of clinical 
homogeneity and resource costs. Both procedures require nuclear 
medicine imaging several days following the injection of a diagnostic 
radiopharmaceutical. We note that these services are nuclear medicine 
procedures and, therefore, their final rule median costs are calculated 
according to the temporary special methodology that relies on the 
subset of claims reporting coded diagnostic radiopharmaceuticals, as 
described in section II.A.4.c. of this final rule with comment period. 
Our claims data from CY 2006 showed that the median cost for CPT code 
78075 is approximately $954 based on 124 single claims for

[[Page 66717]]

ratesetting, which is relatively similar to the median cost of 
approximately $1,194 for the sole procedure code 78804 proposed for 
assignment to APC 0408. In contrast, the HCPCS-specific median costs 
for the individual significant procedures in APC 0391 range from 
approximately $201 to $243, resulting in an APC median cost of 
approximately $217. The median cost of APC 0391 is significantly lower 
than the APC 0408 median cost of approximately $969 and the CPT code 
78075 median cost of approximately $954.
    After considering the public comments received, we are modifying 
our proposal and are reassigning CPT code 78075 to APC 0408, with a CY 
2008 median cost of approximately $969, rather than to APC 0391 as 
proposed.
b. Injection for Sentinel Node Identification (APC 0389)
    For CY 2008, we proposed to assign the sentinel node identification 
procedure, specifically described by CPT code 38792 (Injection 
procedure; for identification of sentinel node), to APC 0389 (Level I 
Non-imaging Nuclear Medicine), with a proposed payment rate of 
approximately $101. Currently, this procedure is assigned to the same 
clinical APC for CY 2007.
    We received several public comments on our CY 2008 proposed 
assignment of CPT code 38792 to APC 0389. A summary of the public 
comments and our responses follow.
    Comment: Some commenters recommended that CPT code 38792 be 
reassigned from APC 0389 to APC 0392 (Level II Non-imaging Nuclear 
Medicine), which had a proposed payment rate of approximately $209. The 
commenters indicated that an injection for sentinel node identification 
is more resource intensive, as corroborated by the CMS hospital 
outpatient claims data, than other procedures also assigned to APC 
0389. These commenters requested that CMS reassign CPT code 38792 to 
APC 0392 for CY 2008.
    Response: Based on our review of the costs and clinical 
characteristics of CPT code 38792, we agree with the commenters that 
this procedure is most similar to those procedures assigned to APC 0392 
for CY 2008. Our claims data from CY 2006 showed that the median cost 
for CPT code 38792 is approximately $174 based on 390 single claims 
available for ratesetting, which is significantly higher than the 
median cost of approximately $114 for APC 0389. The median cost of APC 
0392 of $183, which contains nuclear medicine procedures and, 
therefore, is calculated according to the special methodology described 
in section II.A.4.c. of this final rule with comment period, is more 
consistent with the hospital resources required to perform CPT code 
38792.
    After consideration of the public comments received, we are 
modifying our proposal and reassigning CPT code 38792 to APC 0392, with 
a CY 2008 median cost of approximately $183, rather than to APC 0389 as 
proposed.
c. Myocardial Positron Emission Tomography (PET) Scans (APC 0307)
    From August 2000 to December 31, 2005, under the OPPS, we assigned 
one clinical APC to all myocardial positron emission tomography (PET) 
scan procedures, which were reported with multiple G-codes through 
March 31, 2005. Under the OPPS, effective April 1, 2005, myocardial PET 
scans were reported with three CPT codes, specifically CPT codes 78459 
(Myocardial imaging, positron emission tomography (PET), metabolic 
evaluation), 78491 (Myocardial imaging, positron emission tomography 
(PET), perfusion; single study at rest or stress), and 78492 
(Myocardial imaging, positron emission tomography (PET), perfusion; 
multiple studies at rest and/or stress). From April 1, 2005 through 
December 31, 2005, these three CPT codes were assigned to one APC, 
specifically APC 0285 (Myocardial Positron Emission Tomography (PET), 
with a payment rate of approximately $736. In CY 2006, in response to 
the public comments received on the CY 2006 OPPS proposed rule, and 
based on our claims information, myocardial PET services were assigned 
to two clinical APCs for the CY 2006 OPPS. The CPT codes for the single 
scans, specifically 78459 and 78491, were assigned to APC 0306 
(Myocardial Positron Emission Tomography (PET) Imaging, Single Study, 
Metabolic Evaluation) with a payment rate of approximately $801, and 
the multiple scan CPT code 78492 was assigned to APC 0307 (Myocardial 
Positron Emission Tomography (PET) Imaging, Multiple Studies) with a 
payment rate of approximately $2,485, effective January 1, 2006. 
However, analysis of the CY 2005 claims data that were used to set the 
payment rates for CY 2007 revealed that when all the myocardial PET 
scan procedure codes were combined into a single clinical APC, as they 
were prior to CY 2006, the APC median cost for myocardial PET services 
was very similar to the median cost of their single CY 2005 clinical 
APC. Further, our analysis revealed that the updated differential 
median costs of the single and multiple study procedures no longer 
supported the two-level APC payment structure. Therefore, for CY 2007, 
CPT codes 78459, 78491, and 78492, were assigned to a single clinical 
APC, specifically APC 0307, which was renamed ``Myocardial Positron 
Emission Tomography (PET) Imaging,'' with a median cost of 
approximately $727.
    At its March 2007 meeting, the APC Panel recommended that CMS 
reassign CPT code 78492 to its own clinical APC, to distinguish this 
multiple study procedure that the APC Panel believed would require 
greater hospital resources from less resource intensive single study 
procedures. However, as indicated in the CY 2008 proposed rule (72 FR 
42713), we did not accept the APC Panel's recommendation because, 
consistent with our observations from the CY 2005 claims data, our CY 
2006 claims data available for the proposed rule did not support the 
creation of a clinical APC for CPT code 78492 alone. Analysis of the 
latest CY 2006 claims data continued to support a single level APC 
payment structure for the myocardial PET scan procedures because very 
few single scan studies were performed and we believed single and 
multiple scan procedures were clinically similar. Our claims data 
available for the proposed rule showed a total of 2,547 procedures 
reported with the multiple scan CPT code 78492. Alternatively, our 
claims data showed only a combined total of 249 procedures reported 
with the single scan CPT codes 78459 and 78491, less than 10 percent of 
all studies reported. A similar distribution was observed in the single 
bills available for ratesetting.
    Similar to findings from the CY 2005 data, as we discussed in the 
proposed rule, our CY 2006 claims data revealed that more hospitals 
were not only providing multiple myocardial PET scan services, but most 
myocardial PET scans were multiple studies. Further, our most recent 
data analysis for this final rule with comment period revealed that 
multiple myocardial PET scan services were commonly performed in the 
same hospital encounter with a cardiovascular stress test, specifically 
CPT code 93017 (Cardiovascular stress test using maximal or submaximal 
treadmill or bicycle exercise, continuous electrocardiographic 
monitoring, and/or pharmacological stress; tracing only, without 
interpretation and report).
    In the CY 2008 OPPS/ASC proposed rule, we indicated our belief that 
the assignment of CPT codes 78459, 78491, and 78492 to a single 
clinical APC for CY 2008 was still appropriate because the CY 2006 
claims data did not support a resource differential among significant

[[Page 66718]]

myocardial PET services that would necessitate the placement of single 
and multiple PET scan procedures into two separate clinical APCs. 
Therefore, we proposed to continue to assign both the single and 
multiple myocardial PET scan procedure codes to APC 0307, with a 
proposed APC median cost of approximately $2,678 for CY 2008. We noted 
that the proposed CY 2008 median cost of APC 0307 was significantly 
higher than its CY 2007 median cost, in part because of our proposed CY 
2008 packaging approach discussed in detail in section II.A.4.c.(5) of 
this final rule with comment period that would package payment for 
diagnostic radiopharmaceuticals into the payment for their related 
diagnostic nuclear medicine studies, such as myocardial PET scans. The 
myocardial PET scan CPT codes and their proposed CY 2008 APC 
assignments were displayed in Table 33 of the proposed rule, which has 
been reproduced as Table 20 below, and updated to show the final status 
indicators, APC assignments, and median costs for these services.
    We received a number of public comments concerning our proposed 
payment for myocardial PET scans. A summary of the public comments and 
our response follow.
    Comments: Some commenters disagreed with our proposal to assign CPT 
codes 78459, 78491, and 78492 to a single clinical APC even though the 
CY 2006 claims data did not support a resource differential. They 
requested that CMS separate single (rest or stress) from multiple (rest 
and stress) PET myocardial perfusion imaging studies. Specifically, 
these commenters requested that CMS assign the single myocardial PET 
codes, CPT codes 78459 and 78491, to APC 0307, and create a new 
clinical APC for CPT code 78492, which describes the multiple 
myocardial PET scan procedure. The commenters believed that maintaining 
the multiple myocardial PET scan in the same APC as the single 
myocardial PET scans significantly underpaid hospitals for providing 
multiple myocardial PET scan procedures. They reported that multiple 
myocardial PET procedures require greater hospital resources than 
single myocardial PET scans.
    Response: Based on our review of the hospital outpatient claims 
data from CY 2005 and CY 2006, as well as the clinical characteristics 
of CPT code 78492, we do not agree that we should establish a new 
clinical APC solely for the multiple myocardial PET scans. Our claims 
data for this final rule with comment period showed a total of 2,808 
procedures reported with the multiple scan CPT code 78492. Conversely, 
our claims data showed only a combined total of 286 procedures reported 
with the single scan CPT codes 78459 and 78491.
    We note that our final median cost for this APC is approximately 
$1,384, which is significantly lower than the proposed rule median cost 
for the APC. According to our final ratesetting policies in which we 
included CPT code 93017 on the bypass list as discussed in section 
II.1.b of this final rule with comment period, we based APC 0307's 
final median cost on 1,832 single claims out of 3,094 CY 2006 claims 
for myocardial PET procedures. Due to our bypassing of CPT code 93017 
for the cardiovascular stress test commonly reported with myocardial 
PET scans, we were able to use almost twice the number of claims to 
develop the final median cost based on claims from a large number of 
hospitals in comparison with the proposed rule, and almost all of those 
additional single claims were for multiple myocardial PET scan 
services. As discussed in section II.A.4.c.(5) of this final rule 
comment period, the final median cost for APC 0307 was also calculated 
only from those claims for myocardial PET scan procedures that also 
contained a HCPCS code for a diagnostic radiopharmaceutical. The median 
cost of approximately $1,384 compares favorably to our CY 2007 
estimated average total payment of $1191 for these services, consisting 
of approximately $731 for the scan (APC 0307) and approximately $460 
(average estimate of charges reduced to cost) for the commonly used 
diagnostic radiopharmaceutical A9555 (Rubidium Rb-82-diagnostic, per 
study dose, up to 60 millicuries). Therefore, we believe that the final 
median cost of APC 0307 for the scans and associated diagnostic 
radiopharmaceuticals appropriately reflects the hospital resources 
associated with providing myocardial PET scans to Medicare 
beneficiaries in cost-efficient settings and is adequate to ensure 
appropriate access to these services for Medicare beneficiaries.
    The CY 2008 median cost for APC 0307 of approximately $1,384 is 
very similar to the median cost of CPT code 78492 of $1,467, so we do 
not believe that the assignment of the relatively small number of 
generally lesser cost single scan claims to APC 0307 significantly 
reduces the payment rate for multiple scan studies. In addition, as 
discussed in section II.A.2. of this final rule with comment period, we 
are attempting to reduce the number of low volume APCs under the OPPS 
to promote the stability of payment rates. If we were to create a new 
clinical APC for multiple myocardial PET scans, APC 0307 for single 
scan studies would become a very low volume APC. We continue to believe 
that the assignment of CPT codes 78459, 78491, and 78492 to a single 
clinical APC for CY 2008 remains appropriate because the CY 2006 claims 
data do not support a resource differential among significant 
myocardial PET services that would necessitate the placement of single 
and multiple PET scan procedures into two separate clinical APCs.
    After consideration of the public comments received, we are 
finalizing our CY 2008 proposal, without modification, to provide 
payment for all myocardial PET scans through APC 0307, with a CY 2008 
median cost of approximately $1,384, as shown in Table 20.

                        Table 20.--Final CY 2008 APC Assignments for Myocardial Pet Scans
----------------------------------------------------------------------------------------------------------------
                                                                                                       Final CY
   HCPCS code     Short descriptor  CY 2007 SI   CY 2007   CY 2007 APC   Final CY 2008    Final CY     2008 APC
                                                   APC     median cost        SI          2008 APC   median cost
----------------------------------------------------------------------------------------------------------------
78459..........  Heart muscle       S.........       0307         $727  S.............         0307      $ 1,384
                  imaging (PET).
78491..........  Heart image        S.........       0307         $727  S.............         0307      $ 1,384
                  (pet), single.
78492..........  Heart image        S.........       0307         $727  S.............         0307      $ 1,384
                  (pet), multiple.
----------------------------------------------------------------------------------------------------------------


[[Page 66719]]

d. Nonmyocardial Positron Emission Tomography (PET) Scans (APC 0308)
    For CY 2008, we proposed to continue to assign the nonmyocardial 
PET scans to APC to 0308 (Non-Myocardial Positron Emission Tomography 
(PET) Imaging), with a proposed payment rate of approximately $1,107, 
specifically CPT codes 78811 (Tumor imaging, positron emission 
tomography (PET); limited area (eg, chest, head/neck)), 78812 (Tumor 
imaging, positron emission tomography (PET); skull base to mid-thigh)), 
78813 (Tumor imaging, positron emission tomography (PET); whole body)), 
and 78608 (Brain imaging, positron emission tomography (PET); metabolic 
evaluation). We note that this proposed payment will include payment 
for the diagnostic radiopharmaceuticals used in the PET scans. APC 0308 
will also include concurrent PET/CT procedures. Refer to section 
III.C.2.a. of this final rule with comment period for further 
discussion of the CY 2008 OPPS assignment of concurrent PET/CT 
procedures.
    We received several public comments concerning this proposal. A 
summary of the public comments and our responses follow.
    Comment: Several commenters agreed with the placement of CPT codes 
78811, 78812, and 78813 in APC 0308; however, some commenters requested 
that CMS reassign CPT code 78608 to a new clinical APC for PET brain 
imaging.
    Response: We disagree with the commenters' suggestion that we 
should create a separate clinical APC for CPT code 78608. Brain PET 
scan services have historically been assigned to the same APCs as other 
nonmyocardial PET services for a number of years, initially to the same 
New Technology APCs and for CY 2007 to the same clinical APC. Analysis 
of our hospital outpatient claims data from CY 2006 reveals that the 
median cost of approximately $1,046 for CPT code 78608 falls within the 
range of the HCPCS-specific median costs, approximately $1,004 to 
$1,240, for the other PET procedures also assigned to APC 0308. We are 
not convinced that separating nonmyocardial PET scans according to the 
body site being examined is necessary for clinical homogeneity, and the 
result of such a distinction would be a single CPT code in one APC. The 
OPPS is a prospective payment system that provides payment for groups 
of services that share clinical and resource characteristics. We 
believe that PET scans for tumor imaging and brain imaging are similar 
in both respects and are appropriately assigned to the same clinical 
APC.
    After considering the public comments received, we are finalizing 
our proposal, without modification, including assignment of CPT code 
78608 to APC 0308, with a CY 2008 median cost of approximately $1,044.
e. Proton Beam Therapy (APCs 0664 and 0667)
    For CY 2008, we proposed to pay for the following four CPT codes 
for proton beam therapy: 77520 (Proton treatment delivery; simple, 
without compensation); 77522 (Proton treatment delivery; simple, with 
compensation); 77523 (Proton treatment delivery; intermediate); and CPT 
77525 (Proton treatment delivery; complex). We proposed to continue to 
assign the simple proton beam therapy procedures to APC 0664 (Level I 
Proton Beam Radiation Therapy), with a proposed median cost of 
approximately $845, and the intermediate and complex proton beam 
therapy procedures to APC 0667 (Level II Proton Beam Radiation 
Therapy), with a proposed median cost of approximately $1,012. The CY 
2007 payment rates for these APCs are approximately $1,161 and $1,389, 
respectively. We also proposed to make an exception to the 2 times rule 
for APC 0664, as we did in CYs 2006 and 2007.
    We received several public comments concerning this proposal. A 
summary of the public comments and our responses follow.
    Comment: One commenter expressed concern that the CY 2008 proposed 
payment rates for APCs 0664 and 0667 are approximately 27 percent lower 
than the CY 2007 payment rates for these same APCs. The commenter 
characterized proton beam therapy as an extremely complex and expensive 
technology that is currently offered in only two hospitals. The 
commenter asked CMS to reevaluate the claims data and its analysis of 
the median costs contained in those claims data for errors. The 
commenter asserted that if the data and rate calculations were verified 
as valid, CMS should take into consideration that for any service 
provided by only two hospitals, the payment rates for the service will 
be highly dependent on the idiosyncrasies of the billing and charging 
practices of those two facilities. The commenter stated that a 27 
percent reduction in payment would discourage, if not eliminate, the 
adoption of this technology by other providers. In addition, the 
commenter offered support for the proposal to designate APC 0664 as an 
exception to the 2 times rule for CY 2008.
    Another commenter reviewed its proton beam therapy claims, charges, 
and cost data, and determined that the CY 2008 proposed median costs 
for APCs 0664 and 0667 appropriately reflect the cost of this 
technology.
    Response: In response to one commenter's concern about the validity 
of our data and our ratesetting analyses, we examined the claims and 
cost reports for proton beam therapy and verified our calculations. 
Consistent with the other commenter's examination of its own claims, 
charges, and costs, we found both the data and our calculation of the 
median costs to be accurate for APCs 0664 and 0667. We note that the 
median costs for relatively low volume APCs, such as APCs 0664 and 
0667, often fluctuate from year to year, in part due to the variability 
created by a small number of claims. We agree with the commenter that 
because our standard ratesetting methodology is based on OPPS claims, 
the payment rates for those services provided by only a few hospitals 
to Medicare beneficiaries are dependent on the particular costs and 
charging practices of that small subset of hospitals paid for the 
services under the OPPS. Therefore, the small number of hospitals 
providing proton beam therapy also may contribute to additional 
variation in payment rates as those hospitals' charging and cost 
reporting practices evolve over time. As more hospitals adopt this 
technology, we expect that the fluctuation in payment for APCs 0664 and 
0667 will be moderated by the increased number of observations for 
similar services and the incorporation of claims from a larger number 
of hospitals in the ratesetting process.
    We note that neither of these APCs violate the 2 times rule based 
on the CY 2008 final rule data because the volume of CPT code 77520 is 
such a small percentage of claims for APC 0664. The law permits 
exceptions to the 2 times rule for services that are low volume, which 
we generally have considered as having a single bill frequency that is 
less than or equal to 1,000, or less than or equal to 99 if the service 
constitutes less than 2 percent of the single bill frequency for an 
APC. CPT code 77520 has a single bill frequency of 188 in the CY 2008 
OPPS data and constitutes only 1 percent of the single claims in the 
APC. Therefore, there is no 2 times violation in APC 0664.
    After consideration of the public comments received, we are 
finalizing our CY 2008 proposal, without modification, to assign CPT 
codes 77520 and 77522 to APC 0664, with a median cost of approximately 
$807, and to assign CPT codes 77523 and 77525 to APC 0667, with a 
median cost of approximately $965.

[[Page 66720]]

6. Ocular and Ear, Nose, and Throat Procedures
a. Amniotic Membrane for Ocular Surface Reconstruction (APC 0244)
    We proposed to assign HCPCS code V2790 (Amniotic membrane for 
surgical reconstruction, per procedure) status indicator ``N'' 
(packaged) for CY 2008 and to assign its related CPT procedure codes to 
APC 0244 (Corneal Transplant). The proposed status indicators for the 
item and procedures and the proposed APC assignments for the procedures 
were the same as their CY 2007 OPPS treatment.
    We received several comments on the proposed OPPS treatment of 
HCPCS code V2790 for CY 2008. A summary of the public comments and our 
response follow.
    Comment: Several commenters requested that CMS consider assigning a 
status indicator of ``F'' (paid at reasonable cost) to HCPCS code V2790 
and creating a separate APC for amniotic membrane transplantation 
procedures that includes the costs of amniotic membrane tissue. They 
compared V2785 (Processing, preserving and transporting corneal tissue) 
and V2790, noting a difference in payment policy and status indicator 
assignments for the two types of tissues used for ocular surface 
transplant. That is, HCPCS code V2785, which is assigned status 
indicator ``F'' and HCPCS code V2790, which is assigned status 
indicator ``N,'' are not treated similarly with regard to status 
indicator assignments and OPPS payment policy. Payment for items and 
services assigned status indicator ``N'' is packaged into payment for 
the associated procedures, while payment for items and services with 
status indicator ``F'' is made at reasonable cost, not under the OPPS. 
Another commenter requested that CMS reassign the CPT procedure codes 
associated with the amniotic tissue transplant from APC 0244 to a 
separate APC. This commenter indicated that the source tissue is not 
bundled into the payment for every CPT code in APC 0244, only the 
amniotic membrane tissue.
    In addition, several commenters were concerned that paying 
separately for corneal tissue and not for amniotic membrane tissue 
could create a competitive disadvantage and a financial disincentive 
for hospitals to treat ocular surface diseases using amniotic membrane 
tissue and ultimately would impede beneficiary access to this ocular 
reconstructive procedure. Some commenters indicated that HCPCS code 
V2790 and its related procedure code, specifically CPT code 65780 
(Ocular surface reconstruction; amniotic membrane transplantation), are 
not adequately represented in hospital claims data. Despite 
instructions from CMS that packaged items and services should be 
reported on claims, some commenters believed that hospitals often fail 
to report HCPCS code V2790 because payment for HCPCS code V2790 is 
packaged with its related procedure code. They argued that the 
underreporting of the use of amniotic membrane tissue, which includes 
the costs of procuring, processing, storing, and distributing the 
product, leads to inadequate payment for CPT code 65780. Some 
commenters recommended that CMS establish claims processing edits to 
ensure the presence of the tissue HCPCS code and a charge for the item 
on claims for the ocular reconstruction procedure. One commenter 
indicated that the costs for amniotic membrane tissue can vary widely, 
similar to corneal tissue, and that the procurement of the tissue adds 
to the highly variable costs because hospitals require different sized 
tissues to accommodate various treatment and patient requirements. 
These commenters requested that CMS reassign HCPCS code V2790 from 
status indicator ``N'' to ``F'' and also create a separate APC 
specifically for amniotic membrane transplantation procedures for CY 
2008.
    Response: The OPPS has provided separate payment for corneal tissue 
acquisition at reasonable cost since the beginning of the OPPS, due to 
the highly variable corneal tissue processing fees required for eye 
banks to provide safe corneal tissue from donors as needed for 
transplant, through special distribution channels. These costs may vary 
substantially and unpredictably, depending on philanthropic and in-kind 
service contributions to eye banks that vary from community-to-
community and from year-to-year. Our understanding is that amniotic 
membrane retrieved from donated placental tissues is a processed, 
cryopreserved, and commercially marketed product used for ocular 
reconstruction that may be stocked and stored by hospitals. Unlike 
corneal tissue, we believe that amniotic tissue is a supply with stable 
and predictable costs. We do not consider the circumstances of amniotic 
tissue to be like those of corneal tissue, and consider it appropriate 
to continue to package the payment for amniotic tissue into payment for 
its related procedure code.
    We examined CY 2008 proposed rule claims, derived from CY 2006, for 
CPT code 65780, with and without HCPCS code V2790. While most claims 
did not specifically include HCPCS code V2790, the median costs for 
claims with and without HCPCS code V2790 were reasonably close and 
consistent with the costs of other services assigned to APC 0244. 
Specifically, claims with HCPCS code V2790 had a median cost of 
approximately $2,553, while claims without HCPCS code V2790 had a 
median cost of approximately $2,063. The median line-item cost of HCPCS 
code V2790 was $506, relatively consistent with the difference in cost 
between the claims with and without HCPCS code V2790. Based on our 
analysis, the proposed rule median cost of approximately $2,409 for all 
procedures in APC 0244, which would not include the costs of corneal 
tissue but would incorporate the costs of amniotic membrane tissue, is 
very close to the median cost of the amniotic tissue transplant 
procedure claims that include the HCPCS code for amniotic membrane 
tissue. The CY 2008 APC 0244 final rule median cost of approximately 
$2,359 is consistent with the APC's proposed rule cost.
    Based on our claims data from CY 2006, we believe that the current 
and proposed packaged status of HCPCS code V2790 is appropriate based 
on resource and clinical considerations. We also believe that the 
proposed composition of APC 0244, dominated by claims for corneal 
transplant procedures, reflects appropriate clinical and resource 
homogeneity. While some commenters were concerned with hospitals not 
reporting HCPCS code V2790 when reporting CPT code 65780, we do not 
believe that we should create a claims processing edit in this 
instance. We create device edits, when appropriate, for procedures 
assigned to device-dependent APCs, where those APCs have been 
historically identified under the OPPS as having very high device 
costs. Because APC 0244 is not a device-dependent APC and the costs of 
the procedure with and without HCPCS code V2790 are relatively close, 
we will not create edits. We remind hospitals that they must report all 
of the HCPCS codes that appropriately describe the items used to 
provide services, regardless of whether the HCPCS codes are packaged or 
paid separately.
    After consideration of the public comments received, we are 
finalizing our proposed CY 2008 payment policies, without modification, 
for HCPCS codes V2785 and V2790 as reflected in their status 
indicators, as well as the proposed configuration of APC 0244. We are 
also changing the APC title for APC 0244 from ``Corneal

[[Page 66721]]

Transplant'' to ``Corneal and Amniotic Membrane Transplant,'' effective 
January 1, 2008, to ensure that the title better describes all 
procedures assigned to that APC.
b. Keratoprosthesis (APC 0293)
    CPT code 65570 (Keratoprosthesis) describes the surgical procedure 
for implantation of an artificial cornea, also known as a 
keratoprosthesis. In the CY 2007 OPPS/ASC final rule with comment 
period, we indicated that we were implementing device edits in CY 2007 
for CPT code 65770 to ensure that all claims for CPT code 65570 in CY 
2007 and after include charges for a required device (71 FR 68053). For 
CY 2008, we proposed continued assignment of CPT code 65570 to APC 0293 
(Level V Anterior Segment Eye Procedures), with a proposed payment rate 
of approximately $5,290. The CY 2007 payment rate for APC 0293 is 
approximately $3,196.
    We received one public comment on our CY 2008 proposal for CPT code 
65770. A summary of the public comment and our response follow.
    Comment: One commenter expressed concern that the procedure 
described by CPT code 65570 required significant implantation of a 
costly device, but it was not assigned to a device-dependent APC. The 
commenter stated that assignment to a nondevice-dependent APC may 
result in inadequate payment rates in the ASC setting. The commenter 
noted that the revised ASC payment methodology, which will be 
implemented in CY 2008, includes an exception to the standard 
ratesetting methodology for device-intensive procedures that allows 
only the service portion of the procedure to be reduced by the ASC 
budget neutrality adjustment to reflect the relatively constant price 
of medical devices across hospital outpatient and ASC settings of care. 
Device-intensive procedures are defined as those procedures assigned to 
device-dependent APCs under the OPPS for payment purposes, where the 
APC device cost is greater than 50 percent of the APC median cost. The 
commenter pointed out that by assigning CPT code 65570 to a non-device-
dependent APC under the OPPS, the procedure did not qualify as device 
intensive for ASC payment purposes. The commenter concluded that the 
entire payment rate for the procedure would be reduced by the ASC 
budget neutrality adjustment, rather than just the service portion, in 
contrast to other procedures assigned to APCs for which the device 
costs constitute a significant portion of the total procedure costs.
    Response: We agree with the commenter that the procedure described 
by CPT code 65770 requires the implantation of a device, and that a 
significant portion of the total cost of keratoprosthesis implantation 
procedures is likely to be attributable to device costs. Currently CPT 
code 65570 is assigned to APC 0293 under the OPPS, where it is the only 
procedure in the APC. There also are two device codes for reporting 
keratoprostheses, HCPCS code C1818 (Integrated Keratoprosthesis) that 
describes the expired pass-through device category that was created in 
CY 2003 and HCPCS code L8609 (Artificial cornea) that was first 
available for reporting in CY 2007. It is not possible to calculate a 
device percentage for APC 0293 for CY 2008 that reflects the full costs 
of the devices implanted in CY 2006 because there was no device code 
that described all possible devices that could be implanted in the 
procedure at that time.
    As we stated in the CY 2007 OPPS/ASC final rule with comment 
period, when there are device HCPCS codes for all possible devices that 
could be used to perform a procedure that always requires a device and 
the APC is designated a device-dependent APC, we commonly institute 
device edits that prevent payment of claims that do not include both 
the procedure and an acceptable device code (71 FR 68053). We 
implemented device edits in CY 2007 for APC 0293, the first year that 
device HCPCS codes that describe all possible devices that could be 
used to perform the procedure were available, and we agree with the 
commenter that it would be most consistent with our established device 
editing policy to designate APC 0293 as device-dependent. However, we 
are unable to consider only CY 2006 claims for CPT code 65570 that 
contain a device HCPCS code for CY 2008 ratesetting for the APC. If we 
were to follow our usual ratesetting methodology for device-dependent 
APCs, we could be systematically and incorrectly excluding claims for 
CPT code 65570 that may have been correctly coded at the time by 
hospitals implanting a two-part keratoprosthesis not described by the 
only available HCPCS code, specifically C1818.
    After consideration of the public comments received, we are 
finalizing our CY 2008 proposal, with modification. We are assigning 
CPT code 65570 to APC 0293 as proposed. In addition, we are designating 
APC 0293 as a device-dependent APC, with a median cost of approximately 
$5,335.
c. Palatal Implant (APC 1510)
    In Addendum B to the CY 2008 proposed rule (72 FR 43018), we 
proposed to pay $850 for HCPCS code C9727 (Insertion of implants into 
the soft palate; minimum of three implants) through its assignment to 
New Technology APC 1510 (New Technology--Level X ($800-$900)). This is 
the same APC assignment for the service as its CY 2007 placement.
    We received one comment on our CY 2008 payment proposal for HCPCS 
code C9727. A summary of the comment and our response follow.
    Comment: One commenter considered the proposed CY 2008 payment rate 
for HCPCS code C9727 to be inappropriate based on the costs of the 
clinical staff, supplies, equipment, and overhead required to perform 
the procedure. The commenter reported that, based on its estimate that 
used the MPFS Practice Expense Database as a reference, the appropriate 
median cost for this procedure should be between $1,100 and $1,200. The 
commenter submitted a categorized list of items involved in performing 
the procedure to CMS, along with approximate costs for each category. 
In addition, the commenter asked CMS to reassign HCPCS code C9727 to 
New Technology APC 1514 (New Technology--Level XV ($1200-$1300)) for CY 
2008 because the commenter believed that the payment for this APC would 
appropriately reflect the complexity and resource costs associated with 
performing this procedure.
    Response: We assign a new procedure to a New Technology APC when we 
do not have adequate claims data upon which to determine the median 
cost of performing a procedure and there is no appropriate clinical APC 
for its assignment based on clinical and resource homogeneity 
considerations. We perform our own cost analysis and cost estimate, in 
addition to taking the project costs that may be submitted in a New 
Technology APC application into consideration. As we stated in our 
November 30, 2001 final rule (66 FR 59900), concerning the placement of 
new services into New Technology APCs in response to an application, 
``We will not limit our determination of the cost of the procedure to 
information submitted by the application. Our staff will obtain 
information on cost from other appropriate sources before making a 
determination of the cost of the procedure to hospitals.'' We received 
a New Technology APC application from the manufacturer of palatal 
implants required for the Pillar[supreg] Procedure. Consistent with our 
customary practice,

[[Page 66722]]

we compared the estimated hospital resources, including procedure room 
time, personnel, device costs, and other resources of the new procedure 
to various other OPPS procedures for which we have historical claims 
data. We believed that, based on this analysis, a payment rate of $850 
was appropriate based on all cost and utilization information available 
to us regarding the palatal implant procedure and other services 
provided in the hospital outpatient setting. Consequently, we assigned 
HCPCS code C9727 to New Technology APC 1510, effective October 1, 2006.
    Analysis of our hospital data for claims submitted for CY 2006 
indicates that the palatal implant procedure was rarely performed on 
Medicare beneficiaries in the last quarter of that year when specific 
OPPS payment was first available. OPPS claims for services between 
October 1, 2006, and December 1, 2006, show that there were only two 
claims submitted for HCPCS code C9727. We reexamined the service's 
proposed CY 2008 assignment in light of all current information 
available to us for this final rule with comment period, and we 
conclude that its proposed assignment to New Technology APC 1510 
remains appropriate. We will reexamine the claims data for this 
procedure next year when we review its APC placement in preparation for 
the annual CY 2009 OPPS update.
    Furthermore, the MPFS applies a very different methodology for 
establishing the payment for the physician's office practice expenses 
associated with a procedure, specifically considering the individual 
costs of the inputs, whereas the OPPS generally pays based on relative 
payment weights calculated from hospitals' costs as determined from 
claims data. Thus, comparisons between the MPFS and OPPS payments for 
services are not appropriate. While the palatal implant procedure is a 
relatively new service under the OPPS, the procedure resembles other 
OPPS services for which cost data are currently available.
    Therefore, after consideration of all the public comments received, 
we are finalizing our CY 2008 proposal, without modification, to assign 
HCPCS code C9727 to New Technology APC 1510 with a payment rate of 
$850.
7. Orthopedic Procedures
a. Arthroscopic Procedures (APCs 0041 and 0042)
    For CY 2008, we proposed two primary APCs for arthroscopic 
procedures, APC 0041 (Level I Arthroscopy), comprised of 49 procedures 
with a CY 2008 proposed payment rate of approximately $1,876, and APC 
0042 (Level II Arthroscopy), comprised of 17 procedures with a proposed 
payment rate of approximately $3,043. The CY 2007 payment rates for 
these APCs 0041 and 0042 are approximately $1,759 and $2,797, 
respectively. While we proposed to assign the majority of arthroscopic 
procedures to these APCs for CY 2008, we also proposed to continue the 
assignment of several arthroscopic procedures to APC 0053 (Level I Hand 
Musculoskeletal Procedures), with a proposed CY 2008 payment rate of 
approximately $1,071. The CY 2007 payment rate for APC 0053 is 
approximately $993.
    We received one public comment on our CY 2008 proposed 
configuration of arthroscopy APCs. A summary of the public comment and 
our response follow.
    Comment: A commenter stated that the current configuration of 
arthroscopic procedures assigned to APCs 0041, 0042, and 0053 fails to 
appropriately recognize the distinct clinical and resource features of 
the wide range of arthroscopic procedures now being provided to 
Medicare beneficiaries. The commenter requested that CMS create new 
arthroscopy APCs and reconfigure the current assignment of arthroscopic 
procedures to ensure that the arthroscopy APCs are clinically 
homogenous and contain only those procedure that are similar in 
resource utilization. Specifically, the commenter requested that CMS 
restructure the arthroscopy APCs to reflect the following clinical 
categories: diagnostic arthroscopies, lower extremity versus upper 
extremity arthroscopies, and arthroscopies with implants. The commenter 
suggested that each clinical distinction be divided further into three 
levels of resource utilization, for a total of 9 new APCs for 
arthroscopy procedures with recommended payment ranging from $1,530 to 
$4,100. According to the commenter, these clinical distinctions 
parallel the distinctions CMS has created for other classes of 
procedures, including other orthopedic procedures, and would more 
accurately and equitably reflect the clinical characteristics and 
resource utilization of the services rendered.
    Response: In response to the concerns raised by the commenter, we 
reviewed the clinical characteristics and hospital costs from CY 2006 
claims data for all procedures proposed for CY 2008 assignment to APCs 
0041, 0042, and 0053. In considering the commenter's recommended APC 
configurations, we identified several procedures that were assigned to 
APCs 0041 and 0053 with median costs and clinical characteristics that 
were more similar to procedures assigned to other clinical APCs than 
the APCs to which we proposed their assignment. Therefore, for CY 2008, 
we will reassign 11 arthroscopic procedures that are currently in APC 
0041 to APC 0042, and we will reassign 3 arthroscopic procedures that 
are currently in APC 0053 to 0041, as reflected in Table 21 below. 
While we appreciate the commenter's suggestion for nine new APCs for 
arthroscopic procedures, we believe that the existing clinical APCs, 
with the modifications included in Table 21 that assign procedures to 
the larger groups in a way that is generally consistent with the 
commenter's more specific recommended groupings, sufficiently account 
for the different clinical and resource characteristics of these 
procedures. Furthermore, to reduce the size of the APC payment groups 
and establish new clinical APC payment groups to pay more precisely 
would be inconsistent with our overall strategy to encourage hospitals 
to use resources more efficiently by increasing the size of the payment 
bundles.
    After consideration of the public comment received, we are 
modifying our CY 2008 proposal and will reassign several arthroscopic 
procedures to APCs 0041 and 0042, as displayed in Table 21 below.

                         Table 21.--CY 2008 APC Reassignment of Arthroscopic Procedures
----------------------------------------------------------------------------------------------------------------
                                                                           CY 2007 APC               CY 2008 APC
        HCPCS code                  Short descriptor          CY 2007 APC     median    CY 2008 APC     median
                                                               assignment      cost      assignment      cost
----------------------------------------------------------------------------------------------------------------
29819.....................  Shoulder arthroscopy/surgery....         0041       $1,749         0042       $2,876
29820.....................  Shoulder arthroscopy/surgery....         0041        1,749         0042        2,876
29821.....................  Shoulder arthroscopy/surgery....         0041        1,749         0042        2,876
29823.....................  Shoulder arthroscopy/surgery....         0041        1,749         0042        2,876

[[Page 66723]]

 
29825.....................  Shoulder arthroscopy/surgery....         0041        1,749         0042        2,876
29847.....................  Wrist arthroscopy/surgery.......         0041        1,749         0042        2,876
29856.....................  Tibial arthroscopy/surgery......         0041        1,749         0042        2,876
29860.....................  Hip arthroscopy, dx.............         0041        1,749         0042        2,876
29861.....................  Hip arthroscopy/surgery.........         0041        1,749         0042        2,876
29891.....................  Ankle arthroscopy/surgery.......         0041        1,749         0042        2,876
29892.....................  Ankle arthroscopy/surgery.......         0041        1,749         0042        2,876
29900.....................  Mcp joint arthroscopy, dx.......         0053          987         0041        1,811
29901.....................  Mcp joint arthroscopy, surg.....         0053          987         0041        1,811
29902.....................  Mcp joint arthroscopy, surg.....         0053          987         0041        1,811
----------------------------------------------------------------------------------------------------------------

b. Closed Fracture Treatment (APC 0043)
    For CY 2008, we proposed to continue the assignment of various CPT 
codes that describe closed treatment of fractures of the fingers, toes, 
and trunk to APC 0043 (Closed Treatment Fracture Finger/Toe/Trunk), 
with a proposed payment rate of about $119. We did not propose any CPT 
code reassignment changes for APC 0043.
    We received one public comment on our proposed CY 2008 
configuration of APC 0043. A summary of the public comment and our 
response follow.
    Comment: A commenter expressed concern about the wide variety of 
procedures assigned to APC 0043, which the commenter claimed ranged 
from $1 to $3,000 in cost. The commenter disapproved of CMS assigning 
one APC for various types of fracture treatments as the commenter 
asserted that the costs associated with finger treatments, hip 
dislocations, and spinal fractures vary significantly. The commenter 
indicated specifically that the costs associated with spinal fractures 
are significantly greater than the costs associated with finger or toe 
fractures. The commenter believed that grouping all of these procedures 
in one clinical APC violated the 2 times rule, and that continuing to 
except APC 0043 from the 2 times rule was not appropriate. To pay 
appropriately for these procedures under the current OPPS, the 
commenter recommended that CMS divide the procedures currently assigned 
to APC 0043 among several APCs, because of the existing large 
variations in resource costs for the procedures.
    Response: We thank the commenter for bringing this concern to our 
attention. We agree with the commenter that grouping all of the closed 
fracture treatment procedures in one APC may not most accurately 
distinguish the more expensive from the less resource-intensive 
fracture treatment procedures. We note that while there are about 150 
procedures assigned to APC 0043, only 13 procedures are significant 
procedures with the frequency necessary to assess the APC's alignment 
with the 2 times rule. The remainder of the procedures are low volume 
and, therefore, not significant procedures in the APC for purposes of 
evaluating the APC by applying the 2 times rule. The median costs of 
the significant procedures in APC 0043 for CY 2008 range from about $68 
to $248. This particular APC has been excepted from the 2 times rule 
for the past 6 years under the OPPS, and we have not previously 
received public comments regarding the structure of this APC over the 
past several years. The commenter did not make a specific 
recommendation regarding alternative APC configurations. Because APC 
0043 contains so many different fracture treatment procedures with low 
volume, we are concerned that any restructuring for CY 2008 without the 
benefit of public comment could lead to APCs that do not reflect 
improved clinical and resource homogeneity over the proposed 
configuration; therefore, we will not establish a different APC 
configuration for CY 2008. However, we are specifically inviting public 
comment on potential alternative APC configurations for the services 
currently assigned to APC 0043 for the CY 2009 APC review process. We 
also plan to bring this APC issue to the attention of the APC Panel at 
its winter 2008 meeting and will request its input as to how to 
appropriately categorize the procedures in APC 0043.
    After consideration of the public comment received, we are 
finalizing, without modification, our proposed configuration of APC 
0043, with a median cost of about $111 for CY 2008.
c. Insertion of Posterior Spinous Process Distraction Device (APC 0050)
    We proposed to assign CPT codes 0171T (Insertion of posterior 
spinous process distraction device (including necessary removal of bone 
or ligament for insertion and imaging guidance), lumbar; single level); 
and 0172T (Insertion of posterior spinous process distraction device 
(including necessary removal of bone or ligament for insertion and 
imaging guidance), lumbar; each additional level) to APC 0050 (Level II 
Musculoskeletal Procedures Except Hand and Foot), with a proposed 
payment rate of approximately $1,868. These two codes were new in CY 
2007, where they were assigned to APC 0050 on an interim final basis. 
We created a new device category, specifically, C1821 (Interspinous 
process distraction device (implantable)) for transitional pass-through 
payment, effective January 1, 2007, which we expected to be reported 
with CPT codes 0171T and 0172T. This pass-through device category will 
continue to be paid at hospital charges adjusted to cost for CY 2008, 
as discussed in section IV.A.1.b. of this final rule with comment 
period.
    We received several public comments on our CY 2008 proposed APC 
assignments for CPT codes 0171T and 0172T. A summary of the public 
comments and our response follow.
    Comment: Some commenters disagreed with our proposed APC 
assignments for CPT codes 0171T and 0172T, and indicated that these 
procedures should be reassigned from APC 0050 to APC 0208 (Laminotomies 
and Laminectomies), which had a proposed payment rate of approximately 
$3,036 for CY 2008. The commenter asserted that the spinous distraction 
device insertion is clinically different and involves greater hospital 
resources than the other procedures assigned to APC 0050. This 
commenter cited one procedure in APC 0050, specifically vertebroplasty, 
claiming that its costs are significantly lower than the spinous 
process distraction device procedure. The commenter claimed that the 
vertebroplasty procedure is one that involves an injection procedure 
that is

[[Page 66724]]

performed in 30 minutes and does not involve implanting a spinal 
device. Alternatively, the commenter explained that inserting a spinous 
process distraction device requires an hour in the operating room and 
involves implanting a device in the spine. Several commenters reported 
that the spinous process distraction device insertion is similar to a 
laminectomy procedure in that both procedures involve the spinal 
processes and take approximately 1 hour to perform. These commenters 
requested that CMS reassign CPT codes 0171T and 0172T to APC 0208 based 
on clinical and cost considerations.
    Response: We carefully analyzed the CY 2006 claims data for other 
musculoskeletal procedures under the OPPS, and we believe that CPT 
codes 0171T and 0172T are appropriately assigned to APC 0050, based on 
both clinical and expected resource considerations. We do not agree 
with some commenters that these minimally invasive procedures to insert 
a spinal device are similar to the procedures that are currently 
assigned to APC 0208, which are generally significant open surgical 
procedures on the spine. We believe that the hospital's nondevice costs 
and the clinical characteristics of CPT codes 0171T and 0172T more 
closely align with the less invasive musculoskeletal procedures 
presently assigned to APC 0050.
    We will continue pass-through payment status, initially implemented 
in January 2007, for the spinous process distraction device (C1821) 
reported with CPT codes 0171T and 0172T through CY 2008. Separate 
payment for HCPCS code C1821 will be made under the OPPS for at least 2 
and not more than 3 years of pass-through payment. After that period, 
payment for the cost of the device will be packaged into the procedural 
payment for its implantation, specifically CPT codes 0171T and 0172T.
    After consideration of the public comments received, we are 
finalizing our CY 2008 proposal, without modification, to assign CPT 
codes 0171T and 0172T to APC 0050, with a median cost of approximately 
$1,836.
d. Intradiscal Annuloplasty (APC 0050)
    For CY 2008, we proposed to assign the intradiscal electrothermal 
(IDET) annuloplasty procedures, specifically those described by CPT 
codes 22526 (Percutaneous intradiscal electrothermal annuloplasty, 
unilateral or bilateral including fluoroscopic guidance; single level) 
and 22527 (Percutaneous intradiscal electrothermal annuloplasty, 
unilateral or bilateral including fluoroscopic guidance; one or more 
additional levels (List separately in addition to code for primary 
procedure)) to APC 0050 (Level II Musculoskeletal Procedures Except 
Hand and Foot), with a proposed payment rate of approximately $1,868 
for CY 2008. These CPT codes were new for CY 2007, when they were first 
assigned to APC 0050 under the OPPS on an interim final basis.
    We received several public comments on our CY 2008 proposed APC 
assignments for CPT codes 22526 and 22527. A summary of the public 
comments and our response follow.
    Comment: Several commenters disagreed with the proposed assignment 
for CPT codes 22526 and 22527 and recommended that these procedures be 
reassigned to APC 0051 (Level III Musculoskeletal Procedures Except 
Hand and Foot), which had a proposed CY 2008 payment rate of 
approximately $2,777. These commenters believed that the hospital costs 
associated with IDET are relatively higher than the payment associated 
with APC 0050. One commenter who provided its price list reported that 
the cost of one disposable catheter used in the procedure is 
approximately $1,800. The commenter indicated that APC 0051 would more 
accurately pay hospitals for the IDET procedure. Another commenter 
indicated that the other procedures in APC 0051 are similar to the IDET 
procedure based on clinical homogeneity and resource costs.
    Response: CPT codes 22526 and 22527 were created effective January 
1, 2007. Prior to CY 2007, the IDET procedure was described by CPT code 
0062T, which was implemented on January 1, 2005. The initial code long 
descriptor for CPT code 0062T in CY 2005 was ``Percutaneous intradiscal 
annuloplasty, any method, unilateral or bilateral including 
fluoroscopic guidance; single level.'' However, in CY 2007, the CPT 
Editorial Panel revised this descriptor to ``Percutaneous intradiscal 
annuloplasty, any method except electrothermal, unilateral or bilateral 
including fluoroscopic guidance; single level'' to appropriately 
differentiate between electrothermal and non-electrothermal methods. 
Following the descriptor revision, CPT codes 22526 and 22527 described 
the electrothermal methodology for percutaneous intradiscal 
annuloplasty, while CPT code 0062T described the non-electrothermal 
methodology.
    Since the code descriptor change did not occur until CY 2007, 
hospital outpatient claims from CY 2006 for CPT code 0062T describe 
both electrothermal and non-electrothermal methods. Based on our review 
of the hospital outpatient claims from CY 2006 and CY 2005, 
percutaneous intradiscal annuloplasty is performed infrequently in the 
hospital outpatient setting for the Medicare population. Claims from CY 
2006 show a median cost of approximately $1,019 for CPT code 0062T 
based on 44 single claims, and a median cost of approximately $2,034 
based on only 28 single claims for CY 2005.
    We believe, based on our review of the clinical characteristics and 
historical hospital costs for percutaneous intradiscal annuloplasty and 
other musculoskeletal procedures assigned to APCs 0050 and 0051, that 
the most appropriate APC assignment for percutaneous intradiscal 
annuloplasty procedures, whether electrothermal or non-electrothermal, 
is APC 0050.
    After considering the public comments received, we are finalizing 
our CY 2008 proposal, without modification, to assign CPT codes 22526 
and 22527 to APC 0050, with a median cost of approximately $1,836.
e. Kyphoplasty Procedures (APC 0052)
    For CY 2008, we proposed to assign CPT codes 22523 (Percutaneous 
vertebral augmentation, including cavity creation (fracture reduction 
and bone biopsy included when performed) using mechanical device, one 
vertebral body, unilateral or bilateral cannulation (eg, kyphoplasty); 
thoracic), 22524 (Percutaneous vertebral augmentation, including cavity 
creation (fracture reduction and bone biopsy included when performed) 
using mechanical device, one vertebral body, unilateral or bilateral 
cannulation (eg, kyphoplasty); lumbar), and 22525 (Percutaneous 
vertebral augmentation, including cavity creation (fracture reduction 
and bone biopsy included when performed) using mechanical device, one 
vertebral body, unilateral or bilateral cannulation (eg, kyphoplasty); 
each additional thoracic or lumbar vertebral body (List separately in 
addition to code for primary procedure)) to APC 0052 (Level IV 
Musculoskeletal Procedures Except Hand and Foot) with a proposed 
payment rate of approximately $5,010.
    We received one public comment on our CY 2008 proposal for CPT 
codes 22523, 22524, and 22525. A summary of the public comment and our 
response follow.
    Comment: Some commenters expressed concern about the accuracy of 
hospital charge data for these procedures. Because of charge 
compression, the commenters believed that the current data collected 
from hospital charges do not accurately

[[Page 66725]]

reflect the true costs of the kyphoplasty procedures. The commenters 
appreciated CMS'' attention in reviewing and placing these procedures 
in an appropriate APC for CY 2008; however, they believed that charge 
compression directly contributes to inaccurate and reduced payment 
rates for the services. One commenter explained that procedures that 
involve the use of expensive medical devices, whereby hospitals apply 
smaller mark-up rates to higher-cost medical devices than they do to 
lower-cost supplies used in procedures, results in charge compression. 
Because the current OPPS payment methodology is to calculate the 
payment weight for an APC based on hospital charges adjusted to cost, 
the commenters argued that charge compression results in the lowering 
of payment rates for procedures that involve the use of expensive 
medical devices. These commenters strongly urged CMS to continue to 
consider future refinements to the OPPS payment amounts for kyphoplasty 
procedures in light of the effects of charge compression.
    Response: We thank the commenters for their suggestions and refer 
to section II.A.3. of this final rule with comment period for further 
discussion on charge compression. Consistent with our update process, 
we review hospital outpatient claims data and assign services and items 
to appropriate APCs on an annual basis.
    After consideration of the public comments received, we are 
finalizing our CY 2008 proposal, without modification, to assign CPT 
codes 22523, 22524, and 22525 to APC 0052, with a median cost of 
approximately $4,997.
8. Vascular Procedures
a. Blood Transfusion (APC 0110)
    We have a longstanding policy under the OPPS that blood transfusion 
services are billed and paid on a per encounter basis and not by the 
number of units of blood products transfused (Internet Only Manual 100-
4, Chapter 4, Section 231.8). Under this policy, a transfusion APC 
payment is made to the OPPS provider for transfusing blood products 
once per day, regardless of the number of units or different types of 
blood products transfused. The OCE ensures only one payment for APC 
0110 (Transfusion), regardless of the number of units of CPT code 36430 
(Transfusion, blood or blood components) reported by the hospital on a 
single date of service. The CPT code 36430 descriptor does not include 
``per unit.'' Hence, the median cost for CPT code 36430, which is 
assigned to APC 0110, represents the costs of transfusion of blood or 
blood products on the same date of service, regardless of how many 
units of products are transfused. In addition, for payment of the 
transfusion service, the OCE also requires the claim to contain a Level 
II HCPCS P-code for a blood product on the same date of service as the 
transfusion procedure.
    At its March 2007 meeting, the APC Panel recommended that CMS 
investigate whether CPT code 36430 should identify when multiple units 
are transfused and trigger a discounted payment for the second and 
subsequent administration of additional units of blood or blood 
components. The APC Panel indicated that the current payment for 
transfusion services does not adequately pay hospitals for the costs of 
these complex services, and that payment on a per unit basis rather 
than on a per encounter basis would result in more accurate and 
appropriate payment.
    We did not agree with the APC Panel's recommendation, and we 
proposed to not accept this recommendation for the CY 2008 OPPS. As 
stated in the CY 2008 OPPS/ASC proposed rule (72 FR 42718), we believe 
that our current policy of providing a single payment for blood 
transfusion, regardless of the number of units transfused, is most 
consistent with the goals of a prospective payment system to encourage 
and create incentives for efficiency in providing services. Payment for 
transfusion services on a per encounter basis encourages the 
transfusion of only those blood products that are necessary for the 
beneficiary's treatment during the hospital outpatient encounter. 
Moreover, the current median cost for the transfusion service, 
associated with the transfusion of all blood products furnished on a 
date of service, has been set based on the historical reporting of all 
charges for transfusion on the same date of service and, therefore, 
represents the full cost of an episode of transfusion, rather than the 
cost of transfusion of a single unit of blood or blood product. Given 
our proposed packaging approach for the CY 2008 OPPS, it would be 
inconsistent for us to revise our current transfusion payment policy to 
provide separate payment for each unit of blood product transfused, 
thereby reducing the size of the current transfusion payment bundle (72 
FR 42717 through 42718).
    Therefore, for CY 2008 we proposed to maintain our current payment 
policy, which bases payment for transfusion on the costs of all 
transfusion services furnished on a single date of service and which 
examines hospital claims to ensure that payment is provided for only 
one unit of CPT code 36430 on a date of service. However, we remind 
hospitals that a claim for a single unit of CPT code 36430 should 
include charges for all of the hospital resource costs associated with 
the totality of transfusion services furnished on the date of service, 
so that the payment for one unit of APC 0110 is based on the costs of 
all transfusion services provided in a hospital outpatient encounter.
    We received several public comments on this proposal to maintain 
the current payment policy for blood transfusion services. A summary of 
the public comments and our response follow.
    Comment: Several commenters requested that CMS reconsider the APC 
Panel's recommendation to provide separate payment for the transfusion 
of each unit of blood or blood products, as an alternative to CMS' 
current, encounter-based payment policy. They stated that the current 
policy does not pay OPPS providers adequately for the additional 
resources required for hospital outpatient visits involving multiple 
transfusions. They suggested that hospitals could report the ``59'' 
modifier (distinct procedural service) or another appropriate modifier 
to indicate that additional transfusions provided on the same day are 
distinct from the first transfusion. Some commenters argued that this 
would not conflict with the descriptor for CPT code 36430, as hospitals 
would only report multiple units of the code when they have performed 
more than one distinct transfusion. In contrast, another commenter 
noted that CPT guidelines indicate that CPT code 36430 should be 
reported once per transfusion regardless of the number of units 
administered, and supported CMS' proposal to continue provide one 
payment for blood transfusion services based on charges for all 
services provided in a hospital outpatient encounter.
    One commenter also requested that CMS clarify that hospitals should 
charge for blood transfusion and administration services the same way 
for both hospital inpatients and outpatients. Another commenter 
indicated that hospitals should be able to base blood transfusion 
charges according to instructions published when Medicare was first 
created. According to the commenter, blood transfusion services were 
charged and paid on a per unit basis at that time.
    Response: We believe that the current payment policy for blood 
transfusion services provides adequate and appropriate payment to OPPS 
providers for the additional resources required for hospital outpatient 
visits involving multiple transfusions. As described in

[[Page 66726]]

the proposed rule (72 FR 42718), we instruct hospitals to include 
charges for all of the hospital resource costs associated with the 
totality of transfusion services furnished on a date of service. While 
the CPT code descriptor would not preclude hospitals from reporting 
multiple units of the code when they have performed more than one 
distinct transfusion if they were to consider each unit of blood 
transfused to be a distinct transfusion, CPT coding guidelines indicate 
that CPT code 36430 should be reported only once per transfusion, 
regardless of the number of units administered. We believe that the 
median cost calculated from our claims data for blood transfusion 
services represents the full cost of an episode of transfusion, rather 
than the cost of the transfusion of a single unit of blood or blood 
product. We also believe that our current policy of providing a single 
payment for blood transfusion, regardless of the number of units 
transfused, is most consistent with the goals of a prospective payment 
system to encourage and create incentives for efficiency in providing 
services. Therefore, for CY 2008, we are implementing our proposal to 
maintain our current payment policy, which bases payment for 
transfusion on the costs of all transfusion services furnished on a 
single date of service and which examines hospital claims to ensure 
that payment is provided for only one unit of CPT code 36430 on a date 
of service.
    Hospital inpatient departments and HOPDs have very different 
reporting structures that utilize different coding systems and vary in 
other significant ways. Inpatient charges for blood transfusion 
services are not relevant to the OPPS. Hospitals are free to set their 
charges for all items and services based on their own judgment. As is 
the case in other areas of CMS payment policy, reporting instructions 
for transfusion services reflect our current payment methodologies, 
which have evolved over time, and may not be the same as instructions 
published in the past.
    In summary, for CY 2008, after consideration of the public comments 
received, we are finalizing our proposal, without modification, to 
continue to pay hospitals for only one unit of CPT code 36430 on a 
single date of service. We are not adopting the APC Panel's March 2007 
recommendation to provide a separate payment for each unit of blood or 
blood product transfused. Because the payment for one unit of APC 0110, 
with a final CY 2008 median cost of approximately $214, is based on the 
costs of all transfusion services provided in a hospital outpatient 
encounter, we remind hospitals that a claim for a single unit of CPT 
code 36430 should include charges for all of the hospital resource 
costs associated with the totality of transfusion services furnished on 
the date of service.
b. Endovenous Ablation (APC 0092)
    For CY 2008, we proposed to pay approximately $1,684 for CPT code 
36478 (Endovenous ablation therapy of incompetent vein, extremity, 
inclusive of all imaging guidance and monitoring, percutaneous, laser; 
first vein treated) through its proposed assignment to APC 0092 (Level 
I Vascular Ligation). The proposed APC assignment for this service is 
the same as its CY 2007 APC assignment.
    We received several public comments on the proposed CY 2008 payment 
for CPT code 36478. A summary of the public comments and our response 
follow.
    Comment: Several commenters believed that the proposed payment rate 
for CPT code 36478 was considerably inadequate in view of the expense 
associated with the capital equipment required to perform this 
procedure. One commenter reported that, based on its estimate that used 
the MPFS Practice Expense Database as a reference, the appropriate 
placement for this procedure, in comparison with the practice expense 
of other endovenous procedures, would be APC 0091 (Level II Vascular 
Ligation), which had a CY 2008 proposed payment rate of approximately 
$2,781. Another commenter asserted that the other procedures assigned 
to APC 0092 bear little resemblance to the procedure described by CPT 
code 36478, and that in terms of clinical homogeneity and resource 
costs, endovenous ablation therapy of incompetent veins is very similar 
to those procedures assigned to APC 0091. The commenter requested that 
CMS reassign CPT code 36478 from APC 0092 to APC 0091 for CY 2008.
    Response: We disagree with the commenters' argument that CPT code 
36478 is less clinically related to procedures in APC 0091 than to 
procedures assigned to APC 0092. Procedures assigned to both APCs 0091 
and 0092 include a variety of surgical procedures involving veins, and 
both APCs include endovenous ablation procedures using different 
technologies. Analysis of our CY 2006 hospital claims data results in a 
median cost of approximately $2,681 for APC 0091, which is considerably 
higher than the HCPCS-specific median cost of approximately $1,713 for 
CPT code 36478 based on 984 single claims. However, the median cost of 
CPT code 37478 is quite close to the CY 2008 median cost of 
approximately $1,626 for APC 0092. We believe that CPT code 36478 is 
most appropriately assigned to APC 0092 based on clinical and resource 
considerations.
    We remind hospitals that in a budget neutral environment, Medicare 
does not make payments that fully cover hospitals' costs, including 
those for the purchase and maintenance of capital equipment. We rely on 
hospitals to make their business decisions regarding acquisition of 
expensive capital equipment taking into consideration their knowledge 
about their entire patient base (Medicare beneficiaries included) and 
an understanding of Medicare's and other payers' payment policies.
    Furthermore, the MPFS applies a very different methodology for 
establishing the payment for the physician's office practice expenses 
associated with a procedure, specifically considering the individual 
costs of the inputs, whereas the OPPS generally pays based on relative 
payment weights calculated from hospitals' costs as determined from 
claims data. The application of the different methodologies results in 
different payment amounts in the two settings. Therefore, comparisons 
between the MPFS and OPPS payments for services are not appropriate.
    After consideration of the public comments received, we are 
finalizing our CY 2008 proposal, without modification, to assign CPT 
code 36478 to APC 0092, with a median cost of about $1,626.
c. Insertion of Central Venous Access Device (APC 0625)
    For the CY 2008 OPPS, we proposed to assign CPT code 36566 
(Insertion of tunneled centrally inserted central venous access device, 
requiring two catheters via two separate venous access sites; with 
subcutaneous port(s)) to APC 0625 (Level IV Vascular Access 
Procedures), as the only code in that APC. The procedure is for the 
purpose of implanting a vascular access device that is typically 
furnished to persons with end stage renal disease when there are no 
suitable access points for hemodialysis. The device that is implanted 
is reported under HCPCS code C1881 (Dialysis access system). For CY 
2008, we proposed a national unadjusted payment of approximately $5,562 
for the service, compared to the CY 2007 national unadjusted payment of 
approximately $5,130. As proposed, the payment for the device is 
packaged into the payment for APC 0625, a device-dependent APC.

[[Page 66727]]

    We received several public comments on the proposed CY 2008 payment 
for APC 0625. A summary of the public comments and our responses 
follow.
    Comment: Several commenters stated that the proposed CY 2008 
payment for APC 0625 is excessive and recommended that the CY 2008 APC 
payment not exceed the CY 2007 payment. The commenters also recommended 
that CMS use external data to establish an appropriate benchmark cost 
for HCPCS code C1881. The commenters asked that CMS continue to require 
that hospitals must report HCPCS code C1881 on claims on which they 
report CPT code 36556. They also asked that CMS establish a payment for 
CPT code 36556 that is more stable from year to year. The commenters 
indicated that the low volume of these procedures may result in 
unstable payment rates over time and that use of external data to 
provide a benchmark for the cost of the device could help alleviate 
this problem. The commenters claimed that the cost of the device 
reported by HCPCS code C1881 is approximately $3,500.
    Response: For this final rule with comment period, the median cost 
for APC 0625 is approximately $5,143, as compared with the proposed 
rule median cost of approximately $5,493. Both the proposed and final 
rule medians were calculated using only 8 claims of 479 total bills for 
the proposed rule and 535 total bills (of which 325 were potentially 
usable single bills) for this final rule with comment period. This is, 
in part, because we used only claims that contained the correct device 
code, no token charges for the device, and no ``FB'' modifier. 
Procedure-to-device edits that return to providers those claims for CPT 
code 36556 that do not also contain HCPCS code C1881 did not go into 
place until January 1, 2007 and, therefore, were not in place for CY 
2006. We recognize that the small number of claims that contain the 
HCPCS C-code for the device without which the procedure cannot be 
performed may result in a median that is more volatile than is 
desirable. However, given that the commenter advises us that the cost 
of the device is approximately $3,500 and given that the median we 
calculated using final rule data is approximately $5,143, we believe 
that it is a reasonable estimate of the cost of the procedure, 
including the packaged cost of the device. We expect that the data 
available for future OPPS updates, beginning in CY 2009, will include 
more claims that report the device HCPCS code and, therefore, future 
median costs for APC 0625 may stabilize with additional claims 
available for ratesetting.
    Comment: One commenter asked that CMS change the short descriptor 
for CPT code 36566 to read ``Ins tunneled cath w/subq port'' because 
the commenter believed that it is confusing to have multiple CPT codes 
with the same short descriptor. The commenter also asked that we revise 
the definition for HCPCS code C1881 to read ``Dialysis access system 
with subcutaneous port or valve.''
    Response: The CPT codes, including the short descriptors, are owned 
by the AMA and any change to them is outside of the purview of CMS and 
should be addressed to the AMA CPT Editorial Board. HCPCS code C1881 
describes the category of dialysis access devices, which is an existing 
pass-through device category that expired from pass through status as 
of the CY 2003 OPPS. As stated in the November 1, 2005 OPPS final rule 
with comment period (70 FR 68631), we revise a code that describes an 
existing category of devices (such as C1881) only if such revision is 
necessary to distinguish the existing category from a new category of 
pass-through devices in instances in which we must create a new 
category to describe a device that meets the criteria for pass-through 
payment. Therefore, there is no basis in policy to revise the 
definition of HCPCS code C1881.
    After consideration of the public comments received, we are 
finalizing our CY 2008 proposal, without modification, to pay for CPT 
code 36566 through device-dependent APC 0625, with a median cost of 
approximately $5,143. We will not change the short descriptor for pass-
through device category C1881.
d. Noninvasive Vascular Studies (APC 0267)
    For the CY 2008 OPPS, we proposed to pay approximately $158 for 
procedures assigned to APC 0267 (Noninvasive Vascular Studies). We also 
proposed to pay approximately $420 for services assigned to APC 0269 
(Level II Echocardiogram Except Transesophageal).
    We received one public comment on our CY 2008 proposal. A summary 
of the public comment and our response follow.
    Comment: A commenter stated that the vascular ultrasound procedures 
included in APC 0267 are grossly underpaid and that the CY 2008 payment 
for this APC should be similar to the payment for APC 0269, for which 
CMS proposed to pay approximately $417. The commenter indicated that 
the services in these two APCs require virtually the same resource 
costs. Specifically, the commenter explained that the equipment and 
software are equivalent and have similar costs, and in some facilities, 
the same equipment is used for the services in both APCs. According to 
the commenter, the technicians performing the studies in both APCs are 
of the same skill level and the associated cost is the same. The 
commenter claimed that the pay scale that CMS uses for purposes of 
establishing the MPFS RVUs for the procedures differs by only 2 cents 
per hour. The commenter asserted that the time scheduled for the 
procedures is virtually identical and that the supplies are essentially 
the same for the services assigned to both APCs. Hence, the commenter 
concluded that there is no basis for the differences in calculated 
costs for the services under the OPPS and recommended that CMS study 
this differential to provide insight into situations where the OPPS CCR 
methodology to calculate costs does not result in an accurate measure 
of relative resource utilization.
    Response: We agree that it appears that the resources required to 
perform the vascular ultrasound and echocardiography services in these 
APCs appear, from a clinical perspective, to be very similar. We 
performed a limited initial examination of elements of the CY 2006 
claims data for these APCs to determine if we could identify the reason 
for the difference in estimated median costs. We first looked at the 
charges for the services in these APCs, because one of the most 
fundamental elements of the calculation of estimated costs is 
hospitals'' charges for the services. The mean charge per service for 
the 17 HCPCS codes assigned to APC 0267 was approximately $786. In 
contrast, the mean charge per service for the three procedure codes 
assigned to APC 0269 was approximately $1,135. Clearly, on average 
hospitals charge much more for the services in APC 0269 than for the 
services in APC 0267. However, while the proposed payment for APC 0267 
was 38 percent of the proposed payment for APC 0269, the mean charge 
for APC 0267 based upon the final rule data was 64 percent of the mean 
charge for APC 0269. Therefore, there is more of a disparity between 
the payments (and hence, between the median costs) than between the 
mean charges.
    We next looked at the total frequency of services furnished in each 
APC and found that the total frequency of services was quite 
substantial in each APC. Therefore, it is unlikely that the disparity 
between the median costs for the two APCs is related to differences in

[[Page 66728]]

total volumes of services residing in those APCs. APC 0267 had a total 
frequency of approximately 1.2 million claims and APC 0269 had a total 
frequency of approximately 1 million claims in the final rule data from 
CY 2006 claims.
    We then looked at single bills as a percentage of the total 
frequency and found that there is good representation in the single 
bills. For APC 0267, we were able to use approximately 99 percent of 
the total claims to set the median cost and for APC 0269, we were able 
to use approximately 75 percent of the total claims to set the median 
cost. Hence, the disparity is unlikely to be related to the variability 
associated with using a small percentage of total claims to calculate 
the median costs.
    We also looked at the number of providers that furnish the highest 
volumes of services in each APC to see if there were significantly 
different counts of providers that might be a factor in the differences 
in estimated costs. CPT code 93880 (Duplex scan of intracranial 
arteries; complete bilateral study), assigned to APC 0267, was 
furnished by 3,119 hospitals and CPT code 93970 (Duplex scan of 
extremity veins including responses to compression and other maneuvers, 
complete bilateral study) was furnished by 3,160 hospitals in CY 2006. 
Similarly, CPT code 93307 (Echocardiography, transthoracic, real-time 
with imaging documentation (2D) with or without M-mode recording; 
complete), assigned to APC 0269, was furnished by 3,227 hospitals in CY 
2006. These are a large number of the 4,089 hospitals whose claims were 
used for the final rule median cost calculations and, therefore, it is 
unlikely that idiosyncratic data from a few providers could be causing 
the disparity.
    We note that the CY 2008 median cost of APC 0267 was about the same 
as its CY 2007 median cost, whereas the median cost of APC 0269 was 
almost double its CY 2007 median cost. We believe the increased cost of 
APC 0269 for CY 2008 may be a result of the CY 2008 packaging approach 
for ancillary and supportive services described in section II.A.4.c. of 
this final rule with comment period. In particular, the packaging of 
payment for doppler echocardiography and color flow velocity mapping, 
which are frequently reported with the CPT codes assigned to APC 0269 
and which have been paid separately under the OPPS prior to CY 2008, 
may have contributed to the increased cost for APC 0269, whereas 
services assigned to APC 0267 had little new packaging due to our CY 
2008 packaging approach.
    We note we wish to investigate further the specific packaging 
associated with services assigned to both APCs, the revenue codes under 
which the services were charged, the revenue centers to which these 
revenue codes mapped, and the CCRs that applied to the charges for 
these services. We intend to undertake this further analysis and to 
discuss our findings with the APC Panel at its winter 2008 meeting.
    However, for CY 2008 we are basing payment for APCs 0267 and 0269 
on the median costs calculated from our claims data according to our 
standard median cost calculation process because our investigation of 
the data does not reveal a problem with the methodology or with the 
data. At this point, it appears that the median costs may be different 
because of dissimilar packaging and because hospitals charge 
significantly less for the services in APC 0267 than they charge for 
the services in APC 0269, where this significant difference in charges 
is not neutralized by the application of the CCRs applicable to these 
charges. Therefore, the median cost for APC 0267 is significantly lower 
than the median cost for APC 0269.
    After consideration of the public comment received, we are 
finalizing our CY 2008 proposal, without modification, to provide 
payment for APCs 0267 and 0269 based on costs from claims, according to 
the standard OPPS methodology, with median costs of approximately $150 
and $404, respectively. We note that for CY 2008, APC 0269 will be paid 
specifically for noncontrast echocardiography studies. We plan to 
analyze these APCs further and discuss our findings with the APC Panel 
at its winter 2008 meeting.
9. Other Procedures
a. Hyperbaric Oxygen Therapy (APC 0659)
    When hyperbaric oxygen therapy (HBOT) is prescribed for promoting 
the healing of chronic wounds, it typically is prescribed for 90 
minutes and billed using multiple units of HBOT on a single line or 
multiple occurrences of HBOT on a claim. In addition to the therapeutic 
time spent at full hyperbaric oxygen pressure, treatment involves 
additional time for achieving full pressure (descent), providing air 
breaks to prevent neurological and other complications from occurring 
during the course of treatment, and returning the patient to 
atmospheric pressure (ascent). The OPPS recognizes HCPCS code C1300 
(Hyperbaric oxygen under pressure, full body chamber, per 30 minute 
interval) for HBOT provided in the hospital outpatient setting.
    In the CY 2005 final rule with comment period (69 FR 65758 through 
65759), we finalized a ``per unit'' median cost calculation for APC 
0659 (Hyperbaric Oxygen) using only claims with multiple units or 
multiple occurrences of HCPCS code C1300 because delivery of a typical 
HBOT service requires more than 30 minutes. We observed that claims 
with only a single occurrence of the code were anomalies, either 
because they reflected terminated sessions or because they were 
incorrectly coded with a single unit. In the same rule, we also 
established that HBOT would not generally be furnished with additional 
services that might be packaged under the standard OPPS APC median cost 
methodology. This enabled us to use claims with multiple units or 
multiple occurrences. Finally, we also used each hospital's overall CCR 
to estimate costs for HCPCS code C1300 from billed charges rather than 
the CCR for the respiratory therapy cost center. Comments on the CY 
2005 proposed rule effectively demonstrated that hospitals report the 
costs and charges for HBOT in a wide variety of cost centers. We used 
this methodology to estimate payment for HBOT in CYs 2005, 2006, and 
2007. For CY 2008, we proposed to continue using the same methodology 
to estimate a ``per unit'' median cost for HCPCS code C1300 of 
approximately $99 using 60,775 claims with multiple units or multiple 
occurrences for the proposed rule.
    CY 2008 is the fourth year in which we will have a special 
methodology to develop the median cost for HBOT services that removed 
obviously erroneous claims and deviated from our standard methodology 
of using departmental CCRs, when available, to convert hospitals'' 
charges to costs. Prior to CY 2005, our inclusion of significant 
numbers of miscoded claims in the median calculation for HBOT and our 
exclusion of the claims for multiple units of treatment, the typical 
scenario, resulted in payment rates that were artificially elevated. As 
explained earlier, beginning in CY 2005 and continuing through the 
present, we have adjusted the CCR used in the conversion of charges to 
costs for these services so that claims data would more accurately 
reflect the relative costs of the services. The median costs of HBOT 
calculated using this methodology have been reasonably stable for the 
last 4 years. As stated in the proposed rule (72 FR 42706), we believe 
that this adjustment through use of the hospitals' overall CCRs is all 
that is necessary to yield a

[[Page 66729]]

valid median cost for establishing a scaled weight for HBOT services. 
Therefore, for CY 2008, we proposed to continue to use the same 
methodology that we have used since CY 2005 to estimate payment for 
HBOT.
    We received one public comment on our proposal. A summary of the 
public comment and our response follow.
    Comment: One commenter commended CMS for applying a consistent 
methodology of utilizing an overall hospital CCR to yield a valid 
median cost for HBOT services. However, the commenter also encouraged 
CMS to consider an alternative methodology for calculating a median 
cost for HBOT. Specifically, the commenter stated that a contractor for 
a wound care association had established and reproduced an accurate CCR 
for HBOT and encouraged CMS to consider this methodology for the near 
future.
    Response: We appreciate the commenter's support for our proposed 
methodology for estimating a ``per unit'' median cost for HBOT. In 
response to the comment urging us to utilize an alternate calculation 
to estimate a median cost for HBOT services, we note, as we did in our 
CY 2005 OPPS final rule with comment period (69 FR 65759), that we are 
not confident that the external research produces a definitive CCR for 
HBOT. That final rule with comment period provided an extensive 
discussion of our concerns about using survey findings to set, rather 
than validate, APC medians. These concerns included a lack of 
subscripted cost centers in the electronic cost report database, the 
wide variability in observed CCRs, and the possibility of nonresponse 
bias. As also noted in the CY 2005 final rule with comment period, we 
agree that the previous study definitively demonstrated great diversity 
among hospitals in the subscripted location of reported hyperbaric 
oxygen costs on the cost report, which prompted us to use the 
hospital's overall CCR, rather than a specific cost center CCR that 
would be used in our standard ratesetting methodology. We continue to 
believe that the median cost for APC 0659 developed according to our 
established ``per unit'' median cost calculation for HBOT is an 
appropriate relative cost to be used to set the payment weight upon 
which the HBOT payment is based.
    After consideration of the public comment received, we are 
finalizing our CY 2008 proposal, without modification, for estimating a 
``per unit'' median cost for HCPCS code C1300, assigned to APC 0659, 
with a median cost of approximately $98 based on 67,435 claims with 
multiple units or multiple occurrences.
b. Skin Repair Procedures (APCs 0133, 0134, 0135, 0136, and 0137)
    For CY 2006, the AMA made comprehensive changes, including code 
additions, deletions, and revisions, accompanied by new and revised 
introductory language, parenthetical notes, subheadings and cross-
references, to the Integumentary, Repair (Closure) subsection of 
surgery in the CPT book to facilitate more accurate reporting of skin 
grafts, skin replacements, skin substitutes, and local wound care. 
Specifically, the section of the CPT book previously titled ``Free Skin 
Grafts'' and containing codes for skin repair procedures was renamed, 
reorganized, and expanded. New and existing CPT codes related to skin 
replacement surgery and skin substitutes were organized into five 
subsections: Surgical Preparation, Autograft/Tissue Cultured Autograft, 
Acellular Dermal Replacement, Allograft/Tissue Cultured Allogeneic Skin 
Substitute, and Xenograft.
    As part of the CY 2006 CPT code update in the newly named ``Skin 
Replacement Surgery and Skin Substitutes'' section, certain codes were 
deleted that previously described skin allograft and tissue cultured 
and acellular skin substitute procedures, 37 new CPT codes were created 
in the ``Skin Replacement Surgery and Skin Substitutes'' section, and 
these codes received interim final status indicators and APC 
assignments in the CY 2006 OPPS final rule with comment period and were 
subject to comment.
    In considering the final CY 2007 APC assignments of these 37 ``Skin 
Replacement Surgery and Skin Repair'' codes, we reviewed the 
recommendations made by the APC Panel at its March 2006 meeting; 
presentations made to the APC Panel; comments received on the CY 2007 
proposed rule; the CPT code descriptors, introductory explanations, 
cross-references, and parenthetical notes; the clinical characteristics 
of the procedures; and the code-specific median costs for all related 
CPT codes available from our CY 2005 claims data. A discussion of the 
final CY 2007 APC assignments of these procedures can be found in the 
CY 2007 OPPS/ASC final rule with comment period (71 FR 68054 through 
68057).
    In the CY 2008 OPPS/ASC proposed rule, we observed that we now have 
CY 2006 data for the surgical procedures assigned to the 4 CY 2007 skin 
repair APCs, including the 37 codes considered last year that were new 
for CY 2006. The CY 2007 skin repair APCs are: APC 0024 (Level I Skin 
Repair); APC 0025 (Level II Skin Repair); APC 0686 (Level III Skin 
Repair); and APC 0027 (Level IV Skin Repair). Based on CY 2006 data 
available for the proposed rule, the median costs for the APCs as 
configured for CY 2007 were approximately: $93 for APC 0024; $251 for 
APC 0025; $1,027 for APC 0686; and $1,340 for APC 0027. Both APCs 0024 
and 0025 had 2 times violations based on CY 2006 claims data. The 
HCPCS-specific median costs of significant procedures in APC 0024 
ranged from approximately $83 to $255. We noted that a number of the 
procedures currently assigned to APC 0024 were very low volume, with 
few single claims available for ratesetting. Similarly, the median 
costs of the significant procedures in APC 0025 ranged from a low of 
about $119 to a high of about $399. This APC also contained a number of 
low volume procedures, as well as some new CY 2007 CPT codes without CY 
2006 claims data. There was also some variation in the median costs of 
the HCPCS codes assigned to APCs 0686 and 0027, but there were no 2 
times violations in these two APCs.
    At the March 2007 APC Panel meeting, we discussed with the APC 
Panel one possible reconfiguration of the skin repair APCs in order to 
address the 2 times violations in APCs 0024 and 0025 for CY 2008 by 
improving the resource homogeneity of the APCs, as well as ensuring 
their clinical homogeneity. We reviewed with the APC Panel the 
potential results associated with adding an additional level in this 
APC series and reallocating all of the procedures in the original four 
APCs among five new APCs, taking into account the frequency, resource 
utilization, and clinical characteristics of each procedure. We also 
gave particular attention to CPT code families in considering the 
clinical and resource homogeneity of each APC in the reconfigured 
series. The new configuration of APCs eliminated the 2 times violations 
that would have otherwise existed in APCs 0024 and 0025. It also more 
accurately attributed higher cost procedures to the Levels IV and V 
APCs, which contain the surgical procedures of the greatest intensity 
and resource requirements, leading to a more balanced distribution of 
APC median costs across the five new APC levels.
    The APC Panel made a recommendation at its March 2007 meeting 
supporting the reorganization by CMS of the skin repair APCs into five 
levels. This recommendation also asked CMS to give special 
consideration to the

[[Page 66730]]

APC assignments of ``add-on'' codes; in the context of skin procedures, 
these are generally those CPT codes that report treatment of an 
additional body area and that are reported along with a primary 
procedure for treatment of the first body area. In the proposed rule 
(72 FR 42707), we stated that we accepted the APC Panel's 
recommendation through this CY 2008 proposal to reconfigure the skin 
APCs into five levels, and we reexamined the placement of each of the 
add-on codes within the framework of the five APCs. We agreed with the 
APC Panel that, because these skin repair APCs were assigned to status 
indicator ``T'' so that add-on codes would typically be paid at 50 
percent of their APC payment rate, these add-on codes warranted special 
examination with respect to their median costs and their appropriate 
APC assignments. As a result, several CPT code placements from the 
draft configuration discussed with the APC Panel were changed for the 
CY 2008 proposal.
    In summary, for CY 2008 we proposed to eliminate the four CY 2007 
skin repair APCs and replace them with five new APCs titled: APC 0133 
(Level I Skin Repair); APC 0134 (Level II Skin Repair); APC 0135 (Level 
III Skin Repair); APC 0136 (Level IV Skin Repair); and APC 0137 (Level 
V Skin Repair). We proposed to redistribute each of the procedures 
assigned to the current four levels of skin repair APCs into the five 
proposed APCs, with one exception. Specifically, we proposed to 
reassign CPT code 15835 (Excision, excessive skin and subcutaneous 
tissue (including lipectomy); buttock) to APC 0022 (Level IV, Excision/
Biopsy), where other CPT codes in its code family reside. The median 
costs of the five proposed APCs were approximately $84 (APC 0133); $133 
(APC 0134); $295 (APC 0135); $971 (APC 0136); and $1,317 (APC 0137). 
The proposed configurations of these new APCs were listed in Table 30 
of the proposed rule.
    At the September 2007 meeting of the APC Panel, one presenter 
requested that CPT codes 15340 (Tissue cultured allogeneic skin 
substitute; first 25 sq cm or less) and 15341 (Tissue cultured 
allogeneic skin substitute; each additional 25 sq cm) be moved from the 
proposed APC 0134 (Level II Skin Repair) to APC 0135 (Level III Skin 
Repair). The presenter stated that the CY 2008 proposal to reassign the 
CPT codes for the application of certain skin products to different 
APCs is premature because hospitals have been confused by the CY 2006 
code descriptor changes made by the CPT Editorial Panel. Current CPT 
instructions state that hospitals should not bill these two procedures 
in conjunction with the CPT codes for wound site preparation and 
debridement (CPT codes 15002-15005). The presenter stated that the CMS 
data used in the proposed rule do not reflect the true costs of 
performing CPT codes 15340 or 15341 because hospitals have been slow to 
adjust their charges based on the coding changes. The APC Panel made no 
recommendation at the September 2007 meeting related to the presenter's 
recommendations or to the overall skin repair APC proposal.
    We received numerous public comments concerning our CY 2008 
proposals for these skin repair procedures. A summary of the public 
comments and our responses follow.
    Comment: Many commenters provided recommendations regarding the CY 
2008 proposed treatment of specific skin repair CPT codes. One 
commenter suggested delaying the proposed reconfiguration from four 
skin repair APCs to five. Many commenters submitted similar letters 
requesting that CPT codes 15340 and 15341 be moved from the proposed 
APC 0134 to APC 0135, expressing concern that their placement in 
proposed APC 0134 did not reflect the actual clinical resource use for 
the application of the single skin repair biological product currently 
described by HCPCS code J7340 (Dermal and epidermal, (substitute) 
tissue of human origin, with or without bioengineered or processed 
elements, per square centimeter) because hospitals have been confused 
about appropriate billing for these surgical procedures. The commenters 
expressed concern that the proposed changes to the skin repair APCs 
would negatively impact patient access to skin repair procedures, such 
as CPT codes 15340 and 15341.
    One commenter believed that the proposed payments for the proposed 
five level APC series would create an inappropriate incentive to use 
specific competing skin replacement and skin substitute products, 
because in many cases different biologicals used for skin repair are 
reported with different CPT codes that were, in turn, proposed for 
assignment to various APC levels. The commenter requested that CMS move 
CPT codes 15340 and 15341 from the proposed APC 0134 to APC 0135 in 
order to treat the application of J7340 similarly to other skin repair 
procedures and to recognize the facility costs associated with wound 
site preparation for J7340. Alternatively, the commenter recommended 
that CMS delay restructuring the four CY 2007 APCs and except APCs 0024 
and 0025 (based on their CY 2007 structure) from the 2 times rule until 
another year of claims data are available for the CPT codes that were 
new in CY 2006. As a third alternative, the commenter suggested 
assigning all 16 skin repair CPT codes discussed by the APC Panel last 
year to a new and separate APC. (A complete listing and discussion of 
the codes and recommendations of the APC Panel for CY 2007 may be found 
in the CY 2007 OPPS/ASC final rule with comment period (71 FR 68054 
through 68057).) Finally, the commenter requested that CMS depart from 
CPT billing guidance and allow hospitals to report CPT codes for wound 
site preparation, such as CPT code 15002 (Surgical preparation or 
creation of recipient site by excision of open wounds, burn eschar, or 
scar (including subcutaneous tissues), or incisional release of scar 
contracture, trunk, arms, legs; first 100 sq cm or 1% of body area of 
infants and children), or create a new Level II HCPCS G-code, mapped 
APC 0135, to be used by hospitals to specifically report site 
preparation performed in conjunction with application of tissue 
cultured allogeneic skin substitutes described by HPCS code J7340.
    A few commenters also requested that the CPT skin repair codes 
related to application of the single skin repair biological product 
currently described by HCPCS code J7342 (Dermal (substitute) tissue of 
human origin, with or without other bioengineered or processed 
elements, with metabolically active elements, per square centimeter), 
specifically CPT code 15365 (Tissue cultured allogeneic dermal 
substitute, face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, 
hands, feet, and/or multiple digits; first 100 sq cm or less, or 1% of 
body area of infants and children) and CPT code 15366 (Tissue cultured 
allogeneic dermal substitute, face, scalp, eyelids, mouth, neck, ears, 
orbits, genitalia, hands, feet, and/or multiple digits; first 100 sq cm 
or less, or 1% of body area of infants and children; each additional 
100 sq cm, or each additional 1% of body area of infants and children, 
or part thereof (List separately in addition to code for primary 
procedure)) be moved from the proposed APC 0134 to APC 0135. The 
commenters stated that the storage and handling of the product applied 
with these CPT codes is more resource-intensive than other products 
whose application procedures were proposed for assignment to APC 0135. 
They also explained that the claims data that CMS used for APC 
placement do not accurately reflect the costs associated with these 
procedures because the product was not available on the market from CY 
2006 through the beginning of CY 2007. In addition, they argued that

[[Page 66731]]

hospital confusion about skin repair CPT coding changes has led to 
inaccurate claims.
    Response: We have examined CY 2006 claims data available for the CY 
2008 final rule with comment period, as well as each of the comments 
and the public presentation from the September 2007 APC Panel meeting, 
and find that the five level APC configuration we proposed most 
appropriately allocates the large number of skin repair and replacement 
procedures based on the frequency, resource utilization, and clinical 
characteristics of each procedure. The proposed configuration 
eliminates the 2 times violations in APCs 0024 and 0025 that would 
otherwise exist and more accurately attributes higher cost procedure 
codes to the proposed Levels IV and V APCs.
    As for the specific CPT code assignments raised by commenters (CPT 
codes 15340/15341 and 15365/15366), these codes were all placed in the 
Level II Skin Repair APC for CY 2007 and were proposed to remain in the 
Level II Skin Repair APC for CY 2008. In addition to these codes, the 
following skin repair codes that were new for CY 2006 and discussed by 
the APC Panel in CY 2006 were also proposed to be assigned to proposed 
new APC 0134: CPT codes 15170 (Acellular dermal replacement, truck, 
arms, legs; first 100 sq cm or less, or 1% of body area of infants and 
children); CPT code 15171 (Acellular dermal replacement, truck, arms, 
legs; first 100 sq cm or less, or 1% of body area of infants and 
children; each additional 100 sq cm, or each additional 1% of body area 
of infants and children, or part thereof (List separately in addition 
to code for primary procedure)); CPT code 15360 (Tissue cultured 
allogeneic dermal substitute, trunk, arms, legs; first 100 sq cm or 
less, or 1% of body area of infants and children): and CPT code 15361 
(Tissue cultured allogeneic dermal substitute, trunk, arms, legs; first 
100 sq cm or less, or 1% of body area of infants and children; each 
additional 100 sq cm, or each additional 1% of body area of infants and 
children, or part thereof (List separately in addition to code for 
primary procedure). Therefore, we disagree with commenters who believe 
that we have not treated CPT codes 15340, 15341, 15365 and 15366 
similarly to other skin repair procedures. The other 10 skin repair and 
replacement codes proposed for assignment to APC 0135 have 
significantly higher median costs than the CPT codes discussed by the 
commenters. We note, in particular, that payment for HCPCS code J7341 
(dermal (substitute) tissue of non-human origin, with or without other 
bioengineered or processed with metabolically active elements, per 
square centimeter) whose is application is reported with CPT codes 
15430 (Acellular xenograft implant; first 100 sq cm or less, or 1% of 
body area of infants and children) and 15431 (Acellular xenograft 
implant; first 100 sq cm or less, or 1% of body area of infants and 
children; each additional 100 sq cm, or each additional 1% of body area 
of infants and children, or part thereof (List separately in addition 
to code for primary procedure)), is packaged for CY 2008 because the 
mean per day cost of J7341 is less than the final $60 drug packaging 
threshold. Therefore, it is not surprising that these two CPT codes 
have higher median costs than CPT codes 15340, 15341, 15365 and 15366 
and were proposed for assignment to the higher paying Level III APC 
0135, rather than to APC 0134.
    Further, we do not believe that it would be appropriate to maintain 
our CY 2007 structure for the skin repair APCs because we have 
significant claims data for the new CY 2006 CPT codes that capture the 
differential hospital costs associated with the procedures. We have no 
reason to except two of the four skin repair APCs from the 2 times rule 
based on their CY 2007 structure when the five level configuration that 
we proposed and that was supported by the APC Panel demonstrates 
clinical and resource homogeneity without 2 times violations. In 
particular, we have over 8,000 single claims for CPT code 15340, so we 
are confident that the procedure's final median cost of approximately 
$162 falls within the range of costs for other procedures also assigned 
to APC 0134, and the APC's median cost of approximately $132. 
Similarly, CPT code 15341 for the application of each additional area 
has a median cost of approximately $100, so it would be appropriately 
paid based on the 50 percent multiple procedure reduction applicable to 
APC 0134. Likewise, we have almost 200 claims for CPT code 15365 from 
CY 2006, with a median cost of approximately $147 that is consistent 
with the median costs of other procedures also assigned to APC 0134. We 
note one commenter requested that we provide higher payment for CPT 
codes 15365 and 15366 to apply J7342 because of the greater handling 
and storage costs of the particular biological. However, we pay for 
such pharmacy overhead through payment for the biological, not the 
associated procedures, because, as we describe in section V.B. of this 
final rule with comment period, we believe that hospitals include the 
costs of pharmacy overhead in their charges for drugs and biologicals. 
Despite the commenter's concern about the integrity of the data because 
it reported that there was limited availability of the biological 
described by HCPCS code J7342 in CY 2006, our CY 2006 claims data 
include over 25,000 units of the product provided on almost 1,200 days 
of service under the OPPS. In summary, we are confident that our CY 
2006 claims data for the procedures reported with CPT codes 15340, 
15341, 15365, and 15365 accurately reflect the hospital costs of those 
procedures and that their proposed APC assignments are appropriate. We 
note that HCPCS codes J7340 and J7342 for the associated biologicals 
will be separately paid under the CY 2008 OPPS at ASP+5 percent, as 
discussed in section V.B.3. of this final rule with comment period.
    We do not move CPT codes to higher paying APCs in anticipation of 
future changes in hospital billing practices, so we believe that it 
would be premature to reassign any of the four procedures of particular 
interest to commenters to APC 0135 and unnecessary to create a sixth 
APC specifically for the 16 skin substitute and skin replacement codes 
mentioned by the commenter. We also believe that it would be 
inappropriate in this case to depart from CPT instructions by allowing 
hospitals to separately report wound site preparation and debridement 
when services described by CPT codes 15340 and 15341 are performed, 
whether using the associated CPT codes or by creating a G code. We 
generally advise hospitals to follow CPT billing guidance, and we 
disagree with the commenter that the CPT guidance does not adequately 
reflect the hospital facility component of these services. CPT coding 
instructions package the wound site preparation into the two codes for 
application of the biological, and hospitals have been reporting the 
services since CY 2006 based on those CPT instructions. Given our 
commitment to greater packaging under the OPPS, it would be 
inconsistent to adopt a policy for payment of these skin repair 
procedures that would move away from encounter-based payment by 
unpackaging wound site preparation.
    After consideration of the public comments received, we are 
finalizing our CY 2008 proposed reconfiguration of the skin substitute 
and skin replacement APCs, without modification, as shown in Table 22 
below.

[[Page 66732]]



            Table 22.--CY 2008 Skin Repair APC Configuration
------------------------------------------------------------------------
                                                             CY 2008 APC
     HCPCS code           Short descriptor      CY 2008 APC     median
                                                                 cost
------------------------------------------------------------------------
11950..............  Therapy for contour               0133          $80
                      defects.
11951..............  Therapy for contour
                      defects.
11952..............  Therapy for contour
                      defects.
11954..............  Therapy for contour
                      defects.
12001..............  Repair superficial
                      wound(s).
12002..............  Repair superficial
                      wound(s).
12004..............  Repair superficial
                      wound(s).
12005..............  Repair superficial
                      wound(s).
12006..............  Repair superficial
                      wound(s).
12007..............  Repair superficial
                      wound(s).
12011..............  Repair superficial
                      wound(s).
12013..............  Repair superficial
                      wound(s).
12014..............  Repair superficial
                      wound(s).
12015..............  Repair superficial
                      wound(s).
12016..............  Repair superficial
                      wound(s).
12017..............  Repair superficial
                      wound(s).
12018..............  Repair superficial
                      wound(s).
12031..............  Layer closure of wound(s)
12041..............  Layer closure of wound(s)
12051..............  Layer closure of wound(s)
12052..............  Layer closure of wound(s)
12053..............  Layer closure of wound(s)
15775..............  Hair transplant punch
                      grafts.
15776..............  Hair transplant punch
                      grafts.
11760..............  Repair of nail bed.......         0134          132
11920..............  Correct skin color
                      defects.
11921..............  Correct skin color
                      defects.
11922..............  Correct skin color
                      defects.
12032..............  Layer closure of wound(s)
12034..............  Layer closure of wound(s)
12035..............  Layer closure of wound(s)
12036..............  Layer closure of wound(s)
12037..............  Layer closure of wound(s)
12042..............  Layer closure of wound(s)
12044..............  Layer closure of wound(s)
12045..............  Layer closure of wound(s)
12046..............  Layer closure of wound(s)
12047..............  Layer closure of wound(s)
12054..............  Layer closure of wound(s)
12055..............  Layer closure of wound(s)
12056..............  Layer closure of wound(s)
12057..............  Layer closure of wound(s)
13120..............  Repair of wound or lesion
13122..............  Repair wound/lesion add-
                      on.
13153..............  Repair wound/lesion add-
                      on.
15040..............  Harvest cultured skin
                      graft.
15170..............  Acell graft trunk/arms/
                      legs.
15171..............  Acell graft t/arm/leg add-
                      on.
15340..............  Apply cult skin
                      substitute.
15341..............  Apply cult skin sub add-
                      on.
15360..............  Apply cult derm sub, t/a/
                      l.
15361..............  Aply cult derm sub t/a/l
                      add.
15365..............  Apply cult derm sub f/n/
                      hf/g.
15366..............  Apply cult derm f/hf/g
                      add.
15819..............  Plastic surgery, neck....
12020..............  Closure of split wound...         0135          285
12021..............  Closure of split wound...
13100..............  Repair of wound or lesion
13101..............  Repair of wound or lesion
13102..............  Repair wound/lesion add-
                      on.
13121..............  Repair of wound or lesion
13131..............  Repair of wound or lesion
13132..............  Repair of wound or lesion
13133..............  Repair wound/lesion add-
                      on.
13150..............  Repair of wound or lesion
13151..............  Repair of wound or lesion
13152..............  Repair of wound or lesion
15000..............  Wound prep, 1st 100 sq cm
15001..............  Wound prep, addl 100 sq
                      cm.
15002..............  Wnd prep, ch/inf, trk/arm/
                      lg.

[[Page 66733]]

 
15003..............  Wnd prep, ch/inf addl 100
                      cm.
15004..............  Wnd prep ch/inf, f/n/hf/g
15005..............  Wnd prep, f/n/hf/g, addl
                      cm.
15050..............  Skin pinch graft.........
15110..............  Epidrm autogrft trnk/arm/
                      leg.
15111..............  Epidrm autogrft t/a/l add-
                      on.
15115..............  Epidrm a-grft face/nck/hf/
                      g.
15116..............  Epidrm a-grft f/n/hf/g
                      addl.
15150..............  Cult epiderm grft t/arm/
                      leg.
15151..............  Cult epiderm grft t/a/l
                      addl.
15152..............  Cult epiderm graft t/a/l
                      +%.
15155..............  Cult epiderm graft, f/n/
                      hf/g.
15156..............  Cult epidrm grft f/n/hfg
                      add.
15157..............  Cult epiderm grft f/n/hfg
                      +%.
15175..............  Acellular graft, f/n/hf/g
15176..............  Acell graft, f/n/hf/g add-
                      on.
15221..............  Skin full graft add-on...
15241..............  Skin full graft add-on...
15300..............  Apply skinallogrft, t/arm/
                      lg.
15301..............  Apply sknallogrft t/a/l
                      addl.
15320..............  Apply skin allogrft f/n/
                      hf/g.
15321..............  Aply sknallogrft f/n/hfg
                      add.
15330..............  Aply acell alogrft t/arm/
                      leg.
15331..............  Aply acell grft t/a/l add-
                      on.
15335..............  Apply acell graft, f/n/hf/
                      g.
15336..............  Aply acell grft f/n/hf/g
                      add.
15350..............  Skin homograft...........
15351..............  Skin homograft add-on....
15400..............  Apply skin xenograft, t/a/
                      l.
15401..............  Apply skn xenogrft t/a/l
                      add.
15420..............  Apply skin xgraft, f/n/hf/
                      g.
15421..............  Apply skn xgrft f/n/hf/g
                      add.
15430..............  Apply acellular xenograft
15431..............  Apply acellular xgraft
                      add.
20926..............  Removal of tissue for
                      graft.
43887..............  Remove gastric port, open
11762..............  Reconstruction of nail            0136          947
                      bed.
14000..............  Skin tissue rearrangement
14001..............  Skin tissue rearrangement
14020..............  Skin tissue rearrangement
14021..............  Skin tissue rearrangement
14040..............  Skin tissue rearrangement
14041..............  Skin tissue rearrangement
14060..............  Skin tissue rearrangement
14061..............  Skin tissue rearrangement
15130..............  Derm autograft, trnk/arm/
                      leg.
15131..............  Derm autograft t/a/l add-
                      on.
15135..............  Derm autograft face/nck/
                      hf/g.
15136..............  Derm autograft, f/n/hf/g
                      add.
15200..............  Skin full graft, trunk...
15201..............  Skin full graft trunk add-
                      on.
15220..............  Skin full graft sclp/arm/
                      leg.
15240..............  Skin full grft face/genit/
                      hf.
15260..............  Skin full graft een &
                      lips.
15261..............  Skin full graft add-on...
15740..............  Island pedicle flap graft
15936..............  Remove sacrum pressure
                      sore.
15952..............  Remove thigh pressure
                      sore.
15953..............  Remove thigh pressure
                      sore.
15956..............  Remove thigh pressure
                      sore.
15958..............  Remove thigh pressure
                      sore.
20920..............  Removal of fascia for
                      graft.
20922..............  Removal of fascia for
                      graft.
23921..............  Amputation follow-up
                      surgery.
25929..............  Amputation follow-up
                      surgery.
33222..............  Revise pocket, pacemaker.
33223..............  Revise pocket, pacing-
                      defib.
11960..............  Insert tissue expander(s)         0137        1,271
13160..............  Late closure of wound....
14300..............  Skin tissue rearrangement

[[Page 66734]]

 
14350..............  Skin tissue rearrangement
15100..............  Skin splt grft, trnk/arm/
                      leg.
15101..............  Skin splt grft t/a/l, add-
                      on.
15120..............  Skn splt a-grft fac/nck/
                      hf/g.
15121..............  Skn splt a-grft f/n/hf/g
                      add.
15570..............  Form skin pedicle flap...
15572..............  Form skin pedicle flap...
15574..............  Form skin pedicle flap...
15576..............  Form skin pedicle flap...
15600..............  Skin graft...............
15610..............  Skin graft...............
15620..............  Skin graft...............
15630..............  Skin graft...............
15650..............  Transfer skin pedicle
                      flap.
15731..............  Forehead flap w/vasc
                      pedicle.
15732..............  Muscle-skin graft, head/
                      neck.
15734..............  Muscle-skin graft, trunk.
15736..............  Muscle-skin graft, arm...
15738..............  Muscle-skin graft, leg...
15750..............  Neurovascular pedicle
                      graft.
15760..............  Composite skin graft.....
15770..............  Derma-fat-fascia graft...
15820..............  Revision of lower eyelid.
15821..............  Revision of lower eyelid.
15822..............  Revision of upper eyelid.
15823..............  Revision of upper eyelid.
15824..............  Removal of forehead
                      wrinkles.
15825..............  Removal of neck wrinkles.
15826..............  Removal of brow wrinkles.
15828..............  Removal of face wrinkles.
15829..............  Removal of skin wrinkles.
15840..............  Graft for face nerve
                      palsy.
15841..............  Graft for face nerve
                      palsy.
15842..............  Flap for face nerve palsy
15845..............  Skin and muscle repair,
                      face.
15876..............  Suction assisted
                      lipectomy.
15877..............  Suction assisted
                      lipectomy.
15878..............  Suction assisted
                      lipectomy.
15879..............  Suction assisted
                      lipectomy.
15922..............  Removal of tail bone
                      ulcer.
15934..............  Remove sacrum pressure
                      sore.
15935..............  Remove sacrum pressure
                      sore.
15937..............  Remove sacrum pressure
                      sore.
15944..............  Remove hip pressure sore.
15945..............  Remove hip pressure sore.
15946..............  Remove hip pressure sore.
20101..............  Explore wound, chest.....
20102..............  Explore wound, abdomen...
20910..............  Remove cartilage for
                      graft.
20912..............  Remove cartilage for
                      graft.
43886..............  Revise gastric port, open
43888..............  Change gastric port, open
44312..............  Revision of ileostomy....
44340..............  Revision of colostomy....
------------------------------------------------------------------------

c. Stereotactic Radiosurgery (SRS) Treatment Delivery Services (APCs 
0065, 0066, and 0067)
    For CY 2007, the CPT Editorial Panel created four new SRS Category 
I CPT codes in the Radiation Oncology section of the 2007 CPT manual. 
Specifically, the CPT Editorial Panel created CPT codes 77371 
(Radiation treatment delivery, stereotactic radiosurgery (SRS) 
(complete course of treatment of cerebral lesion(s) consisting of 1 
session); multi-source Cobalt 60 based); 77372 (Radiation treatment 
delivery, stereotactic radiosurgery (SRS) (complete course of treatment 
of cerebral lesion(s) consisting of 1 session); linear accelerator 
based); 77373 (Stereotactic body radiation therapy, treatment delivery, 
per fraction to 1 or more lesions, including image guidance, entire 
course not to exceed 5 fractions); and 77435 (Stereotactic body 
radiation therapy, treatment management, per treatment course, to one 
or more lesions, including image guidance, entire course not to exceed 
5 fractions).
    Of the four CPT codes, CPT codes 77371 and 77435 were recognized 
under the OPPS effective January 1, 2007, while CPT codes 77372 and 
77373 were not. CPT code 77371 was assigned to the same APC and status 
indicator as its

[[Page 66735]]

predecessor code, HCPCS code G0243 (Multi-source photon stereotactic 
radiosurgery, delivery including collimator changes and custom 
plugging, complete course of treatment, all lesions). For CY 2007, CPT 
code 77371 was assigned to APC 0127 (Level IV Stereostatic 
Radiosurgery) with a status indicator of ``S.'' Prior to CY 2007, CPT 
code 77435 was described under CPT code 0083T (Stereotactic body 
radiation therapy, treatment management, per day), which was assigned 
to status indicator ``N'' in the OPPS. The CPT Editorial Panel decided 
to delete CPT code 0083T on December 31, 2006, and replaced it with CPT 
code 77435. Because the costs of SRS treatment management were already 
packaged into the OPPS payment rates for SRS treatment delivery, we 
assigned CPT code 77435 to status indicator ``N'' which was the same 
status indicator that was assigned to its predecessor Category III CPT 
code (0083T), under the OPPS, effective January 1, 2007. In the CY 2008 
OPPS/ASC proposed rule (72 FR 42716), we noted that the OPPS treatment 
of these new CPT codes was open to comment in the CY 2007 OPPS/ASC 
final rule with comment period, and indicated that we would 
specifically respond to those comments, according to our usual 
practice, in this final rule with comment period.
    As we explained in the CY 2007 OPPS/ASC final rule with comment 
period (71 FR 68025), we did not recognize CPT codes 77372 and 77373 
because they did not accurately and specifically describe the HCPCS G-
codes that we used in prior years for linear accelerator (LINAC)-based 
SRS treatment delivery services under the OPPS. During CY 2006, CPT 
code 77372 was reported under one of two HCPCS codes, depending on the 
technology used, specifically, G0173 (Linear accelerator based 
stereotactic radiosurgery, complete course of therapy in one session) 
and G0339 (Image-guided robotic linear accelerator-based stereotactic 
radiosurgery, complete course of therapy in one session or first 
session of fractionated treatment). Because HCPCS codes G0173 and G0339 
were more specific in their descriptors than CPT code 77372, we decided 
to continue using HCPCS codes G0173 and G0339 under the OPPS for CY 
2007. For CY 2007, we assigned CPT code 77372 status indicator ``B'' 
under the OPPS. In addition, during CY 2006, CPT code 77373 was 
reported under one of three HCPCS codes depending on the circumstances 
and technology used, specifically, G0251 (Linear accelerator-based 
stereotactic radiosurgery, delivery including collimator changes and 
custom plugging, fractionated treatment, all lesions, per session, 
maximum five sessions per course of treatment); G0339 (Image-guided 
robotic linear accelerator-based stereotactic radiosurgery, complete 
course of therapy in one session or first session of fractionated 
treatment); and G0340 (Image-guided robotic linear accelerator-based 
stereotactic radiosurgery, delivery including collimator changes and 
custom plugging, fractionated treatment, all lesions, per session, 
second through fifth sessions, maximum five sessions per course of 
treatment). Because HCPCS codes G0251, G0339, and G0340 were more 
specific in their descriptors than CPT code 77373 and were also 
assigned to different clinical APCs for CY 2007, we decided to continue 
recognizing HCPCS codes G0251, G0339, and G0340 under the OPPS for CY 
2007. Therefore, for CY 2007 we assigned CPT code 77373 status 
indicator ``B'' under the OPPS.
    In the CY 2008 proposed rule (72 FR 42716 through 42717), we 
explained that while we had received requests from certain specialty 
societies and other stakeholders that we recognize CPT codes 77372 and 
77373 under the OPPS rather than continuing to use the current Level II 
HCPCS codes for hospital outpatient facility reporting of these 
procedures, we had also heard from others that continued use of the G-
codes under the OPPS would be the most appropriate way to recognize the 
facility resource differences between different types of LINAC-based 
procedures. For the past several years, we had collected information 
through our claims data regarding the hospital costs associated with 
the planning and delivery of SRS services. As new technology emerged in 
the field of SRS several years ago, public commenters urged CMS to 
recognize cost differences associated with the various methods of SRS 
planning and delivery. Beginning in CY 2001, we established G-codes to 
capture any such cost variations associated with the various methods of 
planning and delivery of SRS. Based on comments received on the CY 2004 
OPPS proposed rule regarding the G-codes used for SRS, we made some 
modifications to the coding for CY 2004 (68 FR 63431 and 63432). First, 
we received comments regarding the descriptors for HCPCS codes G0173 
and G0251, indicating that these codes did not accurately distinguish 
image-guided robotic SRS systems from other forms of linear 
accelerator-based SRS systems to account for the cost variation in 
delivering these services. In response, for CY 2004 we modified the 
descriptor for G0173 and also created two HCPCS G-codes, G0339 and 
G0340, to describe complete and fractionated image-guided robotic 
linear accelerator-based SRS treatment. While all of these LINAC-based 
SRS procedures were originally assigned to New Technology APCs under 
the OPPS, we reassigned them to new clinical APCs for CY 2007 based on 
2 full years of hospital claims data reflecting stable median costs 
based on significant volumes of single claims.
    HCPCS codes G0173, G0251, G0339, and G0340 are more specific in 
their descriptors than either CPT code 77372 or 77373. As we discussed 
in the CY 2008 proposed rule (72 FR 42717), their hospital claims data 
continued to reflect significantly different hospital resources that 
would lead to violations of the 2 times rule were we to reassign 
certain procedures to the same clinical APCs in order to crosswalk the 
CY 2006 historical claims data for the 4 G-codes to develop the median 
costs of the APCs to which the 2 CPT codes would be assigned if we were 
to recognize them. Therefore, we believed that we should continue to 
use the G-codes for reporting LINAC-based SRS treatment delivery 
services for CY 2008 under the OPPS to ensure appropriate payment to 
hospitals for the different facility resources associated with 
providing these complex services. That is, we proposed to continue to 
assign HCPCS codes G0173 and G0339 to APC 0067 (Level III Stereotactic 
Radiosurgery, MRgFUS, and MEG), HCPCS code G0251 to APC 0065 (Level I 
Stereotactic Radiosurgery, MRgFUS, and MEG), and HCPCS code G0340 to 
APC 0066 (Level II Stereotactic Radiosurgery, MRgFUS, and MEG) for CY 
2008.
    Since we first established the full group of SRS treatment delivery 
codes in CY 2004, we note that we now have 3 years of hospital claims 
data reflecting the costs of each of these services. Based on the 
latest claims data from CY 2006 for the CY 2008 proposed rule, the 
proposed APC median cost for the complete course of therapy in one 
session or first fraction of image-guided, robotic LINAC-based SRS, as 
described by HCPCS codes G0173 and G0339 respectively in APC 0067, was 
approximately $3,870 based on 1,946 single claims available for 
ratesetting. The proposed CY 2008 APC median cost for the second 
through fifth sessions of image-guided, robotic LINAC-based 
fractionated SRS treatment, reported by HCPCS code G0340 in APC 0066, 
was approximately $2,980 based on 5,209 single claims. The proposed CY 
2008 APC median cost for each fractionated

[[Page 66736]]

session of LINAC-based SRS, as described by HCPCS code G0251 in APC 
0065, was approximately $1,082 based on 1,938 single claims. Therefore, 
for CY 2008, we proposed to continue with the CY 2007 HCPCS coding for 
LINAC-based SRS treatment delivery services under the OPPS. The LINAC 
based SRS codes and their CY 2008 proposed APC assignments were 
displayed in Table 36 of the proposed rule (72 FR 42717).
    We received several public comments concerning our treatment of new 
CPT codes for SRS treatment delivery discussed in the CY 2007 OPPS/ASC 
final rule with comment period and our CY 2008 proposal for these 
services. A summary of the public comments and our responses follow.
    Comment: Several commenters agreed with CMS's proposed continued 
use of HCPCS codes G0173, G0251, G0339, and G0340 to report SRS 
services as these codes were more specific in their descriptors than 
either CPT code 77372 or 77373. However, these commenters requested 
that CMS further clarify the descriptors of these G-codes to more 
specifically differentiate image-guided robotic SRS from other LINAC 
systems. Other commenters to the CY 2008 proposed rule and the CY 2007 
OPPS/ASC final rule with comment period disagreed with the use of the 
G-codes and requested that CMS recognize the CPT codes for ease of 
billing. Some commenters indicated that use of different codes for the 
same service for different payers is not consistent with government and 
industry goals for data uniformity and consistency, and is 
administratively burdensome for hospitals. One commenter explained that 
not all payers recognize Medicare's temporary HCPCS codes. This 
commenter recommended that APCs 0065, 0066 and 0067 be combined into a 
single APC containing the following codes: CPT codes 77372; 77373; 
95966 (Magnetoencephalography (MEG), recording and analysis; for 
spontaneous brain magnetic activity (e.g., epileptic cerebral cortex 
localization)); 95967 (Magnetoencephalography (MEG), recording and 
analysis; for evoked magnetic fields, single modality (e.g., sensory, 
motor, language, or visual cortex localization)); 95965 
(Magnetoencephalography (MEG), recording and analysis; for evoked 
magnetic fields, each additional modality (e.g., sensory, motor, 
language, or visual cortex localization) (List separately in addition 
to code for primary procedure)); 0071T (Focused ultrasound ablation of 
uterine leiomyomata, including MR guidance; total leiomyomata volume 
less than 200 cc of tissue); and 0072T (Focused ultrasound ablation of 
uterine leiomyomata, including MR guidance; total leiomyomata volume 
greater or equal to 200 cc of tissue). Another commenter requested that 
HCPCS code G0251 be reassigned from its proposed APC 0065 to APC 0067.
    Additionally, several commenters disagreed with CMS's proposal to 
assign both the MRgFUS and MEG procedures to APCs 0065, 0066, and 0067. 
These commenters believed that MRgFUS and MEG procedures did not share 
the same clinical or resource characteristics as SRS procedures. They 
urged CMS to reassign the MRgFUS and MEG procedures to other APCs that 
more accurately reflected their clinical characteristics and resource 
use. Some commenters recommended that the MEG procedures be placed in 
an APC that described nerve and muscle tests rather than assigning them 
to an SRS APC. Other commenters did not understand why CMS included the 
words ``MRgFUS'' and/or ``MEG'' in the APC titles for APCs 0065 and 
0066 when the proposed APCs did not include one or both of these 
procedures.
    Response: We appreciate the various differences of opinion offered 
by commenters on coding and payment for LINAC-based SRS treatment 
delivery services under the OPPS. We will not recognize CPT codes 77372 
and 77373 for CY 2008 because we continue to believe that they do not 
accurately and specifically describe the HCPCS G-codes that we 
currently use for reporting LINAC-based SRS treatment delivery services 
under the OPPS. Hospital claims data from CY 2006 for the current G 
codes demonstrate significant resource differences for the four 
different services, ranging from approximately $994 to $3,620, and 
these G-codes cannot be mapped in a one-to-one relationship to the CPT 
codes. We remain unclear about how we could use our historical hospital 
claims data as the basis for establishing appropriate payment rates for 
CPT codes 77372 and 77373. We believe that our CY 2008 proposed APC 
assignments for the four G-codes to APCs 0065, 0066, and 0067, 
consistent with their CY 2007 assignments, will provide the most 
appropriate payment for the SRS services described by these codes in CY 
2008.
    We note that we intend to reevaluate the appropriateness of the use 
of the HCPCS G-codes for LINAC-based SRS services for the CY 2009 OPPS 
rulemaking cycle. With that planned reevaluation in mind, we will not 
modify the G-code descriptors for LINAC based SRS treatment services. 
These codes have been in effect for the past 4 years and, based on 
questions brought to our attention by hospitals, we have no reason to 
believe that hospitals are confused about the reporting of these codes. 
In addition, we see resource differences based on the median costs for 
the four codes that are reasonably consistent with our expectations 
based on the current code descriptors. We believe it would be confusing 
to hospitals if we were to modify these code descriptors at this point 
in time and could lead to instability in our median costs and 
inaccurate payments for some services. Therefore, we believe that 
modifying the G-code descriptors is not necessary for us to continue to 
provide appropriate payment for the services they describe.
    We disagree with the recommendation of some commenters to combine 
all of the SRS, MEG, and MRgFUS procedures into one single clinical 
APC, when the median costs for these services vary from approximately 
$663 to $4,207. Such a single clinical APC would violate the 2 times 
rule based on the different hospital resources required for all of the 
services. With the respect to the proposed assignment of MEG and MRgFUS 
services to APCs 0065 and 0067, we note that the APC Panel recommended 
at its March 2007 meeting that we assign both CPT codes for MRgFUS 
procedures to APC 0067. Although we have no single claims available for 
CPT codes 0071T and 0072T for CY 2008 ratesetting, we continue to 
believe that these services share sufficient clinical and resource 
similarity to LINAC-based SRS procedures based on their use of image-
guidance and focused energy for tissue ablation that they should be 
assigned to APC 0067 for CY 2008 as the APC Panel recommended and as we 
proposed . With respect to MEG procedures, we also believe that, based 
on the clinical characteristics of these services and the procedures' 
median costs from claims data, these three services should also be 
assigned to APCs 0065 and 0067 as proposed.
    In the case of the APC titles for APCs 0065, 0066, and 0067, 
because the titles specify three separate levels of the same series, we 
will follow our usual practice of maintaining the same APC title for 
each level for purposes of clarity and consistency, even if not all 
specific services are assigned to every level.
    After consideration of the public comments received, we are 
finalizing our CY 2008 proposal, without modification, to continue the 
use of the current HCPCS G-codes for LINAC-based SRS treatment delivery 
services, specifically, HCPCS G-codes G0173, G0251, G0339, and G0340, 
under the

[[Page 66737]]

OPPS. We will not recognize CPT codes 77372 and 77373 under the CY 2008 
OPPS. The HCPCS G-codes will continue to be assigned to the same CY 
2007 APCs for CY 2008, specifically, APCs 0065, 0066, and 0067, with 
final APC median costs of approximately $1,044, $2,835, and $3,882, 
respectively. Table 23 displays the final APC median costs for the SRS 
treatment delivery HCPCS G-codes.

            Table 23.--Final CY 2008 APC Assignments for LINAC-Based SRS Treatment Delivery Services
----------------------------------------------------------------------------------------------------------------
                                                                     CY 2007                            Final CY
                                                          CY 2007      APC       Final CY    Final CY   2008 APC
    HCPCS code         Short descriptor      CY 2007 SI     APC       median     2008 SI     2008 APC    median
                                                                       cost                   final       cost
----------------------------------------------------------------------------------------------------------------
G0173............  Linear acc stereo        S..........       0067     $3,873  S..........       0067     $3,882
                    radsur com.
G0251............  Linear acc based stero   S..........       0065      1,242  S..........       0065      1,044
                    radio.
G0339............  Robot lin-radsurg com,   S..........       0067      3,873  S..........       0067      3,882
                    first.
G0340............  Robt lin-radsurg fractx  S..........       0066      2,630  S..........       0066      2,835
                    2-5.
----------------------------------------------------------------------------------------------------------------

10. Medical Services
a. Single Allergy Tests (APC 0381)
    We proposed to continue with our methodology of differentiating 
single allergy tests (``per test'') from multiple allergy tests (``per 
visit'') by assigning these services to two different APCs to provide 
accurate payments for these tests in CY 2008. Multiple allergy tests 
are currently assigned to APC 0370 (Allergy Tests), with a median cost 
calculated based on the standard OPPS methodology. We provided billing 
guidance in CY 2006 in Transmittal 804 (issued on January 3, 2006) 
specifically clarifying that hospitals should report charges for the 
CPT codes that describe single allergy tests to reflect charges ``per 
test'' rather than ``per visit'' and should bill the appropriate number 
of units of these CPT codes to describe all of the tests provided. 
However, our CY 2006 claims data available for the CY 2008 proposed 
rule for APC 0381 (Single Allergy Tests) did not reflect improved and 
more consistent hospital billing practices of ``per test'' for single 
allergy tests. The median cost of APC 0381 calculated for the proposed 
rule according to the standard single claims OPPS methodology was 
approximately $66, significantly higher than the CY 2007 median cost of 
APC 0381 calculated according to the ``per unit'' methodology of 
approximately $16, and greater than we would expect for these 
procedures that are to be reported ``per test'' with the appropriate 
number of units. Some claims for single allergy tests still appeared to 
provide charges that represent a ``per visit'' charge, rather than a 
``per test'' charge. Therefore, consistent with our payment policy for 
CYs 2006 and 2007, we calculated a ``per unit'' median cost for APC 
0381, based upon 276 claims containing multiple units or multiple 
occurrences of a single CPT code, where packaging on the claims is 
allocated equally to each unit of the CPT code. Using this methodology, 
we calculated a proposed median cost of approximately $19 for APC 0381 
for CY 2008. We noted in the CY 2008 OPPS/ASC proposed rule (72 FR 
42713) that we will consider whether further instructions to hospitals 
for reporting these procedures would be beneficial, because we are 
concerned that our claims data for CY 2006 reflect no apparent change 
in hospitals' billing practices following our January 2006 
clarification. We remain hopeful that better and more accurate hospital 
reporting and charging practices for these single allergy test CPT 
codes in future years may allow us to calculate the median cost of APC 
0381 using the standard OPPS process for future OPPS updates.
    We did not receive any public comments on this proposal. Therefore, 
we are finalizing our CY 2008 proposal, without modification, to 
calculate a ``per unit'' median cost for APC 0381 as described above. 
The CY 2008 median cost of APC 0381 is approximately $17.
b. Continuous Glucose Monitoring (APC 0097)
    For CY 2008, we proposed to reassign CPT code 95250 (Ambulatory 
continuous glucose monitoring of interstitial fluid via a subcutaneous 
sensor for up to 72 hours; sensor placement, hook-up; calibration of 
monitor, patient training, removal of sensor, and printout of 
recording) to APC 0097 (Prolonged Physiologic and Ambulatory 
Monitoring), with a proposed payment rate of approximately $66. CPT 
code 95250 is assigned to APC 0421 (Prolonged Physiologic Monitoring) 
for CY 2007, with a payment rate of approximately $100. We also 
proposed to discontinue APC 0421 effective January 1, 2008. At the 
September 2007 APC Panel meeting, the APC Panel recommended that CMS 
retain APC 0421 with its CY 2007 composition, including maintaining CPT 
code 95250 in that APC for CY 2008.
    We received one public comment on our CY 2008 proposed reassignment 
of CPT code 95250 to APC 0097. A summary of the public comment and our 
response follow.
    Comment: One commenter considered the proposal to reassign CPT code 
95250 to APC 0097 to be an apparent violation of the 2 times rule. The 
commenter further reported that placement of CPT code 95250 in APC 0097 
was problematic with respect to ensuring resource comparability among 
all the procedures assigned to the APC for CY 2008, because continuous 
glucose monitoring involves significant patient training of 30 to 40 
minutes, whereas there is minimal to no patient training associated 
with most of the other HCPCS codes in APC 0097. In addition, the 
commenter noted that the OPPS payment for CPT code 95250 should include 
payment for a sensor that costs approximately $35, which would consume 
53 percent of the proposed payment for the service. The commenter 
recommended that CMS not discontinue APC 0421 and maintain CPT code 
95250 in APC 0421 for CY 2008. Alternatively, the commenter believed 
that CMS could split APC 0097 into two APCs for Level I and Level II 
services, assigning CPT code 95250 to the higher paying Level II APC. 
Another commenter also recommended that CMS maintain APC 0421 on the 
basis that the lower payment rate of APC 0097 would potentially result 
in limiting patient access to this monitoring approach for patients 
with diabetes.
    Response: As described in section II.A.2. of this final rule with 
comment period, for CY 2008 we proposed to eliminate many APCs with low 
total claims volume in order to stabilize OPPS payments for these low 
volume services. We generally proposed to reassign the services 
residing in these low volume APCs to other clinical APCs, along with 
services that share clinical and resource characteristics. We note that 
APC 0421, as configured for

[[Page 66738]]

CY 2007 and where CPT code 95250 is currently assigned, is a low volume 
APC, which would have included only about 750 CY 2006 claims. We 
proposed to discontinue APC 0421 and reassign CPT code 95250 to APC 
0097. Proposed APC 0097 consisted of 17 services, with approximately 
487,000 CY 2006 claims for those services. Low volume services, 
including CPT code 95250, are not significant services in APCs and, 
therefore, do not result in violations of the 2 times rule.
    We agree with the commenters that CPT code 95250 should not be 
assigned to APC 0097, based on our review of its clinical and resource 
characteristics. However, we will not maintain APC 0421 for CY 2008, 
given our interest in eliminating low volume APCs, and, therefore, we 
are not adopting the recommendation of the APC Panel. In addition, we 
will not separate APC 0097 into two levels because we believe that an 
alternative assignment of CPT code 95250 to another existing clinical 
APC would be more appropriate. Taking into consideration the patient 
training required in association with CPT code 95250, we believe that 
it would be appropriate to assign this service to APC 0607 (Level 4 
Hospital Clinic Visits), which has a CY 2008 final median cost of 
approximately $104. The median cost of CPT code 95250 of approximately 
$100 is well within the range of approximately $99 to $122 for other 
significant procedures also assigned to that APC for CY 2008. This 
final reassignment of CPT code 95250 to APC 0607 should resolve any 
concerns about violations of the 2 times rule and leads to appropriate 
grouping of the service with other similar services that share clinical 
and resource characteristics.
    After consideration of the public comment received, we are 
finalizing our CY 2008 proposal with modification. We are discontinuing 
APC 0421 and reassigning CPT code 95250 to APC 0607, with a CY 2008 
median cost of approximately $104, rather than to APC 0097 as proposed.
c. Home International Normalized Ratio (INR) Monitoring (APC 0097)
    For CY 2008, we proposed to reassign the two following HCPCS codes 
to APC 0097 (Prolonged Physiologic and Ambulatory Monitoring), with a 
proposed payment rate of approximately $66: G0248 (Demonstration at 
initial use, of home INR monitoring for patient with mechanical heart 
valve(s) who meets Medicare coverage criteria, under the direction of a 
physician; includes: demonstrating use and care of the INR monitor, 
obtaining at least one blood sample, provision of instructions for 
reporting home INR test results, and documentation of patient ability 
to perform testing) and HCPCS code G0249 (Provision of test materials 
and equipment for home INR monitoring to patient with mechanical heart 
valve(s) who meets Medicare coverage criteria; includes provision of 
materials for use in the home and reporting of test results to 
physician; per 4 tests). Currently, HCPCS codes G0248 and G0249 are 
assigned to APC 0421 (Prolonged Physiologic Monitoring), with a payment 
rate of approximately $100 for CY 2007. As stated in section 
III.D.10.b. of this final rule with comment period, we also proposed to 
discontinue APC 0421 effective January 1, 2008. At the September 2007 
APC Panel meeting, the APC Panel recommended that CMS retain APC 0421 
with its CY 2007 composition, including maintaining HCPCS codes G0248 
and G0249 in that APC for CY 2008.
    We received one public comment on our CY 2008 proposed reassignment 
of HCPCS codes G0248 and G0249 to APC 0097. A summary of the public 
comment and our response follow.
    Comment: One commenter was concerned that CMS's proposal to 
reassign HCPCS codes G0248 and G0249 from APC 0421 to APC 0097 would 
substantially reduce payments for these services and would make it 
financially impossible for hospitals to offer these services, thereby 
reducing patient access to home INR monitoring. The commenter urged CMS 
to maintain APC 0421 or, as an alternative, to create a new APC that 
would include HCPCS codes G0248 and G0249 and two other higher cost 
procedures also proposed for CY 2008 assignment to APC 0097, 
specifically CPT code 93271 (Patient demand single or multiple event 
recording with presymptom memory loop, 24-hour attended monitoring, per 
30 day period of time; monitoring, receipt of transmissions, and 
analysis) and CPT code 95250 (Ambulatory continuous glucose monitoring 
of interstitial fluid via a subcutaneous sensor for up to 72 hours; 
sensor placement, hook-up; calibration of monitor, patient training, 
removal of sensor, and printout of recording).
    Response: As described in section II.A.2. of this final rule with 
comment period, for CY 2008 we proposed to eliminate many APCs with low 
total claims volume in order to stabilize OPPS payments for these low 
volume services. We generally proposed to reassign the services 
residing in these low volume APCs to other clinical APCs, along with 
services that share clinical and resource characteristics. We note that 
APC 0421, as configured for CY 2007 and where HCPCS codes G0248 and 
G0249 are currently assigned, is a low volume APC, which would have 
included only about 750 CY 2006 claims. We proposed to discontinue APC 
0421 and reassign HCPCS codes G0248 and G0249 to proposed APC 0097. 
Proposed APC 0097 consisted of 17 services, with approximately 487,000 
CY 2006 claims for those services.
    We agree with the commenter that HCPCS codes G0248 and G0249 should 
not be assigned to APC 0097, based on our reexamination of their 
clinical and resource characteristics. However, we will not maintain 
APC 0421 for CY 2008, given our interest in eliminating low volume 
APCs, and, therefore, we are not adopting the recommendation of the APC 
Panel. In addition, we will not create another new clinical APC 
consisting of four of the higher cost services proposed for CY 2008 
assignment to APC 0097 because we believe that alternative assignments 
of those codes to other existing clinical APCs are more appropriate. We 
discuss the final CY 2008 reassignment of CPT code 95250 to APC 0607 
(Level 4 Hospital Clinic Visits) in section III.D.10.b. of this final 
rule with comment period. In addition, we are reassigning CPT code 
93271, which has a median cost of approximately $93 to APC 0663 (Level 
I Electronic Analysis of Devices), with a CY 2008 median cost of 
approximately $96. Taking into consideration the patient training 
required in association with HCPCS code G0248 in particular, we believe 
that it would be appropriate to assign both HCPCS codes G0248 and G0249 
to APC 0607 (Level 4 Hospital Clinic Visits), which has a CY 2008 final 
median cost of approximately $104. The median costs of HCPCS codes 
G0248 and G0249 are approximately $72 and $120, respectively, similar 
to the hospital costs for other services also assigned to that APC for 
CY 2008.
    After consideration of the public comment received, we are 
finalizing our CY 2008 proposal, with modification. We are 
discontinuing APC 0421 and reassigning HCPCS codes G0248 and G0249 to 
APC 0607, with a CY 2008 median cost of approximately $104, rather than 
to APC 0097 as proposed.
d. Mental Health Services (APCs 0322, 0323, 0324, and 0325)
    For CY 2008, we did not propose any policy changes to the range or 
composition of APCs that describe psychotherapy services provided in 
HOPDs. These APCs include 0322 (Brief Individual Psychotherapy), which 
has a CY 2008 median cost of approximately

[[Page 66739]]

$74; 0323 (Extended Individual Psychotherapy), which has a CY 2008 
median cost of approximately $101; 0324 (Family Psychotherapy), which 
has a CY 2008 median cost of approximately $149; and 0325 (Group 
Psychotherapy), which has a CY 2008 median cost of approximately $62. 
Proposals related to partial hospitalization programs are discussed in 
section II.B. of this final rule with comment period.
    We note that since the inception of the OPPS, CMS has limited the 
aggregate payment for specified less intensive mental health services 
furnished on the same date to the payment for a day of partial 
hospitalization, which we considered to be the most intensive of all 
outpatient mental health treatment (65 FR 18455). The costs associated 
with administering a partial hospitalization program represent the most 
resource-intensive of all outpatient mental health treatment, and we do 
not believe that we should pay more for a day of individual mental 
health services under the OPPS.
    We received several public comments regarding our CY 2008 proposed 
payment for APCs 0332, 0323, 0324, and 0325. A summary of the public 
comments and our responses follow.
    Comment: Several commenters noted that the payment rates associated 
with APCs 0322, 0323, 0324, and 0325 have decreased in recent years. 
Specifically, the commenters stated that payment associated with APC 
0325 decreased by 17 percent between CY 2006 and CY 2007 and was 
proposed to decline by an additional 3 percent for CY 2008. These 
commenters expressed concern that the payment rates are insufficient to 
cover their costs for mental health services. One commenter noted that 
it is more cost-effective to treat Medicare beneficiaries in HOPDs, 
rather than costly partial hospitalization programs, and encouraged CMS 
to provide adequate payment rates to the less intensive programs.
    Response: We carefully analyzed several years of resource cost data 
associated with APCs 0322 through 0325. We note that the median costs 
of APCs 0322, 0323, and 0324 have remained fairly constant in recent 
years. APC 0323 has a small 2 times rule violation for CY 2008, and 
also had a small violation in CY 2007, but it is not clear how to best 
resolve the violation, while ensuring the clinical and resource 
homogeneity of reconfigured APCs. For CY 2007 and CY 2008, APC 0323 is 
excepted from the 2 times rule. We will review APC 0323 at the next APC 
Panel meeting and seek its guidance in reconfiguring this APC for CY 
2009. As the commenters noted, the median cost for APC 0325 declined 
significantly in CY 2007, and declined again for CY 2008, using full 
year CY 2006 claims data. We cannot speculate as to why this recent 
decline in the median cost of group psychotherapy services has 
occurred. We have robust claims data for the CPT codes that map to APC 
0325. Specifically, we were able to use almost 80 percent of the 1.6 
million claims submitted by hospitals to report group psychotherapy 
services. In general, we set payment rates using our standard OPPS 
methodology based on relative costs from hospital outpatient claims. In 
this case, we have no reason to discount our claims data, and it would 
appear that the relative cost of providing these mental health services 
in comparison with other HOPD services has decreased in recent years.
    While reviewing the CY 2008 OPPS proposal for mental health 
services, we noted that CPT code 90862 (Pharmacologic management, 
including prescription, use, and review of medication with no more than 
minimal psychotherapy) and HCPCS code M0064 (Brief office visit for the 
sole purpose of monitoring or changing drug prescriptions used in the 
treatment of mental psychoneurotic and personality disorders) were 
proposed to map to APC 0605 (Level 2 Hospital Clinic Visits) for CY 
2008, with a proposed payment of approximately $64. These assignments 
were proposed changes from their CY 2007 assignments to APC 0374 
(Monitoring Psychiatric Drugs), which has a payment rate of 
approximately $70. We proposed to discontinue APC 0374 for CY 2008. 
Based on our reexamination of the claims data for this final rule with 
comment period, particularly the hospitals costs associated with these 
visits, we are reassigning HCPCS codes 90862 and M0064 to APC 0606 
(Level 3 Hospital Clinic Visits) for CY 2008, with a median cost of 
approximately $83.
    Comment: Several commenters expressed concern that payment for 
mental health services provided on one date is capped at the partial 
hospitalization payment rate. One commenter noted that if an HOPD 
provides four particular mental health services in one day, that 
department would receive full payment for the first two services, 
partial payment for the third service, and no payment for the fourth 
service.
    Response: We continue to believe that the costs associated with 
administering a partial hospitalization program represent the most 
resource intensive of all outpatient mental health treatment, and we do 
not believe that we should pay more for a day of individual mental 
health services under the OPPS. We note that these commenters also 
submitted comments requesting that the partial hospitalization payment 
rate increase for CY 2008. The mental health payment limitation will 
rise and fall in the same manner as payment for partial hospitalization 
services.
    After consideration of the public comments received, we will ask 
the APC Panel to provide advice at its next meeting regarding the 
possible reconfiguration of APC 0323 to resolve a small 2 times 
violation for CY 2009. For CY 2008, we are modifying our proposal for 
two medication management services and will reassign CPT code 90862 and 
HCPCS code M0064 from APC 0605 to APC 0606, with a median cost of 
approximately $83.

IV. OPPS Payment for Devices

A. Treatment of Device-Dependent APCs

1. Background
    Device-dependent APCs are populated by HCPCS codes that usually, 
but not always, require that a device be implanted or used to perform 
the procedure. For the CY 2002 OPPS, we used external data, in part, to 
establish the device-dependent APC medians used for weight setting. At 
that time, many devices were eligible for pass-through payment. For the 
CY 2002 OPPS, we estimated that the total amount of pass-through 
payments would far exceed the limit imposed by statute. To reduce the 
amount of a pro rata adjustment to all pass-through items, we packaged 
75 percent of the cost of the devices, using external data furnished by 
commenters on the August 24, 2001 proposed rule and information 
furnished on applications for pass-through payment, into the median 
costs for the device-dependent APCs associated with these pass-through 
devices. The remaining 25 percent of the cost was considered to be 
pass-through payment.
    In the CY 2003 OPPS, we determined APC medians for device-dependent 
APCs using a three-pronged approach. First, we used only claims with 
device codes on the claim to set the medians for these APCs. Second, we 
used external data, in part, to set the medians for selected device-
dependent APCs by blending that external data with claims data to 
establish the APC medians. Finally, we also adjusted the median for any 
APC (whether device-dependent or not) that declined more than 15 
percent. In addition, in the CY 2003 OPPS we deleted the device codes 
(``C'' codes) from the HCPCS file because we

[[Page 66740]]

believed that hospitals would include the charges for the devices on 
their claims, notwithstanding the absence of specific codes for devices 
used.
    In the CY 2004 OPPS, we used only claims containing device codes to 
set the medians for device-dependent APCs and again used external data 
in a 50/50 blend with claims data to adjust medians for a few device-
dependent codes when it appeared that the adjustments were important to 
ensure access to care. However, hospital device code reporting was 
optional.
    In the CY 2005 OPPS, which was based on CY 2003 claims data, there 
were no device codes on the claims and, therefore, we could not use 
device-coded claims in median calculations as a proxy for completeness 
of the coding and charges on the claims. For the CY 2005 OPPS, we 
adjusted device-dependent APC medians for those device dependent APCs 
for which the CY 2005 OPPS payment median was less than 95 percent of 
the CY 2004 OPPS payment median. In these cases, the CY 2005 OPPS 
payment median was adjusted to 95 percent of the CY 2004 OPPS payment 
median. We also reinstated the device codes and made the use of the 
device codes mandatory where an appropriate code exists to describe a 
device utilized in a procedure. In addition, we implemented HCPCS code 
edits to facilitate complete reporting of the charges for the devices 
used in the procedures assigned to the device dependent APCs.
    In the CY 2006 OPPS, which was based on CY 2004 claims data, we set 
the median costs for device-dependent APCs for CY 2006 at the highest 
of: (1) The median cost of all single bills; (2) the median cost 
calculated using only claims that contained pertinent device codes and 
for which the device cost was greater than $1; or (3) 90 percent of the 
payment median that was used to set the CY 2005 payment rates. We set 
90 percent of the CY 2005 payment median as a floor rather than 85 
percent as proposed, in consideration of public comments that stated 
that a 15 percent reduction from the CY 2005 payment median was too 
large of a transitional step. We noted in our CY 2006 proposed rule 
that we viewed our proposed 85 percent payment adjustment as a 
transitional step from the adjusted medians of past years to the use of 
unadjusted medians based solely on hospital claims data with device 
codes in future years (70 FR 42714). We also incorporated, as part of 
our CY 2006 methodology, the recommendation of commenters to base 
payment on medians that were calculated using only claims that passed 
the device edits. As we stated in the CY 2006 OPPS final rule with 
comment period (70 FR 68620), we believed that this policy provided a 
reasonable transition to full use of claims data in CY 2007, which 
would include device coding and device editing, while better moderating 
the amount of decline from the CY 2005 OPPS payment rates.
    For CY 2007, we based the device-dependent APC medians on CY 2005 
claims, the most current data available at that time. In CY 2005 we 
reinstated hospital reporting of device codes and made the reporting of 
device codes mandatory where an appropriate code exists to describe a 
device utilized. In CY 2005, we also implemented HCPCS code procedure-
to-device edits to facilitate complete reporting of the charges for the 
devices used in the procedures assigned to the device-dependent APCs. 
For CY 2007 ratesetting, we excluded claims for which the charge for a 
device was less than $1.01, in part to recognize hospital charging 
practices due to a recall of cardioverter-defibrillator and pacemaker 
pulse generators in CY 2005 for which the manufacturers provided 
replacement devices without cost to the beneficiary or hospital. We 
also found that there were other devices for which the token charge was 
less than $1.01, and we removed those claims from the set used to 
calculate the median costs of device-dependent APCs. In summary, for 
the CY 2007 OPPS we set the median costs for device-dependent APCs 
using only claims that passed the device edits and did not contain 
token charges for the devices. Therefore, the median costs for these 
APCs for CY 2007 were determined from claims data that generally 
represented the full cost of the required device.
2. Payment Under the CY 2008 OPPS
    For CY 2008, we proposed to calculate the median costs for device-
dependent APCs using three different sets of CY 2006 claims (72 FR 
42719). We first calculated a median cost using all single procedure 
claims that contained appropriate device codes (where there are edits) 
for the procedure codes in those APCs. We then calculated a second 
median cost using only claims that contain allowed device HCPCS codes 
with charges for all device codes that were in excess of $1.00 
(nontoken charge device claims). Third, we calculated the APC median 
cost based only upon nontoken charge device claims with correct devices 
that did not also contain the HCPCS modifier ``FB,'' reported in CY 
2005 to identify that a procedure was performed using an item provided 
without cost to the provider, supplier, or practitioner, or where a 
credit was received for a replaced device (examples include, but are 
not limited to, devices covered under warranty, devices replaced due to 
defects, and free samples).
    As expected, the median costs calculated based upon single 
procedure bills that met all three criteria, that is, correct devices, 
no token charges, and no ``FB'' modifier, were generally higher than 
the median costs calculated using all single bills. We believed that 
the claims that met these three criteria (appropriate device codes, 
nontoken device charges, and no ``FB'' modifier) reflected the best 
estimated costs for these device-dependent APCs when the hospital pays 
the full cost of the device, and we proposed to base our CY 2008 median 
costs on the medians calculated based upon these claims.
    As a result of the effects of the proposed CY 2008 packaging 
approach discussed in detail in section II.A.4. of the proposed rule on 
median costs, we proposed to make some changes to CY 2007 device-
dependent APCs for CY 2008. Specifically, we proposed to delete APC 
0081 (Noncoronary Angioplasty or Atherectomy); APC 0087 (Cardiac 
Electrophysiologic Recording/Mapping); and APC 0670 (Level II 
Intravascular and Intracardiac Ultrasound and Flow Reserve) due to the 
migration of HCPCS codes to other APCs. Some of the HCPCS codes 
assigned to these APCs in CY 2007 would be unconditionally packaged for 
CY 2008. The median costs of the remaining HCPCS codes proposed for 
separate payment in CY 2008 were significantly different than CY 2007 
due to the proposed packaging of additional services. We believed that 
reconfiguration of the APCs was necessary to ensure that the HCPCS 
codes that would be separately paid in CY 2008 and that are assigned to 
these APCs in CY 2007 would be assigned to APCs that are homogeneous 
with regard to clinical characteristics and resource use in CY 2008. 
The APCs we proposed for deletion ceased to be appropriate as a result 
of the reassignment of the HCPCS codes that we proposed for continued 
separate payment in CY 2008.
    As proposed, the following seven APCs remained device-dependent 
APCs for CY 2008, but we proposed to reassign certain HCPCS codes 
mapped to these APCs for CY 2007 either to other APCs or among these 
APCs for CY 2008 to ensure that, in view of the median costs that 
resulted from the proposed CY 2008 packaging approach, the HCPCS codes 
would be assigned to APCs that were homogeneous with regard to clinical 
characteristics and

[[Page 66741]]

resource use for CY 2008: APC 0082 (Coronary Atherectomy); APC 0083 
(Coronary Angioplasty and Percutaneous Valvuloplasty); APC 0085 (Level 
II Electrophysiologic Evaluation); APC 0086 (Ablate Heart Dysrhythm 
Focus); APC 0115 (Cannula/Access Device Procedures); APC 0427 (Level 
III Tube Changes and Repositioning); and APC 0623 (Level III Vascular 
Access Procedures). We also proposed to consider APC 0084 (Level I 
Electrophysiologic Procedures) to be a device-dependent APC for CY 2008 
because we proposed to reassign many of the HCPCS codes that were 
previously in APCs 0086 and 0087 to APC 0084.
    As a result of the proposed APC reconfigurations resulting from 
HCPCS code migration, we noted that it was not appropriate to compare 
the proposed CY 2008 OPPS median costs for these eight APCs to the CY 
2007 OPPS final rule median costs that were the basis for the CY 2007 
OPPS payment rates. When we compared the median costs for the other 
device-dependent APCs with stable proposed CY 2008 configurations in 
comparison with CY 2007, the median costs for 26 APCs increased, some 
of them by significant amounts, and the median costs for 5 APCs 
decreased. We believed that these median costs represented valid 
estimates of the relative costs of the services in these APCs, both 
with regard to the increases and the decreases that appeared when the 
proposed CY 2008 median costs were compared to the CY 2007 median costs 
on which the payment rates for these APCs were based.
    Therefore, we proposed to base the payment rates for CY 2008 for 
all device-dependent APCs on their median costs calculated using only 
single bills that meet the three selection criteria discussed in detail 
above. We did not believe that any special payment policies were 
needed, as we believed that the claims data we proposed to use for 
ratesetting would ensure that the costs of the implantable devices were 
adequately and appropriately reflected in the median costs for these 
device-dependent APCs.
    We received a number of public comments on our CY 2008 proposed 
payment methodology for device-dependent APCs. A summary of the public 
comments and our responses follow.
    Comment: Commenters supported the proposal to set the median costs 
for device-dependent APCs using only claims that meet the three 
selection criteria described in the proposed rule (that is, pass the 
device edits, do not contain token charges, and do not have the without 
cost/full credit modifier ``FB''), and urged CMS to continue to use 
device edits to ensure that hospitals bill Level II HCPCS device codes 
in addition to CPT codes for device-dependent procedures. Commenters 
also suggested certain refinements to CMS' ratesetting methodology for 
device-dependent APCs. One commenter asked for implementation of the 
March 2007 APC Panel's recommendation to edit and return for correction 
all claims that contain an HCPCS code for a separately payable device 
but do not contain a CPT code assigned to a procedural APC. Another 
commenter requested that at least 2 full years of data be used to set 
rates for device-dependent APCs, as it may take hospitals several 
months before they bill new Level II HCPCS device codes correctly, and 
also asked that we implement a payment floor to prevent large decreases 
in payment and promote stability in payment rates from year to year. 
Another commenter asked CMS to redefine ``token charge'' for cochlear 
implants to mean any amount lower than the amount the commenter 
specified should be charged.
    Response: We agree that it is appropriate to base the median costs 
for device-dependent APCs on claims that contain the correct devices, 
do not contain token charges, and do not contain the ``FB'' modifier. 
However, we do not believe that it would be appropriate to define 
``token charge'' at particular amounts for particular devices based on 
external data or otherwise because hospitals are free to set their 
charges for all items and services based on their own judgment. We 
encourage hospitals to develop their charges, revenue centers, and 
internal processes as they find appropriate. We have no reason to 
believe, in any given case other than a token charge reported according 
to CMS' instructions, that the charge on a claim is not an appropriate 
charge by a hospital established for that specific service.
    We agree that claims processing edits for services and items 
integral to the performance of certain OPPS procedures paid under the 
OPPS are an important element of our ratesetting methodology and, 
therefore, we will continue to require that correct devices be billed 
with certain HCPCS procedure codes for services that require devices. 
Moreover, we have expanded their use within and beyond device-dependent 
APCs (see sections II.A.2. and II.A.4.c.(5) of this final rule with 
comment period for a discussion of the March 2007 APC Panel's 
recommendation and measures we are taking to improve claims data for 
diagnostic radiopharmaceuticals by using edits). In general, however, 
we limit edits to the services, items, and procedures we believe 
require extra vigilance to capture all associated charges in 
recognition of the additional administrative burden these edits create 
for hospitals, and the inherent complexity of ensuring that the edits 
we do implement appropriately anticipate all clinical circumstances. 
Particularly for packaged items and services including expensive 
devices, we believe these edits ensure that high cost items are 
reported on appropriate claims, so that the procedural payment rates 
fully incorporate the costs of the items that are required for the 
procedures. For other items, services, and procedures, we believe that 
hospitals have strong incentives to report charges accurately to 
Medicare and all other payers, and that these charges are sufficient to 
provide accurate data. Another important component of ensuring we use 
the most accurate data available for OPPS device-dependent APC 
ratesetting is using the most current claims data and cost reports. 
Therefore, we believe that it would be inconsistent to wait until we 
have 2 full years of claims data before we update payment rates.
    We also do not believe it is necessary to adjust our standard 
device-dependent ratesetting methodology for CY 2008 by implementing a 
payment floor to ensure beneficiary access. The only decline of more 
than 10 percent between the CY 2008 final rule APC medians and the CY 
2007 final rule medians is found in APC 0418 (Insertion of Left 
Ventricular Pacing Electrode). As discussed in the proposed rule (72 FR 
42720), we believe that this decline and variation in the median cost 
for APC 0418 was the result of improvements in provider billing and a 
relatively small number of single bills from a small number of 
providers furnishing the service. We believe that the median cost we 
calculated from the CY 2006 data is a reasonable estimate of the cost 
of the insertion of the left ventricular lead. Furthermore, the 
fluctuation of payment rates is to a certain degree inherent and 
expected in a prospective payment system (see section II.A of this 
final rule with comment period for a broader discussion of the 
variation in APC payment rates from year to year). We note that we have 
put into place reverse device edits for CY 2007 that will continue in 
CY 2008, where we require hospitals reporting certain implantable 
device HCPCS codes, such as ICDs, to report an appropriate procedure 
for the device's use. We do not believe it is necessary to implement a 
payment floor for this procedure, or any other device-

[[Page 66742]]

dependent procedure, to prevent large decreases in payment.
    Comment: One commenter suggested that CMS should consider creation 
of composite APCs for device-dependent procedures, such as ICD 
implantation, where the device costs can vary significantly based on 
the type of device used. The commenter suggested that payment for these 
composite APCs would be based on the combination of the device 
implantation CPT code and the existing Level II HCPCS code for the 
particular device. According to the commenter, this would minimize 
administrative burden for providers, allow coding to remain consistent 
across payers, and enable more appropriate payment for procedures with 
varying device costs.
    Response: Composite APCs provide a single payment for two or more 
major procedures that are commonly performed together, in order to 
promote efficiency by increasing the size of the payment bundle. We do 
not agree that the payment methodology outlined by this commenter, to 
base payment on the combination of the device implantation CPT code and 
the existing device code, is consistent with the concept of composite 
APCs as described in the proposed rule and as finalized in section 
II.A.4.d. of this final rule with comment period. The scenario 
described by the commenter largely describes the current packaging of 
device payment into the payment for the procedure, except that we 
generally base payment on all of the devices associated with a 
procedure as a mechanism to promote the efficient utilization of 
resources. The recommended approach could actually reduce packaging 
under the OPPS by creating small and more specific payment bundles, 
rather than increasing the size of the payment bundles to provide 
hospitals with the flexibility to manage their resources as they 
control costs. To establish a separate APC for each combination of a 
procedure and a particular device used, as described by the commenter, 
would create incentives for the use of the most expensive device rather 
than creating incentives for efficiency and therefore is contrary to 
the principles of a prospective payment system.
    Comment: Several commenters requested that CMS use external data 
for ratesetting. While some commenters called for the broad-scale use 
of external data to identify and adjust payment for technologies they 
perceived to be underpaid both in the past and under the current 
proposal, other commenters focused on the use of external data in 
ratesetting for particular APCs (for example, several commenters asked 
that CMS redefine the token charge criteria and adjust payment for 
cochlear implants to reflect the device's estimated hospital invoice 
price). According to commenters, external data could be used to rectify 
the effects of charge compression, without committing CMS to reliance 
on any particular data source. In addition, commenters requested that 
CMS protect the confidentiality of any external data used in 
ratesetting, because manufacturers and hospitals may be unwilling to 
release proprietary information without assurances that CMS would not 
release that information to the public.
    Response: We review all information that is brought to our 
attention by stakeholders as part of the public comment process, and we 
have a general policy that all data we consider in ratesetting, whether 
internal or external, will be made available to the public, including 
any personally identifiable or confidential business information (for 
example, see the discussion of Inspection of Public Comments in the CY 
2008 OPPS/ASC proposed rule (72 FR 42628)). We have not systematically 
used external data to validate the median costs derived from claims 
data, because external data typically are furnished by parties with 
special interest in a particular item or service. The foundation of a 
system of relative weights is the relativity of the costs of all 
services to one another, as derived from a standardized system that 
uses standardized inputs and a consistent methodology. One of the 
principles behind the use of median costs for weight setting in a 
budget neutral payment system like the OPPS is to allow fair and 
equitable distribution of payment among hospitals, based on their mix 
of services provided to Medicare beneficiaries, by determining the 
appropriate relativity in resource use among services. The median costs 
are estimated relative costs that are converted to relative weights, 
scaled for budget neutrality, and then multiplied by a conversion 
factor to derive a payment under a prospective payment system that is 
not intended to pay reasonable costs. For these reasons, we believe 
that it is not appropriate to use external pricing information in place 
of the costs derived from the claims and Medicare cost report data, 
because we believe that to do so would distort the relativity that is 
so fundamental to the integrity of the OPPS. Similarly, we do not 
believe that it is reasonable or appropriate to exclude specific claims 
from ratesetting if the hospital charge for a particular item does not 
exceed an established threshold such as the manufacturer's estimated 
cost of the item.
    After considering the public comments received on this proposal, we 
are finalizing our proposed payment policies for device-dependent APCs, 
without modification, for CY 2008. The CY 2008 payment rates for 
device-dependent APCs are based on their median costs calculated from 
CY 2006 claims and the most recent cost report data, using only claims 
that pass the device edits, do not contain token charges for devices, 
and do not have a modifier signifying that the device was furnished 
without cost or with full credit. We do not think it is necessary or 
appropriate to apply a maximum payment reduction floor. Consistent with 
data from the proposed rule, payment rates based on final rule data 
show increases for the majority of APCs for which comparison to CY 2007 
payment rates is appropriate. As discussed in the proposed rule (72 FR 
42720 through 42721), we found these differences in payment rates from 
CY 2007 to CY 2008 to be attributable to a variety of factors, 
including the availability of more complete claims data for CY 2008 and 
the packaging approach that is new for CY 2008. Furthermore, as we have 
stated in the past, some variation in relative costs from year to year 
is be expected in a prospective payment system, particularly for low 
volume device dependent APCs such as APC O681 (Knee Arthroplasty), 
which increases 37 percent from CY 2007 to CY 2008. However, even in 
the case of these low volume device dependent APCs, we continue to 
believe that the median costs calculated from the single bills that 
meet the three criteria represent the most valid estimated relative 
costs of these services to hospitals when they incur the full cost of 
the devices required to perform the procedures. In addition, we note 
that we will maintain established device edits for procedures 
previously assigned to device-dependent APCs that were packaged or 
moved to APCs that are not device-dependent for CY 2008, in order to 
ensure that the full costs associated with these services continue to 
be represented adequately in claims data.
    Discussions of HCPCS code and APC-specific issues for device-
dependent APCs are found in section III.D. of this preamble, where 
other APC-specific policies are also discussed. As discussed in detail 
in section III.D.6.b. of this final rue with comment period, we are 
adding APC 0293 (Level V Anterior Segment Eye Procedures) to the

[[Page 66743]]

list of device-dependent APCs for CY 2008, as reflected in Table 24 
below.

                            Table 24.--CY 2008 Median Costs for Device-Dependent APCs
 [Note that N/A indicates APCs for which the CY 2007 OPPS medians are not comparable to the CY 2008 medians, due
                                      to HCPCS code migration for CY 2008.]
----------------------------------------------------------------------------------------------------------------
                                                                                                       Count of
                                                                CY 2007      CY 2008      CY 2008     providers
                                                               final rule   final rule   final rule   billing in
       APC                 SI                APC title         pass edit,   pass edit,   pass edit,   the final
                                                                nontoken     nontoken     nontoken     CY 2008
                                                              median cost  median cost   frequency       data
----------------------------------------------------------------------------------------------------------------
0039.............  S................  Level I Implantation        $11,451      $11,732        2,950          653
                                       of Neurostimulator.
0040.............  S................  Percutaneous                 $3,457       $4,013        5,177        1,040
                                       Implantation of
                                       Neurostimulator
                                       Electrodes, Excluding
                                       Cranial Nerve.
0061.............  S................  Laminectomy or               $5,145       $5,213        1,413          462
                                       Incision for
                                       Implantation of
                                       Neurostimulator
                                       Electrodes, Excluding
                                       Cranial Nerve.
0082.............  T................  Coronary or Non                 N/A       $5,506        4,758          962
                                       Coronary Atherectomy.
0083.............  T................  Coronary or Non                 N/A       $2,855       41,944        1,728
                                       Coronary Angioplasty
                                       and Percutaneous
                                       Valvuloplasty.
0084.............  S................  Level I                         N/A         $603        7,381          616
                                       Electrophysiologic
                                       Procedures.
0085.............  T................  Level II                        N/A       $2,976        4,291          719
                                       Electrophysiologic
                                       Evaluation.
0086.............  T................  Level III                       N/A       $5,842          420          164
                                       Electrophysiologic
                                       Procedures.
0089.............  T................  Insertion/Replacement        $7,557       $7,654          668          370
                                       of Permanent
                                       Pacemaker and
                                       Electrodes.
0090.............  T................  Insertion/Replacement        $6,007       $6,344          584          334
                                       of Pacemaker Pulse
                                       Generator.
0104.............  T................  Transcatheter                $5,360       $5,600          674          233
                                       Placement of
                                       Intracoronary Stents.
0106.............  T................  Insertion/Replacement        $3,138       $4,374          406          281
                                       of Pacemaker Leads
                                       and/or Electrodes.
0107.............  T................  Insertion of                $18,607      $21,001          501          228
                                       Cardioverter-
                                       Defibrillator.
0108.............  T................  Insertion/Replacement/      $23,205      $25,471        3,719          616
                                       Repair of
                                       Cardioverter-
                                       Defibrillator Leads.
0115.............  T................  Cannula/Access Device           N/A       $1,868        1,398          705
                                       Procedures.
0202.............  T................  Level VII Female             $2,627       $2,687       10,851        1,895
                                       Reproductive Proc.
0222.............  S................  Implantation of             $11,099      $15,150        1,465          612
                                       Neurological Device.
0225.............  S................  Implantation of             $13,514      $13,889          254          168
                                       Neurostimulator
                                       Electrodes, Cranial
                                       Nerve.
0227.............  T................  Implantation of Drug        $10,658      $11,569        1,117          477
                                       Infusion Device.
0229.............  T................  Transcatheter                $4,184       $5,570        8,004        1,256
                                       Placement of
                                       Intravascular Shunts.
0259.............  T................  Level VI ENT                $25,351      $24,739          868          174
                                       Procedures.
0293.............  T................  Level V Anterior                N/A      $5,335*          N/A          N/A
                                       Segment Eye
                                       Procedures.
0315.............  S................  Level II Implantation       $14,846      $16,988          691          203
                                       of Neurostimulator.
0384.............  T................  GI Procedures with           $1,402       $1,572        7,484        1,464
                                       Stents.
0385.............  S................  Level I Prosthetic           $4,840       $5,262          648          340
                                       Urological Procedures.
0386.............  S................  Level II Prosthetic          $8,396       $9,067        3,683          887
                                       Urological Procedures.
0418.............  T................  Insertion of Left           $18,778      $16,342          219          152
                                       Ventricular Pacing
                                       Elect.
0425.............  T................  Level II Arthroplasty        $6,551       $7,688          441          278
                                       with Prosthesis.
0427.............  T................  Level III Tube Changes          N/A         $966       13,556        1,293
                                       and Repositioning.
0622.............  T................  Level II Vascular            $1,385       $1,517       36,920        2,408
                                       Access Procedures.
0623.............  T................  Level III Vascular              N/A       $1,817       54,632        2,746
                                       Access Procedures.
0625.............  T................  Level IV Vascular            $5,100       $5,143            8            7
                                       Access Procedures.
0648.............  T................  Level IV Breast              $3,130       $3,560          503          321
                                       Surgery.
0652.............  T................  Insertion of                 $1,805       $1,932        3,801        1,099
                                       Intraperitoneal and
                                       Pleural Catheters.
0653.............  T................  Vascular                     $1,979       $2,546        1,700          713
                                       Reconstruction/
                                       Fistula Repair with
                                       Device.
0654.............  T................  Insertion/Replacement        $6,891       $6,876        1,896          634
                                       of a permanent dual
                                       chamber pacemaker.
0655.............  T................  Insertion/Replacement/       $9,328       $8,810        2,169          554
                                       Conversion of a
                                       permanent dual
                                       chamber pacemaker.
0656.............  T................  Transcatheter                $6,618       $7,451        3,486          399
                                       Placement of
                                       Intracoronary Drug-
                                       Eluting Stents.
0674.............  T................  Prostate Cryoablation.       $6,646       $7,720        2,222          383
0680.............  S................  Insertion of Patient         $4,437       $4,442        1,577          718
                                       Activated Event
                                       Recorders.
0681.............  T................  Knee Arthroplasty.....      $12,569      $17,281          317           59
----------------------------------------------------------------------------------------------------------------
\*\ In CY 2006, there were not HCPCS codes to describe all devices that could be used in this procedure.

3. Payment When Devices Are Replaced With Partial Credit to the 
Hospital
    In recent years there have been several field actions and recalls 
as a result of implantable device failures. In many of these cases, the 
manufacturers have offered replacement devices without cost to the 
hospital or credit for the device being replaced if the patient 
required a more expensive device. In order to ensure that the payment 
we proposed for CY 2008 pays hospitals appropriately when they incur 
the full cost of the device, we calculated the CY 2008 median costs for 
device dependent APCs using only claims that contain the correct device 
code for the procedure. We also did not use claims that contain token 
charges for these expensive devices or that contain the ``FB'' 
modifier, which would signify that the device was replaced without cost 
or with a full credit for the cost of the device being replaced. 
Similarly, to ensure equitable payment when the hospital receives a 
device without cost or receives a full credit for the cost of the 
device being replaced, for CY 2007 we implemented a payment policy that 
reduces the payment for selected device-dependent APCs when the 
hospital receives certain replacement

[[Page 66744]]

devices without cost or receives a full credit for the device being 
replaced (71 FR 68077).
    The CY 2007 final payment policy when devices are replaced without 
cost or when a full credit for a replaced device is furnished to the 
hospital applies to those APCs that meet three criteria as described in 
the CY 2007 OPPS/ASC final rule with comment period (71 FR 68072 
through 68077). Specifically, all procedures assigned to the selected 
APCs must require implantable devices that would be reported if device 
replacement procedures were performed, the required devices must be 
surgically inserted or implanted devices that remain in the patient's 
body after the conclusion of the procedures (at least temporarily), and 
the device offset amount must be significant, which for purposes of 
this policy is defined as exceeding 40 percent of the APC cost. We also 
restricted the devices to which the APC payment adjustment would apply 
to a specific set of costly devices to ensure that the adjustment would 
not be triggered by the replacement of an inexpensive device whose cost 
would not constitute a significant proportion of the total payment rate 
for an APC.
    As discussed in the CY 2008 proposed rule (72 FR 42726), we 
examined the offset amounts calculated from the CY 2008 proposed rule 
data and the clinical characteristics of APCs to determine whether the 
APCs to which the no cost or full credit replacement policy applies in 
CY 2007 continue to meet the criteria for CY 2008 and to determine 
whether other APCs to which the policy does not apply in CY 2007 would 
meet the criteria for CY 2008. Based on data available for the proposed 
rule, we concluded that one additional APC met the criteria for 
inclusion under this policy and that one APC currently on the list 
ceases to meet the criteria. Specifically, we proposed to add APC 0625 
(Level IV Vascular Access Procedures) to the list of APCs to be 
adjusted in cases of full or partial credit for replaced devices (as 
discussed below) and to add the device described by device code C1881 
(Dialysis access system (implantable)) that is implanted in a procedure 
assigned to APC 0625 to the list of devices to which this policy 
applies. We proposed to add APC 0625 and device code C1881 for CY 2008 
because they met the criteria for inclusion in this policy. In 
particular, the single surgical procedure (CPT code 36566 (Insertion of 
tunneled centrally inserted central venous access device, requiring two 
catheters via two separate venous access sites; with subcutaneous 
port(s)) assigned to APC 0625 always requires an implantable device 
that is reported, the proposed CY 2008 APC device offset percent was 
greater than 40 percent, and the device is of a type that is surgically 
implanted in the patient, where it remains at least temporarily. 
Furthermore, costly devices described by device code C1881 are 
implanted in the procedure assigned to APC 0625. We also found that APC 
0229 (Transcatheter Placement of Intravascular Shunts) ceased to meet 
the criteria because the device offset percent for this APC, when 
calculated from proposed rule data, was less than 40 percent. Moreover, 
we believed that the devices that would be implanted in the procedures 
assigned to this APC are not of a type that would be amenable to 
removal and replacement in a device recall or warranty situation. 
Therefore, we proposed to remove APC 0229 from the list of APCs to 
which the no cost or full credit and proposed partial credit reduction 
policies would be applicable for CY 2008. Table 38 of the proposed rule 
(42 CFR 42727) contained the device offset amounts that we proposed to 
apply to the specified APCs in cases of no cost or full or partial 
credit for replaced devices for the CY 2008 OPPS.
    As discussed in the proposed rule (72 FR 42724), subsequent to the 
issuance of the CY 2007 OPPS/ASC final rule with comment period, we had 
many inquiries from hospitals that asked whether the reduction would 
also apply in cases in which there was a partial credit for the cost of 
a device that failed or was otherwise covered under a manufacturer 
warranty. Those inquiring explained that cases of partial credit are 
the vast majority of cases involving devices that have failed or 
otherwise must be replaced under warranty. They indicated that in some 
cases the devices failed, and in other situations the patient's energy 
needs exceeded the capacity of the device and thus the device ceased to 
be useful before the end of the warranty period. They told us that a 
typical industry practice for some types of devices was to provide a 50 
percent credit in cases of device failure (including battery depletion) 
under warranty if a device failed at 3 years of use (failure during the 
first 3 years would result in a full device credit). The credit would 
be prorated further over time between 3 and 5 years after the initial 
device implantation, as the useful life of the device declined. As 
promulgated in the CY 2007 OPPS/ASC final rule with comment period and 
codified at Sec.  419.45, the CY 2007 reduction policy does not apply 
to cases in which there is a partial credit toward the replacement of 
the device.
    In addition to our concern over the replacement of implantable 
devices at no cost to hospitals due to device recalls, device failure, 
or other clinical situations, we believed that it is equally as 
important that timely information be reported and analyzed regarding 
the performance and longevity of devices replaced in partial credit 
situations. This issue is particularly timely due to the recent recall 
of 73,000 ICDs and cardiac resynchronization therapy defibrillators 
(CRT-Ds) because of a faulty capacitor that can cause the batteries to 
deplete sooner than expected. In some cases, patients will require more 
frequent monitoring of their device function and early device 
replacement. (We refer readers to the Web site: http://www.fda.gov/cdrh/news for Questions and Answers posted April 20, 2007 on this 
recall.) Therefore, we believed that hospitals should report 
occurrences of devices being replaced under warranty or otherwise with 
a partial credit granted to the hospital so that we could identify 
systematic failures of devices or device problems through claims 
analysis and so that we could make appropriate payment adjustments in 
these cases. Collecting data on a wider set of device replacements 
under full and partial credit situations would assist in developing 
comprehensive summary data, not just a subset of data related to 
devices replaced without cost or with a full credit to the hospital. In 
the proposed rule, we explained that we are mindful of the need to use 
our claims history, where possible, to promote early awareness of 
problems with implantable medical devices and to promote high quality 
medical care with regard to the devices and the services in which they 
are used.
    We also are concerned with the issue of the increased Medicare and 
beneficiary liability for the monitoring costs that are required as a 
result of the worldwide recall of these 73,000 devices. Specifically, 
the manufacturer of the devices that have been most recently recalled 
recommends that patients with the recalled device consult with their 
physician in each case and, in some cases, begin a routine of monthly 
evaluations. We would expect that not only could extra visits to 
physicians' offices or HOPDs be necessary, but additional diagnostic 
tests may also be needed to care for the beneficiaries who have the 
recalled devices. Thus, even when the device does not immediately 
require replacement, we are concerned that the potential greater costs 
to Medicare and to the beneficiary or his or her

[[Page 66745]]

secondary payor for these unforeseen extra services may be substantial 
and burdensome. We will be actively assessing how we can identify 
additional health care costs and Medicare expenditures associated with 
device recall actions and exploring what actions could be appropriate 
in the case of these additional monitoring and related expenses. In the 
proposed rule, we specifically invited public comment on this issue to 
inform our future review and analyses (72 FR 42724).
    Moreover, the payment rates for the APCs into which the costs of 
the most expensive devices are packaged are set based on the assumption 
that the hospital incurs the full cost of the device. To continue to 
pay the full APC rate when the hospital receives a partial credit 
toward the cost of a very expensive device would result in excessive 
and inappropriate payment for the procedure and its packaged costs. 
Some hospitals have told us that they do not reduce their charges for 
the device being implanted or used in the procedure in cases in which 
they receive a partial credit for the device, even in cases in which 
the credit is for as much as 50 percent of the cost of an expensive 
device.
    For CY 2008, we proposed to create an HCPCS modifier that would be 
reported in all cases in which the hospital receives a partial credit 
toward the replacement of a medical device listed in Table 39 of the 
proposed rule (72 FR 42727). These devices are the same devices to 
which our policy governing payment when the device is furnished to the 
provider without cost or with full credit would apply for CY 2008. As 
we discussed in the CY 2007 OPPS/ASC final rule with comment period (71 
FR 68071), we selected these devices because they have substantial 
device costs and because the device is implanted in the beneficiary at 
least temporarily and, therefore, can be associated with an individual 
beneficiary. This proposed partial credit policy would enhance our 
ability to track the replacement of these implantable medical devices 
and may permit us to identify trends in device failure or limited 
longevity. Moreover, it would enable us to reduce the APC payment in 
cases in which the hospital receives a partial credit towards the cost 
of the replacement device being implanted. We believed that this 
proposal was a logical extension of our policy regarding reduction of 
the APC payment in cases in which the provider furnishes the device 
without cost or with a full credit to the hospital.
    Specifically, as discussed in more detail below, we proposed to 
reduce the payment for the APC into which the device cost is packaged 
by one half of the amount of the offset amount that would apply if the 
device were being replaced without cost or with full credit, but only 
where the amount of the device credit is greater than or equal to 20 
percent of the cost of the new replacement device being implanted. We 
also proposed to base the beneficiary's copayment on the reduced APC 
payment rate so that the beneficiary shares in the hospital's reduced 
costs. We believed that it would be inequitable to set the payment 
rates for the procedures into which payment for these devices is 
packaged on the assumption that the hospital always incurs the full 
cost for these expensive devices but to not adjust the payment when the 
hospital receives a partial credit for a failed or otherwise replaced 
device. Accordingly, we believed that it would be appropriate to make 
an equitable adjustment to the APC payment to ensure that the Medicare 
program payment made for the service and the beneficiary's liability 
are appropriate in these cases in which the hospital's device costs are 
significantly reduced. We proposed changes to Sec.  419.45(a) and (b) 
to reflect our proposed policy of reducing the OPPS payment when 
partial credit for the device cost is received by the hospital for a 
failed or otherwise replaced device.
    Due to the absence of current reporting of the cases in which 
hospitals receive a partial credit for replaced devices and to our 
belief, based on conversations with hospital staff, that hospitals do 
not reduce their device charges to reflect the credits, we had no data 
to determine empirically by how much we should reduce the payment for 
the procedural APC into which the costs of these devices are packaged. 
However, device manufacturers and hospitals have told us that a common 
scenario is that, if a device fails 3 years after implantation, the 
hospital would receive a 50 percent credit towards a replacement 
device. Therefore, we proposed to reduce the payment for these device-
dependent APCs by half of the reduction that would apply when the 
hospital receives a device without cost or receives a full credit for a 
device being replaced. That is, we proposed to reduce the payment for 
the APC by half of the offset amount that represents the cost of the 
device packaged into the APC payment. In the absence of claims data on 
which to base a reduction factor, but taking into consideration what we 
have been told is common industry practice, we believed that reducing 
the amount of payment for the device dependent APC by half of the 
estimated cost of the device packaging represents a reasonable and 
equitable reduction in these cases.
    In the proposed rule (72 FR 42725), we also considered whether to 
propose to require hospitals to reduce their charges in proportion to 
the partial credit they receive for the device so that, in future 
years, we would have cost data reported consistently on which we could 
consider basing the amount of reduction to the payment for the 
procedure in cases of a partial device credit. However, we were 
concerned that such a requirement could impose an administrative burden 
on hospitals that would outweigh the potential benefit of a more 
accurate reduction to payment in these cases. Therefore, we 
specifically requested comments on the extent to which any 
administrative burden would be balanced or compensated for by the 
potential payment accuracy benefit of an empirically based reduction to 
payment in these cases (72 FR 42725).
    In addition, we proposed to take this reduction only when the 
credit is for 20 percent or more of the cost of the new replacement 
device, so that the reduction would not be taken in cases in which more 
than 80 percent of the cost of the replacement device has been incurred 
by the hospital. We were concerned that the burden to hospitals of 
requiring that they report cases in which the partial credit for the 
device being replaced is less than 20 percent of the cost of the new 
replacement device would be greater than the benefit to the Medicare 
program and the beneficiary. In addition, if the partial credit is less 
than 20 percent of the cost of the new replacement device, then 
reducing the APC payment for the device implantation procedure by 50 
percent of the packaged device cost would provide too low a payment to 
hospitals providing the necessary device replacement procedures. 
Therefore, we proposed that the new HCPCS partial credit modifier would 
be reported and the partial credit reduction would be taken only in 
cases in which the credit is equal to or greater than 20 percent of the 
cost of the new replacement device.
    As discussed in the proposed rule (72 FR 42725), even in the 
absence of specific instructions to reduce the device charges in 
partial credit cases, we could monitor the charges that are submitted 
for devices reported with the proposed partial credit modifier to see 
if hospitals appear to be reflecting partial device credits in their 
charges for these implantable devices. We believed that we could use 
pattern analysis to

[[Page 66746]]

determine if a hospital that is reporting the device with the partial 
credit modifier is charging at a lower rate for the same device when 
the modifier appears with the procedure in which the device is used 
than in cases without reporting of the modifier. As proposed, if we 
found that hospitals were adjusting their charges to reflect the 
reduced costs of these devices, we would explore whether revising the 
amount of the reduction could be appropriate.
    In summary, we proposed the following: (1) To create a HCPCS 
modifier to be reported on a procedure code listed in Table 38 of the 
proposed rule if a device listed in Table 39 of that rule is replaced 
with partial credit from the manufacturer that is greater than or equal 
to 20 percent of the cost of the replacement device; and (2) to reduce 
the payment for the procedure by 50 percent of the amount of the 
estimated packaged cost of the device being replaced when the modifier 
is reported with a procedure code that is assigned to an APC in Table 
38. We believed that this policy is necessary to pay equitably for 
these services when the hospital receives a partial credit for the cost 
of the device being implanted.
    At the September 2007 meeting of the APC Panel, the Panel 
recommended that CMS explore whether hospitals could report a modifier 
to reflect the amount of a partial credit for a device as a percentage 
of the cost of the replacement device. According to the Panel, this 
approach could signify that there was a partial credit and provide data 
for use in determining the amount of reduction that could be taken in 
future years.
    We received many public comments on our proposal to reduce the APC 
payment for certain implantation procedures when specific devices are 
replaced with a partial credit to the hospital. A summary of the public 
comments and our responses follow.
    Comment: The majority of commenters agreed that neither Medicare 
nor beneficiaries should have to pay based on a device's full cost when 
the hospital receives a substantial credit from the manufacturer for 
that device, and supported the premise underpinning the proposed policy 
that hospitals'' charges and OPPS payment rates based on those charges 
currently do not reflect partial credits for replaced devices. Some 
commenters argued, however, that all manufacturer rebates, from volume 
discounts to partial credits for replaced devices, are applied to 
hospitals' cost reports, and as such are reflected in hospitals' CCRs. 
Others said that hospitals often do adjust their charges to reflect 
partial credits for replaced devices and that a payment adjustment in 
such cases was not necessary, because payment rates calculated 
according to the standard OPPS ratesetting methodology for device-
dependent APCs already reflect such occurrences. Those opposed to the 
proposed policy in its entirety also noted that it would be 
operationally and administratively difficult to implement and that it 
would result in insufficient payment to hospitals.
    Most commenters that agreed with the premise behind the proposed 
policy to reduce Medicare payment for devices replaced with partial 
credit supported implementation of the proposed policy, but requested 
modifications or a delay in implementation of the policy. The majority 
of these commenters argued that CMS should raise the partial credit 
threshold to which this policy would apply to 50 percent of the cost of 
the replacement device, consistent with the policy CMS recently 
implemented for devices replaced with partial credit for services paid 
under the FY 2008 IPPS. Commenters stated that consistency in policies 
across hospital inpatient and outpatient payment systems would reduce 
confusion, promote compliance, and decrease the administrative burden 
for hospitals. The commenters also argued that a threshold as low as a 
20 percent credit toward the cost of the replacement device would not 
justify the operational and administrative burdens of returning the 
replaced devices to manufacturers for evaluation and applying manual 
billing adjustments. They were concerned that because of these 
administrative burdens, hospitals may not return the failed devices to 
manufacturers at all, thereby interfering with manufacturers' quality 
surveillance programs and preventing the type of data collection the 
proposed policy is meant to promote. According to commenters, a 
threshold of 50 percent would ensure that hospitals do not have to deal 
with these administrative burdens when the credit is nominal or 
relatively inconsequential relative to the overall procedure payment 
and unlikely to result in significant savings to the Medicare program. 
Some commenters noted that a partial credit threshold of 20 percent, 
with a payment reduction of 50 percent, would result in inadequate 
payment to hospitals when the credit received was anywhere between 20 
percent and 50 percent of the cost of the device.
    Response: We agree with the commenters' concerns regarding the 
threshold percentage to which a partial credit adjustment would be 
applied. We are increasing the threshold to which the partial credit 
reduction policy will apply to cases involving a credit of 50 percent 
or more toward the total cost of the replacement device. Commenters 
expressed significant concerns about potential administrative and 
operational burdens associated with partial credits for small 
percentages of device costs, and we agree that the partial credit 
adjustment policy should not apply if only a nominal portion of the 
cost of the device is at issue. We also agree that consistency in 
payment policies across hospital inpatient and outpatient payment 
systems is important and should be maintained whenever appropriate, as 
is true in this case. Raising the partial credit threshold to which 
this policy will apply also addresses concerns that the 50 percent 
reduction to Medicare payment for the replaced device would be more 
than the partial credit received in some cases.
    We disagree with assertions that OPPS payment for device-dependent 
APCs already reflects partial credits to hospitals for replaced 
devices. We go to great lengths to ensure that payment rates for 
device-dependent APCs reflect the full costs of devices by excluding 
claims that contain token charges and/or the ``FB'' modifier. We 
continue to believe that in most cases, hospitals charge the full 
amount for the replaced device, although they may have incurred much 
less than the full cost of the device. While it may be true that some 
hospitals adjust their charges to reflect the partial credits they 
receive for replaced devices, we believe this is a small minority. 
Therefore, we believe our ratesetting methodology generally results in 
median costs that reflect the full costs of these devices. We also 
continue to believe that it is likely the reduced hospital costs 
associated with steady, low volume warranty replacements of implantable 
devices may never be reflected in the CCRs used to adjust charges to 
costs for devices, because those CCRs are overwhelmed by the volume of 
other items attributed to the cost centers. Therefore, our median costs 
for device-dependent APCs would not reflect the reduced hospital costs 
associated with partial credit device replacement procedures.
    As discussed in the proposed rule (72 FR 42725 through 42726), we 
also do not agree that hospitals would refrain from returning a device 
removed from a patient to a manufacturer in order to justify not 
reporting the partial credit modifier to Medicare. We continue to 
believe that hospitals have a strong interest in ensuring that 
manufacturers know as soon as possible when there are problems with the 
devices provided to their patients, whether the result would

[[Page 66747]]

be a full or partial credit for the failed device. In addition, we 
believe that hospitals, key participants in the broader healthcare 
system, are concerned with device performance, patient health, and 
health care quality from the broader public health perspective and are 
committed to appropriate reporting to improve the quality of future 
health care that leads to better health outcomes for patients. 
Moreover, we do not believe that hospitals would intentionally fail to 
report to Medicare the service furnished correctly and completely with 
the partial credit modifier when the modifier applies, because the 
hospital would then knowingly submit incorrect information on the 
claim.
    Comment: Many commenters urged OPPS adoption of the same billing 
options for hospitals as are available under the IPPS for billing 
devices replaced with partial credit. Specifically, they requested 
hospitals be allowed to: (1) Submit the claims for replacement devices 
immediately without the HCPCS modifier signifying partial credit for a 
replacement device and later, if a credit is ultimately issued, submit 
a claim adjustment with the appropriate coding; or (2) hold the claim 
until a credit determination is made. According to the commenters, 
credits are determined after a case-by-case review by the manufacturer 
following explant and replacement of the device, which can take 8 weeks 
or longer. During this time, hospitals often do not know whether or how 
much credit the manufacturer will provide and cannot submit a bill for 
the replacement device implantation procedure, creating substantial 
payment delays. In addition, commenters were concerned about the 
administrative burden of providing paper invoices or other information 
to their fiscal intermediary or MAC indicating the hospital's normal 
cost of the device or the amount of the credit received.
    Several commenters referenced the September 2007 meeting of the APC 
Panel, where the Panel recommended that CMS explore whether hospitals 
could report a modifier to reflect the amount of a partial credit for a 
device as a percentage of the amount of the replacement device. While 
one commenter supported this approach, other commenters expressed 
concerns about the administrative burden associated with this 
alternative. They stated that constructing a modifier in this way may 
be too easily confused with existing numeric modifiers used in 
conjunction with CPT coding. Commenters also shared CMS' concerns about 
hospitals reducing their charges in proportion to the partial credit 
they receive for a replaced device. They encouraged CMS to work with 
providers to develop the least burdensome approach to incorporate 
payment reductions for devices replaced with partial credit based on 
empirical data.
    Response: In order to report that they received a partial credit of 
50 percent or more of the cost of a replacement device, hospitals will 
have the option of either: (1) Submitting the claims immediately 
without the HCPCS modifier signifying partial credit for a replacement 
device and submitting a claim adjustment with the HCPCS modifier at a 
later date once the credit determination is made; or (2) holding the 
claim until a determination is made on the level of credit. We 
understand commenters' concerns about potential delays that could occur 
while a returned device is being evaluated to determine whether and by 
how much a credit will be applied. We agree that hospitals should have 
the same billing options, when appropriate, under the OPPS as are 
available under the IPPS. As described in the FY 2008 IPPS final rule 
(72 FR 47250), we believe that these billing options will facilitate 
more efficient administration of the policy by allowing the hospital to 
gather and report all of the information it needs to be paid correctly 
by Medicare, without the need to suspend claims or delay payment.
    We share commenters' concerns about the administrative and coding 
burdens that could be associated with the September 2007 APC Panel's 
recommendation to report a modifier to reflect the amount of a partial 
credit for a device as a percentage of the cost of the replacement 
device so we are not adopting that recommendation for CY 2008. We also 
note that the claims processing system for Part B hospital outpatient 
bills does not have the capacity to accommodate non-uniform HCPCS 
modifiers. Instead, CMS will recognize a new ``FC'' modifier, effective 
January 1, 2008, that reads: ``Partial credit received for replaced 
device.'' Hospitals will be instructed to append the modifier to the 
HCPCS code for the procedure in which the device was inserted on claims 
when the device that was replaced with partial credit under warranty, 
recall, or field action is one of the devices in Table 26 below 
(hospitals should not append the modifier to the HCPCS procedure code 
if the device is not listed in Table 26). Claims containing the ``FC'' 
modifier will not be accepted unless the modifier is on a procedure 
code with status indicator ``S,'' ``T,'' ``V,'' or ``X.'' If the APC to 
which the procedure code is assigned is one of the APCs listed in Table 
25 below, the fiscal intermediary or MAC will reduce the unadjusted 
payment rate for the procedure by an amount equal to the percent in 
Table 26 for partial credit device replacement multiplied by the 
unadjusted payment rate (if the ``FC'' modifier is assigned to a 
procedure code that is not in Table 26, then no adjustment will be 
taken). The adjustment amounts for no cost, full credit, and partial 
credit cases are included in Table 25 below.
    We believe that it is appropriate to treat the services subject to 
the APC payment reduction in cases of devices replaced with partial 
credit like any other service, and to apply the standard reduction 
policies. Therefore, the partial credit adjustment will occur before 
wage adjustment and before the assessment to determine if the 
reductions for multiple procedures (signified by the presence of more 
than one procedure on the claim with status indicator ``T''), 
discontinued services (signified by modifier 73) or reduced services 
(signified by modifier 52) apply, similar to what occurs when a device 
is replaced at full credit or with no cost to the hospital (see 71 FR 
68076 for more discussion).
    Comment: Some commenters requested that we provide clarification of 
key elements of the proposal, stating that it was unclear what ``cost'' 
should be considered when determining the situations to which the 
partial credit policy should apply, and what constitutes a 
``replacement'' device. For example, some commenters pointed out that 
volume discounts can result in reduced costs for hospitals, and that at 
times devices are replaced at full cost when a new, improved technology 
becomes available. Some commenters also expressed interest in any OPPS 
data we may have about the number of cases to which this policy would 
apply.
    Response: The partial credit policy only applies when hospitals 
receive partial credit for the cost of a device that is replaced due to 
failure or other problems while the device is still under warranty, or 
when there is a recall or field action. The policy does not apply when 
hospitals receive routine rebates such as volume discounts. Hospitals 
should continue to incorporate these other types of rebates into their 
cost reports so that these savings will be reflected in the hospitals' 
CCRs. Neither the partial credit payment reduction for replaced 
devices, nor the payment reduction for devices replaced with full 
credit or at no cost, apply if the hospital pays the full price for the 
device.
    We acknowledge the interest providers have in the data resulting

[[Page 66748]]

from our reporting requirements for devices replaced at no cost or with 
full or partial credit. We will consider what types of information 
could be of value to hospitals as we continue to analyze claims-based 
reporting of full and partial device credit cases, particularly when CY 
2007 claims data become available.
    Comment: One commenter objected to the application of a different 
offset percentage to APC 0385 (Level I Prosthetic Urological 
Procedures) than to APC 0386 (Level II Prosthetic Urological 
Procedures) for purposes of the adjustment when a device is replaced in 
cases of no cost or full or partial credit. The commenter stated that 
the ratio of device costs to overall procedure costs is identical in 
APCs 0385 and 0386, and that the device offset percentage should be at 
least 80 percent for both APCs.
    Response: Our hospital claims data and cost reports indicate the 
device offset percentage for APC 0385 is 52 percent, and the device 
offset percentage for APC 0386 is 64 percent, calculated according to 
our standard methodology for establishing the device offset percentage 
(71 FR 68073). Because the surgical procedures assigned to these two 
APCs are different from one another from clinical and resource 
perspectives as evidenced by the CY 2008 median costs of approximately 
$5,262 and $9,067 for APCs 0385 and 0386, respectively, and because the 
distinct HCPCS device codes allowed in the procedure-to-device-edits 
for the various services assigned to the two APCs are different, we 
would expect that their device offset percentages also would differ. 
Therefore, we conclude that the device cost in APC 0386 is higher than 
the device cost in APC 0385, and that neither device offset percentage 
should be equal to 80 percent.
    After consideration of the public comments received, we are 
finalizing a modified policy for certain procedures involving partial 
credit for a replacement device. Specifically, we will reduce the 
payment for an implantation procedure assigned to APCs listed in Table 
25, below, by one half of the device offset that would be applied if a 
replacement device were provided at no cost or with full credit, if the 
credit is 50 percent or more of the replacement device cost. We will 
recognize the new modifier ``FC'' for reporting these cases, and we are 
not adopting the recommendation of the APC Panel to utilize a modifier 
that specifically reflects the amount of a partial credit for a device 
as a percentage of the cost of the replacement device. Accordingly, we 
are implementing the proposed changes to Sec. Sec.  419.45(a) and (b) 
with modification to reflect the 50 percent partial device credit 
threshold to which the policy will apply. Beneficiary copayment will be 
based on the reduced payment amount. We will continue to evaluate how 
we might refine our methodology for reducing the payment for the 
procedural APCs into which the costs of the devices in 25 below are 
packaged based on the claims data we receive as this policy is 
implemented. We also will continue to monitor charges that are 
submitted for devices reported with the partial credit modifier ``FC'' 
to see if hospitals appear to be reflecting partial device credits in 
their charges for these implantable devices.
    We also are implementing our proposals to add APC 0625 to the list 
of APCs to be adjusted in cases of no cost or full or partial credit 
for replaced devices, to remove APC 0229 from that list, and to add the 
device described by device code C1881 that is implanted in a procedure 
assigned to APC 0625 to the list of devices to which this policy 
applies.

                            Table 25.--Adjustments to APCs in Cases of No Cost or Full or Partial Credit for Replaced Devices
--------------------------------------------------------------------------------------------------------------------------------------------------------
                                                                              CY 2007      CY 2008      CY 2008                   CY 2008      CY 2008
                                                                             reduction    reduction    reduction     CY 2008      adjusted     adjusted
          APC                     SI                     APC title            for full     for full   for partial    payment    payment for  payment for
                                                                            credit case  credit case  credit case      rate     full credit    partial
                                                                              (percent)    (percent)    (percent)                   case     credit case
--------------------------------------------------------------------------------------------------------------------------------------------------------
0039..................  S.....................  Level I Implantation of           78.85        82.73        41.37      $11,877       $2,051       $6,964
                                                 Neurostimulator.
0040..................  S.....................  Percutaneous Implantation         54.06        56.27        28.14        4,063        1,777        2,920
                                                 of Neurostimulator
                                                 Electrodes, Excluding
                                                 Cranial Nerve.
0061..................  S.....................  Laminectomy or Incision           60.06        60.60        30.30        5,278        2,079        3,679
                                                 for Implantation of
                                                 Neurostimulator
                                                 Electrodes, Excluding
                                                 Cranial Nerve.
0089..................  T.....................  Insertion/Replacement of          77.11        72.99        36.50        7,748        2,093        4,921
                                                 Permanent Pacemaker and
                                                 Electrodes.
0090..................  T.....................  Insertion/Replacement of          74.74        76.01        38.01        6,423        1,541        3,982
                                                 Pacemaker Pulse Generator.
0106..................  T.....................  Insertion/Replacement/            41.88        56.25        28.13        4,428        1,937        3,183
                                                 Repair of Pacemaker and/
                                                 or Electrodes.
0107..................  T.....................  Insertion of Cardioverter-        90.44        89.11        44.56       21,262        2,315       11,789
                                                 Defibrillator.
0108..................  T.....................  Insertion/Replacement/            89.40        89.24        44.62       25,787        2,775       14,281
                                                 Repair of Cardioverter-
                                                 Defibrillator Leads.
0222..................  S.....................  Implantation of                   77.65        84.86        42.43       15,337        2,322        8,830
                                                 Neurological Device.
0225..................  S.....................  Implantation of                   79.04        80.57        40.29       14,061        2,732        8,397
                                                 Neurostimulator
                                                 Electrodes, Cranial Nerve.
0227..................  T.....................  Implantation of Drug              80.27        80.73        40.37       11,713        2,257        6,985
                                                 Infusion Device.
0259..................  T.....................  Level VI ENT Procedures...        84.61        82.94        41.47       25,046        4,273       14,659
0315..................  S.....................  Level II Implantation of          76.03        86.15        43.08       17,199        2,382        9,790
                                                 Neurostimulator.
0385..................  S.....................  Level I Prosthetic                83.19        51.56        25.78        5,327        2,580        3,954
                                                 Urological Procedures.

[[Page 66749]]

 
0386..................  S.....................  Level II Prosthetic               61.16        63.53        31.77        9,180        3,348        6,264
                                                 Urological Procedures.
0418..................  T.....................  Insertion of Left                 87.32        82.52        41.26       16,544        2,892        9,718
                                                 Ventricular Pacing Elect.
0625..................  T.....................  Level IV Vascular Access            N/A        58.88        29.44        5,207        2,141        3,674
                                                 Procedures.
0654..................  T.....................  Insertion/Replacement of a        77.35        77.13        38.57        6,961        1,592        4,276
                                                 permanent dual chamber
                                                 pacemaker.
0655..................  T.....................  Insertion/Replacement/            76.59        74.62        37.31        8,919        2,264        5,591
                                                 Conversion of a permanent
                                                 dual chamber pacemaker.
0680..................  S.....................  Insertion of Patient              76.40        73.15        36.58        4,497        1,208        2,852
                                                 Activated Event Recorders.
0681..................  T.....................  Knee Arthroplasty.........        73.37        82.86        41.43       17,495        2,993       10,244
--------------------------------------------------------------------------------------------------------------------------------------------------------


   Table 26.--Devices for Which the ``FB'' or ``FC'' Modifier Must Be
Reported with the Procedure Code When Furnished Without Cost/Full Credit
                 or Partial Credit for a Replaced Device
------------------------------------------------------------------------
         Device HCPCS code                    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.
C1881.............................  Dialysis access system.
C1882.............................  AICD, other than sing/dual.
C1891.............................  Infusion pump, non-prog, perm.
C1895.............................  Lead, AICD, endo dual coil.
C1896.............................  Lead, AICD, non sing/dual.
C1897.............................  Lead, neurostim, test kit.
C1898.............................  Lead, pmkr, other than trans.
C1899.............................  Lead, pmkr/AICD combination.
C1900.............................  Lead coronary venous.
C2619.............................  Pmkr, dual, non rate-resp.
C2620.............................  Pmkr, single, non rate-resp.
C2621.............................  Pmkr, other than sing/dual.
C2622.............................  Prosthesis, penile, non-inf.
C2626.............................  Infusion pump, non-prog, temp.
C2631.............................  Rep dev, urinary, w/o sling.
L8614.............................  Cochlear device/system.
------------------------------------------------------------------------

B. Pass-Through Payments for Devices

1. Expiration of Transitional Pass-Through Payments for Certain Devices
a. Background
    Section 1833(t)(6)(B)(iii) of the Act requires that, under the 
OPPS, a category of devices be eligible for transitional pass-through 
payments for at least 2, but not more than 3, years. This period begins 
with the first date on which a transitional pass-through payment is 
made for any medical device that is described by the category. The 
device category codes became effective April 1, 2001, under the 
provisions of the BIPA. Prior to pass-through device categories, 
Medicare payments for pass-through devices under the OPPS were made on 
a brand-specific basis. All of the initial 97 category codes that were 
established as of April 1, 2001, have expired; 95 categories expired 
after CY 2002, and 2 categories expired after CY 2003. In addition, 
nine new categories have expired since their creation. The three 
categories listed in Table 40 of the CY 2008 OPPS/ASC proposed rule, 
along with their expected expiration dates, were established for pass-
through payment in CY 2006 or CY 2007, as noted. Under our established 
policy, we base the expiration dates for the category codes on the date 
on which a category was first eligible for pass-through payment.
    Of these 3 device categories, there is 1 that would be eligible for 
pass-through payment for at least 2 years as of December 31, 2007; that 
is, device category code C1820 (Generator, neurostimulator 
(implantable), with rechargeable battery and charging system). In the 
CY 2007 OPPS/ASC final rule with comment period (71 FR 68078), we 
finalized our proposal to expire device category C1820 from pass-
through device payment after December 31, 2007.
    In the November 1, 2002 OPPS final rule, we established a policy 
for payment of devices included in pass-through categories that are due 
to expire (67 FR 66763). For CY 2003 through CY 2007, we packaged the 
costs of the devices no longer eligible for pass-through payments into 
the costs of the procedures with which the devices were reported in the 
claims data used to set the payment rates for those years. 
Brachytherapy sources, which are now separately paid in accordance with 
section 1833(t)(2)(H) of the Act, are an exception to this established 
policy (with the exception of brachytherapy sources for prostate 
brachytherapy, which were packaged in the CY 2003 OPPS only).
b. Final Policy
    In the CY 2008 OPPS/ASC proposed rule, we stated that we were 
implementing in CY 2008 the final decision that we discussed in the CY 
2007 OPPS/ASC final rule with comment period that finalized the 
expiration date of pass-through status for device category C1820 (71 FR 
68078). Therefore, as of January 1, 2008, we will discontinue pass-
through payment for device category code C1820. In accordance with our 
established policy, we will package the costs of the device assigned to 
this device category into the costs of the procedures with which the 
device was billed in CY 2006, the year of hospital claims data used for 
this OPPS update. See section III.D.8. of this final rule with comment 
period for a discussion of our

[[Page 66750]]

final CY 2008 payment for the implantation of neurostimulators.
    The 2 device categories that were established for pass-through 
payment as of January 1, 2007, HCPCS code C1821 (Interspinous process 
distraction device (implantable)) and HCPCS code L8690 (Auditory 
osseointegrated device, includes all internal and external components), 
will be active categories for pass-through payment for 2 years as of 
December 31, 2008. Therefore, we proposed that these categories expire 
from pass through device payment as of December 31, 2008.
    We received a number of public comments concerning this proposal. A 
summary of the public comments and our responses follow.
    Comment: A number of commenters objected to our proposal to expire 
device category L8690 from pass-through payment after December 31, 2008 
and recommended that we maintain category code L8690 on pass-through 
status until the end of CY 2009, allowing a third year of pass-through 
payment. These commenters claimed that one year of claims data, that 
is, CY 2007 (which would be used to develop the CY 2009 payment rates 
for the associated implantation procedures) would be insufficient to 
establish an accurate procedure payment rate that reflected the costs 
of implanting the device. They based this recommendation on several 
reasons. They claimed that there were low volumes of charges by 
hospitals to Medicare for HCPCS code L8690. One of the commenters, the 
applicant to establish the pass-through category, projected utilization 
of 525 devices in the first year of device pass-through payment at the 
time of the application, but stated that CMS CY 2006 claims data for 
the proposed rule included only 230 total claims for procedures to 
implant the device. The commenter indicated that it did not expect the 
number of implantation procedures to increase substantially in CYs 2007 
and 2008. Commenters also claimed that given the history of hospital 
billing problems for implantable devices, the new code L8690 was 
generally unknown in CY 2006 and some data might not have been 
accurately reported. Several commenters explained that the four 
different procedure codes associated with implantation of 
osseointegrated devices, CPT codes 69714 (Implantation, osseointegrated 
implant, temporal bone, with percutaneous attachment to external speech 
processor/cochlear stimulator; without mastoidectomy) through 69718 
(Replacement (including removal of existing device), osseointegrated 
implant, temporal bone, with percutaneous attachment to external speech 
processor/cochlear stimulator; with mastoidectomy) demonstrated wide 
variation in hospital costs, from $5,200 through $9,200, and this cost 
variation also pointed to current insufficient data for the procedures 
to implant osseointegrated devices. One commenter recommended that we 
extend pass-through status for L8690 through CY 2010.
    Response: Several commenters reported that the procedures in which 
L8690 was implanted were low volume OPPS procedures. We agree that 
these procedures were low volume in CY 2006, with only 255 total claims 
under the OPPS. However, we would not expect that these procedures 
would ever be commonly performed in the Medicare population because the 
specific clinical indications for implantation of osseointegrated 
implants are most frequently found in younger populations. Therefore, 
the osseointegrated implant procedures would likely continue to exhibit 
low claim volumes relative to many other procedures paid under the 
OPPS. In fact, the projected utilization of 525 devices by one 
commenter for CY 2006 would also be considered low volume for the OPPS, 
but we regularly pay prospectively for many services where there are 
fewer than several hundred OPPS services performed each year. We 
believe that several hundred implantation procedure claims from CY 2007 
should be sufficient for CY 2009 ratesetting, when we would first 
package payment for the device cost of osseointegrated devices that no 
longer had pass-through status. During CYs 2007 and 2008, hospitals 
have a strong financial incentive to report appropriate charges for the 
device's use, because they are paid separately for the device, based on 
charges adjusted to cost during the device's pass-through payment 
period. We note that while there are four CPT codes for the 
osseointegrated device implantation procedures, the vast majority of CY 
2006 claims were for CPT code 69714, for which we had 240 total claims. 
The majority of these claims were single claims that would be available 
for use in establishing the procedure's median cost. While the other 
three procedures had only a few CY 2006 claims each and displayed the 
variable costs that commonly result from a small number of claims, we 
believe that they are similar to CPT code 69714 from both clinical and 
resource perspectives and note that all four procedures require the 
implantable device for their performance. Therefore, we believe that 
our CY 2007 data for implantation of osseointegrated device procedures 
should be sufficient to allow accurate ratesetting for CY 2009 when the 
device cost would be packaged, so there would be no reason to continue 
the pass-through status of L8690 beyond the 2 year period that ends as 
of December 31, 2008. Moreover, as to the commenter who requested pass-
through status for L8690 through CY 2010, we note that the statute at 
section 1833(t)(6)(C) precludes pass-through payments for a category of 
devices for more than 3 years.
    Comment: A commenter stated that we should extend pass-through 
payment for HCPCS code C1821 (Interspinous process distraction device 
(implantable)), presumably for the additional year allowed under the 
statute.
    Response: The commenter stated that we should continue pass-through 
payment for the spinous process distraction device reported with C1821 
but provided no explicit rationale for this recommendation or for how 
much longer than the 2 years we proposed for the pass-through payment 
for C1821. We expect that there would be sufficient CY 2007 claims data 
that reflected the cost of the interspinous distraction device for the 
CY 2009 OPPS update, so that the device cost could be appropriately 
packaged into the APC payment for the associated implantation 
procedures with which the device was reported. During CYs 2007 and 
2008, hospitals have a strong financial incentive to report appropriate 
charges for the device's use, because they are paid separately for the 
device, based on charges adjusted to cost during the device's pass-
through payment period. The associated procedure codes, specifically 
CPT codes 0171T (Insertion of posterior spinous process distraction 
device (including necessary removal of bone or ligament for insertion 
and imaging guidance), lumbar; single level) and 0172T (Insertion of 
posterior spinous process distraction device (including necessary 
removal of bone or ligament for insertion and imaging guidance), 
lumbar; each additional level (List separately in addition to code for 
primary procedure)) were new for CY 2006, where they were assigned to 
APC 0050 (Level II Musculoskeletal Procedures Except Hand and Foot) on 
an interim final basis. See section III.D.8. of this final rule with 
comment period for a discussion of the final CY 2008 APC assignments of 
these procedures to APC 0050. After CY 2008, HCPCS code C1821 would 
have had 2 full years of pass-through payment, and we believe that it 
would be appropriate

[[Page 66751]]

to package the costs of C1821 into payment for the implantation 
procedures with which the device was billed, according to our standard 
methodology, for CY 2009. We see no reason to extend the period of pass 
through payment for C1821 beyond December 31, 2008.
    After consideration of the public comments received, we are 
finalizing our proposal, without modification, to expire device 
categories L8690 and C1821 from transitional pass-through payment after 
December 31, 2008.
2. Provisions for Reducing Transitional Pass Through Payments to Offset 
Costs Packaged Into APC Groups
a. Background
    In the November 30, 2001 OPPS final rule, we explained the 
methodology we used to estimate the portion of each APC payment rate 
that could reasonably be attributed to the cost of the associated 
devices that are eligible for pass-through payments (66 FR 59904). 
Beginning with the implementation of the CY 2002 OPPS quarterly update 
(April 1, 2002), we deducted from the pass-through payments for the 
identified devices an amount that reflected the portion of the APC 
payment amount that we determined was associated with the cost of the 
device, as required by section 1833(t)(6)(D)(ii) of the Act. In the 
November 1, 2002 interim final rule with comment period, we published 
the applicable offset amounts for CY 2003 (67 FR 66801).
    For the CY 2002 and CY 2003 OPPS updates, to estimate the portion 
of each APC payment rate that could reasonably be attributed to the 
cost of an associated device eligible for pass-through payment, we used 
claims data from the period used for recalibration of the APC rates. 
That is, for CY 2002 OPPS updating, we used CY 2000 claims data, and 
for CY 2003 OPPS updating, we used CY 2001 claims data. For CY 2002, we 
used median cost claims data based on specific revenue centers used for 
device related costs because device C-code cost data were not available 
until CY 2003. For CY 2003, we calculated a median cost for every APC 
based on single claims with device codes but without packaging the 
costs of associated C-codes for device categories that were billed with 
the APC. We then calculated a median cost for every APC based on single 
claims with the costs of the associated device category C-codes that 
were billed with the APC packaged into the median. Comparing the median 
APC cost without device packaging to the median APC cost including 
device packaging that was developed from the claims with device codes 
also reported enabled us to determine the percentage of the median APC 
cost that was attributable to the associated pass-through devices. By 
applying those percentages to the APC payment rates, we determined the 
applicable amount to be deducted from the pass-through payment, the 
``offset'' amount. We created an offset list comprised of any APC for 
which the device cost was at least 1 percent of the APC's cost.
    The offset list that we published for CY 2002 through CY 2004 was a 
list of offset amounts associated with those APCs with identified 
offset amounts developed using the methodology described above. As a 
rule, we do not know in advance which procedures residing in certain 
APCs may be billed with new device categories. Therefore, an offset 
amount was applied only when a new device category was billed with a 
HCPCS procedure code that was assigned to an APC appearing on the 
offset list.
    For CY 2004, we modified our policy for applying offsets to device 
pass-through payments. Specifically, we indicated that we would apply 
an offset to a new device category only when we could determine that an 
APC contains costs associated with the device. We continued our 
existing methodology for determining the offset amount, described 
earlier. We were able to use this methodology to establish the device 
offset amounts for CY 2004 because providers reported device codes 
(generally C-codes) on the CY 2002 claims used for the CY 2004 OPPS 
update. For the CY 2005 update to the OPPS, our data consisted of CY 
2003 claims that did not contain device codes and, therefore, for CY 
2005, we utilized the device percentages as developed for CY 2004. In 
the CY 2004 OPPS update, we reviewed the device categories eligible for 
continuing pass-through payment in CY 2004 to determine whether the 
costs associated with the device categories were packaged into the 
existing APCs. Based on our review of the data for the device 
categories existing in CY 2004, we determined that there were no close 
or identifiable costs associated with the devices relating to the 
respective APCs that were normally billed with them. Therefore, for 
those device categories, we set the offset amount to $0 for CY 2004. We 
continued this policy of setting the offset amount to $0 for the device 
categories that continued to receive pass-through payment in CY 2005.
    For the CY 2006 OPPS update, CY 2004 hospital claims were available 
for analysis. Hospitals billed device C-codes in CY 2004 on a voluntary 
basis. We reviewed our CY 2004 data and found that the numbers of 
claims for services in many of the APCs for which we calculated device 
percentages using CY 2004 data were quite small. We also found that 
many of these APCs already had relatively few single claims available 
for median calculations compared with the total bill frequencies, 
because of our inability to use many multiple bills in establishing 
median costs for all APCs. In addition, we found that our claims 
demonstrated that relatively few hospitals specifically coded for 
devices utilized in CY 2004. Thus, we were not confident that CY 2004 
claims reporting device HCPCS codes represented the typical costs of 
all hospitals providing the services. Therefore, we did not use CY 2004 
claims with device codes to calculate CY 2006 device offset amounts. In 
addition, we did not use the CY 2005 methodology, for which we utilized 
the device percentages as developed for CY 2004. Two years had passed 
since we developed the device offsets for CY 2004, and the device 
offsets originally calculated from CY 2002 hospital claims data may 
either have overestimated or underestimated the contributions of device 
costs to total procedural costs in the outpatient hospital environment 
of CY 2006. In addition, a number of the APCs on the CY 2004 and CY 
2005 device offset percent lists were either no longer in existence or 
were so significantly reconfigured that the past device offsets likely 
did not apply.
    For CY 2006, we reviewed the single new device category 
established, C1820, to determine whether device costs associated with 
the new category were packaged into the existing APC structure based on 
partial CY 2005 claims data. Under our established policy, if we 
determine that the device costs associated with the new category are 
closely identifiable to device costs packaged into existing APCs, we 
set the offset amount for the new category to an amount greater than 
$0. Our review of the service indicated that the median cost for the 
applicable APC 0222 (Implantation of Neurological Device) contained 
costs for neurostimulators that were similar to neurostimulators 
described by the new device category C1820. Therefore, we determined 
that a device offset would be appropriate. We announced a CY 2006 
offset amount for that category in Program Transmittal No. 804, dated 
January 3, 2006. (We subsequently were informed that some rechargeable 
neurostimulators described by device category C1820 may also be used 
and billed with a CPT code that

[[Page 66752]]

maps to APC 0039 (Level I Implantation of Neurostimulator). We 
announced an offset amount for device category C1820 when billed with a 
procedure code that maps to APC 0039 in Program Transmittal No. 1209, 
dated March 21, 2007.)
    For CY 2006, we used available partial year CY 2005 hospital claims 
data to calculate device percentages and potential offsets for CY 2006 
applications for new device categories. Effective January 1, 2005, we 
require hospitals to report device HCPCS codes and their charges when 
hospitals bill for services that utilize devices described by the 
existing device category codes. In addition, during CY 2005 we 
implemented device edits for many services that require devices and for 
which appropriate device category HCPCS codes exist. Therefore, we 
expected that the number of claims that included device codes and their 
respective costs to be much more robust and representative for CY 2005 
than for CY 2004.
    For CY 2007, we reviewed the two new device categories, C1821 and 
L8690, to determine whether device costs associated with the new 
categories were packaged into the existing APC structure based on CY 
2005 claims data. As indicated earlier, under our established policy, 
if we determine that the device costs associated with a new category 
are closely identifiable to device costs packaged into existing APCs, 
we set the offset amount for the new category to an amount greater than 
$0. Our review of the related services indicated that the median costs 
for the applicable APC 0256 (Level V ENT Procedures (for L8690)) and 
APC 0050 (Level II Musculoskeletal Procedures Except Hand and Foot (for 
C1821)) did not contain costs for devices that were similar to those 
described by the new device categories. Therefore, we set the 
respective offsets to $0.
    We believed that use of the most current claims data to establish 
offset amounts when they are needed to ensure appropriate payment was 
consistent with our stated policy; therefore, we proposed to continue 
to do so for the CY 2008 OPPS. Specifically, if we created a new device 
category for payment in CY 2008, to calculate potential offsets we 
proposed to examine the most current available claims data, including 
device costs, to determine whether device costs associated with the new 
category were already packaged into the existing APC structure, as 
indicated earlier. If we concluded that some related device costs were 
packaged into existing APCs, we proposed to use the methodology 
described earlier and first used for the CY 2003 OPPS to determine an 
appropriate device offset percent for those APCs with which the new 
category would be reported.
b. Final Policy
    For CY 2008, we proposed to continue to review each new device 
category on a case-by-case basis as we have done since CY 2004, to 
determine whether device costs associated with the new category were 
packaged into the existing APC structure. If we determined that, for 
any new device category, no device costs associated with the new 
category were packaged into existing APCs, we proposed to continue our 
current policy of setting the offset amount for the new category to $0 
for CY 2008. There are currently two new device categories that will 
continue for pass through payment in CY 2008. These categories, 
described by HCPCS codes L8690 and C1821, currently have an offset 
amount equal to $0 because we could not identify device related costs 
in the procedural APCs we expect would be billed with either of the two 
categories L8690 or C1821, that is, in APC 0256 or APC 0050, 
respectively. We proposed that the offsets for CY 2008 for L8690 and 
C1821 remain set to $0, because we could not identify device costs 
packaged in the related procedural APCs that were closely identifiable 
with these device categories, based on the claims data for CY 2006, the 
claims data year for our CY 2008 OPPS update.
    We proposed to continue our existing policy of establishing new 
categories in any quarter when we determined that the criteria for 
granting pass through status for a device category were met. If we 
created a new device category and determined that our CY 2006 claims 
data contained a sufficient number of claims with identifiable costs 
associated with the new category of devices in any APC with which it is 
billed, we proposed to establish an offset amount greater than $0 and 
to reduce the transitional pass through payment for the device by the 
related procedural APC offset amount. If we determined that a device 
offset amount greater than $0 was appropriate for any new category that 
we created, we proposed to announce the offset amount in the program 
transmittal that announced the new category.
    In summary, for CY 2008, we proposed to use CY 2006 hospital claims 
data to calculate device percentages and potential offsets for new 
device categories established in CY 2008. We also proposed to publish 
through program transmittals any new or updated offsets that we 
calculated for CY 2008, corresponding to newly created categories or 
existing categories eligible for pass-through payment, respectively.
    We received no public comments on our proposed continuation of our 
current policy to establish offset amounts for new device categories 
eligible for pass-through payments, and, therefore, we are adopting our 
proposed policy stated above as final for CY 2008.

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

A. Transitional Pass-Through Payment for Additional Costs of Drugs and 
Biologicals

1. Background
    Section 1833(t)(6) of the Act provides for temporary additional 
payments or ``transitional pass-through payments'' for certain drugs 
and biological agents. As originally enacted by the Medicare, Medicaid, 
and SCHIP Balanced Budget Refinement Act (BBRA) of 1999 (Pub. L. 106-
113), this provision requires the Secretary to make additional payments 
to hospitals for current orphan drugs, as designated under section 526 
of the Federal Food, Drug, and Cosmetic Act (Pub. L. 107-186); current 
drugs and biological agents and brachytherapy sources used for the 
treatment of cancer; and current radiopharmaceutical drugs and 
biological products. For those drugs and biological agents referred to 
as ``current,'' the transitional pass-through payment began on the 
first date the hospital OPPS was implemented (before enactment of the 
Medicare, Medicaid, and SCHIP Benefits Improvement and Protection Act 
(BIPA) of 2000 (Pub. L. 106-554), on December 21, 2000).
    Transitional pass-through payments are also provided for certain 
``new'' drugs and biological agents that were not being paid for as an 
HOPD service as of December 31, 1996, and whose cost is ``not 
insignificant'' in relation to the OPPS payments for the procedures or 
services associated with the new drug or biological. For pass-through 
payment purposes, radiopharmaceuticals are included as ``drugs.'' Under 
the statute, transitional pass-through payments can be made for at 
least 2 years but not more than 3 years. CY 2008 pass-through drugs and 
biologicals are assigned status indicator ``G'' as indicated in Addenda 
A and B to the CY 2008 OPPS/ASC proposed rule and this final rule with 
comment period.
    Section 1833(t)(6)(D)(i) of the Act specifies that the pass-through 
payment amount, in the case of a drug or biological, is the amount by 
which the amount determined under section 1842(o) of the Act (or, if 
the drug or

[[Page 66753]]

biological is covered under a competitive acquisition contract under 
section 1847B of the Act, an amount determined by the Secretary equal 
to the average price for the drug or biological for all competitive 
acquisition areas and year established under such section as calculated 
and adjusted by the Secretary) for the drug or biological exceeds the 
portion of the otherwise applicable Medicare OPD fee schedule that the 
Secretary determines is associated with the drug or biological. This 
methodology for determining the pass-through payment amount is set 
forth in Sec.  419.64 of the regulations, which specifies that the 
pass-through payment equals the amount determined under section 1842(o) 
of the Act minus the portion of the APC payment that CMS determines is 
associated with the drug or biological. Section 1847A of the Act, as 
added by section 303(c) of Pub. L. 108-173, establishes the use of the 
average sales price (ASP) methodology as the basis for payment for 
drugs and biologicals described in section 1842(o)(1)(C) of the Act 
that are furnished on or after January 1, 2005. The ASP methodology 
uses several sources of data as a basis for payment, including ASP, 
wholesale acquisition cost (WAC), and average wholesale price (AWP). In 
this final rule with comment period, the term ``ASP methodology'' and 
``ASP-based'' are inclusive of all data sources and methodologies 
described therein. Additional information on the ASP methodology can be 
found on the CMS Web site at: http://www.cms.hhs.gov/
McrPartBDrugAvgSalesPrice/01--overview.asp#TopOfPage.
    As noted above, section 1833(t)(6)(D)(i) of the Act also states 
that if a drug or biological is covered under a competitive acquisition 
contract under section 1847B of the Act, the payment rate is equal to 
the average price for the drug or biological for all competitive 
acquisition areas and the year established as calculated and adjusted 
by the Secretary. Section 1847B of the Act, as added by section 303(d) 
of Pub. L. 108-173, establishes the payment methodology for Medicare 
Part B drugs and biologicals under the competitive acquisition program 
(CAP). The Part B drug CAP was implemented July 1, 2006, and includes 
approximately 180 of the most common Part B drugs provided in the 
physician's office setting. The list of drugs and biologicals covered 
under the Part B drug CAP, their associated payment rates, and the Part 
B drug CAP pricing methodology can be found on the CMS Web site at: 
http://www.cms.hhs.gov/CompetitiveAcquisforBios.
    For CYs 2005, 2006, and 2007, we estimated the OPPS pass-through 
payment amount for drugs and biologicals to be zero based on our 
interpretation that the ``otherwise applicable Medicare OPD fee 
schedule'' amount was equivalent to the amount to be paid for pass-
through drugs and biologicals under section 1842(o) of the Act (or 
section 1847B of the Act, if the drug or biological is covered under a 
competitive acquisition contract). We concluded for those years that 
the resulting difference between these two rates would be zero. OPPS 
pass-through payment estimates for drugs and biologicals in CY 2008 can 
be found in section VI. of this final rule with comment period.
    The pass through application and review process is explained on the 
CMS Web site at: http://www.cms.hhs.gov /HospitalOutpatientPPS/04--
passthrough--payment.asp.
2. Drugs and Biologicals With Expiring Pass-Through Status in CY 2007
    Section 1833(t)(6)(C)(i) of the Act specifies that the duration of 
transitional pass through payments for drugs and biologicals must be no 
less than 2 years and no longer than 3 years. In Table 41 of the CY 
2008 OPPS/ASC proposed rule (72 FR 42730), we proposed to allow the 
expiration of the pass-through status for seven drugs and biologicals 
on December 31, 2007. While it is standard OPPS practice to delete 
temporary C-codes if an alternate permanent HCPCS code becomes 
available for purposes of OPPS billing and payment, there were no 
temporary C-codes used to identify the seven pass-through drugs that 
were proposed for expiring pass-through status on December 31, 2007. 
Table 27 below includes the CY 2008 permanent HCPCS codes of drugs and 
biologicals with expiring pass-through status as of December 31, 2007.
    We received several public comments regarding a drug proposed to 
expire from pass-through status at the end of CY 2007. A summary of the 
comments and our responses follow.
    Comment: A few commenters requested that CMS continue pass-through 
status for HCPCS code Q4079 (Injection, Natalizumab, 1 mg) for an 
additional year. The commenters stated that, while HCPCS code Q4079 was 
granted pass-through status beginning April 2005, the manufacturer of 
this drug voluntarily suspended sales of the drug prior to that date in 
February 2005. Therefore, the commenters believed that the period of 
pass-through under the OPPS did not begin until the drug resumed 
marketing in June 2006 or until the manufacturer again began shipping 
the drug to providers in July 2006. The commenters noted that, under 
these circumstances, pass-through payment had not been made for the 2 
year pass-through minimum. Therefore, they believed that pass-through 
status should continue through CY 2008.
    Response: According to our regulations at 42 CFR 419.64, pass-
through status begins on the date that CMS makes its first pass-through 
payment for the drug or biological. As the commenters noted, HCPCS code 
Q4079 was approved for OPPS pass-through status beginning in April 
2005. However, the manufacturer of the product voluntary suspended 
marketing of the product 2 months prior to April 2005. Therefore, in 
order to determine when pass-through payments were first made for this 
product, we examined OPPS claims data for HCPCS code Q4079 for the 
second, third and fourth quarters of CY 2005. While we found a few 
claims from this time period from several different hospitals, we 
believe that these claims were incorrectly coded. The typical dose of 
HCPCS code Q4079 is 300 mg infused every 4 weeks. The hospital claims 
billed during these three quarters of 2005 reported a median of only 
one unit per day, although the descriptor of HCPCS code Q4079 specifies 
``per 1 mg.'' In comparison, hospital claims show a median of 300 units 
per day billed after this product resumed marketing in July 2006. In 
addition, while there were a few hospital claims for HCPCS code Q4079 
submitted in CY 2005, we received no claims for HCPCS code Q4079 during 
the first two quarters of CY 2006. Therefore, we believe that the CY 
2005 claims were miscoded, so that the first pass-through payment for a 
correctly coded use for HCPCS code Q4079 was actually not made until 
July 2006. As a drug that began pass-through status in July 2006 would 
continue with pass-through status in CY 2008, we are continuing pass-
through status in CY 2008 for HCPCS code Q4079.
    In addition, in accordance with our standard practice to replace 
temporary HCPCS codes with permanent ones when a permanent HCPCS code 
becomes available, we are deleting HCPCS code Q4079 (Injection, 
Natalizumab, per 1 mg), effective December 31, 2007, and replacing it 
with HCPCS code J2323 (Injection, Natalizumab, 1 mg), effective January 
1, 2008. We have identified this drug in Table 27 below and in Addendum 
B of this final rule with comment period

[[Page 66754]]

using HCPCS code J2323 and assigned it status indicator ``G.''
    After consideration of the public comments received, we are 
finalizing our proposed listing of drugs and biologicals whose pass-
through status expires on December 31, 2007, with modification so that 
pass-through status for HCPCS code Q4079 (HCPCS code J2323 beginning in 
CY 2008) continues in CY 2008. In Table 27 below, we list the six drugs 
and biologicals whose pass-through status will expire on December 31, 
2007.

            Table 27.--Drugs and Biologicals for Which Pass-Through Status Expires December 31, 2007
----------------------------------------------------------------------------------------------------------------
     CY 2008  HCPCS           CY 2007  HCPCS          CY 2008 Descriptor           CY 2008  SI       CY 2008 APC
----------------------------------------------------------------------------------------------------------------
J2278..................  J2278..................  Ziconotide injection.....  K.....................         1694
J2503..................  J2503*.................  Pegaptanib sodium          K.....................         1697
                                                   injection.
J7311..................  J7311..................  Fluocinolone acetonide     K.....................         9225
                                                   implt.
J8501..................  J8501..................  Oral aprepitant..........  K.....................         0868
J9027..................  J9027..................  Clofarabine injection....  K.....................         1710
J9264..................  J9264*.................  Paclitaxel protein bound.  K.....................         1712
----------------------------------------------------------------------------------------------------------------
* Indicates that the drug was paid at a rate determined by the Part B drug CAP methodology while identified as
  pass-through under the OPPS.

3. Drugs and Biologicals With Pass-Through Status in CY 2008
    In the CY 2008 OPPS/ASC proposed rule (72 FR 42731), we proposed to 
continue pass through status in CY 2008 for 13 drugs and biologicals. 
These items, which were approved for pass-through status between April 
1, 2006 and July 1, 2007, were listed in Table 42 of the proposed rule. 
The APCs and HCPCS codes for these drugs and biologicals listed in 
Table 42 were assigned status indicator ``G'' in Addenda A and B to the 
proposed rule.
    Section 1833(t)(6)(D)(i) of the Act sets the amount of pass-through 
payment for pass-through drugs and biologicals (the pass-through 
payment amount) as the difference between the amount authorized under 
section 1842(o) of the Act (or, if the drug or biological is covered 
under a CAP under section 1847B of the Act, an amount determined by the 
Secretary equal to the average price for the drug or biological for all 
competitive acquisition areas and year established under such section 
as calculated and adjusted by the Secretary) and the portion of the 
otherwise applicable fee schedule amount that the Secretary determines 
is associated with the drug or biological. Given our CY 2008 proposal 
to provide payment for nonpass-through separately payable drugs and 
biologicals at ASP+5 percent as described further in section V.B.3 of 
this final rule with comment period, in the proposed rule we stated our 
belief that it would be most consistent with the statute to provide 
payment for drugs and biologicals with pass through status that are not 
part of the Part B drug CAP at a rate of ASP+6 percent, compared to 
ASP+5 percent as the otherwise applicable fee schedule portion 
associated with the drug or biological. The difference between ASP+6 
percent and ASP+5 percent, therefore, would be the CY 2008 pass-through 
payment amount for these drugs and biologicals. Thus, for CY 2008, we 
proposed to pay for pass-through drugs and biologicals that are not 
part of the Part B drug CAP at ASP+6 percent, equivalent to the rate 
these drugs and biologicals would receive in the physician's office 
setting in CY 2008.
    Section 1842(o) of the Act also states that if a drug or biological 
is covered under a CAP under section 1847B of the Act, the payment rate 
is equal to the average price for the drug or biological for all 
competitive acquisition areas and year established as calculated and 
adjusted by the Secretary. For CY 2008, we proposed to provide payment 
for drugs and biologicals with pass-through status that are offered 
under the Part B drug CAP at a rate equal to the Part B drug CAP rate. 
Therefore, considering ASP+5 percent to be the otherwise applicable fee 
schedule portion associated with these drugs or biologicals, the 
difference between the Part B drug CAP rate and ASP+5 percent would be 
the pass-through payment amount for these drugs and biologicals. HCPCS 
codes that are offered under the CAP program as of April 1, 2007, are 
identified in Table 28 below with an asterisk.
    In the CY 2008 OPPS/ASC proposed rule, we proposed to continue 
pass-through status for 13 drugs and biologicals. As stated previously, 
it is standard OPPS practice to delete temporary C-codes if an 
alternate permanent HCPCS code becomes available for purposes of OPPS 
billing and payment. For CY 2008, HCPCS code C9232 (Injection, 
idursulfase, 1 mg) is deleted and replaced with HCPCS code J1743 
(Injection, idursulfase, 1 mg); HCPCS code C9233 (Injection, 
ranibizumab, 0.5 mg) is deleted and replaced with HCPCS code J2778 
(Injection, ranibizumab, 0.1 mg); and HCPCS code C9235 (Injection, 
panitumumab, 10 mg) is deleted and replaced with HCPCS code J9303 
(Injection, panitumumab, 10 mg).
    In addition, in order to be consistent with the naming conventions 
of the CMS HCPCS Workgroup, we have deleted HCPCS code C9350 
(Microporous collagen tube of non-human origin, per centimeter length), 
and replaced this code with HCPCS codes C9352 (Microporous collagen 
implantable tube (Neuragen Nerve Guide), per centimeter length) and 
C9353 (Microporous collagen implantable slit tube (NeuraWrap Nerve 
Protector), per centimeter length) in order to more accurately identify 
the two products that were previously described by HCPCS code C9350. 
Similarly, we have deleted HCPCS code C9351 (Acellular dermal tissue 
matrix of nonhuman origin, per square centimeter (Do not report C9351 
in conjunction with J7345)) for CY 2008 and replaced it with HCPCS 
codes J7348 (Dermal (substitute) tissue of nonhuman origin, with or 
without other bioengineered or processed elements, without 
metabolically active elements (Tissuemend) per square centimeter) and 
J7349 (Dermal (substitute) tissue of nonhuman origin, with or without 
other bioengineered or processed elements, without metabolically active 
elements (Primatrix) per square centimeter).
    We received several public comments regarding our proposal to 
continue the pass-through status of certain drugs and biologicals for 
CY 2008. A summary of the comments and our responses follow.
    Comment: Several commenters noted support for specific drugs and 
biologicals proposed for pass-through status in CY 2008 and urged CMS 
to finalize the proposal for these items. The commenters also commended 
CMS for proposing to provide payment for pass-through drugs and 
biologicals at a

[[Page 66755]]

rate equal to the rate these drugs and biologicals would receive under 
the Part B drug CAP program or in the physician's office setting.
    Response: We appreciate the commenters' support for our proposed 
policy. We are finalizing our proposal to provide pass-through payments 
in CY 2008 for the drugs listed in Table 28 below. This table includes 
the continuation of pass-through status for HCPCS code Q4079, as 
discussed previously, and accounts for the coding changes presented 
above.
    Comment: One commenter disagreed with the decision to grant pass-
through status to HCPCS code J3473 (Injection, hyaluronidase, 
recombinant, 1 USP unit) beginning in January 2007 and to continue this 
drug in pass-through status through CY 2008. The commenter believed 
that the product described by HCPCS code J3473 fails to meet the pass-
through criteria of newness and ``not insignificant costs.'' The 
commenter claimed that hyaluronidase was available prior to December 
31, 1996, and was captured in the initial OPPS payment rates and, 
therefore should not be considered new. In addition, the commenter 
explained that the FDA approval of this product was made based on the 
section 505(b)(2) criteria, meaning that the product claimed to be 
identical to products already approved by the FDA. This commenter also 
noted that the administration of HCPCS code J3473 is typically billed 
with ophthalmic procedures, not drug administration procedures. The 
commenter asserted that when the cost significance test is performed 
with APCs more likely to reflect ophthalmic procedures, such as APC 
0246 (Cataract Procedures with IOL Insert), the cost significance test 
for drug and biological pass-through status is not met.
    The commenter further noted that, as a result of this drug being 
granted pass through status, CMS created a market bias towards the use 
of this product, as all other hyaluronidase products are currently 
packaged. The commenter argued that this apparent market bias would be 
further exacerbated as a result of the revised ASC payment system 
policy of providing separate payment for OPPS separately payable drugs 
that are provided in the ASC setting beginning in CY 2008, because the 
majority of procedures that would be likely to use HCPCS code J3473 are 
frequently performed in ASCs.
    Response: Our criteria for reviewing pass-through applications are 
available on the CMS Web site at: http://www.cms.hhs.gov/
HospitalOutpatientPPS/04--passthrough--payment.asp. Based on these 
criteria, we reviewed the application submitted to us for HCPCS code 
J3473 and approved pass-through status beginning on January 1, 2007. We 
do not agree with the commenter that our decision was in error. The 
drug met all criteria established for pass through payment for drugs 
and biologicals. Therefore, as this drug has not met the 2-year minimum 
pass-through time requirement, we are adopting our proposal to continue 
pass-through status for HCPCS code J3473 for CY 2008.
    Comment: One commenter requested that CMS clarify how payment would 
be made for radiopharmaceutical products that are granted pass-through 
status during CY 2008.
    Response: Currently, there are no radiopharmaceuticals that would 
have pass-through status in CY 2008. Consistent with OPPS payment for 
drugs, biologicals, and radiopharmaceuticals without HCPCS codes, in CY 
2008, payment for radiopharmaceuticals that are granted pass-through 
status would be based on the ASP methodology. As stated above, for 
purposes of pass-through payment, we consider radiopharmaceuticals to 
be drugs under the OPPS. Therefore, if a radiopharmaceutical receives 
pass through status during CY 2008, we will follow the standard ASP 
methodology to determine its pass-through payment rate under the OPPS. 
Because ASP data are not available for radiopharmaceuticals, we will 
base the pass-through payment on the product's WAC. If WAC data are 
also not available, we will then provide payment for the pass-through 
radiopharmaceutical at 95 percent of its most recent AWP.
    In the OPPS/ASC CY 2008 proposed rule, we used payment rates for 
drugs with pass-through status based on the ASP data from the fourth 
quarter of CY 2006 for budget neutrality estimates, impact analyses, 
and completion of Addenda A and B to the proposed rule because these 
were the most recent data available to us at that time. These payment 
rates were the basis for drug payments in the physician's office 
setting, effective April 1, 2007. As proposed, we used updated data in 
the development of this final rule with comment period. That is, we 
used the ASP data from the second quarter of CY 2007 (which are the 
basis for drug payments in the physician's office setting, effective 
October 1, 2007) in budget neutrality estimates, impact analyses, and 
completion of Addenda A and B to this final rule with comment period. 
In addition, we are finalizing our proposal to update these pass-
through payment rates on a quarterly basis on our Web site during CY 
2008 if later quarter ASP submissions (or more recent WAC or AWP data, 
as applicable) indicate that adjustments to the payment rates for these 
pass-through drugs and biologicals are necessary. Although there are no 
pass-through radiopharmaceuticals at this time for CY 2008, the payment 
rate for a radiopharmaceutical with pass-through status would also be 
adjusted accordingly.
    As proposed, if a drug that has been granted pass-through status 
for CY 2008 becomes covered under the Part B drug CAP, we will make the 
appropriate adjustments to the payment rates for these drugs and 
biologicals on a quarterly basis. For drugs and biologicals that are 
currently covered under the CAP, we proposed to use the payment rates 
calculated under that program that are in effect as of April 1, 2007, 
which is the most recent update of these payment rates. We proposed to 
update these payment rates if the rates change in the future.
    After consideration of the public comments received, we are 
finalizing our CY 2008 proposal, without modification, to make separate 
payment in CY 2008 for new drugs and biologicals with a HCPCS code, 
consistent with the provisions of section 1842(o) of the Act, at a rate 
that is equivalent to the payment they would receive in a physician's 
office setting (or under section 1847B of the Act, if the drug or 
biological is covered under a CAP) only if we receive a pass-through 
application for the drug or biological and pass-through status is 
subsequently granted. Otherwise, we will pay ASP+5 percent for these 
products in CY 2008. New radiopharmaceuticals with pass-through status 
will be paid based on WAC or, if WAC is not available, based on 95 
percent of the product's most recent AWP. We will update the payment 
rates for pass-through drugs and biologicals quarterly, as new data 
become available.
    The drugs and biologicals that are continuing pass-through status 
or have been granted pass-through status as of January 2008 for CY 2008 
are included in Table 28 below.

[[Page 66756]]



                      Table 28.--Drugs and Biologicals With Pass-Through Status in CY 2008
----------------------------------------------------------------------------------------------------------------
     CY 2007 HCPCS            CY 2008 HCPCS           CY 2008 Descriptor           CY 2008  SI       CY 2008 APC
----------------------------------------------------------------------------------------------------------------
                         C9239..................  Inj, temsirolimus........  G.....................         1168
C9350..................  C9352..................  Neuragen nerve guide, per  G.....................         9350
                                                   cm.
C9350..................  C9353..................  Neurawrap nerve            G.....................         1169
                                                   protector, cm.
J0129..................  J0129..................  Abatacept injection......  G.....................         9230
J0348..................  J0348..................  Anadulafungin injection..  G.....................         0760
J0894*.................  J0894*.................  Decitabine injection.....  G.....................         9231
C9236..................  J1300..................  Eculizumab injection.....  G.....................         9236
J1740..................  J1740..................  Ibandronate sodium         G.....................         9229
                                                   injection.
C9232..................  J1743..................  Idursulfase injection....  G.....................         9232
J2248..................  J2248..................  Micafungin sodium          G.....................         9227
                                                   injection.
Q4079..................  J2323..................  Natalizumab injection....  G.....................         9126
C9233..................  J2778..................  Ranibizumab injection....  G.....................         9233
J3243..................  J3243..................  Tigecycline injection....  G.....................         9228
J3473..................  J3473..................  Hyaluronidase recombinant  G.....................         0806
Q4095..................  J3488..................  Reclast injection........  G.....................         0951
C9351..................  J7348..................  Tissuemend tissue........  G.....................         9351
C9351..................  J7349..................  Primatrix tissue.........  G.....................         1141
J9261..................  J9261..................  Nelarabine injection.....  G.....................         0825
C9235..................  J9303..................  Panitumumab injection....  G.....................         9235
----------------------------------------------------------------------------------------------------------------
* Indicates that the drug was paid at a rate determined by the Part B drug CAP methodology while identified as
  pass-through under the OPPS.

B. Payment for Drugs, Biologicals, and Radiopharmaceuticals Without 
Pass Through Status

1. Background
    Under the CY 2007 OPPS, we currently pay for drugs, biologicals, 
and radiopharmaceuticals that do not have pass-through status in one of 
two ways: packaged payment within the payment for the associated 
service or separate payment (individual APCs). We explained in the 
April 7, 2000 OPPS final rule with comment period (65 FR 18450) that we 
generally package the cost of drugs and radiopharmaceuticals into the 
APC payment rate for the procedure or treatment with which the products 
are usually furnished. Hospitals do not receive separate payment from 
Medicare for packaged items and supplies, and hospitals may not bill 
beneficiaries separately for any packaged items and supplies whose 
costs are recognized and paid within the national OPPS payment rate for 
the associated procedure or service. (Program Memorandum Transmittal A-
01-133, issued on November 20, 2001, explains in greater detail the 
rules regarding separate payment for packaged services.)
    Packaging costs into a single aggregate payment for a service, 
procedure, or episode of care is a fundamental principle that 
distinguishes a prospective payment system from a fee schedule. In 
general, packaging the costs of items and services into the payment for 
the primary procedure or service with which they are associated 
encourages hospital efficiencies and also enables hospitals to manage 
their resources with maximum flexibility.
    Section 1833(t)(16)(B) of the Act, as added by section 621(a)(2) of 
Pub. L. 108-173, sets the threshold for establishing separate APCs for 
drugs and biologicals at $50 per administration for CYs 2005 and 2006. 
Therefore, for CYs 2005 and 2006, we paid separately for drugs, 
biologicals, and radiopharmaceuticals whose per day cost exceeded $50 
and packaged the costs of drugs, biologicals, and radiopharmaceuticals 
whose per day cost was equal to or less than $50 into the procedures 
with which they were billed. For CY 2007, the packaging threshold for 
drugs, biologicals, and radiopharmaceuticals that are not new and do 
not have pass-through status was established at $55. The methodology 
used to establish the $55 threshold for CY 2007 and our proposed 
approach for future years are discussed in more detail in section 
V.B.2. of this final rule with comment period.
    In addition, for CY 2005 to CY 2007, we have provided an exemption 
to this packaging determination for oral and injectable 5HT3 forms of 
anti-emetic products. We discuss in section V.B.2. of this final rule 
with comment period our final CY 2008 payment policy for these anti-
emetic products.
2. Criteria for Packaging Payment for Drugs and Biologicals
    As indicated above, in accordance with section 1833(t)(16)(B) of 
the Act, the threshold for establishing separate APCs for drugs and 
biologicals was set to $50 per administration during CYs 2005 and 2006. 
In CY 2007, we used the fourth quarter moving average Producer Price 
Index (PPI) levels for prescription preparations to trend the $50 
threshold forward from the third quarter of CY 2005 (when the Pub. L. 
108-173 mandated threshold became effective) to the third quarter of CY 
2007. We then rounded the resulting dollar amount to the nearest $5 
increment in order to determine the CY 2007 threshold adjustment amount 
of $55.
    Following the CY 2007 methodology (which is discussed in more 
detail in the CY 2007 OPPS/ASC final rule with comment period (71 FR 
68085 through 68086)), as proposed, we used updated fourth quarter 
moving average PPI levels to trend the $50 threshold forward from the 
third quarter of CY 2005 to the third quarter of CY 2008 and again 
rounded the resulting dollar amount ($57.78) to the nearest $5 
increment, which yielded a figure of $60. In performing this 
calculation, we used the most up-to-date forecasted, quarterly PPI 
estimates from CMS' Office of the Actuary (OACT). As actual inflation 
for past quarters replaced forecasted amounts, the PPI estimates for 
prior quarters were revised (compared with those used in the CY 2007 
OPPS/ASC final rule with comment period) and were incorporated into our 
calculation. Based on the calculations described above, we proposed a 
packaging threshold for CY 2008 of $60. As stated in the CY 2007 OPPS/
ASC final rule with comment period (71 FR 68086), we believe that 
packaging certain items is a fundamental component of a prospective 
payment system, that packaging these items does not lead to

[[Page 66757]]

beneficiary access issues and does not create a problematic site of 
service differential, that the packaging threshold is reasonable based 
on the initial establishment in law of a $50 threshold for the CY 2005 
OPPS, that updating the $50 threshold is consistent with industry and 
government practices, and that the PPI is an appropriate mechanism to 
gauge Part B drug inflation. As indicated in the proposed rule, we did 
not propose for CY 2008 to change this established approach to 
establishing the general packaging threshold for drugs, biologicals, 
and radiopharmaceuticals, in view of our proposed packaging approach 
for the CY 2008 OPPS as outlined in section II.A.4. of that proposed 
rule and our desire to move the OPPS toward a more encounter-based and 
episode-based payment in the future. However, as noted in the proposed 
rule, we will consider expanded packaging of payment for drugs, 
biologicals, and radiopharmaceuticals for a future OPPS update (72 FR 
42732). We believe that consideration of expanded packaging for drugs 
and biologicals is particularly important, given the substantial 
increase that has occurred in recent years in the proportion of HCPCS 
codes for drugs, biologicals, and radiopharmaceuticals that are paid 
separately, from 30 percent in CY 2003 to 50 percent in CY 2007. We 
proposed for CY 2008 to expand the packaging of certain drugs and 
radiopharmaceuticals, specifically contrast agents and diagnostic 
radiopharmaceuticals as discussed in detail in section II.A.4.c.(5) and 
(6) of this final rule with comment period. However, we continue to 
believe that increased packaging of payment for drugs, biologicals, and 
radiopharmaceuticals more generally under the OPPS could provide 
significant incentives for hospital efficiency in adopting the most 
cost-effective approaches to patient care, while providing hospitals 
with maximum flexibility in managing their resources. Therefore, in the 
proposed rule, we specifically solicited public comment regarding 
recommended approaches to increase packaging of these products under 
the OPPS and issues we should consider as we evaluate alternative 
methodologies for the future (72 FR 42732).
    For the third year, we proposed to continue exempting the oral and 
injectable forms of 5HT3 anti-emetics products from packaging, thereby 
making separate payment for all of these products. As we stated in the 
CY 2005 OPPS final rule with comment period (69 FR 65779 through 
65780), it is our understanding that chemotherapy is very difficult for 
many patients to tolerate, as the side effects are often debilitating. 
In order for Medicare beneficiaries to achieve the maximum therapeutic 
benefit from chemotherapy and other therapies with side effects of 
nausea and vomiting, anti-emetic use is often an integral part of the 
treatment regiment. In the proposed rule, we stated our belief that we 
should continue to ensure that Medicare payment rules do not impede a 
beneficiary's access to the particular anti-emetic that is most 
effective for him or her, as determined by the beneficiary and the 
treating physician.
    Comment: A few commenters disagreed with the proposed increase of 
the packaging threshold to $60 and asked CMS to retain the $55 
threshold for CY 2008. The commenters noted that the threshold has 
experienced a 20 percent increase over 2 years, and that an increased 
threshold threatens hospitals' ability to provide quality care without 
compromising the range of services they offer. One commenter suggested 
that CMS implement a contingency that would limit increases to the drug 
packaging amount to the rate of increase in the ASP amount. Other 
commenters suggested increasing the OPPS drug packaging threshold 
either for a subset of items, or for all drugs, biologicals, and 
radiopharmaceuticals. Another commenter recommended that CMS consider a 
drug packaging methodology based on the relative cost of a drug in 
comparison with the associated procedure, instead of continuing the 
absolute cost methodology, proposed for CY 2008 at $60.
    Response: We continue to believe that our approach of applying an 
annual inflation adjustment factor to update the packaging threshold is 
consistent with the practices of many health care payment policy areas, 
and many other areas of government policy, that acknowledge real costs 
by using an inflation adjustment factor instead of static dollar 
values. We continue to be concerned that, absent a mechanism to update 
the threshold, current relatively inexpensive drugs would begin to 
receive separate payment over time. While we understand the commenters' 
concerns that substantial increases in the threshold over a short 
period of time may be undesirable, we do not believe that the changes 
we have implemented over the past 2 years have jeopardized hospitals' 
ability to provide quality patient care. In addition, we again note 
that the updates to the OPPS drug packaging threshold have been 
predicated on relevant inflation rates for prescription drugs. 
Therefore, we continue to believe that our update methodology is 
aligned closely with national industry figures and standards.
    We agree with some commenters that an increased packaging threshold 
would be supportive of our overall increased packaging efforts to 
increase the size of the OPPS payment bundles. As stated above, we 
believe that there are many benefits of increasing the drug packaging 
threshold beyond the current level, one benefit being that items within 
a group of drugs would potentially be paid according to a similar 
methodology. During the September 2007 APC Panel meeting, the Panel 
engaged in a discussion regarding a higher drug packaging threshold for 
the OPPS, and while this discussion did not yield a recommendation, the 
Panel expressed interest in the idea of an increased drug packaging 
threshold. While we understand that there may be benefits to hospitals 
when the drug packaging threshold is relatively low because they would 
be paid separately for many drugs, we believe that a higher packaging 
threshold could encourage efficiencies and provide hospitals more 
flexibility in managing their resources associated with drug 
administration services.
    In addition, while we are unsure how a drug packaging threshold 
based on relative drug costs in comparison to the associated procedure 
costs would operate in a hospital outpatient setting, we believe that 
further investigation of such a methodology could be warranted. 
Therefore, in an effort to gain more information that may help us 
determine the potential effects of an increased drug packaging 
threshold based on either an absolute dollar amount or on a relative 
dollar amount, we are again specifically requesting comments from 
hospital stakeholders and interested individuals on the impact that 
such a change would have on hospitals, and how such a methodology could 
be developed, implemented, and updated.
    Comment: Several commenters requested that CMS eliminate the drug 
packaging threshold and provide separate payment for all Part B drugs. 
The commenters noted that this would eliminate payment disparities 
between the OPPS and the physician's office setting, so there would be 
no site-of-service differential in providing drug therapies.
    Response: We continue to believe that unpackaging payment for all 
drugs, biologicals, and radiopharmaceuticals is inconsistent with the 
concept of a prospective payment system and that such a change could 
create an additional reporting burden for

[[Page 66758]]

hospitals. The OPPS and the MPFS that apply to physician's office 
services are fundamentally different payment systems with essential 
differences in their payment policies. Specifically, the OPPS is a 
prospective payment system, based on the concept of paying for groups 
of services that share clinical and resource characteristics. Payment 
is made under the OPPS according to prospectively established payment 
rates that are related to the relative costs of hospital resources for 
services. The MPFS is a fee schedule that generally provides payment 
for each individual component of a service. Consistent with the MPFS 
approach, separate payment is made for each drug provided in the 
physician's office, but the OPPS packages payment for certain drugs 
into the associated procedure payments for the APC group. Because of 
the different payment policies, differences in the degrees of packaged 
payment and separate payment between these two systems are only to be 
expected. In general, we do not believe that our packaging methodology 
under the OPPS results in limited beneficiary access to drug 
administration services.
    We note that, in CYs 2005 and 2006, the statutorily mandated drug 
packaging threshold was set at $50, and we believe it is currently 
appropriate to continue a modest drug packaging threshold for the CY 
2008 OPPS. Therefore, because of our continued belief that packaging is 
a fundamental component of a prospective payment system that 
contributes to important flexibility and efficiency in the delivery of 
high quality outpatient hospital services, we are not adopting the 
recommendation to pay separately for all drugs, biologicals, and 
radiopharmaceuticals for CY 2008.
    Comment: Several commenters supported the proposal to continue to 
exempt the oral and injectable forms of 5HT3 anti-emetic products (that 
were listed in Table 43 of the proposed rule that is reprinted as Table 
29 below) from packaging, thereby making separate payment for all of 
the 5HT3 anti-emetic products. In addition, a few commenters requested 
that CMS apply the same principle to other groups of drugs in order to 
equalize payment methodologies across drugs in the same clinical group. 
One commenter recommended that payment for all hyaluronidase products 
be packaged.
    Response: We appreciate the support of our proposal to continue 
exempting the 5HT3 anti-emetic products from our packaging 
determination. However, as discussed in the CY 2008 OPPS/ASC proposed 
rule, as we consider moving to additional encounter based and episode-
based payment in future years, we may consider additional options for 
packaging in the future. If we were to increase the OPPS drug packaging 
threshold, we might no longer require a special exemption for these 
products because all these products might be packaged under such an 
approach. Similarly, a higher drug packaging threshold could eliminate 
existing disparities in payment methodologies for other drug groups and 
provide similar methods of payment across items in a group. 
Nevertheless, while we may be interested in alternative threshold 
methodologies for future ratesetting purposes, we realize that there 
are existing situations where drugs in a particular category vary in 
their payment treatment under the OPPS, with some drugs packaged and 
other separately paid. We believe the challenges associated with 
categorizing drugs to assess them for disparities are significant, and 
we are not convinced that ensuring the same payment treatment for other 
drug categories is essential at this time, beyond the proposal we made 
for 5HT3 anti-emetics. Therefore, we do not believe that it would be 
appropriate for CY 2008 to take any additional steps to ensure that all 
drugs in a specific category are either separately paid or packaged, as 
requested by some commenters.
    After considering the public comments received, we are finalizing 
our CY 2008 proposal, without modification, to again exempt the oral 
and injectable forms of 5HT3 anti-emetic products listed in Table 29 
below from our packaging methodology for CY 2008.

  Table 29.--Anti-Emetics Exempted From CY 2008 $60 Packaging Threshold
------------------------------------------------------------------------
            HCPCS code                        Short descriptor
------------------------------------------------------------------------
J1260.............................  Dolasetron mesylate
J1626.............................  Granisetron HCl injection
J2405.............................  Ondansetron hcl injection
J2469.............................  Palonosetron HCl
Q0166.............................  Granisetron HCl 1 mg oral
Q0179.............................  Ondansetron HCl 8 mg oral
Q0180.............................  Dolasetron mesylate oral
------------------------------------------------------------------------

    For CY 2008, we proposed to calculate the per day cost of all 
drugs, biologicals, and radiopharmaceuticals that had a HCPCS code in 
CY 2006 and were paid (via packaged or separate payment) under the OPPS 
using claims data from January 1, 2006, to December 31, 2006, to 
determine their CY 2008 packaging status. In order to calculate the per 
day costs for drugs, biologicals, and radiopharmaceuticals to determine 
their packaging status in CY 2008, we proposed to use the methodology 
that was described in detail in the CY 2006 OPPS proposed rule (70 FR 
42723 through 42724) and finalized in the CY 2006 OPPS final rule with 
comment period (70 FR 68636 through 70 FR 68638). To calculate the 
proposed CY 2008 per day costs, we used an estimated payment rate for 
each drug and biological of ASP+5 percent (which is the payment rate we 
proposed for separately payable drugs and biologicals in CY 2008, as 
discussed in more detail subsequently). As noted in the CY 2008 OPPS/
ASC proposed rule (72 FR 42733), we used the manufacturer submitted ASP 
data from the fourth quarter of CY 2006 (rates that were used for 
payment purposes in the physician's office setting, effective April 1, 
2007) to determine the proposed per day cost. For items that did not 
have an ASP based payment rate, we used their mean unit cost derived 
from the CY 2006 hospital claims data to determine their per day cost. 
As described in the proposed rule, we packaged items with a per day 
cost less than or equal to $60 and identified items with a per day cost 
greater than $60 as separately payable. Consistent with our past 
practice, we crosswalked historical OPPS claims data from the CY 2006 
HCPCS codes that were reported to the CY 2007 HCPCS codes that we 
displayed in Addendum B to the proposed rule for payment in CY 2008.
    Our policy during previous cycles of the OPPS has been to use 
updated data to establish final determinations of the packaging status 
of drugs, biologicals, and radiopharmaceuticals. We note that it is 
also our policy to make an annual packaging determination only when we 
develop the OPPS/ASC final rule for the update year. As indicated in 
the proposed rule (72 FR 42733), only items that are identified as 
separately payable in this final rule with comment period will be 
subject to quarterly updates. As proposed, for our calculation of per 
day costs of drugs, biologicals, and radiopharmaceuticals in this final 
rule with comment period, we used ASP data from the first quarter of CY 
2007, which is the basis for calculating payment rates for drugs and 
biologicals in the physician's office setting using the ASP 
methodology, effective July 1, 2007, along with updated hospital claims 
data from CY 2006.
    Consequently, the packaging status for drugs, biologicals, and 
radiopharmaceuticals in this final rule with comment period using the 
updated data may be different from their packaged status determined 
based on the data used for the proposed rule. Under such circumstances, 
we have

[[Page 66759]]

applied the following policies to these drugs, biologicals, and 
radiopharmaceuticals whose relationship to the $60 threshold changes 
based on the final updated data:
     Drugs, biologicals, and radiopharmaceuticals that were 
paid separately in CY 2007 and that were proposed for separate payment 
in CY 2008, and then have per day costs equal to or less than $60, 
based on the updated ASPs and hospital claims data used for the CY 2008 
final rule with comment period, would continue to receive separate 
payment in CY 2008.
     Drugs, biologicals, and radiopharmaceuticals that were 
packaged in CY 2007 and that were proposed for separate payment in CY 
2008, and then have per day costs equal to or less than $60, based on 
the updated ASPs and hospital claims data used for the CY 2008 final 
rule with comment period, would remain packaged in CY 2008.
     Drugs, biologicals, and radiopharmaceuticals for which we 
proposed packaged payment in CY 2008 but then have per day costs 
greater than $60, based on the updated ASPs and hospital claims data 
used for the CY 2008 final rule with comment period, would receive 
separate payment in CY 2008.
    We note that HCPCS code J0594 (Injection, busulfan, 1 mg) was paid 
separately in CY 2007 and was proposed for separate payment in CY 2008, 
but had a final per day cost of approximately $37, which is less than 
the $60 threshold, based on the updated ASPs and hospital claims data 
used for this CY 2008 final rule with comment period. HCPCS code J0594 
will continue to receive separate payment in CY 2008 according to the 
established methodology set forth above.
    In addition, there were several drugs and biologicals that we 
proposed to package in the proposed rule and that now have per day 
costs greater than $60 using updated ASPs and all of the hospital 
claims data from CY 2006 used for this final rule with comment period. 
In accordance with our established policy for such cases, for CY 2008 
we will pay for these drugs and biologicals separately. Table 30 lists 
the drugs and biologicals that were proposed as packaged, but that will 
be paid separately in CY 2008.

Table 30.--Drugs and Biologicals Proposed as Packaged but With Final Per
 Day Costs Above $60, for Which Separate Payment Will Be Made in CY 2008
------------------------------------------------------------------------
               HCPCS                             Description
------------------------------------------------------------------------
J0190.............................  Inj biperiden lactate/5 mg
J0600.............................  Edetate calcium disodium inj
J1595.............................  Injection glatiramer acetate
J2730.............................  Pralidoxime chloride inj
J9270.............................  Plicamycin (mithramycin) inj
------------------------------------------------------------------------

    Also, according to our packaging policy described above, two drugs, 
specifically HCPCS codes J0520 (injection, bethanechol chloride, 
myotonachol or urecholine, up to 5 mg) and J3364 (injection, urokinase, 
5000 iu vial), were packaged in CY 2007, proposed for separate payment 
in CY 2008, but had final per day costs equal to or less than $60 based 
on the updated ASPs and hospital claims data used for the CY 2008 final 
rule with comment period. Therefore, in accordance with our 
methodology, these two drugs will continue to be packaged in CY 2008.
    In sections II.A.4.c.(5) and (6) of the CY 2008 OPPS/ASC proposed 
rule, we proposed to package payment for all diagnostic 
radiopharmaceuticals and contrast agents that would not otherwise be 
packaged according to the proposed CY 2008 packaging threshold for 
drugs, biologicals and radiopharmaceuticals. Tables 17 and 19 in 
sections II.A.4.c.(5) and (6) of that proposed rule (72 FR 42671 and 
42673 through 42674) listed the diagnostic radiopharmaceuticals and 
contrast agents, respectively, that we proposed to package in CY 2008. 
In section V.B.3.a.(4) of this final rule with comment period, we 
discuss our CY 2008 policies for providing payment for diagnostic and 
therapeutic radiopharmaceuticals.
    We note that HCPCS code A9568 (Technetium Tc-99 arcitumomab, 
diagnostic, per study dose, up to 45 millicuries) replaced HCPCS code 
A9549 (Technetium Tc-99 arcitumomab, diagnostic, per study dose, up to 
25 millicuries) beginning January 1, 2007. Our CY 2006 claims data 
indicate that HCPCS code A9549 was billed an average of one time per 
day. As we did not have claims data available for ratesetting purposes 
for HCPCS code A9568, we estimated the number of units per day to also 
be one.
3. Payment for Drugs and Biologicals Without Pass-Through Status That 
Are Not Packaged
a. Payment for Specified Covered Outpatient Drugs
(1) Background
    Section 1833(t)(14) of the Act, as added by section 621(a)(1) of 
Pub. L. 108-173, requires special classification of certain separately 
paid radiopharmaceuticals, drugs, and biologicals and mandates specific 
payments for these items. Under section 1833(t)(14)(B)(i) of the Act, a 
``specified covered outpatient drug'' is a covered outpatient drug, as 
defined in section 1927(k)(2) of the Act, for which a separate APC has 
been established and that either is a radiopharmaceutical agent or is a 
drug or biological for which payment was made on a pass-through basis 
on or before December 31, 2002.
    Under section 1833(t)(14)(B)(ii) of the Act, certain drugs and 
biologicals are designated as exceptions and are not included in the 
definition of ``specified covered outpatient drugs,'' known as SCODs. 
These exceptions are--
     A drug or biological for which payment is first made on or 
after January 1, 2003, under the transitional pass-through payment 
provision in section 1833(t)(6) of the Act.
     A drug or biological for which a temporary HCPCS code has 
not been assigned.
     During CYs 2004 and 2005, an orphan drug (as designated by 
the Secretary).
    Section 1833(t)(14)(A)(iii) of the Act, as added by section 
621(a)(1) of Pub. L. 108-173, requires that payment for SCODs in CY 
2006 and subsequent years be equal to the average acquisition cost for 
the drug for that year as determined by the Secretary, subject to any 
adjustment for overhead costs and taking into account the hospital 
acquisition cost survey data collected by the Government Accountability 
Office (GAO) in CYs 2004 and 2005. If hospital acquisition cost data 
are not available, the law requires that payment be equal to payment 
rates established under the methodology described in section 1842(o), 
section 1847A, or section 1847B of the Act, as calculated and adjusted 
by the Secretary as necessary.
    In establishing the CY 2006 payment rates, we evaluated the three 
data sources that were available to us for setting the CY 2006 payment 
rates for drugs and biologicals. As described in the CY 2006 OPPS final 
rule with comment period (70 FR 68639 through 68644), these data 
sources were the GAO reported average purchase prices

[[Page 66760]]

for 55 SCOD categories for the period July 1, 2003, to June 30, 2004, 
collected via a survey of 1,400 acute care Medicare-certified 
hospitals; ASP data; and mean costs derived from CY 2004 hospital 
claims data. For the CY 2006 OPPS final rule with comment period, we 
used ASP data from the second quarter of CY 2005, which were used to 
set payment rates for drugs and biologicals in the physician's office 
setting effective October 1, 2005, and updated claims data.
    In our data analysis for the CY 2006 OPPS final rule with comment 
period, we compared the payment rates for drugs and biologicals using 
data from all three sources described above. We estimated aggregate 
expenditures for all drugs and biologicals that would be separately 
payable in CY 2006 and for the 55 drugs and biologicals reported by the 
GAO using mean costs from the claims data, the GAO mean purchase 
prices, and the ASP-based payment amounts (ASP+6 percent in most 
cases), and then calculated the equivalent average ASP-based payment 
rate under each of the three payment methodologies. We excluded 
radiopharmaceuticals in our analysis because they were paid at hospital 
charges reduced to cost during CY 2006. The results based on updated 
ASP and claims data were published in Table 24 of the CY 2006 OPPS 
final rule with comment period. For a full discussion of our reasons 
for using these data, we refer readers to section V.B.3.a. of the CY 
2006 OPPS final rule with comment period (70 FR 68639 through 68644).
    As we noted in the CY 2006 OPPS final rule with comment period, 
findings from a MedPAC survey of hospital charging practices indicated 
that hospitals set charges for drugs, biologicals, and 
radiopharmaceuticals high enough to reflect their pharmacy handling 
costs as well as their acquisition costs. In consideration of this 
information, we stated in the CY 2006 OPPS final rule with comment 
period that payment rates derived from hospital claims data also 
included acquisition and pharmacy handling costs because they are 
derived directly from hospital charges (70 FR 68642). In CYs 2006 and 
2007, we finalized a policy of providing payment to HOPDs for drugs, 
biologicals, and associated pharmacy handling costs at a rate of ASP+6 
percent. In addition, in CY 2006 we had proposed to collect pharmacy 
overhead charge data via special pharmacy overhead HCPCS codes that 
hospitals would report. We did not finalize this proposal for CY 2006 
because of hospital concerns regarding the administrative burden 
associated with reporting pharmacy overhead with these special HCPCS 
codes (70 FR 68657 through 68665).
(2) Final Payment Policy
    The provision in section 1833(t)(14)(A)(iii) of the Act, as 
described above, continues to be applicable to determining payments for 
SCODs for CY 2008. This provision requires that, in CY 2008, payment 
for SCODs be equal to the average acquisition cost for the drug for 
that year as determined by the Secretary, subject to any adjustment for 
overhead costs and taking into account the hospital acquisition cost 
survey data collected by the GAO in CYs 2004 and 2005. If hospital 
acquisition cost data are not available, the law requires that payment 
be equal to payment rates established under the methodology described 
in section 1842(o), section 1847A, or section 1847B of the Act, as 
calculated and adjusted by the Secretary as necessary. In addition, 
section 1833(t)(14)(E)(ii) authorizes the Secretary to adjust APC 
weights for SCODs to take into account the MedPAC report relating to 
overhead and related expenses, such as pharmacy services and handling 
costs.
    We considered several options for payment for drug acquisition 
costs and pharmacy overhead for CY 2008 (72 FR 42735). First, we 
considered proposing again the methodology we had proposed for CY 2006, 
which involved the establishment of three drug overhead categories that 
hospitals would use to report pharmacy overhead charges associated with 
a drug provided in the HOPD. Until such data were available for 
ratesetting purposes, we considered continuing our CY 2007 methodology 
of bundling average hospital acquisition and pharmacy overhead 
payments. While this approach has the advantage of not paying 
separately for pharmacy overhead until we would have claims data on 
which to establish separate payment rates for drug acquisition costs 
and pharmacy overhead, its goal would still be to ultimately unpackage 
OPPS payment for pharmacy overhead. We decided not to propose this 
option because we believed and continue to believe that it is 
undesirable to take steps that would ultimately lead to pharmacy 
overhead being unpackaged at the same time that we have proposed 
measures to expand packaging under the OPPS and have considered moving 
toward more episode-based and encounter-based payment. Furthermore, we 
note that as we considered this approach, we were mindful of the 
comments we received in response to our CY 2006 proposed rule 
expressing concern about the additional administrative burden on staff 
and coders that this methodology might cause.
    The second option we presented in the proposed rule was to continue 
our CY 2007 methodology of providing a single bundled payment 
representing average hospital acquisition costs and associated pharmacy 
overhead costs. As stated previously, we believe that hospitals are 
including pharmacy overhead costs in their charges for drugs, 
consistent with MedPAC's findings. While we continue to believe that a 
combined payment amount for drug acquisition costs and pharmacy 
overhead based on our claims data is a reasonable methodology, 
adequately accounts for acquisition costs and overhead, and is 
consistent with our broader packaging efforts, we proposed a slight 
variant of this approach for CY 2008 instead.
    For CY 2008, we proposed to continue our methodology of providing a 
combined payment rate for drug and biological acquisition costs and 
pharmacy overhead. However, in addition, we proposed to instruct 
hospitals to remove the pharmacy overhead charge from the charge for 
the drug or biological and instead report the pharmacy overhead charge 
on an uncoded revenue code line on the claim beginning in CY 2008. We 
believed that this proposed change, from a CY 2007 policy where 
hospitals include pharmacy overhead in their charges for the drug or 
biological to a CY 2008 policy of including the pharmacy overhead 
charges on an uncoded revenue code line, would allow us to package 
pharmacy overhead costs for drugs and biologicals into payment for the 
associated procedure, likely a drug administration procedure, in future 
years when the CY 2008 claims data become available for ratesetting. We 
proposed to apply this policy to the reporting of charges for all drugs 
and biologicals, including contrast agents, irrespective of the item's 
packaged or separately payable status for the CY 2008 OPPS. We did not 
propose to apply this policy to the reporting of overhead charges for 
radiopharmaceuticals, given the explicit instructions we gave hospitals 
beginning in CY 2006 to include the charges for radiopharmaceutical 
overhead and handling in the charges for the radiopharmaceutical 
product.
    We note that, in the case of current OPPS payment for packaged 
drugs, payment for both the drugs and their associated pharmacy 
overhead costs is already packaged into payment for the associated 
separately payable

[[Page 66761]]

procedures, including drug administration services as discussed in 
detail in section II.A.1.b.(2) of this final rule with comment period. 
In addition, this methodology is consistent with the increased 
packaging efforts discussed earlier in section II.A.4. of this final 
rule with comment period. Because we would not expect to have claims 
data reflecting these reporting changes until CY 2010, we proposed to 
continue to provide a combined payment rate for acquisition costs and 
pharmacy overhead for separately payable drugs and biologicals in CY 
2008, similar to the combined payment rate provided in CYs 2006 and 
2007 that represents the average hospital acquisition cost and pharmacy 
overhead cost.
    During the March 2007 APC Panel meeting, the APC Panel recommended 
that CMS implement a three-phase plan to address OPPS payment for 
pharmacy overhead costs. The first phase of the recommended plan 
involves CMS working with interested stakeholders to develop a system 
of defining pharmacy overhead categories for outpatient drugs that 
require different levels of pharmacy resources. In addition, this phase 
includes a provision recommending that CMS provide payment for pharmacy 
overhead costs by setting payment rates for the developed categories 
through New Technology APCs, presumably while collecting hospital cost 
data on these services. The second phase of the recommended plan calls 
for CMS to review estimates of pharmacy overhead costs as identified by 
the GAO and MedPAC, and to consider external survey data from 
stakeholders. The third and final phase of the recommended plan calls 
for specific billing of pharmacy overhead costs using HCPCS codes 
(corresponding to the categories developed in phase one, with payment 
rates resulting from submitted hospital claims data) on the same claim 
as a drug administration service. The APC Panel recommended that the 
overhead payments be made in addition to the current 2007 ASP+6 percent 
payment rates for separately payable drugs and biologicals that do not 
have pass-through status.
    During the September 2007 APC Panel meeting, the Panel recommended 
that hospitals not be required to separately report charges for 
pharmacy overhead and handling, and that pharmacy overhead and handling 
costs be recognized within drug charges and paid through the packaged 
or separate drug payment (as appropriate based on the drug packaging 
threshold). In addition, the Panel recommended that we continue to 
evaluate alternative methods to standardize the capture of pharmacy 
overhead costs in a manner that is simple to implement at the 
organizational level, similar to the three-phase approach recommended 
by the Panel during the March 2007 meeting. We discuss our responses to 
these recommendations below.
    We received many public comments on our CY 2008 proposal to have 
hospitals report charges for pharmacy overhead on uncoded revenue code 
line. A summary of the public comments and our responses follow.
    Comment: MedPAC supported the proposal to collect pharmacy overhead 
data via uncoded revenue code lines because it would allow hospitals to 
be paid more accurately for the variation in pharmacy overhead costs 
when payment for those costs would be packaged into the costs of the 
associated independent services. However, the vast majority of 
commenters echoed the APC Panel's recommendation to not require 
hospitals to separately report charges for pharmacy overhead and 
handling and the Panel's further recommendation that pharmacy overhead 
and handling costs be recognized within drug charges and be paid 
through the packaged or separate drug payment (as appropriate based on 
the drug packaging threshold). In general, the commenters cited 
overwhelming implementation issues, including administrative reporting 
burdens, challenges involved with identifying and splitting current 
charges for drugs and biologicals into acquisition costs and overhead, 
inflexible hospital accounting systems that are unable to combine and 
differentiate charges depending on the insurer, complexity requiring 
manual changes to individual claims, and beneficiary confusion 
regarding these charges on their bills. In addition, some commenters 
were concerned that secondary private insurers may not accept the 
charges when the claim is submitted after being processed by Medicare. 
The commenters noted that, due to these complex issues and the 
relatively short timeframe in which hospitals would have to make these 
changes, data obtained through this proposal are likely to be 
unreliable.
    A few commenters expressed disappointment that CMS did not propose 
to adopt various methodologies they shared with CMS for capturing 
pharmacy overhead data. Several commenters reiterated their proposals 
for a three-phase system, similar to the three-phase plan recommended 
by the APC Panel and discussed above. The commenters also suggested 
that this plan could be altered, and that the survey contained in the 
second phase survey could be replaced with direct adoption of median 
costs from hospital claims data as long as prospective payments based 
on claims data were not implemented prematurely.
    One commenter suggested a modification to the current hospital cost 
report by splitting the ``Pharmacy'' and ``Drugs Sold to Patient'' cost 
centers into two lines each--one for drug acquisition costs and the 
other for drug-related pharmacy and overhead costs. The commenters 
stated that providers would then apportion their drug charges between 
these two lines, and CMS would use the cost report to determine the 
relative cost of pharmacy overhead to total drug costs.
    Other commenters suggested that CMS conduct hospital surveys, 
gather information through the fiscal intermediaries, or attach an 
additional worksheet to the hospital cost report.
    Several commenters requested that, if CMS were to finalize this 
proposal, CMS should limit the reporting requirement to drugs with 
significant pharmacy overhead and administrative costs.
    In addition to these suggested methodologies, several commenters 
expressed confusion regarding the phrases ``uncoded revenue code line'' 
and ``overhead and handling costs'' and requested clarification, while 
others requested that, if CMS finalized the proposed policy for 
pharmacy overhead services, CMS should delay the implementation date 
and provide hospitals additional time to update their systems.
    Response: We appreciate the commenters' many suggestions on ways to 
collect hospital pharmacy data and the commenters' concerns regarding 
our proposal. While we considered the APC Panel's March 2007 
recommendation, as well as similar suggestions from other stakeholders, 
we did not propose to adopt this recommendation (nor are we adopting 
this recommendation in this final rule with comment period) to 
implement a three-phase plan to address OPPS payment for pharmacy 
overhead costs. For CY 2008, we proposed to expand packaging under the 
OPPS by packaging payment for certain ancillary and supportive services 
as discussed in section II.A.4.c. of this final rule with comment 
period. Given our belief that packaging can be helpful in promoting 
hospital efficiency and long-term cost containment and our belief that 
pharmacy handling is ancillary and supportive to the administration of 
drugs and biologicals in the HOPD, we do not believe it would be 
desirable to take steps that would ultimately lead to payment for 
pharmacy overhead costs being unpackaged under the OPPS.

[[Page 66762]]

    As noted in the proposed rule (72 FR 42734 through 42735), the APC 
Panel recommended that CMS establish separate payment amounts for 
pharmacy overhead in addition to the current CY 2007 combined payment 
for drug acquisition costs and pharmacy overhead of ASP+6 percent. As 
we discussed in the CY 2006 OPPS final rule with comment period (70 FR 
68657) and in the CY 2007 OPPS/ASC final rule with comment period (71 
FR 68089 through 68092), findings from a MedPAC survey of hospital 
charging practices indicated that hospitals set charges for drugs, 
biologicals, and radiopharmaceuticals high enough to reflect their 
pharmacy handling costs as well as their acquisition costs. We continue 
to believe that our payment rates for drug acquisition costs and 
pharmacy overhead should be determined based on the costs reflected in 
our claims data, as these costs reflect both acquisition costs and 
overhead costs. We also believe that establishing additional payment 
for pharmacy overhead beyond our proposed payment rates based on claims 
data would distort the relative relationship of costs across HOPD 
services, which is the basis of the OPPS. As we do consider the Panel's 
March 2007 recommendation to be aligned with the current OPPS trend 
towards increasing the size of payment bundles, we are accepting the 
Panel's September 2007 recommendation to continue to evaluate alternate 
methods to standardize the capture of pharmacy overhead costs in a 
manner that is simple to implement at the organizational level. As 
such, we are interested in continuing our dialogue with hospital 
stakeholders regarding the issue of pharmacy overhead. We generally 
accept requests from interested organizations to discuss their views 
about OPPS payment policy issues, including pharmacy handling issues. 
In addition, we establish the OPPS rates through regulations and, as 
such, consider the timely comments of interested organizations, 
establish the payment policies for the forthcoming year, and respond to 
the timely comments of all public commenters in the final rule in which 
we establish the payment for the forthcoming year.
    After reviewing the public comments we received on the CY 2008 
proposal, we have a better understanding of the scope of our proposal 
and the burden that it would have on hospitals. While we continue to 
believe that packaging pharmacy overhead costs into the associated 
independent procedures for administration of the drugs could pay 
hospitals more appropriately for the variable pharmacy overhead costs 
associated with different types of drugs, we are concerned about the 
operational challenges and administrative burdens that hospitals would 
face in reporting drugs provided in the HOPD. Therefore, we are not 
finalizing our proposal to require hospitals to remove pharmacy 
overhead costs from drug acquisition costs and to report pharmacy 
overhead costs in an uncoded revenue code line.
    We appreciate the suggestions to implement a hospital survey or to 
include a pharmacy overhead worksheet on the hospital cost report. 
However, we do not believe that it would be administratively feasible 
or reasonable from a resource perspective to develop and update 
information regarding pharmacy overhead costs through either of these 
methodologies. Presumably the commenters believe that, by collecting 
these data, we would provide additional separate payments to hospitals 
for pharmacy overhead services. As explained above, separate payment 
for pharmacy overhead would decrease the current size of the drug 
payment bundles and would not be aligned with the additional packaging 
we have implemented in this final rule with comment period.
    In addition, several commenters expressed their preference to 
retain the pharmacy overhead payment packaged with the payment for the 
drug, stating that this is the most logical and appropriate grouping 
for payment purposes. We agree with these commenters and believe that a 
single OPPS payment that represents both drug acquisition and 
associated pharmacy overhead costs is the most reasonable and logical 
method of payment for these services. Therefore, we are adopting the 
September 2007 recommendation of the APC Panel that pharmacy overhead 
and handling costs be recognized within drug charges and be paid 
through the packaged or separate drug payment (as appropriate based on 
the drug packaging threshold). We do not believe that we need to 
provide specific guidance on the elements of pharmacy handling and 
overhead that hospitals should consider in setting their charges for 
drugs, because, as MedPAC found and many commenters confirmed, 
hospitals are currently including the costs of pharmacy overhead in 
their charges for drugs and biologicals.
    After consideration of the public comments received, we are 
finalizing our proposal to provide a single bundled payment for 
separately payable drugs and biologicals, inclusive of both drug 
acquisition and pharmacy overhead costs. Hospitals should continue to 
consider the costs of pharmacy overhead in developing and reporting 
their charges for drugs and biologicals, maintaining their current 
practice.
    For the CY 2008 OPPS/ASC proposed rule, we evaluated two data 
sources that we have available to us for setting the CY 2008 payment 
rates for drugs and biologicals. The first source of drug pricing 
information that we have is the ASP data from the fourth quarter of CY 
2006, which were used to set payment rates for drugs and biologicals in 
the physician's office setting, effective April 1, 2007. We have ASP-
based prices for approximately 500 drugs and biologicals (including 
contrast agents) payable under the OPPS. However, we currently do not 
have any ASP data on radiopharmaceuticals.
    The second source of cost data that we have for drugs, biologicals, 
and radiopharmaceuticals is the mean and median costs derived from the 
CY 2006 hospital claims data. As section 1833(t)(14)(A)(iii) of the Act 
clearly specifies that payment for SCODs in CY 2008 be equal to the 
``average'' acquisition cost for the drug, we limited our analysis to 
the mean costs of drugs determined using the hospital claims data, 
instead of using median costs.
    In our data analysis, we compared the payment rates for drugs and 
biologicals using data from both sources described above. After 
determining the proposed CY 2008 packaging status of drugs and 
biologicals, we estimated aggregate expenditures for all drugs and 
biologicals (excluding radiopharmaceuticals) that would be separately 
payable in CY 2008 using mean costs from the hospital claims data and 
the ASP-based payment amounts, and calculated the equivalent average 
ASP-based payment amount under both payment methodologies.
    The results of our proposed rule data analysis for the proposed 
rule indicated that using mean unit cost to set the payment rates for 
the drugs and biologicals that would be separately payable in CY 2008 
would be equivalent to basing their payment rates, on average, at ASP+5 
percent. Therefore, we proposed to continue to provide a bundled 
payment for the acquisition costs of drugs and biologicals and the 
associated pharmacy overhead in CY 2008 at ASP+5 percent, where the ASP 
add-on percent was calculated based on mean costs from hospital claims 
data. In addition, as described in section II.A.4.c.(6) of this final 
rule with comment period, for contrast agents, we proposed a 
supplemental approach that would package payment for all contrast media 
under the CY 2008 OPPS.

[[Page 66763]]

    During the September 2007 meeting of the APC Panel, the Panel 
recommended that we continue to provide payment for separately payable 
drugs at a rate of ASP+6 percent for CY 2008. We discuss our response 
to this recommendation below.
    We received many public comments on our proposal to pay for 
separately payable drugs and biologicals and their pharmacy overhead at 
ASP+5 percent in CY 2008. A summary of the public comments and our 
responses follow.
    Comment: Many commenters agreed with the Panel's recommendation to 
continue providing payment for separately payable drugs, including 
several specific groups of drugs such as blood clotting factors and 
IVIG, at ASP+6 percent. Some commenters noted that this would eliminate 
a site-of-service differential that would otherwise exist between the 
hospital outpatient and physicians' office settings if HOPDs were paid 
at ASP+5 percent while physicians' offices were paid at ASP+6 percent. 
The commenters also cited issues of charge compression. Specifically, 
the commenters explained that many lower cost packaged drugs have a 
higher markup and the relative ASP number is not inclusive of this 
pricing practice because only separately payable drugs are used in the 
comparison. A few commenters also noted that CMS has not demonstrated 
that concerns that led to a continuation of the ASP+6 percent 
methodology in CY 2007, such as a limited understanding of pharmacy 
overhead costs and their relationship to hospital outpatient drugs, 
have been resolved. Finally, some commenters expressed concern that, 
even at ASP+6 percent, hospitals may not be receiving adequate payments 
to account for both acquisition costs and overhead costs. Furthermore, 
some of these commenters requested payment increases for certain groups 
of drugs, such as IVIG and blood products.
    Response: In analyzing data for the CY 2008 final rule with comment 
period, we again performed the analysis described in the CY 2008 
proposed rule by comparing aggregate expenditures for separately 
payable drugs and biologicals to the ASP-based payment rates, weighting 
these HCPCS codes by their OPPS volumes, and calculating an equivalent 
average ASP-based payment rate for drugs and biologicals provided in 
HOPDs for CY 2008. As we did for our final rule analysis to determine 
the final packaging status for each drug, we used updated CY 2006 mean 
unit costs and drug volumes and updated ASP data. The result of our 
final analysis using updated hospital claims data for the full CY 2006 
year and updated CCRs is that the equivalent average ASP-based payment 
amount for separately payable drugs and biologicals, including pharmacy 
handling costs, is equal to ASP+3 percent for CY 2008. Therefore, 
according to our CY 2008 proposal for payment of separately payable 
drugs and biologicals which includes pharmacy overhead payment, based 
on mean costs from CY 2006 hospital claims, the OPPS payment rate for 
separately payable drugs and biologicals would be ASP+3 percent.
    We acknowledge that different payment rates for drugs and 
biologicals provided in the physician's office and HOPD settings are of 
concern to some commenters. However, the OPPS, the MPFS physician's 
office payments for services and physician's office payments for Part B 
drugs are based on very different payment methodologies. In particular, 
the OPPS relies upon costs from the most updated claims and Medicare 
cost report data to develop payment rates. On the other hand, the MPFS 
pays for services based on estimates of input costs and pays for drugs 
and biologicals at ASP+6 percent, as required by statute. Therefore, it 
is not surprising to us that the estimated costs of drug and 
biologicals and their associated pharmacy overhead, like many other 
OPPS services, could be different in the HOPD than in the physician's 
office, resulting in different payments in the two settings. We do not 
believe that different payment rates for drugs and biologicals in the 
HOPD or physician's office settings will create problems for 
beneficiaries regarding access to drug administration services because 
we have not seen problems with access in the two settings for other 
types of services, including diagnostic studies, surgical procedures, 
and visits, which generally have different payment rates under the two 
payment systems (unless there is an applicable externally applied 
statutory cap to payment, such as the cap on payment for imaging 
services provided in the physician's office based on the OPPS rates).
    In response to the commenters' concerns regarding the effects of 
charge compression on drug payment, as described further in section 
II.A.1.c. of this final rule with comment period, we have contracted 
with RTI to estimate regression-based CCRs using charge data from both 
inpatient and outpatient claims for hospital ancillary departments. We 
will consider whether it would be appropriate to adopt regression-based 
CCRs for the OPPS in the future after we receive RTI's comprehensive 
review of the OPPS cost estimation methodology and review the results 
of the use of both inpatient and outpatient charges across all payers 
to reestimate regression-based CCRs.
    After a period of continuing ASP+6 percent payment in CY 2007 while 
we gathered additional information regarding pharmacy overhead costs, 
we believe that it is most appropriate at this point to continue to pay 
for drugs and biologicals and their associated pharmacy overhead costs 
using an ASP-based system, but to determine the relative ASP percent 
based on mean costs from claims rather than continue to use ASP+6 
percent. Therefore, we are not accepting the recommendation of the APC 
Panel to continue to pay for separately payable drugs and biologicals 
at ASP+6 percent for CY 2008. After reviewing the commenters' responses 
to our CY 2008 proposal, we are reassured that hospitals currently 
capture pharmacy overhead costs in their charges for drugs, and we have 
clear guidance from the APC Panel and some commenters that pharmacy 
overhead and handling costs should continue to be recognized within 
drug charges and paid through the drug payment.
    Our claims data for the CY 2007 and CY 2008 final rules 
consistently have shown equivalent average ASP-based amounts for 
separately payable drugs and biologicals that are lower than ASP+6 
percent, specifically ASP+4 percent and APC+3 percent, respectively. 
However, because we have been paying ASP+6 percent for separately 
payable drugs and biologicals under the OPPS for the last 2 years, we 
believe it is appropriate to transition to the use of hospital claims 
data as the basis for the relative ASP percent. Therefore, we will 
provide a 2-year transition, with a one year transitional payment rate 
in CY 2008, and pay for separately payable drugs and biologicals and 
associated pharmacy overhead based on a 50/50 blend of their CY 2007 
payment rate of ASP+6 percent and their final CY 2008 equivalent 
average ASP-based payment amount of ASP+3 percent. This blend results 
in a payment amount of ASP+4.5 percent. However, because we pay based 
on whole percentages in relation to ASP, we are rounding the blend to 
ASP+5 percent for CY 2008. In summary, we will provide a transitional 
payment of ASP+5 percent for separately payable drugs and biologicals 
and associated pharmacy overhead in CY 2008 as we move toward a 
relative ASP percent based on mean costs from claims for CY 2009.
    Comment: Several commenters disagreed with our calculation of an 
average ASP-based payment amount for drugs and biologicals and 
associated

[[Page 66764]]

pharmacy overhead costs based on aggregate costs from claims. One 
commenter stated that instead of an aggregate amount across all drugs, 
each drug should be individually examined in order to determine average 
hospital acquisition cost. This commenter noted that, by aggregating 
drug costs across all separately paid drugs to determine the equivalent 
average ASP-based payment rate, some drugs could be underpaid while 
others could be overpaid. Other commenters suggested that CMS include 
relatively inexpensive drugs, including drugs that are usually packaged 
as well as drugs that may not have their own HCPCS codes but are 
reported with charges on uncoded revenue code lines. The commenters 
noted that, because of charge compression and hospital billing 
practices, these drugs typically receive the highest markups because 
they are relatively inexpensive. Other commenters recommended that CMS 
include packaged drugs with HCPCS codes that are currently packaged in 
determining the average ASP-based amount. The commenters noted that if 
all drugs were paid separately in the HOPD, there would be better 
representation of pharmacy overhead costs associated with lower cost 
drugs in the average ASP-based amount calculated. The commenters 
explained that hospitals often attribute higher markups to lower cost 
drugs and lower markups to higher cost drugs, an issue known as charge 
compression. By providing separate payment for all drugs, the OPPS 
would then consider the full set of Part B drugs and their associated 
overhead as part of the average ASP-based amount, rather than relying 
on only separately paid, and therefore more expensive, drugs to perform 
this calculation. The commenters claimed that this change would more 
accurately account for the actual pharmacy overhead charges that 
hospitals have built into their accounting systems, and, as a result, 
the equivalent average ASP-based amount would be higher. A few 
commenters expressed concern that ASP reflects prices and discounts not 
passed along to providers and that ASP is a measure of sales to all 
entities, not just hospitals. Other commenters noted that the two 
quarter lag in updated ASP data is problematic for hospitals that 
experience varying purchasing conditions from quarter to quarter.
    Response: We continue to believe that use of ASP as a payment 
methodology is appropriate under the OPPS because these rates are 
updated quarterly and are therefore more reflective of current market 
conditions that influence hospital purchasing prices than hospital 
claims data. Furthermore, comparison of the ASP data to our hospital 
claims data serves to ensure that we are paying for drugs in the OPPS 
in general at rates that are reflective of hospitals' costs for 
acquisition and overhead. While we understand that, by aggregating the 
costs of separately payable drugs and biologicals prior to developing 
an equivalent average ASP-based payment rate, the result could be that 
some drugs could be relatively underpaid in a given clinical scenario 
while others could be relatively overpaid, we continue to believe that 
ASP data are our best proxy for average hospital acquisition costs 
under the OPPS and that the calculation should be performed using 
aggregated drug costs. Given the information provided by commenters 
regarding hospitals' diverse charging practices and the differential 
inclusion of pharmacy overhead costs in charges for low and high cost 
drugs, we do not believe that it would be reasonable to conduct this 
comparison on a drug-specific level to calculate a distinct equivalent 
ASP-based payment for each drug under the OPPS that would reflect the 
acquisition and overhead costs of that particular drug. Instead, we 
continue to believe that it is more appropriate to develop an 
equivalent average ASP-based payment rate that determines the ASP add-
on percent based on the aggregated hospital costs of separately payable 
drugs and biologicals calculated from claims data, recognizing that the 
OPPS is a system based on the averaging of costs for services.
    In addition, we do not include packaged drugs and biologicals in 
this analysis because cost data for these items are already accounted 
for within the APC ratesetting process through the median cost 
calculation methodology discussed in section II.A.2. of this final rule 
with comment period. To include the costs of packaged drugs in both our 
APC ratesetting process (for associated procedures present on the same 
claim) and in our ratesetting process to establish a relative ASP-based 
payment amount for drugs and biologicals would give these data 
disproportionate emphasis in the OPPS system by skewing our analyses, 
as the costs of these packaged items would be, in effect, counted 
twice. Accordingly, we are not implementing the suggestion from 
commenters that we include all packaged and separately payable drugs 
and biologicals when establishing an average ASP-based rate to provide 
payment for the hospital acquisition and pharmacy handling costs of 
drugs and biologicals. However, we remind commenters that because the 
costs of packaged drugs, including their pharmacy overhead costs, are 
packaged into the payments for the procedures in which they are 
administered, the OPPS provides payment for both the drugs and the 
associated pharmacy overhead costs through the applicable procedural 
APC payments.
    As noted in the CY 2007 OPPS final rule with comment period, the 
ASP methodology has been established through rulemaking, and specific 
requests regarding methodological changes to this established system 
are outside the scope of this final rule with comment period. We 
believe that updating drug payment rates quarterly based on the most 
currently available ASP, given that ASP data include sales to hospitals 
in addition to others, provides the most up-to-date payment possible 
that is reflective of contemporary market trends and hospital 
acquisition costs.
    Comment: One commenter requested that CMS create a HCPCS J-code for 
tositumomab, currently provided under a radioimmunotherapy regimen and 
billed as part of HCPCS code G3001 (Administration and supply of 
tositumomab, 450 mg). The commenter argued that because tositumomab is 
listed in compendia, is approved by the FDA as part of the 
BEXXAR[supreg] regimen, and has its own National Drug Code (NDC) 
number, it should be recognized as a drug and, therefore, paid as other 
drugs are paid under the OPPS methodology instead of having a payment 
rate determined by hospital claims data. The commenter suggested that a 
payment rate could be established using the ASP methodology.
    Response: As we have noted in the November 10, 2005 final rule with 
comment period for CY 2006 (70 FR 68654) and the November 7, 2003 final 
rule with comment period for CY 2004 (68 FR 63443), unlabeled 
tositumomab is not approved as either a drug or a radiopharmaceutical, 
but it is a supply that is required as part of the radioimmunotherapy 
treatment regiment. We do not make separate payment for supplies used 
in services provided under the OPPS. Payments for necessary supplies 
are packaged into payments for the separately payable services provided 
by the hospital. Specifically, administration of unlabeled tositumomab 
is a complete service that qualifies for separate payment under its own 
clinical APC. This complete service is currently described by HCPCS 
code G3001. Therefore, we do not agree with the commenter's 
recommendation that we should assign a separate HCPCS code to

[[Page 66765]]

the supply of unlabeled tositumomab. Rather, we will continue to make 
separate payment for the administration of tositumomab, and payment for 
the supply of unlabeled tositumomab is packaged into the administration 
payment.
    After consideration of the public comments received, we are 
finalizing our CY 2008 proposal with a modification to provide a 2-year 
transition for payment for separately payable drugs and biologicals 
under the OPPS based on the equivalent average ASP-based payment amount 
calculated from aggregate costs from hospitals claims. While the 
payment amount without a transition would be ASP+3 percent for CY 2008, 
we will be providing a transitional payment of ASP+5 percent for these 
products in CY 2008.
(3) Payment for Blood Clotting Factors
    For CY 2007, we are providing payment for blood clotting factors 
under the OPPS at ASP+6 percent, plus an additional payment for the 
furnishing fee that is also a part of the payment for blood clotting 
factors furnished in physicians' offices under Medicare Part B. The CY 
2007 updated furnishing fee is $0.152 per unit.
    For the CY 2008 OPPS, we proposed to pay for blood clotting factors 
at ASP+5 percent and to continue our policy for payment of the 
furnishing fee using the updated amount for CY 2008. For CY 2008, the 
furnishing fee increases by 4.0 percent to $0.158.
    As indicated in the CY 2008 OPPS/ASC proposed rule (72 FR 42736), 
we have consistently noted that we would update the payment amount for 
the furnishing fee each year (based on the Consumer Price Index (CPI)) 
so that the payment amount for the furnishing fee is equal to the 
furnishing fee payment amount noted in the MPFS final rule. As 
discussed in greater detail in the CY 2008 MPFS proposed rule (72 FR 
38152), the CPI data for the 12-month period ending in June 2007 were 
not available when we developed the OPPS and the MPFS proposed rules.
    Because the furnishing fee update is based on the percentage 
increase in the CPI for medical care for the 12-month period ending 
with June of the previous year and the Bureau of Labor Statistics 
releases the applicable CPI data after the OPPS and MPFS proposed rules 
are published, we have not been able to include the actual updated 
furnishing fee in the CY 2006 through CY 2008 OPPS and MPFS proposed 
rules. Rather, we announced in these proposed rules that we intended to 
include the actual figure for the percent change in the applicable CPI, 
and the updated furnishing fee calculated based on that figure, in the 
associated final rule. Given the timing of the availability of the 
applicable data and our timeframe for preparing proposed rules, this 
process is unavoidable and likely to remain unchanged in the future. We 
believed that including a discussion of the furnishing fee update in 
annual rulemaking does not provide an advantage over other means of 
announcing this information, so long as the current statutory update 
methodology continues in effect. We believed that the public's need for 
information and adequate notice regarding the updated furnishing fee 
could be better met by issuing program instructions which would 
eliminate the discussion of the furnishing fee update annually in 
rulemaking. In addition, by communicating the updated furnishing fee in 
program instructions, the actual figure for the percent change in the 
applicable CPI and the updated furnishing fee calculated based on that 
figure could be announced more timely than when included as part of the 
annual rulemaking process. Because the furnishing fee update process is 
statutorily determined and is based on an index that is not affected by 
administrative discretion or public comment, we do not believe our 
proposed means of communicating the update would adversely affect 
stakeholders or the public. Therefore, for CY 2009 and thereafter, 
until such time as the update methodology may be modified, we proposed 
to announce the blood clotting factor furnishing fee using applicable 
program instructions and posting on the CMS Web site.
    We received a few public comments on our proposal for the blood 
clotting factor furnishing fee. A summary of the public comments and 
our responses follow.
    Comment: Several commenters supported our proposal to announce the 
blood clotting factor furnishing fee using program instructions. The 
commenters agreed that, by communicating the updated furnishing fee in 
program instructions, the actual figure for the percent change in the 
applicable CPI and the updated furnishing fee calculated based on that 
figure could be announced more timely. To that end, the commenters also 
suggested that CMS post this information on the CMS Web site.
    Response: We appreciate the support of these commenters for our 
proposal. We believe that program instructions allow additional 
flexibility regarding the announcement of the blood clotting factor 
furnishing fee. Therefore, we are finalizing the proposal, without 
modification, and in future years we will announce the updated blood 
clotting factor furnishing fee using applicable program instructions 
and posting on the CMS Web site. (We refer readers to the CY 2008 MPFS 
final rule for further discussion of this issue.)
(4) Payment for Radiopharmaceuticals
(a) Background
    Section 303(h) of Pub. L. 108-173 exempted radiopharmaceuticals 
from ASP pricing in the physician's office setting. Beginning in the CY 
2005 OPPS final rule with comment period, we have exempted 
radiopharmaceutical manufacturers from reporting ASP data for payment 
purposes under the OPPS (for more information, we refer readers to the 
CY 2005 OPPS final rule with comment period and the CY 2006 OPPS final 
rule with comment period, 69 FR 65811 and 70 FR 68655, respectively). 
Consequently, we did not have ASP data for radiopharmaceuticals for 
consideration for CY 2008 OPPS ratesetting. In accordance with section 
1833(t)(14)(B)(i)(I) of the Act, we have classified 
radiopharmaceuticals under the OPPS as SCODs. As such, we have paid for 
radiopharmaceuticals at average acquisition cost as determined by the 
Secretary and subject to any adjustment for overhead costs. 
Radiopharmaceuticals are also subject to the policies affecting all 
similarly classified OPPS drugs and biologicals, such as pass-through 
payments and packaging determinations, discussed earlier in this final 
rule with comment period.
    For CYs 2006 and 2007, we used mean unit cost data from hospital 
claims to determine each radiopharmaceutical's packaging status and 
implemented a temporary policy to pay for separately payable 
radiopharmaceuticals based on the hospital's charge for each 
radiopharmaceutical adjusted to cost using the hospital's overall CCR. 
This methodology was finalized as an interim proxy for average 
acquisition cost because of the unique circumstances associated with 
providing radiopharmaceutical products to Medicare beneficiaries. The 
single OPPS payment represented Medicare payment for both the 
acquisition cost of the radiopharmaceutical and its associated pharmacy 
overhead costs. We clearly stated in both the CY 2006 and CY 2007 OPPS/
ASC final rules with comment period that we did not intend to maintain 
this methodology permanently (70 FR 68656 and 71 FR 68096, 
respectively), and that we would

[[Page 66766]]

continue to actively seek other methodologies for setting payments for 
radiopharmaceuticals in future years.
    During the CY 2006 and CY 2007 rulemaking processes, we encouraged 
hospitals and the radiopharmaceutical stakeholders to assist us in 
developing a viable long-term prospective payment methodology for these 
products under the OPPS. As discussed in the CY 2008 proposed rule, we 
are pleased to note that we have had many discussions over this past 
year with interested parties regarding the availability and limitations 
of radiopharmaceutical cost data. In addition, we have received several 
suggestions from interested parties on how to structure future payment 
methodologies. Many of the proposals we have received have suggested 
that we consider differentiating radiopharmaceutical products into two 
different categories by cost, at least in part because stakeholders 
have speculated that charge compression leads to inappropriately low 
calculated costs for expensive radiopharmaceuticals. For CY 2008, we 
made separate payment proposals for diagnostic radiopharmaceuticals and 
therapeutic radiopharmaceuticals. While we have not grouped 
radiopharmaceuticals based on cost, we note that the therapeutic 
radiopharmaceuticals typically are more expensive than the diagnostic 
radiopharmaceuticals. We identified all diagnostic radiopharmaceuticals 
specifically as those Level II HCPCS codes that include the term 
``diagnostic'' along with a radiopharmaceutical in their long code 
descriptors. Therefore, we were able to distinguish therapeutic 
radiopharmaceuticals from diagnostic radiopharmaceuticals as those 
Level II HCPCS codes that have the term ``therapeutic'' along with a 
radiopharmaceutical in their long code descriptors. We note that all 
radiopharmaceutical products fall into one category or the other; their 
use as a diagnostic radiopharmaceutical or therapeutic 
radiopharmaceutical is mutually exclusive.
(b) Payment for Diagnostic Radiopharmaceuticals
    As discussed in section II.A.4.c.(5) and (6) of the CY 2008 OPPS/
ASC proposed rule, we proposed to package payment for diagnostic 
radiopharmaceuticals and contrast agents with per day costs over $60 as 
part of our packaging proposal for CY 2008. Radiopharmaceuticals and 
contrast agents currently are included as SCODs in section 
1833(t)(14)(B) of the Act, and we currently package payment for 
diagnostic radiopharmaceuticals and contrast agents with per day costs 
of $55 or less. However, our proposal for CY 2008 also included 
packaging payment for all diagnostic radiopharmaceuticals and contrast 
agents, regardless of their per day cost. Packaging costs into a single 
aggregate payment for a service, encounter, or episode of care is a 
fundamental principle that distinguishes a prospective payment system 
from a fee schedule. In general, packaging the costs of items and 
services into the payment for the primary procedure or service with 
which they are associated encourages hospital efficiencies and also 
enables hospitals to manage their resources with maximum flexibility. 
The proportion of drugs, biologicals, and radiopharmaceuticals that are 
separately paid has increased in recent years, from 30 percent of HCPCS 
codes for these products in CY 2003 to 50 percent in CY 2007, a pattern 
that has been noted previously for procedural services as well. Our 
proposal to package payment for diagnostic radiopharmaceuticals and 
contrast agents regardless of per day cost furthers the fundamental 
principles of a prospective payment system.
    In the proposed rule, we stated our belief that our proposed 
treatment of diagnostic radiopharmaceuticals and contrast agents 
differently from other SCODs was appropriate for several reasons. 
First, the statutory requirement that we must pay separately for drugs 
and biologicals for which the per day cost exceeds $50 under section 
1833(t)(16)(B) of the Act has expired. Therefore, we are not restricted 
to the extent to which we can package payment for SCODs and other 
drugs, nor are we required to treat all classes of drugs in the same 
manner with regard to whether they are packaged or separately paid. We 
have used this flexibility to make different packaging determinations 
for several years with regard to specific anti-emetic drugs. While we 
proposed to continue to establish an updated cost threshold for 
packaging drugs, biologicals, and radiopharmaceuticals, we also 
proposed an approach specific to diagnostic radiopharmaceuticals and 
contrast agents that would otherwise be separately paid.
    Second, diagnostic radiopharmaceuticals and contrast agents 
function effectively as supplies that enable the provision of an 
independent service. More specifically, contrast agents are always 
provided in support of a diagnostic or therapeutic procedure that 
involves imaging, and diagnostic radiopharmaceuticals are always 
provided in support of a diagnostic nuclear medicine scan. This is 
different from many other SCODs, for example, therapeutic 
radiopharmaceuticals, where the therapeutic radiopharmaceutical itself 
is the primary therapeutic modality. Given the inherent function of 
contrast agents and diagnostic radiopharmaceuticals as supportive to 
the performance of an independent procedure, we view the packaging of 
payment for contrast agents and diagnostic radiopharmaceuticals as a 
logical initial step to expand packaging for SCODs. As we consider 
moving to additional encounter-based and episode-based payment in 
future years, we may consider additional options for packaging more 
SCODs in the future.
    Third, section 1833(t)(14)(A)(iii) of the Act requires that payment 
for SCODs be set prospectively based on a measure of average hospital 
acquisition cost. While we have ASP data for contrast agents, the lack 
of ASP data as a source of average acquisition cost for 
radiopharmaceuticals and the varying inclusion of overhead and handling 
costs in the charge for a radiopharmaceutical resulted in payment for 
radiopharmaceuticals at charges reduced to cost on a temporary basis 
for CYs 2006 and 2007.
    We now believe our claims data offer an acceptable proxy for 
average hospital acquisition cost and associated handling and 
preparation costs for radiopharmaceuticals. We believe that hospitals 
have adapted to the CY 2006 coding changes for radiopharmaceuticals and 
responded to our instructions to include charges for 
radiopharmaceutical handling in their charges for the 
radiopharmaceutical products. We have relied on mean unit costs derived 
from our claims data as one proxy for average acquisition cost and 
pharmacy overhead, and we use these data to determine the packaging 
status for SCODs. However, in light of improved data for 
radiopharmaceuticals in the CY 2006 claims, we believed that the line-
item estimated cost for a diagnostic radiopharmaceutical in our claims 
data is a reasonable approximation of average acquisition and 
preparation and handling costs for diagnostic radiopharmaceuticals. 
Further, because the standard OPPS packaging methodology packages the 
total estimated cost for each radiopharmaceutical on each claim 
(including the full range of costs observed on the claims) with the 
cost of associated nuclear medicine procedures for ratesetting, this 
packaging approach is consistent with considering the average cost for 
radiopharmaceuticals, rather than the median. We also noted our belief 
that our improved claims data

[[Page 66767]]

could support the establishment of separate, prospective payment rates 
for diagnostic radiopharmaceuticals with per day costs exceeding our 
general packaging threshold (analogous to our proposal for therapeutic 
radiopharmaceuticals). However, we proposed to package all diagnostic 
radiopharmaceuticals because we believed additional packaging of 
payment for supportive and ancillary services, including diagnostic 
radiopharmaceuticals, would provide additional incentives for 
efficiency and greater flexibility for hospitals to manage their 
resources.
    In the case of contrast agents, while we have ASP data that can be 
a proxy for average hospital acquisition cost and associated handling 
and preparation costs, payment for almost all contrast agents would be 
packaged under the OPPS for CY 2008 based on the $60 per day packaging 
threshold. Therefore, as discussed in more detail in section 
V.B.3.a.(4) of this final rule with comment period, we believed it 
would be most appropriate to package payment for all contrast agents 
for CY 2008, to better provide for accurate payment for the associated 
tests and procedures that promotes hospital efficiency.
    In summary, in the context of our CY 2008 proposal, we viewed 
diagnostic radiopharmaceuticals and contrast agents as ancillary and 
supportive of the diagnostic tests and therapeutic procedures in which 
they are used. In light of our authority to make different packaging 
determinations, and the improved reporting of hospital charges for 
radiopharmaceutical handling in the CY 2006 claims data, we proposed to 
package payment for contrast agents and diagnostic radiopharmaceuticals 
for CY 2008.
    For more information on how rates were set for procedures in which 
diagnostic radiopharmaceuticals or contrast agents are used, and for a 
further discussion regarding our final packaging methodology for CY 
2008, we refer readers to section II.B. of this final rule with comment 
period.
    During its March 2007 meeting, the APC Panel made a recommendation 
that CMS work with stakeholders on issues related to payment for 
radiopharmaceuticals, including evaluating claims data for different 
classes of radiopharmaceuticals and ensuring that a nuclear medicine 
procedure claim always includes at least one reported 
radiopharmaceutical agent. As discussed in section II.A.4.c.(5) of the 
proposed rule, we proposed to accept the APC Panel's recommendation, 
and we welcomed public comment on the burden hospitals would experience 
should we require such precise reporting. We also solicited comment 
specifically on the importance of such a requirement in light of our 
discussion in the proposed rule on the representation of 
radiopharmaceuticals in the single claims for diagnostic nuclear 
medicine procedures, the presence of uncoded revenue code charges 
specific to diagnostic radiopharmaceuticals on claims without a coded 
radiopharmaceutical, and our proposal to package payment for all 
diagnostic radiopharmaceuticals for CY 2008. A summary of the public 
comments we received on this issue, our responses, and our response to 
the APC Panel recommendation can be found in section II.A.4.c.(5) of 
this final rule with comment period.
    We received many comments on our proposal to package payment for 
all diagnostic radiopharmaceuticals and contrast agents for CY 2008. A 
summary of the public comments and our responses follow.
    Comment: A number of commenters stated that diagnostic 
radiopharmaceuticals and contrast agents with per day costs over the 
proposed OPPS drug packaging threshold are defined as SCODs and, 
therefore, should be assigned separate APC payments. In particular, the 
commenters questioned CMS's authority to classify groups of drugs, such 
as diagnostic radiopharmaceuticals and contrast agents, and implement 
packaging and payment policies that do not reflect their status as 
SCODs. In addition, the commenters objected to the proposal to package 
payment for diagnostic radiopharmaceuticals and contrast agents 
because, as SCODs, the commenters believed these products were required 
by statute to be paid at average acquisition cost. The commenters 
explained that, when several different diagnostic radiopharmaceuticals 
or contrast agents may be used for a particular procedure, the costs of 
these diagnostic radiopharmaceuticals or contrast agents are averaged 
together and added to the amount for the procedure in order to 
determine the payment rate for the associated procedural APC. 
Therefore, the commenters argued that the amount added to the procedure 
cost through packaging, representing the cost of the diagnostic 
radiopharmaceutical or contrast agent, does not reflect the average 
acquisition cost of any one particular item but, rather, reflects the 
average cost of whatever items may be used with that particular 
procedure.
    Response: As discussed above, we based our proposal to treat 
diagnostic radiopharmaceuticals and contrast agents differently from 
other SCODs upon our reasoning that the statutorily required OPPS drug 
packaging threshold has expired and our view that diagnostic 
radiopharmaceuticals and contrast agents function effectively as 
supplies that enable the provision of an independent service, rather 
than serving themselves as the therapeutic modality. We sought to 
package their payment as ancillary and supportive services in order to 
provide incentives for greater efficiency and to provide hospitals with 
additional flexibility in managing their resources. We note that we 
currently classify different groups of drugs for specific payment 
purposes, as evidenced by our policy regarding the oral and injectable 
forms of the 5HT3 anti-emetics and our fixed price drug packaging 
threshold.
    Although our final CY 2008 policy, as described in section 
II.A.4.c.(5) and (6) of this final rule with comment period, packages 
payment for all diagnostic radiopharmaceuticals and contrast agents 
into the payment for their associated procedures, we will continue to 
provide payment for these items in CY 2008 based on a proxy for average 
acquisition cost. We believe that the line-item estimated cost for a 
diagnostic radiopharmaceutical in our claims data is a reasonable 
approximation of average acquisition and preparation and handling costs 
for diagnostic radiopharmaceuticals. Further, because the standard OPPS 
packaging methodology packages the total estimated cost for each 
radiopharmaceutical on each claim (including the full range of costs 
observed on the claims) with the cost of associated nuclear medicine 
procedures for rate setting, this packaging approach is consistent with 
considering the average cost for radiopharmaceuticals, rather than the 
median cost.
    We further note that these drugs, biologicals, or 
radiopharmaceuticals for which we have not established a separate APC 
and, therefore, for which payment would be packaged rather than 
separately provided under the OPPS, could be considered to not be 
SCODs. Similarly, drugs, biologicals, and therapeutic 
radiopharmaceuticals with mean per day costs of less than $60 that are 
packaged and for which a separate APC has not been established would 
also not be SCODs. This reading is consistent with our final payment 
policy whereby we package payment for diagnostic radiopharmaceuticals 
and contrast agents and provide payment for these products through 
payment for their associated procedures.
    Comment: A few commenters suggested that CMS misclassified

[[Page 66768]]

HCPCS codes A9542 (Indium In-111 ibritumomab tiuxetan, diagnostic, per 
study dose, up to 5 millicuries) and A9544 (Iodine I-131 tositumomab, 
diagnostic, per study dose) as ``diagnostic'' radiopharmaceuticals. The 
commenters explained that these are radiopharmaceutical products that 
are used as part of a therapeutic regimen and, therefore, should be 
considered therapeutic for OPPS payment purposes.
    Response: As discussed above, for the proposed rule, we classified 
each radiopharmaceutical into one of two groups according to whether 
its long descriptor contained the term ``diagnostic'' or 
``therapeutic.'' HCPCS codes A9542 and A9544 both contain the term 
``diagnostic'' in their long code descriptors. Therefore, according to 
this methodology, we classified them as diagnostic for the purposes of 
OPPS payment. While we understand that these items are provided in 
conjunction with additional supplies, imaging tests, and therapeutic 
radiopharmaceuticals for patients already diagnosed with cancer, we 
continue to believe that the purpose of HCPCS codes A9542 and A9544 is 
diagnostic in nature. While the group of services may be considered a 
therapeutic regimen by the commenters, HCPCS codes A9542 and A9544 are 
provided in conjunction with a series of imaging scans. Many nuclear 
medicine studies using diagnostic radiopharmaceuticals are provided to 
patients who already have an established diagnosis. We would not 
consider HCPCS codes A9542 and A9544 to be therapeutic because these 
items are provided immediately prior to the furnishing of a diagnostic 
imaging procedure, and are used to identify the proper dose of the 
therapeutic agent at a later date.
    Comment: One commenter requested that CMS reassign the dosage 
descriptor for HCPCS code A9524 (Iodine I-131 iodinated serum albumin, 
diagnostic, per 5 microcuries) to reflect the usual package size of 
this item. The commenter noted that there is only one manufacturer for 
this product, and it is only available in a single-unit, single-use, 
calibrated dose of 25 microcuries. The commenter claimed that many 
hospitals have been mistakenly billing one unit for this product, 
instead of correctly billing five units. Therefore, the commenter 
requested that the dosage descriptor reflect the single-unit, single-
use, calibrated 25 microcurie dose.
    Response: As we discussed in the CY 2008 proposed rule, at its 
March 2007 meeting, the APC Panel recommended that we consider the use 
of external data and work with stakeholders to determine the correct 
code descriptor units for each radiopharmaceutical, including HCPCS 
code A9524. As stated in the proposed rule (72 FR 42741), we appreciate 
the APC Panel's recommendation. We are always open to meeting with 
interested stakeholders and examining any data they may provide to us. 
However, we were unable to accept the APC Panel's recommendation 
concerning the development of specific code descriptors because 
decisions regarding the creation of permanent Level II HCPCS codes, 
including code descriptors, are coordinated by the CMS HCPCS Workgroup 
and are outside the scope of the OPPS. For further information on the 
HCPCS coding process, we refer readers to the CMS Web site at: http://www.cms.hhs.gov/MedHCPCSGenInfo/01--Overview.asp#TopOfPage. We 
encouraged interested parties to submit requests for revisions of code 
descriptors to the CMS HCPCS Workgroup for its consideration.
    We have learned that the commenter requested the CMS HCPCS 
Workgroup to change the descriptor for HCPCS code A9524 to more 
accurately reflect the dosing of this product. However, the CMS HCPCS 
Workgroup, under its authority and responsibility to create and 
maintain Level II HCPCS codes and their descriptors, has decided to 
retain the current descriptor that includes the ``per 5 microcuries'' 
dosage descriptor. Therefore, hospitals are reminded to ensure that 
units of drugs, biologicals, and radiopharmaceuticals administered to 
patients are accurately reported in terms of the dosage specified in 
the full HCPCS code descriptor. That is, units should be reported in 
multiples of the units included in the HCPCS descriptor. For example, 
if the descriptor of the drug code includes 5 mg, and 5 mg of the drug 
was administered to the patient, the units billed should be 1. If the 
descriptor of the drug code includes 5 mg, but 25 mg of the drug was 
administered to the patient, the units billed should be 5. Hospitals 
should not bill the units for HCCPS codes based on the way the drug, 
biological, or radiopharmaceutical is packaged, stored, or stocked. 
HCPCS short descriptors are limited to 28 characters, including spaces, 
so short descriptors do not always capture the complete description of 
the products. Therefore, before submitting Medicare claims for drugs, 
biologicals, and radiopharmaceuticals, we remind commenters that it is 
extremely important for hospitals to review the complete long 
descriptors for the applicable HCPCS codes in order to determine the 
appropriate units to be reported.
    After consideration of the public comments received, we are 
finalizing our proposal, without modification, to identify diagnostic 
radiopharmaceuticals as those radiopharmaceuticals with the term 
``diagnostic'' in their long code descriptors and therapeutic 
radiopharmaceuticals as those radiopharmaceuticals with the term 
``therapeutic'' in their long code descriptors. Our final payment 
policy packages payment for all diagnostic radiopharmaceuticals in CY 
2008. The related public comments and our responses to the proposed 
payment methodology for diagnostic radiopharmaceuticals are presented 
in section II.A.4.c.(5) of this final rule with comment period.
    In the case of contrast agents, while we have ASP data that can be 
a proxy for average hospital acquisition cost and associated handling 
and preparation costs, payment for almost all contrast agents is 
packaged under the OPPS for CY 2008 based on the $60 per day packaging 
threshold. Therefore, as discussed in the proposed rule, we believed 
that it is most appropriate to package payment for all contrast agents 
for CY 2008 to better provide for payment for the associated tests and 
procedures that promotes hospital efficiency. Our final policy to 
package payment for all contrast agents in CY 2008, and the related 
public comments and our responses to the proposed payment methodology, 
is presented in section II.A.4.c.(6) of this final rule with comment 
period.
    In summary, we view diagnostic radiopharmaceuticals and contrast 
agents as ancillary and supportive to the diagnostic tests and 
therapeutic procedures in which they are used. In light of our 
authority to make different packaging determinations for groups of 
items, and the improved reporting of hospital charges for 
radiopharmaceutical handling in the CY 2006 claims data, we are 
finalizing our proposal, without modification, to package payment for 
contrast agents and diagnostic radiopharmaceuticals for CY 2008. 
Additional discussion of our rationale and further response to public 
comments received and the APC Panel recommendations regarding our 
proposal to package payment for diagnostic radiopharmaceuticals and 
contrast agents appears in sections II.A.4.c.(5) and II.A.4.c.(6), 
respectively, of this final rule with comment period.

[[Page 66769]]

(c) Payment for Therapeutic Radiopharmaceuticals
    For CY 2008, we proposed to continue separate payment for 
therapeutic radiopharmaceuticals that have a mean per day cost of more 
than $60, consistent with the packaging methodology applied to other 
nonpass-through drugs and biologicals. We believed that therapeutic 
radiopharmaceuticals are distinct from diagnostic radiopharmaceuticals 
because the primary purpose of providing a therapeutic 
radiopharmaceutical is the radiopharmaceutical treatment itself, 
whereas a diagnostic radiopharmaceutical is administered in support of 
the performance of a diagnostic nuclear medicine study that is the 
primary service. For separately payable therapeutic 
radiopharmaceuticals, we proposed to establish CY 2008 payment rates 
based on their mean unit costs from our CY 2006 OPPS claims data.
    In the CY 2007 OPPS/ASC final rule with comment period (71 FR 
68095), we again reiterated our intent to develop a suitable 
prospective payment methodology for radiopharmaceutical products paid 
under the OPPS in future years, beginning in CY 2008. Since the start 
of the temporary cost-based payment methodology for 
radiopharmaceuticals in CY 2006, we have met with several interested 
parties on this topic and have received several suggestions from these 
stakeholders regarding payment methodologies that we could employ for 
future use under the OPPS.
    In considering payment options for therapeutic radiopharmaceuticals 
for CY 2008, we examined several alternatives. First, we considered 
retaining the CY 2007 methodology of providing payment for therapeutic 
radiopharmaceuticals at a hospital's charges reduced to cost using the 
hospital's overall CCR. While this option would provide consistency in 
the payment methodology from year to year, we have noted on several 
occasions, including in the CY 2007 OPPS/ASC final rule with comment 
period and in various public forums such as the APC Panel meetings, 
that this methodology was not intended to be the basis of providing 
payment to hospitals for these products beyond CY 2007. Payment on a 
claim-specific cost basis is not consistent with the payment of items 
and services on a prospective basis under the OPPS and may lead to 
extremely high or low payments to hospitals for radiopharmaceuticals, 
even when those products would be expected to have relatively 
predictable and consistent acquisition and handling costs across 
individual clinical cases and hospitals. In addition, we have stated 
that we believe using hospitals' overall CCRs to determine payments 
could result in an overstatement of radiopharmaceutical costs, which 
are likely reported in several cost centers, such as diagnostic 
radiology, that have lower CCRs than hospitals' overall CCRs (71 FR 
68095). For these reasons, we did not propose to use this methodology 
to set their payment rates for CY 2008.
    The second option we considered, and proposed, as a methodology for 
providing payment for therapeutic radiopharmaceuticals in CY 2008, is 
to establish prospective payment rates for separately payable 
therapeutic radiopharmaceuticals using mean costs derived from the CY 
2006 claims data, where the costs are determined using our standard 
methodology of applying hospital-specific departmental CCRs to 
radiopharmaceutical charges, defaulting to hospital-specific overall 
CCRs only if appropriate departmental CCRs are unavailable. As we 
stated in the CY 2007 OPPS/ASC proposed rule, we believe this 
methodology provides us with the most consistent, accurate, and 
efficient methodology for prospectively establishing payment rates for 
separately payable therapeutic radiopharmaceuticals (71 FR 49587). As 
discussed in the CY 2008 OPPS/ASC proposed rule, we believe that 
adopting prospective payment based on historical hospital claims data 
is appropriate because it serves as our most accurate available proxy 
for the average hospital acquisition cost of separately payable 
therapeutic radiopharmaceutical products (72 FR 42739). In addition, we 
have found that our general prospective payment methodology based on 
historical hospital claims data results in more consistent, 
predictable, and equitable payment amounts across hospitals and likely 
provides incentives to hospitals for efficiently and economically 
providing these outpatient services. Therefore, we expect that the 
hospital-specific payment variability found under a charges-reduced-to-
cost methodology would no longer affect these products under our CY 
2008 proposal.
    Although we received public comments on our CY 2007 proposed rule 
indicating that CY 2005 claims data used for that update did not 
incorporate associated overhead charges into the radiopharmaceutical 
charge, in the CY 2007 OPPS/ASC final rule with comment period (71 FR 
68095), we stated that we expected that hospitals would have adapted to 
the CY 2006 HCPCS coding changes for some radiopharmaceuticals and 
responded to our instructions to include their charges for 
radiopharmaceutical handling in their charges for the 
radiopharmaceutical products so these costs would be reflected in the 
CY 2008 ratesetting process. This continues to be our expectation, and, 
as discussed in the CY 2008 OPPS/ASC proposed rule, we believed that 
the CY 2006 claims data that we are using to set the proposed CY 2008 
OPPS payment rates reflect both the radiopharmaceutical charge and 
associated overhead charges. As discussed at the March 2007 APC Panel 
meeting, our CY 2006 claims data show that a greater proportion of 
radiopharmaceuticals experienced an increase in their median costs from 
CY 2005 to CY 2006 than experienced a decrease. We indicated that this 
trend is consistent with the agency's expectations that hospitals would 
comply with our instructions to include charges for radiopharmaceutical 
handling in their charges for the radiopharmaceutical products for CY 
2006. Therefore, we believed that setting CY 2008 prospective payment 
rates based on CY 2006 hospital claims data as described above serves 
as an acceptable combined proxy for average hospital acquisition costs 
and radiopharmaceutical handling.
    As we discussed in the CY 2008 OPPS/ASC proposed rule, during 
meetings with external stakeholders over the past year, we have been 
presented with several other suggestions regarding OPPS payment for 
therapeutic radiopharmaceuticals in CY 2008. One of these options 
included a suggestion that we employ alternative trimming methodologies 
in order to produce a claims-based mean cost that would more accurately 
reflect hospital purchase prices for these products. We did not propose 
a methodology based on special OPPS data trimming for CY 2008 for the 
following reasons. First, the OPPS has a standard data trimming 
methodology to calculate drug, biological, and radiopharmaceutical per 
day costs from hospital claims data. This includes both a specific trim 
on units for drugs, biologicals, and radiopharmaceuticals that is 
3 standard deviations from the geometric mean, and a 
standard trim of any line-item with a cost per unit that is 3 standard deviations from the geometric mean that is applied 
across all items and services. Both trims are conducted on the 
transformed variable, taking the natural log of both units and cost per 
unit, in order to trim evenly relative to the center of the 
distribution. Both units

[[Page 66770]]

and costs per unit are never negative, and there are some therapeutic 
radiopharmaceuticals with very high units and high costs per unit in 
our hospital claims data. These trims are conservative and typically 
eliminate only the most egregious observations, ones that could be due 
to erroneous reporting. For therapeutic radiopharmaceuticals at the 
time of the proposed rule, the unit trim alone removed all items that 
would have been eliminated under the cost trim, and with the exception 
of HCPCS code A9563 (Sodium phosphate P-32, therapeutic, per 
millicurie), this trim removed observations with unit costs below the 
mean unit cost. That is, overall, the result of applying our systematic 
trimming methodology increased the mean unit cost reported in Table 44 
of the proposed rule (72 FR 42740).
    As a payment system based on relative payment weights, altering the 
trimming methodology for a particular set of services could unduly 
influence the relativity of the resulting payment weights for those 
particular services and could inappropriately redistribute payments in 
a budget neutral OPPS. We have no reason to believe that hospitals 
report costs differently for radiopharmaceuticals than they do for 
other items. As we discussed further in section II.A.1. of this final 
rule with comment period, what is important for setting appropriate 
payment rates for most services under a prospective payment system is 
accuracy in estimating the relative costliness of services, and not the 
nominal value of the observed cost. Second, we are not convinced that 
employing an alternative overall trimming methodology would result in 
the most appropriate cost estimates for therapeutic 
radiopharmaceuticals. We have noted our belief that because hospitals 
were paid in CY 2006 for each therapeutic radiopharmaceutical they 
reported according to a claim-specific charge that was reduced to cost 
for payment, hospitals had an incentive to accurately account for the 
full costs of these products in establishing their charges. In 
addition, we have no way of knowing the specific clinical scenario that 
resulted in any given claim with certain reported units and charges for 
a therapeutic radiopharmaceutical. Therefore, we did not believe it 
would be appropriate to utilize a ratesetting methodology that could 
disregard correctly coded claims. While we appreciated this 
recommendation, we did not propose a payment methodology that included 
additional trimming of hospital claims data for therapeutic 
radiopharmaceutical products for CY 2008.
    Recommendations other than trimming centered around providing CMS 
with external data on radiopharmaceutical costs. One specific 
recommendation that we received from interested stakeholders suggested 
that we allow hospitals to submit their invoices to CMS. With the 
invoice information, CMS could establish a prospective payment rate for 
radiopharmaceuticals that would be calculated taking into consideration 
the total amount invoiced for the radiopharmaceutical, transportation 
costs, and applicable rebates. While this payment rate would not 
include payment for certain radiopharmaceutical overhead and handling 
costs, stakeholders suggested that costs could be packaged into the 
associated procedure payment for the radiopharmaceutical. Stakeholders 
also generally recommended that we could collect external data from 
various sources (such as manufacturers, nuclear pharmacies, and others) 
to use for therapeutic radiopharmaceuticals.
    At its September 2007 meeting, the Panel recommended that CMS 
create a composite for BEXXAR[supreg] or related therapies and present 
it for the Panel's consideration at the next APC Panel meeting. We are 
accepting this recommendation and will provide information and analyses 
regarding commonly observed combinations of services provided with 
radioimmunotherapy treatments to the APC Panel at its 2008 winter 
meeting.
    We received many public comments on our CY 2008 proposal to 
establish payments for separately payable therapeutic 
radiopharmaceuticals based on their mean unit costs from hospitals 
claims. A summary of the public comments and our responses follow.
    Comment: Many commenters asked CMS to continue the CY 2007 CCR 
methodology for payments for all radiopharmaceutical products in CY 
2008. The commenters cited inaccurate and incomplete data from 
hospitals as a reason to continue this methodology.
    Response: For the CY 2007 rulemaking cycle, we also received many 
comments that we should not proceed with our CY 2007 proposal to 
establish a prospective payment methodology for radiopharmaceuticals. 
At that time, the commenters were concerned that hospital claims data 
may be inaccurate due to hospitals slow adoption of our billing 
guidance to include radiopharmaceutical pharmacy overhead charges in 
the charge for the radiopharmaceutical. Because of these and other 
concerns, we concluded that, for CY 2007, there was sufficient reason 
to extend the temporary policy of paying for radiopharmaceuticals at 
charges reduced to cost for one additional year. We noted that it was 
still our intention to move toward a prospective payment methodology 
for radiopharmaceuticals in the OPPS (71 FR 68095). In the CY 2008 
OPPS/ASC proposed rule, we again noted our intent to move to a 
prospective payment for therapeutic radiopharmaceuticals under the OPPS 
and did not propose to continue providing payment for therapeutic 
radiopharmaceuticals at hospital charges reduced to cost using the 
hospital's overall CCR for the reasons cited previously. In particular, 
payment on a claim-specific cost basis is not consistent with the 
payment of items and services on a prospective basis under the OPPS and 
may lead to extremely high or low payments to hospitals for 
radiopharmaceuticals, even when those products would be expected to 
have relatively predictable and consistent acquisition and handling 
costs across individual clinical cases and hospitals.
    Comment: Several commenters requested that CMS implement a policy 
that would accept external data submissions from various groups, 
including nuclear pharmacies, hospitals, and manufacturers. The 
commenters recommended that CMS collect Estimated Average Acquisition 
Cost (EAAC), Calculated Pharmacy Sales Price (CPSP), or average selling 
nuclear pharmacy price (ADNPP) data through this process. In addition, 
the commenters suggested that CMS could collect hospital invoice data 
to establish a prospective payment rate for radiopharmaceuticals that 
would be calculated, taking into consideration the total amount 
invoiced for the radiopharmaceutical, transportation costs, and 
applicable rebates.
    Some commenters also recommended that, as CMS proposed the 
reporting of pharmacy overhead charges for drugs and biologicals on 
uncoded revenue code lines for CY 2008, CMS should change its 
instructions for reporting radiopharmaceutical handling charges. Some 
commenters suggested that the radiopharmaceutical handling charges be 
reported separately on uncoded revenue code lines instead of being 
included in the charge for the radiopharmaceutical under current CMS 
instructions. The commenters believed this would allow the costs of 
radiopharmaceutical handling to be packaged into payment for the 
associated procedure, such as a radiopharmaceutical administration 
procedure, in future years when CY

[[Page 66771]]

2008 claims data become available for ratesetting.
    Response: We did not propose a therapeutic radiopharmaceutical 
payment methodology using external data for CY 2008 for the following 
reasons. First, any approach relying on external data has the 
disadvantage of differentially influencing the relativity of payment 
weights for radiopharmaceuticals in the budget neutral OPPS payment 
system where we utilize a standard ratesetting methodology for other 
services. In addition, it is not clear that invoice information from 
hospitals or cost information from nuclear pharmacies or manufacturers 
would be more accurate than hospitals' costs for radiopharmaceuticals 
that we currently calculate based on hospitals' charges reduced to cost 
by application of a CCR, and such external information would generally 
exclude the costs of the hospital's handling of the 
radiopharmaceuticals. However, as noted in the CY 2008 OPPS/ASC 
proposed rule (72 FR 42740), we do not currently identify separate 
costs for this radiopharmaceutical handling that we could then package 
into the costs of the associated diagnostic nuclear medicine studies 
and treatment procedures. Moreover, hospitals currently have the 
flexibility to set their charges for therapeutic radiopharmaceuticals, 
taking into account a variety of factors, including acquisition costs 
and transportation costs. Therefore, we believed, and continue to 
believe, it is likely that hospitals are already taking this 
information into consideration when establishing their charges. 
Further, we have already instructed hospitals to include overhead 
charges for radiopharmaceuticals in the charge for the 
radiopharmaceutical product. We have received several reports that 
hospitals have made these changes, when necessary, and that other 
changes are in process to conform to our instructions. A ratesetting 
approach based on external data could be inconsistent with the charging 
practices of those hospitals that have been working over the past 2 
years to align their charging practices with our stated instructions. 
Moreover, adoption of any methodology systematically relying on 
external data also would be administratively burdensome for us because 
we would need to collect, process, and review external information to 
ensure that it was valid, reliable, and representative of a diverse 
group of hospitals so that it could be used to establish rates for all 
hospitals. For these reasons, we did not propose and are not finalizing 
a policy to collect hospital invoices or otherwise rely on external 
data in order to establish prospective payment rates for therapeutic 
radiopharmaceuticals for CY 2008.
    We are not adopting our proposal to have hospitals separately 
report charges for pharmacy overhead associated with drugs and 
biologicals on uncoded revenue code lines, as discussed earlier. 
Therefore, we also do not believe it would be appropriate to provide 
instructions to hospitals to separately report their 
radiopharmaceutical handling charges in addition to the charge for the 
radiopharmaceutical. Hospitals have recently become accustomed to our 
CY 2006 guidance that they should consider all handling costs in 
setting their charges for radiopharmaceuticals, and we see no reason 
for them to change this practice. We will continue to provide payment 
for the handling costs of radiopharmaceuticals through the packaged or 
separate payment for the products in CY 2008, just as we will for the 
pharmacy handling costs of drugs and biologicals.
    Comment: Many commenters expressed concern over the proposed 
payment rates for very high cost therapeutic radiopharmaceuticals. The 
commenters stated that the proposed payment rates are inadequate to 
cover the cost of the therapeutic radiopharmaceutical itself, let alone 
the added costs of handling, shipping, and compounding. The commenters 
noted that inadequate payment rates may lead to beneficiary access 
issues. Some commenters suggested that systematic special trimming of 
claims data should be considered in order to products costs that 
reflect actual hospital purchase prices for radiopharmaceuticals. A few 
commenters recommended using ASP as an alternative payment methodology 
for the very costly therapeutic radiopharmaceuticals or other 
methodologies based on external data. One commenter noted its intent to 
submit ASP information for an expensive therapeutic radiopharmaceutical 
so that CMS would have an alternative methodology with which to price 
the product.
    Response: While we understand the commenters' concerns regarding 
the unique circumstances associated with radiopharmaceutical products, 
especially very high cost therapeutic radiopharmaceuticals, for the 
majority of services under the OPPS, payment is made according to 
prospectively established payment rates that are related to hospitals' 
costs for those services as calculated from claims data. For the past 2 
years, hospitals have been paid on a CCR methodology for separately 
payable therapeutic radiopharmaceuticals. Therefore, hospitals had 
every incentive to submit a charge representative of their acquisition 
cost and associated handling costs for these radiopharmaceuticals. To 
that extent, we believe that the hospital claims data that we have 
available for ratesetting purposes in CY 2008 are reliable and 
accurate.
    We note that, for CY 2008, separately payable therapeutic 
radiopharmaceuticals meet the definition of SCODs and therefore are to 
be paid at average acquisition cost. While we are implementing a policy 
to provide payment for therapeutic radiopharmaceuticals through the 
standard OPPS methodology relying on hospital claims data for CY 2008 
as a proxy for average acquisition cost as described below, we note 
that there is an established process already in place for submitting 
pricing data for other SCODs to be used for payment purposes. While we 
understand that the standard ASP methodology may not work for all 
therapeutic radiopharmaceuticals, we received comments that this 
approach would work for certain products. Therefore, to the extent that 
manufacturers or stakeholders believe that the ASP methodology that we 
currently use for the payment of separately payable drugs and 
biologicals under the OPPS is appropriate for their particular product, 
we seek comments on that approach and comments on how 
radiopharmaceutical ASP information could be used in future 
ratesetting.
    As we discussed in the proposed rule (72 FR 42739), we do not agree 
with the suggestion of some commenters that special trimming 
methodologies should be applied to develop claims-based means costs for 
therapeutic radiopharmaceuticals. No commenters provided specific 
approaches for our consideration. We believe the standard OPPS data 
trimming methodology is appropriate for establishing the payment rates 
for therapeutic radiopharmaceuticals. Altering the systematic trimming 
methodology for these products in particular could inappropriately 
redistribute payments in the budget neutral OPPS, and we have no reason 
to believe that hospitals report costs differently for 
radiopharmaceuticals than they do for other items. We continue to 
believe that because hospitals were paid in CY 2006 for each 
therapeutic radiopharmaceutical according to a claim-specific charge 
that was adjusted to cost for payment, hospitals had an

[[Page 66772]]

incentive to accurately account for the full costs of these products in 
establishing their charges.
    We examined the final rule claims data for the eight therapeutic 
radiopharmaceuticals that we proposed for separate payment in CY 2008 
after we applied the standard OPPS data trimming methodology of  3 standard deviations from the geometric mean. The standard trim 
removes data outliers, which are rare observations with extremely 
different units and costs from most occurrences in the distribution. 
Our analysis showed that in the case of HCPCS code A9543 (Yttrium Y-90 
ibritumomab tiuxetan, therapeutic, per treatment dose, up to 40 
millicuries) and A9545 (Iodine I-131 tositumomab, therapeutic, per 
treatment dose), there were one and three providers, respectively, who 
consistently (more than 2 times) reported charges in the CY 2006 claims 
data that were less than $100 when converted to costs as part of the 
usual ratesetting process. In addition, we had relatively few claims 
overall for these two products from CY 2006, only 456 line-item charges 
on 455 days for HCPCS code A9543 (458 units) and 262 line-item charges 
on 261 days for HCPCS code A9545 (342 units). The numerous repetitive 
claims with exceptionally low costs had not been removed in the 
standard OPPS mean cost calculation because the significant number of 
these aberrant claims increased the standard deviation and were not 
rare observations. In light of the specialized nature of these 
radioimmunotherapy agents, we believe that these claims were 
incorrectly coded based on their extremely low costs. Therefore, these 
claims from the several providers with very low costs are highly 
unlikely to represent claims for treatment with the products described 
by HCPCS codes A9543 and A9545. After removing these likely incorrectly 
coded claims in the ratesetting process, we were left with 360 line-
item charges on 359 days for HCPCS code A9543 (354 units) and 237 line-
item charges on 326 days for HCPCS code A9545 (238 units). These very 
low cost claims constituted between one quarter and one third of the 
units for HCPCS codes A9543 and A9545, contributing significantly to 
the calculation of the products' mean unit costs. While the mean per 
unit cost was approximately $11,926 for HCPCS code A9543 based on all 
claims, when the repetitive claims from one provider with very low 
costs were removed, the mean per day cost was approximately $15,024. 
Similarly, while the mean per unit cost was approximately $7,844 for 
HCPCS code A9545 based on all claims, when the repetitive claims from 
three providers with very low costs were removed, the mean per day cost 
was approximately $11,264. We continue to believe that providing 
prospective payment for the costs of the eight separately payable 
therapeutic radiopharmaceuticals and their handling is the most 
appropriate payment methodology for CY 2008, because we believe that 
hospitals have set their charges for these products while taking into 
account a variety of factors, including acquisition and transportation 
costs. We believe this methodology provides us with the most 
consistent, accurate, and efficient methodology for prospectively 
establishing payment rates for separately payable therapeutic 
radiopharmaceuticals. The adoption of prospective payment based on 
historical hospital claims data is appropriate because it currently 
serves as our most accurate available proxy for the average hospital 
acquisition cost of separately payable therapeutic radiopharmaceutical 
products. In addition, in the cases of HCPCS codes A9543 and A9445, we 
have specifically removed the likely incorrectly coded claims from 
several providers before applying our standard ratesetting methodology 
to calculating their mean costs from CY 2006 claims.
    After consideration of the public comments received, we are 
finalizing our CY 2008 proposal, with modification to eliminate likely 
incorrectly coded claims from several providers for HCPCS codes A9543 
and A9545 as described above, to provide payment for separately payable 
therapeutic radiopharmaceuticals based on their mean unit costs from CY 
2007 claims. These therapeutic radiopharmaceuticals and their final CY 
2008 payment rates are shown in Table 31 below.

                     Table 31.--CY 2008 Separately Payable Therapeutic Radiopharmaceuticals
----------------------------------------------------------------------------------------------------------------
                                                             Final CY                              Final CY 2008
       HCPCS Code                 Short descriptor           2008 APC       Final CY 2008 SI       payment rate
----------------------------------------------------------------------------------------------------------------
A9517...................  I131 iodide cap, rx............         1064  K.......................          $15.24
A9530...................  I131 iodide sol, rx............         1150  K.......................           11.22
A9543...................  Y90 ibritumomab, rx............         1643  K.......................       15,023.91
A9545...................  I131 tositumomab, rx...........         1645  K.......................       11,264.25
A9563...................  P32 Na phosphate...............         1675  K.......................          113.60
A9564...................  P32 chromic phosphate..........         1676  K.......................          119.18
A9600...................  Sr89 strontium.................         0701  K.......................          612.06
A9605...................  Sm 153 lexidronm...............         0702  K.......................        1,361.07
----------------------------------------------------------------------------------------------------------------

    Comment: Several commenters stated that charge compression may be 
adversely affecting estimates of the mean cost for expensive 
radiopharmaceuticals.
    Response: As discussed in more detail in section II.A.1.c. of this 
final rule with comment period, while we did not propose to implement 
adjustments for charge compression for CY 2008 based on the RTI report 
for inpatient services, which focused only on inpatient charges, we 
planned steps to explore this issue further for the future. Under 
contract with RTI, we are currently examining an all-charges model that 
would compare variation in CCRs with variation in charges to establish 
regression-adjusted CCRs that could be applied to both inpatient and 
outpatient charges. We will consider whether it would be appropriate to 
adopt regression-based CCRs for the OPPS in the future after we receive 
RTI's comprehensive review of the OPPS cost estimation methodology and 
review the results of the use of both inpatient and outpatient charges 
across all payers to reestimate regression-based CCRs.
    b. Payment for Nonpass-Through Drugs, Biologicals, and 
Radiopharmaceuticals with HCPCS Codes, but without OPPS Hospital Claims 
Data
    Pub. L. 108-173 does not address the OPPS payment in CY 2005 and 
after for drugs, biologicals, and radiopharmaceuticals that have 
assigned HCPCS codes, but that do not have a reference AWP or approval 
for payment as pass-through drugs or biologicals.

[[Page 66773]]

Because there is no statutory provision that dictated payment for such 
drugs and biologicals in CY 2005, and because we had no hospital claims 
data to use in establishing a payment rate for them, we investigated 
several payment options for CY 2005 and discussed them in detail in the 
CY 2005 OPPS final rule with comment period (69 FR 65797 through 
65799).
    For CYs 2005, 2006, and 2007, we finalized our policy to provide 
separate payment for new drugs, biologicals, and radiopharmaceuticals 
with HCPCS codes, but which did not have pass through status at a rate 
that was equivalent to the payment they received in the physician's 
office setting, established in accordance with the ASP methodology.
    As discussed in the CY 2005 OPPS final rule with comment period (69 
FR 65797), and the CY 2006 OPPS final rule with comment period (70 FR 
68666), new drugs, biologicals, and radiopharmaceuticals may be 
expensive, and we are concerned that packaging these new items might 
jeopardize beneficiary access to them. In addition, we do not want to 
delay separate payment for these items solely because a pass-through 
application was not submitted. However, for CY 2008 we proposed to 
explicitly account for the pass-through payment amount associated with 
pass-through drugs and biologicals, in the context of our CY 2008 
proposal for the payment of separately payable nonpass-through drugs 
and biologicals at ASP+5 percent.
    We did not receive any public comments explicitly on the topic of 
our proposed payment methodology for nonpass-though drugs, biolgicals, 
and radiopharmaceuticals with HCPCS codes, but without OPPS hospital 
claims data. Therefore, we are finalizing our proposal, without 
modification, to provide payment for these new drugs and biologicals 
with HCPCS codes as of January 1, 2008, but which do not have pass 
through status and are without OPPS hospital claims data, at ASP+5 
percent, consistent with our final payment methodology for other 
separately payable nonpass-through drugs and biologicals. This policy 
ensures that new nonpass-through drugs and biologicals are treated like 
other drugs and biologicals under the OPPS, unless they are granted 
pass-through status. Only pass through drugs and biologicals receive a 
different payment for CY 2008, generally equivalent to the payment 
these drugs and biologicals receive in the physician's office setting, 
consistent with the requirements of the statute. Payment for all new 
nonpass through diagnostic radiopharmaceuticals will be packaged.
    In accordance with the ASP methodology, in the absence of ASP data, 
we proposed, for CY 2008, to continue the policy we implemented during 
CYs 2005, 2006, and 2007 of using the WAC for the product to establish 
the initial payment rate for new nonpass through drugs, and biologicals 
with HCPCS codes, but which are without OPPS claims data. As discussed 
in the proposed rule (72 FR 42741), if the WAC is also unavailable, we 
would make payment at 95 percent of the product's most recent AWP. We 
received no comments on this proposal and are finalizing it without 
modification.
    We also proposed to assign status indicator ``K'' to HCPCS codes 
for new drugs and biologicals for which we have not received a pass-
through application. Again, we received no comments and we are 
finalizing this proposal without modification. We further note that 
with respect to new items for which we do not have ASP data, once their 
ASP data become available in later quarter submissions, their payment 
rates under the OPPS will be adjusted so that the rates are based on 
the ASP methodology and set to ASP+5 percent.
    For CY 2008, we also proposed to base payment for new therapeutic 
radiopharmaceuticals with HCPCS codes as of January 1, 2008, but which 
do not have pass-through status, on the WACs for these products as ASP 
data for radiopharmaceuticals are not available. As proposed, if the 
WACs are also unavailable, we would make payment for the therapeutic 
radiopharmaceuticals at 95 percent of their most recent AWPs. Analogous 
to new drugs and biologicals, we proposed to assign status indicator 
``K'' to HCPCS codes for new therapeutic radiopharmaceuticals for which 
we have not received a pass-through application. We received no 
comments and are finalizing this proposal without modification.
    Consistent with other ASP-based payments, for CY 2008, we proposed 
to make any appropriate adjustments to the payment amounts for drugs 
and biologicals in this final rule with comment period and also on a 
quarterly basis on our Web site during CY 2008 if later quarter ASP 
submissions (or more recent WACs or AWPs) indicate that adjustments to 
the payment rates for these drugs and biologicals are necessary. As 
proposed, the payment rates for new therapeutic radiopharmaceuticals 
would also be adjusted accordingly. We also proposed to make 
appropriate adjustments to the payment rates for new drugs and 
biologicals in the event that they become covered under the CAP in the 
future. As noted in the proposed rule (72 FR 42741), the new CY 2008 
HCPCS codes for drugs, biologicals, and therapeutic 
radiopharmaceuticals were not available at the time we developed the 
proposed rule. We have included these changes in Table 32 below.

               Table 32.--New CY 2008 HCPCS codes for Drugs, Biologicals, and Radiopharmaceuticals
----------------------------------------------------------------------------------------------------------------
                               CY 2008 SI
        CY 2007 HCPCS         for CY 2007    CY 2008     CY 2008    CY 2008         CY 2008 long descriptor
                               HCPCS code     HCPCS         SI        APC
----------------------------------------------------------------------------------------------------------------
A9565.......................            D        A9572          N         --  Indium IN-111 pentetreotide,
                                                                               diagnostic, per study dose, up to
                                                                               6 millicuries.
C9232.......................            D        J1743          G       9232   Injection, idursulfase, 1mg.
C9233.......................            D        J2778          G       9233  Injection, ranibizumab, 0.1 mg.
C9234.......................            D        J0220          K       9234  Injection, aglucosidase alfa, 10
                                                                               mg.
C9235.......................            D        J9303          G       9235  Injection, panitumumab, 10 mg.
C9236.......................            D        J1300          G       9236  Injection, eculizumab, 10 mg.
C9350.......................            D        C9352          G       9350  Microporous collagen implantable
                                                                               tube (Neuragen Nerve Guide), per
                                                                               centimeter length.
C9350.......................            D        C9353          G       1169  Microporous collagen implantable
                                                                               slit tube (NeuraWrap Nerve
                                                                               Protector), per centimeter
                                                                               length.
C9351.......................            D        J7348          G       9351  Dermal (substitute) tissue of
                                                                               nonhuman origin, with or without
                                                                               other bioengineered or processed
                                                                               elements, without metabolically
                                                                               active elements (TissueMend) per
                                                                               square centimeter.

[[Page 66774]]

 
C9351.......................            D        J7349          G       1141  Dermal (substitute) tissue of
                                                                               nonhuman origin, with or without
                                                                               other bioengineered or processed
                                                                               elements, without metabolically
                                                                               active elements (PriMatrix) per
                                                                               square centimeter.
J1567.......................            D        J1561          K       0948  Injection, immune globulin,
                                                                               (Gamunex), intravenous, non-
                                                                               lyophilized (e.g. liquid), 500
                                                                               mg.
J1567.......................            D        J1568          K       0943  Injection, immune globulin,
                                                                               (Octagam), intravenous, non-
                                                                               lyophilized, (e.g. liquid), 500
                                                                               mg.
J1567.......................            D        J1569          K       0944  Injection, immune globulin,
                                                                               (Gammagard Liquid), intravenous,
                                                                               non-lyophilized, (e.g. liquid),
                                                                               500 mg.
J1567.......................            D        J1572          K       0947  Injection, immune globulin,
                                                                               (Flebogamma), intravenous, non-
                                                                               lyophilized (e.g. liquid), 500
                                                                               mg.
J7319.......................            D        J7321          K       0873  Hyaluronan or derivative, Hyalgan
                                                                               or Supartz, for intra-articular
                                                                               injection, per dose.
J7319.......................            D        J7322          K       0874  Hyaluronan or derivative, Synvisc,
                                                                               for intra-articular injection,
                                                                               per dose.
J7319.......................            D        J7323          K       0875  Hyaluronan or derivative,
                                                                               Euflexxa, for intra-articular
                                                                               injection, per dose.
J7319.......................            D        J7324          K       0877  Hyaluronan or derivative,
                                                                               Orthovisc, for intra-articular
                                                                               injection, per dose.
J7345.......................            D        J7348          G       9351  Dermal (substitute) tissue of
                                                                               nonhuman origin, with or without
                                                                               other bioengineered or processed
                                                                               elements, without metabolically
                                                                               active elements (Tissuemend) per
                                                                               square centimeter.
J7345.......................            D        J7349          G       1141  Dermal (substitute) tissue of
                                                                               nonhuman origin, with or without
                                                                               other bioengineered or processed
                                                                               elements, without metabolically
                                                                               active elements (Primatrix) per
                                                                               square centimeter.
Q4079.......................            D        J2323          G       9126  Injection, natalizumab, 1 mg.
Q4083.......................            D        J7321          K       0873  Hyaluronan or derivative, Hyalgan
                                                                               or Supartz, for intra-articular
                                                                               injection, per dose.
Q4084.......................            D        J7322          K       0874  Hyaluronan or derivative, Synvisc,
                                                                               for intra-articular injection,
                                                                               per dose.
Q4085.......................            D        J7323          K       0875  Hyaluronan or derivative,
                                                                               Euflexxa, for intra-articular
                                                                               injection, per dose.
Q4086.......................            D        J7324          K       0877  Hyaluronan or derivative,
                                                                               Orthovisc, for intra-articular
                                                                               injection, per dose.
Q4087.......................            D        J1568          K       0943  Injection, immune globulin,
                                                                               (Octagam), intravenous, non-
                                                                               lyophilized, (e.g. liquid), 500
                                                                               mg.
Q4088.......................            D        J1569          K       0944  Injection, immune globulin,
                                                                               (Gammagard Liquid), intravenous,
                                                                               non-lyophilized, (e.g. liquid),
                                                                               500 mg.
Q4089.......................            D        J2791          K       0945  Injection, rho(d) immune globulin
                                                                               (human), (Rhophylac),
                                                                               intravenous, 100 iu.
Q4090.......................            D        J1571          K       0946  Injection, hepatitis b immune
                                                                               globulin (Hepagam B),
                                                                               intramuscular, 0.5 ml.
Q4091.......................            D        J1572          K       0947  Injection, immune globulin,
                                                                               (Flebogamma), intravenous, non-
                                                                               lyophilized (e.g. liquid), 500
                                                                               mg.
Q4092.......................            D        J1561          K       0948  Injection, immune globulin,
                                                                               (Gamunex), intravenous, non-
                                                                               lyophilized (e.g. liquid), 500
                                                                               mg.
Q4095.......................            D        J3488          G       0951  Injection, zoledronic acid
                                                                               (Reclast), 1 mg.
Q9945.......................            D        Q9965          N  .........  Low osmolar contrast material, 100-
                                                                               199 mg/ml iodine concentration,
                                                                               per ml.
Q9946.......................            D        Q9965          N  .........  Low osmolar contrast material, 100-
                                                                               199 mg/ml iodine concentration,
                                                                               per ml.
Q9947.......................            D        Q9966          N  .........  Low osmolar contrast material, 200-
                                                                               299 mg/ml iodine concentration,
                                                                               per ml.
Q9948.......................            D        Q9966          N  .........  Low osmolar contrast material, 200-
                                                                               299 mg/ml iodine concentration,
                                                                               per ml.
Q9949.......................            D        Q9967          N  .........  Low osmolar contrast material, 300-
                                                                               399 mg/ml iodine concentration,
                                                                               per ml.
Q9950.......................            D        Q9967          N  .........  Low osmolar contrast material, 300-
                                                                               399 mg/ml iodine concentration,
                                                                               per ml.
Q9952.......................            D        A9579          N  .........  Injection, gadolinium-based
                                                                               magnetic resonance contrast
                                                                               agent, not otherwise specified
                                                                               (nos), per ml.
                                                 A9501          N  .........  Technetium TC-99M teboroxime,
                                                                               diagnostic, per study dose.
                                                 A9509          N  .........  Iodine I-123 sodium iodide,
                                                                               diagnostic, per millicurie.
                                                 A9569          N  .........  Technetium TC-99M exametazime
                                                                               labeled autologous white blood
                                                                               cells, diagnostic, per study
                                                                               dose.
                                                 A9570          N  .........  Indium IN-111 labeled autologous
                                                                               white blood cells, diagnostic,
                                                                               per study dose.
                                                 A9571          N  .........  Indium IN-111 labeled autologous
                                                                               platelets, diagnostic, per study
                                                                               dose.
                                                 A9576          N  .........  Injection, gadoteridol, (ProHance
                                                                               Multipack), per ml.
                                                 A9577          N  .........  Injection, gadobenate dimeglumine
                                                                               (MultiHance), per ml.
                                                 A9578          N  .........  Injection, gadobenate dimeglumine
                                                                               (MultiHance Multipack), per ml.
                                                 C9238          K       9238  Injection, levetiracetam, 10 mg.
                                                 C9239          G       1168  Injection, temsirolimus, 1 mg.
                                                 J0400          K       1165  Injection, aripiprazole,
                                                                               intramuscular, 0.25 mg.
                                                 J1573          K       1138  Injection, hepatitis b immune
                                                                               globulin (Hepagam B),
                                                                               intravenous, 0.5 ml.
                                                 J2724          K       1139  Injection, protein c concentrate,
                                                                               intravenous, human, 10 iu.
                                                 J9226          K       1142  Histrelin implant (Supprelin LA),
                                                                               50 mg.
----------------------------------------------------------------------------------------------------------------

    There are several nonpass-through drugs and biologicals that were 
payable in CY 2006 and/or CY 2007 for which we do not have any CY 2006 
hospital claims data. These items were shown in Table 45A of the 
proposed rule (72 FR 42762). In order to determine the packaging status 
of these items for CY 2008, we calculated an estimate of the

[[Page 66775]]

per day cost of each of these items by multiplying the payment rate for 
each product based on ASP+5 percent, similar to other nonpass-through 
drugs and biologicals paid separately under the OPPS, by an estimated 
average number of units of each product that would typically be 
furnished to a patient during one administration in the hospital 
outpatient setting. We proposed to package items for which we estimate 
the per administration cost to be less than or equal to $60, which is 
the general packaging threshold that we proposed for drugs, 
biologicals, and radiopharmaceuticals in CY 2008. We proposed that the 
CY 2008 payment for separately payable items without CY 2006 claims 
data would be based on ASP+5 percent, similar to other separately 
payable nonpass-through drugs and biologicals under the OPPS. In 
accordance with the ASP methodology used in the physician's office 
setting, in the absence of ASP data, we would use the WAC for the 
product to establish the initial payment rate. However, we note that if 
the WAC is also unavailable, we would make payment at 95 percent of the 
most recent AWP available.
    We did not receive any public comments on this proposal and, 
therefore, are finalizing the proposal without modification. Table 33 
lists all of the nonpass-through drugs and biologicals without 
available CY 2006 claims data to which these final policies would apply 
in CY 2008.

                          Table 33.--Drugs and Biologicals Without CY 2006 Claims Data
----------------------------------------------------------------------------------------------------------------
                                                                              Estimated
                                                               ASP-based   average number    Final CY   CY 2008
        HCPCS code                   Short descriptor           payment     of units per     2008 SI      APC
                                                                  rate     administration
----------------------------------------------------------------------------------------------------------------
J0288.....................  Ampho b cholesteryl sulfate......     $11.89                35          K       0735
J0364.....................  Apomorphine hydrochloride........  .........                 6          N
J1324.....................  Enfuvirtide injection............      $0.40               180          K       0767
J2170.....................  Mecasermin injection.............     $15.62              15.6          K       0805
J2315.....................  Naltrexone, depot form...........      $1.87               380          K       0759
J3355.....................  Urofollitropin, 75 iu............     $50.22                 2          K       1741
J8650.....................  Nabilone oral....................     $16.80                 6          K       0808
----------------------------------------------------------------------------------------------------------------

    During the March 2007 APC Panel meeting, the APC Panel reiterated 
its August 2006 recommendation to allow hospitals to report all HCPCS 
codes for drugs. In general, OPPS recognizes the lowest available 
administrative dose of a drug if multiple HCPCS codes exist for the 
drug; for the remainder of the doses, we assign a status indicator 
``B'' indicating that another code exists for OPPS purposes. For 
example, if drug X has 2 HCPCS codes, 1 for a 1 ml dose and a second 
for a 5 ml dose, the OPPS would assign a payable status indicator to 
the 1 ml dose and status indicator ``B'' to the 5 ml dose. Hospitals 
would then need to bill the appropriate number of units for the 1 ml 
dose in order to receive payment under the OPPS. While we were not 
prepared to accept this recommendation when we developed the CY 2007 
OPP/ASC final rule with comment period, we indicated in that rule that 
we would continue to consider the APC Panel's recommendation for future 
OPPS updates (71 FR 68083 through 68084).
    After further consideration of this issue, we stated in the CY 2008 
OPPS/ASC proposed rule that we are now accepting the APC Panel's 
recommendation because we have concluded that recognizing all of these 
HCPCS codes for payment under the OPPS should not have a significant 
effect on our payment methodology for drugs (72 FR 42742). We proposed 
to allow hospitals to submit claims by reporting any HCPCS code for a 
Part B drug that is covered under the OPPS, regardless of the unit 
determination in the HCPCS code descriptor, beginning in CY 2008. 
Stakeholders have told us that this policy would reduce the 
administrative burden associated with our current requirement that 
hospitals report drugs using only the HCPCS codes with the lowest 
increments in their code descriptors. Whenever possible, we seek to 
reduce hospitals' administrative burden in submitting claims for 
payment under the OPPS, and we appreciate the APC Panel's 
recommendation in this area.
    As these HCPCS codes were previously unrecognized in the OPPS, we 
do not have claims data to determine the appropriate packaging status. 
Therefore, we proposed to assign these HCPCS codes the same status 
indicator as the associated recognized HCPCS code (that is, the lowest 
dose), as shown in Table 45B of the proposed rule (72 FR 42743). We 
believed that this approach is the most appropriate and reasonable way 
to implement this proposed change without impacting payment. However, 
once claims data are available for these previously unrecognized HCPCS 
codes, we will determine the packaging status and resulting status 
indicator for each HCPCS code according to the general code-specific 
methodology for determining a code's packaging status for a given 
update year. We plan to closely follow our claims data to ensure that 
our annual packaging determinations for the different HCPCS codes 
describing the same drug do not create inappropriate payment incentives 
for hospitals to report certain HCPCS codes instead of others. In our 
analysis for the proposed rule, we also estimated the packaging status 
of these currently unrecognized HCPCS codes by adjusting the calculated 
average number of units per day for the associated recognized HCPCS 
code with claims data to account for the different dosage descriptors. 
We then multiplied this adjusted average number of units per day value 
by the most recent ASP data available for the unrecognized HCPCS code 
(listed in Table 45B of the proposed rule). As noted in the proposed 
rule (72 FR 42742), this methodology yielded the same packaging 
determinations and resulting status indicators for the currently 
unrecognized HCPCS codes for CY 2008 as for the recognized HCPCS code 
for the same drug.
    We received a number of public comments on our proposal to 
recognize all HCPCS codes Part B drugs for payment under the OPPS. A 
summary of the public comments and our responses follow.
    Comment: Many commenters supported the proposal to allow hospitals 
to submit claims by reporting any HCPCS code for a Part B drug that is 
covered under the OPPS, regardless of the unit determination in the 
HCPCS code descriptor, beginning in CY 2008. Some commenters supported 
this proposal so long as it was not mandatory to report all HCPCS 
codes. One commenter disagreed with our

[[Page 66776]]

proposal and expressed concern that this would increase hospital 
burden.
    Response: We appreciate the general support of our proposal to 
allow hospitals to submit claims by reporting any HCPCS code for a Part 
B drug that is covered under the OPPS, regardless of the unit 
determination in the HCPCS code descriptor. Hospitals that may be 
burdened by reporting multiple HCPCS codes need not change their 
current billing practices, but hospitals that would like additional 
flexibility when billing for drugs with multiple HCPCS dosages may 
implement these changes beginning in CY 2008.

Table 34.--Previously Unrecognized HCPCS Codes and Status Indicators for
                                 CY 2008
------------------------------------------------------------------------
  HCPCS codes                                      Associated
     newly       CY 2007                           HCPCS Code   Final CY
 recognized in      SI        Long descriptor      recognized   2008 SI
    CY 2008                                        in CY 2007
------------------------------------------------------------------------
J1470.........          B  Injection, gamma             J1460          K
                            globulin,
                            intramuscular, 2 cc.
J1480.........          B  Injection, gamma       ...........          K
                            globulin,
                            intramuscular, 3 cc.
J1490.........          B  Injection, gamma       ...........          K
                            globulin,
                            intramuscular, 4 cc.
J1500.........          B  Injection, gamma       ...........          K
                            globulin,
                            intramuscular, 5 cc.
J1510.........          B  Injection, gamma       ...........          K
                            globulin,
                            intramuscular, 6 cc.
J1520.........          B  Injection, gamma       ...........          K
                            globulin,
                            intramuscular, 7 cc.
J1530.........          B  Injection, gamma       ...........          K
                            globulin,
                            intramuscular, 8 cc.
J1540.........          B  Injection, gamma       ...........          K
                            globulin,
                            intramuscular, 9 cc.
J1550.........          B  Injection, gamma       ...........          K
                            globulin,
                            intramuscular, 10 cc.
J1560.........          B  Injection, gamma       ...........          K
                            globulin,
                            intramuscular, over
                            10 cc.
J8521.........          B  Capecitabine, oral,          J8520          K
                            500 mg.
J9094.........          B  Cyclophosphamide             J9093          N
                            lyophilized, 200 mg.
J9095.........          B  Cyclophosphamide       ...........          N
                            lyophilized, 500 mg.
J9096.........          B  Cyclophosphamide       ...........          N
                            lyophilized, 1g.
J9097.........          B  Cyclophosphamide       ...........          N
                            lyophilized, 2g.
J9140.........          B  Dacarbazine, 200 mg..        J9130          N
J9290.........          B  Mitomycin, 20 mg.....        J9280          K
J9291.........          B  Mitomycin, 40 mg.....  ...........          K
J9062.........          B  Cisplatin, 50 mg.....        J9060          N
J9080.........          B  Cyclophosphamide, 200        J9070          N
                            mg.
J9090.........          B  Cyclophosphamide, 500  ...........          N
                            mg.
J9091.........          B  Cyclophosphamide, 1g.  ...........          N
J9092.........          B  Cyclophosphamide, 2 g  ...........          N
J9110.........          B  Cytarabine, 500 mg...        J9100          N
J9182.........          B  Etoposide, 100 mg....        J9181          N
J9260.........          B  Methotrexate sodium,         J9250          N
                            50 mg.
J9375.........          B  Vincristine sulfate,         J9370          N
                            2 mg.
J9380.........          B  Vincristine sulfate,   ...........          N
                            5 mg.
------------------------------------------------------------------------

    Finally, in Table 45C of the proposed rule (72 FR 42743), we 
proposed to package seven drugs and biologicals that were payable in CY 
2006 because we lacked CY 2006 claims data and any other data related 
to the ASP methodology and, therefore, we were unable to determine the 
per day cost of these products. As in previous years of the OPPS, when 
we are unable to determine a drug's packaging status and payment rate 
due to the unavailability of hospital claims data and payment 
information at the time of the final rule, we package payment for those 
drugs. We did not receive any public comments on our proposal to apply 
this methodology to the seven drugs included in the proposed rule. As 
stated elsewhere in this rule, it is our policy to use updated claims 
data to inform our final rule. Since the time of the proposed rule, we 
have received hospital claims data for HCPCS code J0200 (Injection, 
alatrofloxacin mesylate, 100 mg). Therefore, as we now have payment 
information for HCPCS code J0200, we have determined its final CY 2008 
packaging status based on hospital claims data and we will not finalize 
our proposal to package this drug for CY 2008 because of the lack of 
hospital claims data and payment rate information. Hospital claims data 
for HCPCS code J0200 indicate that there were a total of 100 units 
billed over 1 day, with a mean cost of $0.16 per unit. Therefore, the 
average per day cost estimate of HCPCS code J0200 is approximately $16. 
As this cost is below the $60 packaging threshold, its status is 
packaged for CY 2008, according to the standard OPPS packaging 
methodology for drugs and biologicals.
    Therefore, we are finalizing our proposal, with modification to 
exclude HCPCS code J0200, to package payment for the drugs and 
biologicals listed in Table 35 below, due to missing data critical to 
calculating a per day cost.

  Table 35.--Drugs and Biologicals Without Information on Per Day Cost
                      That Are Packaged in CY 2008
------------------------------------------------------------------------
                                                                Final CY
        HCPCS code                   Short descriptor           2008 SI
------------------------------------------------------------------------
90393.....................  Vaccina ig, im...................          N
90477.....................  Adenovirus vaccine, type 7.......          N
90581.....................  Anthrax vaccine, sc..............          N
90727.....................  Plague vaccine, im...............          N
J0395.....................  Arbutamine HCl injection.........          N

[[Page 66777]]

 
J1452.....................  Intraocular Fomivirsen na........          N
------------------------------------------------------------------------

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

A. Total Allowed Pass-Through Spending

    Section 1833(t)(6)(E) of the Act limits the total projected amount 
of transitional pass-through payments for drugs, biologicals, 
radiopharmaceuticals, and categories of devices for a given year to an 
``applicable percentage'' of projected total Medicare and beneficiary 
payments under the hospital OPPS. For a year before CY 2004, the 
applicable percentage was 2.5 percent; for CY 2004 and subsequent 
years, we specify the applicable percentage up to 2.0 percent.
    If we estimate before the beginning of the calendar year that the 
total amount of pass-through payments in that year would exceed the 
applicable percentage, section 1833(t)(6)(E)(iii) of the Act requires a 
uniform reduction in the amount of each of the transitional pass-
through payments made in that year to ensure that the limit is not 
exceeded. We make an estimate of pass-through spending to determine not 
only whether payments exceed the applicable percentage, but also to 
determine the appropriate reduction to the conversion factor for the 
projected level of pass-through spending in the following year.
    For devices, developing an estimate of pass-through spending in CY 
2008 entails estimating spending for two groups of items. The first 
group of items consists of those device categories that were eligible 
for pass-through payment in CY 2006 or CY 2007, or both years, and that 
would continue to be eligible for pass-through payment in CY 2008. The 
second group contains items that we know are newly eligible, or project 
would be newly eligible, for device pass-through payment in the 
remainder of CY 2007 or beginning in CY 2008.
    For drugs and biologicals, section 1833(t)(6)(D)(i) of the Act 
establishes the pass-through payment amount for drugs and biologicals 
eligible for pass-through payment as the amount by which the amount 
authorized under section 1842(o) of the Act (or, if the drug or 
biological is covered under a competitive acquisition contract under 
section 1847B of the Act, an amount determined by the Secretary equal 
to the average price for the drug or biological for all competitive 
acquisition areas and year established under such section as calculated 
and adjusted by the Secretary) exceeds the portion of the otherwise 
applicable fee schedule amount that the Secretary determines is 
associated with the drug or biological. Because we are finalizing our 
CY 2008 proposal to pay for nonpass-through separately payable drugs 
and biologicals under the CY 2008 OPPS at ASP+5 percent, which 
represents the otherwise applicable fee schedule amount associated with 
a pass-through drug or biological, while we would pay for pass-through 
drugs and biologicals at ASP+6 percent or the Part B drug CAP rate, if 
applicable, our estimate of drug and biological pass-through payment 
for CY 2008 is not zero. Similar to estimates for devices, the first 
group of drugs and biologicals requiring a pass-through payment 
estimate consists of those products that were eligible for pass-through 
payment in CY 2006 or CY 2007, or both years, and that would continue 
to be eligible for pass-through payment in CY 2008. The second group 
contains drugs and biologicals that we know are newly eligible, or 
project would be newly eligible, beginning in CY 2008. The sum of the 
CY 2008 pass-through estimates for these two groups of drugs and 
biologicals would equal the total CY 2008 pass-through spending 
estimate for drugs and biologicals with pass-through status.

B. Estimate of CY 2008 Pass-Through Spending

    As we proposed, in this final rule with comment period, we are 
setting the applicable percentage limit at 2.0 percent of the total 
OPPS projected payments for CY 2008, consistent with our OPPS policy 
from CY 2004 through CY 2007.
    As we discuss in section IV.B. of this final rule with comment 
period, there are two device categories receiving pass-through payment 
in CY 2007 that will continue for payment during CY 2008. In accordance 
with the methodology we have used to make estimates in previous years, 
in cases where we have relevant claims data for the procedures 
associated with a device category, we proposed to project these data 
forward using inflation and utilization factors based on total growth 
in OPPS services as projected by CMS' Office of the Actuary (OACT) to 
estimate the upcoming year's pass through spending for this first group 
of device categories. As we stated in the CY 2007 OPPS/ASC final rule 
with comment period (71 FR 68101), we may use an alternate growth 
factor for any specific device category based on our claims data or the 
device's clinical characteristics, or both. We developed estimated OPPS 
utilization of the procedures and costs associated with the two device 
categories continuing for pass-through payment into CY 2008, based upon 
examination of our historical claims data, information provided in the 
pass-through device category applications, and the devices' clinical 
characteristics. Based on these analyses, our final estimate of pass-
through spending attributable to the first group (that is, the two 
device categories continuing in CY 2008) described above is $18.1 
million for CY 2008. The two device categories continuing in CY 2008, 
which are reflected in this $18.1 million estimate for CY 2008 pass-
through spending, are listed in Table 36 below.

     Table 36.--CY 2008 Devices with Current Pass-Through Categories
                         Continuing Into CY 2008
------------------------------------------------------------------------
                                          Current pass-through device
         HCPCS code            APC                 category
------------------------------------------------------------------------
C1821......................     1821  Interspinous process distraction
                                       device (implantable).
L8690......................     1032  Auditory osseointegrated device,
                                       includes all internal and
                                       external components.
------------------------------------------------------------------------


[[Page 66778]]

    In estimating CY 2008 pass-through spending for device categories 
in the second group (that is, device categories that we know at the 
time of the development of this final rule with comment period will be 
newly eligible for pass-through payment in CY 2008 (of which there are 
none)) and contingent projections for new categories in the second 
through fourth quarters of CY 2008, we used the general methodology as 
described above, while also taking into account recent OPPS experience 
in approving new pass through device categories. The final estimate of 
CY 2008 pass-through spending for this second group is $7.5 million. 
Employing our proposed methodology that the estimate of pass through 
device spending in CY 2008 incorporates CY 2008 estimates of pass 
through spending for device categories continuing in CY 2008, those 
first effective January 1, 2008, and those device categories projected 
to be approved during subsequent quarters of CY 2007 and CY 2008, our 
total pass-through estimate for device categories for CY 2008 is $25.6 
million.
    We did not receive any public comments on our proposed methodology 
to estimate transitional pass-through spending for device categories in 
CY 2008. Therefore, we are finalizing our methodology for estimating 
pass-through spending for categories of devices in CY 2008 as proposed, 
without modification, resulting in a total pass-through spending 
estimate of $25.6 million for device categories in CY 2008.
    In accordance with the methodology we proposed in the CY 2008 OPPS/
ASC proposed rule, to estimate CY 2008 pass-through spending for drugs 
and biologicals in the first group, specifically those drugs and 
biologicals initially eligible for pass-through status in CY 2006 or CY 
2007 and proposed for continuation of pass-through payment in CY 2008, 
we utilized the most recent Medicare physician's office data regarding 
their utilization, information provided in the respective pass-through 
applications, historical hospital claims data, pharmaceutical industry 
information, and clinical information regarding the drugs or 
biologicals, in order to project the CY 2008 OPPS utilization of the 
products. For the known drugs and biologicals that will continue on 
pass-through status in CY 2008, we then estimated the total pass 
through payment amount as the difference between ASP+6 percent or the 
Part B drug CAP rate, as applicable, and ASP+5 percent, aggregated 
across the projected CY 2008 OPPS utilization of these products. Based 
on these analyses, we estimated pass-through spending attributable to 
the first group (that is, the drugs and biological continuing with 
pass-through eligibility in CY 2008) described above to be about $1.2 
million for CY 2008. This $1.2 million estimate of CY 2008 pass through 
spending for the first group of pass-through drugs reflects the current 
pass-through drugs that are continuing on pass-through status into CY 
2008, which are displayed in Table 27 in section V.A.3. of this final 
rule with comment period.
    To estimate CY 2008 pass-through spending for drugs and biologicals 
in the second group (that is, drugs and biologicals that we know at the 
time of development of this final rule with comment period are newly 
eligible for pass-through payment as of January 1, 2008, and 
projections for new drugs and biologicals that could be initially 
eligible for pass-through payment in the second through fourth quarters 
of CY 2008), we used utilization estimates from applicants, 
pharmaceutical industry data, and clinical information as the basis for 
pass through spending estimates for these drugs and biologicals for CY 
2008, while also considering the most recent OPPS experience in 
approving new pass through drugs and biologicals. Based on these 
analyses, we estimate pass-through spending attributable to this second 
group of drugs and biologicals will be $5.4 million for CY 2008.
    In the CY 2008 OPPS/ASC proposed rule, we proposed that the 
estimate of pass through drug and biological spending in CY 2008 
incorporate CY 2008 estimates of pass-through spending for drugs and 
biologicals with pass-through status in CY 2007 that would continue for 
CY 2008, those first effective January 1, 2008, and those drugs and 
biologicals projected to be approved during subsequent quarters of CY 
2008.
    We did not receive any public comments on our proposed methodology 
to estimate pass-through spending for drugs and biologicals in CY 2008. 
Therefore, we are finalizing our methodology for estimating pass-
through spending for drugs and biologicals in CY 2008 as proposed, 
without modification, resulting in a total pass-through spending 
estimate of $6.6 million for drugs and biologicals in CY 2008.
    In the CY 2005 OPPS final rule with comment period (69 FR 65810), 
we indicated that we are accepting pass-through applications for new 
radiopharmaceuticals that are assigned a HCPCS code on or after January 
1, 2005. (Prior to this date, radiopharmaceuticals were not included in 
the category of drugs paid under the OPPS, and, therefore, were not 
eligible for pass-through status.) There are no radiopharmaceuticals 
that are eligible for pass-through payment at the time of publication 
of this final rule with comment period. In addition, we have no 
information identifying new radiopharmaceuticals to which a HCPCS code 
might be assigned on or after January 1, 2008, for which pass through 
payment status would be sought. We also have no historical data 
regarding payment for new radiopharmaceuticals with pass-through status 
under the methodology that we specified for the CY 2005 OPPS or the CY 
2008 methodology that we describe in section V.A.3. of this final rule 
with comment period. However, we do not believe that pass through 
spending for new radiopharmaceuticals in CY 2008 will be significant 
enough to materially affect our estimate of total pass-through spending 
in CY 2008. Therefore, we are not including radiopharmaceuticals in our 
final estimate of pass through spending for CY 2008. We discuss the 
methodology for determining the CY 2008 payment amount for new 
radiopharmaceuticals without pass through status in section V.B.3.b. of 
this final rule with comment period.
    We did not receive any public comments on our proposal to estimate 
that pass-through spending for radiopharmaceuticals in CY 2008 will be 
zero. Therefore, we are finalizing our methodology for estimating pass-
through spending for radiopharmaceuticals in CY 2008 as proposed, 
without modification, resulting in a total pass-through spending 
estimate of zero for radiopharmaceuticals in CY 2008.
    In accordance with the comprehensive methodology described above, 
we estimate that total pass through spending for the two device 
categories and the drugs and biologicals that are continuing for pass-
through payment into CY 2008 and those devices, drugs, biologicals, and 
radiopharmaceuticals that first become eligible for pass-through status 
during CY 2008 will approximate $32.2 million, which represents 0.09 
percent of total OPPS projected payments for CY 2008.
    Because we estimate that pass-through spending in CY 2008 will not 
amount to 2.0 percent of total projected OPPS CY 2008 spending, we will 
return 1.91 percent of the pass-through pool to adjust the conversion 
factor, as we discuss in section II.C. of this final rule with comment 
period.

[[Page 66779]]

    Accordingly, we are finalizing our proposed methodology for 
estimating CY 2008 OPPS pass-through spending for drugs, biologicals, 
radiopharmaceuticals, and categories of devices. Our final total pass-
through estimate for CY 2008 is $32.2 million.

VII. OPPS Payment for Brachytherapy Sources

A. Background

    Section 1833(t)(2)(H) of the Act, as added by section 621(b)(2)(C) 
of Pub. L. 108-173, mandated the creation of separate groups of covered 
OPD services that classify brachytherapy devices separately from other 
services or groups of services. The additional groups must reflect the 
number, isotope, and radioactive intensity of the devices of 
brachytherapy furnished, including separate groups for palladium-103 
and iodine-125 devices.
    Section 1833(t)(16)(C) of the Act, as added by section 621(b)(1) of 
Pub. L. 108-173, established payment for devices of brachytherapy 
consisting of a seed or seeds (or radioactive source) based on a 
hospital's charges for the service, adjusted to cost. The period of 
payment under this provision is for brachytherapy sources furnished 
from January 1, 2004, through December 31, 2006. Under section 
1833(t)(16)(C) of the Act, charges for the brachytherapy devices may 
not be used in determining any outlier payments under the OPPS for that 
period of payment. Consistent with our practice under the OPPS to 
exclude items paid at cost from budget neutrality consideration, these 
items were excluded from budget neutrality for that time period as 
well.
    In the OPPS interim final rule with comment period published on 
January 6, 2004 (69 FR 827), we implemented sections 621(b)(1) and 
(b)(2)(C) of Pub. L. 108-173. In that rule, we stated that we would pay 
for the brachytherapy sources (that is, brachytherapy devices) listed 
in Table 4 of the interim final rule with comment period (69 FR 828) on 
a cost basis, as required by the statute. Since January 1, 2004, we 
have used status indicator ``H'' to denote nonpass through 
brachytherapy sources paid on a cost basis, a policy that we finalized 
in the CY 2005 final rule with comment period (69 FR 65838).
    Furthermore, we adopted a standard policy for brachytherapy code 
descriptors, beginning January 1, 2005. We included ``per source'' in 
the HCPCS code descriptors for all those brachytherapy source 
descriptors for which units of payment were not already delineated.
    Section 621(b)(3) of Pub. L. 108-173 required the GAO to conduct a 
study to determine appropriate payment amounts for devices of 
brachytherapy, and to submit a report on its study to the Congress and 
the Secretary, including recommendations on the appropriate payments 
for such devices. This report was due to Congress and to the Secretary 
no later than January 1, 2005. The GAO's final report, ``Medicare 
Outpatient Payments: Rates for Certain Radioactive Sources Used in 
Brachytherapy Could Be Set Prospectively'' (GAO-06-635), was published 
on July 24, 2006. We summarized and discussed the report's findings and 
recommendations in the CY 2007 OPPS/ASC final rule with comment period 
(71 FR 68103 through 68105). The GAO report principally recommended 
that we use OPPS historical claims data to determine prospective 
payment rates for two of the most frequently used brachytherapy 
sources, iodine-125 and palladium-103, and also recommended that we 
consider using claims data for the third source studied, high dose rate 
(HDR) iridium-192.
    The GAO report concluded that CMS could set prospective payment 
rates based on claims data for iodine and palladium sources, because 
the sources' unit costs are generally stable, both sources have 
identifiable unit costs that do not vary substantially and 
unpredictably over time, and reasonably accurate claims data are 
available. On the other hand, the GAO report explained that it was not 
able to determine a suitable methodology for paying separately for HDR 
iridium. The report noted that iridium is reused across multiple 
patients, making its unit cost more difficult to determine. However, 
the report also indicated that CMS has outpatient claims data from all 
hospitals that have used iridium and that in order to identify a 
suitable methodology for separate payment, CMS would be able to use 
these data to establish an average cost and evaluate whether that cost 
varies substantially and unpredictably.
    In our CY 2007 annual OPPS rulemaking, we proposed and finalized a 
policy of prospective payment based on median costs for the 11 
brachytherapy sources for which we had claims data. We based the 
prospective rates on median costs for each source from our CY 2005 
claims data (71 FR 68102 through 71 FR 68114). We also indicated that 
we would assign future new HCPCS codes for new brachytherapy sources to 
their own APCs, with prospective payment rates set based on our 
consideration of external data and other relevant information regarding 
the expected costs of the sources to hospitals (71 FR 68112). We 
changed the definition of status indicator ``K'' to ensure that ``K'' 
appropriately described brachytherapy sources to accommodate the use of 
``K'' for prospective payment for brachytherapy sources (71 FR 68110).
    Subsequent to publication of the CY 2007 OPPS/ASC final rule with 
comment period, section 107(a) of the MIEA-TRHCA amended section 
1833(t)(16)(C) of the Act by extending the payment period for 
brachytherapy sources based on a hospital's charges adjusted to cost 
for one additional year. This requirement for cost-based payment ends 
after December 31, 2007. Therefore, we were required to continue 
payment for sources based on charges adjusted to cost through CY 2007. 
We also have continued using status indicator ``H'' to denote nonpass 
through brachytherapy sources paid on a cost basis as a result of 
enactment of this provision rather than using status indicator ``K'' to 
denote prospective payment for nonpass-through brachytherapy sources, 
as finalized in the CY 2007 OPPS/ASC final rule with comment period.
    Section 107(b)(1) of the MIEA-TRHCA also amended section 
1833(t)(2)(H) of the Act by adding a requirement for the establishment 
of separate payment groups for ``stranded and non-stranded'' 
brachytherapy devices beginning July 1, 2007. Section 107(b)(2) of the 
MIEA-TRHCA authorized the Secretary to implement this new requirement 
by ``program instruction or otherwise.'' This new requirement is in 
addition to the requirement for separate payment groups based on the 
number, isotope, and radioactive intensity of brachytherapy devices 
that was previously established by section 1833(t)(2)(H) of the Act. We 
note that commenters on the CY 2007 proposed rule asserted that 
stranded sources, which they described as embedded into the stranded 
suture material and separated within the strand by material of an 
absorbable nature at specified intervals, had greater production costs 
than non-stranded sources (71 FR 68113 through 68114).
    As a result of the statutory requirement to create separate groups 
for stranded and non-stranded sources as of July 1, 2007, we 
established several coding changes via program transmittal, effective 
July 1, 2007 (Program Transmittal No. 1259, dated June 1, 2007). As 
indicated in the CY 2008 proposed rule, based upon comments to our CY 
2007 proposed rule and industry

[[Page 66780]]

input, we are presently aware of three sources that are currently 
available in stranded and non-stranded forms: iodine-125; palladium-
103; and cesium-131 (72 FR 42746).
    Therefore, in Program Transmittal No. 1259, we created six new 
HCPCS codes to differentiate the stranded and non-stranded versions of 
these three sources. These six new HCPCS codes replaced the three prior 
brachytherapy source HCPCS codes for iodine, palladium and cesium 
(C1718, C1720, and C2633, all of which were deleted as of July 1, 
2007), respectively, effective July 1, 2007. In this program 
transmittal, we also provided specific billing instructions to 
hospitals on how to report stranded sources. We instructed providers, 
when billing for stranded sources, to bill the number of units of the 
appropriate source HCPCS C-code according to the number of 
brachytherapy sources in the strands and specifically not to bill as 
one unit per strand. If a hospital applies both stranded and non-
stranded sources to a patient in a single treatment, the hospital 
should bill the stranded and non-stranded sources separately, according 
to the differentiated HCPCS codes listed in the table found in that 
program transmittal and included in Table 48 of the proposed rule. We 
expected that these instructions would clearly indicate how hospitals 
should bill for stranded and non-stranded brachytherapy sources, and 
that hospital reporting of sources according to these instructions 
would promote accurate claims data for the various source codes in the 
future. In Program Transmittal No. 1259, we also added the term ``non-
stranded'' to the descriptors for all sources that currently have only 
non-stranded versions of a source.
    In Program Transmittal No. 1259, we indicated that if we receive 
information that any of the other sources now designated as non-
stranded are marketed as a stranded source, we would create a code for 
the stranded source. We also established two ``Not Otherwise 
Specified'' (NOS) codes for billing stranded and non-stranded sources 
that are not yet known to us and for which we do not have source-
specific codes. If a hospital purchases an FDA-approved and marketed 
radioactive source consisting of a radioactive isotope (consistent with 
our definition of a brachytherapy source eligible for separate payment 
as discussed below), for which we do not yet have a separate source 
code established, it should bill such sources using the appropriate NOS 
code listed in Program Transmittal No. 1259, that is, C2698 
(Brachytherapy source, stranded, not otherwise specified, per source) 
for stranded NOS sources, or C2699 (Brachytherapy source, non-stranded, 
not otherwise specified, per source) for non-stranded NOS sources, 
which are also listed in Table 37 below. For example, if a new FDA-
approved stranded source comes onto the market and there is currently 
only a billing code for the non-stranded source, the hospital should 
bill the stranded source under C2698 (stranded NOS source) until a 
specific stranded billing code for the source is established.
    In Program Transmittal No. 1259, we reiterated our longstanding 
policy that hospitals and other parties are invited to submit 
recommendations to us for new HCPCS codes to describe new sources 
consisting of a radioactive isotope, including a detailed rationale to 
support recommended new sources. We will continue our endeavor to add 
new brachytherapy source codes and descriptors to our systems for 
payment on a quarterly basis. Such recommendations should be directed 
to the Division of Outpatient Care, Mail Stop C4-05-17, Centers for 
Medicare and Medicaid Services, 7500 Security Boulevard, Baltimore, MD 
21244.
    Finally, we noted that in the CY 2007 OPPS/ASC final rule with 
comment period, we established a definition for brachytherapy source 
for which separate payment under section 1833(t)(2)(H) of the Act is 
required (71 FR 68113). We considered the definition of ``brachytherapy 
source'' in the context of current medical practice and in regard to 
the language in section 1833(t)(2)(H) of the Act, which refers to 
brachytherapy sources as ``a seed or seeds (or radioactive source).'' 
We believed that this provision of the Act mandating separate payment 
refers to sources that are themselves radioactive, meaning that the 
source contains a radioactive isotope. Furthermore, we indicated that 
the statutory language is likewise clear that devices of brachytherapy 
paid separately must reflect the number, isotope, and radioactive 
intensity of such devices furnished. Accordingly, we further believed 
that section 1833(t)(2)(H) of the Act applies only to radioactive 
devices of brachytherapy. In the CY 2007 OPPS/ASC final rule with 
comment period, we also stated that we would not consider specific 
devices, beams of radiation, or equipment that do not constitute 
separate sources that utilize radioactive isotopes to deliver radiation 
to be brachytherapy sources for separate payment, as such items do not 
meet the statutory requirements provided in section 1833(t)(2)(H) of 
the Act (71 FR 68113).

B. Payment for Brachytherapy Sources

    As indicated above, the provision to pay for brachytherapy sources 
at charges adjusted to cost expires after December 31, 2007, in 
accordance with section 1833(t)(16)(C) of the Act, as amended by 
section 107(a) of the MIEA-TRHCA. However, under section 1833(t)(2)(H) 
of the Act, we are still required to create APC groupings that classify 
devices of brachytherapy separately from other services or groups of 
services in a manner reflecting the number, isotope, and radioactive 
intensity of the devices of brachytherapy furnished. In addition, 
section 1833(t)(2)(H) of the Act, as amended by section 107(b)(1) of 
the MIEA-TRHCA, requires separate payment groups based on stranded and 
non-stranded brachytherapy devices on or after July 1, 2007.
    In the CY 2008 proposed rule, we proposed to pay separately for 
each of the sources listed in Table 48 of that rule on a prospective 
basis for CY 2008, with payment rates to be determined using the CY 
2006 claims-based median cost per source for each brachytherapy device. 
Consistent with our policy regarding APC payments made on a prospective 
basis, we proposed that the cost of brachytherapy sources be subject to 
the outlier provision of section 1833(t)(5) of the Act. As indicated in 
section II.A.2. of the proposed rule, for CY 2008 we proposed specific 
prospective payment rates for brachytherapy sources, which would be 
subject to scaling for budget neutrality.
    We stated that we believe that adopting prospective payment for 
brachytherapy sources would be appropriate for a number of reasons. The 
general OPPS payment methodology is a prospective payment system using 
median costs based on claims data. This prospective payment methodology 
results in more consistent, predictable, and equitable payment amounts 
per source across hospitals, and it prevents some of the extremely high 
and low payment amounts found under a charges adjusted to cost 
methodology. The proposed prospective payment would also provide 
hospitals with incentives for efficiency in the provision of 
brachytherapy services to Medicare beneficiaries. Moreover, the 
proposed approach is consistent with our payment methodology for the 
vast majority of items and services paid under the OPPS. Indeed, 
section 1833(t)(2)(C) of the Act requires us to establish prospective 
payment rates for the OPPS system based on median costs (or mean costs 
if elected by the Secretary). As of CY 2007, only pass-through devices, 
radiopharmaceuticals,

[[Page 66781]]

and brachytherapy sources were paid at charges adjusted to cost. Based 
on the proposals in the CY 2008 proposed rule, only pass-through 
devices would continue to be paid at charges adjusted to cost for CY 
2008. As noted earlier, section 107(a) of the MIEA-TRHCA specifically 
extended the payment period for brachytherapy sources based on a 
hospital's charges adjusted to cost for only one additional year, CY 
2007.
    As explained in the proposed rule, the proposal to adopt 
prospective payment for brachytherapy sources provides opportunities 
for hospitals to receive additional payments under certain 
circumstances through the outlier provisions and the 7.1 percent rural 
SCH adjustment (72 FR 42748). Consistent with our policy regarding APC 
payments made on a prospective basis, we proposed that the cost of 
brachytherapy sources be subject to the outlier provision of section 
1833(t)(5) of the Act. Therefore, sources could receive outlier 
payments if the costs of furnishing brachytherapy sources exceed the 
outlier threshold. Also, as discussed in section II.F. of the proposed 
rule, as a result of our CY 2008 proposal to pay prospectively for 
brachytherapy sources, we also proposed to include brachytherapy 
sources in the group of services eligible for the 7.1 percent payment 
increase for rural SCHs, including EACHs.
    We proposed a payment methodology for separately paid brachytherapy 
sources for CY 2008 based upon their median unit costs calculated using 
CY 2006 claims data. Because we are required to create separate APC 
groups for stranded and non-stranded sources and because our CY 2006 
billing codes do not differentiate stranded and non-stranded sources, 
we proposed to make certain assumptions when we estimate the median 
costs for stranded and non-stranded (low activity) iodine-125, 
palladium-103, and cesium-131 sources based on our CY 2006 aggregate 
claims data. As stated earlier, commenters to our CY 2007 proposed rule 
explained that the costs of stranded iodine, palladium and cesium 
sources are higher than non-stranded versions of these sources but 
provided no data regarding the relative cost relationships. Given the 
reported cost differences between stranded and non-stranded sources and 
the statutory requirement that we establish separate payment groups for 
stranded and non-stranded sources, we believed it would be appropriate 
to establish different stranded and non stranded payment rates for 
iodine-125, palladium-103, and cesium-131 sources. However, in order to 
establish separate stranded and non-stranded payment rates for these 
three sources, we proposed to make the following assumptions in our 
calculation of their median costs. Assuming that the reportedly lower 
cost non-stranded sources would be unlikely to be in the top 20 percent 
of the cost distribution in our aggregate (stranded and non-stranded) 
CY 2006 claims data, we proposed to calculate the median cost for these 
3 non-stranded sources based on the bottom 80 percent of the cost 
distribution in our aggregate claims data for each source. Likewise, 
assuming that the reportedly higher cost stranded sources would be 
unlikely to be in the bottom 20 percent of the cost distribution in our 
aggregate CY 2006 claims data, we proposed to calculate the median cost 
for these 3 stranded sources based on the top 80 percent of the cost 
distribution for our aggregate data. This approach to calculating 
median costs for stranded and non-stranded iodine-125, palladium-103, 
and cesium-131 sources resulted in proposed Medicare payment rates 
based on the 60th percentile of our aggregate data for stranded sources 
and the 40th percentile of our aggregate data for non-stranded sources, 
which, after examining the range of our cost data for these sources, 
appeared to provide a reasonable cost differential between stranded and 
non-stranded sources until such time when we have claims data reported 
separately for stranded and non-stranded sources.
    We proposed this approach for stranded and non-stranded iodine-125, 
palladium-103, and cesium-131 sources as a transitional measure, until 
we have sufficient claims data for separately coded stranded and non-
stranded sources upon which to calculate the median costs for these 
sources specifically. (The first partial year claims data for 
separately coded stranded and non-stranded sources will be available in 
CY 2007 claims data for ratesetting in CY 2009.) This methodology has 
the benefits of a prospective payment methodology as discussed above 
and complies with the requirements of the MIEA-TRHCA to provide 
separate payment for stranded and non-stranded sources.
    Table 48 of the proposed rule (72 FR 42750) included a complete 
listing of the HCPCS codes, long descriptors, and APC assignments that 
we currently use for brachytherapy sources paid under the OPPS as of 
July 1, 2007, and the status indicators, estimated median costs, and 
payment rates that we proposed for CY 2008. We noted that some of the 
HCPCS codes for which we proposed payment rates for CY 2008 were not 
shown in Addendum B of the proposed rule because that addendum was 
based on HCPCS codes effective as of April 2007. As explained earlier, 
there are some brachytherapy source HCPCS codes that were added as of 
July 1, 2007. While these HCPCS codes were not shown in Addendum B, the 
proposed payment rates for all brachytherapy sources were shown in 
Table 48 of the proposed rule.
    We invited public comment on all aspects of our proposed 
brachytherapy source payment for CY 2008. We particularly encouraged 
public comment on our proposed median costs estimates for stranded and 
non-stranded iodine-125, palladium-103, and cesium-131 sources, 
including the submission of any available information or data on cost 
differences between stranded and non stranded sources. We also 
indicated in the proposed rule that we were interested in receiving 
information regarding the historical and current relative market share 
for stranded versus non-stranded sources, particularly as used in the 
care of Medicare beneficiaries and with respect to brachytherapy 
treatments for different clinical conditions (72 FR 42749).
    Comment: A number of commenters recommended that CMS continue 
payment for brachytherapy sources using the charges adjusted to cost 
methodology for CYs 2008 and 2009. Some commenters claimed that 
establishing a single prospective payment rate per source would not 
account for the variable costs associated with the different sources 
used in brachytherapy. A commenter claimed that, based upon historical 
hospital claims data, it does not appear that hospitals are charging 
enough to recover their acquisition costs for expensive products in 
particular. Some commenters stated that some products have low volumes 
of claims from small numbers of hospitals, based on recent claims 
analyses. They explained their belief that the low volume of claims for 
certain sources and the wide variation in submitted charges for most 
sources demonstrate that equitable payment rates that approximate true 
acquisition costs for brachytherapy sources cannot be established using 
Medicare claims. Several commenters asserted that CMS' brachytherapy 
source claims data have unresolved problems, such as: (a) The cost of 
renewable high dose rate (HDR) iridium, which may be used to treat a 
number of people, is difficult to estimate, because the cost per source 
depends on the number of patients treated; (b) a lack of meaningful 
data to establish payment rates for stranded brachytherapy sources; (c) 
large variations in per unit costs across

[[Page 66782]]

sources; (d) a lack of sufficient claims to establish rates in the 
cases of 6 sources: ytterbium-169 (C2637), linear palladium (C2636), 
iodine-125 solution (C2632 correctly--coded in CY 2007 as A9527), gold-
198 (C1716), cesium-131 (C2633), and non-HDR iridium (C1719); (e) two-
thirds of the current sources have proposed payment rates based on 
claims from a small number (for example, fewer than 50 or 66) 
hospitals; and (f) a rank order anomaly exists between the proposed 
median costs of iodine-125 ($37.71) and high activity I-125 ($29.56), 
with the high activity source appearing to cost less than the low 
activity source, when high activity sources are reportedly more 
expensive. The commenters also explained that while claims data may be 
improving over time, the majority of hospitals still do not include a 
brachytherapy source code on brachytherapy treatment claims, even 
though a source is required, claiming that only about 31 percent of the 
claims for APC 0312 (Radioelement Applications), 73 percent of the 
claims for APC 0313 (Brachytherapy), and 36 percent of the claims for 
APC 0651 (Complex Interstitial Source Application) include a 
brachytherapy source code.
    Some commenters supported the proposal to establish prospective 
payment rates for brachytherapy in CY 2008 using costs derived from CY 
2006 claims data, rather than through cost-based reimbursement. A 
commenter supported the development of prospective payment rates for 
brachytherapy sources based on CMS' claims data but was concerned that 
the 2-year time lag between the hospital claims data used to establish 
the proposed payment rates for brachytherapy sources and the payment 
year of the proposed update would lead to CY 2008 payments that would 
not reflect the actual CY 2008 costs of brachytherapy sources. The 
commenters recommended the use of historical claims data, in addition 
to an annual inflation rate, to determine the prospective payment 
rates.
    Regarding specific brachytherapy sources, a commenter claimed that 
the proposed payment rate of $11,944 per source for yttrium-90 is below 
the acquisition cost and provides no compensation to providers for 
storage, handling and disposal costs. Two commenters indicated that 
setting a fixed payment rate for High Dose Rate (HDR) iridium-192 is 
problematic, because the source can be used to treat multiple patients 
during its 90-day period of decay. They pointed out that the cost per 
use of the source, therefore, depends on the number of patients treated 
by a hospital during this period. Thus, they concluded there would be 
great variability in the cost of HDR iridium treatment so CMS should 
continue to pay for this source based on the charges adjusted to cost 
payment methodology.
    Response: We believe that median costs based on our hospital claims 
data for brachytherapy sources have produced reasonably consistent per 
source cost estimates over the past several years, comparable to the 
patterns we have observed for many other OPPS services whose payments 
are set based upon relative payment weights from claims data. 
Concerning the claim that a single prospective payment per source would 
not account for the variable costs across sources used, we believe that 
our per source payment methodology specific to each source's 
radioisotope, radioactive intensity, and stranded or non-stranded 
configuration, supplemented by payment based on the number of sources 
used in a specific clinical case, adequately accounts for the major 
expected sources of variability across treatments.
    As a prospective payment system, the OPPS relies on the concept of 
averaging, where the payment may be more or less than the estimated 
costs of providing a service for a particular patient, but with the 
exception of outlier cases, it is adequate to ensure access to 
appropriate care. In the case of brachytherapy sources for which the 
law requires separate payment groups, without packaging, the costs of 
these individual items could be expected to show greater variation than 
some other APCs under the OPPS because higher variability in costs for 
some component items and services is not balanced with lower 
variability for others and because relative weights are typically 
estimated using a smaller set of claims. Nevertheless, we believe that 
prospective payment for brachytherapy sources based on median costs 
from claims calculated according to the standard OPPS methodology is 
appropriate at this point in time and would provide hospitals with the 
greatest incentives for efficiency in providing brachytherapy 
treatment. Under the budget neutral OPPS, it is the relativity of costs 
of services, not their absolute costs, that is important, and we 
believe that brachytherapy sources can now be appropriately paid 
according to the standard OPPS payment approach. All services are 
similarly subjected to the same 2-year lag in costs from claims data 
available for ratesetting, so we believe the relative costs of OPPS 
services should generally be appropriate. It is important that the same 
measure of central tendency (median cost) from claims be used to 
establish the payment weights for all OPPS services in order to provide 
appropriate payment for all of these services. The inflation rate of 
medical services is taken into consideration through the conversion 
factor, which is updated annually to account for inflation and used to 
calculate payment rates from the relative payment weights based on 
median costs.
    When the statutory requirement for payment of brachytherapy sources 
at charges adjusted to cost ends on December 31, 2007, prospective 
payment for brachytherapy sources based on their median costs would 
make the source payment an integral part of the OPPS, rather than a 
separate cost-based payment methodology within the OPPS. We believe 
that consistent and predictable prospectively established payment rates 
under the OPPS for brachytherapy sources are appropriate because we do 
not believe that the hospital resource costs associated with specific 
brachytherapy sources would vary greatly across hospitals or clinical 
conditions under treatment, other than through differences in the 
numbers of source utilized which would be accounted for in the standard 
OPPS payment methodology as proposed. We particularly note that, under 
the final CY 2008 payment policies for all OPPS services, only a few 
pass-through devices that we have determined result in significant 
clinical improvement would continue to be paid based on charges 
adjusted to cost, as required under section 1833(t)(6)(D)(ii) of the 
Act for these items.
    Sources of brachytherapy have been separately paid for virtually 
all of the 7 year history of the OPPS, and hospitals have now had 7 
years of experience in reporting the sources separately to receive 
payment for these relatively costly items. Therefore, hospitals 
historically have had a strong incentive to bill for sources at charges 
that reflected the costs of the sources, leading to CY 2006 data that 
are sufficient to provide the basis for prospective payment. Evolution 
of brachytherapy source technology, just like advances in the provision 
of other OPPS services, would be reflected in updated cost data for 
those sources over time, and those updated costs would be considered 
each year in the annual update cycle for the OPPS. We do not believe 
that special accommodation to support brachytherapy source innovation 
is necessary. We believe that hospitals and physicians regularly 
balance the additional benefits to

[[Page 66783]]

patients of improved products with the additional costs, if any, of 
those products. One of the functions of a prospective payment system is 
to encourage wise purchasing while simultaneously making appropriate 
payments for the services being furnished. We believe that payments 
based on the median unit costs of brachytherapy sources support this 
goal.
    Because HDR iridium has a fixed active life and must be replaced 
every 90 days, we agree with commenters that hospitals' costs for the 
source will be highly dependent on the number of treatments provided by 
a hospital during that time period. The source cost must be amortized 
over the life of the sources so, in establishing their charges for the 
HDR iridium source, we expect that hospitals would project the number 
of treatments that would be provided over the life of the source and 
establish their charges accordingly. For most such OPPS services, our 
practice is to establish prospective payment rates based on the median 
hospital costs as calculated form claims data, to provide incentives 
for efficient and cost-effective delivery of these services. Under a 
prospective payment system methodology, payments generally account for 
the average costs of services and do not specifically account for 
varying circumstances. We believe that hospitals understand this 
prospective payment methodology and should recognize that a prospective 
payment system could pay more or less than the cost of delivering a 
specific service in an individual case. We have no reason to believe 
that a CY 2008 payment based on the median unit cost for HDR iridium 
would place continued access to this source at risk. Furthermore, as 
discussed earlier in this section and in section II.F. of this final 
rule with comment period, prospective payment for brachytherapy sources 
means that there would be opportunities for hospitals to receive 
additional payments under the outlier provisions and the rural 
adjustment.
    We disagree that we are not able to set equitable rates per source 
because of low volumes for some sources and variability of source costs 
in our claims data. The prospective rates we proposed and are 
finalizing would be applied equitably to all sources of the same type 
(for example, all non-stranded iodine-125 sources, all stranded iodine-
125 sources, and so on). The nature of basing payment weights on median 
costs is that the volume of services, by definition, controls the 
median cost because the median is the 50th percentile of the array of 
data. However, use of the median cost also simultaneously eliminates 
the influence of not only the highest but also the lowest values in the 
array. If the use of currently low volume sources increases in 
succeeding years or expands to other hospitals, these additional claims 
would be represented in our claims data in future years, leading to 
more robust claims data for each such source.
    Comment: One commenter claimed that CMS' claims data for the 
cesium-131 source show significant variation in per unit costs reported 
on claims across hospitals. In addition, the commenter believed that 
the number of claims and the number of hospitals submitting data for 
cesium-131 sources are too low to be the basis of appropriate payment 
rates for CY 2008. The commenter also indicated that it has submitted a 
request for a new code for high activity cesium-131 to be effective for 
separate payment as of January 1, 2008.
    Response: We disagree that the number of cesium claims is too low 
and the variability is too high to proceed with prospective payment for 
cesium sources. Our CY 2006 claims data used for the proposed rule 
included 7,435 sources and our final rule claims data include 8,652 
cesium sources. The modest variability of costs observed on claims for 
cesium-131 is similar to the variability we observe for other items and 
services under the OPPS. We expect that some of the cost differences 
associated with claims for the single HCPCS code for cesium-131 sources 
reported in CY 2006 may be associated with the use of stranded versus 
non-stranded sources, and we have accounted for that potential 
variation through our proposal to utilize the 40th and 60th percentiles 
of aggregate cost data for the single source code for ratesetting for 
non-stranded and stranded sources, respectively.
    We note that we have received a request for a new code for separate 
payment of high activity cesium-131 sources and are currently 
evaluating that request.
    Comment: A number of comments expressed varying opinions concerning 
the proposed payment methodology for stranded versus non-stranded 
sources for iodine-125, palladium-103, and cesium-131 sources. Some 
commenters explained that the CY 2006 claims data do not distinguish 
between stranded and non-stranded devices, and that no meaningful data 
exist to support CMS' assumptions underpinning the payment proposal for 
stranded and non-stranded sources. They asserted that CMS' reasoning 
that these assumptions appear to provide a reasonable cost differential 
between stranded and non-stranded sources is not supported by data and 
is merely guesswork. Therefore, these commenters recommended that CMS 
not establish prospective payment rates for stranded and non-stranded 
configurations, especially when appropriate specific codes are now in 
place to collect data on these sources. The commenters also doubted 
that the assumptions CMS made should apply equally to the three 
isotopes with stranded and non-stranded configurations (iodine, 
palladium, and cesium). Those commenters recommended that CMS continue 
to pay for stranded and non-stranded sources based on charges adjusted 
to cost until accurate data are collected and available for 
ratesetting.
    Several commenters specifically urged CMS not to modify the 
proposed payment rates based on ``anecdotal comments that the Agency 
may receive'' regarding stranded versus non-stranded sources. They 
believed that CMS should wait until a ``comprehensive database'' of 
accurate data is available. Many of these commenters generally 
recommended that not only should CMS pay for stranded and non-stranded 
brachytherapy sources based on charges adjusted to cost until robust 
data on the different costs of these sources are available, but that 
CMS should provide payment for all brachytherapy sources using the same 
cost-based methodology in CY 2008.
    One commenter claimed that CMS does not have meaningful data for 
stranded and high activity cesium-131 to establish prospective payment 
levels. The commenter also stated that the stranded versus non-stranded 
cost estimate for cesium does not reflect the fact that this cost 
differential can vary significantly based on the radioactive half-life 
of the source, which is significant for cesium-131. In addition, the 
commenter explained that cesium decays at the rate of 7 percent per day 
and thus the cost differential between its loose seed and stranded seed 
configurations would not be consistent with the cost differential for 
stranded and non-stranded iodine and palladium sources, which also have 
different decay rates. The commenter believed that using the same cost 
assumptions for all sources would have a significant negative impact on 
the payment for brachytherapy sources and argued that the impact on 
cesium sources would be disproportionate in comparison to other 
sources, due to the radioactive isotope half-life alone.
    This commenter offered information as to the actual cost 
differential between stranded and non-stranded sources, a specific 
request that was made of the public in the proposed rule. This

[[Page 66784]]

commenter stated that the cost of non-stranded cesium sources was $61 
to $75 per source, and of stranded cesium sources, $82 to $94 per 
source, in comparison with proposed payment rates of approximately $51 
and $97, respectively. Therefore, the commenter concluded that the 
proposed payment rates would provide a disincentive to utilize non-
stranded cesium relative to stranded cesium sources, encouraging a 
shift of usage to stranded cesium sources. The commenter believed that 
CMS should not rush to establish prospective payment rates for stranded 
and non stranded cesium sources, especially when newly established 
specific source codes are now available.
    Response: We agree with the commenters that our CY 2006 claims data 
do not differentiate between stranded and non-stranded sources, as we 
explained in the proposed rule. We proposed to apply certain 
assumptions that would allow us to make prospective payment for these 
sources while our newly established codes (as of July 1, 2007) would 
allow us to collect specific stranded and non-stranded cost data. In 
the CY 2008 OPPS/ASC proposed rule, we reiterated our intent that the 
proposed payment methodology for stranded and non-stranded sources 
would be a temporary payment methodology, and that we would use the 
newly established codes to collect differential cost data for stranded 
and non-stranded sources for future use.
    While some commenters urged us not to modify the proposed payment 
levels based on ``anecdotal comments that the Agency may receive,'' 
many of those same commenters provided only anecdotal claims that the 
proposed payment levels are inappropriate and not based on meaningful 
data. Additionally, such commenters did not specifically define what 
they would consider to be a comprehensive database. Of note, for many 
of the brachytherapy sources without stranded configurations, we have a 
significant volume of claims that have demonstrated consistent hospital 
costs over the last several years, and our claims data for these 
sources is directly applicable to the currently reported HCPCS codes.
    We thank the commenter for reporting invoice cost data on stranded 
versus non-stranded cesium sources. We have received no information on 
the cost differential between stranded versus non-stranded sources in 
previous comments or correspondence. We note that the median cost based 
on the 40th percentile for non-stranded cesium sources for this final 
rule with comment period is $63, increased from the proposed $51 based 
on proposed rule data, while the final rule 60th percentile for 
stranded cesium sources is $97, consistent with both the proposed and 
final rule data. Therefore, for the only case in which we received 
information from the public regarding the costs of stranded and non-
stranded sources, the final rule 40th and 60th percentiles of aggregate 
source data are aligned with the cost information provided by the 
commenter for the two source configurations. While this limited 
comparison with external data does not allow us to draw definitive 
conclusions, it provides validation of our proposal to base the payment 
for stranded versus non-stranded cesium sources on the 60th versus 40th 
cost percentile from the source's aggregate CY 2006 claims data.
    Comment: Other commenters were generally supportive of prospective 
payment of stranded and non-stranded iodine, palladium, and cesium 
sources, as well as other brachytherapy sources. Some of these 
commenters believed, however, that the payment differential for 
stranded versus non-stranded sources that resulted from our methodology 
to use the 60th percentile cost for stranded and the 40th percentile 
cost for non-stranded sources was too great. The likely result, one 
commenter explained, was to encourage the use of stranded sources for 
financial rather than clinical reasons. One commenter pointed out that 
while the payment differential might not appear to be significant on a 
per source basis, when the number of sources per procedure is 
considered (for example, 50-100 sources), the cost difference to 
providers would be significant. Another commenter asserted that all 
seed-type sources are essentially the same and that any price 
differential between stranded and non-stranded sources is a result of a 
successful marketing strategy by stranded source manufacturers, 
creating a price differential between stranded and non stranded sources 
as a result of customer loyalty to specific products with certain 
features that were initially provided at no additional cost.
    Response: Prospective payment rates under the OPPS are based on the 
median cost for each APC from historical hospital claims, with trimming 
of claims data only at those extremes to eliminate those claims of 
exceptionally high or low cost from contributing to APC median cost 
development. The statute requires us to pay for stranded and non-
stranded sources through different payment groups. As stated earlier, 
our proposal to pay at the 40th and 60th cost percentiles of aggregate 
data for the predecessor HCPCS codes for the three products with two 
clinical configurations is a temporary payment methodology that would 
provide appropriate prospective payment for these sources until more 
specific claims data are available. We note that partial year data will 
be available for CY 2009 ratesetting purposes. Information on the costs 
of stranded and non-stranded configurations of one source is consistent 
with our proposed costs for the two configurations. Therefore, we 
believe that our proposed assumptions about the distribution of non-
stranded and stranded source costs in the CY 2006 aggregate data are 
reasonable and consistent with the standard OPPS ratesetting 
methodology, until more specific data become available. We do not 
believe, based on our claims data and review of public comments, that 
delaying implementation of prospective payment for any brachytherapy 
sources while we are waiting for more detailed cost information is 
reasonable. Coding changes occur on a regular basis, and we routinely 
account for them by crosswalking historical claims data from 
predecessor HCPCS codes to the newly available codes for purposes of 
payment.
    After consideration of the public comments received, we are 
finalizing our proposal, without modification, to pay brachytherapy 
sources prospectively for CY 2008, based on median costs from our CY 
2006 claims data. For stranded sources, that median cost is set at the 
60th percentile of the aggregate claims data for the predecessor code 
for this source, and for non-stranded sources, that median cost is set 
at the 40th percentile of the aggregate claims data for the predecessor 
code for this source. The final brachytherapy source HCPCS codes, APC 
assignments, status indicators, and median costs are displayed in Table 
37 below.

[[Page 66785]]



           Table 37.--Separately Payable Brachytherapy Sources
------------------------------------------------------------------------
                                                               CY 2008
  HCPCS code       Long descriptor       APC      CY 2008       status
                                                median cost   indicator
------------------------------------------------------------------------
A9527.........  Iodine I-125, sodium      2632          $27            K
                 iodide solution,
                 therapeutic, per
                 millicurie.
C1716.........  Brachytherapy source,     1716           33            K
                 non-stranded, Gold-
                 198, per source.
C1717.........  Brachytherapy source,     1717          173            K
                 non-stranded, High
                 Dose Rate Iridium-
                 192, per source.
C1719.........  Brachytherapy source,     1719           64            K
                 non-stranded, Non-
                 High Dose Rate
                 Iridium-192, per
                 source.
C2616.........  Brachytherapy source,     2616       11,621            K
                 non-stranded,
                 Yttrium-90, per
                 source.
C2634.........  Brachytherapy source,     2634           31            K
                 non-stranded, High
                 Activity, Iodine-
                 125, greater than
                 1.01 mCi (NIST), per
                 source.
C2635.........  Brachytherapy source,     2635           46            K
                 non-stranded, High
                 Activity, Palladium-
                 103, greater than
                 2.2 mCi (NIST), per
                 source.
C2636.........  Brachytherapy linear      2636           42            K
                 source, non-
                 stranded, Palladium-
                 103, per 1MM.
C2637.........  Brachytherapy source,     2637          N/A            B
                 non-stranded,
                 Ytterbium-169, per
                 source.
C2638.........  Brachytherapy source,     2638          *45            K
                 stranded, Iodine-
                 125, per source.
C2639.........  Brachytherapy source,     2639         **32            K
                 non-stranded,Iodine-
                 125, per source.
C2640.........  Brachytherapy source,     2640          *65            K
                 stranded,Palladium-
                 103, per source.
C2641.........  Brachytherapy source,     2641         **51            K
                 non-
                 stranded,Palladium-
                 103, per source.
C2642.........  Brachytherapy source,     2642          *97            K
                 stranded,Cesium-131,
                 per source.
C2643.........  Brachytherapy source,     2643         **63            K
                 non-stranded,Cesium-
                 131, per source.
C2698.........  Brachytherapy source,     2698           45            K
                 stranded, not
                 otherwise specified,
                 per source.
C2699.........  Brachytherapy source,     2699           31            K
                 non-stranded, not
                 otherwise specified,
                 per source.
------------------------------------------------------------------------
\*\ Estimated median cost for stranded version is based on the 60th
  percentile of the aggregate (stranded and non-stranded) claims data
  for this source.
\**\ Estimated median cost for non-stranded version is based on the 40th
  percentile of the aggregate (stranded and non-stranded) claims data
  for this source.

    Furthermore, we proposed to pay the two NOS codes, C2698 and C2699, 
based on a rate equal to the lowest stranded or non-stranded 
prospective payment rate for such sources, respectively, on a per 
source basis (as opposed, for example, to per mci). This proposed 
payment methodology for NOS sources would provide payment to a hospital 
for new sources, while encouraging interested parties to quickly bring 
new sources to our attention so specific coding and payment could be 
established. As explained earlier, we may establish new brachytherapy 
source codes on a quarterly basis.
    Comment: Some commenters recommended that CMS pay for all 
brachytherapy sources at charges adjusted to cost, including new 
sources. One commenter commended CMS for establishing two NOS codes for 
billing stranded and non-stranded sources, C2698 and C2699, until 
specific coding for new sources can be established.
    Response: As discussed earlier in this final rule with comment 
period, we are finalizing our proposal to pay for specific 
brachytherapy sources prospectively based on median costs from claims. 
We also believe it is most appropriate to pay for new brachytherapy 
sources based on specific codes that reflect the number, radioisotope, 
radioactive intensity, and stranded or non-stranded configurations of 
those sources. Furthermore, we may establish new source codes on a 
quarterly basis to permit separate reporting of new sources. No 
commenters recommended an alternative prospective payment methodology 
for NOS source codes. It is most consistent with our payment policy for 
other NOS services under the OPPS to pay for NOS brachytherapy source 
codes at the same payment rate as the lowest level clinically related 
APC. In the case of these NOS sources that would be paid through their 
own APCs, we continue to believe it is most appropriate to pay for them 
at the lowest stranded or non-stranded brachytherapy source payment 
rate, as applicable to each NOS code. This payment policy should 
encourage prompt requests for more specific Level II HCPCS codes for 
new brachytherapy sources to ensure more accurate payment for those new 
sources.
    After consideration of the public comments received, we are 
finalizing our proposal, without modification, to pay for the two NOS 
codes, C2698 and C2699, based on a rate equal to the lowest stranded or 
non-stranded prospective payment rate for such sources, respectively, 
on a per source basis. For CY 2008, C2698 for unspecified stranded 
sources will be paid at the same rate as C2638 (Brachytherapy source, 
stranded, Iodine-125, per source) and C2699 will be paid at the same 
rate as C2634 (Brachytherapy source, non-stranded, High Activity, 
Iodine-125, greater than 1.01 mci (NIST), per source).
    Because brachytherapy sources will no longer be paid on the basis 
of their charges adjusted to cost after December 31, 2007, we proposed 
to discontinue our use of payment status indicator ``H'' for APCs 
assigned to brachytherapy sources. For CY 2008, we proposed to use 
status indicator ``K'' for all brachytherapy source APCs. As described 
earlier, the definition of status indicator ``K'' was changed for CY 
2007 to accommodate prospective payment for brachytherapy sources.
    We received no comments specific to the proposal to change the 
status indicator for brachytherapy source APCs. Therefore, we are 
finalizing our proposal, without modification, to use status indicator 
``K'' for all brachytherapy source APCs for CY 2008.
    For CY 2008, we also proposed to implement the policy we 
established in the CY 2007 OPPS/ASC final rule with comment period 
(which was superseded by section 107 of the MIEA-TRHCA) regarding 
payment for new brachytherapy sources for which we have no claims data. 
As discussed earlier, we proposed to assign future new HCPCS codes for 
new brachytherapy sources to their own APCs, with prospective payment 
rates set based on our consideration of external data and other 
relevant information regarding the expected costs of the sources to 
hospitals. Because we proposed to pay prospectively for brachytherapy 
sources beginning in CY 2008, we proposed to implement this policy 
beginning in CY 2008.

[[Page 66786]]

    In the CY 2008 proposed rule (72 FR 42749), we pointed out that 
there is currently one brachytherapy source, ytterbium-169 (HCPCS code 
C2637, Brachytherapy source, ytterbium-169, per source), which has its 
own HCPCS code, but for which we believed we lacked claims data on its 
costs. In the CY 2007 OPPS/ASC proposed rule (71 FR 49598 through 
49599), we explained that it was our understanding that ytterbium-169 
had not yet been marketed, and furthermore that we had no CY 2005 
claims data, external data, or other information on its pricing on 
which to base its payment rate for CY 2007. In response to the CY 2007 
proposed rule, we received no cost data or other information that we 
could use to establish an informed prospective payment rate for 
ytterbium-169. Therefore, in the CY 2007 OPPS/ASC final rule with 
comment period (71 FR 68112), we finalized a policy of assigning HCPCS 
code C2637 the nonpayable status indicator ``B'' and indicated that if 
we later received relevant information, we could establish a payable 
status indicator and appropriate payment rate for the ytterbium source 
in a future OPPS quarterly update. This policy was superseded by 
section 107(a) of the MIEA-TRHCA, which required payment for 
brachytherapy sources in CY 2007 based on charges adjusted to cost. For 
the CY 2008 proposed rule, we believed that we continued to lack claims 
data or other information on the costs of ytteribium-169 on which to 
base an informed prospective payment rate. We noted that our CY 2006 
claims data showed three claims for HCPCS code C2637. We believed these 
three CY 2006 claims may have been incorrectly coded claims that did 
not represent claims for ytterbium, as its manufacturer commented on 
the CY 2007 OPPS proposed rule that ytterbium-169 would first become 
available for market in CY 2007. Consequently, for CY 2008 we again 
proposed to not recognize HCPCS code C2637 and to assign it status 
indicator ``B'' under the OPPS. However, as indicated in the proposed 
rule, if in public comments to the proposed rule or later in CYs 2007 
or 2008, we would receive relevant and reliable information on the 
hospital cost for ytterbium-169 and information that this source is 
being marketed, we could establish a prospective payment rate for the 
source in the CY 2008 final rule with comment period or in a quarterly 
OPPS update, respectively (72 FR 42749).
    Comment: A few commenters recommended that CMS continue to pay for 
new brachytherapy sources (as well as established sources when there 
are no reliable claims-based cost data) at charges adjusted to cost, 
rather than adopting the proposed methodology of using external data 
and other relevant cost data on the expected cost to hospitals.
    Response: As with other brachytherapy sources and other services 
under the OPPS, the development of cost data for new services through 
our claims data is an ongoing process. We regularly price new services, 
placing them in what we consider to be appropriate New Technology or 
clinical APCs. We make ongoing adjustments to their assignments as 
necessary, depending on information and data we develop or receive from 
interested stakeholders. We do not feel that initially having no or 
small amounts of Medicare claims data for new brachytherapy sources or 
established sources with lower volumes than other sources in our claims 
data is a compelling argument to deviate from our prospective payment 
methodology and pay for some sources at charges adjusted to cost while 
others would be paid prospectively based on their median cost. We note 
that we had no additional claims for ytterbium-169 for this final rule 
with comment period, beyond the three likely incorrectly coded CY 2006 
claims discussed in the proposed rule.
    After consideration of the public comments received, we are 
finalizing our proposal, without modification, to assign future new 
HCPCS codes for new brachytherapy sources to their own APCs, with 
prospective payment rates set based on our consideration of external 
data and other relevant information regarding the expected costs of the 
sources to hospitals. This policy will apply to the existing HCPCS code 
C2637 for the ytterbium-169 source, as well, which is assigned status 
indicator ``B'' in Addendum B to this final rule with comment period. 
We received no additional information on this source in comments to the 
CY 2008 proposed rule. In the event that we receive information 
regarding the costs and current marketing of HCPCS code C2637, we will 
consider changing its status indicator to ``K'' in a quarterly OPPS 
update and setting a prospective payment rate for this source.
    Comment: Several commenters requested that CMS implement the APC 
Panel's March 2007 recommendation to edit and return for correction 
claims that contain a HCPCS code for a separately paid drug or device 
without a HCPCS code assigned to a procedural APC.
    Response: We note that brachytherapy treatment services are paid 
separately from brachytherapy sources and do not have the costs of the 
brachytherapy sources packaged into the payment for the associated 
treatment services. While we encourage hospitals to code correctly in 
accordance with all CPT, CMS, and local contractor guidance, in general 
we have historically implemented claims processing edits under the OPPS 
when we believe that these edits help ensure complete claims data for 
ratesetting. In the case of OCE edits for drugs and devices, including 
brachytherapy sources, which are separately paid, it is unclear to us 
that these edits would improve our claims data for median cost 
calculation because the items receive separate payment and do not 
result in multiple procedure claims when they are reported. We also 
understand that there may be some clinical or operational circumstances 
that could result in a hospital submitting an OPPS claim that only 
reported a separately paid drug or device, and we would not want to 
delay a hospital's ability to submit a claim timely because of claims 
edits that do not have the potential to improve the accuracy of OPPS 
ratesetting. Therefore, we are not adopting this APC Panel 
recommendation for broad claims processing edits.
    Comment: A few commenters recommended that CMS revise the 
definition of brachytherapy sources to include all ``brachytherapy 
sources,'' without limitation to a device of brachytherapy.
    Response: We finalized our definition of a source of brachytherapy 
in the CY 2007 final rule with comment period (71 FR 68113) in the 
context of current medical practice and with regard to the statutory 
language. We considered all comments, including some of the same 
arguments presented in comments to the CY 2008 proposed rule. We made 
no proposal to change this definition in our CY 2008 proposed rule and 
are not considering any changes to the established definition at this 
time.
    Comment: One commenter opposed the proposal to include the costs of 
brachytherapy sources in the budget neutrality formula, if CMS adopted 
the proposal to pay for the sources on a prospective basis. The 
commenter believed that brachytherapy treatment is very costly and 
inclusion of the costs would decrease the payment for other OPPS 
services. The commenter also claimed that CMS has not factored into 
payment for brachytherapy treatment the special handling costs of 
radioactive materials.

[[Page 66787]]

    Response: We take into account the estimated costs of brachytherapy 
sources under the methodology of charges adjusted to cost in 
calculating budget neutrality for the OPPS and have continued to do so 
under the prospective payment methodology for the sources that we are 
finalizing for CY 2008. The costs related to supervision, handling, and 
loading of brachytherapy sources are, in fact, also considered under 
the OPPS. As we have previously instructed, these costs are to be 
included by hospitals on claims in one of two ways, either reported as 
a separate charge using CPT code 77790 (Supervision, handling, loading 
of radiation source) or included in the charge reported with the HCPCS 
procedure code(s) for application of the radiation source. Reporting in 
either of these ways results in the costs of special handling being 
packaged into payments for brachytherapy treatment procedures.

VIII. OPPS Drug Administration Coding and Payment

A. Background

    From the start of the OPPS until the end of CY 2004, three HCPCS 
codes were used to bill drug administration services provided in the 
hospital outpatient department (HOPD):
     Q0081 (Infusion therapy, using other than chemotherapeutic 
drugs, per visit)
     Q0083 (Chemotherapy administration by other than infusion 
technique only, (EG subcutaneous, Intramuscular, Push), per visit)
     Q0084 (Chemotherapy administration by infusion technique 
only, per visit).
    A fourth OPPS drug administration HCPCS code, Q0085 (Administration 
of chemotherapy by both infusion and another route, per visit), was 
active from the beginning of the OPPS through the end of CY 2003.
    Each of these four HCPCS codes mapped to an APC (that is, Q0081 
mapped to APC 0120, Q0083 mapped to APC 0116, Q0084 mapped to APC 0117, 
and Q0085 mapped to APC 0118), and the APC payment rates for these 
codes were made on a per-visit basis. The per-visit payment included 
payment for all hospital resources (except separately payable drugs) 
associated with the drug administration procedures. For CY 2004, we 
discontinued using HCPCS code Q0085 to identify drug administration 
services and moved to a combination of HCPCS codes Q0083 and Q0084 that 
allowed more accurate calculations when determining OPPS payment rates.
    In CY 2005, in response to the recommendations made by commenters 
and the hospital industry, OPPS transitioned to the use of CPT codes 
for drug administration services. These CPT codes allowed for more 
specific reporting of services, especially regarding the number of 
hours for an infusion, and provided consistency in coding between 
Medicare and other payers. However, at that time, we did not have any 
data to revise the CY 2005 per-visit APC payment structure for infusion 
services. In order to collect data for future ratesetting purposes, we 
implemented claims processing logic that collapsed payments for drug 
administration services and paid a single APC amount for those services 
for each visit, unless a modifier was used to identify drug 
administration services provided in a separate encounter on the same 
day. Hospitals were instructed to bill all applicable CPT codes for 
drug administration services provided in a HOPD, without regard to 
whether or not the CPT code would receive a separate APC payment during 
OPPS claims processing.
    While hospitals just began adopting CPT codes for outpatient drug 
administration services in CY 2005, physicians paid under the MPFS were 
using HCPCS G-codes in CY 2005 to report office-based drug 
administration services. These G-codes were developed in anticipation 
of substantial revisions to the drug administration CPT codes by the 
CPT Editorial Panel that were expected for CY 2006.
    In CY 2006, as anticipated, the CPT Editorial Panel revised its 
coding structure for drug administration services, incorporating new 
concepts such as initial, sequential, and concurrent services into a 
structure that previously distinguished services based on type of 
administration (chemotherapy/nonchemotherapy), method of administration 
(injection/infusion/push), and for infusion services, first hour and 
additional hours. For CY 2006, we implemented 20 of the 33 CY 2006 drug 
administration CPT codes that did not reflect the concepts of initial, 
sequential, and concurrent services, and we created 6 new HCPCS C-codes 
that generally paralleled the CY 2005 CPT codes for the same services. 
We chose not to implement the full set of CY 2006 CPT codes because of 
our concerns regarding the interface between the complex claims 
processing logic required for correct payments and hospitals' 
challenges in correctly coding their claims to receive accurate 
payments for these services.
    For CY 2007, as a result of comments to our proposed rule and 
feedback from the hospital community and the APC Panel, we implemented 
the full set of CPT codes, including the concepts of initial, 
sequential and concurrent. In addition, the CY 2007 update process 
offered us the first opportunity to consider data gathered from the use 
of CY 2005 CPT codes for purposes of ratesetting. For CY 2007, we used 
CY 2005 claims data to implement a six-level APC structure for drug 
administration services. We assigned all CY 2007 HCPCS codes for drug 
administration services to six new drug administration APCs (as listed 
in Table 34 of the CY 2007 OPPS/ASC final rule with comment period), 
with payment rates based on median costs for the APCs as calculated 
from CY 2005 claims data. In that final rule with comment period, we 
provided a crosswalk that illustrated how we performed our annual 
payment rate update methodology for these services using CY 2005 data.
    As indicated in the CY 2007 OPPS/ASC final rule with comment period 
(71 FR 68122), because the newly recognized CPT codes discriminated 
among services more specifically than the CY 2006 C-codes, as was the 
case when the OPPS transitioned from more general Q-codes to more 
specific CPT codes for the reporting of drug administration services in 
CY 2005, for a period of 2 years drug administration services were paid 
based on the costs of their predecessor HCPCS codes until updated data 
were available for review.

B. Coding and Payment for Drug Administration Services

    During the March 2007 APC Panel meeting, the APC Panel recommended 
that CMS pay separately for CPT code 90768 (Intravenous infusion, for 
therapy, prophylaxis, or diagnosis (specify substance or drug); 
concurrent infusion (list separately in addition to code for primary 
procedure)) at the same rate as CPT code 90767 (Intravenous infusion, 
for therapy, prophylaxis, or diagnosis (specify substance or drug); 
additional sequential infusion, up to 1 hour (list separately in 
addition to code for primary procedure)). We proposed to continue to 
package payment for CPT code 90768 for CY 2008.
    Comment: In addition to the APC Panel's recommendation to unpackage 
CPT code 90768, a few commenters also requested that CMS provide 
separate payment for it in CY 2008.
    Response: As we discuss in section II.A.4.e. of this final rule 
with comment period, in deciding whether to package a service or pay 
for it separately, we consider a variety of factors, including

[[Page 66788]]

whether the service is normally provided separately or in conjunction 
with other services; how likely it is for the costs of the packaged 
code to be appropriately mapped to the separately payable codes with 
which it was performed; and whether the expected cost of the service is 
relatively low. CPT code 90768, by definition, is always provided in 
association with other intravenous infusions. As we discussed in the CY 
2007 OPPS/ASC final rule with comment period (71 FR 68122), CPT code 
90768 was first introduced in the CY 2007 OPPS and, consistent with our 
established ratesetting methodology, we do not anticipate OPPS hospital 
claims data from CY 2007 to be available for ratesetting purposes until 
CY 2009. In addition, as noted in the CY 2008 OPPS/ASC proposed rule 
(72 FR 42751), because the services identified with CPT code 90768 were 
provided in previous years, we determined that these costs are already 
represented in our currently available hospital claims data. Payment 
for these services was provided in previous years through the billing 
of more general drug administration codes. Although more exhaustive 
codes for drug administration services are now available, all of these 
services were paid under the OPPS in previous years.
    As data are not available for all current CPT codes for drug 
administration services for purposes of CY 2008 ratesetting, and as we 
believe that the costs for the drug administration services identified 
by CPT code 90768 are included in our hospital claims data used for 
ratesetting purposes, we are not accepting the APC Panel's 
recommendation nor the commenters' request to provide a separate APC 
payment for this service. Furthermore, we describe in section II.A.4. 
of this final rule with comment period our CY 2008 packaging approach 
for certain (non-drug administration) services. We believe that 
continuing to package payment for CPT code 90768 is consistent with 
these broader efforts. Therefore, we are finalizing our proposal to 
assign status indicator ``N'' to CPT code 90768 for CY 2008.
    For CY 2008, we examined CY 2006 claims data available for the 
proposed rule and continued to believe the CY 2007 drug administration 
APC configuration reflects clinical and resource homogeneous groupings 
of procedures. We noted in the proposed rule (72 FR 42751) that there 
is a violation of the 2 times rule in APC 0438 (Level III Drug 
Administration) as proposed for CY 2008. (For additional information on 
the 2 times rule, we refer readers to section III.B. of this final rule 
with comment period.) For this CY 2008 OPPS/ASC final rule with comment 
period, this 2 times violation continues to exist based upon updated 
data. The violation is related to the comparatively low median cost of 
CPT code 90773 (Therapeutic, prophylactic or diagnostic injection 
(specify substance or drug); intra-arterial) for which we have a 
significantly greater number of CY 2006 single claims available for 
ratesetting than in previous years. The CY 2005 predecessor code for 
this service, CPT code 90783 (Therapeutic, prophylactic or diagnostic 
injection (specify material injected); intra-arterial), had a higher 
median cost that was more similar to the costs of other services also 
assigned to APC 0438. We continue to believe that this intra arterial 
injection procedure is similar from both clinical and hospital resource 
perspectives to the related intravenous push injection procedures that 
are assigned to the same clinical APC and, therefore, we proposed to 
except APC 0438 from the 2 times rule for CY 2008.
    We did not receive any public comments on this proposal. Therefore, 
for CY 2008, we are finalizing our proposed exception to the 2 times 
rule for APC 0438, without modification.
    In the proposed rule, we also continued to ask hospitals to report 
all CPT drug administration codes, and indicated that we expect 
hospitals to report CPT codes consistently with CPT coding guidelines 
and applicable instructions.
    Comment: Several commenters expressed appreciation for CMS' 
proposal to continue the CPT coding structure for drug administration 
services for CY 2008. These commenters noted that the changes made to 
coding and payment for these services in past years has put a burden on 
hospitals to train staff on frequent changes. Other commenters 
expressed frustration over complex CPT coding for drug administration 
services, noting that reporting requirements placed an unreasonable 
burden on hospitals to code correctly and increased hospital staffing 
needs. One commenter suggested that CMS return to simpler coding, such 
as the historical single per-episode-of-care code to report a 
``nonchemotherapy infusion.'' The commenter noted that this methodology 
aligns with CMS' efforts to increase packaging for services and 
simplifies hospital coding requirements.
    Response: We appreciate hospitals' continuing efforts to work with 
us to implement changes to drug administration coding and payment over 
the past few years. We believe that our individual and collaborative 
efforts to refine the codes used and ensure their accurate reporting 
have led to a robust dataset that accurately reflects hospital 
outpatient costs for these common services and results in appropriate 
payment. We understand that it requires significant hospital resources 
to ensure proper coding for drug administration services, and hospitals 
have worked diligently over the past several years to ensure that CMS' 
data appropriately reflect drug administration services provided in the 
HOPD. While we recognize the continued efforts that are necessary to 
accurately document and report drug administration services using CPT 
codes, we believe that hospitals have had sufficient experience with 
these codes, first for non Medicare insurers in CY 2006 and then for 
the Medicare OPPS in CY 2007, that the initial confusion corresponding 
to the new concepts of ``initial,'' ``sequential,'' and ``concurrent'' 
has subsided.
    We agree with the commenter that a return to a single episode-of-
care payment could align with the OPPS shift toward larger payment 
bundles, but we believe that a change in our approach toward drug 
administration payment would be premature at this time. While 
additional packaging for drug administration services could be 
warranted in a prospective payment system such as the OPPS in a 
movement toward encounter-based or episode-based payment, hospital 
stakeholders continue to express their preference for a single set of 
drug administration codes for use by all insurers. Currently, the CPT 
drug administration codes sufficiently meet the needs of non-Medicare 
insurers and Medicare. We do not have any reason to believe that 
hospitals generally would want to implement a per-episode-of-care set 
of drug administration codes for use only under the OPPS, nor do we 
have an operational need for such codes. Therefore, we are finalizing 
our proposal, without modification, to recognize all active CY 2008 CPT 
codes for drug administration services under the CY 2008 OPPS.
    Comment: One commenter requested that CMS review payment 
methodologies for drug administration services across the hospital 
outpatient and physician's office settings. This commenter suggested 
that the OPPS consider implementing a methodology similar to the 
physician's office payment methodology, basing payment rates on the 
time and resource utilization required by the service. The commenter 
believed that standardizing payment rates across sites of care would 
eliminate site of service differentials

[[Page 66789]]

and allow beneficiaries the option of receiving care in either setting.
    Response: We understand that the commenter is concerned about 
differences in payment methodologies and rates across ambulatory 
settings when some of the same services are provided to Medicare 
beneficiaries. Even though both settings use the standard CPT codeset 
for drug administration services, the costs of providing these services 
in one setting may not be the same as the costs in another setting. The 
OPPS and the MPFS are fundamentally different payment systems with 
essential differences in their payment policies. Specifically, the OPPS 
is a prospective payment system, based on the concept of paying for 
groups of services that share clinical and resource characteristics. 
Payment is made under the OPPS according to prospectively established 
payment rates that are related to the relative costs of hospital 
resources for services, as calculated from claims data and Medicare 
cost reports. The MPFS is a fee schedule that generally provides 
separate payment for each individual component of a service, reflecting 
the expected typical inputs into these services. The OPPS methodology 
allows hospitals to actively contribute on an ongoing basis to the 
ratesetting process through its annual updates and to influence future 
payment rates for services by submitting correctly coded and accurately 
priced claims for the services they provide.
    Comment: A few commenters recommended that CMS create two new Level 
II HCPCS codes for IVIG infusion services, one for the first hour and 
the other for additional hours of infusion. The commenter cited 
additional complexities associated with IVIG infusion and increased 
chances of adverse events that are not fully captured in the CPT codes 
currently reported by hospitals for these infusions.
    Response: While we acknowledge these concerns regarding IVIG 
administration, we believe that the current CPT coding structure and 
OPPS payment rates adequately provide for the possible complexities 
associated with IVIG administration services. Hospital costs for IVIG 
administration are taken into account during the ratesetting process, 
as claims for IVIG administration are used in that process for the 
pertinent CPT codes. Hospitals continue to note their strong preference 
for reporting CPT codes for drug administration services, as opposed to 
OPPS-specific Level II HCPCS codes that could be more specifically 
developed for certain services. In addition, in view of the shift 
toward larger payment bundles under the OPPS, we do not believe it 
would be appropriate to create even more specific coding for drug 
administration services than is available through the codeset developed 
by the CPT Editorial Panel.
    As stated earlier, after consideration of the public comment 
received, we are finalizing our proposal, without modification, to 
recognize all active CY 2008 CPT codes for drug administration services 
under the OPPS for CY 2008. In addition, we are finalizing our 
proposal, without modification, to assign status indicator ``N'' to CPT 
code 90768 for CY 2008.

IX. Hospital Coding and Payments for Visits

A. Background

    Currently, CMS instructs hospitals to use the CY 2007 CPT codes, as 
well as six HCPCS codes that became effective January 1, 2007, to 
report clinic and emergency department visits, and critical care 
services on claims paid under the OPPS. The codes are listed below in 
Table 38. These codes are unchanged for CY 2008.

   Table 38.--CY 2007 CPT Evaluation and Management (E/M) and Level II
    HCPCS Codes Used To Report Clinic and Emergency Department Visits
------------------------------------------------------------------------
            HCPCS code                           Descriptor
------------------------------------------------------------------------
                        Clinic Visit HCPCS Codes
------------------------------------------------------------------------
99201.............................  Office or other outpatient visit for
                                     the evaluation and management of a
                                     new patient (Level 1).
99202.............................  Office or other outpatient visit for
                                     the evaluation and management of a
                                     new patient (Level 2).
99203.............................  Office or other outpatient visit for
                                     the evaluation and management of a
                                     new patient (Level 3).
99204.............................  Office or other outpatient visit for
                                     the evaluation and management of a
                                     new patient (Level 4).
99205.............................  Office or other outpatient visit for
                                     the evaluation and management of a
                                     new patient (Level 5).
99211.............................  Office or other outpatient visit for
                                     the evaluation and management of an
                                     established patient (Level 1).
99212.............................  Office or other outpatient visit for
                                     the evaluation and management of an
                                     established patient (Level 2).
99213.............................  Office or other outpatient visit for
                                     the evaluation and management of an
                                     established patient (Level 3).
99214.............................  Office or other outpatient visit for
                                     the evaluation and management of an
                                     established patient (Level 4).
99215.............................  Office or other outpatient visit for
                                     the evaluation and management of an
                                     established patient (Level 5).
99241.............................  Office consultation for a new or
                                     established patient (Level 1).
99242.............................  Office consultation for a new or
                                     established patient (Level 2).
99243.............................  Office consultation for a new or
                                     established patient (Level 3).
99244.............................  Office consultation for a new or
                                     established patient (Level 4).
99245.............................  Office consultation for a new or
                                     established patient (Level 5).
------------------------------------------------------------------------
                 Emergency Department Visit HCPCS Codes
------------------------------------------------------------------------
99281.............................  Emergency department visit for the
                                     evaluation and management of a
                                     patient (Level 1).
99282.............................  Emergency department visit for the
                                     evaluation and management of a
                                     patient (Level 2).
99283.............................  Emergency department visit for the
                                     evaluation and management of a
                                     patient (Level 3).
99284.............................  Emergency department visit for the
                                     evaluation and management of a
                                     patient (Level 4).
99285.............................  Emergency department visit for the
                                     evaluation and management of a
                                     patient (Level 5).
G0380.............................  Type B emergency department visit
                                     (Level 1).
G0381.............................  Type B emergency department visit
                                     (Level 2).
G0382.............................  Type B emergency department visit
                                     (Level 3).
G0383.............................  Type B emergency department visit
                                     (Level 4).
G0384.............................  Type B emergency department visit
                                     (Level 5).
------------------------------------------------------------------------

[[Page 66790]]

 
                   Critical Care Services HCPCS Codes
------------------------------------------------------------------------
99291.............................  Critical care, evaluation and
                                     management of the critically ill or
                                     critically injured patient; first
                                     30-74 minutes.
99292.............................  Each additional 30 minutes.
G0390.............................  Trauma response associated with
                                     hospital critical care services.
------------------------------------------------------------------------

    Presently, there are three types of visit codes to describe three 
types of services: clinic visits, emergency department visits, and 
critical care services. CPT indicates that office or other outpatient 
visit codes are used to report E/M services provided in the physician's 
office or in an outpatient or other ambulatory facility. For OPPS 
purposes, we refer to these as clinic visit codes. CPT also indicates 
that emergency department visit codes are used to report E/M services 
provided in the emergency department, defined as an ``organized 
hospital-based facility for the provision of unscheduled episodic 
services to patients who present for immediate medical attention. The 
facility must be available 24 hours a day.'' For OPPS purposes, we 
refer to these as emergency department visit codes that specifically 
apply to the reporting of visits to Type A emergency departments on or 
after January 1, 2007, as discussed in further detail later in this 
section. We established five new Level II HCPCS codes to report visits 
to Type B emergency departments beginning in CY 2007 because there were 
no CPT codes at that time that fully described services provided in 
this type of facility. CPT defines critical care services as the 
``direct delivery by a physician(s) of medical care for a critically 
ill or critically injured patient.'' It also states that ``critical 
care is usually, but not always, given in a critical care area, such as 
. . . the emergency care facility.'' In addition to reporting critical 
care services, hospitals may utilize G0390 (Trauma response team 
associated with hospital critical care service) for the reporting of a 
trauma response in association with critical care services.
    The majority of CPT code descriptors are applicable to both 
physician and facility resources associated with specific services. 
However, we have acknowledged from the beginning of the OPPS that we 
believe that CPT E/M codes were defined to reflect the activities of 
physicians and do not necessarily fully describe the range and mix of 
services provided by hospitals during visits of clinic and emergency 
department patients and critical care encounters. In the April 7, 2000 
OPPS final rule with comment period (65 FR 18434), we instructed 
hospitals to report facility resources for clinic and emergency 
department visits using CPT E/M codes, and to develop internal hospital 
guidelines to determine what level of visit to report for each patient. 
While awaiting the development of a national set of facility-specific 
codes and guidelines, we have advised hospitals that each hospital's 
internal guidelines should follow the intent of the CPT code 
descriptors, in that the guidelines should be designed to reasonably 
relate the intensity of hospital resources to the different levels of 
effort represented by the codes.
    Critical care services are considered to be outpatient visits, and 
our current payment policy for trauma activation ties separate payment 
to the reporting of hospital critical care services. In the CY 2008 
OPPS/ASC proposed rule, we did not propose to change our OPPS payment 
policy for critical care services for CY 2008. Our CY 2008 proposed and 
final policies for payment for trauma activation are described in 
section II.A.4. of this final rule with comment period.

B. Policies for Hospital Outpatient Visits

1. Clinic Visits: New and Established Patient Visits and Consultations
    As discussed earlier, the majority of all CPT code descriptors are 
applicable to both physician and facility resources associated with 
specific services. However, we believe that CPT E/M codes were defined 
to reflect the activities of physicians, and do not fully describe the 
range and mix of services provided by hospitals during visits of clinic 
and emergency department patients. While awaiting the development of a 
national set of guidelines, we have advised hospitals that each 
hospital's internal guidelines should follow the intent of the CPT code 
descriptors, in that the guidelines should be designed to reasonably 
relate the intensity of hospital resources to the different levels of 
effort represented by the codes. In the CY 2007 OPPS/ASC proposed rule 
(71 FR 49607), we proposed to establish five new codes to replace 
hospitals' reporting of the CPT clinic visit E/M codes for new and 
established patients listed earlier in Table 38. In the CY 2007 OPPS/
ASC final rule with comment period (71 FR 68127 through 68128), we 
specified that we would not create new codes to replace existing CPT E/
M codes for reporting hospital visits until national guidelines were 
developed, in response to commenters who were concerned about 
implementing hospital-specific Level II HCPCS codes without national 
guidelines. We also discussed our intention to reconsider whether G-
codes would be appropriate for the OPPS once national guidelines were 
established.
    In that same CY 2007 final rule with comment period (71 FR 68138), 
we finalized our proposal to make payment for clinic visits at five 
payment rates, rather than three payment rates. Prior to CY 2007, under 
the OPPS, outpatient visits provided by hospitals were paid at three 
payment levels for clinic visits, even though hospitals reported five 
resource-based coding levels of clinic visits using CPT E/M codes. 
Because the three payment rates for clinic visits were based on five 
levels of CPT codes, in general the two lowest levels of CPT codes 
(Levels 1 and 2) were assigned to the low-level visit APC and the two 
highest levels of CPT codes (Levels 4 and 5) were assigned to the high-
level visit APC. The single middle level CPT code (Level 3) was 
assigned to the mid-level visit APC. Historical hospital claims data 
have generally reflected significantly different median costs for the 
two levels of services assigned to the low- and high-level visit APCs. 
We noted that payment at only three levels might not be the most 
accurate method of payment for those very common hospital levels of 
visits that clearly demonstrate differential hospital resources. 
Consequently, for the CY 2007 OPPS, we mapped the data from the CY 2005 
CPT E/M codes and other HCPCS codes assigned previously to the three 
clinic visit APCs to five new clinic visit APCs to develop median costs 
for these APCs. We mapped the CPT E/M codes and other HCPCS codes to 
the clinic visit APCs based on their median

[[Page 66791]]

costs and clinical homogeneity considerations. Table 50 of the CY 2008 
OPPS/ASC proposed rule, which is reprinted below as Table 39, includes 
the median costs based on CY 2006 claims data processed through 
December 31, 2006, and displays the proposed HCPCS codes and APC median 
costs at the five payment levels that we proposed for the CY 2008 OPPS.

 Table 39.--Proposed Rule Assignment of Claims Data From CY 2006 CPT E/M Level II HCPCS Codes To Visit APCs for
                                                     CY 2008
----------------------------------------------------------------------------------------------------------------
                                                                 APC
                                                 Proposed CY   service
          CY 2008 APC title            CY 2008     2008 APC   frequency    HCPCS          Short descriptor
                                         APC        median        (in       code
                                                              millions)
----------------------------------------------------------------------------------------------------------------
Level 1 Hospital Clinic Visits......       0604       $52.72        3.8      92012  Eye exam established pat.
                                                                             99201  Office/outpatient visit, new
                                                                                     (Level 1).
                                                                             99211  Office/outpatient visit, est
                                                                                     (Level 1).
                                                                             99241  Office consultation (Level
                                                                                     1).
                                                                             G0101  CA screen; pelvic/breast
                                                                                     exam.
                                                                             G0245  Initial foot exam pt lops.
                                                                             G0379  Direct admit hospital
                                                                                     observ.
----------------------------------------------------------------------------------------------------------------
Level 2 Hospital Clinic Visits......       0605        63.01        7.3      90862  Medication management.
                                                                             92002  Eye exam, new patient
                                                                             92014  Eye exam and treatment.
                                                                             99202  Office/outpatient visit, new
                                                                                     (Level 2).
                                                                             99212  Office/outpatient visit, est
                                                                                     (Level 2).
                                                                             99213  Office/outpatient visit, est
                                                                                     (Level 3).
                                                                             99242  Office Consultation (Level
                                                                                     2).
                                                                             99243  Office Consultation (Level
                                                                                     3).
                                                                             99431  Initial care, normal
                                                                                     newborn.
                                                                             G0246  Followup eval of foot pt
                                                                                     lop.
                                                                             G0344  Initial preventive exam.
                                                                             M0064  Visit for drug monitoring.
----------------------------------------------------------------------------------------------------------------
Level 3 Hospital Clinic Visits......       0606        85.96        2.9      92004  Eye exam, new patient.
                                                                             99203  Office/outpatient visit, new
                                                                                     (Level 3).
                                                                             99214  Office/outpatient visit, est
                                                                                     (Level 4).
                                                                             99244  Office consultation (Level
                                                                                     4).
----------------------------------------------------------------------------------------------------------------
Level 4 Hospital Clinic Visits......       0607       108.08         .8      99204  Office/outpatient visit, new
                                                                                     (Level 4).
                                                                             99215  Office/outpatient visit, est
                                                                                     (Level 5).
                                                                             99245  Office consultation (Level
                                                                                     5).
----------------------------------------------------------------------------------------------------------------
Level 5 Hospital Clinic Visits......       0608       138.88        .08      99205  Office/outpatient visit, new
                                                                                     (Level 5).
                                                                             G0175  OPPS service, sched team
                                                                                     conf.
----------------------------------------------------------------------------------------------------------------

    In the CY 2007 OPPS/ASC proposed rule (71 FR 49617), we solicited 
comment as to whether a distinction between new and established visits 
was necessary because we were planning to transition to G-codes and did 
not want to unnecessarily create codes for both new and established 
patients. The AMA defines an established patient as ``one who has 
received professional services from the physician or another physician 
of the same specialty who belongs to the same group practice, within 
the past 3 years.'' To apply this definition to hospital visits, we 
stated in the April 7, 2000 OPPS final rule with comment period (65 FR 
18451) that the meanings of ``new'' and ``established'' pertain to 
whether or not the patient already has a hospital medical record 
number. If the patient has a hospital medical record that was created 
within the past 3 years, that patient is considered an established 
patient to the hospital. The same patient could be ``new'' to the 
physician but an ``established'' patient to the hospital. The opposite 
could be true if the physician has a longstanding relationship with the 
patient, in which case the patient would be an ``established'' patient 
with respect to the physician and a ``new'' patient with respect to the 
hospital.
    During CY 2006 and earlier, there was no payment difference between 
new and established patient visits of the same level because both were 
always mapped to the same clinical APC. However, hospital claims data 
regarding the median costs of the specific CPT clinic visit E/M codes 
consistently indicated that new patients were more resource-intensive 
than established patients across all visit levels. The CY 2006 claims 
data available for the CY 2008 rulemaking confirmed that the cost 
difference between new and established patient visits increases as the 
visit level increases.
    Some commenters who responded to prior OPPS rules have stated that 
the hospital resources used for new and established patients to provide 
a specific level of service are very similar, and that it is 
unnecessary and burdensome from a coding perspective to distinguish 
between the two types of visits. On the other hand, other commenters 
have noted, and CY 2005 and CY 2006 claims data have shown, that it may 
be appropriate to continue using different codes for new and 
established patients because of the observed median cost differences in 
the claims data. During the March 2007 APC Panel meeting, the 
Observation and Visit Subcommittee of the APC Panel discussed whether 
the coding distinction between new and established patient visits was 
necessary. Ultimately, the APC Panel

[[Page 66792]]

recommended that CMS eliminate the ``new'' and ``established'' patient 
distinctions in the reporting of hospital clinic visits. During its 
discussion, the APC Panel suggested that hospitals bill the appropriate 
level clinic visit code according to the resources expended while 
treating the beneficiary based on each hospital's internal guidelines. 
The APC Panel also suggested that each hospital's internal guidelines 
reflect resource cost differences (if a difference exists) between new 
and established patients. For example, a visit that involves certain 
interventions may be coded as Level 3 for a new patient and Level 2 for 
an established patient. The APC Panel also made another recommendation, 
which was contingent upon CMS adopting its recommendation to eliminate 
the new and established patient distinction reporting requirement. The 
APC Panel recommended that CMS map each of the five levels of 
outpatient clinic visit codes (which do not distinguish between new and 
established patients) to five separate APCs, thereby paying at five 
payment rates. For example, the APC Panel recommended mapping the Level 
1 patient visit to the Level 1 Clinic Visit APC, mapping the Level 2 
patient visit to the Level 2 Clinic Visit APC, and mapping the Level 3 
patient visit to the Level 3 Clinic Visit APC. In the CY 2008 proposed 
clinic visit APC configuration, as indicated in Table 50 of the CY 2008 
OPPS/ASC proposed rule (72 FR 42753), the APC level assignment did not 
always correspond to the visit level described by each code. For 
example, CPT code 99213 is a Level 3 clinic visit code for an 
established patient, which would seem to logically map to the Level 3 
Clinic Visit APC. However, because CPT code 99213 had a proposed rule 
median cost of $65, we proposed to map this code to the Level 2 Clinic 
Visit APC, which had a median cost of $63. The APC Panel indicated that 
its recommendation would ensure that each visit level would receive its 
own payment rate, rather than both the Level 2 and 3 patient visit 
codes receiving the same payment rate.
    In both the CY 2007 OPPS/ASC proposed and final rules (71 FR 49617 
and 71 FR 68128, respectively), we solicited public comment on the 
potential differences in hospital clinic resource consumption between 
new and established patient visits. We received only a few comments 
related to this distinction in response to the CY 2007 OPPS/ASC 
proposed rule and even fewer comments in response to the CY 2007 OPPS/
ASC final rule with comment period. For CY 2008, because hospitals 
would be reporting CPT E/M codes which distinguish between new and 
established patients for clinic visits and because we saw meaningful 
and consistent cost differences between visits for new and established 
patients, we proposed to continue to recognize the CPT codes for new 
and established patient clinic visits under the OPPS, consistent with 
their CPT code descriptors. Further, we did not propose to adopt the 
recommendation of the APC Panel to eliminate this differentiation for 
the reasons noted. We proposed to reexamine whether the coding 
distinction between new and established patient visits was necessary as 
we further considered national guidelines. We continued to encourage 
public comment about hospitals' experiences with assigning visit levels 
to new and established patients according to their own internal 
guidelines.
    Table 51 of the CY 2008 OPPS/ASC proposed rule, which is reprinted 
below as Table 40, lists the CY 2008 proposed median costs of new and 
established patient clinic visit codes, which were based on CY 2006 
claims data processed through December 31, 2006.

 Table 40.--CY 2008 Proposed Median Costs of New and Established Patient
                             Visit CPT Codes
------------------------------------------------------------------------
                                                              CY 2008
                                            CY 2008 new     established
           Clinic visit level              patient visit   patient visit
                                             proposed        proposed
                                            median cost     median cost
------------------------------------------------------------------------
Level 1.................................          $56.08          $50.70
Level 2.................................           63.18           58.84
Level 3.................................           74.99           64.73
Level 4.................................          109.12           84.17
Level 5.................................          138.06          102.89
------------------------------------------------------------------------

    Comment: Most commenters on the proposals requested that CMS 
eliminate the need for hospitals to distinguish between new and 
established patient visits because they found it cumbersome to bill a 
different code for each type of visit. Specifically, the commenters 
asked CMS not to implement new and established patient visit codes. The 
commenters suggested that hospitals bill the appropriate code, based on 
the resources expended in the visit. Several commenters suggested that 
CMS require hospitals to bill the established patient visit code 
exclusively and change the status of the new patient visit codes to 
nonpayable. The commenters suggested setting the payment rate for the 
established patient visit code at a blend of the new and established 
patient visit rates. One commenter requested that both the new and 
established patient visit codes remain payable, but that the OPPS pay 
the same rate for the new and established patient visit, at each level, 
an approach which would remove any financial incentive for reporting 
one code instead of another. Several commenters supported the proposal 
to continue requiring hospitals to distinguish between new and 
established patient visits. Some of the commenters suggested that the 
AMA create hospital-specific Category I CPT visit codes that do not 
distinguish between new and established patient visits, as appropriate 
for reporting hospital resource use.
    Response: Because hospitals will be reporting CPT codes for CY 2008 
and we continue to observe significant cost differences between new and 
established patient visits of the same level, we will continue to 
recognize new and established patient visit codes under the CY 2008 
OPPS, consistent with their CPT code descriptors. We agree with the 
commenters that it could be simpler and less burdensome from a coding 
perspective if hospitals only needed to report one set of codes and 
could report code levels that reflected their resources used, rather 
than distinguishing between new and established patient visits. 
However, in the absence of hospital-specific CPT codes for the 
reporting of visits in the HOPD, hospitals should continue to 
distinguish between new and established patient visits, consistent

[[Page 66793]]

with their CPT code descriptors. We will reexamine whether the coding 
distinction between new and established patient visits is necessary as 
we continue to explore national guidelines.
    Comment: Several commenters requested that CMS define a new patient 
as a patient who does not have a hospital medical record, rather than a 
patient who does not have a medical record that was created within the 
past 3 years. The commenters cited the definitions of new and 
established patients that we discussed in the CY 2007 OPPS/ASC final 
rule with comment period (71 FR 68128) where CMS stated that if the 
patient had a hospital medical record that was created within the past 
3 years, that patient would be considered an established patient to the 
hospital. Several of the commenters believed that the ``new'' patient 
definition described in the April 7, 2000 OPPS final rule with comment 
period (65 FR 18451) did not require hospitals to determine if a 
medical record had been created for the patient within the past 3 
years.
    Response: We note that we neither proposed a change to the 
definitions of new and established patient visits in the CY 2008 OPPS/
ASC proposed rule nor solicited comment on the definitions of new and 
established patient visits. While several commenters asked us to revise 
these definitions, we are reluctant to make these changes without 
hearing additional perspectives from the larger hospital community. 
Therefore, we are specifically soliciting comment on the definitions of 
new and established patient visits in the HOPD.
    For CY 2008, we are finalizing our proposal, without modification, 
to continue to recognize the CPT codes for new and established patient 
clinic visits under the OPPS, consistent with their CPT code 
descriptors. Further, we are not adopting the recommendation of the APC 
Panel to eliminate this differentiation for the reasons noted above. We 
continue to encourage hospitals to submit comments regarding their 
experiences with assigning visit levels to new and established patients 
according to their own internal guidelines. In addition, as noted 
above, we are specifically soliciting comment on the definitions of new 
and established patient visits in the HOPD.
    As noted above, the APC Panel also recommended that CMS map each 
level of patient visits to its corresponding APC, thereby paying at 
five payment levels. The APC Panel members noted that this mapping 
system would eliminate any payment incentive to distinguish between new 
and established patients, but would ensure five payment levels.
    In the CY 2008 OPPS/ASC proposed rule, we proposed to maintain the 
CY 2007 mapping for the clinic visit codes for established patients. As 
indicated in Table 50 of the proposed rule, which is reprinted earlier 
as Table 39 in this final rule with comment period, we proposed to map 
the Level 1 established patient visit to the Level 1 Clinic Visit APC, 
which resulted in the Level 1 Clinic Visit APC containing both the 
Level 1 new and established patient visit codes, in accordance with the 
APC Panel's recommendation. Similarly, we proposed to map both the 
Level 2 new and established patient visit codes to the Level 2 Clinic 
Visit APC. However, we also proposed to map the Level 3 established 
patient visit code to the Level 2 Clinic Visit APC because our cost 
data indicated that the costs associated with a Level 3 established 
patient visit most closely resembled the costs associated with the 
Level 2 Clinic Visit APC and the Level 2 new and established patient 
visits. If CPT code 99213 for an established Level 3 clinic visit were 
mapped to the Level 3 Clinic Visit APC, which had a proposed median 
cost of approximately $86, we would significantly overpay CPT code 
99213 every time it was billed. Therefore, we proposed to map the Level 
3 new patient visit to the Level 3 Clinic Visit APC, consistent with 
the APC Panel's recommendation. We also proposed to map the Level 4 
established patient visit to the Level 3 Clinic Visit APC, and the 
Level 5 established patient visit to the Level 4 Clinic Visit APC. The 
only CPT E/M code that we proposed to map to the Level 5 Clinic Visit 
APC for CY 2008 payment was the Level 5 new patient visit. These APC 
assignments which were proposed for CY 2008 consistent with their CY 
2007 APC assignments, were determined for each HCPCS code based on CY 
2006 claims data available for CY 2008 ratesetting and clinical 
considerations. In the CY 2008 OPPS/ASC proposed rule, we indicated 
that we were not persuaded by the APC Panel's recommendation, which 
would have required us to ignore significant cost differences based on 
resource data that were clinically consistent and, therefore, we did 
not propose to map each code to its corresponding level APC.
    In the proposed rule, we noted that historical cost data for these 
frequently provided services were extremely consistent. In addition, 
from a clinical perspective, we believed that in some cases, in the 
context of a five-level structure for visit reporting, the hospital 
resources required for a given visit level might only be slightly 
different from those used for a visit that was one level higher or 
lower. For example, it was not surprising that particularly among 
visits for established patients in the middle of the range, such as a 
Level 2 established patient visit and a Level 3 established patient 
visit, the hospital resource costs calculated from claims data were 
similar because these patients would often utilize reasonably 
comparable hospital resources.
    In the proposed rule, we performed data analyses using proposed 
rule data to determine how the median costs of the clinic visit APCs 
would have changed if we fully adopted the APC Panel's recommendation, 
and mapped all of the new and established patient visit codes to the 
corresponding level of clinic visit APC. Our results were shown in 
Table 52 of the CY 2008 OPPS/ASC proposed rule, which is reprinted 
below as Table 41.

  Table 41.--CY 2008 Median Cost Comparison of Clinic Visit APCs in Two
        Different Configurations Using CY 2006 Proposed Rule Data
------------------------------------------------------------------------
                                            APC Median      APC Median
                                            cost in the     cost in the
                   APC                      proposed CY     recommended
                                               2008          APC panel
                                           configuration   configuration
------------------------------------------------------------------------
Level 1 Clinic Visit....................             $53             $53
Level 2 Clinic Visit....................              63              60
Level 3 Clinic Visit....................              86              66
Level 4 Clinic Visit....................             108              88
Level 5 Clinic Visit....................             139             110
------------------------------------------------------------------------


[[Page 66794]]

    In the CY 2008 OPPS/ASC proposed rule, we concluded that the APC 
median cost distribution did not improve when each new and established 
patient visit code was mapped to its corresponding level of APC. In 
fact, the APC Panel's recommended configuration resulted in lower 
payment rates for the Levels 2 through 5 Clinic Visit APCs, and an 
identical payment rate for the Level 1 Clinic Visit APC because our 
proposed mapping and the APC Panel's recommendation for this APC were 
the same. In general, under the OPPS, we rely on resource cost data 
calculated from hospital claims data to determine appropriate APC 
mapping of HCPCS codes, and to set payment rates. While we acknowledged 
in the proposed rule that it might be more predictable for hospitals to 
receive the same payment rate for new and established patients of the 
same visit level, robust cost data clearly indicated that this would 
not be the most accurate payment method. Historical hospital cost data 
demonstrated that new patient visits were more costly than established 
patient visits of the same level, a finding that was consistent with 
the perspective of our medical advisors. Because we proposed that 
hospitals continue to use CPT E/M codes to report clinic visits for CY 
2008, including separate codes for new and established patients, we saw 
no reason to adjust the clinic visit APC configurations. Therefore, for 
CY 2008, we proposed to map the CPT E/M codes and other Level II HCPCS 
codes to the Clinic Visit APCs as configured in Table 50 of the 
proposed rule, and not fully adopt the APC Panel's recommendation to 
map each code to its corresponding APC level. We indicated that we 
would re-examine this issue using the claims data for CY 2009 OPPS 
ratesetting, and would also reconsider whether this mapping is 
appropriate in the future as we continue to work on developing national 
guidelines.
    Comment: A few commenters opposed the proposal to map the CPT E/M 
codes and other Level II HCPCS codes to the Clinic Visit APCs based on 
resource cost and clinical homogeneity and stated that it made sense 
for each code to map to the corresponding APC level. For example, the 
commenters requested that the Level 3 new and established patient visit 
codes both map to the Level 3 Visits APC.
    Response: While we understand that it would be more straightforward 
if each code mapped to its corresponding APC level, we did not receive 
any compelling reasons to ignore significant cost differences based on 
robust resource data that are clinically consistent. We note that we 
will not be adopting the APC Panel's recommendation that each code map 
to its corresponding APC level for CY 2008.
    We are finalizing the proposed Clinic Visit APC configuration, with 
minor modification for CY 2008. Specifically, we are mapping the CPT E/
M codes and other Level II HCPCS to the appropriate Clinic Visit APCs, 
based on resource costs. Several HCPCS codes more appropriately map to 
different Clinic Visit APCs than proposed in Table 50 as a result of 
analyzing the full year final rule resource cost data. In addition, 
several other HCPCS codes for services resembling visits have been 
assigned to the Clinic Visit APCs for CY 2008. We refer readers to 
Addendum B to this final rule with comment period for the complete 
listing of visit codes and their placements for CY 2008. Furthermore, 
as discussed in detail in section II.A.4.c.(7) of this final rule with 
comment period, in some cases when high-level visits are reported with 
a new or established patient Level 5 CPT E/M code, a Level 4 or 5 
emergency department visit CPT code, a critical care CPT code, or 
direct admission to observation HCPCS code in association with 8 or 
more hours of nonsurgical observation services, we will provide a 
single payment in CY 2008 for the encounter through one of two new 
composite APCs, specifically APCs 8002 (Level I Extended Assessment and 
Management) and 8003 (Level II Extended Assessment and Management).
    The APC Panel also recommended that CMS not recognize the CPT 
consultation codes: CPT code 99241 (Office consultation for a new or 
established patient (Level 1)), CPT code 99242 (Office consultation for 
a new or established patient (Level 2)), CPT code 99243 (Office 
consultation for a new or established patient (Level 3)), CPT code 
99244 (Office consultation for a new or established patient (Level 4)), 
and CPT code 99245 (Office consultation for a new or established 
patient (Level 5)). The APC Panel recommended that CMS instruct 
hospitals to build consultation services into their internal hospital 
guidelines related to reporting outpatient clinic visit levels based on 
the complexity and resources used for these outpatient visits.
    CPT defines a consultation as ``a type of service provided by a 
physician whose opinion or advice regarding evaluation and/or 
management of a specific problem is requested by another physician or 
other appropriate source.'' CPT recognizes two subcategories of 
consultations, specifically office or other outpatient and inpatient 
consultations, although only the office consultations would be 
applicable under the OPPS. As we observed in the CY 2008 OPPS/ASC 
proposed rule, the differentiation of consultations from new and 
established patient clinic visits would appear to be clinically 
unnecessary under the OPPS in order to provide proper OPPS payment for 
hospital outpatient visits.
    In the CY 2007 OPPS/ASC final rule with comment period (71 FR 
68128), we stated our belief that it might be unnecessary for hospitals 
to report consultation CPT codes if either a new or established patient 
visit code accurately described the service provided. We stated that we 
were particularly interested in hearing whether consultation codes were 
a useful measure of hospital resource use under the OPPS, and how 
consultation visits were different, from a hospital resource 
perspective, from new patient visits and established patient visits. We 
observed that we did not want to create an incentive for hospitals to 
bill a consultation code instead of a new or established patient code 
because we did not believe that consultation codes necessarily 
reflected different resource utilization than either new or established 
patient codes (71 FR 68138). Therefore, for CY 2007, we finalized a 
payment policy that assigned the consultation code to the same clinical 
APC as the established patient visit code for each level of service. 
For example, CPT code 99242, the Level 2 consultation code, was mapped 
to APC 0605 (Level 2 Clinic Visits), which was where CPT code 99212, 
the Level 2 established patient code, was also assigned for CY 2007. 
Moving the consultation codes to the same APCs as the corresponding 
established patient visit codes eliminated any incentive for hospitals 
to bill a consultation code instead of a new or established patient 
code.

[[Page 66795]]



   Table 42.--CY 2008 Median Costs and Frequencies of CPT Consultation
              Visit Codes Using CY 2006 Proposed Rule Data
------------------------------------------------------------------------
             Code descriptor                Median cost      Frequency
------------------------------------------------------------------------
Level 1 Consultation....................          $66.48          62,000
Level 2 Consultation....................           65.78          73,000
Level 3 Consultation....................           81.95         155,000
Level 4 Consultation....................          109.96         176,000
Level 5 Consultation....................          139.61          94,000
------------------------------------------------------------------------

    Consultation services were provided with much less frequency than 
all levels of established patient visits and low-level new patient 
visits in CY 2006 but were provided more frequently than high-level new 
patient visits. The median costs for consultation codes were generally 
similar to, or slightly higher than, the corresponding median costs of 
the same level of new patient visits.
    Aside from the APC Panel's recommendation, we received a few public 
comments on the CY 2007 OPPS/ASC final rule related to this issue. In 
the CY 2008 OPPS/ASC proposed rule, we noted our continued belief that 
consultation codes were unnecessary and superfluous in the hospital 
outpatient setting because hospitals could appropriately bill either a 
new or established patient visit code, instead of a consultation code, 
as appropriate in these cases. In the interest of simplifying billing, 
for CY 2008, we proposed to assign status indicator ``B'' to the 
consultation codes (that is, not paid under the OPPS), and instructed 
hospitals to bill a new or established visit code instead of an office 
consultation code, thereby adopting the APC Panel's recommendation not 
to recognize these consultation codes. As appropriate, hospitals could 
build consultation services into their internal hospital guidelines 
related to reporting clinic visit levels, based on the complexity and 
resources used for these visits.
    Comment: Many commenters supported the proposal to change the 
status of the consultation codes so that they are no longer recognized 
under the OPPS. The commenters stated that this would simplify 
outpatient hospital billing, and remove the option of reporting 
unnecessary codes. A few commenters requested that the consultation 
codes continue to be recognized under the OPPS because of the 
administrative burden involved with analyzing each consultation to 
determine if the visit should be new or established. In addition, the 
commenters noted that there is a resource cost difference between 
consultations and new and established patient visits. The commenters 
stated that the cognitive intensity and the time to fully establish a 
diagnosis and a treatment plan for consultation types of visits are 
much greater than that of established patient visits.
    Response: We agree with the commenters who requested that we 
finalize our proposal not to recognize consultation codes under the 
OPPS for CY 2008. As described above, we do not believe consultation 
codes are a useful or necessary indicator of hospital resource use 
under the OPPS. The commenters who requested that CMS continue to 
recognize consultation codes may have been measuring physician resource 
use, rather than hospital resource use. In addition, if consultation 
services are more resource-intensive than established patient visits of 
the same level, our proposal would permit hospitals to factor this into 
their internal hospital guidelines that would determine the appropriate 
level of established patient visit to report.
    In summary, we are finalizing our CY 2008 proposal, without 
modification, that hospitals continue to use CPT codes to bill for 
clinic visits, and to distinguish between new and established patient 
visits. For CY 2008, the CPT codes for new and established visits will 
continue to be payable under the OPPS, but we will reconsider in the 
future whether there should be a distinction between new and 
established patient visits as we continue to work on developing 
national guidelines. In the meantime, we will assign these clinic 
visits to different levels of Clinic Visit APCs based on the costs we 
observe from historical hospital claims data. For CY 2008, we are also 
finalizing our proposal, without modification, to change the status of 
the consultation codes so that these codes are no longer recognized for 
payment under the OPPS.
2. Emergency Department Visits
    As described above, CPT defines an emergency department as ``an 
organized hospital based facility for the provision of unscheduled 
episodic services to patients who present for immediate medical 
attention. The facility must be available 24 hours a day.'' Prior to CY 
2007, under the OPPS we restricted the billing of emergency department 
CPT codes to services furnished at facilities that met this CPT 
definition. Facilities open less than 24 hours a day should not have 
reported the emergency department CPT codes.
    Sections 1866(a)(1)(I), 1866(a)(1)(N), and 1867 of the Act impose 
specific obligations on Medicare-participating hospitals and CAHs that 
offer emergency services. These obligations concern individuals who 
come to a hospital's dedicated emergency department and request 
examination or treatment for medical conditions, and apply to all of 
these individuals, regardless of whether or not they are beneficiaries 
of any program under the Act. Section 1867(h) of the Act specifically 
prohibits a delay in providing required screening or stabilization 
services in order to inquire about the individual's payment method or 
insurance status. Section 1867(d) of the Act provides for the 
imposition of civil monetary penalties on hospitals and physicians 
responsible for failing to meet the provisions listed above. These 
provisions, taken together, are frequently referred to as the Emergency 
Medical Treatment and Labor Act (EMTALA). EMTALA was passed in 1986 as 
part of the Consolidated Omnibus Budget Reconciliation Act of 1985 
(COBRA), Pub. L. 99-272.
    Section 489.24 of the EMTALA regulations defines ``dedicated 
emergency department'' as any department or facility of the hospital, 
regardless of whether it is located on or off the main hospital campus, 
that meets at least one of the following requirements: (1) It is 
licensed by the State in which it is located under applicable State law 
as an emergency room or emergency department; (2) It is held out to the 
public (by name, posted signs, advertising, or other means) as a place 
that provides care for emergency medical conditions on an urgent basis 
without requiring a previously scheduled appointment; or (3) During the 
calendar year immediately preceding the calendar year in which a 
determination under the regulations is

[[Page 66796]]

being made, based on a representative sample of patient visits that 
occurred during that calendar year, it provides at least one-third of 
all of its outpatient visits for the treatment of emergency medical 
conditions on an urgent basis without requiring a previously scheduled 
appointment.
    In the CY 2008 OPPS/ASC proposed rule, we reiterated our belief 
that every emergency department that meets the CPT definition of 
emergency department also qualifies as a dedicated emergency department 
under EMTALA. However, we indicated that we were aware that there are 
some departments or facilities of hospitals that meet the definition of 
a dedicated emergency department under the EMTALA regulations, but that 
do not meet the more restrictive CPT definition of an emergency 
department. For example, a hospital department or facility that meets 
the definition of a dedicated emergency department may not be available 
24 hours a day, 7 days a week. Nevertheless, hospitals with such 
departments or facilities incur EMTALA obligations with respect to an 
individual who presents to the department and requests, or has 
requested on his or her behalf, examination or treatment for an 
emergency medical condition. However, because they did not meet the CPT 
requirements for reporting emergency visit E/M codes, prior to CY 2007, 
these facilities were required to bill clinic visit codes for the 
services they furnished under the OPPS. We had no way to distinguish in 
our hospital claims data the costs of visits provided in dedicated 
emergency departments that did not meet the CPT definition of emergency 
department from the costs of clinic visits.
    Prior to CY 2007, some hospitals requested that they be permitted 
to bill emergency department visit codes under the OPPS for services 
furnished in a facility that met the CPT definition for reporting 
emergency department visit E/M codes, except that they were not 
available 24 hours a day. These hospitals believed that their resource 
costs were more similar to those of emergency departments that met the 
CPT definition than they were to the resource costs of clinics. 
Representatives of such facilities argued that emergency department 
visit payments would be more appropriate, on the grounds that their 
facilities treated patients with emergency conditions whose costs 
exceeded the resources reflected in the clinic visit APC payments, even 
though these emergency departments were not available 24 hours per day. 
In addition, these hospital representatives indicated that their 
facilities had EMTALA obligations and should, therefore, be able to 
receive emergency department visit payments. While these emergency 
departments may have provided a broader range and intensity of hospital 
services, and required significant resources to assure their 
availability and capabilities in comparison with typical hospital 
outpatient clinics, the fact that they did not operate with all 
capabilities full-time suggested that hospital resources associated 
with visits to emergency departments or facilities available less than 
24 hours a day might not be as great as the resources associated with 
emergency departments or facilities that were available 24 hours a day, 
and that fully met the CPT definition.
    To determine whether visits to emergency departments or facilities 
(referred to as Type B emergency departments) that incur EMTALA 
obligations, but do not meet more prescriptive expectations that are 
consistent with the CPT definition of an emergency department (referred 
to as Type A emergency departments), have different resource costs than 
visits to either clinics or Type A emergency departments, in the CY 
2007 OPPS/ASC final rule with comment period (71 FR 68132), we 
finalized a set of five G-codes for use by hospitals to report visits 
to all entities that meet the definition of a dedicated emergency 
department under the EMTALA regulations in Sec.  489.24, but that are 
not Type A emergency departments, as described in Table 43 below. These 
codes are called ``Type B emergency department visit codes.'' We 
believed the creation of G-codes for Type B emergency departments was 
necessary because there were no CPT codes that fully described this 
type of facility. If we were to continue instructing Type B emergency 
departments to bill clinic visit codes, we would have no way to track 
resource costs for Type B emergency department visits as distinct from 
clinic visits. In that final rule, we explained that these new G-codes 
would serve as a vehicle to capture median cost and resource 
differences among visits provided by Type A emergency departments, Type 
B emergency departments, and clinics (71 FR 68132).

 Table 43.--CY 2007 Final Level II HCPCS Codes To Be Used To Report Emergency Department Visits Provided in Type
                                             B Emergency Departments
----------------------------------------------------------------------------------------------------------------
        HCPCS code                 Short descriptor                           Long descriptor
----------------------------------------------------------------------------------------------------------------
G0380.....................  Lev 1 hosp type B ED visit...  Level 1 hospital emergency department visit provided
                                                            in a Type B emergency department. (The ED must meet
                                                            at least one of the following requirements: (1) It
                                                            is licensed by the State in which it is located
                                                            under applicable State law as an emergency room or
                                                            emergency department; (2) It is held out to the
                                                            public (by name, posted signs, advertising, or other
                                                            means) as a place that provides care for emergency
                                                            medical conditions on an urgent basis without
                                                            requiring a previously scheduled appointment; or (3)
                                                            During the calendar year immediately preceding the
                                                            calendar year in which a determination under this
                                                            section is being made, based on a representative
                                                            sample of patient visits that occurred during that
                                                            calendar year, it provides at least one-third of all
                                                            of its outpatient visits for the treatment of
                                                            emergency medical conditions on an urgent basis
                                                            without requiring a previously scheduled
                                                            appointment).
G0381.....................  Lev 2 hosp type B ED visit...  Level 2 hospital emergency department visit provided
                                                            in a Type B emergency department. (The ED must meet
                                                            at least one of the following requirements: (1) It
                                                            is licensed by the State in which it is located
                                                            under applicable State law as an emergency room or
                                                            emergency department; (2) It is held out to the
                                                            public (by name, posted signs, advertising, or other
                                                            means) as a place that provides care for emergency
                                                            medical conditions on an urgent basis without
                                                            requiring a previously scheduled appointment; or (3)
                                                            During the calendar year immediately preceding the
                                                            calendar year in which a determination under this
                                                            section is being made, based on a representative
                                                            sample of patient visits that occurred during that
                                                            calendar year, it provides at least one-third of all
                                                            of its outpatient visits for the treatment of
                                                            emergency medical conditions on an urgent basis
                                                            without requiring a previously scheduled
                                                            appointment).

[[Page 66797]]

 
G0382.....................  Lev 3 hosp type B ED visit...  Level 3 hospital emergency department visit provided
                                                            in a Type B emergency department. (The ED must meet
                                                            at least one of the following requirements: (1) It
                                                            is licensed by the State in which it is located
                                                            under applicable State law as an emergency room or
                                                            emergency department; (2) It is held out to the
                                                            public (by name, posted signs, advertising, or other
                                                            means) as a place that provides care for emergency
                                                            medical conditions on an urgent basis without
                                                            requiring a previously scheduled appointment; or (3)
                                                            During the calendar year immediately preceding the
                                                            calendar year in which a determination under this
                                                            section is being made, based on a representative
                                                            sample of patient visits that occurred during that
                                                            calendar year, it provides at least one-third of all
                                                            of its outpatient visits for the treatment of
                                                            emergency medical conditions on an urgent basis
                                                            without requiring a previously scheduled
                                                            appointment).
G0383.....................  Lev 4 hosp type B ED visit...  Level 4 hospital emergency department visit provided
                                                            in a Type B emergency department. (The ED must meet
                                                            at least one of the following requirements: (1) It
                                                            is licensed by the State in which it is located
                                                            under applicable State law as an emergency room or
                                                            emergency department; (2) It is held out to the
                                                            public (by name, posted signs, advertising, or other
                                                            means) as a place that provides care for emergency
                                                            medical conditions on an urgent basis without
                                                            requiring a previously scheduled appointment; or (3)
                                                            During the calendar year immediately preceding the
                                                            calendar year in which a determination under this
                                                            section is being made, based on a representative
                                                            sample of patient visits that occurred during that
                                                            calendar year, it provides at least one-third of all
                                                            of its outpatient visits for the treatment of
                                                            emergency medical conditions on an urgent basis
                                                            without requiring a previously scheduled
                                                            appointment).
G0384.....................  Lev 5 hosp type B ED visit...  Level 5 hospital emergency department visit provided
                                                            in a Type B emergency department. (The ED must meet
                                                            at least one of the following requirements: (1) It
                                                            is licensed by the State in which it is located
                                                            under applicable State law as an emergency room or
                                                            emergency department; (2) It is held out to the
                                                            public (by name, posted signs, advertising, or other
                                                            means) as a place that provides care for emergency
                                                            medical conditions on an urgent basis without
                                                            requiring a previously scheduled appointment; or (3)
                                                            During the calendar year immediately preceding the
                                                            calendar year in which a determination under this
                                                            section is being made, based on a representative
                                                            sample of patient visits that occurred during that
                                                            calendar year, it provides at least one-third of all
                                                            of its outpatient visits for the treatment of
                                                            emergency medical conditions on an urgent basis
                                                            without requiring a previously scheduled
                                                            appointment).
----------------------------------------------------------------------------------------------------------------

    For CY 2007, we assigned the five new Type B emergency department 
visit codes for services provided in a Type B emergency department to 
the five newly-established Clinic Visit APCs, 0604, 0605, 0606, 0607, 
and 0608 (71 FR 68140). This payment policy for Type B emergency 
department visits was similar to our previous policy, which required 
services furnished in emergency departments that had an EMTALA 
obligation, but did not meet the CPT definition of emergency department 
to be reported using CPT clinic visit E/M codes, resulting in payments 
based upon clinic visit APCs. As mentioned above, CPT and CMS required 
an emergency department to be open 24 hours per day in order for it to 
be eligible to bill emergency department E/M codes. While maintaining 
the same payment policy for Type B emergency department visits in CY 
2007, we believed the reporting of specific G-codes for emergency 
department visits provided in Type B emergency departments would permit 
us to specifically collect, and analyze the hospital resource costs of 
visits to these facilities in order to determine if in the future a 
proposal for an alternative payment policy might be warranted. We 
expected hospitals to adjust their charges appropriately to reflect 
differences in Type A and Type B emergency departments. We noted that 
the OPPS rulemaking cycle for CY 2009 would be the first year that we 
would have cost data for these new Type B emergency department HCPCS 
codes available for analysis.
    In the CY 2007 OPPS/ASC proposed rule (71 FR 49609), we proposed to 
create five G codes to be reported by the subset of provider-based 
emergency departments or facilities of the hospital, called Type A 
emergency departments, that are available to provide services 24 hours 
a day, 7 days per week, and meet one or both of the following 
requirements related to the EMTALA definition of a dedicated emergency 
department, specifically: (1) It is licensed by the State in which it 
is located under the applicable State law as an emergency room or 
emergency department; or (2) It is held out to the public (by name, 
posted signs, advertising, or other means) as a place that provides 
care for emergency medical conditions on an urgent basis without 
requiring a previously scheduled appointment. These codes were called 
``Type A emergency visit codes'' and were proposed to replace 
hospitals'' reporting of the CPT emergency department visit E/M codes. 
Our intention was to allow hospital-based emergency departments or 
facilities that were historically appropriately reporting CPT emergency 
department visit E/M codes to bill these new Type A emergency 
department visit codes. In the CY 2007 OPPS/ASC final rule with comment 
period (71 FR 68132), we postponed finalizing G codes to replace CPT 
codes for Type A emergency department visits until national guidelines 
are established, and stated that we would again consider their possible 
utility once national guidelines are adopted. However, for CY 2007, we 
finalized the definition of Type A emergency departments to distinguish 
them from Type B emergency departments. For CY 2007 (71 FR 68140), we 
assigned the five CPT E/M emergency department visit codes for services 
provided in Type A emergency departments to the five newly-created 
Emergency Department Visit APCs, 0609, 0613, 0614, 0615, and 0616.
    We believed that our distinction between Type A and Type B 
emergency departments refined and clarified the CPT definition of 
``emergency department'' for use in the hospital context. As we have 
previously noted, the CPT codes are defined to reflect the activities 
of physicians, and do not always fully describe the range and mix of 
services provided by hospitals during visits of emergency department 
patients. For example, one feature that distinguishes Type A hospital 
emergency departments from other departments of the hospital is that 
Type

[[Page 66798]]

A emergency departments do not generally provide scheduled care, but 
rather regularly operate to provide immediately available unscheduled 
services.
    We were pleased that the majority of commenters to the CY 2007 
OPPS/ASC proposed rule agreed with our general distinction between Type 
A and Type B emergency departments. We noted that after the publication 
of the CY 2007 OPPS/ASC final rule with comment period, numerous 
readers requested clarification about one paragraph that appeared in 
that final rule. The paragraph is reprinted below (71 FR 68132).

    ``We are aware that hospitals operate many types of facilities 
which they view in aggregate as an integrated healthcare system. For 
purposes of determining EMTALA obligations, under Sec.  489.24(b) of 
the regulations, each hospital is evaluated individually to 
determine its own particular obligations. As we have discussed 
previously, hospital facilities or departments of the hospital that 
meet the definition of a dedicated emergency department consistent 
with the EMTALA regulations may bill Type A emergency department 
codes (CPT emergency department visit codes) or Type B emergency 
department codes (HCPCS G-codes), depending on whether or not the 
dedicated emergency department meets the definition of a Type A 
emergency department, which includes operating 24 hours per day, 7 
days a week. For purposes of determining whether to bill Type A or 
Type B emergency department codes, each hospital must be evaluated 
individually and should make a decision specific to each area of the 
hospital to determine which codes would be appropriate. Where a 
hospital maintains a separately identifiable area or part of a 
facility which does not operate on the same schedule (that is, 24 
hours per day, 7 days a week) as its emergency department, that area 
or facility would not be considered an integral part of the 
emergency department that operates 24 hours per day, 7 days a week 
for purposes of determining its emergency department type for 
reporting emergency visit services. Instead, the facility or area 
would be evaluated separately to determine whether it is a Type A 
emergency department, Type B emergency department, or clinic. We 
would expect the hospital providing services in such facilities or 
areas to evaluate the status of those areas and bill accordingly. In 
general, it is not appropriate to consider a satellite emergency 
department or an area of the emergency department as if it were 
available 24 hours a day simply because the main emergency 
department is available 24 hours a day. It may be appropriate for a 
Type A emergency department to `carve out' portions of the emergency 
department that are not available 24 hours a day, where visits would 
be more appropriately billed with Type B emergency department 
codes.''

    In response to the questions we received, in CY 2007 we posted on 
the CMS Web site a ``Frequently Asked Questions'' list that described 
various examples of treating an emergency department as either a Type A 
emergency department or a Type B emergency department. In each case, 
the posted answer stated that hospitals should contact their fiscal 
intermediary to ensure that the fiscal intermediary and the hospital 
are in agreement regarding the emergency room status as either Type A 
or Type B. The response to the posted examples has been positive, and 
the number of inquiries we are receiving has subsided.
    Notwithstanding our subsequent clarification, we did not propose to 
modify the definitions of Type A or Type B emergency departments for CY 
2008 because we believed that our current definition accurately 
distinguished between these two types of emergency departments. While 
we would not know definitively until CY 2009 how the costs of services 
provided in Type A emergency departments differed from the costs of 
services provided in Type B emergency departments, we believed that our 
current distinction between Type A and Type B emergency departments was 
appropriate, and was most likely to capture any resource cost 
differences between the two types of emergency departments. However, we 
specifically solicited public comment regarding any additional 
operational clarifications that we could provide to assist hospitals in 
determining whether an emergency department is considered to be Type A 
or Type B.
    We specifically indicated for CY 2007 that hospitals should 
individually consider separately identifiable areas or parts of 
facilities that did not operate on the same schedule as the main 
emergency department that was open 24 hours a day, 7 days per week to 
determine the appropriate codes for reporting services provided in 
those separately identifiable areas. Because we considered the main 
distinguishing feature between Type A and Type B emergency departments 
to be the full-time versus part-time availability of staffed areas for 
emergency medical care, not the process of care or the site of care (on 
the hospital's main campus or offsite), our final CY 2007 policy 
explained that hospitals needed to assess separately identifiable areas 
individually for their status as Type A or Type B emergency 
departments. In the CY 2008 OPPS/ASC proposed rule, we specifically 
solicited comments that described how this policy could be further 
clarified in light of hospitals' operational responsibility to 
efficiently provide emergency services, holding constant the 
definitions that were developed for CY 2007 and described above. We did 
not believe a policy change in the reporting of these Type A and Type B 
emergency department codes would be appropriate for CY 2008, in light 
of our desire to capture consistent and accurate hospital cost data by 
HCPCS code for consideration for the CY 2009 OPPS. For CY 2008, we 
proposed that Type A emergency department visits would continue to be 
paid based on the five Emergency Department Visit APCs, while Type B 
emergency department visits would continue to be paid based on the five 
Clinic Visit APCs.
    Comment: Many commenters requested that CMS adjust the policy to 
broaden the definition of Type A emergency departments, specifically to 
revise the rule that hospitals must carve out portions of the emergency 
department that are not available 24 hours a day. The commenters 
specifically requested that the definition be adjusted so that a ``fast 
track'' area of an emergency department, located within the same 
building as a Type A emergency department, would be considered Type A, 
regardless of its hours of operation, if it provides unscheduled 
emergency services and shares a common patient registration system with 
the Type A emergency department. Many of the commenters expressed 
concern that hospitals are currently overcrowded, and payment at clinic 
visit rates may cause hospitals to shut down their ``fast track'' or 
other areas of the hospital that deliver expedited care, yet are open 
less than 24 hours a day. The commenters noted that if these areas of 
the hospital were closed, emergency department overcrowding would be 
exacerbated. Other commenters requested that we allow hospitals to 
operate in the most efficient manner and not penalize them for creating 
efficiencies. Several commenters requested additional clarification 
regarding the difference between Type A and Type B emergency 
departments, but did not specifically describe which part of the policy 
was unclear. Several commenters noted that five payment levels for 
emergency department visits was appropriate and would continue to 
support a stable distribution of visit levels.
    Response: As noted above, we consider the main distinguishing 
feature between Type A and Type B emergency departments to be the full-
time versus part-time availability of staffed areas for emergency 
medical care, not the process of care or the site of care (on the 
hospital's main campus or offsite). We continue to believe that 
emergency

[[Page 66799]]

departments or areas of the emergency department that are available 
less than 24 hours a day may have lower resource costs than emergency 
departments or areas of the emergency department that are available 24 
hours a day. We do not believe a policy change in the reporting of 
these Type A and Type B emergency department codes would be appropriate 
for CY 2008, in light of our desire to capture consistent and accurate 
hospital cost data by HCPCS code for consideration for the CY 2009 
OPPS. In addition, if our Type A emergency department payments provide 
support for 24 hour a day availability of services, then services 
provided in areas of the hospital that are not staffed 24 hours a day 
could be overpaid. This could also have the effect of diluting, and 
ultimately decreasing, the median resource costs associated with Type A 
emergency departments. We encourage hospitals that need more specific 
information related to the distinction between Type A and Type B 
emergency departments to contact their local fiscal intermediaries.
    In response to several questions, we are slightly modifying the 
long descriptors of HCPCS codes G0380, G0381, G0382, G0383, and G0384 
by replacing the words ``this section'' with ``42 CFR Sec.  489.24'' in 
order to clarify the reference. The short descriptors remain unchanged 
for CY 2008. Table 44 lists the CY 2008 short and long descriptors for 
the Type B emergency department Visit HCPCS codes.

 Table 44.--CY 2008 Final Level II HCPCS Codes To Be Used To Report Emergency Department Visits Provided in Type
                                             B Emergency Departments
----------------------------------------------------------------------------------------------------------------
        HCPCS code                 Short descriptor                           Long descriptor
----------------------------------------------------------------------------------------------------------------
G0380.....................  Lev 1 hosp type B ED visit...  Level 1 hospital emergency department visit provided
                                                            in a Type B emergency department. (The ED must meet
                                                            at least one of the following requirements: (1) It
                                                            is licensed by the State in which it is located
                                                            under applicable State law as an emergency room or
                                                            emergency department; (2) It is held out to the
                                                            public (by name, posted signs, advertising, or other
                                                            means) as a place that provides care for emergency
                                                            medical conditions on an urgent basis without
                                                            requiring a previously scheduled appointment; or (3)
                                                            During the calendar year immediately preceding the
                                                            calendar year in which a determination under 42 CFR
                                                            Sec.   489.24 is being made, based on a
                                                            representative sample of patient visits that
                                                            occurred during that calendar year, it provides at
                                                            least one-third of all of its outpatient visits for
                                                            the treatment of emergency medical conditions on an
                                                            urgent basis without requiring a previously
                                                            scheduled appointment).
G0381.....................  Lev 2 hosp type B ED visit...  Level 2 hospital emergency department visit provided
                                                            in a Type B emergency department. (The ED must meet
                                                            at least one of the following requirements: (1) It
                                                            is licensed by the State in which it is located
                                                            under applicable State law as an emergency room or
                                                            emergency department; (2) It is held out to the
                                                            public (by name, posted signs, advertising, or other
                                                            means) as a place that provides care for emergency
                                                            medical conditions on an urgent basis without
                                                            requiring a previously scheduled appointment; or (3)
                                                            During the calendar year immediately preceding the
                                                            calendar year in which a determination under 42 CFR
                                                            Sec.   489.24 is being made, based on a
                                                            representative sample of patient visits that
                                                            occurred during that calendar year, it provides at
                                                            least one-third of all of its outpatient visits for
                                                            the treatment of emergency medical conditions on an
                                                            urgent basis without requiring a previously
                                                            scheduled appointment).
G0382.....................  Lev 3 hosp type B ED visit...  Level 3 hospital emergency department visit provided
                                                            in a Type B emergency department. (The ED must meet
                                                            at least one of the following requirements: (1) It
                                                            is licensed by the State in which it is located
                                                            under applicable State law as an emergency room or
                                                            emergency department; (2) It is held out to the
                                                            public (by name, posted signs, advertising, or other
                                                            means) as a place that provides care for emergency
                                                            medical conditions on an urgent basis without
                                                            requiring a previously scheduled appointment; or (3)
                                                            During the calendar year immediately preceding the
                                                            calendar year in which a determination under 42 CFR
                                                            Sec.   489.24 is being made, based on a
                                                            representative sample of patient visits that
                                                            occurred during that calendar year, it provides at
                                                            least one-third of all of its outpatient visits for
                                                            the treatment of emergency medical conditions on an
                                                            urgent basis without requiring a previously
                                                            scheduled appointment).
G0383.....................  Lev 4 hosp type B ED visit...  Level 4 hospital emergency department visit provided
                                                            in a Type B emergency department. (The ED must meet
                                                            at least one of the following requirements: (1) It
                                                            is licensed by the State in which it is located
                                                            under applicable State law as an emergency room or
                                                            emergency department; (2) It is held out to the
                                                            public (by name, posted signs, advertising, or other
                                                            means) as a place that provides care for emergency
                                                            medical conditions on an urgent basis without
                                                            requiring a previously scheduled appointment; or (3)
                                                            During the calendar year immediately preceding the
                                                            calendar year in which a determination under 42 CFR
                                                            Sec.   489.24 is being made, based on a
                                                            representative sample of patient visits that
                                                            occurred during that calendar year, it provides at
                                                            least one-third of all of its outpatient visits for
                                                            the treatment of emergency medical conditions on an
                                                            urgent basis without requiring a previously
                                                            scheduled appointment).
G0384.....................  Lev 5 hosp type B ED visit...  Level 5 hospital emergency department visit provided
                                                            in a Type B emergency department. (The ED must meet
                                                            at least one of the following requirements: (1) It
                                                            is licensed by the State in which it is located
                                                            under applicable State law as an emergency room or
                                                            emergency department; (2) It is held out to the
                                                            public (by name, posted signs, advertising, or other
                                                            means) as a place that provides care for emergency
                                                            medical conditions on an urgent basis without
                                                            requiring a previously scheduled appointment; or (3)
                                                            During the calendar year immediately preceding the
                                                            calendar year in which a determination under 42 CFR
                                                            Sec.   489.24 is being made, based on a
                                                            representative sample of patient visits that
                                                            occurred during that calendar year, it provides at
                                                            least one-third of all of its outpatient visits for
                                                            the treatment of emergency medical conditions on an
                                                            urgent basis without requiring a previously
                                                            scheduled appointment).
----------------------------------------------------------------------------------------------------------------

    In summary, we did not receive any public comments that described 
how the payment policy could be further clarified in light of 
hospitals' operational responsibility to efficiently provide emergency 
services, holding constant the definitions that were developed for CY 
2007. Therefore, we are finalizing our CY 2008 proposal, without 
modification, to pay for Type A emergency department visits at the five 
Emergency Department Visit APC rates, while Type B emergency department 
visits will continue to be paid based on the five Clinic Visit APCs. We 
are also slightly modifying the long descriptors of HCPCS codes G0380 
through G0384 for clarification.

[[Page 66800]]

C. Visit Reporting Guidelines

1. Background
    As described in section IX.A. of this final rule with comment 
period, since April 7, 2000, we have instructed hospitals to report 
facility resources for clinic and emergency department hospital 
outpatient visits using the CPT E/M codes and to develop internal 
hospital guidelines for reporting the appropriate visit level.
    During the January 2002 APC Panel meeting, the APC Panel 
recommended that CMS adopt the American College of Emergency 
Physicians' (ACEP) intervention-based guidelines for facility coding of 
emergency department visits and develop guidelines for clinic visits 
that are modeled on the ACEP guidelines.
    In the August 9, 2002 OPPS proposed rule (67 FR 52133), we proposed 
10 new G-codes (Levels 1-5 Facility Emergency Services and Levels 1-5 
Facility Clinic Services) for use in the OPPS to report hospital 
visits, with the goal of ultimately applying national guidelines to 
these codes and discontinuing the use of CPT E/M codes under the OPPS. 
We also solicited public comments regarding national guidelines for 
hospital coding of emergency department and clinic visits. We discussed 
different types of models, reflecting on the advantages and 
disadvantages of each. We reviewed in detail the considerations around 
various discrete types of specific guidelines, including guidelines 
based on staff interventions, based upon staff time spent with the 
patient, based on resource intensity point scoring, and based on 
severity acuity point scoring related to patient complexity. In that 
proposed rule, we also stated that we were concerned about counting 
separately paid services (for example, intravenous infusions, x rays, 
electrocardiograms, and laboratory tests) as ``interventions,'' or 
including their associated ``staff time'' in determining the level of 
service. We believed that the level of service should be determined by 
resource consumption that is not otherwise captured in payments for 
other separately payable services.
    In response to comments, in the November 1, 2002 OPPS final rule 
(67 FR 66793), we stated that we would not create new codes to replace 
existing CPT E/M codes for reporting hospital visits until national 
guidelines are developed. We noted that an independent panel of experts 
would be an appropriate forum to develop codes and guidelines that are 
simple to understand and implement. We explained that organizations 
such as the American Hospital Association (AHA) and the American Health 
Information Management Association (AHIMA) had such expertise and would 
be capable of creating hospital visit guidelines and providing ongoing 
provider education. We also articulated a set of principles that any 
national guidelines for facility visit coding should satisfy, including 
that coding guidelines should be based on facility resources, should be 
clear to facilitate accurate payments and be usable for compliance 
purposes and audits, should meet HIPAA requirements, should only 
require documentation that is clinically necessary for patient care, 
and should not facilitate upcoding or gaming. We stated that the 
distribution of codes reported for each type of hospital outpatient 
visit (clinic or emergency department) should result in a normal curve. 
We concluded that we believed the most appropriate forum for 
development of code definitions and guidelines was an independent 
expert panel that would make recommendations to CMS.
    The AHA and AHIMA originally supported the ACEP model for emergency 
department visit coding. However, we expressed concern that the ACEP 
guidelines allowed counting of separately payable services in 
determining a service level, which could result in the double counting 
of hospital resources in establishing visit payment rates and payment 
rates for those separately payable services. Subsequently, on their own 
initiative, the AHA and AHIMA formed an independent expert panel, the 
Hospital Evaluation and Management Coding Panel, comprised of members 
with coding, health information management, documentation, billing, 
nursing, finance, auditing, and medical experience. This panel included 
representatives from the AHA, AHIMA, ACEP, Emergency Nurses 
Association, and American Organization of Nurse Executives. CMS and AMA 
representatives observed the meetings. On June 24, 2003, the AHA and 
AHIMA submitted their recommended guidelines, hereafter referred to as 
the AHA/AHIMA guidelines, for reporting three levels of hospital clinic 
and emergency department visits and a single level of critical care 
services to CMS, with the hope that CMS would publish the guidelines in 
the CY 2004 OPPS proposed rule. The AHA and AHIMA acknowledged that 
``continued refinement will be required as in all coding systems. The 
Panel * * * looks forward to working with CMS to incorporate any 
recommendations raised during the public comment period'' (AHA/AHIMA 
guidelines report, page 9). The AHA and AHIMA indicated that the 
guidelines were field-tested several times by panel members at 
different stages of their development. The guidelines are based on an 
intervention model, where the levels are determined by the numbers and 
types of interventions performed by nursing or ancillary hospital 
staff. Higher levels of services are reported as the number and/or 
complexity of staff interventions increase.
    Although we did not publish the guidelines, the AHA and AHIMA 
released the guidelines through their Web sites. Consequently, in CY 
2003 we received numerous comments from providers and associations, 
some in favor and some opposed to the guidelines. We undertook a 
critical review of the recommendations from the AHA and AHIMA and made 
some modifications to the guidelines based on comments we received from 
other hospitals and associations on the AHA/AHIMA guidelines, clinical 
review, and changing payment policies under the OPPS regarding some 
separately payable services.
    In an attempt to validate the modified AHA/AHIMA guidelines and 
examine the distribution of services that would result from their 
application to hospital clinic and emergency department visits paid 
under the OPPS, we contracted for a study that began in September 2004 
and concluded in September 2005 to retrospectively code, under the 
modified AHA/AHIMA guidelines, hospital visits by reviewing hospital 
visit medical chart documentation gathered through Comprehensive Error 
Rate Testing (CERT) work. While a review of documentation and 
assignment of visit levels based on the modified AHA/AHIMA guidelines 
to 12,500 clinic and emergency department visits was initially planned, 
the study was terminated after a pilot review of only 750 visits. The 
contractor identified a number of elements in the guidelines that were 
difficult for coders to interpret, poorly defined, nonspecific, or 
regularly unavailable in the medical records. The contractor's coders 
were unable to determine any level for about 25 percent of the clinic 
cases and about 20 percent of the emergency department cases reviewed. 
The only agreement observed between the levels reported on the claims 
and levels according to the modified AHA/AHIMA guidelines was the 
classification of Level 1 services, where the review supported the 
level on the claims 54 to 70 percent of the time. In addition, the vast 
majority of the clinic and emergency department visits

[[Page 66801]]

reviewed were assigned to Level 1 during the review. Based on these 
findings, we believed that it was not necessary to review additional 
records after the initial sample. The contractor advised that multiple 
terms in the guidelines required clearer definition and believed that 
more examples would be helpful. Although we believed that all of the 
visit documentation for each case was available for the contractor's 
review, we were unable to determine definitively that this was the 
case. Thus, there was some possibility that the contractor's 
assignments would have differed if additional documentation from the 
medical records were available for the visits. In summary, while 
testing of the modified AHA/AHIMA guidelines was helpful in 
illuminating areas of the guidelines that would benefit from 
refinement, we were unable to draw conclusions about the relationship 
between the distribution of hospital reporting of visits using CPT E/M 
codes that were assigned according to each hospital's internal 
guidelines and the distribution of codes under the AHA/AHIMA 
guidelines, nor were we able to demonstrate a normal distribution of 
visit levels under the modified AHA/AHIMA guidelines. In CY 2007, we 
posted to the CMS Web site a summary of the contractor's report.
    Despite the inconclusive findings from the validation study, after 
reviewing the AHA/AHIMA guidelines, as well as approximately a dozen 
other guidelines for outpatient visits submitted by various hospitals 
and hospital associations, we stated in the CY 2007 OPPS/ASC final rule 
with comment period (71 FR 68141) that we believed that the AHA/AHIMA 
guidelines were the most appropriate and well-developed guidelines for 
use in the OPPS of which we were aware. Our particular interest in 
these guidelines was based upon the broad-based input into their 
development, the desire for CMS to move to promulgate national hospital 
outpatient visit coding guidelines in the near future, and full 
consideration of the characteristics of alternative types of 
guidelines. We also believed that hospitals would react favorably to 
guidelines developed and supported by the AHA and AHIMA, national 
organizations that have great interest in hospital coding and payment 
issues, and possess significant medical, technical and practical 
expertise due to their broad membership, which includes hospitals and 
health information management professionals. Anecdotally, we noted that 
we had been told that a number of hospitals were successfully utilizing 
the AHA/AHIMA guidelines to report levels of hospital visits. However, 
other organizations had expressed concern that the AHA/AHIMA guidelines 
might result in a significant redistribution of hospital visits to 
higher levels, reducing the ability of the OPPS to discriminate among 
the hospital resources required for various different levels of visits. 
We, too, remained concerned about the potential redistributive effect 
on OPPS payments for other services or among levels of hospital visits 
when national guidelines for outpatient visit coding are adopted. As we 
explained in the CY 2008 OPPS/ASC proposed rule (72 FR 42761), we 
recognized that there could be difficulty crosswalking historical 
hospital claims data from current CPT E/M codes reported based on 
individual internal hospital guidelines to payments for any new coding 
system developed, in order to provide appropriate payment levels for 
hospital visits reported based on national guidelines in the future.
    In the CY 2008 OPPS/ASC proposed rule (72 FR 42761), we noted that 
there were several types of concerns with the AHA/AHIMA guidelines that 
had been identified based upon extensive staff review and contractor 
use of the guidelines during the validation study. We believed that the 
AHA/AHIMA guidelines would require refinement prior to their adoption 
by the OPPS, as well as continued refinement over time after their 
implementation. Our modified version of the AHA/AHIMA guidelines 
provided some possibilities for addressing certain issues. We reviewed 
our eight general areas of concern regarding the AHA/AHIMA model as 
outlined below. In addition, we posted on the CMS Web site both the 
original AHA/AHIMA guidelines and our modified draft version.
    In the CY 2008 OPPS/ASC proposed rule (72 FR 42761), we reiterated 
our commitment to provide a minimum of 6 to 12 months notice to 
hospitals prior to implementation of national guidelines to provide 
sufficient time for providers to make the necessary systems changes and 
educate their staff.
2. CY 2007 Work on Visit Guidelines
    There were several areas of the AHA/AHIMA guidelines that we 
identified in the CY 2007 OPPS/ASC final rule with comment period that 
would require refinement and further input from the public prior to 
implementation as national guidelines. These areas include the need for 
five rather than three levels of codes for clinic and emergency 
department visits to accommodate the CY 2007 five levels of OPPS 
payment; clarification of documentation that would support certain 
interventions; reconsideration of the inclusion of separately payable 
services as proxies for hospital resources used in visits; examination 
of the valuing of certain interventions; assessment of the need for 
modifications to address the different clinical characteristics of 
specialty clinic visits; consistency with the Americans with 
Disabilities Act; re-evaluation of the way in which additional hospital 
resources required for the treatment of new patients were captured; and 
recommendations for guidelines for the reporting of visits to Type B 
emergency departments.
    In CY 2007, we had a number of meetings and discussions with 
interested stakeholders regarding the AHA/AHIMA guidelines, the CMS 
modified draft version, the contractor pilot work to test the 
guidelines, the concerns we identified in the CY 2007 OPPS/ASC final 
rule with comment period, and alternative guidelines. In the CY 2008 
OPPS/ASC proposed rule (72 FR 42761), we indicated our awareness that 
the AHA and AHIMA were conducting an ongoing dialogue with members of 
their Hospital Evaluation and Management Coding Panel and reviewing 
their previously recommended model guidelines as well as other models 
currently in use. We had not received any additional suggestions or 
modifications from the AHA and AHIMA at the time of the development of 
the CY 2008 proposed rule. We had received a number of new suggestions 
for guidelines from other stakeholders, including individual hospitals 
and associations, that had engaged in a variety of data collection and 
pilot application activities in preparing their recommendations. For 
example, one wound care organization created and presented an 
independent model that could apply to certain specialty clinics. The 
organization claimed that several hospital outpatient specialty clinics 
had already successfully implemented these as their internal 
guidelines, but requested that CMS designate them as the national wound 
care clinic guidelines. One provider group tested several sets of 
guidelines that resembled the ACEP model and compared the results 
across a set of hospitals. This provider group believed that an ACEP-
type model would be the most successful type of national guidelines, 
assuming that the guidelines were flexible in serving as a guide to 
visit level reporting. While using several varieties of ACEP-type 
guidelines in different hospitals, the group noted that across 
hospitals a specific intervention was almost always

[[Page 66802]]

assigned to the same clinic visit level. The group concluded that this 
demonstrated that the ACEP model and its variations could likely be 
successfully implemented as national guidelines. Another association 
reviewed and tested the CMS modified AHA/AHIMA guidelines that were 
posted on the CMS Web site. This association found it cumbersome to 
assign the Level 2 and Level 4 clinic visit codes because those levels 
could only be assigned when a certain number of interventions and/or 
contributory factors were performed. The association suggested changes 
to the CMS modified AHA/AHIMA guidelines for ease of use and 
application to specialty clinics, particularly oncology clinics. One 
developer of national clinic and emergency department visit guidelines 
noted that many hospitals had successfully used the presenting problem-
based guidelines that it had created. The developer noted that its 
system was easy to use, produced consistent coding decisions resulting 
in a normal distribution of visits, and even served as a tool to track 
effectiveness and efficiency.
    In the CY 2008 OPPS/ASC proposed rule (72 FR 42761), we expressed 
our appreciation of the thoughtful information that had been provided 
to us up to that time regarding hospitals' experiences and the 
insightful responses by the public to our concerns about the AHA/AHIMA 
model. We reiterated that we were actively engaged in evaluating and 
comparing various guideline models and suggestions that had been 
provided to us, and that we continued to welcome additional public 
input on this important and complex area of the OPPS. The public input 
we had received continued to reflect a wide variety of perspectives on 
the types and content of the guidelines different commenters 
recommended that we should implement nationally for the OPPS, and no 
single approach appeared to be broadly endorsed by the stakeholder 
community. In addition, we explained that commenters had described the 
successful application of many types of internal hospital guidelines 
with diverse characteristics for the reporting of hospital clinic and 
emergency department visit levels that they believed accurately 
captured the required hospital resources.
3. Visit Guidelines
    In preparation for the CY 2008 OPPS/ASC proposed rule, we performed 
data analyses with the goal of studying the current and historical 
distribution of each level of clinic and emergency department visit 
codes billed nationally, as well as the distribution among various 
classes of hospitals. We analyzed frequency data from claims with dates 
of service from March 1, 2002 through December 31, 2006, including 
those claims that were processed through December 31, 2006. To 
determine the national clinic visit distribution, we reviewed frequency 
data for each level of new patient visits, established patient visits, 
and consultation codes. To determine the national emergency department 
visit distribution, we reviewed frequency data for the five CPT 
emergency department visit codes. We did not include the five G-codes 
that describe Type B emergency departments because they became 
effective January 1, 2007, and we do not yet have a full year of 
frequency data for those codes.
    The clinic visit data, displayed below in Figure 1 that is 
reprinted from the CY 2008 OPPS/ASC proposed rule, revealed a fairly 
normal national distribution of clinic visits, with the curve somewhat 
skewed to the left, consistent with our previous analysis of these data 
in CY 2002 (67 FR 66791). In addition, we noted that the visit 
distributions had been quite stable over the past 5 years.

Figure 1.--Frequency Distribution of New and Established Patient Clinic 
Visits, by Level of Code

[[Page 66803]]

[GRAPHIC] [TIFF OMITTED] TR27NO07.002

    The graph shown in Figure 1 indicated that hospitals, on average, 
were billing all five levels of visit codes with varying frequency, in 
a consistent pattern over time. It was striking to note how similar the 
annual distributions appeared from CY 2002 through CY 2006. We were not 
surprised that hospitals reported a relatively high proportion of low-
level visits, given the typical clinical care provided in HOPDs during 
these visits. Many Medicare patients are evaluated regularly in clinics 
by hospitals' clinical staff to determine the status of their chronic 
medical conditions and to make adjustments to treatment plans, and 
those visits may frequently be reported as a low-level visit if that is 
consistent with the hospital's internal guidelines and fiscal 
intermediary instructions. Some patients may receive minor services 
during low-level visits that are not described by more specific HCPCS 
codes. We noted that, in general, billing a visit in addition to 
another service merely because the patient interacted with hospital 
staff or spent time in a room for that service would be inappropriate. 
If a visit and another service were both billed, such as chemotherapy, 
a diagnostic test, or a surgical procedure, the visit should be 
separately identifiable from the other service because the resources 
used to provide nonvisit services, including staff time, equipment, and 
supplies, among others, were captured in the line item for that 
service. We believed that hospitals by and large were abiding by this 
guidance because more than 90 percent of the CY 2006 claims for Level 1 
established patient visits available for the CY 2008 OPPS/ASC proposed 
rule were single claims.
    In the CY 2008 OPPS/ASC proposed rule (72 FR 42761), we also 
examined the billing patterns for various classes of hospitals, grouped 
by the hospital categories shown in the impact table (Table 61) in 
section XXIV.B. of this final rule with comment period, to see how the 
clinic visit distributions of levels reported for these various 
categories compared to the national distribution of clinic visit 
levels. For these subcategories, we specifically focused on the number 
of established patient visits billed at each level. Generally, the 
distribution for major teaching hospitals, minor teaching hospitals, 
and nonteaching hospitals looked remarkably similar to the

[[Page 66804]]

national distribution of established patient visits. Nonteaching 
hospitals tended to bill a greater proportion of Level 1 and 2 patient 
visits as compared to major teaching hospitals, as would be expected if 
their general patient acuity was slightly lower. Nonteaching hospitals 
include many community hospitals that treat a wide variety of patients, 
likely including a larger proportion of patients with minor ailments. 
Major teaching hospitals reported a slightly higher proportion of Level 
4 and 5 visits. This too correlated positively with our knowledge of 
the patient case-mix of large teaching hospitals, which tend to treat a 
higher proportion of very sick patients than nonteaching hospitals. The 
distributions for urban and rural hospitals also closely resembled the 
national distribution, including the rural SCH visit level 
distribution. The smallest rural hospitals predictably reported a 
higher proportion of Level 1 and 2 visit codes and a lower proportion 
of higher level visit codes, as compared to the national average, 
consistent with their generally lower case-mix severity.
    The national emergency department visit data, displayed below in 
Figure 2 that is reprinted from the CY 2008 OPPS/ASC proposed rule, 
similarly revealed a normal national distribution of emergency 
department visit levels that was even more symmetrical than the 
national clinic visit distribution. The national distributions were 
stable over the past 5 years as well.

Figure 2.--Frequency Distribution of Emergency Department Visits, by 
Level of Code
[GRAPHIC] [TIFF OMITTED] TR27NO07.003

    In the CY 2008 OPPS/ASC proposed rule (72 FR 42761), we also looked 
at various classes of hospitals, grouped by the hospital categories 
that we show in the impact table in section XXIV.B. of this final rule 
with comment period, to see how the emergency department visit 
distributions of levels billed by hospitals in each of these various 
categories compared to the national distribution of emergency 
department visit levels. The emergency department visit distributions 
for major teaching hospitals, minor teaching hospitals, and nonteaching 
hospitals were almost identical to the national distribution of 
emergency department visits. No significant differences were noted. The

[[Page 66805]]

emergency department visit distributions for urban and rural hospitals 
also closely resembled the national distribution of emergency 
department visits. Rural hospitals in the aggregate reported slightly 
higher proportions of Level 2 and 3 emergency department visits than 
the national average, and slightly fewer Level 4 and 5 visits. When 
subdividing rural hospitals into groupings based on size, the 
distribution for small, medium, and large rural hospitals closely 
mirrored the national average distribution. Large rural hospitals 
tended to report higher level emergency department visits than smaller 
rural hospitals. All of these observations regarding the patterns of 
reporting for rural hospitals were consistent with our expectations for 
care delivery at those hospitals.
    Overall, both the clinic and emergency department visit 
distributions indicated that hospitals were billing consistently over 
time and in a manner that distinguished between visit levels, resulting 
in relatively normal distributions nationally for the OPPS, as well as 
for smaller classes of hospitals. These proposed rule analyses were 
generally consistent with our understanding of the clinical and 
resource characteristics of different levels of hospital outpatient 
clinic and emergency department visits.
    In the CY 2008 OPPS/ASC proposed rule, we specifically invited 
public comment as to whether a pressing need for national guidelines 
continued at this point in the maturation of the OPPS, or if the 
current system where hospitals create and apply their own internal 
guidelines to report visits was currently more practical and 
appropriately flexible for hospitals. We explained that although we 
have reiterated our goal since CY 2000 to create national guidelines, 
this complex undertaking for these important and common hospital 
services was proving more challenging than we initially thought as we 
received new and expanded information from the public on current 
hospital reporting practices that led to appropriate payment for the 
hospital resources associated with clinic and emergency department 
visits. We believed that many hospitals had worked diligently and 
carefully to develop and implement their own internal guidelines that 
reflected the scope and types of services they provided throughout the 
hospital outpatient system. Based on public comments, as well as our 
own knowledge of how clinics operate, it seemed unlikely that one set 
of straightforward national guidelines could apply to the reporting of 
visits in all hospitals and specialty clinics. In addition, the stable 
distribution of clinic and emergency department visits reported under 
the OPPS over the past several years indicated that hospitals, both 
nationally in the aggregate and grouped by specific hospital classes, 
were generally billing in an appropriate and consistent manner as we 
would expect in a system that accurately distinguished among different 
levels of service based on the associated hospital resources.
    Therefore, while we explained in the CY 2008 OPPS/ASC proposed rule 
that we would continue to evaluate the information and input we had 
received from the public during CY 2007, as well as comments on the CY 
2008 OPPS/ASC proposed rule, regarding the necessity and feasibility of 
implementing different types of national guidelines, we did not propose 
to implement national visit guidelines for clinic or emergency 
department visits for CY 2008. Instead, hospitals would continue to 
report visits during CY 2008 according to their own internal hospital 
guidelines.
    In the absence of national guidelines, we will continue to 
regularly reevaluate patterns of hospital outpatient visit reporting at 
varying levels of disaggregation below the national level to ensure 
that hospitals continued to bill appropriately and differentially for 
these services. In addition, we note our expectation that hospitals' 
internal guidelines would comport with the principles listed below.
    (1) The coding guidelines should follow the intent of the CPT code 
descriptor in that the guidelines should be designed to reasonably 
relate the intensity of hospital resources to the different levels of 
effort represented by the code (65 FR 18451).
    (2) The coding guidelines should be based on hospital facility 
resources. The guidelines should not be based on physician resources 
(67 FR 66792).
    (3) The coding guidelines should be clear to facilitate accurate 
payments and be usable for compliance purposes and audits (67 FR 
66792).
    (4) The coding guidelines should meet the HIPAA requirements (67 FR 
66792).
    (5) The coding guidelines should only require documentation that is 
clinically necessary for patient care (67 FR 66792).
    (6) The coding guidelines should not facilitate upcoding or gaming 
(67 FR 66792).
    We also proposed the following five additional principles for 
application to hospital-specific guidelines, based on our evolving 
understanding of the important issues addressed by many hospitals in 
developing their internal guidelines that now have been used for a 
number of years. We believed that it was reasonable to elaborate upon 
the standards for hospitals' internal guidelines that we proposed to 
apply in CY 2008, based on our knowledge of hospitals' experiences to 
date with guidelines for visits.
    (7) The coding guidelines should be written or recorded, well-
documented, and provide the basis for selection of a specific code.
    (8) The coding guidelines should be applied consistently across 
patients in the clinic or emergency department to which they apply.
    (9) The coding guidelines should not change with great frequency.
    (10) The coding guidelines should be readily available for fiscal 
intermediary (or, if applicable, MAC) review.
    (11) The coding guidelines should result in coding decisions that 
could be verified by other hospital staff, as well as outside sources.
    In the CY 2008 OPPS/ASC proposed rule, we invited public comment on 
these principles, specifically, whether hospitals' guidelines currently 
met these principles, how difficult it would be for hospitals' 
guidelines to meet these principles if they did not meet them already, 
and whether hospitals believed that certain standards should be added 
or removed. We considered stating that a hospital must use one set of 
emergency department visit guidelines for all emergency departments in 
the hospital but thought that some departments that might be considered 
emergency departments, such as the obstetrics department, might find it 
more practical and appropriate to use a different set of guidelines 
than the general emergency department. Similarly, we believed that it 
was possible that various specialty clinics in a hospital could have 
their own set of guidelines, specific to the services offered in those 
specialty clinics. However, if different guidelines were implemented 
for different clinics, we stated that hospitals should ensure that 
these guidelines reflected comparable resource use at each level to the 
other clinic guidelines that the hospital might apply.
    Comment: A number of commenters were divided as to whether there is 
a need for national guidelines. The majority of the commenters 
requested that CMS continue work on national guidelines to ensure 
consistent reporting of hospital visits. Some of the commenters 
requested that the guidelines be implemented as soon as possible, 
ensuring 6 to 12 months of advance notice. Other commenters suggested 
that guidelines would be helpful, but that it was preferable to invest 
significant time reviewing and

[[Page 66806]]

perfecting guidelines rather than to quickly implement guidelines that 
could later prove to be problematic. Several commenters requested that 
CMS create national guidelines and then request the development of CPT 
codes specific to hospital visits. Several commenters offered their 
assistance in creating specialty clinic guidelines, reviewing 
guidelines, or helping in other ways, with the ultimate goal of 
creating national guidelines. One commenter believed it is absolutely 
necessary to create national guidelines, particularly because CMS is 
moving toward greater packaging.
    Other commenters stated that the principles that were included in 
the CY 2008 OPPS/ASC proposed rule were appropriate, reasonable, and 
sufficient, and that it was unnecessary to implement national 
guidelines. The commenters stated that hospital specific guidelines are 
practical and appropriately flexible. Several of the commenters noted 
that their own internal guidelines already met all of the principles, 
or that the internal guidelines used by member hospitals or their 
associations likely already comply with these principles. Other 
commenters requested that the AMA include these principles in the CPT 
book to clarify that the CPT E/M code descriptors do not fully describe 
hospital resources, and that it is appropriate for hospitals to use 
their internal guidelines to code hospital outpatient visits.
    Several commenters asked for clarification of details related to 
the principles, such as how often the guidelines should be updated, how 
``readily available'' is defined, and whether hospitals can use 
physician guidelines to report hospital visits. Some commenters 
believed the principles were too vague and strongly encouraged the 
creation of national guidelines. Several commenters requested that CMS 
inform the fiscal intermediaries and MACs that they should use each 
hospital's internal guidelines as a reference when auditing hospital 
records, rather than using only the fiscal intermediary's own set of 
guidelines. One commenter requested clarification related to how a 
hospital could create several sets of guidelines for various areas of 
the hospital. Many commenters requested clarification about whether 
separately payable services could be included in internal guidelines, 
in the absence of national guidelines.
    Response: We appreciate all the thoughtful comments that we 
received related to the creation of national guidelines, as well as 
offers from hospitals and associations to help create guidelines. We 
acknowledge that it would be desirable to many hospitals to have one 
set of national guidelines. However, we also understand that it would 
be disruptive to other hospitals that have successfully adopted 
internal guidelines to implement any new set of national guidelines, 
while we address the problems that would be inevitable in the case of 
any new set of guidelines that would be applied by thousands of 
hospitals. Creating national guidelines has proven more difficult than 
initially anticipated, as detailed above, and some hospitals have 
expressed significant concerns about virtually all of the models we 
have discussed.
    Based on our analyses for the CY 2008 proposed rule, both clinic 
and emergency department national visit distributions appear normal and 
relatively stable over time, indicating that hospitals as a whole are 
billing the full range of visit codes in an appropriate manner, a 
reassuring finding. We noted similar distributions for subclasses of 
hospitals, as well. We will continue to work on national guidelines, 
and we continue to encourage comments and submission of successful 
models. In the meantime, before national guidelines are implemented, we 
will require each hospital's internal guidelines to meet the principles 
stated above. We agree with commenters that it could be useful for the 
AMA to publish these principles in order to clarify that it is 
appropriate for hospitals to apply different guidelines than 
physicians' guidelines to report visits provided in HOPDs. We encourage 
interested parties to contact the AMA to determine whether there is an 
appropriate forum to publish these principles, so that they are broadly 
distributed and readily available.
    We will elaborate on the principles that were commented on by 
several commenters. The second principle states that the guidelines 
should not be based on physician resources. Hospitals are responsible 
for reporting the CPT E/M visit code that appropriately represents the 
resources utilized by the hospital, rather than the resources utilized 
by the physician. This does not preclude a hospital from using or 
adapting the physician guidelines if the hospital believes that such 
guidelines adequately describe hospital resources. We note that the 
first principle states that coding guidelines should follow the intent 
of the CPT code descriptor to relate the intensity of resources to 
different levels of effort represented by the code, not that the 
hospital's guidelines need to specifically consider the three factors 
included in the CPT E/M codes for consideration regarding physician 
visit reporting.
    Regarding principle 8, a hospital with multiple clinics (for 
example, primary care, oncology, wound care, etc.) may have different 
coding guidelines for each clinic, but the guidelines must be applied 
uniformly within each separate clinic. We note that the hospital's 
assorted set of internal guidelines must measure resource use in a 
relative manner, in relation to each other. For example, the hospital 
resources required for a Level 3 established patient visit under one 
set of guidelines should be comparable to the resources required for a 
Level 3 established patient visit under all other sets of clinic visit 
guidelines used by the hospital.
    Regarding principle 9, we would generally expect hospitals to 
adjust their guidelines less frequently than every few months, and we 
believe it would be reasonable for hospitals to adjust their guidelines 
annually, if necessary.
    Regarding principle 10, hospitals should use their judgment to 
ensure that coding guidelines are readily available, in an appropriate 
and reasonable format. We would encourage fiscal intermediaries and 
MACs to review a hospital's internal guidelines when an audit occurs.
    Regarding principle 11, hospitals should use their judgment to 
ensure that their coding guidelines can produce results that are 
reproducible by others.
    In the absence of national visit guidelines, hospitals have the 
flexibility to determine whether or not to include separately payable 
services as a proxy to measure hospital resource use that is not 
associated with those separately payable services. The costs of 
hospital resource use associated with those separately payable services 
would be paid through separate OPPS payment for the other services. We 
encourage hospitals with more specific questions related to the 
creation of internal guidelines to contact their local fiscal 
intermediary or MAC.
    Comment: Many commenters requested that CMS allow hospitals to bill 
critical care without a minimum time requirement or with a time 
requirement of 15 minutes. The commenters noted that the hospital may 
have its greatest resource use in the first 10 minutes of critical 
care, much earlier than the 30-minute minimum required in the code 
descriptor.
    Response: The CPT instructions for reporting of critical care 
services with CPT code 99291 (Critical care, evaluation and management 
of the critically ill or critically injured patient; first 30-74 
minutes) and the CPT code descriptor specify that the code can only

[[Page 66807]]

be billed if 30 minutes or more of critical care services are provided. 
Because hospitals will be reporting CPT codes for critical care 
services for CY 2008, they must continue to provide a minimum of 30 
minutes of critical care services in order to bill CPT code 99291, 
according to the CPT code descriptor and CPT instructions. We note that 
hospitals can report the appropriate clinic or emergency department 
visit code consistent with their internal guidelines if fewer than 30 
minutes of critical care is provided.
    We appreciate all of the comments we have received in the past from 
the public on visit guidelines, and we encourage at any time continued 
submission of comments that will assist us and other stakeholders 
interested in the development of national guidelines. Until national 
guidelines are established, hospitals should continue using their own 
internal guidelines to determine the appropriate reporting of different 
levels of clinic and emergency department visits. We would not expect 
individual hospitals to necessarily experience a normal distribution of 
visit levels across their claims, although we would expect a normal 
distribution across all hospitals as currently observed and as we would 
also expect if national guidelines were implemented. We understand 
that, based on different patterns of care, we could expect that a small 
community hospital might provide a greater percentage of low-level 
services than high-level services, while an academic medical center or 
trauma center might provide a greater percentage of high-level services 
than low-level services. We would also expect national guidelines to 
provide for five levels of coding, to parallel the five payment levels 
that currently exist.
    In addition, we are adopting our CY 2008 proposal, without 
modification, that all hospital-specific guidelines for reporting 
visits should meet the 11 guideline principles listed earlier in this 
final rule with comment period.
    While we understand the interest of some hospitals in our moving 
quickly to promulgate national guidelines that will ensure standardized 
reporting of hospital outpatient visit levels, we believe that the 
issues and concerns identified both by us and others that may arise are 
important and require serious consideration prior to the implementation 
of national guidelines. Because of our commitment to provide hospitals 
with 6 to 12 months notice prior to implementation of national 
guidelines, we would not implement national guidelines prior to CY 
2009. Our goal is to ensure that OPPS national or hospital-specific 
visit guidelines continue to facilitate consistent and accurate 
reporting of hospital outpatient visits in a manner that is resource-
based and supportive of appropriate OPPS payments for the efficient and 
effective provision of visits in hospital outpatient settings.

X. OPPS Payment for Blood and Blood Products

A. Background

    Since the implementation of the OPPS in August 2000, separate 
payments have been made for blood and blood products through APCs 
rather than packaging them into payments for the procedures with which 
they were administered. Hospital payments for the costs of blood and 
blood products, as well as the costs of collecting, processing, and 
storing blood and blood products, are made through the OPPS payments 
for specific blood product APCs. On April 12, 2001, CMS issued the 
original billing guidance for blood products to hospitals (Program 
Transmittal A-01-50). In response to requests for clarification of 
these instructions, CMS issued Program Transmittal 496 on March 4, 
2005. The comprehensive billing guidelines in Program Transmittal 496 
also addressed specific concerns and issues related to billing for 
blood-related services, which the public had brought to our attention.
    In the CY 2000 OPPS, payments for blood and blood products were 
established based on external data provided by commenters due to 
limited Medicare claims data. From the CY 2000 OPPS to the CY 2002 
OPPS, payment rates for blood and blood products were updated for 
inflation. For the CY 2003 OPPS, as described in the November 1, 2002 
final rule with comment period (67 FR 66773), we applied a special 
adjustment methodology to blood and blood products that had significant 
reductions in payment rates from the CY 2002 OPPS to the CY 2003 OPPS, 
when median costs were first calculated from hospital claims. Using the 
adjustment methodology, we limited the decrease in payment rates for 
blood and blood products to approximately 15 percent. For the CY 2004 
OPPS, as recommended by the APC Panel, we froze payment rates for blood 
and blood products at CY 2003 levels as we studied concerns raised by 
commenters and presenters at the August 2003 and February 2004 APC 
Panel meetings.
    For the CY 2005 OPPS, we established new APCs that allowed each 
blood product to be assigned to its own separate APC, as several of the 
previous blood product APCs contained multiple blood products with no 
clinical homogeneity or whose product specific median costs may not 
have been similar. Some of the blood product HCPCS codes were 
reassigned to the new APCs (Table 34 of the November 15, 2004 final 
rule with comment period (69 FR 65819)).
    We also noted in the November 15, 2004 final rule with comment 
period that public comments on previous OPPS rules had stated that the 
CCRs that were used to adjust charges to costs for blood products in 
past years were too low. Past commenters indicated that this approach 
resulted in an underestimation of the true hospital costs for blood and 
blood products. In response to these comments and the APC Panel 
recommendations from its February 2004 and September 2004 meetings, we 
conducted a thorough analysis of the CY 2003 claims (used to calculate 
the CY 2005 APC payment rates) to compare CCRs between those hospitals 
reporting a blood-specific cost center and those hospitals defaulting 
to the overall hospital CCR in the conversion of their blood product 
charges to costs. As a result of this analysis, we observed a 
significant difference in CCRs utilized for conversion of blood product 
charges to costs for those hospitals with and without blood-specific 
cost centers. The median hospital blood-specific CCR was almost two 
times the median overall hospital CCR. As discussed in the November 15, 
2004 final rule with comment period, we applied a special methodology 
for hospitals not reporting a blood-specific cost center, which 
simulated a blood-specific CCR for each hospital that we then used to 
convert charges to costs for blood products. Thus, we developed 
simulated medians for all blood and blood products based on CY 2003 
hospital claims data (69 FR 65816).
    For the CY 2005 OPPS, we also identified a subset of blood products 
that had less than 1,000 units billed in CY 2003. For these low-volume 
blood products, we based the CY 2005 OPPS payment rate on a 50/50 blend 
of the CY 2004 OPPS product-specific OPPS median costs and the CY 2005 
OPPS simulated medians based on the application of blood-specific CCRs 
to all claims. We were concerned that, given the low frequency in which 
these products were billed, a few occurrences of coding or billing 
errors may have led to significant variability in the median 
calculation. The claims data may not have captured the complete costs 
of these products to hospitals as fully as possible. This low-volume 
adjustment methodology also allowed us to further study the issues 
raised by commenters

[[Page 66808]]

and by presenters at the September 2004 APC Panel meeting, without 
putting beneficiary access to these low volume blood products at risk. 
We have adopted the use of this modified CCR process for calculating 
unadjusted median costs for blood and blood products each year since 
the CY 2005 OPPS.
    Overall, median costs from CY 2003 (used for the CY 2005 OPPS) to 
CY 2004 (used for the CY 2006 OPPS) were relatively stable, with a few 
significant increases and decreases from the CY 2005 adjusted median 
costs for some specific blood products. For the CY 2006 OPPS, we 
adopted a payment adjustment policy that limited significant decreases 
in APC payment rates for blood and blood products from the CY 2005 OPPS 
to the CY 2006 OPPS to not more than 5 percent. We applied this 
adjustment to 11 blood and blood product APCs for the CY 2006 OPPS, 
which we identified in Table 33 of the CY 2006 OPPS final rule with 
comment period (70 FR 68687).
    In the CY 2007 OPPS, we established payment rates for blood and 
blood products by using the same simulation methodology described in 
the November 15, 2004 final rule with comment period (69 FR 65816), 
which utilizes hospital-specific actual or simulated CCRs for blood 
cost centers to convert hospital charges for blood and blood products 
to costs. However, we provided a payment transition for those blood 
products for which the difference between their CY 2006 adjusted median 
cost and their CY 2007 simulated median cost was greater than 25 
percent. Specifically, we set the CY 2007 median costs upon which 
payments for blood and blood products are based at the higher of the CY 
2007 unadjusted simulated median cost or 75 percent of the CY 2006 
adjusted median cost on which the CY 2006 payment was based.

B. Payment for Blood and Blood Products

    In the CY 2008 OPPS/ASC proposed rule (72 FR 42766 through 42767), 
we proposed to set the payment rates for blood and blood products for 
CY 2008 at the unadjusted median cost for these products, calculated 
using the hospital-specific simulated blood CCR for each hospital that 
does not have a blood cost center. For the proposed rule, we calculated 
median costs for blood and blood products using claims for services 
furnished on or after January 1, 2006, and before January 1, 2007, 
using the actual or simulated CCRs from the most recently available 
hospital cost reports. The median costs derived from this data process 
were relatively stable compared to the median costs on which payment is 
based for CY 2007. Of the 34 blood and blood products, the proposed 
median costs increased for 24 products and declined for 10 products 
compared to the adjusted medians on which payment is based in CY 2007. 
Products with the largest proposed declines were, like the products 
with the greatest increases, mostly those products with low volume use 
in the hospital outpatient setting. The products whose proposed costs 
declined more than 5 percent account for less than 1 percent of the 
total volume of blood and blood products in the claims used to 
calculate the proposed rates. No product's median cost declined by more 
than 18 percent in the proposed rule data. The products whose proposed 
median costs increased account for 79 percent of the total volume of 
blood and blood products in the claims used to calculate the proposed 
rates.
    As we indicated in the CY 2007 OPPS/ASC final rule with comment 
period (71 FR 68147), we believe that the simulated CCR methodology 
results in accurate reflections of the relative estimated costs of 
these products for hospitals without blood cost centers and, therefore, 
for these products in general. Our 1-year adjustment to the median 
costs for CY 2007, where the median costs for blood and blood products 
decreased by more than 25 percent from the CY 2006 adjusted median 
costs, was intended to provide a reasonable transition to use of the 
simulated median costs for payment of blood and blood products under 
the OPPS without further adjustment. The medians that result from the 
use of the simulated CCR process and the CY 2006 claims available for 
the proposed rule generally result in median costs that we believe 
provide an appropriate basis for the relative weights on which the CY 
2008 payments for blood and blood products would be based. Therefore, 
we proposed to use the median costs derived from the application of 
blood cost center CCRs for those hospitals that have blood cost centers 
or simulated blood cost center CCRs for those hospitals that do not 
have blood cost centers as the basis for the CY 2008 payments for blood 
and blood products, without further adjustment.
    We received several public comments regarding this proposal. A 
summary of the comments and our responses follows.
    Comment: Some commenters supported CMS' proposal to increase the 
APC payment rates for many blood products. One commenter expressed 
support for our methodology of utilizing hospital-specific actual or 
simulated CCRs for blood cost centers to convert hospital charges for 
blood and blood products to costs, noting that this methodology is 
consistent with the principles of a prospective payment system.
    Other commenters, however, stated that the payment rates for many 
blood and blood products do not adequately reflect their acquisition, 
management, and processing costs. They noted that the costs of blood 
and blood products continue to increase due to safety requirements, 
technological advances, and donor recruitment and retention challenges, 
and that the 2-year lag inherent in OPPS ratesetting would not allow 
these costs to be captured.
    In particular, these commenters were concerned that the median unit 
cost published in the proposed rule for the blood product with the 
highest Medicare volume, leukocyte-reduced red blood cells, is less 
than the acquisition cost of the product and would fail to pay 
hospitals for overhead costs (for example, storage, handling, inventory 
management). One commenter referred to data submitted by 1,600 
hospitals in response to a survey of 2004 blood costs that was 
conducted by the Department of Health and Human Services under a 
contract with the American Association of Blood Banks (AABB). According 
to the AABB survey, the proposed CY 2008 payment for leukocyte reduced 
red blood cells is less than what hospitals paid for this product in 
2004.
    Response: The median costs for blood and blood products in this 
final rule with comment period are derived from the CY 2006 hospital 
outpatient claims data and have the benefit of reflecting the reporting 
clarifications that were provided through CMS Program Transmittal 496, 
dated March 4, 2005. This instruction articulated and clarified many 
questions that had been raised by hospitals and others about how 
hospitals should report charges for blood and blood products. CY 2006 
claims are the first OPPS claims that represent a full year of 
hospitals' reporting consistent with our detailed blood billing 
guidelines issued in CY 2005. Thus, we expect that the reporting of 
charges and units for blood and blood products in CY 2006 has improved 
over past years, especially with respect to hospitals' inclusion of all 
charges related to acquisition, processing, and handling of blood and 
blood products as specifically described in each of the relevant HCPCS 
P-code descriptors. As such, we believe that the median costs for blood 
and blood products from the CY 2006 claims data reflect this improved 
reporting of charges and units for these products, particularly with

[[Page 66809]]

regard to the most commonly furnished blood and blood products, such as 
leukocyte-reduced red blood cells. We do not believe it is necessary or 
appropriate to incorporate external data such as the AABB survey into 
our ratesetting process for blood and blood products because in a 
relative weight system, it is the relativity of costs to one another, 
rather than absolute cost, that is most important. External data lack 
relativity to the estimated costs derived from the claims and cost 
report data and generally are not appropriate for determining relative 
weights that result in payment rates.
    Comment: One commenter noted that charges billed under revenue code 
0391 are mapped to the blood bank cost center under cost reporting 
rules and in the revenue code to cost center crosswalk that we use to 
reduce charges to estimated costs. According to the commenter, blood 
transfusion or blood administration services billed under this revenue 
code represent charges for nursing costs to administer the blood 
products, rather than blood bank costs for the products themselves. The 
commenter stated that the CCR used by CMS to calculate median unit 
costs for blood is lowered as a result of revenue code 0391 mapping to 
the blood bank cost center, because charges associated with blood 
administration are included in the divisor for the blood bank CCR. 
Accordingly, the commenter requested that CMS not map charges billed 
under 0391 to the blood bank cost center.
    Response: Revenue code 0391 maps to cost report center 4700, Blood 
Storing, Processing, and Transfusing. Because this cost center includes 
transfusion services in its title, it is appropriate for hospitals to 
report charges under revenue code 0391 for nursing costs to administer 
blood products, as well as for blood storage and processing, and for 
revenue code 0391 to map to this cost center. We do not agree that we 
should change our revenue code to cost center crosswalk.
    After consideration of the public comments received on this 
proposal, we are finalizing, without modification, our proposal to 
establish payment rates for blood and blood products by using the same 
simulation methodology described in the November 15, 2004 final rule 
with comment period (69 FR 65816), which utilizes hospital-specific 
actual or simulated CCRs for blood cost centers to convert hospital 
charges for blood and blood products to costs. We continue to believe 
that using blood-specific CCRs applied to hospital claims data will 
result in payments that more fully reflect hospitals' true costs of 
providing blood and blood products than our general methodology of 
defaulting to the overall hospital CCR when more specific CCRs are 
unavailable.
    Table 45 below reflects the final median unit costs developed using 
the methodology described above and compares the difference between the 
CY 2008 simulated CCR median unit costs and the CY 2007 adjusted 
simulated CCR median unit costs. Of the 34 blood products, median costs 
per unit (calculated using the simulated blood-specific CCR 
methodology) for CY 2008 rise for 19 of them compared to their CY 2007 
adjusted simulated median unit costs. These 19 products account for 
about 77 percent of all units of blood and blood products furnished to 
Medicare beneficiaries in the HOPD as reflected in our CY 2006 claims 
data. The median costs decline for 15 products, which constitute 
approximately 23 percent of all units of blood and blood products 
furnished to Medicare beneficiaries in the HOPD in CY 2006. Unlike in 
previous years, none of the high-volume products experience decreases 
of more than 25 percent. While it is true that more blood and blood 
products experienced a decline compared to CY 2007 adjusted simulated 
median costs using final rule data compared with proposed rule data, 
these changes are relatively minor and consistent with normal 
fluctuations due to CCR changes and inclusion of claims from additional 
providers that are commonly observed for OPPS services when additional 
data are considered for the final rule.
    As has been the case in the past, the low-volume products (which we 
have historically defined as fewer than 1,000 units per year) show the 
most volatility, with medians increasing as much as 84 percent compared 
to CY 2007 adjusted simulated median costs. Overall, of the 11 low-
volume products, 7 products show increases in their median unit costs 
compared to their CY 2007 adjusted simulated median unit costs, and 4 
products show decreases in their median unit costs compared to their CY 
2007 adjusted simulated median unit costs. The 4 low-volume products 
for which the median costs decline compared to their CY 2007 adjusted 
simulated median unit costs represent only 0.18 percent of the total 
units of blood products furnished in the CY 2006 OPPS claims data.
    In summary, we are setting the final payment rates for blood and 
blood products for CY 2008 based on the unadjusted medians for blood 
and blood products (calculated using the simulated blood-specific CCR 
methodology) that are derived from CY 2006 claims data as we have 
described. We are reassured by the relatively stable or slightly 
increasing median costs from CY 2005 to CY 2006 claims data for most 
blood products, a pattern that we believe may reflect more accurate and 
complete hospital reporting and charging practices for these products. 
Consistent with our billing guidelines, hospitals may now be taking 
into consideration all appropriate costs associated with providing 
blood and blood products when charging for those products under the 
OPPS. Unlike in previous years, we do not believe it is necessary to 
provide a transitional payment adjustment. Under this final policy, we 
expect that payments would increase for approximately 77 percent of 
blood and blood product units if patterns of furnishing blood products 
in CY 2008 remain similar to those in CY 2006.

                          Table 45.--CY 2008 Median Costs for Blood and Blood Products
----------------------------------------------------------------------------------------------------------------
                                                                                      CY 2007
                                                                                      Payment
                                                                                  median: Higher
                                                                                    of CY 2007
                                                                                   simulated CCR      CY 2008
            HCPCS code*                    Short descriptor        CY 2008 units    median unit    simulated CCR
                                                                                  cost or 75% of    median unit
                                                                                      CY 2006          cost
                                                                                     adjusted
                                                                                    median unit
                                                                                       cost
----------------------------------------------------------------------------------------------------------------
P9010..............................  Whole blood for transfusion           2,687            $131            $252
P9011..............................  Blood split unit...........             330             136             147
P9012..............................  Cryoprecipitate each unit..           5,811              48              41

[[Page 66810]]

 
P9016..............................  RBC leukocytes reduced.....         624,120             175             183
P9017..............................  Plasma 1 donor frz w/in 8            47,159              70              66
                                      hr.
P9019..............................  Platelets, each unit.......          21,160              59              69
P9020*.............................  Plaelet rich plasma unit...             791             208             359
P9021..............................  Red blood cells unit.......         155,886             129             128
P9022..............................  Washed red blood cells unit           2,473             210             274
P9023*.............................  Frozen plasma, pooled, sd..             376              57              73
P9031..............................  Platelets leukocytes                 18,608              95             106
                                      reduced.
P9032..............................  Platelets, irradiated......          10,940             129             120
P9033..............................  Platelets leukoreduced                4,970             125             138
                                      irrad.
P9034..............................  Platelets, pheresis........           9,858             450             436
P9035..............................  Platelet pheres                      51,624             486             493
                                      leukoreduced.
P9036..............................  Platelet pheresis                     1,437             416             413
                                      irradiated.
P9037..............................  Plate pheres leukoredu               26,026             614             622
                                      irrad.
P9038..............................  RBC irradiated.............           6,091             196             193
P9039..............................  RBC deglycerolized.........             908             356             343
P9040..............................  RBC leukoreduced irradiated          79,642             216             237
P9043*.............................  Plasma protein fract, 5%,                24              51              93
                                      50ml.
P9044..............................  Cryoprecipitate reduced               5,437              82              83
                                      plasma.
P9048*.............................  Plasmaprotein fract, 5%,                624             237             213
                                      250ml.
P9050*.............................  Granulocytes, pheresis unit              13             746           1,371
P9051*.............................  Blood, l/r, cmv-neg........           3,831             156             146
P9052..............................  Platelets, hla-m, l/r, unit           1,723             668             638
P9053..............................  Plt, pher, l/r cmv-neg, irr           1,627             701             678
P9054..............................  Blood, l/r, froz/degly/wash             668             210             216
P9055*.............................  Plt, aph/pher, l/r, cmv-neg             922             395             483
P9056..............................  Blood, l/r, irradiated.....           3,986             143             145
P9057..............................  RBC, frz/deg/wsh, l/r,                  156             493             369
                                      irrad.
P9058..............................  RBC, l/r, cmv-neg, irrad...           3,552             261             260
P9059..............................  Plasma, frz between 8-                3,480              74              77
                                      24hour.
P9060..............................  Fr frz plasma donor                     319              74              52
                                      retested.
----------------------------------------------------------------------------------------------------------------
* Indicates CY 2007 payment at 75 percent of CY 2006 adjusted median cost.

XI. OPPS Payment for Observation Services

A. Observation Services (HCPCS code G0378)

    Observation care is a well-defined set of specific, clinically 
appropriate services that include ongoing short-term treatment, 
assessment, and reassessment before a decision can be made regarding 
whether patients will require further treatment as hospital inpatients 
or if they are able to be discharged from the hospital. Observation 
status is commonly assigned to patients with unexpectedly prolonged 
recovery after surgery and to patients who present to the emergency 
department and who then require a significant period of treatment or 
monitoring before a decision is made concerning their next placement.
    Payment for all observation care under the OPPS was packaged prior 
to CY 2002. Since CY 2002, separate payment of a single unit of an 
observation APC for an episode of observation care has been provided in 
limited circumstances. Effective for services furnished on or after 
April 1, 2002, separate payment for observation was made if the 
beneficiary had chest pain, asthma, or congestive heart failure and met 
additional criteria for diagnostic testing, minimum and maximum limits 
to observation care time, physician care, and documentation in the 
medical record (66 FR 59879). Payment for observation care that did not 
meet these specified criteria was packaged. Between CY 2003 and CY 
2006, several more changes were made to the OPPS policy regarding 
separate payment for observation care, such as: clarification that 
observation is not separately payable when billed with ``T'' status 
procedures on the day of or day before observation care; development of 
specific Level II HCPCS codes for hospital observation care and direct 
admission to observation care; and removal of the initially established 
diagnostic testing requirements for separately payable observation (67 
FR 66794, 69 FR 65828, and 70 FR 68688). Throughout this time period, 
we maintained separate payment for observation care only for the three 
specified medical conditions, and OPPS payment for observation for all 
other clinical conditions remained packaged.
    Since January 1, 2006, hospitals have reported observation services 
based on an hourly unit of care using HCPCS code G0378 (Hospital 
observation services, per hour). This code has a status indicator of 
``Q'' under the CY 2007 OPPS, meaning that the OPPS claims processing 
logic determines whether the observation is packaged or separately 
payable. The OCE's current logic determines whether observation 
services billed under HCPCS code G0378 is separately payable through 
APC 0339 (Observation), or whether payment for observation services 
will be packaged into the payment for other separately payable services 
provided by

[[Page 66811]]

the hospital in the same encounter based on criteria discussed below. 
Also since January 1, 2006, hospitals have reported HCPCS code G0379 
(Direct admission of patient for hospital observation care) for a 
direct admission of a patient to observation care. The OPPS pays 
separately for that direct admission reported under HCPCS code G0379 in 
situations where payment for the actual observation services reported 
under HCPCS G0378 are packaged and where the direct admission meets 
certain other criteria. The OCE logic determines when HCPCS code G0379 
is separately payable under the OPPS.
    For CY 2007, we continued to apply the criteria for separate 
payment for observation care and the coding and payment methodology for 
observation care that were implemented in CY 2006. Observation care is 
reported using HCPCS code G0378 and observation that meets the criteria 
for separate payment maps to APC 0339 (Observation). The current 
criteria for separate payment for observation (APC 0339) are:

A. Diagnosis Requirements

    1. The beneficiary must have one of three medical conditions: 
congestive heart failure (CHF), chest pain, or asthma.
    2. Qualifying ICD-9-CM diagnosis codes must be reported in Form 
Locator (FL) 76, Patient Reason for Visit, or FL 67, principal 
diagnosis, or both in order for the hospital to receive separate 
payment for APC 0339. If a qualifying ICD-9-CM diagnosis code(s) is 
reported in the secondary diagnosis field, but is not reported in 
either the Patient Reason for Visit field (FL 76) or in the principal 
diagnosis field (FL 67), separate payment for APC 0339 is not allowed.

B. Observation Time

    1. Observation time must be documented in the medical record.
    2. A beneficiary's time in observation (and hospital billing) 
begins with the beneficiary's admission to an observation bed.
    3. A beneficiary's time in observation (and hospital billing) ends 
when all clinical or medical interventions have been completed, 
including followup care furnished by hospital staff and physicians that 
may take place after a physician has ordered the patient to be released 
or admitted as an inpatient.
    4. The number of units reported with HCPCS code G0378 must equal or 
exceed 8 hours.

C. Additional Hospital Services

    1. The claim for observation services must include one of the 
following services in addition to the reported observation services. 
The additional services listed below must have a line item date of 
service on the same day or the day before the date reported for 
observation:
     An emergency department visit (APC 0609, 0613, 0614, 0615, 
or 0616); or
     A clinic visit (APC 0604, 0605, 0606, 0607, or 0608); or
     Critical care (APC 0617); or
     Direct admission to observation reported with HCPCS code 
G0379 (APC 0604).
    2. No procedure with a ``T'' status indicator can be reported on 
the same day or day before observation care is provided.

D. Physician Evaluation

    1. The beneficiary must be in the care of a physician during the 
period of observation, as documented in the medical record by 
admission, discharge, and other appropriate progress notes that are 
timed, written, and signed by the physician.
    2. The medical record must include documentation that the physician 
explicitly assessed patient risk to determine that the beneficiary 
would benefit from observation care.
    The CY 2007 list of diagnoses eligible as a criterion for separate 
payment for observation services may be found in Table 44 of the CY 
2007 OPPS/ASC final rule with comment period (71 FR 68152).
    For CY 2007, we made one minor change in payment for direct 
admission to observation. As part of the changes in APC assignments and 
payments for clinic and emergency department visits, low level clinic 
visits were moved from APC 0600 (Low Level Clinic Visits) to APC 0604 
(Level 1 Clinic Visits), with a CY 2007 payment rate of approximately 
$51. Under the circumstances where direct admission to observation is 
separately payable, we finalized our CY 2007 assignment of HCPCS code 
G0379 to APC 0604, consistent with its CY 2006 placement in the APC for 
Low Level Clinic Visits.
    During the APC Panel's August 2006 meeting, the Observation 
Subcommittee made several recommendations regarding observation 
services. The first recommendation was that CMS consider adding syncope 
and dehydration to the list of diagnoses for which observation services 
would qualify for separate payment. Second, the Observation 
Subcommittee recommended that CMS perform claims analyses and present 
data that would allow CMS to consider revising criteria for separately 
payable observation care when certain procedures that are assigned 
status indicator ``T,'' for example, insertion of a bladder catheter or 
laceration repair, are reported on the same claim with an emergency 
department visit and observation care, and all other criteria for 
separate observation payment (for example, qualifying diagnosis code, 
number of hours) are met. The Panel also voted to change the name of 
the Observation Subcommittee to the Observation and Visit Subcommittee, 
based on the Panel's interest in expanding the scope of the 
subcommittee's work.
    In response to the August 2006 APC Panel recommendations and public 
comments on the CY 2007 OPPS/ASC proposed rule, we stated in the CY 
2007 OPPS/ASC final rule with comment period that we intended to 
perform a series of analyses over the upcoming year to explore the 
potential effects of adding syncope and dehydration as qualifying 
diagnoses for separately payable observation care, as well as the 
possibility of allowing separate observation payment for claims for 
observation care that also included specific minor or routine 
procedures that have ``T'' status indicators (71 FR 68150).
    At the March 2007 APC Panel meeting, we discussed with the 
Observation and Visit Subcommittee and the full Panel the results of 
the requested data analyses regarding syncope and dehydration, as well 
as the occurrences of claims for observation care that also include 
specific minor or routine procedures that have ``T'' status indicators. 
With respect to the diagnosis analyses, the data presented to the 
Subcommittee and Panel (consisting of partial year 2006 claims data 
that were less complete than the claims data available for the proposed 
rule) showed that there were 136,977 claims for separately payable 
observation services for the currently eligible conditions of chest 
pain, asthma, and congestive heart failure, with a median cost of $453. 
The frequency of claims for observation services for the diagnoses of 
syncope and dehydration, when all other criteria for separate payment 
of observation services (other than diagnosis) were met, was 46,961 
claims, with a somewhat lower median cost of $416. The effect of adding 
both syncope and dehydration to the current diagnoses eligible for 
separate payment would be to lower the median cost for APC 0339 
slightly to $443, based on the early partial 2006 data presented to the 
Subcommittee and Panel. For the study of ``T'' status procedures in 
relation to observation, we identified relatively few instances (5,162) 
where observation met all of the criteria for separate payment,

[[Page 66812]]

including the current three conditions of CHF, asthma, chest pain, 
except for the presence of a ``T'' status procedure. Of these claims, 
very few had any significant frequency. The most common procedures were 
those relating to heart catheterization, angioplasty procedures, and 
endoscopies. As we have stated in the past, we believe that the 
observation services in these cases may be related to these procedures, 
and we have no way of discerning from our data whether the procedure 
happened before or after the observation services.
    The APC Panel made three recommendations related to these topics. 
First, the Panel recommended that CMS add syncope and dehydration to 
the list of clinical conditions eligible for separate observation 
payment. However, the Panel requested that, if CMS added syncope and 
dehydration to the list of conditions eligible for separate observation 
payment, CMS reexamine the claims data once CMS collects a year of 
observation claims data, including the additional conditions, so the 
Panel could reconsider this recommendation at a future meeting. Second, 
the Panel recommended that CMS continue to evaluate the types of 
diagnostic conditions that might qualify for separate observation 
payment in the future. Third, the Panel recommended that CMS make no 
changes to the criteria for separate observation payment related to the 
performance of ``T'' status procedures.
    We have also taken into consideration the June 2006 IOM Report 
entitled, ``Hospital-Based Emergency Care: At the Breaking Point.'' 
This report encourages hospitals to apply tools to improve the flow of 
patients through emergency departments, especially through the use of 
observation units (clinical decision units). The IOM report also 
recommends that separate OPPS payment be made for all conditions for 
which observation is indicated.
    In the CY 2008 OPPS/ASC proposed rule, we indicated that, in light 
of the broader CY 2008 OPPS proposal to move toward expanded packaging 
of payment for supportive, dependent HOPD services, we were not 
accepting the Panel's recommendation related to adding syncope and 
dehydration to the list of diagnoses eligible for separate payment or 
to consider other clinical conditions for separate payment for 
observation care. Instead, we proposed to package all observation 
services (reported with HCPCS code G0378) as part of the proposed 
changes to packaged services discussed in section II.A.4. of the 
proposed rule. Because we proposed to package payment for all 
observation services, we did not propose to adopt the Panel's 
recommendation to study claims data for separately payable observation 
care (including claims for observation for syncope and dehydration) 
that also include specific minor or routine procedures that have ``T'' 
status indicators. We agreed with the APC Panel and the IOM that there 
is currently no compelling rationale for a different OPPS payment 
approach for observation care for only three specific clinical 
conditions. We recognized that observation care may play an important 
role in the treatment of many Medicare beneficiaries in the HOPD, 
decreasing the need for short inpatient admissions and ensuring safe 
discharges of patients to their homes. Therefore, we stated that we 
believe that the proposed CY 2008 payment policy that would package 
payment for all observation services consistently for Medicare 
beneficiaries regardless of their diagnoses is the most appropriate 
approach in every case of observation care. We stated in the proposed 
rule that the proposed methodology encourages hospital efficiency and 
provides a consistent payment policy that allows hospitals to 
thoughtfully plan for the role of observation services in the emergency 
and postsurgical care of patients with many different clinical 
conditions.
    As discussed in section II.A.4.c. of the CY 2008 OPPS/ASC proposed 
rule (and discussed in the same section of this final rule with comment 
period), observation care is one of seven categories of services for 
which we proposed to make packaged payment in CY 2008. In view of the 
recent rapid growth in HOPD services, we proposed to move toward larger 
payment packages and bundles under the OPPS because we believe that 
packaging creates incentives for providers to furnish services in the 
most efficient way by maximizing their flexibility to manage their 
resources, thereby encouraging cost containment.
    We proposed to package observation care reported with HCPCS code 
G0378 for CY 2008 because of our belief that the facility portion of 
observation care is supportive and ancillary to other primary services 
being furnished in the HOPD. Payment for observation would be made as 
part of the payment for the separately payable independent services 
with which it is billed. We indicated in the CY 2008 OPPS/ASC proposed 
rule that, as part of this proposal, we would change the status 
indicator for HCPCS code G0378 from ``Q'' to ``N.'' Although we would 
discontinue recognizing the criteria for separate payment related to 
hospital visits and qualifying conditions, we indicated that we would 
retain as general reporting requirements the criteria related to 
physician evaluation, documentation and observation beginning and 
ending time because those are more general requirements that help to 
ensure proper reporting of observation on hospital claims. The criteria 
for reporting of observation services under HCPCS code G0378 that we 
proposed to retain are:
A. Observation Time
    1. Observation time must be documented in the medical record.
    2. A beneficiary's time in observation (and hospital billing) 
begins with the beneficiary's admission to an observation bed.
    3. A beneficiary's time in observation (and hospital billing) ends 
when all clinical or medical interventions have been completed, 
including followup care furnished by hospital staff and physicians that 
may take place after a physician has ordered the patient to be released 
or admitted as an inpatient.

B. Physician Evaluation

    1. The beneficiary must be in the care of a physician during the 
period of observation, as documented in the medical record by 
admission, discharge, and other appropriate progress notes that are 
timed, written, and signed by the physician.
    2. The medical record must include documentation that the physician 
explicitly assessed patient risk to determine that the beneficiary 
would benefit from observation care.
    At the September 2007 APC Panel meeting, the Observation and Visit 
Subcommittee and the full Panel recommended that the work of the 
subcommittee continue. After two presentations and robust discussion of 
the proposal to package observation services, the Panel made two 
additional recommendations. First, the Panel recommended that CMS not 
finalize the proposal to implement observation services packaging for 
CY 2008, stating that it would be detrimental for patients receiving 
medically necessary services and would increase costs. The Panel also 
requested that CMS provide specific data on observation in order to 
understand trends and utilization for review at the 2008 winter meeting 
of the Panel. This includes data related to inappropriate reporting or 
overutilization of observation services; frequency and utilization data 
for the three conditions for which observation services are now 
separately payable; association of observation services with emergency 
department and clinic visits; analysis of the frequency of claims for

[[Page 66813]]

observation services compared with the inpatient error rate; and a 
frequency distribution showing length of stay data for observation 
services.
    Second, the Panel recommended that, if CMS finalizes the packaging 
of observation services, CMS should create a composite emergency 
department/clinic and observation APC (or a group of composite APCs) 
that is only paid when both services are provided. The Panel added 
that, if the composite APC is paid, neither the clinic nor emergency 
department visit would be paid separately. Also, coding and service 
requirements currently applicable to separately payable observation 
would remain the same, with the exception that there would be no 
clinical condition restriction on payment for the composite APC and 
payment rates for this composite APC would need to be adjusted based on 
readily available historical data. Finally, the Panel recommended that 
CMS evaluate any potential negative impact that the CY 2008 packaging 
proposal and the component specifically concerning observation would 
have on Medicare beneficiaries. We accept the Panel's request that CMS 
provide the Panel with further data related to observation services at 
the next meeting of the APC Panel.
    After considering the APC Panel presentations, the Panel 
recommendations, and the public comments we received, we will neither 
maintain the current CY 2007 payment methodology for observation 
services nor implement the packaging proposal as proposed. Instead, we 
are accepting the recommendation of the APC Panel and the commenters to 
package observation services and provide payment through a composite 
APC methodology when the specified criteria apply, as discussed in 
detail in section II.A.4.c.(7) of this final rule with comment period. 
We note that this payment methodology will require no changes to the 
reporting practices of hospitals, so there should be no associated 
administrative burden on hospitals. The OCE will determine the payment 
for observation as packaged into a composite APC payment or packaged 
into payment for other separately payable services provided in the 
encounter.
    As discussed earlier in section II.A.4.c.(7) of this final rule 
with comment period, HCPCS code G0378 is assigned a status indicator 
``N,'' meaning that its payment will always be packaged, either into 
one of the two composite APCs or, when the composite criteria are not 
met, into the payment for the major services on the claim. In addition, 
we no longer require a qualifying diagnosis but, for the purposes of 
composite APC payment, will retain all other criteria required in CY 
2007 for separate observation care payment, including: a minimum number 
of 8 hours; a qualifying visit, direct admission to observation care, 
or critical care; and no ``T'' status procedure reported on the day 
before or day of observation services. Additionally, we are retaining 
the general reporting requirements for all observation services. These 
are the requirements related to the physician order and evaluation, 
documentation, and observation beginning and ending times. They are 
more general criteria that ensure the proper reporting of observation 
care on correctly coded hospital claims that reflect the charges 
associated with all hospital resources utilized to provide the reported 
services.
    Comment: Many commenters, as well as the APC Panel, urged CMS to 
consider the inpatient error rate as well as QIO review practices 
before packaging observation services. Many commenters pointed to a 
decrease in inpatient admissions as evidence of the impact of separate 
payment for observation services on the decrease in hospital 
admissions. In addition, several commenters were concerned about 
pressure to bill 1 to 2 day stays as outpatient claims with 
observation, resulting in confusion as to the appropriate billing for 
observation services. For example, one commenter stated that care 
provided during outpatient observation is no different than the care 
and monitoring provided to an inpatient, often because patients in 
observation may be placed in a bed within the inpatient setting. One 
commenter requested that CMS review 1 to 2 day inpatient QIO denials 
for accuracy of observation status utilization and denial 
appropriateness.
    Response: We appreciate the commenters' thoughts regarding the 
impact of our OPPS payment policy to pay separately for observation 
care for three clinical conditions on brief inpatient admissions. We 
continue to believe that observation care is a clinically appropriate 
hospital outpatient service that includes ongoing short-term treatment, 
assessment, and reassessment before a decision can be made regarding 
whether patients will require further treatment as hospital inpatients, 
or if they are able to be discharged from the hospital. We expect that 
Medicare beneficiaries who require an inpatient level of care will be 
admitted to the hospital as inpatients by the physicians who care for 
them. We also believe that our final CY 2008 payment policy to pay for 
extended assessment and management services that involve lengthy 
observation through composite APCs should pay hospitals appropriately 
for the services they provide as they are caring for patients until a 
decision about inpatient admission or safe discharge can be made.
    We will work to further educate hospitals, physicians, and all 
Medicare contractors on appropriate billing for observation services. 
We also will analyze the effects of our final CY 2008 OPPS payment 
policy for observation services over time on patterns of Medicare 
beneficiary inpatient admissions, high level clinic and ED visits, and 
observation care.
    Comment: Several commenters discussed the typical length of 
observation stays as support for separate payment of observation care. 
The stays in the comments ranged from 12 to 16 hours (in reference to 
patients with chest pain) to 23 hours (in reference to patients in 
dedicated observation units versus 2 to 3 day stays for inpatient 
care). The topic was also discussed by the APC Panel, which requested 
that CMS provide a frequency distribution of observation lengths of 
stay at the next APC Panel meeting.
    Response: We have stated in past rules and in the Internet Only 
Manual (IOM) that, ``in only rare and exceptional cases do reasonable 
and necessary outpatient observation services span more than 48 hours. 
In the majority of cases, the decision whether to discharge the patient 
from the hospital * * * or to admit the patient as an inpatient can be 
made in less than 48 hours, usually in less than 24 hours.'' We refer 
readers to the Medicare Claims Processing Manual, Pub. 100-4, Chapter 
4, Section 290.1 for more information. We will conduct a study of 
observation lengths of stay for the next APC Panel meeting. However, 
preliminary analyses of CY 2006 claims for observation show that, of 
all observation claims (packaged and paid separately), 43 percent 
lasted 13 to 24 hours (about 358,600 claims), 37 percent lasted 24 to 
48 hours (about 303,000 claims), and 3 percent lasted more than 48 
hours (about 26,000 claims). Less than 10 percent of claims were for 
observation lasting less than 8 hours, and about 8 percent of claims 
were for stays of 8 to 12 hours. With respect to separately payable 
observation, the numbers were very similar: 45 percent lasted 13 to 24 
hours (133,000 claims), 38 percent lasted 24 to 48 hours (112,000 
claims), and 3 percent lasted more than 48 hours (8,600 claims). The 
mean and median number of hours were the same for packaged

[[Page 66814]]

and separately payable observation services: a mean of 25 hours and a 
median of 22 hours.
    We are concerned about the significant number of beneficiaries who 
are receiving observation services for more than 24 hours, especially 
the 26,000 with stays of more than 48 hours. This finding seems to 
indicate that the latter stays are not as rare and exceptional as we 
have stated they should be in the context of contemporary hospital 
outpatient clinical practice. As we stated earlier in section 
II.A.4.c.(7) of this final rule with comment period, we do not expect 
to see an increase in claims for high level visits as a result of the 
new composite APCs adopted for CY 2008. We also do not expect to see a 
large increase in the number of claims or lengths of stay for 
observation care. Depending on our future claims data, we may choose to 
modify the composite APCs that we are adopting for CY 2008, or to move 
to packaging observation services more broadly into payment for all 
other associated services as we originally proposed, if we see that 
observation care is being provided to many more patients than reflected 
in our current data. Since we first established HCPCS code G0378 as an 
hourly code for hospitals to report observation services beginning in 
CY 2006, in accordance with our reporting instructions, hospitals have 
been asked to report all observation services provided with HCPCS code 
G0378.
    Comment: Several commenters stated that providing care through 
outpatient observation versus inpatient admission saves beneficiary 
inpatient benefit days and decreases beneficiary expenses for the 
inpatient deductible and coinsurance. The APC Panel also recommended 
that we evaluate the effect of packaging on beneficiaries.
    Response: We intend to evaluate the effects of packaging payment 
for services, including observation care, on Medicare beneficiaries, 
but note that it is not clear whether care provided through a hospital 
outpatient observation stay would increase or decrease a beneficiary's 
expenditures in comparison with an inpatient admission. In addition, as 
stated earlier, we do not consider observation services and inpatient 
care to be the same level of care and, therefore, they would not be 
interchangeable and appropriate for the same clinical scenario. Under 
the OPPS, the beneficiary copayment increases as the number and payment 
amount of separately payable services on the claim increase. The OPPS 
beneficiary copayment is 20 to 40 percent, depending on the service 
provided. Therefore, to the extent that the resulting APC payments for 
a specific set of services are less under the packaging approach we 
have adopted for CY 2008, as many commenters have indicated they would 
be, beneficiary copayment could be reduced. Additionally, the length of 
stay may greatly impact beneficiary OPPS copayment as the number of 
diagnostic tests and services provided may increase as the stay 
lengthens. Also, self-administered drugs are excluded from Part B 
payment by statute, whereas payment for those costs would be included 
in an inpatient DRG payment. Therefore, a beneficiary placed in 
observation care for an extended period could have a greater or lesser 
out-of-pocket expense than for an inpatient stay, once all direct 
beneficiary expenses are included.
    In summary, we are adopting our proposal to package payment for 
observation care reported with HCPCS code G0378 for CY 2008, with a 
modification to establish two new composite APCs for extended 
assessment and management. For CY 2008, payment for observation 
services reported with HCPCS code G0378 will remain packaged with 
status indicator ``N.'' We are creating two composite APCs for extended 
assessment and management, of which observation care is a component. In 
addition, we will not require a qualifying diagnosis for composite APC 
payment, but for the purposes of composite APC payment, will retain all 
other criteria, including a minimum number of eight hours; a qualifying 
visit, direct admission, or critical care; and no ``T'' status 
procedure reported on the day before or day of observation services. 
Additionally, we are retaining the general reporting requirements for 
all observation services, whether fully packaged or included in the 
composite APC payment. These are criteria related to the physician 
order and evaluation, documentation, and observation beginning and 
ending times. These are the more general requirements that ensure the 
proper reporting of observation care on correctly coded hospital claims 
that reflect the charges associated with all hospital resources 
utilized to provide the reported services.

B. Direct Admission to Observation (HCPCS code G0379)

    For CY 2007, direct admission to observation (HCPCS code G0379 
(Direct admission of patient for hospital observation care)) is 
assigned to APC 0604 (Level 1 Hospital Clinic Visits) when the criteria 
are met for separate payment. For CY 2008, the proposed median cost of 
APC 0604 was approximately $53. We proposed to continue the current 
coding and payment methodology for direct admission to observation, 
with the exception of the prior requirement that HCPCS code G0379 is 
only eligible for separate payment if observation care reported with 
HCPCS code G0378 does not qualify for separate payment. That 
requirement would no longer be applicable, given our CY 2008 proposal 
to provide packaged payment for all observation care. Hospitals report 
HCPCS code G0379 when a patient is admitted directly to observation 
care after being seen by a physician in the community. Thus, for CY 
2008, we proposed that in order to receive separate payment for a 
direct admission into observation (APC 0604), the claim must show:
    1. Both HCPCS codes G0378 (Hospital observation services, per hr) 
and G0379 (Direct admission of patient for hospital observation care) 
with the same date of service.
    2. That no services with a status indicator ``T'' or ``V'' or 
Critical Care (APC 0617) were provided on the same day of service as 
HCPCS code G0379.
    Even though we proposed to package payment for all observation 
services reported by HCPCS code G0378, we indicated in the proposed 
rule that we believe it is necessary to continue the OCE claims 
processing logic in order to make appropriate payment for direct 
admission.
    We did not receive any public comments specific to our proposed 
payment policy for HCPCS code G0379.
    As explained in section II.A.4.c.(7) of this final rule with 
comment period, payment for direct admission to observation will be 
made either under composite APC 8002 (Level I Prolonged Assessment and 
Management Composite) or under APC 0604. The composite APC will apply, 
regardless of the patient's particular clinical condition, if the hours 
of observation services (HCPCS code G0378) are greater than or equal to 
eight and billed on the same date as HCPCS code G0378 and there is not 
a ``T'' status procedure on the same date or day before the date of 
HCPCS code G0378. If the composite is not applicable, payment for HCPCS 
code G0379 may be made under APC 0604. In general, this would occur 
when the units of observation reported under HCPCS code G0378 are less 
than eight and no services with a status indicator ``T'' or ``V'' or 
Critical Care (APC 0617) were provided on the same day of service as 
HCPCS code G0379. The final median cost of APC 0604 for CY 2008 is 
approximately $53. The criteria for payment of HCPCS code G0379 under

[[Page 66815]]

APC 0604 will be the same as in CY 2007:
    1. Both HCPCS codes G0378 (Hospital observation services, per hr) 
and G0379 (Direct admission of patient for hospital observation care) 
with the same date of service.
    2. No service with a status indicator of ``T'' or ``V'' or Critical 
Care (APC 0617) is provided on the same day of service as HCPCS code 
G0379.
    If either of the above criteria is not met, HCPCS code G0379 will 
be assigned status indicator ``N.''
    Comment: One commenter asked CMS to clarify whether there is a 
discrepancy between language describing observation time in the current 
CY 2007 criteria for separate payment of observation services through 
APC 0339, listed on page 42768 of the CY 2008 OPPS/ASC proposed rule 
(72 FR 42628) and language in the Medicare Claims Processing Manual, 
Pub. 100-4, Chapter 4, Section 290.2.2. The commenter requested 
clarification as to whether a physician order is still required for 
observation.
    Response: The language cited in the CY 2008 OPPS/ASC proposed rule 
and earlier in this section is also located in the Medicare Claims 
Processing Manual, Pub. 100-4, Chapter 4, section 290.4.3 ``Separate 
and Packaged Payment for Observation.'' Sections 290.2.2 and 290.4.3 do 
not conflict, although the language is not identical. Section 290.2.2 
is overarching guidance for the reporting of observation services that 
supports and explains section 290.4.3. In regard to the requirement of 
a physician order, although the words ``physician order'' are not 
written in section 290.4.3, a physician order is clearly contemplated, 
as the language in criterion number 4, Physician Evaluation, states, 
``1. The beneficiary must be in the care of a physician during the 
period of observation, as documented in the medical record by 
admission, discharge, and other appropriate progress notes that are 
timed, written, and signed by the physician. 2. The medical record must 
include documentation that the physician explicitly assessed patient 
risk to determine that the beneficiary would benefit from observation 
care.'' This criterion will be retained under the new payment 
methodology, as we proposed. Additionally, section 290.1 ``Observation 
Services Overview'' explicitly states that ``Observation services are 
only covered when provided by the order of a physician or another 
individual authorized by State licensure law and hospital staff bylaws 
to admit patients to the hospital or to order outpatient services.'' We 
are not removing the physician order requirement. The IOM will be 
revised to reflect the payment changes finalized in this final rule 
with comment period. We will revise all sections for consistency and 
accuracy, but we also remind hospitals that Section 290 of the Claims 
Processing Manual should be read in its totality.
    In summary, CY 2008 payment for HCPCS code G0379, direct admission 
for hospital observation care, will be made either through composite 
APC 8002 (Level I Extended Assessment and Management Composite) or APC 
0604 (Level 1 Hospital Clinic Visits). In cases where the criteria for 
payment under either APC are not met, HCPCS code G0379 is assigned 
status indicator ``N.''

XII. Procedures That Will Be Paid Only as Inpatient Procedures

A. Background

    Section 1833(t)(1)(B)(i) of the Act gives the Secretary broad 
authority to determine the services to be covered and paid for under 
the OPPS. Before implementation of the OPPS in August 2000, Medicare 
paid reasonable costs for services provided in the outpatient 
department. The claims submitted were subject to medical review by the 
fiscal intermediaries to determine the appropriateness of providing 
certain services in the outpatient setting. We did not specify in 
regulations those services that were appropriate to provide only in the 
inpatient setting and that, therefore, should be payable only when 
provided in that setting.
    In the April 7, 2000 final rule with comment period, we identified 
procedures that are typically provided only in an inpatient setting 
and, therefore, would not be paid by Medicare under the OPPS (65 FR 
18455). These procedures comprise what is referred to as the 
``inpatient list.'' The inpatient list specifies those services that 
are only paid when provided in an inpatient setting because of the 
nature of the procedure, the need for at least 24 hours of 
postoperative recovery time or monitoring before the patient can be 
safely discharged, or the underlying physical condition of the patient. 
As we discussed in the April 7, 2000 final rule with comment period (65 
FR 18455) and the November 30, 2001 final rule (66 FR 59856), we may 
use any of the following criteria when reviewing procedures to 
determine whether or not they should be moved from the inpatient list 
and assigned to an APC group for payment under the OPPS:
     Most outpatient departments are equipped to provide the 
services to the Medicare population.
     The simplest procedure described by the code may be 
performed in most outpatient departments.
     The procedure is related to codes that we have already 
removed from the inpatient list.
    In the November 1, 2002 final rule with comment period (67 FR 
66741), we added the following criteria for use in reviewing procedures 
to determine whether they should be removed from the inpatient list and 
assigned to an APC group for payment under the OPPS:
     We have determined that the procedure is being performed 
in numerous hospitals on an outpatient basis; or
     We have determined that the procedure can be appropriately 
and safely performed in an ASC and is on the list of approved ASC 
procedures or has been proposed by us for addition to the ASC list.
    We believe that these additional criteria help us to identify 
procedures that are appropriate for removal from the inpatient list.

B. Changes to the Inpatient List

    For the CY 2008 OPPS, we used the same methodology as described in 
the November 15, 2004 final rule with comment period (69 FR 65835) to 
identify a subset of procedures currently on the inpatient list that 
are being widely performed on an outpatient basis. These procedures 
were then clinically reviewed for possible removal from the inpatient 
list. We solicited input from the APC Panel on the appropriateness of 
removing 14 procedures from the OPPS inpatient list at its March 2007 
meeting. Prior to publishing the CY 2008 OPPS/ASC proposed rule, we 
received one other candidate HCPCS code for removal from the OPPS 
inpatient list based on a recommendation from the public that was 
presented to the APC Panel during its meeting on March 8, 2007. The APC 
Panel recommended that 13 of the 14 procedures that CMS identified for 
possible removal be removed from the OPPS inpatient list. It also 
recommended that CMS obtain additional utilization data about 1 of the 
14 procedures identified for possible removal from the OPPS inpatient 
list, specifically CPT code 64818 (Sympathectomy, lumbar); and for 
another procedure presented for possible removal from the OPPS 
inpatient list by the public, specifically, CPT code 20660 (Application 
of cranial tongs caliper, or stereotactic frame,

[[Page 66816]]

including removal (separate procedure)). The APC Panel requested that 
CMS provide that additional information to the APC Panel at its next 
meeting.
    Therefore, in the CY 2008 OPPS/ASC proposed rule (72 FR 42771), we 
proposed to accept the APC Panel's recommendation to remove the 13 
procedures from the OPPS inpatient list for CY 2008 and to assign them 
to clinically appropriate APCs as shown in Table 56 of the proposed 
rule and republished in this final rule with comment period as Table 
46. In the proposed rule, we indicated that we also are accepting the 
recommendation from the APC Panel to gather additional utilization 
information for CPT codes 20660 and 64818, which we would provide to 
the APC Panel at its next meeting.
    We received several comments in response to our proposal for the CY 
2008 OPPS inpatient list. A summary of the comments and our responses 
follows.
    Comment: A few commenters supported the proposal to remove the 13 
codes listed in Table 56 of the proposed rule from the inpatient list 
for CY 2008. One commenter requested that, for CY 2009, CMS reassess 
the APC assignment for CPT code 61770 (Stereotactic localization, 
including burr hole(s), with insertion of catheter(s) or probe(s) for 
placement of radiation source). The commenter supported the proposed CY 
2008 assignment of CPT code 61770 to APC 0221 (Level II Nerve 
Procedures) but asked CMS to ensure that, as data become available, CMS 
makes appropriate adjustments to the APC assignment for this CPT code.
    Response: We appreciate the commenters' support and will review the 
APC assignment for CPT code 61770, and all other procedures payable 
under the OPPS, when updating the OPPS for CY 2009, in order to 
maintain clinical and resource homogeneity within APCs.
    After consideration of the public comments received, we are 
finalizing our proposal, without modification, to remove 13 procedures 
from the OPPS inpatient list for CY 2008 and to assign them to 
clinically appropriate APCs as shown in Table 46 below. Also, as stated 
earlier, we will present data regarding CPT codes 20660 and 64818 to 
the APC Panel at its winter 2008 meeting. We note that we did not have 
additional new data available for CPT code 20660 for the APC Panel to 
consider at its September 2007 meeting.

  Table 46.--HCPCS Codes for Removal From Inpatient List and Their APC
                         Assignments for CY 2008
 
------------------------------------------------------------------------
    HCPCS code       Long descriptor    CY 2008  APC      CY 2008  SI
------------------------------------------------------------------------
21360.............  Open treatment of            0254  T
                     depressed malar
                     fracture,
                     including
                     zygomatic arch
                     and malar tripod.
21365.............  Open treatment of            0256  T
                     complicated
                     (e.g.,
                     comminuted or
                     involving
                     cranial nerve
                     foramina)
                     fracture(s) of
                     malar area,
                     including
                     zygomatic arch
                     and malar
                     tripod; with
                     internal
                     fixation and
                     multiple
                     surgical
                     approaches.
21385.............  Open treatment of            0256  T
                     orbital floor
                     blowout
                     fracture;
                     transantral
                     approach
                     (Caldwell-Luc
                     type operation).
25931.............  Transmetacarpal              0049  T
                     amputation; re-
                     amputation.
27006.............  Tenotomy,                    0050  T
                     abductors and/or
                     extensor(s) of
                     hip, open
                     (separate
                     procedure).
27720.............  Repair of                    0063  T
                     nonunion or
                     malunion, tibia;
                     without graft,
                     (eg, compression
                     technique).
27722.............  Repair of                    0064  T
                     nonunion or
                     malunion, tibia;
                     with sliding
                     graft.
50580.............  Renal endoscopy              0161  T
                     through
                     nephrotomy or
                     pyelotomy, with
                     or without
                     irrigation,
                     instillation or
                     ureteropyelograp
                     hy, exclusive of
                     radiologic
                     service; with
                     removal of
                     foreign body or
                     calculus.
51535.............  Cystotomy for                0162  T
                     excision,
                     incision, or
                     repair of
                     ureterocele.
58805.............  Drainage of                  0195  T
                     ovarian cyst(s),
                     unilateral or
                     bilateral,
                     (separate
                     procedure);
                     abdominal
                     approach.
60271.............  Thyroidectomy,               0256  T
                     including
                     substernal
                     thyroid;
                     cervical
                     approach.
61770.............  Stereotactic                 0221  T
                     localization,
                     including burr
                     hole(s), with
                     insertion of
                     catheter(s) or
                     probe(s) for
                     placement of
                     radiation source.
69970.............  Removal of tumor,            0256  T
                     temporal bone.
------------------------------------------------------------------------

    Comment: Several commenters submitted recommendations for improving 
the effectiveness of the inpatient list. One commenter stated that 
although CMS believes that the inpatient list is serving a protective 
purpose, the payment policy and the format for the list limit its 
effectiveness. The commenter recommended a number of steps that CMS 
could take to improve the usefulness of the inpatient list. The first 
of these recommendations was for CMS to provide the CPT code long 
descriptors for the procedures on the inpatient list instead of listing 
the procedures' CPT code short descriptors. The commenter stated that 
the short descriptors do not provide enough information for hospital 
staff and physicians to readily determine in a specific clinical case 
whether a planned procedure is, or is not, on the inpatient list. The 
commenter believed that inclusion of the long descriptors would make 
the CMS inpatient list a more useful and readily available tool that 
could be used during outpatient scheduling. Further, the commenter 
believed that easier access to the long descriptors would assist 
hospital staff in scheduling, promote appropriate physician planning, 
and provide time to notify any affected beneficiary of his or her 
liability if an inpatient list procedure is to be performed in the OPD.
    In addition, the commenter recommended that CMS consider developing 
a code that would enable hospitals to indicate to Medicare those cases 
in which the physician failed, or refused, to notify the patient that 
the procedure was on the inpatient list and would not be paid by 
Medicare if performed in the hospital outpatient setting. The commenter 
suggested that the physician could then be held accountable for those 
cases, and Medicare could track physicians who repeatedly chose 
inappropriate admission status for procedures on the inpatient list. 
Further, the commenter recommended that CMS implement financial 
disincentives for physicians' performance of the inpatient list 
procedures in the HOPD through proposed professional payment reductions 
and/or practice audits of physicians who repeatedly perform these 
procedures in inappropriate settings.
    The commenter also recommended that CMS consider expanding the 
ability

[[Page 66817]]

of hospital staff and utilization review committees to overturn 
outpatient status orders when procedures on the inpatient list are 
performed, but the services are either not reported timely by the 
attending physician or are not revised upon notification of the status 
conflict.
    Finally, the commenter recommended that if CMS is not willing to 
refocus the payment policy associated with the inpatient list to 
address physician behavior, it should drop the inpatient list 
altogether because the list presents a financial burden that 
beneficiaries and hospitals are no longer willing to bear on behalf of 
noncompliant and noncooperative physicians.
    A number of other commenters also recommended that CMS discontinue 
use of the inpatient list. They stated that the continuing problem 
associated with the list is that the list is not binding on physicians 
and that, therefore, efforts by hospitals to educate them are useless.
    Response: We appreciate the recommendations for improving the 
effectiveness of the inpatient list. We continue to believe that the 
inpatient list serves an important purpose in identifying those 
procedures that cannot be safely and effectively provided to Medicare 
beneficiaries in the HOPD. We are concerned that elimination of the 
inpatient list could result in unsafe or uncomfortable care for 
Medicare beneficiaries and, therefore, we will not discontinue our use 
of the inpatient list at this time. While we are aware that there are 
ongoing hospital concerns related to inpatient procedures being 
performed inappropriately for beneficiaries who are not inpatients and 
that, as a result, beneficiaries may be liable for the charges for the 
services, among the potential results of eliminating the list are long 
observation stays after some procedures and imposition of OPPS 
copayments that could differ significantly from a beneficiary's 
inpatient cost-sharing responsibilities.
    In addition, we have no current plans to develop coding that would 
permit us to identify cases of the outpatient performance of inpatient 
listed procedures on Medicare beneficiaries because information on such 
occurrences is currently available in our OPPS claims data. Payment for 
physicians' services and monitoring of physicians' practice patterns 
are outside of the scope of this OPPS/ASC final rule with comment 
period. We continue to believe that it is very important for hospitals 
to educate physicians on Medicare services covered under the OPPS to 
avoid inadvertently providing services in a hospital outpatient setting 
that only are covered during an inpatient stay.
    We will explore the feasibility of the commenter's recommendation 
that CMS could assist hospitals in this effort by providing the CPT 
code long descriptors for the inpatient list (Addendum E to this final 
rule with comment period). CMS' use of CPT code short and long 
descriptors is governed by its agreement with the AMA, the owner and 
maintainer of the CPT codeset. If we are able to provide a listing of 
long descriptors for the inpatient list procedures, we will post that 
information to the CMS Web site as soon as it is available. We believe 
that enhanced information regarding specific procedures may foster 
increased understanding by physicians about the status of the inpatient 
list procedures and the payment implications for beneficiaries and 
hospitals when the procedures are performed on beneficiaries who are 
not admitted to the hospital.
    Comment: Several commenters recommended that if CMS does not 
eliminate the inpatient list, it should consider developing an appeals 
process to address those circumstances in which payment for a service 
is denied because it is on the inpatient list. One commenter asserted 
that the process would provide an opportunity for the hospital to 
submit documentation to appeal the denial, such as physician intent, 
patient clinical condition, and the circumstances that allowed the 
patient to be sent home safely without an inpatient admission.
    Response: We appreciate these comments and suggestions. As we 
stated in the immediately preceding response, we continue to believe 
that the inpatient list is a valuable tool that is appropriate for the 
OPPS, and we will not eliminate it at this time. We intend to continue 
to encourage physicians' awareness of the implications for 
beneficiaries of performing the inpatient list procedures on 
beneficiaries who are not inpatients. We do not plan to adopt a 
specific appeals process for claims related to inpatient list 
procedures performed in the HOPD, as recommended by some commenters, at 
this time. However, the existing established processes for a 
beneficiary or provider to appeal a specific claim remain in effect.
    Comment: Two commenters requested that CMS remove certain 
procedures from the inpatient list. One commenter requested that CMS 
remove the following three CPT codes that were proposed for removal 
from the inpatient list in the CY 2008 proposed rule: 25931 
(Transmetacarpal amputation; re-amputation), 27006 (Tenotomy, abductors 
and/or extensor(s) of hip, open (separate procedure), and 27720 (Repair 
of nonunion or malunion, tibia; without graft, (eg, compression 
technique)).
    The other commenter requested that CMS remove the following four 
additional CPT codes from the inpatient list: 20660 (Application of 
cranial tongs, caliper, or stereotactic frame, including removal), 
27886 (Amputation, leg, through tibia and fibula; reamputation), 43420 
(Closure of esophagostomy or fistula; cervical approach) and 50727 
(Revision of urinary-cutaneous anastomosis (any type urostomy)).
    Response: As discussed earlier in this section, we are finalizing 
our proposal to remove CPT codes 25931, 27006, and 27720 from the OPPS 
inpatient list for CY 2008.
    We appreciate the additional recommendations for procedures to be 
removed from the inpatient list. We note that CPT code 20660 was 
discussed at the APC Panel's March 2007 meeting and, in accordance with 
the APC Panel's recommendation, we will provide utilization information 
regarding this service at the APC Panel's winter 2008 meeting for its 
consideration. We will undertake a clinical review of the additional 
procedures requested for removal from the inpatient list for CY 2008. 
However, we will not remove those procedures from the inpatient list 
without obtaining additional input from the APC Panel. We will provide 
appropriate information on CPT codes 27886, 43420, and 50727 to the APC 
for its review of these procedures at the APC Panel's winter 2008 
meeting, along with other procedures that we may identify as candidates 
for proposed removal from the inpatient list for CY 2009.

XIII. Nonrecurring Technical and Policy Changes

A. Outpatient Hospital Services and Supplies Incident to a Physician 
Service

    In the CY 2008 OPPS/ASC proposed rule (72 FR 42771), we proposed to 
make a technical change to Sec.  410.27(a)(1)(iii) and (f) of the 
regulations relating to outpatient hospital services and supplies 
incident to a physician service to remove an outdated reference to 
``designation of a department of a provider'' by CMS and replace it 
with language that conforms to current policy under the provider-based 
rules as stated in Sec.  413.65 of the regulations. We proposed to 
remove from both paragraphs (a)(1)(iii) and (f) the phrase ``at a 
location (other than an RHC or an FQHC) that CMS designates as a 
department of a provider under

[[Page 66818]]

Sec.  413.65 of this chapter'' and replace it with ``at a department of 
a provider, as defined in Sec.  413.65(a)(2) of this subchapter, that 
has provider-based status in relation to a hospital under Sec.  413.65 
of this subchapter.''
    Section 410.27 was codified in the April 7, 2000 OPPS final rule 
with comment period. The provider-based rules at Sec.  413.65 were also 
codified in the April 7, 2000 rule, but were subsequently amended in 
the August 1, 2002 IPPS final rule (67 FR 50078 through 50096 and 50114 
through 50118). The proposed deletion of the reference in Sec.  
410.27(a)(1)(iii) and (f) to CMS ``designating'' a department of a 
provider under Sec.  413.65 would make those sections consistent with 
the 2002 amendments to the provider-based rules, in that under the 
amended provider-based rules, a main provider is no longer required to 
ask CMS to make a determination that a facility or organization is 
provider-based before the main provider can bill for services of the 
facility as if the facility were provider-based, or before the main 
provider can include the costs of those services in its cost report.
    In the proposed rule, we also reminded hospitals of the 
requirements of Sec.  410.27 concerning services and supplies furnished 
incident to a physician's service to hospital outpatients. Section 
410.27 applies to all ``incident to'' services covered under section 
1861(s)(2)(B) of the Act. This provision does not apply to services 
covered under other benefit categories, such as clinical diagnostic 
laboratory services covered under section 1833(h)(1) of the Act or 
diagnostic services covered under section 1861(s)(2)(C) of the Act. 
Section 410.27(a)(1) currently states that Medicare Part B pays for 
hospital services and supplies furnished incident to a physician 
service to outpatients, including drugs and biologicals that cannot be 
self-administered, if they are furnished by or under arrangements made 
by a participating hospital, except in the case of a resident of a 
skilled nursing facility as provided in Sec.  411.15(p); as an integral 
though incidental part of a physician's services; and in the hospital 
or at a location (other than a rural health clinic or a Federally 
qualified health center) that CMS designates as a department of a 
provider under Sec.  413.65.
    As discussed in the CY 2008 OPPS/ASC proposed rule, we recognize 
that hospitals consider a variety of business models in their efforts 
to supply efficient and high quality health care services to Medicare 
beneficiaries and the general public, and we support such efforts to 
the extent that they comply with all applicable laws and regulations, 
including, but not limited to, the Stark law and other anti-kickback 
laws. Recently, we have received an increasing number of questions 
about a number of hypothetical business arrangements between hospitals 
and other entities, including ASCs. We remind hospitals contemplating 
various business models that involve ``incident to'' services provided 
to hospital outpatients to consider the requirements of Sec.  410.27. 
Under Sec.  410.27, ``incident to'' services that are provided to 
hospital outpatients must be furnished in the hospital or at a 
department of a provider as described in more detail earlier in our 
proposed technical update to Sec.  410.27(a)(1)(iii) and (f).
    With regard to the potential for ASCs to provide ``incident to'' 
services under arrangements with HOPDs, in the proposed rule, we noted 
that the provider-based rules set forth at Sec.  413.65 do not apply to 
ASCs. In addition, our longstanding policy codified at Sec.  416.30(f) 
for ASCs operated by hospitals requires that ``the ASC participates and 
is paid only as an ASC, without the option of converting to or being 
paid as a hospital outpatient department, unless CMS determines there 
is good cause to do otherwise.'' In the proposed rule, we indicated 
that we did not believe good cause exists such that a Medicare-
certified ASC would be able to provide ``incident to'' services under 
arrangement to hospital outpatients under Sec.  410.27. Section 410.27 
contains longstanding policy codified in the CY 2000 OPPS final rule 
with comment period and applies to all ``incident to'' services covered 
under section 1861(s)(2)(B) of the Act. While the hypothetical example 
we discussed above involves ASCs providing services under arrangement 
to an HOPD, the provision of Sec.  410.27 applies more broadly to all 
``incident to'' services provided either directly or under arrangements 
made by the hospital with another entity.
    Comment: One commenter generally supported the proposed technical 
change to Sec.  410.27(a)(1)(iii) and (f), but cautioned CMS against 
precluding a hospital's ability to offer the best patient care by 
limiting physician and hospital relationships.
    Response: We appreciate the commenter's support for the proposed 
technical change. We do support hospitals' efforts to develop business 
models that lead to the provision of high quality patient care to the 
extent that these models comply with all applicable laws and 
regulations, including, but not limited to, the Stark law and other 
anti-kickback laws.
    After consideration of the public comment received, we are 
finalizing our CY 2008 proposal, without modification, to remove from 
both paragraphs (a)(1)(iii) and (f) of Sec.  410.27 the phrase ``at a 
location (other than an RHC or an FQHC) that CMS designates as a 
department of a provider under Sec.  413.65 of this chapter.'' In place 
of the deleted phrase, we are inserting the phrase ``at a department of 
a provider, as defined in Sec.  413.65(a)(2) of this subchapter, that 
has provider-based status in relation to a hospital under Sec.  413.65 
of this subchapter.'' This finalized technical change removes an 
outdated reference to ``designation of a department of a provider'' by 
CMS and replaces it with language that conforms to current policy under 
the provider-based rules specified in Sec.  413.65 of the regulations.

B. Interrupted Procedures

    Currently, when a procedure is interrupted after its initiation or 
the administration of anesthesia, hospitals append modifier 74 
(Discontinued outpatient procedure after anesthesia administration) to 
the interrupted procedure, and the full OPPS payment for the procedure 
is made. In addition, when a procedure requiring anesthesia is 
discontinued after the beneficiary is prepared for the procedure and 
taken to the room where the procedure is to be performed, but before 
the administration of anesthesia, hospitals currently append modifier 
73 (Discontinued outpatient procedure prior to anesthesia 
administration) to the discontinued procedure and receive 50-percent of 
the OPPS payment for the planned procedure. Hospitals also report 
modifier 52 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. Under the OPPS, we 
apply a 50-percent reduction to the facility payment for interrupted 
procedures and services reported with modifier 52.
    In the CY 2008 OPPS/ASC proposed rule (72 FR 42772), we proposed to 
amend Sec.  419.44 (Payment reductions for surgical procedures) to more 
accurately reflect the current OPPS payment policy for interrupted 
procedures. First, we proposed to make a technical conforming change to 
the title of Sec.  419.44 by removing the word ``surgical,'' in order 
to encompass all the procedures performed in HOPDs. Second, we proposed 
to change the

[[Page 66819]]

heading of Sec.  419.44(b) from ``Terminated procedures'' to 
``Interrupted procedures.'' We proposed to make further technical 
conforming changes to paragraphs (b)(1) and (b)(2) by removing the 
words ``surgical'' to encompass all the procedures performed in HOPDs. 
Finally, we proposed to add a new paragraph (b)(3) to reflect the 
current policy of the application of a 50-percent reduction to the OPPS 
payment when a hospital reports modifier 52 for interrupted or 
discontinued services that do not require anesthesia.
    Comment: One comment supported our proposed changes to Sec.  
419.44.
    Response: We appreciate the commenter's support of our proposed 
changes.
    After consideration of the public comment received, we are 
finalizing the proposed changes to Sec.  419.44, as described above, 
without modification.

C. Transitional Adjustments--Hold Harmless Provisions

    Section 419.70(d) of the regulations relating to transitional 
adjustments to payments for covered outpatient services furnished by 
small rural hospitals and SCHs located in rural areas contains two 
outdated cross-references to Sec.  412.63(b) (the definition of a 
hospital located in a ``rural area''). Several years ago, we made Sec.  
412.63 applicable from FY 1984 through FY 2004 and established a new 
Sec.  412.64, effective for FY 2005 and subsequent fiscal years, to 
incorporate provisions to reflect our adoption of OMB's revised CBSAs 
as geographic area applicable under Medicare. In the CY 2008 OPPS/ASC 
proposed rule (72 FR 42772), we proposed to make a technical correction 
to the regulations by replacing the cross-reference to Sec.  412.63(b) 
in Sec. Sec.  419.70(d)(1)(i), (d)(2)(i), and (d)(4)(ii) with the more 
current applicable cross-reference to Sec.  412.64(b).
    We did not receive any public comments on our proposal. Therefore, 
we are finalizing the proposed technical correction, without 
modification, for CY 2008.

D. Reporting of Wound Care Services

    Section 1834(k) of the Act, as added by section 4541 of the BBA, 
requires payment under a prospective payment system for all outpatient 
therapy services, that is, physical therapy services, speech-language 
pathology services, and occupational therapy services. As provided 
under section 1834(k)(5) of the Act, we created a therapy code list 
based on a uniform coding system (that is, the HCPCS) to identify and 
track these outpatient therapy services paid under the MPFS. We provide 
this list of therapy codes along with their respective designation in 
the Medicare Claims Processing Manual Pub. 100-04, Chapter 5, section 
20. Two of the designations that we use in that manual denote whether 
the listed therapy code is an ``always therapy'' service or a 
``sometimes therapy'' service. We define an ``always therapy'' service 
as a service that must be performed by a qualified therapist under a 
certified therapy plan of care, and a ``sometimes therapy'' service as 
a service that may be performed by an individual outside of a certified 
therapy plan of care.
    In the CY 2006 OPPS final rule with comment period (70 FR 68617), 
we stated that the following CPT codes were classified as ``sometimes 
therapy'' services that may be appropriately provided under either a 
certified therapy plan of care or without a certified therapy plan of 
care: 97597 (Removal of devitalized tissue from wound(s), selective 
debridement, without anesthesia (e.g., high pressure waterjet with/
without suction, sharp selective debridement with scissors, scalpel and 
forceps) with or without topical application(s) for ongoing care, may 
include use of a whirlpool, per session; total wound(s) surface area 
less than or equal to 20 square centimeters); 97598 (Removal of 
devitalized tissue from wound(s), selective debridement, without 
anesthesia (e.g., high pressure waterjet with/without suction, sharp 
selective debridement with scissors, scalpel and forceps) with or 
without topical application(s) for ongoing care, may include use of a 
whirlpool, per session; total wound(s) surface area greater than 20 
square centimeters); 97602 (Removal of revitalized tissue from 
wound(s), non-selective debridement, without anesthesia (e.g., wet-to-
moist dressings, enzymatic, abrasion) including topical application(s), 
wound assessment, and instruction(s) for ongoing care, per session), 
97605 (Negative pressure wound therapy (e.g., vacuum assisted drainage 
collection), including topical application(s), wound assessment, and 
instruction(s) for ongoing care, per session; total wound(s) surface 
area less than or equal to 50 square centimeters); and 97606 (Negative 
pressure wound therapy (e.g., vacuum assisted drainage collection), 
including topical application(s), wound assessment, and instruction(s) 
for ongoing care, per session; total wound(s) surface area greater than 
50 square centimeters). We further stated that hospitals would receive 
separate payment under the OPPS when they bill for wound care services 
described by CPT codes 97597, 97598, 97602, 97605, and 97606 that are 
furnished to hospital outpatients by individuals independent of a 
therapy plan of care. In contrast, when such services are performed by 
a qualified therapist under a certified therapy plan of care, providers 
should attach an appropriate therapy modifier (that is, GP for physical 
therapy, GO for occupational therapy, and GN for speech language 
pathology) or report their charges under a therapy revenue code (that 
is, 0420, 0430, or 0440), or both, to receive payment under the MPFS. 
The OCE logic assigns these services to the appropriate APC for payment 
under the OPPS if the services are not provided under a certified 
therapy plan of care or directs contractors to the MPFS established 
payment rates if the services are identified on hospital claims with a 
therapy modifier or therapy revenue code as therapy services.
    In the CY 2008 OPPS/ASC proposed rule (72 FR 42772), we proposed to 
revise the list of therapy revenue codes that may be reported with CPT 
codes 97597, 97598, 97602, 97605, and 97606 to designate them as 
services that are performed by a qualified therapist under a certified 
therapy plan of care, and thus payable under the MPFS, to be consistent 
with the current billing practices of hospitals and to ensure that we 
are making separate payment under the OPPS only in appropriate 
situations. We proposed to revise the list of therapy revenue codes for 
reporting these five CPT wound care codes as therapy services to 
include all revenue codes in the 042X series, which incorporates all 
revenue codes that begin with 042, such as 0420, 0421, 0422, 0423, 
0424, and 0429; the 043X series, which includes all revenue codes that 
begin with 043, such as 0430, 0431, 0432, 0434, and 0439; and the 044X 
series, which includes all revenue codes that begin with 044, such as 
0440, 0441, 0442, 0443, 0444, and 0449. Therefore, for CY 2008, we 
proposed that when services reported with CPT codes 97597, 97598, 
97602, 97605, and 97606 are performed by a qualified therapist under a 
certified therapy plan of care, providers should attach an appropriate 
therapy modifier (that is, GP for physical therapy, GO for occupational 
therapy, and GN for speech-language pathology) or report their charge 
under a therapy revenue code (that is, 042X,043X, or 044X), or both, to 
receive payment under the MPFS. Under other circumstances, we proposed 
that hospitals would receive separate payment under the OPPS when they 
bill for wound care services

[[Page 66820]]

described by CPT codes 97597, 97598, 97602, 97605, and 97606 that are 
furnished to hospital outpatients by individuals independent of a 
certified therapy plan of care.
    We received several comments on our proposal to modify the list of 
therapy revenue codes that are reported with certain wound care 
services to signify that those services were provided by a qualified 
therapist under a certified therapy plan of care.
    Comment: Several commenters supported the proposal to modify the 
revenue code list to conform to hospital billing practices. One 
commenter opposed the proposal; the commenter stated that changing CPT 
codes 97597, 97598, 97602, 97605, and 97606 to ``always therapy'' codes 
and revising the list of revenue codes that may be reported with these 
wound care codes would unreasonably restrict the use of the codes to a 
limited group of health care providers, thereby limiting beneficiaries' 
access to care.
    Response: We appreciate the commenters' support for our proposal. 
We believe the commenter who expressed concern about the proposal has 
misunderstood our explanation of the proposal. We did not propose to 
change the five CPT codes for wound care from ``sometimes therapy'' to 
``always therapy'' codes. Hospitals will be paid for these wound care 
codes under either the OPPS or the MPFS in CY 2008, just as they have 
been since CY 2006. When hospital outpatients receive wound care 
services by individuals outside of a certified therapy plan of care, 
the hospital reports the appropriate CPT code and nontherapy revenue 
code and is paid under the OPPS. When these services are provided to 
hospital outpatients by a qualified therapist under a therapy plan of 
care and reported using either one of the appropriate therapy 
modifiers, the therapy revenue code series (42X, 43X, or 44X), or both, 
hospitals are paid based on the MPFS. We proposed to make this minor 
conforming change to make our billing policy consistent with the 
current billing practices of hospitals. Therefore, we do not expect the 
change to affect Medicare beneficiaries' access to wound care services 
provided by hospitals.
    After consideration of the public comments received, we are 
finalizing our CY 2008 proposal, without modification, to pay for 
certain wound care services as therapy services when they are reported 
with any revenue code in the 42X, 43X, or 44X series.

E. Reporting of Cardiac Rehabilitation Services

    Since the initiation of the OPPS, Medicare has paid for cardiac 
rehabilitation services in HOPDs using CPT code 93797 (Physician 
services for outpatient cardiac rehabilitation, without continuous ECG 
monitoring (per session)) and CPT code 93798 (Physician services for 
outpatient cardiac rehabilitation, with continuous ECG monitoring (per 
session)). Both codes are assigned status indicator ``S'' and are 
currently mapped to APC 0095 (Cardiac Rehabilitation) for payment.
    In the CY 2008 OPPS/ASC proposed rule (72 FR 42773), for CY 2008, 
we proposed to discontinue recognizing the current CPT codes for 
cardiac rehabilitation services and to establish two new Level II HCPCS 
codes that we believed would be more appropriate for specifically 
reporting cardiac rehabilitation services under the OPPS. The proposed 
HCPCS codes were: GXXX1 (Physician services for outpatient cardiac 
rehabilitation; without continuous ECG monitoring (per hour)) and GXXX2 
(Physician services for outpatient cardiac rehabilitation; with 
continuous ECG monitoring (per hour)). In contrast with the current CPT 
codes, we indicated that we believed the descriptors of these proposed 
G-codes more specifically reflect the way cardiac rehabilitation 
services are provided in HOPDs so that reporting would be more 
straightforward for hospitals and would result in more accurate data 
for OPPS ratesetting in 2 years. Consistent with the current APC 
assignments of the cardiac rehabilitation CPT codes, we proposed to 
assign these new HCPCS codes to APC 0095 for CY 2008, with a status 
indicator of ``S.'' Accordingly, we proposed to change the status 
indicators for CPT codes 93797 and 93798 from ``S'' to ``B'' to 
indicate that alternative codes (GXXX1 and GXXX2) for cardiac 
rehabilitation services would be recognized for payment under the OPPS.
    At the September 2007 meeting of the APC Panel, after a public 
presentation pertaining to the proposed coding change, the Panel 
recommended that CMS continue to use the existing CPT codes for cardiac 
rehabilitation services (CPT codes 93797 and 93798) and not replace 
them with the proposed per hour HCPCS G-codes, GXXX1 and GXXX2.
    We received many public comments on our CY 2008 proposal to adopt 
two new G-codes, rather than continue to use the two available CPT 
codes, for the reporting of cardiac rehabilitation services under the 
OPPS. A summary of the public comments and our responses follow.
    Comment: Some commenters supported the proposal to use G-codes for 
the reporting of cardiac rehabilitation services under the CY 2008 
OPPS. They believed that this proposed coding change would allow for 
more appropriate coding and payment for cardiac rehabilitation services 
in those cases where intensive programs provide multiple sessions each 
day. The commenters argued that appropriate payment for these programs 
was particularly important because of their success in improving the 
health and health outcomes of patients through secondary prevention. In 
addition, the commenters requested that CMS explicitly state that 
multiple sessions of cardiac rehabilitation can be paid for the same 
date of service when modifier 59 is reported. They also requested that 
CMS crosswalk the payments for both of the proposed G-codes to the 
higher cost CPT code 93798 to ensure that the full range of modalities 
provided in certain intensive cardiac rehabilitation programs are 
available.
    Many commenters opposed the proposed change to G-codes under the 
OPPS for several reasons. First, they stated that the proposed change 
would pose an administrative burden on hospitals, which would have to 
report G-codes on Medicare claims and CPT codes on claims to all other 
payers. Although the commenters asserted that most cardiac 
rehabilitation sessions last for approximately 1 hour, they explained 
that it would be difficult to accurately crosswalk codes reported for 
each hour of service to codes reported for each session, in order to 
ensure that Medicare and other payers were charged the same for like 
services. Second, some commenters argued that CMS would gather no new 
useful data with the reporting of ``per hour'' codes because over 90 
percent of cardiac rehabilitation programs provide sessions lasting 
about 1 hour (specifically 45 minutes to 1\1/2\ hours), and costs from 
historical hospital claims data and payment rates for the ``per 
session'' CPT codes have been stable for years. A few commenters also 
stated that this proposal conflicts with the National Coverage 
Determination (NCD) for cardiac rehabilitation, which describes cardiac 
rehabilitation coverage in terms of sessions. They also stated that the 
proposal does not comport with CMS' CY 2008 proposed packaging approach 
and CMS' stated goal of using CPT codes and CPT coding guidelines.
    Almost all of the commenters, both supporting and opposing the 
proposal,

[[Page 66821]]

were concerned that the use of the term ``physician services'' in the 
G-code descriptors could be misinterpreted by Medicare contractors as 
requiring a physician to directly deliver the care or be in attendance 
during each service episode.
    Some commenters who recommended the adoption of the proposed G-
codes requested that CMS provide additional guidance related to 
reporting of the cardiac rehabilitation G-codes, such as: (1) 
Explaining that it is likely to be reasonable and necessary to cover 72 
cardiac rehab sessions when multiple sessions are provided in one day; 
(2) encouraging contractors to factor the ``proven results'' of a 
program into coverage decisions and that 72 sessions should be 
``presumptively covered'' when they are furnished by a certain 
intensive cardiac rehabilitation program; and (3) providing further 
clarification and expansion of nutritional counseling by registered 
dieticians, indicating that they could independently bill for 
nutritional counseling within cardiac rehabilitation programs using the 
medical nutrition therapy codes because the NCD does not specifically 
mention these services.
    Response: We understand hospitals' concerns related to the 
administrative burden associated with reporting cardiac rehabilitation 
services for Medicare differently from other payers and related to the 
potential reporting confusion that could be caused by moving to G-codes 
for the many hospitals whose program sessions last about 1 hour per 
day. However, we also are aware of several intensive cardiac 
rehabilitation programs that provide multiple sessions in a day, 
lasting several hours total. Current OPPS payment policy would provide 
payment for only one session per day for cardiac rehabilitation. The 
NCD for cardiac rehabilitation currently states that cardiac 
rehabilitation programs are covered for certain categories of patients 
and they must be comprehensive. To be comprehensive, the programs must 
include a medical evaluation, a program to modify cardiac risk factors 
(for example, nutritional counseling), prescribed exercise, education, 
and counseling. The NCD does not distinguish between different 
approaches to the delivery of cardiac rehabilitation services, whether 
the more common practice of two sessions per week or the more intensive 
programs of several sessions per day. We have not been prescriptive 
regarding the precise amount of time that must be spent on each 
component of the program to allow for flexibility and tailoring based 
on patient needs. Regarding intensity, we expect the intensity of 
cardiac rehabilitation programs to vary by patient and by program.
    We believe that it is important that our CY 2008 OPPS payment 
policy provide appropriate payment for cardiac rehabilitation services. 
In order to minimize the administrative burden on hospitals related to 
our proposal but permit accurate reporting and payment for cardiac 
rehabilitation programs that provide more than one session per day, we 
believe that continuing the use of CPT codes 93797 and 93798 and 
allowing hospitals to bill more than one session per day under some 
circumstances would be the most appropriate course. Therefore, for CY 
2008, we will allow hospitals to report more than one unit for a date 
of service if more than one cardiac rehabilitation session lasting at 
least 1 hour each is provided on the same day. We will provide a 
separate APC payment for each reported session.
    We note that the concern of some commenters regarding crosswalking 
of payment for the two proposed ``per hour'' G-codes to CPT code 93798 
is not an issue under the OPPS because we will be continuing to use 
both CPT codes that map to the same clinical APC for payment in CY 
2008. With respect to the commenters' concerns about the use of the 
term ``physician services'' in the proposed G-code descriptors, we note 
that these codes were proposed to be parallel to the descriptors of the 
CPT codes for cardiac rehabilitation sessions that contain the term 
``physician services'' in their descriptors. We are not aware that 
hospitals have problems with Medicare contractors' interpretation of 
the CPT codes, which we will continue to use for CY 2008.
    This approach adopts the recommendation of the APC Panel and many 
commenters, as well as addresses some commenters' concerns about 
payment for appropriate cardiac rehabilitation services. We expect that 
most cardiac rehabilitation programs will continue to provide 
approximately 1 hour long session per date of service. We will monitor 
the trends in our claims data to ensure that reporting of cardiac 
rehabilitation remains consistent with expected patterns of 
utilization. We will provide coding and payment instructions for 
cardiac rehabilitation services in the program instructions 
implementing the January 2008 OPPS update. We will not provide the 
additional coverage-related guidance requested by some commenters, such 
as presumptive coverage and independent billing for registered 
dieticians. These recommendations effectively request changes to the 
NCD and, therefore, are outside of the scope of the OPPS and this final 
rule with comment period.
    After consideration of the public comments received, we are not 
finalizing our proposal to establish two new G-codes for reporting 
cardiac rehabilitation services. Instead, we will continue to use CPT 
codes 93797 and 93798 to report cardiac rehabilitation services under 
the CY 2008 OPPS. CPT codes 93797 and 93798 are assigned to APC 0095 
(Cardiac Rehabilitation), with a CY 2008 median cost of approximately 
$36 and status indicator ``S.'' Beginning in CY 2008, we will allow 
hospitals to report more than one unit of service per day if more than 
one cardiac rehabilitation session lasting at least 1 hour each is 
provided on the same day, but will monitor the claims data to ensure 
that utilization of cardiac rehabilitation services remains 
appropriate.

F. Reporting of Bone Marrow and Stem Cell Processing Services

    The OPPS has historically recognized HCPCS code G0267 (Bone marrow 
or peripheral stem cell harvest, modification or treatment to eliminate 
cell type(s)) for depletion services for hematopoietic progenitor 
cells, instead of the more specific CPT codes that describe these 
services, including CPT codes 38210 (Transplant preparation of 
hematopoietic progenitor cells; specific cell depletion within harvest, 
T-cell depletion); 38211 (Transplant preparation of hematopoietic 
progenitor cells; tumor cell depletion); 38212 (Transplant preparation 
of hematopoietic progenitor cells; red blood cell removal); 38213 
(Transplant preparation of hematopoietic progenitor cells; platelet 
depletion); 38214 (Transplant preparation of hematopoietic progenitor 
cells; plasma (volume) depletion); and 38215 (Transplant preparation of 
hematopoietic progenitor cells; cell concentration in plasma, 
mononuclear, of buffy coat layer). These six CPT codes are currently 
assigned to status indicator ``B,'' while HCPCS code G0267 is assigned 
to APC 0110 (Transfusion) for payment, with a status indicator of 
``S.''
    In the CY 2008 OPPS/ASC proposed rule (72 FR 42774), we proposed to 
discontinue recognizing HCPCS code G0267, assign it status indicator 
``B,'' and recognize the six more specific CPT codes, which we proposed 
to assign to APC 0110 with a status indicator of ``S.'' We also 
proposed to continue to assign the historical claims data for HCPCS 
code G0267 to APC 0110. Historically, under the OPPS, we recognized the 
single G-code rather than the CPT codes

[[Page 66822]]

for the individual transplant cell preparation services because we 
believed that the services would be uncommonly provided to Medicare 
beneficiaries in the outpatient setting and would likely require 
similar resources, so that distinguishing among the services would not 
be necessary to ensure appropriate OPPS payment. Stakeholders have 
brought to our attention that the current hospital resources associated 
with the six different bone marrow and stem cell processing procedures 
described by these CPT codes may vary widely. While we recognize that 
the services currently reported with G0267 under the OPPS are not 
common HOPD procedures, the total volume of these procedures has been 
increasing over the past several years. Therefore, we stated that we 
believe that, by recognizing the six CPT codes for bone marrow and stem 
cell processing services, we would obtain more specific claims data for 
ratesetting that would enable us to pay more appropriately for these 
services in the future. Consistent with our general OPPS practice, we 
proposed to assign the newly recognized CPT codes to the clinical APC 
that is most appropriate based on historical claims data for the 
predecessor HCPCS code until we have more specific hospital resource 
data available to assess the specific CPT codes for possible 
reassignment.
    In addition, in the CY 2008 OPPS/ASC proposed rule (72 FR 42774), 
we proposed to discontinue recognition of HCPCS code G0265 
(Cryopreservation, freezing and storage of cells for therapeutic use) 
and G0266 (Thawing and expansion of frozen cells for therapeutic use), 
currently assigned status indicator ``A'' under the OPPS and paid 
according to the Medicare Clinical Laboratory Fee Schedule (CLFS), by 
assigning them status indicator ``B'' for CY 2008. We proposed to 
recognize, instead, CPT codes 38207 (Transplant preparation of 
hematopoietic progenitor cells; cryopreservation and storage); 38208 
(Transplant preparation of hematopoietic progenitor cells; thawing of 
previously frozen harvest, without washing); and 38209 (Transplant 
preparation of hematopoietic progenitor cells; thawing of previously 
frozen harvest, with washing) for payment under the OPPS. We believed 
these services were similar to blood processing services that are 
currently paid under the OPPS. We proposed to assign CPT codes 38207 
through 38209 to APC 0344 (Level IV Pathology) based on their clinical 
characteristics and resource costs from historical hospital claims data 
for HCPCS codes G0265 and G0266, which would have been assigned to the 
same clinical APC if they were to be paid under the OPPS. Although 
HCPCS codes G0265 and G0266 have not historically been paid under the 
OPPS, we have a small number of HOPD single claims from CY 2006 for 
these two predecessor HCPCS codes (when they were paid off the CLFS), 
respectively, and similar laboratory tissue cryopreservation and 
thawing services also were proposed for assignment to APC 0344 under 
the CY 2008 OPPS. We indicated in the CY 2008 OPPS/ASC proposed rule 
that we believe this proposal would allow us to pay appropriately for 
all of these bone marrow and stem cell processing services and to 
collect more specific hospital resource data.
    At the September 2007 meeting of the APC Panel, following a public 
presentation regarding these bone marrow and stem cell processing 
services, the APC Panel recommended that CMS reevaluate its decision to 
place CPT codes 38210, 38211, 38212, 38213, 38214 and 38215 in APC 0110 
and also to reevaluate its decision to place CPT codes 38207, 38208, 
and 38209 in APC 0344.
    We received several public comments on our proposal to recognize 
the nine CPT codes for bone marrow and stem cell processing services 
under the CY 2008, as well on their proposed APC assignments. A summary 
of the comments and our response follows.
    Comment: Commenters universally supported the proposal to 
discontinue using HCPCS codes G0265, G0266, and G0267) and to recognize 
the nine existing CPT codes for bone marrow and stem cell processing 
services. Several commenters also urged reconsideration of the proposed 
APC assignments of the CPT codes. Some commenters objected to the 
placement of CPT codes 38207 through 38209, for cryopreservation and 
thawing, in APC 0344 because they believed that the bone marrow and 
stem cell cryopreservation and thawing services require much greater 
hospital resources than the preparation of laboratory tissue specimens. 
Instead, they recommended that CMS place these codes in APC 0111 (Blood 
Product Exchange) because the proposed payment rate of approximately 
$777 for that APC would pay an average amount for the services as a 
whole, paying less than the commenters' estimated costs of freezing and 
storing the products based upon their survey data from hospital centers 
that perform bone marrow transplantation services and substantially 
more than their average estimated cost of thawing the material.
    A few commenters also disagreed with the proposed assignments of 
CPT codes 38210 through 38215 to APC 0110. They argued that the APC is 
populated mainly by transfusion procedures that do not resemble the 
bone marrow and stem cell depletion services either from the clinical 
or hospital resource perspective. The commenters also believed that, of 
the few single claims for G0267 that were available for ratesetting, 
most of those claims were for the lower cost depletion services instead 
of the much more uncommon and costly services reported with CPT codes 
38210, for T-cell depletion, and 38211, for tumor cell depletion. Based 
on external cost data they collected from hospital transplant centers 
performing specialized bone marrow and stem cell processing services, 
the commenters presented two options for CPT codes 38210 and 38211: (1) 
Place them in APC 0112 (Apheresis and Stem Cell procedures); or (2) pay 
for them based on the hospital's charges adjusted to cost using the 
hospital's overall CCR, similar to the payment methodology for pass-
through devices. The commenters recommended that the remaining CPT 
codes, 38212 through 38215, be placed in a separate APC as an interim 
step, using the median cost data for the predecessor HCPCS code G0267 
to establish the APC payment rate.
    Response: We appreciate the support of commenters and the APC Panel 
for our proposal to discontinue use of the three G-codes currently used 
to report bone marrow and stem cell processing services and recognize 
CPT codes 38207 through 38215 instead. We agree with the commenters 
that using the most specific CPT codes for reporting these bone marrow 
and stem cell processing services would reduce the administrative 
reporting burden for hospitals and provide more specific claims-based 
costs for future ratesetting. We also accept the APC Panel's 
recommendations to reconsider our proposed placements of these bone 
marrow and stem cell processing codes. We have reviewed available 
claims data in view of the comments, as discussed below.
    After reviewing our claims data available for this final rule with 
comment period, we agree with the commenters that, in order to ensure 
clinical and resource homogeneity, it would be preferable to group CPT 
codes 38207 through 38209 for cryopreservation, thawing, and washing 
procedures with other services that involve the handling of blood 
products, rather than to APC 0344, where most procedures involve the 
processing of

[[Page 66823]]

tissue specimens for laboratory analysis. However, we disagree with the 
commenters that APC 0111, with a median cost of approximately $724 for 
apheresis and autologous progenitor cell harvesting services, is an 
appropriate assignment. We do not believe that CPT codes 38207 through 
38209 are clinically similar to apheresis services. We note that the 
limited claims data we have for the predecessor codes, specifically 
HCPCS codes G0265 and G0266, reveal median costs of approximately $118 
and $244 based on 23 and 548 single claims, respectively. Even though 
these services were previously paid in the HOPD through the CLFS, CY 
2006 claims data are available for OPPS ratesetting. Instead, we 
believe that CPT codes 38207 through 38209 should be assigned, along 
with other procedures involving blood products, to APC 0110 with a 
status indicator of ``S'' and an APC median cost of approximately $214. 
This is consistent with the historical hospital costs for the 
cryopreservation and thawing services as reported under the G-codes.
    Additionally, we are assigning CPT codes 38210 through 38215, 
reported for bone marrow and stem cell depletion services, to APC 0393 
with other services that involve red blood cells and plasma. We are 
renaming APC 0393 ``Hematologic Processing and Studies'' so that the 
title more accurately describes all the services assigned to the APC. 
We are maintaining a status indicator of ``S.'' for APC 0393. The 
median cost of APC 0393 is approximately $358, the same median cost as 
HCPCS code G0267, the predecessor code recognized under the OPPS. We 
agree with the commenters that, based on our proposed assignment of the 
depletion services to APC 0110 according to the data for their 
predecessor code, while there was no violation of the 2 times rule, 
HCPCS code G0267 had a high median cost compared to the proposed median 
cost of approximately $220 for that APC. Our reassignment of CPT codes 
38210 through 38215 to APC 0393 will pay appropriately for these CPT 
codes while we collect more specific data on their individual resource 
costs.
    We do not agree with the commenters that the two specific services 
for T-cell or tumor depletion, which that they believe are particularly 
costly, would be appropriately paid through APC 0112, which contains 
procedures for extracorporeal adsorption of cells during apheresis and 
reinfusion into the patient. Furthermore, we believe that a cost-based 
methodology for payment of these procedures would not be consistent 
with the principles of a prospective payment system that provides 
prospectively established payment for services. The cost-based payment 
methodology is statutorily required for payment of pass-through 
devices. As we stated in the proposed rule, it is consistent with our 
general practice under the OPPS to make payment based on historical 
claims data for the predecessor HCPCS code until we have more specific 
hospital resource data available to assess the specific CPT codes for 
possible reassignment.
    After consideration of the public comments received and the 
recommendations of the APC Panel, we are finalizing our proposal, 
without modification, to discontinue use of HCPCS codes G0265, G0266, 
and G0267 and recognize CPT codes 38207 through 38215 to report bone 
marrow and stem cell processing services under the OPPS. However, we 
are not finalizing the APC assignments of these services as proposed. 
Instead, we are assigning CPT codes 38207, 38208 and 38209 for 
cryopreserving, thawing and washing bone marrow and stem cells to APC 
0110, with a median cost of approximately $214 and a status indicator 
of ``S.'' In addition, we are assigning CPT codes 38210 through 38215, 
reported for depletion services of bone marrow and stem cells, to APC 
0393, which is renamed ``Hematologic Processing and Studies,'' with a 
median cost of approximately $358 and a status indicator of ``S.''

G. Reporting of Alcohol and/or Substance Abuse Assessment and 
Intervention Services

    For CY 2008, the CPT Editorial Panel has created two new Category I 
CPT codes for reporting alcohol and/or substance abuse screening. They 
are CPT code 99408 (Alcohol and/or substance (other than tobacco) abuse 
structured screening (e.g., AUDIT, DAST), and brief intervention (SBI) 
services; 15 to 30 minutes); and CPT code 99409 (Alcohol and/or 
substance (other than tobacco) abuse structured screening (e.g., AUDIT, 
DAST), and brief intervention (SBI) services; greater than 30 minutes).
    The code descriptions for these CPT codes suggest that these CPT 
codes may describe services that include screening services. For 
Medicare purposes, screening services are typically considered to be 
provided to beneficiaries in the absence of signs or symptoms of 
illness or injury; therefore, to the extent that services described by 
these two CPT codes have a screening element, the screening component 
would not meet the statutory requirements for coverage under section 
1862(a)(1)(A) of the Act. Screening services are not covered by 
Medicare without specific statutory authority, such as has been 
provided for mammography, diabetes, and colorectal cancer screening. 
Accordingly, we will not recognize these CPT codes that incorporate 
screening for payment under the OPPS.
    Therefore, for CY 2008, we have created two parallel G-codes to 
allow for appropriate Medicare reporting and payment for alcohol and 
substance abuse assessment and intervention services that are not 
provided as screening services, but that are performed in the context 
of the diagnosis or treatment of illness or injury. The codes are HCPCS 
code G0396 (Alcohol and/or substance (other than tobacco) abuse 
structured assessment (e.g., AUDIT, DAST) and brief intervention, 15 to 
30 minutes); and HCPCS code G0397 (Alcohol and/or substance (other than 
tobacco) abuse structured assessment (e.g,. AUDIT, DAST) and 
intervention, greater than 30 minutes). We will instruct Medicare 
contractors to pay for these codes only when considered reasonable and 
necessary. We will also provide coding and payment instructions for 
these assessment and intervention services in the program instructions 
implementing the January 2008 OPPS update.
    CPT codes 99408 and 99409 are assigned status indicator ``E'' for 
CY 2008 on an interim final basis under the OPPS, meaning that they 
will not be recognized for payment under the OPPS or any other Medicare 
payment system. HCPCS codes G0396 and G0397 are assigned status 
indicator ``S.'' They are assigned, on an interim final basis, with 
other health and behavioral assessment and intervention services to APC 
0432 (Health and Behavioral Services). We believe that HCPCS codes 
G0396 and G0397 share significant clinical and resources 
characteristics with other services also assigned to APC 0432 for CY 
2008, thereby ensuring the clinical and resource homogeneity of the 
APC. The final CY 2008 median cost of APC 0432 is approximately $20. 
Because these CPT and Level II HCPCS codes were not available for the 
CY 2008 OPPS/ASC proposed rule, we have flagged them with comment 
indicator ``NI'' in Addendum B of this OPPS final rule with comment 
period to signify that their interim payment status is subject to 
public comment following publication of the final rule that implements 
the annual OPPS update.

[[Page 66824]]

XIV. OPPS Payment Status and Comment Indicators

A. Payment Status Indicator Definitions

    The OPPS payment status indicators (SIs) that we assign to HCPCS 
codes and APCs play an important role in determining payment for 
services under the OPPS. They indicate whether a service represented by 
a HCPCS code is payable under the OPPS or another payment system and 
also whether particular OPPS policies apply to the code. Our final CY 
2008 status indicator assignments for APCs and HCPCS codes are shown in 
Addendum A and Addendum B, respectively, to this final rule with 
comment period. As we proposed in the CY 2008 OPPS/ASC proposed rule, 
in this final rule with comment period we are using the status 
indicators and definitions that are listed in Addendum D1, which we 
discuss below in greater detail.
1. Payment Status Indicators To Designate Services That Are Paid Under 
the OPPS

------------------------------------------------------------------------
      Indicator           Item/code/service        OPPS payment status
------------------------------------------------------------------------
G...................  Pass-Through Drugs and    (1) Paid under OPPS;
                       Biologicals.              separate APC payment.
H...................  Pass-Through Device       Separate cost-based pass-
                       Categories.               through payment; not
                                                 subject to copayment.
K...................  (1) Non-Pass-Through      (1) Paid under OPPS;
                       Drugs and Biologicals.    separate APC payment.
                      (2) Therapeutic           (2) Paid under OPPS;
                       Radiopharmaceuticals.     separate APC payment.
                      (3) Brachytherapy         (3) Paid under OPPS;
                       Sources.                  separate APC payment.
                      (4) Blood and Blood       (4) Paid under OPPS;
                       Products.                 separate APC payment.
N...................  Items and Services        Paid under OPPS; payment
                       Packaged into APC Rates.  is packaged into
                                                 payment for other
                                                 services, including
                                                 outliers. Therefore,
                                                 there is no separate
                                                 APC payment.
P...................  Partial Hospitalization.  Paid under OPPS; per
                                                 diem APC payment.
Q...................  Packaged Services         Paid under OPPS;
                       Subject to Separate       Addendum B displays APC
                       Payment under OPPS        assignments when
                       Payment Criteria.         services are separately
                                                 payable.
                                                (1) Separate APC payment
                                                 based on OPPS payment
                                                 criteria.
                                                (2) If criteria are not
                                                 met, payment is
                                                 packaged into payment
                                                 for other services,
                                                 including outliers.
                                                 Therefore, there is no
                                                 separate APC payment.
S...................  Significant Procedure,    Paid under OPPS;
                       Not Discounted when       separate APC payment.
                       Multiple.
T...................  Significant Procedure,    Paid under OPPS;
                       Multiple Reduction        separate APC payment.
                       Applies.
V...................  Clinic or Emergency       Paid under OPPS;
                       Department Visit.         separate APC payment.
X...................  Ancillary Services......  Paid under OPPS;
                                                 separate APC payment.
------------------------------------------------------------------------

    As discussed in section VII.A. of the proposed rule and this final 
rule with comment period, subsequent to the publication of the CY 2007 
OPPS/ASC final rule with comment period, section 107(a) of the MIEA-
TRHCA extended the payment period for brachytherapy sources paid under 
the OPPS based on a hospital's charges adjusted to cost under section 
1833(t)(16)(C) of the Act for one additional year. This requirement for 
cost-based payment ends after December 31, 2007. Therefore, we 
continued the OPPS cost-based payment for brachytherapy sources through 
CY 2007, and are using status indicator ``H'' during CY 2007 to 
designate non-pass-through brachytherapy sources paid on a cost basis.
    However, as discussed in detail in section VII.A. of this final 
rule with comment period, we are implementing prospective payment for 
brachytherapy sources paid under the OPPS in CY 2008. In accordance 
with this final policy, as proposed we also are discontinuing our use 
of payment status indicator ``H'' for APCs assigned to brachytherapy 
sources. As indicated in section VII.A. of this final rule with comment 
period, for CY 2008 we are using payment status indicator ``K'' to 
designate all brachytherapy source APCs that will be paid under the 
OPPS.
    As discussed in detail in section V.B.3.a.(4)(c) of this final rule 
with comment period, we are implementing prospective payment for 
therapeutic radiopharmaceuticals separately paid under the OPPS in CY 
2008. In accordance with this final policy, as proposed, we also are 
discontinuing our use of payment status indicator ``H'' for APCs 
assigned to therapeutic radiopharmaceuticals. Similar to the 
identification of other non-pass-through drugs and biologicals, for CY 
2008, we are using payment status indicator ``K'' to designate all 
therapeutic radiopharmaceutical APCs that will be paid under the OPPS.
    We received several public comments regarding the appropriateness 
of the status indicator assignments for specific HCPCS codes that are 
discussed in the sections of this final rule with comment period that 
are specific to those topics. There were also recommendations about 
specific payment policies for certain items and services and 
recommended status indicators that are discussed elsewhere in this 
final rule with comment period.
    Comment: One commenter believed that composite APCs differ 
significantly from the conditional packaging methodology for special 
packaged codes, where CMS provides a payment for a service only if 
there is no other service on the claim for the same date with status 
indicator ``X,'' ``V,'' ``S,'' or ``T.'' The commenter believed that 
CMS should assign a status indicator other than ``Q'' to services that 
may be subject to a composite APC methodology, where the service would 
be paid through the composite APC payment for two or more services on 
the same date.
    Response: We appreciate the commenter's interest in refining the 
use of status indicator ``Q'' under the OPPS. However, we are adopting 
our proposal, without modification, to identify HCPCS codes that are 
members of composite APCs with status indicator ``Q'' for CY 2008, 
because we believe the definition of this status indicator 
appropriately describes the payment policy for these codes as well as 
special packaged codes, specifically that separate payment is only made 
if certain criteria are met. As we continue to explore the 
possibilities of greater packaging and encounter- and episode-based 
payment under the OPPS, we will consider how to further refine the OPPS 
status indicators to provide the most relevant information concerning 
payment of OPPS services.
    After considering the public comments received concerning the 
proposed use of status indicators for services that are paid under the 
OPPS, we are adopting as final, without

[[Page 66825]]

modification, the status indicators for payable OPPS services for CY 
2008 as displayed in the table above.
2. Payment Status Indicators To Designate Services That Are Paid Under 
a Payment System Other Than the OPPS

 
------------------------------------------------------------------------
      Indicator           Item/code/service        OPPS payment status
------------------------------------------------------------------------
A...................  Services furnished to a   Not paid under OPPS.
                       hospital outpatient       Paid by fiscal
                       that are paid under a     intermediaries/MACs
                       fee schedule or payment   under a fee schedule or
                       system other than OPPS,   payment system other
                       for example:              than OPPS.
                          Ambulance
                          Services.
                          Clinical      Not subject to
                          Diagnostic             deductible or
                          Laboratory Services.   coinsurance.
                          Non-
                          Implantable
                          Prosthetic and
                          Orthotic Devices.
                          EPO for ESRD
                          Patients.
                          Physical,
                          Occupational, and
                          Speech Therapy.
                          Routine
                          Dialysis Services
                          for ESRD Patients
                          Provided in a
                          Certified Dialysis
                          Unit of a Hospital.
                          Diagnostic
                          Mammography.
                          Screening     Not subject to
                          Mammography.           deductible.
C...................  Inpatient Procedures....  Not paid under OPPS.
                                                 Admit patient. Bill as
                                                 inpatient.
F...................  Corneal Tissue            Not paid under OPPS.
                       Acquisition; Certain      Paid at reasonable
                       CRNA Services; and        cost.
                       Hepatitis B Vaccines.
L...................  Influenza Vaccine;        Not paid under OPPS.
                       Pneumococcal Pneumonia    Paid at reasonable
                       Vaccine.                  cost; not subject to
                                                 deductible or
                                                 coinsurance.
M...................  Items and Services Not    Not paid under OPPS.
                       Billable to the Fiscal
                       Intermediary/MAC.
Y...................  Non-Implantable Durable   Not paid under OPPS. All
                       Medical Equipment.        institutional providers
                                                 other than home health
                                                 agencies bill to DMERC.
------------------------------------------------------------------------

    We did not receive any public comments regarding the status 
indicators to designate services paid under a payment system other than 
the OPPS. Therefore, we are finalizing our CY 2008 proposal, without 
modification. The final status indicators are displayed in the table 
above.
3. Payment Status Indicators To Designate Services That Are Not 
Recognized Under the OPPS But That May Be Recognized by Other 
Institutional Providers

 
------------------------------------------------------------------------
      Indicator           Item/code/service        OPPS payment status
------------------------------------------------------------------------
B...................  Codes that are not        Not paid under OPPS.
                       recognized by OPPS when
                       submitted on an
                       outpatient hospital
                       Part B bill type (12x
                       and13x).
                                                 May be paid by
                                                 intermediaries/MACs
                                                 when submitted on a
                                                 different bill type,
                                                 for example, 75x
                                                 (CORF), but not paid
                                                 under OPPS.
                                                 An alternate
                                                 code that is recognized
                                                 by OPPS when submitted
                                                 on an outpatient
                                                 hospital Part B bill
                                                 type (12x and 13x) may
                                                 be available.
------------------------------------------------------------------------

    We did not receive any public comments regarding the status 
indicators to designate services that are not recognized under the OPPS 
but that may be recognized by other institutional providers. Therefore, 
we are finalizing our CY 2008 proposal, without modification. The final 
status indicators are displayed in the table above.
4. Payment Status Indicators to Designate Services That Are Not Payable 
by Medicare

 
------------------------------------------------------------------------
      Indicator           Item/code/service        OPPS payment status
------------------------------------------------------------------------
D...................  Discontinued Codes......  Not paid under OPPS or
                                                 any other Medicare
                                                 payment system.
E...................  Items, Codes, and         Not paid under OPPS or
                       Services:                 any other Medicare
                                                 payment system.
                          That are not
                          covered by Medicare
                          based on statutory
                          exclusion.
                          That are not
                          covered by Medicare
                          for reasons other
                          than statutory
                          exclusion.
                          That are not
                          recognized by
                          Medicare but for
                          which an alternate
                          code for the same
                          item or service may
                          be available.
                          For which
                          separate payment is
                          not provided by
                          Medicare.
------------------------------------------------------------------------


[[Page 66826]]

    We did not receive any public comments regarding the status 
indicators to designate services that are not payable by Medicare. 
Therefore, we are finalizing our CY 2008 proposal, without 
modification. The final status indicators are displayed in the table 
above.
    To address providers' broader interests and to make the published 
Addendum B more convenient for public use, we are displaying in 
Addendum B to this final rule with comment period all active HCPCS 
codes for CY 2008 and currently active HCPCS codes that will be 
discontinued at the end of CY 2007 that describe items or services that 
are: (1) Payable under the OPPS; (2) paid under a payment system other 
than the OPPS; (3) not recognized under the OPPS but that may be 
recognized by other institutional providers; and (4) not payable by 
Medicare. The universe of CY 2008 status indicators that we proposed 
for these items and services and are adopting as final without 
modification in this final rule with comment period are listed in the 
tables above.
    A complete listing of HCPCS codes with payment status indicators 
and APC assignments for CY 2008 is also available electronically on the 
CMS Web site at http://www.cms.hhs.gov/HospitalOutpatientPPS/HORD/
list.asp#TopOfPage.

B. Comment Indicator Definitions

    In the November 15, 2004 final rule with comment period (69 FR 
65827 and 65828), we made final our policy to use two comment 
indicators to identify in an OPPS final rule the assignment status of a 
specific HCPCS code to an APC and the timeframe when comments on the 
HCPCS APC assignment would be accepted. These two comment indicators 
are listed below.
     ``NF''--New code, final APC assignment; Comments were 
accepted on a proposed APC assignment in the Proposed Rule; APC 
assignment is no longer open to comment.
     ``NI''--New code, interim APC assignment; Comments will be 
accepted on the interim APC assignment for the new code.
    In the November 10, 2005 final rule with comment period (70 FR 
68702 and 68703), we adopted a new comment indicator:
     ``CH''--Active HCPCS codes in current and next calendar 
year; status indicator and/or APC assignment have changed or active 
HCPCS code that will be discontinued at the end of the current calendar 
year.
    We implemented comment indicator ``CH'' to designate a change in 
payment status indicator and/or APC assignment for HCPCS codes in 
Addendum B of the CY 2006 final rule with comment period. We also 
stated that codes flagged with the ``CH'' indicator in that final rule 
would not be open to comment because the changes generally were 
previously subject to comment during the proposed rule comment period. 
In the CY 2008 OPPS/ASC proposed rule, for CY 2008, we proposed to 
continue that policy which we are now adopting in this CY 2008 OPPS/ASC 
final rule with comment period. When used in this OPPS/ASC final rule 
with comment period, the ``CH'' indicator is only intended to 
facilitate the public's review of changes made from one calendar year 
to another.
    Only HCPCS codes with comment indicator ``NI'' in this CY 2008 
OPPS/ASC final rule with comment period are subject to comment during 
the comment period for this final rule with comment period.
    We are using the ``CH'' indicator in this final rule with comment 
period to call attention to changes in the payment status indicator 
and/or APC assignment for HCPCS codes for CY 2008 compared to their 
assignment as of December 31, 2007 and to identify HCPCS codes that 
will be discontinued at the end of CY 2007. The use of the comment 
indicator ``CH'' in association with a composite APC in this final rule 
with comment period indicates that the configuration of the composite 
APC is changed from CY 2007. We believe that using the ``CH'' indicator 
in this final rule with comment period will facilitate the public's 
review of the changes that we are making final for CY 2008.
    As we proposed, we are terminating comment indicator ``NF'' because 
we believe its use is not relevant in the final rule.
    We did not receive any public comments regarding the CY 2008 
proposed OPPS comment indicators. Therefore, we are finalizing our 
proposed use of comment indicators for the CY 2008 OPPS/ASC final rule 
with comment period, without modification. The two comment indicators, 
``NI'' and ``CH,'' that are finalized for continued use in CY 2008 and 
their definitions are listed in Addendum D2 to this final rule with 
comment period.

XV. OPPS Policy and Payment Recommendations

A. MedPAC Recommendations

    MedPAC is an independent Federal commission established under 
section 1805 of the Act to advise the U.S. Congress on issues affecting 
the Medicare program. As required under the statute, MedPAC submits 
reports to Congress in March and June of each year that present its 
payment policy recommendations. The March 2007 MedPAC report, ``Report 
to the Congress: Medicare Payment Policy,'' included the following 
recommendation relating specifically to the hospital OPPS:
    Recommendation 2A-1: The Congress should increase payment rates for 
the * * * outpatient prospective payment system in 2008 by the 
projected rate-of-increase in the hospital market basket index, 
concurrent with the implementation of a quality incentive payment 
program.
    CMS Response: As proposed in the CY 2008 OPPS/ASC proposed rule, in 
this final rule with comment period, we are increasing the payment 
rates for the CY 2008 OPPS by the projected rate-of-increase in the 
hospital market basket index (as discussed in section II.C. of this 
final rule with comment period). We are also implementing, effective 
for CY 2009, the reduction in the annual update factor by 2.0 
percentage points for hospitals that are defined under section 
1886(d)(1)(B) of the Act and that do not meet the hospital outpatient 
quality data reporting required by section 1833(t)(17) of the Act, as 
added by section 109(a) of the MIEA-TRHCA. Our adoption and 
implementation of hospital quality measure reporting for the CY 2008 
OPPS are discussed in detail in section XVII. of this final rule with 
comment period.
    In its June 2007 ``Report to the Congress: Promoting Greater 
Efficiency in Medicare,'' MedPAC did not make any recommendations 
specific to the OPPS for CY 2008. As noted in the FY 2008 IPPS final 
rule with comment period (72 FR 47344), the June 2007 MedPAC report 
includes analysis and recommendations on alternatives to the method to 
compute the IPPS wage index for FY 2009. (See chapter 6 of the June 
2007 MedPAC report to Congress.) Under our current policy, we adopt the 
same wage index for the OPPS as the IPPS, and, therefore, such analysis 
and recommendations may have possible implications for the CY 2009 
OPPS. As indicated in the FY 2008 IPPS final rule with comment period 
(72 FR 47344), we will consider MedPAC's recommendations and analysis 
in making a proposal (or proposals) to revise the IPPS wage index in 
the FY 2009 IPPS proposed rule, as required by section 106(b)(2) of the 
MIEA-TRHCA. The full report can be downloaded from MedPAC's Web site 
at: http://www.medpac.gov/document/Jun07_EntireReport.pdf.

[[Page 66827]]

    MedPAC submitted comments to CMS on the CY 2008 OPPS/ASC proposed 
rule. We have responded to these comments in each relevant section of 
this final rule with comment period.

B. APC Panel Recommendations

    Recommendations made by the APC Panel at its March 2007 meeting are 
discussed in sections of this final rule with comment period that 
correspond to topics addressed by the APC Panel. The report and 
recommendations from the APC Panel's March 7-8, 2007 meeting are 
available on the CMS Web site at: http://www.cms.hhs.gov/FACA/05--
AdvisoryPanelonAmbulatoryPaymentClassificationGroups.asp.
    Recommendations made by the APC Panel at its September 2007 
meeting, when it met to discuss the CY 2008 OPPS/ASC proposed rule and 
to hear testimony from concerned members of the public, are also 
discussed in sections of this final rule with comment period that 
correspond to topics addressed by the APC Panel. The report and 
recommendations of the APC Panel's September 5-6, 2007 meeting are also 
available on the CMS Web site at: http://www.cms.hhs.gov/FACA/05--
AdvisoryPanelonAmbulatoryPaymentClassificationGroups.asp.

XVI. Update of the Revised Ambulatory Surgical Center Payment System

A. Legislative and Regulatory Authority for the ASC Payment System

    Section 1832(a)(2)(F)(i) of the Act provides that benefits under 
the Medicare Part B include payment for facility services furnished in 
connection with surgical procedures specified by the Secretary that are 
performed in an 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.
    To establish the reasonable estimated allowances for ASC facility 
services, section 1833(i)(2)(A)(i) of the Act required us to take into 
account the audited costs incurred by ASCs to perform a procedure, in 
accordance with a survey. 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 141(b) of the Social Security Act Amendments of 1994, Pub. 
L. 103-432, requires us to establish a process for reviewing the 
appropriateness of the payment amount provided under section 
1833(i)(2)(A)(iii) of the Act for intraocular lenses (IOLs) that belong 
to a class of new technology intraocular lenses (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).
    Section 626(b) of the Medicare Prescription Drug, Improvement, and 
Modernization Act of 2003, Pub. L. 108-173, (MMA) 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 required the Secretary to implement a revised ASC 
payment system, to be effective not later than January 1, 2008.
    Section 626(c) of the MMA amended section 1833(a)(1) of the Act to 
require that beginning with implementation of the revised ASC payment 
system, payment for surgical procedures furnished in ASCs shall be 80 
percent of the lesser of the actual charge for the services or the 
amount determined by the Secretary under the revised payment system.
    Section 5103 of the Deficit Reduction Act of 2005, Pub. L. 109-171 
(DRA), 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. The amended language provides that if the standard 
overhead amount under section 1833(i)(2)(A) of the Act for an ASC 
facility service for such surgical procedures, without application of 
any geographic adjustment, exceeds the Medicare payment amount under 
the hospital 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 
(that is, January 1, 2008).
    Section 109(b) of the Medicare Improvements and Extension Act of 
2006 of the Tax Relief and Health Care Act of 2006, Pub. L. 109-432 
(MIEA-TRHCA), amended section 1833(i) of the Act, in part, by adding 
new clause (iv) to paragraph (2)(D) and by also adding new paragraph 
(7)(A), which provides that the Secretary may reduce the annual ASC 
update by 2 percentage points if an ASC fails to submit data as 
required by the Secretary on selected measures of quality of care, 
including medication errors. Section 109(b) of the MIEA-TRCHA requires 
that certain quality of care reporting requirements mandated for 
hospitals paid under the OPPS by section 109(a) of the MIEA-TRCHA be 
applied in a similar manner to ASCs unless otherwise specified by the 
Secretary. We refer readers to sections XVII.A. and H. of this final 
rule with comment period for further discussion of this provision and 
our plans for future ASC implementation.

B. Rulemaking for the Revised ASC Payment System

    On August 2, 2007, we published in the Federal Register (72 FR 
42470) the final rule for the revised ASC payment system, effective 
January 1, 2008. In that final rule, we established that we would 
address two components of the ASC payment system annually as part of 
the OPPS rulemaking cycle. 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, CAH, or 
an HOPD and to review and update the list of ASC procedures at least 
every 2 years.
    In the August 2, 2007 revised ASC payment system final rule, we 
also adopted the method we will use to set payment rates for ASC 
services furnished in association with covered surgical procedures 
beginning in CY 2008. Updating covered surgical procedures and covered 
ancillary services, as well as their payment rates, in association with 
the annual OPPS rulemaking cycle is particularly important because the 
OPPS relative payment weights and rates will be used as the basis for 
the payment of most covered surgical procedures and covered ancillary 
services under the revised ASC payment system. This joint update 
process will ensure that the ASC updates occur in a regular, 
predictable, and timely manner. The final rule included applicable 
regulatory changes to 42 CFR Parts 410 and 416.
    On August 2, 2007, we published in the Federal Register (72 FR 
42778) a proposed rule which proposed to update the revised ASC payment 
system, along with the OPPS. We also proposed to revise the ASC 
regulations to provide practice expense payments to physicians who 
perform noncovered ASC procedures in ASCs based on the

[[Page 66828]]

facility practice expense (PE) relative value units (RVUs) and to 
exclude covered ancillary radiology services and covered ancillary 
drugs and biologicals from the categories of designated health services 
(DHS) that are subject to the physician self-referral prohibition. We 
note that the reference throughout the August 2, 2007 OPPS/ASC proposed 
rule to the final rule for the CY 2008 revised ASC payment system 
erroneously cited that final rule as the July 2007 final rule.
    In this CY 2008 OPPS/ASC final rule with comment period, we are 
performing our annual update of the revised ASC payment system for CY 
2008.

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

1. Covered Surgical Procedures Under the Revised ASC Payment System
a. Definition of Surgical Procedure
    In order to delineate the scope of procedures that constitute 
``outpatient surgical procedures'' for payment under the revised ASC 
payment system, in the August 2, 2007 revised ASC payment system final 
rule, we clarified what we consider to be a ``surgical'' procedure. 
Under the ASC payment system existing through CY 2007, we define a 
surgical procedure as any procedure described within the range of 
Category I CPT codes that the CPT Editorial Panel of the AMA defines as 
``surgery'' (CPT codes 10000 through 69999). Under the revised payment 
system, we continue to define ``surgery'' using that standard. We also 
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 or are clinically similar to 
procedures in the CPT surgical range that we have determined do not 
pose a significant safety risk and that we would not expect to require 
an overnight stay when performed in an ASC. Having established what we 
consider to be a ``surgical procedure,'' we defined criteria that 
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.
b. Identification of Surgical Procedures Eligible for Payment under the 
Revised ASC Payment System
    ASC ``covered surgical procedures'' are those surgical procedures 
for which payment is made under the revised ASC payment system. Our 
final policy for identifying surgical procedures eligible for ASC 
payment excludes those surgical procedures that are on the OPPS 
inpatient list, procedures that are packaged under the OPPS, CPT 
unlisted surgical procedure codes, and surgical procedures that are not 
recognized for payment under the OPPS. Further, we 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 (overnight 
stay), and all surgical procedures that could pose a significant safety 
risk to Medicare beneficiaries. The criteria used under the revised ASC 
payment system to identify procedures that could pose a significant 
safety risk when performed in an ASC include those 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; or commonly require systemic 
thrombolytic therapy. These criteria for evaluating surgical procedures 
are set forth in Sec.  416.166(c).
    The list of surgical procedures that we have excluded from payment 
in ASCs may be found in Addendum EE posted on the CMS Web site at: 
http://www.cms.hhs./ASCPayment. As discussed above, the surgical 
procedures on that exclusionary list are those that are on the OPPS 
inpatient list, CPT unlisted codes, surgical procedures that are not 
recognized for payment under Medicare, and those that our clinical 
staff determined are not safe for Medicare beneficiaries or would be 
expected to require an overnight stay when provided in ASCs.
c. Payment for Covered Surgical Procedures under the Revised ASC 
Payment System
(1) General Policies
    To make payment for most covered surgical procedures, beginning in 
CY 2008, we utilize the OPPS 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, by 
applying a uniform ASC conversion factor to the ASC payment weights. 
For this first year of the revised ASC payment system, we adopted the 
OPPS relative payment weights as the ASC relative payment weights for 
most covered surgical procedures.
    For CY 2009 and beyond, according to our established methodology, 
we will update the ASC relative payment weights annually using the 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 amounts are less than the rates calculated under the standard 
methodology of the revised ASC payment system.
    Just as we scale the OPPS relative payment weights each year to 
ensure that the OPPS is budget neutral from one year to the next, we 
will rescale relative weights each year for the revised ASC payment 
system, beginning with the CY 2009 payment year. The purpose of scaling 
the relative weights is to ensure that the estimated aggregate payments 
under the ASC payment system for an upcoming year will 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. Rescaling enables us to compensate for the 
effects of changes in the OPPS relative payment weights from year to 
year for services that are not performed in ASCs (for example, due to 
sudden increases or decreases in the costs of hospital outpatient 
emergency department visits) that could inappropriately cause the 
estimated ASC expenditures to increase or decrease as a function of 
those changes.
    To establish the budget neutrality adjustment for the revised ASC 
payment system, we used a model that accounts for the migration of 
surgical procedures between ASCs, physicians' offices, and HOPDs, as 
discussed in the August 2, 2007 revised ASC payment system final rule 
(72 FR 42470). The budget neutrality adjustment for CY 2008 is based on 
updated CY 2008 OPPS and MPFS rates, along with updated utilization 
data. The ASC CY 2008 budget neutrality adjustment is multiplied by the 
OPPS conversion factor to establish the ASC conversion factor. The 
standard ASC payment for most of the covered surgical procedures 
displayed in Addendum AA of this final rule with comment period is 
calculated as the product of that ASC conversion factor multiplied by 
the OPPS relative payment weight for each separately payable procedure. 
A more detailed discussion of the methodology is provided in section 
XVI.L. of this final rule with comment period.
    Beginning in CY 2010, we will update the ASC conversion factor for 
the revised ASC payment system by the percentage increase in the CPI-U 
(U.S. city average), as estimated for the 12-

[[Page 66829]]

month period ending with the midpoint of the year involved (72 FR 
42519).
(2) Office-Based Procedures
    Among the procedures newly identified as covered surgical 
procedures for payment in ASCs beginning in CY 2008 are many procedures 
that are performed most of the time in physicians' offices. These 
procedures neither pose a significant safety risk nor are they expected 
to require an overnight stay when performed in ASCs, and they generally 
require a lower level of resource intensity than do most other ASC 
covered surgical procedures. For those reasons, in the August 2, 2007 
revised ASC payment system final rule, we adopted a policy to include 
them as covered surgical procedures but to ensure that payment for the 
facility resources associated with the procedures identified as 
``office-based'' would not be greater when provided in ASCs than when 
furnished in physicians' offices (72 FR 42509).
    Under the August 2, 2007 revised ASC payment system final rule, we 
finalized our policy to cap payment for office-based surgical 
procedures for which ASC payment would first be allowed beginning in CY 
2008 or later years at the lesser of the MPFS nonfacility PE RVU 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 PE RVU amount, we will implement 
the cap, as appropriate, once a MPFS nonfacility PE RVU amount is 
available. When procedures are finalized as being office based 
procedures, they remain designated as office-based in future updates. 
We may propose that additional HCPCS codes be classified as office-
based in a proposed rule for an annual ASC update after review of the 
most recently available utilization data. We consider for additional 
designation as office-based those procedures newly paid in ASCs in CY 
2008 or later years that our review concludes are performed 
predominantly (more than 50 percent of the time) in physicians' 
offices, based on our consideration of volume and site of service 
utilization data for the procedures, as well as clinical information 
and comparable data for related procedures, if appropriate.
    Procedures designated as office-based for CY 2008 are identified in 
Addendum AA to this final rule with comment period and assigned payment 
indicators ``P2'' (Office-based surgical procedures 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). 
Those procedures for which the payment indicator designation as office-
based is temporary for CY 2008 are identified in Addendum AA by an 
asterisk. We use the temporary designation to indicate that the office-
based payment indicator (``P2,'' ``P3,'' or ``R2'') assigned to the 
procedure is subject to change because the HCPCS code is new and we 
believe we have insufficient data upon which to base a final decision 
regarding the code's office-based status. We will reevaluate the 
procedure during the next annual rulemaking cycle, and when there are 
data upon which to base a proposal for a final payment indicator, we 
will include that in our proposed rule. The remainder of the office-
based procedure designations that are not identified as temporary were 
either already finalized in the August 2, 2007 revised ASC payment 
system final rule or are being finalized in this CY 2008 OPPS/ASC final 
rule with comment period.
(3) Device-Intensive Procedures
    Under the payment policy finalized in the revised ASC payment 
system final rule, we use a modified payment methodology to establish 
the ASC payment rates for device-intensive procedures (72 FR 42503). We 
identify device-intensive procedures under the revised ASC payment 
system as covered surgical procedures that, under the OPPS, are 
assigned to those device-dependent APCs for which the ``device offset 
percentage'' is greater than 50 percent of the APC's median cost. The 
device offset percentage is our best estimate of the percentage of 
device cost that is included in an APC payment under the OPPS. The CY 
2008 OPPS final device-dependent APCs and device offset percentages are 
discussed in section IV.A. of this final rule with comment period.
    According to the final ASC policy, payment for implantable devices 
is packaged into payment for the covered surgical procedures, but we 
utilize a modified ASC methodology based on OPPS data to establish 
payment rates for the device-intensive procedures under the revised ASC 
payment system. According to that modified payment methodology, we 
apply the OPPS device offset percentage to the OPPS national unadjusted 
payment to determine the device cost included in the OPPS payment rate 
for a device-intensive ASC covered surgical procedure, which we then 
set as equal to the device portion of the national unadjusted ASC 
payment rate for the procedure. We then calculate the service portion 
of the ASC payment for device-intensive procedures by applying the 
uniform ASC conversion factor to the service (nondevice) portion of the 
OPPS relative payment weight for the device-intensive procedure. 
Finally, we 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. For example, if the OPPS device offset 
percentage for the procedure is 80 percent and the OPPS national 
unadjusted payment is $100, the device cost included in that payment is 
$80. Under the revised ASC payment system, we also pay $80 for the 
device portion of the procedure but the service portion of the OPPS 
payment, $20, is adjusted by the budget neutrality adjustment (for 
example, using the final ASC budget neutrality adjustment, the 
calculation is $20 x 0.65 = $13) and, if it is subject to the 
transition (as set forth in section XVI.C.1.c.(5) of this final rule 
with comment period), it is also adjusted accordingly. If the procedure 
in the example is not subject to the transition, its CY 2008 payment is 
equal to approximately $93 ($80 + $13). This example illustrates the 
contributions of the device and service payment amounts to the national 
unadjusted ASC payment rate; payment to an ASC for the device-intensive 
service is subject to the 50 percent geographic adjustment.
    We also 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. A full discussion of that policy may be found in section 
XVI.F. of this final rule with comment period.
(4) Multiple and Interrupted Procedure Discounting
    Under the revised ASC payment system, we discount payment for 
certain multiple and interrupted procedures performed in ASCs. While 
most covered surgical procedures are subject to a 50 percent reduction 
in ASC payment for the lower-paying procedure when more than one 
procedure is performed in a single operative session, those covered 
surgical procedures that are exempt from the multiple procedure 
reduction

[[Page 66830]]

in ASCs because they are not subject to this reduction under the OPPS, 
are identified in Addendum AA to this final rule with comment period 
with an ``N'' in the column labeled ``Subject to multiple procedure 
discounting.'' 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 are reported 
with modifier 73, and the ASC payment for the covered surgical 
procedure is reduced by 50 percent. Procedures requiring anesthesia 
that are terminated after administration of anesthesia or initiation of 
the procedure are reported with modifier 74, and the ASC payment for 
the covered surgical procedure is made at 100 percent of the 
established payment rate. Procedures and services not requiring 
anesthesia that are partially reduced or discontinued at the 
physician's discretion are reported with modifier 52, and the ASC 
payment for the covered surgical procedure or covered ancillary service 
is reduced by 50 percent.
(5) Transition to Revised ASC Payment Rates
    Under the revised ASC payment system, we are providing a payment 
transition over 4 years for all services on the CY 2007 ASC list of 
covered surgical procedures (72 FR 42519). Beginning in CY 2008, 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 
revised ASC payment rates calculated under the final methodology of the 
revised payment system. While we do not subject the device payment 
portion of the total ASC payment for a device-intensive procedure to 
the transition policy, we transition the service payment portion of the 
total ASC payment for the procedure over the 4 year phase-in period. 
Procedures new to ASC payment for CY 2008 or later calendar years 
receive payments determined according to the final methodology of the 
revised ASC payment system, without a transition.
    ASC covered surgical procedures listed in Addendum AA to this final 
rule with comment period that are subject to the transition are 
assigned 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 with comment period that are not subject to the transition 
are assigned payment indicators ``G2'' (Nonoffice-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).
    We received many public comments on the final payment policies for 
covered surgical procedures under the revised ASC payment system. A 
summary of the public comments and our responses follow.
    Comment: A number of commenters suggested that CMS: (1) Alter the 
definition for surgical procedures and the criteria for evaluating 
procedures for exclusion from the list of covered procedures; (2) not 
implement the office-based designations for procedures; (3) use a lower 
threshold to designate which procedures are eligible for payment as 
device-intensive; (4) allow procedures with high supply costs to go to 
fully implemented revised payment system rates rather than being paid 
at the transitional rates during the first 3 years under the revised 
system; and (5) use either a higher budget neutrality adjustment or 
differential adjustments for high and low volume procedures. Within 
those topics, the commenters made a range of recommendations for 
changes to our final policies.
    Response: We appreciate the commenters' suggestions. However, the 
payment policies for the revised ASC payment system that are addressed 
by the commenters were finalized in the August 2, 2007 revised ASC 
payment system final rule after we received and addressed public 
comments. Therefore, we are not addressing these comments in this final 
rule with comment period. Only the comments we received during the 
comment period related to the proposed annual update of the revised ASC 
payment system that were included in the August 2, 2007 OPPS/ASC 
proposed rule are addressed in this final rule with comment period. Any 
additional changes to the payment policies in that final rule would 
need to be subjected to the notice and comment rulemaking procedures 
through issuance of a proposed rule before any such changes could be 
finalized.
    Comment: Several commenters recommended that CMS establish an 
advisory group of clinically-trained ASC experts to work with CMS staff 
prior to release of the annual proposed rule to review and provide 
clinical safety and procedure-specific data on procedures that CMS may 
initially deem a safety risk.
    Response: We appreciate the commenters' suggestion. However, we 
believe that the current process for identifying procedures for 
exclusion from the list of covered procedures is sufficient. The 
process we have established allows for clinical review by our medical 
staff and expert advisors, as well as comments from the public on an 
annual basis prior to making final decisions regarding surgical 
procedures for exclusion from the list of ASC covered surgical 
procedures. Further, in contrast to the biennial process to update the 
ASC list under the existing ASC payment system in effect through CY 
2007, the process for updating the list annually under the revised 
payment system increases opportunities for the public to comment on our 
proposed changes to the list and other aspects of the payment system 
that may be included in the proposed rule.
    Comment: One commenter suggested CMS should develop and implement 
modifiers for hospitals and ASCs to use to monitor beneficiaries who, 
after undergoing procedures in ASCs, are discharged to hospitals. The 
commenter stated that, with the greatly expanded list of covered 
surgical procedures in place, ASCs will be prone to provide services 
that are beyond their capabilities. The commenter believed that ASCs 
may underestimate the severity of certain types of patients or cases, 
or both, and that as a result, beneficiaries requiring continued care 
will be transferred to the hospital. The commenter argued that this 
would result in increased health care costs. The commenter believed 
that, in this way, the revised ASC payment system may introduce payment 
inequities whereby hospitals lose money by caring for patients 
transferred from ASCs, many times for hospital outpatient services that 
would not be paid by Medicare under existing OPPS payment policy. 
Further, the commenter was concerned that transferred beneficiaries 
also may be exposed to increased financial liability for hospital 
services not covered by Medicare under the OPPS and that the quality of 
care would

[[Page 66831]]

suffer due to the transfer, which would require the involvement of 
multiple providers. For those reasons, the commenter suggested that CMS 
develop and implement a method to monitor ASC-to-hospital transfer 
activity.
    Response: We do not anticipate a significant influx of transfers 
from ASCs to hospitals to accompany implementation of the revised 
payment system. As discussed above, we have an established review 
policy to identify and exclude from ASC payment those procedures that 
could pose a significant safety risk to beneficiaries when performed in 
the ASC setting or that are expected to require an overnight stay. We 
have expanded the ASC list of covered surgical procedures in order to 
increase physicians' choices when selecting the most appropriate place 
of care for beneficiaries. To this end, the implementation of the 
revised ratesetting methodology removes site-of-service payment 
differentials that may have affected physicians' decisions in the past. 
We believe that, under the revised payment system, physicians will 
choose the setting for a procedure that best suits the needs of the 
individual beneficiary, and that beneficiaries will benefit from 
expanded access to surgical services in the most efficient and 
appropriate setting available.
    Thus, although we are sensitive to the commenter's concerns, we see 
no reason to implement modifiers as suggested by the commenter at this 
time. We will continue to analyze claims and other available data 
during our annual rulemaking cycle to assess the effectiveness of our 
policies and to make our annual updates.
2. Covered Ancillary Services Under the Revised ASC Payment System
a. General Policies
    As described in 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 Sec.  416.2, ASC services 
include both facility services, which are defined as 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 performed in an ASC, for which separate payment is 
made under the revised ASC payment system.
    ``Covered ancillary services'' include the following, as specified 
in Sec.  416.164(b): 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.
    Under the revised ASC payment system, we designate specific 
services that are separately payable under the OPPS as ``covered 
ancillary services'' and make separate payment to ASCs when any of the 
services so designated are provided on the same day as integral to a 
covered surgical procedure provided in the ASC (72 FR 42477). Payment 
for ancillary services that are packaged under the OPPS also is 
packaged under the revised ASC payment system (and those services are 
not considered to be ASC covered ancillary services). Furthermore, only 
the ASC can receive payment for the facility resources required to 
provide the covered ancillary radiology or other covered ancillary 
services, and ASCs are no longer able to bill as independent diagnostic 
testing facility (IDTF) suppliers 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.
    We continue to 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.
    We received one public comment specific to our general final 
payment policy for separate payment of covered ancillary services in 
ASCs under the revised ASC payment system. A summary of the public 
comment and our response follow.
    Comment: MedPAC expressed concern regarding our final payment 
policy under the revised ASC payment system for covered ancillary 
services. The revised ASC payment system pays separately for covered 
ancillary services in order to align the ASC payment bundles with the 
OPPS. However, MedPAC was concerned that separate payment for these 
services for which payment is currently packaged under the existing ASC 
payment system may lead to growth of the covered ancillary services in 
ASCs. MedPAC recommended that CMS pursue broader packaging policies for 
both ASCs and the OPPS to promote efficient resource use in both 
settings.
    Response: We appreciate this comment from MedPAC, and as evidenced 
by the packaging approach that we are finalizing for the CY 2008 OPPS, 
as described in section II.A.4.c. of this final rule with comment 
period, we are expanding the packaging of ancillary services to 
increase the size of the payment bundles in both the OPPS and ASC 
settings. In particular, there are a number of radiology services, 
including guidance procedures, that are newly packaged under the OPPS, 
but which otherwise would have been paid separately in the ASC setting 
as covered ancillary services. We do not expect significant growth of 
separately payable covered ancillary services in ASCs as a direct 
result of providing separate payment for these services beginning in CY 
2008 because, to be paid, these services must always be provided 
integral to covered surgical procedures in ASCs.
    As discussed above, we have revised the ASC payment system to more 
appropriately pay for surgical procedures that are covered in that 
setting; that is, those procedures we have determined do not pose a 
significant risk to beneficiary safety and would not be expected to 
require an overnight stay. Because we are paying for these surgical 
procedures using the OPPS APCs as the grouper, we believe it is most 
appropriate to align the payment bundles under the OPPS and the revised 
ASC payment system. Increased packaging under the OPPS that alters the 
OPPS payment bundles will also occur under the revised ASC payment 
system. We believe that the changes to the ASC payment system will 
allow beneficiaries to receive the care they require in the most 
appropriate setting and ASCs to be appropriately paid for that care. We 
have no reason to believe that increased service growth for covered 
ancillary services provided in ASCs will be more likely than growth for 
those services provided in other settings.

[[Page 66832]]

b. Payment Policies for Specific Items and Services
(1) Radiology Services
    Under the revised ASC payment system, we designate as ``covered 
ancillary services'' those ancillary radiology services that are 
separately payable under the OPPS. Thus, ASCs receive a separate 
payment for a covered ancillary radiology service which, by definition, 
is provided in the ASC integral to the performance of a covered 
surgical procedure. ASC payment for those covered ancillary services is 
at the lower of the rate developed according to the standard 
methodology of the revised ASC payment system or the MPFS nonfacility 
PE RVU amount (specifically for the technical component (TC) if the 
service is assigned a TC under the MPFS). No separate payment is made 
for ancillary services that are designated as packaged under the OPPS. 
We specify that a covered ancillary 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. Payment under the revised ASC payment system for 
covered ancillary radiology services is subject to geographic 
adjustment, like payment for ASC surgical procedures. Only the ASC can 
receive payment for the facility resources required to provide the 
covered ancillary radiology services, and ASCs are no longer able to 
bill as independent diagnostic testing facility (IDTF) suppliers to 
receive payment for any ancillary radiology services that are integral 
to the performance of a covered surgical procedure for which the ASC is 
billing Medicare. Because the packaging status of radiology services 
under the revised ASC payment system parallels the OPPS, any changes to 
the packaging of radiology services under the OPPS will also occur 
under the revised ASC payment system.
    Ancillary 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 applies to all radiology services that 
are separately payable under the OPPS in that same calendar year. A 
list that includes all covered ancillary radiology services may be 
found in Addendum BB to this final rule with comment period. Covered 
ancillary radiology services are assigned 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 surgical procedure on ASC list; payment based on MPFS nonfacility PE 
RVUs). Payment for ancillary radiology services that are packaged under 
the OPPS is packaged under the revised ASC payment system, and those 
services are identified in Addendum BB to this final rule with comment 
period with payment indicator ``N1'' (Packaged service/item; no 
separate payment made). ASC payment for covered ancillary radiology 
services is not subject to the 4-year transition.
(2) Brachytherapy Sources
    Under the revised ASC payment system, we designate as ``covered 
ancillary services'' those brachytherapy sources that are separately 
payable under the OPPS. Thus, ASCs receive separate payment for those 
covered ancillary brachytherapy sources that are implanted in 
conjunction with covered surgical procedures billed by ASCs. The 
application of the brachytherapy sources is integrally related to the 
covered surgical procedures for insertion of brachytherapy needles and 
catheters. 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 specifically do not include payment for brachytherapy sources. 
The ASC brachytherapy source payment rate for a given calendar year is 
the same as the OPPS payment rate for that year, without application of 
the ASC budget neutrality adjustment or, if specific OPPS prospective 
payment rates are unavailable, ASC payments for brachytherapy sources 
are contractor-priced. In addition, consistent with the payment of 
brachytherapy sources under the OPPS, the ASC payment rates for 
brachytherapy sources are not adjusted for geographic wage differences. 
The Level II HCPCS codes for brachytherapy sources and their payment 
rates under the CY 2008 revised ASC payment system, the same as those 
finalized for the CY 2008 OPPS, are included in Addendum BB to this 
final rule with comment period. Brachytherapy sources are assigned 
payment indicator ``H2'' (Brachytherapy source paid separately when 
provided integral to a surgical procedure on ASC list; payment based on 
OPPS rate). We note that we are finalizing our proposal to change the 
brachytherapy source payment indicator from ``H4,'' defined as 
``Brachytherapy source paid separately when provided integral to a 
surgical procedure on ASC list; payment contractor-priced'' to ``H2,'' 
in order to be consistent with the final CY 2008 OPPS policy for 
payment of brachytherapy sources, as described in section VII. of this 
final rule with comment period. For CY 2008, we are paying under the 
OPPS at prospective rates calculated from historical claims data and, 
therefore, the ASC payment for brachytherapy sources will be at those 
same rates. The HCPCS codes for all brachytherapy sources and their ASC 
payment amounts and ASC payment indicators are listed in Table 47 
below.

 Table 47.--CY 2008 Payments for Brachytherapy Sources Implanted in ASCs
------------------------------------------------------------------------
                                          ASC payment       CY 2008 ASC
    HCPCS code       Short descriptor      indicator       payment rate
------------------------------------------------------------------------
A9527.............  Iodine I-125       H2...............          $27.55
                     sodium iodide.
C1716.............  Brachytx, non-     H2...............           33.30
                     str, Gold-198.
C1717.............  Brachytx, non-     H2...............          175.19
                     str, HDR Ir-192.
C1719.............  Brachytx, NS, Non- H2...............           65.13
                     HDRIr-192.
C2616.............  Brachytx, non-     H2...............       11,764.95
                     str,Yttrium-90.
C2634.............  Brachytx, non-     H2...............           30.94
                     str, HA, I-125.
C2635.............  Brachytx, non-     H2...............           46.92
                     str, HA, P-103.
C2636.............  Brachy linear,     H2...............           42.04
                     non-str, P-103.
C2638.............  Brachytx,          H2...............           45.31
                     stranded, I-125.

[[Page 66833]]

 
C2639.............  Brachytx, non-     H2...............           32.10
                     stranded, I-125.
C2640.............  Brachytx,          H2...............           65.66
                     stranded, P-103.
C2641.............  Brachytx, non-     H2...............           51.45
                     stranded, P-103.
C2642.............  Brachytx,          H2...............           97.72
                     stranded, C-131.
C2643.............  Brachytx, non-     H2...............           64.08
                     stranded, C-131.
C2698.............  Brachytx,          H2...............           45.31
                     stranded, NOS.
C2699.............  Brachytx, non-     H2...............           30.94
                     stranded, NOS.
------------------------------------------------------------------------

(3) Drugs and Biologicals
    Under the revised ASC payment system, we designate as ``covered 
ancillary services'' all drugs and biologicals that are separately paid 
under the OPPS. Thus, ASCs receive separate payment for those covered 
ancillary drugs and biologicals which, by definition, are provided 
integral to a covered surgical procedure performed in an ASC. We 
specify that a drug or biological is integral to a covered surgical 
procedure if it is required for the successful performance of the 
surgery and is provided to the beneficiary in the ASC immediately 
preceding, during, or immediately following the covered surgical 
procedure. Payments for covered ancillary drugs and biologicals under 
the revised ASC payment system for a calendar year are equal to the 
OPPS payment rates for those drugs and biologicals that same year, 
without application of the ASC budget neutrality adjustment. In 
addition, consistent with the payment of drugs and biologicals under 
the OPPS, the ASC payment rates for these items are not adjusted for 
geographic wage differences.
    A list of the covered ancillary drugs and biologicals under the CY 
2008 revised ASC payment system and their payment rates are included in 
Addendum BB to this final rule with comment period. Covered ancillary 
drugs and biologicals are assigned payment indicator ``K2'' (Drugs and 
biologicals paid separately when provided integral to a surgical 
procedure on ASC list; payment based on OPPS rate). Ancillary drugs and 
biologicals for which payment is packaged into the ASC payment for the 
covered surgical procedure in CY 2008 are also listed in Addendum BB, 
and are assigned payment indicator ``N1'' (Packaged service/item; no 
separate payment made).
(4) Implantable Devices With Pass-Through Status Under the OPPS
    Under the revised ASC payment system, we provide separate payment 
at contractor-priced rates for devices that are included in device 
categories with pass through status under the OPPS when the devices are 
an integral part of a covered surgical procedure. As we have specified 
for other services designated as covered ancillary services, a pass-
through device would be considered integral to the covered surgical 
procedure when it is required for the successful performance of the 
procedure; is provided in the ASC immediately before, during, or 
immediately following the covered surgical procedure; and is billed by 
the ASC on the same day as the covered surgical procedure.
    In the future, new device categories may be established that will 
have OPPS pass through status during all or a portion of any calendar 
year. For CY 2008, there are two device categories with OPPS pass-
through status that are continuing in that status under the OPPS for CY 
2008, specifically HCPCS code C1821 (Interspinous process distraction 
device (implantable)) and HCPCS code L8690 (Auditory osseointegrated 
device, includes all internal and external components). We note that 
only the surgical procedures associated with the implantation of HCPCS 
code L8690 are ASC covered surgical procedures for CY 2008. As under 
the OPPS, ASC payment for covered ancillary services, including pass-
through devices, is not subject to the geographic wage adjustment.
    The pass-through device category HCPCS codes are included in 
Addendum BB to this final rule with comment period and are assigned 
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 receive packaged payment 
because they do not have OPPS pass-through status are also listed in 
Addendum BB to this final rule with comment period, where they are 
assigned payment indicator ``N1'' (Packaged service/item; no separate 
payment made).
    The associated nondevice facility resources for the device 
implantation procedures are paid through the ASC surgical procedure 
service payment, based upon the payment weight for the nondevice 
portion of the related OPPS APC payment weight.
(5) Corneal Tissue Acquisition
    Under the revised ASC payment system, we pay separately for corneal 
tissue procurement provided integral to the performance of an ASC 
covered surgical procedure based on invoice costs. The HCPCS code for 
corneal tissue acquisition, V2785 (Processing, preserving and 
transporting corneal tissue), is listed in Addendum BB to this final 
rule with comment period rule, and it is assigned payment indicator 
``F4'' (Corneal tissue processing; paid at reasonable cost).
3. General Payment Policies
a. Adjustment for Geographic Wage Differences
    Under the revised ASC payment system policy, we utilize 50 percent 
as the labor related share to adjust national ASC payment rates for 
geographic wage differences. Fifty percent is significantly higher than 
the labor-related share used for the ASC payment system through CY 2007 
(34.45 percent) 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.
    We apply to ASC payments 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 the labor-
related portion of the national ASC payment rates for geographic wage 
differences. b. Beneficiary Coinsurance
    Under the revised ASC payment system, beneficiary coinsurance 
remains at 20 percent for ASC services, except for screening flexible 
sigmoidoscopy and screening colonoscopy procedures. The coinsurance for 
screening

[[Page 66834]]

colonoscopies and screening flexible sigmoidoscopies is 25 percent, as 
required by section 1834(d) of the Act, with no deductible for those 
services under the revised ASC payment system.
    Comment: Several commenters suggested that CMS limit the 
beneficiary coinsurance amount for ASC services to the Medicare Part A 
hospital deductible, as occurs under the OPPS. The commenters stated 
that the potential for higher coinsurance in the ASC setting could have 
a negative financial impact on beneficiaries.
    Response: Although this comment is outside of the scope for this 
final rule with comment period, we are responding in order to provide 
further clarification to interested stakeholders. The revised ASC 
payment system results in many different payment rates effective 
January 1, 2008, some lower than under the existing system and some 
higher. The final beneficiary coinsurance policy may be found in the 
August 2, 2007 revised ASC payment system final rule (72 FR 42519). For 
the first year of the revised payment system in CY 2008, there are 171 
procedures with payment rates higher than $1,339, the highest rate 
under the existing ASC payment system. That means that beneficiary 
liability for those procedures will be greater under the revised 
payment system than under the existing ASC payment system. Of those 
procedures, 27 will result in beneficiary liability that is greater 
than the CY 2008 Medicare Part A hospital deductible amount of $1,024.
    While we have statutory authority to limit beneficiary copayments 
under the OPPS to no more than the Medicare Part A deductible for the 
year, Medicare program payments to ASCs are required by section 
1833(a)(1)(G) of the Act to be 80 percent of the lesser of the payment 
amount or actual ASC charges, and beneficiaries are responsible for the 
remaining 20 percent. We have no authority to revise those policies. 
However, we point out that the coinsurance amounts under the revised 
ASC payment system are limited to 20 percent of the payment rate and, 
as such, other than for the 27 procedures noted above, are almost 
without exception lower than the copayment amounts under the OPPS 
because most of the ASC rates are lower than OPPS rates and because 
beneficiary copayments vary from 20 to 40 percent under the OPPS. We 
note that, just like under the OPPS, the ASC coinsurance amounts are 
applied to each separate payment made for covered surgical procedures 
and covered ancillary services.

D. Treatment of New HCPCS Codes

1. Treatment of New CY 2008 Category I and III CPT Codes and Level II 
HCPCS Codes
    We finalized a policy in the August 2, 2007 revised ASC payment 
system final rule to evaluate each year all new HCPCS codes that 
describe surgical procedures to make preliminary determinations in the 
annual OPPS/ASC final rule with comment period regarding whether or not 
they meet the criteria for payment in the ASC setting and, if so, 
whether they are office-based procedures. These interim determinations 
must be made in the OPPS/ASC final rule with comment period because the 
new HCPCS codes and their descriptors for the upcoming calendar year 
are not available at the time of development of the OPPS/ASC proposed 
rule. In the absence of claims data that indicate where procedures 
described by new codes are being performed and reflect the facility 
resources required to perform them, we use other available information 
to make interim decisions regarding assignment of payment indicators 
for the new codes. The other sources available to us include our 
clinical advisors' judgment, data regarding predecessor and related 
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. Each year, 
we will publish in the annual OPPS/ASC payment update final rule the 
interim ASC determinations for the new codes to be effective January 1 
of the update year. The interim payment indicators assigned to new 
codes under the revised ASC payment system will be subject to comment 
on that final rule. We will respond to those comments in the OPPS/ASC 
update final rule for the following calendar year, just as we currently 
respond to comments about APC and status indicator assignments for new 
procedure codes in the OPPS update final rule for the year following 
publication of the code's interim OPPS treatment.
    After our review of public comments and in the absence of 
physicians'' claims data, our determination that a new code is an 
office based procedure and is, thereby, subject to the payment 
limitation, will remain temporary and subject to review, until there 
are adequate data available to assess the procedure's predominant sites 
of service. Using those data, if we confirm our determination that the 
new code is office-based after taking into account the volume and 
utilization data for the procedure code and/or, if appropriate, the 
clinical characteristics, utilization, and volume of related codes, the 
code will be assigned permanently to the list of office-based 
procedures subject to the ASC payment limitation, as discussed in 
section XVI.C.1.c.(2) of this final rule with comment period.
    New HCPCS codes for ASC implementation on January 1, 2008 are 
designated in Addenda AA and BB to this OPPS/ASC final rule with 
comment period with comment indicator ``NI.'' The ``NI'' comment 
indicator is used to identify those HCPCS codes for which the assigned 
ASC payment indicator is subject to public comment. (We refer readers 
to section XVI.J. of this final rule with comment period for a 
discussion of the ASC payment and comment indicators.)
2. Treatment of New Mid-Year Category III CPT Codes
    Twice each year, the AMA issues Category III CPT codes, which the 
AMA defines as temporary codes for emerging technology, services, and 
procedures. The AMA established Category III CPT codes to allow 
collection of data specific to the service described by the code which 
otherwise only could be reported using a Category I CPT unlisted code. 
The AMA releases Category III CPT codes in January, for implementation 
beginning the following July, and in July, for implementation beginning 
the following January.
    CMS provides predictable quarterly updates for the OPPS throughout 
each calendar year (January, April, July, and October), and the final 
payment policies of the revised ASC payment system parallel, in many 
cases, the OPPS treatment of HCPCS codes. As discussed in the August 2, 
2007 revised ASC payment system final rule, we also provide quarterly 
ASC updates for each calendar quarter to recognize newly created HCPCS 
codes for ASC payment and to update the payment rates for separately 
paid drugs and biologicals based on the most recently submitted ASP 
data.
    Under the OPPS and MPFS, CMS allows Category III CPT codes that are 
released by the AMA in January to be effective beginning July of the 
same calendar year in which they are issued, rather than deferring 
implementation of those codes to the following calendar year update of 
the payment systems, as is the case for the CPT Category I and Category 
III codes that are released in July by the AMA for implementation in 
January of the upcoming calendar year. Thus, new Category III CPT codes 
are

[[Page 66835]]

made effective under the MPFS and OPPS biannually. In order to be 
consistent in this regard across the three payment systems, in the CY 
2008 OPPS/ASC proposed rule (72 FR 42783), we proposed to adopt that 
same policy under the revised ASC payment system.
    Some of the new Category III CPT codes may describe services that 
our clinical advisors determine directly crosswalk or are clinically 
similar to HCPCS codes that describe ASC covered surgical procedures. 
In those instances, we may allow ASC payment for new Category III CPT 
codes as covered surgical procedures. Similarly, a new code may 
represent an ancillary service that directly crosswalks or is 
clinically similar to an ancillary service for which separate ASC 
payment is allowed when it is performed integral to an ASC covered 
surgical procedure, and, as such, the new code also may be determined 
to be eligible for ASC payment as a covered ancillary service.
    We did not receive any public comments regarding our proposal to 
recognize for ASC payment new CPT Category III codes, as appropriate, 
in July of each year as we do under the OPPS and MPFS. Therefore, 
beginning in CY 2008, we are including in the July quarterly update to 
the ASC payment system, the ASC payment indicators for new Category III 
CPT codes that the AMA releases in January, and that we determine are 
appropriate ASC covered surgical procedures or covered ancillary 
services for implementation, as payable in ASCs beginning in July of 
the same year. Likewise, as described above, we will implement annually 
for payment in the January update of the ASC payment system any of the 
Category III CPT codes that the AMA released the previous July, along 
with new Category I CPT codes that are determined to be appropriate for 
ASC payment. Interim ASC payment indicators will be assigned to those 
new mid-year Category III CPT codes that are released in January for 
implementation in July of a given calendar year, and the interim ASC 
indicators will be open to comment in the OPPS/ASC proposed rule for 
the following calendar year and their status will be made final in the 
update year's final rule.
    Of the Category III CPT codes the AMA released January 1, 2007, we 
have determined that only one is appropriate for payment in ASCs as a 
covered ancillary radiology service. The new CPT code is 0182T (High 
dose rate electronic brachytherapy, per fraction), and we proposed to 
assign it to the list of covered ancillary services with payment 
indicator ``Z2'' for payment in ASCs beginning January 1, 2008. This 
service has no MPFS nonfacility PE RVUs assigned to it. Therefore, we 
proposed that its CY 2008 ASC payment be calculated according to the 
standard ASC payment system methodology, based on the code's OPPS 
relative payment weight.
    We do not believe that any of the other Category III CPT codes 
released in January 2007 for implementation in July 2007 meet the 
criteria for inclusion on the ASC list of covered surgical procedures 
or covered ancillary services because they do not directly crosswalk 
and are not clinically similar to established covered ASC services.
    We did not receive any public comments about our proposed 
assignment of ASC payment indicator ``Z2'' to CPT code 0182T. 
Therefore, we are finalizing our assignment of ASC payment indicator 
``Z2'' to CPT code 0182T for CY 2008.
3. Treatment of Level II HCPCS Codes Released on a Quarterly Basis
    In addition to the Category III CPT codes that are released twice 
each year, new Level II HCPCS codes may be created more frequently and 
are implemented for the MPFS and OPPS on a quarterly basis. Level II 
HCPCS codes are most commonly created for the purpose of reporting new 
drugs and biologicals but also are created for reporting some surgical 
procedures and other services for which payment may be made under the 
revised ASC payment system, as it is under the OPPS.
    We base the ASC payment policies for covered surgical procedures, 
drugs, biologicals, and certain other covered ancillary services 
integral to ASC covered surgical procedures on the OPPS. Therefore, we 
proposed to update the coding and payment for the services in ASCs at 
the same time that the OPPS is updated. We proposed to recognize newly 
created Level II HCPCS codes under the revised ASC payment system for 
payment on a quarterly basis, consistent with the quarterly updates to 
the OPPS. Just as we provide a predictable quarterly update for the 
OPPS occurring throughout each calendar year (January, April, July, and 
October), we also would provide predictable quarterly updates for ASCs 
to recognize newly created Level II HCPCS codes for ASC payment and to 
update the payment rates for separately paid drugs and biologicals 
based on the most recently submitted ASP data.
    In the CY 2008 OPPS/ASC proposed rule, we also proposed to update 
the lists of covered surgical procedures and ancillary services that 
qualify for separate payment in ASCs in CY 2008 by adding eight new CY 
2007 Level II HCPCS codes that were implemented in the OPPS in July 
2007. Because of the timing of the proposed rule, the new Level II 
HCPCS codes implemented through the July 2007 OPPS update were not 
included in Addendum BB to the proposed rule.
    We did not receive any comments regarding the proposed payment 
indicators for the eight new CY 2007 Level II HCPCS codes that were 
implemented in the OPPS in July 2007. Therefore, we are finalizing our 
payment for them in the ASC setting, as proposed. The eight codes are 
listed in Table 48 below, as well as in Addendum BB to this final rule 
with comment. Beginning in CY 2008, with implementation of the revised 
ASC payment system, the Level II HCPCS codes describing new procedures, 
drugs, and biologicals will be payable in ASCs in the same calendar 
quarter as they are initially paid under the OPPS.
    We assigned payment indicator ``K2'' to seven of the eight new 
codes for drugs to indicate that separate payment will be made for 
those drugs when they are provided to beneficiaries in ASCs integral to 
covered surgical procedures. Level II HCPCS code C9728 (Placement of 
interstitial device(s) for radiation/surgery guidance (e.g., fiducial 
markers, dosimeter), other than prostate (any approach), single or 
multiple) is a covered surgical procedure with payment indicator ``R2'' 
because it is clinically similar to CPT code 55876 (Placement of 
interstitial device(s) for radiation therapy guidance (e.g., fiducial 
markers, dosimeter), prostate (via needle, any approach), single or 
multiple) that we have included on the list of covered surgical 
procedures with a payment indicator of ``P3.'' While we believe both 
procedures are office-based, there are currently no MPFS nonfacility PE 
RVUs available for the Level II HCPCS code C9728, which was initially 
established in response to a New Technology APC application under the 
OPPS, and, therefore, its payment indicator is ``R2.''

[[Page 66836]]



 Table 48.--Level II HCPCS Codes Implemented Under the OPPS in July 2007
                  That Will Be Paid in CY 2008 in ASCS
------------------------------------------------------------------------
                                                           CY 2008 ASC
  CY 2007 HCPCS      CY 2008 HCPCS       Descriptor          payment
       code               code                              indicator
------------------------------------------------------------------------
C9728............  C9728............  Placement of      R2
                                       interstitial
                                       device(s) for
                                       radiation
                                       therapy/surgery
                                       guidance (e.g.,
                                       fiducial
                                       markers,
                                       dosimeter),
                                       other than
                                       prostate (any
                                       approach),
                                       single or
                                       multiple.
Q4087............  J1568............  Injection,        K2
                                       immune
                                       globulin,
                                       (Octagam),
                                       intravenous,
                                       non-
                                       lyophilized,
                                       (e.g. liquid),
                                       500 mg.
Q4088............  J1569............  Injection,        K2
                                       immune
                                       globulin,
                                       (Gammagard
                                       Liquid),
                                       intravenous,
                                       non-
                                       lyophilized,
                                       (e.g. liquid),
                                       500 mg.
Q4089............  J2791............  Injection,        K2
                                       rho(d) immune
                                       globulin
                                       (human),
                                       (Rhophylac),
                                       intravenous,
                                       100 iu.
Q4090............  J1571............  Injection,        K2
                                       hepatitis b
                                       immune globulin
                                       (Hepagam B),
                                       intramuscular,
                                       0.5 ml.
Q4091............  J1572............  Injection,        K2
                                       immune
                                       globulin,
                                       (Flebogamma),
                                       intravenous,
                                       non-lyophilized
                                       (e.g. liquid),
                                       500 mg.
Q4092............  J1561............  Injection,        K2
                                       immune
                                       globulin,
                                       (Gamunex),
                                       intravenous,
                                       non-lyophilized
                                       (e.g. liquid),
                                       500 mg.
Q4095............  J3488............  Injection,        K2
                                       zoledronic acid
                                       (Reclast), 1 mg.
------------------------------------------------------------------------

    We did not receive any public comments regarding our proposal to 
implement new Level II HCPCS codes for ASC payment on a quarterly basis 
each year and new Category III CPT codes on a semiannual basis, to 
parallel the policies under the MPFS and OPPS for the recognition of 
those codes. Therefore, beginning in CY 2008 with implementation of the 
revised ASC payment system, we are implementing new Level II HCPCS 
codes for ASC payment on a quarterly basis each year and new Category 
III CPT codes on a semiannual basis, to parallel the policies under the 
MPFS and OPPS for the recognition of those codes. Also, consistent with 
the MPFS and OPPS policies, our final policy with regard to HCPCS codes 
implemented on January 1 of a calendar year is to publish the new codes 
and interim payment indicators annually in the OPPS/ASC final rule with 
comment period.

E. Updates to Covered Surgical Procedures and Covered Ancillary 
Services

1. Identification of Covered Surgical Procedures
a. General Policies
    We published Addendum AA to the August 2, 2007 revised ASC payment 
system final rule as an illustrative list of covered surgical 
procedures and payment rates for the revised ASC payment system to be 
implemented January 1, 2008. The final rule established our policies 
for determining which procedures are eligible to be considered ASC 
covered surgical procedures and, of those, which are excluded from ASC 
payment because they pose a significant risk to beneficiary safety or 
would be expected to require an overnight stay. We adopted a definition 
of surgical procedure for the revised ASC payment system as those 
procedures described by all Category I CPT codes in the surgical range 
from 10000 through 69999 except unlisted procedure codes, as well as 
those Category III CPT codes and Level II HCPCS codes that crosswalk or 
are clinically similar to ASC covered surgical procedures.
    Section 1833(i)(1) of the Act requires us to review and update the 
list of ASC procedures at least every 2 years. We finalized our policy 
to update the ASC list of covered surgical procedures annually, in 
conjunction with annual proposed and final rulemaking to update the 
OPPS and ASC payment systems. Each year we undertake a review of 
excluded procedures, new procedures, and procedures for which there is 
revised coding to identify any that we believe are appropriate for 
coverage in ASCs because they do not pose significant risks to 
beneficiary safety and would not be expected to require overnight 
stays.
    In the August 2, 2007 revised ASC payment system final rule, we 
finalized the addition of approximately 790 new covered surgical 
procedures for payment under the revised ASC payment system beginning 
in CY 2008. In the CY 2008 OPPS/ASC proposed rule, we proposed to 
remove 13 procedures from the OPPS inpatient list and, of those 13, we 
believe that 3 are safe for performance in ASCs. Therefore, we proposed 
to add the following three additional surgical procedures to the ASC 
list of covered surgical procedures eligible for Medicare ASC payment 
in CY 2008: CPT codes 25931 (Amputation, forearm, through radius and 
ulna; re-amputation); 50580 (Renal endoscopy through nephrotomy or 
pyelotomy, with or without irrigation, instillation, or 
uteropyelography, exclusive of radiologic service; with removal of 
foreign body or calculus); and 58805 (Drainage of ovarian cyst(s), 
unilateral or bilateral, (separate procedure); abdominal approach).
    We did not receive any public comments about our proposal to 
designate CPT codes 25931, 50580, and 58805 as payable in ASCs as 
covered surgical procedures beginning CY 2008. Therefore, we are 
finalizing our proposal to designate the three procedures as payable in 
ASCs as covered surgical procedures, assigning them payment indicator 
``G2,'' beginning in CY 2008.
    In the CY 2008 OPPS/ASC proposed rule, we also solicited comments 
and recommendations regarding additional surgical procedures that 
commenters believe should not be excluded from ASC payment beginning in 
CY 2008. We specifically encouraged commenters to provide evidence, to 
the extent possible, to support their recommendations regarding 
procedures and services they believe should not be excluded from ASC 
payment.
    We received many public comments from individuals and organizations 
requesting that specific procedures be added or removed from the CY 
2008 proposed list of ASC covered surgical procedures. A summary of the 
public comments and our responses follow.
    Comment: Some commenters stated that certain procedures CMS had 
proposed to exclude from coverage as payable in ASCs do not pose a risk 
to beneficiary safety and are not expected to require an overnight 
stay, and as such, should not be excluded from the ASC list. Table 49 
below includes a list of all procedures for which the commenters 
requested designation as covered surgical procedures in ASCs.

[[Page 66837]]



Table 49.--Specific Procedures That Commenters Requested Not Be Excluded
                       From ASC Payment in CY 2008
------------------------------------------------------------------------
            HCPCS code                        Short descriptor
------------------------------------------------------------------------
0088T............................  Rf tongue base vol reduxn
0135T............................  Perq cryoablate renal tumor.
0137T............................  Prostate saturation sampling.
0170T............................  Anorectal fistula plug rpr.
0184T............................  Transanal resect rectal tumor.
0186T............................  Suprachoroidal drug delivery.
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.
21360............................  Treat cheek bone fracture.
21365............................  Treat cheek bone fracture.
21385............................  Treat eye socket fracture.
21386............................  Treat eye socket fracture.
21387............................  Treat eye socket fracture.
22526............................  Idet, single level.
22527............................   Idet, 1 or more levels.
27093............................  Injection for hip x-ray.
27096............................  Inject sacroiliac joint.
29866............................  Autgrft implnt, knee w/scope.
29867............................  Allgrft implnt, knee w/scope.
29868............................  Meniscal trnspl, knee w/scpe.
32998............................  Perq rf ablate tx, pul tumor.
35470............................  Repair arterial blockage.
35471............................  Repair arterial blockage.
35472............................  Repair arterial blockage.
35490............................  Atherectomy, percutaneous.
35491............................  Atherectomy, percutaneous.
35493............................  Atherectomy, percutaneous.
35494............................  Atherectomy, percutaneous.
35495............................  Atherectomy, percutaneous.
37182............................  Insert hepatic shunt (tips).
37182............................  Remove hepatic shunt (tips).
37201............................  Transcatheter therapy infuse.
37202............................  Transcatheter therapy infuse.
37204............................  Transcatheter occlusion.
37205............................  Transcath iv stent, precut.
37206............................  Transcath iv stent/perc addl.
37209............................  Change iv cath at thromb tx.
37210............................  Embolization uterine fibroid.
37620............................  Revision of major vein.
44300............................  Open bowel to skin.
44500............................  Intro, gastrointestinal tube.
44901............................  Drain app abscess, precut.
47011............................  Percut drain, liver lesion.
47490............................  Incision of gallbladder.
48511............................  Drain pancreatic pseudocyst.
49021............................  Drain abdominal abscess.
49041............................  Drain, percut, abdom abscess.
49061............................  Drain, percut, retroper absc.
50021............................  Renal abscess, percut drain.
50080............................  Removal of kidney stone.
50081............................  Removal of kidney stone.
58823............................  Drain pelvic abscess, precut.
62290............................  Inject for spine disk x-ray.
62291............................  Inject for spine disk x-ray.
63020............................  Neck spine disk surgery.
63030............................  Low back disk surgery.
63035............................  Spinal disk surgery add-on.
63040............................  Laminotomy, single cervical.
63042............................  Laminotomy, single lumbar.
63044............................  Laminotomy, add'l lumbar.
63047............................  Removal of spinal lamina.
63056............................  Decompress spinal cord.
64448............................  N block inj fem, cont inf.
64449............................  N block inj, lumbar plexus.
64910............................  Nerve repair w/allograft.
G0289............................  Arthro, loose body + chondro.
0171T............................  Lumbar spine process distract.
0172T............................  Lumbar spine process addl.
------------------------------------------------------------------------

    Response: In response to the public comments received, our clinical 
advisors evaluated each of the procedures listed in Table 49 to 
determine whether it poses a significant safety risk to beneficiaries 
or would be expected to require an overnight stay. Several of those 
procedures, specifically CPT codes 27093 (Injection procedure for hip 
arthrography); 62290 (Injection procedure for discography, each level; 
lumbar) 62291 (Injection procedure for discography, each level; 
cervical or thoracic); and G0289 (Arthroscopy, knee, surgical, for 
removal of loose body, foreign body, debridement/shaving of articular 
cartilage (chondroplasty) at the time of other surgical knee 
arthroscopy in a different compartment of the same knee), are packaged 
procedures under the OPPS and, therefore, are not eligible for 
designation as separately payable procedures under the revised ASC 
payment system. However, we note that these packaged procedures are 
also not excluded from Medicare payment when performed in the ASC 
setting. Their payment will be packaged into payment for the ASC 
covered surgical procedure performed in the ASC.
    As a result of our review of the other procedures listed in Table 
49 that would be candidates for separate ASC payment according to their 
OPPS payment policies, we are not excluding 11 additional procedures 
from Medicare payment when performed in the ASC setting in CY 2008. In 
making our determinations, even where procedures had high inpatient 
utilization due to their frequent performance on hospital inpatients, 
we considered the clinical characteristics of the surgical procedure 
itself. As we stated in the August 2, 2007 revised ASC payment system 
final rule, we examine all the clinical information regarding the 
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 (72 FR 42482). Of the procedures that commenters requested 
not be excluded from the list of covered surgical procedures, those 
that we determined are appropriate for payment in an ASC and their 
final CY 2008 payment indicators are displayed in Table 50.

 Table 50.--Specific Procedures Newly Designated as Covered ASC Surgical
                         Procedures for CY 2008
------------------------------------------------------------------------
                                                      CY 2008 payment
      HCPCS code            Short descriptor             indicator
------------------------------------------------------------------------
0088T................  Rf tongue vol reduxn.....  G2
0137T................  Prostate saturation        G2
                        sampling.
0170T................  Anorectal fistula plug     G2
                        rpr.
0186T................  Suprachoroidal drug        G2
                        delivery.
21360................  Treat cheek bone fracture  G2
22526................  Idet, single level.......  G2
22527................  Idet, 1 or more levels...  G2
29866................  Autgrt implnt, knee w/     G2
                        scope.
32998................  Perq rf ablate tx, pul     G2
                        tumor.
44500................  Intro, gastrointestinal    G2
                        tube.
64910................  Nerve repair w/allograft.  G2
------------------------------------------------------------------------

    We determined that each of the remaining 57 procedures (those not 
packaged or listed in Table 50) requested by the commenters and listed 
in Table 49 would pose a significant risk to beneficiary safety or be 
expected to require an overnight stay, so they will continue to be 
excluded from the list of ASC covered surgical procedures for CY 2008. 
A complete list of surgical procedures that are excluded from Medicare 
payment when provided in ASCs may be found in Addendum EE posted on the 
CMS Web site at: http://www.cms.hhs.gov/ASCPayment.
    Comment: Several commenters requested that specific procedures be 
removed from the ASC list of covered procedures in order to enhance the 
safety and quality of care that is delivered by ASCs. The commenters 
stated that CMS should exercise caution in granting patients and 
physicians the flexibility to determine appropriate sites of care, 
particularly for procedures that could have catastrophic outcomes if 
the appropriate emergent care equipment and training are not available 
in the site where care is delivered. Specifically, the commenters 
requested removal of percutaneous transluminal angioplasty procedures, 
transvenous electrode procedures, and certain cardiac electrophysiology 
procedures, as well as palatal surgical procedures. Table 51 below 
lists the procedures for which the

[[Page 66838]]

commenters requested removal from the ASC list of covered surgical 
procedures.

Table 51.--Procedures Recommended by Commenters for Removal From the ASC
                   List of Covered Surgical Procedures
------------------------------------------------------------------------
            HCPCS code                        Short descriptor
------------------------------------------------------------------------
33206............................  Insertion of heart pacemaker.
33207............................  Insertion of heart pacemaker.
33208............................  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, one.
33220............................  Repair lead pace-defib, dual.
33224............................  Insert pacing lead & connect.
33225............................  L ventric pacing lead add-on.
33226............................  Reposition l ventric lead.
33234............................  Removal of pacemaker system.
33235............................  Removal pacemaker electrode.
33249............................  Eltrd/insert pace-defib.
35473............................  Repair arterial blockage.
35474............................  Repair arterial blockage.
35476............................  Repair venous blockage.
35492............................  Atherectomy, percutaneous.
42200............................  Reconstruct cleft palate.
42205............................  Reconstruct cleft palate.
42210............................  Reconstruct cleft palate.
42215............................  Reconstruct cleft palate.
42220............................  Reconstruct cleft palate.
------------------------------------------------------------------------

    Response: In response to the public comments received, our clinical 
advisors reevaluated each of the procedures listed in Table 51 to 
determine whether it poses a significant safety risk to beneficiaries 
or would be expected to require an overnight stay. We note that while 
CPT codes 42200 (Palatoplasty for left palate, soft and/or hard palate 
only); 42205 (Palatoplasty for cleft palate, with closure of alveolar 
ridge; soft tissue only); 42210 (Palatoplasty for cleft palate; with 
closure of alveolar ridge; with bone graft to alveolar ridge (includes 
obtaining graft)); 42215 (Palatoplasty for cleft palate; major 
revision); and 42220 (Palatoplasty for cleft palate; attachment 
pharyngeal flap) were eligible for payment when performed in the ASC in 
CY 2007, the remainder of the codes listed in Table 51 were added to 
the ASC list of covered surgical procedures in the August 2, 2007 
revised ASC payment system final rule for CY 2008.
    We continue to believe that these palatoplasty procedures that have 
been on the ASC list of covered surgical procedures for more than 5 
years do not pose a significant risk to beneficiary safety in the ASC 
setting, nor would they be expected to require an overnight stay. We 
are not aware of any safety problems regarding the performance of these 
procedures in ASCs over the years Medicare has included them on the 
list of ASC covered surgical procedures.
    With respect to the pacemaker and ICD lead placement, 
repositioning, and removal procedures, we proposed a number of these 
procedures for addition to the ASC list for CY 2008 in the August 23, 
2006 proposed rule for the revised ASC payment system. We received a 
number of comments on the proposed rule regarding these procedures, as 
well as related surgical procedures, which we carefully reviewed prior 
to placing them on the ASC list of covered surgical procedures in the 
August 2, 2007 revised ASC payment system final rule. We have once 
again examined these procedures in light of comments received on the CY 
2008 OPPS/ASC proposed rule and, we believe, under the safety and 
overnight stay criteria that were adopted to exclude procedures from 
ASC payment, all of these procedures are appropriate for ASC 
performance. In particular, we do not believe they pose a significant 
safety risk, nor would be expected to require an overnight stay when 
provided in ASCs.
    We also closely reexamined the transluminal balloon angioplasty 
services described by CPT codes 35473 (Transluminal balloon 
angioplasty, percutaneous; iliac); 35474 (Transluminal balloon 
angioplasty, percutaneous; femoral-popliteal); and 35476 (Transluminal 
balloon angioplasty, percutaneous; venous). All three of these 
procedures were proposed for addition to the ASC list for CY 2008 in 
the August 23, 2006 OPPS/ASC proposed rule. We received requests to add 
CPT code 36476 to the ASC list for CY 2007, but we did not add this 
code at that point, based on the evaluation criteria for the existing 
ASC payment system. We then added all three codes to the CY 2008 ASC 
list in the August 2, 2007 revised ASC payment system final rule after 
evaluating the public comments and concluding that the procedures 
should not be excluded from ASC performance, consistent with the final 
exclusion criteria for the revised system. In response to the comments 
on the CY 2008 OPPS/ASC proposed rule that reflected the commenters' 
ongoing concerns about the safety of these procedures in ASCs, our 
clinical advisors engaged in a comprehensive assessment of their safety 
based on current clinical practice patterns and the contemporary 
medical literature. We have concluded that CPT codes 35473 and 35476 do 
not pose a significant safety risk to beneficiaries nor would either 
procedure be expected to require an overnight stay in ASCs. Therefore, 
we are including CPT codes 35473 and 35476 on the CY 2008 ASC list of 
covered surgical procedures. However, we have determined that CPT code 
35474 would pose a significant safety risk to beneficiaries when 
performed in an ASC. Therefore, we are excluding CPT code 35474 from 
the CY 2008 ASC list of covered surgical procedures.
    In summary, as a result of our review of the procedures the 
commenters requested that we remove from the proposed CY 2008 ASC list 
of covered surgical procedures, we are retaining all of the procedures 
in Table 51 on the final CY 2008 list of ASC covered surgical 
procedures except CPT code 35474. The full CY 2008 list of ASC covered 
surgical procedures is included in Addendum AA to this final rule with 
comment period.
b. Change in Designation of Covered Surgical Procedures as Office-Based
    According to our final policy for the revised ASC payment system, 
we designate as office-based procedures those that are added to the ASC 
list of covered surgical procedures in CY 2008 or later years and that 
we determine are predominantly performed in physicians' offices based 
on consideration of 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.
    The list of codes that we identified as office-based in the August 
2, 2007 revised ASC payment system final rule took into account the 
most recently available CY 2005 volume and utilization data for each 
individual procedure code or related codes. In that rule, we finalized 
our policy 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 and to exempt all procedures on the CY 2007 ASC list 
from application of the office-based classification. We believe that 
the resulting list accurately reflected Medicare practice patterns and 
was clinically consistent. In Addendum AA to the August 2, 2007 revised 
ASC payment system final rule, each of the office-based procedures was 
identified by payment indicator ``P2,'' ``P3,'' or ``R2,'' depending on 
whether we estimated it would be paid according to the standard ASC 
payment methodology based on its OPPS relative payment weight or at the 
MPFS nonfacility PE RVU amount.
    Consistent with our final ASC policy to review and update annually 
the surgical procedures for which ASC payment is made and to identify 
new procedures that may be appropriate for

[[Page 66839]]

ASC payment, in developing the CY 2008 OPPS/ASC proposed rule, we 
reviewed the CY 2006 utilization data for all those surgical procedures 
newly added for ASC payment in CY 2008 that were assigned payment 
indicator ``G2'' as nonoffice-based additions in the August 2, 2007 
revised ASC payment system final rule. We based our evaluation of the 
potential designation of a procedure as office-based on the most recent 
available volume and utilization data for each individual procedure 
code and/or, as appropriate, the clinical characteristics, utilization, 
and volume of related codes. As a result of that review, we identified 
19 procedures that were assigned payment indicator ``G2'' in the August 
2, 2007 revised ASC payment system final rule that we proposed to 
assign to the office-based procedure list, effective January 1, 2008, 
with payment indicator ``P2,'' ``P3,'' or ``R2,'' as appropriate. We 
refer readers to Addendum DD1 to this final rule with comment period 
for the definitions of the ASC payment indicators.
    In the CY 2008 OPPS/ASC proposed rule, we indicated that we would 
consider comments submitted timely on the proposed designation of these 
19 new procedures as office-based for CY 2008. For example, in the 
August 2, 2007 revised ASC payment system final rule, payment indicator 
``G2'' was assigned to CPT code 64650 (Chemodenervation of eccrine 
glands; both axillae). After reviewing more recent CY 2006 data, we 
discovered that the procedure is performed predominantly in physicians' 
offices and we believed the procedure should be designated as an 
office-based procedure. Therefore, we proposed to assign payment 
indicator ``P3'' to CPT code 64650, effective for CY 2008. In the 
proposed rule, we proposed to assign an office based payment indicator 
for CPT code 64650 and 18 other procedures.
    We also reviewed the five procedures that were assigned temporary 
office-based payment indicators in the August 2, 2007 revised ASC 
payment system final rule. Using CY 2006 data, we believed there were 
adequate claims data for two of those procedures upon which to base 
assignment of permanent payment indicators. Therefore, we proposed to 
assign CPT code 36598 (Contrast injection(s) for radiologic evaluation 
of existing central venous access device, including fluoroscopy, image 
documentation and report) permanently to the office-based list, with 
payment indicator ``P3'' for CY 2008. In the case of the second 
procedure, CPT code 58110 (Endometrial sampling (biopsy) performed in 
conjunction with colposcopy), in accordance with the CY 2008 OPPS 
proposal to package its payment, we also proposed to package payment 
for that procedure under the ASC payment system and assign it payment 
indicator ``N1.''
    We proposed to maintain the temporary office-based payment 
indicator assignments for the other three procedures. We have only a 
few claims for CPT code 0099T (Implantation of intrastromal corneal 
ring segments) and no claims for CPT code 0124T (Conjunctival incision 
with posterior juxtascleral placement of pharmacological agent (does 
not include supply of medication)) or CPT code 55876 (Placement of 
interstitial device(s) for radiation therapy guidance (e.g., fiduciary 
markers, dosimeter), prostate (via needle, any approach), single or 
multiple). We continue to believe these procedures are predominantly 
office-based. Therefore, we proposed not to make any change to the 
temporary office-based designation of these procedures at that time.
    We received many public comments on our general payment policy for 
office-based surgical procedures under the revised ASC payment system 
and on our proposal to add 19 additional procedures to the office-based 
list for CY 2008. A summary of the public comments and our responses 
follow.
    Comment: Many commenters opposed the policies related to the 
designation of procedures as office-based and the subsequent payment 
limitations for procedures that are so designated. Some commenters 
recommended that, if CMS is going to maintain a list of office-based 
procedures, it should restrict the criteria used to make office-based 
determinations. They stated that designation of a procedure as office-
based should be made either based on utilization data for multiple 
years or on the frequency of performance of the procedure in the HOPD 
or ASC settings. The commenters stated that CMS's consideration of 
clinical information and utilization data for related procedures is not 
transparent, making it impossible for the public to assess whether its 
determinations are rational and fair.
    Several commenters specifically requested that one or more of the 
19 additional procedures proposed for designation as office-based not 
receive that designation. The commenters recommended that CMS not 
finalize the proposal to designate 15 of the 19 procedures as office-
based because commenters believe they are not performed in physicians' 
offices 50 percent or more of the time. Each of those codes the 
commenters recommended not be designated as office-based is marked by a 
plus (+) in Table 52 below.
    Several commenters recommended that CMS not finalize the proposal 
to designate CPT code 28890 (Extracorporeal shock wave, high energy, 
performed by a physician, requiring anesthesia other than local, 
including ultrasound guidance, involving the plantar fascia) as office-
based because they believe the CMS data that indicate the procedure's 
performance in physicians' offices more than 50 percent of the time are 
erroneous. The commenters stated that CMS assigned payment indicator 
``G2'' to three high energy extracorporeal shock wave therapy (ESWT) 
procedures, CPT codes 28890, 0101T (Extracorporeal shock wave involving 
musculoskeletal system, not otherwise specified, high energy); and 
0102T (Extracorporeal shock wave, high energy, performed by a 
physician, requiring anesthesia other than local, involving lateral 
humeral epicondyle) in the August 2, 2007 revised ASC payment system 
final rule but then proposed to designate only CPT code 28890 as 
office-based in the CY 2008 OPPS/ASC proposed rule. They stated that 
CMS provided no explanation for the proposed change to the payment 
indicator of CPT code 28890. Furthermore, the commenters argued that 
the procedure is most appropriately provided in a facility setting and 
that the proposed ASC payment for the procedure would be limited to the 
MPFS nonfacility PE RVU amount, which is too low to cover the costs 
associated with providing the procedure. The commenters recommended 
that, because the CPT code was new for CY 2006, CMS should wait until 
sufficient time has passed to collect and review adequate Medicare data 
for its decision-making.
    Another commenter requested that CMS not designate CPT codes 64650 
(Chemodenervation of eccrine glands; both axillae) and 64653 
(Chemodenervation of eccrine glands; other area(s) (e.g., scalp, face, 
neck), per day) as office-based procedures because the codes were new 
for CY 2006 and there are not yet adequate data on which to base that 
determination.
    Response: While we appreciate the concerns of commenters regarding 
the limitation on payment for office-based procedures under the revised 
ASC payment system, we note that we finalized that payment policy in 
the August 2, 2007 revised ASC payment system final rule that set forth 
the final policies for the revised system after receiving and 
responding to public

[[Page 66840]]

comments (72 FR 42486). In that rule, we also finalized the evaluation 
criteria for the designation of surgical procedures as office-based (72 
FR 42512). Therefore, the evaluation criteria and payment policy for 
office-based procedures were not open to comment in the CY 2008 OPPS/
ASC proposed rule and we are not addressing additional comments in this 
final rule with comment period.
    Based on the public comments we received, we reexamined the 
relevant data and clinical characteristics for each of the 15 
procedures for which we received comments. Although, as the commenters 
asserted, many of the 15 procedures are performed in physicians' 
offices somewhat less than 50 percent of the time, our final policy for 
designating ASC procedures as office-based allows us to take into 
account the clinical characteristics, volume, and utilization data of 
related HCPCS codes to supplement our consideration of data specific to 
the codes of interest (72 FR 42512). Our review of the clinical 
characteristics of the 15 procedures and volume and utilization data 
for them and for similar procedures convinced us that our proposed 
designations are correct for all but 1 of the procedures.
    We are not finalizing our proposal to designate CPT code 46505 
(Chemodenervation of internal anal sphincter) as an office-based 
procedure. After reviewing the currently available utilization data for 
this code and related codes, we believe this procedure is not 
predominantly performed in physicians' offices and should maintain the 
``G2'' payment indicator assigned to CPT code 46505 in the August 2, 
2007 revised ASC payment system final rule for CY 2008.
    In the case of CPT code 28890, although Medicare utilization data 
show that over 70 percent of CY 2006 utilization occurred in the 
physician's office, we are persuaded by commenters that this code was 
new for CY 2006 and some providers may have confused this service with 
the performance of low energy ESWT procedures. Stakeholders have 
explained to us that, although the physician utilization data may 
reflect that the service is performed mainly in the physician's office, 
this finding could be due to miscoding of low energy procedures that 
use only local anesthesia, rather than correct use of the CPT code 
28890 to report high energy procedures that require anesthesia other 
than local. Nevertheless, we do not believe it would be appropriate to 
consider CPT code 28890 to be nonoffice-based for CY 2008 based on the 
significant utilization reported for the physician's office setting. 
Under the MPFS, this service has been priced specifically for 
performance in the office; therefore, we believe it can be 
appropriately performed in the physician's office. Furthermore, we note 
that there is an existing Category III CPT code for reporting the low 
energy services, specifically CPT code 0019T (Extracorporeal shock wave 
involving musculoskeletal system, not otherwise specified, low energy), 
for which the facility resources would be expected to differ. 
Nevertheless, given the concerns over the utilization data in the 
code's first year of use, while we follow the utilization of CPT code 
28890 for another year, we will maintain the office-based designation 
of this procedure as temporary to allow for the possibility that coding 
for high energy ESWT for the plantar fascia will improve as providers 
gain more experience with the CPT code. This designation is indicated 
with an asterisk in Table 52 below. When we have sufficient data, we 
will either propose to finalize the office-based designation of the 
service or propose to change its payment indicator to ``G2'' as a 
nonoffice-based procedure.
    While we are aware of the existence of CPT codes 0101T and 0102T 
for high energy ESWT for body areas other than treatment of the plantar 
fascia, utilization data available for the proposed rule did not 
support a proposal to designate those codes as office-based for CY 
2008. Furthermore, these services have no MPFS nonfacility PE RVUs at 
this time. Therefore, a payment limitation based on the MPFS 
nonfacility PE RVUs could not be applied. We will review their 
utilization data for the next ASC annual update.
    The procedures proposed for designation as office-based and their 
final CY 2008 payment indicators are listed in Table 52 below. All 
office-based designations are final, with the exception of the 
designation of CPT code 28890 as office-based, which will remain 
temporary until we have adequate utilization data to support a proposal 
to remove it from the office-based list or finalize the office-based 
designation.

      Table 52.--CY 2008 Final New Designations of ASC Covered Surgical Procedures Proposed as Office-Based
----------------------------------------------------------------------------------------------------------------
    HCPCS code (+ indicates                                                              Final CY 2008 payment
     procedures commenters                                  Proposed CY 2008 payment        indicator (* if
 recommended not be designated       Short descriptor               indicator           designation is temporary
       as office-based)                                                                       for CY 2008)
----------------------------------------------------------------------------------------------------------------
24640+........................  Treat elbow dislocation..  P3........................  P3
26641+........................  Treat thumb dislocation..  P2........................  P2
26670+........................  Treat hand dislocation...  P2........................  P2
26700+........................  Treat knuckle dislocation  P2........................  P2
26775+........................  Treat finger dislocation.  P3........................  P3
28630+........................  Treat toe dislocation....  P3........................  P3
28660+........................  Treat toe dislocation....  P3........................  P3
28890+........................  High energy eswt, plantar  P3........................  P3*
                                 fascia.
29035.........................  Application of body cast.  P2........................  P2
29305.........................  Application of hip cast..  P2........................  P2
29325.........................  Application of hip casts.  P2........................  P2
29505+........................  Application, long leg      P3........................  P3
                                 splint.
29515+........................  Application lower leg      P3........................  P3
                                 splint.
36469+........................  Injection(s), spider       R2........................  R2
                                 veins.
46505+........................  Chemodenervation anal      P3........................  G2
                                 misc.
62292.........................  Injection into disk        R2........................  R2
                                 lesion.
64447+........................  Nblock inj fem, single...  R2........................  R2
64650+........................  Chemodenerv, eccrine       P3........................  P3
                                 glands.

[[Page 66841]]

 
64653+........................  Chemodenerv, eccrine       P3........................  P3
                                 glands.
----------------------------------------------------------------------------------------------------------------

    We did not receive any public comments regarding our proposal to 
maintain as temporary the office-based designation for CPT codes 0099T 
(Implantation of intrastromal corneal ring segments); 0124T 
(Conjunctival incision with posterior juxtascleral placement of 
pharmacological agent (does not include supply of medication); and 
55876 (Placement of interstitial device(s) for radiation therapy 
guidance (e.g., fiducial markers, dosimeter), prostate (via needle, any 
approach), single or multiple) or our proposal to make permanent the 
designation of CPT code 36598 (Contrast injection(s) for radiologic 
evaluation of existing central venous access device, including 
fluoroscopy, image documentation and report) as office-based. Although 
we received public comments about the proposed policy to package more 
procedures for CY 2008 under the OPPS, we did not receive any specific 
public comments regarding the designation of CPT code 58110 
(Endometrial sampling (biopsy) with or without endocervical sampling 
(biopsy), without cervical dilation, any method (separate procedure)) 
as packaged for CY 2008.
    Therefore, we are finalizing our CY 2008 proposals, without 
modification, to maintain the temporary office-based designations of 
CPT codes 0099T, 0124T, and 55876, the permanent office-based 
designation of CPT code 36598, and the packaged status of CPT code 
58110. The procedures and the final payment indicators for CY 2008 are 
displayed below in Table 53.
    Displayed in Table 53 are the new CY 2008 HCPCS codes (excluding 
renumbered codes) to which we have assigned temporary office-based 
payment indicators. Those designations are temporary and are open to 
comment during the 60-day comment period for this final rule with 
comment period. We will respond to public comments on those 
designations in the OPPS/ASC final rule with comment period for CY 
2009.

 Table 53.--CY 2008 Payment Indicators for Procedures Assigned Temporary
    Office-Based Payment Indicators in the August 2, 2007 Revised ASC
                        Payment System Final Rule
------------------------------------------------------------------------
                                                    Final CY 2008 ASC
                                                 payment indicator (* if
     HCPCS code           Short descriptor            designation is
                                                  temporary for CY 2008)
------------------------------------------------------------------------
0099T..............  Implant corneal ring......  R2*
0124T..............  Conjunctival drug           R2*
                      placement.
36598..............  Inj w/fluor, eval cv        P3
                      device.
55876..............  Place rt device/marker,     P3*
                      pros.
58110..............  Bx done w/colposcopy add-   N1
                      on.
------------------------------------------------------------------------


    Table 54.--CY 2008 Payment Indicators for New CY 2008 ASC Covered
 Surgical Procedures Assigned Temporary Office-Based Payment Indicators
                        on an Interim Final Basis
------------------------------------------------------------------------
                                                    Final CY 2008 ASC
                                                 payment indicator (* if
     HCPCS code           Short descriptor            designation is
                                                  temporary for CY 2008)
------------------------------------------------------------------------
21073..............  Mnpj of tmj w/anesth......  P3*
67229..............  Tr retinal les preterm inf   R2*
68816..............  Probe nl duct w/balloon...  P3*
------------------------------------------------------------------------

c. Changes in Designation of Covered Surgical Procedures as Device-
Intensive
    As explained in section XVI.C.1.c.(3) of this final rule with 
comment period, we adopted a modified payment methodology for 
calculating the ASC payment rates for ASC covered surgical procedures 
that are assigned to the subset of device-dependent APCs under the OPPS 
with a device offset percentage greater than 50 percent under the OPPS 
to ensure that payment for the procedure is adequate to provide 
packaged payment for the high-cost implantable devices used in those 
procedures. In the August 2, 2007 revised ASC payment system final 
rule, we identified 24 procedures that were on the CY 2007 ASC list of 
covered surgical procedures that would be subject to this policy, as 
well as 15 new

[[Page 66842]]

ASC covered surgical procedures for CY 2008, to which we expected the 
final policy to apply.
    As a result of the proposed CY 2008 reconfiguration of several 
device-dependent APCs under the OPPS and the proposed updated APC 
device offset percentages in the CY 2008 OPPS/ASC proposed rule, we 
proposed to designate as device-intensive for ASC payment in CY 2008 an 
additional 10 ASC covered surgical procedures. We also proposed to 
remove 4 procedures from their estimated designation as device-
intensive because we proposed to recognize CPT codes instead of Level 
II HCPCS codes for ICD implantation procedures as discussed in section 
III.D.1.c. of this final rule with comment period. We proposed to 
assign payment indicators ``H8'' or ``J8,'' as appropriate, to the 
covered surgical procedures identified as device-intensive so that 
payment would be made consistent with our final revised ASC payment 
system payment policy.
    We received a number of public comments on our proposal for payment 
of device-intensive procedures in ASCs for CY 2008. A summary of the 
public comments and our responses follow.
    Comment: Most commenters were generally pleased with the final 
payment policy, but several commenters requested that CMS apply the 
device-intensive payment methodology to either all ASC covered 
procedures assigned to device-dependent APCs or to those assigned to 
APCs with a lower offset percentage threshold than 50 percent so that 
more ASC covered surgical procedure rates would be calculated using the 
device-intensive methodology. Many commenters requested that covered 
procedures for which ASCs billed separately for implantable prosthetic 
devices under the CY 2007 payment system also be treated like those 
procedures CMS has identified as device-intensive, even though the 
device offset percentage under the OPPS for the procedures may be less 
than the 50 percent threshold. Specifically, some of the commenters 
requested that the ASC payment rates for the CPT codes listed in Table 
55 of this final rule with comment period be calculated as device-
intensive procedure rates, that they be allowed to be paid at revised 
ASC rates without being subject to the transitional ASC rates for CYs 
2008, 2009, and 2010 or that the device cost be added to the CY 2007 
ASC rate which would be used to calculate the transitional rate. The 
commenters stated that the payment rates during the transition period 
for procedures like these, that require high cost implantable products, 
are too low for ASCs to be able to continue to provide the services. 
The commenters advised CMS to monitor the migration of these 
procedures, and others like them, into the higher cost HOPD setting 
during the first years under the revised ASC payment system.

  Table 55.--Specific Procedures for Which Commenters Requested CY 2008
   Payment Rates That Fully Recognize the Costs of Implantable Devices
------------------------------------------------------------------------
                                                  Final CY 2008 payment
     HCPCS code            Long descriptor              indicator
------------------------------------------------------------------------
51715..............  Endoscopic injection of     A2
                      implant material into the
                      submucosal tissues of the
                      urethra and/or bladder
                      neck.
57288..............  Sling operation for stress  A2
                      incontinence (e.g.,
                      fascia or synthetic).
65105..............  Enucleation of eye; within  A2
                      implant, muscles attached
                      to implant.
65140..............  Insertion of ocular         A2
                      implant secondary; after
                      enucleation, muscles
                      attached to implant.
65155..............  Reinsertion of ocular       A2
                      implant; with use of
                      foreign material for
                      reinforcement and/or
                      attachment of muscles to
                      implant.
65770..............  Keratoprosthesis..........  A2
66180..............  Aqueous shunt to            A2
                      extraocular reservoir
                      (e.g., Molteno, Schocket,
                      Denver-Krupin).
67912..............  Correction of               A2
                      lagophthalmos, with
                      implantation of upper
                      eyelid lid load (e.g.,
                      gold weight).
------------------------------------------------------------------------

    Response: We appreciate the information shared by the commenters 
and their suggestions for payment policies for ASC procedures included 
on the CY 2007 ASC list for which separate payment is currently made 
for implantable prosthetic devices. Nonetheless, the policy for payment 
of these procedures was made final in the August 2, 2007 revised ASC 
payment system final rule after we received and addressed public 
comments (72 FR 42503). Only two of the procedures cited by the 
commenter, CPT codes 57288 and 65770, are assigned to device-dependent 
APCs under the OPPS, and neither APC has a device offset percentage 
above 50 percent. Payment will be made for all of these services at the 
transitional rates for CY 2008, based on their status as nondevice-
intensive procedures.
    Comment: Several commenters suggested that CMS should create 
additional payment policies to provide special payment for new 
technologies, procedures on the CY 2007 ASC list of covered procedures 
that never were provided in ASCs, and previous pass-through devices. 
The commenters were concerned about procedures included on the CY 2007 
ASC list that are not currently provided in ASCs. They stated that the 
very low payment amounts under the existing system precluded the 
performance of those procedures and, therefore, the procedures should 
not be subject to the transitional payment rates. In effect, the 
commenters explained, those procedures are new to the ASC list for CY 
2008 and as such, they should be allowed to bypass the transition to be 
paid at the revised ASC rates in CY 2008. For example, one commenter 
suggested that CPT code 55873 (Cryosurgical ablation of the prostate 
(includes ultrasonic guidance for interstitial cryosurgical probe 
placement)), a device-intensive procedure, should not be subject to the 
transition at all because it was not performed in ASCs prior to CY 
2008, even though it was included on the ASC list of covered surgical 
procedures beginning in CY 2005.
    The commenter who suggested additional policies for new technology 
and pass through payments under the ASC payment system stated that 
adequate payment for newer advanced technologies in the most 
appropriate setting would ensure beneficiary access to optimum care.
    Response: The payment policies for the revised ASC payment system 
to be implemented January 1, 2008 were finalized in the August 2, 2007 
revised ASC payment system final rule after we received and addressed 
public comments (72 FR 42493). With respect to device-intensive 
procedures such as CPT codes 55873 that were on the CY 2008 ASC list, 
the device portion of the payment is not subject to the transition, 
while the payment portion will receive

[[Page 66843]]

transitional payment. The final policies do not incorporate a 
methodology to exclude from the transitional payment any procedures on 
the CY 2007 ASC list. We will not consider any changes to those 
policies in this final rule with comment period.
    The final policies for the revised ASC payment system will pay 
separately for those implantable devices with pass-through status under 
the OPPS and will pay for new technology surgical procedures described 
by Category III CPT codes or Level II HCPCS codes that crosswalk 
directly or are clinically similar to established procedures already on 
the ASC list of covered surgical procedures. In this way, we believe 
these policies will serve to appropriately incorporate payment for new 
technologies under the revised ASC payment system.
    In summary, after consideration of the public comments received, we 
are implementing, without modification, the proposal to designate the 
procedures listed in Table 56 as device-intensive ASC covered surgical 
procedures for CY 2008, based on their CY 2008 final assignments to 
APCs under the OPPS that are device-dependent and which have device 
offset percentages greater than 50 percent. We are not making any 
changes to our final ASC policies related to the designation of device-
intensive procedures, transitional payment for procedures covered in 
the ASC setting in CY 2007, or payment for new technologies.

              Table 56.--ASC Covered Surgical Procedures Designated as Device-Intensive for CY 2008
----------------------------------------------------------------------------------------------------------------
                                                                                                  CY 2008 device-
                                                                                   CY 2008 OPPS    dependent APC
               HCPCS code                            Short descriptor                   APC           offset
                                                                                                    percentage
----------------------------------------------------------------------------------------------------------------
33206..................................  Insertion of heart pacemaker...........            0089           72.99
33207..................................  Insertion of heart pacemaker...........            0089           72.99
33208..................................  Insertion of heart pacemaker...........            0655           74.62
33210..................................  Insertion of heart electrode...........            0106           56.25
33211..................................  Insertion of heart electrode...........            0106           56.25
33212..................................  Insertion of pulse generator...........            0090           76.01
33213..................................  Insertion of pulse generator...........            0654           77.13
33214..................................  Upgrade of pacemaker system............            0655           74.62
33216..................................  Insert lead pace-defib, one............            0106           56.25
33217..................................  Insert lead pace-defib, dual...........            0106           56.25
33224..................................  Insert pacing lead & connect...........            0418           82.52
33225..................................  Lventric pacing lead add-on............            0418           82.52
33240..................................  Insert pulse generator.................            0107           89.11
33249..................................  Eltrd/insert pace-defib................            0108           89.24
33282..................................  Implant pat-active ht record...........            0680           73.15
36566..................................  Insert tunneled cv cath................            0625           58.88
53440..................................  Male sling procedure...................            0385           51.56
53444..................................  Insert tandem cuff.....................            0385           51.56
53445..................................  Insert uro/ves nck sphincter...........            0386           63.53
53447..................................  Remove/replace ur sphincter............            0386           63.53
54400..................................  Insert semi-rigid prosthesis...........            0385           51.56
54401..................................  Insert self-contd prosthesis...........            0386           63.53
54405..................................  Insert multi-comp penis pros...........            0386           63.53
54410..................................  Remove/replace penis prosth............            0386           63.53
54416..................................  Remv/repl penis contain pros...........            0386           63.53
55873..................................  Cryoablate prostate....................            0674           60.27
61885..................................  Insrt/redo neurostim 1 array...........            0039           82.73
61886..................................  Implant neurostim arrays...............            0315           86.15
62361..................................  Implant spine infusion pump............            0227           80.73
62362..................................  Implant spine infusion pump............            0227           80.73
63650..................................  Implant neuroelectrodes................            0040           56.27
63655..................................  Implant neuroelectrodes................            0061           60.60
63685..................................  Insrt/redo spine n generator...........            0222           84.86
64553..................................  Implant neuroelectrodes................            0225           80.57
64555..................................  Implant neuroelectrodes................            0040           56.27
64560..................................  Implant neuroelectrodes................            0040           56.27
64561..................................  Implant neuroelectrodes................            0040           56.27
64565..................................  Implant neuroelectrodes................            0040           56.27
64573..................................  Implant neuroelectrodes................            0225           80.57
64575..................................  Implant neuroelectrodes................            0061           60.60
64577..................................  Implant neuroelectrodes................            0061           60.60
64580..................................  Implant neuroelectrodes................            0061           60.60
64581..................................  Implant neuroelectrodes................            0061           60.60
64590..................................  Insrt/redo pn/gastr stimul.............            0222           84.86
69930..................................  Implant cochlear device................            0259           82.94
----------------------------------------------------------------------------------------------------------------

2. Changes for Identification of Covered Ancillary Services
    In the August 2, 2007 revised ASC payment system final rule, we set 
forth our policy to make separate ASC payments for certain ancillary 
services, for which separate payment is made under the OPPS, when they 
are provided integral to ASC covered surgical procedures. Under the 
revised ASC payment system, we exclude from the scope of ASC facility 
services, for which payment is packaged into the ASC payment for the 
covered surgical procedure, the following ancillary

[[Page 66844]]

services that are integral to a covered surgical procedure: 
brachytherapy sources; certain implantable items that have pass-through 
status under the OPPS; certain items and services that we designate as 
contractor-priced, including, but not limited to, 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. These covered 
ancillary services are specified in Sec.  416.164(b) and fall within 
the scope of ASC services, so they are eligible for separate ASC 
payment.
    In the CY 2008 OPPS/ASC proposed rule (72 FR 42788), we proposed to 
make changes to the list of covered ancillary services eligible for 
separate ASC payment, as proposed in Addendum BB to that proposed rule, 
to comport with their proposed treatment under the OPPS according to 
the final payment policies of the revised ASC payment system, and to 
add new Category III CPT code 0182T (High dose rate electronic 
brachytherapy, per fraction), as discussed in section XVI.D.2. of this 
final rule with comment period. Accordingly, we are finalizing changes 
to the list of covered ancillary services eligible for ASC payment in 
Addendum BB of this final rule with comment period to reflect the 
policies finalized for the CY 2008 OPPS and to add Category III CPT 
code 0182T to the list of covered ancillary services.

F. Payment for Covered Surgical Procedures and Covered Ancillary 
Services

1. Payment for Covered Surgical Procedures
a. Update to Payment Rates
    Our final payment policy for covered surgical procedures under the 
revised ASC payment system is described in section XVI.C. of this final 
rule with comment period. In the CY 2008 OPPS/ASC proposed rule (72 FR 
42788), for CY 2008, we proposed to update payment for procedures with 
payment indicators ``G2'' and ``A2,'' using CY 2006 utilization data. 
We did not propose to make any changes to the final policies 
established in the August 2, 2007 revised ASC payment system final rule 
related to the methodology for developing the relative payment weights 
and rates. The differences in the payment rates for covered surgical 
procedures with ``G2'' and ``A2'' payment indicators, reflected in 
Addendum AA to the proposed rule, compared with the August 2, 2007 
revised ASC payment system final rule, were due to our use of updated 
CY 2006 utilization data, proposed payment policy changes for the CY 
2008 OPPS, including APC reassignments and changes to packaged 
services, and the proposed OPPS update factor.
    We also proposed to update the payment amounts for the office-based 
procedures in the CY 2008 OPPS/ASC proposed rule. Using the most recent 
available MPFS and OPPS data, including the proposed CY 2008 rates, we 
compared the estimated CY 2008 rate for each of the office-based 
procedures calculated according to the standard methodology of the 
revised ASC payment system and to the MPFS nonfacility PE RVUs to 
determine which is the lower payment amount that, therefore, is the 
rate we proposed for payment of the procedure according to the final 
policy of the revised ASC payment system. The proposed update to the 
rates resulted in changes to the payment indicators, as well as the 
rates, for several of the office-based procedures. For example, a 
procedure with payment indicator ``P2'' in the August 2, 2007 revised 
ASC payment system final rule may have been assigned payment indicator 
``P3'' in the CY 2008 OPPS/ASC proposed rule, depending on the outcome 
of that rate comparison.
    In addition, we proposed to update the payment amounts for the 
device intensive procedures in the proposed rule, based on the CY 2008 
OPPS proposal and updated OPPS claims data.
    We received many public comments on the proposed CY 2008 payment 
rates for covered surgical procedures. A summary of the public comments 
and our responses follow.
    Comment: Many commenters were concerned that the proposed ASC rates 
for covered surgical procedures that require expensive equipment and 
single-use, disposable supplies would not be adequate to cover the 
costs, especially during the first 3 years of the revised payment 
system. The commenters offered a number of suggestions, such as 
establishing a class of procedures that are ``equipment-intensive'' for 
which an alternate payment methodology similar to that for ``device-
intensive'' procedures could be used to set rates, to address their 
concern that payments, even at the revised ASC rates, would be 
inadequate for procedures like lithotripsy (CPT code 50590 
(Lithotripsy, extracorporeal shock wave)), which requires equipment 
that costs the same wherever the procedure is performed. Other 
commenters suggested that procedures that include use of expensive 
single-use supplies be paid at the fully implemented rate beginning in 
CY 2008.
    Response: We appreciate the commenters' concerns. However, the 
payment methodologies for the revised ASC payment system were made 
final in the revised ASC payment system final rule published on August 
2, 2007 after we received and addressed public comments. As explained 
in that final rule (72 FR 42503), we believe that it would not be 
appropriate to provide separate payment for aspects of procedures (for 
example, implantable prosthetics or equipment) that are packaged into 
the ASC payment rates for the procedures under the revised payment 
system.
    Comment: None of the commenters opposed updating the payment rates 
for covered surgical procedures by using the most recent available MPFS 
and OPPS data. However, several commenters asked that CMS review the 
proposed payment rate for CPT code 64517 (Injection, anesthetic agent; 
superior hypogastric plexus) because they believed that the proposed CY 
2008 rate included in Addendum AA to the proposed rule might be 
erroneous.
    Response: We reviewed the proposed rate for CPT code 64517, which 
is assigned payment indicator ``A2,'' and found that the rate for CY 
2008 displayed in Addendum AA of the proposed rule was correct. The 
method for calculating the rate for procedures with ``A2'' payment 
indicator, like CPT code 64517, is displayed in Table 57. As can be 
seen in the table, the proposed rate of $178.12 for CPT code 64517 
included in the CY 2008 OPPS/ASC proposed rule Addendum AA was correct. 
We believe the example presented is helpful in understanding the 
transitional payment rate calculations.

[[Page 66845]]



 Table 57.--Sample Calculation of Year One (CY 2008) National Unadjusted
   Transitional Payment Rate for Covered Surgical Procedures Assigned
                        Payment Indicator ``A2''
------------------------------------------------------------------------
                                  CY 2008 rate
Steps in calculation of year     calculation for      CY 2008 proposed
 one (CY 2008) transitional      procedures with    rule calculation for
      ASC payment rate          payment indicator      CPT code 64517
                                     ``A2''
------------------------------------------------------------------------
Step 1......................   Multiply transition  0.75 x $139 =
                               year one CY 2007      $104.25.
                               ASC portion of
                               blended rate by the
                               CY 2007 ASC rate.
Step 2......................   Calculate CY 2008    7.1370 x $41.400 =
                               fully implemented     $295.4718.
                               ASC rate by
                               multiplying ASC
                               relative weight by
                               ASC conversion
                               factor.
Step 3......................  Multiply transition   0.25 x $295.4718 =
                               year one CY 2008      $73.86795.
                               portion of blended
                               rate by the fully
                               implemented ASC
                               rate.
Step 4......................  Add the 75 percent    $104.25 + $73.86795
                               and 25 percent        = $178.11795 which
                               amounts of the        rounds to $178.12.
                               blended rate to
                               equal the year one
                               (CY 2008)
                               transitional rate;
                               round to two
                               decimal places.
------------------------------------------------------------------------

    Therefore, after consideration of all public comments received, we 
are implementing our policy to update the CY 2008 ASC rates using the 
most recently available OPPS and MPFS data. The ASC national unadjusted 
rates for all covered surgical procedures are displayed in Addendum AA 
to this final rule with comment period.
b. Payment Policies When Devices Are Replaced at No Cost or With Credit
(1) Policy When Devices Are Replaced at No Cost or With Full Credit
    Our final ASC policy with regard to payment for costly devices 
implanted in ASCs is fully consistent with the current OPPS policy. The 
ASC policy includes adoption of the OPPS policy for payment to 
providers when a device is replaced without cost or with full credit 
for the cost of the device being replaced, for those ASC covered 
surgical procedures that are assigned to APCs under the OPPS to which 
this policy applies. In the case of no cost or full credit cases under 
the OPPS, we reduce the APC payment to the hospital by the device 
offset amount that we estimate represents the cost of the device. 
Therefore, in accordance with the OPPS policy implemented in CY 2007, 
and the ASC policy as finalized in the August 2, 2007 revised ASC 
payment system final rule, beginning in CY 2008, we reduce the amount 
of payment made to ASCs for certain covered surgical procedures when 
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 provide the same amount of payment reduction based on the 
device offset amount in ASCs that would apply under the OPPS for 
performance of those procedures under the same circumstances. 
Specifically, when a procedure that is listed in Table 58 below is 
performed in an ASC and the case involves implantation of a no cost or 
full credit device listed in Table 59, the ASC must report the HCPCS 
``FB'' modifier on the line with the covered surgical procedure code to 
indicate that an implantable device in Table 59 was furnished without 
cost. The devices listed in Table 59 are the same devices to which the 
policy applies under the OPPS, and the procedures listed in Table 58 
are those ASC covered surgical procedures assigned to APCs under the 
OPPS to which the policy applies.
    As finalized in the August 2, 2007 revised ASC payment system final 
rule (72 FR 42506), when the ``FB'' modifier is reported with a 
procedure code that is listed in Table 58, the contractor reduces the 
ASC payment by the amount of payment that we 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.
(2) Policy When Implantable Devices Are Replaced with Partial Credit
    Consistent with our CY 2008 OPPS proposal discussed in section 
IV.A.3. of this final rule with comment period, we proposed to reduce 
the ASC payment by one half of the device offset amount for certain 
surgical procedures into which the device cost is packaged, when an ASC 
receives a partial credit toward replacement of an implantable device 
(72 FR 42788). We proposed that the partial payment reduction would 
apply to covered surgical procedures in which the amount of the device 
credit is greater than or equal to 20 percent of the cost of the new 
replacement device being implanted. We also proposed to base the 
beneficiary's coinsurance on the reduced ASC payment rate so that the 
beneficiary shares the benefit of the ASC's reduced costs.
    We have no OPPS data to empirically determine by how much we should 
reduce the payment for ASC surgical procedures into which the costs of 
these devices are packaged. Device manufacturers and hospitals have 
told us that a common scenario is that, if a device fails 3 years after 
implantation, the hospital would receive a 50 percent credit towards a 
replacement device. We do not believe that hospitals reduce their 
device charges to reflect the credits that may have been received, so 
the lower facility costs associated with the partial credit scenarios 
would likely not be reflected in our proposed OPPS rates for these 
device-dependent procedures. Therefore, we proposed under the OPPS to 
reduce the payment for the relevant device dependent APCs and, under 
the revised ASC payment system, to reduce the payment for those ASC 
covered surgical procedures assigned to those APCs under the OPPS by 
half of the reduction that applies when the hospital or ASC receives a 
device without cost or receives a full credit for a device being 
replaced. That is, we proposed to reduce the payments by half of the 
offset amount that represents the cost of the device packaged into the 
procedure payment. In the absence of OPPS claims data on which to base 
a reduction factor, but taking into consideration what we have been 
told is common industry practice, we believe that reducing the amount 
of payment for the device dependent APC and the related ASC covered 
surgical procedure by half of the estimated cost of the device 
packaging represents a reasonable reduction in these cases. We listed 
the ASC procedures to which this proposed policy would apply in Table 
64 of the CY 2008 OPPS/ASC proposed rule (72 FR 42790).
    Moreover, we proposed to take this reduction only when the credit 
is for 20 percent or more of the cost of the new replacement device, so 
that the

[[Page 66846]]

reduction is not taken in cases in which more than 80 percent of the 
cost of the replacement device has been incurred by the facility. If 
the partial credit is less than 20 percent of the cost of the new 
replacement device, we believe that reducing the payment for the device 
implantation procedure by 50 percent of the packaged device cost would 
provide too low a payment for necessary device replacement procedures. 
Accordingly, we proposed that the new HCPCS partial credit modifier 
must be reported for cases in which the device credit is equal to or 
greater than 20 percent of the cost of the new replacement device if 
the device was listed in Table 65 of the CY 2008 OPPS/ASC proposed rule 
with comment period (72 FR 42790). We selected these devices because 
they have substantial costs and because each device is implanted in one 
beneficiary at least temporarily and, therefore, can be associated with 
an individual beneficiary.
    The proposed policy related to partial device credits applies to 
the same devices and procedures to which our policy governing payment 
when the device is furnished to the ASC without cost or with full 
credit applies. We believe that this policy is a logical extension of 
our established policy regarding reduction of the ASC payment in cases 
in which the facility furnishes the device without cost or with a full 
credit to the ASC and ensures that beneficiary and Medicare payments 
are appropriate and consistent with costs incurred by ASCs.
    This partial device credit policy that we proposed would enhance 
our ability to track the replacement of these implantable medical 
devices and may enable us to identify patterns of device failure or 
limited longevity early in their natural history so that appropriate 
strategies to reduce future problems for our beneficiaries may be 
developed. We also are mindful of the opportunity to use our claims 
history data to promote high quality medical care with regard to the 
devices and the services in which they are used. Collecting data on a 
wider set of device replacements under full and partial credit 
situations in all sites of outpatient surgery, including ASCs, would 
assist in developing comprehensive summary data, not just a subset of 
data related to devices replaced without cost or with a full credit to 
facilities.
    Comment: As described in section IV.A.3. of this final rule with 
comment period, we received several public comments on our proposal to 
reduce payment if an expensive implantable device is replaced and the 
facility receives a partial credit toward the cost of the replacement 
device. Principally, the commenters agreed that neither Medicare nor 
beneficiaries should have to pay based on a device's full cost when the 
hospital receives a substantial credit from the manufacturer for that 
device and supported the premise underpinning the proposed policy that 
hospitals' charges and the payment rates based on those charges 
currently do not reflect partial credits for replaced devices. However, 
the commenters argued that CMS should raise the partial credit 
threshold to which this policy would apply to 50 percent of the cost of 
the replacement device, consistent with the policy CMS recently 
implemented for devices replaced with partial credit for services paid 
under the FY 2008 IPPS. Many commenters also urged adoption of the same 
billing options that are available under the IPPS for billing devices 
replaced with partial credit. Specifically, they requested that 
hospitals and ASCs be allowed to: (1) Submit the claims for replacement 
devices immediately without the HCPCS modifier signifying partial 
credit for a replacement device and later, if a credit is ultimately 
issued, submit a claim adjustment with the appropriate coding; or (2) 
hold the claim until a credit determination is made. We refer readers 
to section IV.A.3. of this final rule with comment period for a more 
detailed summary of the comments we received on this proposal.
    Response: After consideration of the public comments received, we 
are adopting a modified policy for certain procedures involving partial 
credit for a replacement device. Consistent with the final CY 2008 OPPS 
policy described in detail in section IV.A.3. of this final rule with 
comment period, and the recently implemented FY 2008 IPPS policy, we 
will reduce the ASC payment for implantation procedures listed in Table 
58 below by one half of the device offset that would be applied if a 
replacement device were provided at no cost or with full credit, if the 
credit is 50 percent or more of the replacement device cost, rather 
than the proposed 20 percent. We believe that payment policies across 
hospital payment systems, including the OPPS, the IPPS, and the revised 
ASC payment system, should align whenever possible and appropriate, as 
is true in this case. We refer readers to section IV.A.3. of this final 
rule with comment period for a more detailed discussion of our decision 
to implement a 50 percent rather than 20 percent threshold to which the 
partial credit policy will apply.
    ASCs will be instructed to append the new ``FC'' modifier to the 
HCPCS code for the procedure in which the device was inserted on claims 
when the device that was replaced with partial credit under warranty, 
recall, or field action is one of the devices in Table 59 below (ASCs 
should not append the modifier to the HCPCS procedure code if the 
device is not listed in Table 59 below). The partial credit adjustment 
will be made to the national unadjusted rate, similar to what occurs 
when a device is replaced at full credit or with no cost, and 
beneficiary coinsurance will be adjusted to reflect the reduced payment 
amount.
    As discussed in section IV.A.3. of this final rule with comment 
period, we understand commenters' concerns about potential delays that 
could occur while a returned device is being evaluated to determine 
whether and by how much a credit will be applied. In order to report 
that they received a partial credit of 50 percent or more of the cost 
of a replacement device, ASCs will have the option of either: (1) 
Submitting the claim for the device replacement procedure to their 
Medicare contractor after the procedure's performance but prior to 
manufacturer acknowledgment of credit for a replacement device, and 
subsequently contacting the contractor regarding a claims adjustment 
once the credit determination is made; or (2) holding the claim for the 
device replacement procedure until a determination is made by the 
manufacturer on the partial credit and submitting the claim with the 
``FC'' modifier appended to the implantation procedure HCPCS code if 
the partial credit is 50 percent or more of the cost of the replacement 
device. If choosing the first billing option, to request a claim 
adjustment once the credit determination is made, ASCs should keep in 
mind that the initial Medicare payment for the procedure involving the 
replacement device is conditional and subject to adjustment. These 
billing instructions are consistent with instructions issued for 
billing under the IPPS and OPPS. We will issue additional billing 
instructions in a separate transmittal after publication of this final 
rule with comment period.
    In summary, after consideration of the public comments received, we 
are finalizing a modified policy for certain procedures involving 
partial credit for a replacement device. Specifically, we will reduce 
the payment for implantation procedures listed in Table 58 below by one 
half of the device offset that would be applied if a replacement device 
were provided at no cost or with full credit, if the credit is 50 
percent or more of the replacement device cost. In order to implement 
this policy, we will require ASCs to report the new modifier

[[Page 66847]]

``FC'' in all cases in which the ASC receives a partial credit toward 
the replacement of a medical device listed in Table 59 below when used 
in a surgical procedure listed in Table 58 for which the ASC received 
at least a 50 percent credit. In order to report that they received a 
partial credit of 50 percent or more of the cost of a replacement 
device, ASCs will have the option of either: (1) Submitting the claim 
for the device replacement procedure to their Medicare contractor after 
the procedure's performance but prior to manufacturer acknowledgment of 
credit for a replacement device, and subsequently contacting the 
contractor regarding a claims adjustment once the credit determination 
is made; or (2) holding the claim for the device replacement procedure 
until a determination is made by the manufacturer on the partial credit 
and submitting the claim with the ``FC'' modifier appended to the 
implantation procedure HCPCS code if the partial credit is 50 percent 
or more of the cost of the replacement device. Beneficiary coinsurance 
will be based on the reduced payment amount.

 Table 58.--Adjustments to Payments for ASC Covered Surgical Procedures in CY 2008 in Cases of Devices Reported
                          Without Cost or for Which Full or Partial Credit is Received
----------------------------------------------------------------------------------------------------------------
                                                                                                      50 percent
                                                    CY 2008                               CY 2008     of CY 2008
      HCPCS code            Short descriptor        OPPS APC          APC title         OPPS offset  OPPS offset
                                                                                         percentage   percentage
----------------------------------------------------------------------------------------------------------------
61885.................  Insrt/redo neurostim 1           0039  Level I Implantation of        82.73        41.37
                         array.                                 Neurostimulator.......
64590.................  Insrt/redo perph n
                         generator.
----------------------------------------------------------------------------------------------------------------
63650.................  Implant neuroelectrodes.         0040  Percutaneous                   56.27        28.14
                                                                Implantation of
                                                                Neurostimulator
                                                                Electrodes, Excluding
                                                                Cranial Nerve.
64555.................  Implant neuroelectrodes.
64560.................  Implant neuroelectrodes.
64561.................  Implant neuroelectrodes.
64565.................  Implant neuroelectrodes.
----------------------------------------------------------------------------------------------------------------
63655.................  Implant neuroelectrodes.         0061  Laminectomy or Incision        60.60        30.30
                                                                for Implantation of
                                                                Neurostimulator
                                                                Electrodes, Excluding
                                                                Cranial Nerve.
64575.................  Implant neuroelectrodes.
64577.................  Implant neuroelectrodes.
64580.................  Implant neuroelectrodes.
64581.................  Implant neuroelectrodes.
----------------------------------------------------------------------------------------------------------------
33206.................  Insertion of heart               0089  Insertion/Replacement          72.99        36.50
                         pacemaker.                             of Permanent Pacemaker
                                                                and Electrodes.
----------------------------------------------------------------------------------------------------------------
33207.................  Insertion of heart
                         pacemaker.
----------------------------------------------------------------------------------------------------------------
33212.................  Insertion of pulse               0090  Insertion/Replacement          76.01        38.01
                         generator.                             of Pacemaker Pulse
                                                                Generator.
----------------------------------------------------------------------------------------------------------------
33210.................  Insertion of heart               0106  Insertion/Replacement/         56.25        28.13
                         electrode.                             Repair of Pacemaker
                                                                and/or Electrodes.
33211.................  Insertion of heart
                         electrode.
33216.................  Insert lead pace-defib,
                         one.
33217.................  Insert lead pace-defib,
                         dual.
----------------------------------------------------------------------------------------------------------------
33240.................  Insert pulse generator..         0107  Insertion of                   89.11        44.56
                                                                Cardioverter-
                                                                Defibrillator.
----------------------------------------------------------------------------------------------------------------
33249.................  Eltrd/insert pace-defib.         0108  Insertion/Replacement/         89.24        44.62
                                                                Repair of Cardioverter-
                                                                Defibrillator Leads.
----------------------------------------------------------------------------------------------------------------
63685.................  Insrt/redo spine n               0222  Implantation of                84.86        42.43
                         generator.                             Neurological Device.
----------------------------------------------------------------------------------------------------------------
64553.................  Implant neuroelectrodes.         0225  Implantation of                80.57        40.29
                                                                Neurostimulator
                                                                Electrodes, Cranial
                                                                Nerve.
64573.................  Implant neuroelectrodes.
----------------------------------------------------------------------------------------------------------------
62361.................  Implant spine infusion           0227  Implantation of Drug           80.73        40.37
                         pump.                                  Infusion Device.
62362.................  Implant spine infusion
                         pump.
----------------------------------------------------------------------------------------------------------------
69930.................  Implant cochlear device.         0259  Level VI ENT Procedures        82.94        41.47
----------------------------------------------------------------------------------------------------------------
61886.................  Implant neurostim arrays         0315  Level II Implantation          86.15        43.08
                                                                of.
                                                                Neurostimulator.......
----------------------------------------------------------------------------------------------------------------
53440.................  Male sling procedure....         0385  Level I Prosthetic             51.56        25.78
                                                                Urological Procedures.
53444.................  Insert tandem cuff......
54400.................  Insert semi-rigid
                         prosthesis.
----------------------------------------------------------------------------------------------------------------

[[Page 66848]]

 
53445.................  Insert uro/ves nck               0386  Level II Prosthetic            63.53        31.77
                         sphincter.                             Urological Procedures.
53447.................  Remove/replace ur
                         sphincter.
54401.................  Insert self-contd
                         prosthesis.
54405.................  Insert multi-comp penis
                         pros.
54410.................  Remove/replace penis
                         prosth.
54416.................  Remv/repl penis contain
                         pros.
----------------------------------------------------------------------------------------------------------------
33224.................  Insert pacing lead &             0418  Insertion of Left              82.52        41.26
                         connect.                               Ventricular Pacing
                                                                Elect.
33225.................  L ventric pacing lead
                         add-on.
----------------------------------------------------------------------------------------------------------------
36566.................  Insert tunneled cv cath.         0625  Level IV Vascular              58.88        29.44
                                                                Access Procedures.
----------------------------------------------------------------------------------------------------------------
33213.................  Insertion of pulse               0654  Insertion/Replacement          77.13        38.57
                         generator.                             of a permanent dual
                                                                chamber pacemaker.
----------------------------------------------------------------------------------------------------------------
33214.................  Upgrade of pacemaker             0655  Insertion/Replacement/         74.62        37.31
                         system.                                Conversion of a
                                                                permanent dual chamber
                                                                pacemaker.
33208.................  Insertion of heart
                         pacemaker.
----------------------------------------------------------------------------------------------------------------
33282.................  Implant pat-active ht            0680  Insertion of Patient           73.15        36.58
                         record.                                Activated Event
                                                                Recorders.
----------------------------------------------------------------------------------------------------------------


   Table 59.--Devices for Which the ``FB'' or ``FC'' Modifier Must Be
   Reported With the Procedure Code When Furnished Without Cost or for
                Which Full or Partial Credit is Received
------------------------------------------------------------------------
             Device HCPCS code                    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, neurostimulators.
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.
C1881.....................................  Dialysis access system.
C1882.....................................  AICD, other than sing/dual.
C1891.....................................  Infusion pump, non-prog,
                                             perm.
C1895.....................................  Lead, AICD, endo dual coil.
C1896.....................................  Lead, AICD, non sing/dual.
C1897.....................................  Lead, neurostim, test kit.
C1898.....................................  Lead, pmkr, other than
                                             trans.
C1899.....................................  Lead, pmkr/AICD combination.
C1900.....................................  Lead coronary venous.
C2619.....................................  Pmkr, dual, non rate-resp.
C2620.....................................  Pmkr, single, non rate-resp.
C2621.....................................  Pmkr, other than sing/dual.
C2622.....................................  Prosthesis, penile, non-inf.
C2626.....................................  Infusion pump, non-prog,
                                             temp.
C2631.....................................  Rep dev, urinary, w/o sling.
L8614.....................................  Cochlear device/system.
------------------------------------------------------------------------

2. Payment for Covered Ancillary Services
    Our final CY 2008 payment policies under the revised ASC payment 
system for covered ancillary services vary according to the particular 
type of service and its payment policy under the OPPS. Our overall 
policy provides for separate ASC payment for certain ancillary services 
integrally related to the provision of ASC covered surgical procedures 
if those services are paid separately under the OPPS. Thus, we 
established a policy to align ASC payment bundles with those under the 
OPPS. Specifically, our final ASC payment policies provide separate ASC 
payment for brachytherapy sources and drugs and biologicals that are 
separately paid under the OPPS at the OPPS rates, while we pay for 
radiology services at the lower of the MPFS nonfacility PE RVU (or 
technical component) amount or the rate calculated according to the 
standard methodology of the revised ASC payment system based on the 
OPPS relative payment weight for the service.
    As evidenced by our final policies for 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 only for 
those ancillary services that are paid separately under the OPPS, in 
the CY 2008 OPPS/ASC proposed rule (72 FR 42790), we also proposed to 
package into the ASC payment for covered surgical procedures the costs 
of those ancillary services that are proposed to be packaged under the 
OPPS for CY 2008. Certain covered ancillary services that we proposed 
to package for the CY 2008 OPPS were assigned payment indicator ``Z2'' 
or ``Z3'' in the August 2, 2007 revised ASC payment system final rule, 
but they were assigned payment indicator ``N1'' in Addendum BB to the 
CY 2008 OPPS/ASC proposed rule. We refer readers to section II.A.4.c. 
of this final rule with comment period for a description of the CY 2008 
OPPS proposed packaging approach that we also proposed to adopt in 
ASCs. In addition, OPPS payments for brachytherapy sources and 
separately payable drugs and biologicals are discussed in sections 
VII.B. and V. of this final rule with comment period, respectively. 
Other separately paid covered ancillary services in ASCs, specifically 
corneal tissue acquisition and devices with OPPS pass-through status, 
do not have prospectively established ASC payment rates according to 
the final policies of the revised ASC payment system. Payments for 
devices with pass through status under the OPPS, for which separate 
payment would be made to ASCs at contractor-priced rates, are discussed 
in detail in section VI. of this final rule with comment period.
    We received many public comments on our proposal for payment of 
covered ancillary services under the CY 2008 revised ASC payment 
system. A

[[Page 66849]]

summary of the public comments and our response follow.
    Comment: Many commenters disagree with the proposal to package 
payment for CPT codes 72285 (Discography, cervical or thoracic, 
radiologic supervision and interpretation) and 72295 (Discography, 
lumbar, radiological supervision and interpretation), in accordance 
with the proposed packaging policy under the OPPS. The commenters were 
concerned that the surgical procedures that are packaged into CPT codes 
72285 and 72295 (CPT codes 62290 (Injection procedure for discography, 
each level; lumbar) and 62291 (Injection procedure for discography, 
each level; cervical or thoracic)), as well as a number of other 
surgical procedures that are packaged into other codes in the range of 
CPT codes for radiology services, will no longer be available in ASCs 
as a result of the new packaging policy. The commenters requested that 
CMS develop a payment policy like that applied to these codes under the 
OPPS to allow separate payment for the services when they are provided 
without a covered surgical procedure.
    Response: As explained in the August 2, 2007 revised ASC payment 
system final rule (72 FR 42485), we continue to believe that packaging 
payment for those surgical procedures that are packaged under the OPPS 
is appropriate under the revised ASC payment system. Our policy is 
aligned with the recommendation of the Practicing Physicians Advisory 
Council (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 the services, consistent with 
the recommendation of MedPAC to maintain consistent payment bundles 
under both payment systems.
    Under the OPPS, the services described by CPT codes 72285 and 72295 
may be provided without another separately paid surgical procedure and, 
therefore, have been assigned to the OPPS status indicator ``Q'' to 
indicate that payment for the service is usually packaged into payment 
for another procedure but that under some circumstances, the service 
may be paid separately. For example, in the HOPD, if the service 
described by CPT code 72285 is provided without another separately paid 
service (into which it usually would be packaged), then a separate 
payment is made for it under the OPPS.
    According to the revised ASC payment system policies, there is no 
instance in which payment for a service is packaged only sometimes. The 
services that are packaged into covered surgical procedures are always 
packaged; that is, they are unconditionally packaged. There is no 
payment policy for ASCs that parallels the OPPS policy for the ``Q'' 
status indicator which, under OPPS conditional packaging policies, 
provides packaged payment for the service unless it is billed without 
any other separately payable OPPS service (or in some cases, without 
any other separately payable surgical procedure) on the same day, in 
which case separate OPPS payment is allowed for the status indicator 
``Q'' service. In ASCs, there is no circumstance in which Medicare 
would make separate payment to an ASC for a service if it was not 
performed with a covered surgical procedure. Only covered surgical 
procedures may be paid when billed alone, without other separately 
payable services. Our policy is to make separate payment for all 
covered surgical procedures and for all covered ancillary services 
which, by definition, are provided integral to a covered surgical 
procedure performed in an ASC. Therefore, under the revised ASC payment 
system, the radiology services of concern to the commenters are 
packaged for CY 2008.
    After consideration of the public comments received, we are 
providing CY 2008 payment for covered ancillary procedures in 
accordance with their final payment policies under the revised ASC 
payment system as described in the August 2, 2007 revised ASC payment 
system final rule and their final treatment under the CY 2008 OPPS. 
Covered ancillary services and their final payment indicators are 
listed in Addendum BB to this final rule with comment period.

G. Physician Payment for Procedures and Services Provided in ASCs

    Under current policy, when physicians perform surgical procedures 
in ASCs that are included on the ASC list of covered surgical 
procedures, they are paid under the MPFS for the PE component using the 
facility PE RVUs. This is appropriate because the surgical procedures 
are those for which Medicare allows facility payment to ASCs. However, 
when physicians perform surgical procedures in ASCs that are not 
included on the ASC list of covered surgical procedures and for which 
Medicare does not allow facility payments to ASCs, physicians are paid 
for the PE component at the higher MPFS nonfacility PE RVUs (unless a 
nonfacility rate does not exist, in which case Medicare pays the 
physician at the facility rate). These policies are set forth in 
Sec. Sec.  414.22(b)(5)(i)(A) and (b)(5)(i)(B), respectively. 
Furthermore, physician payment for nonsurgical services provided in 
ASCs, for which no facility payment is made to ASCs under the existing 
ASC payment system, varies based on local Medicare contractor policy. 
Some contractors pay physicians only for the professional component 
(PC) of the service and others make payment to the physician for the 
technical component (TC) as well. Under the current policy, as 
described in the CY 2002 Physician Fee Schedule final rule with comment 
period (66 FR 55264), Medicare payment to the physician for a 
noncovered surgical procedure performed in an ASC constitutes payment 
in full. This is so even if the physician is paid the facility rate 
(because there is no nonfacility rate). In this case, there is no 
beneficiary liability other than the deductible and copayment for the 
physician's services.
    According to the policy adopted in the August 2, 2007 revised ASC 
payment system final rule, Medicare will make facility payments to ASCs 
for all covered surgical procedures except those that could pose a 
significant risk to beneficiary safety or would be expected to require 
active medical monitoring and care at midnight following the procedure 
(that is, an overnight stay). The revised policy will result in a 
significant expansion in the number and type of surgical procedures for 
which Medicare will make an ASC facility payment. The final payment 
policy for the revised ASC payment system also allows separate payments 
to ASCs for certain covered ancillary services (for example, some 
drugs, brachytherapy sources, and certain radiology services) that are 
provided integral to an ASC covered surgical procedure. According to 
the final policy, when covered ancillary services, which are integral 
to the performance of a covered surgical procedure and are performed on 
the same day as the covered surgery, immediately before, during or 
following the procedure, Medicare will allow separate ASC payment for 
those services.
    The revised ASC payment system is based on the APC groups and 
payment weights of the OPPS. We believe ASCs are facilities that are 
similar, insofar as the delivery of surgical and related nonsurgical 
services, to HOPDs. Specifically, when services are provided in ASCs, 
the ASC, not the physician, bears responsibility for the facility costs 
associated with the service. This situation parallels the hospital 
facility resource responsibility for hospital outpatient services. 
Therefore, as explained in the CY 2008 OPPS/ASC

[[Page 66850]]

proposed rule, we believe it would be more appropriate for physicians 
to be paid for all services furnished in ASCs just as they would be 
paid for all services furnished in the hospital outpatient setting. In 
addition, because we have adopted a final policy for the revised ASC 
payment system that identifies and excludes from ASC payment only those 
procedures that could pose a significant risk to beneficiary safety or 
would be expected to require an overnight stay, we believe that it 
would be incongruous with the revised ASC payment system methodology to 
continue to pay the higher nonfacility rate to physicians who furnish 
excluded ASC procedures. Because these excluded procedures have been 
specifically identified by CMS as procedures that could pose a 
significant risk to beneficiary safety or would be expected to require 
an overnight stay, we do not believe it would be appropriate to provide 
payment based on the higher nonfacility PE RVUs to physicians who 
furnish them. In fact, we do not expect that the excluded procedures 
will be performed in ASCs after the revised ASC payment system is 
implemented on January 1, 2008. Therefore, we proposed to revise 
Sec. Sec.  414.22(b)(5)(i)(A) and (b)(5)(i)(B) to reflect this proposed 
policy.
    We believe that the proposed revised policy would provide 
appropriate payment to physicians for services provided in the ASC 
facility setting and would encourage the most appropriate utilization 
of ASCs. For procedures that are not excluded from coverage under the 
revised ASC payment system, the ASC would be paid for the covered 
surgical procedure and associated covered ancillary services, and the 
physician would be paid for the professional work and facility PE 
associated with performing the procedure. In the case of noncovered 
surgical procedures or other noncovered services provided in ASCs, 
Medicare would make no payment to the ASC under the revised ASC payment 
system and no payment to the physician under the MPFS for the facility 
resources associated with providing those services. Although the 
current MPFS payment policy provides payment to the physician for some 
facility costs as if the service were being furnished in a physician's 
office, according to the final policy of the revised payment system, 
the services would not be covered ASC services. Consistent with 
Medicare payment policy in other care settings, no payment for facility 
costs would be made for the noncovered services. In this case, the 
noncovered services have been excluded from ASC payment for safety 
reasons, because they are expected to require an overnight stay, or 
because they are not surgical procedures, and they would not be covered 
by Medicare either directly, under the ASC payment system, or 
indirectly, through PE payments to the physicians who perform them.
    In summary, under the proposed policy, physicians would receive 
payment for all surgical and nonsurgical services furnished in ASCs 
based on the facility PE RVUs and excluding the TC payment, if 
applicable, consistent with physician payment for HOPD services. 
Medicare would make no payment for facility services to ASCs or 
physicians for procedures or services that are performed in ASCs but 
that are excluded from the list of covered ASC surgical procedures or 
that are not covered ancillary services. While physicians would be paid 
for these services based on the facility PE RVUs, physicians would no 
longer receive the additional payment for the associated facility 
resources.
    Consistent with the current OPPS payment policy that prohibits 
facility payments to the hospital for noncovered services (such as 
those surgical procedures on the OPPS inpatient list) and makes the 
beneficiary liable for those charges, this proposed policy would make 
beneficiaries responsible for the ASC charges for noncovered services 
furnished to them in ASCs.
    We received a number of public comments on our proposal to pay 
physicians at the facility PE rate instead of the nonfacility PE amount 
for excluded procedures, to not pay physicians the technical component 
(TC) payment for ancillary services, and to make beneficiaries 
responsible for the ASC charges for noncovered services furnished to 
them in ASCs. A summary of the public comments and our responses 
follow.
    Comment: Several commenters requested that CMS not proceed with the 
proposal and continue the existing payment policy for excluded services 
performed in ASCs and payment for the TC associated with ancillary 
services to physicians who provide those services. One commenter stated 
that he provides permanent seed prostate brachytherapy services to 
Medicare beneficiaries in hospital and ASC settings. Under current 
Medicare payment policy, the commenter received the TC payment for a 
number of services in the radiology range of CPT codes because he 
brought the necessary equipment to the facility with him when he came 
to provide the brachytherapy procedures. The commenter stated that he 
would be able to provide prostate brachytherapy services to a larger 
number of Medicare patients if he could continue to receive the TC 
payment for the ancillary services.
    Response: Our proposed policy for physician payment would preclude 
physicians from receiving the TC payment for procedures performed in 
ASCs because, under the revised ASC payment system, Medicare will make 
payment only to ASCs for ancillary services provided integral to 
covered surgical procedures. The costs associated with the provision of 
covered ancillary services are facility resources, and Medicare will 
provide separate ASC payment for those costs. However, the ASC is not 
precluded from contracting with another entity to provide the equipment 
and supplies required to provide specific services. The ASC would make 
payment to its contractors.
    Comment: Some commenters stated that beneficiaries should not be 
liable for the costs of procedures and services that are not covered 
when performed in ASCs. A few commenters believed that the beneficiary 
should only be liable for his or her deductible and coinsurance 
amounts, just as he or she would be for covered procedures in ASCs. One 
commenter stated that the course of a planned, covered procedure cannot 
always be determined in advance because the physician may have to alter 
the procedure intraoperatively, and sometimes that alteration results 
in performance of an excluded, noncovered procedure. The commenter did 
not believe it would be fair to hold the beneficiary liable in such 
cases. One commenter suggested that CMS create a modifier that the ASC 
would use to identify cases in which the planned, covered procedure was 
altered intraoperatively due to unexpected circumstances. The commenter 
indicated that payment in those cases could be priced by the contractor 
based on review of the operative report. The commenter stated that use 
of the modifier would enable CMS to track such occurrences and could 
audit as needed.
    Response: We appreciate the commenters'' concern regarding 
beneficiary liability for excluded ASC procedures. However, because we 
have adopted a final policy for the revised ASC payment system that 
identifies and excludes from ASC payment only those procedures that 
pose a significant risk to beneficiary safety or would be expected to 
require an overnight stay, we continue to believe that it would be 
incongruous with the revised ASC payment system methodology to continue 
to pay the higher nonfacility

[[Page 66851]]

rate to physicians who furnish excluded ASC procedures. Therefore, 
consistent with Medicare payment policy in other care settings, no 
payment for facility costs would be made for the noncovered services, 
and the beneficiary would be liable. As we explained in the CY 2008 
OPPS/ASC proposed rule, because of the significant expansion of the ASC 
list of covered surgical procedures, we expect that excluded procedures 
will not be performed in ASCs beginning in CY 2008.
    After consideration of the public comments received, we are 
finalizing our CY 2008 proposal, without modification, to pay 
physicians only the facility PE amount and exclude payment of the TC if 
applicable, for the performance of surgical procedures and nonsurgical 
services in ASCs and to make beneficiaries liable for the facility 
charges for procedures provided in the ASC that are excluded from ASC 
payment.

H. Changes to Definitions of ``Radiology and Certain Other Imaging 
Services'' and ``Outpatient Prescription Drugs''

    In section 1877(h)(6) of the Act, the Congress defined the 
``designated health services'' (DHS) that are subject to the physician 
self-referral prohibition to include 11 broad categories of services. 
In our regulations at Sec.  411.351, we define each of the 11 DHS 
categories, including ``radiology and certain other imaging services'' 
and ``outpatient prescription drugs.'' The definition of ``designated 
health services'' at Sec.  411.351 excludes ``services that are 
reimbursed by Medicare as part of a composite rate (for example, ASC 
services or SNF Part A services),'' except to the extent that the DHS 
categories are themselves payable through a composite rate. In the 
definition of ``radiology and certain other imaging services'' at Sec.  
411.351, we previously excluded x-ray, fluoroscopy, and ultrasound 
procedures that require the insertion of a needle, catheter, tube, or 
probe through the skin or into a body orifice. In addition, the 
definition of ``radiology and certain other imaging services'' excludes 
radiology procedures that are integral to the performance of a 
nonradiological medical procedure and (1) performed during the 
nonradiological medical procedure or (2) performed immediately 
following the nonradiological medical procedure when necessary to 
confirm placement of an item placed during the nonradiological medical 
procedure. Radiology and certain other imaging services performed 
before a nonradiological medical procedure have been subject to the 
physician self-referral prohibition.
    Taken together, these provisions effectively excluded from the 
physician self-referral prohibition referrals for: (1) Radiology and 
certain other imaging services that were paid through the ASC composite 
payment rate; and (2) radiology procedures that were integral to the 
performance of an ASC covered surgical procedure, that were paid 
separately, and that were performed in the ASC either (a) during the 
surgical procedure or (b) immediately after the surgical procedure if 
required to confirm placement of an item placed during the 
nonradiological medical procedure. (For physician self-referral 
purposes, we have considered radiology and certain other imaging 
services that are performed while the patient is still in the operating 
room to confirm that ASC surgery is effective to be performed during 
the surgical procedure.)
    Under the August 2, 2007 revised ASC payment system final rule (72 
FR 42470), effective January 1, 2008, Medicare makes a bundled or 
composite payment for facility services and a separate payment for each 
covered ancillary service that is integral to a covered surgical 
procedure and performed in the ASC on the same day. Because facility 
services continue to be paid under a composite rate, a physician 
referral for any radiology or other imaging service or outpatient 
prescription drug that is paid for as a facility service under Sec.  
416.164(a) is excluded from the physician self-referral prohibition 
under paragraph (2) of the definition of ``designated health services'' 
at Sec.  411.351.
    Covered ancillary services for which separate payment is made per 
item or service include many radiology and certain other imaging 
services. The August 2, 2007 revised ASC payment system final rule 
discusses the radiology services that are included in new Sec.  
416.164(b) as covered ancillary services integral to, and furnished on 
the same day as the ASC surgical procedure (72 FR 42496 through 42498).
    Under the revised ASC payment system, a greater variety of surgical 
procedures than previously allowed can be provided as ASC services, 
and, thus, a greater number of ``radiology and certain other imaging 
services'' would be subject to the physician self-referral prohibition. 
Accordingly, in the August 2, 2007 rule proposing changes to both the 
outpatient hospital prospective payment system and the ASC payment 
system, we proposed to revise the physician self-referral definition of 
``radiology and certain other imaging services'' to exclude those 
radiology and imaging services that are ``covered ancillary services,'' 
as defined at 416.164(b), for which separate payment is made under the 
revised ASC payment system (72 FR 42792). That is, we proposed that 
those radiology and imaging procedures that are integral to a covered 
ASC surgical procedure and that are performed immediately before, 
during, or immediately following the surgical procedure (that is, on 
the same day) would not constitute ``radiology and certain other 
imaging procedures'' for purposes of the physician self-referral law. 
We noted that if we did not revise the definition of ``radiology and 
certain other imaging services'' for physician self-referral purposes 
to exclude these radiology and other imaging procedures, the physician 
self-referral law would prohibit an ASC from billing Medicare for these 
separately payable, integral ancillary services rendered to patients 
who had been referred by a physician with an ownership or investment 
interest in, or compensation relationship with, an ASC unless an 
exception applies.
    For the reasons that warrant our revising the definition of 
``radiology and certain other imaging services,'' we also proposed to 
exclude from the definition of ``outpatient prescription drugs'' at 
Sec.  411.351, drugs that are ``covered as ancillary services'' as 
defined at new Sec.  416.164(b) under the revised ASC payment system. 
These drugs are furnished, for example, during the immediate 
postoperative recovery period to a patient to reduce suffering from 
nausea or pain. Under our proposal, such drugs would not constitute 
DHS, although the physician self-referral provisions would continue to 
be applicable when an ASC furnishes outpatient prescription drugs for 
use in the patient's home.
    Although we believe that physician referrals to entities with which 
they have a financial relationship are susceptible to abuse, we believe 
that our revision to the definitions of ``radiology and certain other 
imaging services'' and ``outpatient prescription drugs'' promote 
quality of care without posing a risk of abuse. The change will promote 
quality of care by allowing patients timely, convenient access to 
outpatient drugs and radiology and imaging services that are integral 
to an ASC procedure and necessary for its safe performance in an ASC. 
The risk of program abuse is avoided by the requirement that the items 
and services must be ``integral to'' the ASC procedure (that is, 
performed in the ASC immediately preceding, during, or immediately 
following the covered surgical procedure). We caution that only those 
items and services that

[[Page 66852]]

are integral to an ASC procedure and performed on the same day as the 
covered surgical procedure will qualify for the exclusion from the 
definitions of ``radiology and certain other imaging services'' and 
``outpatient prescription drugs.'' Other separately billable services 
that do not satisfy these conditions will remain subject to the 
physician self-referral prohibition. We will continue to monitor the 
provision of services in ASCs for potential abuse.
    In addition, for clarity, we proposed to make a technical 
correction to paragraph (2) of the definition of ``radiology and 
certain other imaging services'' at Sec.  411.351 to exclude from the 
definition not only ``radiology procedures'' that are integral to the 
performance of a ``nonradiological procedure,'' but also to exclude 
``radiology and certain other imaging services'' that are integral to 
the performance of ``a medical procedure that is not identified on the 
List of CPT/HCPCS Codes as a `radiology or certain other imaging 
service.' ''
    We received one public comment supporting the proposed change in 
the definition of ``radiology and other imaging services.'' Two 
additional public comments concern radioactive seeds and ribbons 
(radioactive sources) implanted during brachytherapy procedures 
performed in an ASC. These items are included within the DHS category 
of ``radiation therapy and supplies.''
    Comment: Two commenters asked CMS to exclude from the definition of 
DHS radioactive sources (including seeds and ribbons) furnished during 
a brachytherapy procedure performed in an ASC because DHS, as defined 
at Sec.  411.351, does not include ``services that are reimbursed by 
Medicare as part of a composite rate (for example, ambulatory surgical 
center services * * *).'' In addition, the commenter suggested that, 
consistent with our proposal to exclude radiology services and 
outpatient prescription drugs that are ``covered ancillary services'' 
furnished on the same day as an ASC procedure, we should exclude from 
the definition of ``radiation therapy services and supplies'' 
brachytherapy sources that are also ASC covered ancillary services 
integral to a covered surgical procedure for which separate payment is 
made under new Sec.  416.164(b). The commenters pointed out that, if 
these radioactive sources were not excluded from the physician self-
referral prohibition, many urologist-owners of ASCs would not be able 
to order and furnish brachytherapy services because the ASC must bill 
Medicare for the radioactive sources and they are not included in a 
composite rate.
    Response: The DHS category ``radiation therapy services and 
supplies'' includes radioactive sources used in connection with 
brachytherapy procedures. The commenters are correct that a urologist 
or other type of physician who has an ownership or investment interest 
in, or a compensation relationship with, an ASC may not refer a 
Medicare patient to the ASC for a brachytherapy procedure, unless an 
exception is satisfied.
    Previously, except for brachytherapy procedures performed as 
inpatient or outpatient hospital procedures, Medicare made payment for 
the radioactive sources to the individual or entity that furnished the 
radioactive sources. Under the ASC payment system effective for 
procedures performed on or after January 1, 2008, Medicare pays the ASC 
for facility services that are packaged into the ASC payment. In 
addition, Medicare makes a separate payment to an ASC for certain 
ancillary items and services, including brachytherapy sources.
    The commenters are correct that, without an exception under the 
physician self-referral provisions, a urologist who refers a Medicare 
patient for an ASC-covered brachytherapy procedure may not have either 
an ownership or investment interest in the ASC or a compensation 
relationship with the ASC because the brachytherapy sources are DHS.
    Although we did not propose to exclude, nor are we excluding in 
this final rule with comment period, brachytherapy sources supplied in 
connection with an ASC-covered brachytherapy procedure, we intend to 
consider this issue, and if we decide to propose an exception, we will 
include such changes in a proposed rule and seek public comment.
    We are adopting the proposed physician self-referral provisions 
without change and we are making one additional technical, 
nonsubstantive change. We are revising the definition of ``designated 
health services'' at Sec.  411.351 to reflect the fact that CMS no 
longer pays for all ASC procedures under a composite rate. 
Specifically, the definition will refer to ``SNF Part A payments or ASC 
services identified at Sec.  416.164(a)'' as examples of services that 
Medicare pays as part of a composite rate. Section 416.164(a) sets 
forth the facility services for which a bundled or composite payment is 
made under the revised ASC payment system.

I. New Technology Intraocular Lenses

1. Background
    At the inception of the ASC benefit on September 7, 1982, Medicare 
paid 80 percent of the reasonable charge for IOLs supplied for 
insertion concurrent with or following cataract surgery performed in an 
ASC (47 FR 34082, August 5, 1982). Section 4063(b) of OBRA 1987, Pub. 
L. 100-203, amended the Act to mandate that we include payment for an 
IOL furnished by an ASC for insertion during or following cataract 
surgery as part of the ASC facility fee for insertion of the IOL, and 
that the facility fee include payment that is reasonable and related to 
the cost of acquiring the class of lens involved in the procedure.
    Section 4151(c)(3) of the Omnibus Budget Reconciliation Act of 1990 
(OBRA 1990), Pub. L. 101-508, froze the IOL payment amount at $200 for 
IOLs furnished by ASCs in conjunction with surgery performed during the 
period beginning November 5, 1990, and ending December 31, 1992. We 
continued paying an IOL allowance of $200 from January 1, 1993, through 
December 31, 1993.
    Section 13533 of the Omnibus Budget Reconciliation Act of 1993 
(OBRA 1993), Pub. L. 103-66, mandated that payment for an IOL furnished 
by an ASC be equal to $150 beginning January 1, 1994, through December 
31, 1998. Section 141(b)(1) of the Social Security Act Amendments of 
1994 (SSAA 1994), Pub. L. 103-432, required us to develop and implement 
a process under which interested parties may request a review of the 
appropriateness of the payment amount for insertion of an IOL, to 
ensure that the facility fee for the procedure includes payment that is 
reasonable and related to the cost of acquiring a lens that belongs to 
a class of NTIOLs.
    In the February 8, 1990 Federal Register (55 FR 4526), we published 
a final notice entitled ``Revision of Ambulatory Surgery Center Payment 
Rate Methodology,'' which implemented Medicare payment for an IOL 
furnished at an ASC as part of the ASC facility fee for insertion of 
the IOL. In the June 16, 1999 Federal Register (64 FR 32198), we 
published a final rule entitled ``Adjustment in Payment Amounts for New 
Technology Intraocular Lenses Furnished by Ambulatory Surgical 
Centers,'' to add Subpart F (Sec. Sec.  416.180 through 416.200) to 42 
CFR Part 416, which established a process for adjusting payment amounts 
for insertion of a class of NTIOLs furnished by ASCs.

[[Page 66853]]

    Since June 16, 1999, we have issued a series of Federal Register 
notices to list lenses for which we received requests for an NTIOL 
payment adjustment and to solicit comments on those requests, or to 
announce the lenses that we have determined meet the criteria and 
definition of NTIOLs. We last published a Federal Register notice 
pertaining specifically to NTIOLs on April 28, 2006 (71 FR 25176).
2. Changes to the NTIOL Determination Process Finalized for CY 2008
    In the CY 2007 OPPS/ASC final rule with comment period, we 
finalized our proposal to update and streamline the process for 
recognizing IOLs inserted during or subsequent to cataract extraction 
as belonging to a new, active NTIOL class that is qualified for a 
payment adjustment. The following is a summary of the changes beginning 
for CY 2008 that were finalized in the CY 2007 OPPS/ASC final rule with 
comment period (71 FR 68176 through 68181).
    We modified the historical process of using separate Federal 
Register notices to notify the public of requests to review lenses for 
membership in new NTIOL classes, to solicit public comment on requests, 
and to notify the public of CMS's determinations concerning lenses 
assigned to classes of NTIOLs for which an ASC payment adjustment would 
be made. In the CY 2007 OPPS/ASC final rule with comment period (71 FR 
68176), we specified that these NTIOL-related notifications will be 
fully integrated into the annual notice and comment rulemaking cycle 
for updating the ASC payment rates, the specific payment system in 
which NTIOL payment adjustments are made. Our final policy for updating 
the revised ASC payment system to be implemented in January 2008 will 
utilize an annual update process in coordination with notice and 
comment rulemaking for the OPPS. Aligning the NTIOL process with this 
annual update will promote coordination and efficiency, thereby 
streamlining and expediting the NTIOL notification, comment, and review 
process.
    Specifically, we established the following process:
     We will announce annually in the Federal Register document 
that proposes the update of ASC payment rates for the following 
calendar year, a list of all requests to establish new NTIOL classes 
accepted for review during the calendar year in which the proposal is 
published and the deadline for submission of public comments regarding 
those requests. The deadline for receipt of public comments will be 30 
days following publication of the list of requests.
     In the Federal Register document that finalizes the update 
of ASC payment rates for the following calendar year, we will--
    + Provide a list of determinations made as a result of our review 
of all requests and public comments; and
    + Publish the deadline for submitting requests for review in the 
following calendar year.
    In determining whether a lens belongs to a new class of NTIOLs and 
whether the ASC payment amount for insertion of that lens in 
conjunction with cataract surgery is appropriate, we expect that the 
insertion of the candidate IOL would result in significantly improved 
clinical outcomes compared to currently available IOLs. In addition, to 
establish a new NTIOL class, the candidate lens must be distinguishable 
from lenses already approved as members of active or expired classes of 
NTIOLs that share a predominant characteristic associated with improved 
clinical outcomes that was identified for each class. In the CY 2007 
final rule, we finalized our proposal to base our determinations on 
consideration of the following factors:
     The IOL must have been approved by the FDA and claims of 
specific clinical benefits and/or lens characteristics with established 
clinical relevance in comparison with currently available IOLs must 
have been approved by the FDA for use in labeling and advertising.
     The IOL is not described by an active or expired NTIOL 
class; that is, it does not share the predominant, class-defining 
characteristic associated with improved clinical outcomes with 
designated members of an active or expired NTIOL class.
     Evidence demonstrates that use of the IOL results in 
measurable, clinically meaningful, improved outcomes in comparison with 
use of currently available IOLs. According to the statute, and 
consistent with previous examples provided by CMS, superior outcomes 
that would be considered include the following:
    + Reduced risk of intraoperative or postoperative complication or 
trauma;
    + Accelerated postoperative recovery;
    + Reduced induced astigmatism;
    + Improved postoperative visual acuity;
    + More stable postoperative vision;
    + Other comparable clinical advantages, such as--
    ++ Reduced dependence on other eyewear (for example, spectacles, 
contact lenses, and reading glasses);
    ++ Decreased rate of subsequent diagnostic or therapeutic 
interventions, such as the need for YAG laser treatment;
    ++ Decreased incidence of subsequent IOL exchange;
    ++ Decreased blurred vision, glare, other quantifiable symptom or 
vision deficiency.
    For a request to be considered complete, we require submission of 
the information that is found in the guidance document entitled 
``Application Process and Information Requirements for Requests for a 
New Class of New Technology Intraocular Lens (NTIOL)'' posted on the 
CMS Web site at: http://www.cms.hhs.gov/ASCPayment/05--NTIOLs.asp.
    As stated in the CY 2007 OPPS/ASC final rule with comment period 
(71 FR 68180), there are three possible outcomes from our review of a 
request for determination of a new NTIOL class. As appropriate, for 
each completed request for a candidate IOL that is received by the 
established deadline, one of the following determinations would be 
announced annually in the final rule updating the ASC payment rates for 
the next calendar year:
     The request for a payment adjustment is approved for the 
IOL for 5 full years as a member of a new NTIOL class described by a 
new HCPCS code.
     The request for a payment adjustment is approved for the 
IOL for the balance of time remaining as a member of an active NTIOL 
class.
     The request for a payment adjustment is not approved.
    We also discussed our plan to summarize briefly in the final rule 
the evidence that was reviewed, the public comments, and the basis for 
our determinations. We established that when a new NTIOL class is 
created, we would identify the predominant characteristic of NTIOLs in 
that class that sets them apart from other IOLs (including those 
previously approved as members of other expired or active NTIOL 
classes) and is associated with improved clinical outcomes. The date of 
implementation of a payment adjustment in the case of approval of an 
IOL as a member of a new NTIOL class would be set prospectively as of 
30 days after publication of the ASC payment update final rule, 
consistent with the statutory requirement.
3. NTIOL Application Process for CY 2008 Payment Adjustment
    To provide process and information requirements for applications 
requesting a review of the appropriateness of the payment amount for 
insertion of an IOL to ensure that the ASC payment for covered surgical 
procedures includes

[[Page 66854]]

payment that is reasonable and related to the cost of acquiring a lens 
that is approved as belonging to a new class of NTIOLs, in February 
2007 we posted the guidance document to the CMS Web site regarding such 
requests as described above. We did not receive any review requests by 
the deadline of April 1, 2007, in response to the announcement made in 
the CY 2007 OPPS/ASC final rule with comment period (71 FR 68181) 
soliciting CY 2008 requests for review of the appropriateness of the 
payment amount for new classes of NTIOLs furnished in ASCs.
    We note that we have also issued a guidance document entitled 
``Revised Process for Recognizing Intraocular Lenses Furnished by 
Ambulatory Surgery Centers (ASCs) as Belonging to an Active Subset of 
New Technology Intraocular Lenses (NTIOLs).'' This guidance document 
can be accessed on the CMS Web site at: http://www.cms.hhs.gov/
ASCPayment/05--NTIOLs.asp.
    This guidance document provides specific details regarding requests 
for recognition of IOLs as belonging to an existing, active NTIOL 
class, the review process, and information required for a request to 
review. Currently, there is one active NTIOL class whose defining 
characteristic is the reduction of spherical aberration. CMS accepts 
requests throughout the year to review the appropriateness of 
recognizing an IOL as a member of an active class of NTIOLs. That is, 
review of candidate lenses for membership in an existing, active NTIOL 
class is ongoing and not limited to the annual review process that 
applies to the establishment of new NTIOL classes. We ordinarily 
complete the review of such a request within 90 days of receipt, and 
upon completion of our review, we notify the requestor of our 
determination and post on the CMS Web site notification of a lens newly 
approved for a payment adjustment as an NTIOL belonging to an active 
NTIOL class when furnished in an ASC.
4. Classes of NTIOLs Approved for Payment Adjustment
    Since implementation of the process for adjustment of payment 
amounts for NTIOLs that was established in the June 16, 1999 Federal 
Register, we have approved three classes of NTIOLs, as shown in the 
following table:

----------------------------------------------------------------------------------------------------------------
                                                $50 approved for
     NTIOL category          HCPCS code      services furnished on   NTIOL characteristic    IOLs eligible for
                                                    or after                                     adjustment
----------------------------------------------------------------------------------------------------------------
1......................  Q1001.............  May 18, 2000, through  Multifocal...........  Allergan AMO Array
                                              May 18, 2005.                                 Multifocal lens,
                                                                                            model SA40N.
2......................  Q1002.............  May 18, 2000, through  Reduction in           STAAR Surgical
                                              May 18, 2005.          Preexisting            Elastic Ultraviolet-
                                                                     Astigmatism.           Absorbing Silicone
                                                                                            Posterior Chamber
                                                                                            IOL with Toric
                                                                                            Optic, models
                                                                                            AA4203T, AA4203TF,
                                                                                            and AA4203TL.
3......................  Q1003.............  February 27, 2006,     Reduced Spherical      Advanced Medical
                                              through February 26,   Aberration.            Optics (AMO)
                                              2011.                                         Tecnis[supreg] IOL
                                                                                            models Z9000, Z9001,
                                                                                            Z9002, ZA9003 and
                                                                                            AR40xEM; Alcon
                                                                                            Acrysof[supreg] IQ
                                                                                            Model SN60WF and
                                                                                            Acrysert Delivery
                                                                                            System Model SN60WS;
                                                                                            Bausch & Lomb
                                                                                            Sofport AO model
                                                                                            LI61AOV.
----------------------------------------------------------------------------------------------------------------

5. Payment Adjustment
    The current payment adjustment for a 5-year period from the 
implementation date of a new NTIOL class is $50. In the CY 2007 OPPS/
ASC final rule with comment period, we revised Sec.  416.200(a) through 
(c) to clarify how the IOL payment adjustment will be made and how an 
NTIOL will be paid after expiration of the payment adjustment, as well 
as made minor editorial changes to Sec.  416.200(d). For CY 2008, we 
did not propose to revise, nor are we revising in this final rule with 
comment period, the current payment adjustment amount, but we reiterate 
our intention, as stated in the CY 2007 final rule, to reevaluate 
whether or not the ASC payment rates established for cataract surgery 
with IOL insertion are appropriate when a lens determined to be an 
NTIOL is furnished after we have implemented the revised ASC payment 
system in CY 2008.
6. CY 2008 ASC Payment for Insertion of IOLs
    In accordance with the final policies of the revised ASC payment 
system for CY 2008, payment for IOL insertion services will be 
established according to the standard payment methodology of the 
revised payment system, which applies the ASC budget neutrality 
adjustment to the OPPS conversion factor to calculate an ASC conversion 
factor that is then multiplied by the ASC payment weight for the 
surgical procedure to implant the IOL. CY 2008 ASC payment for the cost 
of a conventional lens will be packaged into the payment for the 
associated covered surgical procedure performed by the ASC. We included 
the proposed CY 2008 ASC payment rates for IOL insertion procedures in 
Table 66 of the proposed rule (72 FR 42795) that is reprinted, with 
final CY 2008 ASC payment rates, below.
    Comment: Several commenters supported the revision to the process 
for recognizing IOLs inserted during or subsequent to cataract 
extraction as belonging to a new or active NTIOL class. One commenter 
suggested that, for purposes of administrative simplicity, CMS should 
make the comment period on requests for new NTIOL classes 60 days, 
rather than 30 days as proposed. The commenter believed that Congress 
intended that CMS provide at least a 30-day comment period and argued 
that further adjusting the comment period for NTIOLs to 60 days would 
be consistent with the comment period for the rest of the OPPS/ASC 
proposed rule.
    Response: We appreciate the commenters' continuing support 
regarding our recent revision to the process for recognizing IOLs 
inserted during or subsequent to cataract extraction as belonging to a 
new or active NTIOL class. We continue to believe that aligning the 
NTIOL process with annual updates to the OPPS and the revised ASC 
payment system promotes coordination and efficiency, thereby 
streamlining and expediting the NTIOL notification, comment, and review 
process. In response to the comment urging us to adjust the comment 
period regarding requests to establish new classes of NTIOLs to 60 
days, we note that section 141(b)(3) of the Social Security Act 
Amendments of 1994 (SSAA 1994), Pub. L. 103-432, clearly requires us to 
provide a 30-day comment period on lenses that are the subject of 
requests for recognition as belonging to a new class of NTIOLs. 
Therefore, we will continue to provide a 30-day comment period on 
lenses that are the subject of requests for recognition as members of a 
new class of NTIOLs.
    After considering the public comments received, we are finalizing,

[[Page 66855]]

without modification, the process and timelines proposed for NTIOL 
consideration under the ASC payment system. The payment adjustment for 
NTIOLs will continue to be $50 for CY 2008.
7. Announcement of CY 2008 Deadline for Submitting Requests for CMS 
Review of Appropriateness of ASC Payment for Insertion of an NTIOL 
Following Cataract Surgery
    In accordance with Sec.  416.185(a) of our regulations, as revised 
by the CY 2007 OPPS/ASC final rule with comment period, CMS announces 
that, in order to be considered for payment effective January 1, 2009, 
requests for a review of an application for a new class of new 
technology IOLs must be received at CMS by 5 p.m., EST, on March 14, 
2008. Send requests to: ASC/NTIOL, Division of Outpatient Care, 
Mailstop C4-05-17, Centers for Medicare and Medicaid Services,7500 
Security Boulevard, Baltimore, MD 21244-1850.
    To be considered, requests for NTIOL reviews must include the 
information posted on the CMS Web site at http://cms.hhs.gov/ASCPayment/05_NTIOLs.asp#TopOfPage.

  Table 60.--Insertion of IOL Procedures and Their CY 2008 ASC Payment
                                  Rates
------------------------------------------------------------------------
                                                             CY 2008 ASC
         HCPCS code                  Long descriptor           payment
------------------------------------------------------------------------
66983......................  Intracapsular cataract              $976.76
                              extraction with insertion of
                              intraocular lens prosthesis
                              (one stage procedure).
66984......................  Extracapsular cataract removal       976.76
                              with insertion of intraocular
                              lens prosthesis (one stage
                              procedure), manual or
                              mechanical technique (e.g.,
                              irrigation and aspiration or
                              phacoemulsification).
66985......................  Insertion of intraocular lens        866.51
                              prosthesis (secondary
                              implant), not associated with
                              concurrent cataract removal.
66986......................  Exchange of intraocular lens..       866.51
------------------------------------------------------------------------

J. ASC Payment and Comment Indicators

    In addition to the payment indicators that we introduced in the 
August 2, 2007 revised ASC payment system final rule, we also 
introduced comment indicators for the ASC payment system in the CY 2008 
OPPS/ASC proposed rule (72 FR 42795). We created Addendum DD1 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 define in 
Addendum D1 to the annual OPPS proposed and final rules, 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 designations as device-intensive; their designations as 
office-based and the corresponding ASC payment methodology; and their 
classifications as separately payable radiology services, brachytherapy 
sources, OPPS pass-through devices, corneal tissue acquisition 
services, drugs or biologicals, or NTIOLs.
    We have also created new Addendum DD2 that lists the ASC comment 
indicators. Like the comment indicators used in the OPPS, the ASC 
comment indicators used in Addenda AA and BB to this OPPS/ASC final 
rule with comment period serve to identify, for the revised ASC payment 
system, the status of a specific HCPCS code and its payment indicator 
with respect to the timeframe when comments would be accepted. The 
comment indicator ``NI'' is used in this final rule with comment period 
to indicate new HCPCS codes for which the interim payment indicator 
assigned is subject to comment in this final rule.
    The changes for CY 2008 that we proposed to the payment indicators 
assigned to HCPCS codes for procedures and services in the August 2, 
2007 revised ASC payment system final rule were identified with a 
``CH'' in the OPPS/ASC proposed rule and were subject to comment during 
the 60-day comment period provided for that proposed rule. ``CH'' is 
used in Addenda AA and BB to this CY 2008 OPPS/ASC final rule with 
comment period to indicate that a new payment indicator (in comparison 
with that in the August 2, 2007 revised ASC payment system final rule) 
has been assigned to an active HCPCS code for the next calendar year; 
that an active HCPCS code has been added to the list of procedures or 
services payable in ASCs; or that an active HCPCS code will be deleted 
at the end of the current calendar year. The ``CH'' comment indicators 
that are published in this CY 2008 OPPS/ASC final rule with comment 
period are provided to alert our readers that a change has been made 
since the August 2, 2007 revised ASC payment system final rule, but do 
not indicate that the change is subject to comment. The full 
definitions for the comment indicators are provided in Addendum DD2 to 
this final rule with comment period.
    We did not receive any comments that addressed our proposal related 
to implementation and use of comment indicators for the revised ASC 
payment system. Therefore, we are finalizing our proposal, without 
modification, to adopt the comment indicators as defined in Addendum 
DD2 to this final rule with comment period.

K. ASC Policy and Payment Recommendations

    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 the August 2, 2007 revised ASC 
payment system final rule. 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 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

[[Page 66856]]

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.
    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. The 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. 
The ASC-to-APC median cost ratio is a comparison of the median cost of 
each of the 20 surgical procedures with the highest ASC claims volume 
to the median cost of the APC group in which it would be placed under 
the OPPS, while the OPPS-to-APC cost ratio is a comparison of the 
median cost of each of those same procedures under the OPPS with the 
median cost of its assigned APC group. These patterns demonstrated that 
the APC groups reflect the relative costs of procedures performed by 
ASCs as they do for procedures performed in HOPDs 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 are 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 HOPDs. 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: One commenter expressed concern that the public was denied 
time to analyze and respond to the findings in the congressionally 
mandated GAO report on ASC costs. The commenter believed that CMS' 
reliance on the GAO Report findings in finalizing the development of 
the revised payment system for ASCs, without also considering comments 
from the public about those findings, potentially violated principles 
of fairness and transparency. The commenter specifically stated that 
the report's findings are flawed and that the OPPS is not a relative 
cost proxy for ASCs' costs for gastrointestinal (GI) procedures.
    Response: As we discussed in our response to comments on this topic 
in the August 2, 2007 revised ASC payment system final rule (72 FR 
42475), 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. We 
appreciate the public's interest in providing us with detailed input 
regarding the revised ASC payment system from a variety of 
perspectives. We noted that the GAO's recommendations were in complete 
accord with our proposal for the revised ASC payment system (71 FR 
49635), and we provided a 90-day comment period on our proposal for CY 
2008. We believe that the comment period for the August 23, 2006 
proposed rule provided the public with ample opportunity to comment on 
the policies that ultimately were recommended by the GAO.

L. Calculation of the ASC Conversion Factor and ASC Payment Rates

1. Overview
    As discussed in section XVI.C. of this final rule with comment 
period, we finalized our policy to base ASC relative payment weights 
and payment rates under the revised ASC payment system on APC groups 
and relative payment weights. In the August 2, 2007 revised ASC payment 
system final rule, we made final our proposal to set the ASC relative 
payment weight for certain office-based surgical procedures so that the 
national unadjusted ASC payment rate does not exceed the MPFS 
unadjusted nonfacility PE RVU amount. Our final policy is to calculate 
ASC payment rates by multiplying the ASC relative payment weights by 
the ASC conversion factor. In the August 2, 2007 revised ASC payment 
system final rule, our estimate of the CY 2008 budget neutral ASC 
conversion factor was $42.542. In the CY 2008 OPPS/ASC proposed rule, 
the proposed ASC conversion factor for CY 2008 was $41.400. For this 
final rule with comment period, the ASC conversion factor for CY 2008 
is $41.401. Although this final ASC conversion factor differs little 
from the estimate in the August 2, 2007 revised ASC payment system 
final rule and the CY 2008 OPPS/ASC proposed rule, it reflects several 
changes, including: (1) Use of the final OPPS relative payment weights 
for CY 2008; (2) use of the final MPFS nonfacility PE RVU amounts for 
CY 2008; (3) use of updated utilization data from CY 2006; and (4) 
application of an adjustment to reflect differences in the geographic 
wage adjustment policy between the current and revised systems 
(discussed in further detail below). As in the proposed rule, in this 
final rule with comment period, we use the final methodology described 
in the August 2, 2007 revised ASC payment system final rule (72 FR 
42522) to calculate the final CY 2008 ASC conversion factor and the 
final ASC relative payment weights and rates.
2. Budget Neutrality Requirement
    Section 626(b) of Pub. L. 108-173 amended section 1833(i)(2) of the 
Act by adding subparagraph (D) to require that in the year the revised 
ASC payment 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 2, 2007 revised ASC payment system final 
rule, 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

[[Page 66857]]

statute. That is, application of the ASC conversion factor is 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 Pub. L. 109-171.
    We note that we consider the term ``expenditures'' in the context 
of the budget neutrality requirement under section 626(b) of Pub. L. 
108-173 to mean expenditures from the Medicare Part B Trust Fund. We do 
not consider expenditures to include beneficiary coinsurance and 
copayments.
3. Calculation of the ASC Payment Rates for CY 2008
    The following is a step-by-step illustration of the final budget 
neutrality adjustment calculation as finalized in the August 2, 2007 
revised ASC payment system final rule and as applied to updated data 
available for this final rule with comment period.
    The final methodology for establishing budget neutrality under the 
revised ASC payment system takes into account a 4-year transition to 
full implementation of the revised payment rates and the effects of 
several assumptions regarding migration of services across ASCs, HOPDs, 
and physicians' offices. Payments during the 4-year transition to the 
fully implemented revised ASC payment rates will be based on a blend of 
the CY 2007 ASC payment rates and the revised ASC payment rates at 75/
25 in CY 2008, 50/50 in CY 2009, and 25/75 in CY 2010, with payment at 
100 percent of the revised ASC payment rates in 2011. The methodology 
assumes no net cost or savings to Medicare from the migration of 
existing ASC services among ASCs, HOPDs, and physicians' offices. It 
includes assumptions that 15 percent of physicians' office utilization 
for new ASC procedures, specifically those first added for ASC payment 
beginning in CY 2008, will migrate to ASCs over a 4-year period (3.75 
percent each year) and that 25 percent of the new procedures' HOPD 
utilization will migrate over the first 2 years under the revised 
payment system (12.5 percent each year) and accounts for the Medicare 
costs and savings associated with that movement. A detailed explanation 
of the model may be found in section V.C. of the August 2, 2007 revised 
ASC payment system final rule (72 FR 42521).
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 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 occur 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. the August 2, 
2007 revised ASC payment system final rule).
    (b) For each new ASC procedure, we multiply the results of Step 
1(a) by the 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 CY 2008 physician in-office payment rates. ``Physician in-
office payment rate'' is equal to the MPFS nonfacility PE RVUs 
multiplied by the 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 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 (71 FR 68243 through 68283) and take into account 
the OPPS cap on payment for ASC services as required by section 5103 of 
Pub. L. 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 the 
August 2, 2007 revised ASC payment system 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 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 the August 2, 2007 revised ASC payment 
system final rule).
    Step 7: Migration of new ASC office-based procedures from 
physicians' offices to ASCs is valued based on CY 2008 OPPS payment 
rates capped at the 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 CY 2008 OPPS rate for the procedure; or
    (2) The 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 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 CY 2008 OPPS rate for 
the

[[Page 66858]]

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 CY 2008 MPFS physician out-of-office 
payment rate. ``Physician out of-office payment rate'' is equal to the 
facility PE RVUs multiplied by the CY 2008 MFPS conversion factor.
    (a) For each new ASC procedure, we multiply the results of Step 
2(a) from above by the 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 CY 2008 OPPS 
payment rates.
    To estimate the aggregate amount of expenditures that would be made 
in CY 2008, we use 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 of covered surgical procedures by the 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 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 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.
    The application of the above methodology to the data available for 
this final rule with comment period results in a budget neutrality 
adjustment of 0.65. This number does not differ from the estimated 
budget neutrality adjustment of 0.65 for the CY 2008 OPPS/ASC proposed 
rule for the revised ASC payment system that was based on partial year 
CY 2006 utilization and proposed CY 2008 OPPS and MPFS payment rates 
(72 FR 42797).
    We built an estimate of differences in total payment created by 
differences in the geographic adjustment policy between current and 
revised systems into the above model. Medicare currently accounts for 
geographic wage variations when calculating individual ASC payments 
under the existing payment system by applying the relevant IPPS wage 
index values and localities that were established under the IPPS prior 
to the implementation of Core Based Statistical Areas (CBSAs) issued by 
the Office of Management and Budget in June 2003 to a labor-related 
portion of 34.45 percent of the ASC payment amount. As discussed in the 
August 2, 2007 revised ASC payment system final rule (72 FR 42518), the 
revised payment system will account for geographic wage variations when 
calculating individual ASC payments by applying the pre-
reclassification wage index to a labor-related portion of 50 percent of 
the ASC payment amount.
    In the CY 2008 OPPS/ASC proposed rule, we noted that we did not 
have a provider-level dataset of ASC utilization that accurately 
identified unique ASCs and their geographic information and that this 
prevented us from calculating a budget-neutral wage adjustment. In our 
August 2, 2007 revised ASC payment system final rule, we estimated that 
the change in the wage policy would not significantly change aggregate 
ASC payment. We have since constructed this provider-level database 
using several sources to verify the validity of geographic information 
on the file. We have also crosswalked deleted HCPCS codes and their 
associated utilization to the CY 2008 HCPCS codes. Items previously 
paid under the ASC system, for which payment was not adjusted for 
differences in labor costs (for example, NTIOLs), were not included in 
this analysis. Using this provider-level dataset of CY 2006 ASC claims, 
we estimated total CY 2008 payment using revised ASC payment rates, the 
existing payment system labor-related portion of 34.45 percent, and the 
existing payment system wage index values. Using the same dataset, we 
also estimated total CY 2008 payment using revised ASC payment rates, a 
labor-related portion of 50 percent, and the pre-reclassification wage 
index values based on CBSAs. Comparing the two totals, we calculated an 
adjustment of 1.00464, suggesting that the revised wage index values 
and labor-related portion would modestly reduce payments under the 
revised wage policy compared to the current policy. We built this 
adjustment factor into our budget neutrality model to calculate the 
final budget neutrality adjustment for the revised ASC payment system. 
Incorporating an adjustment for geographic wage differences did not 
change the final budget neutrality adjustment.
    The final budget neutrality adjustment of 0.65 for the CY 2008 
revised ASC payment system reflects updated data, including complete CY 
2006 utilization and final CY 2008 OPPS and MPFS payment rates, as well 
as the addition of an adjustment for the final geographic wage 
adjustment policy of the revised ASC payment system.
d. Calculation of the CY 2008 ASC Payment Rates
    After developing the final CY 2008 budget neutrality adjustment of 
0.65 according to the policies established in the August 2, 2007 
revised ASC payment system final rule, to determine the final CY 2008 
ASC conversion factor, we multiplied the final CY 2008 OPPS conversion 
factor by the ASC budget neutrality adjustment. The final CY 2008 OPPS 
conversion factor is $63.694, and multiplying that by the 0.65 budget 
neutrality adjustment yields our final CY 2008 ASC conversion factor of 
$41.401. To determine the fully implemented ASC payment rates for this 
final rule with comment period, including beneficiary coinsurance, 
according to the final payment methodology that applies to most covered 
surgical procedures and certain covered ancillary services under the 
revised ASC payment system, we multiplied the ASC conversion factor by 
the ASC relative payment weight (which equals the OPPS payment weight 
in CY 2008) for each procedure or service. As further discussed in 
section XVI.C. of this final rule with comment period, 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 PE RVU amount. In addition, the ASC relative payment 
weights for device-intensive covered surgical procedures are set 
according to a modified payment

[[Page 66859]]

methodology to ensure the same device payment under the revised ASC 
payment system as under the OPPS. The CY 2008 ASC payment rates of 
covered ancillary drugs and biologicals and brachytherapy sources are 
set equal to their final CY 2008 OPPS payment rates, so the ASC 
conversion factor is not applicable to these items. We then calculated 
the 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 final CY 2008 ASC payment 
rate developed according to the methodology of the revised ASC payment 
system, applying the special transition treatment to device-intensive 
procedures as discussed in section XVI.C of this final rule with 
comment period. We refer readers to Addenda AA and BB to this final 
rule with comment period for the final 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.
4. Calculation of the ASC Payment Rates for CY 2009 and Future Years
a. Updating the ASC Relative Payment Weights
    In the August 2, 2007 revised ASC payment system final rule, we 
finalized our policy to update the ASC relative payment weights in the 
revised ASC payment system each year using the national OPPS relative 
payment weights (and MPFS nonfacility PE RVU amounts, as applicable) 
for that same calendar year and to uniformly scale the ASC relative 
payment weights for each update year to make them budget neutral (72 FR 
42531). 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 services whose payment rates are related to OPPS relative 
payment weights. Scaling would not apply in the case of ASC payment for 
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. 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.
b. 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, as discussed 
in the August 2, 2007 revised ASC payment system final rule, we adopted 
a final policy to update the ASC conversion factor using the CPI-U in 
order to adjust ASC payment rates for inflation (72 FR 42518). We will 
implement the annual updates 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.
    We received a number of public comments regarding the update of the 
ASC conversion factor using the CPI-U. A summary of the public comments 
and our responses follow.
    Comment: Several commenters were concerned that updating the 
conversion factor for the revised ASC payment system using the CPI-U 
would cause divergence in the relationship between payment to HOPDs 
(the OPPS is updated annually as the statute requires, using the 
hospital market basket percentage increase, as described in section 
II.C. of this final rule with comment period) and ASCs over time that 
would not be based on growing differences between the costs of 
providing procedures in those two different settings. The commenters 
believed that hospitals and ASCs experienced similar inflationary 
pressures. Therefore, they recommended that CMS use the hospital market 
basket as the update for inflation under the revised ASC payment system 
because that update would more appropriately reflect inflation in the 
costs of providing surgical services. In addition, the commenters 
believed that the same update under the two payment systems would allow 
for a consistent relationship between their payment for the same 
surgical procedures.
    Response: While we appreciate the commenters' concerns, the update 
policy for the revised ASC payment system was not open to comment in 
the CY 2008 OPPS/ASC proposed rule because we finalized that policy in 
the August 2, 2007 revised ASC payment system final rule after we 
received and addressed public comments (72 FR 42519). Beginning in CY 
2010, when the period of the zero update for ASCs that the statute 
requires ends, we will apply the CPI-U to update the ASC conversion 
factor for inflation under the revised ASC payment system.

M. Annual Updates

    Under the revised ASC payment system, we 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 ASC payment. To the extent 
possible under the rules and policies of the revised ASC payment 
system, we 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 will 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 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 believe that including the ASC update as 
part of the OPPS rulemaking cycle will ensure that updates of the ASC 
payment rates and the list of covered surgical procedures for which 
Medicare makes payment to ASCs will be issued in a regular, 
predictable, and timely manner. Moreover, the ASC payment system will 
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.

[[Page 66860]]

    In addition, we 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 publish in the 
annual OPPS/ASC payment update final rule those interim determinations 
for the new codes to be active January 1 of the update year. The ASC 
payment system treatment of those procedures will be open to comment on 
that final rule, and we will respond to comments about our interim 
determinations in the OPPS/ASC 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 be 
included 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 are able to consider more recent 
volume and utilization data for each individual procedure code or, if 
appropriate, the clinical characteristics, utilization, and volume of 
related codes. Using that information, if we confirm our determination 
that the new code was appropriately assigned to an office-based payment 
indicator, it will then be permanently assigned to the list of office-
based procedures subject to the payment limitation.
    Accordingly, this annual rulemaking and publication of revised 
payment methodologies and payment rates are reflected in Sec.  416.173 
of the regulations.
    Comment: A few commenters urged us to complete the alignment of the 
OPPS and ASC by migrating from the CMS-1500 form to the UB-04 billing 
form for ASC claims submission, the same claim form that is used by 
HOPDs for Medicare payment and by ASCs for some other payers. They 
recommended that CMS initiate a transition process for providers and 
the agency's administrative contractors to implement the UB-04 form for 
ASCs in CY 2010. The commenters stated that during CYs 2008 and 2009 
ASCs would gain experience with the revised payment system and 
reporting quality measures and by CY 2010 could be ready to adopt the 
UB-04 for submitting their Medicare claims.
    Response: This same comment was addressed in the August 2, 2007 
revised ASC payment system final rule (72 FR 42534). As we discussed in 
that final rule, we will explore the feasibility of adopting the ASC 
billing change recommended by commenters. We reiterate here that a 
policy change that requires ASCs to use a different billing format 
would have to allow 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. 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 modifications or improvements that we 
should consider once the revised payment system is implemented.

XVII. Reporting Quality Data for Annual Payment Rate Updates

A. Background

1. Reporting Hospital Outpatient Quality Data for Annual Payment Update
    Section 109(a) of the MIEA-TRHCA (Pub. L. 109 432) amended section 
1833(t) of the Act by adding a new subsection (17) that affects the 
payment rate update applicable to OPPS payments for services furnished 
by hospitals in outpatient settings on or after January 1, 2009. New 
section 1833(t)(17)(A) of the Act, which applies to hospitals as 
defined under section 1886(d)(1)(B) of the Act, requires that hospitals 
that fail to report data required for the quality measures selected by 
the Secretary in the form and manner required by the Secretary under 
section 1833(t)(17)(B) of the Act will incur a reduction in their 
annual payment update factor by 2.0 percentage points. New section 
1833(t)(17)(B) of the Act requires that hospitals submit quality data 
in a form and manner, and at a time that the Secretary specifies. New 
sections 1833(t)(17)(C)(i) and (ii) of the Act require the Secretary to 
develop measures appropriate for the measurement of the quality of care 
(including medication errors) furnished by hospitals in outpatient 
settings and that these measures reflect consensus among affected 
parties and, to the extent feasible and practicable, include measures 
set forth by one or more national consensus building entities. The 
Secretary is not prevented from selecting measures that are the same as 
(or a subset of) the measures for which data are required to be 
submitted under section 1886(b)(3)(B)(viii) of the Act for the IPPS 
Reporting Hospital Quality Data for Annual Payment Update (RHQDAPU) 
program. New section 1833(t)(17)(D) of the Act gives the Secretary the 
authority to replace measures or indicators as appropriate, such as 
when all hospitals are effectively in compliance or when the measures 
or indicators have been subsequently shown not to represent the best 
clinical practice. New section 1833(t)(17)(E) of the Act requires the 
Secretary to establish procedures for making data submitted available 
to the public. Such procedures must give hospitals the opportunity to 
review data before these data are released.
    In the CY 2007 OPPS/ASC final rule with comment period (71 FR 
68189), we indicated our intent to establish, in CY 2009, an OPPS 
RHQDAPU program modeled after the current IPPS RHQDAPU program. We 
stated our belief that the quality of hospital outpatient services 
would be most appropriately and fairly rewarded through the reporting 
of quality measures developed specifically for application in the 
hospital outpatient setting. We agreed with the commenters that 
assessment of hospital outpatient performance would ultimately be most 
appropriately based on reporting of hospital outpatient measures 
developed specifically for this purpose. We stated our intent to 
condition the full OPPS payment rate update beginning in CY 2009 based 
upon hospital reporting of quality data beginning in CY 2008, using 
effective measures of the quality of hospital outpatient care that have 
been carefully developed and evaluated, and endorsed as appropriate, 
with significant input from stakeholders.
    The amendments to the Act made by section 109(a) of the MIEA-TRHCA 
are consistent with our intent and direction outlined in the CY 2007 
OPPS/ASC final rule with comment period. Under these amendments, we are 
now statutorily required to establish a program under which hospitals 
will report data on the quality of hospital outpatient care using 
standardized measures of care in order to receive the full annual 
update to the OPPS payment rate, effective for payments beginning in CY 
2009. We will refer to the program established under these amendments 
as

[[Page 66861]]

the Hospital Outpatient Quality Data Reporting Program (HOP QDRP).
    In reviewing the measures currently available for care in the 
hospital outpatient settings, we continue to believe that it would be 
most appropriate and desirable to use measures that have been 
specifically developed for application in the hospital outpatient 
setting. Although we still believe that hospitals generally function as 
integrated systems in inpatient and outpatient settings, we do not 
believe it is appropriate to use participation in the IPPS RHQDAPU 
program for the purpose of implementing section 1833(t)(17) of the Act 
in the hospital outpatient setting. Nonetheless, section 
1833(t)(17)(C)(ii) of the Act indicates that the Secretary is not 
prevented ``from selecting measures that are the same as (or a subset 
of) the measures for which data are required to be submitted'' under 
the IPPS RHQDAPU program. In the CY 2008 OPPS/ASC proposed rule (72 FR 
42799), we proposed to establish a separate reporting program and 
proposed quality measures that are appropriate for measuring hospital 
outpatient quality of care, that reflect consensus among affected 
parties, and are set forth by one or more of the national consensus 
building entities.
2. Reporting ASC Quality Data for Annual Payment Increase
    Section 109(b) of the MIEA-TRHCA, Pub. L. 109-432 amended section 
1833(i) of the Act by adding new sections 1833(i)(2)(D)(iv) and 
1833(i)(7) to the Act. These amendments may affect ASC payments for 
services furnished in ASC settings on or after January 1, 2009. New 
section 1833(i)(2)(D)(iv) of the Act authorizes the Secretary to 
implement the revised payment system for services furnished in ASCs 
(established under section 1833(i)(2)(D) of the Act), ``so as to 
provide for a reduction in any annual payment increase for failure to 
report on quality measures.''
    New section 1833(i)(7)(A) of the Act authorizes the Secretary to 
provide that any ASC that fails to report data required for the quality 
measures selected by the Secretary in the form and manner required by 
the Secretary under new section 1833(i)(7) of the Act will incur a 
reduction in any annual payment increase of 2.0 percentage points. New 
section 1833(i)(7)(A) of the Act also specifies that a reduction for 
one year cannot be taken into account in computing the ASC update for a 
subsequent year.
    New section 1833(i)(7)(B) of the Act provides that, ``except as the 
Secretary may otherwise provide,'' the hospital outpatient quality data 
provisions of section 1833(t)(17)(B) through (E) of the Act, summarized 
above, shall apply to ASCs.
    We refer readers to section XVII.I. of this final rule with comment 
period for a discussion of our decision to introduce implementation of 
ASC quality data reporting in a later rulemaking.
3. Reporting Hospital Inpatient Quality Data for Annual Payment Update
    Section 5001(a) of the Deficit Reduction Act of 2005, Pub. L. 109-
171, set out the current requirements for the IPPS RHQDAPU program. We 
established the RHQDAPU program in order to implement section 501(b) of 
Pub. L. 108-173. The program builds on our ongoing voluntary Hospital 
Quality Initiative. The Initiative is intended to empower consumers 
with quality of care information so that they can make more informed 
decisions about their health care while also encouraging hospitals and 
clinicians to improve the quality of their care. Under the current 
statutory provisions found in section 1886(b)(3)(B)(viii) of the Act, 
the IPPS annual payment update for ``subsection (d)'' hospitals that do 
not submit inpatient quality data in a form, and manner, and at a time 
specified by the Secretary is reduced by 2.0 percentage points.
    We used an initial ``starter set'' of 10 quality measures for the 
IPPS RHQDAPU program under section 501(b) of Pub. L. 108-173 and have 
expanded the measures as required under section 
1886(b)(3)(B)(viii)((IV) and (V) of the Act, as added by section 
5001(a) of Pub. L. 109-171. We initially added measures as a part of 
the annual IPPS rulemaking process. In response to public comments 
asking that we issue IPPS RHQDAPU program quality measures and other 
requirements as far in advance as possible, we also have used the OPPS 
annual payment update rulemaking process to adopt IPPS RHQDAPU program 
measures and requirements. In the CY 2007 OPPS final rule (71 FR 
68201), we added six additional IPPS RHQDAPU program quality measures 
for FY 2008 update.
    Most recently, in the FY 2008 IPPS proposed rule (72 FR 24805), we 
proposed adding 5 additional quality measures in for the FY 2009 
update. However, in the FY 2008 IPPS final rule with comment period (72 
FR 47351), we only adopted one of the proposed additional five 
measures. We indicated that we intended to adopt three additional 
measures in this CY 2008 OPPS/ASC final rule with comment period, but 
only if the measures were adopted by the National Quality Forum (NQF). 
The NQF is a voluntary consensus standard-setting organization 
established to standardize health care quality measurement and 
reporting through its consensus development process. Under section 
1886(b)(3)(B)(viii)(V) of the Act, we are required, to the extent 
feasible and practicable, to use measures set forth by entities such as 
NQF when adding new measures.
    Section XVII.J. of this final rule with comment period contains a 
discussion of our decision to add two additional NQF-endorsed quality 
measures to the IPPS RHQDAPU program, with reporting to begin with the 
first calendar quarter of 2008 discharges, for the FY 2009 annual 
payment update.

B. Hospital Outpatient Measures

    For the initial implementation of the HOP QDRP, we proposed 10 
quality measures that we believed to be both applicable to care 
provided in hospital outpatient settings and likely to be sufficiently 
developed to permit data collection consistent with the timeframes 
defined by statute. These measures address care provided to a large 
number of adult patients in hospital outpatient settings, across a 
diverse set of conditions, and were selected for the initial set of HOP 
QDRP measures based on their relevance as a set to all hospitals.
    The first five of these measures capture the quality of outpatient 
care in hospital emergency departments (EDs), specifically for those 
adult patients with acute myocardial infarction (AMI) who are treated 
and then transferred to another facility for further care. These 
patients receive many of the same interventions as patients who are 
evaluated and admitted at the same facility, whose care is currently 
assessed in measures that are endorsed by the National Quality Forum 
(NQF). NQF is a voluntary consensus standard setting organization 
established to standardize health care quality measurement and 
reporting through its consensus development process. Moreover, these 
are also inpatient AMI measures that have long been reported under the 
IPPS RHQDAPU program, and are published on the Hospital Compare Web 
site at: www.HospitalCompare.hhs.gov.
    Transferred AMI patients historically have not been included with 
the directly-admitted patients for purposes of the calculation of the 
inpatient AMI measures because of differences in data collection and 
reporting for the two groups. With the input of provider and 
practitioner experts in the field, we

[[Page 66862]]

developed specifications for related emergency department transfer 
measures that, while consistent with the measure specifications for the 
related hospital inpatient measures, reflect the unique operational and 
clinical aspects of care in hospital outpatient settings. The processes 
of care encompassed by these measures address care on arrival, the 
promptness of interventions, and discharge care for patients presenting 
to a hospital with an AMI.
    In addition to the five ED-AMI measures, CMS identified five 
quality measures that were directly related to conditions treated or 
interventions provided in hospital outpatient settings and that we 
believed were also appropriate and fully developed for use in the HOP 
QDRP. These measures were specified in a form that assessed the care 
provided by physicians, however, these measures are also relevant to 
assessing care at the facility level. CMS was engaged in reviewing, and 
where appropriate, revising these measure specifications so that they 
explicitly assess care provided in hospital outpatient settings. he 
five measures included one measure related to treatment of heart 
failure, two measures related to surgical care improvement, one measure 
addressing treatment of community-acquired pneumonia, and one measure 
related to diabetes care.
    Therefore, for hospitals to receive the full OPPS payment update 
for services furnished in CY 2009, in the CY 2008 OPPS/ASC proposed 
rule (72 FR 42800) we proposed to require that hospital outpatient 
settings submit data on the following 10 measures, effective with 
hospital outpatient services furnished on or after January 1, 2008.
     ED-AMI-1--Aspirin at Arrival.
     ED-AMI-2--Median Time to Fibrinolysis.
     ED-AMI-3--Fibrinolytic Therapy Received Within 30 Minutes 
of Arrival.
     ED-AMI-4--Median Time to Electrocardiogram (ECG).
     ED-AMI-5--Median Time to Transfer for Primary PCI.
     PQRI 5 Heart Failure: Angiotensin-Converting 
Enzyme (ACE) Inhibitor or Angiotensin Receptor Blocker (ARB) Therapy 
for Left Ventricular Systolic Dysfunction (LVSD).
     PQRI 20 Perioperative Care: Timing of Antibiotic 
Prophylaxis.
     PQRI 21 Perioperative Care: Selection of 
Prophylactic Antibiotic.
     PQRI 59 Empiric Antibiotic for Community-Acquired 
Pneumonia.
     PQRI 1 Hemoglobin A1c Poor Control in Type 1 or 2 
Diabetes Mellitus.
    As required by statute, consensus was reached by affected parties, 
as the measures were identified as appropriate for reporting on 
hospital outpatient care in collaboration with professionals and 
providers with experience in hospital outpatient settings as well as 
with the Hospital Quality Alliance (HQA), a hospital-industry led, 
public-private collaboration established to promote public reporting on 
hospital quality of care. The specifications for outpatient measures 
were then completed for hospital data collection using the same format 
that is used for inpatient measures. CMS finalized the specifications 
for these 10 measures and released them publicly on August 28, 2007. In 
addition these 10 measures have gone through the NQF steering committee 
process.
    Nine of the ten proposed measures are process measures, while one 
measure--Hemoglobin A1c >9.0 percent--is an intermediate outcome 
measure that has not been risk adjusted. While poor quality of care can 
lead to poor diabetes control and elevated A1c levels, CMS recognizes 
that patient noncompliance with prescribed treatment regimen can also 
lead to poor diabetes control and elevated A1c levels. Patients with 
comorbidities or diabetes complications may also have a harder time 
controlling their diabetes and thus have higher A1c levels. Therefore, 
we specifically requested comments on this intermediate outcome measure 
and whether it may lead to unintended consequences.
    CMS believes that an A1c level higher than 9.0 percent represents a 
level of control that is sufficiently poor enough that it should not 
result in any unintended consequences. The scientific literature would 
suggest that an A1c level of 8.0 percent or less might represent the 
best control that could be expected for some patients: therefore, CMS 
believes that an A1c level of > 9.0 percent represents a level of 
control that is poor enough that risk-adjustment is not warranted. 
Additionally, this A1c measure was endorsed by the National Quality 
Forum (NQF) in 2006. One of the criteria for evaluation of measures 
within the NQF process is ``scientific acceptability,'' which includes 
appropriate risk-adjustment. Some measures are not endorsed by NQF if 
risk-adjustment is determined to be appropriate and is found to be 
inadequate. CMS believes that additional risk-adjustment is not 
necessary because the NQF endorsed this measure. We invited public 
comment on our rationale for choosing a diabetes outcome measure rather 
than a process measure.
    Comment: Several commenters supported collecting quality measure 
data for outpatient hospital services. Several commenters agreed with 
not using any inpatient quality measures for the outpatient hospital 
setting. One commenter stated that the proposed indicators are things 
that providers should be achieving for patients, and if done correctly, 
this endeavor will help to drive down the overall expenditures in 
health care.
    Response: We thank the commenters for their support.
    Comment: Several commenters supported the emergency room measures. 
However, the commenters also expressed concern that these measures 
would most affect smaller facilities that may not have the resources 
required for such data collection. One commenter stated that its 
facility does not transfer such patients and would not have any data 
for this set of measures.
    Response: We appreciate the support expressed by commenters for the 
five ED-AMI measures. We agree that these measures will mostly apply to 
smaller facilities that do not admit such patients, transferring them 
instead. In fact, these measures were designed specifically for smaller 
facilities that were not included under quality measure reporting for 
inpatient measures. We recognize that some facilities, usually larger 
ones, do not transfer such patients; information on these patients for 
these facilities is captured under quality measure reporting for 
inpatient measures. Including the five ED-AMI measures in the required 
measure set for HOP QDRP will allow smaller facilities the opportunity 
to report quality measure data. We acknowledge that there are resource 
costs associated with collecting quality measure data, however, we also 
view it important that an opportunity to report such data be provided 
to smaller facilities and that consumers have information available 
from this type of facility. There is no penalty for not reporting 
quality measure data in the event that the provider does not have 
relevant cases.
    Comment: One commenter did not support the use of the ED-AMI-4-
Median Time to Electrocardiogram as this measure has not been adopted 
by NQF, nor is it collected for inpatients and, thus, is not ready for 
reporting.
    Response: As statutorily required, affected parties reached 
consensus on the 10 proposed quality measures for outpatient hospital 
services. In addition, the ED-AMI-4 measure has been submitted for NQF 
endorsement with the other ED-AMI measures; all of these

[[Page 66863]]

measures have gone through the NQF steering committee process and have 
been recommended for endorsement.
    Comment: One commenter expressed concern that for the five ED-AMI 
measures, the specifications contain no mention of observation 
patients.
    Response: Observation care is a well-defined set of specific, 
clinically appropriate services, which include ongoing short-term 
treatment, assessment, and reassessment, before a decision can be made 
regarding whether a patient will require further treatment as a 
hospital inpatient. Observation status is commonly assigned to patients 
who present to the emergency room. Thus, the five ED-AMI measures are 
specifically designed to capture care rendered to such patients; 
patients that receive care but are not admitted as inpatients, that is, 
have outpatient status.
    Comment: Many comments addressed the use of the Hemoglobin A1c 
measure. Several commenters expressed opinions ranging from concern 
with to strong opposition to the use of the Hemoglobin A1c measure for 
measuring outpatient hospital quality of care. While agreeing with the 
importance of hemoglobin A1c levels as a clinical measure for diabetes 
care, some commenters viewed this as more reflective of physician care 
and patient compliance. As the proposed Hemoglobin A1c measure is an 
outcome measure that is not risk adjusted; the need to use only process 
measures or risk adjust any outcome measures was also stated. One 
commenter agreed with the use of the proposed Hemoglobin A1c measure 
and that this measure did not require risk adjustment, but stated that 
this measure does need definition of the expected frequency of what the 
inclusion and exclusion criteria are. One commenter supported the 
Hemoglobin A1c measure but suggested a revision to being <7 percent, 
consistent with clinical guidelines.
    Response: We agree with these comments regarding the Hemoglobin A1c 
measure. As noted in the proposed rule, the Hemoglobin A1c measure is 
an intermediate outcome measure that has not been risk adjusted. 
Recognizing the individual patient challenges with regard to this 
measure, as well as the need to otherwise modify the measure, we will 
not include the Hemoglobin A1c measure in the final HOP QDRP measure 
set at this time.
    Comment: Several commenters stated that, except for the ED 
patients, it was unclear what the patient populations of interest are 
under the proposed outpatient hospital measures. For example, surgery 
patients could come from several areas of the hospital and PQRI 
1 and 5 could apply to outpatients that present for 
services unrelated to their conditions. Two commenters expressed 
concerns about patients that walk out from the ED and requested that 
these patients be excluded from any ED measures.
    Response: As discussed previously and noted below, data collection 
on the PQRI 1 measure will not be required for any CY 2009 HOP 
QDRP determinations. We thank the commenters for raising the issue of 
patients that walk out from the ED and will consider this issue in the 
formulation of future measure specifications. We are also concerned 
about the comments received concerning the administrative burden for 
collection on PQRI 5-Heart failure and PQRI 59-
communicty acquired pneumonia. We agree with the commenters that, at 
this point, those proposed quality measures may not be sufficiently 
refined for use in the outpatient setting. Therefore, we are not 
adopting PQRI 5 and PQRI 59 at this point as quality 
measures for the HOP QDRP.
    Comment: Several commenters disagreed with the use of any or all of 
the five, non-ED-AMI measures as measures of quality of care for 
hospital outpatient services on the grounds that these measures were 
more indicative of the care provided by other settings, especially 
physician practices.
    Response: We acknowledge that the five non-ED AMI measures were 
initially developed for measurement of quality of care provided by 
physician practices, and are all part of CMS'' physician quality 
reporting initiative. However, the two surgical infection prevention 
measures would also apply to patients who have surgery in the hospital 
outpatient department. The diabetes measure and the heart failure 
measure apply to hospital outpatient department clinics that provide 
primary care services, and the pneumonia measure applies to hospital 
outpatient clinic departments and patients who are seen in an emergency 
department and discharged to home from the ED. Thus, it is our view 
that all of these measures could be fairly applied to hospital 
outpatient services as these patients are seen and services are 
rendered in this setting. However, in understanding of various concerns 
with some of these measures, we have decided to not include collection 
of data for the proposed heart failure, pneumonia, and diabetes 
measures as discussed in this section, for making HOP QDRP decisions 
for the CY 2009 payment update determinations. Data for the two 
perioperative care measures will be required.
    Comment: Commenters supported some of the non-ED measures. One 
commenter stated that perioperative care and timing of antibiotics 
(PQRI 20) are currently captured for inpatients and would be 
suitable reporting indicators for outpatient surgical cases if 
hospitals are provided specific surgical procedures to be included, are 
informed whether interventional procedures would be included, and are 
notified which prophylactic antibiotics would be included. One 
commenter stated that the proposed pneumonia measure was logical for 
measuring quality of care related to antibiotic administration in the 
ED and for patients under observation status.
    Response: We thank the commenters for their support of these 
quality measures and intend to provide necessary specifications for 
data collection. At this time, there are no requirements to sample 
cases for the perioperative care measures by surgery type and thus 
there is no need to separate out specific surgical procedures for the 
purposes of selecting cases for the perioperative measures.
    Comment: Several commenters expressed concern about the 
administrative and financial burden that would be associated with 
collecting outpatient hospital quality measure data, and indicated that 
the effort to be expended to collect such information would outweigh 
the benefit of this collection. Two commenters stated that data should 
be collected to improve clinical practice not just for payment 
purposes.
    Response: We recognize that there are administrative and financial 
costs associated with collecting quality measure data. The reporting of 
quality measures for hospital outpatient services builds on our 
previous efforts in the inpatient arena, having the same purpose. 
Reporting is intended to encourage hospitals and clinicians to improve 
their quality of care and to empower consumers with quality of care 
information to make more informed decisions about their health care. We 
also note the requirement to report hospital outpatient quality measure 
data is statutory with the payment implication contingent upon the 
reporting of such information.
    Comment: Several commenters stated that the infrastructure did not 
exist to support collecting outpatient hospital data as it did for 
collecting inpatient hospital data. The commenters stated that it would 
be extremely difficult if not impossible to meet the

[[Page 66864]]

implementation timeline due to the complexities of building data 
collection information systems. In particular, some of the commenters 
pointed out differences in storage of outpatient hospital services 
information and the possible need to connect information systems and 
people from different parts of a hospital and the lack of existing 
vendors as important differences.
    Response: We recognize that the data infrastructure necessary to 
support collecting outpatient hospital data varies considerably among 
hospitals. To lessen the burden associated with this effort and 
recognizing the need for further refinement of some of the proposed 
measures for the outpatient setting, we have reduced the number of 
required measures and delayed implementation as discussed later in this 
final rule with comment period. Also, to aid hospitals in collecting 
these data, we will be providing a data collection tool in sufficient 
advance timing of required data submission.
    Comment: Several commenters expressed concerns for training/
support. For example, the commenters asked if a Quest or Quest-like 
entity would be provided and whether QIOs would be involved for the HOP 
QDRP. One commenter urged that QIOs be involved in providing support to 
hospitals for the HOP QDRP.
    Response: We recognize the need for hospital support under the HOP 
QDRP. It is our intent that a Quest or Quest-like entity be provided to 
support this effort. In addition, we are in the process of procuring a 
contractor to assist in supporting implementation of HOP QDRP. Under 
the initial implementation of the HOP QDRP, there will be no QIO 
involvement.
    Comment: Several commenters asked questions related to the source 
of required data, in particular, what claim submission form would be 
the data source, what is the definition of outpatient hospital 
services, what is the population or universe for sampling purposes, 
what is considered a hospital-based outpatient clinic (for example if a 
hospital owns an outside clinic, are these cases included or are only 
the clinics within the hospital to be included).
    Response: Under MIEA-TRCHA, Quality Measure Reporting for 
Outpatient Hospital Services applies to ``subsection (d)'' hospitals 
subject to the OPPS. The Medicare Benefit Policy Manual, Chapter 6, 
under Hospital Services Covered Under Part B, provides the following 
definition of ``hospital outpatient'': ``A hospital outpatient is a 
person who has not been admitted by the hospital as an inpatient but is 
registered on the hospital records as an outpatient and received 
services (rather than supplies alone) from the hospital.'' Under this 
definition, such services must be directly received from the hospital. 
Thus, the population of interest consists of services rendered to 
Medicare beneficiaries reimbursed to hospitals under the OPPS or 
comparable services rendered under other payers. For Medicare 
beneficiaries, the claims data source for this information would be the 
UB-04, formally known as the UB-92. The UB-04 is a uniform 
institutional provider bill suitable for use in billing multiple third 
party payers. All other information necessary would come from the 
medical record.
    Comment: Several commenters asked when the algorithms used for the 
measures would be available for review. In particular, they asked if 
the algorithms would be available for review at least 120 days prior to 
any start date to allow for vendor programming.
    Response: The measure specifications were posted on August 28, 
2007, far in advance of any proposed data reporting requirements. The 
following Web site includes the 10 proposed Hospital Outpatient (HOP) 
Measures: http://www.cms.hhs.gov/QualityInitiativesGenInfo/01--
overview.asp. These measure specifications are final for April 2008 
discharges forward. As discussed later in this section, data collection 
will begin with services rendered beginning April 2008 rather than 
beginning January 2008. From our perspective, the specifications for 
the final HOP measures finalized in this final rule with comment period 
are ready to use for programming purposes. It is possible that we will 
issue a revised version of the measure specifications for services 
after April 2008, but sufficient time for programming and data 
submission will be allowed.
    Comment: One commenter asked whether vendor tools would be required 
to have reporting capabilities.
    Response: We do not supply external vendors with requirements; we 
provide the measure specifications. We will consider providing such 
functionality in any reporting tool supplied by CMS.
    Comment: Several commenters asked whether critical access hospitals 
would be required to report quality measures for hospital outpatient 
services. One commenter stated that critical access hospitals should be 
required to report data on the five ED-AMI measures proposed.
    Response: The statute specifically notes the entities subject to 
the reporting quality measure data requirement for OPPS annual payment 
updates. Section 1833(t)(17)(A)(i) of the Act, as added by section 
109(a) of the MIEA-TRHCA (Pub. L. 109-432), requires a 2.0 percentage 
point reduction to the OPPS conversion factor update for those 
``subsection (d)'' hospitals that do not submit to the Secretary data 
required to be submitted on measures selected in a form and manner, and 
at a time, specified by the Secretary. Subsection (d) hospitals are 
defined in section 1886(d)(1)(B) of the Act and do not include critical 
access hospitals. Additionally, outpatient hospital services at 
critical access hospitals are not reimbursed under the OPPS, so a 
reduction in the OPPS update factor would not affect critical access 
hospitals.
    Comment: Several commenters asked whether the proposed payment 
reduction would apply to all services reported in CY 2009.
    Response: As stated in the statute, the payment reduction would 
affect the annual OPPS payment increase by 2.0 percentage points. Thus, 
all hospital outpatient services subject to this update would be 
affected.
    Comment: Several commenters urged CMS to not proceed with 
implementation of measures that have not received NQF endorsement and 
to wait until HQA finalizes their list of measures; field testing of 
measures was also recommended.
    Response: The statute requires that we develop measures appropriate 
for the measurement of the quality of care furnished by hospitals in 
outpatient settings and that these measures reflect consensus among 
affected parties and, to the extent feasible and practicable, we 
include measures set forth by one or more national consensus building 
entities. The five ED-AMI measures address care provided to outpatients 
that receive many of the same interventions as inpatients who are 
evaluated and admitted at the same facility, and whose care is 
currently assessed in measures that are endorsed by NQF. Also, these 
five ED-AMI measures are inpatient AMI measures that have long been 
reported under the IPPS RHQDAPU program. As of the publication of this 
final rule with comment period, the two perioperative measures, 
Perioperative Care: Timing of Antibiotic Prophylaxis and Perioperative 
Care: Selection of Prophylactic Antibiotic, have received NQF 
endorsement. As discussed in this final rule with comment period, data 
collection for the remaining three proposed measures for heart failure, 
pneumonia, and diabetes mellitus will

[[Page 66865]]

not be required for CY 2009 payment decisions.
    We utilize field-testing to the extent it is feasible and 
practical. The five ED-AMI transfer measures have been extensively 
tested for use in the inpatient setting. We have removed the transfer 
exclusion in order to incorporate the ED-AMI measure into the 
outpatient hospital setting. We believe the five ED-AMI measures are 
optimal for use in the outpatient hospital setting and will help 
fulfill our MIEA-TRCHA requirements for outpatient quality measure 
reporting. We intend to begin additional field testing in November 2007 
and plan to make changes as necessary to specifications for future 
reporting.
    Comment: One commenter recommended that any CMS-supplied tool 
should have separate modules for inpatient and outpatient data 
collection and reporting.
    Response: It is our intent that the CMS-supplied tool will have 
separate modules for inpatient and outpatient data collection and 
reporting.
    Comment: Several commenters noted that in the specifications of the 
two surgical measures in the Specifications Manual for hospital 
outpatient measures, CPT codes as opposed to ICD-9 codes were used to 
define the relevant procedures and questioned this approach. Several 
commenters also suggested that for any NQF-endorsed measures, the ``all 
codes'' versions should be used.
    Response: CPT, E/M (Evaluation and Management) and ICD-9-CM Codes 
are used to identify eligible cases in the outpatient measures. Because 
the set of measures crosses settings (clinic, emergency department, 
hospital outpatient surgery department), it is necessary to utilize a 
variety of codes to adequately capture and sample the appropriate 
populations. For the surgical measures, each procedure is assigned a 
CPT code on the claim form and hospitals will use this information to 
pull the charts to be abstracted. The CPT-4 is a uniform coding system 
consisting of descriptive terms and identifying codes that are used 
primarily to identify medical services and procedures furnished by 
physicians and other health care professionals. More information 
regarding coding can be found on the CMS Web site at: http://www.cms.hhs.gov/MedHCPCSGenInfo/20--HCPCS--Coding--Questions.asp.
    Comment: Several commenters expressed concerns about OPPS data 
reliability due to coding disparities from the high volume of many 
closely related codes.
    Response: We understand the complexities of coding for outpatient 
services and have designed specifications with this in consideration. 
While data validation will not be used in the CY 2009 HOP QDRP 
determinations, as discussed below, future validation efforts can help 
to reduce coding disparities.
    After consideration of the public comments received and as 
discussed in the above responses to those comments, for the CY 2009 
annual payment update we are requiring HOP QDRP reporting using 7 of 
the proposed measures--the five ED-AMI measures as well as the two 
Perioperative Care measures, PQRI 20 Perioperative Care: 
Timing of Antibiotic Prophylaxis and PQRI 21 Perioperative 
Care: Selection of Prophylactic Antibiotic. As noted previously, we 
have decided to not implement three of the proposed measures, 
specifically those related to heart failure, diabetes, and community-
acquired pneumonia for CY 2009 payment decisions. These decisions are 
based upon the recognition of the burden placed on providers in 
developing systems to collect outpatient quality measure data and need 
to utilize quality measures sufficiently refined for use in the 
outpatient setting.

C. Other Hospital Outpatient Measures

    In addition to the 10 measures discussed above, we are considering 
a number of other possible quality measures for use in assessing the 
care provided by hospital outpatient settings, for the HOP QDRP 
determinations for CY 2010 or subsequent calendar year payment updates. 
These measures are, for the most part, either currently in use or were 
developed for use in settings other than hospital outpatient. However, 
we believe that these measures are applicable to the hospital 
outpatient settings.
    These measures have not received formal review by either the HQA or 
the NQF as measures of HOP performance. As noted in the chart, however, 
the inpatient or ambulatory versions of these measures have all been 
either recommended by an NQF subgroup for endorsement, are pending 
endorsement by the NQF, or are currently endorsed by the NQF. The 
measures present the diversity of services and clinical topics provided 
to adult patients in hospital outpatient settings. The measures address 
some aspects of care provided to cancer patients, patients presenting 
with diabetes, pneumonia, chest pains, syncope, or depression, and 
patients receiving services related to bones, eyes, and problems 
associated with aging. While some of the measures relate to acute care 
provided in a hospital outpatient setting, others assess care that a 
hospital outpatient clinic might provide on an ongoing basis. In the CY 
2008 OPPS/ASC proposed rule, (72 FR 42801), we expressed interest in 
receiving comments from the public concerning all dimensions of these 
measures.
    We expect that once the HOP QDRP is established, we will expand the 
set of measures on which hospital outpatient settings must report data. 
In the CY 2008 OPPS/ASC proposed rule, (72 FR 42801), we also expressed 
interest in receiving comments concerning the relative priority that 
should be assigned to each of the measures or topics identified in the 
list below, as well as any additional measures, measure sets, or topics 
that should be developed for future reporting.
    We would like to note that, while we are committed to identifying 
measures that are relevant to care in hospital outpatient settings, it 
is also our intent to develop, where feasible, hospital outpatient 
measures that are ``harmonized'' with measures for assessing comparable 
inpatient and ambulatory care--that is, measures that are similar in 
both the care that is assessed and the manner in which data are 
collected, regardless of the setting. The goal of harmonization is to 
assure that comparable care in different care settings can be evaluated 
in similar ways, which further assures that quality measurement and 
improvement can focus more on the needs of a patient with a particular 
condition than on the specific program or policy attributes of the 
setting at which the care is provided.
    Therefore, we sought public comment on the following 30 additional 
measures, which have been identified as hospital outpatient-appropriate 
measures and are under consideration for inclusion in the HOP QDRP 
measure set, for CY 2010 or subsequent calendar years:

[[Page 66866]]



------------------------------------------------------------------------
                                    NQF endorsed for
                                      inpatient or
                     Measure           ambulatory         Description
                                         setting
------------------------------------------------------------------------
1............  PQRI 2     Endorsed 2006.....  Percentage of
                Low Density                             patients aged 18-
                Lipoprotein                             75 years with
                Control in Type 1                       diabetes (type 1
                or 2 Diabetes                           or type 2) who
                Mellitus.                               had most recent
                                                        LDL-C level in
                                                        control (less
                                                        than 100 mg/dl).
2............  PQRI 3     Endorsed 2006.....  Percentage of
                High Blood                              patients aged 18-
                Pressure Control                        75 years with
                in Type 1 or 2                          diabetes (type 1
                Diabetes Mellitus.                      or type 2) who
                                                        had most recent
                                                        blood pressure
                                                        in control (less
                                                        than 140/80 mm
                                                        Hg).
3............  PQRI 4     2 year Endorsement  Percentage of
                Screening for       until May 8, 2009.  patients aged 65
                Fall Risk.                              years and older
                                                        who were
                                                        screened for
                                                        fall risk (2 or
                                                        more falls in
                                                        the past year or
                                                        any fall with
                                                        injury in the
                                                        past year) at
                                                        least once
                                                        within 12
                                                        months.
4............  PQRI 9     Endorsed 2006.....  Percentage of
                Antidepressant                          patients aged 18
                Medication During                       years and older
                Acute Phase for                         diagnosed with
                Patient with New                        new episode of
                Episode of Major                        major depressive
                Depression.                             disorder (MDD)
                                                        and documented
                                                        as treated with
                                                        antidepressant
                                                        medication
                                                        during the
                                                        entire 84-day
                                                        (12 week) acute
                                                        treatment phase.
5............  PQRI 10    2 year Endorsement  Percentage of
                Stroke and Stroke   until May 8, 2009.  patients aged 18
                Rehabilitation:                         years and older
                Computed                                with a diagnosis
                Tomography (CT)                         of ischemic
                or Magnetic                             stroke or
                Resonance Imaging                       transient
                (MRI) Reports.                          ischemic attack
                                                        (TIA) or
                                                        intracranial
                                                        hemorrhage
                                                        undergoing CT or
                                                        MRI of the brain
                                                        within 24 hours
                                                        of arrival to
                                                        the hospital
                                                        whose final
                                                        report of the CT
                                                        or MRI includes
                                                        documentation of
                                                        the presence or
                                                        absence of each
                                                        of the
                                                        following:
                                                        Hemorrhage and
                                                        mass lesion and
                                                        acute
                                                        infarction.
6............  PQRI 11    2 year Endorsement  Percentage of
                Stroke and Stroke   until May 8, 2009.  patients aged 18
                Rehabilitation:                         years and older
                Carotid Imaging                         with a diagnosis
                Reports.                                of ischemic
                                                        stroke or
                                                        transient
                                                        ischemic attack
                                                        (TIA) whose
                                                        final reports of
                                                        the carotid
                                                        imaging studies
                                                        performed, with
                                                        characterization
                                                        of internal
                                                        carotid stenosis
                                                        in the 30-99
                                                        percent range,
                                                        include
                                                        reference to
                                                        measurements of
                                                        distal internal
                                                        carotid diameter
                                                        as the
                                                        denominator for
                                                        stenosis
                                                        measurement.
7............  PQRI 24    2 year Endorsement  Percentage of
                Osteoporosis:       until May 8, 2009.  patients aged 50
                Communication                           years and older
                with the                                treated for a
                Physician                               hip, spine or
                Managing Ongoing                        distal radial
                Care Post                               fracture with
                Fracture.                               documentation of
                                                        communication
                                                        with the
                                                        physician
                                                        managing the
                                                        patient's
                                                        ongoing care
                                                        that a fracture
                                                        occurred and
                                                        that the patient
                                                        was or should be
                                                        tested or
                                                        treated for
                                                        osteoporosis.
8............  PQRI 46    2 year Endorsement  Percentage of
                Medication          until May 8, 2009.  patients aged 65
                Reconciliation.                         years and older
                                                        discharged from
                                                        any inpatient
                                                        facility (e.g.,
                                                        hospital skilled
                                                        nursing
                                                        facility, or
                                                        rehabilitation
                                                        facility) and
                                                        seen within 60
                                                        days following
                                                        discharge in the
                                                        office by the
                                                        physician
                                                        providing on-
                                                        going care who
                                                        had a
                                                        reconciliation
                                                        of the discharge
                                                        medications with
                                                        the current
                                                        medication list
                                                        in the medical
                                                        record
                                                        documented.
9............  PQRI 53    Endorsed 2006.....  Percentage of
                Asthma                                  patients aged 5
                Pharmacological                         to 40 with a
                Therapy.                                diagnosis of
                                                        mild, moderate,
                                                        or severe
                                                        persistent
                                                        asthma who were
                                                        prescribed
                                                        either the
                                                        preferred long-
                                                        term control
                                                        medication
                                                        (inhaled
                                                        corticosteroid)
                                                        or an acceptable
                                                        alternative
                                                        treatment.
10...........  PQRI 58    2 year Endorsement  Percentage of
                Assessment of       until May 8, 2009.  patients aged 18
                Mental Status for                       years and older
                Community-                              with a diagnosis
                acquired                                of community-
                Pneumonia.                              acquired
                                                        bacterial
                                                        pneumonia with
                                                        mental status
                                                        assessed.
11...........  Radiation therapy   Endorsed May 9,     Radiation therapy
                is administered     2007.               to the breast
                within 1 year of                        initiated within
                diagnosis for                           1 year of date
                women under age                         of diagnosis.
                70 receiving
                breast conserving
                surgery for
                breast cancer.
12...........  Adjuvant            Endorsed May 9,     Consideration or
                chemotherapy is     2007.               administration
                considered or                           of chemotherapy
                administered                            initiated within
                within 4 months                         4 months of date
                of surgery to                           of diagnosis.
                patients under
                the age of 80
                with AJCC III
                (lymph node
                positive) colon
                cancer.
13...........  Adjuvant hormonal   Endorsed May 9,     Cancer--Breast--c
                therapy.            2007.               onsideration or
                                                        administration
                                                        of accompanying
                                                        hormonal therapy
                                                        for treatment of
                                                        breast cancer.
14...........  Needle biopsy to    Endorsed May 9,     Patient whose
                establish           2007.               date of needle
                diagnosis of                            biopsy precedes
                cancer precedes                         the date of
                surgical excision/                      surgery.
                resection.
15...........  Osteo-02:           2 year Endorsement  Bone and joint
                Screening or        until May 8, 2009.  conditions
                Therapy for Women                       (osteoporosis)--
                Aged 65 years and                       Screening or
                Older.                                  therapy for
                                                        women aged 65
                                                        years and older.

[[Page 66867]]

 
16...........  Osteo-03:           2 year Endorsement  Bone and joint
                Management          until May 8, 2009.  conditions
                following                               (osteoporosis)--
                fracture.                               Management
                                                        following
                                                        fracture.
17...........  Osteo-04:           2 year Endorsement  Bone and joint
                Pharmacologic       until May 8, 2009.  conditions
                Therapy.                                (osteoporosis)--
                                                        Pharmacologic
                                                        therapy.
18...........  EC-01:              2 year Endorsement  Percentage of
                Electrocardiogram   until May 8, 2009.  patients aged 40
                (ECG) for                               years and older
                Patients with Non-                      with an
                Traumatic Chest                         emergency
                Pain.                                   department
                                                        discharge
                                                        diagnosis of
                                                        nontraumatic
                                                        chest pain who
                                                        had an
                                                        electrocardiogra
                                                        m (ECG).
19...........  EC-03: ECG          2 year Endorsement  Percentage of
                Performed for       until May 8, 2009.  patients aged 18
                Patients with                           to 60 years with
                Syncope.                                an emergency
                                                        department
                                                        discharge
                                                        diagnosis of
                                                        syncope who had
                                                        an ECG
                                                        performed.
20...........  EC-04: Vital Signs  2 year Endorsement  Percentage of
                Recorded and        until May 8, 2009.  patients aged 18
                Reviewed for                            years and older
                Patients with                           with a diagnosis
                Community-                              of community-
                Acquired                                acquired
                Bacterial                               bacterial
                Pneumonia.                              pneumonia with
                                                        vital signs
                                                        recorded and
                                                        reviewed.
21...........  Eye-01: Primary     2 year Endorsement  Primary open
                Open Angle          until May 8, 2009.  angle glaucoma--
                Glaucoma--Optic                         optic nerve
                Nerve Evaluation.                       evaluation.
22...........  Eye-02: Age-        Recommended for     Age-related
                Related Macular     Endorsement.        macular
                Degeneration--Ant                       degeneration--an
                ioxidant                                tioxidant
                Supplement                              supplement
                Prescribed/                             prescribed/
                Recommended.                            recommended.
23...........  Eye-03: Age-        2 year Endorsement  Age-related
                Related Macular     until May 8, 2009.  macular
                Degeneration--Dil                       degeneration--di
                ated Macular                            lated macular
                Examination.                            examination.
24...........  Eye-07: Diabetic    2 year Endorsement  Documentation of
                Retinopathy--Docu   until May 8, 2009.  presence or
                mentation of                            absence of
                Presence or                             macular edema
                Absence of                              and level of
                Macular Edema and                       severity of
                Level of Severity                       retinopathy.
                of Retinopathy.
25...........  Eye-08: Diabetic    2 year Endorsement  Communication
                Retinopathy--Comm   until May 8, 2009.  with the
                unication with                          physician
                the Physician                           managing ongoing
                Managing Ongoing                        diabetes care.
                Diabetes Care.
26...........  GI-09: Colonoscopy  Recommended for     Colonoscopy for
                for Polyp           Endorsement.        polyp
                Surveillance--Des                       surveillance--de
                cription of Polyp                       scription of
                Characteristics.                        polyp
                                                        characteristics.
27...........  GER-02: Advance     Recommended for     Advance care
                Care Plan.          Endorsement.        plan.
28...........  GER-03: Urinary     2 year Endorsement  Assessment of
                Incontinence--Ass   until May 8, 2009.  presence or
                essment of                              absence of
                Presence or                             urinary
                Absence of                              incontinence in
                Urinary                                 women aged 65
                Incontinence in                         years and older.
                Women Aged 65
                Years and Older.
29...........  GER-04: Urinary     2 year Endorsement  Characterization
                Incontinence--Cha   until May 8, 2009.  of urinary
                racterization of                        incontinence in
                Urinary                                 women aged 65
                Incontinence in                         years and older.
                Women Aged 65
                Years and Older.
30...........  GER-05: Urinary     2 year Endorsement  Plan of care for
                Incontinence--Pla   until May 8, 2009.  urinary
                n of Care for                           incontinence in
                Urinary                                 women aged 65
                Incontinence in                         years and older.
                Women Aged 65
                Years and Older.
------------------------------------------------------------------------

    As with the Hemoglobin A1c diabetes intermediate outcome measure 
described in XVII.B of this preamble, we included two diabetes 
intermediate outcome measures in this list of 30 additional measures--
that is, good control of blood pressure (less than 140/80 mm Hg) and 
LDL-C levels (less than 100 mg/dl). We specifically invited comment on 
these outcome measures.
    We solicited comments on these 30 additional measures for inclusion 
in the HOP QDRP for CY 2010 or subsequent calendar years and welcomed 
comments on whether any of these additional measures should be included 
effective for services furnished on or after January 1, 2008 for the CY 
2009 update.
    Comment: Several commenters questioned in general the 
appropriateness of the proposed measures for hospital outpatient care. 
In particular, several commenters stated that the listed additional 30 
measures were not suitable for hospital outpatient care in their 
present form and that the measures should be refined to be more 
specific to the hospital outpatient setting. The commenters viewed the 
listed additional 30 measures as more relevant to care provided in 
other settings, especially physician-based settings.
    Response: We acknowledged in the proposed rule that the listed 
additional 30 measures are either in use or were developed for use in 
settings other than hospital outpatient (72 FR 42801). As we stated, it 
is our intent to develop, where feasible, hospital outpatient measures 
that are ``harmonized,'' with measures for assessing comparable 
inpatient and ambulatory care, that is, comparable care rendered in 
different settings can be evaluated in similar ways. We intend to 
expand the set of measures on which hospital outpatient settings must 
report data for payment decisions for CY 2010 and subsequent calendar 
years.
    Comment: Several commenters stated that it was difficult to comment 
on the additional 30 measures proposed for future use as it was 
difficult to know if any of them would be considered best practice in 
the near future, noting the period of endorsement was short for many. 
Several commenters stated that any quality measure chosen for public 
reporting and pay for performance should be generally accepted as best 
practice. One commenter stated that quality measures with longer 
``shelf-life'' be used.
    Response: We agree with the commenters'' position that any quality 
measures chosen for public reporting and pay for performance should be 
generally accepted as best practice. We understand that it is more 
desirable to utilize quality measures with more longevity. We will take 
these comments into consideration when we review additional measures 
for possible inclusion in the HOP QDRP measure set.
    Comment: Three commenters stated that the requirement to collect

[[Page 66868]]

information that affected hospital payment that was dependent on 
physician activity fostered a hostile environment. One commenter 
emphasized that there is no financial incentive for physicians to 
participate in improving hospital outpatient quality measures. One 
commenter stated that creation of this hostile environment affected 
larger hospitals to a lesser extent and made recruitment/retention more 
difficult for smaller hospitals.
    Response: Under section 1833(t)(17) of the Act, as added by section 
109(a) of the MIEA-TRHCA, CMS is statutorily required to establish a 
hospital outpatient care data reporting program. We will continue to 
utilize a consensus process in devising measures applicable to the 
hospital outpatient setting. As discussed in this final rule with 
comment period, a sampling scheme devised around hospital outpatient 
volume will be devised to lessen the burden for smaller hospitals. It 
is our intent that quality measure reporting will encourage providers 
and clinicians to improve their quality of care.
    Comment: One commenter provided strong support for one potential 
indicator, ``Radiation therapy is administered within 1 year of 
diagnosis for women under age 70 receiving breast conserving surgery 
for breast cancer.''
    Response: We thank the commenter for supplying information 
supporting this quality measure and will consider it in the selection 
of future HOP QDRP measures.
    Comment: Several commenters stated that in regard to the 30 
additional measures listed, given the lack of operational data 
collection processes for outpatient hospital data and the associated 
costs of collecting quality measure data, CMS should not consider any 
additional measures, especially for the first year of reporting.
    Response: We acknowledge that there is a burden with collecting 
quality measure data. As stated in the proposed rule, we indicated that 
we were considering the additional listed 30 measures for CY 2010 or 
subsequent calendar year reporting requirements, although we also 
solicited comments on whether any of the listed 30 additional measures 
should be included in reporting for the CY 2009 payment year. Further, 
as discussed elsewhere in this final rule with comment period, we have 
reduced the number of required reporting measures for the CY 2009 
payment year from the 10 we proposed. However, given the importance of 
outpatient hospital quality measure reporting it is our intent to 
propose additional measures in the future.
    Comment: One commenter expressed concern with the use of PQRI 
2 and PQRI 3 as these are outcome measures and as 
such should not be used as a basis for determining payment. One 
commenter strongly opposed the PQRI 14 measure, stating that a 
needle biopsy is not always appropriate. One commenter strongly opposed 
the PQRI 18 measure, stating that ordering an ECG is a 
judgment call, and that an ECG is not always indicated with non-
traumatic chest pain. Several commenters expressed support for cancer 
care related measures.
    Response: We thank the commenters for expressing these concerns and 
will hold these concerns in consideration of future measure 
requirements.
    Comment: One commenter strongly supported imaging-related quality 
measures.
    Response: CMS appreciates this comment and intends to incorporate 
imaging measures in the future.
    Comment: One commenter stated that the term ``outpatient'' needed 
to be more clearly defined and that an approach that narrowed the 
population of interest for outpatient care by service as do the five 
ED-AMI measures and the surgical day care measures (PQRI 21 
and PQRI 22) should be used for other measures.
    Response: Although PQRI 21 and PQRI 22 were not 
in the list of 30 measures included in the proposed rule, we understand 
the commenter's intent and thank the commenter for this suggestion. We 
will keep it in mind as we consider future measures.
    Comment: Several commenters recommended that the same numbering 
system be used in the specifications manuals for both the inpatient and 
outpatient data tables and in particular, that CMS use of the same 
number for corresponding tables.
    Response: We thank the commenters for this suggestion and will look 
to aligning the specification manuals for inpatient and outpatient 
quality measures to the extent possible.
    Comment: Several commenters suggested that osteoporosis measures 
(PQRI 24, 39, 40, and 41) be 
included in the HOP QDRP; and also asked that data collection for these 
measures begin in CY 2008. One commenter stated that CMS should promote 
the prevention of fragility fractures by distinguishing DXA testing 
from pharmacologic therapy in HOP QDRP measures.
    Response: We thank the commenters for support of these measures and 
for the suggestions. As noted above, to reduce provider burden and 
recognizing the need for further refinement of some of the proposed 
measures for the outpatient setting, the number of required measures 
has been reduced for CY 2008 quality data reporting efforts. We will 
consider these measures for future implementation.
    Comment: One commenter stated that with respect to the 30 
additional listed measures, populations to be included must be 
carefully defined so that any public reporting will compare like 
populations, to the extent that outcomes data are reported, risk 
adjustment was critical, and that process measures be reasonable.
    Response: We thank the commenter for these comments to be used in 
consideration of future measures.
    After consideration of the public comments received and as noted in 
the above responses to those comments, we are not collecting data for 
any of the additional 30 listed measures under the HOP QDRP for 
purposes of the CY 2009 update.

D. Implementation of the HOP QDRP and Request for Additional Suggested 
Measures

    In the CY 2008 OPPS/ASC proposed rule, (72 FR 42803), we stated 
that for purposes of CY 2009 payments, we would require hospitals to 
begin to submit data on the 10 measures that we identified under 
section XVII.B. of the proposed rule. We also noted that, while we 
would expect to focus on these 10 measures and would consider comments 
on them for the CY 2009 payment year, we would also consider the 
comments received from the public on the list of 30 additional measures 
cited above in developing the final lists of measures for future 
payment years.
    As described below, procedures for submission of hospital 
outpatient quality information will mirror as closely as possible all 
procedures for submission of inpatient quality information. The 
inpatient procedures are identified on the QualityNet Web site, at 
http://www.qualitynet.org. As required by new section 1833(t)(17)(E) of 
the Act, we will develop procedures to publicly report the measure 
results obtained under the HOP QDRP. Hospitals will have an opportunity 
to review the information that is to be made available to the public 
prior to its being made public.
    We believe that ensuring that Medicare beneficiaries receive the 
care they need and that such services are of appropriately high quality 
are the necessary initial steps to the incorporation of value-based 
purchasing into the OPPS. We seek to encourage care that is both 
efficient and of high quality in the hospital outpatient setting. We 
plan to work quickly and

[[Page 66869]]

collaboratively with the hospital community to develop and implement 
quality measures for the OPPS that are fully and specifically 
reflective of the quality of hospital outpatient services.
    In the CY 2008 OPPS/ASC proposed rule, (72 FR 42803), we welcomed 
suggestions of other additional measures and topics relevant to the 
hospital outpatient setting for future development of the measure set, 
particularly measures from other settings (such as hospital inpatient, 
physician office, and emergency care settings) that would contribute to 
better coordination and harmonization of high quality patient care.
    Comment: Two commenters asked for the consideration of the PQRI 
4 Screening for Future Fall Risk outpatient quality measure as 
well as the following occupational therapist measures, Patient Co-
Development of Plan of Care, Pain Assessment Prior to Initiation of 
Patient Treatment, and Universal Documentation and Verification of 
Current Medications in the Medical Record. One commenter suggested 
measures for preventive care for future use. Several commenters 
suggested the inclusion of administration of anti-platelet therapy for 
patients with coronary artery disease. One commenter suggested the 
inclusion of measures on venous thromboembolism and care coordination. 
One commenter suggested the inclusion of additional medical prophylaxis 
safety measures including 2 SCIP measures (SCIP-VTE1, venous 
thromboembolism prophylaxis ordered for a surgery patient and SCIP-
VTE2, prophylaxis within 24 hours pre/post surgery). One commenter 
suggested the development of additional VTE measures. One commenter 
suggested that in addition to quality measures, the hospital component 
of the Consumer Assessment of Health Providers and Systems (HCAHPS) has 
several questions directed to patients that are applicable to hospital 
outpatient care and, thus, could provide useful information about 
outpatient quality care.
    Response: We thank the commenters for supplying additional, 
potential quality measures for consideration in the HOP QDRP measure 
set.
    Comment: One commenter noted that there is a discrepancy between 
the SCIP VTE-1 and PQRI 23 measures and that while these are 
not proposed measures under this rule, CMS should review all of its 
quality measures to ensure compatibility and lack of conflict. One 
commenter suggested aligning the PQRI measures with the outpatient 
quality measures.
    Response: We thank the commenters for these observations, and we 
will continue to strive to ensure compatibility and alignment of 
measures across settings.
    Comment: Several commenters suggested that any financial 
implications related to outpatient quality measure reporting be 
deferred.
    Response: Under section 1833(t)(17)(A)(i) of the Act, as added by 
section 109(a) of the MIEA-TRHCA, the HOP QDRP is established to affect 
payments effective beginning in CY 2009.

E. Requirements for HOP QDRP for CY 2009 and Subsequent Calendar Years

    In the CY 2008 OPPS/ASC proposed rule, (72 FR 42803), we stated 
that in order to participate in the HOP QDRP for CY 2009 and subsequent 
calendar years, hospitals must meet administrative, data collection and 
submission, and data validation requirements. Hospitals not 
participating in the program or that withdraw from the program will not 
receive the full OPPS payment rate update. Instead, in accordance with 
the law, those hospitals would receive a reduction of 2.0 percentage 
points in their updates for the affected payment year.
    Hospitals not meeting the requirements of the HOP QDRP also will 
not receive the full OPPS payment rate update. Instead, in accordance 
with the law, those hospitals also would receive a reduction of 2.0 
percentage points in their payment update factor for the affected 
payment year.
    We proposed the following requirements for participation in the HOP 
QDRP:
1. Administrative Requirements
    To participate in the HOP QDRP, the hospital must complete several 
administrative steps. These steps, as in the current IPPS RHQDAPU 
program, require the hospital to:
     Identify a QualityNet Exchange administrator who follows 
the registration process and submits the information through the CMS-
designated contractor. The same person may be the QualityNet Exchange 
administrator for both the IPPS RHQDAPU program and the HOP QDRP. This 
designation must be kept current and must be done, regardless of 
whether the hospital submits data directly to the CMS designated 
contractor or uses a vendor for transmission of data.
     Register with the QualityNet Exchange, regardless of the 
method used for data submission.
     Complete the Notice of Participation form. All hospitals 
must send the form to a CMS-designated contractor no later than 
November 15, 2007 for the CY 2009 HOP QDRP. At this time, the 
participation form for the HOP QDRP is separate from the IPPS RHQDAPU 
program and completing a submission form for each program is required. 
Agreeing to participate includes acknowledging that the data submitted 
to the CMS designated contractor will be submitted to CMS and may be 
shared with a CMS contractor or contractors supporting the 
implementation of this program.
    Hospitals not wishing to participate must submit a nonparticipation 
form. Hospitals that have completed a notice of participation form and 
subsequently wish to stop participating must submit a withdrawal form.
    To reduce the burden on hospitals, once a hospital has indicated 
its intent to participate or not participate, we will consider the 
hospital to be in that status (either a participant or nonparticipant) 
until the hospital indicates a change in status by submitting a notice 
of participation or a withdrawal form.
    Comment: Several commenters requested delays in implementation in 
general, though the November 15, 2007 date for submitting the Notice of 
Participation form was not mentioned. One commenter urged that 
communication of this requirement be made clearly and frequently so 
that all hospitals are aware of the steps they need to take to 
participate in the HOP QDRP.
    Response: We understand the concerns of these commenters and have 
decided to delay the deadline for completing the Notice of 
Participation form. The deadline for submission of the Notice of 
Participation form will be revised from November 15, 2007 to January 
31, 2008. It is our intent that the forms for the inpatient and 
outpatient programs will be available on the same Web site. We 
understand the difficulties inherent in implementing a new data 
collection system and have revised the deadline for completion of the 
Notice of Participation form as part of efforts to reduce hospital 
burden as discussed further later in this section.
    Comment: Several commenters expressed appreciation that CMS was 
working to utilize existing processes in implementing data collection 
of hospital outpatient quality measures.
    Response: We thank the commenters for their support of our efforts.
    Comment: One commenter suggested that small or low volume hospitals 
be held harmless on the reporting of outpatient hospital quality 
measure data

[[Page 66870]]

due to the undue burden of an essentially unfunded mandate.
    Response: We acknowledge the commenter's concern regarding burden 
on smaller hospitals, but continue to view the importance of quality 
measure data from all providers of comparable services. As discussed 
throughout this section of the final rule with comment period, in 
response to such burden concerns, several aspects of the HOP QDRP have 
been revised for the first reporting year.
    Comment: One commenter asked that there be a single Notice of 
Participation form for reporting inpatient and outpatient hospital 
quality measure data.
    Response: We agree that it would be preferable to have a single 
Notice of Participation form for the inpatient and outpatient hospital 
quality measure data reporting programs. However, a single form is not 
possible at this time due to separations of the data and administrative 
systems for the two programs. We will seek to consolidate processes as 
much as possible in the future to ease burdens associated with meeting 
the different requirements of these two programs.
    We are finalizing the administrative requirements as proposed, with 
the modification of changing the deadline for the Notice of 
Participation form to January 31, 2008.
2. Data Collection and Submission Requirements
    We proposed that, to be eligible for the full OPPS payment update 
in CY 2009 and subsequent years, hospitals must:
     Collect data required for the finalized set of measures, 
beginning with the specifications of the finalized set of measures that 
will be identified in the CY 2008 OPPS/ASC final rule (for payment 
updates for CY 2009 services) and that will be published and maintained 
in a specifications manual to be found on the Web site at: http://www.qualitynet.org.
     Submit the data according to a data submission schedule 
that will be available on the QualityNet Exchange Web site. We proposed 
to have HOP data submitted through the QualityNet Exchange secure Web 
site (https://www.qnetexchange.org). This Web site meets or exceeds all 
current Health Insurance Portability and Accountability Act 
requirements. The submission deadline for January 2008 discharges was 
May 31, 2008 with proposed submission deadlines for all other data 
submissions being 4 months after the last day of the calendar quarter. 
Data would be submitted to the CMS designated contractor using either 
the CMS Abstraction and Reporting Tool for Outpatient Department 
measures (CART-OPD) or another third-party vendor that has a tool which 
has met the measure specification requirements for data transmission to 
the QualityNet Exchange.
    HOP QDRP data submission will be through the CMS contractor's 
secure Web site. Detailed information about the Web site for submitting 
quality measure data under the HOP QDRP is not available as of the 
publication of this final rule with comment period. We anticipate 
awarding the contract to design and manage the OPPS Clinical Warehouse 
in the near future. We expect the CMS contractor's Web site to meet or 
exceed all current Health Insurance Portability and Accountability Act 
requirements for security of personal health information.
    The OPPS Clinical Warehouse will submit the data to CMS on behalf 
of the hospitals. While the CMS contract for managing the OPPS Clinical 
Warehouse was not awarded prior to publishing the proposed rule, we 
noted it was possible that a QIO contractor (or subcontractor) would 
manage the OPPS Clinical Warehouse. Because the information in the OPPS 
Clinical Warehouse also may be considered QIO information, it may be 
subject to the stringent QIO confidentiality regulations in 42 CFR part 
480.
    For purposes of the CY 2009 annual payment update, we proposed to 
require hospitals to submit data, for the finalized set of measures, 
beginning with services furnished on or after January 1, 2008. The 
deadline for submission of data for January 2008 discharges would be 4 
months from the last day of the month, May 31, 2008. The deadline for 
submission for February-March 2008 discharges would be August 1, 2008. 
Thereafter, participating hospitals would be required to submit 
quarterly data on finalized measures 4 months from the last day of the 
calendar quarter for as long as the hospitals participated in the HOP 
QDRP.
    In the CY 2008 OPPS/ASC proposed rule (72 FR 42804), we stated our 
expectation that hospitals will submit data under the HOP QDRP on 
outpatient episodes of care to which the required measures apply. For 
the purposes of the HOP QDRP, an outpatient episode of care is defined 
as care provided to a patient who has not been admitted as an inpatient 
but who is registered on the hospital's medical records as an 
outpatient and receives services (rather than supplies alone) directly 
from the hospital. Every effort will be made to assure that data 
elements common to both inpatient and outpatient settings are defined 
consistently (such as ``time of arrival''). However, HOP QDRP quality 
data, not quality data required to be submitted for a patient treated 
under the IPPS RHQDAPU program, would be submitted under the HOP QDRP.
    To be accepted by the CMS designated contractor, submissions would, 
at a minimum, need to be accurate, timely, and complete. Data are 
considered to have been ``accepted'' by the CMS designated contractor, 
for purposes of determining eligibility for the full payment rate 
update, only when data are submitted prior to the reporting deadline 
and after they have passed all CMS designated contractor edits.
    In addition to collecting and submitting data as noted above, we 
proposed that, to be eligible for the full OPPS payment update in CY 
2009 and subsequent years, hospitals must also:
     Submit complete and accurate data. A ``complete'' 
submission would be determined based on sampling criteria that will be 
published and maintained in a specifications manual to be found on the 
Web site at http://www.qualitynet.org, and must correspond to both the 
aggregate number of cases submitted by a hospital and the number of 
Medicare claims it submits for payment.
     Submit the aggregate numbers of outpatient episodes of 
care which were eligible for submission under the HOP QRDP. These 
numbers would indicate the number of outpatient episodes of care in the 
universe to which sampling criteria are applied.
    New hospitals are expected to begin reporting data as soon as 
possible, but no later than beginning with services provided the first 
day of the calendar quarter immediately following a hospital's receipt 
of its Medicare provider number and the hospital's timely completion of 
the administrative requirements for participating in the HOP QDRP.
    Comment: Several commenters recommended that CMS adopt some delay 
in implementation. The commenters suggested that this delay could be 
accomplished by phasing in or reducing the number of measures that 
hospitals would be required to collect data and delaying the deadline 
for initial data submission. Several commenters viewed some or all of 
the additional five non-emergency department measures as an 
unnecessary, additional burden, asking for delay or elimination of some 
or all of these five measures until a system for collecting and 
reporting can be evaluated.

[[Page 66871]]

    Response: As noted previously, we have revised the number of 
required outpatient hospital measure information by reducing the 
required measure set from 10 to 7 measures for initial implementation. 
For the reporting of quality measures for HOPD affecting CY 2009 
payments, data will be required only for the five ED-AMI measures and 
the two perioperative care measures (PQRI 20 Perioperative 
Care: Timing of Antibiotic Prophylaxis and PQRI 21 
Perioperative Care: Selective of Prophylactic Antibiotic). For reasons 
discussed above related to hospital burden and refinement of measures 
for the outpatient setting, data collection on PQRI 5 Heart 
Failure: Angiotensin Converting Enzyme (ACE) Inhibitor or Angiotensin 
Receptor Blocker (ARB) for Left Ventricular Systolic Dysfunction 
(LSVD), PQRI 59: Empiric Antibiotic for Community-Acquired 
Pneumonia, and PQRI 1: Hemoglobin A1c Poor Control in Type I 
or II Diabetes Mellitus will not be required in the initial HOP QDRP 
measure set.
    With regard to commenters' requests that we delay the deadline for 
initial data submission, we agree. Due to the importance of the HOP 
QDRP and the need for accurate and timely submission of required data, 
we are revising our proposed submission period and deadline. Rather 
than requiring initial submission for services furnished on or after 
January 1, 2008, we are requiring initial submission for services 
furnished on or after April 1, 2008. The data submission deadline for 
April to June 2008 discharges is November 1, 2008, 4 months from the 
last day of the calendar quarter. As proposed, thereafter, 
participating hospitals would be required to submit quarterly data on 
finalized measures 4 months from the last day of the calendar quarter 
for as long as the hospitals participate in the HOP QDRP. As noted, we 
are statutorily required to establish a program under which hospitals 
will report data on the quality of hospital outpatient care using 
standardized measures of care in order to receive the full annual OPPS 
update effective for payments beginning in CY 2009. In balancing the 
commenters' concerns and the statutory requirements, we have delayed 
the initial data submission as much as we believe is possible while 
still meeting statutory deadline. For the subsequent data submissions 
for CY 2008 services the submission deadlines will be February 1, 2009 
for July to September 2008 services and May 1, 2009 for October to 
December 2008 services.
    Comment: One commenter asked if the quarterly data submission was 
due November 1, 2009, as stated in the proposed rule, or if this date 
should be November 1, 2008.
    Response: As stated above, the deadline for submitting data for the 
initial quarterly data submission of April-June 2008 services will be 
November 1, 2008.
    Comment: One commenter noted that the OPPS appeared to have 1st of 
the month data submission deadlines, whereas, the inpatient measures 
have a 15th of the month submission deadline and asked for alignment of 
the submission deadlines for both.
    Response: We understand that there is an interest in alignment to 
reduce confusion and data submission errors. However, the dates were 
deliberately chosen and spaced accordingly to avoid issues with 
concurrent submission of large amounts of data.
    Comment: Due to the large volume of outpatient services potentially 
involved for quality measure reporting, several commenters suggested 
the use of sampling of cases.
    Response: We agree with the idea of sampling of cases for reporting 
under the HOP QDRP and it is our intent to devise a methodology for 
determining sample size requirements based on hospital volume as is 
done for inpatient quality measure reporting.
    We are finalizing the proposed data collection and submission 
requirements with modifications. The initial submission will be for 
services furnished on or after April 1, 2008. The final submission date 
for the initial quarterly data for April-June 2008 services is November 
1, 2008.
3. HOP QDRP Validation Requirements
    In the CY 2008 OPPS/ASC proposed rule, we proposed that data 
submitted under this program meet validation requirements. The proposed 
validation requirements were similar to the FY 2006 IPPS RHQDAPU 
program validation requirement (the initial year validation requirement 
was added to the IPPS RHQDAPU program) and included independent re-
abstraction of medical record data elements by a clinical data 
abstraction center (CDAC). The CMS contractor would randomly select 5 
medical records from all January 2008 discharge cases successfully 
submitted to the OPPS Clinical Warehouse. The CDAC would mail requests 
to the hospitals to send the selected medical records to the CDAC 
within 30 calendar days. The CDAC would independently re-abstract the 
medical record data elements. We proposed to provide abstraction 
feedback to all hospitals on abstracted data elements.
    We also proposed the following chart audit validation requirements 
for full CY 2009 payment updates:
     Apply to January 2008 discharges only.
     Require submission of 5 charts sampled from each hospital.
     Establish a passing threshold of 80 percent reliability 
reflecting the accuracy of submitted data elements used to calculate 
quality measures.
     Use an upper bound of 95 percent confidence interval to 
measure accuracy.
     Incorporate clustering of variability at the chart level 
into the confidence interval.
    Validation is intended to provide some assurance of the accuracy of 
the hospital abstracted data. We have specifically chosen these 
validation requirements and thresholds to allow this assurance, provide 
sufficient time to fully process validation data, and minimize the 
burden on hospitals.
    To receive the full OPPS payment rate update in CY 2009, CMS 
proposed that the hospital must pass our validation requirement of a 
minimum of 80 percent reliability, based upon our chart-audit 
validation process, for the January 2008 discharges. The 80-percent 
reliability threshold is consistent with the IPPS RHQDAPU program 
validation reliability threshold. Based on our previous IPPS RHQDAPU 
program experience, we believe that this threshold is reasonable and 
attainable by the vast majority of hospitals. Several of the measures 
used in the OPPS HOP QDRP are similar in construction to inpatient 
measures used in the current IPPS RHQDAPU program. Based on the similar 
nature of the inpatient and outpatient measure sets, we believe that 
the 80-percent reliability threshold is applicable in the OPPS HOP 
QDRP.
    We proposed that the data for the first reporting period would be 
due to the CMS designated contractor by May 31, 2008. We would use 
confidence intervals, as discussed below, to determine if a hospital 
has achieved an 80-percent reliability. The use of confidence intervals 
would allow us to establish an appropriate range below the 80-percent 
reliability threshold that would demonstrate a sufficient level of 
reliability to allow the data to still be considered validated. We note 
that, for both timing and burden reasons, we proposed to apply the 
validation requirements only to January 2008 discharges for purposes of 
determining eligibility for the full CY 2009 OPPS payment rate update. 
However, hospitals would still be required to submit data for 
subsequent time periods.

[[Page 66872]]

    We proposed to use January 2008 discharges to estimate the 
hospitals' validation score for the CY 2009 validation proposed 
requirement. The timeframe for data collection, abstraction, and 
validation tasks total about nine to ten months between patient 
discharges to completion of validation appeals. We believe that using 
later discharges for the CY 2009 annual payment update would adversely 
impact CMS' ability to complete these tasks and apply the results to 
the CY 2009 annual payment update.
    Based on our proposed methodology, the confidence interval would be 
slightly wider than is currently utilized for the IPPS RHQDAPU program 
due to the smaller sample size. However, given this is the first year 
of the HOP QDRP, we believe this would be appropriate. We would 
estimate the percent reliability based upon a review of five charts and 
then calculate the upper 95 percent confidence limit for that estimate. 
If this upper limit is above the required 80 percent reliability 
threshold, the hospital data would be considered validated. We proposed 
to use the design specific estimate of the variance for the confidence 
interval calculation, which, in this case, is a single stage cluster 
sample, with unequal cluster sizes. (For reference, see Cochran, 
William G. (1977) Sampling Techniques, John Wiley & Sons, New York, 
chapter 3, section 3.12.) Each sampled medical record is considered as 
a cluster for variance estimation purposes, as documentation and 
abstraction errors are believed to be clustered within specific medical 
records.
    Comment: Many commenters asked that validation not be used in 
determining payment decisions; that is, that receipt of full OPPS 
payment update be attached only to the submission of quality data, 
especially for the first year of the program. Commenters urged that for 
the CY 2009 HOP QDRP, data validation should be conducted only as a 
learning tool for hospitals.
    Response: In response to the many comments received on the 
validation requirement, acknowledging this is a new data collection 
effort, and consistent with the initial implementation of the IPPS 
RHQDAPU program, we have decided not to use the HOP QDRP validation 
requirement for purposes of the CY 2009 payment update. Thus, there 
will be no validation requirement for April-June 2008 services for the 
CY 2009 payment update. However, it is our intent to use validation 
requirements for determining the CY 2010 payment update.
    Comment: Several commenters addressed the reliability threshold set 
for validation. Some commenters suggested that reliability thresholds 
should start at lower levels and gradually be raised to 80 percent.
    Response: We understand that there may be difficulties with 
validation levels due to this being a new data collection effort. As 
discussed in this final rule with comment period, validation will not 
be required for payment decisions affecting the CY 2009 payment update. 
We continue to believe that a reliability threshold of 80 percent for 
data validation purposes for future years is appropriate, and we intend 
to use it beginning with the CY 2010 payment update.
    Comment: Several commenters expressed concern about validating data 
from a single month for determining payment. Several commenters stated 
that at least 6 months of reporting should be required for any measure 
before any data validation is done or any decisions regarding payment 
are made.
    Response: As noted previously, in response to comments on data 
volume for determining payment and validation concerns, for purposes of 
the CY 2009 payment update, we will consider data reported for the 
second calendar quarter of 2008, April to June 2008 without any 
validation requirement. It is our intent to use at least 6 months of 
reported data for the HOP QDRP for purposes of the CY 2010 payment 
update and for subsequent calendar years. Thus, we intend to begin 
validation efforts on data submitted from July-September 2008 services 
forward.
    We are revising our validation requirements from our proposal and 
not requiring validation for purposes of the CY 2009 payment update. We 
intend to use validation for purposes of the CY 2010 HOP QDRP, 
beginning with July-September 2008 services and for subsequent 
services.
    In summary, after consideration of the public comments received and 
as discussed in the above responses to those comments, we are requiring 
hospitals to meet the below outlined administrative, data collection, 
and submission requirements under the HOP QDRP for payment 
determinations affecting the CY 2009 payment update.
1. Administrative Requirements
     Identify a QualityNet Exchange administrator who follows 
the registration process and submits the information through the CMS-
designated contractor. The same person may be the QualityNet Exchange 
administrator for both the IPPS RHQDAPU program and the HOP QDRP. This 
designation must be kept current and must be done, regardless of 
whether the hospital submits data directly to the CMS designated 
contractor or uses a vendor for transmission of data.
     Register with the QualityNet Exchange, regardless of the 
method used for data submission.
     Complete the Notice of Participation form. All hospitals 
must send the form to a CMS-designated contractor no later than January 
31, 2008 for the CY 2009 HOP QDRP. At this time, the participation form 
for the HOP QDRP is separate from the IPPS RHQDAPU program, and 
completing a submission form for each program is required. Agreeing to 
participate includes acknowledging that the data submitted to the CMS-
designated contractor will be submitted to CMS and may be shared with a 
CMS contractor or contractors supporting the implementation of this 
program.
    Hospitals not wishing to participate must submit a Notice of 
Participation form indicating non-participation in the HOP QDRP. 
Hospitals that have completed a notice of participation form and 
subsequently wish to stop participating must submit a withdrawal form. 
Hospitals not participating in the HOP QDRP program or that withdraw 
from the program will not receive the full OPPS payment rate update. 
Instead, in accordance with the law, those hospitals would receive a 
reduction of 2.0 percentage points in their updates for the affected 
payment year.
    To reduce the burden on hospitals, once a hospital has indicated 
its intent to participate or not participate, we will consider the 
hospital to be in that status (either a participant or nonparticipant) 
until the hospital indicates a change in status by submitting a notice 
of participation or a withdrawal form.
2. Data Collection and Submission Requirements
     Collect data required for the finalized set of 7 measures 
outlined below, beginning with the specifications of the finalized set 
of measures identified in this final rule for payment updates for CY 
2009 services and that will be published and maintained in a 
specifications manual to be found on the Web site at: http://www.cms.hhs.gov.
    Participating hospitals must collect data on the 7 required 
measures listed below if they have cases meeting the data collection 
specifications. Hospitals will be allowed to sample cases and this

[[Page 66873]]

sampling scheme will be provided in advance of required data 
collection.
     ED-AMI-1--Aspirin at Arrival.
     ED-AMI-2--Median Time to Fibrinolysis.
     ED-AMI-3--Fibrinolytic Therapy Received Within 30 Minutes 
of Arrival.
     ED-AMI-4--Median Time to Electrocardiogram (ECG).
     ED-AMI-5--Median Time to Transfer for Primary PCI.
     PQRI 20 Perioperative Care: Timing of Antibiotic 
Prophylaxis.
     PQRI 21 Perioperative Care: Selection of 
Prophylactic Antibiotic.
    Providers must collect data for the required finalized set of 
measures identified in this final rule to receive the full payment 
update for CY 2009 OPPS services. The measure specifications will be 
published and maintained in a specifications manual to be found on the 
CMS Web site at: http://www.cms.hhs.gov.
     Submit the data according to a data submission schedule 
that will be available on the QualityNet Exchange Web site. HOP data 
will be submitted through the QualityNet Exchange secure Web site 
(https://www.qnetexchange.org). This Web site meets or exceeds all 
current Health Insurance Portability and Accountability Act 
requirements. Data for the 7 quality measures finalized in this rule 
from services occurring during second calendar quarter of 2008 (April-
June 2008) are to be collected. The submission deadline for April-June 
2008 service data will be November 1, 2008. All submission deadlines 
will be 4 months after the last day of the calendar quarter. Data must 
be submitted to the CMS designated contractor using either the CMS 
Abstraction and Reporting Tool for Outpatient Department measures 
(CART-OPD) or another third-party vendor that has a tool which has met 
the measure specification requirements for data transmission to the 
QualityNet Exchange.
    Hospitals must submit quality data through the CMS contractor's 
secure Web site. Detailed information about the Web site for submitting 
quality measure data under the HOP QDRP is not available as of the 
publication of this final rule with comment period. We anticipate 
awarding the contract to design and manage the OPPS Clinical Warehouse 
in the near future. We expect the CMS contractor's Web site to meet or 
exceed all current Health Insurance Portability and Accountability Act 
requirements for security of personal health information.
    The OPPS Clinical Warehouse will submit the data to CMS on behalf 
of the hospitals. It is possible that the information in the OPPS 
Clinical Warehouse may be considered QIO information. If so, it may be 
subject to the stringent QIO confidentiality regulations in 42 CFR part 
480.
    Hospitals are expected to submit data under the HOP QDRP on 
outpatient episodes of care to which the required measures apply. For 
the purposes of the HOP QDRP, an outpatient episode of care is defined 
as care provided to a patient who has not been admitted as an inpatient 
but who is registered on the hospital's medical records as an 
outpatient and receives services (rather than supplies alone) directly 
from the hospital. Every effort will be made to assure that data 
elements common to both inpatient and outpatient settings are defined 
consistently (such as ``time of arrival''). However, HOP QDRP quality 
data, not quality data required to be submitted for a patient treated 
under the IPPS RHQDAPU program, would be submitted under the HOP QDRP.
    To be accepted by the CMS designated contractor, submissions must 
be, at a minimum, accurate, timely, and complete. Data are considered 
to have been ``accepted'' by the CMS designated contractor, for 
purposes of determining eligibility for the full payment rate update, 
only when data are submitted prior to the reporting deadline and after 
they have passed all CMS designated contractor edits.
    In addition to collecting and submitting data as noted above, to be 
eligible for the full OPPS payment update in CY 2009 and subsequent 
years, hospitals must also:
     Submit complete and accurate data. A ``complete'' 
submission is determined based on sampling criteria that will be 
published and maintained in a specifications manual to be found on the 
Web site at http://www.qualitynet.org, and must correspond to both the 
aggregate number of cases submitted by a hospital and the number of 
Medicare claims it submits for payment. To be considered ``accurate,'' 
submissions must pass validation. As stated previously in this section, 
we are revising our validation requirement from the proposed rule for 
purposes of the CY 2009 payment update. Thus, there is no validation 
requirement for the initial reporting period (April to June 2008) 
affecting the CY 2009 payment update. It is our intention that there 
will be validation requirements under the HOP QDRP as outlined in this 
section for reporting periods beginning July-September 2008 services 
forward that will be considered for payment decisions beginning with 
the CY 2010 payment update.
     Submit the aggregate numbers of outpatient episodes of 
care which were eligible for submission under the HOP QRDP beginning 
with the first reporting period (April-June 2008) forward. These 
numbers would indicate the number of outpatient episodes of care in the 
universe to which sampling criteria are applied.
    New hospitals are expected to begin reporting data as soon as 
possible, but no later than beginning with services provided the first 
day of the calendar quarter immediately following a hospital's receipt 
of its Medicare provider number and the hospital's timely completion of 
the administrative requirements for participating in the HOP QDRP.
    Hospitals must submit data under the HOP QDRP on outpatient 
episodes of care to which the required measures apply. Data submission 
deadlines for the submission of this data will be the same as for 
submission of quality measure data, will begin with the submission of 
April-June 2008 services forward, and will be due 4 months from the 
last day of the calendar quarter. For the purposes of the HOP QDRP, an 
outpatient episode of care is defined as care provided to a patient who 
has not been admitted as an inpatient but who is registered on the 
hospital's medical records as an outpatient and receives services 
(rather than supplies alone) directly from the hospital.
3. HOP QDRP Validation Requirements
    As discussed above, we are not implementing a data validation 
requirement for data submitted for the April-June 2008 time period for 
the purposes of the CY 2009 annual payment update. It is our intention 
that there will be validation requirements as discussed previously and 
outlined below for data submitted for July 2008 services forward to 
affect payment determinations for CY 2010 and subsequent calendar 
years. The validation requirements include independent reabstraction of 
medical data elements by a clinical data abstraction center (CDAC). The 
CMS contractor will randomly select 5 cases from all cases successfully 
submitted to the OPPS Clinical Warehouse for any relevant time period. 
The CDAC will mail requests to the hospitals to send the selected 
medical records or other supporting documentation to the CDAC within 30 
calendar days. The CDAC will independently reabstract the medical 
record data elements. Abstraction feedback will be provided to all 
hospitals on abstracted data elements.
    At this time, the following audit validation requirements are 
intended to

[[Page 66874]]

apply for full CY 2010 payment updates forward:
     A time period of services after the initial April to June 
2008 time period will be determined. At this time, we intend to use 
data from July 2008 services forward for the HOP QDRP for the CY 2010 
payment update.
     Submission of supporting documentation for 5 selected 
cases sampled from each hospital is required.
     A passing threshold of 80 percent reliability reflecting 
the accuracy of submitted data elements is set to calculate quality 
measures.
     An upper bound of 95 percent confidence interval to 
measure accuracy is set.
     Clustering of variability at the chart level will be 
incorporated into the confidence interval.
    To receive the full OPPS payment rate update, the hospital must 
pass our validation requirement of a minimum of 80 percent reliability, 
based upon our audit validation process, for the designated time 
periods.
    The methodology to be used for calculating the confidence intervals 
under the HOP QDRP is that currently utilized for the IPPS RHQDAPU 
program. Due to the small sample sizes during CY 2010 (as noted above, 
data from only 5 cases will be used), we anticipate that the calculated 
confidence intervals will be larger. However, as CY 2010 is only the 
second year of the HOP QDRP, we view this as appropriate. We anticipate 
estimating the percent reliability based upon a review of 5 
documentation audits and then calculating the upper 95 percent 
confidence limit for that estimate. If that upper limit is above the 
required 80 percent reliability threshold, we anticipate considering 
the hospital's data valid for payment update purposes for CY 2010 
forward. As proposed, we intend to use the design specific estimate of 
the variance for the confidence interval calculation, which, in this 
case, is a single stage cluster sample, with unequal cluster sizes. 
(For reference, see Cochran, William G. (1977) Sampling Techniques, 
John Wiley & Sons, New York, chapter 3, section 3.12.) Each sampled 
medical record is considered as a cluster for variance estimation 
purposes, as documentation and abstraction errors are believed to be 
clustered within specific medical records.

F. Publication of HOP QDRP Data Collected

    New section 1833(t)(17)(E) of the Act requires that the Secretary 
establish procedures to make data collected under this program 
available to the public and to report the quality measures on the CMS 
Web site. Our intent is to make this information public in CY 2009 by 
posting it on the CMS Web site. Participating hospitals will be granted 
the opportunity to preview this information prior to its public posting 
as we have recorded it.
    Comment: Several commenters provided thoughts on the publication of 
quality data collected. The commenters believed that consumers should 
be able to access quality data and cost information electronically that 
is organized to allow comparison of information that is correct, 
current, and clear. They suggested that the information be presented on 
all available sites of service so consumers can compare a hospital 
outpatient department with an ASC for a procedure that can be performed 
in both settings. They also suggested that there be a provider 
narrative section to address information regarding reliability or 
accuracy, and provider-specific information such as accreditation 
status.
    Response: We thank the commenters for their support of providing 
public access to hospital outpatient quality data. We strive to present 
information contained on Web sites in as complete and clear manner 
possible. We also thank the commenters for their thoughts on additional 
information that could be included that would aid consumers in 
assessing a provider's quality measure data.
    After consideration of the public comments received and as 
discussed in the above responses to those comments, we intend that 
information collected under the HOP QDRP will be made public in CY 2009 
by posting it on the CMS Web site. Information from non-validated data, 
including the initial reporting period (April-June 2008) will not be 
posted. Participating hospitals will be granted the opportunity to 
preview this information prior to its public posting as we have 
recorded it.

G. Attestation Requirement for Future Payment Years

    CMS also solicited comments on whether to implement an HOP QDRP 
attestation requirement in CY 2010 and subsequent payment years similar 
to the proposed attestation requirement in the IPPS RHQDAPU program set 
out in the FY 2008 IPPS proposed rule (72 FR 24808). Hospitals would be 
required to submit a written form to a CMS contractor indicating that 
they formally attest to the accuracy and completeness of their data, 
including the volume of data submitted to the OPPS Data Warehouse. We 
anticipated that the attestation form submission deadlines would 
parallel the HOP QDRP periodic data submission deadlines.
    Comment: One commenter stated that an attestation statement would 
be acceptable as long as providers have sufficient time to review and 
verify that data were submitted accurately. No comments against the 
requirement of an attestation statement were received.
    Response: Under any attestation procedure we implement, providers 
would have time to review and verify that data were submitted 
accurately.
    In light of the public comments received we intend that an 
attestation procedure similar to the attestation requirement utilized 
in the IPPS RHQDAPU program will be included in the HOP QDRP for CY 
2010 and subsequent payment years.

H. HOP QDRP Reconsiderations

    When the IPPS RHQDAPU program was initially implemented, it did not 
include a reconsideration submission process for hospitals. 
Subsequently, we received many requests for reconsideration of those 
payment decisions, and as a result identified a process by which 
participating hospitals would submit requests for reconsideration. We 
anticipate similar concerns with the HOP QDRP and, therefore, in the CY 
2008 OPPS/ASC proposed rule (72 FR 42805) we proposed to establish a 
reconsideration process for the HOP QDRP for those hospitals that fail 
to meet the CY 2009 HOP QDRP requirements with the procedural details 
of that process posted to the QualityNet Exchange Web site, https://www.qnetexchange.org. In the CY 2008 OPPS/ASC proposed rule (72 FR 
42805), we sought public comment specifically on the need for a 
structured reconsideration process for CY 2009 and subsequent calendar 
years. We also requested comment on what such a process should entail. 
For example, such a process, if established, could include--
     A limited time, such as 30 days from the public release of 
the decision, for requesting a reconsideration;
     Specific individuals or functions in a hospital 
organization that can request such a reconsideration and that would be 
notified of its outcome;
     The specific factors that CMS will consider in such a 
reconsideration, such as an inability to submit data timely due to CMS 
systems failures;
     Specific requirements for submitting a reconsideration 
request, such as a written request for reconsideration specifically 
stating all reasons and factors why the hospital believes it did meet 
the HOP QDRP program requirements;

[[Page 66875]]

     Suggestions regarding the type of entity that should 
conduct the reconsideration process; and
     The timeframe, such as 60 days, for CMS to provide its 
reconsideration decision to the hospital.
    We also requested comments on the reasons for not establishing such 
a reconsideration process. We indicated that we planned to establish 
procedures that are as similar as possible to those used by the IPPS 
RHQDAPU program should we finalize our proposal to implement a 
reconsideration process for HOP QDRP.
    Comment: While we did not receive any comments opposing a 
reconsideration process, two commenters suggested that the 
reconsideration process be straightforward, transparent, and timely. 
One commenter requested that clear guidance on how to submit appeals be 
provided, and that any appeals be expedited. One commenter stated that 
it was important to have a reconsideration process in the case of 
disputes regarding submitted data. One commenter supported having a 
reconsideration process similar to the one used under the inpatient 
quality measure reporting program.
    Response: We thank the commenters for voicing their support for a 
reconsideration process. CMS always strives to implement processes that 
are straightforward, transparent, and timely and fully intend to 
provide guidance on any reconsideration process used for outpatient 
hospital data. It is our intent to model a reconsideration process for 
the HOP QDRP similar to the one used under the inpatient quality 
measure reporting program.
    Comment: Several commenters stated there should be an expeditious 
mechanism for corrections or resolution of disagreements about any 
information posted for public presentation.
    Response: We intend that any process put in place for corrections 
or resolution of disagreements about any information posted for public 
presentation will be as expeditious as possible.
    After consideration of the public comments received and as 
discussed in the above responses to those comments, we intend that a 
reconsideration process modeled after that for reporting inpatient 
quality measures will be included in the HOP QDRP for CY 2009 and 
subsequent calendar years.

I. Reporting of ASC Quality Data

    As discussed in section XVII.A.2. of this final rule with comment 
period, section 109(b) of the MIEA-TRHCA (Pub. L. 109-432) amended 
section 1833(i) of the Act by redesignating clause (iv) as clause (v), 
adding new section 1833(i)(2)(D)(iv), and adding new section 1833(i)(7) 
to the Act. These amendments authorize the Secretary to require ASCs to 
submit data on quality measures and to reduce the annual increase in a 
year by 2.0 percentage points for ASCs that fail to do so. These 
provisions permit, but do not require, the Secretary to require ASCs to 
submit such data and to reduce any annual increase for non-compliant 
ASCs.
    In the CY 2008 OPPS/ASC proposed rule, we did not propose to 
introduce quality measures for reporting in ASCs for CY 2008 as we did 
for the OPPS as described in sections XVII.B. through H. of the 
proposed rule. We believe that promoting high quality care in the ASC 
setting through quality reporting is highly desirable and fully in line 
with our efforts under other payment systems. However, we also believe 
that the transition to the revised ASC payment system in CY 2008 poses 
such a significant challenge to ASCs that it would be most appropriate 
to allow some experience with the revised payment system before 
introducing other new requirements. Implementation of quality reporting 
at this time would require systems changes and other accommodations by 
ASCs, facilities which do not have prior experience with quality 
reporting as hospitals already have for inpatient quality measures, at 
a time when they are implementing a significantly revised payment 
system. We believe that our CY 2008 proposal to implement quality 
reporting for HOPDs prior to establishing quality reporting for ASCs 
would allow time for ASCs to adjust to the changes in payment and case-
mix that are anticipated under the revised payment system. We would 
also gain experience with quality measurement in the ambulatory setting 
in order to identify the most appropriate measures for quality 
reporting in ASCs prior to the introduction of the requirement in ASCs. 
We intend to implement the provisions of section 109(b) of the MIEA-
TRHCA, Pub. L. 109-432, in a future rulemaking.
    Comment: Several commenters agreed with our decisions to delay 
implementation of quality measures for ASCs. However, one commenter 
urged CMS to implement a quality reporting system for ASCs as soon as 
possible as all providers that perform the same services should be held 
to the same accountability standards with respect to the quality of the 
care the deliver. There were no other comments in disagreement with the 
planned delay.
    Response: We appreciate these commenters' support for our decision 
to delay implementation of collection of ASC quality measure data. We 
also recognize the necessity of equal accountability for providers of 
the same services and appreciate this reminder.
    Comment: Several commenters stated that an administrative claims-
based quality measure reporting system should be implemented for ASCs, 
similar to that in place for physician reporting. Commenters suggested 
that a claims-based system would reduce the financial and 
administrative burden for these smaller facilities that more resemble 
physician offices than hospitals, noting that ASCs will continue 
submitting Medicare claims using the CMS 1500 form as do physicians at 
least through 2008, providing ASCs the ability to report data in the 
same manner as physicians. One commenter suggested CMS work with ASC 
leaders to develop HCPCS level II G codes that would allow facility-
level quality measures to be reported using an administrative claims-
based approach.
    Response: We thank the commenters for their suggestions for our 
consideration in implementing a quality measure program for ASCs.
    Comment: Several commenters stated that CMS should consider the use 
of five ASC measures currently under development if the five were NQF-
endorsed. These five measures focus on patient falls, patient burns, 
hospital transfer/admission, wrong site/patient/procedure/implant 
situations, and prophylactic antibiotic timing similar to PQRI 
20 and 21.
    Response: We thank the commenters for supplying this information 
for our consideration in developing quality measures for ASCs.
    After consideration of the public comments received, and as 
discussed in the above responses to those comments, we are finalizing 
to our decision to delay implementation of ASC quality measure 
reporting. We expect to implement the provisions of section 109(b) of 
the MIEA-TRHCA, Pub. L. 109-432, in a future rulemaking.

J. FY 2009 IPPS Quality Measures Under the RHQDAPU Program

    As stated in FY 2008 IPPS proposed rule (72 FR 24805), we proposed 
to add 1 outcome measure and 4 process measures to the existing 27 
measure set to establish a new set of 32 quality measures to be used 
under the RHQDAPU program for the FY 2009 IPPS annual payment 
determination. We proposed to add the following five measures for the 
FY 2009 IPPS annual payment determination:
     PNE 30-day mortality measure (Medicare patients)

[[Page 66876]]

     SCIP Infection 4: Cardiac Surgery Patients With Controlled 
6AM Postoperative Serum Glucose
     SCIP Infection 6: Surgery Patients With Appropriate Hair 
Removal
     SCIP Infection 7: Colorectal Patients With Immediate 
Postoperative Normothermia
     SCIP Cardiovascular 2: Surgery Patients on a Beta-Blocker 
Prior to Arrival Who Received a Beta-blocker During the Perioperative 
Period
    We stated that we planned to formally adopt these measures a year 
in advance in order to provide time for hospitals to prepare for 
changes related to the RHQDAPU program. We also stated that we 
anticipated that the proposed measures would be endorsed by the NQF. 
Finally, we stated that any proposed measure that was not endorsed by 
the NQF by the time that we published the FY 2008 IPPS final rule would 
not be finalized in that final rule.
    At the time we published the FY 2008 IPPS final rule, only the PNE 
30-day mortality measure had been endorsed by the NQF. Therefore, we 
finalized only that measure as part of the FY 2009 IPPS measure set and 
stated that we would further address adding additional measures in the 
CY 2008 OPPS final rule (that is, this CY 2008 OPPS/ASC final rule with 
comment period) and, if necessary, in the FY 2009 IPPS proposed and 
final rules. We also responded to comments we had received on the 5 
proposed measures. (72 FR 47348 through 47351)
    The NQF has endorsed the following additional process measures that 
we proposed to include in the FY 2009 RHQDAPU measure set:
     SCIP Infection 4: Cardiac Surgery Patients With Controlled 
6AM Postoperative Serum Glucose
     SCIP Infection 6: Surgery Patients With Appropriate Hair 
Removal
    As we stated in the FY 2008 IPPS proposed rule (72 FR 24805), these 
measures reflect our continuing commitment to quality improvement in 
both clinical care and quality, and they demonstrate our commitment to 
include in the RHQDAPU program only those quality measures that reflect 
consensus among affected parties and that have been reviewed by a 
consensus building process. Because these measures are now endorsed by 
the NQF, we are finalizing them for the FY 2009 measure set, bringing 
the total number of measures in that measure set to 30.
    The measure set to be used for FY 2009 annual payment determination 
is as follows:

------------------------------------------------------------------------
                Topic                           Quality measure
------------------------------------------------------------------------
Heart Attack (Acute Myocardial          Aspirin at arrival.*
 Infarction).                           Aspirin prescribed at
                                        discharge.*
                                        ACE inhibitor (ACE-I) or
                                        Angiotensin Receptor Blocker
                                        (ARBs) for left ventricular
                                        systolic dysfunction.*
                                        Beta blocker at
                                        arrival.*
                                        Beta blocker prescribed
                                        at discharge.*
                                        Fibrinolytic
                                        (thrombolytic) agent received
                                        within 30 minutes of hospital
                                        arrival.**
                                        Primary Percutaneous
                                        Coronary Intervention (PCI)
                                        received within 120 minutes of
                                        hospital arrival.**
                                        Adult smoking cessation
                                        advice/counseling.**
------------------------------------------------------------------------
Heart Failure (HF)...................   Left ventricular
                                        function assessment.*
                                        ACE inhibitor (ACE-I) or
                                        Angiotensin Receptor Blocker
                                        (ARBs) for left ventricular
                                        systolic dysfunction.*
                                        Discharge
                                        instructions.**
                                        Adult smoking cessation
                                        advice/counseling.**
------------------------------------------------------------------------
Pneumonia (PNE)......................   Initial antibiotic
                                        received within 4 hours of
                                        hospital arrival.*
                                        Oxygenation assessment.*
                                        Pneumococcal vaccination
                                        status.*
                                        Blood culture performed
                                        before first antibiotic received
                                        in hospital.**
                                        Adult smoking cessation
                                        advice/counseling.**
                                        Appropriate initial
                                        antibiotic selection.**
                                        Influenza vaccination
                                        status.**
------------------------------------------------------------------------
Surgical Care Improvement Project       Prophylactic antibiotic
 (SCIP) named SIP for discharges        received within 1 hour prior to
 prior to July 2006 (3Q06).             surgical incision.**
                                        Prophylactic antibiotics
                                        discontinued within 24 hours
                                        after surgery end time.**
                                        SCIP-VTE 1: Venous
                                        thromboembolism (VTE)
                                        prophylaxis ordered for surgery
                                        patients.***
                                        SCIP-VTE 2: VTE
                                        prophylaxis within 24 hours pre/
                                        post surgery.***
                                        SCIP-Infection 2:
                                        Prophylactic antibiotic
                                        selection for surgical
                                        patients.***
                                        SCIP-Infection 4:
                                        Cardiac Surgery Patients with
                                        Controlled 6AM Postoperative
                                        Serum Glucose.*****
                                        SCIP-Infection 6:
                                        Surgery Patients with
                                        Appropriate Hair Removal.*****
------------------------------------------------------------------------
Mortality Measures (Medicare            Acute Myocardial
 patients).                             Infarction 30-day mortality
                                        Medicare patients.***
                                        Heart Failure 30-day
                                        mortality Medicare patients.***
                                        Pneumonia 30-day
                                        mortality Medicare patients.****
------------------------------------------------------------------------
Patients' Experience of Care.........   HCAHPS patient
                                        survey.***
------------------------------------------------------------------------
* Measure included in 10 measure starter set.
** Measure included in 21 measure expanded set.
*** Measure added in CY 2007 OPPS final rule.
**** Measure added in FY 2008 IPPS final rule.
***** Measure added in CY 2008 OPPS final rule.


[[Page 66877]]

    We also stated in the FY 2008 final rule that the RHQDAPU 
participation requirements for the FY 2009 program would apply to 
additional measures we adopt for that year's program (72 FR 47361).
    Therefore, hospitals must start submitting data for SCIP Infection 
4 and SCIP Infection 6 starting with first quarter calendar year 2008 
discharges and subsequent quarters until further notice, and hospitals 
must submit their aggregate population and sample size counts for 
Medicare and non-Medicare patients. These requirements are consistent 
with the requirements for the other 24 AMI, HF, PN, and SCIP process 
measures included in the FY 2009 measure set. The complete list of 
procedures for participating in the RHQDAPU program for FY 2009 is 
provided in the FY 2008 final rule (72 FR 47359-47361).
    We plan to propose in the FY 2009 IPPS proposed rule that we will 
add these two measures to the current 24 process measures included in 
the RHQDAPU chart audit validation requirement starting with first 
quarter 2008 calendar year discharges. These validation results would 
be included as part of a RHQDAPU FY 2010 chart validation requirement 
if they are finalized in the FY 2009 IPPS final rule. We are announcing 
our intention to make this proposal to provide hospitals with 
sufficient advance notice when abstracting and submitting these 
measures to CMS.
    Since SCIP Cardiovascular 2 is not currently endorsed by the NQF, 
CMS will not adopt this measure as part of the official FY 2009 IPPS 
measure set for annual payment determination at this time. In addition, 
as stated in the FY 2008 IPPS final rule, CMS is not adopting the SCIP 
Infection 7 measure as part of the FY 2009 IPPS measure set for annual 
payment determination at this time.

XVIII. Changes Affecting Critical Access Hospitals (CAHs) and Hospital 
Conditions of Participation (CoPs)

A. Changes Affecting CAHs

1. Background
    CAHs are subject to different participation requirements than are 
hospitals. Among other requirements, a CAH must be located in a rural 
area (or an area treated as rural) and, under section 
1820(c)(2)(B)(i)(I) of the Act and Sec.  485.610(c) of our regulations, 
must meet an additional distance-related location requirement. Under 
this requirement, a CAH must be located at least 35-miles (or, in the 
case of mountainous terrain or in areas with only secondary roads, 15-
miles) from the nearest hospital or other CAH. In addition, CAHs 
receive payment for services furnished to Medicare beneficiaries 
differently. CAHs receive cost-based payment for 101 percent of their 
reasonable costs.
    Prior to January 1, 2006, the CAH minimum distance eligibility 
requirement was not applicable to entities States had certified as 
necessary provider CAHs. Approximately 850 current CAHs have been 
designated by their States as necessary providers. The criteria used to 
qualify a CAH as a necessary provider were established by each State in 
its Medicare Rural Hospital Flexibility Program (MRHFP). The State's 
MRHFP rural health care plan contains the necessary assurances that the 
plan was developed to further the goals of the statute and regulations 
to ensure access to essential health care services for rural residents. 
States, in consultation with their hospital associations and Offices of 
Rural Health, have defined those CAHs that provide necessary services 
to a particular patient community in the event that the facility did 
not meet the required 35-mile (or, in the case of mountainous terrain 
or in areas with only secondary roads, 15-mile) distance requirement 
from the nearest hospital or CAH. Each State's criteria are different, 
but the criteria share certain similarities and all define a necessary 
provider related to the facility location.
    However, section 405(h)(1) of Public Law 108-173 amended section 
1820(c)(2)(B)(i)(II) of the Act by adding language that ended States' 
authority to certify a CAH as a necessary provider, effective January 
1, 2006. In addition, section 405(h)(2) of Public Law 108-173 amended 
section 1820(h) of the Act to include a grandfathering provision for 
CAHs that were certified as necessary providers prior to January 1, 
2006. We incorporated these amendments in Sec.  485.610(c) of our 
regulations in the FY 2005 IPPS final rule (69 FR 49220). Because those 
regulations did not address the situation where the grandfathered CAH 
is no longer the same facility due to relocation, in the FY 2006 IPPS 
final rule (70 FR 47490), we amended Sec.  485.610 of our regulations 
to add a new Sec.  485.610(d) that addressed the relocation criteria a 
necessary provider CAH has to meet to retain its necessary provider 
designation.
    Additional circumstances concerning CAHs with existing necessary 
provider designations have come to our attention that we believe also 
need to be addressed. Specifically, we have learned that some CAHs with 
grandfathered necessary provider designations are co-located with other 
hospitals, which typically are PPS-excluded inpatient psychiatric 
facilities or inpatient rehabilitation facilities. We are also aware 
that there is interest in the creation or acquisition by CAHs with 
necessary provider designation of off-campus facilities that they do 
not believe would be subject to CAH location requirements.
    For the reasons noted below, in the CY 2008 OPPS/ASC proposed rule 
(72 FR 42806), we took a proactive approach by proposing a change in 
the regulation to be consistent with our belief that the intent of the 
CAH program is to maintain hospital level services in rural communities 
while ensuring access to care. We believe that this proposed change to 
the regulations will help to maintain the integrity of the MRHFP within 
the statutory requirements.
2. Co-location of Necessary Provider CAHs
    Some necessary provider CAHs are co-located with other hospitals, 
particularly specialty psychiatric and/or rehabilitation hospitals. 
Prior to the enactment of section 405(g) of Public Law 108-173, it is 
understandable that a State MRHFP might have allowed co-location of a 
CAH with a necessary provider designation with the specialized services 
of a psychiatric and/or an inpatient rehabilitation hospital. The State 
may have believed that beneficiary access to care would be enhanced 
through the provision of both CAH and these specialized services at the 
same location, and the CAH itself might have had difficulty in 
providing such services within its permitted bed limits. However, 
section 405 of Public Law 108-173 included several provisions that 
permit CAHs themselves to address such access to care issues.
    Specifically, section 405(e) of Public Law 108-173 amended sections 
1820(c)(2)(B)(iii) and 1820(f) of the Act to increase the permitted 
number of CAH inpatient beds from 15 to 25. In addition, section 405(g) 
of Public Law 108-173 added section 1820(c)(2)(E) to the Act, which 
permits a CAH to operate distinct part inpatient psychiatric and/or 
rehabilitation units, each subject to a 10-bed limit that is not 
included as part of the CAH's 25-bed limit. Therefore, a CAH can 
operate a 45-bed facility addressing a wide range of needs in the rural 
community it serves. We believe that CAHs seeking to provide access to 
specialized services should avail themselves of the statutory 
provisions governing distinct part units in CAHs rather than making 
arrangements with

[[Page 66878]]

other hospital providers to share space at the CAH location.
    In light of these changes to the statute, we proposed to no longer 
allow a necessary provider CAH to enter into co-location arrangements 
between CAHs and hospitals, unless such arrangements were in effect 
before January 1, 2008, and the type and scope of services offered by 
the facility co-located with the necessary provider CAH do not change.
    Currently, co-location arrangements seem to involve psychiatric or 
rehabilitation hospitals. However, we are concerned that, without this 
change, there may be situations where more necessary provider CAHs will 
co-locate with PPS hospitals. We also cannot rule out a scenario where 
two necessary provider CAHs could co-locate after relocation. We 
believe the co location of a necessary provider CAH with another 
hospital or necessary provider CAH is not consistent with the CAH 
statutory framework that establishes requirements for a CAH to be a 
certain minimum distance from other hospitals or CAHs. We believe that 
the elimination of States' authority to designate necessary provider 
CAHs and the new authority for CAHs to operate psychiatric and 
rehabilitation units in addition to their expanded ceiling for 
inpatient beds should provide sufficient flexibility for necessary 
provider CAHs to operate within the statutory framework without 
engaging in additional arrangements.
    We also proposed to clarify that, under certain circumstances, a 
change of ownership of any of the facilities (either the CAH or the 
existing co-located facility) with a co-location arrangement that was 
in effect before January 1, 2008, will not be considered to be a new 
co-location arrangement. If a change of ownership should occur in a CAH 
with a grandfathered co-location arrangement on or after January 1, 
2008, the provider agreement will be assigned to the new owner unless 
the new owner rejects assignment of the provider agreement. 
Grandfathered necessary provider CAH status, including grandfathered 
co-location arrangements, would not transfer to a new CAH owner who 
does not assume the provider agreement from the previous owner. To 
obtain CAH designation, the new provider would have to comply with all 
the CAH designation requirements, including the location requirements 
relative to other providers, that is, more than a 35-mile drive (or 15 
miles in areas of mountainous terrain or secondary roads).
3. CAH Provider-Based Facilities
    We have consistently taken the position that the intent of the CAH 
program is to keep hospital-level services in rural communities, 
thereby ensuring access to care (FY 2006 IPPS final rule (70 FR 
47469)). A CAH is permitted to create or acquire an off-campus 
location, including a distinct part unit that satisfies the location 
criteria for a CAH and operates under the CAH's provider agreement 
under the provider-based regulations at 42 CFR 413.65. We note that, 
under section 1820(c)(2)(B)(i)(II) of the Act, a CAH does not have to 
meet the distance requirements relative to other hospitals or CAHs if 
it was certified as a necessary provider by the State prior to January 
1, 2006. We stated in the FY 2006 IPPS final rule (70 FR 47472), when 
addressing the relocation criteria for a necessary provider CAH, that 
the ``necessary provider'' designation is specific to the physical 
location(s) of the CAH in existence at the time of the designation. We 
believe the necessary provider CAH designation cannot be considered to 
extend to any new facilities not in existence when the CAH received its 
original necessary provider designation. Accordingly, we believe the 
creation of any new location that would cause any part of the CAH to be 
situated at a location not in compliance with the distance requirements 
at 42 CFR 485.610 would cause the entire CAH to violate the distance 
requirements.
    Of the approximately 1,300 CAHs, 453 CAHs have health clinics, 81 
have psychiatric units, and 20 have rehabilitation units. We do not 
know how many of the existing clinics and distinct part units are at 
off-site locations. However, we are concerned with CAHs creating or 
acquiring off-campus locations, including distinct part psychiatric and 
rehabilitation units, that do not comply with the CAH location 
requirement relative to other facilities. Therefore, when such off-
campus facilities are created by a CAH with a necessary provider 
designation, there is no reason to assume that the distance exemption 
given to the CAH should be extended without qualification to any 
location for that CAH's off-campus facilities. Accordingly, any CAH 
off-campus locations must satisfy the current statutory CAH distance 
requirements, without exception, regardless of whether the main 
provider CAH is a necessary provider CAH.
    Therefore, in the CY 2008 OPPS/ASC proposed rule (72 FR 42807), we 
proposed to clarify that if a necessary provider CAH, or a CAH that 
does not have a necessary provider designation, operates a provider-
based facility as defined in Sec.  413.65(a)(2), or a psychiatric or 
rehabilitation distinct part unit as defined in Sec.  485.647 that was 
created or acquired on or after January 1, 2008, it must comply with 
the distance requirement of a 35-mile drive to the nearest hospital or 
CAH (or 15 miles in the case of mountainous terrain or in areas with 
only secondary roads). (In the proposed Sec.  485.610(e)(2), we 
inadvertently used the phrase ``after January 1, 2008'' instead of ``on 
or after January 1, 2008.'' We have corrected this language in this 
final rule with comment period. We also included the words ``off-
campus'' before the words ``provider-based locations'' in the same 
regulation to conform to the references in the section for off campus 
location.)
4. Termination of Provider Agreement
    In the event that a CAH with a necessary provider designation 
enters into a co location arrangement on or after January 1, 2008, or 
acquires or creates an off-campus facility on or after January 1, 2008, 
that does not satisfy the CAH distance requirements in Sec.  
485.610(c), we proposed that we would terminate that CAH's provider 
agreement, in accordance with the provisions of Sec.  489.53(a)(3). (In 
proposed Sec.  485.610(e)(3), we inadvertently used the phrase ``after 
January 1, 2008'' instead of ``on or after January 1, 2008.'' We have 
corrected this language in this final rule with comment period.) The 
necessary provider CAH could avoid termination by converting to a 
hospital that is paid under the IPPS, assuming that the facility 
satisfies all requirements for participation as a hospital in the 
Medicare program under the provisions in 42 CFR Part 482. We also noted 
that if the necessary provider CAH corrects the situation that led to 
the noncompliance, a termination action will not be triggered. A CAH 
that is not a necessary provider CAH could not have a co-location 
situation due to the distance requirements it is required to meet at 
Sec.  485.610(c).
5. Regulation Changes
    In the CY 2008 OPPS/ASC proposed rule (72 FR 42807), we proposed to 
amend Sec.  485.610 by adding a new paragraph (e) to address situations 
under our proposal relating to off-campus and co-location requirements 
for all CAHs (including CAHs with necessary provider designations).
    Comment: Several commenters stated that while it is a good policy 
to eliminate future co-location

[[Page 66879]]

arrangements between CAHs and acute care hospitals, they do not believe 
it is a good policy to eliminate relationships between CAHs and other 
hospitals in opening psychiatric or rehabilitation services. They 
indicated that such a policy change would only limit access to care 
without providing cost savings or improving efficiency. The commenters 
stated that co-locating with other providers would lead to cost-
effective high quality delivery of health care services to Medicare 
beneficiaries and others who need the services. Another commenter 
stated that CMS provided no basis for this proposal in the background 
material to the proposed rule.
    Response: We disagree with the comment that we did not provide a 
basis for the proposed requirements. Additionally, we are not seeking 
to eliminate Medicare beneficiary access to inpatient psychiatric and 
rehabilitation services specifically, or access to any type of care in 
general. As we explained in the preamble to the proposed rule, we 
proposed the revisions to Sec.  485.610 in light of recent changes to 
the statute. These statutory changes allow for: (1) An increase in the 
number of CAH inpatient beds from 15 to 25; and (2) a CAH to operate 
distinct part inpatient psychiatric and/or rehabilitation units, each 
with a 10-bed limit that is not included as part of the CAH's 25-bed 
limit. By allowing a CAH to operate a 45-bed facility, these amendments 
to the statute permit CAHs themselves to address the access to care 
issues mentioned by the commenters.
    These statutory provisions clearly provide an opportunity for the 
CAH to directly meet the wide range of needs in the rural community it 
serves. However, co-location arrangements between CAHs and hospitals 
that were in effect before January 1, 2008 would still be permitted, 
provided that there is no change in the type and scope of services 
offered by the facility co-located with the necessary provider CAH.
    Comment: One commenter expressed complete support for the proposal, 
and saw it as a clarification of existing policy. The commenter stated 
that a CAH provider-based clinic was built across the street from its 
outpatient clinic to increase market share as its population was 
dwindling. The commenter stated that CAHs were financed and designed to 
serve the needs of the underserved, not to compete in the market 
against not-for-profit hospitals that are not subsidized like CAHs. The 
commenter also stated that since the regulation is a clarification and 
is not new, the existing provider-based clinics should not be 
grandfathered.
    Another commenter stated that it valued the cost-based financial 
support that CMS extends to CAHs. The commenter supported CMS' proposed 
rule and viewed the proposed policy changes as a step towards restoring 
the ``intended spirit'' of the CAH designation.
    Response: We appreciate the commenters' support. However, we 
disagree with the comment that existing provider-based clinics should 
not be grandfathered. The current regulations did not explicitly 
address the issue of necessary provider CAHs from acquiring or creating 
off-campus facilities that do not meet the minimum distance 
requirements. However, our policy has been that CAHs are required to 
meet the distance requirement, including any off-campus facilities. In 
light of the statutory change to the designations for necessary 
provider CAHs, we believe that it is necessary to grandfather existing 
provider-based clinics.
    Comment: Numerous commenters requested that rural health clinics 
(RHCs) be excluded from the category of provider-based entities that 
must comply with the proposed change. Some commenters stated that 
operating an RHC is the only way to provide healthcare to the medically 
underserved population in their service area. One commenter stated that 
if CMS does not exempt RHCs from the proposed policy, CMS should allow 
grandfathered CAH/provider-based RHCs to move the location of the RHC 
without jeopardizing the CAH status of the parent provider.
    Response: To be certified as an RHC, the clinic must be located in 
an area designated, either by population or geographic area or 
location, as a Medically Underserved Area (MUA) or Health Professional 
Shortage Area (HPSA). In addition, State governors are allowed to 
designate areas with a shortage of professional health services through 
the use of statewide shortage designation plans approved by HRSA's 
Bureau of Health Professions. Because RHCs have their own location 
requirements and because, unlike other provider-based clinics, a 
provider-based RHC is a separate entity which undergoes a separate 
certification process and has a unique provider identification number 
from the base provider, we believe that our concerns leading to our 
provider based proposal do not apply to CAH provider-based RHCs. 
Accordingly, in this final rule with comment period, we are excluding 
RHCs from the list of provider-based facilities at Sec.  413.65(a)(2) 
that must comply with this requirement.
    Comment: One commenter stated that for any CAH that is landlocked 
against future growth, this proposed change would severely restrict the 
CAH's ability to provide the quality services required by the 
community. At the very least, the commenter urged that CMS increase the 
current on-campus yards from 250 yards to 500 or 750 yards. Another 
commenter stated that it is reasonable that CAHs are prohibited from 
creating new services that are close to competing organizations, but 
believed that limiting all off-campus services to only those in place 
by the end of the year, would freeze the CAH into an increasingly out-
of-date delivery modality.
    Response: We acknowledge the CAH's constraints of having to locate 
a provider-based clinic on its campus. However, this rule will not 
restrict a CAH from building or obtaining an off-site provider-based 
clinic on or after January 1, 2008. The CAH can have a provider-based 
clinic that complies with the provider-based rules in Sec.  413.65. In 
addition, the off-site clinic must be located more than a 35-mile (or 
15-mile) drive from another CAH or hospital. For example, the CAH could 
have a provider-based clinic located 2 miles or 10 miles from the 
provider CAH, providing the clinic complies with the distance 
requirements and is 35 (or 15) miles away from another CAH or hospital. 
The regional offices will evaluate these issues on a case-by-case 
basis, consistent with all existing regulations. Also, as discussed 
above, because we are now excluding RHCs from these CAH provider-based 
requirements, a CAH would have even more flexibility in choosing the 
location of its provider-based RHC.
    Comment: Several commenters stated that they have started plans 
(and, in some cases, construction) for a new provider-based facility 
that will not be completed by January 1, 2008. They have requested an 
exemption to be able to move forward with their plans that were 
initiated prior to the publication of the proposed rule.
    Response: We recognize that a number of CAHs have plans underway to 
build or acquire provider-based facilities that will not be completed 
before January 1, 2008. For those CAHs that demonstrate that they have 
begun such planning and/or construction, our regional offices will 
evaluate those issues on a case-by-case basis. A demonstration that 
construction plans were ``under development'' prior to January 1, 2008 
could include supporting documentation such as the drafting of 
architectural specifications,

[[Page 66880]]

the letting of bids for construction, the purchase of land and building 
supplies, documented efforts to secure financing for construction, 
expenditure of funds for construction, and compliance with State 
requirements for construction such as zoning requirements, application 
for a certificate of need, and architectural review. However, we 
recognize that it may not have been feasible for a CAH to have 
completed all of these activities noted above as examples prior to 
January 1, 2008. Thus, we expect the CMS Regional Offices to consider 
all of the factors involved in each CAH's plan and make case by case 
determinations of whether a CAH can continue its plans to acquire or 
construct an off-campus provider-based clinic. We note that we have 
also used the above documentation guidelines in Publication 100-20 for 
grandfathered specialty hospitals to determine if construction plans 
were ``under development.''
    Comment: Many commenters stated that CMS should not adopt the 
provisions in the proposed rule because limiting off-site clinics would 
impede the provision of health care in their surrounding communities 
due to the fact that it could not be provided without cost-based 
reimbursements. Also, the commenters suggested that as physicians 
cannot be paid competitively without cost-based reimbursement, this 
would further compound the difficulties in recruiting healthcare 
providers to work in rural areas. Other commenters stated that the only 
way to recruit and maintain physicians is for hospitals to offer the 
competitive salaries that are afforded through a provider-based 
arrangement. A few commenters stated that denying CAHs the opportunity 
to invest in physician offices in communities where physicians are 
desperately needed will disadvantage the patients living in those 
areas. One commenter requested that CMS not adopt the provisions of the 
proposed rule and enter into a dialogue with CAHs about an approach 
that would allow for the level of community-based access and 
collaboration being called for by the Institute of Medicine (IOM), the 
National Advisory Committee on Rural Health and Human Services, and 
other national bodies.
    Response: We do not agree that CMS should not adopt the provisions 
in the proposed rule because, in addition to grandfathering the 
existing provider-based clinics, CAHs will still be able to provide 
needed services in their communities through existing and new provider-
based clinics that meet the distance requirements and through on-campus 
facilities. In addition, and perhaps most importantly for those CAHs 
concerned about access to primary care services in the communities that 
they serve, we have revised our initial proposal in order to permit 
CAHs to continue to operate provider-based RHCs. Additionally, 
physician offices, owned by CAHs, that are not provider-based (billed 
under the CAH's provider number) can continue to be operated by CAHs.
    We agree with the IOM and other national bodies that contend that 
quality of care in rural areas can be maximized through collaboration. 
The IOM report entitled, ``Quality through Collaboration: The Future of 
Rural Health'' \1\ states that some of the quality shortcomings in 
rural areas stem from the lack of access to ``core health care 
services'' such as primary care in the community, emergency medical 
services, and hospital care. We believe that CAH provider-based 
facilities that are located in the immediate communities of the CAH 
will help to ensure that the people in those communities have access to 
primary care. Also, CAHs will be able to utilize provider-based RHCs to 
provide primary care to Medicare beneficiaries.
---------------------------------------------------------------------------

    \1\ Institute of Medicine of the National Academies of Science; 
Report released on November 1, 2004.
---------------------------------------------------------------------------

    Comment: By providing specific details and scenarios about their 
own CAHs, many commenters expressed other reasons for requesting that 
CMS not adopt this proposal. Overall, the commenters believed that the 
proposed requirements, if implemented, would have the unintended effect 
of limiting access to healthcare services for the residents of their 
communities. The reasons these commenters gave for requesting that CMS 
not adopt the proposal were as follows:
     Several commenters stated that the rule would have a 
devastating impact on many senior citizens who do not drive and who 
would therefore not have access to quality health care in their rural 
community. One commenter stated that the proposed change would take 
away their organization's opportunity to be cost reimbursed from 
Medicare and Medicaid. The commenters stated that this would be a 
roadblock to increased access to care for the elderly and low income.
     One commenter expressed concern about linking an off-
campus or distinct part unit's compliance to the CAH distance 
requirements with the hospital's continued designation as a CAH and 
believed that such applications of the distance requirements could 
result in decreasing patients' access to surgical and other procedures 
that are provided in the CAH. Other commenters were concerned that this 
proposed rule would ban necessary provider CAHs from operating an off-
site facility.
     One commenter stated that its Medicare designation as a 
sole community hospital has geographic limitations, but that it should 
not be threatened with loss of its special reimbursement status if it 
meets community needs by developing provider-based or off-campus 
services. The commenter questioned why CMS is treating CAHs 
differently.
     Several commenters stated that access will be diminished 
in many rural communities because those areas are experiencing an 
increasing inability to recruit or retain physicians in non-provider-
based practices due to perceived inadequate Medicare and Medicaid 
payment to free-standing RHCs, insufficient payment for physicians 
under the fee-schedule, and healthcare professional workforce 
shortages. One commenter stated that to continue to apply the 
``necessary provider'' designation to off-site services will preserve 
one of the only methods that a CAH has to recruit physicians to rural 
service areas. The commenter stated that CMS should allow the necessary 
provider CAH to have a waiver provision for off-site services beyond 
January 1, 2008 if other hospitals within the radius have no objections 
to the services.
     One commenter stated that the proposed rule indicates CMS' 
interest in constraining CAHs. The commenter encouraged CMS to adopt a 
philosophy that limits unnecessary constraints and enables CAHs to 
serve their patients. The commenter urged CMS to remain supportive of 
the CAH program. Additionally, one commenter stated that CMS has 
already weighed in on the issues where cost-based reimbursement could 
be a major advantage and has eliminated cost-based reimbursement for 
certain lab services. The commenter noted that there may be situations 
where other services need to be considered, but that they should be 
dealt with on a case-by-case basis. If competitive advantage for CAHs 
is a concern for CMS, the commenter asked that examples be given of 
such arrangements and suggested that a more narrowly tailored rule 
should be designed to address such issues.
     Several commenters stated that the purpose of the CAH 
program is to provide financial stability for small rural hospitals to 
serve their communities. The commenters believed that this rule would 
eliminate the CAH's ability to provide care to rural seniors. Another 
commenter stated that the

[[Page 66881]]

regulation would be devastating to many provider-based clinics because 
they would be unable to provide the same level of care, services, and 
staffing as independent sites. Several commenters stated that by 
forcing CAHs to have services on-campus, CMS will be leaving some 
community members without access to services.
    Response: We appreciate the varied comments. We first note that the 
proposed change will not eliminate the 101 percent reasonable cost 
reimbursement that CAHs currently receive. As stated earlier, we do not 
believe access to these needed services will be diminished as CAHs will 
still be able to increase access to care for the population of its 
community through a variety of means. Both the grandfathering provision 
of this rule, which allows for provider-based locations and off-campus 
distinct part psychiatric and rehabilitation units that were created or 
acquired before January 1, 2008, and the exclusion of provider-based 
RHCs from the rule provide CAHs with excellent opportunities to not 
only maintain access to care but to expand it as well. The role that 
RHCs play in providing rural communities with essential access to 
primary care services cannot be overemphasized.
    From the inception of the CAH program, which started with the 
essential access community hospitals and rural primary care hospitals 
(EACH/RPCH) 7-State demonstration program, we have been sensitive to 
the special needs of, not only the CAH program, but of all rural and 
remote providers. This sensitivity has been demonstrated in regulations 
we recently adopted that provide flexibility in staffing requirements 
and physician oversight of nonphysician practitioners in CAHs.
    Ultimately though, the distance-based requirement, as one of the 
requirements to become certified as a CAH, is provided for in the 
statute and in the regulation. We believe the distance requirement is a 
statutory requirement that reflects the intent of the CAH program to 
provide hospital-level services in essentially small rural communities. 
Our proposal reflects this understanding and the special status of CAHs 
(as opposed to other rural entities) and should not limit access to 
care. In addition, as the distance requirement is statutory, a waiver 
of the distance requirement for some CAHs, as one commenter requested, 
would not be allowed under the statute. However, CAHs (including 
necessary provider CAHs) will still be able to acquire and create new 
provider-based clinics as long as those provider-based clinics are 
either RHCs or entities that comply with the distance requirements for 
a CAH that are allowed under the Act and under the requirements. In 
addition, all CAHs will be able to establish provider-based entities on 
their campus.
    Comment: One commenter requested that CMS clarify provider-based 
location and indicate whether it includes on-campus.
    Response: Provider-based status means the relationship between a 
main provider and a provider-based entity or a department of a provider 
(with all terms being defined in detail under Sec.  413.65(a)(2)). 
Provider-based locations can be both on-campus and off-campus. This 
rule would not restrict CAHs from having a provider-based entity on 
campus.
    Comment: One commenter stated that if CMS adopted the proposed 
change for CAHs it should apply to all providers, such as RHCs and 
Federally qualified health centers (FQHCs).
    Response: We appreciate the commenter's opinion regarding treatment 
of all rural providers; however, we note that RHCs and FQHCs have 
different requirements for participating in the Medicare/Medicaid 
programs than those for CAHs. As we noted previously, we are excluding 
RHCs from the CAH provider-based requirement in light of the specific 
RHC certification requirements.
    Comment: One commenter stated that the proposed change would limit 
CAH's ability to compete on a level playing field with PPS or other 
for-profit providers who have no restrictions on location of 
facilities. Another commenter stated that it is cheaper for the CAH or 
other hospitals to move offsite the care that does not need high cost 
hospital wing space, such as that provided in physical therapy. The 
commenters suggested that it would save CMS money on the cost-report to 
allow CAHs to open these offsite locations. A few commenters also 
stated that offsite locations may be secured much more reasonably to 
offer additional services than additional space which may be obtained 
through construction of new facilities on campus.
    Response: As stated previously, there are statutory requirements 
that dictate the location of CAHs. These statutory location 
requirements support the original intent of the CAH program, that is, 
to ensure and extend access to healthcare services for rural and remote 
communities. The program was never intended to encourage competition 
between CAHs and PPS hospitals. However, it might be a reasonable 
course of action for a CAH to reevaluate whether the CAH program still 
meets the needs of the immediate and surrounding communities. If the 
community's needs have changed, the facility may want to reconsider 
their CAH status and may elect to become a PPS acute care hospital 
without the location limitations that are imposed on CAHs and their 
provider-based locations.
    Comment: A few commenters stated that since all of their CAHs are 
necessary provider CAHs, it would be geographically impossible to find 
a new off-campus location that would meet the 35-mile requirement and 
that this rule should not apply to necessary provider CAHs.
    Response: We believe that there are other options for necessary 
provider CAHs that cannot meet the mileage requirements. Some examples 
that we have previously discussed are on-campus clinics, provider-based 
RHCs, or non-provider-based physician offices owned by CAHs.
    Comment: One commenter stated that instead of a 35 (or 15)-mile 
restriction, a minimum mileage limitation (for example 10 miles) would 
be effective without the potential effect of reducing and/or limiting 
resources for rural citizens. Additionally, one commenter stated that 
it objected to CMS' classification of this new policy as a 
``clarification.''
    Response: As we have stated previously, the statute, at section 
1820(c)(2)(B)(i)(I) of the Act, and the regulation, at 42 CFR Sec.  
485.610, both state that the criteria for designation as a CAH is that 
it must be located more than a 35-mile drive (or, in the case of 
mountainous terrain or in areas with only secondary roads available, a 
15-mile drive) from a hospital, or another CAH. We note a provider-
based clinic (other than an RHC) is considered part of the CAH and it 
is paid the same as the CAH, that is, 101 percent of reasonable cost. 
As stated above, CAHs by statute and regulation must comply with the 
distance requirements. As such, we view this rule as a clarification on 
the distance requirements of participation for CAHs and their provider-
based locations and off-campus distinct part units in light of the 
change in statute concerning necessary provider designations.
    Comment: One commenter objected to CMS proposing these changes in 
the hospital OPPS proposed rule because they believed that many CAHs 
will not evaluate, pay attention to, or read the OPPS proposed rule. 
The commenter believed that such proposed changes should be the subject 
of a separate proposed rule. They also believe that, as a result of CMS 
proposing these changes

[[Page 66882]]

in the OPPS rule, CMS might not have all the information necessary to 
finish the rulemaking on the proposed requirements.
    Response: On occasion, we have proposed changes to the CAH program 
in an OPPS rulemaking. We point out that the subject of the CAH 
proposed changes was included in the title of the OPPS rule. In 
addition, CMS has announced the proposed changes during its Open Door 
Forums. Having received comments from approximately 200 commenters 
(including various rural health and hospital associations), we are 
confident that we have received sufficient information, through the 
public comment process, necessary to complete the rulemaking process.
    Comment: One commenter requested clarification on what CMS means in 
the termination discussion of the proposed rule and suggested that 
clarification was needed to explain how such a process would work in 
practice and how a CAH could avoid losing CAH status. In addition the 
commenter believed that the threat of closure is an unduly harsh 
punishment when payment for an offending facility could be withheld.
    Response: Failure to substantially meet one or more conditions of 
participation is a cause for termination in the Medicare program, not 
closure of the CAH. A CAH with a necessary provider designation that 
enters into a co-location arrangement on or after January 1, 2008, or 
acquires or creates an off-campus facility on or after January 1, 2008, 
that does not satisfy the CAH distance requirements in Sec.  
485.610(c), will be placed on a 90-day termination track as outlined in 
section 3012 of the State Operations Manual. During this 90-day period, 
the CAH will be afforded every opportunity to come back into compliance 
and meet all conditions of participation. As we noted in the proposed 
rule, if the CAH corrects the situation that led to the non-compliance, 
the termination action against the CAH will cease.
    Comment: Several commenters asked if current facilities would be 
allowed to relocate or be replaced and keep the current relationship 
under the grandfather provisions.
    Response: We have addressed in greater detail the situation of a 
relocated CAH in the FY 2006 IPPS final rule (70 FR 47490). Generally, 
we believe that it would be reasonable for a CAH to be able to move its 
facility as long as the new facility can meet the relocation 
requirements contained under Sec.  485.610(d), which specify the 
criteria a necessary provider CAH must satisfy upon relocation in order 
to retain its Medicare provider agreement as a CAH. The requirements 
permit such CAHs to relocate as long as they remain essentially the 
same provider and continue to provide services to the same rural 
service area.
    Comment: Several commenters requested that we state which types of 
entities to which this policy applies.
    Response: While we do not provide a complete list of provider-based 
entities in this final rule with comment period, we define a provider-
based entity at Sec.  413.65(a)(2). Generally, with the exception of 
RHCs, this CAH provider-based rule will apply to an entity that is 
provider-based to a CAH that will bill Medicare under its provider 
number for services rendered.
    After consideration of the public comments received, we are 
finalizing the requirements as proposed with the following revisions. 
For the reasons noted previously, in Sec.  485.610(e)(2), we have 
revised the language of the regulation to exclude RHCs, as defined 
under Sec.  405.2401(b), from the list of provider-based facilities 
that must comply with this requirement. We revised proposed Sec.  
485.610(e)(2) and Sec.  485.610(e)(3) to correct the date references to 
``on or after January 1, 2008.'' Finally, we also added the words 
``off-campus'' before the words ``provider-based locations'' in Sec.  
485.610(e)(2) and Sec.  485.610(e)(3) to conform these references to 
the preamble language.

B. Revisions to Hospital CoPs

1. Background
    On November 27, 2006, we published a final rule in the Federal 
Register entitled ``Medicare and Medicaid Programs; Hospital Conditions 
of Participation: Requirements for History and Physical Examinations; 
Authentication of Verbal Orders; Securing Medications; and 
Postanesthesia Evaluations'' (71 FR 68672). In that final rule (also 
frequently referred to as the ``Carve-out rule''), we finalized 
changes, which were based on timely public comments submitted on the 
proposed rule published in the March 25, 2005 Federal Register (70 FR 
15266), to four of the requirements (or conditions of participation 
(CoPs)) that hospitals must meet to participate in the Medicare and 
Medicaid programs. Specifically, that final rule revised and updated 
our CoP requirements for: completion of the history and physical 
examination in the Medical staff and the Medical record services CoPs; 
authentication of verbal orders in the Nursing services and the Medical 
record services CoPs; securing medications in the Pharmaceutical 
services CoP; and, completion of the postanesthesia evaluation in the 
Anesthesia services CoP. This action was initiated in response to broad 
criticism from the medical community that the then-current requirements 
governing these areas were burdensome and did not reflect current 
practice.
    Since this final rule became effective on January 26, 2007, we have 
received a great number of comments and questions from providers about 
the timeframe requirements (for both the initial medical history and 
physical examination and its update) as well as about the 
postanesthesia evaluation requirements. In both areas, commenters have 
sought clarification on the application of these requirements for 
patients undergoing outpatient surgeries and procedures. While the new 
requirements contained in the Carve-out rule provide hospitals greater 
flexibility in ensuring the quality of inpatient care, the issues 
surrounding outpatient care in the hospital setting, particularly with 
regard to outpatient surgeries and procedures, are not clear. After 
conducting a thorough review of the hospital CoPs and the interpretive 
guidelines, we isolated the relevant issues regarding outpatient care 
and proposed revisions to the current regulations to address these 
concerns.
    According to the most recent data, 30 million surgical procedures 
are performed each year in the United States with over 60 percent done 
as outpatient procedures and another 10 to 15 percent performed on a 
same-day admission basis. These figures combined translate to 
approximately 21 million surgical procedures performed each year in the 
U.S. on patients who are admitted to the hospital on the day of their 
procedure. A majority of these patients are also discharged from the 
hospital the same day that they are admitted. It is unclear whether 
these numbers also include other procedures, such as diagnostic ones, 
which also require anesthesia services, and which include all of the 
risks to patient safety inherent in such procedures. In either case, 
significant numbers of patients undergo surgeries and other procedures 
each year as either outpatients or same-day admission patients.
    The current requirements for the completion of the medical history 
and physical examination are found in the regulations at Sec.  482.22 
(Medical staff CoP), Sec.  482.24 (Medical record services CoP), and 
Sec.  482.51 (Surgical services CoP). We believe that these 
requirements do not adequately address the patient who is admitted for 
outpatient or same-day surgery or a procedure requiring anesthesia 
services.

[[Page 66883]]

The standards at Sec.  482.22(c), Medical staff bylaws, and Sec.  
482.24(c), Content of record, both contain requirements for a medical 
history and physical examination, and an update of the medical history 
and physical examination documenting any changes in a patient's 
condition if the medical history and physical examination was completed 
within 30 days before admission, to be completed and documented within 
24 hours after admission. Under the Surgical services CoP at Sec.  
482.51(b)(1), there is a provision that requires a complete history and 
physical workup to be in the chart of every patient prior to surgery. 
However, there is currently no requirement for an updated examination 
of the patient, including any changes to the patient's condition, to be 
completed and documented after admission or registration, and prior to 
any surgery or procedure being performed. For patients who are admitted 
as inpatients for surgery to be performed in the next day or so, this 
does not pose a problem. These inpatients will be followed while in the 
hospital with both daily progress and nursing notes made in their 
medical record. In addition, as required under the current regulations, 
these patients will also have an updated examination for any changes in 
their condition within 24 hours after their admission.
    As evidenced by the numbers of outpatient and same day admission 
inpatient procedures discussed above, procedures that were once done 
only on an inpatient basis are now routinely performed in outpatient 
settings. Therefore, the patient is not admitted or registered as an 
outpatient until the day of the procedure. Often this admission or 
registration is just hours before the procedure is performed. In 
addition, there are many patients who are admitted as inpatients on the 
same day that they are scheduled for more complex procedures, which 
will then require postoperative hospital stays. However, for patients 
admitted or registered for outpatient procedures as well as for those 
patients admitted on the same day as their surgery, there is currently 
no mechanism to ensure that these patients are examined for any changes 
in their condition prior to undergoing a procedure. Paragraph (b)(1) of 
Sec.  482.51 currently requires that every patient have a complete 
medical history and physical examination documented in the chart prior 
to surgery, except in emergencies. However, the timeframe requirements 
for this medical history and physical examination contained under both 
Sec.  482.22(c)(5) and Sec.  482.24(c)(2)(i)(A) allow for a medical 
history and physical examination that may be as much as 30 days old. 
Without a requirement that an updated examination be completed after 
admission and prior to surgery or other procedure, any changes in a 
patient's condition would most likely be missed by hospital staff. 
Failing to identify changes in a patient's condition prior to surgery 
may adversely impact not only the procedure but also consequently, and 
perhaps more significantly, the outcome of the procedure for the 
patient.
    In the CY 2008 OPPS/ASC proposed rule (72 FR 42808), we proposed 
revisions to Sec. Sec.  482.22, 482.24, and 482.51 that would require 
an updated examination, including any changes in a patient's condition, 
to be completed and documented for each patient after admission or 
registration and prior to surgery or to a procedure requiring 
anesthesia services. These revisions would ensure that any changes in 
the patient's condition are discovered before a procedure is performed. 
With the most up-to-date information regarding a patient's condition 
readily available to hospital staff prior to a procedure, the risks to 
patient safety should be minimized and a poor outcome for the patient 
would be avoided. However, under these proposed requirements, it is not 
our intent to include those minor procedures that only require the 
administration of local anesthetics, as might be the case for 
procedures such as biopsies of skin lesions or suturing of noncomplex 
lacerations.
    Conversely, the current requirements at Sec.  482.52, Anesthesia 
services, still distinguish between inpatients and outpatients with 
regard to postanesthesia evaluation, with the requirements for 
outpatient evaluation actually being less stringent than those for 
inpatients. When the current hospital regulations were originally 
written in 1986, these differences in regulatory oversight may have 
been entirely appropriate. At that time there were still very clear 
differences between inpatient and outpatient procedures, with inpatient 
procedures (and the anesthesia services required) considered much more 
serious and complex in nature. Since that time, there has been a 
gradual blurring of the distinctions between what were previously 
termed ``inpatient'' procedures and those that were classified as 
``outpatient'' procedures. Procedures that were once done only on an 
inpatient basis are now routinely performed in outpatient settings. 
While advances in medical technology and surgical technique have 
allowed for this shift, the complexity and seriousness of these 
procedures still remain as do the risks to patient health and safety. 
Along with the increased complexity and types of outpatient procedures 
being performed today, come the higher levels of sedation and 
anesthesia required for these procedures. Thus, distinctions between 
inpatients and outpatients in the requirements for postanesthesia 
evaluations are less relevant than ever.
    In addition, the current language regarding the completion and 
documentation of an evaluation ``within 48 hours after surgery'' 
assumes that all patients receiving anesthesia services have undergone 
surgery. It also assumes that they have not been discharged from the 
hospital prior to the end of this 48-hour timeframe and that they are 
still available for evaluation. Many patients who have received 
anesthesia services (either general anesthesia or monitored anesthesia 
care) have undergone diagnostic or therapeutic procedures as opposed to 
surgical ones and are discharged within hours after such procedures. 
Diagnostic and therapeutic procedures that require anesthesia services 
(either general anesthesia or monitored anesthesia care) include 
esophagogastroduodenoscopy (EGD), colonoscopy, endoscopic retrograde 
cholangiopancreatography (ERCP), and electroconvulsive therapy (ECT). 
Furthermore, and as noted above, even those patients who have undergone 
inpatient surgical procedures are often discharged well before 48 hours 
after surgery.
    Therefore, in the CY 2008 OPPS/ASC proposed rule (72 FR 42809), we 
proposed revisions to Sec.  482.52(b) that would ensure that all 
patients who have received anesthesia services, regardless of inpatient 
or outpatient status, have a postanesthesia evaluation completed and 
documented by an individual qualified to administer anesthesia before 
they are discharged or transferred from the postanesthesia recovery 
area.
    Finally, in our review of the CoPs, we discovered a cross-reference 
under Sec.  482.23, Nursing services, that is no longer valid. We took 
the opportunity in the proposed rule to correct this error through a 
proposed technical amendment.

2. Provisions of the Final Regulations

a. Timeframes for Completion and Documentation of the Medical History 
and Physical Examination
    The proposed revisions to Sec.  482.22(c)(5) retained the 
requirement that the medical staff bylaws include a requirement that a 
medical history and physical examination be completed no

[[Page 66884]]

more than 30 days before or 24 hours after admission for each patient. 
We proposed to revise this provision to include the requirement that 
the completion and documentation of the medical history and physical 
examination (and the updated examination) would also be required prior 
to surgery or a procedure requiring anesthesia services.
    We also proposed to retain the current provision that the medical 
staff bylaws contain a requirement for the completion and documentation 
of an updated examination within 24 hours after admission (when the 
medical history and physical examination has been completed within 30 
days before admission). However, we proposed to delete the language 
regarding the placement of the medical history and physical examination 
and the updated examination in the medical record within 24 hours after 
admission because we believed that the proposed language requiring not 
only the completion, but also the documentation, of both the medical 
history and physical examination and the updated examination, would 
achieve this purpose. In addition, requirements for the physical 
placement of the medical history and physical examination and the 
updated examination in the patient's medical record are currently, and 
more appropriately, contained under the ``Medical record services'' CoP 
at Sec.  482.24(c)(2), which we proposed to retain under the proposed 
rule.
    Further, we proposed to separate the requirements for the medical 
history and physical examination and for the updated examination under 
two provisions at Sec.  482.22(c)(5)(i) and Sec.  482.22(c)(5)(ii), 
respectively. At Sec.  482.22(c)(5)(i), we proposed to retain the 
current requirement that the medical history and physical examination 
be completed by a physician (as defined in section 1861(r) of the Act), 
an oromaxillofacial surgeon, or other qualified individual in 
accordance with State law and hospital policy. However, we proposed to 
add the words ``and documented'' after ``be completed'' as well as the 
word ``licensed'' after ``qualified'' to further clarify this 
requirement. In addition, we proposed to revise Sec.  482.22(c)(5)(ii) 
to require that the updated examination of the patient must be 
completed and documented by the same individuals as proposed above. We 
also proposed to add the words ``or registration'' to follow ``after 
admission'' to reflect differences in terminology that may exist with 
the admission of patients for outpatient procedures. We proposed this 
revision here as well as in Sec.  482.24 and Sec.  482.51, where 
appropriate.
    We proposed to revise the words ``for any changes in the patient's 
condition'' to ``including any changes in the patient's condition'' at 
both Sec.  482.22(c)(5) and Sec.  482.24(c)(2)(i)(B).
    Under Sec.  482.24(c), Content of record, we proposed to revise 
both Sec.  482.24(c)(2)(i)(A) and Sec.  482.24(c)(2)(i)(B) by adding 
the language ``but prior to surgery or a procedure requiring anesthesia 
services'' with regard to both the completion and the documentation of 
the medical history and physical examination and the updated 
examination.
    We proposed to revise the Surgical services CoP at Sec.  
482.51(b)(1) by deleting the language regarding medical histories and 
physical examinations that have been dictated but which are not yet 
recorded in the patient's chart. Our overall intent in the proposed 
rule was to require that the most current information regarding a 
patient's condition be available to the hospital staff prior to surgery 
or a procedure requiring anesthesia services so that risks to patient 
safety can be minimized and potential adverse outcomes can be avoided.
    We proposed to retain the language regarding the requirement for a 
medical history and physical examination prior to surgery, except in 
the case of emergencies, and proposed to extend this to a requirement 
for an updated examination. We proposed to divide the requirements for 
the medical history physical examination and the updated examination 
under two separate provisions at Sec.  482.51(b)(1)(i) and Sec.  
482.51(b)(1)(ii) in the Surgical services CoP.
b. Requirements for Preanesthesia and Postanesthesia Evaluations
    In the CY 2008 OPPS/ASC proposed rule (72 FR 42810), we proposed to 
revise the requirement at Sec.  482.52(b)(1), under the ``Delivery of 
services'' standard of the ``Anesthesia services'' CoP for a 
preanesthesia evaluation to include the language ``or a procedure 
requiring anesthesia services.'' We proposed this revision in order to 
include the range of procedures that require anesthesia services but 
that are not necessarily surgical in nature. We proposed to add this 
language under Sec.  482.52(b)(3) for the postanesthesia evaluation 
requirement.
    Further, we proposed to revise this standard by deleting both the 
words ``with respect to inpatients'' at Sec.  482.52(b)(3) and the 
entire provision at Sec.  482.52(b)(4), which are the current 
requirements for postanesthesia evaluations for patients. We proposed 
to revise Sec.  482.52(b)(3) by requiring that the postanesthesia 
evaluation be completed and documented before discharge or transfer 
from the postanesthesia recovery area. As discussed above, the intent 
of this section of the proposed rule was to eliminate the distinctions 
currently found in the regulations between inpatients and outpatients 
with regard to anesthesia services.
    Comment: One commenter supported CMS's efforts to eliminate the 
distinctions, currently found in the hospital CoPs, between inpatients 
and outpatients with regard to history and physical examinations, 
examination updates, and anesthesia evaluations. They noted that the 
proposed changes would help to dispel misconceptions regarding 
documentation completion and timeframe requirements. Additionally, the 
commenter expressed the opinion that such revisions to the CoPs would 
not only ensure complete, accurate, and timely documentation, which is 
vital for the protection of patients and for the monitoring of the 
quality of care provided by clinical staff but would also ensure the 
efficient and effective coordination of care by case managers, 
discharge planners, and social services staff.
    Response: We appreciate the commenter's support of the proposed 
changes and agree that the accurate and timely documentation of patient 
medical information is an essential component of quality across the 
spectrum of patient care.
    Comment: One commenter stated that the proposed requirements for an 
updated examination of the patient to be completed and documented in 
the patient's medical record within 24 hours after admission or 
registration but prior to surgery or any procedure requiring anesthesia 
services, would be operationally and unnecessarily burdensome on 
hospitals. The commenter noted that the requirement would lead to 
surgical scheduling inefficiencies, since surgeons would need to stop 
procedures so that they could dictate a medical history and physical 
examination or an update. The commenter also expressed the opinion that 
it was operationally difficult, if not impossible, to ensure that 
documentation of a medical history and physical examination or an 
update was placed in the patient's medical record prior to the 
beginning of surgery. The commenter requested clarification on these 
proposed changes, particularly on which provider could complete the 
update and whether it would need to be dictated.

[[Page 66885]]

    Response: The changes contained in the proposal are a clarification 
of the current medical history and physical examination requirements, 
which were contained in the Carve-out rule (71 FR 68672) published 
November 27, 2006, and which were discussed above. At the time of the 
publication of that final rule, we explained in the preamble that if 
the patient's medical history and physical examination was completed 
before admission to the hospital, the updated examination must be 
completed and documented within 24 hours after admission but before a 
surgical procedure. This original intention from the Carve-out rule has 
been clarified in this final rule with comment period.
    Both the medical history and physical examination and the update 
can be completed and documented by a physician (as defined in section 
1861(r) of the Act), an oromaxillofacial surgeon, or other qualified 
licensed individual in accordance with State law and hospital policy. 
The individual who completes the update does not have to be the same 
individual who did the medical history and physical examination. Both 
documents may be handwritten, dictated and transcribed, or completed 
electronically. Under these requirements, hospitals have the 
flexibility to establish their own policies for the format in which 
this essential patient information is documented in the medical record.
    Comment: One commenter stated that they were opposed to the removal 
of the language in the current CoPs that requires that the medical 
history and physical examination be documented and placed ``on the 
medical record'' [sic] within 24 hours. The commenter expressed 
concerns about physicians who continue to believe that a dictated, but 
not yet transcribed, medical history and physical examination is 
adequate because it is ``in the system,'' even though it is not yet 
physically in the patient's medical record. The commenter stated that 
the current JCAHO standards require that the medical history and 
physical examination be in the medical record. The commenter believed 
that this requirement should be reinforced in the Medicare hospital 
CoPs.
    Response: As we stated in our discussion of the proposed change, we 
believe that the requirements for the physical placement of the medical 
history and physical examination, as well as those for its update, are 
more appropriately located where they currently are, that is, under the 
Medical record services CoP at Sec.  482.24(c)(2), which we will retain 
under this rule. Furthermore, we appreciate the commenter's concerns 
regarding medical histories and physical examinations that have been 
dictated but not yet transcribed, and, thus, are not physically present 
in the patient's medical record. Supporting the overall intent of this 
rule to require that the most current information regarding a patient's 
condition be available to hospital staff prior to surgery or a 
procedure requiring anesthesia services, we proposed to delete the 
language currently contained under the Surgical services CoP at Sec.  
482.51(b)(1) which allows for medical histories and physical 
examinations that have been dictated but which are not yet recorded in 
the chart. Additionally, the proposed revisions at Sec. Sec.  482.22, 
482.24, and 482.51 all require that the medical history and physical 
examination (and its update) be completed and documented in the 
patient's medical record within 24 hours after admission or 
registration but prior to surgery or a procedure requiring anesthesia 
services (and except in the case of emergencies as allowed for under 
Sec.  482.51(b)(1)). We intend to finalize the proposed requirements 
without further revision. We believe that these requirements will 
address concerns regarding documentation and will emphasize the 
important role that the timely and complete documentation of patient 
information plays in reducing patient risk.
    Comment: One commenter stated that the term ``anesthesia services'' 
should be defined in the requirements and that it should include 
standard terminology such as moderate sedation, deep sedation, and 
general anesthesia. The commenter also asked whether CMS intends to 
apply the same requirements regarding medical histories and physical 
examinations and postanesthesia evaluations to moderate sedation 
administered by a physician or surgeon and to general anesthesia 
administered by an anesthesiologist.
    Response: We expect hospitals, which furnish anesthesia services, 
to follow the current standards of anesthesia care, along with the 
accepted definitions of such care, that have been established by 
nationally recognized bodies such as the American Society of 
Anesthesiologists (ASA) and the American Association of Nurse 
Anesthetists (AANA). We also expect that those established guidelines 
should be reflected in the hospital's policies and procedures regarding 
anesthesia services as appropriate to the scope of services offered.
    The requirements for H&Ps and postanesthesia evaluations are not 
the same. As previously discussed, a medical history and physical 
examination (and its update, if applicable) is required for each 
patient admitted or registered to the hospital. This requirement is not 
based on whether the patient is undergoing surgery or a procedure 
requiring anesthesia services. However, the medical history and 
physical examination (and its update) are required prior to surgery or 
a procedure requiring anesthesia services, except in the case of 
emergencies.
    A postanesthesia evaluation would be required after surgery or a 
procedure requiring anesthesia services and must be completed and 
documented by an individual qualified to administer anesthesia. The 
list of individuals who are qualified to administer anesthesia is set 
out at Sec.  482.52(a).
    Comment: One commenter supported the proposed changes to the 
preanesthesia and postanesthesia evaluation requirements and believed 
that they reflected current standards of care. The commenter agreed 
with CMS' decision to remove the distinctions between inpatients and 
outpatients with regard to the postanesthesia evaluation. The commenter 
also agreed with the application of the standards to all patients 
receiving anesthesia services regardless of whether they were 
undergoing surgical or non-surgical procedures.
    However, several commenters took exception to the proposed 
requirement that the postanesthesia evaluation be completed and 
documented before the patient is discharged or transferred from the 
postanesthesia recovery area. Several commenters stated that this part 
of the provision does not reflect current standards of postanesthesia 
care. One commenter noted that its State's regulations allow for the 
use of approved medical staff postanesthesia recovery area criteria, 
which means that qualified postanesthesia recovery area staff can 
discharge patients from the recovery area if they meet certain 
standards established by qualified anesthesia practitioners.
    Another commenter pointed out that, as proposed, Sec.  482.52(b)(3) 
would create a situation where patients who could be safely transferred 
to another unit of the hospital or discharged home would be held for 
hours in the recovery area. The commenter further stated that 
completing the postanesthesia evaluation in the recovery area is simply 
too soon to fully capture or address the patient's complete 
postanesthesia experience, including any anesthesia-related 
complications, which is more effectively done by anesthesia providers 
who make follow-up visits or phone

[[Page 66886]]

calls to patients either later that day or the next.
    One commenter stressed that it is the surgeon or lead physician who 
determines when the patient is ready for discharge or transfer and that 
this decision is based on the monitoring and documentation of the 
patient by the recovery nurse. This commenter noted that though there 
may be some residual effects from anesthesia, this does not mean that 
it is inappropriate to discharge or transfer the patient from the 
recovery area. This commenter believed that with proper discharge 
instructions specific to that patient, a patient may be safely 
discharged home to rest following a procedure and that follow-up over 
the phone by the anesthesia provider would then complete the 
postanesthesia evaluation.
    Two commenters also stated that the proposed requirement for the 
timing of the postanesthesia evaluation would place an undue burden on 
small rural hospitals where there are a limited number of anesthesia 
providers. They argued that such constraints would limit access to 
surgical services in these communities by significantly slowing down 
the number of cases each day. These commenters argued that such 
hospitals would have to hire an additional provider to comply with this 
requirement without yielding any benefits to patient safety or access 
to care.
    Response: We appreciate the comments received. After consideration 
of the public comments and a further review of the current standards of 
anesthesia care, we agree that our proposed changes to the 
postanesthesia evaluation requirements may not truly reflect current 
and safe anesthesia practice, may in fact impose a burden on hospitals 
and anesthesia providers, and, as an unintended consequence, limit some 
patients' access to health care services. Therefore, we have revised 
the proposed requirements for the postanesthesia evaluation in this 
final rule with comment period to better reflect current standards of 
care. We are requiring that the postanesthesia evaluation must be 
completed and documented by an individual qualified to administer 
anesthesia no later than 48 hours after surgery or a procedure 
requiring anesthesia services, and that the postanesthesia evaluation 
for anesthesia recovery must be completed in accordance with State law 
and with hospital policies and procedures that have been approved by 
the medical staff and that reflect current standards of anesthesia 
care.
    Comment: One commenter requested that CMS regularly update the 
online Interpretive Guidelines to reflect changes in the hospital CoPs 
and that healthcare professionals and their professional associations 
be notified by CMS on a timely basis regarding such updates.
    Response: This request is outside of the scope of this rule. 
However, we will forward this comment to the appropriate component 
within CMS responsible for the Interpretive Guidelines.
c. Technical Amendment to Nursing Services CoP
    In the CY 2008 OPPS/ASC proposed rule (72 FR 42810), we proposed to 
revise the cross-reference to Sec.  405.1910(c) currently found under 
the nursing services CoP at Sec.  482.23(b)(1), as this citation has 
been changed and is no longer valid. We proposed a technical amendment 
to this provision to correct the cross-reference to Sec.  488.54(c).
    We did not receive any public comments on this proposed change.
    After consideration of the public comments received, we are 
finalizing the proposed changes without revision, with the exception of 
those under Sec.  482.52(b)(3). We are revising the proposed revision 
to require that the postanesthesia evaluation must be completed and 
documented by an individual qualified to administer anesthesia no later 
than 48 hours after surgery or a procedure requiring anesthesia 
services, and that the postanesthesia evaluation for anesthesia 
recovery must be in accordance with State law and with hospital 
policies and procedures, which have been approved by the medical staff 
and which reflect current standards of anesthesia care. As finalized in 
this final rule with comment period, these requirements will provide 
hospitals greater flexibility while ensuring the quality and safety of 
care provided to patients.

XIX. Changes to the FY 2008 Hospital Inpatient Prospective Payment 
System (IPPS) Payment Rates

A. Background

    On August 1, 2007, we issued a final rule with comment period to 
update the hospital inpatient prospective payment system (IPPS) for FY 
2008. (This rule was printed in the August 22, 2007 Federal Register at 
72 FR 47130 through 48175.) In that final rule with comment period, as 
part of the annual update of policies and payment rates under the IPPS, 
we adopted a new patient diagnosis classification system, the Medicare 
severity diagnosis-related group (MS-DRG) system, to replace the 
existing CMS-DRG system, effective October 1, 2007. To maintain budget 
neutrality for the transition to the MS-DRG patient classification 
system, using the Secretary's authority under section 1886(d)(3)(A)(vi) 
of the Act to adjust the standardized amount to eliminate the effect of 
changes in coding or classification that do not reflect real change in 
case-mix, we also provided for a documentation and coding adjustment to 
the IPPS payment rates of -1.2 percent. On September 28, 2007, we 
issued a correction notice to the FY 2008 IPPS final rule with comment 
period that corrected an inadvertent technical calculation error made 
in the FY 2008 IPPS final rule with comment period that affected IPPS 
payment rates, factors, and thresholds. (This notice, which we will 
refer to as the ``second FY 2008 IPPS correction notice,'' was printed 
in the October 10, 2007 Federal Register at 72 FR 57634.)
    On September 29, 2007, the TMA, Abstinence Education, and QI 
Programs Extension Act of 2007 TMA), Public Law 110-90, was enacted. As 
discussed in more detail in section XIX.B. of this final rule, section 
7 of Public Law 110-90 included a provision that reduces the -1.2 
percent documentation and coding adjustment for the MS-DRG system that 
we adopted in the FY 2008 IPPS final rule to -0.6 percent. To comply 
with the provision of section 7 of Public Law 110-90, we are revising 
certain FY 2008 IPPS payment rate, thresholds, and factors that were 
included in the October 10, 2007 correction notice for the FY 2008 
final rule with comment period.
    In addition, in this final rule, we are making a policy change to 
the IPPS that was not part of Public Law 110-90. In the FY 2008 IPPS 
final rule, we established a policy of applying the documentation and 
coding adjustment to the hospital-specific rates for Medicare-
dependent, small rural hospitals (MDHs) and sole community hospitals 
(SCHs) for FY 2008. We have determined that application of the 
documentation and coding adjustment to the hospital-specific rates is 
not consistent with the plain meaning of section 1886(d)(3)(A)(vi) of 
the Act. Therefore, we have decided to change this policy, effective 
October 1, 2007, as discussed in section XIX.B.2. of this final rule.

B. Revised IPPS Payment Rates

1. MS-DRG Documentation and Coding Adjustment
    As stated earlier, we adopted the new MS-DRG patient classification 
system for the IPPS, effective October 1, 2007. The intent of the MS-
DRG system is to better recognize severity of illness in

[[Page 66887]]

Medicare payment rates. Adoption of the MS-DRGs resulted in the 
expansion of the number of DRGs from 538 to 745. By increasing the 
number of DRGs and more fully taking into account severity of illness 
in Medicare payment rates, the MS-DRGs encourage hospitals to improve 
their documentation and coding of patient diagnoses. Because of the 
incentives that the MS-DRGs provide for improved documentation and 
coding of patient diagnoses, we indicated in the FY 2008 IPPS final 
rule that we believe the adoption of the MS-DRGs would lead to 
increases in aggregate payments due to improved documentation and 
coding without a corresponding increase in actual patient severity of 
illness. To maintain budget neutrality, using the Secretary's authority 
under section 1886(d)(3)(A)(vi) of the Act to adjust the standardized 
amount to eliminate the effect of changes in coding or classification 
that do not reflect real change in case-mix, we established a 
documentation and coding adjustment of -1.2 percent for FY 2008.
    Section 7 of Public Law 110-90 included a provision concerning this 
documentation and coding adjustment for the MS-DRGs. Specifically, 
section 7 of Public Law 110-90 requires the Secretary to apply a 
prospective documentation and coding adjustment for discharges during 
FY 2008 of -0.6 percent rather than the -1.2 percent adjustment 
specified in the FY 2008 IPPS final rule. To comply with the provision 
of section 7 of Public Law 110-90, we are changing the IPPS 
documentation and coding adjustment for FY 2008 to -0.6 percent and 
recalculating the operating standardized amounts, capital standard 
Federal payment rates, the outlier threshold, the offset factors that 
are applied to the standardized amounts to account for projected 
outlier payments, and the thresholds that are used to evaluate 
applications for new technology add-on payments for FY 2008. All of 
these revised rates, factors, and thresholds are effective October 1, 
2007. These revised rates, factors, and thresholds replace those rates, 
factors, and thresholds published in the FY 2008 IPPS final rule and in 
the second FY 2008 IPPS correction notice. We issued the second FY 2008 
IPPS correction notice prior to enactment of Public Law 110-90 and, 
consequently, that correction notice did not reflect the change from 
the -1.2 percent to the -0.6 percent documentation and coding 
adjustment for FY 2008.
    The revised standardized amounts are shown in Table 1A, 1B, 1C, and 
1D. As expected, the standardized amounts have increased by about 0.6 
percent as a result of changes in the documentation and coding 
adjustment required under section 7 of Public Law 110-90.
    We also have recalculated the outlier threshold based on the 
revised standardized amounts. As a result of the change made by section 
7 of Public Law 110-90, the revised outlier threshold for FY 2008 is 
$22,185. This represents a decrease of $275 from the previously 
published FY 2008 outlier threshold. The revised outlier factors are: 
0.948983 for operating national; 0.964060 for operating Puerto Rico; 
0.952336 for capital national; and 0.959464 for capital Puerto Rico.
    In addition, we have recalculated the thresholds that are being 
used to evaluate applications for new technology add-on payments for FY 
2008 under the IPPS, as shown in Table 10 below. (We note that, for 
ease of reference, we have retained the original table numbering from 
the FY 2008 IPPS final rule and the second FY 2008 IPPS correction 
notice. As a result, table numbering in this section is not sequential 
because only certain tables from the FY 2008 IPPS final rule and the 
second FY 2008 IPPS correction notice require changes to comply with 
the provisions of section 7 of Public Law 110-90.) These thresholds, 
which are equal to the geometric mean standardized charges plus the 
lesser of 75 percent of the national adjusted operating standardized 
payment amount (increased to reflect the differences between costs and 
charges) or 75 percent of 1 standard deviation of mean charges by MS-
DRG, were recalculated due to the change in the standardized operating 
amount resulting from the change made by section 7 of Public Law 110-
90. Depending on the particular MS-DRG, the revised new technology 
thresholds are either the same as, or have increased slightly from, the 
previously published amounts.
    Both the FY 2008 IPPS final rule and the second FY 2008 IPPS 
correction notice included a table entitled ``Comparison of FY 2007 
Standardized Amounts to the FY 2008 Single Standardized Amount with 
Full Update and Reduced Update.'' We are including an updated version 
of that table in this final rule, which reflects the payment rates, 
factors, and thresholds that have been revised to comply with section 7 
of Public Law 110-90.
    We note that section 7 of Public Law 110-90 includes provisions 
concerning documentation and coding adjustments to payment rates for 
years after FY 2008. We will address those provisions in future years' 
rulemaking for the IPPS.
2. Application of the Documentation and Coding Adjustment to the 
Hospital-Specific Rates
    Under section 1886(d)(5)(D)(i) of the Act, SCHs are paid based on 
whichever of the following rates yields the greatest aggregate payment: 
the Federal national rate; the updated hospital-specific rate based on 
FY 1982 costs per discharge; the updated hospital-specific rate based 
on FY 1987 costs per discharge; or the updated hospital-specific rate 
based on FY 1996 costs per discharge. Under section 1886(d)(5)(G) of 
the Act, MDHs are paid based on the Federal national rate or, if 
higher, the Federal national rate plus 75 percent of the difference 
between the Federal national rate and the updated hospital-specific 
rate based on either the FY 1982, 1987, or 2002 costs per discharge. 
When we recalculated the FY 2008 IPPS rates to comply with the 
provision of section 7 of Public Law 110-90, we reviewed the policy we 
established in the FY 2008 IPPS final rule of applying the document and 
coding adjustment to the hospital-specific rates for MDHs and SCHs. In 
that final rule, we stated that we believe the hospital-specific rates 
for MDHs and SCHs should be subject to the documentation and coding 
adjustment that we were applying under section 1886(d)(3)(A)(vi) of the 
Act to maintain budget neutrality for the adoption of the MS-DRGs. That 
is, as these hospitals use the same DRG system as all other hospitals, 
we believe they should be equally subject to the budget neutrality 
adjustment that we were applying for adoption of the MS-DRGs to all 
other hospitals.
    After further review of this issue, we have decided that the 
application of the documentation and coding adjustment to the hospital-
specific rates is not consistent with the plain meaning of the statute. 
Section 1886(d)(3)(A)(vi) of the Act provides the Secretary with the 
authority to adjust ``the average standardized amounts'' so as to 
eliminate the effect of changes in coding or classification of 
discharges that do not reflect real changes in case-mix. However, 
section 1886(d)(3)(A)(vi) of the Act only provides authority to adjust 
the average standardized amounts, and does not refer to the hospital-
specific rates. We continue to believe that it would be appropriate to 
apply the documentation and coding adjustment to the hospital-specific 
rates because we believe that aggregate IPPS payments will increase 
after implementation of the MS-DRGs due to incentives to improve coding 
and documentation. However, we believe that such an adjustment is not 
authorized under

[[Page 66888]]

section 1886(d)(3)(A)(vi) of the Act. As a result, we are establishing 
a policy of not applying the documentation and coding adjustment to the 
hospital-specific rates for FY 2008. Consequently, the revised DRG 
classification and recalibration factor of 0.995743, established in the 
October 10, 2007 correction notice for the FY 2008 IPPS final rule, 
which corrected the budget neutrality factor established in the FY 2008 
IPPS final rule (72 FR 47416 and 47423), will be applied to the 
hospital-specific rates of MDHs and SCHs for FY 2008 without 
application of a -1.2 percent or a -0.6 percent documentation and 
coding adjustment. This policy is effective October 1, 2007, for FY 
2008.

   Table 1A.--National Adjusted Operating Standardized Amounts; Labor/
                                Nonlabor
   [69.7 Percent Labor Share/30.3 Percent Nonlabor Share if Wage Index
                             Greater Than 1]
------------------------------------------------------------------------
      Full update (3.3 percent)          Reduced update (1.3 percent)
------------------------------------------------------------------------
  Labor-related     Nonlabor-related    Labor-related   Nonlabor-related
------------------------------------------------------------------------
     $3,478.45          $1,512.15         $3,411.10         $1,482.87
------------------------------------------------------------------------


   Table 1B.--National Adjusted Operating Standardized Amounts, Labor/
                                Nonlabor
  [62 Percent Labor Share/38 Percent Nonlabor Share if Wage Index Less
                           Than Or Equal to 1]
------------------------------------------------------------------------
      Full update (3.3 percent)          Reduced update (1.3 percent)
------------------------------------------------------------------------
  Labor-related     Nonlabor-related    Labor-related   Nonlabor-related
------------------------------------------------------------------------
     $3,094.17          $1,896.43         $3,034.26         $1,859.71
------------------------------------------------------------------------


               Table 1C.--Adjusted Operating Standardized Amounts for Puerto Rico, Labor/Nonlabor
----------------------------------------------------------------------------------------------------------------
                                                                 Rates if wage index    Rates if wage index less
                                                                   greater than 1          than or equal to 1
                                                             ---------------------------------------------------
                                                                 Labor       Nonlabor      Labor       Nonlabor
----------------------------------------------------------------------------------------------------------------
National....................................................    $3,478.45    $1,512.15    $3,094.17    $1,896.43
Puerto Rico.................................................     1,462.27       896.23     1,384.44       974.06
----------------------------------------------------------------------------------------------------------------


            Table 1D.--Capital Standard Federal Payment Rate
------------------------------------------------------------------------
                                                                  Rate
------------------------------------------------------------------------
National.....................................................    $426.14
Puerto Rico..................................................     201.67
------------------------------------------------------------------------


    Table 10.--Geometric Mean Plus the Lesser of .75 of the National
Adjusted Operating Standardized Payment Amount (Increased To Reflect the
 Difference Between Costs and Charges) or .75 of One Standard Deviation
  of Mean Charges by Medicare Severity-Diagnosis-Related Group (MS DRG)
                            October 2007 \1\
------------------------------------------------------------------------
                                                 Number of    Threshold
                    MS-DRG                         cases         ($)
------------------------------------------------------------------------
1.............................................          652     $345,031
2.............................................          335      178,142
3.............................................       24,400      248,318
4.............................................       21,825      149,288
5.............................................          634      167,763
6.............................................          296       92,366
7.............................................          378      134,606
8.............................................          583       92,357
9.............................................        1,388       97,098
10............................................          182       73,504
11............................................        1,297       71,694
12............................................        1,956       51,613
13............................................        1,476       37,000
20............................................          910      138,461
21............................................          566      108,125
22............................................          249       74,864
23............................................        3,564       81,082
24............................................        2,168       57,415
25............................................        8,493       77,774
26............................................       12,059       52,410
27............................................       14,191       41,344
28............................................        1,623       74,228
29............................................        3,089       45,957
30............................................        3,592       30,059
31............................................        1,061       60,385
32............................................        3,064       35,538
33............................................        4,237       28,788
34............................................          821       58,431
35............................................        2,911       41,625
36............................................        7,454       36,602
37............................................        4,803       51,825
38............................................       16,531       32,848
39............................................       53,619       23,940
40............................................        4,585       57,599
41............................................        8,005       39,541
42............................................        5,216       34,291
52............................................        1,188       29,379
53............................................          590       21,941
54............................................        4,750       30,273
55............................................       16,945       24,952
56............................................        7,800       28,358
57............................................       48,665       18,154
58............................................          796       28,750
59............................................        2,676       21,475
60............................................        4,240       16,415
61............................................        1,368       53,087
62............................................        2,320       42,059
63............................................        1,150       36,344

[[Page 66889]]

 
64............................................       56,448       33,903
65............................................      115,423       26,274
66............................................       91,644       19,975
67............................................        1,403       30,850
68............................................       12,512       21,801
69............................................      104,325       17,613
70............................................        7,165       33,429
71............................................       10,283       26,043
72............................................        5,811       19,097
73............................................        8,728       27,072
74............................................       32,760       19,857
75............................................        1,229       34,005
76............................................          861       22,530
77............................................        1,112       33,155
78............................................        1,386       23,660
79............................................          896       18,688
80............................................        2,095       24,178
81............................................        8,250       15,979
82............................................        1,664       34,288
83............................................        2,070       28,476
84............................................        2,527       21,042
85............................................        5,383       34,836
86............................................       10,921       26,197
87............................................       11,827       18,483
88............................................          730       30,589
89............................................        2,836       22,350
90............................................        3,285       16,402
91............................................        6,763       29,413
92............................................       15,467       20,636
93............................................       15,043       15,988
94............................................        1,533       55,314
95............................................        1,101       41,950
96............................................          749       35,573
97............................................        1,266       50,432
98............................................        1,065       35,836
99............................................          637       30,059
100...........................................       16,012       28,517
101...........................................       57,312       17,754
102...........................................        1,373       24,528
103...........................................       15,199       15,977
113...........................................          592       31,418
114...........................................          593       19,667
115...........................................        1,110       25,665
116...........................................          715       23,533
117...........................................        1,406       15,540
121...........................................          609       21,777
122...........................................          666       12,422
123...........................................        2,865       17,881
124...........................................          684       24,261
125...........................................        4,742       15,308
129...........................................        1,401       38,113
130...........................................        1,063       27,826
131...........................................          895       36,667
132...........................................          910       26,200
133...........................................        2,057       31,674
134...........................................        3,781       19,478
135...........................................          430       34,472
136...........................................          503       21,916
137...........................................          847       27,054
138...........................................          926       17,071
139...........................................        1,710       19,625
146...........................................          696       35,254
147...........................................        1,457       25,264
148...........................................          924       17,390
149...........................................       39,487       14,828
150...........................................          945       25,286
151...........................................        6,840       12,717
152...........................................        2,363       22,142
153...........................................       16,167       14,126
154...........................................        1,857       28,071
155...........................................        4,431       20,298
156...........................................        4,969       14,819
157...........................................        1,164       28,432
158...........................................        3,158       19,955
159...........................................        2,365       14,144
163...........................................       13,502       78,360
164...........................................       18,484       48,016
165...........................................       14,267       37,961
166...........................................       20,398       57,329
167...........................................       21,074       39,878
168...........................................        5,555       30,256
175...........................................       12,032       33,180
176...........................................       40,330       25,127
177...........................................       57,526       35,918
178...........................................       72,497       29,908
179...........................................       26,495       23,293
180...........................................       22,628       33,071
181...........................................       32,425       26,996
182...........................................        6,085       21,762
183...........................................        1,679       29,948
184...........................................        4,279       21,041
185...........................................        2,607       14,730
186...........................................        8,586       31,572
187...........................................       10,362       25,688
188...........................................        4,840       19,425
189...........................................      105,009       28,936
190...........................................       57,361       27,734
191...........................................      126,608       22,656
192...........................................      193,798       17,011
193...........................................       88,637       29,505
194...........................................      274,002       23,196
195...........................................      142,476       16,909
196...........................................        5,173       30,869
197...........................................        7,087       25,433
198...........................................        4,822       19,617
199...........................................        3,279       33,401
200...........................................        8,321       23,384
201...........................................        3,470       16,338
202...........................................       32,849       19,060
203...........................................       40,990       13,891
204...........................................       26,244       16,200
205...........................................        5,816       26,248
206...........................................       22,615       17,512
207...........................................       46,394       81,181
208...........................................       79,797       41,263
215...........................................          154      151,824
216...........................................        8,437      161,730
217...........................................        7,940      116,752
218...........................................        2,963       97,926
219...........................................       10,112      131,361
220...........................................       14,302       93,832
221...........................................        7,644       81,272
222...........................................        2,862      150,295
223...........................................        5,774      116,655
224...........................................        1,930      138,362
225...........................................        5,882      109,348
226...........................................        7,078      112,911
227...........................................       50,687       88,751
228...........................................        3,099      124,543
229...........................................        4,351       88,368
230...........................................        1,797       72,722
231...........................................        1,484      138,797
232...........................................        1,799      107,899
233...........................................       16,996      118,324
234...........................................       39,349       86,766
235...........................................        9,680       95,767
236...........................................       33,005       68,343
237...........................................       22,981       84,187
238...........................................       43,967       53,516
239...........................................       13,900       59,293
240...........................................       13,862       40,658
241...........................................        2,927       30,323
242...........................................       17,243       63,797
243...........................................       40,609       50,067
244...........................................       65,831       42,281
245...........................................        6,081       54,243
246...........................................       41,300       65,115
247...........................................      272,543       46,643
248...........................................        5,558       58,161
249...........................................       29,332       41,991
250...........................................        5,768       53,663
251...........................................       39,992       38,522
252...........................................       44,846       48,444
253...........................................       52,457       42,864
254...........................................       53,894       34,709
255...........................................        2,624       38,540
256...........................................        3,944       29,847
257...........................................          694       21,430
258...........................................          599       50,000
259...........................................        7,342       35,334
260...........................................          872       47,409
261...........................................        2,921       28,499
262...........................................        3,284       21,635
263...........................................          792       29,116
264...........................................       30,336       39,332
280...........................................       61,020       35,621
281...........................................       62,050       27,981
282...........................................       57,249       21,202
283...........................................       16,022       31,225
284...........................................        5,089       23,429
285...........................................        3,008       16,066
286...........................................       23,379       40,375
287...........................................      173,151       27,701
288...........................................        3,262       48,462
289...........................................        1,471       35,223
290...........................................          447       27,620
291...........................................      184,689       29,043

[[Page 66890]]

 
292...........................................      245,075       22,187
293...........................................      200,858       16,283
294...........................................        1,756       20,506
295...........................................        1,631       12,987
296...........................................        1,844       26,712
297...........................................          893       18,216
298...........................................          518       11,608
299...........................................       17,570       27,717
300...........................................       49,533       20,057
301...........................................       37,733       14,452
302...........................................        7,919       23,176
303...........................................       81,896       14,065
304...........................................        2,116       24,314
305...........................................       36,019       13,919
306...........................................        1,385       27,686
307...........................................        6,479       17,568
308...........................................       33,741       27,391
309...........................................       85,320       19,164
310...........................................      156,223       13,820
311...........................................       25,143       12,408
312...........................................      170,267       16,986
313...........................................      222,163       13,782
314...........................................       60,587       30,529
315...........................................       33,354       22,371
316...........................................       18,077       15,239
326...........................................       11,616       86,300
327...........................................       11,348       49,623
328...........................................        8,994       31,842
329...........................................       48,381       78,446
330...........................................       68,497       46,925
331...........................................       29,611       34,940
332...........................................        1,897       72,565
333...........................................        6,490       45,834
334...........................................        3,751       34,051
335...........................................        7,194       67,395
336...........................................       12,815       43,093
337...........................................        8,636       32,710
338...........................................        1,513       58,176
339...........................................        3,289       39,849
340...........................................        3,551       29,763
341...........................................          878       43,074
342...........................................        2,662       32,095
343...........................................        6,796       22,560
344...........................................          897       51,758
345...........................................        3,090       33,808
346...........................................        2,758       25,650
347...........................................        1,577       36,724
348...........................................        4,295       27,903
349...........................................        5,539       17,498
350...........................................        1,802       41,307
351...........................................        4,663       28,433
352...........................................        8,835       18,578
353...........................................        3,076       44,840
354...........................................        9,041       30,936
355...........................................       16,621       21,562
356...........................................        8,411       57,588
357...........................................        8,336       39,793
358...........................................        2,477       30,966
368...........................................        3,069       31,708
369...........................................        4,850       24,300
370...........................................        3,104       18,383
371...........................................       16,940       32,006
372...........................................       23,722       26,630
373...........................................       14,227       19,299
374...........................................        9,505       34,394
375...........................................       20,165       26,552
376...........................................        4,486       20,960
377...........................................       50,797       30,805
378...........................................      118,928       22,456
379...........................................       95,521       17,322
380...........................................        2,934       32,459
381...........................................        5,702       25,732
382...........................................        4,681       18,936
383...........................................        1,307       28,384
384...........................................        8,723       19,941
385...........................................        2,119       33,612
386...........................................        7,449       24,853
387...........................................        5,105       19,162
388...........................................       18,375       29,468
389...........................................       47,827       21,609
390...........................................       47,010       15,176
391...........................................       47,836       25,010
392...........................................      308,502       16,603
393...........................................       24,053       29,116
394...........................................       48,058       22,377
395...........................................       24,695       16,159
405...........................................        3,949       82,266
406...........................................        5,420       49,216
407...........................................        2,195       36,325
408...........................................        1,682       68,612
409...........................................        1,771       46,946
410...........................................          693       35,927
411...........................................          985       65,669
412...........................................        1,098       47,894
413...........................................          850       37,530
414...........................................        5,643       59,314
415...........................................        7,154       40,716
416...........................................        6,018       30,467
417...........................................       16,735       46,569
418...........................................       28,654       36,593
419...........................................       37,427       27,109
420...........................................          738       62,636
421...........................................        1,118       37,131
422...........................................          359       28,797
423...........................................        1,528       64,794
424...........................................          934       44,801
425...........................................          148       35,332
432...........................................       16,397       30,728
433...........................................        9,146       21,794
434...........................................          931       15,756
435...........................................       12,004       32,834
436...........................................       14,157       26,609
437...........................................        4,304       23,809
438...........................................       14,497       31,835
439...........................................       25,932       25,153
440...........................................       26,506       17,450
441...........................................       14,036       29,059
442...........................................       13,192       22,508
443...........................................        6,445       16,775
444...........................................       12,529       31,163
445...........................................       17,390       25,361
446...........................................       16,434       18,758
453...........................................          852      162,946
454...........................................        1,700      108,994
455...........................................        1,715       84,036
456...........................................          770      132,720
457...........................................        2,084       93,391
458...........................................        1,282       76,799
459...........................................        3,212       91,603
460...........................................       51,227       61,623
461...........................................        1,071       78,604
462...........................................       14,292       59,135
463...........................................        5,317       58,718
464...........................................        6,589       40,875
465...........................................        2,748       30,484
466...........................................        3,914       70,332
467...........................................       14,340       53,276
468...........................................       21,479       45,819
469...........................................       29,879       56,126
470...........................................      412,628       41,706
471...........................................        2,241       71,743
472...........................................        6,629       48,496
473...........................................       22,659       39,769
474...........................................        2,857       47,857
475...........................................        3,709       34,489
476...........................................        1,560       23,529
477...........................................        2,262       56,532
478...........................................        7,379       41,594
479...........................................       10,118       33,437
480...........................................       25,993       50,104
481...........................................       74,669       37,466
482...........................................       49,780       31,682
483...........................................        6,572       44,289
484...........................................       17,287       37,116
485...........................................        1,152       55,664
486...........................................        2,066       41,511
487...........................................        1,345       33,504
488...........................................        2,541       33,357
489...........................................        6,198       25,879
490...........................................       21,668       34,253
491...........................................       57,424       22,157
492...........................................        4,761       47,754
493...........................................       16,833       36,159
494...........................................       29,419       27,047
495...........................................        1,888       49,306
496...........................................        5,499       34,296
497...........................................        7,196       26,140
498...........................................        1,258       36,549
499...........................................        1,173       20,709
500...........................................        1,359       47,311
501...........................................        3,956       30,725
502...........................................        6,635       21,338
503...........................................          743       38,573
504...........................................        2,274       30,902
505...........................................        3,142       22,627
506...........................................          921       23,455
507...........................................          840       33,200

[[Page 66891]]

 
508...........................................        2,717       24,377
509...........................................          674       24,413
510...........................................          994       38,968
511...........................................        4,183       30,425
512...........................................       12,088       21,576
513...........................................        1,104       28,511
514...........................................        1,175       18,054
515...........................................        3,601       50,850
516...........................................       11,512       37,284
517...........................................       17,926       30,578
533...........................................          835       26,707
534...........................................        3,647       14,482
535...........................................        6,888       26,510
536...........................................       34,492       14,330
537...........................................          694       19,017
538...........................................        1,139       12,077
539...........................................        3,397       33,275
540...........................................        4,317       26,909
541...........................................        1,787       20,216
542...........................................        6,196       32,603
543...........................................       18,834       24,660
544...........................................       12,389       16,758
545...........................................        4,061       33,895
546...........................................        6,159       23,684
547...........................................        4,717       16,961
548...........................................          592       32,830
549...........................................        1,139       25,116
550...........................................          855       16,440
551...........................................        9,580       29,166
552...........................................       88,568       17,262
553...........................................        2,820       24,459
554...........................................       20,429       13,865
555...........................................        2,006       21,701
556...........................................       19,316       13,456
557...........................................        3,196       28,928
558...........................................       14,252       17,984
559...........................................        1,646       27,945
560...........................................        4,208       19,203
561...........................................        7,439       12,631
562...........................................        5,051       26,500
563...........................................       36,361       14,373
564...........................................        1,622       27,272
565...........................................        3,385       19,726
566...........................................        2,673       14,394
573...........................................        5,721       44,240
574...........................................       12,468       32,357
575...........................................        6,221       24,293
576...........................................          563       45,021
577...........................................        2,305       31,260
578...........................................        3,228       21,726
579...........................................        3,359       42,843
580...........................................       11,019       29,022
581...........................................       12,249       19,890
582...........................................        5,787       22,538
583...........................................        9,356       17,024
584...........................................          801       29,827
585...........................................        1,687       19,824
592...........................................        4,026       29,402
593...........................................       13,080       21,992
594...........................................        2,828       15,050
595...........................................        1,092       29,735
596...........................................        5,792       18,108
597...........................................          555       29,944
598...........................................        1,502       23,666
599...........................................          342       14,643
600...........................................          611       21,165
601...........................................          841       13,706
602...........................................       21,456       26,755
603...........................................      132,037       16,799
604...........................................        2,652       25,338
605...........................................       22,943       15,043
606...........................................        1,371       23,134
607...........................................        7,242       13,623
614...........................................        1,429       44,434
615...........................................        1,594       32,741
616...........................................        1,145       57,824
617...........................................        6,944       36,311
618...........................................          268       26,622
619...........................................          675       60,418
620...........................................        2,007       41,247
621...........................................        6,560       35,467
622...........................................        1,241       43,164
623...........................................        3,392       32,438
624...........................................          392       23,639
625...........................................        1,107       40,382
626...........................................        2,751       27,124
627...........................................       14,146       17,672
628...........................................        3,297       50,999
629...........................................        4,125       39,920
630...........................................          551       30,418
637...........................................       16,431       26,770
638...........................................       46,657       17,852
639...........................................       36,178       12,405
640...........................................       56,149       24,007
641...........................................      189,293       15,306
642...........................................        1,570       23,279
643...........................................        5,072       30,747
644...........................................       12,220       23,221
645...........................................        8,140       17,134
652...........................................       10,695       57,657
653...........................................        1,591       83,632
654...........................................        3,387       53,616
655...........................................        1,514       40,319
656...........................................        3,739       56,790
657...........................................        7,946       38,780
658...........................................        7,957       31,512
659...........................................        4,484       50,404
660...........................................        7,985       36,216
661...........................................        4,264       28,963
662...........................................          998       41,878
663...........................................        2,288       29,568
664...........................................        4,543       21,878
665...........................................          693       47,261
666...........................................        2,405       30,788
667...........................................        3,765       17,825
668...........................................        3,768       39,776
669...........................................       13,307       27,864
670...........................................       12,685       17,652
671...........................................          917       28,789
672...........................................          940       17,260
673...........................................       12,678       43,365
674...........................................       13,848       38,562
675...........................................        8,371       31,105
682...........................................       76,428       30,069
683...........................................      128,229       25,154
684...........................................       28,358       16,191
685...........................................        2,520       18,480
686...........................................        1,596       31,266
687...........................................        3,467       24,382
688...........................................        1,098       16,621
689...........................................       55,794       25,693
690...........................................      201,347       16,948
691...........................................          908       32,141
692...........................................          653       23,510
693...........................................        2,256       27,791
694...........................................       19,345       16,454
695...........................................          982       24,103
696...........................................       10,646       13,740
697...........................................          585       16,016
698...........................................       21,255       27,734
699...........................................       27,064       21,858
700...........................................       11,141       15,265
707...........................................        6,053       34,784
708...........................................       15,996       27,483
709...........................................          796       33,829
710...........................................        2,015       28,079
711...........................................          953       34,060
712...........................................          793       18,806
713...........................................       12,009       24,773
714...........................................       32,647       14,452
715...........................................          662       34,122
716...........................................        1,367       26,199
717...........................................          666       31,542
718...........................................          601       17,543
722...........................................          881       29,202
723...........................................        2,078       23,886
724...........................................          648       14,696
725...........................................          808       23,735
726...........................................        3,956       15,110
727...........................................        1,106       26,438
728...........................................        6,224       15,600
729...........................................          603       22,575
730...........................................          533       13,176
734...........................................        1,528       39,574
735...........................................        1,278       24,152
736...........................................          842       68,949
737...........................................        3,487       39,556
738...........................................          912       26,791
739...........................................          980       48,297
740...........................................        4,638       31,766
741...........................................        6,330       22,182
742...........................................       11,685       29,942
743...........................................       34,686       19,452
744...........................................        1,634       28,687
745...........................................        2,080       18,005
746...........................................        2,664       27,898
747...........................................       11,073       19,176

[[Page 66892]]

 
748...........................................       21,289       18,499
749...........................................        1,048       42,978
750...........................................          477       22,403
754...........................................        1,097       31,885
755...........................................        3,219       24,350
756...........................................          783       15,311
757...........................................        1,326       31,206
758...........................................        1,659       24,086
759...........................................        1,141       17,474
760...........................................        1,815       17,766
761...........................................        1,844       12,285
765...........................................        2,606       19,738
766...........................................        2,664       13,500
767...........................................          123       14,158
768...........................................           10       28,544
769...........................................           87       30,064
770...........................................          188       15,884
774...........................................        1,476       11,268
775...........................................        5,343        8,224
776...........................................          495       14,028
777...........................................          180       17,674
778...........................................          494        7,925
779...........................................          107       12,859
780...........................................           50        5,097
781...........................................        3,062       11,922
782...........................................          129        7,495
790...........................................            1       10,892
793...........................................            1        7,090
799...........................................          631       76,408
800...........................................          730       45,534
801...........................................          581       35,405
802...........................................          693       51,922
803...........................................        1,030       33,848
804...........................................          978       23,443
808...........................................        8,276       34,018
809...........................................       15,783       25,043
810...........................................        3,694       19,852
811...........................................       18,481       24,822
812...........................................       83,743       16,735
813...........................................       15,112       25,412
814...........................................        1,649       29,868
815...........................................        3,483       23,384
816...........................................        2,274       16,506
820...........................................        1,490       83,924
821...........................................        2,593       40,916
822...........................................        2,108       28,993
823...........................................        2,452       64,964
824...........................................        3,130       40,720
825...........................................        1,940       29,726
826...........................................          566       77,536
827...........................................        1,354       40,320
828...........................................          851       29,066
829...........................................        1,386       44,486
830...........................................          520       24,753
834...........................................        5,293       50,536
835...........................................        1,458       30,848
836...........................................        1,554       23,636
837...........................................        1,638       86,041
838...........................................          942       41,650
839...........................................        1,368       27,174
840...........................................       15,248       37,709
841...........................................       11,355       28,818
842...........................................        7,431       22,926
843...........................................        1,498       32,726
844...........................................        2,893       25,240
845...........................................          988       19,989
846...........................................        2,498       37,638
847...........................................       23,816       25,436
848...........................................        1,695       18,894
849...........................................        1,507       27,052
853...........................................       31,591       74,820
854...........................................        6,945       49,005
855...........................................          429       35,456
856...........................................        6,215       64,154
857...........................................       10,284       36,043
858...........................................        3,362       28,370
862...........................................        7,481       32,201
863...........................................       21,957       20,215
864...........................................       19,959       19,205
865...........................................        2,032       28,153
866...........................................        9,474       15,750
867...........................................        5,387       37,627
868...........................................        2,507       24,427
869...........................................        1,129       18,549
870...........................................       13,815       88,107
871...........................................      204,810       33,501
872...........................................       92,533       25,285
876...........................................          971       40,709
880...........................................       10,578       14,303
881...........................................        4,636       10,640
882...........................................        1,673       11,353
883...........................................          799       16,323
884...........................................       21,747       17,521
885...........................................       78,937       14,233
886...........................................          377       13,044
887...........................................          427       17,908
894...........................................        4,627        7,335
895...........................................        6,777       14,018
896...........................................        5,447       25,226
897...........................................       36,860       12,339
901...........................................          924       48,983
902...........................................        2,217       31,794
903...........................................        1,687       22,773
904...........................................          980       39,791
905...........................................          779       24,032
906...........................................          751       22,406
907...........................................        8,164       53,029
908...........................................        8,553       34,813
909...........................................        5,427       25,547
913...........................................          828       26,581
914...........................................        7,082       15,123
915...........................................          928       24,288
916...........................................        5,418        9,886
917...........................................       14,498       28,189
918...........................................       35,052       13,329
919...........................................       10,672       28,054
920...........................................       14,259       20,512
921...........................................        9,672       13,742
922...........................................        1,027       26,694
923...........................................        4,264       14,600
927...........................................          187      176,359
928...........................................          819       59,807
929...........................................          448       32,905
933...........................................          158       31,820
934...........................................          701       23,903
935...........................................        2,209       21,647
939...........................................          428       42,892
940...........................................          732       32,945
941...........................................        1,058       25,659
945...........................................        5,485       19,140
946...........................................        2,759       16,452
947...........................................        6,597       22,649
948...........................................       34,624       14,331
949...........................................          767       17,139
950...........................................          463       11,233
951...........................................        1,008       13,228
955...........................................          456       82,569
956...........................................        3,769       54,324
957...........................................        1,324       98,399
958...........................................        1,221       65,730
959...........................................          295       44,733
963...........................................        1,509       46,426
964...........................................        2,538       32,437
965...........................................        1,105       23,186
969...........................................          676       74,072
970...........................................          159       41,796
974...........................................        6,358       38,864
975...........................................        4,516       27,898
976...........................................        2,770       20,952
977...........................................        5,016       23,376
981...........................................       26,444       75,197
982...........................................       19,320       52,409
983...........................................        6,143       37,918
984...........................................          671       56,061
985...........................................        1,108       38,816
986...........................................          833       27,982
987...........................................        8,040       53,190
988...........................................       12,302       35,697
989...........................................        6,162       25,762
999...........................................           30       11,270
------------------------------------------------------------------------
\1\ Cases taken from the FY 2006 MedPAR file; MS-DRGs are from GROUPER
  Version 25.0.


[[Page 66893]]


                Comparison of FY 2007 Standardized Amounts to the FY 2008 Single Standardized Amount With Full Update and Reduced Update
--------------------------------------------------------------------------------------------------------------------------------------------------------
                                 Full update (3.3 percent);     Full update (3.3 percent);   Reduced update (1.3 percent);       Reduced update (1.3
                                 wage index is greater than      wage index is less than       wage index is greater than   percent); wage index is less
                                           1.0000                         1.0000                         1.0000                      than 1.0000
--------------------------------------------------------------------------------------------------------------------------------------------------------
FY 2007 Base Rate, after       Labor: $3,609.23.............  Labor: $3,210.51.............  Labor: $3,609.23.............  Labor: $3,210.51
 removing reclassification     Nonlabor: $1,569.01..........  Nonlabor: $1,967.73..........  Nonlabor: $1,569.01..........  Nonlabor: $1,967.73.
 budget neutrality,
 demonstration budget
 neutrality, wage index
 transition budget neutrality
 factors and outlier offset
 (based on the labor and
 market share percentage for
 FY 2008).
FY 2008 Update Factor........  1.033........................  1.033........................  1.013........................  1.013.
FY 2008 DRG Recalibrations     0.996383.....................  0.996383.....................  0.996383.....................  0.996383.
 and Wage Index Budget
 Neutrality Factor.
FY 2008 Reclassification       0.991290.....................  0.991290.....................  0.991290.....................  0.991290.
 Budget Neutrality Factor.
Adjusted for Blend of FY 2007  Labor: $3,682.49.............  Labor: $3,275.68.............  Labor: $3,611.20.............  Labor: $3,212.26.
 DRG Recalibration and Wage    Nonlabor: $1,600.86..........  Nonlabor: $2,007.67..........  Nonlabor: $1,569.86..........  Nonlabor: $1,968.80.
 Index Budget Neutrality
 Factors.
Imputed Rural Floor Budget     0.999265.....................  0.999265.....................  0.999265.....................  0.999265.
 Neutrality Factor.
FY 2008 Outlier Factor.......  0.948983.....................  0.948983.....................  0.948983.....................  0.948983.
Rural Demonstration Budget     0.999902.....................  0.999902.....................  0.999902.....................  0.999902.
 Neutrality Factor.
FY 2008 Documentation and      0.994........................  0.994........................  0.994........................  0.994.
 Coding Adjustment.
Rural Floor Adjustment.......  1.002214.....................  1.002214.....................  1.002214.....................  1.002214.
Rate for FY 2008.............  Labor: $3,478.45.............  Labor: $3,094.17.............  Labor: $3,411.10.............  Labor: $3,034.26.
                               Nonlabor: $1,512.15..........  Nonlabor: $1,896.43..........  Nonlabor: $1,482.87..........  Nonlabor: $1,859.71.
--------------------------------------------------------------------------------------------------------------------------------------------------------

XX. Medicare Graduate Medical Education Affiliation Provisions for 
Teaching Hospitals in Certain Emergency Situations

    If you choose to comment on issues in this section, please include 
the caption ``Medicare GME Affiliations'' at the beginning of your 
comment.

A. Background

1. Legislative Authority
    The stated purpose of section 1135 of the Act is to enable the 
Secretary to ensure, to the maximum extent feasible, in any emergency 
area and during an emergency period, that sufficient health care items 
and services are available to meet the needs of enrollees in Medicare, 
Medicaid, and the State Children's Health Insurance Program (SCHIP). 
Section 1135 of the Act authorizes the Secretary, to the extent 
necessary to accomplish the statutory purpose, to temporarily waive or 
modify the application of certain types of statutory and regulatory 
provisions (such as conditions of participation or other certification 
requirements, program participation or similar requirements, or 
preapproval requirements) with respect to health care items and 
services furnished by health care provider(s) in an emergency area 
during an emergency period.
    The Secretary's authority under section 1135 of the Act arises in 
the event there is an ``emergency area'' and continues during an 
``emergency period'' as those terms are defined in the statute. Under 
section 1135(g) of the Act, an emergency area is a geographic area in 
which there exists an emergency or disaster that is declared by the 
President according to the National Emergencies Act or the Robert T. 
Stafford Disaster Relief and Emergency Assistance Act, and a public 
health emergency declared by the Secretary according to section 319 of 
the Public Health Service Act. (Section 319 of the Public Health 
Service Act authorizes the Secretary to declare a public health 
emergency and take the appropriate action to respond to the emergency, 
consistent with existing authorities.) Throughout the remainder of this 
discussion, we will refer to such emergency areas and emergency periods 
as ``section 1135'' emergency areas and emergency periods.
    Under section 1886(h) of the Act, as amended by section 9202 of the 
Consolidated Omnibus Budget Reconciliation Act (COBRA) of 1985 (Public 
Law 99-272), the Secretary is authorized to make payments to hospitals 
for the direct costs of approved GME programs. Section 1886(d)(5)(B) of 
the Act provides for an additional payment per Medicare discharge for 
acute care hospitals paid under the inpatient prospective payment 
system (IPPS) that have residents in an approved GME program. This 
additional payment is to reflect the higher patient care costs of 
teaching hospitals, that is, the indirect graduate medical education 
(IME) costs. Sections 1886(h)(4)(F) and 1886(d)(5)(B)(v) of the Act 
establish limits on the number of allopathic and osteopathic residents 
that hospitals may count for purposes of calculating direct GME 
payments and the IME adjustment, respectively, establishing hospital-
specific direct GME and IME full-time equivalent (FTE) resident caps. 
Under the authority granted by section 1886(h)(4)(H)(ii) of the Act, 
the Secretary has issued rules to allow institutions that are members 
of the same affiliated group to apply their direct GME and IME FTE 
resident caps on an aggregate basis through a Medicare GME affiliation 
agreement. The Medicare regulations at Sec. Sec.  413.75 and 413.79 
permit hospitals, through a Medicare GME affiliation agreement, to 
adjust IME and direct GME FTE resident caps to reflect the rotation of 
residents among affiliated hospitals.
2. Existing Medicare Direct GME and Indirect GME Policies
    The Medicare program makes payments to teaching hospitals to 
account for two types of costs, the direct costs (direct GME) and the 
indirect costs (IME) of a hospital's GME program. Direct GME payments 
represent the direct costs of training residents (for

[[Page 66894]]

example, resident salaries and fringe benefits, and teaching physician 
costs associated with an approved GME program) and generally are 
calculated by determining the product of the Medicare patient load 
(that is, the Medicare percentage of the hospital's inpatient days), 
the hospital's per resident payment amount, and the weighted number of 
FTE residents training at the hospital.
    The IME adjustment is made to teaching hospitals for the additional 
indirect patient care costs attributable to teaching activities. For 
example, teaching hospitals typically offer more technologically 
advanced treatments to their patients, and therefore, patients who are 
sicker and need more sophisticated treatment are more likely to go to 
teaching hospitals. Furthermore, there are additional costs associated 
with teaching residents resulting from the additional tests or 
procedures ordered by residents and the demands put on physicians who 
supervise, and staff who support, the residents. IME payments are made 
as a percentage add-on adjustment to the per discharge IPPS payment, 
and are calculated based on the hospital's ratio of FTE residents to 
available beds as defined at Sec.  412.105(b). The statutory formula 
for calculating the IME adjustment is: c x [(1 + r).405 - 
1], where ``r'' represents the hospital's ratio of FTE residents to 
beds, and ``c'' represents an IME multiplier, which is set by the 
Congress.
    The amount of IME payment a hospital receives for a particular 
discharge is dependent upon the number of FTE residents the hospital 
trains, the hospital's number of available beds, the current level of 
the statutory IME multiplier, and the otherwise payable per discharge 
IPPS payment. Sections 1886(d)(5)(B)(v) and 1886(h)(4)(F) of the Act 
established hospital-specific limits (that is, caps) on the number of 
allopathic and osteopathic FTE residents that hospitals may count for 
purposes of calculating indirect and direct GME payments, respectively.
3. Regulatory Changes Issued in 2006 To Address Certain Emergency 
Situations
    As explained above, when Hurricane Katrina occurred on August 29, 
2005, disrupting health care operations and medical residency training 
programs at teaching hospitals in New Orleans and the surrounding area, 
the conditions were met to establish an emergency area and emergency 
period under section 1135(g) of the Act. Shortly after Hurricane 
Katrina occurred, we were informed by hospitals in New Orleans that the 
training programs at many teaching hospitals in the city were closed as 
a result of the disaster and that the displaced residents were being 
transferred to training programs at host hospitals in other parts of 
the country. For purposes of discussion in this rule, a host hospital 
is a hospital that trains residents displaced from a training program 
in a section 1135 emergency area. Also, a home hospital is one that 
meets all of the following: (1) Is located in a section 1135 emergency 
area (2) had its inpatient bed occupancy decreased by 20 percent or 
more due to the disaster so that it is unable to train the number of 
residents it originally intended to train in that academic year, and 
(3) needs to send the displaced residents to train at a host hospital.
    Section 413.79(h) allows a hospital that closed, or that closed one 
or more of its residency training programs, to temporarily transfer FTE 
residents and part or all of its FTE resident caps to another hospital 
in order to allow the accepting hospital to count the displaced 
residents for direct GME and IME payment and to enable the displaced 
residents to complete their training despite closure of either the 
hospital or the residency training program in which they were 
originally training. In the aftermath of Hurricanes Katrina and Rita, 
the training programs at many teaching hospitals in New Orleans and 
surrounding areas were temporarily closed (or substantially reduced), 
and the displaced residents were even transferred to other hospitals in 
other parts of the country to continue their training programs. We 
initially suggested that hospitals whose GME programs were affected by 
Hurricanes Katrina and Rita could use these ``closed hospital'' and 
``closed program'' regulations to address issues relating to displaced 
residents. (We refer readers to the CMS Q&A's Web site at: http://questions.cms.hhs.gov. The Web site link is located at ID 5696.)
    While a number of the residents have since returned to the 
hurricane-affected hospitals, others remain displaced to other 
hospitals, including hospitals located in States outside of the section 
1135 emergency area. In response to immediate concerns relating to 
displaced residents, CMS issued regulations on April 12, 2006 in an 
interim final rule with comment period published in the Federal 
Register (71 FR 18654). The regulatory changes in that rule allowed 
home and host hospitals under certain circumstances to form emergency 
Medicare GME affiliations. The purpose of these emergency Medicare GME 
affiliation rules was to permit Medicare GME support to be maintained 
while displaced residents are training at various hospitals, even as 
the hurricane affected hospitals are rebuilding their training 
programs. The modifications to the regulations at Sec.  413.75(b) and 
Sec.  413.79(f) provided flexibility for home hospitals whose residency 
programs have been disrupted in an emergency area to enter into 
emergency Medicare GME affiliation agreements with host hospitals where 
the hospitals may not meet the regulatory requirements for regular 
Medicare GME affiliations. Due to the infrastructure damage and 
continued disruption of operations experienced by medical facilities, 
and the consequent disruption in residency training, caused by 
Hurricanes Katrina and Rita in 2005, there became an urgent need for 
these regulation changes to be applied retroactively.
    Section 1871(e)(1)(A) of the Act, as amended by section 903(a)(1) 
of the Medicare Prescription Drug, Improvement, and Modernization Act 
of 2003 (MMA) (Public Law 108-173), generally prohibits the Secretary 
from making retroactive substantive changes in policy unless 
retroactive application of the change is necessary to comply with 
statutory requirements, or failure to apply the change retroactively 
would be contrary to the public interest. Because existing regulations 
did not adequately address the issues faced by hospitals that are 
located in the emergency areas, or hospitals that assisted by training 
displaced residents from the emergency area, and because we believed 
hospitals affected by Hurricanes Katrina and Rita would otherwise have 
faced dramatic financial hardship and the recovery of graduate medical 
education programs in the emergency area would have been impeded, we 
found that failure to apply the regulatory changes in the April 12, 
2006, interim final rule retroactively would be contrary to the public 
interest. Thus, the provisions of this interim final rule were made 
effective retroactively as of August 29, 2005.
    To provide regulatory relief, especially in situations not 
addressed under existing regulations (for example, where hospitals had 
initially closed, but were in the process of gradually reopening their 
programs, or where hospitals had severely reduced but never completely 
closed their programs after Hurricanes Katrina and Rita), we 
established the emergency Medicare GME affiliation provisions in the 
April 12, 2006 interim final rule with comment period. In summary, the 
April 12, 2006 interim final rule with comment period made changes as 
follows:

[[Page 66895]]

     To provide hospitals with more flexibility to train 
displaced residents at various sites, and to allow host hospitals to 
count displaced residents for IME and direct GME payment purposes, home 
hospitals were permitted to enter into emergency Medicare GME 
affiliation agreements effective retroactive to the date of the first 
day of the section 1135 emergency period.
     Home hospitals were permitted to affiliate with host 
hospitals anywhere in the country. That is, a host hospital may be 
located in any State and may receive a temporary adjustment to its FTE 
caps to reflect displaced residents added or subtracted because the 
hospital is participating in an emergency Medicare GME affiliated group 
as defined at Sec.  413.75(b).
     Emergency Medicare GME affiliation agreements were 
required to be submitted to CMS with a copy to the CMS fiscal 
intermediary or Medicare administrative contractor (MAC) by the later 
of 180 days after the section 1135 emergency period begins or by July 1 
of the academic year in which the emergency Medicare GME affiliation 
agreement is effective. However, for hospitals affected by Hurricanes 
Katrina and Rita, the deadline was subsequently extended to October 9, 
2006. (We refer readers to the final rule published in the Federal 
Register on July 6, 2006, for a detailed discussion (71 FR 38264 
through 38266).
     The effective period of the emergency Medicare GME 
affiliation agreement was permitted to begin on or after the first day 
of a section 1135 emergency period, and must terminate no later than at 
the conclusion of 2 academic years following the academic year during 
which the section 1135 emergency period began.
     During the effective period of the emergency Medicare GME 
affiliation agreement, hospitals in the emergency Medicare GME 
affiliated group were not required to participate in a shared 
rotational arrangement (as they would be under a regular Medicare GME 
affiliation agreement).
     Host hospitals were allowed an exception from the 
otherwise applicable rolling average resident count for FTE residents 
added as a result of an emergency Medicare GME affiliation agreement, 
but only during the period from August 29, 2005 to June 30, 2006.
    For a detailed discussion on each of the above emergency Medicare 
GME affiliation provisions, we refer readers to the April 12, 2006 
interim final rule with comment period. (71 FR 18654 through 18667).
    In the April 12, 2006 interim final rule with comment period, we 
revised the regulations at Sec.  413.79(f) to provide for more 
flexibility than would have been possible under regular Medicare GME 
affiliations to allow home hospitals to efficiently find training sites 
for displaced residents. Under the flexibility provided by the 
emergency Medicare GME affiliated group provisions as specified at 
Sec.  413.79(f)(6), decisions regarding the transfer of FTE resident 
cap slots, including how to distribute slots up to the home hospital's 
FTE resident caps in situations where the home hospital was training a 
number of residents in excess of its cap before the disaster, as well 
as the tracking of those FTE resident slots, was left to the home and 
host hospitals to work out among themselves. However, the home and host 
hospitals were required to include much of this information in their 
emergency Medicare GME affiliation agreements submitted both to CMS and 
the CMS contractor, as specified under Sec.  413.79(f)(6). Furthermore, 
since hospitals were permitted to amend their emergency Medicare GME 
affiliation agreements (on or before June 30 of the relevant academic 
year) to reflect the actual training situation among the hospitals 
participating in the emergency Medicare GME affiliated group, hospitals 
were provided with a great degree of flexibility to accommodate any 
changing residency training circumstances within the emergency Medicare 
GME affiliated group. We note that the emergency Medicare GME 
affiliation provisions are intended for the purpose of enabling the 
continued training of residents displaced from a section 1135 emergency 
area, and not to enable hospitals to take advantage of the increased 
flexibility in order to shift FTE resident cap slots to other hospitals 
in the country (for instance, in order to maximize Medicare IME and 
direct GME payments).
    We stated in the April 12, 2006 interim final rule with comment 
period that, in developing a policy to provide hospitals increased 
flexibility in response to a disaster, we intended to address two 
priorities. First, we believe that in disaster situations, to the 
extent that the statute permits, the policy should facilitate the 
continuity of GME, minimizing the disruption of residency training. 
Second, the policy should take into account that the training programs 
in the section 1135 emergency area have been severely disrupted by a 
disaster and that the hospitals affected by the disaster will usually 
want to rebuild their GME programs as soon as possible.

B. Additional Changes in This Interim Final Rule With Comment Period

1. Summary of Regulatory Changes
    Since the establishment of the emergency provisions in the April 
12, 2006 interim final rule with comment period, we have been 
monitoring the application of the emergency Medicare GME affiliation 
agreement rules in order to assess whether those regulatory changes 
were adequate to address the needs of hospitals located in the section 
1135 emergency area in the aftermath of Hurricanes Katrina and Rita. We 
understand that hospitals with GME programs in the section 1135 area 
continue to find it necessary to adjust the location of resident 
training both within and outside the emergency area, as affected 
hospitals continue to reopen beds at different rates, and as feedback 
from accreditation surveys warrants educational adjustments. 
Furthermore, stakeholders in Louisiana have informed CMS that they 
believe fluidity in GME programs will continue for several more years, 
and are not likely to stabilize until permanent replacement facilities 
are established and functioning in the emergency area. As a result, we 
believe the provisions first established in the April 12, 2006 interim 
final rule need to be further modified to meet the two priorities 
stated earlier. Therefore, through this interim final rule with comment 
period, we are modifying the regulations for emergency Medicare GME 
affiliated groups at Sec.  413.79(f)(6) to provide continuing relief to 
home and host hospitals affected by disruptions in residency programs 
in the section 1135 emergency area declared after Hurricanes Katrina 
and Rita, as well as to provide relief for similar challenges in any 
future emergency situation. We note that we did receive a number of 
comments on the interim final rule with comment period issued on April 
12, 2006. However, we believe it would be beneficial to provide the 
public with the opportunity to submit formal comments on these latest 
changes in the context of the current training situation in the area 
affected by Hurricanes Katrina and Rita. We intend to respond to 
comments submitted on both this interim final rule with comment period 
and the April 12, 2006 interim final rule with comment period in a 
future final rule.
    Under existing regulations, the emergency Medicare GME affiliation 
agreement must be written, signed, and dated by responsible 
representatives of each participating hospital and must: (1) List each 
participating hospital and its provider number, and specify whether the 
hospital is a home or host hospital; (2) specify the effective period 
of the

[[Page 66896]]

emergency Medicare GME affiliation agreement (which must, in any event, 
terminate at the conclusion of two academic years following the 
academic year in which the section 1135 emergency period began); (3) 
list each participating hospital's IME and direct GME FTE caps in 
effect for the current academic year before the emergency Medicare GME 
affiliation (that is, if the hospital was already a member of a regular 
Medicare GME affiliated group before entering into the emergency 
Medicare GME affiliation, the emergency Medicare GME affiliation must 
be premised on the FTE caps of the hospital as adjusted per the regular 
Medicare GME affiliation agreement, and not include any slots gained 
under section 422 of the MMA); and (4) specify the total adjustment to 
each hospital's FTE caps in each year that the emergency Medicare GME 
affiliation agreement is in effect, for both direct GME and IME, that 
reflects a positive adjustment to the host hospital's direct and 
indirect FTE caps that is offset by a negative adjustment to the home 
hospital's (or hospitals') direct and indirect FTE caps of at least the 
same amount. The sum total of all the participating hospitals' FTE caps 
under the emergency Medicare GME affiliation agreement may not exceed 
the aggregate adjusted caps of the hospitals participating in the 
emergency Medicare GME affiliated group. A home hospital's IME and 
direct GME FTE cap reduction under an emergency Medicare GME 
affiliation agreement is limited to the home hospital's IME and direct 
GME FTE resident caps in effect for the academic year, in accordance 
with regulations at Sec.  413.79(c) or Sec.  413.79 (f)(1) through 
(f)(5), that is, the hospital's base year FTE resident caps as adjusted 
by any and all existing affiliation agreements in effect as of the 
first day of the section 1135 period. Finally, as we stated in the 
April 12, 2006 interim final rule with comment period, amendments to 
the emergency Medicare GME affiliation agreement to adjust the 
distribution of the FTE resident caps specified in the original 
emergency Medicare GME affiliation among the hospitals that are part of 
the emergency Medicare GME affiliated group in order to reflect the 
actual placement of residents can be made through June 30 of the 
academic year for which it is effective. [71 FR 18662]
    In this interim final rule with comment period, we are further 
modifying the regulations at Sec.  413.75(b) and Sec.  413.79(f) to 
allow hospitals to enter into emergency Medicare GME affiliation 
agreements with the following increased flexibility. First, for 
emergency Medicare GME affiliation agreements involving a host hospital 
located in a different State from the home hospital (hereinafter, an 
``out-of-State host hospital''), the permissible effective period for 
such agreements is extended from up to 3 years (i.e., the year in which 
the section 1135 emergency period began plus two subsequent academic 
years) to up to 5 years (i.e., the year in which the section 1135 
emergency period began plus four subsequent academic years). However, 
emergency Medicare GME affiliation agreements involving out of State 
host hospitals during these two additional periods may only apply with 
respect to the actual residents that were displaced from training in a 
hospital located in the section 1135 emergency area. By ``actual 
residents that were displaced from training in a hospital located in 
the section 1135 area,'' we mean residents in an approved medical 
residency training program at a home hospital at the time of the 
disaster that were either actually training at the home hospital or 
were scheduled to rotate to the home hospital during the training 
program. For emergency Medicare GME affiliation agreements involving a 
host hospital located in the same State as the home hospital 
(hereinafter, an ``in-State host hospital''), the permissible effective 
period for such agreements is extended from up to 3 years to up to 5 
years for any resident (even those not displaced from training in a 
hospital located in the 1135 emergency area). Emergency Medicare GME 
affiliation agreements involving in-State host hospitals during these 
additional two academic years need not apply only with respect to the 
actual residents that were displaced immediately following the 
disaster. In other words, such agreements may apply with respect to 
residents that were actually displaced as a result of the disaster, as 
well as to new residents that were not training in the program at the 
time the disaster occurred. With the 2-year extension described above, 
the effective period of an emergency Medicare GME affiliation agreement 
may begin with the first day of a section 1135 emergency period, and 
must terminate no later than at the end of the fourth academic year 
following the academic year during which the section 1135 emergency 
period began (for Hurricanes Katrina and Rita, this would be June 30, 
2010). As home hospitals recover the ability to train residents after a 
disaster, the effective period for emergency Medicare GME affiliation 
agreements is intended to allow home hospitals to balance their desire 
to return residents to their original training sites, with their need 
to be given the opportunity to rebuild their programs incrementally. We 
believe extending the applicability of emergency affiliations for out 
of State host hospitals for 2 years (for a total of up to 5 years) only 
for the actual residents displaced from home hospitals allows such 
displaced residents to complete their training outside the affected 
area while providing an incentive for home hospitals to begin training 
new incoming residents locally (or closer to the home hospital), 
increasing the likelihood for the residents to stay and practice in the 
area after their training is completed. Affected hospitals in the New 
Orleans area have informed CMS that residents will tend to go into 
practice where they train. We believe this makes intuitive sense and 
the policy established in this interim final rule with comment period 
will provide additional impetus for residents to return to the State 
where their ``home hospital'' is located, increasing the odds that the 
physicians will stay and practice there, and encouraging regeneration 
of the health care system affected by the section 1135 emergency. We 
note that this is consistent with needs expressed by affected hospitals 
in the New Orleans area for more physicians to replace the large 
numbers that left immediately after the hurricane Furthermore, after 
the expiration of the initial 3 years of the emergency Medicare GME 
affiliation agreement effective period, we believe it would be 
appropriate to begin bringing emergency Medicare GME affiliation rules 
into accord with regular Medicare GME affiliation rules which specify 
geographical limits. That is, regular Medicare GME affiliation rules 
limit hospitals geographically to affiliations with other hospitals 
that are located in the same urban or rural area (as those terms are 
defined under Sec.  412.62(f)) or in a contiguous area.
    In addition, home or host hospitals that have emergency Medicare 
GME affiliation agreements and are training displaced residents in 
nonhospital sites are permitted to submit written agreements with 
nonhospital sites, as described under Sec.  413.78, that may be 
effective beginning with the first day of the section 1135 emergency 
period to cover the displaced residents training at nonhospital sites. 
We discuss the policy for training that occurs in the nonhospital 
setting and the requirements for written agreements in further detail 
in the following section. However, in brief, this interim final rule 
with comment period provides hospitals

[[Page 66897]]

that are participating in emergency Medicare GME affiliation agreements 
with increased flexibility in submitting written agreements relating to 
training that occurs in nonhospital sites. Home or host hospitals with 
valid emergency Medicare GME affiliation agreements training displaced 
residents in a nonhospital site may submit a copy of the written 
agreement, as specified under Sec.  413.78(e)(iii) and (f)(iii) as 
applicable, to the CMS contractor servicing the hospital by 180 days 
after the first day the resident began training at the nonhospital 
site. We note that, as with the existing rules for written agreements 
specified at Sec.  413.78(f), adjustments to the amounts specified (in 
other words, the total program costs and the portion of certain costs 
to be incurred by the hospital) in the written agreement can be made 
through June 30 of the academic year for which it is effective.
    Furthermore, under current rules, hospitals that are training 
residents at nonhospital sites have two options as specified by the 
regulations at Sec.  413.78(e). That is, hospitals must either have a 
written agreement in place before the training occurs or they must pay 
``all or substantially all'' of the costs for the training program in 
the nonhospital setting attributable to training that occurs during a 
month by the end of the third month following the month in which the 
training in the nonhospital site occurred. We discuss this ``concurrent 
payment'' option in more detail in the following section. In this 
interim final rule with comment period, we are providing additional 
flexibility in the ``concurrent payment'' option for home or host 
hospitals that have emergency Medicare GME affiliation agreements and 
are training displaced residents in nonhospital sites by extending the 
time allowable for ``concurrent payment'' from 3 months to 6 months. 
That is, a home or host hospital with a valid emergency Medicare GME 
affiliation agreement is permitted to incur ``all or substantially 
all'' of the costs for the training program in the nonhospital setting 
attributable to training that occurs during a month by the end of the 
sixth month following the month in which the training in the 
nonhospital site occurred.
    In the case of the section 1135 emergency resulting from Hurricanes 
Katrina and Rita, the time limit we are adopting to submit written 
agreements or to meet the ``concurrent payment'' requirement may have 
already passed. Therefore, as discussed in detail in the following 
section, we are providing that, for residents training in nonhospital 
sites during the period of August 29, 2005, to November 1, 2007, home 
or host hospitals with valid emergency Medicare GME affiliation 
agreements may submit written agreements or incur ``all or 
substantially all'' of the costs of the training program (that is, the 
``concurrent payment'' option) to cover those specific residents by 
April 29, 2008.
    Based on what we have learned about the impact of a disaster on 
teaching hospitals, we continue to believe it is necessary to provide 
hospitals with greater flexibility to distribute FTE resident caps 
within a group of home and host hospitals if there is an emergency at a 
home hospital resulting in the designation of a section 1135 emergency 
area. We believe that this modified emergency Medicare GME affiliation 
policy will allow affected hospitals an appropriate degree of 
flexibility following the disaster so that residents displaced by the 
disaster can continue their residency training at other hospitals, 
while the home hospitals can remain committed to reopening their 
programs.
    Emergency Medicare GME affiliation agreements should be submitted 
to: Centers for Medicare & Medicaid Services, Division of Acute Care, 
Attention: Elizabeth Truong or Renate Rockwell,Mailstop C4-08-06, 7500 
Security Boulevard, Baltimore, MD 21244.
    ``Emergency Medicare GME Affiliation Agreement'' should be clearly 
labeled on the outside envelope.
2. Discussion of Training in Nonhospital Settings
    Under the existing regulations at Sec.  413.78(e) and (f), for 
portions of cost reporting periods occurring on or after October 1, 
2004, the time residents spend in nonhospital settings such as 
freestanding clinics, nursing homes, and physicians' offices in 
connection with approved programs may be included in determining the 
hospital's number of FTE residents for purposes of calculating both 
direct GME and IME payments, if all of the following conditions are 
met:
    (1) The resident spends his or her time in patient care activities.
    (2) The hospital incurs ``all or substantially all'' of the costs 
for the training program in the nonhospital setting. In the May 11, 
2007 final rule (72 FR 26948), we revised the definition of ``all or 
substantially all of the costs for the training program in the 
nonhospital setting'' to mean: (a) Effective on or after January 1, 
1999 and for cost reporting periods beginning before July 1, 2007, the 
residents'' salaries and fringe benefits (including travel and lodging 
where applicable) and the portion of the cost of teaching physicians'' 
salaries and fringe benefits attributable to direct graduate medical 
education (GME); and (b) effective for cost reporting periods beginning 
on or after July 1, 2007, at least 90 percent of the total of the costs 
of the residents'' salaries and fringe benefits (including travel and 
lodging where applicable) and the portion of the cost of teaching 
physicians'' salaries attributable to non-patient care direct GME 
activities.
    (3) There is a written agreement between the hospital and the 
nonhospital site that indicates that the hospital will incur the costs 
of the resident's salary and fringe benefits while the resident is 
training in the nonhospital site, and the hospital is providing 
reasonable compensation to the nonhospital site for supervisory 
teaching activities. The agreement must indicate the compensation the 
hospital is providing to the nonhospital site for supervisory teaching 
activities. In addition, in the same May 11, 2007 final rule cited 
above, we clarified the regulations at Sec.  413.78(f)(3)(ii) to 
specify that the written agreement must be in place between the 
hospital and the nonhospital site before the training begins in that 
nonhospital site. We also specified that the written agreement must 
specify the total cost of the training program in the nonhospital site, 
the amount of the total cost that the hospital will incur (at least 90 
percent of the total cost of the training program), and must indicate 
the portion of the amount the hospital will incur that reflects 
residents'' salaries and fringe benefits (and travel and lodging where 
applicable), and the portion of the amount the hospital will incur that 
reflects teaching physician compensation. Furthermore, we revised the 
regulations to indicate that the amounts specified in the written 
agreement may be modified by June 30 of the applicable academic year.
    (4) Alternatively, for portions of cost reporting periods occurring 
on or after October 1, 2004, hospitals have two options as specified by 
the regulations at Sec.  413.78(e). Hospitals must either have a 
written agreement in place before the training occurs or they must 
incur ``all or substantially all'' of the costs for the training 
program in the nonhospital setting attributable to training that occurs 
during a month by the end of the third month following the month in 
which the training in the nonhospital site occurred (the ``concurrent 
payment'' option).
    For a more detailed discussion on the requirements a hospital must 
meet in order to count residents training in

[[Page 66898]]

nonhospital sites for IME and direct GME payment purposes, we refer 
readers to the May 11, 2007 final rule (72 FR 26948 through 26977).
    Recently, it has come to our attention that in the wake of 
Hurricanes Katrina and Rita, host hospitals, many of which received 
large numbers of displaced residents, were hard-pressed to find 
training sites for these unanticipated residents. Many host hospitals 
called upon community physician practices, clinics, and other 
nonhospital settings to supplement existing training locations and 
accommodate the displaced residents. Some of the host hospitals that 
took in displaced residents had never before had any residency training 
programs, and were therefore new to Medicare rules regarding graduate 
medical education. In the haste and confusion surrounding this 
unprecedented displacement of residents, many host hospitals arranged 
for displaced residents to begin training in nonhospital sites without 
first establishing a written agreement, as specified in Sec.  
413.78(e), between the hospital and nonhospital site. Similarly, home 
hospitals that may have sent some of their residents away to train at 
host hospitals while continuing to train a reduced number of residents 
in the home hospital program, may find that the usual nonhospital sites 
for the residents in that program have also been negatively affected by 
the disaster. Consequently, home hospitals may have hastily arranged 
for displaced residents to begin training in nonhospital sites and due 
to the reduced administrative capability in the aftermath of the 
disaster, home hospitals may not have been able to establish a written 
agreement, as specified in Sec.  413.78(e), with the nonhospital site 
before residents started training in the nonhospital site. Also, in the 
confusion and haste under which arrangements were made for displaced 
residents to train in nonhospital sites, many hospitals did not 
actually incur all or substantially all of the costs of the training 
program in the nonhospital site in accordance with our regulations at 
Sec.  413.78(e)(3)(i) or (f)(3)(i).
    In the April 12, 2006 interim final rule with comment period, we 
did not specifically mention the policies that pertain to training in 
nonhospital sites, although we did indicate that, to determine direct 
GME and IME payments under an emergency Medicare GME affiliation, all 
of the normal rules for counting FTEs as specified at Sec.  413.78 
apply. Based on what we have learned since the occurrence of Hurricanes 
Katrina and Rita, we believe it would be appropriate to provide home 
hospitals that have been adversely affected by the disaster and host 
hospitals that accept residents pursuant to an emergency Medicare GME 
affiliation agreement greater flexibility in the timeframes for 
compliance with our nonhospital site policies. Consequently, we are 
providing additional flexibility in regards to the submission of 
written agreements by home and host hospitals by specifying in this 
interim final rule with comment period that home or host hospitals with 
a valid emergency Medicare GME affiliation agreement may submit the 
written agreement required under our regulations even after the 
residents have begun training at the nonhospital site. The submission 
deadline for written agreements after a disaster is subject to the 
following requirements: (1) A home or host hospital must be 
participating in a valid emergency Medicare GME affiliation and (2) a 
home or host hospital training displaced residents in a nonhospital 
site must submit a copy of the written agreement, subject to the 
requirements of a written agreement as specified under Sec.  413.78 
(e)(iii) or (f)(iii) as applicable, to the CMS fiscal intermediary or 
MAC servicing the hospital by 180 days after the first day the resident 
began training at the nonhospital site. We are also specifying that 
amendments to the written agreement can be made through June 30 of the 
academic year for which it is effective.
    Furthermore, as we discussed above, under current rules hospitals 
that are training residents at nonhospital sites have the option of 
paying ``all or substantially all'' of the costs for the training 
program in the nonhospital setting attributable to training that occurs 
during a month by the end of the third month following the month in 
which the training in the nonhospital site occurred. For the same 
reasons cited above supporting our belief that it is appropriate to 
extend the deadline to submit written agreements after a disaster, we 
are also providing additional flexibility in the ``concurrent payment'' 
option for home or host hospitals that have emergency Medicare GME 
affiliation agreements and are training displaced residents in 
nonhospital sites by extending the time allowable for ``concurrent 
payment'' from 3 months to 6 months. That is, a home or host hospital 
with a valid emergency Medicare GME affiliation agreement is permitted 
to pay ``all or substantially all'' of the costs for the training 
program in the nonhospital setting attributable to training that occurs 
during a month by the end of the sixth month following the month in 
which the training in the nonhospital site occurred.
    In the case of Hurricanes Katrina and Rita, the time limits we are 
adopting regarding the submission of written agreements to cover 
residents training in nonhospital sites for home or host hospitals with 
a valid emergency Medicare GME affiliation agreement may have already 
passed. Therefore, we are providing that a home or host hospitals with 
valid emergency Medicare GME affiliation agreements may submit written 
agreements to cover residents training in nonhospital sites during the 
period of August 29, 2005, to November 1, 2007, by April 29, 2008. 
Similarly, for residents training in nonhospital sites during the 
period of August 29, 2005, to November 1, 2007, home or host hospitals 
with valid emergency Medicare GME affiliation agreements may pay ``all 
or substantially all'' of the costs of the training program (i.e., the 
``concurrent payment'' option) to cover those specific residents by 
April 29, 2008.

C. Response to Comments on the April 12, 2006 Interim Final Rule With 
Comment Period and This Interim Final Rule With Comment Period

    We note that we did receive a number of comments on the interim 
final rule with comment issued on April 12, 2006. We believe it would 
be beneficial to provide the public with the opportunity to submit 
formal comments on the latest changes in this interim final rule with 
comment period in the context of the current training situation in the 
area affected by Hurricanes Katrina and Rita. We intend to respond to 
comments submitted on both this interim final rule with comment period 
(to be submitted as specified in the ADDRESSES section of this 
document) and the April 12, 2006 interim final rule with comment period 
in a future final rule.

XXI. Files Available to the Public Via the Internet

A. Information in Addenda Related to the Revised CY 2008 Hospital OPPS

    Addenda A and B to this final rule with comment period provide 
various data pertaining to the CY 2008 payment for items and services 
under the OPPS. Addendum A, which includes a complete list of all APCs 
payable under the OPPS, and Addendum B, which includes a complete list 
of all active HCPCS codes for CY 2008 and all currently active HCPCS 
codes that will be discontinued at the end of CY 2007 with assigned 
payment status and comment indicators, are available to the

[[Page 66899]]

public by clicking ``Addendum A and Addendum B Updates'' on the CMS Web 
site at: http://www.cms.hhs.gov/HospitalOutpatientPPS/.
    For the convenience of the public, we are also including on the CMS 
Web site a table that displays the HCPCS data in Addendum B sorted by 
APC assignment, identified as Addendum C.
    Addendum D1 defines payment status indicators that are used in 
Addenda A and B. Addendum D2 defines comment indicators that are used 
in Addendum B. Addendum E lists HCPCS codes that are only payable as 
inpatient procedures and are not payable under the OPPS. Addendum L 
contains the out-migration wage adjustment for CY 2008. Addendum M 
lists the HCPCS codes that are members of a composite APC and 
identifies the composite APC to which they are assigned. This addendum 
also identifies the status indicator for the code and a comment 
indicator if there has been a change in the code's status with regard 
to its membership in the composite APC. Each of the HCPCS codes 
included in Addendum M has a single procedure payment APC, listed in 
Addendum B, to which it is assigned when the criteria for assignment to 
the composite APC are not met. When the criteria for payment of the 
code through the composite APC are met, one unit of the composite APC 
payment is paid, thereby providing packaged payment for all services 
that are assigned to the composite APC according to the specific 
Outpatient Code Editor (OCE) logic that applies to the APC. We refer 
readers to the discussion of composite APCs in section II.A.4.d of this 
final rule with comment period for a complete description of the 
composite APCs.
    Those addenda and other supporting OPPS data files are available on 
the CMS Web site at: http://www.cms.hhs.gov/HospitalOutpatientPPS/.

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

    Addenda AA, BB, DD1, and DD2 to this final rule with comment period 
provide various data pertaining to the ASC covered surgical procedures 
and the covered ancillary services for which ASCs may receive separate 
payment beginning in CY 2008 when the ancillary service provided in the 
ASC is integral to a covered surgical procedure and provided 
immediately before, during, or immediately following the covered 
surgical procedure. All relative payment weights and payment rates are 
final for CY 2008 as a result of applying the revised ASC payment 
system methodology established in the final rule for the revised ASC 
payment system published in the Federal Register on August 2, 2007 (72 
FR 42470) to the final CY 2008 OPPS and MPFS ratesetting information.
    Addendum DD1 defines the payment indicators that are used in 
Addenda AA and BB to this final rule with comment period. Addenda AA 
and BB provide payment information regarding covered surgical 
procedures and covered ancillary services under the revised ASC payment 
system. Addendum DD2 defines the comment indicators that we are using 
to provide additional information about the status of ASC covered 
surgical procedures and covered ancillary services.
    Addendum EE (available only on the Internet) lists the surgical 
procedures that are excluded from Medicare payment in ASCs. The 
excluded procedures listed in Addendum EE are surgical procedures that 
either are assigned to the OPPS inpatient list, are not covered by 
Medicare, are reported using a CPT unlisted code, or are determined to 
pose a significant safety risk or are expected to require an overnight 
stay when performed in ASCs.
    Those addenda and other supporting ASC data files are included on 
the CMS Web site at: http://www.cms.hhs.gov/ASCPayment/ in a format 
that can be easily downloaded and manipulated. The final ASC relative 
weights and payment rates for CY 2008 are published in this CY 2008 
OPPS/ASC final rule with comment period, and related data files are 
included on the CMS Web site as noted above. MPSF data files are 
located at http://www.cms.hhs.gov/PhysicianFeeSched/.
    The links to all of the FY 2008 IPPS wage index related tables 
(that are used for the CY 2008 OPPS) from the FY 2008 IPPS final rule 
with comment period (72 FR 47436 through 47539) as corrected in the 
October 10, 2007 Federal Register notice to the FY 2008 IPPS final rule 
with comment period (72 FR 57634 through 57738) are accessible on the 
CMS Web site at: http://www.cms.hhs.gov/AcuteInpatientPPS/WIFN/
list.asp#TopOfPage.
    For additional assistance, contact Chuck Braver, (410) 786-6719.

XXII. Collection of Information Requirements

    Under the Paperwork Reduction Act of 1995, we are required to 
provide 30-day notice in the Federal Register and solicit public 
comment when a collection of information requirement is submitted to 
the Office of Management and Budget (OMB) for review and approval. In 
order to fairly evaluate whether an information collection should be 
approved by OMB, section 3506(c)(2)(A) of the Paperwork Reduction Act 
of 1995 (PRA) requires that we solicit comment on the following issues:
     The need for the information collection and its usefulness 
in carrying out the proper functions of our agency.
     The accuracy of our estimate of the information collection 
burden.
     The quality, utility, and clarity of the information to be 
collected.
     Recommendations to minimize the information collection 
burden on the affected public, including automated collection 
techniques.
    In the CY 2008 OPPS/ASC proposed rule, we solicited public comment 
on each of these issues for the following sections included in the 
proposed rule that contain information collection requirements.
    Section 419.43(h) Adjustment to national program payment and 
beneficiary copayment amounts: Applicable adjustments to conversion 
factor for CY 2009 and for subsequent calendar years
    Section 419.43(h) requires hospitals, in order to qualify for the 
full annual update, to submit quality data to CMS, as specified by CMS. 
In the proposed rule, we proposed the specific requirements related to 
the data that must be submitted for the update for CY 2009. The burden 
associated with this section is the time and effort associated with 
collecting and submitting the data, completing participating forms and 
submitting charts. We estimate that there will be approximately 3,500 
respondents per year.
    For hospitals to collect and submit the information on the required 
measures, we estimate it will take 30 minutes per sampled case. 
Further, based on an estimated ten percent sample size and estimated 
populations of 2.5-5 million outpatient visits per measure, we estimate 
a total of 1,800,000 cases per year. In addition, we estimate that 
completing participation forms with require approximately 4 hours per 
hospital per year. We expect the burden for all of these hospitals to 
total 914,000 hours per year.
    In this final rule with comment period, for CY 2009, we have 
delayed implementation of our validation process which will require 
participating hospitals to submit 5 charts. The burden associated with 
this requirement is the time and effort associated with collecting, 
copying, and submitting these charts. It will take approximately 2 
hours per hospital to submit the 5 charts. There will be a total of 
approximately 17,500 charts (3,500

[[Page 66900]]

hospitals x 5 charts per hospital) submitted by the hospitals to CMS 
for a total burden of 7,000 hours. However, as noted above, this 
validation process will not apply for the CY 2009 update. Therefore, we 
expect the total burden for all hospitals for the CY 2009 updates to be 
921,000 hours per year.
    In section XVII.J. of this final rule with comment period, we are 
finalizing a provision from the FY 2008 IPPS final rule with comment 
period relating to the FY 2009 RHQDAPU quality measure set to include 
SCIP Infection 4: Cardiac Surgery Patients with Controlled 6AM 
Postoperative Serum Glucose and SCIP Infection 6: Surgery Patients with 
Appropriate Hair Removal, bringing the total number of measures in that 
measure set to 30.) The burden associated with the collection of these 
two measures was included in the burden estimates in the FY 2008 IPPS 
final rule with comment period (72 FR 47409 and 48169). There is no 
additional burden imposed in this final rule with comment period.
    Section 482.22 Condition of participation: Medical staff
    We proposed under Sec.  482.22(c)(5)(i) to require that a medical 
history and physical examination be completed and documented no more 
than 30 days before or 24 hours after admission or registration, but 
prior to surgery or a procedure requiring anesthesia services, for each 
patient by a physician (as defined in section 1861(r) of the Act), an 
oromaxillofacial surgeon, or other qualified licensed individual in 
accordance with State law and hospital policy.
    The burden associated with this requirement is the time and effort 
it would take for medical staff to document the patient's medical 
history and the results of a physical examination. While the burden 
associated with this proposed requirement is subject to the PRA, we 
believe the burden is exempt as defined in 5 CFR 1320.3(b)(2) because 
the time, effort, and financial resources necessary to comply with the 
requirement would be incurred by persons in the normal course of their 
activities.
    We proposed under Sec.  482.22(c)(5)(ii) to require that an updated 
examination of the patient, including any changes in the patient's 
condition, be completed and documented within 24 hours after admission 
or registration, but prior to surgery or a procedure requiring 
anesthesia services, when the medical history and physical examination 
are completed within 30 days before admission or registration. The 
updated examination must also be completed and documented by the 
individuals as required under Sec.  482.22(c)(5)(i).
    The burden associated with this proposed requirement is the time 
and effort it would take for medical staff to document any changes in 
the patient's condition. While the burden associated with this proposed 
requirement is subject to the PRA, we believe the burden is exempt as 
defined in 5 CFR 1320.3(b)(2) because the time, effort, and financial 
resources necessary to comply with the requirement would be incurred by 
persons in the normal course of their activities.
    Section 482.24 Condition of participation: Medical record services
    We proposed under Sec.  482.24(c)(2)(i) to require evidence of:
    (A) A medical history and physical examination completed and 
documented no more than 30 days before or 24 hours after admission or 
registration, but prior to surgery or a procedure requiring anesthesia 
services. The medical history and physical examination must be placed 
in the patient's medical record within 24 hours after admission or 
registration, but prior to surgery or a procedure requiring anesthesia.
    (B) An updated examination of the patient, including any changes in 
the patient's condition, when the medical history and physical 
examination are completed within 30 days before admission or 
registration. Documentation of the updated examination must be placed 
in the patient's medical record within 24 hours after admission or 
registration, but prior to surgery or a procedure requiring anesthesia 
services.
    While the burden associated with these two proposed requirements is 
subject to the PRA, we believe the burden is exempt as defined in 5 CFR 
1320.3(b)(2) because the time, effort, and financial resources 
necessary to comply with the requirement would be incurred by persons 
in the normal course of their activities.
    Section 482.51 Condition of participation: Surgical services
    We proposed under Sec.  482.51(b)(1) to require medical staff, 
prior to surgery or a procedure requiring anesthesia services, and 
except in the case of emergencies, to document no more than 30 days 
before or 24 hours after admission or registration a patient's medical 
history, the results of the patient's physical examination, and any 
changes in the patient's condition.
    While the burden associated with these requirements is subject to 
the PRA, we believe the burden is exempt as defined in 5 CFR 
1320.3(b)(2) because the time, effort, and financial resources 
necessary to comply with the requirement would be incurred by persons 
in the normal course of their activities.
    Section 482.52 Condition of participation: Anesthesia services
    We proposed under Sec.  482.52(b)(1) to require a preanesthesia 
evaluation to be completed and documented by an individual qualified to 
administer anesthesia, performed within 48 hours prior to surgery or a 
procedure requiring anesthesia services. We proposed under Sec.  
482.52(b)(3) to require a postanesthesia evaluation to be completed and 
documented by an individual qualified to administer anesthesia, after 
surgery or a procedure requiring anesthesia services, but before 
discharge or transfer from the postanesthesia recovery area.
    As discussed in section XVIII.B.2. of this final rule with comment 
period, in response to public comments, we have revised Sec.  
482.52(b)(3) to specify that a postanesthesia evaluation must be 
completed and documented no later than 48 hours after surgery or a 
procedure requiring anesthesia services. The postanesthesia evaluation 
must be completed in accordance with State law and with hospital 
policies and procedures that are approved by the medical staff and that 
reflect current standards of anesthesia care.
    While the burden associated with these requirements is subject to 
the PRA, we believe the burden is exempt as defined in 5 CFR 
1320.3(b)(2) because the time, effort, and financial resources 
necessary to comply with the requirement would be incurred by persons 
in the normal course of their activities.
    In section XX. of this document, we are specifying the requirement 
for the submittal of emergency Medicare GME affiliation agreements 
under the provisions of Sec.  413.79(f) of the regulations by hospitals 
in declared emergency areas. The burden associated with this 
requirement is the time and effort it would take for the GME affiliated 
hospital to develop and submit the emergency Medicare GME affiliation 
agreement. It is difficult for us to determine estimated annual burden 
because we do not know how many hospitals will be affected in any given 
disaster. It would depend on what resources are available to the 
affected hospitals after sustaining damage from the disaster. This 
could take a few hours per hospital or much longer depending on if they 
keep records available and current. Hospitals also have to coordinate 
with other hospitals to draw up an affiliation agreement which may

[[Page 66901]]

take more time if the hospitals have to negotiate.
    We have submitted a copy of this final rule with comment period and 
this interim final rule with comment period to OMB for its review of 
the information collection requirements described above. These 
requirements are not effective until they have been approved by OMB.
    If you comment on these information collection and recordkeeping 
requirements, please mail copies directly to the following:

Centers for Medicare & Medicaid Services, Office of Strategic 
Operations and Regulatory Affairs, Division of Regulations Development, 
Attn: Melissa Musotto, (CMS-1392-FC for OPPS/ASC matters, or CMS-1531-
IFC2, for Medicare GME Affiliation Agreement matters) Room C4-26-05, 
7500 Security Boulevard, Baltimore, MD 21244-1850; and
Office of Information and Regulatory Affairs, Office of Management and 
Budget, Room 10235, New Executive Office Building, Washington, DC 
20503, Attn: Carolyn Lovett, CMS Desk Officer, CMS-1392-FC for OPPS/ASC 
matters, or CMS-1531-IFC2, for Medicare GME Affiliation Agreement 
matters carolyn--lovett@ omb.eop.gov. Fax (202) 395-6974.

XXIII. Response to Comments

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

XXIV. Regulatory Impact Analysis

A. Overall Impact

    We have examined the impacts of this final rule with comment period 
as required by Executive Order 12866 (September 1993, Regulatory 
Planning and Review), the Regulatory Flexibility Act (RFA) (September 
19, 1980, Public Law 96-354), section 1102(b) of the Social Security 
Act, the Unfunded Mandates Reform Act of 1995 (Public Law 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 effects of the OPPS provisions that would be 
implemented by this final rule with comment period will result in 
expenditures exceeding $100 million in any 1 year. We estimate the 
total increase (from changes in this final rule with comment period as 
well as enrollment, utilization, and case-mix changes) in expenditures 
under the OPPS for CY 2008 compared to CY 2007 to be approximately $3.4 
billion.
    We estimate that implementing the revised ASC payment system in CY 
2008 based on the August 2, 2007 final rule for the revised ASC payment 
system and the final policies in this CY 2008 OPPS/ASC final rule with 
comment period (such as adding 11 procedures to the ASC list of covered 
surgical procedures and designating 18 additional procedures as office-
based) will have no net effect on Medicare expenditures in CY 2008 
compared to the level of 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 XXIV.C. of this final rule 
with comment period.
    While we estimate that there will be no net change in Medicare 
expenditures in CY 2008 as a result of implementing the revised ASC 
payment system and the ASC provisions of this final rule with comment 
period, we estimate that the revised system will result in savings of 
$220 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 that there will be a total increase in Medicare 
payments to ASCs of approximately $240 million for CY 2008 compared to 
Medicare expenditures that would have occurred in the absence of the 
revised payment system. These additional payments to ASCs of 
approximately $240 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, as described in 
detail in section XVI.L. of this final rule with comment period.
    Our estimate in this final rule with comment period of 5-year 
savings as a result of the revised ASC payment system and our estimate 
of additional payments to ASCs in CY 2008 differ slightly from the 
estimates presented in the August 2, 2007 revised ASC payment system 
final rule. The ASC budget neutrality adjustment and the resulting 
savings estimates in the August 2, 2007 final rule are calculated using 
CY 2005 utilization data, the current CY 2007 OPPS relative weights 
with an estimated update factor for CY 2008, and the CY 2007 MPFS PE 
RVUs trended forwarded to CY 2008. The ASC budget neutrality adjustment 
and the resulting savings estimates in this final rule with comment 
period are calculated using the newly available CY 2006 utilization 
data, the CY 2008 OPPS relative payment weights finalized in this final 
rule with comment period, and the CY 2008 MPFS PE RVUs finalized in the 
CY 2008 MPFS final rule. As we indicated in the August 2, 2007 revised 
ASC payment system final rule, the estimates in that rule were meant to 
be illustrative of the final policies only, in large part because we 
used the existing CY 2007 OPPS relative payment weights and the 
existing CY 2007 MPFS PE RVUs to estimate the CY 2008 values. Because 
the savings estimates in this final rule with comment period are based 
on the final CY 2008 OPPS relative payment weights that have just 
become available in this final rule with comment period and the final 
CY 2008 MPFS PE RVUs that recently became available in the CY 2008 MPFS 
final rule with comment period, the estimates in this final rule with 
comment period based on that newly available information represent our 
best estimates at this time.
    This final rule with comment period is an economically significant 
rule under Executive Order 12866, and a major rule under 5 U.S.C. 
804(2).
2. Regulatory Flexibility Act (RFA)
    The RFA requires agencies to determine whether a rule would have a 
significant economic impact on a substantial number of small entities. 
For purposes of the RFA, small entities include small businesses, 
nonprofit organizations, and small governmental jurisdictions. Most 
hospitals and most other providers and suppliers are small entities, 
either by nonprofit status or by having average annual revenues of $31 
million or less.
    For purposes of the RFA, we have determined that approximately 37 
percent of hospitals and 73 percent of

[[Page 66902]]

ASCs would be considered small entities according to the Small Business 
Administration (SBA) size standards. (We refer readers to the standards 
at the Web site: http://www.sba.gov/idc/groups/public/documents/serv_sstd_tablepdf.pdf). Individuals and States are not included in the 
definition of a small entity.
    Not-for-profit organizations are also considered to be small 
entities under the RFA. There are 2,141 voluntary hospitals that we 
consider to be not for-profit organizations to which this final rule 
with comment period applies.
3. Small Rural Hospitals
    In addition, section 1102(b) of the Act requires us to prepare a 
regulatory impact analysis if a rule may have a significant impact on 
the operations of a substantial number of small rural hospitals. This 
analysis must conform to the provisions of section 604 of the RFA. With 
the exception of hospitals located in certain New England counties, for 
purposes of section 1102(b) of the Act, we previously defined a small 
rural hospital as a hospital with fewer than 100 beds that is located 
outside of a Metropolitan Statistical Area (MSA) (or New England County 
Metropolitan Area (NECMA)). However, under the new labor market 
definitions that we adopted in the CY 2005 final rule with comment 
period (consistent with the FY 2005 IPPS final rule), we no longer 
employ NECMAs to define urban areas in New England. Therefore, we now 
define a small rural hospital as a hospital with fewer than 100 beds 
that is located outside of an MSA. Section 601(g) of the Social 
Security Amendments of 1983 (Public Law 98-21) designated hospitals in 
certain New England counties as belonging to the adjacent NECMA. Thus, 
for purposes of the OPPS, we classify these hospitals as urban 
hospitals. We believe that the changes to the OPPS in this final rule 
with comment period rule will affect both a substantial number of rural 
hospitals as well as other classes of hospitals and that the effects on 
some may be significant. The changes to the ASC payment system for CY 
2008 will have no effect on small rural hospitals. Therefore, we 
conclude that this final rule with comment period will have a 
significant impact on a substantial number of small rural hospitals.
4. Unfunded Mandates
    Section 202 of the Unfunded Mandates Reform Act of 1995 (Public Law 
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 with comment period does not mandate any requirements for 
State, local, or tribal government, nor does 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 with comment period in accordance 
with Executive Order 13132, Federalism, and have determined that it 
will not have an impact on the rights, roles, and responsibilities of 
State, local or tribal governments. As reflected in Table 61, we 
estimate that OPPS payments to governmental hospitals (including State 
and local governmental hospitals) will increase by 3.9 percent under 
this final rule with comment period. The provisions related to payments 
to ASCs in CY 2008 will not affect payments to government hospitals.

B. Effects of OPPS Changes in This Final Rule With Comment Period

    We are making several changes to the OPPS that are required by the 
statute. We are required under section 1833(t)(3)(C)(ii) of the Act to 
update annually the conversion factor used to determine the APC payment 
rates. We are also required under section 1833(t)(9)(A) of the Act to 
revise, not less often than annually, the wage index and other 
adjustments. In addition, we must review the clinical integrity of 
payment groups and weights at least annually. Accordingly, in this 
final rule with comment period, we are updating the conversion factor 
and the wage index adjustment for hospital outpatient services 
furnished beginning January 1, 2008, as we discuss in sections II.C. 
and II.D., respectively, of this final rule with comment period. We 
also are revising the relative APC payment weights using claims data 
from January 1, 2006, through December 31, 2006, and updated cost 
report information. In response to a provision in Public Law 108-173 
that we analyze the cost of outpatient services in rural hospitals 
relative to urban hospitals, we are continuing increased payments to 
rural SCHs, including EACHs. Section II.F. of this final rule with 
comment period provides greater detail on this rural adjustment. 
Finally, we are removing one device category, HCPCS code C1820 
(Generator, neurostimulator, (implantable), with rechargeable battery 
and charging system), from pass through payment status in CY 2008.
    Under this final rule with comment period, the update change to the 
conversion factor as provided by statute will increase total OPPS 
payments by 3.3 percent in CY 2008. The one time wage reclassification 
under section 508 expired September 30, 2007, and therefore, is not 
contemplated in this final rule with comment period. The changes to the 
APC weights, including the changes that will result from the expansion 
of packaging, changes to the wage indices, and the continuation of a 
payment adjustment for rural SCHs and EACHs with extension to 
brachytherapy sources in CY 2008 will not increase OPPS payments 
because these changes to the OPPS are budget neutral. However, these 
updates do change the distribution of payments within the budget 
neutral system as shown in Table 61 and described in more detail in 
this section.
1. Alternatives Considered
    Alternatives to the changes we are making and the reasons that we 
have chosen the options are discussed throughout this final rule with 
comment period. Some of the major issues discussed in this final rule 
with comment period and the options considered are discussed below.
a. Alternatives Considered for the Packaging Policies for CY 2008 OPPS
    In section II.A.4.c. of this final rule with comment period, we are 
packaging payment for the following seven categories of ancillary and 
supportive services into payment for the independent service with which 
they are billed. We are also making payment for several composite APCs 
in which a single payment is made for multiple major services that are 
commonly performed on the same date. We discuss below each category of 
services that we are packaging and each set of services for which we 
are establishing a composite APC.
(1) Guidance Services
    We are packaging payment for supportive guidance services into the 
payment for the independent procedure to which the guidance service is 
ancillary and supportive. In the case of one particular guidance 
procedure, which would usually be provided in conjunction with another 
independent procedure but may occasionally be provided without another 
independent service on the same date of service, we

[[Page 66903]]

will permit separate payment if the service is billed without an 
independent procedure on the same date of service. We refer readers to 
section II.A.4.c.(1) of this final rule with comment period for the 
complete discussion of this final policy. We considered several policy 
options for the payment of guidance services in CY 2008.
    The first alternative we considered was to not make any changes to 
packaging for the CY 2008 OPPS. Under this alternative, codes that were 
packaged for CY 2007 would have remained packaged for CY 2008 and codes 
that were separately paid for CY 2007 would have remained separately 
paid for CY 2008. There are a number of CPT codes that describe 
independent surgical procedures for which the code descriptors indicate 
that guidance is included in the code reported for the surgical 
procedure if it is used and, therefore, for which the OPPS already 
makes packaged payment for the associated guidance service. With a 
number of guidance services already packaged, we did not select this 
option in part because we did not want to create financial incentives 
for hospitals to use one form of guidance instead of another or to use 
guidance all the time, even if a procedure could be safely provided 
without guidance. Furthermore, we believe this alternative would not 
provide additional incentives for hospitals to utilize the most cost-
effective and clinically advantageous method of guidance that is 
appropriate in each situation.
    The second alternative we considered was to package the costs of 
guidance services in all cases, without regard to the possibility of 
the service being furnished without an independent service on the same 
date of service. We did not select this alternative because we believe 
that in the case of one particular guidance procedure, the procedure 
may sometimes be appropriately furnished without other independent 
services on the same date and in these cases, we believe that there 
should be separate payment for the guidance service.
    The third alternative we considered, and the alternative we 
selected, was to unconditionally package payment for most supportive 
guidance services, while allowing separate payment for one particular 
guidance service when that guidance service is furnished without an 
independent service. When guidance services are furnished as an 
ancillary and supportive adjunct to an independent procedure, we are 
packaging payment for all guidance procedures. When one specific 
guidance service (which is occasionally not provided in conjunction 
with an independent procedure on the same date of service) is not 
provided on the same date as an independent procedure, we will pay 
separately for that service. We believe that this alternative will 
provide the most appropriate incentives to control volume and spending 
for these services, without discouraging the performance of the service 
in those infrequent cases when one particular guidance service is 
provided without an independent procedure.
(2) Image Processing
    We are packaging payment for image processing services into the 
payment for the major independent service to which the image processing 
service is ancillary and supportive. We refer readers to section 
II.A.4.c.(2) of this final rule with comment period for the complete 
discussion of this final policy. We considered several policy options 
for the payment of image processing services in CY 2008.
    The first alternative we considered was to make no changes to 
packaging for the CY 2008 OPPS. Under this alternative, codes that were 
packaged for CY 2007 would have remained packaged for CY 2008 and codes 
that were separately paid for CY 2007 would have remained separately 
paid for CY 2008. We did not select this alternative because we believe 
it would not provide additional incentives for hospitals to utilize the 
most cost-effective and clinically advantageous image processing 
services that are appropriate in each situation.
    The second alternative we considered was to package the costs of 
image processing services in cases in which the image processing 
service is furnished on the same date as an independent service to 
which the image processing service is ancillary and supportive but to 
pay separately for the image processing service when it is furnished 
without an independent service on the same date of service. We did not 
select this alternative because it would not have provided substantial 
additional incentives for hospitals to utilize image processing in the 
most cost-effective and clinically advantageous manner.
    The third alternative we considered, and ultimately selected, was 
to package payment for the costs of image processing services in all 
cases, without regard to the possibility of the service being furnished 
without an independent service on the same date of service. While an 
image processing service is not necessarily provided on the same date 
of service as the independent procedure to which it is ancillary and 
supportive, providing separate payment for each imaging processing 
service whenever it is performed is not consistent with encouraging 
value-based purchasing under the OPPS. We believe it is important to 
package payment for supportive dependent services that accompany 
independent procedures but that may not need to be provided face-to-
face with the patient in the same encounter as the independent service. 
Packaging encourages hospitals to establish protocols that ensure that 
services are furnished only when they are medically necessary and to 
carefully scrutinize the services ordered by practitioners to minimize 
unnecessary use of hospital resources. Therefore, we believe that this 
alternative will provide additional appropriate incentives to control 
volume and spending for these services, without discouraging the use of 
the service in those infrequent cases when it is provided with an 
independent procedure but on a different date of service.
(3) Intraoperative Services
    We are packaging payment for intraoperative services into the 
payment for the independent procedure to which the intraoperative 
service is ancillary and supportive. In the case of two intraoperative 
services, which would usually be provided in conjunction with another 
independent procedure but may occasionally be provided without another 
independent service on the same date of service, we will permit 
separate payment if the services are billed without an independent 
procedure on the same date of service. We refer readers to section 
II.A.4.c.(3) of this final rule with comment period for the complete 
discussion of this final policy. We considered several policy options 
for the payment of intraoperative services in CY 2008.
    The first alternative we considered was to make no changes to 
packaging for the CY 2008 OPPS. Under this alternative, codes that were 
packaged for CY 2007 would have remained packaged for CY 2008 and codes 
that were separately paid for CY 2007 would have remained separately 
paid for CY 2008. We did not select this alternative because we believe 
it would not provide additional incentives for hospitals to utilize the 
most cost-effective and clinically advantageous intraoperative services 
that are appropriate in each situation.
    The second alternative we considered was to package payment for the 
costs of intraoperative services in all cases, without regard to the 
possibility of the service being furnished without an independent 
service on the same date of

[[Page 66904]]

service. We did not select this alternative because we believe that, in 
the case of two particular intraoperative procedures, those procedures 
may sometimes be appropriately furnished without other independent 
services on the same date and, in these cases, we believe that there 
should be separate payment for the intraoperative services.
    The third alternative we considered, and ultimately selected, was 
to unconditionally package the costs of intraoperative services in all 
cases except two, to allow for the possibility of these two 
intraoperative services being furnished without an independent service 
on the same date of service. We believe that there is some possibility 
that these procedures could be appropriately performed without another 
independent procedure on the same date of service. We do not believe 
this to be true of the other intraoperative services that we proposed 
to unconditionally package. We selected this alternative because we 
believe it unlikely that intraoperative services other than the two 
particular services would ever be provided without an independent 
service. Packaging encourages hospitals to establish protocols that 
ensure that services are furnished only when they are medically 
necessary and to carefully scrutinize the services ordered by 
practitioners to minimize unnecessary use of hospital resources. We 
believe that this is the most appropriate alternative because, in 
general, it creates additional incentives for hospitals to provide 
intraoperative services only when both medically necessary and cost 
efficient for the individual patient. Therefore, we believe that this 
alternative will provide the most appropriate incentives to control 
volume and spending for these services.
(4) Imaging Supervision and Interpretation Services
    We are unconditionally packaging payment for some imaging 
supervision and interpretation services into the payment for the 
independent service to which the imaging supervision and interpretation 
service is ancillary and supportive and conditionally packaging payment 
for other imaging supervision and interpretation services when the 
independent service has a status indicator of ``T.'' For this latter 
subset of codes, we are permitting separate payment if there is no 
service with status indicator of ``T'' billed the same date of service. 
We refer readers to section II.A.4.c.(4) of this final rule with 
comment period for the complete discussion of this final policy. We 
considered several policy options for the payment of imaging 
supervision and interpretation services in CY 2008.
    The first alternative we considered was to make no changes to 
packaging for the CY 2008 OPPS. Under this alternative, codes that were 
packaged for CY 2007 would have remained packaged and codes that were 
separately paid for CY 2007 would have remained separately paid for CY 
2008. We did not select this alternative because we believe it would 
not provide additional incentives for hospitals to utilize the most 
cost effective and clinically advantageous imaging supervision and 
interpretation services that are appropriate in each situation.
    The second alternative we considered was to unconditionally package 
imaging supervision and interpretation procedures that we believe are 
always integral to and dependent upon an independent separately payable 
procedure, but to conditionally package payment for those imaging 
supervision and interpretation services that we believe are sometimes 
furnished without another separately payable service on the same date. 
We did not accept this alternative because commenters convinced us that 
to do this would sometimes result in packaging these services with 
services for which packaging of the imaging supervision and 
interpretation services was inappropriate (for example, visits and 
minor diagnostic tests).
    The third alternative we considered, and the alternative we 
selected, was to unconditionally package imaging supervision and 
interpretation procedures that we believe are always integral to and 
dependent upon an independent separately payable procedure, but to 
conditionally package payment for certain imaging supervision and 
interpretation services only when they are provided on the same date of 
service as a service with a status indicator of ``T.'' We believe that 
this alternative is the most appropriate choice because it creates 
additional incentives for hospitals to provide services only when 
medically necessary to an individual patient when the supervision and 
interpretation service is furnished as an ancillary and supportive 
adjunct to the independent procedural service and does not package the 
payment for the supervision and interpretation service with the payment 
for a visit or other service. We will pay separately for some imaging 
supervision and interpretation services in those cases where they are 
not furnished on the same date as a service with status indicator of 
``T.'' Therefore, we believe that this alternative will provide the 
most appropriate incentives to control volume and spending for these 
services, without discouraging the performance of the services in those 
cases when they are furnished with a service with a status indicator 
other than ``T.''
(5) Diagnostic Radiopharmaceuticals
    We are packaging payment for diagnostic radiopharmaceuticals into 
the payment for their associated nuclear medicine procedures. In 
response to comments, we are using only claims for nuclear medicine 
procedures that contain a Level II HCPCS code for a diagnostic 
radiopharmaceutical to set the median costs for the nuclear medicine 
services, and we are implementing claims processing edits that require 
that a nuclear medicine service must have a diagnostic 
radiopharmaceutical HCPCS code on the same claim to be accepted for 
processing. We refer readers to section II.A.4.c.(5) of this final rule 
with comment period for the complete discussion of this final policy. 
We considered several policy options for the payment of diagnostic 
radiopharmaceuticals in CY 2008.
    The first alternative we considered was to make no changes to our 
packaging methodology for diagnostic radiopharmaceuticals in the CY 
2008 OPPS. Under this alternative, diagnostic radiopharmaceuticals with 
a mean per-day cost of $60 or less would be packaged into the payment 
for associated procedures present on the claim. Diagnostic 
radiopharmaceuticals with a per-day cost over $60 would receive 
separate payment. We did not select this alternative because we believe 
it would not provide additional incentives for hospitals to utilize the 
most cost-effective and clinically advantageous diagnostic 
radiopharmaceuticals that are appropriate in each situation.
    The second alternative we considered was to package the costs of 
diagnostic radiopharmaceuticals in cases in which the diagnostic 
radiopharmaceutical is furnished on the same date as an independent 
service to which the diagnostic radiopharmaceutical is ancillary and 
supportive, but to pay separately for the diagnostic 
radiopharmaceutical when it is furnished without an independent service 
on the same date of service. We did not select this alternative because 
diagnostic radiopharmaceuticals are always intended to be used with a 
diagnostic nuclear medicine procedure. Our claims data indicate that 
diagnostic radiopharmaceuticals are infrequently provided on a 
different date of service from a nuclear medicine procedure. Because 
our standard OPPS ratesetting

[[Page 66905]]

methodology packages costs across dates of service on ``natural'' 
single claims, we believe that our standard methodology adequately 
captures the costs of diagnostic radiopharmaceuticals associated with 
diagnostic nuclear medicine procedures that are not provided on the 
same date of service.
    The third alternative we considered, and the alternative we 
selected, was to package the costs of diagnostic radiopharmaceuticals 
with their associated nuclear medicine procedures, to calculate the 
median costs of nuclear medicine procedures using only claims that 
contain a Level II HCPCS code for a diagnostic radiopharmaceutical, and 
to implement claims processing edits that require that a claim that 
reports a code for a nuclear medicine procedure must also contain a 
code for a diagnostic radiopharmaceutical to be accepted for 
processing. Packaging the costs of supportive items and services into 
the payment for the independent procedure or service with which they 
are associated encourages additional hospital efficiencies and enables 
hospitals to better manage their resources with maximum flexibility. 
Diagnostic radiopharmaceuticals are always intended to be used with a 
diagnostic nuclear medicine procedure, and are, therefore, particularly 
well suited for packaging under the OPPS for the reasons identified in 
section II.A.4.c.(5) of this final rule with comment period. Moreover, 
calculating the median cost of nuclear medicine procedures using only 
claims that also contain at least one diagnostic radiopharmaceutical 
will ensure that the cost of the radiopharmaceuticals used in the 
procedure will be captured in the median cost. In addition, 
implementing a claims processing edit that will require that a claim 
that contains a code for a nuclear medicine procedure must also contain 
a code for a diagnostic radiopharmaceutical will ensure that in future 
years, all claims for nuclear medicine procedures will include the cost 
of the radiopharmaceuticals used to furnish the service.
(6) Contrast Media
    We are packaging payment for contrast media into their associated 
independent diagnostic and therapeutic procedures. We refer readers to 
section II.A.4.c.(6) of this final rule with comment period for the 
complete discussion of this final policy. We considered several policy 
options for the payment of contrast media in CY 2008.
    The first alternative we considered was to make no changes to our 
packaging methodology for contrast media in the CY 2008 OPPS. Under 
this alternative, contrast media with a mean per-day cost of $60 or 
less would be packaged into the payment for associated procedures 
present on the claim. Contrast media with a per-day cost over $60 would 
receive separate payment. We did not select this alternative because we 
believe it would not provide additional incentives for hospitals to 
utilize contrast media in the most cost-effective and clinically 
advantageous manner. With most contrast media already packaged based on 
our $60 packaging threshold, this alternative would potentially 
maintain inconsistent payment incentives across similar products.
    The second alternative we considered was to package the costs of 
contrast media in cases in which the contrast medium is furnished on 
the same date as an independent service but to pay separately for the 
contrast medium when it is furnished without an independent service on 
the same date of service. We did not select this alternative because we 
believe it is unlikely that contrast media would ever be provided 
without an independent service on the same date of service.
    The third alternative we considered, and the alternative we 
selected, was to unconditionally package the costs of contrast media 
with their associated independent diagnostic and therapeutic 
procedures. The vast majority of contrast media will currently be 
packaged under the $60 packaging threshold. Given that most contrast 
agents will already be packaged under the OPPS in CY 2008, we believe 
it would be desirable to package payment for the remaining contrast 
agents, as this approach promotes additional efficiency and results in 
a more consistent payment policy across products that may be used in 
many of the same independent procedures. In the case of 
echocardiography procedures that are performed with contrast, we have 
established separate Level II HCPCS codes to report these services, so 
that we will pay for contrast and noncontrast studies through separate 
APC groups as section 1833(t)(2)(G) of the Act requires. The median 
cost of the APC for noncontrast echocardiography services was set based 
on those claims for the studies that also reported a contrast agent, to 
ensure that the procedure payment includes the cost of the necessary 
contrast agent.
(7) Observation Services
    We are packaging payment for all observation care, reported under 
HCPCS code G0378 (Hospital observation services, per hour) for CY 2008. 
Payment for observation will be packaged as part of the payment for the 
separately payable services with which it is billed. In addition, we 
created two additional composite APCs for extended assessment and 
management, of which observation care is a component. We refer readers 
to section II.A.4.c.(7) of this final rule with comment period for the 
complete discussion of this final policy. We considered several policy 
options for the payment of observation services in CY 2008.
    The first alternative we considered was to make no changes to 
payment of observation services for the CY 2008 OPPS. Since January 1, 
2006, hospitals have reported observation services based on an hourly 
unit of care using HCPCS code G0378. This code has a status indicator 
of ``Q'' under the CY 2007 OPPS, meaning that the OPPS claims 
processing logic determines whether the observation is packaged or 
separately payable. The OCE's current logic determines whether 
observation care billed under G0378 is separately payable through APC 
0339 (Observation), or whether payment for observation services will be 
packaged into the payment for other separately payable services 
provided by the hospital in the same encounter based on criteria 
discussed in more detail in section II.A.4.c.(7) of this final rule 
with comment period. For CY 2007, we continued to apply the criteria 
for separate payment for observation care and the coding and payment 
methodology for observation care that were implemented in CY 2006. We 
did not select this alternative because the current criteria for 
separate payment for observation services treat payment for observation 
care for various clinical conditions differently and may provide 
disincentives for efficiency. In addition, there has been substantial 
growth in program expenditures for hospital outpatient services under 
the OPPS in recent years, a trend that is reflected in the rapidly 
increasing volume of claims for separately payable observation 
services. This alternative would not provide additional incentives for 
hospitals to utilize observation services in the most cost effective 
and clinically advantageous manner.
    The second alternative we considered was to accept the APC Panel's 
recommendations to add syncope and dehydration to the list of diagnoses 
eligible for separate payment or to consider other clinical conditions 
for separate payment for observation care. We believe that, in certain 
circumstances, observation could be appropriate for patients with a 
range of

[[Page 66906]]

diagnoses. Both the APC Panel and numerous commenters to prior OPPS 
proposed rules have confirmed their agreement with this perspective. 
However, as packaging payment provides additional desirable incentives 
for more efficient delivery of health care and provides hospitals with 
significant flexibility to manage their resources, we believe it is 
most appropriate to treat observation care for all diagnoses similarly 
by packaging its costs into payment for the separately payable 
procedures with which the observation is associated. Consequently, we 
did not select this alternative to expand separate observation payment 
to additional diagnoses.
    The third alternative we considered was to package payment for all 
observation services reported with HCPCS code G0378 under the CY 2008 
OPPS. We believe this is the most appropriate alternative within the 
context of our packaging approach because observation is always 
provided as a supportive service in conjunction with other independent 
separately payable hospital outpatient services such as an emergency 
department visit, surgical procedure, or another separately payable 
service, and thus its costs can be packaged into the OPPS payment for 
such services. We believe that packaging payment into larger payment 
bundles creates incentives for providers to furnish services in the 
most efficient way that meets the needs of the patient, encouraging 
long-term cost containment. With approximately 70 percent of the 
occurrences of observation care billed under the OPPS currently 
packaged, this alternative will extend the incentives for efficiency 
already present for the vast majority of observation care that is 
already packaged under the OPPS to the remaining 30 percent of 
observation care for which we currently make separate payment.
    However, based on the public comments we received, while we are 
adopting our proposal to package payment for all observation services 
reported with HCPCS code G0378 under the CY 2008 OPPS, we will also 
create two additional composite APCs for extended assessment and 
management, of which observation care is a major component. This 
refinement of the third alternative responds to commenters who stated 
that observation care is sometimes a major component of a patient's 
visit. We continue to believe that observation services are usually 
ancillary and supportive to the other independent services that are 
provided to the patient on the same day. However, we believe that 
observation care may sometimes rise to the level of a major component 
service, specifically, when it is provided for 8 hours or more in 
association with a high level clinic or emergency department visit, 
direct admission to observation, or critical care services and it is 
not provided in conjunction with a surgical procedure. Therefore, we 
have created two composite APCs that will provide payment to hospitals 
in certain circumstances when extended assessment and management of a 
patient occur. These composite APCs describe an extended encounter for 
care provided to a patient. Specifically, we are creating two new 
composite APCs for CY 2008, APC 8002 (Level I Extended Assessment and 
Management Composite) and APC 8003 (Level II Extended Assessment and 
Management Composite). The payment associated with APCs 8002 and 8003 
is intended to pay the hospital for the costs associated with a single 
episode of care involving more intense extended assessment and 
management that includes a high level clinic or emergency department 
visit, direct admission to observation, or critical care services; 8 
hours or more of observation services; and any associated packaged 
services.
    In summary, for CY 2008, payment for observation services will 
remain packaged with a status indicator ``N.'' We are creating two 
composite APCs for extended assessment and management, of which 
observation care is a major component service. When criteria for 
payment of one of the composite APCs are met, separate payment will be 
made to the hospital through the composite APC. This composite APC 
payment methodology will contribute to our goal of providing payment 
under the OPPS for a larger bundle of component services provided in a 
single hospital outpatient encounter, creating additional hospital 
incentives for efficiency and cost containment, while providing 
hospitals with the most flexibility to manage their resources.
(8) Composite APCs
    We are establishing five composite APCs for the CY 2008 OPPS. In 
addition to the two composite APCs that we proposed for the CY 2008 
OPPS and for which we discuss the alternatives considered in this 
section, we have also created two composite APCs for extended 
assessment and management (of which observation care is a part), and we 
identify APC 0034 (Mental Health Services Composite), the longstanding 
limit on per diem payment for mental health services, as a composite 
APC. We refer readers to the discussion of alternatives considered for 
observation services, above, and to section II.A.4.c.(7) of this final 
rule with comment period for further discussion of the composite APCs 
of which observation is a part. We refer readers to section II.A.4.d. 
of this final rule with comment period for a discussion of APC 0034.
    A composite APC is an APC that provides a single payment for 
several independent services when they are furnished on the same date 
of service. Composite APCs are intended to establish APC payment rates 
for combinations of services that are frequently furnished together so 
that the multiple procedure claims on which they are submitted may be 
used to set the payment rates for them and so that the payment for the 
services provides greater incentives for efficient use of hospital 
resources. Specifically, as proposed, we are establishing composite APC 
8000 for low dose rate prostate brachytherapy (which will be paid when 
CPT codes 55875 (Transperineal placement of needles or catheters into 
prostate for interstitial radioelement application, with or without 
cystoscopy) and 77778 (Interstitial radiation source application; 
complex) are billed on the same date of service) and APC 8001 for 
cardiac electrophysiologic evaluation and ablation services (which will 
be paid when at least one designated cardiac electrophysiologic 
evaluation service is billed on the same date as at least one 
designated cardiac ablation service). We refer readers to sections 
II.A.4.d.(2) and II.A.4.d.(3) of this final rule with comment period 
for a detailed discussion of the policies for these APCs. We note that 
we will continue to pay individual services under their single 
procedure APCs as we have in the past, in those clinical circumstances 
in which the combinations of services proposed for payment through the 
composite APCs are not furnished on the same date. We considered two 
alternatives with regard to creating composite APCs.
    The first alternative we considered was to make no change to how we 
pay for these services. If we were to make no change, we could continue 
to pay separately for each service. We did not select this alternative 
because the payment rates would continue to be based on single 
procedure claims, which we have been told by stakeholders do not 
represent the typical treatment scenario. Interested parties have 
repeatedly told us, and our examination of claims data supports, that 
these services are typically furnished in combination with one another 
and, therefore, this may suggest that the use of single procedure 
claims

[[Page 66907]]

to establish the median costs that form the basis for payment for these 
services may result in our using clinically unusual or incorrectly 
coded claims as the basis for payment.
    The second alternative we considered, and the alternative we 
selected, is to create composite APCs for these services, which are 
commonly furnished in combination with one another, and to make a 
single payment for the multiple services specified in the composite APC 
at a prospectively established rate based on the total cost of the 
combination of services furnished. This alternative responds to public 
comments that multiple procedure claims for these services that we have 
heretofore been unable to use for ratesetting reflect the most common 
treatment scenarios. It also provides additional incentives for 
efficient provision of services by bundling payment for multiple 
services into a single payment. Composite APCs enable us to use more of 
our claims data and to use single procedure claims only to set payment 
rates for the uncommon circumstances in which a particular service is 
not furnished in combination with other related independent services. 
Therefore, we are establishing composite APCs 0034, 8000, 8001, 8002, 
and 8003 for the CY 2008 OPPS.
b. Partial Device Credits
    We are reducing payment by 50 percent of the device offset amount 
for specified APCs when hospitals report that they have received a 
credit for a replacement device of greater than or equal to 50 percent 
of the cost of the new replacement device being implanted, if the 
device is on a list of specified devices. We refer readers to section 
IV.A.3. of this final rule with comment period for a complete 
discussion of this final policy. This is an extension of the current 
policy that reduces the APC payment by the full device offset amount 
when the hospital receives a replacement device without cost or 
receives a credit for the full cost of the device being replaced. We 
considered several alternatives in developing this partial device 
credit policy for CY 2008.
    The first alternative we considered was to make no change to the 
current policy. Under this alternative, Medicare and the beneficiary 
would continue to pay the full APC rate, which is calculated using only 
claims for which the full cost of a device is billed by the hospital, 
even if the hospital received a substantial credit towards the cost of 
the replacement device. We did not select this alternative because we 
believe that, as long as the APC payment amount is initially 
established to reflect the full cost of the device when there is no 
credit, there should be a reduction in the Medicare payment amount when 
the hospital receives a substantial credit toward cost of the 
replacement device. Similarly, we believe that the beneficiary cost 
sharing should be based on an amount that also reflects the credit.
    The second alternative we considered was to extend the current 
policy to cases of partial credit without change. This would reduce the 
payment in all cases in which the hospital received a credit by the 
full offset amount for the APC, that is, by 100 percent of the 
estimated device cost contained in the APC. We considered this 
alternative because, in our discussions with hospitals about partial 
credits for devices, they advised us that hospitals generally charge 
the same amount for a device regardless of whether they receive a 
significant amount in credit towards the cost of that device. Hence, in 
such a case the costs that are packaged into the APC payment for the 
applicable procedure contain the same amount of device cost as if the 
hospital incurred the full cost of the device. We did not select this 
alternative because we did not believe it was appropriate to reduce the 
payment to the hospital by the full cost of a device if the hospital 
only received a partial credit, and not a full credit, towards the cost 
of the device.
    The third alternative we considered was to reduce the APC payment 
by 50 percent of the offset amount (that would be applied if the 
hospital received full credit) in cases in which the hospital receives 
a partial credit of 20 percent or more of the cost of the new 
replacement device being implanted. We would require hospitals to 
report a new modifier when the hospital receives a partial credit that 
is 20 percent or more of the cost of the device being replaced. We are 
not adopting this policy, which we proposed in the CY 2008 OPPS/ASC 
proposed rule, for several reasons. We note it would not be consistent 
with the FY 2008 IPPS partial credit device policy, and we were 
concerned that 20 percent is a nominal portion of the cost of a device 
and would not justify the administrative and operational burden posed 
by the policy and, accordingly, the 50-percent payment reduction would 
be more than the partial credit received in some cases.
    The fourth alternative, which we are adopting, is a modification of 
the third alternative described above. This alternative is to reduce 
the APC payment by 50 percent of the offset amount (that would be 
applied if the hospital received full credit) in cases in which the 
hospital receives a partial credit of 50 percent or more of the cost of 
the new replacement device being implanted. We are requiring hospitals 
to report the ``FC'' modifier when the hospital receives a partial 
credit that is 50 percent or more of the cost of the device being 
replaced. We are adopting this alternative because we believe that this 
approach provides an appropriate and equitable payment to the hospital 
from Medicare and, depending on the service, may reduce the 
beneficiary's cost sharing for the service.
c. Brachytherapy Sources
    Pursuant to sections 1833(t)(2)(H) and 1833(t)(16)(C) of the Act, 
we paid for brachytherapy sources furnished from January 1, 2004 
through December 31, 2006, on a per source basis at an amount equal to 
the hospital's charge adjusted to cost by application of the hospital-
specific overall CCR. Moreover, pursuant to section 107(a) of the MIEA-
TRHCA, which amended section 1833(t)(16)(C) of the Act by extending the 
payment period for brachytherapy sources based on a hospital's charges 
adjusted to cost, we are paying for brachytherapy sources using the 
charges adjusted to cost methodology through December 31, 2007. Section 
107(b)(1) of the MIEA-TRHCA amended section 1833(t)(2)(H) of the Act, 
by adding a requirement for the establishment of separate payment 
groups for ``stranded and non-stranded'' brachytherapy devices 
beginning July 1, 2007. In section VII.B. of this final rule with 
comment period, we are adopting prospective payment for all 
brachytherapy sources under the CY 2008 OPPS, including separate 
payment for stranded and non-stranded versions of sources currently 
known to us, that is, iodine-125, palladium-103 and cesium-131. For 
each of the sources for which we have information that only non-
stranded source versions are marketed, we are making payment based on 
the median cost per source based on our CY 2006 claims data. For 
sources for which we have information that both stranded and non-
stranded versions are marketed and for which our CY 2006 billing codes 
do not differentiate stranded and non-stranded sources, we are basing 
payment for stranded and non-stranded brachytherapy sources on the 60th 
percentile and 40th percentile of our claims data, respectively, for CY 
2008. We discuss each alternative we considered below.
    The first alternative we considered was to pay for each source of 
brachytherapy based on our CY 2006 median costs, with the exception of 
the 3 sources for which we do not have separately reported cost data 
for their

[[Page 66908]]

stranded and non-stranded versions, that is, iodine-125, palladium-103, 
and cesium-131. Under this option, for these six stranded and non-
stranded sources, we considered payment based on hospital charges 
reduced to cost for CY 2008. This approach would be a step toward 
prospective payment for brachytherapy sources, as the sources that only 
have non-stranded versions would receive prospective payment consistent 
with the overall OPPS methodology. However, payment for stranded and 
non-stranded iodine-125, palladium-103 and cesium-131 would deviate 
from the overall OPPS framework for prospective payment and from the 
prospective payment of the non-stranded only sources specifically. This 
approach would subject similar items that are essential to 
brachytherapy treatments to different payment methodologies and could 
potentially create financial incentives for the use of some products 
over others.
    The second alternative we considered was to continue making 
payments for all sources based on hospital charges reduced to cost. 
Although hospitals are familiar with this payment methodology and this 
methodology would be consistent with the requirement that brachytherapy 
sources be paid separately, we believe that to continue to pay on this 
basis would be inconsistent with the general methodology of a 
prospective payment system and would provide no incentive for hospitals 
to provide brachytherapy treatments in the most cost-effective and 
clinically advantageous manner.
    The third alternative we considered, and the alternative we 
selected, is to provide prospective payment for each brachytherapy 
source based on its median costs. For the sources which only have non-
stranded versions, we are using our standard median cost methodology. 
For the 3 sources that have stranded and non-stranded versions and for 
which we do not yet have separately reported stranded and non-stranded 
claims data, we are calculating the median costs based on the 
assumption that the reportedly lower cost non-stranded sources would be 
unlikely to be in the top 20 percent of the cost distribution of our 
aggregate CY 2006 claims data for each respective source, and on the 
assumption that the reportedly higher cost stranded sources would be 
unlikely to be in the bottom 20 percent of the CY 2006 cost 
distribution for each source. This approach to calculating median costs 
for stranded and non-stranded iodine-125, palladium-103, and cesium-131 
sources results in Medicare payment rates based on the 60th percentile 
of our aggregate data for stranded sources and the 40th percentile of 
our aggregate data for non-stranded sources. This methodology provides 
for separate payment of all sources, including stranded and non-
stranded sources, recognizes a cost differential between stranded and 
non-stranded sources, is consistent with our prospective payment 
methodology for setting payment rates for other services, and is 
consistent with the expiration of the requirement of the MIEA-TRHCA 
that payment for brachytherapy sources be made at charges reduced to 
cost through December 31, 2007.
2. Limitations of Our Analysis
    The distributional impacts presented here are the projected effects 
of the policy changes on various hospital groups. We post our hospital-
specific estimated payments for CY 2008 with the other supporting 
documentation for this final rule with comment period. To view the 
hospital-specific estimates, we refer readers to the Web site at: 
http://www.cms.hhs.gov/HospitalOutpatientPPS/. Select ``regulations and 
notices'' from the left side of the page and then select CMS-1392-FC 
from the list of regulations and notices. The hospital-specific file 
layout and the hospital-specific file are listed with the other 
supporting documentation for this final rule with comment period. We 
show hospital-specific data only for hospitals whose claims were used 
for modeling the impacts shown in Table 61. We do not show hospital-
specific impacts for hospitals whose claims we were unable to use. We 
refer readers to Section II.A.2. of this final with comment period for 
a discussion of the hospitals whose claims we do not use for 
ratesetting and impact purposes.
    We estimate the effects of individual policy changes by estimating 
payments per service, while holding all other payment policies 
constant. We use the best data available but do not attempt to predict 
behavioral responses to our policy changes. In addition, we do not make 
adjustments for future changes in variables such as service volume, 
service-mix, or number of encounters. As we have done in previous 
rules, we solicited comments and information about the anticipated 
effect of the changes on hospitals and our methodology for estimating 
them. We discuss below several specific limitations of our analysis.
    One limitation of our analysis is our inability to estimate 
behavioral responses to our increase in packaging and our payment for 
multiple procedures based on one composite payment rate. Specifically, 
it is possible that there could be a behavioral response to our final 
policy to package payment for guidance services, image processing 
services, intraoperative services, imaging supervision and 
interpretation services, diagnostic radiopharmaceuticals, contrast 
agents, and observation services, and to pay for certain services 
through composite APCs when the services are furnished in specified 
combinations. However, we are unable to estimate what the effect of 
possible behavioral responses may be on payment to hospitals. We refer 
readers to section II.A.4. of this final rule with comment period for 
further discussion of the packaging approach. The purpose of packaging 
these services and creating composite APCs is to remove financial 
incentives to furnish additional services and, instead, to provide 
greater incentives for hospitals to assess the most cost-effective and 
appropriate means to furnish necessary services. In addition, we expect 
that hospitals will negotiate for lower prices from suppliers to 
maximize the margin between their cost of providing services and the 
Medicare payment for the services. We recognize that it is also 
possible that hospitals could change behavior in a manner that seeks to 
overcome any reductions in total payments by ceasing to provide certain 
packaged services on the same date of service and instead requiring 
patients to receive those services on different dates of service or at 
different locations, so as to either receive separate additional 
payment for services that would otherwise be packaged or to not incur 
the additional costs of those services. However, we believe that this 
will be uncommon for several reasons. We anticipate that hospitals will 
continue to provide care that is aligned with the best interests of the 
patient. In the vast majority of cases for the services that are newly 
unconditionally packaged in CY 2008, the services need to be provided 
in the same facility and during the same encounter as the independent 
procedure they support. Furthermore, in the case of conditionally 
packaged services, we note that the supportive services that we have 
included in our packaging policies are typically services that are 
provided during or shortly preceding the independent procedure to which 
they are ancillary and supportive, and thus it is unlikely that the 
supportive service that is packaged and the independent procedure will 
be performed in different locations. However, we are unable to quantify 
the extent to which such behavioral change may impact Medicare payments 
to hospitals.

[[Page 66909]]

    Secondly, we are not able to estimate the impact on hospitals of 
our policy to reduce payment when a hospital receives a partial credit 
for a medical device that fails while under warranty or otherwise. We 
do not currently require hospitals to notify us when they received a 
partial credit for a device for which they are billing. In addition, 
hospitals have informed us that hospitals generally do not currently 
reduce the charge for a device when they receive a partial credit 
toward the device for which they are billing Medicare. Therefore, we 
have no means of knowing the frequency with which this happens or the 
extent to which hospitals' costs for the devices being replaced are 
reduced as a result of the partial credits and cannot estimate the 
impact of the policy on hospital payments under the OPPS in CY 2008.
    Third, we are unable to estimate the extent to which hospitals will 
incur no cost for devices or will receive full or partial credits for 
devices being replaced as a result of the failure of the device. In CY 
2006, hospitals reported the ``FB'' modifier on codes for devices that 
they received without cost or for which they received a full credit. 
However, we are unable to forecast the extent to which the frequency or 
the type of device for which this occurred in CY 2006 will recur for CY 
2008. We believe that most of these occurrences were the result of 
specific activity that we have no reason to believe will occur in CY 
2008 at the same frequency at which it occurred in CY 2006, and hence 
we have made no estimates of how such activity may impact payments to 
hospitals. Similarly, we have no estimate of the extent to which 
hospitals will receive partial credits for devices under warranty 
actions in CY 2008. Beginning January 1, 2008, hospitals will report 
cases in which they receive a partial credit for a device if the credit 
is 50 percent or more of the cost of the replacement device. However, 
these data will not be available until the development of the CY 2010 
OPPS, which will be based on CY 2008 claims.
    Fourth, for purposes of this impact analysis, for those 
brachytherapy sources with new codes to distinguish between stranded 
and non-stranded version, we assume that half of the brachytherapy 
sources that hospitals will use in CY 2008 will be stranded sources and 
that half of them will be non-stranded sources. The statute requires us 
to pay for stranded and non-stranded sources through different APC 
groups, but given the lack of separately reported claims data for 
stranded and non-stranded sources, for the purposes of this impact 
analysis, we make this assumption. In the CY 2008 OPPS/ASC proposed 
rule, we welcomed data that would provide the expected CY 2008 ratio of 
stranded sources to non-stranded sources for purposes of this CY 2008 
final rule impact analysis. We did not receive any information 
regarding the ratio of stranded to non-stranded sources in the public 
comments on the proposed rule.
    The final limitation of our analysis is that we cannot predict the 
utilization of new CY 2007 and CY 2008 CPT codes that replace existing 
CY 2006 CPT codes for which we have cost data on which we base the CY 
2008 OPPS payment rates. In years past, we have estimated the impact of 
these code changes as if the deleted codes would continue to exist for 
the applicable year for which we were estimating impacts. For this 
final rule with comment period, we applied the AMA's estimates of new 
code utilization which are used for the MPFS final rule with comment 
period. However, we do not know whether these estimates of physician 
utilization are equally applicable to hospital outpatient services.
    In the CY 2008 OPPS/ASC proposed rule, we requested comments 
regarding whether it would be appropriate for us to use the AMA 
estimates of utilization for new codes in the estimation of the impact 
of the final CY 2008 payments for hospitals. We received no comments on 
this issue.
3. Estimated Impacts of This Final Rule With Comment Period on 
Hospitals and CMHCs
    Table 61 below shows the estimated impacts of this final rule with 
comment period on hospitals. Historically, the first line of the impact 
table, which estimates the change in payments to all hospitals, has 
always included cancer and children's hospitals, which are held 
harmless to their pre-BBA payment to cost ratio. This year, for the 
first time, we are also including CMHCs in the first line that includes 
all providers because we included CMHCs in our weight scaler estimate. 
We are not showing the estimated impact of the changes on CMHCs alone 
because CMHCs bill only one service under the OPPS, partial 
hospitalization, and each CMHC can easily estimate the impact of the 
changes by referencing payment for APC 0033 (Partial Hospitalization) 
in Addendum A to this final rule with comment period. As discussed in 
section II.B. of this final rule with comment period, the payment for 
APC 0033 (Partial Hospitalization) for CY 2008 will decline by 13 
percent compared to the payment for APC 0033 for CY 2007.
    The estimated increase in the total payments made under the OPPS is 
limited by the increase to the conversion factor set under the 
methodology in the statute. The distributional impacts presented do not 
include assumptions about changes in volume and service-mix. The 
enactment of Public Law 108-173 on December 8, 2003, provided for the 
additional payment outside of the budget neutrality requirement for 
wage indices for specific hospitals reclassified under section 508. The 
amounts attributable to this reclassification are incorporated into the 
CY 2007 estimates but because section 508 expired for CY 2008 rates, no 
additional payments under section 508 are considered for CY 2008 in 
this impact analysis.
    Table 61 shows the estimated redistribution of hospital and CMHC 
payments among providers as a result of APC reconfiguration and 
recalibration including the expansion of packaging; wage indices, and 
continuation of the adjustment for rural SCHs and EACHs with extension 
to brachytherapy sources in CY 2008; the estimated distribution of 
increased payments in CY 2008 resulting from the combined impact of the 
APC recalibration with the expansion of packaging, wage effects, the 
rural SCH and EACH adjustment, and the market basket update to the 
conversion factor; and, finally, estimated payments considering all 
payments for CY 2008 relative to all payments for CY 2007, including 
the impact of expiring wage provisions of section 508, changes in the 
outlier threshold, and changes to the pass-through estimate. Because 
updates to the conversion factor, including the update of the market 
basket and the addition of money not dedicated to pass-through 
payments, are applied uniformly, observed redistributions of payments 
in the impact table for hospitals largely depend on the mix of services 
furnished by a hospital (for example, how the APCs for the hospital's 
most frequently furnished services would change), the impact of the 
wage index changes on the hospital, and the impact of the payment 
adjustment for rural SCHs, including EACHs. However, total payments 
made under this system and the extent to which this final rule with 
comment period will redistribute money during implementation also would 
depend on changes in volume, practice patterns, and the mix of services 
billed between CY 2007 and CY 2008, which CMS cannot forecast.
    Overall, the final OPPS rates for CY 2008 will have a positive 
effect for providers paid under the OPPS,

[[Page 66910]]

resulting in a 3.6 percent increase in Medicare payments. Removing 
cancer and children's hospitals because their payments are held 
harmless to the pre-BBA ratio between payment and cost, and CMHCs, 
suggests that changes will result in a 3.8 percent increase in Medicare 
payments to all other hospitals, exclusive of transitional pass-through 
payments.
    To illustrate the impact of the final CY 2008 changes, our analysis 
begins with a baseline simulation model that uses the final CY 2007 
weights, the FY 2007 final post-reclassification IPPS wage indices, and 
the final CY 2007 conversion factor. Column 2 in Table 61 shows the 
independent effect of changes resulting from the reclassification of 
services among APC groups, the recalibration of APC weights and the 
changes to packaging that we adopted for this final rule with comment 
period, based on 12 months of CY 2006 hospital OPPS claims data and 
more recent cost report data. We modeled the effect of APC 
recalibration and packaging changes for CY 2008 by varying only the 
weights (the final CY 2007 weights versus the estimated CY 2008 weights 
including expanded packaging in our baseline model) and calculating the 
percent difference in payments. Column 2 also reflects the effect of 
changes resulting from the APC reclassification and recalibration 
changes and changes in multiple procedure discount patterns that occur 
as a result of the changes to packaging. When services are packaged, 
the resulting median costs at the HCPCS code level often change, 
requiring migration of HCPCS codes to different APCs to address 
violations of the 2 times rule (that is, to ensure that the HCPCS codes 
within the APC remain homogeneous with regard to clinical and resource 
characteristics). The placement of the HCPCS code in a new APC as a 
result of the effect of the packaging approach often changes the APC 
median cost. Furthermore, changing the cost of a service subject to the 
multiple procedure discount policy, as well as packaging some services 
previously subject to the multiple procedure discount policy, changes 
the relative weight ranking of services on a claim subject to the 
multiple procedure discount policy, significantly changing discounting 
patterns in some cases.
    Column 3 reflects the independent effects of updated wage indices, 
including the new occupational mix data described in the FY 2008 IPPS 
final rule, and the 7.1 percent rural adjustment for SCHs and EACHs 
with extension to brachytherapy sources. The OPPS wage index for CY 
2008 includes the budget neutrality adjustment for the rural floor, as 
discussed in section II.D. of this final rule with comment period. We 
modeled the independent effect of updating the wage index and the rural 
adjustment by varying only the wage index, using the CY 2008 scaled 
weights, and a CY 2007 conversion factor that included a budget 
neutrality adjustment for changes in wage effects and the rural 
adjustment between CY 2007 and CY 2008.
    Column 4 demonstrates the combined ``budget neutral'' impact of APC 
recalibration with the packaging policy (that is, Column 2), the wage 
index update and the adjustment for rural SCHs and EACHs (that is, 
Column 3), as well as the impact of updating the conversion factor with 
the market basket update. We modeled the independent effect of the 
budget neutrality adjustments and the market basket update by using the 
weights and wage indices for each year, and using a CY 2007 conversion 
factor that included the market basket update and budget neutrality 
adjustments for differences in wages and the adjustment for rural SCHs 
and EACHs.
    Finally, Column 5 depicts the full impact of the CY 2008 policy on 
each hospital group by including the effect of all the changes for CY 
2008 (including the APC reconfiguration and recalibration with the 
packaging changes shown in Column 2) and comparing them to all 
estimated payments in CY 2007, including changes to the wage index 
under section 508 of Public Law 108 173. Column 5 shows the combined 
budget neutral effects of Columns 2 through 4, plus the impact of the 
change to the fixed outlier threshold from $1,825 to $1,575, expiring 
section 508 reclassification wage index increases, and the impact of 
reducing the percentage of total payments dedicated to transitional 
pass-through payments. We estimate that these cumulative changes 
increase payments by 3.6 percent. We modeled the independent effect of 
all changes in Column 5 using the final weights for CY 2007 and the 
final weights for CY 2008. We used the final conversion factor for CY 
2007 of $61.468 and the final CY 2008 conversion factor of $63.694. 
Column 5 also contains simulated outlier payments for each year. We 
used the charge inflation factor used in the FY 2008 IPPS final rule of 
6.2 percent (1.062) to increase individual costs on the CY 2006 claims 
to reflect CY 2007 dollars, and we used the most recent overall CCR in 
the July 2007 Outpatient Provider-Specific File. Using the CY 2006 
claims and a 6.2 percent charge inflation factor, we currently estimate 
that outlier payments for CY 2007, using a multiple threshold of 1.75 
and a fixed-dollar threshold of $1,825 would be approximately 0.73 
percent of total payments. Outlier payments of 0.73 percent appear in 
the CY 2007 comparison in Column 5. We used the same set of claims and 
a charge inflation factor of 12.78 percent (1.1278) and the CCRs on the 
July 2007 Outpatient Provider-Specific File, with an adjustment of 
1.0027 to reflect relative changes in cost and charge inflation between 
CY 2006 and CY 2008, to model the CY 2008 outliers at 1.0 percent of 
total payments using a multiple threshold of 1.75 and a fixed dollar 
threshold of $1,575.

Column 1: Total Number of Hospitals

    The first line in Column 1 in Table 61 shows the total number of 
providers (4,250), including cancer and children's hospitals and CMHCs 
for which we were able to use CY 2006 hospital outpatient claims to 
model CY 2007 and CY 2008 payments by classes of hospitals. We excluded 
all hospitals for which we could not accurately estimate CY 2007 or CY 
2008 payment and entities that are not paid under the OPPS. The latter 
entities include CAHs, all-inclusive hospitals, and hospitals located 
in Guam, the U.S. Virgin Islands, Northern Mariana Islands, American 
Samoa, and the State of Maryland. This process is discussed in greater 
detail in section II.A. of this final rule with comment period. At this 
time, we are unable to calculate a disproportionate share (DSH) 
variable for hospitals not participating in the IPPS. Hospitals for 
which we do not have a DSH variable are grouped separately and 
generally include psychiatric hospitals, rehabilitation hospitals, and 
LTCHs. We show the total number (3,984) of OPPS hospitals, excluding 
the hold-harmless cancer and children's hospitals, and CMHCs, on the 
second line of the table. We excluded cancer and children's hospitals 
because section 1833(t)(7)(D) of the Act permanently holds harmless 
cancer hospitals and children's hospitals to a proportion of their pre-
BBA payment relative to their pre-BBA costs and, therefore, we removed 
them from our impact analyses. We excluded CMHCs because they only bill 
one service under the OPPS, and thus they can easily determine the 
impact of the changes.

Column 2: APC Changes Due to Reassignment, Recalibration and Packaging

    This column shows the combined effects of reconfiguration, 
recalibration, finalizing the packaging proposal and other policies 
(for example, changes to

[[Page 66911]]

payment for brachytherapy sources and therapeutic 
radiopharmaceuticals). In many cases, the redistribution created by the 
reduction in the partial hospitalization payment offsets other 
recalibration losses. Specifically, the reduction in partial 
hospitalization payment is redistributed to hospitals and reflected in 
the 0.2 percent increase for the 3,984 hospitals that remain after 
excluding hospitals held harmless and CMHCs. Overall, these changes 
will increase payments to urban hospitals by 0.3 percent. We estimate 
that large urban hospitals will see an increase of 0.1 percent and 
other urban hospitals will see a 0.4 percent increase in payments 
attributable to all recalibration.
    Overall, rural hospitals will show a modest 0.2 percent decrease as 
a result of changes to the APC structure and the expansion of 
packaging. Rural hospitals of all bed sizes will experience no change 
or will experience decreases ranging from 0.1 to 0.6 percent. The 
declines for rural hospitals for this final rule with public comment 
period compared to the projected increases of 0.2 to 0.6 for rural 
hospitals in the proposed rule is attributable to the changes in 
packaging that we made as a result of public comments with regard to 
observation and imaging supervision and interpretation services. The 
proposed packaging of these services into payment for any service with 
a status indicator of ``S,'' ``T,'' ``V,'' or ``X'' would have 
increased OPPS payments for visits and other services provided in rural 
hospitals. However, in response to public comments, we created 
composite APCs for extended assessment and management involving 
significant observation stays and we are packaging imaging supervision 
and interpretation services only into services with a status indicator 
of ``T.'' The services for which the median costs are increased as a 
result of these final policies are performed more often in urban 
hospitals than in rural hospitals, and this utilization is reflected in 
the negative percents in Column 2.
    Among teaching hospitals, the largest observed impacts resulting 
from APC recalibration and the expansion of packaging include an 
increase of 0.2 percent for major teaching hospitals and an increase of 
0.4 percent for minor teaching hospitals.
    Classifying hospitals by type of ownership suggests that 
proprietary hospitals will see an increase of 0.3 percent while 
governmental and voluntary hospitals will each see an increase of 0.2 
percent.
    We note also that both low volume urban and rural hospitals with 
less than 5,000 lines and hospitals for which DSH payments are not 
available will experience decreases of 3.7 to 5.5 percent as a result 
of the decline in payment for partial hospitalization from CY 2007 to 
CY 2008. These declines are somewhat moderated in Column 5 as a result 
of the increased outlier payments that result from the lower payment 
rates.

Column 3: New Wage Indices and the Effect of the Rural Adjustment

    This column estimates the impact of applying the final IPPS FY 2008 
wage indices for CY 2008, continuing the rural adjustment for CY 2008, 
and extending the rural adjustment to include brachytherapy sources. 
Overall, these changes will not change the payments to urban hospitals. 
Overall, rural hospitals show a decrease of 0.1 percent.
    Among teaching hospitals, the largest observed impacts resulting 
from changes to the wage indices and the continuation of the rural 
adjustment include a decrease of 0.1 percent for major teaching 
hospitals and no change for minor teaching hospitals.
    Classifying hospitals by type of ownership suggests that 
proprietary hospitals will gain 0.1 percent and that governmental 
hospitals and voluntary hospitals will each experience no change.

Column 4: All Budget Neutrality Changes and Market Basket Update

    The addition of the market basket update of 3.3 percent alleviates 
any negative impacts on payments for CY 2008 created by the budget 
neutrality adjustments made in Columns 2 and 3, with the exception of 
urban and rural hospitals with the lowest volume of services and 
hospitals not paid under the IPPS, including psychiatric hospitals, 
rehabilitation hospitals, and long term care hospitals (DSH not 
available). In general, all hospitals see an increase of 3.5 percent, 
attributable to the 3.3 percent market basket increase and the 0.2 
percent increase in payment weight created by the reduction in payment 
for partial hospitalization that is then redistributed to other 
services.
    Overall, these changes will increase payments to urban hospitals by 
3.6 percent. We estimate that large urban hospitals will see an 
increase of 3.5 percent and other urban hospitals will see a 3.7 
percent increase. In contrast, small urban hospitals that bill fewer 
than 5,000 lines per year will experience a decrease in payment of 0.4 
percent, largely as a result of the decrease in payment for partial 
hospitalization and mental health services appearing in Column 2.
    Overall, rural hospitals show a 3.0 percent increase as a result of 
the market basket update. Rural hospitals that bill less than 5,000 
lines will see a 1.8 percent decrease, also as a result of decreases in 
payment for partial hospitalization appearing in Column 2. Rural 
hospitals that bill more than 5,000 lines will experience increases of 
2.8 to 3.5 percent.
    Among teaching hospitals, the observed impacts resulting from the 
market basket update include an increase of 3.6 percent for minor 
teaching hospitals and an increase of 3.3 percent for major teaching 
hospitals.
    Classifying hospitals by type of ownership suggests that 
proprietary hospitals will increase 3.8 percent and governmental and 
voluntary hospitals will experience an increase of 3.5 percent.

Column 5: All Changes for CY 2008

    Column 5 compares all changes for CY 2008 to final payment for CY 
2007 and includes the expired section 508 reclassification wage 
indices, the change in the outlier threshold, and the difference in 
pass through estimates which are not included in the combined 
percentages shown in Column 4. Overall, we estimate that providers will 
see an increase of 3.6 percent under this final rule with comment 
period in CY 2008 relative to total spending in CY 2007. The 3.6 
percent increase for all providers in Column 5, which is rounded from 
3.56 percent, reflects the 3.3 percent market basket increase, plus 
0.12 percent for the change in the pass-through estimate between CY 
2007 and CY 2008, plus 0.27 percent for the difference in estimated 
outlier payments between CY 2007 (0.73 percent) and CY 2008 (1.0 
percent), less 0.13 percent for the expired section 508 wage payments. 
When we exclude cancer and children's hospitals (which are held 
harmless to their pre-OPPS costs), and CMHCs, the gain becomes 3.8 
percent.
    The combined effect of all changes for CY 2008 will increase 
payments to urban hospitals by 3.9 percent. We estimate that large 
urban hospitals will see a 3.9 percent increase, while ``other'' urban 
hospitals will experience an increase of 3.8 percent. Urban hospitals 
that bill less than 5,000 lines will experience an increase of 0.8 
percent, up from the 0.4 percent decrease in Column 4 due to increases 
in outlier payments for partial hospitalization.
    Overall, rural hospitals will show a 3.1 percent increase as a 
result of the combined effects of all changes for CY 2008. Rural 
hospitals will experience a

[[Page 66912]]

lower increase than the 3.8 percent overall hospital increase as a 
result of the combined effects of the changes to the packaging policies 
that were made in response to public comments and the expiration of the 
section 508 reclassification wage indices. Rural hospitals that bill 
less than 5,000 lines experience a decrease of 1.5 percent, which is 
less than the 1.8 percent decrease in Column 4 due to an increase in 
outlier payments for partial hospitalization. All rural hospitals that 
bill greater than 5,000 lines experience increases ranging from 2.9 
percent to 3.7 percent.
    Among teaching hospitals, the largest observed impacts resulting 
from the combined effects of all changes include an increase of 3.8 
percent for major teaching hospitals and minor teaching hospitals.
    Classifying hospitals by type of ownership suggests that 
proprietary hospitals will gain 4.1 percent, governmental hospitals 
will experience an increase of 3.9 percent, and voluntary hospitals 
will experience an increase of 3.7 percent.

             Table 61.--Impact of Changes for CY 2008 Hospital Outpatient Prospective Payment System
----------------------------------------------------------------------------------------------------------------
                                                                                          Combined
                                                                             New wage    (cols 2,3)
                                                  Number of   APC changes   index and   with market  All changes
                                                  hospitals                   rural        basket
                                                                            adjustment     update
                                                         (1)          (2)          (3)          (4)          (5)
----------------------------------------------------------------------------------------------------------------
ALL PROVIDERS \*\..............................        4,250          0.0          0.0          3.3          3.6
ALL HOSPITALS (excludes hospitals held harmless        3,984          0.2          0.0          3.5          3.8
 and CMHCs)....................................
URBAN HOSPITALS................................        2,978          0.3          0.0          3.6          3.9
    Large urban (GT 1 MILL.)...................        1,620          0.1          0.1          3.5          3.9
    Other urban (LE 1 MILL.)...................        1,358          0.4          0.0          3.7          3.8
RURAL HOSPITALS................................        1,006         -0.2         -0.1          3.0          3.1
    Sole community.............................          407         -0.2          0.1          3.1          3.0
    Other rural................................          599         -0.2         -0.3          2.8          3.1
BEDS (URBAN):
    0-99 Beds..................................        1,002          0.3          0.1          3.7          3.9
    100-199 Beds...............................          919          0.1          0.1          3.5          3.6
    200-299 Beds...............................          476          0.4          0.0          3.7          4.0
    300-499 Beds...............................          399          0.3          0.1          3.7          4.0
    500 + Beds.................................          182          0.3         -0.1          3.5          3.9
BEDS (RURAL):
    0-49 Beds \***\............................          350         -0.1         -0.2          3.1          3.3
    50-100 Beds \***\..........................          391         -0.2          0.0          3.1          3.3
    101-149 Beds...............................          156          0.0         -0.1          3.2          3.4
    150-199 Beds...............................           66         -0.2         -0.7          2.4          2.5
    200 + Beds.................................           43         -0.6          0.1          2.8          2.6
VOLUME (URBAN):
    LT 5,000 Lines.............................          616         -3.7          0.0         -0.4          0.8
    5,000-10,999 Lines.........................          174          0.2          0.1          3.6          4.0
    11,000-20,999 Lines........................          247          0.6          0.1          4.0          4.4
    21,000-42,999 Lines........................          526          0.5          0.2          4.0          4.2
    GT 42,999 Lines............................        1,415          0.3          0.0          3.6          3.9
VOLUME (RURAL):
    LT 5,000 Lines.............................           83         -4.8         -0.3         -1.8         -1.5
    5,000-10,999 Lines.........................           92         -0.1         -0.1          3.1          3.6
    11,000-20,999 Lines........................          189          0.1         -0.1          3.3          3.4
    21,000-42,999 Lines........................          314          0.1          0.1          3.5          3.7
    GT 42,999 Lines............................          328         -0.3         -0.2          2.8          2.9
REGION (URBAN):
    New England................................          157         -0.3          0.2          3.2          3.3
    Middle Atlantic............................          378          0.2         -0.1          3.4          3.5
    South Atlantic.............................          462          0.2         -0.1          3.5          3.8
    East North Cent............................          469          0.4         -0.1          3.6          3.7
    East South Cent............................          194          0.4         -0.3          3.5          3.8
    West North Cent............................          186          0.4          0.1          3.8          4.1
    West South Cent............................          493          0.6         -0.4          3.5          3.8
    Mountain...................................          189          0.7          0.0          4.0          4.4
    Pacific....................................          398         -0.1          0.9          4.2          4.7
    Puerto Rico................................           52          1.0          0.0          4.3          4.7
REGION (RURAL):
    New England................................           25         -0.5         -0.6          2.2          2.6
    Middle Atlantic............................           70         -0.7          0.0          2.7          2.9
    South Atlantic.............................          172         -0.3         -0.2          2.7          3.0
    East North Cent............................          129         -0.1         -0.1          3.2          3.0
    East South Cent............................          177         -0.1         -0.4          2.8          3.0
    West North Cent............................          115         -0.2          0.0          3.1          3.1
    West South Cent............................          205         -0.1         -0.8          2.4          2.7
    Mountain...................................           76          0.0          0.3          3.6          3.8
    Pacific....................................           37          0.0          1.9          5.2          5.1
TEACHING STATUS:
    Non-teaching...............................        2,956          0.1          0.1          3.5          3.7

[[Page 66913]]

 
    Minor......................................          748          0.4          0.0          3.6          3.8
    Major......................................          280          0.2         -0.1          3.3          3.8
DSH PATIENT PERCENT:
    0..........................................            5          4.4         -0.5          7.3          7.5
    GT 0-0.10..................................          416          0.3          0.1          3.6          3.9
    0.10-0.16..................................          451          0.3         -0.1          3.4          3.4
    0.16-0.23..................................          796          0.3          0.0          3.6          3.7
    0.23-0.35..................................          948          0.2          0.0          3.4          3.7
    GE 0.35....................................          754          0.3          0.1          3.7          4.2
    DSH not available \**\.....................          614         -5.5          0.4         -1.9         -1.3
URBAN TEACHING/DSH:
    Teaching & DSH.............................          920          0.3         -0.1          3.6          3.9
    No teaching/DSH............................        1,472          0.3          0.1          3.7          4.0
    No teaching/no DSH.........................            5          4.4         -0.5          7.3          7.5
    DSH not available \**\.....................          581         -5.5          0.4         -1.8         -1.3
TYPE OF OWNERSHIP:
    Voluntary..................................        2,141          0.2          0.0          3.5          3.7
    Proprietary................................        1,255          0.3          0.1          3.8          4.1
    Government.................................          588          0.2          0.0          3.5          3.9
----------------------------------------------------------------------------------------------------------------
Column (1) shows total hospitals.
Column (2) shows the impact of changes resulting from the reclassification of HCPCS codes among APC groups and
  the recalibration of APC weights based on 2006 hospital claims data.
Column (3) shows the budget neutral impact of updating the wage index and rural adjustment by applying the FY
  2008 hospital inpatient wage index and extended to rural adjustment to brachytherapy sources.
Column (4) shows the impact of all budget neutrality adjustments and the addition of the market basket update.
Column (5) shows the additional adjustments to the conversion factor resulting from a change in the pass-through
  estimate, and adds outlier payments. The change in outlier payments reflects a decrease in the fixed dollar
  threshold resulting from updated claim, CCR, and inflation estimates. This column also shows the impact of the
  expired section 508 wage reclassification, which ended on September 30, 2007.
\*\ These 4,250 providers include children and cancer hospitals, which are held harmless to pre-BBA payments,
  and CMHCs.
\**\ Complete DSH numbers are not available for providers that are not paid under IPPS, including
  rehabilitation, psychiatric, and long-term care hospitals.
\***\ Section 1833(t)(7)(D) of the Act specifies that rural hospitals with 100 or fewer beds (that are not also
  SCHs) receive additional payment for covered hospital outpatient services furnished during CY 2008 for which
  the prospective payment system amount is less than the pre-BBA amount. The amount of payment is increased by
  85 percent of the difference for CY 2008.

4. Estimated Effect of This Final Rule With Comment Period on 
Beneficiaries
    For services for which the beneficiary pays a copayment of 20 
percent of the payment rate, the beneficiary share of payment will 
increase for services for which the OPPS payments will rise and will 
decrease for services for which the OPPS payments will fall. For 
example, for an electrocardiogram (APC 0099), the minimum unadjusted 
copayment in CY 2007 was $4.66. In this final rule with comment period, 
the minimum unadjusted copayment for APC 0099 is $4.96 because the OPPS 
payment for the service will increase under this final rule with 
comment period. In another example, for a service assigned to Level IV 
Needle Biopsy/Aspiration Except Bone Marrow (APC 0037) in the CY 2007 
OPPS, the national unadjusted copayment was $228.76, and the minimum 
unadjusted copayment was $126.20. In this final rule with comment 
period, the national unadjusted copayment for APC 0037 is $228.76, the 
same national unadjusted copayment in effect for CY 2007. The minimum 
unadjusted copayment for APC 0037 is $172.95, or 20 percent of the 
payment for APC 0037. The minimum unadjusted copayment will rise 
because the payment rate for APC 0037 will rise. In all cases, the 
statute limits beneficiary liability for copayment for a service to the 
inpatient hospital deductible for the applicable year. For CY 2008, the 
inpatient deductible is $1,024.
    In order to better understand the impact of changes in copayment on 
beneficiaries, we modeled the percent change in total copayment 
liability using CY 2006 claims. We estimate, using the claims of the 
4,250 hospitals and CMHCs on which our modeling is based, that total 
beneficiary liability for copayments will decline as an overall 
percentage of total payments from 26.5 percent in CY 2007 to 25.1 
percent in CY 2008. This estimated decline in beneficiary liability is 
a consequence of the APC recalibration and reconfiguration we are 
making for CY 2008.
    With respect to partial hospitalization, the copayment in CY 2007 
of $46.95 will decline to $41.03 under this final rule with comment 
period as a result of the decline in the per diem payment for partial 
hospitalization from $234.73 in CY 2007 to $205.16 for CY 2008.
5. Conclusion
    The changes in this final rule with comment period will affect all 
classes of hospitals. Some classes of hospitals experience significant 
gains and others less significant gains, but almost all classes of 
hospitals will experience positive updates in OPPS payments in CY 2008. 
Table 61 demonstrates the estimated distributional impact of the OPPS 
budget neutrality requirements and an additional 3.6 percent increase 
in payments for CY 2008, after considering all changes to APC 
reconfiguration and recalibration, including those resulting from the 
expansion of packaging and the payment for brachytherapy sources on a 
prospective payment basis, as well as

[[Page 66914]]

the market basket increase, and the estimated cost of outliers and 
changes to the pass through estimate. The accompanying discussion, in 
combination with the rest of this final rule with comment period 
constitutes a regulatory impact analysis.
6. Accounting Statement
    As required by OMB Circular A-4 (available at http://www.whitehouse.gov/omb/circulars/a004/a-4.pdf), in Table 62, we have 
prepared an accounting statement showing the CY 2008 estimated hospital 
OPPS incurred benefit impact associated with the CY 2008 outpatient 
hospital market basket update shown in this final rule with comment 
period, based on the Mid-Session Review of the FY 2008 President's 
Budget baseline. All estimated impacts are classified as transfers.

    Table 62.--Accounting Statement: CY 2008 Estimated Hospital OPPS
 Incurred Benefit Impact Associated With the CY 2008 Hospital Outpatient
                          Market Basket Update
                              [In billions]
------------------------------------------------------------------------
               Category                            Transfers
------------------------------------------------------------------------
Annualized Monetized Transfers.......  $0.9.
From Whom To Whom?...................  Federal Government to outpatient
                                        hospitals and other providers
                                        who receive payment under the
                                        hospital OPPS.
------------------------------------------------------------------------

C. Effects of ASC Payment System Changes in This Final Rule With 
Comment Period

    On August 2, 2007, we published in the Federal Register the final 
rule for the revised ASC payment system, effective January 1, 2008 (72 
FR 42470). In that final rule for the revised ASC payment system, we 
adopted the methodologies we will use to set payment rates for ASC 
services furnished in association with covered surgical procedures and 
covered ancillary procedures beginning January 1, 2008, and established 
that the OPPS relative payment weights will be used as the basis for 
the payment of most covered surgical procedures and covered ancillary 
services under the revised ASC payment system.
    In the August 2, 2007 revised ASC payment system final rule, we 
established that we will update the ASC payment system annually as part 
of the OPPS rulemaking cycle. As part of the annual OPPS rulemaking 
cycle, we indicated we will update the lists of ASC covered surgical 
procedures and covered ancillary services, as well as their payment 
rates. Such an update is very important because the OPPS relative 
payment weights will be used as the basis for the payment of most 
covered surgical procedures and covered ancillary services under the 
revised ASC payment system. This joint update process will ensure that 
the ASC updates occur in a regular, predictable, and timely manner, and 
that the ASC payment rates immediately reflect the updated OPPS 
relative payment weights.
    In the CY 2008 OPPS/ASC proposed rule, we proposed to update the 
revised ASC payment system for CY 2008 to reflect the CY 2008 OPPS 
relative payment weights and rates, as well as update the lists of 
covered surgical and covered ancillary services (72 FR 42778). We also 
proposed to revise the regulations to make practice expense payment to 
physicians who perform noncovered ASC procedures in ASCs based on the 
MPFS facility PE RVUs (72 FR 42791) and to exclude covered ancillary 
radiology services and covered ancillary drugs and biologicals from the 
categories of DHS that are subject to the physician self-referral 
prohibition (72 FR 42792). We are finalizing those proposals in this 
final rule with comment period.
    The revised Medicare ASC payment system that we are implementing 
beginning January 1, 2008, could have a far-reaching effect on the 
provision of outpatient surgical services for a number of years to come 
for several reasons. First, the list of procedures that will be 
eligible for payment under the revised ASC payment system is greatly 
expanded from the list of surgical procedures eligible for payment 
under the ASC payment system in CY 2007 and earlier years. In addition, 
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, that is, the APC groups that are the unit of payment 
in 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 calculated 
to result in the same amount of aggregate Medicare expenditures in CY 
2008 as we estimate would have been made if the revised payment system 
were not implemented (72 FR 42796).
    The effects of the expanded number 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 the August 2, 2007 OPPS/ASC proposed rule (42 FR 42628), we 
estimated the CY 2008 ASC payment rates, budget neutrality adjustment 
factor, and impacts using the proposed CY 2008 OPPS relative payment 
weights and update factor for CY 2008, the proposed CY 2008 MPFS PE 
RVUs, and partial CY 2006 utilization data projected forward to CY 
2008. In this final rule with comment period, we are establishing the 
final CY 2008 ASC payment rates and budget neutrality adjustment in 
accordance with the methodology for calculating budget neutrality 
established in the August 2, 2007 revised ASC payment system final rule 
and based on the final CY 2008 OPPS payment weights, the final CY 2008 
MPFS PE RVUs, and updated CY 2006 utilization data projected forward to 
CY 2008.
    Our final methodology for calculating the budget neutrality 
adjustment established in the August 2, 2007 revised ASC payment system 
final rule considered not only the effects of the new payment rates to 
be implemented under the revised ASC payment system, but also the 
estimated net effect of migration of new ASC procedures across 
ambulatory care settings. Both the

[[Page 66915]]

proposed budget neutrality adjustment presented in the August 2, 2007 
OPPS/ASC proposed rule and the budget neutrality adjustment in this 
final rule with comment period are based on that methodology, which 
takes into account projected migration. In the final model, we assume 
that over the first 2 years of the revised payment system, 
approximately 25 percent of the HOPD volume of new ASC procedures will 
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 will migrate to ASCs.
    We estimate that the revised ASC payment system 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 will 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 (non-office) 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
    Alternatives to the changes we are making and the reasons that we 
have chosen the options are discussed throughout this final rule with 
comment period. Some of the major issues discussed in this final rule 
with comment period and the options considered are discussed below.
a. Office-Based Procedures
    According to our final policy for the revised ASC payment system, 
we designate as office-based those procedures that are added to the ASC 
list of covered surgical procedures in CY 2008 or later years and that 
we determine are predominantly performed in physicians' offices based 
on consideration of 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 
establish payment for procedures designated as office-based at the 
lesser of the MPFS nonfacility PE RVU amount or the ASC rate developed 
according to the standard methodology of the revised ASC payment 
system. In the August 2, 2007 OPPS/ASC proposed rule, we proposed to 
designate 19 additional procedures as office-based, based on our 
evaluation of the most recent available CY 2006 volume and utilization 
data for each individual procedure code and/or related codes. In 
developing this final rule with comment period, we reviewed the newly 
available CY 2006 utilization data for all the surgical procedures we 
proposed to designate as office-based. Based on that review, we are 
designating 18 additional procedures as office-based for CY 2008. We 
considered two alternatives in developing this policy.
    The first alternative we considered was to make no change to the 
current policy for these 19 procedures. This would mean that we would 
continue to pay these procedures at the standard ASC payment rate 
developed according to the standard methodology of the revised ASC 
payment system. We did not select this alternative because our analysis 
of data for these services and related procedures indicated that 18 of 
the procedures we proposed to designate as office-based could be 
considered to be predominantly performed in physicians' offices. 
Consistent with our final policy adopted in the August 2, 2007 revised 
ASC payment system final rule (72 FR 42509), we were concerned that if 
these services were not designated as office-based, it could create 
financial incentives for the procedures to shift from physicians' 
offices to ASCs for reasons unrelated to the most appropriate setting 
for surgical care.
    The second alternative we considered, and the alternative we 
selected, is to designate 18 additional procedures as office-based for 
CY 2008. We selected this alternative because our claims data indicate 
that these procedures could be considered to be predominantly performed 
in physicians' offices. We believe that designating these procedures as 
office-based, which results in the ASC payment rate for these 
procedures being capped at the physician's office rate (that is, the 
MPFS nonfacility practice PE RVU amount), if applicable, is an 
appropriate step to ensure that Medicare payment policy does not create 
financial incentives for such procedures to shift unnecessarily from 
physicians' offices to ASCs, consistent with our final policy adopted 
in the August 2, 2007 revised ASC payment system final rule.
b. Partial Device Credits
    We are reducing the ASC payment by one half of the device offset 
amount for certain surgical procedures into which the device cost is 
packaged, when an ASC receives a partial credit toward replacement of 
specific implantable devices. This partial payment reduction will apply 
when the amount of the device credit is greater than or equal to 50 
percent of the cost of the new replacement device being implanted. 
Under this policy, both the Medicare payment to the ASC and the 
beneficiary coinsurance liability will be reduced when an ASC receives 
a partial device credit. This policy is an extension of the policy 
established in the August 2, 2007 revised ASC payment system final 
rule, which reduces the ASC payment by the full device offset amount 
for certain devices when the ASC receives a replacement device without 
cost or receives a credit for the full cost of the device being 
replaced. The final partial device credit policy for ASCs mirrors the 
final partial device credit for the OPPS in this final rule with 
comment period. We considered several alternatives in developing this 
partial device credit policy for CY 2008.
    The first alternative we considered was to make no change to the 
current policy. Under this alternative, Medicare and the beneficiary 
would continue to pay the ASC the full payment rate for the device 
implantation procedure even if the ASC received a substantial credit 
towards the cost of the replacement

[[Page 66916]]

device. The ASC payment for the device implantation procedure is based 
on the OPPS relative weight for the procedure, which is calculated 
using only OPPS claims for which the full cost of a device is billed. 
We did not select this alternative because we believe that, as long as 
the ASC payment amount is established based on an OPPS relative weight 
that is calculated using only claims that reflect the full cost of the 
device when there is no credit, there should be a reduction in the 
Medicare payment amount when the ASC receives a substantial credit 
toward the cost of the replacement device. Similarly, we believe that 
the beneficiary cost sharing should be based on an amount that also 
reflects the device credit.
    The second alternative we considered was to extend the current no 
cost/full credit reduction policy to cases of partial credit, without 
change. This would reduce the payment in all cases in which the ASC 
received a credit by the full offset amount for the device implantation 
procedure, that is, by 100 percent of the estimated device cost 
included in the procedure payment rate. We did not select this 
alternative because we did not believe it was appropriate to reduce the 
payment to the ASC by the full cost of a device if the ASC only 
received a partial credit, and not a full credit, towards the cost of 
the device.
    The third alternative, which we are adopting in this final rule 
with comment period, is to reduce the ASC procedure payment by 50 
percent of the offset amount (that will be applied if the ASC received 
full credit) in cases in which the ASC receives a partial credit 
greater than or equal to 50 percent of the cost of the new replacement 
device being implanted. This is consistent with the final CY 2008 OPPS 
policy described in detail in section IV.A.3. of this final rule with 
comment period. We will reduce the ASC payment for the specific 
procedure to implant the device by one-half of the device offset that 
would be applied if a replacement device were provided at no cost or 
with full credit, if the credit is 50 percent or more of the new 
replacement device cost, rather than the proposed 20 percent. We 
believe that payment policies across the OPPS and the ASC payment 
system should align whenever possible and appropriate, as is true in 
this case. Moreover, we are requiring the ASC to report a new modifier 
when the ASC receives a partial credit that is greater than or equal to 
50 percent of the cost of the device being replaced. We are selecting 
this alternative because we believe that this approach provides an 
appropriate and equitable payment to the ASC from Medicare and will 
reduce the beneficiary's cost sharing for the service.
c. Payment to Physicians for Services Not on the ASC List of Covered 
Surgical Procedures
    Under current policy, when physicians perform surgical procedures 
in ASCs that are included on the ASC list of covered surgical 
procedures, they are paid under the MPFS for the PE component using the 
facility PE RVUs. When physicians perform surgical procedures in ASCs 
that are not included on the ASC list of covered surgical procedures 
and for which Medicare does not allow facility payments to ASCs, 
physicians currently are paid for the PE component at the higher 
nonfacility rate (unless a nonfacility rate does not exist, in which 
case Medicare pays the facility rate). In this final rule with comment 
period, we are providing that regardless of whether a procedure is on 
the ASC list of covered surgical procedures, a physician performing 
that procedure in an ASC will receive payment based on the facility PE 
RVUs and excluding the technical component (TC) payment, if applicable. 
We considered two alternatives in developing this policy.
    The first alternative we considered was to make no change to the 
current policy concerning physician payment for services performed in 
ASCs that are not on the ASC list of covered surgical procedures. Under 
current policy, the physician is paid the higher nonfacility PE amount 
for performing a service in an ASC that is not on the ASC list of 
covered surgical procedures (unless a nonfacility rate does not exist 
in which case Medicare pays the facility PE rate). We adopted a final 
policy to identify and exclude from ASC payment only those procedures 
that could pose a significant risk to beneficiary safety or would be 
expected to require an overnight stay. Because the excluded procedures 
have been specifically identified by CMS as procedures that are unsafe 
for Medicare beneficiaries in ASCs because they could pose a 
significant risk to beneficiary safety or would be expected to require 
an overnight stay, we do not believe it would be appropriate to provide 
payment based on the higher nonfacility PE RVUs to physicians who 
furnish them. Consequently, we did not select this alternative.
    The second alternative that we considered, and that we selected, 
was to provide payment to physicians for performing procedures in ASCs 
based on the facility PE RVUs and excluding the TC payment, if 
applicable, regardless of whether a procedure is on the ASC list of 
covered surgical procedures. We selected this alternative for several 
reasons. We believe ASCs are facilities that are similar, insofar as 
the delivery of surgical and related nonsurgical services, to HOPDs. 
Specifically, when services are provided in ASCs, the ASC, not the 
physician, bears responsibility for the facility costs associated with 
the service. This situation parallels the hospital facility resource 
responsibility for hospital outpatient services. Therefore, we believe 
it would be more appropriate for physicians to be paid for all services 
furnished in ASCs just as they would be paid for all services furnished 
in the hospital outpatient setting. In addition, because we have 
adopted a final policy for the revised ASC payment system that 
identifies and excludes from ASC payment only those procedures that 
could pose a significant risk to beneficiary safety or would be 
expected to require an overnight stay, we believe that it would be 
incongruous with the revised ASC payment system methodology to continue 
to pay the higher nonfacility rate to physicians who furnish excluded 
ASC 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 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 second 
limitation of our analysis is our inability to predict changes in 
service mix between CY 2006 and CY 2008 with precision. The aggregated 
impact tables below are based upon a methodology that assumes no 
changes in service mix with respect to the CY 2006 ASC data used for 
this final rule with comment period. We believe that the net effect on 
Medicare expenditures resulting from changes in service mix for current 
ASC covered surgical procedures will be negligible in the aggregate. 
Such changes may have differential effects across surgical specialties 
as ASCs adjust to payment rates. However, we are unable to accurately 
project such changes at a disaggregated level. Clearly, individual ASCs 
will experience changes in payment that differ from the aggregated 
estimated changes presented below.

[[Page 66917]]

3. Estimated Effects of This Final Rule With Comment Period on ASCs
a. Payment to 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, digestive 
system, or orthopedic procedures. 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. The following discussion 
presents 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 reflected in our CY 2006 claims 
data. Table 63 depicts the aggregate percent change in payment by 
surgical specialty group and Table 64 shows a comparison of payment for 
procedures that we estimate would receive the most Medicare payment in 
CY 2008 under the current payment system.
    In section XVI.C.1.c.(5) of this final rule with comment period, we 
reiterate the transition of 4 years under the revised ASC payment 
system, where payments for most surgical procedures will be made using 
a blend of the rates based on the CY 2007 ASC payment rate and the 
revised ASC payment rate. 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 CY 2008 revised ASC 
rate for the same procedure. For CYs 2009 and 2010, we will transition 
the blend 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, we will 
pay ASCs for covered surgical procedures on the CY 2007 ASC list at the 
fully implemented revised ASC payment rates. We will not transition 
payment for procedures that were not included on the ASC list of 
covered surgical procedures in CY 2007; we will pay for these 
procedures at the fully implemented ASC rate, beginning in CY 2008.
    Table 63 shows the effects on aggregate Medicare payments under the 
revised ASC payment system by surgical specialty group. 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 ASC payment rate discussed above. 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 63.
     Column 1--Surgical Specialty Group indicates the surgical 
specialties into which ASC procedures are grouped. We used the CPT code 
range definitions and 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 
2006 ASC utilization multiplied by a factor of 1.176 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 estimated CY 2008 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 CY 2008 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 
comparisons to the percentage changes under the transition policy in 
column 3 and do not depict the impact of the fully implemented policy 
in 2011.
    As seen in Table 63, for all but digestive system procedures, if an 
ASC offers the same mix of services in CY 2008 that is reflected in our 
national CY 2006 claims data, Medicare payments to the ASC for services 
in that surgical specialty group are expected to increase under the 
revised payment system. If the revised payment system was fully 
implemented in CY 2008, we expect all but digestive system procedures 
and nervous system procedures to receive greater Medicare payment. In 
addition to the effects on Medicare payments for current ASC procedures 
shown in Table 63, it is important to note that estimated CY 2008 
payments to ASCs are estimated to increase by more than $240 million in 
CY 2008 due to projected migration of new ASC services from HOPDs and 
physicians' offices to ASC. 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 63.--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...........................................          $1,247               2               3

[[Page 66918]]

 
Digestive system................................................             708              -4             -16
Nervous system..................................................             260               3              -4
Musculoskeletal system..........................................             165              24              94
Integumentary system............................................              75               8              32
Genitourinary system............................................              74              11              43
Respiratory system..............................................              18              16              64
Cardiovascular system...........................................               8              24              94
Auditory system.................................................               4              23              80
Hemic and lymphatic systems.....................................               2              31             124
Other systems...................................................             0.1              27             108
----------------------------------------------------------------------------------------------------------------

    Table 64 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 most Medicare estimated CY 2008 ASC payments under the 
existing Medicare payment system. The HCPCS codes are sorted in 
descending order by estimated program payment.
     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 2006 
ASC utilization multiplied by a factor of 1.176 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 estimated CY 2008 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 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 
CY 2008 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 to the percentage 
changes under the transition policy in Column 4 and do not depict the 
impact of the fully implemented policy in 2011.

 Table 64.--Estimated CY 2008 Impact of Revised ASC Payment System on Aggregate Payments for Procedures With the
                        Most Medicare Estimated CY 2008 Payments Under the Current System
----------------------------------------------------------------------------------------------------------------
                                                                                                    Estimated CY
                                                                           Estimated    Estimated   2008 percent
                                                                          CY 2008 ASC    CY 2008       changes
           HCPCS code                        Short descriptor               payments     percent       without
                                                                              (in      change (75/   transition
                                                                           millions)    25 blend)      (fully
                                                                                                    implemented)
----------------------------------------------------------------------------------------------------------------
66984...........................  Cataract surg w/iol, 1 stage..........        1,017            0             1
43239...........................  Upper GI endoscopy, biopsy............          156           -5           -17
45378...........................  Diagnostic colonoscopy................          141           -4           -14
45380...........................  Colonoscopy and biopsy................          115           -4           -14
45385...........................  Lesion removal colonoscopy............           95           -4           -14
66821...........................  After cataract laser surgery..........           89           -8           -25
62311...........................  Inject spine l/s (cd).................           75           -3           -10
64483...........................  Inj foramen epidural l/s..............           43           -3           -10
66982...........................  Cataract surgery, complex.............           39            0             1
45384...........................  Lesion remove colonoscopy.............           39           -4           -14
G0121...........................  Colon ca scrn not hi rsk ind..........           36           -7           -22
G0105...........................  Colorectal scrn; hi risk ind..........           28           -7           -22
15823...........................  Revision of upper eyelid..............           26            4            12
43235...........................  Uppr gi endoscopy, diagnosis..........           24            1             4
52000...........................  Cystoscopy............................           23           -6           -21
64475...........................  Inj paravertebral l/s.................           23           -3           -10

[[Page 66919]]

 
64476...........................  Inj paravertebral l/s ADD-on..........           22          -18           -65
29881...........................  Knee arthroscopy/surgery..............           17           22            55
64721...........................  Carpal tunnel surgery.................           16           17            43
43248...........................  Uppr gi endoscopy/guide wire..........           14           -5           -17
62310...........................  Inject spine c/t......................           13           -3           -10
67904...........................  Repair eyelid defect..................           12            6            16
29880...........................  Knee arthroscopy/surgery..............           12           22            55
64484...........................  Inj foramen epidural ADD-on...........           12          -12           -42
28285...........................  Repair of hammertoe...................           10           17            44
G0260...........................  Inj for sacroiliac jt anesth..........           10           -3           -10
29848...........................  Wrist endoscopy/surgery...............            9           -3            -8
64623...........................  Destr paravertebral n ADD-on..........            9           -3           -10
45383...........................  Lesion removal colonoscopy............            8           -4           -14
26055...........................  Incise finger tendon sheath...........            8           13            35
----------------------------------------------------------------------------------------------------------------

    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 will support the ASC's continued 
operation. We note 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 note that procedures with existing ASC payment rates 
that are substantially lower than the OPPS rates are performed least 
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 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 64 identifies a number of ASC procedures receiving the most 
Medicare estimated CY 2008 payment 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 63. In fact, Table 63 shows only one surgical 
specialty group of procedures for which the payments are expected to 
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 CY 2008 payment rates. The estimated 
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 
projected aggregate increase in CY 2008 under the revised system is 
driven by a very small increase, less than 1 percent, 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 the payment rate for cystoscopy (CPT code 52000), the highest 
volume ASC genitourinary procedure, is 6 percent less for CY 2008 than 
under the existing payment system, overall payment to ASCs for the 
group of genitourinary procedures currently performed in ASCs is 
expected to increase by 11 percent. Although a urology specialty ASC 
may currently perform more cystoscopy procedures than any other 
genitourinary procedure, we believe that under the revised ASC payment 
system, each 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, payment for all of the highest volume pain management 
injection procedures are expected to decrease in CY 2008, although 
payment for nervous system procedures overall are expected to increase. 
However, if there were no transition period, we estimate that CY 2008 
payments also would decrease slightly for the nervous system surgical 
specialty group.
    We note that the estimated percent changes in payment under the 
revised ASC payment system for the surgical procedures with the highest 
aggregate Medicare ASC payments closely resemble those presented in the 
CY 2008 OPPS/ASC proposed rule, with the exception of CPT codes 64476 
(Injection, anesthetic agent and/or steroid, paravertebral facet joint 
or facet joint nerve; lumbar or sacral, each additional level (List 
separately in addition to code for primary procedure)); and 64484 
(Injection, anesthetic agent and/or steroid, transforaminal epidural; 
lumbar or sacral, each additional level (List separately in addition to 
code for primary procedure)). Our estimates of the percent changes in 
ASC payment for these two injection procedures are

[[Page 66920]]

considerably greater for this final rule than they were for the CY 2008 
OPPS/ASC proposed rule. Both of these nervous system procedures had 
significantly more single claims available for OPPS ratesetting for 
this final rule with comment period, reflecting much lower costs that 
their median costs for the proposed rule. These data resulted in the 
reassignment of CPT codes 64476 and 64484 to different clinical APCs 
for CY 2008 than proposed, in order to ensure the clinical and resource 
homogeneity of the OPPS APCs for CY 2008. Their lower OPPS payment 
rates in turn resulted in lower payments than those estimated in the 
proposed rule for the two services under the revised ASC payment 
system. However, as shown in Table 63, above, the final estimated 
decrease in ASC payment for nervous system procedures overall without 
the transition is estimated to be 4 percent in this final rule with 
comment period, very close to the CY 2008 OPPS/ASC proposed rule 
estimated decrease of 2 percent for nervous system procedures. Thus, we 
believe that our final policies will continue to ensure Medicare 
beneficiary access to surgical procedures involving the nervous system 
in ASCs under the revised ASC payment system in CY 2008.
    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 are the rates for 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 for its report to Congress 
on ASC costs, as described in the August 2, 2007 revised ASC payment 
system final rule (72 FR 42474), appear in Table 64 with payment 
decreases under the revised ASC payment system. The GAO concluded that 
for those procedures the OPPS APC groups accurately reflect the 
relative costs of procedures performed at ASCs and that ASCs have 
substantially lower costs.
    For some procedures, the payment amounts in CY 2008 are much higher 
than the CY 2007 rates currently paid to ASCs. For example, payments 
for CPT codes 29880 (Arthroscopy, knee, surgical; with meniscectomy 
(medial AND lateral, including any meniscal shaving)) and 29881 
(Arthroscopy, knee, surgical; with meniscectomy (medial OR lateral, 
including meniscal shaving)) increase by 22 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 amounts.
    As indicated elsewhere in this final rule with comment period, 
payments for most of the highest volume colonoscopy and upper 
gastrointestinal endoscopy procedures will decrease under the revised 
payment system. Table 63 estimates that payment decreases also are 
expected for the digestive system surgical specialty group overall. We 
believe that the reason for decreased payments for so many of the 
digestive system procedures is that the 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 negatively affected under the 
revised payment system while procedures for which ASC rates have 
historically been much lower than the comparable OPPS rates are 
positively affected. The payment decreases expected in the first year 
under the revised ASC payment system for some of the high volume 
digestive system procedures are not large (all less than or equal to 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 addition to the procedures currently on the ASC list of covered 
surgical procedures discussed above, 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 the MPFS nonfacility PE RVU amount, whichever is lower, the other 
covered ancillary items and services 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, the August 2, 2007 revised ASC payment system final rule 
established 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. We expect that 
this final methodology will allow ASCs to continue to expand their 
provision of device-intensive services and to begin performing new 
device-intensive ASC procedures.
b. Payment to Physicians for Performing Excluded ASC Procedures in an 
ASC
    As discussed in section XVI.G. of this final rule with comment 
period, we are paying physicians at the facility rate for furnishing 
procedures in ASCs that are excluded from the ASC list of covered 
procedures. This policy reduces site of service (facility versus 
nonfacility) differentials that currently exist and aligns physician 
payment policies for services furnished in ASCs and HOPDs.
    We believe that the effect of the change will be small. Currently, 
physicians are paid for procedures performed in ASCs that are not on 
the list of ASC covered surgical procedures based on the nonfacility PE 
RVUs, unless a nonfacility rate does not exist, in which case they are 
paid based on the facility rate. For CY 2008, we excluded procedures 
from the ASC list of covered surgical procedures because they could 
pose a significant risk to beneficiary safety or would be expected to 
require an overnight stay and, as such, the excluded procedures are 
generally more complex than procedures furnished in physicians' 
offices. Consequently, most surgical procedures that are excluded from 
the list of ASC covered surgical procedures in CY 2008 do not have 
nonfacility PE RVUs. Specifically, only about 46 of approximately 2,000 
excluded ASC procedures for CY 2008 have nonfacility PE RVUs. As a 
result, even under our current policy, physicians performing an 
excluded ASC procedure in an ASC would be paid for most excluded 
procedures based on the facility PE RVUs. Thus, our policy to pay 
physicians for excluded ASC procedures performed in ASCs based on the 
facility PE RVUs will only affect Medicare payment rates for the small 
proportion of excluded procedures that have nonfacility PE RVUs.

[[Page 66921]]

4. Estimated Effects of This Final Rule With Comment Period on 
Beneficiaries
a. Payment to ASCs
    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 approximately 800 surgical procedures to the 
ASC list of covered surgical services eligible for Medicare payment in 
CY 2008. 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.
b. Payment to ASCs for Excluded Procedures Performed in an ASC
    In addition, the revision to Sec. Sec.  414.22(b)(5)(i)(A) and (B) 
will impose beneficiary liability for facility costs associated with 
surgical procedures that are not Medicare covered surgical procedures 
in ASCs. In the August 2, 2007 revised ASC payment system final rule, 
CMS determined that the only surgical procedures that will be excluded 
from ASC payment in CY 2008 are those that could pose a significant 
safety risk to beneficiaries when furnished in an ASC or are expected 
to require an overnight stay when furnished in ASCs and, therefore, 
Medicare provides no payment to ASCs for these procedures. The revision 
to Sec. Sec.  414.22(b)(5)(i)(A) and (B) will also provide for no 
payment to physicians for the facility resources required to furnish 
excluded services in ASCs, leaving the beneficiary liable for the 
facility payment if a surgical procedure excluded by Medicare from ASC 
payment is, in fact, performed in the ASC setting. We do not expect 
that the change will result in a meaningful increase in beneficiary 
liability because we do not expect that excluded services, which we 
have determined could pose a significant risk to beneficiary safety or 
would be expected to require an overnight stay, will be furnished to 
Medicare beneficiaries in ASCs. Furthermore, we expect that physicians 
and ASCs will advise beneficiaries of all of the possible consequences 
(including denial of Medicare payment with concomitant beneficiary 
liability and significant surgical risk) if surgical procedures 
excluded from ASC payment are provided in ASCs.
5. Conclusion
    The changes to the ASC payment system for CY 2008 will affect each 
of the approximately 4,800 ASCs currently approved for participation in 
the Medicare program. The effect on an individual ASC will depend on 
the ASC's mix of patients, the proportion of 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 $240 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 
XVI.L. of this final rule with comment period). Furthermore, we 
estimate that the revised ASC payment system will result in Medicare 
savings of $220 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 with comment period 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 65 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 with 
comment period. As explained above, we estimate that Medicare payments 
to ASCs for CY 2008 will be about $240 million higher than they 
otherwise would be in the absence of the revised ASC payment system. 
This $240 million in additional payments to ASCs will be fully offset 
by savings from reduced Medicare 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 with comment period. All expenditures are 
classified as transfers.

      Table 65.--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.
------------------------------------------------------------------------


[[Page 66922]]

D. Effects of the Requirements for Reporting of Quality Data for 
Hospital Outpatient Settings

    In section XVII. of this final rule with comment period, we discuss 
our measures and requirements for reporting of quality data to CMS for 
services furnished in hospital outpatient settings under the HOP QDRP. 
We note that we have reduced the number of initial quality measures to 
be reported from the 10 we proposed to 7. We have also modified the 
date for which the initial submission of quality data begins from 
services furnished on or after January 2008 to services furnished on or 
after April 2008. The initial submission for data for April-June 2008 
services is due to the OPPS Clinical Warehouse by November 1, 2008. CMS 
and its contractors will provide assistance to all hospitals that wish 
to submit data. In addition, we have modified our proposal for the CY 
2009 payment update, so that hospitals are not required to submit 
charts for or pass our validation requirement of a minimum of 80 
percent reliability, based upon our chart-audit validation process for 
January 2008 services. As noted in section XVII.E. of this final rule 
with comment period, we are providing validation criteria for services 
furnished on or after July 1, 2008 for purposes of the CY 2010 and 
subsequent years' payment updates to ensure that the quality data being 
sent to CMS are accurate. The requirement of five charts per hospital 
per quarter will result in the submission of approximately 21,500 
charts per quarter for services furnished on or after July 1, 2008 to 
the agency. We believe that a requirement for five charts per hospital 
per quarter for services furnished on or after July 1, 2008, represents 
a minimal burden to the participating hospital.

E. Effects of Policy Revisions on CAH Off-Campus and Co-Location 
Requirements

    In section XVIII.A. of the preamble of this final rule with comment 
period, we discuss our changes regarding a CAH's ability to co-locate 
with another acute care hospital or establish an off-campus location 
that does not comply with the location requirements (more than a 35-
mile drive, or in the case of mountainous terrain or in areas with only 
secondary roads available, a 15-mile drive) for CAHs. We clarified in 
this final rule with comment period that if a CAH with a necessary 
provider designation has a co-location arrangement with another 
hospital or CAH that was in effect before January 1, 2008, and the type 
and scope of services offered by the facilities co-located with the 
necessary provider CAH do not change, the CAH can continue those 
arrangements. In addition, if a CAH (including one with a necessary 
provider designation) acquires or creates an off-campus provider-based 
location or an off-campus distinct part psychiatric or rehabilitation 
unit on or after January 1, 2008, the CAH off-campus provider-based 
facility must comply with the location requirements. We revised the 
language of the regulation to exclude RHCs, as defined under Sec.  
405.2401(b), from the list of provider-based facilities that must 
comply with this regulation. Because CAHs can continue current co-
location and off-campus arrangements that are in place before January 
1, 2008, we believe there is no burden associated with this regulation.

F. Effects of Policy Revisions to the Hospital CoPs

    In section XVIII.B. of the preamble of this final rule with 
comment, we discuss changes to the hospital CoPs relating to timeframes 
for completion of medical history and physical examinations and 
requirements for preanesthesia and postanesthesia evaluations of 
Medicare beneficiaries. We believe that these revisions would impose 
minimal additional costs on hospitals. In fact, hospitals may realize 
some minimal cost savings. The cost of implementing these changes would 
largely be limited to the one-time cost related to the revision of a 
hospital's medical staff bylaws and its policies and procedures as they 
relate to the requirements for medical history and physical 
examinations and for preanesthesia and postanesthesia evaluations. 
There also may be some minimal cost associated with communicating these 
changes to affected hospital staff. However, we believe that these 
costs would be offset by the benefits derived from the overall intent 
of these revisions to require that the most current information 
regarding a patient's condition be available to hospital staff so that 
risks to patient safety can be minimized and potential adverse outcomes 
can be avoided. Furthermore, the changes would clarify existing 
hospital CoPs to make them more consistent with current practice, while 
still retaining the flexibility and reduction in burden that hospitals 
are currently provided in meeting those CoPs. Therefore, no burden is 
being assessed on the revision of medical staff bylaws and hospital 
policies and procedures or on the communication of these revisions to 
staff that would be required by these revisions as these practices are 
usual and customary business practices.
    In accordance with the provisions of Executive Order 12866, this 
final rule with comment period was reviewed by the OMB.

G. Impact of the Changes to the Hospital Inpatient Prospective Payment 
System (IPPS) Payment Rates

1. Overall Impact
    We have examined the impacts of this final rule relating to the 
changes to hospital inpatient prospective payment system payment rates 
as required by Executive Order 12866 (September 1993, Regulatory 
Planning and Review), section 1102(b) of the Social Security Act, the 
Unfunded Mandates Reform Act of 1995 (Public Law 104-4), and Executive 
Order 13132. We have also examined the impacts of this final rule in 
the context of the Regulatory Flexibility Act (RFA) (September 19, 
1980, Public Law 96-354).
    Based on the IPPS provisions specified in section XIX. of this 
final rule, we have determined that this rule is a major rule as 
defined in 5 U.S.C. 804(2). This final rule includes changes in FY 2008 
IPPS payments due to the enactment of Public Law 110-90, which requires 
the Secretary to apply a prospective documentation and coding 
adjustment for discharges during FY 2008 of -0.6 percent rather than 
the -1.2 percent specified in the FY 2008 IPPS final rule. In addition, 
this final rule includes a change in policy to not apply the 
documentation and coding adjustment to the hospital-specific payment 
rates. We estimate that the increase in FY 2008 IPPS operating and 
capital payments to hospitals resulting from the provisions of this 
final rule will be in excess of $100 million.
    With the exception of the IPPS changes included in this final rule, 
all FY 2008 IPPS payment policies were established in the FY 2008 IPPS 
final rule (72 FR 47130) issued on August 1, 2007. As noted in section 
XIX. of this document, on September 28, 2007, we issued a notice 
relating to the FY 2008 IPPS final rule that corrected a technical 
calculation and typographical errors in that final rule. The correction 
notice appeared in the October 10, 2007 Federal Register and is 
hereinafter referred to as the ``second FY 2008 IPPS correction 
notice.'' In the second FY 2008 IPPS correction notice, we estimated a 
$4.0 billion increase in FY 2008 operating and capital payments as a 
result of the market basket update to the FY 2008 IPPS rates required 
by the statute, in conjunction with the other payment policies 
established in the FY

[[Page 66923]]

2008 IPPS final rule. In this final rule, we have updated our estimate 
of the increase in FY 2008 IPPS operating and capital payments based on 
the policies and market basket update established in the FY 2008 IPPS 
final rule and the addition of the IPPS provisions included in this 
final rule. We now estimate an increase in FY 2008 operating and 
capital payments of approximately $4.6 billion, an increase of about 
$665 million over our prior estimate. Our current estimate includes the 
statutorily mandated -0.6 percent adjustment for documentation and 
coding changes to the IPPS standardized amounts and capital Federal 
rates for FY 2008 under section 7 of Public Law 110-90, and the removal 
of the application of the documentation and coding adjustment to the 
hospital-specific rates. For purposes of the impact analysis, we also 
assume a 1.2 percent increase in case-mix growth, as determined by the 
Office of the Actuary, because we believe the adoption of the MS-DRGs 
will result in case-mix growth due to documentation and coding changes 
that do not reflect real changes in patient severity of illness. The 
estimates do not reflect any other changes in hospital admissions or 
case-mix intensity in operating PPS payments, which will also affect 
overall payment changes.
    The RFA requires agencies to analyze options for regulatory relief 
of small businesses for any rule for which the agency publishes a 
general notice of proposed rulemaking. Since we have waived notice and 
comment rulemaking for the IPPS provisions in this final rule as 
discussed in section XIX.C. of this final rule, we do not believe the 
Regulatory Flexibility Act requires a regulatory flexibility analysis 
in this case. While we do not believe we are required to perform a 
regulatory flexibility analysis, we are including in section XIX. of 
this final rule and in this impact analysis section final rule all of 
the components that would be required of a final regulatory flexibility 
analysis.
    For purposes of the RFA, small entities include small businesses, 
nonprofit organizations, and government agencies. Most hospitals and 
most other providers and suppliers are considered to be small entities, 
either by nonprofit status or by having revenues of $31.5 million or 
less in any 1 year. (For details on the latest standards for heath care 
providers, we refer readers to page 33 of the Table of Small Business 
Size Standards at the Small Business Administration Web site at: http://www.sba.gov/services/contractingopportunities/sizestandardstopics/tableofsize/index.html.) For purposes of the RFA, all hospitals and 
other providers and suppliers are considered to be small entities. 
Individuals and States are not included in the definition of a small 
entity. We believe that the IPPS payment rate changes in this final 
rule will have a significant impact on small entities as explained 
subsequently.
    In addition, section 1102(b) of the Act requires us to prepare a 
regulatory impact analysis for any proposed or final rule that may have 
a significant impact on the operations of a substantial number of small 
rural hospitals. This analysis must conform to the provisions of 
section 604 of the RFA. With the exception of hospitals located in 
certain New England counties, for purposes of section 1102(b) of the 
Act, we now define a small rural hospital as a hospital that is located 
outside of an urban area and has fewer than 100 beds. Section 601(g) of 
the Social Security Amendments of 1983 (Public Law 98-21) designated 
hospitals in certain New England counties as belonging to the adjacent 
urban area. Thus, for purposes of the IPPS, we continue to classify 
these hospitals as urban hospitals.
    Section 202 of the Unfunded Mandates Reform Act of 1995 (Public Law 
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 IPPS 
changes in this final rule will not mandate any requirements for State, 
local, or tribal governments, nor will it affect private sector costs.
    Executive Order 13132 establishes certain requirements that an 
agency must meet when it promulgates a proposed rule (and subsequent 
final rule) that imposes substantial direct requirement costs on State 
and local governments, preempts State law, or otherwise has Federalism 
implications. As stated above, the IPPS changes in this final rule will 
not have a substantial effect on State and local governments.
    The following analysis, in conjunction with the section XIX. of 
this document, demonstrates that this rule is consistent with the 
regulatory philosophy and principles identified in Executive Order 
12866, the RFA, and section 1102(b) of the Act. The rule will affect 
payments to a substantial number of small rural hospitals, as well as 
other classes of hospitals, and the effects on some hospitals may be 
significant.
2. Objectives
    The primary objective of the IPPS is to create incentives for 
hospitals to operate efficiently and minimize unnecessary costs while 
at the same time ensuring that payments are sufficient to adequately 
compensate hospitals for their legitimate costs. In addition, we share 
national goals of preserving the Medicare Hospital Insurance Trust 
Fund.
    We believe that the policies established in the FY 2008 IPPS final 
rule and the IPPS provisions of this final rule will further each of 
these goals while maintaining the financial viability of the hospital 
industry and ensuring access to high quality health care for Medicare 
beneficiaries. We expect that these changes will ensure that the 
outcomes of this payment system are reasonable and equitable while 
avoiding or minimizing unintended adverse consequences.
3. Limitations of Our Analysis
    The following quantitative analysis presents the projected effects 
of our IPPS policy changes, as well as statutory changes effective for 
FY 2008, on various hospital groups. We use the best available data, 
but generally do not attempt to make adjustments for future changes in 
such variables as admissions, length of stay, or case-mix. However, as 
stated in the FY 2008 IPPS final rule, we believe that adoption of the 
MS-DRGs will create a risk of increased aggregate levels of payment as 
a result of more comprehensive documentation and coding. As explained 
in section XIX. of this final rule, the FY 2008 IPPS final rule 
established a documentation and coding adjustment of -1.2 percent to 
maintain budget neutrality for the transition to the MS-DRGs. 
Subsequently, Congress enacted Public Law 110-90, which reduced the FY 
2008 IPPS documentation and coding adjustment from -1.2 percent to -0.6 
percent. Therefore, in section XIX. of this final rule, we have revised 
the payment rates, factors and thresholds to reflect the -0.6 percent 
documentation and coding adjustment. While the documentation and coding 
adjustment has been changed for payment purposes, we continue to 
believe that an increase in case mix of 1.2 percent in FY 2008 is 
likely as a result of the adoption of the MS-DRGs. The impacts shown 
below illustrate the impact of the FY 2008 IPPS changes on hospital 
operating payments, including the -0.6 percent documentation and coding 
adjustment to the IPPS standardized amounts, both prior to and 
following the projected 1.2 percent growth in case-mix.

[[Page 66924]]

4. Quantitative Effects of the IPPS Policy Changes for Operating Costs
    In this final rule, we are employing the same operating payment 
simulation model as used in the FY 2008 IPPS final rule. Our 
methodology underlying the simulation model is discussed in detail in 
the FY 2008 IPPS final rule (72 FR 48158 through 48159). The difference 
between the impact estimates in this final rule and the FY 2008 IPPS 
final rule reflects the application of a documentation and coding 
adjustment of -0.6 percent (instead of -1.2 percent) and the removal of 
the application of the documentation and coding adjustment to the 
hospital-specific rates. Our impact estimates in this final rule also 
reflect a technical correction to a calculation error made in our 
previously published impact estimates, as discussed in more detail 
subsequently.
5. Analysis of Table I
    Table I displays the estimated increase in IPPS operating payments 
between FY 2007 and FY 2008. It compares the impact estimates 
previously published in the second FY 2008 IPPS correction notice to 
the FY 2008 IPPS final rule, which is based on the payment policies and 
market basket update established in the FY 2008 IPPS final rule, with 
our current impact estimates, which are based on both the IPPS policies 
established in the FY 2008 IPPS final rule and the IPPS policy changes 
included in this final rule.
    As noted previously, we believe that the adoption of the MS-DRGs in 
FY 2008 will create a financial risk of increased aggregate payments as 
a result of more comprehensive documentation and coding. To maintain 
budget neutrality, the FY 2008 IPPS final rule established a 
documentation and coding adjustment of -1.2 percent for FY 2008. 
Subsequently, Public Law 110-90 was enacted, which reduces the FY 2008 
documentation and coding adjustment from -1.2 percent to -0.6 percent. 
Thus, our previously published impact estimates reflect a -1.2 percent 
documentation and coding adjustment and our current impact estimates 
reflect a -0.6 percent adjustment. While the documentation and coding 
adjustment has been changed for payment purposes, we continue to 
believe that an increase in case-mix of 1.2 percent for FY 2008 is 
likely to occur. Table 1 illustrates the impact of the FY 2008 IPPS 
changes on hospital payments, including the documentation and coding 
adjustment to the IPPS standardized amounts, both prior to and 
following the projected 1.2 percent growth in case-mix.
    The table categorizes hospitals by various geographic and special 
payment considerations to illustrate the varying impacts on different 
types of hospitals. The top row of the table shows the overall impact 
on the 3,534 hospitals included in the analysis.
    The next four rows of Table I contain hospitals categorized 
according to their geographic location: All urban, which is further 
divided into large urban and other urban; and rural. There are 2,539 
hospitals located in urban areas included in our analysis. Among these, 
there are 1,406 hospitals located in large urban areas (populations 
over 1 million), and 1,133 hospitals in other urban areas (populations 
of 1 million or fewer). In addition, there are 995 hospitals in rural 
areas. The next two groupings are by bed size categories, shown 
separately for urban and rural hospitals. The final groupings by 
geographic location are by census divisions, also shown separately for 
urban and rural hospitals.
    The second part of Table I shows hospital groups based on 
hospitals' FY 2008 payment classifications, including any 
reclassifications under section 1886(d)(10) of the Act. For example, 
the rows labeled urban, large urban, other urban, and rural show that 
the number of hospitals paid based on these categorizations after 
consideration of geographic reclassifications (including 
reclassifications under section 1886(d)(8)(B) and section 1886(d)(8)(E) 
of the Act that have implications for capital payments) are 2,578, 
1,425, 1,153, and 956, respectively.
    The next three groupings examine the impacts of the changes on 
hospitals grouped by whether or not they have GME residency programs 
(teaching hospitals that receive an IME adjustment) or receive DSH 
payments, or some combination of these two adjustments. There are 2,480 
nonteaching hospitals in our analysis, 815 teaching hospitals with 
fewer than 100 residents, and 239 teaching hospitals with 100 or more 
residents.
    In the DSH categories, hospitals are grouped according to their DSH 
payment status, and whether they are considered urban or rural for DSH 
purposes. The next category groups together hospitals considered urban 
after geographic reclassification, in terms of whether they receive the 
IME adjustment, the DSH adjustment, both, or neither.
    The next five rows examine the impacts of the changes on rural 
hospitals by special payment groups (SCHs, RRCs, and MDHs), as well as 
rural hospitals not receiving a special payment designation. There were 
194 RRCs, 367 SCHs, 150 MDHs, 99 hospitals that are both SCHs and RRCs, 
and 8 hospitals that are both an MDH and an RRC.
    The next series of groupings concern the geographic 
reclassification status of hospitals. The first grouping displays all 
urban hospitals that were reclassified by the MGCRB for FY 2008. The 
second grouping shows the MGCRB rural reclassifications.
    The final two groupings are based on the type of ownership and the 
hospital's Medicare utilization expressed as a percent of total patient 
days. These data were taken from the FY 2004 Medicare cost reports.

                                Table I.--Impact Analysis of Changes for FY 2008
----------------------------------------------------------------------------------------------------------------
                                                               Previously    Current     Previously    Current
                                                               published   estimate of   published   estimate of
                                                              all FY 2008  all FY 2008  all FY 2008  all FY 2008
                                                               changes w/   changes w/   changes w/   changes w/
                                                    No. of        CMI          CMI          CMI          CMI
                                                  hospitals    adjustment   adjustment   adjustment   adjustment
                                                                prior to     prior to       and          and
                                                               estimated    estimated    estimated    estimated
                                                              growth \11\  growth \12\  growth \13\  growth \14\
                                                         (1)         (2a)         (2b)         (3a)         (3b)
----------------------------------------------------------------------------------------------------------------
All Hospitals..................................        3,534          2.5          3.1          3.7          4.3
By Geographic Location:
    Urban hospitals............................        2,539          2.6          3.3          3.9          4.5
    Large urban areas..........................        1,406          3.1          3.7          4.3          5.0
    Other urban areas..........................        1,133            2          2.7          3.3          3.9

[[Page 66925]]

 
    Rural hospitals............................          995          1.2          1.7          2.4          2.9
Bed Size (Urban):
    0-99 beds..................................          630            1          1.6          2.2          2.8
    100-199 beds...............................          851          2.3          2.9          3.6          4.2
    200-299 beds...............................          480          2.5          3.1          3.8          4.4
    300-499 beds...............................          411            3          3.6          4.2          4.8
    500 or more beds...........................          167          2.9          3.5          4.1          4.8
Bed Size (Rural):
    0-49 beds..................................          337          0.1          0.5          1.3          1.7
    50-99 beds.................................          372          1.2          1.6          2.4          2.9
    100-149 beds...............................          173          1.2          1.8          2.5          3.0
    150-199 beds...............................           68          1.2          1.8          2.5          3.0
    200 or more beds...........................           45          1.8          2.3          3.1          3.6
Urban by Region:
    New England................................          122          2.4          3.0          3.7          4.3
    Middle Atlantic............................          350          2.2          2.9          3.5          4.1
    South Atlantic.............................          390          2.7          3.4            4          4.6
    East North Central.........................          395          2.4          3.0          3.7          4.3
    East South Central.........................          166          2.1          2.7          3.3          3.9
    West North Central.........................          157          2.4          3.0          3.6          4.2
    West South Central.........................          355          2.6          3.2          3.8          4.4
    Mountain...................................          153          2.6          3.2          3.8          4.4
    Pacific....................................          398            4          4.6          5.2          5.8
    Puerto Rico................................           53          2.9          3.5          4.1          4.8
Rural by Region:
    New England................................           23          1.2          1.6          2.4          2.8
    Middle Atlantic............................           72          1.4          1.8          2.6          3.0
    South Atlantic.............................          173          1.6          2.2          2.8          3.4
    East North Central.........................          122          1.4          1.8          2.7          3.1
    East South Central.........................          177          0.9          1.5          2.1          2.7
    West North Central.........................          115          1.4          1.8          2.6          3.0
    West South Central.........................          199         -0.3          0.3          0.9          1.5
    Mountain...................................           77            2          2.4          3.2          3.6
    Pacific....................................           37          2.9          3.3          4.2          4.6
By Payment Classification:
    Urban hospitals............................        2,578          2.6          3.3          3.9          4.5
    Large urban areas..........................        1,425          3.1          3.7          4.3          4.9
    Other urban areas..........................        1,153            2          2.6          3.3          3.9
    Rural areas................................          956          1.3          1.7          2.5          3.0
Teaching Status:
    Nonteaching................................        2,480          2.1          2.7          3.3          3.9
    Fewer than 100 residents...................          815          2.5          3.1          3.8          4.4
    100 or more residents......................          239          3.1          3.8          4.4          5.0
Urban DSH:
    Non-DSH....................................          859          1.7          2.3            3          3.6
    100 or more beds...........................        1,512          2.9          3.5          4.1          4.7
    Less than 100 beds.........................          355          1.9          2.5          3.1          3.7
Rural DSH:
    SCH........................................          384          1.6          2.0          2.9          3.2
    RRC........................................          203          1.3          1.9          2.5          3.1
    100 or more beds...........................           46          1.4          2.0          2.6          3.3
    Less than 100 beds.........................          175          0.2          0.8          1.4          2.1
Urban teaching and DSH:
    Both teaching and DSH......................          807            3          3.6          4.2          4.8
    Teaching and no DSH........................          186          1.9          2.5          3.2          3.8
    No teaching and DSH........................        1,060          2.6          3.2          3.8          4.4
    No teaching and no DSH.....................          525          1.7          2.3          2.9          3.6
Special Hospital Types:
    RRC........................................          194          1.5          2.1          2.7          3.3
    SCH........................................          367          1.3          1.6          2.5          2.8
    MDH........................................          150            2          2.3          3.2          3.6
    SCH and RRC................................           99          1.7          2.0          2.9          3.3
    MDH and RRC................................            8          1.3          1.5          2.6          2.7
Type of Ownership:

[[Page 66926]]

 
    Voluntary..................................        2,064          2.4          3.0          3.6          4.2
    Proprietary................................          823          2.7          3.3            4          4.6
    Government.................................          597          2.7          3.3          3.9          4.5
Medicare Utilization as a Percent of Inpatient
 Days:
    0-25.......................................          230          4.2          4.9          5.5          6.1
    25-50......................................        1,289          3.1          3.7          4.3          4.9
    50-65......................................        1,451          1.9          2.4          3.1          3.7
    Over 65....................................          440          1.2          1.8          2.5          3.0
FY 2008 Reclassifications by the Medicare
 Geographic Classification Review Board:
    All Reclassified Hospitals.................          738          2.2          2.8          3.4          4.0
    Non-Reclassified Hospitals.................        2,796          2.6          3.2          3.8          4.4
    Urban Hospitals Reclassified...............          372          2.4          3.1          3.7          4.3
    Urban Nonreclassified, FY 2008:............        2,147          2.7          3.3          3.9          4.5
    All Rural Hospitals Reclassified Full Year           366          1.6          2.1          2.8          3.3
     FY 2008:..................................
    Rural Nonreclassified Hospitals Full Year            566          0.4          0.9          1.7          2.1
     FY 2008:..................................
    All Section 401 Reclassified Hospitals:....           26          0.6          0.8          1.8          2.0
    Other Reclassified Hospitals (Section                 63          1.5          2.0          2.8          3.3
     1886(d)(8)(B))............................
    Former 508 Hospitals.......................          107         -0.6          0.0          0.6          1.2
Specialty Hospitals:
    Cardiac specialty Hospitals................           22         -0.4          0.2          0.8          1.4
----------------------------------------------------------------------------------------------------------------
\11\ This column shows our previous estimate published in the second FY 2008 IPPS correction notice of the
  changes in payments from FY 2007 to FY 2008 including a 0.988 CMI adjustment for coding and documentation
  improvements that are anticipated with the adoption of the MS-DRGs prior to the estimated growth occurring. It
  also reflects all FY 2008 IPPS policies adopted in the FY 2008 IPPS final rule.
\12\ This column shows our current estimate of the changes in payments from FY 2007 to FY 2008 including a 0.994
  CMI adjustment for coding and documentation improvements that are anticipated with the adoption of the MS-DRGs
  prior to the estimated growth occurring. It also reflects all FY 2008 IPPS policies adopted in the FY 2008
  IPPS final rule and this final rule.
\13\ This column shows our previous estimate published in CMS-1533-CN2 of the changes in payments from FY 2007
  to FY 2008 including a .988 CMI adjustment and the estimated case-mix growth of 1.2 percent as a result of
  improvements in documentation and coding. It also reflects all FY 2008 IPPS policies adopted in the FY 2008
  IPPS final rule.
\14\ This column shows our current estimate of the changes in payments from FY 2007 to FY 2008 including a .994
  CMI adjustment and the estimated case-mix growth of 1.2 percent (when comparing column 2b to column 3b) as a
  result of improvements in documentation and coding. It also reflects all FY 2008 IPPS policies adopted in the
  FY 2008 IPPS final rule and this final rule.

a. Effects of All Changes With CMI Adjustment Prior to Estimated Growth 
(Columns 2a and 2b)
    Columns 2a and 2b show our previously published and current 
estimates of the change in IPPS payments from FY 2007 to FY 2008, 
reflecting all FY 2008 IPPS policies including a documentation and 
coding adjustment to the FY 2008 rates, but not taking into account the 
expected 1.2 percent growth in case-mix due to the anticipated 
improvement in documentation and coding as a result of the MS-DRGs. 
Because columns 2a and 2b model the impact to include the documentation 
and coding adjustment for anticipated case-mix increase without 
accounting for the actual case-mix increase itself, these columns 
illustrate a total payment change that is less than what is anticipated 
to occur.
    Column 2a shows our previously published estimate in the October 
10, 2007 correction notice to the FY 2008 IPPS proposed rule based on 
the policies established in the FY 2008 IPPS final rule, including a -
1.2 percent documentation and coding adjustment. Column 2b shows our 
current estimate based on the same FY 2008 IPPS payment policies, 
except it also includes the policy changes established in this final 
rule (that is, the statutorily mandated -0.6 percent documentation and 
coding adjustment and the change in policy of not applying the 
documentation and coding adjustment to the hospital specific rates). 
Column 2b also corrects for a technical error that occurred in the 
second FY 2008 IPPS correction notice that inadvertently overestimated 
FY 2008 payments to providers that receive the hospital specific rate.
    Comparing columns 2a and 2b, the average increase in FY 2008 IPPS 
payment for all hospitals is approximately 0.6 percentage points higher 
than in the second FY 2008 IPPS correction notice, as would be expected 
with the statutorily mandated change in the documentation and coding 
adjustment from -1.2 percent to -0.6 percent. As a result of the 
combination of the law change and a policy of not applying the 
documentation and coding adjustment to the hospital-specific rates for 
MDHs and SCHs, certain categories of hospitals (MDHs, SCHs, rural 
hospitals, and certain rural geographic areas with relatively large 
numbers of SCHs and MDHs) are estimated to experience an increase in 
their operating payments of slightly more than 0.6 percentage points 
compared with the policies articulated in the FY 2008 IPPS final rule. 
However, column 2b shows an increase in operating payments for these 
categories of hospitals of only about 0.2 to 0.5 percentage points 
greater than our previously published impact estimates in column 2a 
(rather than more than 0.6 percentage points) due to a technical error 
in our previously published impact estimates that had overstated the

[[Page 66927]]

FY 2008 increase in payments to these hospitals.
b. Effects of All Changes With CMI Adjustment and Estimated Growth 
(Column 3)
    Columns 3a and 3b show our previously published and current 
estimates of the change in IPPS payments from FY 2007 to FY 2008, 
reflecting all FY 2008 IPPS policies including a documentation and 
coding adjustment to the FY 2008 rates and taking into account the 
expected 1.2 percent growth in case-mix in FY 2008 due to anticipated 
improvements in documentation and coding as a result of the MS-DRGs.
    Column 3a shows our previously published estimate in the correction 
notice to the FY 2008 IPPS proposed rule of the FY 2008 increase in 
operating payments based on the policies established in the FY 2008 
IPPS final rule, including a -1.2 percent documentation and coding 
adjustment which is assumed to be fully offset by a 1.2 percent 
increase in case-mix. Column 3b shows our current estimate based on the 
same FY 2008 IPPS payment policies, except it also includes the policy 
changes established in this final rule (that is, the statutorily 
mandated -0.6 percent documentation and coding adjustment and the 
change in policy of not applying the documentation and coding 
adjustment to the hospital-specific rates). In column 3b, even though 
the documentation and coding adjustment reduces the standardized amount 
by 0.6 percent, this column assumes a 1.2 percent increase in case-mix 
due to improved documentation and coding that is estimated to occur 
equally across all hospitals as determined by the Office of the 
Actuary. Furthermore, it assumes that a 1.2 percent increase in case-
mix from improved documentation and coding will occur for hospitals 
that receive the hospital-specific rate. Similar to column 2b, column 
3b also corrects for a technical error that occurred in the second FY 
2008 IPPS correction notice that inadvertently overstated the FY 2008 
increase in payments to providers that receive the hospital specific-
rate.
    Column 3b reflects our current estimate of the impact of all FY 
2008 changes relative to FY 2007. The average increase for all 
hospitals is approximately 4.3 percent. This is a 0.6 percent increase 
in expected payments compared to the 3.7 percent average increase to 
all hospitals published in the second FY 2008 IPPS correction notice. 
This estimated increase in payments can be attributed to the 
statutorily mandated change in the documentation and coding adjustment 
to the standardized amounts from -1.2 percent to -0.6 percent. As shown 
in table 1, columns 3a and 3b, most classes of hospitals are estimated 
to experience an additional 0.6 percent increase in payments in FY 2008 
compared with our previously published estimates with the increases 
shown in the table sometimes appearing to be slightly more (0.7 
percentage points) due to rounding. As noted previously, as a result of 
the combination of the law change and a policy change to not apply the 
documentation and coding adjustment to the hospital-specific rates for 
MDHs and SCHs, certain categories of hospitals (MDHs, SCHs, rural 
hospitals, and certain rural geographic areas with relatively large 
numbers of SCHs and MDHs) are estimated to experience an increase in 
their operating payments of slightly more than 0.6 percentage points 
compared with the policies articulated in the FY 2008 IPPS final rule. 
However, column 3b shows an increase in operating payments for these 
categories of hospitals of only about 0.1 to 0.5 percentage points 
greater than our previously published impact estimates in column 3a 
(rather than more than 0.6 percentage points) due to a technical error 
in our previously published impact estimates that had overstated the FY 
2008 increase in payments to these hospitals.
6. Overall Conclusion
    The IPPS changes we are making in this final rule will affect all 
classes of hospitals. All classes of hospitals are expected to 
experience increases in their FY 2008 IPPS payments as a result of the 
provisions of this final rule. Table I of this section demonstrates the 
statutorily mandated change to the documentation and coding adjustment 
applied to the standardized amount, the policy change of the 
nonapplication of the documentation and coding adjustment to the 
hospital-specific rate and all other policies reflected in the FY 2008 
IPPS final rule. Table I also shows an overall increase of 4.3 percent 
in operating payments, an estimated increase of $4.29 billion, which 
includes hospital reporting of quality data program costs ($1.89 
million) and all operating payment policies as described in this 
section XXIV.G. Capital payments are estimated to increase by 1.2 
percent per case from FY 2007 to FY 2008. The average increase in FY 
2008 capital IPPS payments for all hospitals is approximately 0.6 
percentage points higher than in the second FY 2008 IPPS correction 
notice, as expected based on the statutorily mandated change in the FY 
2008 documentation and coding adjustment from -1.2 percent to -0.6 
percent. Therefore, we project that capital payments will increase by 
$342 million in FY 2008 compared to FY 2007. The operating and capital 
payments should result in a net increase of $4.635 billion to IPPS 
providers. This is an additional increase in estimated payments by $665 
million compared to the estimated increase in payments published in the 
second FY 2008 IPPS correction notice. The discussions presented in the 
previous subsections, in combination with section XIX. of this final 
rule, constitute a regulatory impact analysis.
7. Accounting Statement
    As required by OMB Circular A-4 (available at http://www.whitehousegov/omb/circulars/a004/a-4.pdf), in Table II below, we 
have prepared an accounting statement showing the classification of the 
expenditures associated with the IPPS provisions of this final rule. 
This table provides our best estimate of the increase in Medicare 
payments to providers from FY 2007 to FY 2008 as a result of the IPPS 
policies established in the FY 2008 IPPS final rule and in section XIX. 
of this final rule. All expenditures are classified as transfers to 
Medicare providers.

      Table II.--Accounting Statement: Classification of Estimated
                  Expenditures From FY 2007 to FY 2008
------------------------------------------------------------------------
                 Category                             Transfers
------------------------------------------------------------------------
Annualized Monetized Transfers............  $4.635 Billion.
From Whom to Whom.........................  Federal Government to IPPS
                                             Medicare Providers.
                                           -----------------------------
    Total.................................  $4.635 Billion.
------------------------------------------------------------------------

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

H. Impact of the Policy Revisions Related to Emergency Medicare GME 
Affiliated Groups for Hospitals in Certain Declared Emergency Areas

    As we discussed in detail in section XX. of this document, we are 
issuing an interim final rule with comment period that modifies the 
current GME regulations as they apply to emergency Medicare GME 
affiliated groups to provide for greater flexibility in training 
residents in approved residency programs during times of disaster.

[[Page 66928]]

Specifically, the interim final rule with comment period modifies 
provisions for ``emergency Medicare GME affiliated groups'' to address 
the needs of teaching hospitals that are forced to find alternate 
training sites for residents that were displaced by a disaster.
1. Overall Impact
    This interim final rule with comment period rule is not a major 
rule under Executive Order 12866 because we anticipate that the cost to 
the Medicare program will be negligible under the provisions included 
in this rule.
2. RFA
    For purposes of the RFA, we believe that the impact on the affected 
hospitals will not be significant and will not affect a substantial 
number of small entities.
3. Small Rural Hospitals
    For purposes of section 1102(b) of the Act, we define a small rural 
hospital as a hospital that is located outside of a Metropolitan 
Statistical Area and has fewer than 100 beds. This interim final rule 
with comment period is not anticipated to have a significant effect on 
small rural hospitals because the provisions of this interim final rule 
with comment period are most likely to be used by large teaching 
hospitals that have established residency programs and the capacity to 
train a larger complement of displaced residents. The majority of this 
type of teaching hospital is located in non-rural areas.
4. Unfunded Mandates
    Section 202 of the Unfunded Mandates Reform Act of 1995 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 interim final rule with 
comment period will not have an effect on State, local, or tribal 
governments in the aggregate and the private sector costs will be less 
than the $120 million threshold.
5. Federalism
    Executive Order 13132 establishes certain requirements that an 
agency must meet when it promulgates a proposed rule (and subsequent 
final rule) that imposes substantial direct requirement costs on State 
and local governments, preempts State law, or otherwise has Federalism 
implications. This interim final rule with comment period will not have 
a substantial effect on State or local governments.
6. Anticipated Effects
    We believe that there are limited effects associated with modifying 
the existing emergency Medicare GME affiliation regulations to extend 
the effective period as well as to permit certain written agreements 
for training that occurs in the nonhospital setting to be submitted 
retroactively. We note that these changes do not allow hospitals to 
count for Medicare IME or direct GME payment purposes additional FTE 
residents that had not been counted by Medicare before a qualifying 
emergency. Hospitals participating in emergency Medicare GME affiliated 
groups are held to their respective FTE resident caps as specified by 
the emergency affiliation agreement. IME and direct GME payments to the 
hospitals under this provision will not be based upon any FTE residents 
in excess of the caps specified under the emergency Medicare GME 
affiliation agreements.
7. Alternatives Considered
    We considered making no changes at this time to the existing 
emergency Medicare GME affiliation provisions. However, teaching 
hospitals affected by Hurricanes Katrina and Rita have reported to us 
that they are still experiencing difficulties in reestablishing their 
training programs and they have requested the extension of the 
effective period for emergency Medicare GME affiliation agreements to 
continue beyond June 30, 2008. We understand that GME programs in the 
affected area are finding it necessary to continue to adjust the 
location of resident training both within the emergency area and in 
other States, as affected hospitals in the section 1135 emergency area 
continue to reopen beds at different rates, and as feedback from 
accreditation surveys warrant educational adjustments. Extending the 
effective period of emergency Medicare GME affiliation agreements for 
two more academic years (for a total effective period of up to 5 
academic years) would allow these hospitals the time to stabilize their 
training programs. Furthermore, we considered the option of extending 
the effective period for emergency Medicare GME affiliations for two 
additional academic years without limiting the out of State emergency 
affiliations to apply to only the residents that were immediately 
displaced following the disaster. However, we ultimately specified that 
in the additional 2 years, only the residents that were immediately 
displaced following the disaster would be eligible to participate in 
out of State emergency affiliations while residents that entered the 
program after the disaster occurred would be limited to in State 
emergency affiliations. We believe that the policy established in this 
interim final rule with comment period extends additional flexibility 
while providing an incentive for home hospitals to bring displaced 
residents back to train in the State in which the home hospital is 
located, increasing the probability that the physicians would stay and 
practice locally after their training is completed. In addition, we 
believe that providing for flexibility in submitting written agreements 
after residents begin training in the nonhospital sites for hospitals 
participating in emergency Medicare GME affiliation agreements 
alleviates an additional deadline burden and allows appropriate GME 
payments to be made to those hospitals that are facing financial and 
programmatic hardships due to a disaster. We believe failure to apply 
the regulatory changes in this interim final rule with comment would be 
contrary to the public interest because hospitals affected by 
Hurricanes Katrina and Rita could otherwise face dramatic disruptions 
in their Medicare GME funding, with possible dire effects on their GME 
programs and financial stability.
8. Conclusion
    For these reasons, we are not preparing analyses for either the RFA 
or section 1102(b) of the Act because we have determined that this 
interim final rule with comment period would not have a significant 
economic impact on a substantial number of small entities or a 
significant impact on the operations of a substantial number of small 
rural hospitals.
9. Executive Order 12866
    In accordance with the provisions of Executive Order 12866, this 
interim final rule with comment period was reviewed by the Office of 
Management and Budget.

XXV. Waiver of Proposed Rulemaking, Waiver of Delay in Effective Date, 
and Retroactive Effective Date

A. Requirements for Waivers and Retroactive Rulemaking

    We ordinarily publish a notice of proposed rulemaking in the 
Federal Register to provide for public comment before the provisions of 
a rule take effect in accordance with section 553(b) of the 
Administrative Procedure Act (APA). However, we can waive notice-and-
comment procedures if the Secretary finds, for good cause, that the 
notice-and-comment process is impracticable,

[[Page 66929]]

unnecessary, or contrary to the public interest, and incorporates a 
statement of the finding and the reasons therefore in the rule. Section 
553(d) of the APA also ordinarily requires a 30-day delay in effective 
date of final rules after the date of their publication. However, this 
30-day delay in effective date can be waived if an agency finds for 
good cause that the delay is impracticable, unnecessary, or contrary to 
the public interest, and the agency incorporates a statement of the 
findings and its reasons in the rule issued. Moreover, section 
1871(e)(1)(A) of the Act generally prohibits the Secretary from making 
retroactive substantive changes in policy unless retroactive 
application of the change is necessary to comply with statutory 
requirements or failure to apply the change retroactively would be 
contrary to the public interest.

B. IPPS Payment Rate Policies

    We are waiving notice-and-comment procedures and the 30-day delay 
in effective date with respect to the revised payment factors, rates, 
and thresholds discussed in section XIX.B.1. of this final rule. In 
section XIX.B.1. of this final rule, we are revising certain payment 
factors, rates, and thresholds under the IPPS to reflect the changes to 
the documentation and coding adjustment mandated under section 7 of 
Public Law 110-90. The policies adopted in the FY 2008 IPPS final rule 
were subjected to notice-and-comment procedures. The payment factors, 
rates, and thresholds discussed in section XIX.B.1. of this final rule 
reflect the payment policies adopted in the FY 2008 IPPS final rule, 
but have been recalculated using the reduced coding and documentation 
adjustment to the standardized amounts. Therefore, we find that it 
would be unnecessary and contrary to the public interest to delay 
correction of payment factors and rates under the IPPS by undertaking 
further notice-and-comment procedures. For the same reasons, we are 
also waiving the 30-day delay in effective date with respect to the 
revised payment factors, rates, and thresholds discussed in section 
XIX.B.1. of this final rule. We believe that it is in the public 
interest to ensure that these revised payment factors, rates, and 
thresholds are effective as of the October 1, 2007 effective date of 
the FY 2008 IPPS final rule.
    The revised payment factors, rates, and thresholds discussed in 
section XIX.B.1. of this final rule do not substantively change 
policies adopted in the FY 2008 IPPS final rule. Under section 7 of 
Public Law 110-90, we are required to reduce the documentation and 
coding adjustment that we adopted in the FY 2008 IPPS final rule and, 
as a result, the standardized amounts for FY 2008 will be higher. In 
section XIX.B.1. of this final rule, we merely are announcing new 
payment factors, rates, and thresholds that result from applying the 
statutorily mandated documentation and coding adjustment pf -0.6 
percent to the payment policies we adopted in the FY 2008 IPPS final 
rule. Therefore, we do not believe these changes implicate section 
1871(e)(1)(A) of the Act.
    With respect to the application of the documentation and coding 
adjustment to hospital-specific rates discussed in section XIX.B.2. of 
this final rule, we are waiving notice-and-comment procedures, the 30-
day delay in effective date, and making a retroactive substantive 
change to a policy adopted in the FY 2008 IPPS final rule. As discussed 
in section XIX.B.2. of this final rule, we believe that the policy we 
adopted in the FY 2008 IPPS final rule was not consistent with the 
plain meaning of section 1886(d)(3)(A)(vi) of the Act. Therefore, we 
are waiving notice-and-comment procedures with respect to this policy 
change because we believe it would be unnecessary and contrary to the 
public interest to undertake notice-and-comment procedures prior to 
changing our policy to make the policy consistent with the plain 
meaning of the statute. For the same reasons, we are waiving the 30-day 
delay in effective date because we believe it would be unnecessary and 
contrary to the public interest to delay the policy change beyond the 
October 1, 2007 effective date of the FY 2008 IPPS final rule. We are 
also applying this policy change retroactive to October 1, 2007 under 
section 1871(e)(1)(A)(i) of the Act because it would be contrary to the 
public interest for our policy not to be consistent with the plain 
meaning of the statute. Furthermore, because an adjustment to the 
hospital-specific rates to account for changes in documentation and 
coding is not authorized under section 1886(d)(3)(A)(vi) of the Act, 
retroactive application of this change is necessary to comply with the 
statute.

C. Medicare GME Affiliation Agreement Provisions

    We find that failure to apply the provisions of this interim final 
rule with comment period retroactively to August 29, 2005, which is the 
first date on which there was an emergency area and emergency period 
under section 1135 of the Act resulting from the impact of Hurricane 
Katrina, would be contrary to the public interest. Due to the 
infrastructure damage and disruption of operations experienced by 
medical facilities, and the consequent and continuing disruption in 
residency training, caused by Hurricanes Katrina and Rita in August of 
2005, there is an urgent need for the regulation changes provided in 
this interim final rule with comment period to be applied 
retroactively. The existing regulations specify that the effective 
period for emergency Medicare GME affiliation agreements must end no 
later than June 30, 2008, even though many hospitals within the section 
1135 emergency area have not fully recovered from the disruption caused 
by Hurricanes Katrina and Rita. Hospitals have informed CMS that it is 
critical for the permissible effective period for emergency Medicare 
GME affiliation agreements to be extended because the current 
regulations do not adequately address the continuing issues relating to 
Medicare GME payment policy faced by both home and host hospitals. 
Specifically, where home or host hospitals with valid emergency 
Medicare GME affiliation agreements have been training displaced 
residents in non-hospital sites at any time since August 29, 2005, the 
provisions in this interim final rule with comment period allow these 
home or host hospitals to submit written agreements or incur all or 
substantially all of the costs of the program at the nonhospital site 
retroactive to that date in order to permit the home or host hospitals 
to count the FTE residents training in non-hospital sites for direct 
GME and IME payment purposes. We believe failure to apply the 
regulatory changes contained in this interim final rule with comment 
period retroactively would be contrary to the public interest because 
hospitals whose graduate medical education programs were affected by 
Hurricanes Katrina and Rita could otherwise face dramatic disruptions 
in their Medicare GME funding, with possible dire effects on the 
residency training programs and financial stability of the hospitals, 
and possible adverse consequences for the Medicare program in terms of 
access to hospital and physician health care resources.
    Furthermore, the training programs at many teaching hospitals in 
New Orleans and surrounding areas were temporarily closed or 
significantly reduced in the aftermath of the hurricanes, and the 
displaced residents were transferred to other hospitals to continue 
their training programs in other parts of the country. While some 
residents have returned to the hurricane-affected hospitals, others 
remain displaced from their home

[[Page 66930]]

hospitals to hospitals located out-of-state. Immediate regulatory 
changes are required in order to maintain Medicare GME funding relating 
to displaced residents training at various hospitals outside of the 
emergency area, and at the same time, to encourage re-establishment of 
residency training within the hurricane-affected State, and to assist 
home hospitals to rebuild incrementally their GME programs. Existing 
regulations relating to closed hospitals and closed residency training 
programs, and relating to regular and emergency Medicare GME 
affiliation agreements, as well as to residency training that occurs in 
non-hospital settings, contain certain limitations that render them 
inapplicable or ineffective to address the issues faced by hospitals as 
a result of disruptions caused by Hurricanes Katrina and Rita.
    We also ordinarily publish a notice of proposed rulemaking in the 
Federal Register and invite public comment on the proposed rule. The 
notice of proposed rulemaking includes a reference to the legal 
authority under which the rule is proposed, and the terms and substance 
of the proposed rule or a description of the subjects and issues 
involved. However, this procedure can be waived if an agency finds good 
cause that a notice-and-comment procedure is impracticable, unnecessary 
or contrary to the public interest and incorporates a statement of the 
finding and supporting reasons in the rule issued. We find that good 
cause exists to waive the requirement for publication of a notice of 
proposed rulemaking and public comment prior to the effective date of 
this rule because such a procedure would be impracticable and contrary 
to the public interest. As explained above, in order to respond to the 
urgent needs of the hospitals and GME programs affected by Hurricanes 
Katrina and Rita, particularly in the provision regarding the 
retroactive submission of written agreements or payment of all or 
substantially all of the costs of the program at the non-hospital site 
to allow hospitals that have been training residents in non-hospital 
sites since the first day of the section 1135 emergency period relating 
to Hurricanes Katrina and Rita on August 29, 2005, it is necessary for 
the regulation to take effect retroactively to August 29, 2005. 
Furthermore, as hospitals engage in planning for the training of 
residents in programs for the upcoming academic year which begins on 
July 1, 2008, hospitals need adequate time to arrange emergency 
Medicare GME affiliation agreements with respect to remaining displaced 
residents training at host hospitals. The ordinary notice-and-comment 
procedures would serve to delay (or, in certain cases, preclude) 
hurricane-affected hospitals and GME programs from responding 
effectively to their circumstances by availing themselves of the 
flexibility permitted under this interim final rule with comment 
period.

List of Subjects

42 CFR Part 410

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

42 CFR Part 411

    Kidney diseases, Medicare, Physician referral, Reporting and 
recordkeeping requirements

42 CFR Part 413

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

42 CFR Part 414

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

42 CFR Part 416

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

42 CFR Part 419

    Hospitals, Medicare, Reporting and recordkeeping requirements.

42 CFR Part 482

    Grant program-health, Hospitals, Medicaid, Medicare, Reporting and 
recordkeeping requirements

42 CFR Part 485

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


0
For reasons stated in the preamble of this final rule with comment 
period, 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 410.27 is amended by--
0
a. Revising paragraph (a)(1)(iii).
0
b. Revising paragraph (f).
    The revisions read as follows:


Sec.  410.27  Outpatient hospital services and supplies incident to a 
physician service: Conditions.

    (a) * * *
    (1) * * *
    (iii) In the hospital or at a department of a provider, as defined 
in Sec.  413.65(a)(2) of this subchapter, that has provider-based 
status in relation to a hospital under Sec.  413.65 of this subchapter; 
and
* * * * *
    (f) Services furnished at a department of a provider, as defined in 
Sec.  413.65(a)(2) of this subchapter, that has provider-based status 
in relation to a hospital under Sec.  413.65 of this subchapter, must 
be under the direct supervision of a physician. ``Direct supervision'' 
means the physician must be present and on the premises of the location 
and immediately available to furnish assistance and direction 
throughout the performance of the procedure. It does not mean that the 
physician must be present in the room when the procedure is performed.

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

0
3. The authority citation for Part 411 continues to read as follows:

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


0
4. Section 411.351 is amended by revising paragraph (2) of the 
definition of ``designated health services'' and the definitions of 
``outpatient prescription drugs'' and ``radiology and certain other 
imaging services'' to read as follows:


Sec.  411.351  Definitions.

* * * * *
    Designated health services (DHS) means * * *
    (2) Except as otherwise noted in this subpart, the term 
``designated health services'' or DHS means only DHS payable, in whole 
or in part, by Medicare. DHS do not include services that are 
reimbursed by Medicare as part of a composite rate (for example, SNF 
Part A payments or ASC services identified at Sec.  416.164(a)), except 
to the extent that services listed in paragraphs (1)(i) through (1)(x) 
of this definition are themselves payable through a composite rate (for 
example, all services provided as home health services or inpatient and 
outpatient hospital services are DHS).
* * * * *

[[Page 66931]]

    Outpatient prescription drugs means all drugs covered by Medicare 
Part B or D, except for those drugs that are ``covered ancillary 
services,'' as defined at Sec.  416.164(b) of this chapter, for which 
separate payment is made to an ambulatory surgical center.
* * * * *
    Radiology and certain other imaging services means those particular 
services so identified on the List of CPT/HCPCS Codes. All services 
identified on the List

of CPT/HCPCS Codes are radiology and certain other imaging services for 
purposes of this subpart. Any service not specifically identified as 
radiology and certain other imaging services on the List of CPT/HCPCS 
Codes is not a radiology or certain other imaging service for purposes 
of this subpart. The list of codes identifying radiology and certain 
other imaging services includes the professional and technical 
components of any diagnostic test or procedure using x-rays, 
ultrasound, computerized axial tomography, magnetic resonance imaging, 
nuclear medicine (effective January 1, 2007), or other imaging 
services. All codes identified as radiology and certain other imaging 
services are covered under section 1861(s)(3) of the Act and Sec.  
410.32 and Sec.  410.34 of this chapter, but do not include--
    (1) 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;
    (2) Radiology or certain other imaging services that are integral 
to the performance of a medical procedure that is not identified on the 
list of CPT/HCPCS codes as a radiology or certain other imaging service 
and is performed--
    (i) Immediately prior to or during the medical procedure; or
    (ii) Immediately following the medical procedure when necessary to 
confirm placement of an item placed during the medical procedure.
    (3) Radiology and certain other imaging services that are ``covered 
ancillary services,'' as defined at Sec.  416.164(b), for which 
separate payment is made to an ASC.
* * * * *

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

0
5. The authority citation for Part 413 is revised to read as follows:

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


0
6. Section 413.75(b) is amended by revising paragraph (2) under the 
definition of ``Emergency Medicare GME affiliated group'' to read as 
follows:


Sec.  413.75  Direct GME payments: General requirements.

* * * * *
    (b) * * *
    Emergency Medicare GME affiliated group * * *
    (2) Host hospital means a hospital training residents displaced 
from a home hospital.
    (a) In-State host hospital means a host hospital located in the 
same State as a home hospital.
    (b) Out-of-State host hospital means a host hospital located in a 
different State from the home hospital.
* * * * *

0
7. Section 413.78 is amended by--
0
a. Removing the semicolon and the word ``or'' at the end of paragraph 
(e)(3)(i) and replacing them with a period.
0
b. Adding a new paragraph (e)(3)(iii).
0
c. Removing the semicolon and the word ``or'' at the end of paragraph 
(f)(3)(i) and replacing them with a period.
0
d. Adding a new paragraph (f)(3)(iii).
    The additions read as follows:


Sec.  413.78  Direct GME payments: Determination of the total number of 
FTE residents.

* * * * *
    (e) * * *
    (3) * * *
    (iii) If the hospital has in place an emergency Medicare GME 
affiliation agreement in accordance with Sec.  413.79(f)(6), during the 
period covered by the emergency Medicare GME affiliation agreement--
    (A) The hospital must pay all or substantially all of the costs of 
the training program in a nonhospital setting(s) attributable to 
training that occurs during a month by the end of the sixth month 
following the month in which the training in the nonhospital site 
occurred. For the costs that would otherwise be required to be paid by 
the hospital during the period of August 29, 2005 through November 1, 
2007, the participating hospital must pay the costs by April 29, 2008; 
or
    (B) There is a written agreement that specifies that the hospital 
is incurring the cost of the resident's salary and fringe benefits 
while the resident is training in the nonhospital site and the hospital 
is providing reasonable compensation to the nonhospital site for 
supervisory teaching activities. The agreement must indicate the 
compensation the hospital is providing to the nonhospital site for 
supervisory teaching activities. The written agreement must be 
submitted to the contractor by 180 days after the training at the 
nonhospital site begins. For written agreements that would otherwise be 
required to be submitted prior to the date the resident(s) begin 
training at the nonhospital site during the period of August 29, 2005 
through November 1, 2007, the written agreement must be submitted to 
the CMS contractor by April 29, 2008.
* * * * *
    (f) * * *
    (3) * * *
    (iii) If the hospital has in place an emergency Medicare GME 
affiliation agreement in accordance with Sec.  413.79(f)(6), during the 
period covered by the emergency Medicare GME affiliation agreement--
    (A) The hospital must pay all or substantially all of the costs of 
the training program in a nonhospital setting(s) attributable to 
training that occurs during a month by the end of the sixth month after 
the month in which the training in the nonhospital site occurs. For the 
costs that would otherwise be required to be incurred by the hospital 
during the period of August 29, 2005 through November 1, 2007, the 
participating hospital must incur the costs by April 29, 2008; or
    (B) There is a written agreement that specifies that the hospital 
will incur at least 90 percent of the total of the costs of the 
resident's salary and fringe benefits (and travel and lodging where 
applicable) while the resident is training in the nonhospital site and 
the portion of the cost of the teaching physician's salary attributable 
to nonpatient care direct GME activities. The written agreement must 
specify the total cost of the training program at the nonhospital site, 
and the amount the hospital will incur (at least 90 percent of the 
total), and must indicate the portion of the amount the hospital will 
incur that reflects residents' salaries and fringe benefits (and travel 
and lodging where applicable), and the portion of this amount that 
reflects teaching physician compensation. The written agreement must be 
submitted to the contractor by 180 days after the training at the 
nonhospital site begins. Hospitals may modify the amounts specified in 
the

[[Page 66932]]

written agreement by the end of the academic year (that is, June 30) to 
reflect that at least 90 percent of the costs of the training program 
in the nonhospital site has been incurred. For written agreements that 
would otherwise be required to be submitted prior to the date the 
training begins in the nonhospital site during the period of August 29, 
2005 through November 1, 2007, the hospital must submit the written 
agreement to its contractor by April 29, 2008.
* * * * *

0
8. Section 413.79 is amended by--
0
a. Revising the introductory text of paragraph (f)(6).
0
b. Revising paragraph (f)(6)(i)(D).
0
c. Revising paragraph (f)(6)(ii)(A)(2).
    The revisions read as follows:


Sec.  413.79  Direct GME payments: Determination of the weighted number 
of FTE residents.

* * * * *
    (f) * * *
    (6) Emergency Medicare GME affiliated group. Effective on or after 
August 29, 2005, home and host hospitals as defined in Sec.  413.75(b) 
may form an emergency Medicare GME affiliated group by meeting the 
requirements provided in this section. The emergency Medicare GME 
affiliation agreements may be made effective beginning on or after the 
first day of a section 1135 emergency period, and must terminate no 
later than at the conclusion of 4 academic years following the academic 
year during which the section 1135 emergency period began.
* * * * *
    (i) * * *
    (D) Specify the total adjustment to each participating hospital's 
FTE caps in each academic year that the emergency Medicare GME 
affiliation agreement is in effect, for both direct GME and IME, that 
reflects a positive adjustment to the host hospital's direct and 
indirect FTE caps that is offset by a negative adjustment to the home 
hospital's (or hospitals') direct and indirect FTE caps of at least the 
same amount subject to the following--
    (1) The sum total of adjustments to all the participating 
hospitals' FTE caps under the emergency Medicare GME affiliation 
agreement may not exceed the aggregate adjusted FTE caps of the 
hospitals participating in the emergency Medicare GME affiliated group.
    (2) A home hospital's IME and direct GME FTE cap reductions in an 
emergency Medicare GME affiliation agreement are limited to the home 
hospital's IME and direct GME FTE resident caps at Sec.  413.79(c) or 
Sec.  413.79(f)(1) through (f)(5), that is, as adjusted by any and all 
existing affiliation agreements as applicable.
    (3) For emergency Medicare GME affiliation agreements for the third 
or fourth academic years subsequent to the year in which the section 
1135 emergency period began and involving an out-of-State host 
hospital, the positive adjustment to the out-of-State host hospital's 
direct and indirect FTE caps pursuant to the agreement shall reflect 
only FTE residents that were actually displaced from a home hospital 
immediately following the emergency.
* * * * *
    (ii) * * *
    (A) * * *
    (2) Four subsequent academic years. The later of 180 days after the 
section 1135 emergency period begins, or by July 1 of each academic 
year for 4 subsequent years.
* * * * *

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

0
9. The authority citation for Part 414 continues to read as follows:

    Authority: Secs. 1102, 1871, and 1881(b)(1) of the Social 
Security Act (42 U.S.C. 1302, 1395hh, and 1395rr(b)(1)).

0
10. Section 414.22 is amended by revising paragraphs (b)(5)(i)(A) and 
(B) to read as follows:


Sec.  414.22  Relative value units (RVUs).

* * * * *
    (b) * * *
    (5) * * *
    (i) * * *
    (A) Facility practice expense RVUs. The lower facility practice 
expense RVUs apply to services furnished to patients in the hospital, 
skilled nursing facility, community mental health center, or in an 
ambulatory surgical center. (The facility practice expense RVUs for a 
particular code may not be greater than the nonfacility RVUs for the 
code.)
    (B) Nonfacility practice expense RVUs. The higher nonfacility 
practice expense RVUs apply to services performed in a physician's 
office, a patient's home, a nursing facility, or a facility or 
institution other than a hospital or skilled nursing facility, 
community mental health center, or ASC.
* * * * *

PART 416--AMBULATORY SURGICAL SERVICES

0
11. 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
12. Section 416.179 is amended by--
0
a. Revising the section heading.
0
b. Revising paragraphs (a)(1) and (a)(2).
0
c. Adding new paragraph (a)(3).
0
d. Revising paragraph (b).
    The revisions and additions read as follows:


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

    (a) * * *
    (1) The device is replaced without cost to the ASC or the 
beneficiary;
    (2) The ASC receives full credit for the cost of a replaced device; 
or
    (3) The ASC receives partial credit for the cost of a replaced 
device but only where the amount of the device credit is greater than 
or equal to 50 percent of the cost of the new replacement device being 
implanted.
    (b) Amount of reduction to the ASC payment for the covered surgical 
procedure.
    (1) The amount of the reduction to the ASC payment made under 
paragraphs (a)(1) and (a)(2) 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 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.
    (2) The amount of the reduction to the ASC payment made under 
paragraph (a)(3) of this section is 50 percent of the payment reduction 
that would be calculated under paragraph (b)(1) of this section.
* * * * *

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

0
13. The authority citation for Part 419 continues to read as follows:

    Authority: Secs. 1102, 1833(t), and 1871 of the Social Security 
Act (42 U.S.C. 1302, 1395l(t), and 1395hh).


0
14. Section 419.43 is amended by revising paragraph (g)(4) to read as 
follows:

[[Page 66933]]

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

* * * * *
    (g) * * *
    (4) Excluded services and groups. Drugs and biologicals that are 
paid under a separate APC and devices paid under Sec.  419.66 are 
excluded from qualification for the payment adjustment in paragraph 
(g)(2) of this section.
* * * * *

0
15. Section 419.44 is amended by--
0
a. Revising the section heading.
0
b. Revising paragraph (b).
    The revisions and addition read as follows:


Sec.  419.44  Payment reductions for procedures.

* * * * *
    (b) Interrupted procedures. When a procedure 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 copayment amount are based on--
    (1) The full program and beneficiary copayment 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 the full program and the beneficiary copayment amounts 
if the procedure for which anesthesia is planned is discontinued after 
the patient is prepared and taken to the room where the procedure is to 
be performed but before anesthesia is induced; or
    (3) One-half of the full program and beneficiary copayment amounts 
if a procedure for which anesthesia is not planned is discontinued 
after the patient is prepared and taken to the room where the procedure 
is to be performed.

0
16. Section 419.45 is amended by--
0
a. Revising the section heading.
0
b. Revising paragraph (a)(1).
0
c. Revising paragraph (a)(2).
0
d. Adding new paragraph (a)(3).
0
e. Revising paragraph (b).
    The revisions and additions read as follows:


Sec.  419.45  Payment and copayment reduction for devices replaced 
without cost or when full or partial credit is received.

    (a) * * *
    (1) The device is replaced without cost to the provider or the 
beneficiary;
    (2) The provider receives full credit for the cost of a replaced 
device; or
    (3) The provider receives partial credit for the cost of a replaced 
device but only where the amount of the device credit is greater than 
or equal to 50 percent of the cost of the new replacement device being 
implanted.
    (b) Amount of reduction to the APC payment.
    (1) The amount of the reduction to the APC payment made under 
paragraphs (a)(1) and (a)(2) of this section is calculated in the same 
manner as the offset amount that would be applied if the device 
implanted during a procedure assigned to the APC had transitional pass-
through status under Sec.  419.66.
    (2) The amount of the reduction to the APC payment made under 
paragraph (a)(3) of this section is 50 percent of the offset amount 
that would be applied if the device implanted during a procedure 
assigned to the APC had transitional pass-through status under Sec.  
419.66.
* * * * *


Sec.  419.70  [Amended]

0
17. Section 419.70 is amended by--
0
a. In paragraph (d)(1)(i), removing the cross-reference ``Sec.  
412.63(b)'' and adding the cross-reference ``Sec.  412.64(b)'' in its 
place.
0
b. In paragraph (d)(2)(i), removing the cross-reference ``Sec.  
412.63(b)'' and adding the cross-reference ``Sec.  412.64(b)'' in its 
place.
0
c. In paragraph (d)(4)(ii), removing the cross-reference ``Sec.  
412.63(b)'' and adding the phrase ``Sec.  412.63(b) or Sec.  412.64(b), 
as applicable,'' in its place.

PART 482--CONDITIONS OF PARTICIPATION FOR HOSPITALS

0
18. The authority citation for Part 482 continues to read as follows:

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

0
19. Section 482.22 is amended by revising paragraph (c)(5) to read as 
follows:


Sec.  482.22  Condition of participation: Medical staff.

* * * * *
    (c) * * *
    (5) Include a requirement that--
    (i) A medical history and physical examination be completed and 
documented for each patient no more than 30 days before or 24 hours 
after admission or registration, but prior to surgery or a procedure 
requiring anesthesia services. The medical history and physical 
examination must be completed and documented by a physician (as defined 
in section 1861(r) of the Act), an oromaxillofacial surgeon, or other 
qualified licensed individual in accordance with State law and hospital 
policy.
    (ii) An updated examination of the patient, including any changes 
in the patient's condition, be completed and documented within 24 hours 
after admission or registration, but prior to surgery or a procedure 
requiring anesthesia services, when the medical history and physical 
examination are completed within 30 days before admission or 
registration. The updated examination of the patient, including any 
changes in the patient's condition, must be completed and documented by 
a physician (as defined in section 1861(r) of the Act), an 
oromaxillofacial surgeon, or other qualified licensed individual in 
accordance with State law and hospital policy.
* * * * *


Sec.  482.23  [Amended]

0
20. In Sec.  482.23(b)(1), the cross-reference ``Sec.  405.1910(c)'' is 
removed and the cross-reference ``Sec.  488.54(c)'' is added in its 
place.

0
21. Section 482.24 is amended by revising paragraph (c)(2)(i) to read 
as follows:


Sec.  482.24  Condition of participation: Medical record services.

* * * * *
    (c) * * *
    (2) * * *
    (i) Evidence of--
    (A) A medical history and physical examination completed and 
documented no more than 30 days before or 24 hours after admission or 
registration, but prior to surgery or a procedure requiring anesthesia 
services. The medical history and physical examination must be placed 
in the patient's medical record within 24 hours after admission or 
registration, but prior to surgery or a procedure requiring anesthesia 
services.
    (B) An updated examination of the patient, including any changes in 
the patient's condition, when the medical history and physical 
examination are completed within 30 days before admission or 
registration. Documentation of the updated examination must be placed 
in the patient's medical record within 24 hours after admission or 
registration, but prior to surgery or a procedure requiring anesthesia 
services.
* * * * *

0
22. Section 482.51 is amended by revising paragraph (b)(1) to read as 
follows:


Sec.  482.51  Condition of participation: Surgical services.

* * * * *

[[Page 66934]]

    (b) * * *
    (1) Prior to surgery or a procedure requiring anesthesia services 
and except in the case of emergencies:
    (i) A medical history and physical examination must be completed 
and documented no more than 30 days before or 24 hours after admission 
or registration.
    (ii) An updated examination of the patient, including any changes 
in the patient's condition, must be completed and documented within 24 
hours after admission or registration when the medical history and 
physical examination are completed within 30 days before admission or 
registration.
* * * * *

0
23. Section 482.52 is amended by--
0
a. Revising paragraph (b)(1).
0
b. Revising paragraph (b)(3).
0
c. Removing paragraph (b)(4).
    The revisions read as follows:


Sec.  482.52  Condition of participation: Anesthesia services.

* * * * *
    (b) * * *
    (1) A preanesthesia evaluation completed and documented by an 
individual qualified to administer anesthesia, as specified in 
paragraph (a) of this section, performed within 48 hours prior to 
surgery or a procedure requiring anesthesia services.
* * * * *
    (3) A postanesthesia evaluation completed and documented by an 
individual qualified to administer anesthesia, as specified in 
paragraph (a) of this section, no later than 48 hours after surgery or 
a procedure requiring anesthesia services. The postanesthesia 
evaluation for anesthesia recovery must be completed in accordance with 
State law and with hospital policies and procedures that have been 
approved by the medical staff and that reflect current standards of 
anesthesia care.
* * * * *

PART 485--CONDITIONS OF PARTICIPATION: SPECIALIZED PROVIDERS

0
24. The authority citation for Part 485 continues to read as follows:

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

0
25. Section 485.610 is amended by adding new paragraph (e) to read as 
follows:


Sec.  485.610  Condition of participation: Status and location.

* * * * *
    (e) Standard: Off-campus and co-location requirements for CAHs. A 
CAH may continue to meet the location requirement of paragraph (c) of 
this section based only if the CAH meets the following:
    (1) If a CAH with a necessary provider designation is co-located 
(that is, it shares a campus, as defined in Sec.  413.65(a)(2) of this 
chapter, with another hospital or CAH), the necessary provider CAH can 
continue to meet the location requirement of paragraph (c) of this 
section only if the co-location arrangement was in effect before 
January 1, 2008, and the type and scope of services offered by the 
facility co-located with the necessary provider CAH do not change. A 
change of ownership of any of the facilities with a co-location 
arrangement that was in effect before January 1, 2008, will not be 
considered to be a new co-location arrangement.
    (2) If a CAH or a necessary provider CAH operates an off-campus 
provider-based location, excluding an RHC as defined in Sec.  
405.2401(b) of this chapter, but including a department or remote 
location, as defined in Sec.  413.65(a)(2) of this chapter, or an off-
campus distinct part psychiatric or rehabilitation unit, as defined in 
Sec.  485.647, that was created or acquired by the CAH on or after 
January 1, 2008, the CAH can continue to meet the location requirement 
of paragraph (c) of this section only if the off-campus provider-based 
location or off-campus distinct part unit is located more than a 35-
mile drive (or, in the case of mountainous terrain or in areas with 
only secondary roads available, a 15-mile drive) from a hospital or 
another CAH.
    (3) If either a CAH or a CAH that has been designated as a 
necessary provider by the State does not meet the requirements in 
paragraph (e)(1) of this section, by co-locating with another hospital 
or CAH on or after January 1, 2008, or creates or acquires an off-
campus provider-based location or off-campus distinct part unit on or 
after January 1, 2008, that does not meet the requirements in paragraph 
(e)(2) of this section, the CAH's provider agreement will be subject to 
termination in accordance with the provisions of Sec.  489.53(a)(3) of 
this subchapter, unless the CAH terminates the off-campus arrangement 
or the co-location arrangement, or both.

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

(Catalog of Federal Domestic Assistance Program No. 93.778, Medical 
Assistance Program)

    Dated: October 25, 2007.
Kerry Weems,
Acting Administrator, Centers for Medicare & Medicaid Services.

    Dated: October 30, 2007.
Michael O. Leavitt,
Secretary.

                                       Addendum A.--OPPS APCS for CY 2008
----------------------------------------------------------------------------------------------------------------
                                                                                          National     Minimum
       APC               Group title               SI           Relative     Payment     unadjusted   unadjusted
                                                                 weight        rate      copayment    copayment
----------------------------------------------------------------------------------------------------------------
0001.............  Level I                  S...............       0.4806       $30.61        $7.00        $6.12
                    Photochemotherapy.
0002.............  Level I Fine Needle      T...............       1.1097       $70.68  ...........       $14.14
                    Biopsy/Aspiration.
0003.............  Bone Marrow Biopsy/      T...............       3.1008      $197.50  ...........       $39.50
                    Aspiration.
0004.............  Level I Needle Biopsy/   T...............       4.3270      $275.60  ...........       $55.12
                    Aspiration Except Bone
                    Marrow.
0005.............  Level II Needle Biopsy/  T...............       7.1147      $453.16  ...........       $90.63
                    Aspiration Except Bone
                    Marrow.
0006.............  Level I Incision &       T...............       1.4066       $89.59  ...........       $17.92
                    Drainage.
0007.............  Level II Incision &      T...............      11.5594      $736.26  ...........      $147.25
                    Drainage.
0008.............  Level III Incision and   T...............      18.3197    $1,166.85  ...........      $233.37
                    Drainage.
0012.............  Level I Debridement &    T...............       0.2963       $18.87  ...........        $3.77
                    Destruction.
0013.............  Level II Debridement &   T...............       0.7930       $50.51  ...........       $10.10
                    Destruction.
0015.............  Level III Debridement &  T...............       1.4595       $92.96  ...........       $18.59
                    Destruction.
0016.............  Level IV Debridement &   T...............       2.6604      $169.45  ...........       $33.89
                    Destruction.
0017.............  Level VI Debridement &   T...............      19.9041    $1,267.77  ...........      $253.55
                    Destruction.
0019.............  Level I Excision/        T...............       4.3039      $274.13       $71.87       $54.83
                    Biopsy.
0020.............  Level II Excision/       T...............       8.6850      $553.18  ...........      $110.64
                    Biopsy.
0021.............  Level III Excision/      T...............      16.1001    $1,025.48      $219.48      $205.10
                    Biopsy.
0022.............  Level IV Excision/       T...............      21.1098    $1,344.57      $354.45      $268.91
                    Biopsy.

[[Page 66935]]

 
0023.............  Exploration Penetrating  T...............       9.6341      $613.63  ...........      $122.73
                    Wound.
0028.............  Level I Breast Surgery.  T...............      20.6417    $1,314.75      $303.74      $262.95
0029.............  Level II Breast Surgery  T...............      31.7134    $2,019.95      $581.52      $403.99
0030.............  Level III Breast         T...............      39.8191    $2,536.24      $747.07      $507.25
                    Surgery.
0031.............  Smoking Cessation        X...............       0.1648       $10.50  ...........        $2.10
                    Services.
0033.............  Partial Hospitalization  P...............       3.2211      $205.16  ...........       $41.03
0034.............  Mental Health Services   P...............       3.2211      $205.16  ...........       $41.03
                    Composite.
0035.............  Arterial/Venous          T...............       0.2143       $13.65  ...........        $2.73
                    Puncture.
0037.............  Level IV Needle Biopsy/  T...............      13.5764      $864.74      $228.76      $172.95
                    Aspiration Except Bone
                    Marrow.
0039.............  Level I Implantation of  S...............     186.4739   $11,877.27  ...........    $2,375.45
                    Neurostimulator.
0040.............  Percutaneous             S...............      63.7866    $4,062.82  ...........      $812.56
                    Implantation of
                    Neurostimulator
                    Electrodes, Excluding
                    Cranial Nerve.
0041.............  Level I Arthroscopy....  T...............      28.7803    $1,833.13  ...........      $366.63
0042.............  Level II Arthroscopy...  T...............      45.7072    $2,911.27      $804.74      $582.25
0043.............  Closed Treatment         T...............       1.7682      $112.62  ...........       $22.52
                    Fracture Finger/Toe/
                    Trunk.
0045.............  Bone/Joint Manipulation  T...............      14.7658      $940.49      $268.47      $188.10
                    Under Anesthesia.
0047.............  Arthroplasty without     T...............      35.9040    $2,286.87      $537.03      $457.37
                    Prosthesis.
0048.............  Level I Arthroplasty     T...............      50.8876    $3,241.23  ...........      $648.25
                    with Prosthesis.
0049.............  Level I Musculoskeletal  T...............      21.2689    $1,354.70  ...........      $270.94
                    Procedures Except Hand
                    and Foot.
0050.............  Level II                 T...............      29.1900    $1,859.23  ...........      $371.85
                    Musculoskeletal
                    Procedures Except Hand
                    and Foot.
0051.............  Level III                T...............      42.9850    $2,737.89  ...........      $547.58
                    Musculoskeletal
                    Procedures Except Hand
                    and Foot.
0052.............  Level IV                 T...............      79.4244    $5,058.86  ...........    $1,011.77
                    Musculoskeletal
                    Procedures Except Hand
                    and Foot.
0053.............  Level I Hand             T...............      16.4637    $1,048.64      $253.49      $209.73
                    Musculoskeletal
                    Procedures.
0054.............  Level II Hand            T...............      26.3105    $1,675.82  ...........      $335.16
                    Musculoskeletal
                    Procedures.
0055.............  Level I Foot             T...............      20.8284    $1,326.64      $355.34      $265.33
                    Musculoskeletal
                    Procedures.
0056.............  Level II Foot            T...............      44.2687    $2,819.65  ...........      $563.93
                    Musculoskeletal
                    Procedures.
0057.............  Bunion Procedures......  T...............      29.4167    $1,873.67      $475.91      $374.73
0058.............  Level I Strapping and    S...............       1.0931       $69.62  ...........       $13.92
                    Cast Application.
0060.............  Manipulation Therapy...  S...............       0.4482       $28.55  ...........        $5.71
0061.............  Laminectomy,             S...............      82.8597    $5,277.67  ...........    $1,055.53
                    Laparoscopy, or
                    Incision for
                    Implantation of
                    Neurostimulator
                    Electrodes, Excluding
                    Cranial Nerve.
0062.............  Level I Treatment        T...............      26.1592    $1,666.18      $372.87      $333.24
                    Fracture/Dislocation.
0063.............  Level II Treatment       T...............      41.1091    $2,618.40      $548.33      $523.68
                    Fracture/Dislocation.
0064.............  Level III Treatment      T...............      59.2233    $3,772.17      $835.79      $754.43
                    Fracture/Dislocation.
0065.............  Level I Stereotactic     S...............      16.5911    $1,056.75  ...........      $211.35
                    Radiosurgery, MRgFUS,
                    and MEG.
0066.............  Level II Stereotactic    S...............      45.0693    $2,870.64  ...........      $574.13
                    Radiosurgery, MRgFUS,
                    and MEG.
0067.............  Level III Stereotactic   S...............      61.6965    $3,929.70  ...........      $785.94
                    Radiosurgery, MRgFUS,
                    and MEG.
0069.............  Thoracoscopy...........  T...............      32.5666    $2,074.30      $591.64      $414.86
0070.............  Thoracentesis/Lavage     T...............       5.2024      $331.36  ...........       $66.27
                    Procedures.
0071.............  Level I Endoscopy Upper  T...............       0.8224       $52.38       $11.20       $10.48
                    Airway.
0072.............  Level II Endoscopy       T...............       1.6115      $102.64       $21.27       $20.53
                    Upper Airway.
0073.............  Level III Endoscopy      T...............       3.9940      $254.39       $69.15       $50.88
                    Upper Airway.
0074.............  Level IV Endoscopy       T...............      17.0160    $1,083.82      $292.25      $216.76
                    Upper Airway.
0075.............  Level V Endoscopy Upper  T...............      22.7191    $1,447.07      $445.92      $289.41
                    Airway.
0076.............  Level I Endoscopy Lower  T...............       9.9575      $634.23      $189.82      $126.85
                    Airway.
0077.............  Level I Pulmonary        S...............       0.3877       $24.69        $7.74        $4.94
                    Treatment.
0078.............  Level II Pulmonary       S...............       1.3362       $85.11  ...........       $17.02
                    Treatment.
0079.............  Ventilation Initiation   S...............       2.4783      $157.85  ...........       $31.57
                    and Management.
0080.............  Diagnostic Cardiac       T...............      38.9204    $2,479.00      $838.92      $495.80
                    Catheterization.
0082.............  Coronary or Non-         T...............      87.5137    $5,574.10  ...........    $1,114.82
                    Coronary Atherectomy.
0083.............  Coronary or Non-         T...............      45.3845    $2,890.72  ...........      $578.14
                    Coronary Angioplasty
                    and Percutaneous
                    Valvuloplasty.
0084.............  Level I                  S...............       9.5834      $610.41  ...........      $122.08
                    Electrophysiologic
                    Procedures.
0085.............  Level II                 T...............      47.2949    $3,012.40  ...........      $602.48
                    Electrophysiologic
                    Procedures.
0086.............  Level III                T...............      92.8564    $5,914.40  ...........    $1,182.88
                    Electrophysiologic
                    Procedures.
0088.............  Thrombectomy...........  T...............      38.7673    $2,469.24      $655.22      $493.85
0089.............  Insertion/Replacement    T...............     121.6508    $7,748.43    $1,682.28    $1,549.69
                    of Permanent Pacemaker
                    and Electrodes.
0090.............  Insertion/Replacement    T...............     100.8341    $6,422.53    $1,612.80    $1,284.51
                    of Pacemaker Pulse
                    Generator.
0091.............  Level II Vascular        T...............      42.6114    $2,714.09  ...........      $542.82
                    Ligation.
0092.............  Level I Vascular         T...............      25.8410    $1,645.92  ...........      $329.18
                    Ligation.
0093.............  Vascular Reconstruction/ T...............      30.1294    $1,919.06  ...........      $383.81
                    Fistula Repair without
                    Device.
0094.............  Level I Resuscitation    S...............       2.4590      $156.62       $46.29       $31.32
                    and Cardioversion.
0095.............  Cardiac Rehabilitation.  S...............       0.5685       $36.21       $13.86        $7.24
0096.............  Non-Invasive Vascular    S...............       1.4689       $93.56       $37.42       $18.71
                    Studies.
0097.............  Cardiac and Ambulatory   X...............       1.0015       $63.79       $23.79       $12.76
                    Blood Pressure
                    Monitoring.
0099.............  Electrocardiograms.....  S...............       0.3892       $24.79  ...........        $4.96
0100.............  Cardiac Stress Tests...  X...............       2.5547      $162.72       $41.44       $32.54
0101.............  Tilt Table Evaluation..  S...............       4.1973      $267.34      $100.24       $53.47
0103.............  Miscellaneous Vascular   T...............      14.6576      $933.60  ...........      $186.72
                    Procedures.
0104.............  Transcatheter Placement  T...............      89.0159    $5,669.78  ...........    $1,133.96
                    of Intracoronary
                    Stents.
0105.............  Repair/Revision/Removal  T...............      23.9802    $1,527.39  ...........      $305.48
                    of Pacemakers, AICDs,
                    or Vascular Devices.
0106.............  Insertion/Replacement    T...............      69.5217    $4,428.12  ...........      $885.62
                    of Pacemaker Leads and/
                    or Electrodes.
0107.............  Insertion of             T...............     333.8096   $21,261.67  ...........    $4,252.33
                    Cardioverter-
                    Defibrillator.
0108.............  Insertion/Replacement/   T...............     404.8543   $25,786.79  ...........    $5,157.36
                    Repair of Cardioverter-
                    Defibrillator Leads.
0109.............  Removal/Repair of        T...............       5.6614      $360.60  ...........       $72.12
                    Implanted Devices.
0110.............  Transfusion............  S...............       3.3967      $216.35  ...........       $43.27
0111.............  Blood Product Exchange.  S...............      11.5058      $732.85      $198.40      $146.57
0112.............  Apheresis and Stem Cell  S...............      30.6035    $1,949.26      $433.29      $389.85
                    Procedures.
0113.............  Excision Lymphatic       T...............      22.9584    $1,462.31  ...........      $292.46
                    System.
0114.............  Thyroid/Lymphadenectomy  T...............      44.3240    $2,823.17  ...........      $564.63
                    Procedures.
0115.............  Cannula/Access Device    T...............      29.6965    $1,891.49  ...........      $378.30
                    Procedures.

[[Page 66936]]

 
0121.............  Level I Tube changes     T...............       3.2383      $206.26       $43.80       $41.25
                    and Repositioning.
0125.............  Refilling of Infusion    T...............       2.3544      $149.96  ...........       $29.99
                    Pump.
0126.............  Level I Urinary and      T...............       1.0356       $65.96       $16.21       $13.19
                    Anal Procedures.
0127.............  Level IV Stereotactic    S...............     126.4653    $8,055.08  ...........    $1,611.02
                    Radiosurgery, MRgFUS,
                    and MEG.
0128.............  Echocardiogram with      S...............       8.4896      $540.74      $216.29      $108.15
                    Contrast.
0130.............  Level I Laparoscopy....  T...............      34.3958    $2,190.81      $659.53      $438.16
0131.............  Level II Laparoscopy...  T...............      45.5317    $2,900.10    $1,001.89      $580.02
0132.............  Level III Laparoscopy..  T...............      69.6652    $4,437.26    $1,239.22      $887.45
0133.............  Level I Skin Repair....  T...............       1.2792       $81.48       $25.67       $16.30
0134.............  Level II Skin Repair...  T...............       2.1051      $134.08       $42.24       $26.82
0135.............  Level III Skin Repair..  T...............       4.5263      $288.30  ...........       $57.66
0136.............  Level IV Skin Repair...  T...............      15.0458      $958.33  ...........      $191.67
0137.............  Level V Skin Repair....  T...............      20.2069    $1,287.06  ...........      $257.41
0140.............  Esophageal Dilation      T...............       5.8431      $372.17       $91.40       $74.43
                    without Endoscopy.
0141.............  Level I Upper GI         T...............       8.5030      $541.59      $143.38      $108.32
                    Procedures.
0142.............  Small Intestine          T...............       9.5292      $606.95      $152.78      $121.39
                    Endoscopy.
0143.............  Lower GI Endoscopy.....  T...............       8.8486      $563.60      $186.06      $112.72
0146.............  Level I Sigmoidoscopy    T...............       5.0972      $324.66  ...........       $64.93
                    and Anoscopy.
0147.............  Level II Sigmoidoscopy   T...............       8.7031      $554.34  ...........      $110.87
                    and Anoscopy.
0148.............  Level I Anal/Rectal      T...............       4.7935      $305.32  ...........       $61.06
                    Procedures.
0149.............  Level III Anal/Rectal    T...............      22.7451    $1,448.73      $293.06      $289.75
                    Procedures.
0150.............  Level IV Anal/Rectal     T...............      30.1606    $1,921.05      $437.12      $384.21
                    Procedures.
0151.............  Endoscopic Retrograde    T...............      20.9510    $1,334.45  ...........      $266.89
                    Cholangio-
                    Pancreatography (ERCP).
0152.............  Level I Percutaneous     T...............      28.6884    $1,827.28  ...........      $365.46
                    Abdominal and Biliary
                    Procedures.
0153.............  Peritoneal and           T...............      25.6947    $1,636.60      $397.95      $327.32
                    Abdominal Procedures.
0154.............  Hernia/Hydrocele         T...............      30.6788    $1,954.06      $464.85      $390.81
                    Procedures.
0155.............  Level II Anal/Rectal     T...............      10.9132      $695.11  ...........      $139.02
                    Procedures.
0156.............  Level III Urinary and    T...............       3.0469      $194.07  ...........       $38.81
                    Anal Procedures.
0157.............  Colorectal Cancer        S...............       2.0651      $131.53  ...........       $26.31
                    Screening: Barium
                    Enema.
0158.............  Colorectal Cancer        T...............       7.8504      $500.02  ...........      $125.01
                    Screening: Colonoscopy.
0159.............  Colorectal Cancer        S...............       4.7010      $299.43  ...........       $74.86
                    Screening: Flexible
                    Sigmoidoscopy.
0160.............  Level I                  T...............       5.9735      $380.48  ...........       $76.10
                    Cystourethroscopy and
                    other Genitourinary
                    Procedures.
0161.............  Level II                 T...............      17.9420    $1,142.80      $241.15      $228.56
                    Cystourethroscopy and
                    other Genitourinary
                    Procedures.
0162.............  Level III                T...............      24.7749    $1,578.01  ...........      $315.60
                    Cystourethroscopy and
                    other Genitourinary
                    Procedures.
0163.............  Level IV                 T...............      36.0774    $2,297.91  ...........      $459.58
                    Cystourethroscopy and
                    other Genitourinary
                    Procedures.
0164.............  Level II Urinary and     T...............       2.0077      $127.88  ...........       $25.58
                    Anal Procedures.
0165.............  Level IV Urinary and     T...............      19.3414    $1,231.93  ...........      $246.39
                    Anal Procedures.
0166.............  Level I Urethral         T...............      19.1505    $1,219.77  ...........      $243.95
                    Procedures.
0168.............  Level II Urethral        T...............      29.7864    $1,897.21      $388.16      $379.44
                    Procedures.
0169.............  Lithotripsy............  T...............      41.5299    $2,645.21      $997.74      $529.04
0170.............  Dialysis...............  S...............       6.5383      $416.45  ...........       $83.29
0181.............  Level II Male Genital    T...............      33.9306    $2,161.18      $621.82      $432.24
                    Procedures.
0183.............  Level I Male Genital     T...............      22.3251    $1,421.97  ...........      $284.39
                    Procedures.
0184.............  Prostate Biopsy........  T...............      11.0338      $702.79  ...........      $140.56
0188.............  Level II Female          T...............       1.3520       $86.11  ...........       $17.22
                    Reproductive Proc.
0189.............  Level III Female         T...............       2.7584      $175.69  ...........       $35.14
                    Reproductive Proc.
0190.............  Level I Hysteroscopy...  T...............      21.6576    $1,379.46      $424.28      $275.89
0191.............  Level I Female           T...............       0.1309        $8.34        $2.36        $1.67
                    Reproductive Proc.
0192.............  Level IV Female          T...............       6.0783      $387.15  ...........       $77.43
                    Reproductive Proc.
0193.............  Level V Female           T...............      19.0203    $1,211.48  ...........      $242.30
                    Reproductive Proc.
0195.............  Level VI Female          T...............      32.4237    $2,065.20      $483.80      $413.04
                    Reproductive
                    Procedures.
0202.............  Level VII Female         T...............      42.7099    $2,720.36      $981.50      $544.07
                    Reproductive
                    Procedures.
0203.............  Level IV Nerve           T...............      14.4879      $922.79      $240.33      $184.56
                    Injections.
0204.............  Level I Nerve            T...............       2.3213      $147.85       $40.13       $29.57
                    Injections.
0206.............  Level II Nerve           T...............       4.0964      $260.92       $56.01       $52.18
                    Injections.
0207.............  Level III Nerve          T...............       7.0546      $449.34  ...........       $89.87
                    Injections.
0208.............  Laminotomies and         T...............      46.7724    $2,979.12  ...........      $595.82
                    Laminectomies.
0209.............  Level II Extended EEG    S...............      11.2822      $718.61      $268.73      $143.72
                    and Sleep Studies.
0212.............  Nervous System           T...............       8.5263      $543.07  ...........      $108.61
                    Injections.
0213.............  Level I Extended EEG     S...............       2.2980      $146.37       $53.58       $29.27
                    and Sleep Studies.
0215.............  Level I Nerve and        S...............       0.5804       $36.97  ...........        $7.39
                    Muscle Tests.
0216.............  Level III Nerve and      S...............       2.6846      $170.99  ...........       $34.20
                    Muscle Tests.
0218.............  Level II Nerve and       S...............       1.1550       $73.57  ...........       $14.71
                    Muscle Tests.
0220.............  Level I Nerve            T...............      18.0518    $1,149.79  ...........      $229.96
                    Procedures.
0221.............  Level II Nerve           T...............      33.2707    $2,119.14      $463.62      $423.83
                    Procedures.
0222.............  Level II Implantation    S...............     240.7990   $15,337.45  ...........    $3,067.49
                    of Neurostimulator.
0224.............  Implantation of          T...............      36.2768    $2,310.61  ...........      $462.12
                    Catheter/Reservoir/
                    Shunt.
0225.............  Implantation of          S...............     220.7642   $14,061.35  ...........    $2,812.27
                    Neurostimulator
                    Electrodes, Cranial
                    Nerve.
0227.............  Implantation of Drug     T...............     183.8928   $11,712.87  ...........    $2,342.57
                    Infusion Device.
0229.............  Transcatherter           T...............      88.5367    $5,639.26  ...........    $1,127.85
                    Placement of
                    Intravascular Shunts.
0230.............  Level I Eye Tests &      S...............       0.5903       $37.60  ...........        $7.52
                    Treatments.
0231.............  Level III Eye Tests &    S...............       2.1790      $138.79  ...........       $27.76
                    Treatments.
0232.............  Level I Anterior         T...............       5.1169      $325.92       $81.65       $65.18
                    Segment Eye Procedures.
0233.............  Level II Anterior        T...............      16.1710    $1,030.00      $266.33      $206.00
                    Segment Eye Procedures.
0234.............  Level III Anterior       T...............      23.1758    $1,476.16      $511.31      $295.23
                    Segment Eye Procedures.
0235.............  Level I Posterior        T...............       4.1331      $263.25       $58.93       $52.65
                    Segment Eye Procedures.
0236.............  Level II Posterior       T...............      18.2350    $1,161.46  ...........      $232.29
                    Segment Eye Procedures.
0237.............  Level III Posterior      T...............      27.8450    $1,773.56  ...........      $354.71
                    Segment Eye Procedures.
0238.............  Level I Repair and       T...............       2.9022      $184.85  ...........       $36.97
                    Plastic Eye Procedures.
0239.............  Level II Repair and      T...............       7.2847      $463.99  ...........       $92.80
                    Plastic Eye Procedures.

[[Page 66937]]

 
0240.............  Level III Repair and     T...............      18.7307    $1,193.03      $309.52      $238.61
                    Plastic Eye Procedures.
0241.............  Level IV Repair and      T...............      24.3077    $1,548.25      $383.45      $309.65
                    Plastic Eye Procedures.
0242.............  Level V Repair and       T...............      37.7243    $2,402.81      $597.36      $480.56
                    Plastic Eye Procedures.
0243.............  Strabismus/Muscle        T...............      24.1291    $1,536.88      $430.35      $307.38
                    Procedures.
0244.............  Corneal and Amniotic     T...............      37.4896    $2,387.86      $803.26      $477.57
                    Membrane Transplant.
0245.............  Level I Cataract         T...............      14.9171      $950.13      $217.05      $190.03
                    Procedures without IOL
                    Insert.
0246.............  Cataract Procedures      T...............      23.8649    $1,520.05      $495.96      $304.01
                    with IOL Insert.
0247.............  Laser Eye Procedures...  T...............       5.2001      $331.22      $104.31       $66.24
0249.............  Level II Cataract        T...............      28.7035    $1,828.24      $524.67      $365.65
                    Procedures without IOL
                    Insert.
0250.............  Nasal Cauterization/     T...............       1.1251       $71.66       $25.10       $14.33
                    Packing.
0251.............  Level I ENT Procedures.  T...............       2.5002      $159.25  ...........       $31.85
0252.............  Level II ENT Procedures  T...............       7.4474      $474.35      $109.16       $94.87
0253.............  Level III ENT            T...............      16.3288    $1,040.05      $282.29      $208.01
                    Procedures.
0254.............  Level IV ENT Procedures  T...............      23.9765    $1,527.16      $321.35      $305.43
0256.............  Level V ENT Procedures.  T...............      39.8776    $2,539.96  ...........      $507.99
0258.............  Tonsil and Adenoid       T...............      22.2557    $1,417.55      $437.25      $283.51
                    Procedures.
0259.............  Level VI ENT Procedures  T...............     393.2242   $25,046.02    $8,543.66    $5,009.20
0260.............  Level I Plain Film       X...............       0.6954       $44.29  ...........        $8.86
                    Except Teeth.
0261.............  Level II Plain Film      X...............       1.1570       $73.69  ...........       $14.74
                    Except Teeth Including
                    Bone Density
                    Measurement.
0262.............  Plain Film of Teeth....  X...............       0.5749       $36.62  ...........        $7.32
0263.............  Level I Miscellaneous    X...............       2.6838      $170.94  ...........       $34.19
                    Radiology Procedures.
0265.............  Level I Diagnostic and   S...............       0.9570       $60.96       $22.35       $12.19
                    Screening Ultrasound.
0266.............  Level II Diagnostic and  S...............       1.5094       $96.14       $37.80       $19.23
                    Screening Ultrasound.
0267.............  Level III Diagnostic     S...............       2.3792      $151.54       $60.50       $30.31
                    and Screening
                    Ultrasound.
0269.............  Level II Echocardiogram  S...............       6.3751      $406.06  ...........       $81.21
                    Without Contrast
                    Except Transesophageal.
0270.............  Transesophageal          S...............       8.2165      $523.34      $141.32      $104.67
                    Echocardiogram Without
                    Contrast.
0272.............  Fluoroscopy............  X...............       1.3271       $84.53       $31.64       $16.91
0274.............  Myelography............  S...............       7.5589      $481.46  ...........       $96.29
0275.............  Arthrography...........  S...............       4.0031      $254.97       $69.09       $50.99
0276.............  Level I Digestive        S...............       1.3834       $88.11       $34.97       $17.62
                    Radiology.
0277.............  Level II Digestive       S...............       2.2222      $141.54       $54.52       $28.31
                    Radiology.
0278.............  Diagnostic Urography...  S...............       2.6121      $166.38       $59.40       $33.28
0279.............  Level II Angiography     S...............      28.8788    $1,839.41  ...........      $367.88
                    and Venography.
0280.............  Level III Angiography    S...............      44.7114    $2,847.85  ...........      $569.57
                    and Venography.
0282.............  Miscellaneous Computed   S...............       1.5839      $100.88       $37.81       $20.18
                    Axial Tomography.
0283.............  Computed Tomography      S...............       4.3564      $277.48      $100.37       $55.50
                    with Contrast.
0284.............  Magnetic Resonance       S...............       6.2350      $397.13      $148.40       $79.43
                    Imaging and Magnetic
                    Resonance Angiography
                    with Contrast.
0288.............  Bone Density:Axial       S...............       1.1384       $72.51       $28.90       $14.50
                    Skeleton.
0293.............  Level V Anterior         T...............      84.8039    $5,401.50    $1,128.29    $1,080.30
                    Segment Eye Procedures.
0299.............  Hyperthermia and         S...............       5.7996      $369.40  ...........       $73.88
                    Radiation Treatment
                    Procedures.
0300.............  Level I Radiation        S...............       1.4229       $90.63  ...........       $18.13
                    Therapy.
0301.............  Level II Radiation       S...............       2.2167      $141.19  ...........       $28.24
                    Therapy.
0303.............  Treatment Device         X...............       2.8878      $183.94       $66.95       $36.79
                    Construction.
0304.............  Level I Therapeutic      X...............       1.5576       $99.21       $38.68       $19.84
                    Radiation Treatment
                    Preparation.
0305.............  Level II Therapeutic     X...............       3.9276      $250.16       $91.38       $50.03
                    Radiation Treatment
                    Preparation.
0307.............  Myocardial Positron      S...............      21.9955    $1,400.98      $292.49      $280.20
                    Emission Tomography
                    (PET) imaging.
0308.............  Non-Myocardial Positron  S...............      16.6001    $1,057.33  ...........      $211.47
                    Emission Tomography
                    (PET) imaging.
0310.............  Level III Therapeutic    X...............      13.5621      $863.82      $325.27      $172.76
                    Radiation Treatment
                    Preparation.
0312.............  Radioelement             S...............       8.5140      $542.29  ...........      $108.46
                    Applications.
0313.............  Brachytherapy..........  S...............      11.6779      $743.81  ...........      $148.76
0315.............  Level III Implantation   S...............     270.0190   $17,198.59  ...........    $3,439.72
                    of Neurostimulator.
0317.............  Level II Miscellaneous   X...............       5.3623      $341.55       $77.89       $68.31
                    Radiology Procedures.
0320.............  Electroconvulsive        S...............       5.7299      $364.96       $80.06       $72.99
                    Therapy.
0322.............  Brief Individual         S...............       1.1729       $74.71  ...........       $14.94
                    Psychotherapy.
0323.............  Extended Individual      S...............       1.6044      $102.19  ...........       $20.44
                    Psychotherapy.
0324.............  Family Psychotherapy...  S...............       2.3616      $150.42  ...........       $30.08
0325.............  Group Psychotherapy....  S...............       0.9913       $63.14       $13.81       $12.63
0330.............  Dental Procedures......  S...............       9.1677      $583.93  ...........      $116.79
0332.............  Computed Tomography      S...............       3.0109      $191.78       $75.24       $38.36
                    without Contrast.
0333.............  Computed Tomography      S...............       5.1125      $325.64      $119.01       $65.13
                    without Contrast
                    followed by Contrast).
0335.............  Magnetic Resonance       S...............       4.8830      $311.02      $111.92       $62.20
                    Imaging, Miscellaneous.
0336.............  Magnetic Resonance       S...............       5.3933      $343.52      $137.40       $68.70
                    Imaging and Magnetic
                    Resonance Angiography
                    without Contrast.
0337.............  Magnetic Resonance       S...............       8.2463      $525.24      $199.53      $105.05
                    Imaging and Magnetic
                    Resonance Angiography
                    without Contrast
                    followed by Contrast.
0340.............  Minor Ancillary          X...............       0.6310       $40.19  ...........        $8.04
                    Procedures.
0341.............  Skin Tests.............  X...............       0.0844        $5.38        $2.14        $1.08
0342.............  Level I Pathology......  X...............       0.0969        $6.17        $2.02        $1.23
0343.............  Level III Pathology....  X...............       0.5142       $32.75       $10.84        $6.55
0344.............  Level IV Pathology.....  X...............       0.8167       $52.02       $15.66       $10.40
0345.............  Level I Transfusion      X...............       0.2140       $13.63        $2.87        $2.73
                    Laboratory Procedures.
0346.............  Level II Transfusion     X...............       0.3346       $21.31        $4.37        $4.26
                    Laboratory Procedures.
0347.............  Level III Transfusion    X...............       0.7739       $49.29       $11.28        $9.86
                    Laboratory Procedures.
0350.............  Administration of flu    S...............       0.3945       $25.13  ...........        $0.00
                    and PPV vaccine.
0360.............  Level I Alimentary       X...............       1.5330       $97.64       $33.88       $19.53
                    Tests.
0361.............  Level II Alimentary      X...............       3.9276      $250.16       $83.23       $50.03
                    Tests.
0363.............  Level I                  X...............       0.8067       $51.38       $17.10       $10.28
                    Otorhinolaryngologic
                    Function Tests.
0364.............  Level I Audiometry.....  X...............       0.4490       $28.60        $7.06        $5.72
0365.............  Level II Audiometry....  X...............       1.2549       $79.93       $18.52       $15.99

[[Page 66938]]

 
0366.............  Level III Audiometry...  X...............       1.7624      $112.25       $25.79       $22.45
0367.............  Level I Pulmonary Test.  X...............       0.5677       $36.16       $13.76        $7.23
0368.............  Level II Pulmonary       X...............       0.9253       $58.94       $22.77       $11.79
                    Tests.
0369.............  Level III Pulmonary      X...............       2.7550      $175.48       $44.18       $35.10
                    Tests.
0370.............  Allergy Tests..........  X...............       1.0430       $66.43  ...........       $13.29
0373.............  Level I                  X...............       1.2448       $79.29  ...........       $15.86
                    Neuropsychological
                    Testing.
0375.............  Ancillary Outpatient     S...............      78.5966    $5,006.13  ...........    $1,001.23
                    Services When Patient
                    Expires.
0377.............  Level II Cardiac         S...............      11.8512      $754.85      $158.84      $150.97
                    Imaging.
0378.............  Level II Pulmonary       S...............       4.9509      $315.34      $125.33       $63.07
                    Imaging.
0379.............  Injection adenosine 6    K...............  ...........       $25.10  ...........        $5.02
                    MG.
0381.............  Single Allergy Tests...  X...............       0.2773       $17.66  ...........        $3.53
0382.............  Level II                 X...............       2.6169      $166.68  ...........       $33.34
                    Neuropsychological
                    Testing.
0383.............  Cardiac Computed         S...............       4.7005      $299.39      $117.06       $59.88
                    Tomographic Imaging.
0384.............  GI Procedures with       T...............      24.9814    $1,591.17  ...........      $318.23
                    Stents.
0385.............  Level I Prosthetic       S...............      83.6366    $5,327.15  ...........    $1,065.43
                    Urological Procedures.
0386.............  Level II Prosthetic      S...............     144.1246    $9,179.87  ...........    $1,835.97
                    Urological Procedures.
0387.............  Level II Hysteroscopy..  T...............      34.2048    $2,178.64      $655.55      $435.73
0388.............  Discography............  S...............      20.1823    $1,285.49      $289.72      $257.10
0389.............  Level I Non-imaging      S...............       1.8190      $115.86       $33.81       $23.17
                    Nuclear Medicine.
0390.............  Level I Endocrine        S...............       2.0471      $130.39       $52.15       $26.08
                    Imaging.
0391.............  Level II Endocrine       S...............       3.4513      $219.83       $66.18       $43.97
                    Imaging.
0392.............  Level II Non-imaging     S...............       2.9022      $184.85       $49.31       $36.97
                    Nuclear Medicine.
0393.............  Hematologic Processing   S...............       5.6921      $362.55       $82.04       $72.51
                    & Studies.
0394.............  Hepatobiliary Imaging..  S...............       4.4603      $284.09      $102.61       $56.82
0395.............  GI Tract Imaging.......  S...............       3.7911      $241.47       $89.73       $48.29
0396.............  Bone Imaging...........  S...............       3.8039      $242.29       $95.02       $48.46
0397.............  Vascular Imaging.......  S...............       3.1433      $200.21       $49.58       $40.04
0398.............  Level I Cardiac Imaging  S...............       4.8620      $309.68      $100.06       $61.94
0400.............  Hematopoietic Imaging..  S...............       3.9293      $250.27       $93.22       $50.05
0401.............  Level I Pulmonary        S...............       3.3954      $216.27       $78.19       $43.25
                    Imaging.
0402.............  Level II Nervous System  S...............       8.8235      $562.00      $114.12      $112.40
                    Imaging.
0403.............  Level I Nervous System   S...............       3.2295      $205.70       $79.87       $41.14
                    Imaging.
0404.............  Renal and Genitourinary  S...............       5.0824      $323.72       $84.11       $64.74
                    Studies.
0406.............  Level I Tumor/Infection  S...............       5.0681      $322.81       $98.18       $64.56
                    Imaging.
0407.............  Level I Radionuclide     S...............       3.3020      $210.32       $78.13       $42.06
                    Therapy.
0408.............  Level III Tumor/         S...............      15.4033      $981.10  ...........      $196.22
                    Infection Imaging.
0409.............  Red Blood Cell Tests...  X...............       0.1190        $7.58        $2.20        $1.52
0412.............  IMRT Treatment Delivery  S...............       5.4582      $347.65  ...........       $69.53
0413.............  Level II Radionuclide    S...............       5.2741      $335.93  ...........       $67.19
                    Therapy.
0414.............  Level II Tumor/          S...............       8.4176      $536.15      $214.44      $107.23
                    Infection Imaging.
0415.............  Level II Endoscopy       T...............      24.0654    $1,532.82      $459.92      $306.56
                    Lower Airway.
0418.............  Insertion of Left        T...............     259.7486   $16,544.43            .    $3,308.89
                    Ventricular Pacing
                    Elect.
0422.............  Level II Upper GI        T...............      25.3233    $1,612.94      $448.81      $322.59
                    Procedures.
0423.............  Level II Percutaneous    T...............      42.9980    $2,738.71  ...........      $547.74
                    Abdominal and Biliary
                    Procedures.
0425.............  Level II Arthroplasty    T...............     122.2057    $7,783.77  ...........    $1,556.75
                    with Prosthesis.
0426.............  Level II Strapping and   S...............       2.2910      $145.92  ...........       $29.18
                    Cast Application.
0427.............  Level II Tube Changes    T...............      15.3545      $977.99  ...........      $195.60
                    and Repositioning.
0428.............  Level III Sigmoidoscopy  T...............      21.4632    $1,367.08  ...........      $273.42
                    and Anoscopy.
0429.............  Level V                  T...............      45.2042    $2,879.24  ...........      $575.85
                    Cystourethroscopy and
                    other Genitourinary
                    Procedures.
0430.............  Drug Preadministration-  S...............       0.5921       $37.71  ...........        $7.54
                    Related Services.
0432.............  Health and Behavior      S...............       0.3128       $19.92  ...........        $3.98
                    Services.
0433.............  Level II Pathology.....  X...............       0.2397       $15.27        $5.17        $3.05
0434.............  Cardiac Defect Repair..  T...............     132.4129    $8,433.91  ...........    $1,686.78
0436.............  Level I Drug             S...............       0.2545       $16.21  ...........        $3.24
                    Administration.
0437.............  Level II Drug            S...............       0.3945       $25.13  ...........        $5.03
                    Administration.
0438.............  Level III Drug           S...............       0.8041       $51.22  ...........       $10.24
                    Administration.
0439.............  Level IV Drug            S...............       1.6544      $105.38  ...........       $21.08
                    Administration.
0440.............  Level V Drug             S...............       1.7998      $114.64  ...........       $22.93
                    Administration.
0441.............  Level VI Drug            S...............       2.3446      $149.34  ...........       $29.87
                    Administration.
0442.............  Dosimetric Drug          S...............      27.4298    $1,747.11  ...........      $349.42
                    Administration.
0604.............  Level 1 Hospital Clinic  V...............       0.8388       $53.43  ...........       $10.69
                    Visits.
0605.............  Level 2 Hospital Clinic  V...............       0.9964       $63.46  ...........       $12.69
                    Visits.
0606.............  Level 3 Hospital Clinic  V...............       1.3226       $84.24  ...........       $16.85
                    Visits.
0607.............  Level 4 Hospital Clinic  V...............       1.6604      $105.76  ...........       $21.15
                    Visits.
0608.............  Level 5 Hospital Clinic  V...............       2.1740      $138.47  ...........       $27.69
                    Visits.
0609.............  Level 1 Emergency        V...............       0.7970       $50.76       $12.70       $10.15
                    Visits.
0613.............  Level 2 Emergency        V...............       1.3137       $83.67       $21.06       $16.73
                    Visits.
0614.............  Level 3 Emergency        V...............       2.0750      $132.17       $34.50       $26.43
                    Visits.
0615.............  Level 4 Emergency        V...............       3.3377      $212.59       $48.49       $42.52
                    Visits.
0616.............  Level 5 Emergency        V...............       4.9535      $315.51       $72.86       $63.10
                    Visits.
0617.............  Critical Care..........  S...............       7.3166      $466.02      $111.59       $93.20
0618.............  Trauma Response with     S...............       5.1854      $330.28      $132.11       $66.06
                    Critical Care.
0621.............  Level I Vascular Access  T...............      10.9092      $694.85  ...........      $138.97
                    Procedures.
0622.............  Level II Vascular        T...............      24.1069    $1,535.46  ...........      $307.09
                    Access Procedures.
0623.............  Level III Vascular       T...............      28.8743    $1,839.12  ...........      $367.82
                    Access Procedures.
0624.............  Phlebotomy and Minor     X...............       0.5689       $36.24       $12.65        $7.25
                    Vascular Access Device
                    Procedures.
0625.............  Level IV Vascular        T...............      81.7482    $5,206.87  ...........    $1,041.37
                    Access Procedures.
0648.............  Level IV Breast Surgery  T...............      56.5774    $3,603.64  ...........      $720.73
0651.............  Complex Interstitial     S...............      18.1228    $1,154.31  ...........      $230.86
                    Radiation Source
                    Application.
0652.............  Insertion of             T...............      30.7096    $1,956.02  ...........      $391.20
                    Intraperitoneal and
                    Pleural Catheters.

[[Page 66939]]

 
0653.............  Vascular Reconstruction/ T...............      40.4667    $2,577.49  ...........      $515.50
                    Fistula Repair with
                    Device.
0654.............  Insertion/Replacement    T...............     109.2851    $6,960.81  ...........    $1,392.16
                    of a permanent dual
                    chamber pacemaker.
0655.............  Insertion/Replacement/   T...............     140.0317    $8,919.18  ...........    $1,783.84
                    Conversion of a
                    permanent dual chamber
                    pacemaker.
0656.............  Transcatheter Placement  T...............     118.4265    $7,543.06  ...........    $1,508.61
                    of Intracoronary Drug-
                    Eluting Stents.
0659.............  Hyperbaric Oxygen......  S...............       1.5579       $99.23  ...........       $19.85
0660.............  Level II                 X...............       1.4312       $91.16       $28.06       $18.23
                    Otorhinolaryngologic
                    Function Tests.
0661.............  Level V Pathology......  X...............       2.6949      $171.65       $62.09       $34.33
0662.............  CT Angiography.........  S...............       5.1641      $328.92      $118.88       $65.78
0663.............  Level I Electronic       S...............       1.5313       $97.53  ...........       $19.51
                    Analysis of Devices.
0664.............  Level I Proton Beam      S...............      12.8205      $816.59  ...........      $163.32
                    Radiation Therapy.
0665.............  Bone                     S...............       0.5087       $32.40       $12.95        $6.48
                    Density:AppendicularSk
                    eleton.
0667.............  Level II Proton Beam     S...............      15.3404      $977.09  ...........      $195.42
                    Radiation Therapy.
0668.............  Level I Angiography and  S...............       9.3506      $595.58  ...........      $119.12
                    Venography.
0672.............  Level IV Posterior       T...............      37.2078    $2,369.91  ...........      $473.98
                    Segment Eye Procedures.
0673.............  Level IV Anterior        T...............      39.7101    $2,529.30      $649.56      $505.86
                    Segment Eye Procedures.
0674.............  Prostate Cryoablation..  T...............     122.7133    $7,816.10  ...........    $1,563.22
0676.............  Thrombolysis and         T...............       2.4824      $158.11  ...........       $31.62
                    Thrombectomy.
0678.............  External                 T...............       1.7187      $109.47  ...........       $21.89
                    Counterpulsation.
0679.............  Level II Resuscitation   S...............       5.4502      $347.15       $95.30       $69.43
                    and Cardioversion.
0680.............  Insertion of Patient     S...............      70.6073    $4,497.26  ...........      $899.45
                    Activated Event
                    Recorders.
0681.............  Knee Arthroplasty......  T...............     274.6715   $17,494.93  ...........    $3,498.99
0682.............  Level V Debridement &    T...............       6.8816      $438.32      $158.65       $87.66
                    Destruction.
0683.............  Level II                 S...............       2.6045      $165.89  ...........       $33.18
                    Photochemotherapy.
0685.............  Level III Needle Biopsy/ T...............       9.3354      $594.61  ...........      $118.92
                    Aspiration Except Bone
                    Marrow.
0687.............  Revision/Removal of      T...............      22.4734    $1,431.42      $438.47      $286.28
                    Neurostimulator
                    Electrodes.
0688.............  Revision/Removal of      T...............      34.4166    $2,192.13      $874.57      $438.43
                    Neurostimulator Pulse
                    Generator Receiver.
0689.............  Electronic Analysis of   S...............       0.5946       $37.87  ...........        $7.57
                    Cardioverter-
                    defibrillators.
0690.............  Electronic Analysis of   S...............       0.3504       $22.32        $8.67        $4.46
                    Pacemakers and other
                    Cardiac Devices.
0691.............  Level III Electronic     S...............       2.3269      $148.21       $50.49       $29.64
                    Analysis of Devices.
0692.............  Level II Electronic      S...............       1.8376      $117.04       $29.72       $23.41
                    Analysis of Devices.
0694.............  Mohs Surgery...........  T...............       3.6321      $231.34       $91.69       $46.27
0697.............  Level I Echocardiogram   S...............       3.3401      $212.74  ...........       $42.55
                    Without Contrast
                    Except Transesophageal.
0698.............  Level II Eye Tests &     S...............       0.8696       $55.39  ...........       $11.08
                    Treatments.
0699.............  Level IV Eye Tests &     T...............      13.7453      $875.49  ...........      $175.10
                    Treatments.
0701.............  Sr89 strontium.........  K...............       9.6094      $612.06  ...........      $122.41
0702.............  Sm 153 lexidronm.......  K...............      21.3689    $1,361.07  ...........      $272.21
0726.............  Dexrazoxane HCl          K...............  ...........      $162.11  ...........       $32.42
                    injection.
0728.............  Filgrastim 300 mcg       K...............  ...........      $193.79  ...........       $38.76
                    injection.
0730.............  Pamidronate disodium...  K...............  ...........       $28.31  ...........        $5.66
0731.............  Sargramostim injection.  K...............  ...........       $24.86  ...........        $4.97
0732.............  Mesna injection........  K...............  ...........        $7.97  ...........        $1.59
0735.............  Ampho b cholesteryl      K...............  ...........       $11.89  ...........        $2.38
                    sulfate.
0736.............  Amphotericin b liposome  K...............  ...........       $16.21  ...........        $3.24
                    inj.
0738.............  Rasburicase............  K...............  ...........      $144.43  ...........       $28.89
0747.............  Chlorothiazide sodium    K...............  ...........      $141.07  ...........       $28.21
                    inj.
0748.............  Bleomycin sulfate        K...............  ...........       $42.93  ...........        $8.59
                    injection.
0750.............  Dolasetron mesylate....  K...............  ...........        $4.66  ...........        $0.93
0751.............  Mechlorethamine hcl inj  K...............  ...........      $143.08  ...........       $28.62
0752.............  Dactinomycin             K...............  ...........      $488.78  ...........       $97.76
                    actinomycin d.
0759.............  Naltrexone, depot form.  K...............  ...........        $1.87  ...........        $0.37
0760.............  Anadulafungin injection  G...............  ...........        $1.91  ...........        $0.38
0763.............  Dolasetron mesylate      K...............  ...........       $43.77  ...........        $8.75
                    oral.
0764.............  Granisetron HCl          K...............  ...........        $5.74  ...........        $1.15
                    injection.
0765.............  Granisetron HCl 1 mg     K...............  ...........       $49.96  ...........        $9.99
                    oral.
0767.............  Enfuvirtide injection..  K...............  ...........        $0.40  ...........        $0.08
0768.............  Ondansetron hcl          K...............  ...........        $0.26  ...........        $0.06
                    injection.
0769.............  Ondansetron HCl 8mg      K...............  ...........       $18.37  ...........        $3.67
                    oral.
0800.............  Leuprolide acetate.....  K...............  ...........      $452.58  ...........       $90.52
0802.............  Etoposide oral.........  K...............  ...........       $29.46  ...........        $5.89
0804.............  Vivaglobin, inj........  K...............  ...........        $7.01  ...........        $1.40
0805.............  Mecasermin injection...  K...............  ...........       $15.62  ...........        $3.12
0806.............  Hyaluronidase            G...............  ...........        $0.40  ...........        $0.08
                    recombinant.
0807.............  Aldesleukin/single use   K...............  ...........      $788.84  ...........      $157.77
                    vial.
0808.............  Nabilone oral..........  K...............  ...........       $16.80  ...........        $3.36
0809.............  Bcg live intravesical    K...............  ...........      $113.75  ...........       $22.75
                    vac.
0810.............  Goserelin acetate        K...............  ...........      $192.29  ...........       $38.46
                    implant.
0811.............  Carboplatin injection..  K...............  ...........        $7.44  ...........        $1.49
0812.............  Carmus bischl nitro inj  K...............  ...........      $152.24  ...........       $30.45
0814.............  Asparaginase injection.  K...............  ...........       $54.26  ...........       $10.85
0820.............  Daunorubicin...........  K...............  ...........       $19.33  ...........        $3.87
0821.............  Daunorubicin citrate     K...............  ...........       $55.23  ...........       $11.05
                    liposom.
0823.............  Docetaxel..............  K...............  ...........      $310.85  ...........       $62.17
0825.............  Nelarabine injection...  G...............  ...........       $86.84  ...........       $17.37
0827.............  Floxuridine injection..  K...............  ...........       $54.63  ...........       $10.93
0828.............  Gemcitabine HCl........  K...............  ...........      $127.31  ...........       $25.46
0830.............  Irinotecan injection...  K...............  ...........      $124.61  ...........       $24.92
0831.............  Ifosfomide injection...  K...............  ...........       $38.13  ...........        $7.63
0832.............  Idarubicin hcl           K...............  ...........      $302.42  ...........       $60.48
                    injection.
0834.............  Interferon alfa-2a inj.  K...............  ...........       $41.37  ...........        $8.27

[[Page 66940]]

 
0835.............  Inj cosyntropin........  K...............  ...........       $64.01  ...........       $12.80
0836.............  Interferon alfa-2b inj.  K...............  ...........       $13.92  ...........        $2.78
0838.............  Interferon gamma 1-b     K...............  ...........      $306.66  ...........       $61.33
                    inj.
0840.............  Inj melphalan hydrochl.  K...............  ...........    $1,548.88  ...........      $309.78
0842.............  Fludarabine phosphate    K...............  ...........      $226.67  ...........       $45.33
                    inj.
0843.............  Pegaspargase/singl dose  K...............  ...........    $2,080.19  ...........      $416.04
                    vial.
0844.............  Pentostatin injection..  K...............  ...........    $2,051.68  ...........      $410.34
0849.............  Rituximab cancer         K...............  ...........      $504.40  ...........      $100.88
                    treatment.
0850.............  Streptozocin injection.  K...............  ...........      $146.93  ...........       $29.39
0851.............  Thiotepa injection.....  K...............  ...........       $41.12  ...........        $8.22
0852.............  Topotecan..............  K...............  ...........      $859.62  ...........      $171.92
0855.............  Vinorelbine tartrate...  K...............  ...........       $21.41  ...........        $4.28
0856.............  Porfimer sodium........  K...............  ...........    $2,532.53  ...........      $506.51
0858.............  Inj cladribine.........  K...............  ...........       $32.04  ...........        $6.41
0861.............  Leuprolide acetate       K...............  ...........        $7.98  ...........        $1.60
                    injeciton.
0862.............  Mitomycin 5 MG inj.....  K...............  ...........       $14.39  ...........        $2.88
0863.............  Paclitaxel injection...  K...............  ...........       $14.57  ...........        $2.91
0864.............  Mitoxantrone hydrochl..  K...............  ...........      $107.96  ...........       $21.59
0865.............  Interferon alfa-n3 inj.  K...............  ...........        $9.03  ...........        $1.81
0868.............  Oral aprepitant........  K...............  ...........        $4.99  ...........        $1.00
0873.............  Hyalgan/supartz inj per  K...............  ...........      $101.81  ...........       $20.36
                    dose.
0874.............  Synvisc inj per dose...  K...............  ...........      $178.11  ...........       $35.62
0875.............  Euflexxa inj per dose..  K...............  ...........      $110.95  ...........       $22.19
0877.............  Orthovisc inj per dose.  K...............  ...........      $174.50  ...........       $34.90
0878.............  Gallium nitrate          K...............  ...........        $1.61  ...........        $0.32
                    injection.
0880.............  Pentastarch 10%          K...............  ...........       $21.98  ...........        $4.40
                    solution.
0882.............  Melphalan oral.........  K...............  ...........        $4.14  ...........        $0.83
0883.............  Fondaparinux sodium....  K...............  ...........        $5.92  ...........        $1.18
0884.............  Rho d immune globulin    K...............  ...........       $80.79  ...........       $16.16
                    inj.
0887.............  Azathioprine parenteral  K...............  ...........       $47.88  ...........        $9.58
0888.............  Cyclosporine oral......  K...............  ...........        $3.52  ...........        $0.70
0890.............  Lymphocyte immune        K...............  ...........      $336.10  ...........       $67.22
                    globulin.
0891.............  Tacrolimus oral........  K...............  ...........        $3.69  ...........        $0.74
0898.............  Gamma globulin 2 CC inj  K...............  ...........       $23.82  ...........        $4.76
0899.............  Gamma globulin 3 CC inj  K...............  ...........       $35.72  ...........        $7.14
0900.............  Alglucerase injection..  K...............  ...........       $38.85  ...........        $7.77
0901.............  Alpha 1 proteinase       K...............  ...........        $3.28  ...........        $0.66
                    inhibitor.
0902.............  Botulinum toxin a per    K...............  ...........        $5.21  ...........        $1.04
                    unit.
0903.............  Cytomegalovirus imm IV / K...............  ...........      $870.53  ...........      $174.11
                    vial.
0904.............  Gamma globulin 4 CC inj  K...............  ...........       $47.64  ...........        $9.53
0906.............  RSV-ivig...............  K...............  ...........       $16.02  ...........        $3.20
0910.............  Interferon beta-1b /     K...............  ...........      $106.57  ...........       $21.31
                    .25 MG.
0911.............  Inj streptokinase /      K...............  ...........      $129.75  ...........       $25.95
                    250000 IU.
0912.............  Interferon alfacon-1...  K...............  ...........        $4.62  ...........        $0.92
0913.............  Ganciclovir long act     K...............  ...........    $4,707.90  ...........      $941.58
                    implant.
0916.............  Injection imiglucerase / K...............  ...........        $3.89  ...........        $0.78
                    unit.
0917.............  Adenosine injection....  K...............  ...........       $67.89  ...........       $13.58
0919.............  Gamma globulin 5 CC inj  K...............  ...........       $59.54  ...........       $11.91
0920.............  Gamma globulin 6 CC inj  K...............  ...........       $71.50  ...........       $14.30
0921.............  Gamma globulin 7 CC inj  K...............  ...........       $83.30  ...........       $16.66
0922.............  Gamma globulin 8 CC inj  K...............  ...........       $95.27  ...........       $19.05
0923.............  Gamma globulin 9 CC inj  K...............  ...........      $107.25  ...........       $21.45
0924.............  Gamma globulin 10 CC     K...............  ...........      $119.09  ...........       $23.82
                    inj.
0925.............  Factor viii............  K...............  ...........        $0.75  ...........        $0.15
0927.............  Factor viii recombinant  K...............  ...........        $1.07  ...........        $0.21
0928.............  Factor ix complex......  K...............  ...........        $0.80  ...........        $0.16
0929.............  Anti-inhibitor.........  K...............  ...........        $1.42  ...........        $0.28
0930.............  Antithrombin iii         K...............  ...........        $1.82  ...........        $0.36
                    injection.
0931.............  Factor IX non-           K...............  ...........        $0.89  ...........        $0.18
                    recombinant.
0932.............  Factor IX recombinant..  K...............  ...........        $0.99  ...........        $0.20
0933.............  Gamma globulin > 10 CC   K...............  ...........      $119.09  ...........       $23.82
                    inj.
0934.............  Capecitabine, oral.....  K...............  ...........       $14.19  ...........        $2.84
0935.............  Clonidine hydrochloride  K...............  ...........       $62.78  ...........       $12.56
0941.............  Mitomycin 20 MG inj....  K...............  ...........       $57.56  ...........       $11.51
0942.............  Mitomycin 40 MG inj....  K...............  ...........      $115.11  ...........       $23.02
0943.............  Octagam injection......  K...............  ...........       $33.19  ...........        $6.64
0944.............  Gammagard liquid         K...............  ...........       $31.06  ...........        $6.21
                    injection.
0945.............  Rhophylac injection....  K...............  ...........        $5.29  ...........        $1.06
0946.............  HepaGam B IM injection.  K...............  ...........       $63.51  ...........       $12.70
0947.............  Flebogamma injection...  K...............  ...........       $32.27  ...........        $6.45
0948.............  Gamunex injection......  K...............  ...........       $32.06  ...........        $6.41
0949.............  Frozen plasma, pooled,   K...............       1.1598       $73.87  ...........       $14.77
                    sd.
0950.............  Whole blood for          K...............       4.0011      $254.85  ...........       $50.97
                    transfusion.
0951.............  Reclast injection......  G...............  ...........      $220.81  ...........       $44.16
0952.............  Cryoprecipitate each     K...............       0.6474       $41.24  ...........        $8.25
                    unit.
0954.............  RBC leukocytes reduced.  K...............       2.9069      $185.15  ...........       $37.03
0955.............  Plasma, frz between 8-   K...............       1.2235       $77.93  ...........       $15.59
                    24hour.
0956.............  Plasma protein           K...............       1.4739       $93.88  ...........       $18.78
                    fract,5%,50ml.
0957.............  Platelets, each unit...  K...............       1.0911       $69.50  ...........       $13.90
0958.............  Plaelet rich plasma      K...............       5.7070      $363.50  ...........       $72.70
                    unit.

[[Page 66941]]

 
0959.............  Red blood cells unit...  K...............       2.0356      $129.66  ...........       $25.93
0960.............  Washed red blood cells   K...............       4.3494      $277.03  ...........       $55.41
                    unit.
0961.............  Albumin (human),5%,      K...............       0.3413       $21.74  ...........        $4.35
                    50ml.
0963.............  Albumin (human), 5%,     K...............       1.0987       $69.98  ...........       $14.00
                    250 ml.
0964.............  Albumin (human), 25%,    K...............       0.4118       $26.23  ...........        $5.25
                    20 ml.
0965.............  Albumin (human), 25%,    K...............       1.1362       $72.37  ...........       $14.47
                    50ml.
0966.............  Plasmaprotein            K...............       3.3792      $215.23  ...........       $43.05
                    fract,5%,250ml.
0967.............  Blood split unit.......  K...............       2.3409      $149.10  ...........       $29.82
0968.............  Platelets leukoreduced   K...............       2.1971      $139.94  ...........       $27.99
                    irrad.
0969.............  RBC leukoreduced         K...............       3.7722      $240.27  ...........       $48.05
                    irradiated.
0998.............  Inj biperiden lactate/5  K...............  ...........       $88.15  ...........       $17.63
                    mg.
0999.............  Edetate calcium          K...............  ...........       $49.64  ...........        $9.93
                    disodium inj.
1009.............  Cryoprecipitatereducedp  K...............       1.3139       $83.69  ...........       $16.74
                    lasma.
1010.............  Blood, l/r, cmv-neg....  K...............       2.3221      $147.90  ...........       $29.58
1011.............  Platelets, hla-m, l/r,   K...............      10.1413      $645.94  ...........      $129.19
                    unit.
1013.............  Platelets leukocytes     K...............       1.6879      $107.51  ...........       $21.50
                    reduced.
1015.............  Injection glatiramer     K...............  ...........       $52.04  ...........       $10.41
                    acetate.
1016.............  Blood, l/r, froz/degly/  K...............       3.4353      $218.81  ...........       $43.76
                    wash.
1017.............  Plt, aph/pher, l/r, cmv- K...............       7.6733      $488.74  ...........       $97.75
                    neg.
1018.............  Blood, l/r, irradiated.  K...............       2.3099      $147.13  ...........       $29.43
1019.............  Plate pheres leukoredu   K...............       9.8923      $630.08  ...........      $126.02
                    irrad.
1020.............  Plt, pher, l/r cmv-neg,  K...............      10.7787      $686.54  ...........      $137.31
                    irr.
1021.............  RBC, frz/deg/wsh, l/r,   K...............       5.8716      $373.99  ...........       $74.80
                    irrad.
1022.............  RBC, l/r, cmv-neg,       K...............       4.1363      $263.46  ...........       $52.69
                    irrad.
1023.............  Pralidoxime chloride     K...............  ...........       $35.20  ...........        $7.04
                    inj.
1032.............  Aud osseo dev, int/ext   H...............  ...........  ...........  ...........            .
                    comp.
1041.............  Plicamycin               K...............  ...........      $172.41  ...........       $34.48
                    (mithramycin) inj.
1052.............  Injection, voriconazole  K...............  ...........        $4.93  ...........        $0.99
1064.............  I131 iodide cap, rx....  K...............       0.2393       $15.24  ...........        $3.05
1083.............  Adalimumab injection...  K...............  ...........      $329.58  ...........       $65.92
1084.............  Denileukin diftitox....  K...............  ...........    $1,386.59  ...........      $277.32
1086.............  Temozolomide...........  K...............  ...........        $7.49  ...........        $1.50
1138.............  Hepagam B intravenous,   K...............  ...........       $63.51  ...........       $12.70
                    inj.
1139.............  Protein C concentrate..  K...............  ...........       $12.08  ...........        $2.42
1140.............  Integra matrix tissue..  K...............  ...........       $33.14  ...........        $6.63
1141.............  Primatrix tissue.......  G...............  ...........       $67.96  ...........       $13.59
1142.............  Supprelin LA implant...  K...............  ...........   $14,700.00  ...........    $2,940.00
1150.............  I131 iodide sol, rx....  K...............       0.1762       $11.22  ...........        $2.24
1165.............  Aripiprazole injection.  K...............  ...........        $0.28  ...........        $0.06
1166.............  Cytarabine liposome....  K...............  ...........      $412.21  ...........       $82.44
1167.............  Inj, epirubicin hcl....  K...............  ...........       $19.79  ...........        $3.96
1168.............  Inj, temsirolimus......  G...............  ...........       $48.41  ...........        $9.68
1169.............  Neurawrap nerve          G...............  ...........      $482.56  ...........       $96.51
                    protector,cm.
1178.............  Busulfan injection.....  K...............  ...........        $9.17  ...........        $1.83
1203.............  Verteporfin injection..  K...............  ...........        $8.99  ...........        $1.80
1207.............  Octreotide injection,    K...............  ...........       $99.04  ...........       $19.81
                    depot.
1280.............  Corticotropin injection  K...............  ...........      $169.77  ...........       $33.95
1436.............  Etidronate disodium inj  K...............  ...........       $70.73  ...........       $14.15
1491.............  New Technology--Level    S...............  ...........        $5.00  ...........        $1.00
                    IA ($0-$10).
1492.............  New Technology--Level    S...............  ...........       $15.00  ...........        $3.00
                    IB ($10-$20).
1493.............  New Technology--Level    S...............  ...........       $25.00  ...........        $5.00
                    IC ($20-$30).
1494.............  New Technology--Level    S...............  ...........       $35.00  ...........        $7.00
                    ID ($30-$40).
1495.............  New Technology--Level    S...............  ...........       $45.00  ...........        $9.00
                    IE ($40-$50).
1496.............  New Technology--Level    T...............  ...........        $5.00  ...........        $1.00
                    IA ($0-$10).
1497.............  New Technology--Level    T...............  ...........       $15.00  ...........        $3.00
                    IB($10-$20).
1498.............  New Technology--Level    T...............  ...........       $25.00  ...........        $5.00
                    IC ($20-$30).
1499.............  New Technology--Level    T...............  ...........       $35.00  ...........        $7.00
                    ID($30-$40).
1500.............  New Technology--Level    T...............  ...........       $45.00  ...........        $9.00
                    IE ($40-$50).
1502.............  New Technology--Level    S...............  ...........       $75.00  ...........       $15.00
                    II ($50-$100).
1503.............  New Technology--Level    S...............  ...........      $150.00  ...........       $30.00
                    III ($100-$200).
1504.............  New Technology--Level    S...............  ...........      $250.00  ...........       $50.00
                    IV ($200-$300).
1505.............  New Technology--Level V  S...............  ...........      $350.00  ...........       $70.00
                    ($300-$400).
1506.............  New Technology--Level    S...............  ...........      $450.00  ...........       $90.00
                    VI ($400-$500).
1507.............  New Technology--Level    S...............  ...........      $550.00  ...........      $110.00
                    VII ($500-$600).
1508.............  New Technology--Level    S...............  ...........      $650.00  ...........      $130.00
                    VIII ($600-$700).
1509.............  New Technology--Level    S...............  ...........      $750.00  ...........      $150.00
                    IX ($700-$800).
1510.............  New Technology--Level X  S...............  ...........      $850.00  ...........      $170.00
                    ($800-$900).
1511.............  New Technology--Level    S...............  ...........      $950.00  ...........      $190.00
                    XI ($900-$1000).
1512.............  New Technology--Level    S...............  ...........    $1,050.00  ...........      $210.00
                    XII ($1000-$1100).
1513.............  New Technology--Level    S...............  ...........    $1,150.00  ...........      $230.00
                    XIII ($1100-$1200).
1514.............  New Technology--Level    S...............  ...........    $1,250.00  ...........      $250.00
                    XIV($1200-$1300).
1515.............  New Technology--Level    S...............  ...........    $1,350.00  ...........      $270.00
                    XV ($1300-$1400).
1516.............  New Technology--Level    S...............  ...........    $1,450.00  ...........      $290.00
                    XVI ($1400-$1500).
1517.............  New Technology--Level    S...............  ...........    $1,550.00  ...........      $310.00
                    XVII ($1500-$1600).
1518.............  New Technology--Level    S...............  ...........    $1,650.00  ...........      $330.00
                    XVIII ($1600-$1700).
1519.............  New Technology--Level    S...............  ...........    $1,750.00  ...........      $350.00
                    IXX ($1700-$1800).
1520.............  New Technology--Level    S...............  ...........    $1,850.00  ...........      $370.00
                    XX ($1800-$1900).
1521.............  New Technology--Level    S...............  ...........    $1,950.00  ...........      $390.00
                    XXI ($1900-$2000).
1522.............  New Technology--Level    S...............  ...........    $2,250.00  ...........      $450.00
                    XXII ($2000-$2500).
1523.............  New Technology--Level    S...............  ...........    $2,750.00  ...........      $550.00
                    XXIII ($2500-$3000).

[[Page 66942]]

 
1524.............  New Technology--Level    S...............  ...........    $3,250.00  ...........      $650.00
                    XXIV ($3000-$3500).
1525.............  New Technology--Level    S...............  ...........    $3,750.00  ...........      $750.00
                    XXV ($3500-$4000).
1526.............  New Technology--Level    S...............  ...........    $4,250.00  ...........      $850.00
                    XXVI ($4000-$4500).
1527.............  New Technology--Level    S...............  ...........    $4,750.00  ...........      $950.00
                    XXVII ($4500-$5000).
1528.............  New Technology--Level    S...............  ...........    $5,250.00  ...........    $1,050.00
                    XXVIII ($5000-$5500).
1529.............  New Technology--Level    S...............  ...........    $5,750.00  ...........    $1,150.00
                    XXIX ($5500-$6000).
1530.............  New Technology--Level    S...............  ...........    $6,250.00  ...........    $1,250.00
                    XXX ($6000-$6500).
1531.............  New Technology--Level    S...............  ...........    $6,750.00  ...........    $1,350.00
                    XXXI ($6500-$7000).
1532.............  New Technology--Level    S...............  ...........    $7,250.00  ...........    $1,450.00
                    XXXII ($7000-$7500).
1533.............  New Technology--Level    S...............  ...........    $7,750.00  ...........    $1,550.00
                    XXXIII ($7500-$8000).
1534.............  New Technology--Level    S...............  ...........    $8,250.00  ...........    $1,650.00
                    XXXIV ($8000-$8500).
1535.............  New Technology--Level    S...............  ...........    $8,750.00  ...........    $1,750.00
                    XXXV ($8500-$9000).
1536.............  New Technology--Level    S...............  ...........    $9,250.00  ...........    $1,850.00
                    XXXVI ($9000-$9500).
1537.............  New Technology--Level    S...............  ...........    $9,750.00  ...........    $1,950.00
                    XXXVII ($9500-$10000).
1539.............  New Technology--Level    T...............  ...........       $75.00  ...........       $15.00
                    II ($50-$100).
1540.............  New Technology--Level    T...............  ...........      $150.00  ...........       $30.00
                    III ($100-$200).
1541.............  New Technology--Level    T...............  ...........      $250.00  ...........       $50.00
                    IV ($200-$300).
1542.............  New Technology--Level V  T...............  ...........      $350.00  ...........       $70.00
                    ($300-$400).
1543.............  New Technology--Level    T...............  ...........      $450.00  ...........       $90.00
                    VI ($400-$500).
1544.............  New Technology--Level    T...............  ...........      $550.00  ...........      $110.00
                    VII ($500-$600).
1545.............  New Technology--Level    T...............  ...........      $650.00  ...........      $130.00
                    VIII ($600-$700).
1546.............  New Technology--Level    T...............  ...........      $750.00  ...........      $150.00
                    IX ($700-$800).
1547.............  New Technology--Level X  T...............  ...........      $850.00  ...........      $170.00
                    ($800-$900).
1548.............  New Technology--Level    T...............  ...........      $950.00  ...........      $190.00
                    XI ($900-$1000).
1549.............  New Technology--Level    T...............  ...........    $1,050.00  ...........      $210.00
                    XII ($1000-$1100).
1550.............  New Technology--Level    T...............  ...........    $1,150.00  ...........      $230.00
                    XIII ($1100-$1200).
1551.............  New Technology--Level    T...............  ...........    $1,250.00  ...........      $250.00
                    XIV ($1200-$1300).
1552.............  New Technology--Level    T...............  ...........    $1,350.00  ...........      $270.00
                    XV ($1300-$1400).
1553.............  New Technology--Level    T...............  ...........    $1,450.00  ...........      $290.00
                    XVI ($1400-$1500).
1554.............  New Technology--Level    T...............  ...........    $1,550.00  ...........      $310.00
                    XVII ($1500-$1600).
1555.............  New Technology--Level    T...............  ...........    $1,650.00  ...........      $330.00
                    XVIII ($1600-$1700).
1556.............  New Technology--Level    T...............  ...........    $1,750.00  ...........      $350.00
                    XIX ($1700-$1800).
1557.............  New Technology--Level    T...............  ...........    $1,850.00  ...........      $370.00
                    XX ($1800-$1900).
1558.............  New Technology--Level    T...............  ...........    $1,950.00  ...........      $390.00
                    XXI ($1900-$2000).
1559.............  New Technology--Level    T...............  ...........    $2,250.00  ...........      $450.00
                    XXII ($2000-$2500).
1560.............  New Technology--Level    T...............  ...........    $2,750.00  ...........      $550.00
                    XXIII ($2500-$3000).
1561.............  New Technology--Level    T...............  ...........    $3,250.00  ...........      $650.00
                    XXIV ($3000-$3500).
1562.............  New Technology--Level    T...............  ...........    $3,750.00  ...........      $750.00
                    XXV ($3500-$4000).
1563.............  New Technology--Level    T...............  ...........    $4,250.00  ...........      $850.00
                    XXVI ($4000-$4500).
1564.............  New Technology--Level    T...............  ...........    $4,750.00  ...........      $950.00
                    XXVII ($4500-$5000).
1565.............  New Technology--Level    T...............  ...........    $5,250.00  ...........    $1,050.00
                    XXVIII ($5000-$5500).
1566.............  New Technology--Level    T...............  ...........    $5,750.00  ...........    $1,150.00
                    XXIX ($5500-$6000).
1567.............  New Technology--Level    T...............  ...........    $6,250.00  ...........    $1,250.00
                    XXX ($6000-$6500).
1568.............  New Technology--Level    T...............  ...........    $6,750.00  ...........    $1,350.00
                    XXXI ($6500-$7000).
1569.............  New Technology--Level    T...............  ...........    $7,250.00  ...........    $1,450.00
                    XXXII ($7000-$7500).
1570.............  New Technology--Level    T...............  ...........    $7,750.00  ...........    $1,550.00
                    XXXIII ($7500-$8000).
1571.............  New Technology--Level    T...............  ...........    $8,250.00  ...........    $1,650.00
                    XXXIV ($8000-$8500).
1572.............  New Technology--Level    T...............  ...........    $8,750.00  ...........    $1,750.00
                    XXXV ($8500-$9000).
1573.............  New Technology--Level    T...............  ...........    $9,250.00  ...........    $1,850.00
                    XXXVI ($9000-$9500).
1574.............  New Technology--Level    T...............  ...........    $9,750.00  ...........    $1,950.00
                    XXXVII ($9500-$10000).
1605.............  Abciximab injection....  K...............  ...........      $420.17  ...........       $84.03
1606.............  Injection anistreplase   K...............  ...........    $2,693.80  ...........      $538.76
                    30 u.
1607.............  Eptifibatide injection.  K...............  ...........       $17.67  ...........        $3.53
1608.............  Etanercept injection...  K...............  ...........      $167.12  ...........       $33.42
1609.............  Rho(D) immune globulin   K...............  ...........       $15.62  ...........        $3.12
                    h, sd.
1612.............  Daclizumab, parenteral.  K...............  ...........      $322.28  ...........       $64.46
1613.............  Trastuzumab............  K...............  ...........       $58.51  ...........       $11.70
1629.............  Nonmetabolic act d/e     K...............  ...........       $20.22  ...........        $4.04
                    tissue.
1630.............  Hep b ig, im...........  K...............  ...........      $122.02  ...........       $24.40
1631.............  Baclofen intrathecal     K...............  ...........       $69.73  ...........       $13.95
                    trial.
1632.............  Metabolic active D/E     K...............  ...........       $28.45  ...........        $5.69
                    tissue.
1633.............  Alefacept..............  K...............  ...........       $26.47  ...........        $5.29
1643.............  Y90 ibritumomab, rx....  K...............     235.8764   $15,023.91  ...........    $3,004.78
1645.............  I131 tositumomab, rx...  K...............     176.8495   $11,264.25  ...........    $2,252.85
1670.............  Tetanus immune globulin  K...............  ...........      $103.46  ...........       $20.69
                    inj.
1675.............  P32 Na phosphate.......  K...............       1.7835      $113.60  ...........       $22.72
1676.............  P32 chromic phosphate..  K...............       1.8711      $119.18  ...........       $23.84
1682.............  Aprotonin, 10,000 kiu..  K...............  ...........        $2.66  ...........        $0.53
1683.............  Basiliximab............  K...............  ...........    $1,541.03  ...........      $308.21
1684.............  Corticorelin ovine       K...............  ...........        $4.43  ...........        $0.89
                    triflutal.
1685.............  Darbepoetin alfa, non-   K...............  ...........        $2.88  ...........        $0.58
                    esrd.
1686.............  Epoetin alfa, non-esrd.  K...............  ...........        $8.97  ...........        $1.79
1687.............  Digoxin immune fab       K...............  ...........      $478.88  ...........       $95.78
                    (ovine).
1688.............  Ethanolamine oleate....  K...............  ...........       $79.23  ...........       $15.85
1689.............  Fomepizole.............  K...............  ...........       $12.80  ...........        $2.56
1690.............  Hemin..................  K...............  ...........        $7.08  ...........        $1.42
1691.............  Iron dextran 165         K...............  ...........       $11.82  ...........        $2.36
                    injection.
1692.............  Iron dextran 267         K...............  ...........       $10.30  ...........        $2.06
                    injection.
1693.............  Lepirudin..............  K...............  ...........      $159.44  ...........       $31.89
1694.............  Ziconotide injection...  K...............  ...........        $6.46  ...........        $1.29

[[Page 66943]]

 
1695.............  Nesiritide injection...  K...............  ...........       $32.95  ...........        $6.59
1696.............  Palifermin injection...  K...............  ...........       $11.24  ...........        $2.25
1697.............  Pegaptanib sodium        K...............  ...........    $1,035.69  ...........      $207.14
                    injection.
1700.............  Inj secretin synthetic   K...............  ...........       $20.12  ...........        $4.02
                    human.
1701.............  Treprostinil injection.  K...............  ...........       $55.36  ...........       $11.07
1703.............  Ovine, 1000 USP units..  K...............  ...........      $133.77  ...........       $26.75
1704.............  Humate-P, inj..........  K...............  ...........        $0.88  ...........        $0.18
1705.............  Factor viia............  K...............  ...........        $1.15  ...........        $0.23
1709.............  Azacitidine injection..  K...............  ...........        $4.35  ...........        $0.87
1710.............  Clofarabine injection..  K...............  ...........      $114.41  ...........       $22.88
1711.............  Vantas implant.........  K...............  ...........    $1,412.46  ...........      $282.49
1712.............  Paclitaxel protein       K...............  ...........        $8.79  ...........        $1.76
                    bound.
1716.............  Brachytx, non-str, Gold- K...............       0.5228       $33.30  ...........        $6.66
                    198.
1717.............  Brachytx, non-str, HDR   K...............       2.7505      $175.19  ...........       $35.04
                    Ir-192.
1719.............  Brachytx, NS, Non-HDRIr- K...............       1.0226       $65.13  ...........       $13.03
                    192.
1738.............  Oxaliplatin............  K...............  ...........        $9.15  ...........        $1.83
1739.............  Pegademase bovine, 25    K...............  ...........      $197.51  ...........       $39.50
                    iu.
1740.............  Diazoxide injection....  K...............  ...........      $113.24  ...........       $22.65
1741.............  Urofollitropin, 75 iu..  K...............  ...........       $50.22  ...........       $10.04
1821.............  Interspinous implant...  H...............  ...........  ...........  ...........            .
2210.............  Methyldopate hcl         K...............  ...........       $13.04  ...........        $2.61
                    injection.
2616.............  Brachytx, non-           K...............     184.7105   $11,764.95  ...........    $2,352.99
                    str,Yttrium-90.
2632.............  Iodine I-125 sodium      K...............       0.4325       $27.55  ...........        $5.51
                    iodide.
2634.............  Brachytx, non-str, HA,   K...............       0.4858       $30.94  ...........        $6.19
                    I-125.
2635.............  Brachytx, non-str, HA,   K...............       0.7366       $46.92  ...........        $9.38
                    P-103.
2636.............  Brachy linear, non-      K...............       0.6600       $42.04  ...........        $8.41
                    str,P-103.
2638.............  Brachytx, stranded, I-   K...............       0.7113       $45.31  ...........        $9.06
                    125.
2639.............  Brachytx, non-           K...............       0.5039       $32.10  ...........        $6.42
                    stranded,I-125.
2640.............  Brachytx, stranded, P-   K...............       1.0308       $65.66  ...........       $13.13
                    103.
2641.............  Brachytx, non-           K...............       0.8077       $51.45  ...........       $10.29
                    stranded,P-103.
2642.............  Brachytx, stranded, C-   K...............       1.5342       $97.72  ...........       $19.54
                    131.
2643.............  Brachytx, non-           K...............       1.0060       $64.08  ...........       $12.82
                    stranded,C-131.
2698.............  Brachytx, stranded, NOS  K...............       0.7113       $45.31  ...........        $9.06
2699.............  Brachytx, non-stranded,  K...............       0.4858       $30.94  ...........        $6.19
                    NOS.
2731.............  Immune globulin, powder  K...............  ...........       $26.89  ...........        $5.38
2770.............  Quinupristin/            K...............  ...........      $126.44  ...........       $25.29
                    dalfopristin.
2940.............  Somatrem injection.....  K...............  ...........      $168.90  ...........       $33.78
3030.............  Sumatriptan succinate..  K...............  ...........       $61.27  ...........       $12.25
3041.............  Bivalirudin............  K...............  ...........        $1.84  ...........        $0.37
3043.............  Gamma globulin 1 CC inj  K...............  ...........       $11.91  ...........        $2.38
3050.............  Sermorelin acetate       K...............  ...........        $1.74  ...........        $0.35
                    injection.
7000.............  Amifostine.............  K...............  ...........      $490.93  ...........       $98.19
7005.............  Gonadorelin hydroch....  K...............  ...........      $178.59  ...........       $35.72
7011.............  Oprelvekin injection...  K...............  ...........      $247.02  ...........       $49.40
7015.............  Oral busulfan..........  K...............  ...........        $2.26  ...........        $0.45
7028.............  Fosphenytoin...........  K...............  ...........        $5.76  ...........        $1.15
7034.............  Somatropin injection...  K...............  ...........       $48.52  ...........        $9.70
7035.............  Teniposide.............  K...............  ...........      $280.26  ...........       $56.05
7036.............  Urokinase 250,000 IU     K...............  ...........      $453.41  ...........       $90.68
                    inj.
7038.............  Monoclonal antibodies..  K...............  ...........      $977.75  ...........      $195.55
7041.............  Tirofiban HCl..........  K...............  ...........        $7.56  ...........        $1.51
7042.............  Capecitabine, oral.....  K...............  ...........        $4.28  ...........        $0.86
7043.............  Infliximab injection...  K...............  ...........       $54.42  ...........       $10.88
7045.............  Inj trimetrexate         K...............  ...........      $148.30  ...........       $29.66
                    glucoronate.
7046.............  Doxorubicin hcl          K...............  ...........      $396.15  ...........       $79.23
                    liposome inj.
7048.............  Alteplase recombinant..  K...............  ...........       $33.39  ...........        $6.68
7049.............  Filgrastim 480 mcg       K...............  ...........      $298.39  ...........       $59.68
                    injection.
7051.............  Leuprolide acetate       K...............  ...........    $1,648.41  ...........      $329.68
                    implant.
7308.............  Aminolevulinic acid hcl  K...............  ...........      $109.92  ...........       $21.98
                    top.
8000.............  Cardiac                  T...............     134.1189    $8,542.57  ...........    $1,708.51
                    Electrophysiologic
                    Evaluation and
                    Ablation Composite.
8001.............  LDR Prostate             T...............      53.8937    $3,432.71  ...........      $686.54
                    Brachytherapy
                    Composite.
8002.............  Level I Extended         V...............       5.5113      $351.04  ...........       $70.21
                    Assessment &
                    Management Composite.
8003.............  Level II Extended        V...............      10.0270      $638.66  ...........      $127.73
                    Assessment &
                    Management Composite.
9001.............  Linezolid injection....  K...............  ...........       $25.17  ...........        $5.03
9002.............  Tenecteplase injection.  K...............  ...........    $2,034.65  ...........      $406.93
9003.............  Palivizumab............  K...............  ...........      $810.67  ...........      $162.13
9004.............  Gemtuzumab ozogamicin..  K...............  ...........    $2,411.98  ...........      $482.40
9005.............  Reteplase injection....  K...............  ...........      $841.28  ...........      $168.26
9006.............  Tacrolimus injection...  K...............  ...........      $138.64  ...........       $27.73
9012.............  Arsenic trioxide.......  K...............  ...........       $34.44  ...........        $6.89
9015.............  Mycophenolate mofetil    K...............  ...........        $2.66  ...........        $0.53
                    oral.
9018.............  Botulinum toxin type B.  K...............  ...........        $8.63  ...........        $1.73
9019.............  Caspofungin acetate....  K...............  ...........       $24.05  ...........        $4.81
9020.............  Sirolimus, oral........  K...............  ...........        $7.50  ...........        $1.50
9022.............  IM inj interferon beta   K...............  ...........      $118.84  ...........       $23.77
                    1-a.
9023.............  Rho d immune globulin..  K...............  ...........       $26.41  ...........        $5.28
9024.............  Amphotericin b lipid     K...............  ...........       $10.40  ...........        $2.08
                    complex.
9032.............  Baclofen 10 MG           K...............  ...........      $193.29  ...........       $38.66
                    injection.
9033.............  Cidofovir injection....  K...............  ...........      $754.39  ...........      $150.88
9038.............  Inj estrogen conjugate.  K...............  ...........       $66.64  ...........       $13.33

[[Page 66944]]

 
9042.............  Glucagon hydrochloride.  K...............  ...........       $68.84  ...........       $13.77
9044.............  Ibutilide fumarate       K...............  ...........      $287.15  ...........       $57.43
                    injection.
9046.............  Iron sucrose injection.  K...............  ...........        $0.36  ...........        $0.08
9047.............  Itraconazole injection.  K...............  ...........       $39.68  ...........        $7.94
9051.............  Urea injection.........  K...............  ...........       $74.16  ...........       $14.83
9054.............  Metabolically active     K...............  ...........       $36.40  ...........        $7.28
                    tissue.
9104.............  Antithymocyte globuln    K...............  ...........      $337.82  ...........       $67.56
                    rabbit.
9108.............  Thyrotropin injection..  K...............  ...........      $834.18  ...........      $166.84
9110.............  Alemtuzumab injection..  K...............  ...........      $549.77  ...........      $109.95
9115.............  Zoledronic acid........  K...............  ...........      $205.76  ...........       $41.15
9119.............  Injection,               K...............  ...........    $2,145.12  ...........      $429.02
                    pegfilgrastim 6mg.
9120.............  Injection, Fulvestrant.  K...............  ...........       $80.60  ...........       $16.12
9121.............  Injection, argatroban..  K...............  ...........       $18.96  ...........        $3.79
9122.............  Triptorelin pamoate....  K...............  ...........      $159.38  ...........       $31.88
9124.............  Daptomycin injection...  K...............  ...........        $0.35  ...........        $0.07
9125.............  Risperidone, long        K...............  ...........        $4.86  ...........        $0.97
                    acting.
9126.............  Natalizumab injection..  G...............  ...........        $7.51  ...........        $1.50
9133.............  Rabies ig, im/sc.......  K...............  ...........       $68.22  ...........       $13.64
9134.............  Rabies ig, heat treated  K...............  ...........       $71.69  ...........       $14.34
9135.............  Varicella-zoster ig, im  K...............  ...........      $122.74  ...........       $24.55
9137.............  Bcg vaccine, percut....  K...............  ...........      $118.98  ...........       $23.80
9139.............  Rabies vaccine, im.....  K...............  ...........      $150.80  ...........       $30.16
9140.............  Rabies vaccine, id.....  K...............  ...........      $119.86  ...........       $23.97
9141.............  Measles-rubella          K...............  ...........       $45.53  ...........        $9.11
                    vaccine, sc.
9143.............  Meningococcal vaccine,   K...............  ...........       $85.29  ...........       $17.06
                    sc.
9144.............  Encephalitis vaccine,    K...............  ...........       $98.17  ...........       $19.63
                    sc.
9145.............  Meningococcal vaccine,   K...............  ...........       $82.00  ...........       $16.40
                    im.
9156.............  Nonmetabolic active      K...............  ...........       $94.53  ...........       $18.91
                    tissue.
9167.............  Valrubicin, 200 mg.....  K...............  ...........       $77.96  ...........       $15.59
9207.............  Bortezomib injection...  K...............  ...........       $33.20  ...........        $6.64
9208.............  Agalsidase beta          K...............  ...........      $126.00  ...........       $25.20
                    injection.
9209.............  Laronidase injection...  K...............  ...........       $23.64  ...........        $4.73
9210.............  Palonosetron HCl.......  K...............  ...........       $16.45  ...........        $3.29
9213.............  Pemetrexed injection...  K...............  ...........       $44.49  ...........        $8.90
9214.............  Bevacizumab injection..  K...............  ...........       $56.93  ...........       $11.39
9215.............  Cetuximab injection....  K...............  ...........       $49.43  ...........        $9.89
9216.............  Abarelix injection.....  K...............  ...........       $67.97  ...........       $13.59
9217.............  Leuprolide acetate       K...............  ...........      $236.06  ...........       $47.21
                    suspnsion.
9219.............  Mycophenolic acid......  K...............  ...........        $2.41  ...........        $0.48
9222.............  Injectable human tissue  K...............  ...........      $774.46  ...........      $154.89
9224.............  Galsulfase injection...  K...............  ...........      $306.88  ...........       $61.38
9225.............  Fluocinolone acetonide   K...............  ...........   $19,162.50  ...........    $3,832.50
                    implt.
9227.............  Micafungin sodium        G...............  ...........        $1.44  ...........        $0.29
                    injection.
9228.............  Tigecycline injection..  G...............  ...........        $0.96  ...........        $0.19
9229.............  Ibandronate sodium       G...............  ...........      $138.96  ...........       $27.79
                    injection.
9230.............  Abatacept injection....  G...............  ...........       $18.69  ...........        $3.74
9231.............  Decitabine injection...  G...............  ...........       $26.48  ...........        $5.30
9232.............  Idursulfase injection..  G...............  ...........      $455.03  ...........       $91.01
9233.............  Ranibizumab injection..  G...............  ...........    $2,030.23  ...........      $406.05
9234.............  Aglucosidase alfa        K...............  ...........      $126.00  ...........       $25.20
                    injection.
9235.............  Panitumumab injection..  G...............  ...........       $83.15  ...........       $16.63
9236.............  Eculizumab injection...  G...............  ...........      $176.38  ...........       $35.28
9238.............  Inj, levetiracetam.....  K...............  ...........        $6.30  ...........        $1.26
9300.............  Omalizumab injection...  K...............  ...........       $17.12  ...........        $3.42
9350.............  Neuragen nerve guide,    G...............  ...........      $482.56  ...........       $96.51
                    per cm.
9351.............  Tissuemend tissue......  G...............  ...........       $67.96  ...........       $13.59
9500.............  Platelets, irradiated..  K...............       1.9110      $121.72  ...........       $24.34
9501.............  Platelet pheres          K...............       7.8426      $499.53  ...........       $99.91
                    leukoreduced.
9502.............  Platelet pheresis        K...............       6.5581      $417.71  ...........       $83.54
                    irradiated.
9503.............  Fr frz plasma donor      K...............       0.8264       $52.64  ...........       $10.53
                    retested.
9504.............  RBC deglycerolized.....  K...............       5.4516      $347.23  ...........       $69.45
9505.............  RBC irradiated.........  K...............       3.0643      $195.18  ...........       $39.04
9506.............  Granulocytes, pheresis   K...............      21.7847    $1,387.55  ...........      $277.51
                    unit.
9507.............  Platelets, pheresis....  K...............       6.9242      $441.03  ...........       $88.21
9508.............  Plasma 1 donor frz w/in  K...............       1.0524       $67.03  ...........       $13.41
                    8 hr.
----------------------------------------------------------------------------------------------------------------


[[Page 66945]]










    --------------------
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 HCPCS 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.

                                                Addendum AA.--ASC Covered Surgical Procedures for CY 2008
                                              [Including surgical procedures for which payment is packaged]
--------------------------------------------------------------------------------------------------------------------------------------------------------
                                                                                                                     CY 2008                   CY 2008
                                                 Subject to                                           CY 2007 ASC     fully       CY 2008       first
    HCPCS code         Short descriptor           multiple           Comment            Payment         payment    implemented     fully      transition
                                                 procedure          indicator          indicator          rate       payment    implemented      year
                                                discounting                                                           weight      payment      payment
--------------------------------------------------------------------------------------------------------------------------------------------------------
0016T............  Thermotx choroid vasc     Y................  .................  R2...............  ...........       4.1331      $171.11      $171.11
                    lesion.
0017T............  Photocoagulat macular     Y................  .................  R2...............  ...........       4.1331      $171.11      $171.11
                    drusen.
0027T............  Endoscopic epidural       Y................  .................  G2...............  ...........      18.0518      $747.36      $747.36
                    lysis.
0031T............  Speculoscopy............  N................  .................  N1...............  ...........  ...........  ...........  ...........
0032T............  Speculoscopy w/direct     N................  .................  N1...............  ...........  ...........  ...........  ...........
                    sample.
0046T............  Cath lavage, mammary      Y................  .................  R2...............  ...........      16.1001      $666.56      $666.56
                    duct(s).
0047T............  Cath lavage, mammary      Y................  .................  R2...............  ...........      16.1001      $666.56      $666.56
                    duct(s).
0062T............  Rep intradisc annulus;1   Y................  .................  G2...............  ...........        29.19    $1,208.50    $1,208.50
                    lev.
0063T............  Rep intradisc             Y................  .................  G2...............  ...........        29.19    $1,208.50    $1,208.50
                    annulus;>1lev.
0084T............  Temp prostate urethral    Y................  .................  G2...............  ...........       2.0077       $83.12       $83.12
                    stent.
0088T............  Rf tongue base vol        Y................  CH...............  G2...............  ...........      16.3288      $676.03      $676.03
                    reduxn.
0099T*...........  Implant corneal ring....  Y................  .................  R2...............  ...........       16.171      $669.50      $669.50
0100T............  Prosth retina             Y................  .................  G2...............  ...........      37.2078    $1,540.44    $1,540.44
                    receive&gen.
0101T............  Extracorp shockwv tx,hi   Y................  .................  G2...............  ...........        29.19    $1,208.50    $1,208.50
                    enrg.
0102T............  Extracorp shockwv         Y................  .................  G2...............  ...........        29.19    $1,208.50    $1,208.50
                    tx,anesth.
0123T............  Scleral fistulization...  Y................  .................  G2...............  ...........      23.1758      $959.50      $959.50
0124T*...........  Conjunctival drug         Y................  .................  R2...............  ...........       5.1169      $211.84      $211.84
                    placement.
0137T............  Prostate saturation       Y................  CH...............  G2...............  ...........      11.0338      $456.81      $456.81
                    sampling.
0170T............  Anorectal fistula plug    Y................  CH...............  G2...............  ...........      30.1606    $1,248.68    $1,248.68
                    rpr.
0176T............  Aqu canal dilat w/o       Y................  .................  A2...............    $1,339.00      39.7101    $1,644.04    $1,415.26
                    retent.
0177T............  Aqu canal dilat w retent  Y................  .................  A2...............    $1,339.00      39.7101    $1,644.04    $1,415.26
0186T............  Suprachoroidal drug       Y................  NI...............  G2...............  ...........       18.235      $754.95      $754.95
                    delivery.
10021............  Fna w/o image...........  Y................  .................  P2...............  ...........       1.1097       $45.94       $45.94
10022............  Fna w/image.............  Y................  .................  G2...............  ...........        4.327      $179.14      $179.14
10040............  Acne surgery............  Y................  .................  P2...............  ...........        0.793       $32.83       $32.83
10060............  Drainage of skin abscess  Y................  .................  P3...............  ...........       1.1108       $45.99       $45.99
10061............  Drainage of skin abscess  Y................  .................  P2...............  ...........       1.4066       $58.23       $58.23
10080............  Drainage of pilonidal     Y................  .................  P2...............  ...........       1.4066       $58.23       $58.23
                    cyst.
10081............  Drainage of pilonidal     Y................  .................  P3...............  ...........       3.1023      $128.44      $128.44
                    cyst.
10120............  Remove foreign body.....  Y................  .................  P2...............  ...........       1.4066       $58.23       $58.23
10121............  Remove foreign body.....  Y................  .................  A2...............      $446.00      16.1001      $666.56      $501.14
10140............  Drainage of hematoma/     Y................  .................  P3...............  ...........       1.6541       $68.48       $68.48
                    fluid.
10160............  Puncture drainage of      Y................  CH...............  P3...............  ...........       1.4154       $58.60       $58.60
                    lesion.
10180............  Complex drainage, wound.  Y................  .................  A2...............      $446.00      18.3197      $758.45      $524.11
11000............  Debride infected skin...  Y................  .................  P3...............  ...........       0.5348       $22.14       $22.14
11001............  Debride infected skin     Y................  .................  P3...............  ...........       0.1894        $7.84        $7.84
                    add-on.
11010............  Debride skin, fx........  Y................  .................  A2...............      $251.52       4.3039      $178.19      $233.19
11011............  Debride skin/muscle, fx.  Y................  .................  A2...............      $251.52       4.3039      $178.19      $233.19
11012............  Debride skin/muscle/      Y................  .................  A2...............      $251.52       4.3039      $178.19      $233.19
                    bone, fx.
11040............  Debride skin, partial...  Y................  .................  P3...............  ...........       0.4937       $20.44       $20.44
11041............  Debride skin, full......  Y................  .................  P3...............  ...........       0.5679       $23.51       $23.51
11042............  Debride skin/tissue.....  Y................  .................  A2...............      $164.42       2.6604      $110.14      $150.85
11043............  Debride tissue/muscle...  Y................  .................  A2...............      $164.42       2.6604      $110.14      $150.85
11044............  Debride tissue/muscle/    Y................  .................  A2...............      $423.10       6.8816      $284.91      $388.55
                    bone.
11055............  Trim skin lesion........  Y................  .................  P3...............  ...........       0.5596       $23.17       $23.17
11056............  Trim skin lesions, 2 to   Y................  .................  P3...............  ...........       0.6253       $25.89       $25.89
                    4.
11057............  Trim skin lesions, over   Y................  .................  P3...............  ...........       0.7077       $29.30       $29.30
                    4.
11100............  Biopsy, skin lesion.....  Y................  .................  P2...............  ...........        0.793       $32.83       $32.83
11101............  Biopsy, skin add-on.....  Y................  .................  P3...............  ...........       0.3046       $12.61       $12.61
11200............  Removal of skin tags....  Y................  CH...............  P2...............  ...........        0.793       $32.83       $32.83
11201............  Remove skin tags add-on.  Y................  .................  P3...............  ...........       0.1316        $5.45        $5.45
11300............  Shave skin lesion.......  Y................  .................  P2...............  ...........        0.793       $32.83       $32.83
11301............  Shave skin lesion.......  Y................  .................  P2...............  ...........        0.793       $32.83       $32.83
11302............  Shave skin lesion.......  Y................  .................  P2...............  ...........        0.793       $32.83       $32.83
11303............  Shave skin lesion.......  Y................  .................  P3...............  ...........       1.4811       $61.32       $61.32
11305............  Shave skin lesion.......  Y................  .................  P3...............  ...........       0.7901       $32.71       $32.71
11306............  Shave skin lesion.......  Y................  CH...............  P2...............  ...........        0.793       $32.83       $32.83
11307............  Shave skin lesion.......  Y................  .................  P2...............  ...........        0.793       $32.83       $32.83
11308............  Shave skin lesion.......  Y................  .................  P2...............  ...........        0.793       $32.83       $32.83
11310............  Shave skin lesion.......  Y................  CH...............  P2...............  ...........        0.793       $32.83       $32.83
11311............  Shave skin lesion.......  Y................  .................  P2...............  ...........        0.793       $32.83       $32.83
11312............  Shave skin lesion.......  Y................  .................  P2...............  ...........        0.793       $32.83       $32.83
11313............  Shave skin lesion.......  Y................  CH...............  P2...............  ...........        0.793       $32.83       $32.83
11400............  Exc tr-ext b9+marg 0.5 <  Y................  .................  P3...............  ...........       1.5963       $66.09       $66.09
                    cm.
11401............  Exc tr-ext b9+marg 0.6-1  Y................  .................  P3...............  ...........       1.7444       $72.22       $72.22
                    cm.
11402............  Exc tr-ext b9+marg 1.1-2  Y................  .................  P3...............  ...........       1.9009       $78.70       $78.70
                    cm.
11403............  Exc tr-ext b9+marg 2.1-3  Y................  .................  P3...............  ...........       2.0326       $84.15       $84.15
                    cm.
11404............  Exc tr-ext b9+marg 3.1-4  Y................  .................  A2...............      $333.00      16.1001      $666.56      $416.39
                    cm.
11406............  Exc tr-ext b9+marg > 4.0  Y................  .................  A2...............      $446.00      16.1001      $666.56      $501.14
                    cm.

[[Page 66946]]

 
11420............  Exc h-f-nk-sp b9+marg     Y................  .................  P3...............  ...........       1.4729       $60.98       $60.98
                    0.5 <.
11421............  Exc h-f-nk-sp b9+marg     Y................  .................  P3...............  ...........       1.7611       $72.91       $72.91
                    0.6-1.
11422............  Exc h-f-nk-sp b9+marg     Y................  .................  P3...............  ...........       1.9256       $79.72       $79.72
                    1.1-2.
11423............  Exc h-f-nk-sp b9+marg     Y................  .................  P3...............  ...........        2.156       $89.26       $89.26
                    2.1-3.
11424............  Exc h-f-nk-sp b9+marg     Y................  .................  A2...............      $446.00      16.1001      $666.56      $501.14
                    3.1-4.
11426............  Exc h-f-nk-sp b9+marg >   Y................  .................  A2...............      $446.00      21.1098      $873.97      $552.99
                    4 cm.
11440............  Exc face-mm b9+marg 0.5   Y................  .................  P3...............  ...........        1.728       $71.54       $71.54
                    < cm.
11441............  Exc face-mm b9+marg 0.6-  Y................  .................  P3...............  ...........       1.9338       $80.06       $80.06
                    1 cm.
11442............  Exc face-mm b9+marg 1.1-  Y................  .................  P3...............  ...........       2.1313       $88.24       $88.24
                    2 cm.
11443............  Exc face-mm b9+marg 2.1-  Y................  .................  P3...............  ...........       2.3864       $98.80       $98.80
                    3 cm.
11444............  Exc face-mm b9+marg 3.1-  Y................  .................  A2...............      $333.00        8.685      $359.57      $339.64
                    4 cm.
11446............  Exc face-mm b9+marg > 4   Y................  .................  A2...............      $446.00      21.1098      $873.97      $552.99
                    cm.
11450............  Removal, sweat gland      Y................  .................  A2...............      $446.00      21.1098      $873.97      $552.99
                    lesion.
11451............  Removal, sweat gland      Y................  .................  A2...............      $446.00      21.1098      $873.97      $552.99
                    lesion.
11462............  Removal, sweat gland      Y................  .................  A2...............      $446.00      21.1098      $873.97      $552.99
                    lesion.
11463............  Removal, sweat gland      Y................  .................  A2...............      $446.00      21.1098      $873.97      $552.99
                    lesion.
11470............  Removal, sweat gland      Y................  .................  A2...............      $446.00      21.1098      $873.97      $552.99
                    lesion.
11471............  Removal, sweat gland      Y................  .................  A2...............      $446.00      21.1098      $873.97      $552.99
                    lesion.
11600............  Exc tr-ext mlg+marg 0.5   Y................  .................  P3...............  ...........       2.2135       $91.64       $91.64
                    < cm.
11601............  Exc tr-ext mlg+marg 0.6-  Y................  .................  P3...............  ...........       2.5263      $104.59      $104.59
                    1 cm.
11602............  Exc tr-ext mlg+marg 1.1-  Y................  .................  P3...............  ...........       2.7403      $113.45      $113.45
                    2 cm.
11603............  Exc tr-ext mlg+marg 2.1-  Y................  .................  P3...............  ...........       2.9294      $121.28      $121.28
                    3 cm.
11604............  Exc tr-ext mlg+marg 3.1-  Y................  .................  A2...............      $418.49        8.685      $359.57      $403.76
                    4 cm.
11606............  Exc tr-ext mlg+marg > 4   Y................  .................  A2...............      $446.00      16.1001      $666.56      $501.14
                    cm.
11620............  Exc h-f-nk-sp mlg+marg    Y................  .................  P3...............  ...........       2.2384       $92.67       $92.67
                    0.5 <.
11621............  Exc h-f-nk-sp mlg+marg    Y................  .................  P3...............  ...........       2.5509      $105.61      $105.61
                    0.6-1.
11622............  Exc h-f-nk-sp mlg+marg    Y................  .................  P3...............  ...........       2.8224      $116.85      $116.85
                    1.1-2.
11623............  Exc h-f-nk-sp mlg+marg    Y................  .................  P3...............  ...........        3.061      $126.73      $126.73
                    2.1-3.
11624............  Exc h-f-nk-sp mlg+marg    Y................  .................  A2...............      $446.00      16.1001      $666.56      $501.14
                    3.1-4.
11626............  Exc h-f-nk-sp mlg+mar >   Y................  .................  A2...............      $446.00      21.1098      $873.97      $552.99
                    4 cm.
11640............  Exc face-mm malig+marg    Y................  .................  P3...............  ...........       2.3451       $97.09       $97.09
                    0.5 <.
11641............  Exc face-mm malig+marg    Y................  .................  P3...............  ...........       2.7403      $113.45      $113.45
                    0.6-1.
11642............  Exc face-mm malig+marg    Y................  .................  P3...............  ...........        3.061      $126.73      $126.73
                    1.1-2.
11643............  Exc face-mm malig+marg    Y................  .................  P3...............  ...........       3.3246      $137.64      $137.64
                    2.1-3.
11644............  Exc face-mm malig+marg    Y................  .................  A2...............      $446.00      16.1001      $666.56      $501.14
                    3.1-4.
11646............  Exc face-mm mlg+marg > 4  Y................  .................  A2...............      $446.00      21.1098      $873.97      $552.99
                    cm.
11719............  Trim nail(s)............  Y................  .................  P3...............  ...........       0.2551       $10.56       $10.56
11720............  Debride nail, 1-5.......  Y................  .................  P3...............  ...........       0.3292       $13.63       $13.63
11721............  Debride nail, 6 or more.  Y................  .................  P3...............  ...........       0.4031       $16.69       $16.69
11730............  Removal of nail plate...  Y................  CH...............  P2...............  ...........        0.793       $32.83       $32.83
11732............  Remove nail plate, add-   Y................  .................  P3...............  ...........       0.4031       $16.69       $16.69
                    on.
11740............  Drain blood from under    Y................  CH...............  P2...............  ...........       0.2963       $12.27       $12.27
                    nail.
11750............  Removal of nail bed.....  Y................  .................  P3...............  ...........       2.1065       $87.21       $87.21
11752............  Remove nail bed/finger    Y................  .................  P3...............  ...........       2.8965      $119.92      $119.92
                    tip.
11755............  Biopsy, nail unit.......  Y................  .................  P3...............  ...........       1.4729       $60.98       $60.98
11760............  Repair of nail bed......  Y................  .................  G2...............  ...........       2.1051       $87.15       $87.15
11762............  Reconstruction of nail    Y................  CH...............  P3...............  ...........       2.7072      $112.08      $112.08
                    bed.
11765............  Excision of nail fold,    Y................  .................  P2...............  ...........       1.4595       $60.42       $60.42
                    toe.
11770............  Removal of pilonidal      Y................  .................  A2...............      $510.00      21.1098      $873.97      $600.99
                    lesion.
11771............  Removal of pilonidal      Y................  .................  A2...............      $510.00      21.1098      $873.97      $600.99
                    lesion.
11772............  Removal of pilonidal      Y................  .................  A2...............      $510.00      21.1098      $873.97      $600.99
                    lesion.
11900............  Injection into skin       Y................  .................  P3...............  ...........       0.6418       $26.57       $26.57
                    lesions.
11901............  Added skin lesions        Y................  .................  P3...............  ...........       0.6831       $28.28       $28.28
                    injection.
11920............  Correct skin color        Y................  .................  P2...............  ...........       2.1051       $87.15       $87.15
                    defects.
11921............  Correct skin color        Y................  .................  P2...............  ...........       2.1051       $87.15       $87.15
                    defects.
11922............  Correct skin color        Y................  .................  P3...............  ...........       0.8476       $35.09       $35.09
                    defects.
11950............  Therapy for contour       Y................  .................  P3...............  ...........       0.8311       $34.41       $34.41
                    defects.
11951............  Therapy for contour       Y................  .................  P3...............  ...........       0.9792       $40.54       $40.54
                    defects.
11952............  Therapy for contour       Y................  CH...............  P2...............  ...........       1.2792       $52.96       $52.96
                    defects.
11954............  Therapy for contour       Y................  .................  P2...............  ...........       1.2792       $52.96       $52.96
                    defects.
11960............  Insert tissue             Y................  .................  A2...............      $446.00      20.2069      $836.59      $543.65
                    expander(s).
11970............  Replace tissue expander.  Y................  .................  A2...............      $510.00       42.985    $1,779.62      $827.41
11971............  Remove tissue             Y................  .................  A2...............      $333.00      21.1098      $873.97      $468.24
                    expander(s).
11976............  Removal of contraceptive  Y................  .................  P3...............  ...........       1.4154       $58.60       $58.60
                    cap.
11980............  Implant hormone           N................  .................  P2...............  ...........        0.631       $26.12       $26.12
                    pellet(s).
11981............  Insert drug implant       N................  .................  P2...............  ...........        0.631       $26.12       $26.12
                    device.
11982............  Remove drug implant       N................  .................  P2...............  ...........        0.631       $26.12       $26.12
                    device.
11983............  Remove/insert drug        N................  .................  P2...............  ...........        0.631       $26.12       $26.12
                    implant.
12001............  Repair superficial        Y................  .................  P2...............  ...........       1.2792       $52.96       $52.96
                    wound(s).
12002............  Repair superficial        Y................  .................  P2...............  ...........       1.2792       $52.96       $52.96
                    wound(s).
12004............  Repair superficial        Y................  .................  P2...............  ...........       1.2792       $52.96       $52.96
                    wound(s).
12005............  Repair superficial        Y................  .................  A2...............       $91.24       1.2792       $52.96       $81.67
                    wound(s).
12006............  Repair superficial        Y................  .................  A2...............       $91.24       1.2792       $52.96       $81.67
                    wound(s).

[[Page 66947]]

 
12007............  Repair superficial        Y................  .................  A2...............       $91.24       1.2792       $52.96       $81.67
                    wound(s).
12011............  Repair superficial        Y................  .................  P2...............  ...........       1.2792       $52.96       $52.96
                    wound(s).
12013............  Repair superficial        Y................  .................  P2...............  ...........       1.2792       $52.96       $52.96
                    wound(s).
12014............  Repair superficial        Y................  .................  P2...............  ...........       1.2792       $52.96       $52.96
                    wound(s).
12015............  Repair superficial        Y................  .................  G2...............  ...........       1.2792       $52.96       $52.96
                    wound(s).
12016............  Repair superficial        Y................  .................  A2...............       $91.24       1.2792       $52.96       $81.67
                    wound(s).
12017............  Repair superficial        Y................  .................  A2...............       $91.24       1.2792       $52.96       $81.67
                    wound(s).
12018............  Repair superficial        Y................  .................  A2...............       $91.24       1.2792       $52.96       $81.67
                    wound(s).
12020............  Closure of split wound..  Y................  .................  A2...............       $91.24       4.5263      $187.39      $115.28
12021............  Closure of split wound..  Y................  .................  A2...............       $91.24       4.5263      $187.39      $115.28
12031............  Layer closure of          Y................  .................  P2...............  ...........       2.1051       $87.15       $87.15
                    wound(s).
12032............  Layer closure of          Y................  .................  P2...............  ...........       2.1051       $87.15       $87.15
                    wound(s).
12034............  Layer closure of          Y................  .................  A2...............       $91.24       2.1051       $87.15       $90.22
                    wound(s).
12035............  Layer closure of          Y................  .................  A2...............       $91.24       2.1051       $87.15       $90.22
                    wound(s).
12036............  Layer closure of          Y................  .................  A2...............       $91.24       2.1051       $87.15       $90.22
                    wound(s).
12037............  Layer closure of          Y................  .................  A2...............      $323.28       2.1051       $87.15      $264.25
                    wound(s).
12041............  Layer closure of          Y................  .................  P2...............  ...........       2.1051       $87.15       $87.15
                    wound(s).
12042............  Layer closure of          Y................  .................  P2...............  ...........       2.1051       $87.15       $87.15
                    wound(s).
12044............  Layer closure of          Y................  .................  A2...............       $91.24       2.1051       $87.15       $90.22
                    wound(s).
12045............  Layer closure of          Y................  .................  A2...............       $91.24       2.1051       $87.15       $90.22
                    wound(s).
12046............  Layer closure of          Y................  .................  A2...............       $91.24       2.1051       $87.15       $90.22
                    wound(s).
12047............  Layer closure of          Y................  .................  A2...............      $323.28       2.1051       $87.15      $264.25
                    wound(s).
12051............  Layer closure of          Y................  .................  P2...............  ...........       2.1051       $87.15       $87.15
                    wound(s).
12052............  Layer closure of          Y................  .................  P2...............  ...........       2.1051       $87.15       $87.15
                    wound(s).
12053............  Layer closure of          Y................  .................  P2...............  ...........       2.1051       $87.15       $87.15
                    wound(s).
12054............  Layer closure of          Y................  .................  A2...............       $91.24       2.1051       $87.15       $90.22
                    wound(s).
12055............  Layer closure of          Y................  .................  A2...............       $91.24       2.1051       $87.15       $90.22
                    wound(s).
12056............  Layer closure of          Y................  .................  A2...............       $91.24       2.1051       $87.15       $90.22
                    wound(s).
12057............  Layer closure of          Y................  .................  A2...............      $323.28       2.1051       $87.15      $264.25
                    wound(s).
13100............  Repair of wound or        Y................  .................  A2...............      $323.28       4.5263      $187.39      $289.31
                    lesion.
13101............  Repair of wound or        Y................  .................  A2...............      $323.28       4.5263      $187.39      $289.31
                    lesion.
13102............  Repair wound/lesion add-  Y................  .................  A2...............       $91.24       4.5263      $187.39      $115.28
                    on.
13120............  Repair of wound or        Y................  .................  A2...............       $91.24       2.1051       $87.15       $90.22
                    lesion.
13121............  Repair of wound or        Y................  .................  A2...............       $91.24       4.5263      $187.39      $115.28
                    lesion.
13122............  Repair wound/lesion add-  Y................  .................  A2...............       $91.24       2.1051       $87.15       $90.22
                    on.
13131............  Repair of wound or        Y................  .................  A2...............       $91.24       4.5263      $187.39      $115.28
                    lesion.
13132............  Repair of wound or        Y................  .................  A2...............       $91.24       4.5263      $187.39      $115.28
                    lesion.
13133............  Repair wound/lesion add-  Y................  .................  A2...............       $91.24       4.5263      $187.39      $115.28
                    on.
13150............  Repair of wound or        Y................  .................  A2...............      $323.28       4.5263      $187.39      $289.31
                    lesion.
13151............  Repair of wound or        Y................  .................  A2...............      $323.28       4.5263      $187.39      $289.31
                    lesion.
13152............  Repair of wound or        Y................  .................  A2...............      $323.28       4.5263      $187.39      $289.31
                    lesion.
13153............  Repair wound/lesion add-  Y................  .................  A2...............       $91.24       2.1051       $87.15       $90.22
                    on.
13160............  Late closure of wound...  Y................  .................  A2...............      $446.00      20.2069      $836.59      $543.65
14000............  Skin tissue               Y................  .................  A2...............      $446.00      15.0458      $622.91      $490.23
                    rearrangement.
14001............  Skin tissue               Y................  .................  A2...............      $510.00      15.0458      $622.91      $538.23
                    rearrangement.
14020............  Skin tissue               Y................  .................  A2...............      $510.00      15.0458      $622.91      $538.23
                    rearrangement.
14021............  Skin tissue               Y................  .................  A2...............      $510.00      15.0458      $622.91      $538.23
                    rearrangement.
14040............  Skin tissue               Y................  .................  A2...............      $446.00      15.0458      $622.91      $490.23
                    rearrangement.
14041............  Skin tissue               Y................  .................  A2...............      $510.00      15.0458      $622.91      $538.23
                    rearrangement.
14060............  Skin tissue               Y................  .................  A2...............      $510.00      15.0458      $622.91      $538.23
                    rearrangement.
14061............  Skin tissue               Y................  .................  A2...............      $510.00      15.0458      $622.91      $538.23
                    rearrangement.
14300............  Skin tissue               Y................  .................  A2...............      $630.00      20.2069      $836.59      $681.65
                    rearrangement.
14350............  Skin tissue               Y................  .................  A2...............      $510.00      20.2069      $836.59      $591.65
                    rearrangement.
15002............  Wnd prep, ch/inf, trk/    Y................  .................  A2...............      $323.28       4.5263      $187.39      $289.31
                    arm/lg.
15003............  Wnd prep, ch/inf addl     Y................  .................  A2...............      $323.28       4.5263      $187.39      $289.31
                    100 cm.
15004............  Wnd prep ch/inf, f/n/hf/  Y................  .................  A2...............      $323.28       4.5263      $187.39      $289.31
                    g.
15005............  Wnd prep, f/n/hf/g, addl  Y................  .................  A2...............      $323.28       4.5263      $187.39      $289.31
                    cm.
15040............  Harvest cultured skin     Y................  .................  A2...............       $91.24       2.1051       $87.15       $90.22
                    graft.
15050............  Skin pinch graft........  Y................  .................  A2...............      $323.28       4.5263      $187.39      $289.31
15100............  Skin splt grft, trnk/arm/ Y................  .................  A2...............      $446.00      20.2069      $836.59      $543.65
                    leg.
15101............  Skin splt grft t/a/l,     Y................  .................  A2...............      $510.00      20.2069      $836.59      $591.65
                    add-on.
15110............  Epidrm autogrft trnk/arm/ Y................  .................  A2...............      $446.00       4.5263      $187.39      $381.35
                    leg.
15111............  Epidrm autogrft t/a/l     Y................  .................  A2...............      $333.00       4.5263      $187.39      $296.60
                    add-on.
15115............  Epidrm a-grft face/nck/   Y................  .................  A2...............      $446.00       4.5263      $187.39      $381.35
                    hf/g.
15116............  Epidrm a-grft f/n/hf/g    Y................  .................  A2...............      $333.00       4.5263      $187.39      $296.60
                    addl.
15120............  Skn splt a-grft fac/nck/  Y................  .................  A2...............      $446.00      20.2069      $836.59      $543.65
                    hf/g.
15121............  Skn splt a-grft f/n/hf/g  Y................  .................  A2...............      $510.00      20.2069      $836.59      $591.65
                    add.
15130............  Derm autograft, trnk/arm/ Y................  .................  A2...............      $446.00      15.0458      $622.91      $490.23
                    leg.
15131............  Derm autograft t/a/l add- Y................  .................  A2...............      $333.00      15.0458      $622.91      $405.48
                    on.
15135............  Derm autograft face/nck/  Y................  .................  A2...............      $446.00      15.0458      $622.91      $490.23
                    hf/g.
15136............  Derm autograft, f/n/hf/g  Y................  .................  A2...............      $333.00      15.0458      $622.91      $405.48
                    add.
15150............  Cult epiderm grft t/arm/  Y................  .................  A2...............      $446.00       4.5263      $187.39      $381.35
                    leg.
15151............  Cult epiderm grft t/a/l   Y................  .................  A2...............      $333.00       4.5263      $187.39      $296.60
                    addl.

[[Page 66948]]

 
15152............  Cult epiderm graft t/a/l  Y................  .................  A2...............      $333.00       4.5263      $187.39      $296.60
                    +%.
15155............  Cult epiderm graft, f/n/  Y................  .................  A2...............      $446.00       4.5263      $187.39      $381.35
                    hf/g.
15156............  Cult epidrm grft f/n/hfg  Y................  .................  A2...............      $333.00       4.5263      $187.39      $296.60
                    add.
15157............  Cult epiderm grft f/n/    Y................  .................  A2...............      $333.00       4.5263      $187.39      $296.60
                    hfg +%.
15200............  Skin full graft, trunk..  Y................  .................  A2...............      $510.00      15.0458      $622.91      $538.23
15201............  Skin full graft trunk     Y................  .................  A2...............      $323.28      15.0458      $622.91      $398.19
                    add-on.
15220............  Skin full graft sclp/arm/ Y................  .................  A2...............      $446.00      15.0458      $622.91      $490.23
                    leg.
15221............  Skin full graft add-on..  Y................  .................  A2...............      $323.28       4.5263      $187.39      $289.31
15240............  Skin full grft face/      Y................  .................  A2...............      $510.00      15.0458      $622.91      $538.23
                    genit/hf.
15241............  Skin full graft add-on..  Y................  .................  A2...............      $323.28       4.5263      $187.39      $289.31
15260............  Skin full graft een &     Y................  .................  A2...............      $446.00      15.0458      $622.91      $490.23
                    lips.
15261............  Skin full graft add-on..  Y................  .................  A2...............      $323.28      15.0458      $622.91      $398.19
15300............  Apply skinallogrft, t/    Y................  .................  A2...............      $323.28       4.5263      $187.39      $289.31
                    arm/lg.
15301............  Apply sknallogrft t/a/l   Y................  .................  A2...............      $323.28       4.5263      $187.39      $289.31
                    addl.
15320............  Apply skin allogrft f/n/  Y................  .................  A2...............      $323.28       4.5263      $187.39      $289.31
                    hf/g.
15321............  Aply sknallogrft f/n/hfg  Y................  .................  A2...............      $323.28       4.5263      $187.39      $289.31
                    add.
15330............  Aply acell alogrft t/arm/ Y................  .................  A2...............      $323.28       4.5263      $187.39      $289.31
                    leg.
15331............  Aply acell grft t/a/l     Y................  .................  A2...............      $323.28       4.5263      $187.39      $289.31
                    add-on.
15335............  Apply acell graft, f/n/   Y................  .................  A2...............      $323.28       4.5263      $187.39      $289.31
                    hf/g.
15336............  Aply acell grft f/n/hf/g  Y................  .................  A2...............      $323.28       4.5263      $187.39      $289.31
                    add.
15340............  Apply cult skin           Y................  CH...............  G2...............  ...........       2.1051       $87.15       $87.15
                    substitute.
15341............  Apply cult skin sub add-  Y................  .................  G2...............  ...........       2.1051       $87.15       $87.15
                    on.
15360............  Apply cult derm sub, t/a/ Y................  .................  G2...............  ...........       2.1051       $87.15       $87.15
                    l.
15361............  Aply cult derm sub t/a/l  Y................  .................  G2...............  ...........       2.1051       $87.15       $87.15
                    add.
15365............  Apply cult derm sub f/n/  Y................  .................  G2...............  ...........       2.1051       $87.15       $87.15
                    hf/g.
15366............  Apply cult derm f/hf/g    Y................  .................  G2...............  ...........       2.1051       $87.15       $87.15
                    add.
15400............  Apply skin xenograft, t/  Y................  .................  A2...............      $323.28       4.5263      $187.39      $289.31
                    a/l.
15401............  Apply skn xenogrft t/a/l  Y................  .................  A2...............      $323.28       4.5263      $187.39      $289.31
                    add.
15420............  Apply skin xgraft, f/n/   Y................  .................  A2...............      $323.28       4.5263      $187.39      $289.31
                    hf/g.
15421............  Apply skn xgrft f/n/hf/g  Y................  .................  A2...............      $323.28       4.5263      $187.39      $289.31
                    add.
15430............  Apply acellular           Y................  .................  A2...............      $323.28       4.5263      $187.39      $289.31
                    xenograft.
15431............  Apply acellular xgraft    Y................  .................  A2...............      $323.28       4.5263      $187.39      $289.31
                    add.
15570............  Form skin pedicle flap..  Y................  .................  A2...............      $510.00      20.2069      $836.59      $591.65
15572............  Form skin pedicle flap..  Y................  .................  A2...............      $510.00      20.2069      $836.59      $591.65
15574............  Form skin pedicle flap..  Y................  .................  A2...............      $510.00      20.2069      $836.59      $591.65
15576............  Form skin pedicle flap..  Y................  .................  A2...............      $510.00      20.2069      $836.59      $591.65
15600............  Skin graft..............  Y................  .................  A2...............      $510.00      20.2069      $836.59      $591.65
15610............  Skin graft..............  Y................  .................  A2...............      $510.00      20.2069      $836.59      $591.65
15620............  Skin graft..............  Y................  .................  A2...............      $630.00      20.2069      $836.59      $681.65
15630............  Skin graft..............  Y................  .................  A2...............      $510.00      20.2069      $836.59      $591.65
15650............  Transfer skin pedicle     Y................  .................  A2...............      $717.00      20.2069      $836.59      $746.90
                    flap.
15731............  Forehead flap w/vasc      Y................  .................  A2...............      $510.00      20.2069      $836.59      $591.65
                    pedicle.
15732............  Muscle-skin graft, head/  Y................  .................  A2...............      $510.00      20.2069      $836.59      $591.65
                    neck.
15734............  Muscle-skin graft, trunk  Y................  .................  A2...............      $510.00      20.2069      $836.59      $591.65
15736............  Muscle-skin graft, arm..  Y................  .................  A2...............      $510.00      20.2069      $836.59      $591.65
15738............  Muscle-skin graft, leg..  Y................  .................  A2...............      $510.00      20.2069      $836.59      $591.65
15740............  Island pedicle flap       Y................  .................  A2...............      $446.00      15.0458      $622.91      $490.23
                    graft.
15750............  Neurovascular pedicle     Y................  .................  A2...............      $446.00      20.2069      $836.59      $543.65
                    graft.
15760............  Composite skin graft....  Y................  .................  A2...............      $446.00      20.2069      $836.59      $543.65
15770............  Derma-fat-fascia graft..  Y................  .................  A2...............      $510.00      20.2069      $836.59      $591.65
15775............  Hair transplant punch     Y................  .................  A2...............      $323.28       1.2792       $52.96      $255.70
                    grafts.
15776............  Hair transplant punch     Y................  .................  A2...............      $323.28       1.2792       $52.96      $255.70
                    grafts.
15780............  Abrasion treatment of     Y................  .................  P3...............  ...........       9.3563      $387.36      $387.36
                    skin.
15781............  Abrasion treatment of     Y................  .................  P2...............  ...........       4.3039      $178.19      $178.19
                    skin.
15782............  Abrasion treatment of     Y................  .................  P2...............  ...........       4.3039      $178.19      $178.19
                    skin.
15783............  Abrasion treatment of     Y................  .................  P2...............  ...........       2.6604      $110.14      $110.14
                    skin.
15786............  Abrasion, lesion, single  Y................  .................  P2...............  ...........        0.793       $32.83       $32.83
15787............  Abrasion, lesions, add-   Y................  .................  P3...............  ...........       0.7901       $32.71       $32.71
                    on.
15788............  Chemical peel, face,      Y................  .................  P2...............  ...........        0.793       $32.83       $32.83
                    epiderm.
15789............  Chemical peel, face,      Y................  .................  P2...............  ...........       1.4595       $60.42       $60.42
                    dermal.
15792............  Chemical peel, nonfacial  Y................  .................  P2...............  ...........       1.4595       $60.42       $60.42
15793............  Chemical peel, nonfacial  Y................  .................  P2...............  ...........        0.793       $32.83       $32.83
15819............  Plastic surgery, neck...  Y................  .................  G2...............  ...........       2.1051       $87.15       $87.15
15820............  Revision of lower eyelid  Y................  .................  A2...............      $510.00      20.2069      $836.59      $591.65
15821............  Revision of lower eyelid  Y................  .................  A2...............      $510.00      20.2069      $836.59      $591.65
15822............  Revision of upper eyelid  Y................  .................  A2...............      $510.00      20.2069      $836.59      $591.65
15823............  Revision of upper eyelid  Y................  .................  A2...............      $717.00      20.2069      $836.59      $746.90
15824............  Removal of forehead       Y................  .................  A2...............      $510.00      20.2069      $836.59      $591.65
                    wrinkles.
15825............  Removal of neck wrinkles  Y................  .................  A2...............      $510.00      20.2069      $836.59      $591.65
15826............  Removal of brow wrinkles  Y................  .................  A2...............      $510.00      20.2069      $836.59      $591.65
15828............  Removal of face wrinkles  Y................  .................  A2...............      $510.00      20.2069      $836.59      $591.65
15829............  Removal of skin wrinkles  Y................  .................  A2...............      $717.00      20.2069      $836.59      $746.90
15830............  Exc skin abd............  Y................  .................  A2...............      $510.00      21.1098      $873.97      $600.99

[[Page 66949]]

 
15832............  Excise excessive skin     Y................  .................  A2...............      $510.00      21.1098      $873.97      $600.99
                    tissue.
15833............  Excise excessive skin     Y................  .................  A2...............      $510.00      21.1098      $873.97      $600.99
                    tissue.
15834............  Excise excessive skin     Y................  .................  A2...............      $510.00      21.1098      $873.97      $600.99
                    tissue.
15835............  Excise excessive skin     Y................  .................  A2...............      $323.28      21.1098      $873.97      $460.95
                    tissue.
15836............  Excise excessive skin     Y................  .................  A2...............      $510.00      16.1001      $666.56      $549.14
                    tissue.
15837............  Excise excessive skin     Y................  .................  G2...............  ...........      16.1001      $666.56      $666.56
                    tissue.
15838............  Excise excessive skin     Y................  .................  G2...............  ...........      16.1001      $666.56      $666.56
                    tissue.
15839............  Excise excessive skin     Y................  .................  A2...............      $510.00      16.1001      $666.56      $549.14
                    tissue.
15840............  Graft for face nerve      Y................  .................  A2...............      $630.00      20.2069      $836.59      $681.65
                    palsy.
15841............  Graft for face nerve      Y................  .................  A2...............      $630.00      20.2069      $836.59      $681.65
                    palsy.
15842............  Flap for face nerve       Y................  .................  G2...............  ...........      20.2069      $836.59      $836.59
                    palsy.
15845............  Skin and muscle repair,   Y................  .................  A2...............      $630.00      20.2069      $836.59      $681.65
                    face.
15847............  Exc skin abd add-on.....  Y................  .................  A2...............      $510.00      21.1098      $873.97      $600.99
15850............  Removal of sutures......  Y................  .................  G2...............  ...........       2.6604      $110.14      $110.14
15851............  Removal of sutures......  Y................  .................  P3...............  ...........       1.2343       $51.10       $51.10
15852............  Dressing change not for   N................  .................  G2...............  ...........        0.631       $26.12       $26.12
                    burn.
15860............  Test for blood flow in    N................  .................  G2...............  ...........        0.631       $26.12       $26.12
                    graft.
15876............  Suction assisted          Y................  .................  A2...............      $510.00      20.2069      $836.59      $591.65
                    lipectomy.
15877............  Suction assisted          Y................  .................  A2...............      $510.00      20.2069      $836.59      $591.65
                    lipectomy.
15878............  Suction assisted          Y................  .................  A2...............      $510.00      20.2069      $836.59      $591.65
                    lipectomy.
15879............  Suction assisted          Y................  .................  A2...............      $510.00      20.2069      $836.59      $591.65
                    lipectomy.
15920............  Removal of tail bone      Y................  .................  A2...............      $251.52       4.3039      $178.19      $233.19
                    ulcer.
15922............  Removal of tail bone      Y................  .................  A2...............      $630.00      20.2069      $836.59      $681.65
                    ulcer.
15931............  Remove sacrum pressure    Y................  .................  A2...............      $510.00      21.1098      $873.97      $600.99
                    sore.
15933............  Remove sacrum pressure    Y................  .................  A2...............      $510.00      21.1098      $873.97      $600.99
                    sore.
15934............  Remove sacrum pressure    Y................  .................  A2...............      $510.00      20.2069      $836.59      $591.65
                    sore.
15935............  Remove sacrum pressure    Y................  .................  A2...............      $630.00      20.2069      $836.59      $681.65
                    sore.
15936............  Remove sacrum pressure    Y................  .................  A2...............      $630.00      15.0458      $622.91      $628.23
                    sore.
15937............  Remove sacrum pressure    Y................  .................  A2...............      $630.00      20.2069      $836.59      $681.65
                    sore.
15940............  Remove hip pressure sore  Y................  .................  A2...............      $510.00      21.1098      $873.97      $600.99
15941............  Remove hip pressure sore  Y................  .................  A2...............      $510.00      21.1098      $873.97      $600.99
15944............  Remove hip pressure sore  Y................  .................  A2...............      $510.00      20.2069      $836.59      $591.65
15945............  Remove hip pressure sore  Y................  .................  A2...............      $630.00      20.2069      $836.59      $681.65
15946............  Remove hip pressure sore  Y................  .................  A2...............      $630.00      20.2069      $836.59      $681.65
15950............  Remove thigh pressure     Y................  .................  A2...............      $510.00      21.1098      $873.97      $600.99
                    sore.
15951............  Remove thigh pressure     Y................  .................  A2...............      $630.00      21.1098      $873.97      $690.99
                    sore.
15952............  Remove thigh pressure     Y................  .................  A2...............      $510.00      15.0458      $622.91      $538.23
                    sore.
15953............  Remove thigh pressure     Y................  .................  A2...............      $630.00      15.0458      $622.91      $628.23
                    sore.
15956............  Remove thigh pressure     Y................  .................  A2...............      $510.00      15.0458      $622.91      $538.23
                    sore.
15958............  Remove thigh pressure     Y................  .................  A2...............      $630.00      15.0458      $622.91      $628.23
                    sore.
16000............  Initial treatment of      Y................  .................  P3...............  ...........         0.65       $26.91       $26.91
                    burn(s).
16020............  Dress/debrid p-thick      Y................  .................  P3...............  ...........       0.9874       $40.88       $40.88
                    burn, s.
16025............  Dress/debrid p-thick      Y................  .................  A2...............       $67.11       2.6604      $110.14       $77.87
                    burn, m.
16030............  Dress/debrid p-thick      Y................  .................  A2...............       $99.83       2.6604      $110.14      $102.41
                    burn, l.
16035............  Incision of burn scab,    Y................  .................  G2...............  ...........       2.6604      $110.14      $110.14
                    initi.
17000............  Destruct premalg lesion.  Y................  .................  P2...............  ...........        0.793       $32.83       $32.83
17003............  Destruct premalg les, 2-  Y................  .................  P3...............  ...........       0.0906        $3.75        $3.75
                    14.
17004............  Destroy premlg lesions    Y................  .................  P3...............  ...........       1.9502       $80.74       $80.74
                    15+.
17106............  Destruction of skin       Y................  .................  P2...............  ...........       2.6604      $110.14      $110.14
                    lesions.
17107............  Destruction of skin       Y................  .................  P2...............  ...........       2.6604      $110.14      $110.14
                    lesions.
17108............  Destruction of skin       Y................  .................  P2...............  ...........       2.6604      $110.14      $110.14
                    lesions.
17110............  Destruct b9 lesion, 1-14  Y................  .................  P2...............  ...........        0.793       $32.83       $32.83
17111............  Destruct lesion, 15 or    Y................  .................  P2...............  ...........       1.4595       $60.42       $60.42
                    more.
17250............  Chemical cautery, tissue  Y................  .................  P3...............  ...........       1.0451       $43.27       $43.27
17260............  Destruction of skin       Y................  .................  P3...............  ...........       1.1026       $45.65       $45.65
                    lesions.
17261............  Destruction of skin       Y................  .................  P2...............  ...........       1.4595       $60.42       $60.42
                    lesions.
17262............  Destruction of skin       Y................  .................  P2...............  ...........       1.4595       $60.42       $60.42
                    lesions.
17263............  Destruction of skin       Y................  .................  P2...............  ...........       1.4595       $60.42       $60.42
                    lesions.
17264............  Destruction of skin       Y................  .................  P2...............  ...........       1.4595       $60.42       $60.42
                    lesions.
17266............  Destruction of skin       Y................  .................  P3...............  ...........       2.4685      $102.20      $102.20
                    lesions.
17270............  Destruction of skin       Y................  .................  P2...............  ...........       1.4595       $60.42       $60.42
                    lesions.
17271............  Destruction of skin       Y................  .................  P2...............  ...........       1.4595       $60.42       $60.42
                    lesions.
17272............  Destruction of skin       Y................  .................  P2...............  ...........       1.4595       $60.42       $60.42
                    lesions.
17273............  Destruction of skin       Y................  CH...............  P3...............  ...........       2.2299       $92.32       $92.32
                    lesions.
17274............  Destruction of skin       Y................  .................  P3...............  ...........       2.5345      $104.93      $104.93
                    lesions.
17276............  Destruction of skin       Y................  .................  P2...............  ...........       2.6604      $110.14      $110.14
                    lesions.
17280............  Destruction of skin       Y................  CH...............  P2...............  ...........       1.4595       $60.42       $60.42
                    lesions.
17281............  Destruction of skin       Y................  CH...............  P3...............  ...........       1.9091       $79.04       $79.04
                    lesions.
17282............  Destruction of skin       Y................  CH...............  P3...............  ...........       2.1724       $89.94       $89.94
                    lesions.
17283............  Destruction of skin       Y................  CH...............  P3...............  ...........       2.5098      $103.91      $103.91
                    lesions.
17284............  Destruction of skin       Y................  .................  P2...............  ...........       2.6604      $110.14      $110.14
                    lesions.
17286............  Destruction of skin       Y................  .................  P2...............  ...........       2.6604      $110.14      $110.14
                    lesions.
17311............  Mohs, 1 stage, h/n/hf/g.  Y................  .................  P2...............  ...........       3.6321      $150.37      $150.37

[[Page 66950]]

 
17312............  Mohs addl stage.........  Y................  .................  P2...............  ...........       3.6321      $150.37      $150.37
17313............  Mohs, 1 stage, t/a/l....  Y................  .................  P2...............  ...........       3.6321      $150.37      $150.37
17314............  Mohs, addl stage, t/a/l.  Y................  .................  P2...............  ...........       3.6321      $150.37      $150.37
17315............  Mohs surg, addl block...  Y................  .................  P3...............  ...........       0.9381       $38.84       $38.84
17340............  Cryotherapy of skin.....  Y................  .................  P3...............  ...........       0.2961       $12.26       $12.26
17360............  Skin peel therapy.......  Y................  .................  P2...............  ...........        0.793       $32.83       $32.83
17380............  Hair removal by           Y................  .................  R2...............  ...........        0.793       $32.83       $32.83
                    electrolysis.
19000............  Drainage of breast        Y................  .................  P3...............  ...........       1.6046       $66.43       $66.43
                    lesion.
19001............  Drain breast lesion add-  Y................  .................  P3...............  ...........       0.2058        $8.52        $8.52
                    on.
19020............  Incision of breast        Y................  .................  A2...............      $446.00      18.3197      $758.45      $524.11
                    lesion.
19030............  Injection for breast x-   N................  .................  N1...............  ...........  ...........  ...........  ...........
                    ray.
19100............  Bx breast percut w/o      Y................  .................  A2...............      $240.00        4.327      $179.14      $224.79
                    image.
19101............  Biopsy of breast, open..  Y................  .................  A2...............      $446.00      20.6417      $854.59      $548.15
19102............  Bx breast percut w/image  Y................  .................  A2...............      $240.00       7.1147      $294.56      $253.64
19103............  Bx breast percut w/       Y................  .................  A2...............      $395.77      13.5764      $562.08      $437.35
                    device.
19105............  Cryosurg ablate fa, each  Y................  .................  G2...............  ...........      31.7134    $1,312.97    $1,312.97
19110............  Nipple exploration......  Y................  .................  A2...............      $446.00      20.6417      $854.59      $548.15
19112............  Excise breast duct        Y................  .................  A2...............      $510.00      20.6417      $854.59      $596.15
                    fistula.
19120............  Removal of breast lesion  Y................  .................  A2...............      $510.00      20.6417      $854.59      $596.15
19125............  Excision, breast lesion.  Y................  .................  A2...............      $510.00      20.6417      $854.59      $596.15
19126............  Excision, addl breast     Y................  .................  A2...............      $510.00      20.6417      $854.59      $596.15
                    lesion.
19290............  Place needle wire,        N................  .................  N1...............  ...........  ...........  ...........  ...........
                    breast.
19291............  Place needle wire,        N................  .................  N1...............  ...........  ...........  ...........  ...........
                    breast.
19295............  Place breast clip,        N................  CH...............  N1...............  ...........  ...........  ...........  ...........
                    percut.
19296............  Place po breast cath for  Y................  .................  A2...............    $1,339.00      56.5774    $2,342.36    $1,589.84
                    rad.
19297............  Place breast cath for     Y................  .................  A2...............    $1,339.00      56.5774    $2,342.36    $1,589.84
                    rad.
19298............  Place breast rad tube/    Y................  .................  A2...............    $1,339.00      56.5774    $2,342.36    $1,589.84
                    caths.
19300............  Removal of breast tissue  Y................  .................  A2...............      $630.00      20.6417      $854.59      $686.15
19301............  Partical mastectomy.....  Y................  .................  A2...............      $510.00      20.6417      $854.59      $596.15
19302............  P-mastectomy w/ln         Y................  .................  A2...............      $995.00      39.8191    $1,648.55    $1,158.39
                    removal.
19303............  Mast, simple, complete..  Y................  .................  A2...............      $630.00      31.7134    $1,312.97      $800.74
19304............  Mast, subq..............  Y................  .................  A2...............      $630.00      31.7134    $1,312.97      $800.74
19316............  Suspension of breast....  Y................  .................  A2...............      $630.00      31.7134    $1,312.97      $800.74
19318............  Reduction of large        Y................  .................  A2...............      $630.00      39.8191    $1,648.55      $884.64
                    breast.
19324............  Enlarge breast..........  Y................  .................  A2...............      $630.00      39.8191    $1,648.55      $884.64
19325............  Enlarge breast with       Y................  .................  A2...............    $1,339.00      56.5774    $2,342.36    $1,589.84
                    implant.
19328............  Removal of breast         Y................  .................  A2...............      $333.00      31.7134    $1,312.97      $577.99
                    implant.
19330............  Removal of implant        Y................  .................  A2...............      $333.00      31.7134    $1,312.97      $577.99
                    material.
19340............  Immediate breast          Y................  .................  A2...............      $446.00      39.8191    $1,648.55      $746.64
                    prosthesis.
19342............  Delayed breast            Y................  .................  A2...............      $510.00      56.5774    $2,342.36      $968.09
                    prosthesis.
19350............  Breast reconstruction...  Y................  .................  A2...............      $630.00      20.6417      $854.59      $686.15
19355............  Correct inverted          Y................  .................  A2...............      $630.00      31.7134    $1,312.97      $800.74
                    nipple(s).
19357............  Breast reconstruction...  Y................  .................  A2...............      $717.00      56.5774    $2,342.36    $1,123.34
19366............  Breast reconstruction...  Y................  .................  A2...............      $717.00      31.7134    $1,312.97      $865.99
19370............  Surgery of breast         Y................  .................  A2...............      $630.00      31.7134    $1,312.97      $800.74
                    capsule.
19371............  Removal of breast         Y................  .................  A2...............      $630.00      31.7134    $1,312.97      $800.74
                    capsule.
19380............  Revise breast             Y................  .................  A2...............      $717.00      39.8191    $1,648.55      $949.89
                    reconstruction.
19396............  Design custom breast      Y................  .................  G2...............  ...........      31.7134    $1,312.97    $1,312.97
                    implant.
20000............  Incision of abscess.....  Y................  .................  P2...............  ...........       1.4066       $58.23       $58.23
20005............  Incision of deep abscess  Y................  .................  A2...............      $446.00      21.2689      $880.55      $554.64
20103............  Explore wound, extremity  Y................  .................  G2...............  ...........       9.6341      $398.86      $398.86
20150............  Excise epiphyseal bar...  Y................  .................  G2...............  ...........       42.985    $1,779.62    $1,779.62
20200............  Muscle biopsy...........  Y................  .................  A2...............      $446.00      16.1001      $666.56      $501.14
20205............  Deep muscle biopsy......  Y................  .................  A2...............      $510.00      16.1001      $666.56      $549.14
20206............  Needle biopsy, muscle...  Y................  .................  A2...............      $240.00       7.1147      $294.56      $253.64
20220............  Bone biopsy, trocar/      Y................  .................  A2...............      $251.52        8.685      $359.57      $278.53
                    needle.
20225............  Bone biopsy, trocar/      Y................  .................  A2...............      $418.49        8.685      $359.57      $403.76
                    needle.
20240............  Bone biopsy, excisional.  Y................  .................  A2...............      $446.00      21.1098      $873.97      $552.99
20245............  Bone biopsy, excisional.  Y................  .................  A2...............      $510.00      21.1098      $873.97      $600.99
20250............  Open bone biopsy........  Y................  .................  A2...............      $510.00      21.2689      $880.55      $602.64
20251............  Open bone biopsy........  Y................  .................  A2...............      $510.00      21.2689      $880.55      $602.64
20500............  Injection of sinus tract  Y................  .................  P3...............  ...........       1.4811       $61.32       $61.32
20501............  Inject sinus tract for x- N................  .................  N1...............  ...........  ...........  ...........  ...........
                    ray.
20520............  Removal of foreign body.  Y................  .................  P3...............  ...........       2.2712       $94.03       $94.03
20525............  Removal of foreign body.  Y................  .................  A2...............      $510.00      21.1098      $873.97      $600.99
20526............  Ther injection, carp      Y................  .................  P3...............  ...........       0.7323       $30.32       $30.32
                    tunnel.
20550............  Inj tendon sheath/        Y................  .................  P3...............  ...........       0.5514       $22.83       $22.83
                    ligament.
20551............  Inj tendon origin/        Y................  .................  P3...............  ...........       0.5432       $22.49       $22.49
                    insertion.
20552............  Inj trigger point, 1/2    Y................  .................  P3...............  ...........       0.5348       $22.14       $22.14
                    muscl.
20553............  Inject trigger points, =/ Y................  .................  P3...............  ...........       0.6007       $24.87       $24.87
                    > 3.
20555............  Place ndl musc/tis for    Y................  NI...............  G2...............  ...........        29.19    $1,208.50    $1,208.50
                    rt.
20600............  Drain/inject, joint/      Y................  .................  P3...............  ...........       0.5432       $22.49       $22.49
                    bursa.
20605............  Drain/inject, joint/      Y................  .................  P3...............  ...........       0.6171       $25.55       $25.55
                    bursa.

[[Page 66951]]

 
20610............  Drain/inject, joint/      Y................  .................  P3...............  ...........       0.8311       $34.41       $34.41
                    bursa.
20612............  Aspirate/inj ganglion     Y................  .................  P3...............  ...........       0.5761       $23.85       $23.85
                    cyst.
20615............  Treatment of bone cyst..  Y................  CH...............  P3...............  ...........       2.5591      $105.95      $105.95
20650............  Insert and remove bone    Y................  .................  A2...............      $510.00      21.2689      $880.55      $602.64
                    pin.
20662............  Application of pelvis     Y................  .................  R2...............  ...........      21.2689      $880.55      $880.55
                    brace.
20663............  Application of thigh      Y................  .................  R2...............  ...........      21.2689      $880.55      $880.55
                    brace.
20665............  Removal of fixation       N................  .................  G2...............  ...........        0.631       $26.12       $26.12
                    device.
20670............  Removal of support        Y................  .................  A2...............      $333.00      16.1001      $666.56      $416.39
                    implant.
20680............  Removal of support        Y................  .................  A2...............      $510.00      21.1098      $873.97      $600.99
                    implant.
20690............  Apply bone fixation       Y................  .................  A2...............      $446.00        29.19    $1,208.50      $636.63
                    device.
20692............  Apply bone fixation       Y................  .................  A2...............      $510.00        29.19    $1,208.50      $684.63
                    device.
20693............  Adjust bone fixation      Y................  .................  A2...............      $510.00      21.2689      $880.55      $602.64
                    device.
20694............  Remove bone fixation      Y................  .................  A2...............      $333.00      21.2689      $880.55      $469.89
                    device.
20822............  Replantation digit,       Y................  .................  G2...............  ...........      26.3105    $1,089.28    $1,089.28
                    complete.
20900............  Removal of bone for       Y................  .................  A2...............      $510.00        29.19    $1,208.50      $684.63
                    graft.
20902............  Removal of bone for       Y................  .................  A2...............      $630.00        29.19    $1,208.50      $774.63
                    graft.
20910............  Remove cartilage for      Y................  .................  A2...............      $510.00      20.2069      $836.59      $591.65
                    graft.
20912............  Remove cartilage for      Y................  .................  A2...............      $510.00      20.2069      $836.59      $591.65
                    graft.
20920............  Removal of fascia for     Y................  .................  A2...............      $630.00      15.0458      $622.91      $628.23
                    graft.
20922............  Removal of fascia for     Y................  .................  A2...............      $510.00      15.0458      $622.91      $538.23
                    graft.
20924............  Removal of tendon for     Y................  .................  A2...............      $630.00        29.19    $1,208.50      $774.63
                    graft.
20926............  Removal of tissue for     Y................  .................  A2...............      $630.00       4.5263      $187.39      $519.35
                    graft.
20950............  Fluid pressure, muscle..  Y................  .................  G2...............  ...........       1.4066       $58.23       $58.23
20972............  Bone/skin graft,          Y................  .................  G2...............  ...........      44.2687    $1,832.77    $1,832.77
                    metatarsal.
20973............  Bone/skin graft, great    Y................  .................  R2...............  ...........      44.2687    $1,832.77    $1,832.77
                    toe.
20975............  Electrical bone           N................  CH...............  N1...............  ...........  ...........  ...........  ...........
                    stimulation.
20979............  Us bone stimulation.....  N................  .................  P3...............  ...........       0.5843       $24.19       $24.19
20982............  Ablate, bone tumor(s)     Y................  .................  G2...............  ...........       42.985    $1,779.62    $1,779.62
                    perq.
20985............  Cptr-asst dir ms px.....  N................  NI...............  N1...............  ...........  ...........  ...........  ...........
20986............  Cptr-asst dir ms px io    N................  NI...............  N1...............  ...........  ...........  ...........  ...........
                    img.
20987............  Cptr-asst dir ms px pre   N................  NI...............  N1...............  ...........  ...........  ...........  ...........
                    img.
21010............  Incision of jaw joint...  Y................  .................  A2...............      $446.00      23.9765      $992.65      $582.66
21015............  Resection of facial       Y................  .................  A2...............      $510.00      16.3288      $676.03      $551.51
                    tumor.
21025............  Excision of bone, lower   Y................  .................  A2...............      $446.00      39.8776    $1,650.97      $747.24
                    jaw.
21026............  Excision of facial        Y................  .................  A2...............      $446.00      39.8776    $1,650.97      $747.24
                    bone(s).
21029............  Contour of face bone      Y................  .................  A2...............      $446.00      39.8776    $1,650.97      $747.24
                    lesion.
21030............  Excise max/zygoma b9      Y................  .................  P3...............  ...........       5.5627      $230.30      $230.30
                    tumor.
21031............  Remove exostosis,         Y................  .................  P3...............  ...........       4.5588      $188.74      $188.74
                    mandible.
21032............  Remove exostosis,         Y................  .................  P3...............  ...........       4.6823      $193.85      $193.85
                    maxilla.
21034............  Excise max/zygoma mlg     Y................  .................  A2...............      $510.00      39.8776    $1,650.97      $795.24
                    tumor.
21040............  Excise mandible lesion..  Y................  .................  A2...............      $446.00      23.9765      $992.65      $582.66
21044............  Removal of jaw bone       Y................  .................  A2...............      $446.00      39.8776    $1,650.97      $747.24
                    lesion.
21046............  Remove mandible cyst      Y................  .................  A2...............      $446.00      39.8776    $1,650.97      $747.24
                    complex.
21047............  Excise lwr jaw cyst w/    Y................  .................  A2...............      $446.00      39.8776    $1,650.97      $747.24
                    repair.
21048............  Remove maxilla cyst       Y................  .................  R2...............  ...........      39.8776    $1,650.97    $1,650.97
                    complex.
21050............  Removal of jaw joint....  Y................  .................  A2...............      $510.00      39.8776    $1,650.97      $795.24
21060............  Remove jaw joint          Y................  .................  A2...............      $446.00      39.8776    $1,650.97      $747.24
                    cartilage.
21070............  Remove coronoid process.  Y................  .................  A2...............      $510.00      39.8776    $1,650.97      $795.24
21073*...........  Mnpj of tmj w/anesth....  Y................  NI...............  P3...............  ...........        4.526      $187.38      $187.38
21076............  Prepare face/oral         Y................  .................  P3...............  ...........       8.3769      $346.81      $346.81
                    prosthesis.
21077............  Prepare face/oral         Y................  .................  P3...............  ...........       20.457      $846.94      $846.94
                    prosthesis.
21079............  Prepare face/oral         Y................  .................  P3...............  ...........      14.5815      $603.69      $603.69
                    prosthesis.
21080............  Prepare face/oral         Y................  .................  P3...............  ...........      16.7129      $691.93      $691.93
                    prosthesis.
21081............  Prepare face/oral         Y................  .................  P3...............  ...........      15.3467      $635.37      $635.37
                    prosthesis.
21082............  Prepare face/oral         Y................  .................  P3...............  ...........      14.0796      $582.91      $582.91
                    prosthesis.
21083............  Prepare face/oral         Y................  .................  P3...............  ...........      13.8492      $573.37      $573.37
                    prosthesis.
21084............  Prepare face/oral         Y................  .................  P3...............  ...........      16.1532      $668.76      $668.76
                    prosthesis.
21085............  Prepare face/oral         Y................  .................  P3...............  ...........        6.254      $258.92      $258.92
                    prosthesis.
21086............  Prepare face/oral         Y................  .................  P3...............  ...........       15.067      $623.79      $623.79
                    prosthesis.
21087............  Prepare face/oral         Y................  .................  P3...............  ...........      14.9354      $618.34      $618.34
                    prosthesis.
21088............  Prepare face/oral         Y................  .................  R2...............  ...........      39.8776    $1,650.97    $1,650.97
                    prosthesis.
21100............  Maxillofacial fixation..  Y................  .................  A2...............      $446.00      39.8776    $1,650.97      $747.24
21110............  Interdental fixation....  Y................  .................  P2...............  ...........       7.4474      $308.33      $308.33
21116............  Injection, jaw joint x-   N................  .................  N1...............  ...........  ...........  ...........  ...........
                    ray.
21120............  Reconstruction of chin..  Y................  .................  A2...............      $995.00      23.9765      $992.65      $994.41
21121............  Reconstruction of chin..  Y................  .................  A2...............      $995.00      23.9765      $992.65      $994.41
21122............  Reconstruction of chin..  Y................  .................  A2...............      $995.00      23.9765      $992.65      $994.41
21123............  Reconstruction of chin..  Y................  .................  A2...............      $995.00      23.9765      $992.65      $994.41
21125............  Augmentation, lower jaw   Y................  .................  A2...............      $995.00      23.9765      $992.65      $994.41
                    bone.
21127............  Augmentation, lower jaw   Y................  .................  A2...............    $1,339.00      39.8776    $1,650.97    $1,416.99
                    bone.
21137............  Reduction of forehead...  Y................  .................  G2...............  ...........      23.9765      $992.65      $992.65
21138............  Reduction of forehead...  Y................  .................  G2...............  ...........      39.8776    $1,650.97    $1,650.97
21139............  Reduction of forehead...  Y................  .................  G2...............  ...........      39.8776    $1,650.97    $1,650.97

[[Page 66952]]

 
21150............  Reconstruct midface,      Y................  .................  G2...............  ...........      39.8776    $1,650.97    $1,650.97
                    lefort.
21181............  Contour cranial bone      Y................  .................  A2...............      $995.00      23.9765      $992.65      $994.41
                    lesion.
21198............  Reconstr lwr jaw segment  Y................  .................  G2...............  ...........      39.8776    $1,650.97    $1,650.97
21199............  Reconstr lwr jaw w/       Y................  .................  G2...............  ...........      39.8776    $1,650.97    $1,650.97
                    advance.
21206............  Reconstruct upper jaw     Y................  .................  A2...............      $717.00      39.8776    $1,650.97      $950.49
                    bone.
21208............  Augmentation of facial    Y................  .................  A2...............      $995.00      39.8776    $1,650.97    $1,158.99
                    bones.
21209............  Reduction of facial       Y................  .................  A2...............      $717.00      39.8776    $1,650.97      $950.49
                    bones.
21210............  Face bone graft.........  Y................  .................  A2...............      $995.00      39.8776    $1,650.97    $1,158.99
21215............  Lower jaw bone graft....  Y................  .................  A2...............      $995.00      39.8776    $1,650.97    $1,158.99
21230............  Rib cartilage graft.....  Y................  .................  A2...............      $995.00      39.8776    $1,650.97    $1,158.99
21235............  Ear cartilage graft.....  Y................  .................  A2...............      $995.00      23.9765      $992.65      $994.41
21240............  Reconstruction of jaw     Y................  .................  A2...............      $630.00      39.8776    $1,650.97      $885.24
                    joint.
21242............  Reconstruction of jaw     Y................  .................  A2...............      $717.00      39.8776    $1,650.97      $950.49
                    joint.
21243............  Reconstruction of jaw     Y................  .................  A2...............      $717.00      39.8776    $1,650.97      $950.49
                    joint.
21244............  Reconstruction of lower   Y................  .................  A2...............      $995.00      39.8776    $1,650.97    $1,158.99
                    jaw.
21245............  Reconstruction of jaw...  Y................  .................  A2...............      $995.00      39.8776    $1,650.97    $1,158.99
21246............  Reconstruction of jaw...  Y................  .................  A2...............      $995.00      39.8776    $1,650.97    $1,158.99
21248............  Reconstruction of jaw...  Y................  .................  A2...............      $995.00      39.8776    $1,650.97    $1,158.99
21249............  Reconstruction of jaw...  Y................  .................  A2...............      $995.00      39.8776    $1,650.97    $1,158.99
21260............  Revise eye sockets......  Y................  .................  G2...............  ...........      39.8776    $1,650.97    $1,650.97
21267............  Revise eye sockets......  Y................  .................  A2...............      $995.00      39.8776    $1,650.97    $1,158.99
21270............  Augmentation, cheek bone  Y................  .................  A2...............      $717.00      39.8776    $1,650.97      $950.49
21275............  Revision, orbitofacial    Y................  .................  A2...............      $995.00      39.8776    $1,650.97    $1,158.99
                    bones.
21280............  Revision of eyelid......  Y................  .................  A2...............      $717.00      39.8776    $1,650.97      $950.49
21282............  Revision of eyelid......  Y................  .................  A2...............      $717.00      16.3288      $676.03      $706.76
21295............  Revision of jaw muscle/   Y................  .................  A2...............      $333.00       7.4474      $308.33      $326.83
                    bone.
21296............  Revision of jaw muscle/   Y................  .................  A2...............      $333.00      23.9765      $992.65      $497.91
                    bone.
21310............  Treatment of nose         Y................  .................  A2...............      $150.72       2.5002      $103.51      $138.92
                    fracture.
21315............  Treatment of nose         Y................  .................  A2...............      $150.72       2.5002      $103.51      $138.92
                    fracture.
21320............  Treatment of nose         Y................  .................  A2...............      $446.00      16.3288      $676.03      $503.51
                    fracture.
21325............  Treatment of nose         Y................  .................  A2...............      $630.00      23.9765      $992.65      $720.66
                    fracture.
21330............  Treatment of nose         Y................  .................  A2...............      $717.00      23.9765      $992.65      $785.91
                    fracture.
21335............  Treatment of nose         Y................  .................  A2...............      $995.00      23.9765      $992.65      $994.41
                    fracture.
21336............  Treat nasal septal        Y................  .................  A2...............      $630.00      26.1592    $1,083.02      $743.26
                    fracture.
21337............  Treat nasal septal        Y................  .................  A2...............      $446.00      16.3288      $676.03      $503.51
                    fracture.
21338............  Treat nasoethmoid         Y................  .................  A2...............      $630.00      23.9765      $992.65      $720.66
                    fracture.
21339............  Treat nasoethmoid         Y................  .................  A2...............      $717.00      23.9765      $992.65      $785.91
                    fracture.
21340............  Treatment of nose         Y................  .................  A2...............      $630.00      39.8776    $1,650.97      $885.24
                    fracture.
21345............  Treat nose/jaw fracture.  Y................  .................  A2...............      $995.00      23.9765      $992.65      $994.41
21355............  Treat cheek bone          Y................  .................  A2...............      $510.00      39.8776    $1,650.97      $795.24
                    fracture.
21356............  Treat cheek bone          Y................  .................  A2...............      $510.00      23.9765      $992.65      $630.66
                    fracture.
21360............  Treat cheek bone          Y................  CH...............  G2...............  ...........      23.9765      $992.65      $992.65
                    fracture.
21390............  Treat eye socket          Y................  .................  G2...............  ...........      39.8776    $1,650.97    $1,650.97
                    fracture.
21400............  Treat eye socket          Y................  .................  A2...............      $446.00       7.4474      $308.33      $411.58
                    fracture.
21401............  Treat eye socket          Y................  .................  A2...............      $510.00      16.3288      $676.03      $551.51
                    fracture.
21406............  Treat eye socket          Y................  .................  G2...............  ...........      39.8776    $1,650.97    $1,650.97
                    fracture.
21407............  Treat eye socket          Y................  .................  G2...............  ...........      39.8776    $1,650.97    $1,650.97
                    fracture.
21421............  Treat mouth roof          Y................  .................  A2...............      $630.00      23.9765      $992.65      $720.66
                    fracture.
21440............  Treat dental ridge        Y................  .................  P3...............  ...........       7.0605      $292.31      $292.31
                    fracture.
21445............  Treat dental ridge        Y................  .................  A2...............      $630.00      23.9765      $992.65      $720.66
                    fracture.
21450............  Treat lower jaw fracture  Y................  .................  A2...............      $150.72       2.5002      $103.51      $138.92
21451............  Treat lower jaw fracture  Y................  .................  A2...............      $464.15       7.4474      $308.33      $425.20
21452............  Treat lower jaw fracture  Y................  .................  A2...............      $446.00      16.3288      $676.03      $503.51
21453............  Treat lower jaw fracture  Y................  .................  A2...............      $510.00      39.8776    $1,650.97      $795.24
21454............  Treat lower jaw fracture  Y................  .................  A2...............      $717.00      23.9765      $992.65      $785.91
21461............  Treat lower jaw fracture  Y................  .................  A2...............      $630.00      39.8776    $1,650.97      $885.24
21462............  Treat lower jaw fracture  Y................  .................  A2...............      $717.00      39.8776    $1,650.97      $950.49
21465............  Treat lower jaw fracture  Y................  .................  A2...............      $630.00      39.8776    $1,650.97      $885.24
21480............  Reset dislocated jaw....  Y................  .................  A2...............      $150.72       2.5002      $103.51      $138.92
21485............  Reset dislocated jaw....  Y................  .................  A2...............      $446.00      16.3288      $676.03      $503.51
21490............  Repair dislocated jaw...  Y................  .................  A2...............      $510.00      39.8776    $1,650.97      $795.24
21495............  Treat hyoid bone          Y................  .................  G2...............  ...........      16.3288      $676.03      $676.03
                    fracture.
21497............  Interdental wiring......  Y................  .................  A2...............      $446.00      16.3288      $676.03      $503.51
21501............  Drain neck/chest lesion.  Y................  .................  A2...............      $446.00      18.3197      $758.45      $524.11
21502............  Drain chest lesion......  Y................  .................  A2...............      $446.00      21.2689      $880.55      $554.64
21550............  Biopsy of neck/chest....  Y................  .................  G2...............  ...........        8.685      $359.57      $359.57
21555............  Remove lesion, neck/      Y................  .................  A2...............      $446.00      21.1098      $873.97      $552.99
                    chest.
21556............  Remove lesion, neck/      Y................  .................  A2...............      $446.00      21.1098      $873.97      $552.99
                    chest.
21557............  Remove tumor, neck/chest  Y................  .................  G2...............  ...........      21.1098      $873.97      $873.97
21600............  Partial removal of rib..  Y................  .................  A2...............      $446.00        29.19    $1,208.50      $636.63
21610............  Partial removal of rib..  Y................  .................  A2...............      $446.00        29.19    $1,208.50      $636.63
21685............  Hyoid myotomy &           Y................  .................  G2...............  ...........       7.4474      $308.33      $308.33
                    suspension.
21700............  Revision of neck muscle.  Y................  .................  A2...............      $446.00      21.2689      $880.55      $554.64

[[Page 66953]]

 
21720............  Revision of neck muscle.  Y................  .................  A2...............      $510.00      21.2689      $880.55      $602.64
21725............  Revision of neck muscle.  Y................  .................  A2...............       $88.46       1.4066       $58.23       $80.90
21800............  Treatment of rib          Y................  .................  A2...............      $103.62       1.7682       $73.21       $96.02
                    fracture.
21805............  Treatment of rib          Y................  .................  A2...............      $446.00      26.1592    $1,083.02      $605.26
                    fracture.
21820............  Treat sternum fracture..  Y................  .................  A2...............      $103.62       1.7682       $73.21       $96.02
21920............  Biopsy soft tissue of     Y................  .................  P3...............  ...........       3.1763      $131.50      $131.50
                    back.
21925............  Biopsy soft tissue of     Y................  .................  A2...............      $446.00      21.1098      $873.97      $552.99
                    back.
21930............  Remove lesion, back or    Y................  .................  A2...............      $446.00      21.1098      $873.97      $552.99
                    flank.
21935............  Remove tumor, back......  Y................  .................  A2...............      $510.00      21.1098      $873.97      $600.99
22102............  Remove part, lumbar       Y................  .................  G2...............  ...........      46.7724    $1,936.42    $1,936.42
                    vertebra.
22103............  Remove extra spine        Y................  .................  G2...............  ...........      46.7724    $1,936.42    $1,936.42
                    segment.
22305............  Treat spine process       Y................  .................  A2...............      $103.62       1.7682       $73.21       $96.02
                    fracture.
22310............  Treat spine fracture....  Y................  .................  A2...............      $103.62       1.7682       $73.21       $96.02
22315............  Treat spine fracture....  Y................  .................  A2...............      $103.62       1.7682       $73.21       $96.02
22505............  Manipulation of spine...  Y................  .................  A2...............      $446.00      14.7658      $611.32      $487.33
22520............  Percut vertebroplasty     Y................  .................  A2...............    $1,339.00        29.19    $1,208.50    $1,306.38
                    thor.
22521............  Percut vertebroplasty     Y................  .................  A2...............    $1,339.00        29.19    $1,208.50    $1,306.38
                    lumb.
22522............  Percut vertebroplasty     Y................  .................  A2...............    $1,339.00        29.19    $1,208.50    $1,306.38
                    add 1.
22523............  Percut kyphoplasty, thor  Y................  .................  G2...............  ...........      79.4244    $3,288.25    $3,288.25
22524............  Percut kyphoplasty,       Y................  .................  G2...............  ...........      79.4244    $3,288.25    $3,288.25
                    lumbar.
22525............  Percut kyphoplasty, add-  Y................  .................  G2...............  ...........      79.4244    $3,288.25    $3,288.25
                    on.
22526............  Idet, single level......  Y................  CH...............  G2...............  ...........        29.19    $1,208.50    $1,208.50
22527............  Idet, 1 or more levels..  Y................  CH...............  G2...............  ...........        29.19    $1,208.50    $1,208.50
22900............  Remove abdominal wall     Y................  .................  A2...............      $630.00      21.1098      $873.97      $690.99
                    lesion.
23000............  Removal of calcium        Y................  .................  A2...............      $446.00      16.1001      $666.56      $501.14
                    deposits.
23020............  Release shoulder joint..  Y................  .................  A2...............      $446.00       42.985    $1,779.62      $779.41
23030............  Drain shoulder lesion...  Y................  .................  A2...............      $333.00      18.3197      $758.45      $439.36
23031............  Drain shoulder bursa....  Y................  .................  A2...............      $510.00      18.3197      $758.45      $572.11
23035............  Drain shoulder bone       Y................  .................  A2...............      $510.00      21.2689      $880.55      $602.64
                    lesion.
23040............  Exploratory shoulder      Y................  .................  A2...............      $510.00        29.19    $1,208.50      $684.63
                    surgery.
23044............  Exploratory shoulder      Y................  .................  A2...............      $630.00        29.19    $1,208.50      $774.63
                    surgery.
23065............  Biopsy shoulder tissues.  Y................  .................  P3...............  ...........       2.2384       $92.67       $92.67
23066............  Biopsy shoulder tissues.  Y................  .................  A2...............      $446.00      21.1098      $873.97      $552.99
23075............  Removal of shoulder       Y................  .................  A2...............      $446.00      16.1001      $666.56      $501.14
                    lesion.
23076............  Removal of shoulder       Y................  .................  A2...............      $446.00      21.1098      $873.97      $552.99
                    lesion.
23077............  Remove tumor of shoulder  Y................  .................  A2...............      $510.00      21.1098      $873.97      $600.99
23100............  Biopsy of shoulder joint  Y................  .................  A2...............      $446.00      21.2689      $880.55      $554.64
23101............  Shoulder joint surgery..  Y................  .................  A2...............      $995.00        29.19    $1,208.50    $1,048.38
23105............  Remove shoulder joint     Y................  .................  A2...............      $630.00        29.19    $1,208.50      $774.63
                    lining.
23106............  Incision of collarbone    Y................  .................  A2...............      $630.00        29.19    $1,208.50      $774.63
                    joint.
23107............  Explore treat shoulder    Y................  .................  A2...............      $630.00        29.19    $1,208.50      $774.63
                    joint.
23120............  Partial removal, collar   Y................  .................  A2...............      $717.00        29.19    $1,208.50      $839.88
                    bone.
23125............  Removal of collar bone..  Y................  .................  A2...............      $717.00        29.19    $1,208.50      $839.88
23130............  Remove shoulder bone,     Y................  .................  A2...............      $717.00       42.985    $1,779.62      $982.66
                    part.
23140............  Removal of bone lesion..  Y................  .................  A2...............      $630.00      21.2689      $880.55      $692.64
23145............  Removal of bone lesion..  Y................  .................  A2...............      $717.00        29.19    $1,208.50      $839.88
23146............  Removal of bone lesion..  Y................  .................  A2...............      $717.00        29.19    $1,208.50      $839.88
23150............  Removal of humerus        Y................  .................  A2...............      $630.00        29.19    $1,208.50      $774.63
                    lesion.
23155............  Removal of humerus        Y................  .................  A2...............      $717.00        29.19    $1,208.50      $839.88
                    lesion.
23156............  Removal of humerus        Y................  .................  A2...............      $717.00        29.19    $1,208.50      $839.88
                    lesion.
23170............  Remove collar bone        Y................  .................  A2...............      $446.00        29.19    $1,208.50      $636.63
                    lesion.
23172............  Remove shoulder blade     Y................  .................  A2...............      $446.00        29.19    $1,208.50      $636.63
                    lesion.
23174............  Remove humerus lesion...  Y................  .................  A2...............      $446.00        29.19    $1,208.50      $636.63
23180............  Remove collar bone        Y................  .................  A2...............      $630.00        29.19    $1,208.50      $774.63
                    lesion.
23182............  Remove shoulder blade     Y................  .................  A2...............      $630.00        29.19    $1,208.50      $774.63
                    lesion.
23184............  Remove humerus lesion...  Y................  .................  A2...............      $630.00        29.19    $1,208.50      $774.63
23190............  Partial removal of        Y................  .................  A2...............      $630.00        29.19    $1,208.50      $774.63
                    scapula.
23195............  Removal of head of        Y................  .................  A2...............      $717.00        29.19    $1,208.50      $839.88
                    humerus.
23330............  Remove shoulder foreign   Y................  .................  A2...............      $333.00        8.685      $359.57      $339.64
                    body.
23331............  Remove shoulder foreign   Y................  .................  A2...............      $333.00      21.1098      $873.97      $468.24
                    body.
23350............  Injection for shoulder x- N................  .................  N1...............  ...........  ...........  ...........  ...........
                    ray.
23395............  Muscle transfer,shoulder/ Y................  .................  A2...............      $717.00       42.985    $1,779.62      $982.66
                    arm.
23397............  Muscle transfers........  Y................  .................  A2...............      $995.00      79.4244    $3,288.25    $1,568.31
23400............  Fixation of shoulder      Y................  .................  A2...............      $995.00        29.19    $1,208.50    $1,048.38
                    blade.
23405............  Incision of tendon &      Y................  .................  A2...............      $446.00        29.19    $1,208.50      $636.63
                    muscle.
23406............  Incise tendon(s) &        Y................  .................  A2...............      $446.00        29.19    $1,208.50      $636.63
                    muscle(s).
23410............  Repair rotator cuff,      Y................  .................  A2...............      $717.00       42.985    $1,779.62      $982.66
                    acute.
23412............  Repair rotator cuff,      Y................  .................  A2...............      $995.00       42.985    $1,779.62    $1,191.16
                    chronic.
23415............  Release of shoulder       Y................  .................  A2...............      $717.00       42.985    $1,779.62      $982.66
                    ligament.
23420............  Repair of shoulder......  Y................  .................  A2...............      $995.00       42.985    $1,779.62    $1,191.16
23430............  Repair biceps tendon....  Y................  .................  A2...............      $630.00       42.985    $1,779.62      $917.41
23440............  Remove/transplant tendon  Y................  .................  A2...............      $630.00       42.985    $1,779.62      $917.41
23450............  Repair shoulder capsule.  Y................  .................  A2...............      $717.00      79.4244    $3,288.25    $1,359.81

[[Page 66954]]

 
23455............  Repair shoulder capsule.  Y................  .................  A2...............      $995.00      79.4244    $3,288.25    $1,568.31
23460............  Repair shoulder capsule.  Y................  .................  A2...............      $717.00      79.4244    $3,288.25    $1,359.81
23462............  Repair shoulder capsule.  Y................  .................  A2...............      $995.00       42.985    $1,779.62    $1,191.16
23465............  Repair shoulder capsule.  Y................  .................  A2...............      $717.00      79.4244    $3,288.25    $1,359.81
23466............  Repair shoulder capsule.  Y................  .................  A2...............      $995.00       42.985    $1,779.62    $1,191.16
23480............  Revision of collar bone.  Y................  .................  A2...............      $630.00       42.985    $1,779.62      $917.41
23485............  Revision of collar bone.  Y................  .................  A2...............      $995.00      79.4244    $3,288.25    $1,568.31
23490............  Reinforce clavicle......  Y................  .................  A2...............      $510.00       42.985    $1,779.62      $827.41
23491............  Reinforce shoulder bones  Y................  .................  A2...............      $510.00      79.4244    $3,288.25    $1,204.56
23500............  Treat clavicle fracture.  Y................  .................  A2...............      $103.62       1.7682       $73.21       $96.02
23505............  Treat clavicle fracture.  Y................  .................  A2...............      $103.62       1.7682       $73.21       $96.02
23515............  Treat clavicle fracture.  Y................  .................  A2...............      $510.00      59.2233    $2,451.90      $995.48
23520............  Treat clavicle            Y................  .................  A2...............      $103.62       1.7682       $73.21       $96.02
                    dislocation.
23525............  Treat clavicle            Y................  .................  A2...............      $103.62       1.7682       $73.21       $96.02
                    dislocation.
23530............  Treat clavicle            Y................  .................  A2...............      $510.00      41.1091    $1,701.96      $807.99
                    dislocation.
23532............  Treat clavicle            Y................  .................  A2...............      $630.00      26.1592    $1,083.02      $743.26
                    dislocation.
23540............  Treat clavicle            Y................  .................  A2...............      $103.62       1.7682       $73.21       $96.02
                    dislocation.
23545............  Treat clavicle            Y................  .................  A2...............      $103.62       1.7682       $73.21       $96.02
                    dislocation.
23550............  Treat clavicle            Y................  .................  A2...............      $510.00      41.1091    $1,701.96      $807.99
                    dislocation.
23552............  Treat clavicle            Y................  .................  A2...............      $630.00      41.1091    $1,701.96      $897.99
                    dislocation.
23570............  Treat shoulder blade fx.  Y................  .................  A2...............      $103.62       1.7682       $73.21       $96.02
23575............  Treat shoulder blade fx.  Y................  .................  A2...............      $103.62       1.7682       $73.21       $96.02
23585............  Treat scapula fracture..  Y................  .................  A2...............      $510.00      59.2233    $2,451.90      $995.48
23600............  Treat humerus fracture..  Y................  .................  P2...............  ...........       1.7682       $73.21       $73.21
23605............  Treat humerus fracture..  Y................  .................  A2...............      $103.62       1.7682       $73.21       $96.02
23615............  Treat humerus fracture..  Y................  .................  A2...............      $630.00      59.2233    $2,451.90    $1,085.48
23616............  Treat humerus fracture..  Y................  .................  A2...............      $630.00      59.2233    $2,451.90    $1,085.48
23620............  Treat humerus fracture..  Y................  .................  P2...............  ...........       1.7682       $73.21       $73.21
23625............  Treat humerus fracture..  Y................  .................  A2...............      $103.62       1.7682       $73.21       $96.02
23630............  Treat humerus fracture..  Y................  .................  A2...............      $717.00      59.2233    $2,451.90    $1,150.73
23650............  Treat shoulder            Y................  .................  A2...............      $103.62       1.7682       $73.21       $96.02
                    dislocation.
23655............  Treat shoulder            Y................  .................  A2...............      $333.00      14.7658      $611.32      $402.58
                    dislocation.
23660............  Treat shoulder            Y................  .................  A2...............      $510.00      41.1091    $1,701.96      $807.99
                    dislocation.
23665............  Treat dislocation/        Y................  .................  A2...............      $103.62       1.7682       $73.21       $96.02
                    fracture.
23670............  Treat dislocation/        Y................  .................  A2...............      $510.00      59.2233    $2,451.90      $995.48
                    fracture.
23675............  Treat dislocation/        Y................  .................  A2...............      $103.62       1.7682       $73.21       $96.02
                    fracture.
23680............  Treat dislocation/        Y................  .................  A2...............      $510.00      41.1091    $1,701.96      $807.99
                    fracture.
23700............  Fixation of shoulder....  Y................  .................  A2...............      $333.00      14.7658      $611.32      $402.58
23800............  Fusion of shoulder joint  Y................  .................  A2...............      $630.00      79.4244    $3,288.25    $1,294.56
23802............  Fusion of shoulder joint  Y................  .................  A2...............      $995.00       42.985    $1,779.62    $1,191.16
23921............  Amputation follow-up      Y................  .................  A2...............      $323.28      15.0458      $622.91      $398.19
                    surgery.
23930............  Drainage of arm lesion..  Y................  .................  A2...............      $333.00      18.3197      $758.45      $439.36
23931............  Drainage of arm bursa...  Y................  .................  A2...............      $446.00      18.3197      $758.45      $524.11
23935............  Drain arm/elbow bone      Y................  .................  A2...............      $446.00      21.2689      $880.55      $554.64
                    lesion.
24000............  Exploratory elbow         Y................  .................  A2...............      $630.00        29.19    $1,208.50      $774.63
                    surgery.
24006............  Release elbow joint.....  Y................  .................  A2...............      $630.00        29.19    $1,208.50      $774.63
24065............  Biopsy arm/elbow soft     Y................  .................  P3...............  ...........       3.0282      $125.37      $125.37
                    tissue.
24066............  Biopsy arm/elbow soft     Y................  .................  A2...............      $446.00      16.1001      $666.56      $501.14
                    tissue.
24075............  Remove arm/elbow lesion.  Y................  .................  A2...............      $446.00      16.1001      $666.56      $501.14
24076............  Remove arm/elbow lesion.  Y................  .................  A2...............      $446.00      21.1098      $873.97      $552.99
24077............  Remove tumor of arm/      Y................  .................  A2...............      $510.00      21.1098      $873.97      $600.99
                    elbow.
24100............  Biopsy elbow joint        Y................  .................  A2...............      $333.00      21.2689      $880.55      $469.89
                    lining.
24101............  Explore/treat elbow       Y................  .................  A2...............      $630.00        29.19    $1,208.50      $774.63
                    joint.
24102............  Remove elbow joint        Y................  .................  A2...............      $630.00        29.19    $1,208.50      $774.63
                    lining.
24105............  Removal of elbow bursa..  Y................  .................  A2...............      $510.00      21.2689      $880.55      $602.64
24110............  Remove humerus lesion...  Y................  .................  A2...............      $446.00      21.2689      $880.55      $554.64
24115............  Remove/graft bone lesion  Y................  .................  A2...............      $510.00        29.19    $1,208.50      $684.63
24116............  Remove/graft bone lesion  Y................  .................  A2...............      $510.00        29.19    $1,208.50      $684.63
24120............  Remove elbow lesion.....  Y................  .................  A2...............      $510.00      21.2689      $880.55      $602.64
24125............  Remove/graft bone lesion  Y................  .................  A2...............      $510.00        29.19    $1,208.50      $684.63
24126............  Remove/graft bone lesion  Y................  .................  A2...............      $510.00        29.19    $1,208.50      $684.63
24130............  Removal of head of        Y................  .................  A2...............      $510.00        29.19    $1,208.50      $684.63
                    radius.
24134............  Removal of arm bone       Y................  .................  A2...............      $446.00        29.19    $1,208.50      $636.63
                    lesion.
24136............  Remove radius bone        Y................  .................  A2...............      $446.00        29.19    $1,208.50      $636.63
                    lesion.
24138............  Remove elbow bone lesion  Y................  .................  A2...............      $446.00        29.19    $1,208.50      $636.63
24140............  Partial removal of arm    Y................  .................  A2...............      $510.00        29.19    $1,208.50      $684.63
                    bone.
24145............  Partial removal of        Y................  .................  A2...............      $510.00        29.19    $1,208.50      $684.63
                    radius.
24147............  Partial removal of elbow  Y................  .................  A2...............      $446.00        29.19    $1,208.50      $636.63
24149............  Radical resection of      Y................  .................  G2...............  ...........        29.19    $1,208.50    $1,208.50
                    elbow.
24152............  Extensive radius surgery  Y................  .................  G2...............  ...........       42.985    $1,779.62    $1,779.62
24153............  Extensive radius surgery  Y................  .................  G2...............  ...........      79.4244    $3,288.25    $3,288.25
24155............  Removal of elbow joint..  Y................  .................  A2...............      $510.00       42.985    $1,779.62      $827.41
24160............  Remove elbow joint        Y................  .................  A2...............      $446.00        29.19    $1,208.50      $636.63
                    implant.

[[Page 66955]]

 
24164............  Remove radius head        Y................  .................  A2...............      $510.00        29.19    $1,208.50      $684.63
                    implant.
24200............  Removal of arm foreign    Y................  .................  P3...............  ...........       2.5263      $104.59      $104.59
                    body.
24201............  Removal of arm foreign    Y................  .................  A2...............      $446.00      16.1001      $666.56      $501.14
                    body.
24220............  Injection for elbow x-    N................  .................  N1...............  ...........  ...........  ...........  ...........
                    ray.
24300............  Manipulate elbow w/       Y................  .................  G2...............  ...........      14.7658      $611.32      $611.32
                    anesth.
24301............  Muscle/tendon transfer..  Y................  .................  A2...............      $630.00        29.19    $1,208.50      $774.63
24305............  Arm tendon lengthening..  Y................  .................  A2...............      $630.00        29.19    $1,208.50      $774.63
24310............  Revision of arm tendon..  Y................  .................  A2...............      $510.00      21.2689      $880.55      $602.64
24320............  Repair of arm tendon....  Y................  .................  A2...............      $510.00       42.985    $1,779.62      $827.41
24330............  Revision of arm muscles.  Y................  .................  A2...............      $510.00      79.4244    $3,288.25    $1,204.56
24331............  Revision of arm muscles.  Y................  .................  A2...............      $510.00       42.985    $1,779.62      $827.41
24332............  Tenolysis, triceps......  Y................  .................  G2...............  ...........      21.2689      $880.55      $880.55
24340............  Repair of biceps tendon.  Y................  .................  A2...............      $510.00       42.985    $1,779.62      $827.41
24341............  Repair arm tendon/muscle  Y................  .................  A2...............      $510.00       42.985    $1,779.62      $827.41
24342............  Repair of ruptured        Y................  .................  A2...............      $510.00       42.985    $1,779.62      $827.41
                    tendon.
24343............  Repr elbow lat ligmnt w/  Y................  .................  G2...............  ...........        29.19    $1,208.50    $1,208.50
                    tiss.
24344............  Reconstruct elbow lat     Y................  .................  G2...............  ...........      79.4244    $3,288.25    $3,288.25
                    ligmnt.
24345............  Repr elbw med ligmnt w/   Y................  .................  A2...............      $446.00        29.19    $1,208.50      $636.63
                    tissu.
24346............  Reconstruct elbow med     Y................  .................  G2...............  ...........       42.985    $1,779.62    $1,779.62
                    ligmnt.
24350............  Repair of tennis elbow..  N................  CH...............  D5...............  ...........  ...........  ...........  ...........
24351............  Repair of tennis elbow..  N................  CH...............  D5...............  ...........  ...........  ...........  ...........
24352............  Repair of tennis elbow..  N................  CH...............  D5...............  ...........  ...........  ...........  ...........
24354............  Repair of tennis elbow..  N................  CH...............  D5...............  ...........  ...........  ...........  ...........
24356............  Revision of tennis elbow  N................  CH...............  D5...............  ...........  ...........  ...........  ...........
24357............  Repair elbow, perc......  Y................  NI...............  G2...............  ...........        29.19    $1,208.50    $1,208.50
24358............  Repair elbow w/deb, open  Y................  NI...............  G2...............  ...........        29.19    $1,208.50    $1,208.50
24359............  Repair elbow deb/attch    Y................  NI...............  G2...............  ...........        29.19    $1,208.50    $1,208.50
                    open.
24360............  Reconstruct elbow joint.  Y................  .................  A2...............      $717.00       35.904    $1,486.46      $909.37
24361............  Reconstruct elbow joint.  Y................  .................  A2...............      $717.00     122.2057    $5,059.44    $1,802.61
24362............  Reconstruct elbow joint.  Y................  .................  A2...............      $717.00      50.8876    $2,106.80    $1,064.45
24363............  Replace elbow joint.....  Y................  .................  A2...............      $995.00     122.2057    $5,059.44    $2,011.11
24365............  Reconstruct head of       Y................  .................  A2...............      $717.00       35.904    $1,486.46      $909.37
                    radius.
24366............  Reconstruct head of       Y................  .................  A2...............      $717.00     122.2057    $5,059.44    $1,802.61
                    radius.
24400............  Revision of humerus.....  Y................  .................  A2...............      $630.00        29.19    $1,208.50      $774.63
24410............  Revision of humerus.....  Y................  .................  A2...............      $630.00        29.19    $1,208.50      $774.63
24420............  Revision of humerus.....  Y................  .................  A2...............      $510.00       42.985    $1,779.62      $827.41
24430............  Repair of humerus.......  Y................  .................  A2...............      $510.00      79.4244    $3,288.25    $1,204.56
24435............  Repair humerus with       Y................  .................  A2...............      $630.00      79.4244    $3,288.25    $1,294.56
                    graft.
24470............  Revision of elbow joint.  Y................  .................  A2...............      $510.00       42.985    $1,779.62      $827.41
24495............  Decompression of forearm  Y................  .................  A2...............      $446.00        29.19    $1,208.50      $636.63
24498............  Reinforce humerus.......  Y................  .................  A2...............      $510.00      79.4244    $3,288.25    $1,204.56
24500............  Treat humerus fracture..  Y................  .................  A2...............      $103.62       1.7682       $73.21       $96.02
24505............  Treat humerus fracture..  Y................  .................  A2...............      $103.62       1.7682       $73.21       $96.02
24515............  Treat humerus fracture..  Y................  .................  A2...............      $630.00      59.2233    $2,451.90    $1,085.48
24516............  Treat humerus fracture..  Y................  .................  A2...............      $630.00      59.2233    $2,451.90    $1,085.48
24530............  Treat humerus fracture..  Y................  .................  A2...............      $103.62       1.7682       $73.21       $96.02
24535............  Treat humerus fracture..  Y................  .................  A2...............      $103.62       1.7682       $73.21       $96.02
24538............  Treat humerus fracture..  Y................  .................  A2...............      $446.00      26.1592    $1,083.02      $605.26
24545............  Treat humerus fracture..  Y................  .................  A2...............      $630.00      59.2233    $2,451.90    $1,085.48
24546............  Treat humerus fracture..  Y................  .................  A2...............      $717.00      59.2233    $2,451.90    $1,150.73
24560............  Treat humerus fracture..  Y................  .................  A2...............      $103.62       1.7682       $73.21       $96.02
24565............  Treat humerus fracture..  Y................  .................  A2...............      $103.62       1.7682       $73.21       $96.02
24566............  Treat humerus fracture..  Y................  .................  A2...............      $446.00      26.1592    $1,083.02      $605.26
24575............  Treat humerus fracture..  Y................  .................  A2...............      $510.00      59.2233    $2,451.90      $995.48
24576............  Treat humerus fracture..  Y................  .................  A2...............      $103.62       1.7682       $73.21       $96.02
24577............  Treat humerus fracture..  Y................  .................  A2...............      $103.62       1.7682       $73.21       $96.02
24579............  Treat humerus fracture..  Y................  .................  A2...............      $510.00      59.2233    $2,451.90      $995.48
24582............  Treat humerus fracture..  Y................  .................  A2...............      $446.00      26.1592    $1,083.02      $605.26
24586............  Treat elbow fracture....  Y................  .................  A2...............      $630.00      59.2233    $2,451.90    $1,085.48
24587............  Treat elbow fracture....  Y................  .................  A2...............      $717.00      59.2233    $2,451.90    $1,150.73
24600............  Treat elbow dislocation.  Y................  .................  A2...............      $103.62       1.7682       $73.21       $96.02
24605............  Treat elbow dislocation.  Y................  .................  A2...............      $446.00      14.7658      $611.32      $487.33
24615............  Treat elbow dislocation.  Y................  .................  A2...............      $510.00      59.2233    $2,451.90      $995.48
24620............  Treat elbow fracture....  Y................  .................  A2...............      $103.62       1.7682       $73.21       $96.02
24635............  Treat elbow fracture....  Y................  .................  A2...............      $510.00      59.2233    $2,451.90      $995.48
24640............  Treat elbow dislocation.  Y................  CH...............  P3...............  ...........       1.3823       $57.23       $57.23
24650............  Treat radius fracture...  Y................  .................  P2...............  ...........       1.7682       $73.21       $73.21
24655............  Treat radius fracture...  Y................  .................  A2...............      $103.62       1.7682       $73.21       $96.02
24665............  Treat radius fracture...  Y................  .................  A2...............      $630.00      41.1091    $1,701.96      $897.99
24666............  Treat radius fracture...  Y................  .................  A2...............      $630.00      59.2233    $2,451.90    $1,085.48
24670............  Treat ulnar fracture....  Y................  .................  A2...............      $103.62       1.7682       $73.21       $96.02
24675............  Treat ulnar fracture....  Y................  .................  A2...............      $103.62       1.7682       $73.21       $96.02
24685............  Treat ulnar fracture....  Y................  .................  A2...............      $510.00      41.1091    $1,701.96      $807.99

[[Page 66956]]

 
24800............  Fusion of elbow joint...  Y................  .................  A2...............      $630.00       42.985    $1,779.62      $917.41
24802............  Fusion/graft of elbow     Y................  .................  A2...............      $717.00       42.985    $1,779.62      $982.66
                    joint.
24925............  Amputation follow-up      Y................  .................  A2...............      $510.00      21.2689      $880.55      $602.64
                    surgery.
25000............  Incision of tendon        Y................  .................  A2...............      $510.00      21.2689      $880.55      $602.64
                    sheath.
25001............  Incise flexor carpi       Y................  .................  G2...............  ...........      21.2689      $880.55      $880.55
                    radialis.
25020............  Decompress forearm 1      Y................  .................  A2...............      $510.00      21.2689      $880.55      $602.64
                    space.
25023............  Decompress forearm 1      Y................  .................  A2...............      $510.00        29.19    $1,208.50      $684.63
                    space.
25024............  Decompress forearm 2      Y................  .................  A2...............      $510.00        29.19    $1,208.50      $684.63
                    spaces.
25025............  Decompress forearm 2      Y................  .................  A2...............      $510.00        29.19    $1,208.50      $684.63
                    spaces.
25028............  Drainage of forearm       Y................  .................  A2...............      $333.00      21.2689      $880.55      $469.89
                    lesion.
25031............  Drainage of forearm       Y................  .................  A2...............      $446.00      21.2689      $880.55      $554.64
                    bursa.
25035............  Treat forearm bone        Y................  .................  A2...............      $446.00      21.2689      $880.55      $554.64
                    lesion.
25040............  Explore/treat wrist       Y................  .................  A2...............      $717.00        29.19    $1,208.50      $839.88
                    joint.
25065............  Biopsy forearm soft       Y................  .................  P3...............  ...........       3.1023      $128.44      $128.44
                    tissues.
25066............  Biopsy forearm soft       Y................  .................  A2...............      $446.00      21.1098      $873.97      $552.99
                    tissues.
25075............  Removal forearm lesion    Y................  .................  A2...............      $446.00      16.1001      $666.56      $501.14
                    subcu.
25076............  Removal forearm lesion    Y................  .................  A2...............      $510.00      21.1098      $873.97      $600.99
                    deep.
25077............  Remove tumor, forearm/    Y................  .................  A2...............      $510.00      21.1098      $873.97      $600.99
                    wrist.
25085............  Incision of wrist         Y................  .................  A2...............      $510.00      21.2689      $880.55      $602.64
                    capsule.
25100............  Biopsy of wrist joint...  Y................  .................  A2...............      $446.00      21.2689      $880.55      $554.64
25101............  Explore/treat wrist       Y................  .................  A2...............      $510.00        29.19    $1,208.50      $684.63
                    joint.
25105............  Remove wrist joint        Y................  .................  A2...............      $630.00        29.19    $1,208.50      $774.63
                    lining.
25107............  Remove wrist joint        Y................  .................  A2...............      $510.00        29.19    $1,208.50      $684.63
                    cartilage.
25109............  Excise tendon forearm/    Y................  .................  G2...............  ...........      21.2689      $880.55      $880.55
                    wrist.
25110............  Remove wrist tendon       Y................  .................  A2...............      $510.00      21.2689      $880.55      $602.64
                    lesion.
25111............  Remove wrist tendon       Y................  .................  A2...............      $510.00      16.4637      $681.61      $552.90
                    lesion.
25112............  Reremove wrist tendon     Y................  .................  A2...............      $630.00      16.4637      $681.61      $642.90
                    lesion.
25115............  Remove wrist/forearm      Y................  .................  A2...............      $630.00      21.2689      $880.55      $692.64
                    lesion.
25116............  Remove wrist/forearm      Y................  .................  A2...............      $630.00      21.2689      $880.55      $692.64
                    lesion.
25118............  Excise wrist tendon       Y................  .................  A2...............      $446.00        29.19    $1,208.50      $636.63
                    sheath.
25119............  Partial removal of ulna.  Y................  .................  A2...............      $510.00        29.19    $1,208.50      $684.63
25120............  Removal of forearm        Y................  .................  A2...............      $510.00        29.19    $1,208.50      $684.63
                    lesion.
25125............  Remove/graft forearm      Y................  .................  A2...............      $510.00        29.19    $1,208.50      $684.63
                    lesion.
25126............  Remove/graft forearm      Y................  .................  A2...............      $510.00        29.19    $1,208.50      $684.63
                    lesion.
25130............  Removal of wrist lesion.  Y................  .................  A2...............      $510.00        29.19    $1,208.50      $684.63
25135............  Remove & graft wrist      Y................  .................  A2...............      $510.00        29.19    $1,208.50      $684.63
                    lesion.
25136............  Remove & graft wrist      Y................  .................  A2...............      $510.00        29.19    $1,208.50      $684.63
                    lesion.
25145............  Remove forearm bone       Y................  .................  A2...............      $446.00        29.19    $1,208.50      $636.63
                    lesion.
25150............  Partial removal of ulna.  Y................  .................  A2...............      $446.00        29.19    $1,208.50      $636.63
25151............  Partial removal of        Y................  .................  A2...............      $446.00        29.19    $1,208.50      $636.63
                    radius.
25210............  Removal of wrist bone...  Y................  .................  A2...............      $510.00      26.3105    $1,089.28      $654.82
25215............  Removal of wrist bones..  Y................  .................  A2...............      $630.00      26.3105    $1,089.28      $744.82
25230............  Partial removal of        Y................  .................  A2...............      $630.00        29.19    $1,208.50      $774.63
                    radius.
25240............  Partial removal of ulna.  Y................  .................  A2...............      $630.00        29.19    $1,208.50      $774.63
25246............  Injection for wrist x-    N................  .................  N1...............  ...........  ...........  ...........  ...........
                    ray.
25248............  Remove forearm foreign    Y................  .................  A2...............      $446.00      21.2689      $880.55      $554.64
                    body.
25250............  Removal of wrist          Y................  .................  A2...............      $333.00        29.19    $1,208.50      $551.88
                    prosthesis.
25251............  Removal of wrist          Y................  .................  A2...............      $333.00        29.19    $1,208.50      $551.88
                    prosthesis.
25259............  Manipulate wrist w/       Y................  .................  G2...............  ...........       1.7682       $73.21       $73.21
                    anesthes.
25260............  Repair forearm tendon/    Y................  .................  A2...............      $630.00        29.19    $1,208.50      $774.63
                    muscle.
25263............  Repair forearm tendon/    Y................  .................  A2...............      $446.00        29.19    $1,208.50      $636.63
                    muscle.
25265............  Repair forearm tendon/    Y................  .................  A2...............      $510.00        29.19    $1,208.50      $684.63
                    muscle.
25270............  Repair forearm tendon/    Y................  .................  A2...............      $630.00        29.19    $1,208.50      $774.63
                    muscle.
25272............  Repair forearm tendon/    Y................  .................  A2...............      $510.00        29.19    $1,208.50      $684.63
                    muscle.
25274............  Repair forearm tendon/    Y................  .................  A2...............      $630.00        29.19    $1,208.50      $774.63
                    muscle.
25275............  Repair forearm tendon     Y................  .................  A2...............      $630.00        29.19    $1,208.50      $774.63
                    sheath.
25280............  Revise wrist/forearm      Y................  .................  A2...............      $630.00        29.19    $1,208.50      $774.63
                    tendon.
25290............  Incise wrist/forearm      Y................  .................  A2...............      $510.00        29.19    $1,208.50      $684.63
                    tendon.
25295............  Release wrist/forearm     Y................  .................  A2...............      $510.00      21.2689      $880.55      $602.64
                    tendon.
25300............  Fusion of tendons at      Y................  .................  A2...............      $510.00        29.19    $1,208.50      $684.63
                    wrist.
25301............  Fusion of tendons at      Y................  .................  A2...............      $510.00        29.19    $1,208.50      $684.63
                    wrist.
25310............  Transplant forearm        Y................  .................  A2...............      $510.00       42.985    $1,779.62      $827.41
                    tendon.
25312............  Transplant forearm        Y................  .................  A2...............      $630.00       42.985    $1,779.62      $917.41
                    tendon.
25315............  Revise palsy hand         Y................  .................  A2...............      $510.00       42.985    $1,779.62      $827.41
                    tendon(s).
25316............  Revise palsy hand         Y................  .................  A2...............      $510.00      79.4244    $3,288.25    $1,204.56
                    tendon(s).
25320............  Repair/revise wrist       Y................  .................  A2...............      $510.00       42.985    $1,779.62      $827.41
                    joint.
25332............  Revise wrist joint......  Y................  .................  A2...............      $717.00       35.904    $1,486.46      $909.37
25335............  Realignment of hand.....  Y................  .................  A2...............      $510.00       42.985    $1,779.62      $827.41
25337............  Reconstruct ulna/         Y................  .................  A2...............      $717.00       42.985    $1,779.62      $982.66
                    radioulnar.
25350............  Revision of radius......  Y................  .................  A2...............      $510.00      79.4244    $3,288.25    $1,204.56
25355............  Revision of radius......  Y................  .................  A2...............      $510.00       42.985    $1,779.62      $827.41
25360............  Revision of ulna........  Y................  .................  A2...............      $510.00        29.19    $1,208.50      $684.63
25365............  Revise radius & ulna....  Y................  .................  A2...............      $510.00        29.19    $1,208.50      $684.63

[[Page 66957]]

 
25370............  Revise radius or ulna...  Y................  .................  A2...............      $510.00       42.985    $1,779.62      $827.41
25375............  Revise radius & ulna....  Y................  .................  A2...............      $630.00       42.985    $1,779.62      $917.41
25390............  Shorten radius or ulna..  Y................  .................  A2...............      $510.00        29.19    $1,208.50      $684.63
25391............  Lengthen radius or ulna.  Y................  .................  A2...............      $630.00       42.985    $1,779.62      $917.41
25392............  Shorten radius & ulna...  Y................  .................  A2...............      $510.00        29.19    $1,208.50      $684.63
25393............  Lengthen radius & ulna..  Y................  .................  A2...............      $630.00       42.985    $1,779.62      $917.41
25394............  Repair carpal bone,       Y................  .................  G2...............  ...........      16.4637      $681.61      $681.61
                    shorten.
25400............  Repair radius or ulna...  Y................  .................  A2...............      $510.00      79.4244    $3,288.25    $1,204.56
25405............  Repair/graft radius or    Y................  .................  A2...............      $630.00      79.4244    $3,288.25    $1,294.56
                    ulna.
25415............  Repair radius & ulna....  Y................  .................  A2...............      $510.00      79.4244    $3,288.25    $1,204.56
25420............  Repair/graft radius &     Y................  .................  A2...............      $630.00      79.4244    $3,288.25    $1,294.56
                    ulna.
25425............  Repair/graft radius or    Y................  .................  A2...............      $510.00       42.985    $1,779.62      $827.41
                    ulna.
25426............  Repair/graft radius &     Y................  .................  A2...............      $630.00       42.985    $1,779.62      $917.41
                    ulna.
25430............  Vasc graft into carpal    Y................  .................  G2...............  ...........      26.3105    $1,089.28    $1,089.28
                    bone.
25431............  Repair nonunion carpal    Y................  .................  G2...............  ...........      26.3105    $1,089.28    $1,089.28
                    bone.
25440............  Repair/graft wrist bone.  Y................  .................  A2...............      $630.00      79.4244    $3,288.25    $1,294.56
25441............  Reconstruct wrist joint.  Y................  .................  A2...............      $717.00     122.2057    $5,059.44    $1,802.61
25442............  Reconstruct wrist joint.  Y................  .................  A2...............      $717.00     122.2057    $5,059.44    $1,802.61
25443............  Reconstruct wrist joint.  Y................  .................  A2...............      $717.00      50.8876    $2,106.80    $1,064.45
25444............  Reconstruct wrist joint.  Y................  .................  A2...............      $717.00      50.8876    $2,106.80    $1,064.45
25445............  Reconstruct wrist joint.  Y................  .................  A2...............      $717.00      50.8876    $2,106.80    $1,064.45
25446............  Wrist replacement.......  Y................  .................  A2...............      $995.00     122.2057    $5,059.44    $2,011.11
25447............  Repair wrist joint(s)...  Y................  .................  A2...............      $717.00       35.904    $1,486.46      $909.37
25449............  Remove wrist joint        Y................  .................  A2...............      $717.00       35.904    $1,486.46      $909.37
                    implant.
25450............  Revision of wrist joint.  Y................  .................  A2...............      $510.00       42.985    $1,779.62      $827.41
25455............  Revision of wrist joint.  Y................  .................  A2...............      $510.00       42.985    $1,779.62      $827.41
25490............  Reinforce radius........  Y................  .................  A2...............      $510.00       42.985    $1,779.62      $827.41
25491............  Reinforce ulna..........  Y................  .................  A2...............      $510.00       42.985    $1,779.62      $827.41
25492............  Reinforce radius and      Y................  .................  A2...............      $510.00       42.985    $1,779.62      $827.41
                    ulna.
25500............  Treat fracture of radius  Y................  .................  P2...............  ...........       1.7682       $73.21       $73.21
25505............  Treat fracture of radius  Y................  .................  A2...............      $103.62       1.7682       $73.21       $96.02
25515............  Treat fracture of radius  Y................  .................  A2...............      $510.00      41.1091    $1,701.96      $807.99
25520............  Treat fracture of radius  Y................  .................  A2...............      $103.62       1.7682       $73.21       $96.02
25525............  Treat fracture of radius  Y................  .................  A2...............      $630.00      41.1091    $1,701.96      $897.99
25526............  Treat fracture of radius  Y................  .................  A2...............      $717.00      41.1091    $1,701.96      $963.24
25530............  Treat fracture of ulna..  Y................  .................  P2...............  ...........       1.7682       $73.21       $73.21
25535............  Treat fracture of ulna..  Y................  .................  A2...............      $103.62       1.7682       $73.21       $96.02
25545............  Treat fracture of ulna..  Y................  .................  A2...............      $510.00      41.1091    $1,701.96      $807.99
25560............  Treat fracture radius &   Y................  .................  P2...............  ...........       1.7682       $73.21       $73.21
                    ulna.
25565............  Treat fracture radius &   Y................  .................  A2...............      $103.62       1.7682       $73.21       $96.02
                    ulna.
25574............  Treat fracture radius &   Y................  .................  A2...............      $510.00      59.2233    $2,451.90      $995.48
                    ulna.
25575............  Treat fracture radius/    Y................  .................  A2...............      $510.00      59.2233    $2,451.90      $995.48
                    ulna.
25600............  Treat fracture radius/    Y................  .................  P2...............  ...........       1.7682       $73.21       $73.21
                    ulna.
25605............  Treat fracture radius/    Y................  .................  A2...............      $103.62       1.7682       $73.21       $96.02
                    ulna.
25606............  Treat fx distal radial..  Y................  .................  A2...............      $510.00      26.1592    $1,083.02      $653.26
25607............  Treat fx rad extra-       Y................  .................  A2...............      $717.00      59.2233    $2,451.90    $1,150.73
                    articul.
25608............  Treat fx rad intra-       Y................  .................  A2...............      $717.00      59.2233    $2,451.90    $1,150.73
                    articul.
25609............  Treat fx radial 3+ frag.  Y................  .................  A2...............      $717.00      59.2233    $2,451.90    $1,150.73
25622............  Treat wrist bone          Y................  .................  P2...............  ...........       1.7682       $73.21       $73.21
                    fracture.
25624............  Treat wrist bone          Y................  .................  A2...............      $103.62       1.7682       $73.21       $96.02
                    fracture.
25628............  Treat wrist bone          Y................  .................  A2...............      $510.00      41.1091    $1,701.96      $807.99
                    fracture.
25630............  Treat wrist bone          Y................  .................  P2...............  ...........       1.7682       $73.21       $73.21
                    fracture.
25635............  Treat wrist bone          Y................  .................  A2...............      $103.62       1.7682       $73.21       $96.02
                    fracture.
25645............  Treat wrist bone          Y................  .................  A2...............      $510.00      41.1091    $1,701.96      $807.99
                    fracture.
25650............  Treat wrist bone          Y................  .................  P2...............  ...........       1.7682       $73.21       $73.21
                    fracture.
25651............  Pin ulnar styloid         Y................  .................  G2...............  ...........      26.1592    $1,083.02    $1,083.02
                    fracture.
25652............  Treat fracture ulnar      Y................  .................  G2...............  ...........      41.1091    $1,701.96    $1,701.96
                    styloid.
25660............  Treat wrist dislocation.  Y................  .................  A2...............      $103.62       1.7682       $73.21       $96.02
25670............  Treat wrist dislocation.  Y................  .................  A2...............      $510.00      26.1592    $1,083.02      $653.26
25671............  Pin radioulnar            Y................  .................  A2...............      $333.00      26.1592    $1,083.02      $520.51
                    dislocation.
25675............  Treat wrist dislocation.  Y................  .................  A2...............      $103.62       1.7682       $73.21       $96.02
25676............  Treat wrist dislocation.  Y................  .................  A2...............      $446.00      26.1592    $1,083.02      $605.26
25680............  Treat wrist fracture....  Y................  .................  A2...............      $103.62       1.7682       $73.21       $96.02
25685............  Treat wrist fracture....  Y................  .................  A2...............      $510.00      26.1592    $1,083.02      $653.26
25690............  Treat wrist dislocation.  Y................  .................  A2...............      $103.62       1.7682       $73.21       $96.02
25695............  Treat wrist dislocation.  Y................  .................  A2...............      $446.00      26.1592    $1,083.02      $605.26
25800............  Fusion of wrist joint...  Y................  .................  A2...............      $630.00      79.4244    $3,288.25    $1,294.56
25805............  Fusion/graft of wrist     Y................  .................  A2...............      $717.00       42.985    $1,779.62      $982.66
                    joint.
25810............  Fusion/graft of wrist     Y................  .................  A2...............      $717.00      79.4244    $3,288.25    $1,359.81
                    joint.
25820............  Fusion of hand bones....  Y................  .................  A2...............      $630.00      16.4637      $681.61      $642.90
25825............  Fuse hand bones with      Y................  .................  A2...............      $717.00      79.4244    $3,288.25    $1,359.81
                    graft.
25830............  Fusion, radioulnar jnt/   Y................  .................  A2...............      $717.00      79.4244    $3,288.25    $1,359.81
                    ulna.
25907............  Amputation follow-up      Y................  .................  A2...............      $510.00      21.2689      $880.55      $602.64
                    surgery.

[[Page 66958]]

 
25922............  Amputate hand at wrist..  Y................  .................  A2...............      $510.00      21.2689      $880.55      $602.64
25929............  Amputation follow-up      Y................  .................  A2...............      $510.00      15.0458      $622.91      $538.23
                    surgery.
25931............  Amputation follow-up      Y................  CH...............  G2...............  ...........      21.2689      $880.55      $880.55
                    surgery.
26010............  Drainage of finger        Y................  .................  P2...............  ...........       1.4066       $58.23       $58.23
                    abscess.
26011............  Drainage of finger        Y................  .................  A2...............      $333.00      11.5594      $478.57      $369.39
                    abscess.
26020............  Drain hand tendon sheath  Y................  .................  A2...............      $446.00      16.4637      $681.61      $504.90
26025............  Drainage of palm bursa..  Y................  .................  A2...............      $333.00      16.4637      $681.61      $420.15
26030............  Drainage of palm          Y................  .................  A2...............      $446.00      16.4637      $681.61      $504.90
                    bursa(s).
26034............  Treat hand bone lesion..  Y................  .................  A2...............      $446.00      16.4637      $681.61      $504.90
26035............  Decompress fingers/hand.  Y................  .................  G2...............  ...........      16.4637      $681.61      $681.61
26040............  Release palm contracture  Y................  .................  A2...............      $630.00      26.3105    $1,089.28      $744.82
26045............  Release palm contracture  Y................  .................  A2...............      $510.00      26.3105    $1,089.28      $654.82
26055............  Incise finger tendon      Y................  .................  A2...............      $446.00      16.4637      $681.61      $504.90
                    sheath.
26060............  Incision of finger        Y................  .................  A2...............      $446.00      16.4637      $681.61      $504.90
                    tendon.
26070............  Explore/treat hand joint  Y................  .................  A2...............      $446.00      16.4637      $681.61      $504.90
26075............  Explore/treat finger      Y................  .................  A2...............      $630.00      16.4637      $681.61      $642.90
                    joint.
26080............  Explore/treat finger      Y................  .................  A2...............      $630.00      16.4637      $681.61      $642.90
                    joint.
26100............  Biopsy hand joint lining  Y................  .................  A2...............      $446.00      16.4637      $681.61      $504.90
26105............  Biopsy finger joint       Y................  .................  A2...............      $333.00      16.4637      $681.61      $420.15
                    lining.
26110............  Biopsy finger joint       Y................  .................  A2...............      $333.00      16.4637      $681.61      $420.15
                    lining.
26115............  Removal hand lesion       Y................  .................  A2...............      $446.00      21.1098      $873.97      $552.99
                    subcut.
26116............  Removal hand lesion,      Y................  .................  A2...............      $446.00      21.1098      $873.97      $552.99
                    deep.
26117............  Remove tumor, hand/       Y................  .................  A2...............      $510.00      21.1098      $873.97      $600.99
                    finger.
26121............  Release palm contracture  Y................  .................  A2...............      $630.00      26.3105    $1,089.28      $744.82
26123............  Release palm contracture  Y................  .................  A2...............      $630.00      26.3105    $1,089.28      $744.82
26125............  Release palm contracture  Y................  .................  A2...............      $630.00      16.4637      $681.61      $642.90
26130............  Remove wrist joint        Y................  .................  A2...............      $510.00      16.4637      $681.61      $552.90
                    lining.
26135............  Revise finger joint,      Y................  .................  A2...............      $630.00      26.3105    $1,089.28      $744.82
                    each.
26140............  Revise finger joint,      Y................  .................  A2...............      $446.00      16.4637      $681.61      $504.90
                    each.
26145............  Tendon excision, palm/    Y................  .................  A2...............      $510.00      16.4637      $681.61      $552.90
                    finger.
26160............  Remove tendon sheath      Y................  .................  A2...............      $510.00      16.4637      $681.61      $552.90
                    lesion.
26170............  Removal of palm tendon,   Y................  .................  A2...............      $510.00      16.4637      $681.61      $552.90
                    each.
26180............  Removal of finger tendon  Y................  .................  A2...............      $510.00      16.4637      $681.61      $552.90
26185............  Remove finger bone......  Y................  .................  A2...............      $630.00      16.4637      $681.61      $642.90
26200............  Remove hand bone lesion.  Y................  .................  A2...............      $446.00      16.4637      $681.61      $504.90
26205............  Remove/graft bone lesion  Y................  .................  A2...............      $510.00      26.3105    $1,089.28      $654.82
26210............  Removal of finger lesion  Y................  .................  A2...............      $446.00      16.4637      $681.61      $504.90
26215............  Remove/graft finger       Y................  .................  A2...............      $510.00      16.4637      $681.61      $552.90
                    lesion.
26230............  Partial removal of hand   Y................  .................  A2...............      $992.95      16.4637      $681.61      $915.12
                    bone.
26235............  Partial removal, finger   Y................  .................  A2...............      $510.00      16.4637      $681.61      $552.90
                    bone.
26236............  Partial removal, finger   Y................  .................  A2...............      $510.00      16.4637      $681.61      $552.90
                    bone.
26250............  Extensive hand surgery..  Y................  .................  A2...............      $510.00      16.4637      $681.61      $552.90
26255............  Extensive hand surgery..  Y................  .................  A2...............      $510.00      26.3105    $1,089.28      $654.82
26260............  Extensive finger surgery  Y................  .................  A2...............      $510.00      16.4637      $681.61      $552.90
26261............  Extensive finger surgery  Y................  .................  A2...............      $510.00      16.4637      $681.61      $552.90
26262............  Partial removal of        Y................  .................  A2...............      $446.00      16.4637      $681.61      $504.90
                    finger.
26320............  Removal of implant from   Y................  .................  A2...............      $446.00      16.1001      $666.56      $501.14
                    hand.
26340............  Manipulate finger w/      Y................  .................  G2...............  ...........       1.7682       $73.21       $73.21
                    anesth.
26350............  Repair finger/hand        Y................  .................  A2...............      $333.00      26.3105    $1,089.28      $522.07
                    tendon.
26352............  Repair/graft hand tendon  Y................  .................  A2...............      $630.00      26.3105    $1,089.28      $744.82
26356............  Repair finger/hand        Y................  .................  A2...............      $630.00      26.3105    $1,089.28      $744.82
                    tendon.
26357............  Repair finger/hand        Y................  .................  A2...............      $630.00      26.3105    $1,089.28      $744.82
                    tendon.
26358............  Repair/graft hand tendon  Y................  .................  A2...............      $630.00      26.3105    $1,089.28      $744.82
26370............  Repair finger/hand        Y................  .................  A2...............      $630.00      26.3105    $1,089.28      $744.82
                    tendon.
26372............  Repair/graft hand tendon  Y................  .................  A2...............      $630.00      26.3105    $1,089.28      $744.82
26373............  Repair finger/hand        Y................  .................  A2...............      $510.00      26.3105    $1,089.28      $654.82
                    tendon.
26390............  Revise hand/finger        Y................  .................  A2...............      $630.00      26.3105    $1,089.28      $744.82
                    tendon.
26392............  Repair/graft hand tendon  Y................  .................  A2...............      $510.00      26.3105    $1,089.28      $654.82
26410............  Repair hand tendon......  Y................  .................  A2...............      $510.00      16.4637      $681.61      $552.90
26412............  Repair/graft hand tendon  Y................  .................  A2...............      $510.00      26.3105    $1,089.28      $654.82
26415............  Excision, hand/finger     Y................  .................  A2...............      $630.00      26.3105    $1,089.28      $744.82
                    tendon.
26416............  Graft hand or finger      Y................  .................  A2...............      $510.00      26.3105    $1,089.28      $654.82
                    tendon.
26418............  Repair finger tendon....  Y................  .................  A2...............      $630.00      16.4637      $681.61      $642.90
26420............  Repair/graft finger       Y................  .................  A2...............      $630.00      26.3105    $1,089.28      $744.82
                    tendon.
26426............  Repair finger/hand        Y................  .................  A2...............      $510.00      26.3105    $1,089.28      $654.82
                    tendon.
26428............  Repair/graft finger       Y................  .................  A2...............      $510.00      26.3105    $1,089.28      $654.82
                    tendon.
26432............  Repair finger tendon....  Y................  .................  A2...............      $510.00      16.4637      $681.61      $552.90
26433............  Repair finger tendon....  Y................  .................  A2...............      $510.00      16.4637      $681.61      $552.90
26434............  Repair/graft finger       Y................  .................  A2...............      $510.00      26.3105    $1,089.28      $654.82
                    tendon.
26437............  Realignment of tendons..  Y................  .................  A2...............      $510.00      16.4637      $681.61      $552.90
26440............  Release palm/finger       Y................  .................  A2...............      $510.00      16.4637      $681.61      $552.90
                    tendon.
26442............  Release palm & finger     Y................  .................  A2...............      $510.00      26.3105    $1,089.28      $654.82
                    tendon.
26445............  Release hand/finger       Y................  .................  A2...............      $510.00      16.4637      $681.61      $552.90
                    tendon.

[[Page 66959]]

 
26449............  Release forearm/hand      Y................  .................  A2...............      $510.00      26.3105    $1,089.28      $654.82
                    tendon.
26450............  Incision of palm tendon.  Y................  .................  A2...............      $510.00      16.4637      $681.61      $552.90
26455............  Incision of finger        Y................  .................  A2...............      $510.00      16.4637      $681.61      $552.90
                    tendon.
26460............  Incise hand/finger        Y................  .................  A2...............      $510.00      16.4637      $681.61      $552.90
                    tendon.
26471............  Fusion of finger tendons  Y................  .................  A2...............      $446.00      16.4637      $681.61      $504.90
26474............  Fusion of finger tendons  Y................  .................  A2...............      $446.00      16.4637      $681.61      $504.90
26476............  Tendon lengthening......  Y................  .................  A2...............      $333.00      16.4637      $681.61      $420.15
26477............  Tendon shortening.......  Y................  .................  A2...............      $333.00      16.4637      $681.61      $420.15
26478............  Lengthening of hand       Y................  .................  A2...............      $333.00      16.4637      $681.61      $420.15
                    tendon.
26479............  Shortening of hand        Y................  .................  A2...............      $333.00      16.4637      $681.61      $420.15
                    tendon.
26480............  Transplant hand tendon..  Y................  .................  A2...............      $510.00      26.3105    $1,089.28      $654.82
26483............  Transplant/graft hand     Y................  .................  A2...............      $510.00      26.3105    $1,089.28      $654.82
                    tendon.
26485............  Transplant palm tendon..  Y................  .................  A2...............      $446.00      26.3105    $1,089.28      $606.82
26489............  Transplant/graft palm     Y................  .................  A2...............      $510.00      26.3105    $1,089.28      $654.82
                    tendon.
26490............  Revise thumb tendon.....  Y................  .................  A2...............      $510.00      26.3105    $1,089.28      $654.82
26492............  Tendon transfer with      Y................  .................  A2...............      $510.00      26.3105    $1,089.28      $654.82
                    graft.
26494............  Hand tendon/muscle        Y................  .................  A2...............      $510.00      26.3105    $1,089.28      $654.82
                    transfer.
26496............  Revise thumb tendon.....  Y................  .................  A2...............      $510.00      26.3105    $1,089.28      $654.82
26497............  Finger tendon transfer..  Y................  .................  A2...............      $510.00      26.3105    $1,089.28      $654.82
26498............  Finger tendon transfer..  Y................  .................  A2...............      $630.00      26.3105    $1,089.28      $744.82
26499............  Revision of finger......  Y................  .................  A2...............      $510.00      26.3105    $1,089.28      $654.82
26500............  Hand tendon               Y................  .................  A2...............      $630.00      16.4637      $681.61      $642.90
                    reconstruction.
26502............  Hand tendon               Y................  .................  A2...............      $630.00      26.3105    $1,089.28      $744.82
                    reconstruction.
26508............  Release thumb             Y................  .................  A2...............      $510.00      16.4637      $681.61      $552.90
                    contracture.
26510............  Thumb tendon transfer...  Y................  .................  A2...............      $510.00      26.3105    $1,089.28      $654.82
26516............  Fusion of knuckle joint.  Y................  .................  A2...............      $333.00      26.3105    $1,089.28      $522.07
26517............  Fusion of knuckle joints  Y................  .................  A2...............      $510.00      26.3105    $1,089.28      $654.82
26518............  Fusion of knuckle joints  Y................  .................  A2...............      $510.00      26.3105    $1,089.28      $654.82
26520............  Release knuckle           Y................  .................  A2...............      $510.00      16.4637      $681.61      $552.90
                    contracture.
26525............  Release finger            Y................  .................  A2...............      $510.00      16.4637      $681.61      $552.90
                    contracture.
26530............  Revise knuckle joint....  Y................  .................  A2...............      $510.00       35.904    $1,486.46      $754.12
26531............  Revise knuckle with       Y................  .................  A2...............      $995.00      50.8876    $2,106.80    $1,272.95
                    implant.
26535............  Revise finger joint.....  Y................  .................  A2...............      $717.00       35.904    $1,486.46      $909.37
26536............  Revise/implant finger     Y................  .................  A2...............      $717.00      50.8876    $2,106.80    $1,064.45
                    joint.
26540............  Repair hand joint.......  Y................  .................  A2...............      $630.00      16.4637      $681.61      $642.90
26541............  Repair hand joint with    Y................  .................  A2...............      $995.00      26.3105    $1,089.28    $1,018.57
                    graft.
26542............  Repair hand joint with    Y................  .................  A2...............      $630.00      16.4637      $681.61      $642.90
                    graft.
26545............  Reconstruct finger joint  Y................  .................  A2...............      $630.00      26.3105    $1,089.28      $744.82
26546............  Repair nonunion hand....  Y................  .................  A2...............      $630.00      26.3105    $1,089.28      $744.82
26548............  Reconstruct finger joint  Y................  .................  A2...............      $630.00      26.3105    $1,089.28      $744.82
26550............  Construct thumb           Y................  .................  A2...............      $446.00      26.3105    $1,089.28      $606.82
                    replacement.
26555............  Positional change of      Y................  .................  A2...............      $510.00      26.3105    $1,089.28      $654.82
                    finger.
26560............  Repair of web finger....  Y................  .................  A2...............      $446.00      16.4637      $681.61      $504.90
26561............  Repair of web finger....  Y................  .................  A2...............      $510.00      26.3105    $1,089.28      $654.82
26562............  Repair of web finger....  Y................  .................  A2...............      $630.00      26.3105    $1,089.28      $744.82
26565............  Correct metacarpal flaw.  Y................  .................  A2...............      $717.00      26.3105    $1,089.28      $810.07
26567............  Correct finger deformity  Y................  .................  A2...............      $717.00      26.3105    $1,089.28      $810.07
26568............  Lengthen metacarpal/      Y................  .................  A2...............      $510.00      26.3105    $1,089.28      $654.82
                    finger.
26580............  Repair hand deformity...  Y................  .................  A2...............      $717.00      16.4637      $681.61      $708.15
26587............  Reconstruct extra finger  Y................  .................  A2...............      $717.00      16.4637      $681.61      $708.15
26590............  Repair finger deformity.  Y................  .................  A2...............      $717.00      16.4637      $681.61      $708.15
26591............  Repair muscles of hand..  Y................  .................  A2...............      $510.00      26.3105    $1,089.28      $654.82
26593............  Release muscles of hand.  Y................  .................  A2...............      $510.00      16.4637      $681.61      $552.90
26596............  Excision constricting     Y................  .................  A2...............      $446.00      16.4637      $681.61      $504.90
                    tissue.
26600............  Treat metacarpal          Y................  .................  P2...............  ...........       1.7682       $73.21       $73.21
                    fracture.
26605............  Treat metacarpal          Y................  .................  A2...............      $103.62       1.7682       $73.21       $96.02
                    fracture.
26607............  Treat metacarpal          Y................  .................  A2...............      $103.62       1.7682       $73.21       $96.02
                    fracture.
26608............  Treat metacarpal          Y................  .................  A2...............      $630.00      26.1592    $1,083.02      $743.26
                    fracture.
26615............  Treat metacarpal          Y................  .................  A2...............      $630.00      41.1091    $1,701.96      $897.99
                    fracture.
26641............  Treat thumb dislocation.  Y................  CH...............  P2...............  ...........       1.7682       $73.21       $73.21
26645............  Treat thumb fracture....  Y................  .................  A2...............      $103.62       1.7682       $73.21       $96.02
26650............  Treat thumb fracture....  Y................  .................  A2...............      $446.00      26.1592    $1,083.02      $605.26
26665............  Treat thumb fracture....  Y................  .................  A2...............      $630.00      41.1091    $1,701.96      $897.99
26670............  Treat hand dislocation..  Y................  CH...............  P2...............  ...........       1.7682       $73.21       $73.21
26675............  Treat hand dislocation..  Y................  .................  A2...............      $103.62       1.7682       $73.21       $96.02
26676............  Pin hand dislocation....  Y................  .................  A2...............      $446.00      26.1592    $1,083.02      $605.26
26685............  Treat hand dislocation..  Y................  .................  A2...............      $510.00      26.1592    $1,083.02      $653.26
26686............  Treat hand dislocation..  Y................  .................  A2...............      $510.00      59.2233    $2,451.90      $995.48
26700............  Treat knuckle             Y................  CH...............  P2...............  ...........       1.7682       $73.21       $73.21
                    dislocation.
26705............  Treat knuckle             Y................  .................  A2...............      $103.62       1.7682       $73.21       $96.02
                    dislocation.
26706............  Pin knuckle dislocation.  Y................  .................  A2...............      $103.62       1.7682       $73.21       $96.02
26715............  Treat knuckle             Y................  .................  A2...............      $630.00      26.1592    $1,083.02      $743.26
                    dislocation.
26720............  Treat finger fracture,    Y................  .................  P2...............  ...........       1.7682       $73.21       $73.21
                    each.

[[Page 66960]]

 
26725............  Treat finger fracture,    Y................  .................  P2...............  ...........       1.7682       $73.21       $73.21
                    each.
26727............  Treat finger fracture,    Y................  .................  A2...............      $995.00      26.1592    $1,083.02    $1,017.01
                    each.
26735............  Treat finger fracture,    Y................  .................  A2...............      $630.00      26.1592    $1,083.02      $743.26
                    each.
26740............  Treat finger fracture,    Y................  .................  P2...............  ...........       1.7682       $73.21       $73.21
                    each.
26742............  Treat finger fracture,    Y................  .................  A2...............      $103.62       1.7682       $73.21       $96.02
                    each.
26746............  Treat finger fracture,    Y................  .................  A2...............      $717.00      26.1592    $1,083.02      $808.51
                    each.
26750............  Treat finger fracture,    Y................  .................  P2...............  ...........       1.7682       $73.21       $73.21
                    each.
26755............  Treat finger fracture,    Y................  .................  G2...............  ...........       1.7682       $73.21       $73.21
                    each.
26756............  Pin finger fracture,      Y................  .................  A2...............      $446.00      26.1592    $1,083.02      $605.26
                    each.
26765............  Treat finger fracture,    Y................  .................  A2...............      $630.00      26.1592    $1,083.02      $743.26
                    each.
26770............  Treat finger dislocation  Y................  .................  G2...............  ...........       1.7682       $73.21       $73.21
26775............  Treat finger dislocation  Y................  CH...............  P3...............  ...........        4.032      $166.93      $166.93
26776............  Pin finger dislocation..  Y................  .................  A2...............      $446.00      26.1592    $1,083.02      $605.26
26785............  Treat finger dislocation  Y................  .................  A2...............      $446.00      26.1592    $1,083.02      $605.26
26820............  Thumb fusion with graft.  Y................  .................  A2...............      $717.00      26.3105    $1,089.28      $810.07
26841............  Fusion of thumb.........  Y................  .................  A2...............      $630.00      26.3105    $1,089.28      $744.82
26842............  Thumb fusion with graft.  Y................  .................  A2...............      $630.00      26.3105    $1,089.28      $744.82
26843............  Fusion of hand joint....  Y................  .................  A2...............      $510.00      26.3105    $1,089.28      $654.82
26844............  Fusion/graft of hand      Y................  .................  A2...............      $510.00      26.3105    $1,089.28      $654.82
                    joint.
26850............  Fusion of knuckle.......  Y................  .................  A2...............      $630.00      26.3105    $1,089.28      $744.82
26852............  Fusion of knuckle with    Y................  .................  A2...............      $630.00      26.3105    $1,089.28      $744.82
                    graft.
26860............  Fusion of finger joint..  Y................  .................  A2...............      $510.00      26.3105    $1,089.28      $654.82
26861............  Fusion of finger jnt,     Y................  .................  A2...............      $446.00      26.3105    $1,089.28      $606.82
                    add-on.
26862............  Fusion/graft of finger    Y................  .................  A2...............      $630.00      26.3105    $1,089.28      $744.82
                    joint.
26863............  Fuse/graft added joint..  Y................  .................  A2...............      $510.00      26.3105    $1,089.28      $654.82
26910............  Amputate metacarpal bone  Y................  .................  A2...............      $510.00      26.3105    $1,089.28      $654.82
26951............  Amputation of finger/     Y................  .................  A2...............      $446.00      16.4637      $681.61      $504.90
                    thumb.
26952............  Amputation of finger/     Y................  .................  A2...............      $630.00      16.4637      $681.61      $642.90
                    thumb.
26990............  Drainage of pelvis        Y................  .................  A2...............      $333.00      21.2689      $880.55      $469.89
                    lesion.
26991............  Drainage of pelvis bursa  Y................  .................  A2...............      $333.00      21.2689      $880.55      $469.89
27000............  Incision of hip tendon..  Y................  .................  A2...............      $446.00      21.2689      $880.55      $554.64
27001............  Incision of hip tendon..  Y................  .................  A2...............      $510.00        29.19    $1,208.50      $684.63
27003............  Incision of hip tendon..  Y................  .................  A2...............      $510.00        29.19    $1,208.50      $684.63
27033............  Exploration of hip joint  Y................  .................  A2...............      $510.00       42.985    $1,779.62      $827.41
27035............  Denervation of hip joint  Y................  .................  A2...............      $630.00       42.985    $1,779.62      $917.41
27040............  Biopsy of soft tissues..  Y................  .................  A2...............      $333.00        8.685      $359.57      $339.64
27041............  Biopsy of soft tissues..  Y................  .................  A2...............      $418.49        8.685      $359.57      $403.76
27047............  Remove hip/pelvis lesion  Y................  .................  A2...............      $446.00      21.1098      $873.97      $552.99
27048............  Remove hip/pelvis lesion  Y................  .................  A2...............      $510.00      21.1098      $873.97      $600.99
27049............  Remove tumor, hip/pelvis  Y................  .................  A2...............      $510.00      21.1098      $873.97      $600.99
27050............  Biopsy of sacroiliac      Y................  .................  A2...............      $510.00      21.2689      $880.55      $602.64
                    joint.
27052............  Biopsy of hip joint.....  Y................  .................  A2...............      $510.00      21.2689      $880.55      $602.64
27060............  Removal of ischial bursa  Y................  .................  A2...............      $717.00      21.2689      $880.55      $757.89
27062............  Remove femur lesion/      Y................  .................  A2...............      $717.00      21.2689      $880.55      $757.89
                    bursa.
27065............  Removal of hip bone       Y................  .................  A2...............      $717.00      21.2689      $880.55      $757.89
                    lesion.
27066............  Removal of hip bone       Y................  .................  A2...............      $717.00        29.19    $1,208.50      $839.88
                    lesion.
27067............  Remove/graft hip bone     Y................  .................  A2...............      $717.00        29.19    $1,208.50      $839.88
                    lesion.
27080............  Removal of tail bone....  Y................  .................  A2...............      $446.00        29.19    $1,208.50      $636.63
27086............  Remove hip foreign body.  Y................  .................  A2...............      $333.00        8.685      $359.57      $339.64
27087............  Remove hip foreign body.  Y................  .................  A2...............      $510.00      21.2689      $880.55      $602.64
27093............  Injection for hip x-ray.  N................  .................  N1...............  ...........  ...........  ...........  ...........
27095............  Injection for hip x-ray.  N................  .................  N1...............  ...........  ...........  ...........  ...........
27097............  Revision of hip tendon..  Y................  .................  A2...............      $510.00        29.19    $1,208.50      $684.63
27098............  Transfer tendon to        Y................  .................  A2...............      $510.00        29.19    $1,208.50      $684.63
                    pelvis.
27100............  Transfer of abdominal     Y................  .................  A2...............      $630.00       42.985    $1,779.62      $917.41
                    muscle.
27105............  Transfer of spinal        Y................  .................  A2...............      $630.00       42.985    $1,779.62      $917.41
                    muscle.
27110............  Transfer of iliopsoas     Y................  .................  A2...............      $630.00       42.985    $1,779.62      $917.41
                    muscle.
27111............  Transfer of iliopsoas     Y................  .................  A2...............      $630.00       42.985    $1,779.62      $917.41
                    muscle.
27193............  Treat pelvic ring         Y................  .................  A2...............      $103.62       1.7682       $73.21       $96.02
                    fracture.
27194............  Treat pelvic ring         Y................  .................  A2...............      $446.00      14.7658      $611.32      $487.33
                    fracture.
27200............  Treat tail bone fracture  Y................  CH...............  P3...............  ...........       1.7693       $73.25       $73.25
27202............  Treat tail bone fracture  Y................  .................  A2...............      $446.00      41.1091    $1,701.96      $759.99
27220............  Treat hip socket          Y................  .................  G2...............  ...........       1.7682       $73.21       $73.21
                    fracture.
27230............  Treat thigh fracture....  Y................  .................  A2...............      $103.62       1.7682       $73.21       $96.02
27238............  Treat thigh fracture....  Y................  .................  A2...............      $103.62       1.7682       $73.21       $96.02
27246............  Treat thigh fracture....  Y................  .................  A2...............      $103.62       1.7682       $73.21       $96.02
27250............  Treat hip dislocation...  Y................  .................  A2...............      $103.62       1.7682       $73.21       $96.02
27252............  Treat hip dislocation...  Y................  .................  A2...............      $446.00      14.7658      $611.32      $487.33
27256............  Treat hip dislocation...  Y................  .................  G2...............  ...........       1.7682       $73.21       $73.21
27257............  Treat hip dislocation...  Y................  .................  A2...............      $510.00      14.7658      $611.32      $535.33
27265............  Treat hip dislocation...  Y................  .................  A2...............      $103.62       1.7682       $73.21       $96.02
27266............  Treat hip dislocation...  Y................  .................  A2...............      $446.00      14.7658      $611.32      $487.33
27267............  Cltx thigh fx...........  Y................  NI...............  G2...............  ...........       1.7682       $73.21       $73.21

[[Page 66961]]

 
27275............  Manipulation of hip       Y................  .................  A2...............      $446.00      14.7658      $611.32      $487.33
                    joint.
27301............  Drain thigh/knee lesion.  Y................  .................  A2...............      $510.00      18.3197      $758.45      $572.11
27305............  Incise thigh tendon &     Y................  .................  A2...............      $446.00      21.2689      $880.55      $554.64
                    fascia.
27306............  Incision of thigh tendon  Y................  .................  A2...............      $510.00      21.2689      $880.55      $602.64
27307............  Incision of thigh         Y................  .................  A2...............      $510.00      21.2689      $880.55      $602.64
                    tendons.
27310............  Exploration of knee       Y................  .................  A2...............      $630.00        29.19    $1,208.50      $774.63
                    joint.
27323............  Biopsy, thigh soft        Y................  .................  A2...............      $333.00        8.685      $359.57      $339.64
                    tissues.
27324............  Biopsy, thigh soft        Y................  .................  A2...............      $333.00      21.1098      $873.97      $468.24
                    tissues.
27325............  Neurectomy, hamstring...  Y................  .................  A2...............      $446.00      18.0518      $747.36      $521.34
27326............  Neurectomy, popliteal...  Y................  .................  A2...............      $446.00      18.0518      $747.36      $521.34
27327............  Removal of thigh lesion.  Y................  .................  A2...............      $446.00      21.1098      $873.97      $552.99
27328............  Removal of thigh lesion.  Y................  .................  A2...............      $510.00      21.1098      $873.97      $600.99
27329............  Remove tumor, thigh/knee  Y................  .................  A2...............      $630.00      21.1098      $873.97      $690.99
27330............  Biopsy, knee joint        Y................  .................  A2...............      $630.00        29.19    $1,208.50      $774.63
                    lining.
27331............  Explore/treat knee joint  Y................  .................  A2...............      $630.00        29.19    $1,208.50      $774.63
27332............  Removal of knee           Y................  .................  A2...............      $630.00        29.19    $1,208.50      $774.63
                    cartilage.
27333............  Removal of knee           Y................  .................  A2...............      $630.00        29.19    $1,208.50      $774.63
                    cartilage.
27334............  Remove knee joint lining  Y................  .................  A2...............      $630.00        29.19    $1,208.50      $774.63
27335............  Remove knee joint lining  Y................  .................  A2...............      $630.00        29.19    $1,208.50      $774.63
27340............  Removal of kneecap bursa  Y................  .................  A2...............      $510.00      21.2689      $880.55      $602.64
27345............  Removal of knee cyst....  Y................  .................  A2...............      $630.00      21.2689      $880.55      $692.64
27347............  Remove knee cyst........  Y................  .................  A2...............      $630.00      21.2689      $880.55      $692.64
27350............  Removal of kneecap......  Y................  .................  A2...............      $630.00        29.19    $1,208.50      $774.63
27355............  Remove femur lesion.....  Y................  .................  A2...............      $510.00        29.19    $1,208.50      $684.63
27356............  Remove femur lesion/      Y................  .................  A2...............      $630.00        29.19    $1,208.50      $774.63
                    graft.
27357............  Remove femur lesion/      Y................  .................  A2...............      $717.00        29.19    $1,208.50      $839.88
                    graft.
27358............  Remove femur lesion/      Y................  .................  A2...............      $717.00        29.19    $1,208.50      $839.88
                    fixation.
27360............  Partial removal, leg      Y................  .................  A2...............      $717.00        29.19    $1,208.50      $839.88
                    bone(s).
27370............  Injection for knee x-ray  N................  .................  N1...............  ...........  ...........  ...........  ...........
27372............  Removal of foreign body.  Y................  .................  A2...............      $995.00      21.1098      $873.97      $964.74
27380............  Repair of kneecap tendon  Y................  .................  A2...............      $333.00      21.2689      $880.55      $469.89
27381............  Repair/graft kneecap      Y................  .................  A2...............      $510.00      21.2689      $880.55      $602.64
                    tendon.
27385............  Repair of thigh muscle..  Y................  .................  A2...............      $510.00      21.2689      $880.55      $602.64
27386............  Repair/graft of thigh     Y................  .................  A2...............      $510.00      21.2689      $880.55      $602.64
                    muscle.
27390............  Incision of thigh tendon  Y................  .................  A2...............      $333.00      21.2689      $880.55      $469.89
27391............  Incision of thigh         Y................  .................  A2...............      $446.00      21.2689      $880.55      $554.64
                    tendons.
27392............  Incision of thigh         Y................  .................  A2...............      $510.00      21.2689      $880.55      $602.64
                    tendons.
27393............  Lengthening of thigh      Y................  .................  A2...............      $446.00        29.19    $1,208.50      $636.63
                    tendon.
27394............  Lengthening of thigh      Y................  .................  A2...............      $510.00        29.19    $1,208.50      $684.63
                    tendons.
27395............  Lengthening of thigh      Y................  .................  A2...............      $510.00       42.985    $1,779.62      $827.41
                    tendons.
27396............  Transplant of thigh       Y................  .................  A2...............      $510.00        29.19    $1,208.50      $684.63
                    tendon.
27397............  Transplants of thigh      Y................  .................  A2...............      $510.00       42.985    $1,779.62      $827.41
                    tendons.
27400............  Revise thigh muscles/     Y................  .................  A2...............      $510.00       42.985    $1,779.62      $827.41
                    tendons.
27403............  Repair of knee cartilage  Y................  .................  A2...............      $630.00        29.19    $1,208.50      $774.63
27405............  Repair of knee ligament.  Y................  .................  A2...............      $630.00       42.985    $1,779.62      $917.41
27407............  Repair of knee ligament.  Y................  .................  A2...............      $630.00      79.4244    $3,288.25    $1,294.56
27409............  Repair of knee ligaments  Y................  .................  A2...............      $630.00       42.985    $1,779.62      $917.41
27416............  Osteochondral knee        Y................  NI...............  G2...............  ...........       42.985    $1,779.62    $1,779.62
                    autograft.
27418............  Repair degenerated        Y................  .................  A2...............      $510.00       42.985    $1,779.62      $827.41
                    kneecap.
27420............  Revision of unstable      Y................  .................  A2...............      $510.00       42.985    $1,779.62      $827.41
                    kneecap.
27422............  Revision of unstable      Y................  .................  A2...............      $995.00       42.985    $1,779.62    $1,191.16
                    kneecap.
27424............  Revision/removal of       Y................  .................  A2...............      $510.00       42.985    $1,779.62      $827.41
                    kneecap.
27425............  Lat retinacular release   Y................  .................  A2...............      $995.00        29.19    $1,208.50    $1,048.38
                    open.
27427............  Reconstruction, knee....  Y................  .................  A2...............      $510.00       42.985    $1,779.62      $827.41
27428............  Reconstruction, knee....  Y................  .................  A2...............      $630.00      79.4244    $3,288.25    $1,294.56
27429............  Reconstruction, knee....  Y................  .................  A2...............      $630.00      79.4244    $3,288.25    $1,294.56
27430............  Revision of thigh         Y................  .................  A2...............      $630.00       42.985    $1,779.62      $917.41
                    muscles.
27435............  Incision of knee joint..  Y................  .................  A2...............      $630.00       42.985    $1,779.62      $917.41
27437............  Revise kneecap..........  Y................  .................  A2...............      $630.00       35.904    $1,486.46      $844.12
27438............  Revise kneecap with       Y................  .................  A2...............      $717.00      50.8876    $2,106.80    $1,064.45
                    implant.
27440............  Revision of knee joint..  Y................  .................  G2...............  ...........       35.904    $1,486.46    $1,486.46
27441............  Revision of knee joint..  Y................  .................  A2...............      $717.00       35.904    $1,486.46      $909.37
27442............  Revision of knee joint..  Y................  .................  A2...............      $717.00       35.904    $1,486.46      $909.37
27443............  Revision of knee joint..  Y................  .................  A2...............      $717.00       35.904    $1,486.46      $909.37
27446............  Revision of knee joint..  Y................  .................  G2...............  ...........     274.6715   $11,371.67   $11,371.67
27496............  Decompression of thigh/   Y................  .................  A2...............      $717.00      21.2689      $880.55      $757.89
                    knee.
27497............  Decompression of thigh/   Y................  .................  A2...............      $510.00      21.2689      $880.55      $602.64
                    knee.
27498............  Decompression of thigh/   Y................  .................  A2...............      $510.00      21.2689      $880.55      $602.64
                    knee.
27499............  Decompression of thigh/   Y................  .................  A2...............      $510.00      21.2689      $880.55      $602.64
                    knee.
27500............  Treatment of thigh        Y................  .................  A2...............      $103.62       1.7682       $73.21       $96.02
                    fracture.
27501............  Treatment of thigh        Y................  .................  A2...............      $103.62       1.7682       $73.21       $96.02
                    fracture.
27502............  Treatment of thigh        Y................  .................  A2...............      $103.62       1.7682       $73.21       $96.02
                    fracture.
27503............  Treatment of thigh        Y................  .................  A2...............      $103.62       1.7682       $73.21       $96.02
                    fracture.

[[Page 66962]]

 
27508............  Treatment of thigh        Y................  .................  A2...............      $103.62       1.7682       $73.21       $96.02
                    fracture.
27509............  Treatment of thigh        Y................  .................  A2...............      $510.00      26.1592    $1,083.02      $653.26
                    fracture.
27510............  Treatment of thigh        Y................  .................  A2...............      $103.62       1.7682       $73.21       $96.02
                    fracture.
27516............  Treat thigh fx growth     Y................  .................  A2...............      $103.62       1.7682       $73.21       $96.02
                    plate.
27517............  Treat thigh fx growth     Y................  .................  A2...............      $103.62       1.7682       $73.21       $96.02
                    plate.
27520............  Treat kneecap fracture..  Y................  .................  A2...............      $103.62       1.7682       $73.21       $96.02
27530............  Treat knee fracture.....  Y................  .................  A2...............      $103.62       1.7682       $73.21       $96.02
27532............  Treat knee fracture.....  Y................  .................  A2...............      $103.62       1.7682       $73.21       $96.02
27538............  Treat knee fracture(s)..  Y................  .................  A2...............      $103.62       1.7682       $73.21       $96.02
27550............  Treat knee dislocation..  Y................  .................  A2...............      $103.62       1.7682       $73.21       $96.02
27552............  Treat knee dislocation..  Y................  .................  A2...............      $333.00      14.7658      $611.32      $402.58
27560............  Treat kneecap             Y................  .................  A2...............      $103.62       1.7682       $73.21       $96.02
                    dislocation.
27562............  Treat kneecap             Y................  .................  A2...............      $333.00      14.7658      $611.32      $402.58
                    dislocation.
27566............  Treat kneecap             Y................  .................  A2...............      $446.00      41.1091    $1,701.96      $759.99
                    dislocation.
27570............  Fixation of knee joint..  Y................  .................  A2...............      $333.00      14.7658      $611.32      $402.58
27594............  Amputation follow-up      Y................  .................  A2...............      $510.00      21.2689      $880.55      $602.64
                    surgery.
27600............  Decompression of lower    Y................  .................  A2...............      $510.00      21.2689      $880.55      $602.64
                    leg.
27601............  Decompression of lower    Y................  .................  A2...............      $510.00      21.2689      $880.55      $602.64
                    leg.
27602............  Decompression of lower    Y................  .................  A2...............      $510.00      21.2689      $880.55      $602.64
                    leg.
27603............  Drain lower leg lesion..  Y................  .................  A2...............      $446.00      18.3197      $758.45      $524.11
27604............  Drain lower leg bursa...  Y................  .................  A2...............      $446.00      21.2689      $880.55      $554.64
27605............  Incision of achilles      Y................  .................  A2...............      $333.00      20.8284      $862.32      $465.33
                    tendon.
27606............  Incision of achilles      Y................  .................  A2...............      $333.00      21.2689      $880.55      $469.89
                    tendon.
27607............  Treat lower leg bone      Y................  .................  A2...............      $446.00      21.2689      $880.55      $554.64
                    lesion.
27610............  Explore/treat ankle       Y................  .................  A2...............      $446.00        29.19    $1,208.50      $636.63
                    joint.
27612............  Exploration of ankle      Y................  .................  A2...............      $510.00        29.19    $1,208.50      $684.63
                    joint.
27613............  Biopsy lower leg soft     Y................  .................  P3...............  ...........       2.9376      $121.62      $121.62
                    tissue.
27614............  Biopsy lower leg soft     Y................  .................  A2...............      $446.00      21.1098      $873.97      $552.99
                    tissue.
27615............  Remove tumor, lower leg.  Y................  .................  A2...............      $510.00        29.19    $1,208.50      $684.63
27618............  Remove lower leg lesion.  Y................  .................  A2...............      $446.00      16.1001      $666.56      $501.14
27619............  Remove lower leg lesion.  Y................  .................  A2...............      $510.00      21.1098      $873.97      $600.99
27620............  Explore/treat ankle       Y................  .................  A2...............      $630.00        29.19    $1,208.50      $774.63
                    joint.
27625............  Remove ankle joint        Y................  .................  A2...............      $630.00        29.19    $1,208.50      $774.63
                    lining.
27626............  Remove ankle joint        Y................  .................  A2...............      $630.00        29.19    $1,208.50      $774.63
                    lining.
27630............  Removal of tendon lesion  Y................  .................  A2...............      $510.00      21.2689      $880.55      $602.64
27635............  Remove lower leg bone     Y................  .................  A2...............      $510.00        29.19    $1,208.50      $684.63
                    lesion.
27637............  Remove/graft leg bone     Y................  .................  A2...............      $510.00        29.19    $1,208.50      $684.63
                    lesion.
27638............  Remove/graft leg bone     Y................  .................  A2...............      $510.00        29.19    $1,208.50      $684.63
                    lesion.
27640............  Partial removal of tibia  Y................  .................  A2...............      $446.00       42.985    $1,779.62      $779.41
27641............  Partial removal of        Y................  .................  A2...............      $446.00        29.19    $1,208.50      $636.63
                    fibula.
27647............  Extensive ankle/heel      Y................  .................  A2...............      $510.00       42.985    $1,779.62      $827.41
                    surgery.
27648............  Injection for ankle x-    N................  .................  N1...............  ...........  ...........  ...........  ...........
                    ray.
27650............  Repair achilles tendon..  Y................  .................  A2...............      $510.00       42.985    $1,779.62      $827.41
27652............  Repair/graft achilles     Y................  .................  A2...............      $510.00      79.4244    $3,288.25    $1,204.56
                    tendon.
27654............  Repair of achilles        Y................  .................  A2...............      $510.00       42.985    $1,779.62      $827.41
                    tendon.
27656............  Repair leg fascia defect  Y................  .................  A2...............      $446.00      21.2689      $880.55      $554.64
27658............  Repair of leg tendon,     Y................  .................  A2...............      $333.00      21.2689      $880.55      $469.89
                    each.
27659............  Repair of leg tendon,     Y................  .................  A2...............      $446.00      21.2689      $880.55      $554.64
                    each.
27664............  Repair of leg tendon,     Y................  .................  A2...............      $446.00      21.2689      $880.55      $554.64
                    each.
27665............  Repair of leg tendon,     Y................  .................  A2...............      $446.00        29.19    $1,208.50      $636.63
                    each.
27675............  Repair lower leg tendons  Y................  .................  A2...............      $446.00      21.2689      $880.55      $554.64
27676............  Repair lower leg tendons  Y................  .................  A2...............      $510.00        29.19    $1,208.50      $684.63
27680............  Release of lower leg      Y................  .................  A2...............      $510.00        29.19    $1,208.50      $684.63
                    tendon.
27681............  Release of lower leg      Y................  .................  A2...............      $446.00        29.19    $1,208.50      $636.63
                    tendons.
27685............  Revision of lower leg     Y................  .................  A2...............      $510.00        29.19    $1,208.50      $684.63
                    tendon.
27686............  Revise lower leg tendons  Y................  .................  A2...............      $510.00        29.19    $1,208.50      $684.63
27687............  Revision of calf tendon.  Y................  .................  A2...............      $510.00        29.19    $1,208.50      $684.63
27690............  Revise lower leg tendon.  Y................  .................  A2...............      $630.00       42.985    $1,779.62      $917.41
27691............  Revise lower leg tendon.  Y................  .................  A2...............      $630.00       42.985    $1,779.62      $917.41
27692............  Revise additional leg     Y................  .................  A2...............      $510.00       42.985    $1,779.62      $827.41
                    tendon.
27695............  Repair of ankle ligament  Y................  .................  A2...............      $446.00        29.19    $1,208.50      $636.63
27696............  Repair of ankle           Y................  .................  A2...............      $446.00        29.19    $1,208.50      $636.63
                    ligaments.
27698............  Repair of ankle ligament  Y................  .................  A2...............      $446.00        29.19    $1,208.50      $636.63
27700............  Revision of ankle joint.  Y................  .................  A2...............      $717.00       35.904    $1,486.46      $909.37
27704............  Removal of ankle implant  Y................  .................  A2...............      $446.00      21.2689      $880.55      $554.64
27705............  Incision of tibia.......  Y................  .................  A2...............      $446.00       42.985    $1,779.62      $779.41
27707............  Incision of fibula......  Y................  .................  A2...............      $446.00      21.2689      $880.55      $554.64
27709............  Incision of tibia &       Y................  .................  A2...............      $446.00        29.19    $1,208.50      $636.63
                    fibula.
27726............  Repair fibula nonunion..  Y................  NI...............  G2...............  ...........      26.1592    $1,083.02    $1,083.02
27730............  Repair of tibia           Y................  .................  A2...............      $446.00        29.19    $1,208.50      $636.63
                    epiphysis.
27732............  Repair of fibula          Y................  .................  A2...............      $446.00        29.19    $1,208.50      $636.63
                    epiphysis.
27734............  Repair lower leg          Y................  .................  A2...............      $446.00        29.19    $1,208.50      $636.63
                    epiphyses.
27740............  Repair of leg epiphyses.  Y................  .................  A2...............      $446.00        29.19    $1,208.50      $636.63

[[Page 66963]]

 
27742............  Repair of leg epiphyses.  Y................  .................  A2...............      $446.00       42.985    $1,779.62      $779.41
27745............  Reinforce tibia.........  Y................  .................  A2...............      $510.00      79.4244    $3,288.25    $1,204.56
27750............  Treatment of tibia        Y................  .................  A2...............      $103.62       1.7682       $73.21       $96.02
                    fracture.
27752............  Treatment of tibia        Y................  .................  A2...............      $103.62       1.7682       $73.21       $96.02
                    fracture.
27756............  Treatment of tibia        Y................  .................  A2...............      $510.00      26.1592    $1,083.02      $653.26
                    fracture.
27758............  Treatment of tibia        Y................  .................  A2...............      $630.00      41.1091    $1,701.96      $897.99
                    fracture.
27759............  Treatment of tibia        Y................  .................  A2...............      $630.00      59.2233    $2,451.90    $1,085.48
                    fracture.
27760............  Cltx medial ankle fx....  Y................  .................  A2...............      $103.62       1.7682       $73.21       $96.02
27762............  Cltx med ankle fx w/mnpj  Y................  .................  A2...............      $103.62       1.7682       $73.21       $96.02
27766............  Optx medial ankle fx....  Y................  .................  A2...............      $510.00      41.1091    $1,701.96      $807.99
27767............  Cltx post ankle fx......  Y................  NI...............  G2...............  ...........       1.7682       $73.21       $73.21
27768............  Cltx post ankle fx w/     Y................  NI...............  G2...............  ...........       1.7682       $73.21       $73.21
                    mnpj.
27769............  Optx post ankle fx......  Y................  NI...............  G2...............  ...........      41.1091    $1,701.96    $1,701.96
27780............  Treatment of fibula       Y................  .................  A2...............      $103.62       1.7682       $73.21       $96.02
                    fracture.
27781............  Treatment of fibula       Y................  .................  A2...............      $103.62       1.7682       $73.21       $96.02
                    fracture.
27784............  Treatment of fibula       Y................  .................  A2...............      $510.00      41.1091    $1,701.96      $807.99
                    fracture.
27786............  Treatment of ankle        Y................  .................  A2...............      $103.62       1.7682       $73.21       $96.02
                    fracture.
27788............  Treatment of ankle        Y................  .................  A2...............      $103.62       1.7682       $73.21       $96.02
                    fracture.
27792............  Treatment of ankle        Y................  .................  A2...............      $510.00      41.1091    $1,701.96      $807.99
                    fracture.
27808............  Treatment of ankle        Y................  .................  A2...............      $103.62       1.7682       $73.21       $96.02
                    fracture.
27810............  Treatment of ankle        Y................  .................  A2...............      $103.62       1.7682       $73.21       $96.02
                    fracture.
27814............  Treatment of ankle        Y................  .................  A2...............      $510.00      41.1091    $1,701.96      $807.99
                    fracture.
27816............  Treatment of ankle        Y................  .................  A2...............      $103.62       1.7682       $73.21       $96.02
                    fracture.
27818............  Treatment of ankle        Y................  .................  A2...............      $103.62       1.7682       $73.21       $96.02
                    fracture.
27822............  Treatment of ankle        Y................  .................  A2...............      $510.00      41.1091    $1,701.96      $807.99
                    fracture.
27823............  Treatment of ankle        Y................  .................  A2...............      $510.00      59.2233    $2,451.90      $995.48
                    fracture.
27824............  Treat lower leg fracture  Y................  .................  A2...............      $103.62       1.7682       $73.21       $96.02
27825............  Treat lower leg fracture  Y................  .................  A2...............      $103.62       1.7682       $73.21       $96.02
27826............  Treat lower leg fracture  Y................  .................  A2...............      $510.00      41.1091    $1,701.96      $807.99
27827............  Treat lower leg fracture  Y................  .................  A2...............      $510.00      59.2233    $2,451.90      $995.48
27828............  Treat lower leg fracture  Y................  .................  A2...............      $630.00      59.2233    $2,451.90    $1,085.48
27829............  Treat lower leg joint...  Y................  .................  A2...............      $446.00      41.1091    $1,701.96      $759.99
27830............  Treat lower leg           Y................  .................  A2...............      $103.62       1.7682       $73.21       $96.02
                    dislocation.
27831............  Treat lower leg           Y................  .................  A2...............      $103.62       1.7682       $73.21       $96.02
                    dislocation.
27832............  Treat lower leg           Y................  .................  A2...............      $446.00      41.1091    $1,701.96      $759.99
                    dislocation.
27840............  Treat ankle dislocation.  Y................  .................  A2...............      $103.62       1.7682       $73.21       $96.02
27842............  Treat ankle dislocation.  Y................  .................  A2...............      $333.00      14.7658      $611.32      $402.58
27846............  Treat ankle dislocation.  Y................  .................  A2...............      $510.00      41.1091    $1,701.96      $807.99
27848............  Treat ankle dislocation.  Y................  .................  A2...............      $510.00      41.1091    $1,701.96      $807.99
27860............  Fixation of ankle joint.  Y................  .................  A2...............      $333.00      14.7658      $611.32      $402.58
27870............  Fusion of ankle joint,    Y................  .................  A2...............      $630.00      79.4244    $3,288.25    $1,294.56
                    open.
27871............  Fusion of tibiofibular    Y................  .................  A2...............      $630.00      79.4244    $3,288.25    $1,294.56
                    joint.
27884............  Amputation follow-up      Y................  .................  A2...............      $510.00      21.2689      $880.55      $602.64
                    surgery.
27889............  Amputation of foot at     Y................  .................  A2...............      $510.00        29.19    $1,208.50      $684.63
                    ankle.
27892............  Decompression of leg....  Y................  .................  A2...............      $510.00      21.2689      $880.55      $602.64
27893............  Decompression of leg....  Y................  .................  A2...............      $510.00      21.2689      $880.55      $602.64
27894............  Decompression of leg....  Y................  .................  A2...............      $510.00      21.2689      $880.55      $602.64
28001............  Drainage of bursa of      Y................  .................  P3...............  ...........       2.8719      $118.90      $118.90
                    foot.
28002............  Treatment of foot         Y................  .................  A2...............      $510.00      21.2689      $880.55      $602.64
                    infection.
28003............  Treatment of foot         Y................  .................  A2...............      $510.00      21.2689      $880.55      $602.64
                    infection.
28005............  Treat foot bone lesion..  Y................  .................  A2...............      $510.00      20.8284      $862.32      $598.08
28008............  Incision of foot fascia.  Y................  .................  A2...............      $510.00      20.8284      $862.32      $598.08
28010............  Incision of toe tendon..  Y................  .................  P3...............  ...........        2.156       $89.26       $89.26
28011............  Incision of toe tendons.  Y................  .................  A2...............      $510.00      20.8284      $862.32      $598.08
28020............  Exploration of foot       Y................  .................  A2...............      $446.00      20.8284      $862.32      $550.08
                    joint.
28022............  Exploration of foot       Y................  .................  A2...............      $446.00      20.8284      $862.32      $550.08
                    joint.
28024............  Exploration of toe joint  Y................  .................  A2...............      $446.00      20.8284      $862.32      $550.08
28035............  Decompression of tibia    Y................  .................  A2...............      $630.00      18.0518      $747.36      $659.34
                    nerve.
28043............  Excision of foot lesion.  Y................  .................  A2...............      $446.00      21.1098      $873.97      $552.99
28045............  Excision of foot lesion.  Y................  .................  A2...............      $510.00      20.8284      $862.32      $598.08
28046............  Resection of tumor, foot  Y................  .................  A2...............      $510.00      20.8284      $862.32      $598.08
28050............  Biopsy of foot joint      Y................  .................  A2...............      $446.00      20.8284      $862.32      $550.08
                    lining.
28052............  Biopsy of foot joint      Y................  .................  A2...............      $446.00      20.8284      $862.32      $550.08
                    lining.
28054............  Biopsy of toe joint       Y................  .................  A2...............      $446.00      20.8284      $862.32      $550.08
                    lining.
28055............  Neurectomy, foot........  Y................  .................  A2...............      $630.00      18.0518      $747.36      $659.34
28060............  Partial removal, foot     Y................  .................  A2...............      $446.00      20.8284      $862.32      $550.08
                    fascia.
28062............  Removal of foot fascia..  Y................  .................  A2...............      $510.00      20.8284      $862.32      $598.08
28070............  Removal of foot joint     Y................  .................  A2...............      $510.00      20.8284      $862.32      $598.08
                    lining.
28072............  Removal of foot joint     Y................  .................  A2...............      $510.00      20.8284      $862.32      $598.08
                    lining.
28080............  Removal of foot lesion..  Y................  .................  A2...............      $510.00      20.8284      $862.32      $598.08
28086............  Excise foot tendon        Y................  .................  A2...............      $446.00      20.8284      $862.32      $550.08
                    sheath.
28088............  Excise foot tendon        Y................  .................  A2...............      $446.00      20.8284      $862.32      $550.08
                    sheath.
28090............  Removal of foot lesion..  Y................  .................  A2...............      $510.00      20.8284      $862.32      $598.08

[[Page 66964]]

 
28092............  Removal of toe lesions..  Y................  .................  A2...............      $510.00      20.8284      $862.32      $598.08
28100............  Removal of ankle/heel     Y................  .................  A2...............      $446.00      20.8284      $862.32      $550.08
                    lesion.
28102............  Remove/graft foot lesion  Y................  .................  A2...............      $510.00      44.2687    $1,832.77      $840.69
28103............  Remove/graft foot lesion  Y................  .................  A2...............      $510.00      44.2687    $1,832.77      $840.69
28104............  Removal of foot lesion..  Y................  .................  A2...............      $446.00      20.8284      $862.32      $550.08
28106............  Remove/graft foot lesion  Y................  .................  A2...............      $510.00      44.2687    $1,832.77      $840.69
28107............  Remove/graft foot lesion  Y................  .................  A2...............      $510.00      44.2687    $1,832.77      $840.69
28108............  Removal of toe lesions..  Y................  .................  A2...............      $446.00      20.8284      $862.32      $550.08
28110............  Part removal of           Y................  .................  A2...............      $510.00      20.8284      $862.32      $598.08
                    metatarsal.
28111............  Part removal of           Y................  .................  A2...............      $510.00      20.8284      $862.32      $598.08
                    metatarsal.
28112............  Part removal of           Y................  .................  A2...............      $510.00      20.8284      $862.32      $598.08
                    metatarsal.
28113............  Part removal of           Y................  .................  A2...............      $510.00      20.8284      $862.32      $598.08
                    metatarsal.
28114............  Removal of metatarsal     Y................  .................  A2...............      $510.00      20.8284      $862.32      $598.08
                    heads.
28116............  Revision of foot........  Y................  .................  A2...............      $510.00      20.8284      $862.32      $598.08
28118............  Removal of heel bone....  Y................  .................  A2...............      $630.00      20.8284      $862.32      $688.08
28119............  Removal of heel spur....  Y................  .................  A2...............      $630.00      20.8284      $862.32      $688.08
28120............  Part removal of ankle/    Y................  .................  A2...............      $995.00      20.8284      $862.32      $961.83
                    heel.
28122............  Partial removal of foot   Y................  .................  A2...............      $510.00      20.8284      $862.32      $598.08
                    bone.
28124............  Partial removal of toe..  Y................  .................  P3...............  ...........       4.8385      $200.32      $200.32
28126............  Partial removal of toe..  Y................  .................  A2...............      $510.00      20.8284      $862.32      $598.08
28130............  Removal of ankle bone...  Y................  .................  A2...............      $510.00      20.8284      $862.32      $598.08
28140............  Removal of metatarsal...  Y................  .................  A2...............      $510.00      20.8284      $862.32      $598.08
28150............  Removal of toe..........  Y................  .................  A2...............      $510.00      20.8284      $862.32      $598.08
28153............  Partial removal of toe..  Y................  .................  A2...............      $510.00      20.8284      $862.32      $598.08
28160............  Partial removal of toe..  Y................  .................  A2...............      $510.00      20.8284      $862.32      $598.08
28171............  Extensive foot surgery..  Y................  .................  A2...............      $510.00      20.8284      $862.32      $598.08
28173............  Extensive foot surgery..  Y................  .................  A2...............      $510.00      20.8284      $862.32      $598.08
28175............  Extensive foot surgery..  Y................  .................  A2...............      $510.00      20.8284      $862.32      $598.08
28190............  Removal of foot foreign   Y................  .................  P3...............  ...........       3.0446      $126.05      $126.05
                    body.
28192............  Removal of foot foreign   Y................  .................  A2...............      $446.00      16.1001      $666.56      $501.14
                    body.
28193............  Removal of foot foreign   Y................  .................  A2...............      $418.49        8.685      $359.57      $403.76
                    body.
28200............  Repair of foot tendon...  Y................  .................  A2...............      $510.00      20.8284      $862.32      $598.08
28202............  Repair/graft of foot      Y................  .................  A2...............      $510.00      20.8284      $862.32      $598.08
                    tendon.
28208............  Repair of foot tendon...  Y................  .................  A2...............      $510.00      20.8284      $862.32      $598.08
28210............  Repair/graft of foot      Y................  .................  A2...............      $510.00      44.2687    $1,832.77      $840.69
                    tendon.
28220............  Release of foot tendon..  Y................  .................  P3...............  ...........       4.5588      $188.74      $188.74
28222............  Release of foot tendons.  Y................  .................  A2...............      $333.00      20.8284      $862.32      $465.33
28225............  Release of foot tendon..  Y................  .................  A2...............      $333.00      20.8284      $862.32      $465.33
28226............  Release of foot tendons.  Y................  .................  A2...............      $333.00      20.8284      $862.32      $465.33
28230............  Incision of foot          Y................  .................  P3...............  ...........       4.4929      $186.01      $186.01
                    tendon(s).
28232............  Incision of toe tendon..  Y................  .................  P3...............  ...........       4.2955      $177.84      $177.84
28234............  Incision of foot tendon.  Y................  .................  A2...............      $446.00      20.8284      $862.32      $550.08
28238............  Revision of foot tendon.  Y................  .................  A2...............      $510.00      44.2687    $1,832.77      $840.69
28240............  Release of big toe......  Y................  .................  A2...............      $446.00      20.8284      $862.32      $550.08
28250............  Revision of foot fascia.  Y................  .................  A2...............      $510.00      20.8284      $862.32      $598.08
28260............  Release of midfoot joint  Y................  .................  A2...............      $510.00      20.8284      $862.32      $598.08
28261............  Revision of foot tendon.  Y................  .................  A2...............      $510.00      20.8284      $862.32      $598.08
28262............  Revision of foot and      Y................  .................  A2...............      $630.00      20.8284      $862.32      $688.08
                    ankle.
28264............  Release of midfoot joint  Y................  .................  A2...............      $333.00      44.2687    $1,832.77      $707.94
28270............  Release of foot           Y................  .................  A2...............      $510.00      20.8284      $862.32      $598.08
                    contracture.
28272............  Release of toe joint,     Y................  .................  P3...............  ...........       4.1144      $170.34      $170.34
                    each.
28280............  Fusion of toes..........  Y................  .................  A2...............      $446.00      20.8284      $862.32      $550.08
28285............  Repair of hammertoe.....  Y................  .................  A2...............      $510.00      20.8284      $862.32      $598.08
28286............  Repair of hammertoe.....  Y................  .................  A2...............      $630.00      20.8284      $862.32      $688.08
28288............  Partial removal of foot   Y................  .................  A2...............      $510.00      20.8284      $862.32      $598.08
                    bone.
28289............  Repair hallux rigidus...  Y................  .................  A2...............      $510.00      20.8284      $862.32      $598.08
28290............  Correction of bunion....  Y................  .................  A2...............      $446.00      29.4167    $1,217.88      $638.97
28292............  Correction of bunion....  Y................  .................  A2...............      $446.00      29.4167    $1,217.88      $638.97
28293............  Correction of bunion....  Y................  .................  A2...............      $510.00      29.4167    $1,217.88      $686.97
28294............  Correction of bunion....  Y................  .................  A2...............      $510.00      29.4167    $1,217.88      $686.97
28296............  Correction of bunion....  Y................  .................  A2...............      $510.00      29.4167    $1,217.88      $686.97
28297............  Correction of bunion....  Y................  .................  A2...............      $510.00      29.4167    $1,217.88      $686.97
28298............  Correction of bunion....  Y................  .................  A2...............      $510.00      29.4167    $1,217.88      $686.97
28299............  Correction of bunion....  Y................  .................  A2...............      $717.00      29.4167    $1,217.88      $842.22
28300............  Incision of heel bone...  Y................  .................  A2...............      $446.00      44.2687    $1,832.77      $792.69
28302............  Incision of ankle bone..  Y................  .................  A2...............      $446.00      20.8284      $862.32      $550.08
28304............  Incision of midfoot       Y................  .................  A2...............      $446.00      44.2687    $1,832.77      $792.69
                    bones.
28305............  Incise/graft midfoot      Y................  .................  A2...............      $510.00      44.2687    $1,832.77      $840.69
                    bones.
28306............  Incision of metatarsal..  Y................  .................  A2...............      $630.00      20.8284      $862.32      $688.08
28307............  Incision of metatarsal..  Y................  .................  A2...............      $630.00      20.8284      $862.32      $688.08
28308............  Incision of metatarsal..  Y................  .................  A2...............      $446.00      20.8284      $862.32      $550.08
28309............  Incision of metatarsals.  Y................  .................  A2...............      $630.00      44.2687    $1,832.77      $930.69
28310............  Revision of big toe.....  Y................  .................  A2...............      $510.00      20.8284      $862.32      $598.08

[[Page 66965]]

 
28312............  Revision of toe.........  Y................  .................  A2...............      $510.00      20.8284      $862.32      $598.08
28313............  Repair deformity of toe.  Y................  .................  A2...............      $446.00      20.8284      $862.32      $550.08
28315............  Removal of sesamoid bone  Y................  .................  A2...............      $630.00      20.8284      $862.32      $688.08
28320............  Repair of foot bones....  Y................  .................  A2...............      $630.00      44.2687    $1,832.77      $930.69
28322............  Repair of metatarsals...  Y................  .................  A2...............      $630.00      44.2687    $1,832.77      $930.69
28340............  Resect enlarged toe       Y................  .................  A2...............      $630.00      20.8284      $862.32      $688.08
                    tissue.
28341............  Resect enlarged toe.....  Y................  .................  A2...............      $630.00      20.8284      $862.32      $688.08
28344............  Repair extra toe(s).....  Y................  .................  A2...............      $630.00      20.8284      $862.32      $688.08
28345............  Repair webbed toe(s)....  Y................  .................  A2...............      $630.00      20.8284      $862.32      $688.08
28400............  Treatment of heel         Y................  .................  A2...............      $103.62       1.7682       $73.21       $96.02
                    fracture.
28405............  Treatment of heel         Y................  .................  A2...............      $103.62       1.7682       $73.21       $96.02
                    fracture.
28406............  Treatment of heel         Y................  .................  A2...............      $446.00      26.1592    $1,083.02      $605.26
                    fracture.
28415............  Treat heel fracture.....  Y................  .................  A2...............      $510.00      59.2233    $2,451.90      $995.48
28420............  Treat/graft heel          Y................  .................  A2...............      $630.00      41.1091    $1,701.96      $897.99
                    fracture.
28430............  Treatment of ankle        Y................  .................  P2...............  ...........       1.7682       $73.21       $73.21
                    fracture.
28435............  Treatment of ankle        Y................  .................  A2...............      $103.62       1.7682       $73.21       $96.02
                    fracture.
28436............  Treatment of ankle        Y................  .................  A2...............      $446.00      26.1592    $1,083.02      $605.26
                    fracture.
28445............  Treat ankle fracture....  Y................  .................  A2...............      $510.00      41.1091    $1,701.96      $807.99
28446............  Osteochondral talus       Y................  NI...............  G2...............  ...........      44.2687    $1,832.77    $1,832.77
                    autogrft.
28450............  Treat midfoot fracture,   Y................  .................  P2...............  ...........       1.7682       $73.21       $73.21
                    each.
28455............  Treat midfoot fracture,   Y................  .................  P2...............  ...........       1.7682       $73.21       $73.21
                    each.
28456............  Treat midfoot fracture..  Y................  .................  A2...............      $446.00      26.1592    $1,083.02      $605.26
28465............  Treat midfoot fracture,   Y................  .................  A2...............      $510.00      41.1091    $1,701.96      $807.99
                    each.
28470............  Treat metatarsal          Y................  .................  P2...............  ...........       1.7682       $73.21       $73.21
                    fracture.
28475............  Treat metatarsal          Y................  .................  P2...............  ...........       1.7682       $73.21       $73.21
                    fracture.
28476............  Treat metatarsal          Y................  .................  A2...............      $446.00      26.1592    $1,083.02      $605.26
                    fracture.
28485............  Treat metatarsal          Y................  .................  A2...............      $630.00      41.1091    $1,701.96      $897.99
                    fracture.
28490............  Treat big toe fracture..  Y................  .................  P3...............  ...........       1.6869       $69.84       $69.84
28495............  Treat big toe fracture..  Y................  .................  P2...............  ...........       1.7682       $73.21       $73.21
28496............  Treat big toe fracture..  Y................  .................  A2...............      $446.00      26.1592    $1,083.02      $605.26
28505............  Treat big toe fracture..  Y................  .................  A2...............      $510.00      26.1592    $1,083.02      $653.26
28510............  Treatment of toe          Y................  .................  P3...............  ...........       1.3166       $54.51       $54.51
                    fracture.
28515............  Treatment of toe          Y................  .................  P3...............  ...........       1.6951       $70.18       $70.18
                    fracture.
28525............  Treat toe fracture......  Y................  .................  A2...............      $510.00      26.1592    $1,083.02      $653.26
28530............  Treat sesamoid bone       Y................  .................  P3...............  ...........       1.2589       $52.12       $52.12
                    fracture.
28531............  Treat sesamoid bone       Y................  .................  A2...............      $510.00      26.1592    $1,083.02      $653.26
                    fracture.
28540............  Treat foot dislocation..  Y................  .................  P2...............  ...........       1.7682       $73.21       $73.21
28545............  Treat foot dislocation..  Y................  .................  A2...............      $333.00      26.1592    $1,083.02      $520.51
28546............  Treat foot dislocation..  Y................  .................  A2...............      $446.00      26.1592    $1,083.02      $605.26
28555............  Repair foot dislocation.  Y................  .................  A2...............      $446.00      41.1091    $1,701.96      $759.99
28570............  Treat foot dislocation..  Y................  .................  P2...............  ...........       1.7682       $73.21       $73.21
28575............  Treat foot dislocation..  Y................  .................  A2...............      $103.62       1.7682       $73.21       $96.02
28576............  Treat foot dislocation..  Y................  .................  A2...............      $510.00      26.1592    $1,083.02      $653.26
28585............  Repair foot dislocation.  Y................  .................  A2...............      $510.00      26.1592    $1,083.02      $653.26
28600............  Treat foot dislocation..  Y................  .................  P2...............  ...........       1.7682       $73.21       $73.21
28605............  Treat foot dislocation..  Y................  .................  A2...............      $103.62       1.7682       $73.21       $96.02
28606............  Treat foot dislocation..  Y................  .................  A2...............      $446.00      26.1592    $1,083.02      $605.26
28615............  Repair foot dislocation.  Y................  .................  A2...............      $510.00      41.1091    $1,701.96      $807.99
28630............  Treat toe dislocation...  Y................  CH...............  P3...............  ...........        1.399       $57.92       $57.92
28635............  Treat toe dislocation...  Y................  .................  A2...............      $333.00      14.7658      $611.32      $402.58
28636............  Treat toe dislocation...  Y................  .................  A2...............      $510.00      26.1592    $1,083.02      $653.26
28645............  Repair toe dislocation..  Y................  .................  A2...............      $510.00      26.1592    $1,083.02      $653.26
28660............  Treat toe dislocation...  Y................  CH...............  P3...............  ...........       1.0534       $43.61       $43.61
28665............  Treat toe dislocation...  Y................  .................  A2...............      $333.00      14.7658      $611.32      $402.58
28666............  Treat toe dislocation...  Y................  .................  A2...............      $510.00      26.1592    $1,083.02      $653.26
28675............  Repair of toe             Y................  .................  A2...............      $510.00      26.1592    $1,083.02      $653.26
                    dislocation.
28705............  Fusion of foot bones....  Y................  .................  A2...............      $630.00      44.2687    $1,832.77      $930.69
28715............  Fusion of foot bones....  Y................  .................  A2...............      $630.00      79.4244    $3,288.25    $1,294.56
28725............  Fusion of foot bones....  Y................  .................  A2...............      $630.00      44.2687    $1,832.77      $930.69
28730............  Fusion of foot bones....  Y................  .................  A2...............      $630.00      44.2687    $1,832.77      $930.69
28735............  Fusion of foot bones....  Y................  .................  A2...............      $630.00      44.2687    $1,832.77      $930.69
28737............  Revision of foot bones..  Y................  .................  A2...............      $717.00      44.2687    $1,832.77      $995.94
28740............  Fusion of foot bones....  Y................  .................  A2...............      $630.00      44.2687    $1,832.77      $930.69
28750............  Fusion of big toe joint.  Y................  .................  A2...............      $630.00      44.2687    $1,832.77      $930.69
28755............  Fusion of big toe joint.  Y................  .................  A2...............      $630.00      20.8284      $862.32      $688.08
28760............  Fusion of big toe joint.  Y................  .................  A2...............      $630.00      44.2687    $1,832.77      $930.69
28810............  Amputation toe &          Y................  .................  A2...............      $446.00      20.8284      $862.32      $550.08
                    metatarsal.
28820............  Amputation of toe.......  Y................  .................  A2...............      $446.00      20.8284      $862.32      $550.08
28825............  Partial amputation of     Y................  .................  A2...............      $446.00      20.8284      $862.32      $550.08
                    toe.
28890*...........  High energy eswt,         Y................  CH...............  P3...............  ...........       4.2296      $175.11      $175.11
                    plantar f.
29000............  Application of body cast  N................  .................  G2...............  ...........       1.0931       $45.26       $45.26
29010............  Application of body cast  N................  .................  P2...............  ...........        2.291       $94.85       $94.85
29015............  Application of body cast  N................  .................  P2...............  ...........        2.291       $94.85       $94.85

[[Page 66966]]

 
29020............  Application of body cast  N................  .................  G2...............  ...........       1.0931       $45.26       $45.26
29025............  Application of body cast  N................  .................  P2...............  ...........       1.0931       $45.26       $45.26
29035............  Application of body cast  N................  CH...............  P2...............  ...........        2.291       $94.85       $94.85
29040............  Application of body cast  N................  .................  G2...............  ...........       1.0931       $45.26       $45.26
29044............  Application of body cast  N................  .................  P2...............  ...........        2.291       $94.85       $94.85
29046............  Application of body cast  N................  .................  G2...............  ...........        2.291       $94.85       $94.85
29049............  Application of figure     N................  .................  P3...............  ...........       0.9956       $41.22       $41.22
                    eight.
29055............  Application of shoulder   N................  .................  P2...............  ...........        2.291       $94.85       $94.85
                    cast.
29058............  Application of shoulder   N................  .................  P2...............  ...........       1.0931       $45.26       $45.26
                    cast.
29065............  Application of long arm   N................  .................  P3...............  ...........       1.0698       $44.29       $44.29
                    cast.
29075............  Application of forearm    N................  .................  P3...............  ...........       1.0203       $42.24       $42.24
                    cast.
29085............  Apply hand/wrist cast...  N................  .................  P3...............  ...........       1.0451       $43.27       $43.27
29086............  Apply finger cast.......  N................  .................  P3...............  ...........       0.8394       $34.75       $34.75
29105............  Apply long arm splint...  N................  .................  P3...............  ...........       0.9546       $39.52       $39.52
29125............  Apply forearm splint....  N................  .................  P3...............  ...........       0.8147       $33.73       $33.73
29126............  Apply forearm splint....  N................  .................  P3...............  ...........       0.9135       $37.82       $37.82
29130............  Application of finger     N................  .................  P3...............  ...........       0.3703       $15.33       $15.33
                    splint.
29131............  Application of finger     N................  .................  P3...............  ...........       0.5432       $22.49       $22.49
                    splint.
29200............  Strapping of chest......  N................  .................  P3...............  ...........       0.5432       $22.49       $22.49
29220............  Strapping of low back...  N................  .................  P3...............  ...........       0.5596       $23.17       $23.17
29240............  Strapping of shoulder...  N................  .................  P3...............  ...........       0.6253       $25.89       $25.89
29260............  Strapping of elbow or     N................  .................  P3...............  ...........       0.5761       $23.85       $23.85
                    wrist.
29280............  Strapping of hand or      N................  .................  P3...............  ...........       0.6007       $24.87       $24.87
                    finger.
29305............  Application of hip cast.  N................  CH...............  P2...............  ...........        2.291       $94.85       $94.85
29325............  Application of hip casts  N................  CH...............  P2...............  ...........        2.291       $94.85       $94.85
29345............  Application of long leg   N................  .................  P3...............  ...........       1.4072       $58.26       $58.26
                    cast.
29355............  Application of long leg   N................  .................  P3...............  ...........       1.3659       $56.55       $56.55
                    cast.
29358............  Apply long leg cast       N................  .................  P3...............  ...........       1.6705       $69.16       $69.16
                    brace.
29365............  Application of long leg   N................  .................  P3...............  ...........       1.3331       $55.19       $55.19
                    cast.
29405............  Apply short leg cast....  N................  .................  P3...............  ...........       0.9874       $40.88       $40.88
29425............  Apply short leg cast....  N................  .................  P3...............  ...........       1.0038       $41.56       $41.56
29435............  Apply short leg cast....  N................  .................  P3...............  ...........       1.2674       $52.47       $52.47
29440............  Addition of walker to     N................  .................  P3...............  ...........       0.5514       $22.83       $22.83
                    cast.
29445............  Apply rigid leg cast....  N................  .................  P3...............  ...........       1.3823       $57.23       $57.23
29450............  Application of leg cast.  N................  .................  P2...............  ...........       1.0931       $45.26       $45.26
29505............  Application, long leg     N................  CH...............  P3...............  ...........       0.9217       $38.16       $38.16
                    splint.
29515............  Application lower leg     N................  CH...............  P3...............  ...........       0.7488       $31.00       $31.00
                    splint.
29520............  Strapping of hip........  N................  .................  P3...............  ...........       0.6171       $25.55       $25.55
29530............  Strapping of knee.......  N................  .................  P3...............  ...........       0.5925       $24.53       $24.53
29540............  Strapping of ankle and/   N................  .................  P3...............  ...........       0.3949       $16.35       $16.35
                    or ft.
29550............  Strapping of toes.......  N................  .................  P3...............  ...........       0.4031       $16.69       $16.69
29580............  Application of paste      N................  .................  P3...............  ...........       0.5596       $23.17       $23.17
                    boot.
29590............  Application of foot       N................  .................  P3...............  ...........       0.4526       $18.74       $18.74
                    splint.
29700............  Removal/revision of cast  N................  .................  P3...............  ...........        0.757       $31.34       $31.34
29705............  Removal/revision of cast  N................  .................  P3...............  ...........         0.65       $26.91       $26.91
29710............  Removal/revision of cast  N................  .................  P3...............  ...........       1.1686       $48.38       $48.38
29715............  Removal/revision of cast  N................  .................  P3...............  ...........        0.971       $40.20       $40.20
29720............  Repair of body cast.....  N................  .................  P3...............  ...........       0.9546       $39.52       $39.52
29730............  Windowing of cast.......  N................  .................  P3...............  ...........       0.6336       $26.23       $26.23
29740............  Wedging of cast.........  N................  .................  P3...............  ...........       0.8968       $37.13       $37.13
29750............  Wedging of clubfoot cast  N................  .................  P3...............  ...........       0.8722       $36.11       $36.11
29800............  Jaw arthroscopy/surgery.  Y................  .................  A2...............      $510.00      28.7803    $1,191.53      $680.38
29804............  Jaw arthroscopy/surgery.  Y................  .................  A2...............      $510.00      28.7803    $1,191.53      $680.38
29805............  Shoulder arthroscopy, dx  Y................  .................  A2...............      $510.00      28.7803    $1,191.53      $680.38
29806............  Shoulder arthroscopy/     Y................  .................  A2...............      $510.00      45.7072    $1,892.32      $855.58
                    surgery.
29807............  Shoulder arthroscopy/     Y................  .................  A2...............      $510.00      45.7072    $1,892.32      $855.58
                    surgery.
29819............  Shoulder arthroscopy/     Y................  .................  A2...............      $510.00      45.7072    $1,892.32      $855.58
                    surgery.
29820............  Shoulder arthroscopy/     Y................  .................  A2...............      $510.00      45.7072    $1,892.32      $855.58
                    surgery.
29821............  Shoulder arthroscopy/     Y................  .................  A2...............      $510.00      45.7072    $1,892.32      $855.58
                    surgery.
29822............  Shoulder arthroscopy/     Y................  .................  A2...............      $510.00      28.7803    $1,191.53      $680.38
                    surgery.
29823............  Shoulder arthroscopy/     Y................  .................  A2...............      $510.00      45.7072    $1,892.32      $855.58
                    surgery.
29824............  Shoulder arthroscopy/     Y................  .................  A2...............      $717.00      28.7803    $1,191.53      $835.63
                    surgery.
29825............  Shoulder arthroscopy/     Y................  .................  A2...............      $510.00      45.7072    $1,892.32      $855.58
                    surgery.
29826............  Shoulder arthroscopy/     Y................  .................  A2...............      $510.00      45.7072    $1,892.32      $855.58
                    surgery.
29827............  Arthroscop rotator cuff   Y................  .................  A2...............      $717.00      45.7072    $1,892.32    $1,010.83
                    repr.
29828............  Arthroscopy biceps        Y................  NI...............  G2...............  ...........      45.7072    $1,892.32    $1,892.32
                    tenodesis.
29830............  Elbow arthroscopy.......  Y................  .................  A2...............      $510.00      28.7803    $1,191.53      $680.38
29834............  Elbow arthroscopy/        Y................  .................  A2...............      $510.00      28.7803    $1,191.53      $680.38
                    surgery.
29835............  Elbow arthroscopy/        Y................  .................  A2...............      $510.00      28.7803    $1,191.53      $680.38
                    surgery.
29836............  Elbow arthroscopy/        Y................  .................  A2...............      $510.00      28.7803    $1,191.53      $680.38
                    surgery.
29837............  Elbow arthroscopy/        Y................  .................  A2...............      $510.00      28.7803    $1,191.53      $680.38
                    surgery.
29838............  Elbow arthroscopy/        Y................  .................  A2...............      $510.00      28.7803    $1,191.53      $680.38
                    surgery.
29840............  Wrist arthroscopy.......  Y................  .................  A2...............      $510.00      28.7803    $1,191.53      $680.38

[[Page 66967]]

 
29843............  Wrist arthroscopy/        Y................  .................  A2...............      $510.00      28.7803    $1,191.53      $680.38
                    surgery.
29844............  Wrist arthroscopy/        Y................  .................  A2...............      $510.00      28.7803    $1,191.53      $680.38
                    surgery.
29845............  Wrist arthroscopy/        Y................  .................  A2...............      $510.00      28.7803    $1,191.53      $680.38
                    surgery.
29846............  Wrist arthroscopy/        Y................  .................  A2...............      $510.00      28.7803    $1,191.53      $680.38
                    surgery.
29847............  Wrist arthroscopy/        Y................  .................  A2...............      $510.00      45.7072    $1,892.32      $855.58
                    surgery.
29848............  Wrist endoscopy/surgery.  Y................  .................  A2...............    $1,339.00      28.7803    $1,191.53    $1,302.13
29850............  Knee arthroscopy/surgery  Y................  .................  A2...............      $630.00      28.7803    $1,191.53      $770.38
29851............  Knee arthroscopy/surgery  Y................  .................  A2...............      $630.00      45.7072    $1,892.32      $945.58
29855............  Tibial arthroscopy/       Y................  .................  A2...............      $630.00      45.7072    $1,892.32      $945.58
                    surgery.
29856............  Tibial arthroscopy/       Y................  .................  A2...............      $630.00      45.7072    $1,892.32      $945.58
                    surgery.
29860............  Hip arthroscopy, dx.....  Y................  .................  A2...............      $630.00      45.7072    $1,892.32      $945.58
29861............  Hip arthroscopy/surgery.  Y................  .................  A2...............      $630.00      45.7072    $1,892.32      $945.58
29862............  Hip arthroscopy/surgery.  Y................  .................  A2...............    $1,339.00      45.7072    $1,892.32    $1,477.33
29863............  Hip arthroscopy/surgery.  Y................  .................  A2...............      $630.00      45.7072    $1,892.32      $945.58
29866............  Autgrft implnt, knee w/   Y................  CH...............  G2...............  ...........      45.7072    $1,892.32    $1,892.32
                    scope.
29870............  Knee arthroscopy, dx....  Y................  .................  A2...............      $510.00      28.7803    $1,191.53      $680.38
29871............  Knee arthroscopy/         Y................  .................  A2...............      $510.00      28.7803    $1,191.53      $680.38
                    drainage.
29873............  Knee arthroscopy/surgery  Y................  .................  A2...............      $510.00      28.7803    $1,191.53      $680.38
29874............  Knee arthroscopy/surgery  Y................  .................  A2...............      $510.00      28.7803    $1,191.53      $680.38
29875............  Knee arthroscopy/surgery  Y................  .................  A2...............      $630.00      28.7803    $1,191.53      $770.38
29876............  Knee arthroscopy/surgery  Y................  .................  A2...............      $630.00      28.7803    $1,191.53      $770.38
29877............  Knee arthroscopy/surgery  Y................  .................  A2...............      $630.00      28.7803    $1,191.53      $770.38
29879............  Knee arthroscopy/surgery  Y................  .................  A2...............      $510.00      28.7803    $1,191.53      $680.38
29880............  Knee arthroscopy/surgery  Y................  .................  A2...............      $630.00      28.7803    $1,191.53      $770.38
29881............  Knee arthroscopy/surgery  Y................  .................  A2...............      $630.00      28.7803    $1,191.53      $770.38
29882............  Knee arthroscopy/surgery  Y................  .................  A2...............      $510.00      28.7803    $1,191.53      $680.38
29883............  Knee arthroscopy/surgery  Y................  .................  A2...............      $510.00      28.7803    $1,191.53      $680.38
29884............  Knee arthroscopy/surgery  Y................  .................  A2...............      $510.00      28.7803    $1,191.53      $680.38
29885............  Knee arthroscopy/surgery  Y................  .................  A2...............      $510.00      45.7072    $1,892.32      $855.58
29886............  Knee arthroscopy/surgery  Y................  .................  A2...............      $510.00      28.7803    $1,191.53      $680.38
29887............  Knee arthroscopy/surgery  Y................  .................  A2...............      $510.00      28.7803    $1,191.53      $680.38
29888............  Knee arthroscopy/surgery  Y................  .................  A2...............      $510.00      45.7072    $1,892.32      $855.58
29889............  Knee arthroscopy/surgery  Y................  .................  A2...............      $510.00      45.7072    $1,892.32      $855.58
29891............  Ankle arthroscopy/        Y................  .................  A2...............      $510.00      45.7072    $1,892.32      $855.58
                    surgery.
29892............  Ankle arthroscopy/        Y................  .................  A2...............      $510.00      45.7072    $1,892.32      $855.58
                    surgery.
29893............  Scope, plantar            Y................  .................  A2...............    $1,255.56      20.8284      $862.32    $1,157.25
                    fasciotomy.
29894............  Ankle arthroscopy/        Y................  .................  A2...............      $510.00      28.7803    $1,191.53      $680.38
                    surgery.
29895............  Ankle arthroscopy/        Y................  .................  A2...............      $510.00      28.7803    $1,191.53      $680.38
                    surgery.
29897............  Ankle arthroscopy/        Y................  .................  A2...............      $510.00      28.7803    $1,191.53      $680.38
                    surgery.
29898............  Ankle arthroscopy/        Y................  .................  A2...............      $510.00      28.7803    $1,191.53      $680.38
                    surgery.
29899............  Ankle arthroscopy/        Y................  .................  A2...............      $510.00      45.7072    $1,892.32      $855.58
                    surgery.
29900............  Mcp joint arthroscopy,    Y................  .................  A2...............      $510.00      28.7803    $1,191.53      $680.38
                    dx.
29901............  Mcp joint arthroscopy,    Y................  .................  A2...............      $510.00      28.7803    $1,191.53      $680.38
                    surg.
29902............  Mcp joint arthroscopy,    Y................  .................  A2...............      $510.00      28.7803    $1,191.53      $680.38
                    surg.
29904............  Subtalar arthro w/fb      Y................  NI...............  G2...............  ...........      28.7803    $1,191.53    $1,191.53
                    rmvl.
29905............  Subtalar arthro w/exc...  Y................  NI...............  G2...............  ...........      28.7803    $1,191.53    $1,191.53
29906............  Subtalar arthro w/deb...  Y................  NI...............  G2...............  ...........      28.7803    $1,191.53    $1,191.53
29907............  Subtalar arthro w/fusion  Y................  NI...............  G2...............  ...........      45.7072    $1,892.32    $1,892.32
30000............  Drainage of nose lesion.  Y................  .................  P2...............  ...........       2.5002      $103.51      $103.51
30020............  Drainage of nose lesion.  Y................  .................  P2...............  ...........       2.5002      $103.51      $103.51
30100............  Intranasal biopsy.......  Y................  .................  P3...............  ...........       1.8763       $77.68       $77.68
30110............  Removal of nose polyp(s)  Y................  .................  P3...............  ...........       2.9376      $121.62      $121.62
30115............  Removal of nose polyp(s)  Y................  .................  A2...............      $446.00      16.3288      $676.03      $503.51
30117............  Removal of intranasal     Y................  .................  A2...............      $510.00      16.3288      $676.03      $551.51
                    lesion.
30118............  Removal of intranasal     Y................  .................  A2...............      $510.00      23.9765      $992.65      $630.66
                    lesion.
30120............  Revision of nose........  Y................  .................  A2...............      $333.00      16.3288      $676.03      $418.76
30124............  Removal of nose lesion..  Y................  .................  R2...............  ...........       7.4474      $308.33      $308.33
30125............  Removal of nose lesion..  Y................  .................  A2...............      $446.00      39.8776    $1,650.97      $747.24
30130............  Excise inferior           Y................  .................  A2...............      $510.00      16.3288      $676.03      $551.51
                    turbinate.
30140............  Resect inferior           Y................  .................  A2...............      $446.00      23.9765      $992.65      $582.66
                    turbinate.
30150............  Partial removal of nose.  Y................  .................  A2...............      $510.00      39.8776    $1,650.97      $795.24
30160............  Removal of nose.........  Y................  .................  A2...............      $630.00      39.8776    $1,650.97      $885.24
30200............  Injection treatment of    Y................  .................  P3...............  ...........       1.4975       $62.00       $62.00
                    nose.
30210............  Nasal sinus therapy.....  Y................  .................  P3...............  ...........       1.8927       $78.36       $78.36
30220............  Insert nasal septal       Y................  .................  A2...............      $464.15       7.4474      $308.33      $425.20
                    button.
30300............  Remove nasal foreign      N................  .................  P2...............  ...........        0.631       $26.12       $26.12
                    body.
30310............  Remove nasal foreign      Y................  .................  A2...............      $333.00      16.3288      $676.03      $418.76
                    body.
30320............  Remove nasal foreign      Y................  .................  A2...............      $446.00      16.3288      $676.03      $503.51
                    body.
30400............  Reconstruction of nose..  Y................  .................  A2...............      $630.00      39.8776    $1,650.97      $885.24
30410............  Reconstruction of nose..  Y................  .................  A2...............      $717.00      39.8776    $1,650.97      $950.49
30420............  Reconstruction of nose..  Y................  .................  A2...............      $717.00      39.8776    $1,650.97      $950.49
30430............  Revision of nose........  Y................  .................  A2...............      $510.00      23.9765      $992.65      $630.66
30435............  Revision of nose........  Y................  .................  A2...............      $717.00      39.8776    $1,650.97      $950.49

[[Page 66968]]

 
30450............  Revision of nose........  Y................  .................  A2...............      $995.00      39.8776    $1,650.97    $1,158.99
30460............  Revision of nose........  Y................  .................  A2...............      $995.00      39.8776    $1,650.97    $1,158.99
30462............  Revision of nose........  Y................  .................  A2...............    $1,339.00      39.8776    $1,650.97    $1,416.99
30465............  Repair nasal stenosis...  Y................  .................  A2...............    $1,339.00      39.8776    $1,650.97    $1,416.99
30520............  Repair of nasal septum..  Y................  .................  A2...............      $630.00      23.9765      $992.65      $720.66
30540............  Repair nasal defect.....  Y................  .................  A2...............      $717.00      39.8776    $1,650.97      $950.49
30545............  Repair nasal defect.....  Y................  .................  A2...............      $717.00      39.8776    $1,650.97      $950.49
30560............  Release of nasal          Y................  .................  A2...............      $150.72       2.5002      $103.51      $138.92
                    adhesions.
30580............  Repair upper jaw fistula  Y................  .................  A2...............      $630.00      39.8776    $1,650.97      $885.24
30600............  Repair mouth/nose         Y................  .................  A2...............      $630.00      39.8776    $1,650.97      $885.24
                    fistula.
30620............  Intranasal                Y................  .................  A2...............      $995.00      39.8776    $1,650.97    $1,158.99
                    reconstruction.
30630............  Repair nasal septum       Y................  .................  A2...............      $995.00      23.9765      $992.65      $994.41
                    defect.
30801............  Ablate inf turbinate,     Y................  .................  A2...............      $333.00       7.4474      $308.33      $326.83
                    superf.
30802............  Cauterization, inner      Y................  .................  A2...............      $333.00       7.4474      $308.33      $326.83
                    nose.
30901............  Control of nosebleed....  Y................  .................  P3...............  ...........        1.078       $44.63       $44.63
30903............  Control of nosebleed....  Y................  .................  A2...............       $72.48       1.1251       $46.58       $66.01
30905............  Control of nosebleed....  Y................  .................  A2...............       $72.48       1.1251       $46.58       $66.01
30906............  Repeat control of         Y................  .................  A2...............       $72.48       1.1251       $46.58       $66.01
                    nosebleed.
30915............  Ligation, nasal sinus     Y................  .................  A2...............      $446.00       25.841    $1,069.84      $601.96
                    artery.
30920............  Ligation, upper jaw       Y................  .................  A2...............      $510.00       25.841    $1,069.84      $649.96
                    artery.
30930............  Ther fx, nasal inf        Y................  .................  A2...............      $630.00      16.3288      $676.03      $641.51
                    turbinate.
31000............  Irrigation, maxillary     Y................  .................  P3...............  ...........       2.4934      $103.23      $103.23
                    sinus.
31002............  Irrigation, sphenoid      Y................  .................  R2...............  ...........       7.4474      $308.33      $308.33
                    sinus.
31020............  Exploration, maxillary    Y................  .................  A2...............      $446.00      23.9765      $992.65      $582.66
                    sinus.
31030............  Exploration, maxillary    Y................  .................  A2...............      $510.00      39.8776    $1,650.97      $795.24
                    sinus.
31032............  Explore sinus, remove     Y................  .................  A2...............      $630.00      39.8776    $1,650.97      $885.24
                    polyps.
31040............  Exploration behind upper  Y................  .................  R2...............  ...........      23.9765      $992.65      $992.65
                    jaw.
31050............  Exploration, sphenoid     Y................  .................  A2...............      $446.00      39.8776    $1,650.97      $747.24
                    sinus.
31051............  Sphenoid sinus surgery..  Y................  .................  A2...............      $630.00      39.8776    $1,650.97      $885.24
31070............  Exploration of frontal    Y................  .................  A2...............      $446.00      23.9765      $992.65      $582.66
                    sinus.
31075............  Exploration of frontal    Y................  .................  A2...............      $630.00      39.8776    $1,650.97      $885.24
                    sinus.
31080............  Removal of frontal sinus  Y................  .................  A2...............      $630.00      39.8776    $1,650.97      $885.24
31081............  Removal of frontal sinus  Y................  .................  A2...............      $630.00      39.8776    $1,650.97      $885.24
31084............  Removal of frontal sinus  Y................  .................  A2...............      $630.00      39.8776    $1,650.97      $885.24
31085............  Removal of frontal sinus  Y................  .................  A2...............      $630.00      39.8776    $1,650.97      $885.24
31086............  Removal of frontal sinus  Y................  .................  A2...............      $630.00      39.8776    $1,650.97      $885.24
31087............  Removal of frontal sinus  Y................  .................  A2...............      $630.00      39.8776    $1,650.97      $885.24
31090............  Exploration of sinuses..  Y................  .................  A2...............      $717.00      39.8776    $1,650.97      $950.49
31200............  Removal of ethmoid sinus  Y................  .................  A2...............      $446.00      39.8776    $1,650.97      $747.24
31201............  Removal of ethmoid sinus  Y................  .................  A2...............      $717.00      39.8776    $1,650.97      $950.49
31205............  Removal of ethmoid sinus  Y................  .................  A2...............      $510.00      39.8776    $1,650.97      $795.24
31231............  Nasal endoscopy, dx.....  Y................  .................  P2...............  ...........       1.6115       $66.72       $66.72
31233............  Nasal/sinus endoscopy,    Y................  .................  A2...............       $86.39       1.6115       $66.72       $81.47
                    dx.
31235............  Nasal/sinus endoscopy,    Y................  .................  A2...............      $333.00       17.016      $704.48      $425.87
                    dx.
31237............  Nasal/sinus endoscopy,    Y................  .................  A2...............      $446.00       17.016      $704.48      $510.62
                    surg.
31238............  Nasal/sinus endoscopy,    Y................  .................  A2...............      $333.00       17.016      $704.48      $425.87
                    surg.
31239............  Nasal/sinus endoscopy,    Y................  .................  A2...............      $630.00      22.7191      $940.59      $707.65
                    surg.
31240............  Nasal/sinus endoscopy,    Y................  .................  A2...............      $446.00       17.016      $704.48      $510.62
                    surg.
31254............  Revision of ethmoid       Y................  .................  A2...............      $510.00      22.7191      $940.59      $617.65
                    sinus.
31255............  Removal of ethmoid sinus  Y................  .................  A2...............      $717.00      22.7191      $940.59      $772.90
31256............  Exploration maxillary     Y................  .................  A2...............      $510.00      22.7191      $940.59      $617.65
                    sinus.
31267............  Endoscopy, maxillary      Y................  .................  A2...............      $510.00      22.7191      $940.59      $617.65
                    sinus.
31276............  Sinus endoscopy,          Y................  .................  A2...............      $510.00      22.7191      $940.59      $617.65
                    surgical.
31287............  Nasal/sinus endoscopy,    Y................  .................  A2...............      $510.00      22.7191      $940.59      $617.65
                    surg.
31288............  Nasal/sinus endoscopy,    Y................  .................  A2...............      $510.00      22.7191      $940.59      $617.65
                    surg.
31300............  Removal of larynx lesion  Y................  .................  A2...............      $717.00      23.9765      $992.65      $785.91
31320............  Diagnostic incision,      Y................  .................  A2...............      $446.00      39.8776    $1,650.97      $747.24
                    larynx.
31400............  Revision of larynx......  Y................  .................  A2...............      $446.00      39.8776    $1,650.97      $747.24
31420............  Removal of epiglottis...  Y................  .................  A2...............      $446.00      39.8776    $1,650.97      $747.24
31500............  Insert emergency airway.  N................  .................  G2...............  ...........        2.459      $101.81      $101.81
31502............  Change of windpipe        N................  .................  G2...............  ...........       1.3362       $55.32       $55.32
                    airway.
31505............  Diagnostic laryngoscopy.  Y................  .................  P2...............  ...........       0.8224       $34.05       $34.05
31510............  Laryngoscopy with biopsy  Y................  .................  A2...............      $446.00       17.016      $704.48      $510.62
31511............  Remove foreign body,      Y................  .................  A2...............       $86.39       1.6115       $66.72       $81.47
                    larynx.
31512............  Removal of larynx lesion  Y................  .................  A2...............      $446.00       17.016      $704.48      $510.62
31513............  Injection into vocal      Y................  .................  A2...............       $86.39       1.6115       $66.72       $81.47
                    cord.
31515............  Laryngoscopy for          Y................  .................  A2...............      $333.00       17.016      $704.48      $425.87
                    aspiration.
31520............  Dx laryngoscopy, newborn  Y................  .................  G2...............  ...........       1.6115       $66.72       $66.72
31525............  Dx laryngoscopy excl nb.  Y................  .................  A2...............      $333.00       17.016      $704.48      $425.87
31526............  Dx laryngoscopy w/oper    Y................  .................  A2...............      $446.00      22.7191      $940.59      $569.65
                    scope.
31527............  Laryngoscopy for          Y................  .................  A2...............      $333.00      22.7191      $940.59      $484.90
                    treatment.
31528............  Laryngoscopy and          Y................  .................  A2...............      $446.00       17.016      $704.48      $510.62
                    dilation.
31529............  Laryngoscopy and          Y................  .................  A2...............      $446.00       17.016      $704.48      $510.62
                    dilation.

[[Page 66969]]

 
31530............  Laryngoscopy w/fb         Y................  .................  A2...............      $446.00      22.7191      $940.59      $569.65
                    removal.
31531............  Laryngoscopy w/fb & op    Y................  .................  A2...............      $510.00      22.7191      $940.59      $617.65
                    scope.
31535............  Laryngoscopy w/biopsy...  Y................  .................  A2...............      $446.00      22.7191      $940.59      $569.65
31536............  Laryngoscopy w/bx & op    Y................  .................  A2...............      $510.00      22.7191      $940.59      $617.65
                    scope.
31540............  Laryngoscopy w/exc of     Y................  .................  A2...............      $510.00      22.7191      $940.59      $617.65
                    tumor.
31541............  Larynscop w/tumr exc +    Y................  .................  A2...............      $630.00      22.7191      $940.59      $707.65
                    scope.
31545............  Remove vc lesion w/scope  Y................  .................  A2...............      $630.00      22.7191      $940.59      $707.65
31546............  Remove vc lesion scope/   Y................  .................  A2...............      $630.00      22.7191      $940.59      $707.65
                    graft.
31560............  Laryngoscop w/            Y................  .................  A2...............      $717.00      22.7191      $940.59      $772.90
                    arytenoidectom.
31561............  Larynscop, remve cart +   Y................  .................  A2...............      $717.00      22.7191      $940.59      $772.90
                    scop.
31570............  Laryngoscope w/vc inj...  Y................  .................  A2...............      $446.00       17.016      $704.48      $510.62
31571............  Laryngoscop w/vc inj +    Y................  .................  A2...............      $446.00      22.7191      $940.59      $569.65
                    scope.
31575............  Diagnostic laryngoscopy.  Y................  .................  P3...............  ...........       1.4811       $61.32       $61.32
31576............  Laryngoscopy with biopsy  Y................  .................  A2...............      $446.00      22.7191      $940.59      $569.65
31577............  Remove foreign body,      Y................  .................  A2...............      $236.42        3.994      $165.36      $218.66
                    larynx.
31578............  Removal of larynx lesion  Y................  .................  A2...............      $446.00      22.7191      $940.59      $569.65
31579............  Diagnostic laryngoscopy.  Y................  .................  P3...............  ...........       2.7321      $113.11      $113.11
31580............  Revision of larynx......  Y................  .................  A2...............      $717.00      39.8776    $1,650.97      $950.49
31582............  Revision of larynx......  Y................  .................  A2...............      $717.00      39.8776    $1,650.97      $950.49
31588............  Revision of larynx......  Y................  .................  A2...............      $717.00      39.8776    $1,650.97      $950.49
31590............  Reinnervate larynx......  Y................  .................  A2...............      $717.00      39.8776    $1,650.97      $950.49
31595............  Larynx nerve surgery....  Y................  .................  A2...............      $446.00      39.8776    $1,650.97      $747.24
31603............  Incision of windpipe....  Y................  .................  A2...............      $333.00       7.4474      $308.33      $326.83
31605............  Incision of windpipe....  Y................  .................  G2...............  ...........       7.4474      $308.33      $308.33
31611............  Surgery/speech            Y................  .................  A2...............      $510.00      23.9765      $992.65      $630.66
                    prosthesis.
31612............  Puncture/clear windpipe.  Y................  .................  A2...............      $333.00      23.9765      $992.65      $497.91
31613............  Repair windpipe opening.  Y................  .................  A2...............      $446.00      23.9765      $992.65      $582.66
31614............  Repair windpipe opening.  Y................  .................  A2...............      $446.00      39.8776    $1,650.97      $747.24
31615............  Visualization of          Y................  .................  A2...............      $333.00       9.9575      $412.25      $352.81
                    windpipe.
31620............  Endobronchial us add-on.  N................  CH...............  N1...............  ...........  ...........  ...........  ...........
31622............  Dx bronchoscope/wash....  Y................  .................  A2...............      $333.00       9.9575      $412.25      $352.81
31623............  Dx bronchoscope/brush...  Y................  .................  A2...............      $446.00       9.9575      $412.25      $437.56
31624............  Dx bronchoscope/lavage..  Y................  .................  A2...............      $446.00       9.9575      $412.25      $437.56
31625............  Bronchoscopy w/biopsy(s)  Y................  .................  A2...............      $446.00       9.9575      $412.25      $437.56
31628............  Bronchoscopy/lung bx,     Y................  .................  A2...............      $446.00       9.9575      $412.25      $437.56
                    each.
31629............  Bronchoscopy/needle bx,   Y................  .................  A2...............      $446.00       9.9575      $412.25      $437.56
                    each.
31630............  Bronchoscopy dilate/fx    Y................  .................  A2...............      $446.00      24.0654      $996.33      $583.58
                    repr.
31631............  Bronchoscopy, dilate w/   Y................  .................  A2...............      $446.00      24.0654      $996.33      $583.58
                    stent.
31632............  Bronchoscopy/lung bx,     Y................  .................  G2...............  ...........       9.9575      $412.25      $412.25
                    add?l.
31633............  Bronchoscopy/needle bx    Y................  .................  G2...............  ...........       9.9575      $412.25      $412.25
                    add?l.
31635............  Bronchoscopy w/fb         Y................  .................  A2...............      $446.00       9.9575      $412.25      $437.56
                    removal.
31636............  Bronchoscopy, bronch      Y................  .................  A2...............      $446.00      24.0654      $996.33      $583.58
                    stents.
31637............  Bronchoscopy, stent add-  Y................  .................  A2...............      $333.00       9.9575      $412.25      $352.81
                    on.
31638............  Bronchoscopy, revise      Y................  .................  A2...............      $446.00      24.0654      $996.33      $583.58
                    stent.
31640............  Bronchoscopy w/tumor      Y................  .................  A2...............      $446.00      24.0654      $996.33      $583.58
                    excise.
31641............  Bronchoscopy, treat       Y................  .................  A2...............      $446.00      24.0654      $996.33      $583.58
                    blockage.
31643............  Diag bronchoscope/        Y................  .................  A2...............      $446.00       9.9575      $412.25      $437.56
                    catheter.
31645............  Bronchoscopy, clear       Y................  .................  A2...............      $333.00       9.9575      $412.25      $352.81
                    airways.
31646............  Bronchoscopy, reclear     Y................  .................  A2...............      $333.00       9.9575      $412.25      $352.81
                    airway.
31656............  Bronchoscopy, inj for x-  Y................  .................  A2...............      $333.00       9.9575      $412.25      $352.81
                    ray.
31715............  Injection for bronchus x- N................  .................  N1...............  ...........  ...........  ...........  ...........
                    ray.
31717............  Bronchial brush biopsy..  Y................  .................  A2...............      $236.42        3.994      $165.36      $218.66
31720............  Clearance of airways....  N................  .................  A2...............       $47.32       0.3877       $16.05       $39.50
31730............  Intro, windpipe wire/     Y................  .................  A2...............      $236.42        3.994      $165.36      $218.66
                    tube.
31750............  Repair of windpipe......  Y................  .................  A2...............      $717.00      39.8776    $1,650.97      $950.49
31755............  Repair of windpipe......  Y................  .................  A2...............      $446.00      39.8776    $1,650.97      $747.24
31820............  Closure of windpipe       Y................  .................  A2...............      $333.00      16.3288      $676.03      $418.76
                    lesion.
31825............  Repair of windpipe        Y................  .................  A2...............      $446.00      23.9765      $992.65      $582.66
                    defect.
31830............  Revise windpipe scar....  Y................  .................  A2...............      $446.00      23.9765      $992.65      $582.66
32000............  Drainage of chest.......  N................  CH...............  D5...............  ...........  ...........  ...........  ...........
32002............  Treatment of collapsed    N................  CH...............  D5...............  ...........  ...........  ...........  ...........
                    lung.
32019............  Insert pleural catheter.  N................  CH...............  D5...............  ...........  ...........  ...........  ...........
32400............  Needle biopsy chest       Y................  .................  A2...............      $333.00       9.3354      $386.49      $346.37
                    lining.
32405............  Biopsy, lung or           Y................  .................  A2...............      $333.00       9.3354      $386.49      $346.37
                    mediastinum.
32420............  Puncture/clear lung.....  Y................  .................  A2...............      $222.78       5.2024      $215.38      $220.93
32421............  Thoracentesis for         Y................  NI...............  A2...............      $222.78       5.2024      $215.38      $220.93
                    aspiration.
32422............  Thoracentesis w/tube      Y................  NI...............  G2...............  ...........       5.2024      $215.38      $215.38
                    insert.
32550............  Insert pleural cath.....  Y................  NI...............  G2...............  ...........      30.7096    $1,271.41    $1,271.41
32960............  Therapeutic pneumothorax  Y................  .................  G2...............  ...........       5.2024      $215.38      $215.38
32998............  Perq rf ablate tx, pul    Y................  CH...............  G2...............  ...........       42.998    $1,780.16    $1,780.16
                    tumor.
33010............  Drainage of heart sac...  Y................  .................  A2...............      $222.78       5.2024      $215.38      $220.93
33011............  Repeat drainage of heart  Y................  .................  A2...............      $222.78       5.2024      $215.38      $220.93
                    sac.
33206............  Insertion of heart        Y................  .................  J8...............  ...........     169.4628    $7,015.93    $7,015.93
                    pacemaker.

[[Page 66970]]

 
33207............  Insertion of heart        Y................  .................  J8...............  ...........     169.4628    $7,015.93    $7,015.93
                    pacemaker.
33208............  Insertion of heart        Y................  .................  J8...............  ...........     196.2967    $8,126.88    $8,126.88
                    pacemaker.
33210............  Insertion of heart        Y................  CH...............  J8...............  ...........       90.579    $3,750.06    $3,750.06
                    electrode.
33211............  Insertion of heart        Y................  CH...............  J8...............  ...........       90.579    $3,750.06    $3,750.06
                    electrode.
33212............  Insertion of pulse        Y................  .................  H8...............      $510.00     142.1043    $5,883.26    $5,514.64
                    generator.
33213............  Insertion of pulse        Y................  .................  H8...............      $510.00     154.6733    $6,403.63    $6,010.06
                    generator.
33214............  Upgrade of pacemaker      Y................  .................  J8...............  ...........     196.2967    $8,126.88    $8,126.88
                    system.
33215............  Reposition pacing-defib   Y................  .................  G2...............  ...........      23.9802      $992.80      $992.80
                    lead.
33216............  Insert lead pace-defib,   Y................  CH...............  J8...............  ...........       90.579    $3,750.06    $3,750.06
                    one.
33217............  Insert lead pace-defib,   Y................  CH...............  J8...............  ...........       90.579    $3,750.06    $3,750.06
                    dual.
33218............  Repair lead pace-defib,   Y................  .................  G2...............  ...........      23.9802      $992.80      $992.80
                    one.
33220............  Repair lead pace-defib,   Y................  .................  G2...............  ...........      23.9802      $992.80      $992.80
                    dual.
33222............  Revise pocket, pacemaker  Y................  .................  A2...............      $446.00      15.0458      $622.91      $490.23
33223............  Revise pocket, pacing-    Y................  .................  A2...............      $446.00      15.0458      $622.91      $490.23
                    defib.
33224............  Insert pacing lead &      Y................  .................  J8...............  ...........     375.1658   $15,532.24   $15,532.24
                    connect.
33225............  L ventric pacing lead     Y................  .................  J8...............  ...........     375.1658   $15,532.24   $15,532.24
                    add-on.
33226............  Reposition l ventric      Y................  .................  G2...............  ...........      23.9802      $992.80      $992.80
                    lead.
33233............  Removal of pacemaker      Y................  .................  A2...............      $446.00      23.9802      $992.80      $582.70
                    system.
33234............  Removal of pacemaker      Y................  .................  G2...............  ...........      23.9802      $992.80      $992.80
                    system.
33235............  Removal pacemaker         Y................  .................  G2...............  ...........      23.9802      $992.80      $992.80
                    electrode.
33240............  Insert pulse generator..  Y................  CH...............  J8...............  ...........     493.9803   $20,451.28   $20,451.28
33241............  Remove pulse generator..  Y................  .................  G2...............  ...........      23.9802      $992.80      $992.80
33249............  Eltrd/insert pace-defib.  Y................  CH...............  J8...............  ...........     599.3974   $24,815.65   $24,815.65
33282............  Implant pat-active ht     N................  .................  J8...............  ...........      98.4186    $4,074.63    $4,074.63
                    record.
33284............  Remove pat-active ht      Y................  .................  G2...............  ...........        8.685      $359.57      $359.57
                    record.
33508............  Endoscopic vein harvest.  N................  .................  N1...............  ...........  ...........  ...........  ...........
35188............  Repair blood vessel       Y................  .................  A2...............      $630.00      38.7673    $1,605.00      $873.75
                    lesion.
35207............  Repair blood vessel       Y................  .................  A2...............      $630.00      38.7673    $1,605.00      $873.75
                    lesion.
35473............  Repair arterial blockage  Y................  .................  G2...............  ...........      45.3845    $1,878.96    $1,878.96
35476............  Repair venous blockage..  Y................  .................  G2...............  ...........      45.3845    $1,878.96    $1,878.96
35492............  Atherectomy,              Y................  .................  G2...............  ...........      87.5137    $3,623.15    $3,623.15
                    percutaneous.
35572............  Harvest femoropopliteal   N................  .................  N1...............  ...........  ...........  ...........  ...........
                    vein.
35761............  Exploration of artery/    Y................  .................  G2...............  ...........      29.6965    $1,229.46    $1,229.46
                    vein.
35875............  Removal of clot in graft  Y................  .................  A2...............    $1,339.00      38.7673    $1,605.00    $1,405.50
35876............  Removal of clot in graft  Y................  .................  A2...............    $1,339.00      38.7673    $1,605.00    $1,405.50
36000............  Place needle in vein....  N................  .................  N1...............  ...........  ...........  ...........  ...........
36002............  Pseudoaneurysm injection  N................  .................  G2...............  ...........       2.3792       $98.50       $98.50
                    trt.
36005............  Injection ext venography  N................  .................  N1...............  ...........  ...........  ...........  ...........
36010............  Place catheter in vein..  N................  .................  N1...............  ...........  ...........  ...........  ...........
36011............  Place catheter in vein..  N................  .................  N1...............  ...........  ...........  ...........  ...........
36012............  Place catheter in vein..  N................  .................  N1...............  ...........  ...........  ...........  ...........
36013............  Place catheter in artery  N................  .................  N1...............  ...........  ...........  ...........  ...........
36014............  Place catheter in artery  N................  .................  N1...............  ...........  ...........  ...........  ...........
36015............  Place catheter in artery  N................  .................  N1...............  ...........  ...........  ...........  ...........
36100............  Establish access to       N................  .................  N1...............  ...........  ...........  ...........  ...........
                    artery.
36120............  Establish access to       N................  .................  N1...............  ...........  ...........  ...........  ...........
                    artery.
36140............  Establish access to       N................  .................  N1...............  ...........  ...........  ...........  ...........
                    artery.
36145............  Artery to vein shunt....  N................  .................  N1...............  ...........  ...........  ...........  ...........
36160............  Establish access to       N................  .................  N1...............  ...........  ...........  ...........  ...........
                    aorta.
36200............  Place catheter in aorta.  N................  .................  N1...............  ...........  ...........  ...........  ...........
36215............  Place catheter in artery  N................  .................  N1...............  ...........  ...........  ...........  ...........
36216............  Place catheter in artery  N................  .................  N1...............  ...........  ...........  ...........  ...........
36217............  Place catheter in artery  N................  .................  N1...............  ...........  ...........  ...........  ...........
36218............  Place catheter in artery  N................  .................  N1...............  ...........  ...........  ...........  ...........
36245............  Place catheter in artery  N................  .................  N1...............  ...........  ...........  ...........  ...........
36246............  Place catheter in artery  N................  .................  N1...............  ...........  ...........  ...........  ...........
36247............  Place catheter in artery  N................  .................  N1...............  ...........  ...........  ...........  ...........
36248............  Place catheter in artery  N................  .................  N1...............  ...........  ...........  ...........  ...........
36260............  Insertion of infusion     Y................  .................  A2...............      $510.00      28.8743    $1,195.42      $681.36
                    pump.
36261............  Revision of infusion      Y................  .................  A2...............      $446.00      23.9802      $992.80      $582.70
                    pump.
36262............  Removal of infusion pump  Y................  .................  A2...............      $333.00      23.9802      $992.80      $497.95
36400............  Bl draw < 3 yrs fem/      N................  .................  N1...............  ...........  ...........  ...........  ...........
                    jugular.
36405............  Bl draw < 3 yrs scalp     N................  .................  N1...............  ...........  ...........  ...........  ...........
                    vein.
36406............  Bl draw < 3 yrs other     N................  .................  N1...............  ...........  ...........  ...........  ...........
                    vein.
36410............  Non-routine bl draw > 3   N................  .................  N1...............  ...........  ...........  ...........  ...........
                    yrs.
36416............  Capillary blood draw....  N................  .................  N1...............  ...........  ...........  ...........  ...........
36420............  Vein access cutdown < 1   Y................  .................  G2...............  ...........       0.2143        $8.87        $8.87
                    yr.
36425............  Vein access cutdown > 1   Y................  .................  R2...............  ...........       0.2143        $8.87        $8.87
                    yr.
36430............  Blood transfusion         N................  .................  P3...............  ...........       0.7983       $33.05       $33.05
                    service.
36440............  Bl push transfuse, 2 yr   N................  .................  R2...............  ...........       3.3967      $140.63      $140.63
                    or <.
36450............  Bl exchange/transfuse,    N................  .................  R2...............  ...........       3.3967      $140.63      $140.63
                    nb.
36468............  Injection(s), spider      Y................  .................  R2...............  ...........        0.793       $32.83       $32.83
                    veins.
36469............  Injection(s), spider      Y................  CH...............  R2...............  ...........        0.793       $32.83       $32.83
                    veins.

[[Page 66971]]

 
36470............  Injection therapy of      Y................  .................  P2...............  ...........        0.793       $32.83       $32.83
                    vein.
36471............  Injection therapy of      Y................  .................  P2...............  ...........        0.793       $32.83       $32.83
                    veins.
36475............  Endovenous rf, 1st vein.  Y................  .................  A2...............    $1,339.00      42.6114    $1,764.15    $1,445.29
36476............  Endovenous rf, vein add-  Y................  .................  A2...............    $1,339.00       25.841    $1,069.84    $1,271.71
                    on.
36478............  Endovenous laser, 1st     Y................  .................  A2...............    $1,339.00       25.841    $1,069.84    $1,271.71
                    vein.
36479............  Endovenous laser vein     Y................  .................  A2...............    $1,339.00       25.841    $1,069.84    $1,271.71
                    addon.
36481............  Insertion of catheter,    N................  .................  N1...............  ...........  ...........  ...........  ...........
                    vein.
36500............  Insertion of catheter,    N................  .................  N1...............  ...........  ...........  ...........  ...........
                    vein.
36510............  Insertion of catheter,    N................  .................  N1...............  ...........  ...........  ...........  ...........
                    vein.
36511............  Apheresis wbc...........  N................  .................  G2...............  ...........      11.5058      $476.35      $476.35
36512............  Apheresis rbc...........  N................  .................  G2...............  ...........      11.5058      $476.35      $476.35
36513............  Apheresis platelets.....  N................  .................  G2...............  ...........      11.5058      $476.35      $476.35
36514............  Apheresis plasma........  N................  .................  G2...............  ...........      11.5058      $476.35      $476.35
36515............  Apheresis, adsorp/        N................  .................  G2...............  ...........      30.6035    $1,267.02    $1,267.02
                    reinfuse.
36516............  Apheresis, selective....  N................  .................  G2...............  ...........      30.6035    $1,267.02    $1,267.02
36522............  Photopheresis...........  N................  .................  G2...............  ...........      30.6035    $1,267.02    $1,267.02
36540............  Collect blood venous      N................  CH...............  D5...............  ...........  ...........  ...........  ...........
                    device.
36550............  Declot vascular device..  N................  CH...............  D5...............  ...........  ...........  ...........  ...........
36555............  Insert non-tunnel cv      Y................  .................  A2...............      $333.00      10.9092      $451.65      $362.66
                    cath.
36556............  Insert non-tunnel cv      Y................  .................  A2...............      $333.00      10.9092      $451.65      $362.66
                    cath.
36557............  Insert tunneled cv cath.  Y................  .................  A2...............      $446.00      24.1069      $998.05      $584.01
36558............  Insert tunneled cv cath.  Y................  .................  A2...............      $446.00      24.1069      $998.05      $584.01
36560............  Insert tunneled cv cath.  Y................  .................  A2...............      $510.00      28.8743    $1,195.42      $681.36
36561............  Insert tunneled cv cath.  Y................  .................  A2...............      $510.00      28.8743    $1,195.42      $681.36
36563............  Insert tunneled cv cath.  Y................  .................  A2...............      $510.00      28.8743    $1,195.42      $681.36
36565............  Insert tunneled cv cath.  Y................  .................  A2...............      $510.00      28.8743    $1,195.42      $681.36
36566............  Insert tunneled cv cath.  Y................  .................  H8...............      $510.00     107.6665    $4,457.50    $3,796.23
36568............  Insert picc cath........  Y................  .................  A2...............      $333.00      10.9092      $451.65      $362.66
36569............  Insert picc cath........  Y................  .................  A2...............      $333.00      10.9092      $451.65      $362.66
36570............  Insert picvad cath......  Y................  .................  A2...............      $510.00      24.1069      $998.05      $632.01
36571............  Insert picvad cath......  Y................  .................  A2...............      $510.00      24.1069      $998.05      $632.01
36575............  Repair tunneled cv cath.  Y................  .................  A2...............      $446.00       5.6614      $234.39      $393.10
36576............  Repair tunneled cv cath.  Y................  .................  A2...............      $446.00      10.9092      $451.65      $447.41
36578............  Replace tunneled cv cath  Y................  .................  A2...............      $446.00      24.1069      $998.05      $584.01
36580............  Replace cvad cath.......  Y................  .................  A2...............      $333.00      10.9092      $451.65      $362.66
36581............  Replace tunneled cv cath  Y................  .................  A2...............      $446.00      24.1069      $998.05      $584.01
36582............  Replace tunneled cv cath  Y................  .................  A2...............      $510.00      28.8743    $1,195.42      $681.36
36583............  Replace tunneled cv cath  Y................  .................  A2...............      $510.00      28.8743    $1,195.42      $681.36
36584............  Replace picc cath.......  Y................  .................  A2...............      $333.00      10.9092      $451.65      $362.66
36585............  Replace picvad cath.....  Y................  .................  A2...............      $510.00      24.1069      $998.05      $632.01
36589............  Removal tunneled cv cath  Y................  .................  A2...............      $333.00       5.6614      $234.39      $308.35
36590............  Removal tunneled cv cath  Y................  .................  A2...............      $333.00      10.9092      $451.65      $362.66
36591............  Draw blood off venous     N................  NI...............  N1...............  ...........  ...........  ...........  ...........
                    device.
36592............  Collect blood from picc.  N................  NI...............  N1...............  ...........  ...........  ...........  ...........
36593............  Declot vascular device..  Y................  NI...............  P3...............  ...........       0.4937       $20.44       $20.44
36595............  Mech remov tunneled cv    Y................  .................  G2...............  ...........      24.1069      $998.05      $998.05
                    cath.
36596............  Mech remov tunneled cv    Y................  .................  G2...............  ...........      10.9092      $451.65      $451.65
                    cath.
36597............  Reposition venous         Y................  .................  G2...............  ...........      10.9092      $451.65      $451.65
                    catheter.
36598............  Inj w/fluor, eval cv      Y................  CH...............  P3...............  ...........       1.9997       $82.79       $82.79
                    device.
36600............  Withdrawal of arterial    N................  .................  N1...............  ...........  ...........  ...........  ...........
                    blood.
36620............  Insertion catheter,       N................  .................  N1...............  ...........  ...........  ...........  ...........
                    artery.
36625............  Insertion catheter,       N................  .................  N1...............  ...........  ...........  ...........  ...........
                    artery.
36640............  Insertion catheter,       Y................  .................  A2...............      $333.00      28.8743    $1,195.42      $548.61
                    artery.
36680............  Insert needle, bone       Y................  .................  G2...............  ...........       1.1097       $45.94       $45.94
                    cavity.
36800............  Insertion of cannula....  Y................  .................  A2...............      $510.00      29.6965    $1,229.46      $689.87
36810............  Insertion of cannula....  Y................  .................  A2...............      $510.00      29.6965    $1,229.46      $689.87
36815............  Insertion of cannula....  Y................  .................  A2...............      $510.00      29.6965    $1,229.46      $689.87
36818............  Av fuse, uppr arm,        Y................  .................  A2...............      $510.00      38.7673    $1,605.00      $783.75
                    cephalic.
36819............  Av fuse, uppr arm,        Y................  .................  A2...............      $510.00      38.7673    $1,605.00      $783.75
                    basilic.
36820............  Av fusion/forearm vein..  Y................  .................  A2...............      $510.00      38.7673    $1,605.00      $783.75
36821............  Av fusion direct any      Y................  .................  A2...............      $510.00      38.7673    $1,605.00      $783.75
                    site.
36825............  Artery-vein autograft...  Y................  .................  A2...............      $630.00      38.7673    $1,605.00      $873.75
36830............  Artery-vein nonautograft  Y................  .................  A2...............      $630.00      38.7673    $1,605.00      $873.75
36831............  Open thrombect av         Y................  .................  A2...............    $1,339.00      38.7673    $1,605.00    $1,405.50
                    fistula.
36832............  Av fistula revision,      Y................  .................  A2...............      $630.00      38.7673    $1,605.00      $873.75
                    open.
36833............  Av fistula revision.....  Y................  .................  A2...............      $630.00      38.7673    $1,605.00      $873.75
36834............  Repair a-v aneurysm.....  Y................  .................  A2...............      $510.00      38.7673    $1,605.00      $783.75
36835............  Artery to vein shunt....  Y................  .................  A2...............      $630.00      29.6965    $1,229.46      $779.87
36860............  External cannula          Y................  .................  A2...............      $127.40       2.4824      $102.77      $121.24
                    declotting.
36861............  Cannula declotting......  Y................  .................  A2...............      $510.00      29.6965    $1,229.46      $689.87
36870............  Percut thrombect av       Y................  .................  A2...............    $1,339.00      40.4667    $1,675.36    $1,423.09
                    fistula.
37184............  Prim art mech             Y................  .................  G2...............  ...........      38.7673    $1,605.00    $1,605.00
                    thrombectomy.
37185............  Prim art m-thrombect add- Y................  .................  G2...............  ...........      38.7673    $1,605.00    $1,605.00
                    on.

[[Page 66972]]

 
37186............  Sec art m-thrombect add-  Y................  .................  G2...............  ...........      38.7673    $1,605.00    $1,605.00
                    on.
37187............  Venous mech thrombectomy  Y................  .................  G2...............  ...........      38.7673    $1,605.00    $1,605.00
37188............  Venous m-thrombectomy     Y................  .................  G2...............  ...........      38.7673    $1,605.00    $1,605.00
                    add-on.
37200............  Transcatheter biopsy....  Y................  .................  G2...............  ...........      28.8743    $1,195.42    $1,195.42
37203............  Transcatheter retrieval.  Y................  .................  G2...............  ...........      28.8743    $1,195.42    $1,195.42
37250............  Iv us first vessel add-   N................  CH...............  N1...............  ...........  ...........  ...........  ...........
                    on.
37251............  Iv us each add vessel     N................  CH...............  N1...............  ...........  ...........  ...........  ...........
                    add-on.
37500............  Endoscopy ligate perf     Y................  .................  A2...............      $510.00      42.6114    $1,764.15      $823.54
                    veins.
37607............  Ligation of a-v fistula.  Y................  .................  A2...............      $510.00       25.841    $1,069.84      $649.96
37609............  Temporal artery           Y................  .................  A2...............      $446.00      16.1001      $666.56      $501.14
                    procedure.
37650............  Revision of major vein..  Y................  .................  A2...............      $446.00       25.841    $1,069.84      $601.96
37700............  Revise leg vein.........  Y................  .................  A2...............      $446.00       25.841    $1,069.84      $601.96
37718............  Ligate/strip short leg    Y................  .................  A2...............      $510.00       25.841    $1,069.84      $649.96
                    vein.
37722............  Ligate/strip long leg     Y................  .................  A2...............      $510.00      42.6114    $1,764.15      $823.54
                    vein.
37735............  Removal of leg veins/     Y................  .................  A2...............      $510.00      42.6114    $1,764.15      $823.54
                    lesion.
37760............  Ligation, leg veins,      Y................  .................  A2...............      $510.00       25.841    $1,069.84      $649.96
                    open.
37765............  Phleb veins extrem 10-20  Y................  .................  R2...............  ...........       25.841    $1,069.84    $1,069.84
37766............  Phleb veins extrem 20+..  Y................  .................  R2...............  ...........       25.841    $1,069.84    $1,069.84
37780............  Revision of leg vein....  Y................  .................  A2...............      $510.00       25.841    $1,069.84      $649.96
37785............  Ligate/divide/excise      Y................  .................  A2...............      $510.00       25.841    $1,069.84      $649.96
                    vein.
37790............  Penile venous occlusion.  Y................  .................  A2...............      $510.00      33.9306    $1,404.76      $733.69
38200............  Injection for spleen x-   N................  .................  N1...............  ...........  ...........  ...........  ...........
                    ray.
38204............  Bl donor search           N................  .................  N1...............  ...........  ...........  ...........  ...........
                    management.
38205............  Harvest allogenic stem    N................  .................  G2...............  ...........      11.5058      $476.35      $476.35
                    cells.
38206............  Harvest auto stem cells.  N................  .................  G2...............  ...........      11.5058      $476.35      $476.35
38220............  Bone marrow aspiration..  Y................  CH...............  P3...............  ...........       2.6333      $109.02      $109.02
38221............  Bone marrow biopsy......  Y................  CH...............  P3...............  ...........       2.7649      $114.47      $114.47
38230............  Bone marrow collection..  N................  .................  G2...............  ...........      30.6035    $1,267.02    $1,267.02
38241............  Bone marrow/stem          N................  .................  G2...............  ...........      30.6035    $1,267.02    $1,267.02
                    transplant.
38242............  Lymphocyte infuse         N................  .................  R2...............  ...........      11.5058      $476.35      $476.35
                    transplant.
38300............  Drainage, lymph node      Y................  .................  A2...............      $333.00      11.5594      $478.57      $369.39
                    lesion.
38305............  Drainage, lymph node      Y................  .................  A2...............      $446.00      18.3197      $758.45      $524.11
                    lesion.
38308............  Incision of lymph         Y................  .................  A2...............      $446.00      22.9584      $950.50      $572.13
                    channels.
38500............  Biopsy/removal, lymph     Y................  .................  A2...............      $446.00      22.9584      $950.50      $572.13
                    nodes.
38505............  Needle biopsy, lymph      Y................  .................  A2...............      $240.00       7.1147      $294.56      $253.64
                    nodes.
38510............  Biopsy/removal, lymph     Y................  .................  A2...............      $446.00      22.9584      $950.50      $572.13
                    nodes.
38520............  Biopsy/removal, lymph     Y................  .................  A2...............      $446.00      22.9584      $950.50      $572.13
                    nodes.
38525............  Biopsy/removal, lymph     Y................  .................  A2...............      $446.00      22.9584      $950.50      $572.13
                    nodes.
38530............  Biopsy/removal, lymph     Y................  .................  A2...............      $446.00      22.9584      $950.50      $572.13
                    nodes.
38542............  Explore deep node(s),     Y................  .................  A2...............      $446.00       44.324    $1,835.06      $793.27
                    neck.
38550............  Removal, neck/armpit      Y................  .................  A2...............      $510.00      22.9584      $950.50      $620.13
                    lesion.
38555............  Removal, neck/armpit      Y................  .................  A2...............      $630.00      22.9584      $950.50      $710.13
                    lesion.
38570............  Laparoscopy, lymph node   Y................  .................  A2...............    $1,339.00      45.5317    $1,885.06    $1,475.52
                    biop.
38571............  Laparoscopy,              Y................  .................  A2...............    $1,339.00      69.6652    $2,884.21    $1,725.30
                    lymphadenectomy.
38572............  Laparoscopy,              Y................  .................  A2...............    $1,339.00      45.5317    $1,885.06    $1,475.52
                    lymphadenectomy.
38700............  Removal of lymph nodes,   Y................  .................  G2...............  ...........      22.9584      $950.50      $950.50
                    neck.
38740............  Remove armpit lymph       Y................  .................  A2...............      $446.00       44.324    $1,835.06      $793.27
                    nodes.
38745............  Remove armpit lymph       Y................  .................  A2...............      $630.00       44.324    $1,835.06      $931.27
                    nodes.
38760............  Remove groin lymph nodes  Y................  .................  A2...............      $446.00      22.9584      $950.50      $572.13
38790............  Inject for lymphatic x-   N................  .................  N1...............  ...........  ...........  ...........  ...........
                    ray.
38792............  Identify sentinel node..  N................  .................  N1...............  ...........  ...........  ...........  ...........
38794............  Access thoracic lymph     N................  .................  N1...............  ...........  ...........  ...........  ...........
                    duct.
40490............  Biopsy of lip...........  Y................  .................  P3...............  ...........       1.5224       $63.03       $63.03
40500............  Partial excision of lip.  Y................  .................  A2...............      $446.00      16.3288      $676.03      $503.51
40510............  Partial excision of lip.  Y................  .................  A2...............      $446.00      23.9765      $992.65      $582.66
40520............  Partial excision of lip.  Y................  .................  A2...............      $446.00      16.3288      $676.03      $503.51
40525............  Reconstruct lip with      Y................  .................  A2...............      $446.00      23.9765      $992.65      $582.66
                    flap.
40527............  Reconstruct lip with      Y................  .................  A2...............      $446.00      23.9765      $992.65      $582.66
                    flap.
40530............  Partial removal of lip..  Y................  .................  A2...............      $446.00      23.9765      $992.65      $582.66
40650............  Repair lip..............  Y................  .................  A2...............      $464.15       7.4474      $308.33      $425.20
40652............  Repair lip..............  Y................  .................  A2...............      $464.15       7.4474      $308.33      $425.20
40654............  Repair lip..............  Y................  .................  A2...............      $464.15       7.4474      $308.33      $425.20
40700............  Repair cleft lip/nasal..  Y................  .................  A2...............      $995.00      39.8776    $1,650.97    $1,158.99
40701............  Repair cleft lip/nasal..  Y................  .................  A2...............      $995.00      39.8776    $1,650.97    $1,158.99
40702............  Repair cleft lip/nasal..  Y................  .................  R2...............  ...........      39.8776    $1,650.97    $1,650.97
40720............  Repair cleft lip/nasal..  Y................  .................  A2...............      $995.00      39.8776    $1,650.97    $1,158.99
40761............  Repair cleft lip/nasal..  Y................  .................  A2...............      $510.00      39.8776    $1,650.97      $795.24
40800............  Drainage of mouth lesion  Y................  .................  P2...............  ...........       1.4066       $58.23       $58.23
40801............  Drainage of mouth lesion  Y................  .................  A2...............      $446.00       7.4474      $308.33      $411.58
40804............  Removal, foreign body,    N................  .................  P2...............  ...........        0.631       $26.12       $26.12
                    mouth.
40805............  Removal, foreign body,    Y................  .................  P3...............  ...........       3.9499      $163.53      $163.53
                    mouth.
40806............  Incision of lip fold....  Y................  .................  P3...............  ...........       1.7529       $72.57       $72.57
40808............  Biopsy of mouth lesion..  Y................  .................  P2...............  ...........       2.5002      $103.51      $103.51

[[Page 66973]]

 
40810............  Excision of mouth lesion  Y................  .................  P3...............  ...........        2.699      $111.74      $111.74
40812............  Excise/repair mouth       Y................  .................  P3...............  ...........       3.3985      $140.70      $140.70
                    lesion.
40814............  Excise/repair mouth       Y................  .................  A2...............      $446.00      16.3288      $676.03      $503.51
                    lesion.
40816............  Excision of mouth lesion  Y................  .................  A2...............      $446.00      23.9765      $992.65      $582.66
40818............  Excise oral mucosa for    Y................  .................  A2...............      $150.72       2.5002      $103.51      $138.92
                    graft.
40819............  Excise lip or cheek fold  Y................  .................  A2...............      $333.00       7.4474      $308.33      $326.83
40820............  Treatment of mouth        Y................  .................  P3...............  ...........       3.7934      $157.05      $157.05
                    lesion.
40830............  Repair mouth laceration.  Y................  .................  G2...............  ...........       2.5002      $103.51      $103.51
40831............  Repair mouth laceration.  Y................  .................  A2...............      $333.00       7.4474      $308.33      $326.83
40840............  Reconstruction of mouth.  Y................  .................  A2...............      $446.00      23.9765      $992.65      $582.66
40842............  Reconstruction of mouth.  Y................  .................  A2...............      $510.00      23.9765      $992.65      $630.66
40843............  Reconstruction of mouth.  Y................  .................  A2...............      $510.00      23.9765      $992.65      $630.66
40844............  Reconstruction of mouth.  Y................  .................  A2...............      $717.00      39.8776    $1,650.97      $950.49
40845............  Reconstruction of mouth.  Y................  .................  A2...............      $717.00      39.8776    $1,650.97      $950.49
41000............  Drainage of mouth lesion  Y................  .................  P3...............  ...........       1.9997       $82.79       $82.79
41005............  Drainage of mouth lesion  Y................  .................  A2...............      $150.72       2.5002      $103.51      $138.92
41006............  Drainage of mouth lesion  Y................  .................  A2...............      $333.00      23.9765      $992.65      $497.91
41007............  Drainage of mouth lesion  Y................  .................  A2...............      $333.00      16.3288      $676.03      $418.76
41008............  Drainage of mouth lesion  Y................  .................  A2...............      $333.00      16.3288      $676.03      $418.76
41009............  Drainage of mouth lesion  Y................  .................  A2...............      $150.72       2.5002      $103.51      $138.92
41010............  Incision of tongue fold.  Y................  .................  A2...............      $333.00       7.4474      $308.33      $326.83
41015............  Drainage of mouth lesion  Y................  .................  A2...............      $150.72       2.5002      $103.51      $138.92
41016............  Drainage of mouth lesion  Y................  .................  A2...............      $333.00       7.4474      $308.33      $326.83
41017............  Drainage of mouth lesion  Y................  .................  A2...............      $333.00       7.4474      $308.33      $326.83
41018............  Drainage of mouth lesion  Y................  .................  A2...............      $333.00       7.4474      $308.33      $326.83
41019............  Place needles h&n for rt  Y................  NI...............  G2...............  ...........      23.9765      $992.65      $992.65
41100............  Biopsy of tongue........  Y................  .................  P3...............  ...........       2.0983       $86.87       $86.87
41105............  Biopsy of tongue........  Y................  .................  P3...............  ...........        2.049       $84.83       $84.83
41108............  Biopsy of floor of mouth  Y................  .................  P3...............  ...........       1.8927       $78.36       $78.36
41110............  Excision of tongue        Y................  .................  P3...............  ...........       2.7321      $113.11      $113.11
                    lesion.
41112............  Excision of tongue        Y................  .................  A2...............      $446.00      16.3288      $676.03      $503.51
                    lesion.
41113............  Excision of tongue        Y................  .................  A2...............      $446.00      16.3288      $676.03      $503.51
                    lesion.
41114............  Excision of tongue        Y................  .................  A2...............      $446.00      23.9765      $992.65      $582.66
                    lesion.
41115............  Excision of tongue fold.  Y................  .................  P3...............  ...........       3.0777      $127.42      $127.42
41116............  Excision of mouth lesion  Y................  .................  A2...............      $333.00      16.3288      $676.03      $418.76
41120............  Partial removal of        Y................  .................  A2...............      $717.00      23.9765      $992.65      $785.91
                    tongue.
41250............  Repair tongue laceration  Y................  .................  A2...............      $150.72       2.5002      $103.51      $138.92
41251............  Repair tongue laceration  Y................  .................  A2...............      $150.72       2.5002      $103.51      $138.92
41252............  Repair tongue laceration  Y................  .................  A2...............      $446.00       7.4474      $308.33      $411.58
41500............  Fixation of tongue......  Y................  .................  A2...............      $333.00      23.9765      $992.65      $497.91
41510............  Tongue to lip surgery...  Y................  .................  A2...............      $333.00      16.3288      $676.03      $418.76
41520............  Reconstruction, tongue    Y................  .................  A2...............      $446.00       7.4474      $308.33      $411.58
                    fold.
41800............  Drainage of gum lesion..  Y................  .................  A2...............       $88.46       1.4066       $58.23       $80.90
41805............  Removal foreign body,     Y................  .................  P3...............  ...........       3.0036      $124.35      $124.35
                    gum.
41806............  Removal foreign           Y................  .................  P3...............  ...........       3.8675      $160.12      $160.12
                    body,jawbone.
41820............  Excision, gum, each       Y................  .................  R2...............  ...........       7.4474      $308.33      $308.33
                    quadrant.
41821............  Excision of gum flap....  Y................  .................  G2...............  ...........       7.4474      $308.33      $308.33
41822............  Excision of gum lesion..  Y................  .................  P3...............  ...........       3.5714      $147.86      $147.86
41823............  Excision of gum lesion..  Y................  .................  P3...............  ...........       4.9455      $204.75      $204.75
41825............  Excision of gum lesion..  Y................  .................  P3...............  ...........       2.7731      $114.81      $114.81
41826............  Excision of gum lesion..  Y................  .................  P3...............  ...........       3.0941      $128.10      $128.10
41827............  Excision of gum lesion..  Y................  .................  A2...............      $446.00      23.9765      $992.65      $582.66
41828............  Excision of gum lesion..  Y................  .................  P3...............  ...........       3.2422      $134.23      $134.23
41830............  Removal of gum tissue...  Y................  .................  P3...............  ...........       4.5011      $186.35      $186.35
41850............  Treatment of gum lesion.  Y................  .................  R2...............  ...........      16.3288      $676.03      $676.03
41870............  Gum graft...............  Y................  .................  G2...............  ...........      23.9765      $992.65      $992.65
41872............  Repair gum..............  Y................  .................  P3...............  ...........       4.5506      $188.40      $188.40
41874............  Repair tooth socket.....  Y................  .................  P3...............  ...........       4.3202      $178.86      $178.86
42000............  Drainage mouth roof       Y................  .................  A2...............      $150.72       2.5002      $103.51      $138.92
                    lesion.
42100............  Biopsy roof of mouth....  Y................  .................  P3...............  ...........       1.7939       $74.27       $74.27
42104............  Excision lesion, mouth    Y................  .................  P3...............  ...........       2.5181      $104.25      $104.25
                    roof.
42106............  Excision lesion, mouth    Y................  .................  P3...............  ...........       3.1516      $130.48      $130.48
                    roof.
42107............  Excision lesion, mouth    Y................  .................  A2...............      $446.00      23.9765      $992.65      $582.66
                    roof.
42120............  Remove palate/lesion....  Y................  .................  A2...............      $630.00      39.8776    $1,650.97      $885.24
42140............  Excision of uvula.......  Y................  .................  A2...............      $446.00       7.4474      $308.33      $411.58
42145............  Repair palate, pharynx/   Y................  .................  A2...............      $717.00      23.9765      $992.65      $785.91
                    uvula.
42160............  Treatment mouth roof      Y................  .................  P3...............  ...........       3.2997      $136.61      $136.61
                    lesion.
42180............  Repair palate...........  Y................  .................  A2...............      $150.72       2.5002      $103.51      $138.92
42182............  Repair palate...........  Y................  .................  A2...............      $446.00      39.8776    $1,650.97      $747.24
42200............  Reconstruct cleft palate  Y................  .................  A2...............      $717.00      39.8776    $1,650.97      $950.49
42205............  Reconstruct cleft palate  Y................  .................  A2...............      $717.00      39.8776    $1,650.97      $950.49
42210............  Reconstruct cleft palate  Y................  .................  A2...............      $717.00      39.8776    $1,650.97      $950.49
42215............  Reconstruct cleft palate  Y................  .................  A2...............      $995.00      39.8776    $1,650.97    $1,158.99

[[Page 66974]]

 
42220............  Reconstruct cleft palate  Y................  .................  A2...............      $717.00      39.8776    $1,650.97      $950.49
42226............  Lengthening of palate...  Y................  .................  A2...............      $717.00      39.8776    $1,650.97      $950.49
42235............  Repair palate...........  Y................  .................  A2...............      $717.00      16.3288      $676.03      $706.76
42260............  Repair nose to lip        Y................  .................  A2...............      $630.00      23.9765      $992.65      $720.66
                    fistula.
42280............  Preparation, palate mold  Y................  .................  P3...............  ...........        1.728       $71.54       $71.54
42281............  Insertion, palate         Y................  .................  G2...............  ...........      16.3288      $676.03      $676.03
                    prosthesis.
42300............  Drainage of salivary      Y................  .................  A2...............      $333.00      16.3288      $676.03      $418.76
                    gland.
42305............  Drainage of salivary      Y................  .................  A2...............      $446.00      16.3288      $676.03      $503.51
                    gland.
42310............  Drainage of salivary      Y................  .................  A2...............      $150.72       2.5002      $103.51      $138.92
                    gland.
42320............  Drainage of salivary      Y................  .................  A2...............      $150.72       2.5002      $103.51      $138.92
                    gland.
42330............  Removal of salivary       Y................  .................  P3...............  ...........       2.6908      $111.40      $111.40
                    stone.
42335............  Removal of salivary       Y................  .................  P3...............  ...........       4.3859      $181.58      $181.58
                    stone.
42340............  Removal of salivary       Y................  .................  A2...............      $446.00      16.3288      $676.03      $503.51
                    stone.
42400............  Biopsy of salivary gland  Y................  .................  P3...............  ...........       1.4975       $62.00       $62.00
42405............  Biopsy of salivary gland  Y................  .................  A2...............      $446.00      16.3288      $676.03      $503.51
42408............  Excision of salivary      Y................  .................  A2...............      $510.00      16.3288      $676.03      $551.51
                    cyst.
42409............  Drainage of salivary      Y................  .................  A2...............      $510.00      16.3288      $676.03      $551.51
                    cyst.
42410............  Excise parotid gland/     Y................  .................  A2...............      $510.00      39.8776    $1,650.97      $795.24
                    lesion.
42415............  Excise parotid gland/     Y................  .................  A2...............      $995.00      39.8776    $1,650.97    $1,158.99
                    lesion.
42420............  Excise parotid gland/     Y................  .................  A2...............      $995.00      39.8776    $1,650.97    $1,158.99
                    lesion.
42425............  Excise parotid gland/     Y................  .................  A2...............      $995.00      39.8776    $1,650.97    $1,158.99
                    lesion.
42440............  Excise submaxillary       Y................  .................  A2...............      $510.00      39.8776    $1,650.97      $795.24
                    gland.
42450............  Excise sublingual gland.  Y................  .................  A2...............      $446.00      23.9765      $992.65      $582.66
42500............  Repair salivary duct....  Y................  .................  A2...............      $510.00      23.9765      $992.65      $630.66
42505............  Repair salivary duct....  Y................  .................  A2...............      $630.00      39.8776    $1,650.97      $885.24
42507............  Parotid duct diversion..  Y................  .................  A2...............      $510.00      39.8776    $1,650.97      $795.24
42508............  Parotid duct diversion..  Y................  .................  A2...............      $630.00      39.8776    $1,650.97      $885.24
42509............  Parotid duct diversion..  Y................  .................  A2...............      $630.00      39.8776    $1,650.97      $885.24
42510............  Parotid duct diversion..  Y................  .................  A2...............      $630.00      39.8776    $1,650.97      $885.24
42550............  Injection for salivary x- N................  .................  N1...............  ...........  ...........  ...........  ...........
                    ray.
42600............  Closure of salivary       Y................  .................  A2...............      $333.00      16.3288      $676.03      $418.76
                    fistula.
42650............  Dilation of salivary      Y................  .................  P3...............  ...........       0.9792       $40.54       $40.54
                    duct.
42660............  Dilation of salivary      Y................  .................  P3...............  ...........       1.1521       $47.70       $47.70
                    duct.
42665............  Ligation of salivary      Y................  .................  A2...............      $995.00      23.9765      $992.65      $994.41
                    duct.
42700............  Drainage of tonsil        Y................  .................  A2...............      $150.72       2.5002      $103.51      $138.92
                    abscess.
42720............  Drainage of throat        Y................  .................  A2...............      $333.00      16.3288      $676.03      $418.76
                    abscess.
42725............  Drainage of throat        Y................  .................  A2...............      $446.00      39.8776    $1,650.97      $747.24
                    abscess.
42800............  Biopsy of throat........  Y................  .................  P3...............  ...........       1.9091       $79.04       $79.04
42802............  Biopsy of throat........  Y................  .................  A2...............      $333.00      16.3288      $676.03      $418.76
42804............  Biopsy of upper nose/     Y................  .................  A2...............      $333.00      16.3288      $676.03      $418.76
                    throat.
42806............  Biopsy of upper nose/     Y................  .................  A2...............      $446.00      23.9765      $992.65      $582.66
                    throat.
42808............  Excise pharynx lesion...  Y................  .................  A2...............      $446.00      16.3288      $676.03      $503.51
42809............  Remove pharynx foreign    N................  .................  G2...............  ...........        0.631       $26.12       $26.12
                    body.
42810............  Excision of neck cyst...  Y................  .................  A2...............      $510.00      23.9765      $992.65      $630.66
42815............  Excision of neck cyst...  Y................  .................  A2...............      $717.00      39.8776    $1,650.97      $950.49
42820............  Remove tonsils and        Y................  .................  A2...............      $510.00      22.2557      $921.41      $612.85
                    adenoids.
42821............  Remove tonsils and        Y................  .................  A2...............      $717.00      22.2557      $921.41      $768.10
                    adenoids.
42825............  Removal of tonsils......  Y................  .................  A2...............      $630.00      22.2557      $921.41      $702.85
42826............  Removal of tonsils......  Y................  .................  A2...............      $630.00      22.2557      $921.41      $702.85
42830............  Removal of adenoids.....  Y................  .................  A2...............      $630.00      22.2557      $921.41      $702.85
42831............  Removal of adenoids.....  Y................  .................  A2...............      $630.00      22.2557      $921.41      $702.85
42835............  Removal of adenoids.....  Y................  .................  A2...............      $630.00      22.2557      $921.41      $702.85
42836............  Removal of adenoids.....  Y................  .................  A2...............      $630.00      22.2557      $921.41      $702.85
42860............  Excision of tonsil tags.  Y................  .................  A2...............      $510.00      22.2557      $921.41      $612.85
42870............  Excision of lingual       Y................  .................  A2...............      $510.00      22.2557      $921.41      $612.85
                    tonsil.
42890............  Partial removal of        Y................  .................  A2...............      $995.00      39.8776    $1,650.97    $1,158.99
                    pharynx.
42892............  Revision of pharyngeal    Y................  .................  A2...............      $995.00      39.8776    $1,650.97    $1,158.99
                    walls.
42900............  Repair throat wound.....  Y................  .................  A2...............      $333.00       7.4474      $308.33      $326.83
42950............  Reconstruction of throat  Y................  .................  A2...............      $446.00      23.9765      $992.65      $582.66
42955............  Surgical opening of       Y................  .................  A2...............      $446.00      23.9765      $992.65      $582.66
                    throat.
42960............  Control throat bleeding.  Y................  .................  A2...............       $72.48       1.1251       $46.58       $66.01
42962............  Control throat bleeding.  Y................  .................  A2...............      $446.00      39.8776    $1,650.97      $747.24
42970............  Control nose/throat       Y................  .................  R2...............  ...........       1.1251       $46.58       $46.58
                    bleeding.
42972............  Control nose/throat       Y................  .................  A2...............      $510.00      16.3288      $676.03      $551.51
                    bleeding.
43030............  Throat muscle surgery...  Y................  .................  G2...............  ...........      16.3288      $676.03      $676.03
43200............  Esophagus endoscopy.....  Y................  .................  A2...............      $333.00        8.503      $352.03      $337.76
43201............  Esoph scope w/submucous   Y................  .................  A2...............      $333.00        8.503      $352.03      $337.76
                    inj.
43202............  Esophagus endoscopy,      Y................  .................  A2...............      $333.00        8.503      $352.03      $337.76
                    biopsy.
43204............  Esoph scope w/sclerosis   Y................  .................  A2...............      $333.00        8.503      $352.03      $337.76
                    inj.
43205............  Esophagus endoscopy/      Y................  .................  A2...............      $333.00        8.503      $352.03      $337.76
                    ligation.
43215............  Esophagus endoscopy.....  Y................  .................  A2...............      $333.00        8.503      $352.03      $337.76
43216............  Esophagus endoscopy/      Y................  .................  A2...............      $333.00        8.503      $352.03      $337.76
                    lesion.
43217............  Esophagus endoscopy.....  Y................  .................  A2...............      $333.00        8.503      $352.03      $337.76

[[Page 66975]]

 
43219............  Esophagus endoscopy.....  Y................  .................  A2...............      $333.00      24.9814    $1,034.25      $508.31
43220............  Esoph endoscopy,          Y................  .................  A2...............      $333.00        8.503      $352.03      $337.76
                    dilation.
43226............  Esoph endoscopy,          Y................  .................  A2...............      $333.00        8.503      $352.03      $337.76
                    dilation.
43227............  Esoph endoscopy, repair.  Y................  .................  A2...............      $446.00        8.503      $352.03      $422.51
43228............  Esoph endoscopy,          Y................  .................  A2...............      $446.00      25.3233    $1,048.41      $596.60
                    ablation.
43231............  Esoph endoscopy w/us      Y................  .................  A2...............      $446.00        8.503      $352.03      $422.51
                    exam.
43232............  Esoph endoscopy w/us fn   Y................  .................  A2...............      $446.00        8.503      $352.03      $422.51
                    bx.
43234............  Upper gi endoscopy, exam  Y................  .................  A2...............      $333.00        8.503      $352.03      $337.76
43235............  Uppr gi endoscopy,        Y................  .................  A2...............      $333.00        8.503      $352.03      $337.76
                    diagnosis.
43236............  Uppr gi scope w/submuc    Y................  .................  A2...............      $446.00        8.503      $352.03      $422.51
                    inj.
43237............  Endoscopic us exam,       Y................  .................  A2...............      $446.00        8.503      $352.03      $422.51
                    esoph.
43238............  Uppr gi endoscopy w/us    Y................  .................  A2...............      $446.00        8.503      $352.03      $422.51
                    fn bx.
43239............  Upper gi endoscopy,       Y................  .................  A2...............      $446.00        8.503      $352.03      $422.51
                    biopsy.
43240............  Esoph endoscope w/drain   Y................  .................  A2...............      $446.00        8.503      $352.03      $422.51
                    cyst.
43241............  Upper gi endoscopy with   Y................  .................  A2...............      $446.00        8.503      $352.03      $422.51
                    tube.
43242............  Uppr gi endoscopy w/us    Y................  .................  A2...............      $446.00        8.503      $352.03      $422.51
                    fn bx.
43243............  Upper gi endoscopy &      Y................  .................  A2...............      $446.00        8.503      $352.03      $422.51
                    inject.
43244............  Upper gi endoscopy/       Y................  .................  A2...............      $446.00        8.503      $352.03      $422.51
                    ligation.
43245............  Uppr gi scope dilate      Y................  .................  A2...............      $446.00        8.503      $352.03      $422.51
                    strictr.
43246............  Place gastrostomy tube..  Y................  .................  A2...............      $446.00        8.503      $352.03      $422.51
43247............  Operative upper gi        Y................  .................  A2...............      $446.00        8.503      $352.03      $422.51
                    endoscopy.
43248............  Uppr gi endoscopy/guide   Y................  .................  A2...............      $446.00        8.503      $352.03      $422.51
                    wire.
43249............  Esoph endoscopy,          Y................  .................  A2...............      $446.00        8.503      $352.03      $422.51
                    dilation.
43250............  Upper gi endoscopy/tumor  Y................  .................  A2...............      $446.00        8.503      $352.03      $422.51
43251............  Operative upper gi        Y................  .................  A2...............      $446.00        8.503      $352.03      $422.51
                    endoscopy.
43255............  Operative upper gi        Y................  .................  A2...............      $446.00        8.503      $352.03      $422.51
                    endoscopy.
43256............  Uppr gi endoscopy w/      Y................  .................  A2...............      $510.00      24.9814    $1,034.25      $641.06
                    stent.
43257............  Uppr gi scope w/thrml     Y................  .................  A2...............      $510.00      25.3233    $1,048.41      $644.60
                    txmnt.
43258............  Operative upper gi        Y................  .................  A2...............      $510.00        8.503      $352.03      $470.51
                    endoscopy.
43259............  Endoscopic ultrasound     Y................  .................  A2...............      $510.00        8.503      $352.03      $470.51
                    exam.
43260............  Endo                      Y................  .................  A2...............      $446.00       20.951      $867.39      $551.35
                    cholangiopancreatograph.
43261............  Endo                      Y................  .................  A2...............      $446.00       20.951      $867.39      $551.35
                    cholangiopancreatograph.
43262............  Endo                      Y................  .................  A2...............      $446.00       20.951      $867.39      $551.35
                    cholangiopancreatograph.
43263............  Endo                      Y................  .................  A2...............      $446.00       20.951      $867.39      $551.35
                    cholangiopancreatograph.
43264............  Endo                      Y................  .................  A2...............      $446.00       20.951      $867.39      $551.35
                    cholangiopancreatograph.
43265............  Endo                      Y................  .................  A2...............      $446.00       20.951      $867.39      $551.35
                    cholangiopancreatograph.
43267............  Endo                      Y................  .................  A2...............      $446.00       20.951      $867.39      $551.35
                    cholangiopancreatograph.
43268............  Endo                      Y................  .................  A2...............      $446.00      24.9814    $1,034.25      $593.06
                    cholangiopancreatograph.
43269............  Endo                      Y................  .................  A2...............      $446.00      24.9814    $1,034.25      $593.06
                    cholangiopancreatograph.
43271............  Endo                      Y................  .................  A2...............      $446.00       20.951      $867.39      $551.35
                    cholangiopancreatograph.
43272............  Endo                      Y................  .................  A2...............      $446.00       20.951      $867.39      $551.35
                    cholangiopancreatograph.
43450............  Dilate esophagus........  Y................  .................  A2...............      $333.00       5.8431      $241.91      $310.23
43453............  Dilate esophagus........  Y................  .................  A2...............      $333.00       5.8431      $241.91      $310.23
43456............  Dilate esophagus........  Y................  .................  A2...............      $335.41       5.8431      $241.91      $312.04
43458............  Dilate esophagus........  Y................  .................  A2...............      $335.41        8.503      $352.03      $339.57
43600............  Biopsy of stomach.......  Y................  .................  A2...............      $333.00        8.503      $352.03      $337.76
43653............  Laparoscopy, gastrostomy  Y................  .................  A2...............    $1,339.00      45.5317    $1,885.06    $1,475.52
43750............  Place gastrostomy tube..  N................  CH...............  D5...............  ...........  ...........  ...........  ...........
43760............  Change gastrostomy tube.  Y................  .................  A2...............      $144.98       3.2383      $134.07      $142.25
43761............  Reposition gastrostomy    Y................  .................  A2...............      $333.00        8.503      $352.03      $337.76
                    tube.
43870............  Repair stomach opening..  Y................  .................  A2...............      $333.00        8.503      $352.03      $337.76
43886............  Revise gastric port,      Y................  .................  G2...............  ...........      20.2069      $836.59      $836.59
                    open.
43887............  Remove gastric port,      Y................  .................  G2...............  ...........       4.5263      $187.39      $187.39
                    open.
43888............  Change gastric port,      Y................  .................  G2...............  ...........      20.2069      $836.59      $836.59
                    open.
44100............  Biopsy of bowel.........  Y................  .................  A2...............      $333.00        8.503      $352.03      $337.76
44312............  Revision of ileostomy...  Y................  .................  A2...............      $333.00      20.2069      $836.59      $458.90
44340............  Revision of colostomy...  Y................  .................  A2...............      $510.00      20.2069      $836.59      $591.65
44360............  Small bowel endoscopy...  Y................  .................  A2...............      $446.00       9.5292      $394.52      $433.13
44361............  Small bowel endoscopy/    Y................  .................  A2...............      $446.00       9.5292      $394.52      $433.13
                    biopsy.
44363............  Small bowel endoscopy...  Y................  .................  A2...............      $446.00       9.5292      $394.52      $433.13
44364............  Small bowel endoscopy...  Y................  .................  A2...............      $446.00       9.5292      $394.52      $433.13
44365............  Small bowel endoscopy...  Y................  .................  A2...............      $446.00       9.5292      $394.52      $433.13
44366............  Small bowel endoscopy...  Y................  .................  A2...............      $446.00       9.5292      $394.52      $433.13
44369............  Small bowel endoscopy...  Y................  .................  A2...............      $446.00       9.5292      $394.52      $433.13
44370............  Small bowel endoscopy/    Y................  .................  A2...............    $1,339.00      24.9814    $1,034.25    $1,262.81
                    stent.
44372............  Small bowel endoscopy...  Y................  .................  A2...............      $446.00       9.5292      $394.52      $433.13
44373............  Small bowel endoscopy...  Y................  .................  A2...............      $446.00       9.5292      $394.52      $433.13
44376............  Small bowel endoscopy...  Y................  .................  A2...............      $446.00       9.5292      $394.52      $433.13
44377............  Small bowel endoscopy/    Y................  .................  A2...............      $446.00       9.5292      $394.52      $433.13
                    biopsy.
44378............  Small bowel endoscopy...  Y................  .................  A2...............      $446.00       9.5292      $394.52      $433.13
44379............  S bowel endoscope w/      Y................  .................  A2...............    $1,339.00      24.9814    $1,034.25    $1,262.81
                    stent.
44380............  Small bowel endoscopy...  Y................  .................  A2...............      $333.00       9.5292      $394.52      $348.38
44382............  Small bowel endoscopy...  Y................  .................  A2...............      $333.00       9.5292      $394.52      $348.38

[[Page 66976]]

 
44383............  Ileoscopy w/stent.......  Y................  .................  A2...............    $1,339.00      24.9814    $1,034.25    $1,262.81
44385............  Endoscopy of bowel pouch  Y................  .................  A2...............      $333.00       8.8486      $366.34      $341.34
44386............  Endoscopy, bowel pouch/   Y................  .................  A2...............      $333.00       8.8486      $366.34      $341.34
                    biop.
44388............  Colonoscopy.............  Y................  .................  A2...............      $333.00       8.8486      $366.34      $341.34
44389............  Colonoscopy with biopsy.  Y................  .................  A2...............      $333.00       8.8486      $366.34      $341.34
44390............  Colonoscopy for foreign   Y................  .................  A2...............      $333.00       8.8486      $366.34      $341.34
                    body.
44391............  Colonoscopy for bleeding  Y................  .................  A2...............      $333.00       8.8486      $366.34      $341.34
44392............  Colonoscopy &             Y................  .................  A2...............      $333.00       8.8486      $366.34      $341.34
                    polypectomy.
44393............  Colonoscopy, lesion       Y................  .................  A2...............      $333.00       8.8486      $366.34      $341.34
                    removal.
44394............  Colonoscopy w/snare.....  Y................  .................  A2...............      $333.00       8.8486      $366.34      $341.34
44397............  Colonoscopy w/stent.....  Y................  .................  A2...............      $333.00      24.9814    $1,034.25      $508.31
44500............  Intro, gastrointestinal   Y................  CH...............  G2...............  ...........       3.2383      $134.07      $134.07
                    tube.
44701............  Intraop colon lavage add- N................  .................  N1...............  ...........  ...........  ...........  ...........
                    on.
45000............  Drainage of pelvic        Y................  .................  A2...............      $312.07      10.9132      $451.82      $347.01
                    abscess.
45005............  Drainage of rectal        Y................  .................  A2...............      $446.00      10.9132      $451.82      $447.46
                    abscess.
45020............  Drainage of rectal        Y................  .................  A2...............      $446.00      10.9132      $451.82      $447.46
                    abscess.
45100............  Biopsy of rectum........  Y................  .................  A2...............      $333.00      22.7451      $941.67      $485.17
45108............  Removal of anorectal      Y................  .................  A2...............      $446.00      22.7451      $941.67      $569.92
                    lesion.
45150............  Excision of rectal        Y................  .................  A2...............      $446.00      22.7451      $941.67      $569.92
                    stricture.
45160............  Excision of rectal        Y................  .................  A2...............      $446.00      22.7451      $941.67      $569.92
                    lesion.
45170............  Excision of rectal        Y................  .................  A2...............      $446.00      22.7451      $941.67      $569.92
                    lesion.
45190............  Destruction, rectal       Y................  .................  A2...............    $1,339.00      22.7451      $941.67    $1,239.67
                    tumor.
45300............  Proctosigmoidoscopy dx..  Y................  .................  P3...............  ...........       1.4318       $59.28       $59.28
45303............  Proctosigmoidoscopy       Y................  .................  P2...............  ...........       8.7031      $360.32      $360.32
                    dilate.
45305............  Proctosigmoidoscopy w/bx  Y................  .................  A2...............      $333.00       8.7031      $360.32      $339.83
45307............  Proctosigmoidoscopy fb..  Y................  .................  A2...............      $333.00      21.4632      $888.60      $471.90
45308............  Proctosigmoidoscopy       Y................  .................  A2...............      $333.00       8.7031      $360.32      $339.83
                    removal.
45309............  Proctosigmoidoscopy       Y................  .................  A2...............      $333.00       8.7031      $360.32      $339.83
                    removal.
45315............  Proctosigmoidoscopy       Y................  .................  A2...............      $333.00       8.7031      $360.32      $339.83
                    removal.
45317............  Proctosigmoidoscopy       Y................  .................  A2...............      $333.00       8.7031      $360.32      $339.83
                    bleed.
45320............  Proctosigmoidoscopy       Y................  .................  A2...............      $333.00      21.4632      $888.60      $471.90
                    ablate.
45321............  Proctosigmoidoscopy       Y................  .................  A2...............      $333.00      21.4632      $888.60      $471.90
                    volvul.
45327............  Proctosigmoidoscopy w/    Y................  .................  A2...............      $333.00      24.9814    $1,034.25      $508.31
                    stent.
45330............  Diagnostic sigmoidoscopy  Y................  .................  P3...............  ...........       1.9748       $81.76       $81.76
45331............  Sigmoidoscopy and biopsy  Y................  .................  A2...............      $299.24       5.0972      $211.03      $277.19
45332............  Sigmoidoscopy w/fb        Y................  .................  A2...............      $299.24       5.0972      $211.03      $277.19
                    removal.
45333............  Sigmoidoscopy &           Y................  .................  A2...............      $333.00       8.7031      $360.32      $339.83
                    polypectomy.
45334............  Sigmoidoscopy for         Y................  .................  A2...............      $333.00       8.7031      $360.32      $339.83
                    bleeding.
45335............  Sigmoidoscopy w/submuc    Y................  .................  A2...............      $299.24       5.0972      $211.03      $277.19
                    inj.
45337............  Sigmoidoscopy &           Y................  .................  A2...............      $299.24       5.0972      $211.03      $277.19
                    decompress.
45338............  Sigmoidoscopy w/tumr      Y................  .................  A2...............      $333.00       8.7031      $360.32      $339.83
                    remove.
45339............  Sigmoidoscopy w/ablate    Y................  .................  A2...............      $333.00       8.7031      $360.32      $339.83
                    tumr.
45340............  Sig w/balloon dilation..  Y................  .................  A2...............      $333.00       8.7031      $360.32      $339.83
45341............  Sigmoidoscopy w/          Y................  .................  A2...............      $333.00       8.7031      $360.32      $339.83
                    ultrasound.
45342............  Sigmoidoscopy w/us guide  Y................  .................  A2...............      $333.00       8.7031      $360.32      $339.83
                    bx.
45345............  Sigmoidoscopy w/stent...  Y................  .................  A2...............      $333.00      24.9814    $1,034.25      $508.31
45355............  Surgical colonoscopy....  Y................  .................  A2...............      $333.00       8.8486      $366.34      $341.34
45378............  Diagnostic colonoscopy..  Y................  .................  A2...............      $446.00       8.8486      $366.34      $426.09
45379............  Colonoscopy w/fb removal  Y................  .................  A2...............      $446.00       8.8486      $366.34      $426.09
45380............  Colonoscopy and biopsy..  Y................  .................  A2...............      $446.00       8.8486      $366.34      $426.09
45381............  Colonoscopy, submucous    Y................  .................  A2...............      $446.00       8.8486      $366.34      $426.09
                    inj.
45382............  Colonoscopy/control       Y................  .................  A2...............      $446.00       8.8486      $366.34      $426.09
                    bleeding.
45383............  Lesion removal            Y................  .................  A2...............      $446.00       8.8486      $366.34      $426.09
                    colonoscopy.
45384............  Lesion remove             Y................  .................  A2...............      $446.00       8.8486      $366.34      $426.09
                    colonoscopy.
45385............  Lesion removal            Y................  .................  A2...............      $446.00       8.8486      $366.34      $426.09
                    colonoscopy.
45386............  Colonoscopy dilate        Y................  .................  A2...............      $446.00       8.8486      $366.34      $426.09
                    stricture.
45387............  Colonoscopy w/stent.....  Y................  .................  A2...............      $333.00      24.9814    $1,034.25      $508.31
45391............  Colonoscopy w/endoscope   Y................  .................  A2...............      $446.00       8.8486      $366.34      $426.09
                    us.
45392............  Colonoscopy w/endoscopic  Y................  .................  A2...............      $446.00       8.8486      $366.34      $426.09
                    fnb.
45500............  Repair of rectum........  Y................  .................  A2...............      $446.00      22.7451      $941.67      $569.92
45505............  Repair of rectum........  Y................  .................  A2...............      $446.00      30.1606    $1,248.68      $646.67
45520............  Treatment of rectal       Y................  .................  P2...............  ...........        0.793       $32.83       $32.83
                    prolapse.
45560............  Repair of rectocele.....  Y................  .................  A2...............      $446.00      30.1606    $1,248.68      $646.67
45900............  Reduction of rectal       Y................  .................  A2...............      $312.07       4.7935      $198.46      $283.67
                    prolapse.
45905............  Dilation of anal          Y................  .................  A2...............      $333.00      22.7451      $941.67      $485.17
                    sphincter.
45910............  Dilation of rectal        Y................  .................  A2...............      $333.00      22.7451      $941.67      $485.17
                    narrowing.
45915............  Remove rectal             Y................  .................  A2...............      $312.07      10.9132      $451.82      $347.01
                    obstruction.
45990............  Surg dx exam, anorectal.  Y................  .................  A2...............      $312.07      22.7451      $941.67      $469.47
46020............  Placement of seton......  Y................  .................  A2...............      $510.00      22.7451      $941.67      $617.92
46030............  Removal of rectal marker  Y................  .................  A2...............      $312.07       4.7935      $198.46      $283.67
46040............  Incision of rectal        Y................  .................  A2...............      $510.00      22.7451      $941.67      $617.92
                    abscess.
46045............  Incision of rectal        Y................  .................  A2...............      $446.00      22.7451      $941.67      $569.92
                    abscess.
46050............  Incision of anal abscess  Y................  .................  A2...............      $312.07      10.9132      $451.82      $347.01

[[Page 66977]]

 
46060............  Incision of rectal        Y................  .................  A2...............      $446.00      22.7451      $941.67      $569.92
                    abscess.
46070............  Incision of anal septum.  Y................  .................  G2...............  ...........      10.9132      $451.82      $451.82
46080............  Incision of anal          Y................  .................  A2...............      $510.00      22.7451      $941.67      $617.92
                    sphincter.
46083............  Incise external           Y................  .................  P3...............  ...........       2.0079       $83.13       $83.13
                    hemorrhoid.
46200............  Removal of anal fissure.  Y................  .................  A2...............      $446.00      22.7451      $941.67      $569.92
46210............  Removal of anal crypt...  Y................  .................  A2...............      $446.00      22.7451      $941.67      $569.92
46211............  Removal of anal crypts..  Y................  .................  A2...............      $446.00      22.7451      $941.67      $569.92
46220............  Removal of anal tag.....  Y................  .................  A2...............      $333.00      22.7451      $941.67      $485.17
46221............  Ligation of               Y................  .................  P3...............  ...........       2.6251      $108.68      $108.68
                    hemorrhoid(s).
46230............  Removal of anal tags....  Y................  .................  A2...............      $333.00      22.7451      $941.67      $485.17
46250............  Hemorrhoidectomy........  Y................  .................  A2...............      $510.00      22.7451      $941.67      $617.92
46255............  Hemorrhoidectomy........  Y................  .................  A2...............      $510.00      22.7451      $941.67      $617.92
46257............  Remove hemorrhoids &      Y................  .................  A2...............      $510.00      22.7451      $941.67      $617.92
                    fissure.
46258............  Remove hemorrhoids &      Y................  .................  A2...............      $510.00      22.7451      $941.67      $617.92
                    fistula.
46260............  Hemorrhoidectomy........  Y................  .................  A2...............      $510.00      22.7451      $941.67      $617.92
46261............  Remove hemorrhoids &      Y................  .................  A2...............      $630.00      22.7451      $941.67      $707.92
                    fissure.
46262............  Remove hemorrhoids &      Y................  .................  A2...............      $630.00      22.7451      $941.67      $707.92
                    fistula.
46270............  Removal of anal fistula.  Y................  .................  A2...............      $510.00      22.7451      $941.67      $617.92
46275............  Removal of anal fistula.  Y................  .................  A2...............      $510.00      22.7451      $941.67      $617.92
46280............  Removal of anal fistula.  Y................  .................  A2...............      $630.00      22.7451      $941.67      $707.92
46285............  Removal of anal fistula.  Y................  .................  A2...............      $333.00      22.7451      $941.67      $485.17
46288............  Repair anal fistula.....  Y................  .................  A2...............      $630.00      22.7451      $941.67      $707.92
46320............  Removal of hemorrhoid     Y................  .................  P3...............  ...........       1.8596       $76.99       $76.99
                    clot.
46500............  Injection into            Y................  .................  P3...............  ...........       2.3536       $97.44       $97.44
                    hemorrhoid(s).
46505............  Chemodenervation anal     Y................  .................  G2...............  ...........       4.7935      $198.46      $198.46
                    musc.
46600............  Diagnostic anoscopy.....  N................  .................  P2...............  ...........        0.631       $26.12       $26.12
46604............  Anoscopy and dilation...  Y................  .................  P2...............  ...........       8.7031      $360.32      $360.32
46606............  Anoscopy and biopsy.....  Y................  .................  P3...............  ...........       3.1434      $130.14      $130.14
46608............  Anoscopy, remove for      Y................  .................  A2...............      $333.00       8.7031      $360.32      $339.83
                    body.
46610............  Anoscopy, remove lesion.  Y................  .................  A2...............      $333.00      21.4632      $888.60      $471.90
46611............  Anoscopy................  Y................  .................  A2...............      $333.00       8.7031      $360.32      $339.83
46612............  Anoscopy, remove lesions  Y................  .................  A2...............      $333.00      21.4632      $888.60      $471.90
46614............  Anoscopy, control         Y................  .................  P3...............  ...........       1.7529       $72.57       $72.57
                    bleeding.
46615............  Anoscopy................  Y................  .................  A2...............      $446.00      21.4632      $888.60      $556.65
46700............  Repair of anal stricture  Y................  .................  A2...............      $510.00      22.7451      $941.67      $617.92
46706............  Repr of anal fistula w/   Y................  .................  A2...............      $333.00      30.1606    $1,248.68      $561.92
                    glue.
46750............  Repair of anal sphincter  Y................  .................  A2...............      $510.00      30.1606    $1,248.68      $694.67
46753............  Reconstruction of anus..  Y................  .................  A2...............      $510.00      22.7451      $941.67      $617.92
46754............  Removal of suture from    Y................  .................  A2...............      $446.00      22.7451      $941.67      $569.92
                    anus.
46760............  Repair of anal sphincter  Y................  .................  A2...............      $446.00      30.1606    $1,248.68      $646.67
46761............  Repair of anal sphincter  Y................  .................  A2...............      $510.00      30.1606    $1,248.68      $694.67
46762............  Implant artificial        Y................  .................  A2...............      $995.00      30.1606    $1,248.68    $1,058.42
                    sphincter.
46900............  Destruction, anal         Y................  .................  P3...............  ...........       2.5673      $106.29      $106.29
                    lesion(s).
46910............  Destruction, anal         Y................  .................  P3...............  ...........       2.7895      $115.49      $115.49
                    lesion(s).
46916............  Cryosurgery, anal         Y................  .................  P2...............  ...........       1.4595       $60.42       $60.42
                    lesion(s).
46917............  Laser surgery, anal       Y................  .................  A2...............      $333.00      19.9041      $824.05      $455.76
                    lesions.
46922............  Excision of anal          Y................  .................  A2...............      $333.00      19.9041      $824.05      $455.76
                    lesion(s).
46924............  Destruction, anal         Y................  .................  A2...............      $333.00      19.9041      $824.05      $455.76
                    lesion(s).
46934............  Destruction of            Y................  .................  P3...............  ...........       4.3695      $180.90      $180.90
                    hemorrhoids.
46935............  Destruction of            Y................  .................  P3...............  ...........       3.0118      $124.69      $124.69
                    hemorrhoids.
46936............  Destruction of            Y................  .................  P3...............  ...........        4.567      $189.08      $189.08
                    hemorrhoids.
46937............  Cryotherapy of rectal     Y................  .................  A2...............      $446.00      22.7451      $941.67      $569.92
                    lesion.
46938............  Cryotherapy of rectal     Y................  .................  A2...............      $446.00      30.1606    $1,248.68      $646.67
                    lesion.
46940............  Treatment of anal         Y................  .................  P3...............  ...........       1.9915       $82.45       $82.45
                    fissure.
46942............  Treatment of anal         Y................  .................  P3...............  ...........       1.9091       $79.04       $79.04
                    fissure.
46945............  Ligation of hemorrhoids.  Y................  .................  P3...............  ...........       3.3161      $137.29      $137.29
46946............  Ligation of hemorrhoids.  Y................  .................  A2...............      $333.00      10.9132      $451.82      $362.71
46947............  Hemorrhoidopexy by        Y................  .................  A2...............      $995.00      30.1606    $1,248.68    $1,058.42
                    stapling.
47000............  Needle biopsy of liver..  Y................  .................  A2...............      $333.00       9.3354      $386.49      $346.37
47001............  Needle biopsy, liver add- N................  .................  N1...............  ...........  ...........  ...........  ...........
                    on.
47382............  Percut ablate liver rf..  Y................  .................  G2...............  ...........       42.998    $1,780.16    $1,780.16
47500............  Injection for liver x-    N................  .................  N1...............  ...........  ...........  ...........  ...........
                    rays.
47505............  Injection for liver x-    N................  .................  N1...............  ...........  ...........  ...........  ...........
                    rays.
47510............  Insert catheter, bile     Y................  .................  A2...............      $446.00      28.6884    $1,187.73      $631.43
                    duct.
47511............  Insert bile duct drain..  Y................  .................  A2...............    $1,245.85      28.6884    $1,187.73    $1,231.32
47525............  Change bile duct          Y................  .................  A2...............      $333.00      15.3545      $635.69      $408.67
                    catheter.
47530............  Revise/reinsert bile      Y................  .................  A2...............      $333.00      15.3545      $635.69      $408.67
                    tube.
47552............  Biliary endoscopy thru    Y................  .................  A2...............      $446.00      28.6884    $1,187.73      $631.43
                    skin.
47553............  Biliary endoscopy thru    Y................  .................  A2...............      $510.00      28.6884    $1,187.73      $679.43
                    skin.
47554............  Biliary endoscopy thru    Y................  .................  A2...............      $510.00      28.6884    $1,187.73      $679.43
                    skin.
47555............  Biliary endoscopy thru    Y................  .................  A2...............      $510.00      28.6884    $1,187.73      $679.43
                    skin.
47556............  Biliary endoscopy thru    Y................  .................  A2...............    $1,245.85      28.6884    $1,187.73    $1,231.32
                    skin.
47560............  Laparoscopy w/cholangio.  Y................  .................  A2...............      $510.00      34.3958    $1,424.02      $738.51

[[Page 66978]]

 
47561............  Laparo w/cholangio/       Y................  .................  A2...............      $510.00      34.3958    $1,424.02      $738.51
                    biopsy.
47562............  Laparoscopic              Y................  .................  G2...............  ...........      45.5317    $1,885.06    $1,885.06
                    cholecystectomy.
47563............  Laparo cholecystectomy/   Y................  .................  G2...............  ...........      45.5317    $1,885.06    $1,885.06
                    graph.
47564............  Laparo cholecystectomy/   Y................  .................  G2...............  ...........      45.5317    $1,885.06    $1,885.06
                    explr.
47630............  Remove bile duct stone..  Y................  .................  A2...............      $510.00      28.6884    $1,187.73      $679.43
48102............  Needle biopsy, pancreas.  Y................  .................  A2...............      $333.00       9.3354      $386.49      $346.37
49080............  Puncture, peritoneal      Y................  .................  A2...............      $222.78       5.2024      $215.38      $220.93
                    cavity.
49081............  Removal of abdominal      Y................  .................  A2...............      $222.78       5.2024      $215.38      $220.93
                    fluid.
49180............  Biopsy, abdominal mass..  Y................  .................  A2...............      $333.00       9.3354      $386.49      $346.37
49250............  Excision of umbilicus...  Y................  .................  A2...............      $630.00      25.6947    $1,063.79      $738.45
49320............  Diag laparo separate      Y................  .................  A2...............      $510.00      34.3958    $1,424.02      $738.51
                    proc.
49321............  Laparoscopy, biopsy.....  Y................  .................  A2...............      $630.00      34.3958    $1,424.02      $828.51
49322............  Laparoscopy, aspiration.  Y................  .................  A2...............      $630.00      34.3958    $1,424.02      $828.51
49400............  Air injection into        N................  .................  N1...............  ...........  ...........  ...........  ...........
                    abdomen.
49402............  Remove foreign body,      Y................  .................  A2...............      $446.00      25.6947    $1,063.79      $600.45
                    adbomen.
49419............  Insrt abdom cath for      Y................  .................  A2...............      $333.00      29.6965    $1,229.46      $557.12
                    chemotx.
49420............  Insert abdom drain, temp  Y................  .................  A2...............      $333.00      30.7096    $1,271.41      $567.60
49421............  Insert abdom drain, perm  Y................  .................  A2...............      $333.00      30.7096    $1,271.41      $567.60
49422............  Remove perm cannula/      Y................  .................  A2...............      $333.00      23.9802      $992.80      $497.95
                    catheter.
49423............  Exchange drainage         Y................  .................  G2...............  ...........      15.3545      $635.69      $635.69
                    catheter.
49424............  Assess cyst, contrast     N................  .................  N1...............  ...........  ...........  ...........  ...........
                    inject.
49426............  Revise abdomen-venous     Y................  .................  A2...............      $446.00      25.6947    $1,063.79      $600.45
                    shunt.
49427............  Injection, abdominal      N................  .................  N1...............  ...........  ...........  ...........  ...........
                    shunt.
49429............  Removal of shunt........  Y................  .................  G2...............  ...........      23.9802      $992.80      $992.80
49440............  Place gastrostomy tube    Y................  NI...............  G2...............  ...........        8.503      $352.03      $352.03
                    perc.
49441............  Place duod/jej tube perc  Y................  NI...............  G2...............  ...........        8.503      $352.03      $352.03
49446............  Change g-tube to g-j      Y................  NI...............  G2...............  ...........        8.503      $352.03      $352.03
                    perc.
49450............  Replace g/c tube perc...  Y................  NI...............  G2...............  ...........       3.2383      $134.07      $134.07
49451............  Replace duod/jej tube     Y................  NI...............  G2...............  ...........       3.2383      $134.07      $134.07
                    perc.
49452............  Replace g-j tube perc...  Y................  NI...............  G2...............  ...........       3.2383      $134.07      $134.07
49460............  Fix g/colon tube w/       Y................  NI...............  G2...............  ...........       3.2383      $134.07      $134.07
                    device.
49465............  Fluoro exam of g/colon    N................  NI...............  N1...............  ...........  ...........  ...........  ...........
                    tube.
49495............  Rpr ing hernia baby,      Y................  .................  A2...............      $630.00      30.6788    $1,270.13      $790.03
                    reduc.
49496............  Rpr ing hernia baby,      Y................  .................  A2...............      $630.00      30.6788    $1,270.13      $790.03
                    blocked.
49500............  Rpr ing hernia, init,     Y................  .................  A2...............      $630.00      30.6788    $1,270.13      $790.03
                    reduce.
49501............  Rpr ing hernia, init      Y................  .................  A2...............    $1,339.00      30.6788    $1,270.13    $1,321.78
                    blocked.
49505............  Prp i/hern init reduc >5  Y................  .................  A2...............      $630.00      30.6788    $1,270.13      $790.03
                    yr.
49507............  Prp i/hern init block >5  Y................  .................  A2...............    $1,339.00      30.6788    $1,270.13    $1,321.78
                    yr.
49520............  Rerepair ing hernia,      Y................  .................  A2...............      $995.00      30.6788    $1,270.13    $1,063.78
                    reduce.
49521............  Rerepair ing hernia,      Y................  .................  A2...............    $1,339.00      30.6788    $1,270.13    $1,321.78
                    blocked.
49525............  Repair ing hernia,        Y................  .................  A2...............      $630.00      30.6788    $1,270.13      $790.03
                    sliding.
49540............  Repair lumbar hernia....  Y................  .................  A2...............      $446.00      30.6788    $1,270.13      $652.03
49550............  Rpr rem hernia, init,     Y................  .................  A2...............      $717.00      30.6788    $1,270.13      $855.28
                    reduce.
49553............  Rpr fem hernia, init      Y................  .................  A2...............    $1,339.00      30.6788    $1,270.13    $1,321.78
                    blocked.
49555............  Rerepair fem hernia,      Y................  .................  A2...............      $717.00      30.6788    $1,270.13      $855.28
                    reduce.
49557............  Rerepair fem hernia,      Y................  .................  A2...............    $1,339.00      30.6788    $1,270.13    $1,321.78
                    blocked.
49560............  Rpr ventral hern init,    Y................  .................  A2...............      $630.00      30.6788    $1,270.13      $790.03
                    reduc.
49561............  Rpr ventral hern init,    Y................  .................  A2...............    $1,339.00      30.6788    $1,270.13    $1,321.78
                    block.
49565............  Rerepair ventrl hern,     Y................  .................  A2...............      $630.00      30.6788    $1,270.13      $790.03
                    reduce.
49566............  Rerepair ventrl hern,     Y................  .................  A2...............    $1,339.00      30.6788    $1,270.13    $1,321.78
                    block.
49568............  Hernia repair w/mesh....  Y................  .................  A2...............      $995.00      30.6788    $1,270.13    $1,063.78
49570............  Rpr epigastric hern,      Y................  .................  A2...............      $630.00      30.6788    $1,270.13      $790.03
                    reduce.
49572............  Rpr epigastric hern,      Y................  .................  A2...............    $1,339.00      30.6788    $1,270.13    $1,321.78
                    blocked.
49580............  Rpr umbil hern, reduc <   Y................  .................  A2...............      $630.00      30.6788    $1,270.13      $790.03
                    5 yr.
49582............  Rpr umbil hern, block <   Y................  .................  A2...............    $1,339.00      30.6788    $1,270.13    $1,321.78
                    5 yr.
49585............  Rpr umbil hern, reduc >   Y................  .................  A2...............      $630.00      30.6788    $1,270.13      $790.03
                    5 yr.
49587............  Rpr umbil hern, block >   Y................  .................  A2...............    $1,339.00      30.6788    $1,270.13    $1,321.78
                    5 yr.
49590............  Repair spigelian hernia.  Y................  .................  A2...............      $510.00      30.6788    $1,270.13      $700.03
49600............  Repair umbilical lesion.  Y................  .................  A2...............      $630.00      30.6788    $1,270.13      $790.03
49650............  Laparo hernia repair      Y................  .................  A2...............      $630.00      45.5317    $1,885.06      $943.77
                    initial.
49651............  Laparo hernia repair      Y................  .................  A2...............      $995.00      45.5317    $1,885.06    $1,217.52
                    recur.
50200............  Biopsy of kidney........  Y................  .................  A2...............      $333.00       9.3354      $386.49      $346.37
50382............  Change ureter stent,      Y................  .................  G2...............  ...........      24.7749    $1,025.71    $1,025.71
                    percut.
50384............  Remove ureter stent,      Y................  .................  G2...............  ...........       17.942      $742.82      $742.82
                    percut.
50385............  Change stent via          Y................  NI...............  G2...............  ...........       17.942      $742.82      $742.82
                    transureth.
50386............  Remove stent via          Y................  NI...............  G2...............  ...........       5.9735      $247.31      $247.31
                    transureth.
50387............  Change ext/int ureter     Y................  .................  G2...............  ...........      15.3545      $635.69      $635.69
                    stent.
50389............  Remove renal tube w/      Y................  .................  G2...............  ...........       5.9735      $247.31      $247.31
                    fluoro.
50390............  Drainage of kidney        Y................  .................  A2...............      $333.00       9.3354      $386.49      $346.37
                    lesion.
50391............  Instll rx agnt into rnal  Y................  .................  P2...............  ...........       1.0356       $42.87       $42.87
                    tub.
50392............  Insert kidney drain.....  Y................  .................  A2...............      $333.00       17.942      $742.82      $435.46
50393............  Insert ureteral tube....  Y................  .................  A2...............      $333.00      24.7749    $1,025.71      $506.18
50394............  Injection for kidney x-   N................  .................  N1...............  ...........  ...........  ...........  ...........
                    ray.

[[Page 66979]]

 
50395............  Create passage to kidney  Y................  .................  A2...............      $333.00       17.942      $742.82      $435.46
50396............  Measure kidney pressure.  Y................  .................  A2...............      $131.50       2.0077       $83.12      $119.41
50398............  Change kidney tube......  Y................  .................  A2...............      $333.00      15.3545      $635.69      $408.67
50551............  Kidney endoscopy........  Y................  .................  A2...............      $333.00       5.9735      $247.31      $311.58
50553............  Kidney endoscopy........  Y................  .................  A2...............      $333.00      24.7749    $1,025.71      $506.18
50555............  Kidney endoscopy &        Y................  .................  A2...............      $333.00       5.9735      $247.31      $311.58
                    biopsy.
50557............  Kidney endoscopy &        Y................  .................  A2...............      $333.00      24.7749    $1,025.71      $506.18
                    treatment.
50561............  Kidney endoscopy &        Y................  .................  A2...............      $333.00      24.7749    $1,025.71      $506.18
                    treatment.
50562............  Renal scope w/tumor       Y................  .................  G2...............  ...........       5.9735      $247.31      $247.31
                    resect.
50570............  Kidney endoscopy........  Y................  .................  G2...............  ...........       5.9735      $247.31      $247.31
50572............  Kidney endoscopy........  Y................  .................  G2...............  ...........       5.9735      $247.31      $247.31
50574............  Kidney endoscopy &        Y................  .................  G2...............  ...........       5.9735      $247.31      $247.31
                    biopsy.
50575............  Kidney endoscopy........  Y................  .................  G2...............  ...........      36.0774    $1,493.64    $1,493.64
50576............  Kidney endoscopy &        Y................  .................  G2...............  ...........       17.942      $742.82      $742.82
                    treatment.
50580............  Kidney endoscopy &        Y................  CH...............  G2...............  ...........       17.942      $742.82      $742.82
                    treatment.
50590............  Fragmenting of kidney     Y................  .................  G2...............  ...........      41.5299    $1,719.38    $1,719.38
                    stone.
50592............  Perc rf ablate renal      Y................  .................  G2...............  ...........       42.998    $1,780.16    $1,780.16
                    tumor.
50684............  Injection for ureter x-   N................  .................  N1...............  ...........  ...........  ...........  ...........
                    ray.
50686............  Measure ureter pressure.  Y................  .................  P2...............  ...........       1.0356       $42.87       $42.87
50688............  Change of ureter tube/    Y................  .................  A2...............      $333.00      15.3545      $635.69      $408.67
                    stent.
50690............  Injection for ureter x-   N................  .................  N1...............  ...........  ...........  ...........  ...........
                    ray.
50947............  Laparo new ureter/        Y................  .................  A2...............    $1,339.00      45.5317    $1,885.06    $1,475.52
                    bladder.
50948............  Laparo new ureter/        Y................  .................  A2...............    $1,339.00      45.5317    $1,885.06    $1,475.52
                    bladder.
50951............  Endoscopy of ureter.....  Y................  .................  A2...............      $333.00       5.9735      $247.31      $311.58
50953............  Endoscopy of ureter.....  Y................  .................  A2...............      $333.00       5.9735      $247.31      $311.58
50955............  Ureter endoscopy &        Y................  .................  A2...............      $333.00      24.7749    $1,025.71      $506.18
                    biopsy.
50957............  Ureter endoscopy &        Y................  .................  A2...............      $333.00      24.7749    $1,025.71      $506.18
                    treatment.
50961............  Ureter endoscopy &        Y................  .................  A2...............      $333.00      24.7749    $1,025.71      $506.18
                    treatment.
50970............  Ureter endoscopy........  Y................  .................  A2...............      $333.00       5.9735      $247.31      $311.58
50972............  Ureter endoscopy &        Y................  .................  A2...............      $333.00       5.9735      $247.31      $311.58
                    catheter.
50974............  Ureter endoscopy &        Y................  .................  A2...............      $333.00       17.942      $742.82      $435.46
                    biopsy.
50976............  Ureter endoscopy &        Y................  .................  A2...............      $333.00       17.942      $742.82      $435.46
                    treatment.
50980............  Ureter endoscopy &        Y................  .................  A2...............      $333.00      24.7749    $1,025.71      $506.18
                    treatment.
51000............  Drainage of bladder.....  N................  CH...............  D5...............  ...........  ...........  ...........  ...........
51005............  Drainage of bladder.....  N................  CH...............  D5...............  ...........  ...........  ...........  ...........
51010............  Drainage of bladder.....  N................  CH...............  D5...............  ...........  ...........  ...........  ...........
51020............  Incise & treat bladder..  Y................  .................  A2...............      $630.00      24.7749    $1,025.71      $728.93
51030............  Incise & treat bladder..  Y................  .................  A2...............      $630.00      24.7749    $1,025.71      $728.93
51040............  Incise & drain bladder..  Y................  .................  A2...............      $630.00      24.7749    $1,025.71      $728.93
51045............  Incise bladder/drain      Y................  .................  A2...............      $399.24       5.9735      $247.31      $361.26
                    ureter.
51050............  Removal of bladder stone  Y................  .................  A2...............      $630.00      24.7749    $1,025.71      $728.93
51065............  Remove ureter calculus..  Y................  .................  A2...............      $630.00      24.7749    $1,025.71      $728.93
51080............  Drainage of bladder       Y................  .................  A2...............      $333.00      18.3197      $758.45      $439.36
                    abscess.
51100............  Drain bladder by needle.  Y................  NI...............  P3...............  ...........        0.757       $31.34       $31.34
51101............  Drain bladder by trocar/  Y................  NI...............  P2...............  ...........       1.0356       $42.87       $42.87
                    cath.
51102............  Drain bl w/cath           Y................  NI...............  A2...............      $333.00      19.3414      $800.75      $449.94
                    insertion.
51500............  Removal of bladder cyst.  Y................  .................  A2...............      $630.00      30.6788    $1,270.13      $790.03
51520............  Removal of bladder        Y................  .................  A2...............      $630.00      24.7749    $1,025.71      $728.93
                    lesion.
51600............  Injection for bladder x-  N................  .................  N1...............  ...........  ...........  ...........  ...........
                    ray.
51605............  Preparation for bladder   N................  .................  N1...............  ...........  ...........  ...........  ...........
                    xray.
51610............  Injection for bladder x-  N................  .................  N1...............  ...........  ...........  ...........  ...........
                    ray.
51700............  Irrigation of bladder...  Y................  .................  P3...............  ...........       1.2756       $52.81       $52.81
51701............  Insert bladder catheter.  N................  .................  P2...............  ...........        0.631       $26.12       $26.12
51702............  Insert temp bladder cath  N................  .................  P2...............  ...........        0.631       $26.12       $26.12
51703............  Insert bladder cath,      Y................  .................  P2...............  ...........       1.0356       $42.87       $42.87
                    complex.
51705............  Change of bladder tube..  Y................  .................  P3...............  ...........       1.7693       $73.25       $73.25
51710............  Change of bladder tube..  Y................  .................  A2...............      $333.00      15.3545      $635.69      $408.67
51715............  Endoscopic injection/     Y................  .................  A2...............      $510.00      29.7864    $1,233.19      $690.80
                    implant.
51720............  Treatment of bladder      Y................  .................  P3...............  ...........       1.3823       $57.23       $57.23
                    lesion.
51725............  Simple cystometrogram...  Y................  .................  P2...............  ...........       3.0469      $126.14      $126.14
51726............  Complex cystometrogram..  Y................  .................  A2...............      $209.48       3.0469      $126.14      $188.65
51736............  Urine flow measurement..  Y................  .................  P3...............  ...........       0.4444       $18.40       $18.40
51741............  Electro-uroflowmetry,     Y................  .................  P3...............  ...........       0.5101       $21.12       $21.12
                    first.
51772............  Urethra pressure profile  Y................  .................  A2...............      $131.50       2.0077       $83.12      $119.41
51784............  Anal/urinary muscle       Y................  .................  P2...............  ...........       1.0356       $42.87       $42.87
                    study.
51785............  Anal/urinary muscle       Y................  .................  A2...............       $66.92       2.0077       $83.12       $70.97
                    study.
51792............  Urinary reflex study....  Y................  .................  P2...............  ...........       1.0356       $42.87       $42.87
51795............  Urine voiding pressure    Y................  .................  P2...............  ...........       2.0077       $83.12       $83.12
                    study.
51797............  Intraabdominal pressure   Y................  .................  P2...............  ...........       2.0077       $83.12       $83.12
                    test.
51798............  Us urine capacity         N................  .................  P3...............  ...........       0.3867       $16.01       $16.01
                    measure.
51880............  Repair of bladder         Y................  .................  A2...............      $333.00      24.7749    $1,025.71      $506.18
                    opening.
51992............  Laparo sling operation..  Y................  .................  A2...............      $717.00      45.5317    $1,885.06    $1,009.02
52000............  Cystoscopy..............  Y................  .................  A2...............      $333.00       5.9735      $247.31      $311.58

[[Page 66980]]

 
52001............  Cystoscopy, removal of    Y................  .................  A2...............      $399.24       17.942      $742.82      $485.14
                    clots.
52005............  Cystoscopy & ureter       Y................  .................  A2...............      $446.00       17.942      $742.82      $520.21
                    catheter.
52007............  Cystoscopy and biopsy...  Y................  .................  A2...............      $446.00      24.7749    $1,025.71      $590.93
52010............  Cystoscopy & duct         Y................  .................  A2...............      $399.24       5.9735      $247.31      $361.26
                    catheter.
52204............  Cystoscopy w/biopsy(s)..  Y................  .................  A2...............      $446.00       17.942      $742.82      $520.21
52214............  Cystoscopy and treatment  Y................  .................  A2...............      $446.00      24.7749    $1,025.71      $590.93
52224............  Cystoscopy and treatment  Y................  .................  A2...............      $446.00      24.7749    $1,025.71      $590.93
52234............  Cystoscopy and treatment  Y................  .................  A2...............      $446.00      24.7749    $1,025.71      $590.93
52235............  Cystoscopy and treatment  Y................  .................  A2...............      $510.00      24.7749    $1,025.71      $638.93
52240............  Cystoscopy and treatment  Y................  .................  A2...............      $510.00      24.7749    $1,025.71      $638.93
52250............  Cystoscopy and            Y................  .................  A2...............      $630.00      24.7749    $1,025.71      $728.93
                    radiotracer.
52260............  Cystoscopy and treatment  Y................  .................  A2...............      $446.00       17.942      $742.82      $520.21
52265............  Cystoscopy and treatment  Y................  .................  P2...............  ...........       5.9735      $247.31      $247.31
52270............  Cystoscopy & revise       Y................  .................  A2...............      $446.00       17.942      $742.82      $520.21
                    urethra.
52275............  Cystoscopy & revise       Y................  .................  A2...............      $446.00      24.7749    $1,025.71      $590.93
                    urethra.
52276............  Cystoscopy and treatment  Y................  .................  A2...............      $510.00      24.7749    $1,025.71      $638.93
52277............  Cystoscopy and treatment  Y................  .................  A2...............      $446.00      24.7749    $1,025.71      $590.93
52281............  Cystoscopy and treatment  Y................  .................  A2...............      $446.00       17.942      $742.82      $520.21
52282............  Cystoscopy, implant       Y................  .................  A2...............    $1,339.00      36.0774    $1,493.64    $1,377.66
                    stent.
52283............  Cystoscopy and treatment  Y................  .................  A2...............      $446.00      24.7749    $1,025.71      $590.93
52285............  Cystoscopy and treatment  Y................  .................  A2...............      $446.00       17.942      $742.82      $520.21
52290............  Cystoscopy and treatment  Y................  .................  A2...............      $446.00       17.942      $742.82      $520.21
52300............  Cystoscopy and treatment  Y................  .................  A2...............      $446.00      24.7749    $1,025.71      $590.93
52301............  Cystoscopy and treatment  Y................  .................  A2...............      $510.00      24.7749    $1,025.71      $638.93
52305............  Cystoscopy and treatment  Y................  .................  A2...............      $446.00      24.7749    $1,025.71      $590.93
52310............  Cystoscopy and treatment  Y................  .................  A2...............      $399.24       17.942      $742.82      $485.14
52315............  Cystoscopy and treatment  Y................  .................  A2...............      $446.00      24.7749    $1,025.71      $590.93
52317............  Remove bladder stone....  Y................  .................  A2...............      $333.00      24.7749    $1,025.71      $506.18
52318............  Remove bladder stone....  Y................  .................  A2...............      $446.00      24.7749    $1,025.71      $590.93
52320............  Cystoscopy and treatment  Y................  .................  A2...............      $717.00      24.7749    $1,025.71      $794.18
52325............  Cystoscopy, stone         Y................  .................  A2...............      $630.00      24.7749    $1,025.71      $728.93
                    removal.
52327............  Cystoscopy, inject        Y................  .................  A2...............      $446.00      24.7749    $1,025.71      $590.93
                    material.
52330............  Cystoscopy and treatment  Y................  .................  A2...............      $446.00      24.7749    $1,025.71      $590.93
52332............  Cystoscopy and treatment  Y................  .................  A2...............      $446.00      24.7749    $1,025.71      $590.93
52334............  Create passage to kidney  Y................  .................  A2...............      $510.00      24.7749    $1,025.71      $638.93
52341............  Cysto w/ureter stricture  Y................  .................  A2...............      $510.00      24.7749    $1,025.71      $638.93
                    tx.
52342............  Cysto w/up stricture tx.  Y................  .................  A2...............      $510.00      24.7749    $1,025.71      $638.93
52343............  Cysto w/renal stricture   Y................  .................  A2...............      $510.00      24.7749    $1,025.71      $638.93
                    tx.
52344............  Cysto/uretero, stricture  Y................  .................  A2...............      $510.00      24.7749    $1,025.71      $638.93
                    tx.
52345............  Cysto/uretero w/up        Y................  .................  A2...............      $510.00      24.7749    $1,025.71      $638.93
                    stricture.
52346............  Cystouretero w/renal      Y................  .................  A2...............      $510.00      24.7749    $1,025.71      $638.93
                    strict.
52351............  Cystouretero & or         Y................  .................  A2...............      $510.00      24.7749    $1,025.71      $638.93
                    pyeloscope.
52352............  Cystouretero w/stone      Y................  .................  A2...............      $630.00      24.7749    $1,025.71      $728.93
                    remove.
52353............  Cystouretero w/           Y................  .................  A2...............      $630.00      36.0774    $1,493.64      $845.91
                    lithotripsy.
52354............  Cystouretero w/biopsy...  Y................  .................  A2...............      $630.00      24.7749    $1,025.71      $728.93
52355............  Cystouretero w/excise     Y................  .................  A2...............      $630.00      24.7749    $1,025.71      $728.93
                    tumor.
52400............  Cystouretero w/congen     Y................  .................  A2...............      $510.00      24.7749    $1,025.71      $638.93
                    repr.
52402............  Cystourethro cut ejacul   Y................  .................  A2...............      $510.00      24.7749    $1,025.71      $638.93
                    duct.
52450............  Incision of prostate....  Y................  .................  A2...............      $510.00      24.7749    $1,025.71      $638.93
52500............  Revision of bladder neck  Y................  .................  A2...............      $510.00      24.7749    $1,025.71      $638.93
52510............  Dilation prostatic        N................  CH...............  D5...............  ...........  ...........  ...........  ...........
                    urethra.
52601............  Prostatectomy (turp)....  Y................  .................  A2...............      $630.00      36.0774    $1,493.64      $845.91
52606............  Control postop bleeding.  Y................  .................  A2...............      $333.00      24.7749    $1,025.71      $506.18
52612............  Prostatectomy, first      Y................  .................  A2...............      $446.00      36.0774    $1,493.64      $707.91
                    stage.
52614............  Prostatectomy, second     Y................  .................  A2...............      $333.00      36.0774    $1,493.64      $623.16
                    stage.
52620............  Remove residual prostate  Y................  .................  A2...............      $333.00      36.0774    $1,493.64      $623.16
52630............  Remove prostate regrowth  Y................  .................  A2...............      $446.00      36.0774    $1,493.64      $707.91
52640............  Relieve bladder           Y................  .................  A2...............      $446.00      24.7749    $1,025.71      $590.93
                    contracture.
52647............  Laser surgery of          Y................  .................  A2...............    $1,339.00      45.2042    $1,871.50    $1,472.13
                    prostate.
52648............  Laser surgery of          Y................  .................  A2...............    $1,339.00      45.2042    $1,871.50    $1,472.13
                    prostate.
52700............  Drainage of prostate      Y................  .................  A2...............      $446.00      24.7749    $1,025.71      $590.93
                    abscess.
53000............  Incision of urethra.....  Y................  .................  A2...............      $333.00      19.1505      $792.85      $447.96
53010............  Incision of urethra.....  Y................  .................  A2...............      $333.00      19.1505      $792.85      $447.96
53020............  Incision of urethra.....  Y................  .................  A2...............      $333.00      19.1505      $792.85      $447.96
53025............  Incision of urethra.....  Y................  .................  R2...............  ...........      19.1505      $792.85      $792.85
53040............  Drainage of urethra       Y................  .................  A2...............      $446.00      19.1505      $792.85      $532.71
                    abscess.
53060............  Drainage of urethra       Y................  .................  P3...............  ...........       1.7198       $71.20       $71.20
                    abscess.
53080............  Drainage of urinary       Y................  .................  A2...............      $510.00      19.1505      $792.85      $580.71
                    leakage.
53085............  Drainage of urinary       Y................  .................  G2...............  ...........      19.1505      $792.85      $792.85
                    leakage.
53200............  Biopsy of urethra.......  Y................  .................  A2...............      $333.00      19.1505      $792.85      $447.96
53210............  Removal of urethra......  Y................  .................  A2...............      $717.00      29.7864    $1,233.19      $846.05
53215............  Removal of urethra......  Y................  .................  A2...............      $717.00      19.1505      $792.85      $735.96
53220............  Treatment of urethra      Y................  .................  A2...............      $446.00      29.7864    $1,233.19      $642.80
                    lesion.

[[Page 66981]]

 
53230............  Removal of urethra        Y................  .................  A2...............      $446.00      29.7864    $1,233.19      $642.80
                    lesion.
53235............  Removal of urethra        Y................  .................  A2...............      $510.00      19.1505      $792.85      $580.71
                    lesion.
53240............  Surgery for urethra       Y................  .................  A2...............      $446.00      29.7864    $1,233.19      $642.80
                    pouch.
53250............  Removal of urethra gland  Y................  .................  A2...............      $446.00      19.1505      $792.85      $532.71
53260............  Treatment of urethra      Y................  .................  A2...............      $446.00      19.1505      $792.85      $532.71
                    lesion.
53265............  Treatment of urethra      Y................  .................  A2...............      $446.00      19.1505      $792.85      $532.71
                    lesion.
53270............  Removal of urethra gland  Y................  .................  A2...............      $446.00      19.1505      $792.85      $532.71
53275............  Repair of urethra defect  Y................  .................  A2...............      $446.00      19.1505      $792.85      $532.71
53400............  Revise urethra, stage 1.  Y................  .................  A2...............      $510.00      29.7864    $1,233.19      $690.80
53405............  Revise urethra, stage 2.  Y................  .................  A2...............      $446.00      29.7864    $1,233.19      $642.80
53410............  Reconstruction of         Y................  .................  A2...............      $446.00      29.7864    $1,233.19      $642.80
                    urethra.
53420............  Reconstruct urethra,      Y................  .................  A2...............      $510.00      29.7864    $1,233.19      $690.80
                    stage 1.
53425............  Reconstruct urethra,      Y................  .................  A2...............      $446.00      29.7864    $1,233.19      $642.80
                    stage 2.
53430............  Reconstruction of         Y................  .................  A2...............      $446.00      29.7864    $1,233.19      $642.80
                    urethra.
53431............  Reconstruct urethra/      Y................  .................  A2...............      $446.00      29.7864    $1,233.19      $642.80
                    bladder.
53440............  Male sling procedure....  N................  CH...............  H8...............      $446.00     106.8568    $4,423.98    $3,500.50
53442............  Remove/revise male sling  Y................  .................  A2...............      $333.00      29.7864    $1,233.19      $558.05
53444............  Insert tandem cuff......  N................  CH...............  H8...............      $446.00     106.8568    $4,423.98    $3,500.50
53445............  Insert uro/ves nck        N................  .................  H8...............      $333.00     193.4277    $8,008.10    $6,625.75
                    sphincter.
53446............  Remove uro sphincter....  Y................  .................  A2...............      $333.00      29.7864    $1,233.19      $558.05
53447............  Remove/replace ur         N................  .................  H8...............      $333.00     193.4277    $8,008.10    $6,625.75
                    sphincter.
53449............  Repair uro sphincter....  Y................  .................  A2...............      $333.00      29.7864    $1,233.19      $558.05
53450............  Revision of urethra.....  Y................  .................  A2...............      $333.00      29.7864    $1,233.19      $558.05
53460............  Revision of urethra.....  Y................  .................  A2...............      $333.00      19.1505      $792.85      $447.96
53502............  Repair of urethra injury  Y................  .................  A2...............      $446.00      19.1505      $792.85      $532.71
53505............  Repair of urethra injury  Y................  .................  A2...............      $446.00      29.7864    $1,233.19      $642.80
53510............  Repair of urethra injury  Y................  .................  A2...............      $446.00      19.1505      $792.85      $532.71
53515............  Repair of urethra injury  Y................  .................  A2...............      $446.00      29.7864    $1,233.19      $642.80
53520............  Repair of urethra defect  Y................  .................  A2...............      $446.00      29.7864    $1,233.19      $642.80
53600............  Dilate urethra stricture  Y................  .................  P3...............  ...........       0.9381       $38.84       $38.84
53601............  Dilate urethra stricture  Y................  CH...............  P2...............  ...........       1.0356       $42.87       $42.87
53605............  Dilate urethra stricture  Y................  .................  A2...............      $446.00       17.942      $742.82      $520.21
53620............  Dilate urethra stricture  Y................  .................  P3...............  ...........       1.5142       $62.69       $62.69
53621............  Dilate urethra stricture  Y................  .................  P3...............  ...........       1.5963       $66.09       $66.09
53660............  Dilation of urethra.....  Y................  CH...............  P2...............  ...........       1.0356       $42.87       $42.87
53661............  Dilation of urethra.....  Y................  CH...............  P2...............  ...........       1.0356       $42.87       $42.87
53665............  Dilation of urethra.....  Y................  .................  A2...............      $333.00      19.1505      $792.85      $447.96
53850............  Prostatic microwave       Y................  .................  P2...............  ...........      45.2042    $1,871.50    $1,871.50
                    thermotx.
53852............  Prostatic rf thermotx...  Y................  .................  P2...............  ...........      45.2042    $1,871.50    $1,871.50
53853............  Prostatic water           Y................  .................  P2...............  ...........      24.7749    $1,025.71    $1,025.71
                    thermother.
54000............  Slitting of prepuce.....  Y................  .................  A2...............      $446.00      19.1505      $792.85      $532.71
54001............  Slitting of prepuce.....  Y................  .................  A2...............      $446.00      19.1505      $792.85      $532.71
54015............  Drain penis lesion......  Y................  .................  A2...............      $630.00      18.3197      $758.45      $662.11
54050............  Destruction, penis        Y................  .................  P2...............  ...........       1.4595       $60.42       $60.42
                    lesion(s).
54055............  Destruction, penis        Y................  .................  P3...............  ...........       1.4565       $60.30       $60.30
                    lesion(s).
54056............  Cryosurgery, penis        Y................  .................  P2...............  ...........        0.793       $32.83       $32.83
                    lesion(s).
54057............  Laser surg, penis         Y................  .................  A2...............      $333.00      19.9041      $824.05      $455.76
                    lesion(s).
54060............  Excision of penis         Y................  .................  A2...............      $333.00      19.9041      $824.05      $455.76
                    lesion(s).
54065............  Destruction, penis        Y................  .................  A2...............      $333.00      19.9041      $824.05      $455.76
                    lesion(s).
54100............  Biopsy of penis.........  Y................  .................  A2...............      $333.00      16.1001      $666.56      $416.39
54105............  Biopsy of penis.........  Y................  .................  A2...............      $333.00      21.1098      $873.97      $468.24
54110............  Treatment of penis        Y................  .................  A2...............      $446.00      33.9306    $1,404.76      $685.69
                    lesion.
54111............  Treat penis lesion,       Y................  .................  A2...............      $446.00      33.9306    $1,404.76      $685.69
                    graft.
54112............  Treat penis lesion,       Y................  .................  A2...............      $446.00      33.9306    $1,404.76      $685.69
                    graft.
54115............  Treatment of penis        Y................  .................  A2...............      $333.00      18.3197      $758.45      $439.36
                    lesion.
54120............  Partial removal of penis  Y................  .................  A2...............      $446.00      33.9306    $1,404.76      $685.69
54150............  Circumcision w/regionl    Y................  .................  A2...............      $333.00      22.3251      $924.28      $480.82
                    block.
54160............  Circumcision, neonate...  Y................  .................  A2...............      $446.00      22.3251      $924.28      $565.57
54161............  Circum 28 days or older.  Y................  .................  A2...............      $446.00      22.3251      $924.28      $565.57
54162............  Lysis penil circumic      Y................  .................  A2...............      $446.00      22.3251      $924.28      $565.57
                    lesion.
54163............  Repair of circumcision..  Y................  .................  A2...............      $446.00      22.3251      $924.28      $565.57
54164............  Frenulotomy of penis....  Y................  .................  A2...............      $446.00      22.3251      $924.28      $565.57
54200............  Treatment of penis        Y................  .................  P3...............  ...........       1.5635       $64.73       $64.73
                    lesion.
54205............  Treatment of penis        Y................  .................  A2...............      $630.00      33.9306    $1,404.76      $823.69
                    lesion.
54220............  Treatment of penis        Y................  .................  A2...............      $131.50       2.0077       $83.12      $119.41
                    lesion.
54230............  Prepare penis study.....  N................  .................  N1...............  ...........  ...........  ...........  ...........
54231............  Dynamic cavernosometry..  Y................  .................  P3...............  ...........       1.3741       $56.89       $56.89
54235............  Penile injection........  Y................  .................  P3...............  ...........       0.9628       $39.86       $39.86
54240............  Penis study.............  Y................  .................  P3...............  ...........       0.6667       $27.60       $27.60
54250............  Penis study.............  Y................  .................  P3...............  ...........       0.2304        $9.54        $9.54
54300............  Revision of penis.......  Y................  .................  A2...............      $510.00      33.9306    $1,404.76      $733.69
54304............  Revision of penis.......  Y................  .................  A2...............      $510.00      33.9306    $1,404.76      $733.69
54308............  Reconstruction of         Y................  .................  A2...............      $510.00      33.9306    $1,404.76      $733.69
                    urethra.

[[Page 66982]]

 
54312............  Reconstruction of         Y................  .................  A2...............      $510.00      33.9306    $1,404.76      $733.69
                    urethra.
54316............  Reconstruction of         Y................  .................  A2...............      $510.00      33.9306    $1,404.76      $733.69
                    urethra.
54318............  Reconstruction of         Y................  .................  A2...............      $510.00      33.9306    $1,404.76      $733.69
                    urethra.
54322............  Reconstruction of         Y................  .................  A2...............      $510.00      33.9306    $1,404.76      $733.69
                    urethra.
54324............  Reconstruction of         Y................  .................  A2...............      $510.00      33.9306    $1,404.76      $733.69
                    urethra.
54326............  Reconstruction of         Y................  .................  A2...............      $510.00      33.9306    $1,404.76      $733.69
                    urethra.
54328............  Revise penis/urethra....  Y................  .................  A2...............      $510.00      33.9306    $1,404.76      $733.69
54340............  Secondary urethral        Y................  .................  A2...............      $510.00      33.9306    $1,404.76      $733.69
                    surgery.
54344............  Secondary urethral        Y................  .................  A2...............      $510.00      33.9306    $1,404.76      $733.69
                    surgery.
54348............  Secondary urethral        Y................  .................  A2...............      $510.00      33.9306    $1,404.76      $733.69
                    surgery.
54352............  Reconstruct urethra/      Y................  .................  A2...............      $510.00      33.9306    $1,404.76      $733.69
                    penis.
54360............  Penis plastic surgery...  Y................  .................  A2...............      $510.00      33.9306    $1,404.76      $733.69
54380............  Repair penis............  Y................  .................  A2...............      $510.00      33.9306    $1,404.76      $733.69
54385............  Repair penis............  Y................  .................  A2...............      $510.00      33.9306    $1,404.76      $733.69
54400............  Insert semi-rigid         N................  CH...............  H8...............      $510.00     106.8568    $4,423.98    $3,548.50
                    prosthesis.
54401............  Insert self-contd         N................  .................  H8...............      $510.00     193.4277    $8,008.10    $6,758.50
                    prosthesis.
54405............  Insert multi-comp penis   N................  .................  H8...............      $510.00     193.4277    $8,008.10    $6,758.50
                    pros.
54406............  Remove muti-comp penis    Y................  .................  A2...............      $510.00      33.9306    $1,404.76      $733.69
                    pros.
54408............  Repair multi-comp penis   Y................  .................  A2...............      $510.00      33.9306    $1,404.76      $733.69
                    pros.
54410............  Remove/replace penis      N................  .................  H8...............      $510.00     193.4277    $8,008.10    $6,758.50
                    prosth.
54415............  Remove self-contd penis   Y................  .................  A2...............      $510.00      33.9306    $1,404.76      $733.69
                    pros.
54416............  Remv/repl penis contain   N................  .................  H8...............      $510.00     193.4277    $8,008.10    $6,758.50
                    pros.
54420............  Revision of penis.......  Y................  .................  A2...............      $630.00      33.9306    $1,404.76      $823.69
54435............  Revision of penis.......  Y................  .................  A2...............      $630.00      33.9306    $1,404.76      $823.69
54440............  Repair of penis.........  Y................  .................  A2...............      $630.00      33.9306    $1,404.76      $823.69
54450............  Preputial stretching....  Y................  .................  A2...............      $209.48       3.0469      $126.14      $188.65
54500............  Biopsy of testis........  Y................  .................  A2...............      $333.00      13.5764      $562.08      $390.27
54505............  Biopsy of testis........  Y................  .................  A2...............      $333.00      22.3251      $924.28      $480.82
54512............  Excise lesion testis....  Y................  .................  A2...............      $446.00      22.3251      $924.28      $565.57
54520............  Removal of testis.......  Y................  .................  A2...............      $510.00      22.3251      $924.28      $613.57
54522............  Orchiectomy, partial....  Y................  .................  A2...............      $510.00      22.3251      $924.28      $613.57
54530............  Removal of testis.......  Y................  .................  A2...............      $630.00      30.6788    $1,270.13      $790.03
54550............  Exploration for testis..  Y................  .................  A2...............      $630.00      30.6788    $1,270.13      $790.03
54560............  Exploration for testis..  Y................  .................  G2...............  ...........      22.3251      $924.28      $924.28
54600............  Reduce testis torsion...  Y................  .................  A2...............      $630.00      22.3251      $924.28      $703.57
54620............  Suspension of testis....  Y................  .................  A2...............      $510.00      22.3251      $924.28      $613.57
54640............  Suspension of testis....  Y................  .................  A2...............      $630.00      30.6788    $1,270.13      $790.03
54660............  Revision of testis......  Y................  .................  A2...............      $446.00      22.3251      $924.28      $565.57
54670............  Repair testis injury....  Y................  .................  A2...............      $510.00      22.3251      $924.28      $613.57
54680............  Relocation of testis(es)  Y................  .................  A2...............      $510.00      22.3251      $924.28      $613.57
54690............  Laparoscopy, orchiectomy  Y................  .................  A2...............    $1,339.00      45.5317    $1,885.06    $1,475.52
54692............  Laparoscopy, orchiopexy.  Y................  .................  G2...............  ...........      69.6652    $2,884.21    $2,884.21
54700............  Drainage of scrotum.....  Y................  .................  A2...............      $446.00      22.3251      $924.28      $565.57
54800............  Biopsy of epididymis....  Y................  .................  A2...............      $127.16        4.327      $179.14      $140.16
54830............  Remove epididymis lesion  Y................  .................  A2...............      $510.00      22.3251      $924.28      $613.57
54840............  Remove epididymis lesion  Y................  .................  A2...............      $630.00      22.3251      $924.28      $703.57
54860............  Removal of epididymis...  Y................  .................  A2...............      $510.00      22.3251      $924.28      $613.57
54861............  Removal of epididymis...  Y................  .................  A2...............      $630.00      22.3251      $924.28      $703.57
54865............  Explore epididymis......  Y................  .................  A2...............      $333.00      22.3251      $924.28      $480.82
54900............  Fusion of spermatic       Y................  .................  A2...............      $630.00      22.3251      $924.28      $703.57
                    ducts.
54901............  Fusion of spermatic       Y................  .................  A2...............      $630.00      22.3251      $924.28      $703.57
                    ducts.
55000............  Drainage of hydrocele...  Y................  .................  P3...............  ...........       1.6128       $66.77       $66.77
55040............  Removal of hydrocele....  Y................  .................  A2...............      $510.00      30.6788    $1,270.13      $700.03
55041............  Removal of hydroceles...  Y................  .................  A2...............      $717.00      30.6788    $1,270.13      $855.28
55060............  Repair of hydrocele.....  Y................  .................  A2...............      $630.00      22.3251      $924.28      $703.57
55100............  Drainage of scrotum       Y................  .................  A2...............      $333.00      11.5594      $478.57      $369.39
                    abscess.
55110............  Explore scrotum.........  Y................  .................  A2...............      $446.00      22.3251      $924.28      $565.57
55120............  Removal of scrotum        Y................  .................  A2...............      $446.00      22.3251      $924.28      $565.57
                    lesion.
55150............  Removal of scrotum......  Y................  .................  A2...............      $333.00      22.3251      $924.28      $480.82
55175............  Revision of scrotum.....  Y................  .................  A2...............      $333.00      22.3251      $924.28      $480.82
55180............  Revision of scrotum.....  Y................  .................  A2...............      $446.00      22.3251      $924.28      $565.57
55200............  Incision of sperm duct..  Y................  .................  A2...............      $446.00      22.3251      $924.28      $565.57
55250............  Removal of sperm duct(s)  Y................  .................  A2...............      $446.00      22.3251      $924.28      $565.57
55300............  Prepare, sperm duct x-    N................  .................  N1...............  ...........  ...........  ...........  ...........
                    ray.
55400............  Repair of sperm duct....  Y................  .................  A2...............      $333.00      22.3251      $924.28      $480.82
55450............  Ligation of sperm duct..  Y................  .................  P3...............  ...........       5.1182      $211.90      $211.90
55500............  Removal of hydrocele....  Y................  .................  A2...............      $510.00      22.3251      $924.28      $613.57
55520............  Removal of sperm cord     Y................  .................  A2...............      $630.00      22.3251      $924.28      $703.57
                    lesion.
55530............  Revise spermatic cord     Y................  .................  A2...............      $630.00      22.3251      $924.28      $703.57
                    veins.
55535............  Revise spermatic cord     Y................  .................  A2...............      $630.00      30.6788    $1,270.13      $790.03
                    veins.
55540............  Revise hernia & sperm     Y................  .................  A2...............      $717.00      30.6788    $1,270.13      $855.28
                    veins.
55550............  Laparo ligate spermatic   Y................  .................  A2...............    $1,339.00      45.5317    $1,885.06    $1,475.52
                    vein.
55600............  Incise sperm duct pouch.  Y................  .................  R2...............  ...........      22.3251      $924.28      $924.28

[[Page 66983]]

 
55680............  Remove sperm pouch        Y................  .................  A2...............      $333.00      22.3251      $924.28      $480.82
                    lesion.
55700............  Biopsy of prostate......  Y................  .................  A2...............      $345.83      11.0338      $456.81      $373.58
55705............  Biopsy of prostate......  Y................  .................  A2...............      $345.83      11.0338      $456.81      $373.58
55720............  Drainage of prostate      Y................  .................  A2...............      $333.00      24.7749    $1,025.71      $506.18
                    abscess.
55725............  Drainage of prostate      Y................  .................  A2...............      $446.00      24.7749    $1,025.71      $590.93
                    abscess.
55860............  Surgical exposure,        Y................  .................  G2...............  ...........      19.3414      $800.75      $800.75
                    prostate.
55870............  Electroejaculation......  Y................  .................  P3...............  ...........       1.6541       $68.48       $68.48
55873............  Cryoablate prostate.....  Y................  .................  H8...............    $1,339.00     162.5379    $6,729.23    $6,219.63
55875............  Transperi needle place,   N................  .................  A2...............    $1,339.00      36.0774    $1,493.64    $1,377.66
                    pros.
55876*...........  Place rt device/marker,   Y................  .................  P3...............  ...........       1.7033       $70.52       $70.52
                    pros.
55920............  Place needles pelvic for  Y................  NI...............  G2...............  ...........      25.6947    $1,063.79    $1,063.79
                    rt.
56405............  I & d of vulva/perineum.  Y................  .................  P3...............  ...........       1.0287       $42.59       $42.59
56420............  Drainage of gland         Y................  .................  P2...............  ...........        1.352       $55.97       $55.97
                    abscess.
56440............  Surgery for vulva lesion  Y................  .................  A2...............      $446.00      19.0203      $787.46      $531.37
56441............  Lysis of labial           Y................  .................  A2...............      $333.00      19.0203      $787.46      $446.62
                    lesion(s).
56442............  Hymenotomy..............  Y................  .................  A2...............      $333.00      19.0203      $787.46      $446.62
56501............  Destroy, vulva lesions,   Y................  .................  P3...............  ...........       1.4072       $58.26       $58.26
                    sim.
56515............  Destroy vulva lesion/s    Y................  .................  A2...............      $510.00      19.9041      $824.05      $588.51
                    compl.
56605............  Biopsy of vulva/perineum  Y................  .................  P3...............  ...........       0.8229       $34.07       $34.07
56606............  Biopsy of vulva/perineum  Y................  .................  P3...............  ...........       0.3456       $14.31       $14.31
56620............  Partial removal of vulva  Y................  .................  A2...............      $717.00      19.0203      $787.46      $734.62
56625............  Complete removal of       Y................  .................  A2...............      $995.00      19.0203      $787.46      $943.12
                    vulva.
56700............  Partial removal of hymen  Y................  .................  A2...............      $333.00      19.0203      $787.46      $446.62
56740............  Remove vagina gland       Y................  .................  A2...............      $510.00      19.0203      $787.46      $579.37
                    lesion.
56800............  Repair of vagina........  Y................  .................  A2...............      $510.00      19.0203      $787.46      $579.37
56805............  Repair clitoris.........  Y................  .................  G2...............  ...........      19.0203      $787.46      $787.46
56810............  Repair of perineum......  Y................  .................  A2...............      $717.00      19.0203      $787.46      $734.62
56820............  Exam of vulva w/scope...  Y................  .................  P3...............  ...........       1.0287       $42.59       $42.59
56821............  Exam/biopsy of vulva w/   Y................  .................  P3...............  ...........       1.3495       $55.87       $55.87
                    scope.
57000............  Exploration of vagina...  Y................  .................  A2...............      $333.00      19.0203      $787.46      $446.62
57010............  Drainage of pelvic        Y................  .................  A2...............      $446.00      19.0203      $787.46      $531.37
                    abscess.
57020............  Drainage of pelvic fluid  Y................  .................  A2...............      $409.33       6.0783      $251.65      $369.91
57022............  I & d vaginal hematoma,   Y................  .................  G2...............  ...........      11.5594      $478.57      $478.57
                    pp.
57023............  I & d vag hematoma, non-  Y................  .................  A2...............      $333.00      18.3197      $758.45      $439.36
                    ob.
57061............  Destroy vag lesions,      Y................  .................  P3...............  ...........       1.3002       $53.83       $53.83
                    simple.
57065............  Destroy vag lesions,      Y................  .................  A2...............      $333.00      19.0203      $787.46      $446.62
                    complex.
57100............  Biopsy of vagina........  Y................  .................  P3...............  ...........       0.8311       $34.41       $34.41
57105............  Biopsy of vagina........  Y................  .................  A2...............      $446.00      19.0203      $787.46      $531.37
57130............  Remove vagina lesion....  Y................  .................  A2...............      $446.00      19.0203      $787.46      $531.37
57135............  Remove vagina lesion....  Y................  .................  A2...............      $446.00      19.0203      $787.46      $531.37
57150............  Treat vagina infection..  Y................  CH...............  P3...............  ...........       0.6913       $28.62       $28.62
57155............  Insert uteri tandems/     Y................  .................  A2...............      $409.33       6.0783      $251.65      $369.91
                    ovoids.
57160............  Insert pessary/other      Y................  .................  P3...............  ...........       0.8476       $35.09       $35.09
                    device.
57170............  Fitting of diaphragm/cap  Y................  .................  P2...............  ...........       0.1309        $5.42        $5.42
57180............  Treat vaginal bleeding..  Y................  .................  A2...............      $178.05        1.352       $55.97      $147.53
57200............  Repair of vagina........  Y................  .................  A2...............      $333.00      19.0203      $787.46      $446.62
57210............  Repair vagina/perineum..  Y................  .................  A2...............      $446.00      19.0203      $787.46      $531.37
57220............  Revision of urethra.....  Y................  .................  A2...............      $510.00      42.7099    $1,768.23      $824.56
57230............  Repair of urethral        Y................  .................  A2...............      $510.00      32.4237    $1,342.37      $718.09
                    lesion.
57240............  Repair bladder & vagina.  Y................  .................  A2...............      $717.00      32.4237    $1,342.37      $873.34
57250............  Repair rectum & vagina..  Y................  .................  A2...............      $717.00      32.4237    $1,342.37      $873.34
57260............  Repair of vagina........  Y................  .................  A2...............      $717.00      32.4237    $1,342.37      $873.34
57265............  Extensive repair of       Y................  .................  A2...............      $995.00      42.7099    $1,768.23    $1,188.31
                    vagina.
57267............  Insert mesh/pelvic flr    Y................  .................  A2...............      $995.00      32.4237    $1,342.37    $1,081.84
                    addon.
57268............  Repair of bowel bulge...  Y................  .................  A2...............      $510.00      32.4237    $1,342.37      $718.09
57287............  Revise/remove sling       Y................  .................  G2...............  ...........      32.4237    $1,342.37    $1,342.37
                    repair.
57288............  Repair bladder defect...  Y................  .................  A2...............      $717.00      42.7099    $1,768.23      $979.81
57289............  Repair bladder & vagina.  Y................  .................  A2...............      $717.00      32.4237    $1,342.37      $873.34
57291............  Construction of vagina..  Y................  .................  A2...............      $717.00      32.4237    $1,342.37      $873.34
57300............  Repair rectum-vagina      Y................  .................  A2...............      $510.00      32.4237    $1,342.37      $718.09
                    fistula.
57320............  Repair bladder-vagina     Y................  .................  G2...............  ...........      32.4237    $1,342.37    $1,342.37
                    lesion.
57400............  Dilation of vagina......  Y................  .................  A2...............      $446.00      19.0203      $787.46      $531.37
57410............  Pelvic examination......  Y................  .................  A2...............      $446.00      19.0203      $787.46      $531.37
57415............  Remove vaginal foreign    Y................  .................  A2...............      $446.00      19.0203      $787.46      $531.37
                    body.
57420............  Exam of vagina w/scope..  Y................  .................  P3...............  ...........       1.0616       $43.95       $43.95
57421............  Exam/biopsy of vag w/     Y................  .................  P3...............  ...........       1.4154       $58.60       $58.60
                    scope.
57452............  Exam of cervix w/scope..  Y................  .................  P3...............  ...........       1.0121       $41.90       $41.90
57454............  Bx/curett of cervix w/    Y................  .................  P3...............  ...........       1.2425       $51.44       $51.44
                    scope.
57455............  Biopsy of cervix w/scope  Y................  .................  P3...............  ...........       1.3248       $54.85       $54.85
57456............  Endocerv curettage w/     Y................  .................  P3...............  ...........       1.2756       $52.81       $52.81
                    scope.
57460............  Bx of cervix w/scope,     Y................  .................  P3...............  ...........       4.1639      $172.39      $172.39
                    leep.
57461............  Conz of cervix w/scope,   Y................  .................  P3...............  ...........       4.3859      $181.58      $181.58
                    leep.
57500............  Biopsy of cervix........  Y................  .................  P3...............  ...........       1.8763       $77.68       $77.68

[[Page 66984]]

 
57505............  Endocervical curettage..  Y................  .................  P3...............  ...........       1.1437       $47.35       $47.35
57510............  Cauterization of cervix.  Y................  .................  P3...............  ...........       1.1768       $48.72       $48.72
57511............  Cryocautery of cervix...  Y................  .................  P2...............  ...........        1.352       $55.97       $55.97
57513............  Laser surgery of cervix.  Y................  .................  A2...............      $446.00      19.0203      $787.46      $531.37
57520............  Conization of cervix....  Y................  .................  A2...............      $446.00      19.0203      $787.46      $531.37
57522............  Conization of cervix....  Y................  .................  A2...............      $446.00      19.0203      $787.46      $531.37
57530............  Removal of cervix.......  Y................  .................  A2...............      $510.00      32.4237    $1,342.37      $718.09
57550............  Removal of residual       Y................  .................  A2...............      $510.00      32.4237    $1,342.37      $718.09
                    cervix.
57556............  Remove cervix, repair     Y................  .................  A2...............      $717.00      42.7099    $1,768.23      $979.81
                    bowel.
57558............  D&c of cervical stump...  Y................  .................  A2...............      $510.00      19.0203      $787.46      $579.37
57700............  Revision of cervix......  Y................  .................  A2...............      $333.00      19.0203      $787.46      $446.62
57720............  Revision of cervix......  Y................  .................  A2...............      $510.00      19.0203      $787.46      $579.37
57800............  Dilation of cervical      Y................  .................  P3...............  ...........       0.6089       $25.21       $25.21
                    canal.
58100............  Biopsy of uterus lining.  Y................  .................  P3...............  ...........       1.0121       $41.90       $41.90
58110............  Bx done w/colposcopy add- N................  CH...............  N1...............  ...........  ...........  ...........  ...........
                    on.
58120............  Dilation and curettage..  Y................  .................  A2...............      $446.00      19.0203      $787.46      $531.37
58145............  Myomectomy vag method...  Y................  .................  A2...............      $717.00      32.4237    $1,342.37      $873.34
58301............  Remove intrauterine       Y................  .................  P3...............  ...........        0.971       $40.20       $40.20
                    device.
58321............  Artificial insemination.  Y................  .................  P3...............  ...........       0.8558       $35.43       $35.43
58322............  Artificial insemination.  Y................  .................  P3...............  ...........       0.9135       $37.82       $37.82
58323............  Sperm washing...........  Y................  .................  P3...............  ...........       0.2797       $11.58       $11.58
58340............  Catheter for              N................  .................  N1...............  ...........  ...........  ...........  ...........
                    hysterography.
58345............  Reopen fallopian tube...  Y................  .................  R2...............  ...........      19.0203      $787.46      $787.46
58346............  Insert heyman uteri       Y................  .................  A2...............      $446.00      19.0203      $787.46      $531.37
                    capsule.
58350............  Reopen fallopian tube...  Y................  .................  A2...............      $510.00      32.4237    $1,342.37      $718.09
58353............  Endometr ablate, thermal  Y................  .................  A2...............      $995.00      32.4237    $1,342.37    $1,081.84
58356............  Endometrial cryoablation  Y................  .................  P3...............  ...........      43.0862    $1,783.81    $1,783.81
58545............  Laparoscopic myomectomy.  Y................  .................  A2...............    $1,339.00      34.3958    $1,424.02    $1,360.26
58546............  Laparo-myomectomy,        Y................  .................  A2...............    $1,339.00      45.5317    $1,885.06    $1,475.52
                    complex.
58550............  Laparo-asst vag           Y................  .................  A2...............    $1,339.00      69.6652    $2,884.21    $1,725.30
                    hysterectomy.
58552............  Laparo-vag hyst incl t/o  Y................  .................  G2...............  ...........      45.5317    $1,885.06    $1,885.06
58555............  Hysteroscopy, dx, sep     Y................  .................  A2...............      $333.00      21.6576      $896.65      $473.91
                    proc.
58558............  Hysteroscopy, biopsy....  Y................  .................  A2...............      $510.00      21.6576      $896.65      $606.66
58559............  Hysteroscopy, lysis.....  Y................  .................  A2...............      $446.00      21.6576      $896.65      $558.66
58560............  Hysteroscopy, resect      Y................  .................  A2...............      $510.00      34.2048    $1,416.11      $736.53
                    septum.
58561............  Hysteroscopy, remove      Y................  .................  A2...............      $510.00      34.2048    $1,416.11      $736.53
                    myoma.
58562............  Hysteroscopy, remove fb.  Y................  .................  A2...............      $510.00      21.6576      $896.65      $606.66
58563............  Hysteroscopy, ablation..  Y................  .................  A2...............    $1,339.00      34.2048    $1,416.11    $1,358.28
58565............  Hysteroscopy,             Y................  .................  A2...............    $1,339.00      42.7099    $1,768.23    $1,446.31
                    sterilization.
58600............  Division of fallopian     Y................  .................  G2...............  ...........      32.4237    $1,342.37    $1,342.37
                    tube.
58615............  Occlude fallopian         Y................  .................  G2...............  ...........      19.0203      $787.46      $787.46
                    tube(s).
58660............  Laparoscopy, lysis......  Y................  .................  A2...............      $717.00      45.5317    $1,885.06    $1,009.02
58661............  Laparoscopy, remove       Y................  .................  A2...............      $717.00      45.5317    $1,885.06    $1,009.02
                    adnexa.
58662............  Laparoscopy, excise       Y................  .................  A2...............      $717.00      45.5317    $1,885.06    $1,009.02
                    lesions.
58670............  Laparoscopy, tubal        Y................  .................  A2...............      $510.00      45.5317    $1,885.06      $853.77
                    cautery.
58671............  Laparoscopy, tubal block  Y................  .................  A2...............      $510.00      45.5317    $1,885.06      $853.77
58672............  Laparoscopy,              Y................  .................  A2...............      $717.00      45.5317    $1,885.06    $1,009.02
                    fimbrioplasty.
58673............  Laparoscopy,              Y................  .................  A2...............      $717.00      45.5317    $1,885.06    $1,009.02
                    salpingostomy.
58800............  Drainage of ovarian       Y................  .................  A2...............      $510.00      19.0203      $787.46      $579.37
                    cyst(s).
58805............  Drainage of ovarian       Y................  CH...............  G2...............  ...........      32.4237    $1,342.37    $1,342.37
                    cyst(s).
58820............  Drain ovary abscess,      Y................  .................  A2...............      $510.00      32.4237    $1,342.37      $718.09
                    open.
58900............  Biopsy of ovary(s)......  Y................  .................  A2...............      $510.00      19.0203      $787.46      $579.37
58970............  Retrieval of oocyte.....  Y................  .................  A2...............      $245.92       2.7584      $114.20      $212.99
58974............  Transfer of embryo......  Y................  .................  A2...............      $245.92       2.7584      $114.20      $212.99
58976............  Transfer of embryo......  Y................  .................  A2...............      $245.92       2.7584      $114.20      $212.99
59000............  Amniocentesis,            Y................  CH...............  P3...............  ...........       1.5717       $65.07       $65.07
                    diagnostic.
59001............  Amniocentesis,            Y................  .................  R2...............  ...........       6.0783      $251.65      $251.65
                    therapeutic.
59012............  Fetal cord                Y................  .................  G2...............  ...........       2.7584      $114.20      $114.20
                    puncture,prenatal.
59015............  Chorion biopsy..........  Y................  .................  P3...............  ...........       1.2178       $50.42       $50.42
59020............  Fetal contract stress     Y................  .................  P3...............  ...........       0.5761       $23.85       $23.85
                    test.
59025............  Fetal non-stress test...  Y................  .................  P3...............  ...........       0.2961       $12.26       $12.26
59070............  Transabdom amnioinfus w/  Y................  .................  G2...............  ...........       2.7584      $114.20      $114.20
                    us.
59072............  Umbilical cord occlud w/  Y................  .................  G2...............  ...........       2.7584      $114.20      $114.20
                    us.
59076............  Fetal shunt placement, w/ Y................  .................  G2...............  ...........       2.7584      $114.20      $114.20
                    us.
59100............  Remove uterus lesion....  Y................  .................  R2...............  ...........      32.4237    $1,342.37    $1,342.37
59150............  Treat ectopic pregnancy.  Y................  .................  G2...............  ...........      45.5317    $1,885.06    $1,885.06
59151............  Treat ectopic pregnancy.  Y................  .................  G2...............  ...........      45.5317    $1,885.06    $1,885.06
59160............  D & c after delivery....  Y................  .................  A2...............      $510.00      19.0203      $787.46      $579.37
59200............  Insert cervical dilator.  Y................  .................  P3...............  ...........       0.8722       $36.11       $36.11
59300............  Episiotomy or vaginal     Y................  .................  P3...............  ...........       1.7939       $74.27       $74.27
                    repair.
59320............  Revision of cervix......  Y................  .................  A2...............      $333.00      19.0203      $787.46      $446.62
59412............  Antepartum manipulation.  Y................  .................  G2...............  ...........      19.0203      $787.46      $787.46
59414............  Deliver placenta........  Y................  .................  G2...............  ...........      19.0203      $787.46      $787.46

[[Page 66985]]

 
59812............  Treatment of miscarriage  Y................  .................  A2...............      $717.00      19.0203      $787.46      $734.62
59820............  Care of miscarriage.....  Y................  .................  A2...............      $717.00      19.0203      $787.46      $734.62
59821............  Treatment of miscarriage  Y................  .................  A2...............      $717.00      19.0203      $787.46      $734.62
59840............  Abortion................  Y................  .................  A2...............      $717.00      19.0203      $787.46      $734.62
59841............  Abortion................  Y................  .................  A2...............      $717.00      19.0203      $787.46      $734.62
59866............  Abortion (mpr)..........  Y................  .................  G2...............  ...........       2.7584      $114.20      $114.20
59870............  Evacuate mole of uterus.  Y................  .................  A2...............      $717.00      19.0203      $787.46      $734.62
59871............  Remove cerclage suture..  Y................  .................  A2...............      $717.00      19.0203      $787.46      $734.62
60000............  Drain thyroid/tongue      Y................  .................  A2...............      $333.00       7.4474      $308.33      $326.83
                    cyst.
60001............  Aspirate/inject thyriod   N................  CH...............  D5...............  ...........  ...........  ...........  ...........
                    cyst.
60100............  Biopsy of thyroid.......  Y................  .................  P3...............  ...........       1.1108       $45.99       $45.99
60200............  Remove thyroid lesion...  Y................  .................  A2...............      $446.00       44.324    $1,835.06      $793.27
60280............  Remove thyroid duct       Y................  .................  A2...............      $630.00       44.324    $1,835.06      $931.27
                    lesion.
60281............  Remove thyroid duct       Y................  .................  A2...............      $630.00       44.324    $1,835.06      $931.27
                    lesion.
60300............  Aspir/inj thyroid cyst..  Y................  NI...............  P3...............  ...........       1.3741       $56.89       $56.89
61000............  Remove cranial cavity     Y................  .................  R2...............  ...........       8.5263      $353.00      $353.00
                    fluid.
61001............  Remove cranial cavity     Y................  .................  R2...............  ...........       8.5263      $353.00      $353.00
                    fluid.
61020............  Remove brain cavity       Y................  .................  A2...............      $183.83       8.5263      $353.00      $226.12
                    fluid.
61026............  Injection into brain      Y................  .................  A2...............      $183.83       8.5263      $353.00      $226.12
                    canal.
61050............  Remove brain canal fluid  Y................  .................  A2...............      $183.83       8.5263      $353.00      $226.12
61055............  Injection into brain      Y................  .................  A2...............      $183.83       8.5263      $353.00      $226.12
                    canal.
61070............  Brain canal shunt         Y................  .................  A2...............      $183.83       3.2383      $134.07      $171.39
                    procedure.
61215............  Insert brain-fluid        Y................  .................  A2...............      $510.00      36.2768    $1,501.90      $757.98
                    device.
61330............  Decompress eye socket...  Y................  .................  G2...............  ...........      39.8776    $1,650.97    $1,650.97
61334............  Explore orbit/remove      Y................  .................  G2...............  ...........      39.8776    $1,650.97    $1,650.97
                    object.
61790............  Treat trigeminal nerve..  Y................  .................  A2...............      $510.00      18.0518      $747.36      $569.34
61791............  Treat trigeminal tract..  Y................  .................  A2...............      $351.92      14.4879      $599.81      $413.89
61795............  Brain surgery using       N................  CH...............  N1...............  ...........  ...........  ...........  ...........
                    computer.
61880............  Revise/remove             Y................  .................  G2...............  ...........      22.4734      $930.42      $930.42
                    neuroelectrode.
61885............  Insrt/redo neurostim 1    N................  .................  H8...............      $446.00      269.543   $11,159.35   $10,493.89
                    array.
61886............  Implant neurostim arrays  N................  .................  H8...............      $510.00     395.2777   $16,364.89   $15,586.16
61888............  Revise/remove             Y................  .................  A2...............      $333.00      34.4166    $1,424.88      $605.97
                    neuroreceiver.
62194............  Replace/irrigate          Y................  .................  A2...............      $333.00       8.5263      $353.00      $338.00
                    catheter.
62225............  Replace/irrigate          Y................  .................  A2...............      $333.00      15.3545      $635.69      $408.67
                    catheter.
62230............  Replace/revise brain      Y................  .................  A2...............      $446.00      36.2768    $1,501.90      $709.98
                    shunt.
62252............  Csf shunt reprogram.....  N................  .................  P3...............  ...........       1.0698       $44.29       $44.29
62263............  Epidural lysis mult       Y................  .................  A2...............      $333.00      14.4879      $599.81      $399.70
                    sessions.
62264............  Epidural lysis on single  Y................  .................  A2...............      $333.00      14.4879      $599.81      $399.70
                    day.
62268............  Drain spinal cord cyst..  Y................  .................  A2...............      $183.83       8.5263      $353.00      $226.12
62269............  Needle biopsy, spinal     Y................  .................  A2...............      $333.00       9.3354      $386.49      $346.37
                    cord.
62270............  Spinal fluid tap,         Y................  .................  A2...............      $139.00       4.0964      $169.60      $146.65
                    diagnostic.
62272............  Drain cerebro spinal      Y................  .................  A2...............      $139.00       4.0964      $169.60      $146.65
                    fluid.
62273............  Inject epidural patch...  Y................  .................  A2...............      $333.00       4.0964      $169.60      $292.15
62280............  Treat spinal cord lesion  Y................  .................  A2...............      $333.00       7.0546      $292.07      $322.77
62281............  Treat spinal cord lesion  Y................  .................  A2...............      $333.00       7.0546      $292.07      $322.77
62282............  Treat spinal canal        Y................  .................  A2...............      $333.00       7.0546      $292.07      $322.77
                    lesion.
62284............  Injection for myelogram.  N................  .................  N1...............  ...........  ...........  ...........  ...........
62287............  Percutaneous diskectomy.  Y................  .................  A2...............    $1,339.00      33.2707    $1,377.44    $1,348.61
62290............  Inject for spine disk x-  N................  .................  N1...............  ...........  ...........  ...........  ...........
                    ray.
62291............  Inject for spine disk x-  N................  .................  N1...............  ...........  ...........  ...........  ...........
                    ray.
62292............  Injection into disk       Y................  CH...............  R2...............  ...........       8.5263      $353.00      $353.00
                    lesion.
62294............  Injection into spinal     Y................  .................  A2...............      $183.83       8.5263      $353.00      $226.12
                    artery.
62310............  Inject spine c/t........  Y................  .................  A2...............      $333.00       7.0546      $292.07      $322.77
62311............  Inject spine l/s (cd)...  Y................  .................  A2...............      $333.00       7.0546      $292.07      $322.77
62318............  Inject spine w/cath, c/t  Y................  .................  A2...............      $333.00       7.0546      $292.07      $322.77
62319............  Inject spine w/cath l/s   Y................  .................  A2...............      $333.00       7.0546      $292.07      $322.77
                    (cd).
62350............  Implant spinal canal      Y................  .................  A2...............      $446.00      36.2768    $1,501.90      $709.98
                    cath.
62355............  Remove spinal canal       Y................  .................  A2...............      $446.00      14.4879      $599.81      $484.45
                    catheter.
62360............  Insert spine infusion     Y................  .................  A2...............      $446.00      36.2768    $1,501.90      $709.98
                    device.
62361............  Implant spine infusion    Y................  .................  H8...............      $446.00     263.8315   $10,922.89   $10,157.07
                    pump.
62362............  Implant spine infusion    Y................  .................  H8...............      $446.00     263.8315   $10,922.89   $10,157.07
                    pump.
62365............  Remove spine infusion     Y................  .................  A2...............      $446.00      33.2707    $1,377.44      $678.86
                    device.
62367............  Analyze spine infusion    N................  .................  P3...............  ...........        0.428       $17.72       $17.72
                    pump.
62368............  Analyze spine infusion    N................  .................  P3...............  ...........       0.5183       $21.46       $21.46
                    pump.
63600............  Remove spinal cord        Y................  .................  A2...............      $446.00      18.0518      $747.36      $521.34
                    lesion.
63610............  Stimulation of spinal     Y................  .................  A2...............      $333.00      18.0518      $747.36      $436.59
                    cord.
63615............  Remove lesion of spinal   Y................  .................  R2...............  ...........      18.0518      $747.36      $747.36
                    cord.
63650............  Implant neuroelectrodes.  N................  .................  H8...............      $446.00      83.1135    $3,440.98    $2,909.36
63655............  Implant neuroelectrodes.  N................  .................  J8...............  ...........     109.8976    $4,549.87    $4,549.87
63660............  Revise/remove             Y................  .................  A2...............      $333.00      22.4734      $930.42      $482.36
                    neuroelectrode.
63685............  Insrt/redo spine n        N................  .................  H8...............      $446.00     350.8302   $14,524.72   $13,727.20
                    generator.
63688............  Revise/remove             Y................  .................  A2...............      $333.00      34.4166    $1,424.88      $605.97
                    neuroreceiver.
63744............  Revision of spinal shunt  Y................  .................  A2...............      $510.00      36.2768    $1,501.90      $757.98

[[Page 66986]]

 
63746............  Removal of spinal shunt.  Y................  .................  A2...............      $446.00       5.6614      $234.39      $393.10
64400............  N block inj, trigeminal.  Y................  .................  P3...............  ...........       1.3577       $56.21       $56.21
64402............  N block inj, facial.....  Y................  .................  P3...............  ...........       1.2425       $51.44       $51.44
64405............  N block inj, occipital..  Y................  .................  P3...............  ...........        1.078       $44.63       $44.63
64408............  N block inj, vagus......  Y................  .................  P3...............  ...........       1.2425       $51.44       $51.44
64410............  N block inj, phrenic....  Y................  .................  A2...............      $333.00       7.0546      $292.07      $322.77
64412............  N block inj, spinal       Y................  .................  P3...............  ...........       1.9666       $81.42       $81.42
                    accessor.
64413............  N block inj, cervical     Y................  .................  P3...............  ...........        1.292       $53.49       $53.49
                    plexus.
64415............  N block inj, brachial     Y................  .................  A2...............      $139.00       4.0964      $169.60      $146.65
                    plexus.
64416............  N block cont infuse, b    Y................  .................  G2...............  ...........       7.0546      $292.07      $292.07
                    plex.
64417............  N block inj, axillary...  Y................  .................  A2...............      $139.00       4.0964      $169.60      $146.65
64418............  N block inj,              Y................  .................  P3...............  ...........       1.8596       $76.99       $76.99
                    suprascapular.
64420............  N block inj, intercost,   Y................  .................  A2...............      $139.00       4.0964      $169.60      $146.65
                    sng.
64421............  N block inj, intercost,   Y................  .................  A2...............      $333.00       4.0964      $169.60      $292.15
                    mlt.
64425............  N block inj, ilio-ing/    Y................  .................  P3...............  ...........       1.2096       $50.08       $50.08
                    hypogi.
64430............  N block inj, pudendal...  Y................  .................  A2...............      $139.00       7.0546      $292.07      $177.27
64435............  N block inj,              Y................  .................  P3...............  ...........       1.8596       $76.99       $76.99
                    paracervical.
64445............  N block inj, sciatic,     Y................  .................  P3...............  ...........       1.7693       $73.25       $73.25
                    sng.
64446............  N blk inj, sciatic, cont  Y................  .................  G2...............  ...........      14.4879      $599.81      $599.81
                    inf.
64447............  N block inj fem, single.  Y................  CH...............  R2...............  ...........       4.0964      $169.60      $169.60
64450............  N block, other            Y................  .................  P3...............  ...........       1.0287       $42.59       $42.59
                    peripheral.
64470............  Inj paravertebral c/t...  Y................  .................  A2...............      $333.00       7.0546      $292.07      $322.77
64472............  Inj paravertebral c/t     Y................  .................  A2...............      $333.00       4.0964      $169.60      $292.15
                    add-on.
64475............  Inj paravertebral l/s...  Y................  .................  A2...............      $333.00       7.0546      $292.07      $322.77
64476............  Inj paravertebral l/s     Y................  .................  A2...............      $333.00       2.3213       $96.10      $273.78
                    add-on.
64479............  Inj foramen epidural c/t  Y................  .................  A2...............      $333.00       7.0546      $292.07      $322.77
64480............  Inj foramen epidural add- Y................  .................  A2...............      $333.00       4.0964      $169.60      $292.15
                    on.
64483............  Inj foramen epidural l/s  Y................  .................  A2...............      $333.00       7.0546      $292.07      $322.77
64484............  Inj foramen epidural add- Y................  .................  A2...............      $333.00       4.0964      $169.60      $292.15
                    on.
64505............  N block, spenopalatine    Y................  .................  P3...............  ...........        0.971       $40.20       $40.20
                    gangl.
64508............  N block, carotid sinus s/ Y................  .................  P3...............  ...........       2.2053       $91.30       $91.30
                    p.
64510............  N block, stellate         Y................  .................  A2...............      $333.00       7.0546      $292.07      $322.77
                    ganglion.
64517............  N block inj, hypogas      Y................  .................  A2...............      $139.00       7.0546      $292.07      $177.27
                    plxs.
64520............  N block, lumbar/thoracic  Y................  .................  A2...............      $333.00       7.0546      $292.07      $322.77
64530............  N block inj, celiac       Y................  .................  A2...............      $333.00       7.0546      $292.07      $322.77
                    pelus.
64553............  Implant neuroelectrodes.  N................  .................  H8...............      $333.00     316.5407   $13,105.10   $12,022.95
64555............  Implant neuroelectrodes.  N................  .................  J8...............  ...........      83.1135    $3,440.98    $3,440.98
64560............  Implant neuroelectrodes.  N................  .................  J8...............  ...........      83.1135    $3,440.98    $3,440.98
64561............  Implant neuroelectrodes.  N................  .................  H8...............      $510.00      83.1135    $3,440.98    $2,957.36
64565............  Implant neuroelectrodes.  N................  .................  J8...............  ...........      83.1135    $3,440.98    $3,440.98
64573............  Implant neuroelectrodes.  N................  .................  H8...............      $333.00     316.5407   $13,105.10   $12,022.95
64575............  Implant neuroelectrodes.  N................  .................  H8...............      $333.00     109.8976    $4,549.87    $3,785.92
64577............  Implant neuroelectrodes.  N................  .................  H8...............      $333.00     109.8976    $4,549.87    $3,785.92
64580............  Implant neuroelectrodes.  N................  .................  H8...............      $333.00     109.8976    $4,549.87    $3,785.92
64581............  Implant neuroelectrodes.  N................  .................  H8...............      $510.00     109.8976    $4,549.87    $3,918.67
64585............  Revise/remove             Y................  .................  A2...............      $333.00      22.4734      $930.42      $482.36
                    neuroelectrode.
64590............  Insrt/redo pn/gastr       N................  .................  H8...............      $446.00      269.543   $11,159.35   $10,493.89
                    stimul.
64595............  Revise/rmv pn/gastr       Y................  .................  A2...............      $333.00      34.4166    $1,424.88      $605.97
                    stimul.
64600............  Injection treatment of    Y................  .................  A2...............      $333.00      14.4879      $599.81      $399.70
                    nerve.
64605............  Injection treatment of    Y................  .................  A2...............      $333.00      14.4879      $599.81      $399.70
                    nerve.
64610............  Injection treatment of    Y................  .................  A2...............      $333.00      14.4879      $599.81      $399.70
                    nerve.
64612............  Destroy nerve, face       Y................  .................  P3...............  ...........       1.6705       $69.16       $69.16
                    muscle.
64613............  Destroy nerve, neck       Y................  .................  P3...............  ...........       1.7693       $73.25       $73.25
                    muscle.
64614............  Destroy nerve, extrem     Y................  .................  P3...............  ...........       1.9915       $82.45       $82.45
                    musc.
64620............  Injection treatment of    Y................  .................  A2...............      $333.00       7.0546      $292.07      $322.77
                    nerve.
64622............  Destr paravertebrl nerve  Y................  .................  A2...............      $333.00      14.4879      $599.81      $399.70
                    l/s.
64623............  Destr paravertebral n     Y................  .................  A2...............      $333.00       7.0546      $292.07      $322.77
                    add-on.
64626............  Destr paravertebrl nerve  Y................  .................  A2...............      $333.00      14.4879      $599.81      $399.70
                    c/t.
64627............  Destr paravertebral n     Y................  .................  A2...............      $333.00       2.3213       $96.10      $273.78
                    add-on.
64630............  Injection treatment of    Y................  .................  A2...............      $351.92       7.0546      $292.07      $336.96
                    nerve.
64640............  Injection treatment of    Y................  .................  P3...............  ...........       2.7156      $112.43      $112.43
                    nerve.
64650............  Chemodenerv eccrine       Y................  CH...............  P3...............  ...........         0.65       $26.91       $26.91
                    glands.
64653............  Chemodenerv eccrine       Y................  CH...............  P3...............  ...........       0.6831       $28.28       $28.28
                    glands.
64680............  Injection treatment of    Y................  .................  A2...............      $390.95      14.4879      $599.81      $443.17
                    nerve.
64681............  Injection treatment of    Y................  .................  A2...............      $446.00      14.4879      $599.81      $484.45
                    nerve.
64702............  Revise finger/toe nerve.  Y................  .................  A2...............      $333.00      18.0518      $747.36      $436.59
64704............  Revise hand/foot nerve..  Y................  .................  A2...............      $333.00      18.0518      $747.36      $436.59
64708............  Revise arm/leg nerve....  Y................  .................  A2...............      $446.00      18.0518      $747.36      $521.34
64712............  Revision of sciatic       Y................  .................  A2...............      $446.00      18.0518      $747.36      $521.34
                    nerve.
64713............  Revision of arm nerve(s)  Y................  .................  A2...............      $446.00      18.0518      $747.36      $521.34
64714............  Revise low back nerve(s)  Y................  .................  A2...............      $446.00      18.0518      $747.36      $521.34
64716............  Revision of cranial       Y................  .................  A2...............      $510.00      18.0518      $747.36      $569.34
                    nerve.
64718............  Revise ulnar nerve at     Y................  .................  A2...............      $446.00      18.0518      $747.36      $521.34
                    elbow.

[[Page 66987]]

 
64719............  Revise ulnar nerve at     Y................  .................  A2...............      $446.00      18.0518      $747.36      $521.34
                    wrist.
64721............  Carpal tunnel surgery...  Y................  .................  A2...............      $446.00      18.0518      $747.36      $521.34
64722............  Relieve pressure on       Y................  .................  A2...............      $333.00      18.0518      $747.36      $436.59
                    nerve(s).
64726............  Release foot/toe nerve..  Y................  .................  A2...............      $333.00      18.0518      $747.36      $436.59
64727............  Internal nerve revision.  Y................  .................  A2...............      $333.00      18.0518      $747.36      $436.59
64732............  Incision of brow nerve..  Y................  .................  A2...............      $446.00      18.0518      $747.36      $521.34
64734............  Incision of cheek nerve.  Y................  .................  A2...............      $446.00      18.0518      $747.36      $521.34
64736............  Incision of chin nerve..  Y................  .................  A2...............      $446.00      18.0518      $747.36      $521.34
64738............  Incision of jaw nerve...  Y................  .................  A2...............      $446.00      18.0518      $747.36      $521.34
64740............  Incision of tongue nerve  Y................  .................  A2...............      $446.00      18.0518      $747.36      $521.34
64742............  Incision of facial nerve  Y................  .................  A2...............      $446.00      18.0518      $747.36      $521.34
64744............  Incise nerve, back of     Y................  .................  A2...............      $446.00      18.0518      $747.36      $521.34
                    head.
64746............  Incise diaphragm nerve..  Y................  .................  A2...............      $446.00      18.0518      $747.36      $521.34
64761............  Incision of pelvis nerve  Y................  .................  G2...............  ...........      18.0518      $747.36      $747.36
64763............  Incise hip/thigh nerve..  Y................  .................  G2...............  ...........      18.0518      $747.36      $747.36
64766............  Incise hip/thigh nerve..  Y................  .................  G2...............  ...........      33.2707    $1,377.44    $1,377.44
64771............  Sever cranial nerve.....  Y................  .................  A2...............      $446.00      18.0518      $747.36      $521.34
64772............  Incision of spinal nerve  Y................  .................  A2...............      $446.00      18.0518      $747.36      $521.34
64774............  Remove skin nerve lesion  Y................  .................  A2...............      $446.00      18.0518      $747.36      $521.34
64776............  Remove digit nerve        Y................  .................  A2...............      $510.00      18.0518      $747.36      $569.34
                    lesion.
64778............  Digit nerve surgery add-  Y................  .................  A2...............      $446.00      18.0518      $747.36      $521.34
                    on.
64782............  Remove limb nerve lesion  Y................  .................  A2...............      $510.00      18.0518      $747.36      $569.34
64783............  Limb nerve surgery add-   Y................  .................  A2...............      $446.00      18.0518      $747.36      $521.34
                    on.
64784............  Remove nerve lesion.....  Y................  .................  A2...............      $510.00      18.0518      $747.36      $569.34
64786............  Remove sciatic nerve      Y................  .................  A2...............      $510.00      33.2707    $1,377.44      $726.86
                    lesion.
64787............  Implant nerve end.......  Y................  .................  A2...............      $446.00      18.0518      $747.36      $521.34
64788............  Remove skin nerve lesion  Y................  .................  A2...............      $510.00      18.0518      $747.36      $569.34
64790............  Removal of nerve lesion.  Y................  .................  A2...............      $510.00      18.0518      $747.36      $569.34
64792............  Removal of nerve lesion.  Y................  .................  A2...............      $510.00      33.2707    $1,377.44      $726.86
64795............  Biopsy of nerve.........  Y................  .................  A2...............      $446.00      18.0518      $747.36      $521.34
64802............  Remove sympathetic        Y................  .................  A2...............      $446.00      18.0518      $747.36      $521.34
                    nerves.
64820............  Remove sympathetic        Y................  .................  G2...............  ...........      18.0518      $747.36      $747.36
                    nerves.
64821............  Remove sympathetic        Y................  .................  A2...............      $630.00      26.3105    $1,089.28      $744.82
                    nerves.
64822............  Remove sympathetic        Y................  .................  G2...............  ...........      26.3105    $1,089.28    $1,089.28
                    nerves.
64823............  Remove sympathetic        Y................  .................  G2...............  ...........      26.3105    $1,089.28    $1,089.28
                    nerves.
64831............  Repair of digit nerve...  Y................  .................  A2...............      $630.00      33.2707    $1,377.44      $816.86
64832............  Repair nerve add-on.....  Y................  .................  A2...............      $333.00      33.2707    $1,377.44      $594.11
64834............  Repair of hand or foot    Y................  .................  A2...............      $446.00      33.2707    $1,377.44      $678.86
                    nerve.
64835............  Repair of hand or foot    Y................  .................  A2...............      $510.00      33.2707    $1,377.44      $726.86
                    nerve.
64836............  Repair of hand or foot    Y................  .................  A2...............      $510.00      33.2707    $1,377.44      $726.86
                    nerve.
64837............  Repair nerve add-on.....  Y................  .................  A2...............      $333.00      33.2707    $1,377.44      $594.11
64840............  Repair of leg nerve.....  Y................  .................  A2...............      $446.00      33.2707    $1,377.44      $678.86
64856............  Repair/transpose nerve..  Y................  .................  A2...............      $446.00      33.2707    $1,377.44      $678.86
64857............  Repair arm/leg nerve....  Y................  .................  A2...............      $446.00      33.2707    $1,377.44      $678.86
64858............  Repair sciatic nerve....  Y................  .................  A2...............      $446.00      33.2707    $1,377.44      $678.86
64859............  Nerve surgery...........  Y................  .................  A2...............      $333.00      33.2707    $1,377.44      $594.11
64861............  Repair of arm nerves....  Y................  .................  A2...............      $510.00      33.2707    $1,377.44      $726.86
64862............  Repair of low back        Y................  .................  A2...............      $510.00      33.2707    $1,377.44      $726.86
                    nerves.
64864............  Repair of facial nerve..  Y................  .................  A2...............      $510.00      33.2707    $1,377.44      $726.86
64865............  Repair of facial nerve..  Y................  .................  A2...............      $630.00      33.2707    $1,377.44      $816.86
64870............  Fusion of facial/other    Y................  .................  A2...............      $630.00      33.2707    $1,377.44      $816.86
                    nerve.
64872............  Subsequent repair of      Y................  .................  A2...............      $446.00      33.2707    $1,377.44      $678.86
                    nerve.
64874............  Repair & revise nerve     Y................  .................  A2...............      $510.00      33.2707    $1,377.44      $726.86
                    add-on.
64876............  Repair nerve/shorten      Y................  .................  A2...............      $510.00      33.2707    $1,377.44      $726.86
                    bone.
64885............  Nerve graft, head or      Y................  .................  A2...............      $446.00      33.2707    $1,377.44      $678.86
                    neck.
64886............  Nerve graft, head or      Y................  .................  A2...............      $446.00      33.2707    $1,377.44      $678.86
                    neck.
64890............  Nerve graft, hand or      Y................  .................  A2...............      $446.00      33.2707    $1,377.44      $678.86
                    foot.
64891............  Nerve graft, hand or      Y................  .................  A2...............      $446.00      33.2707    $1,377.44      $678.86
                    foot.
64892............  Nerve graft, arm or leg.  Y................  .................  A2...............      $446.00      33.2707    $1,377.44      $678.86
64893............  Nerve graft, arm or leg.  Y................  .................  A2...............      $446.00      33.2707    $1,377.44      $678.86
64895............  Nerve graft, hand or      Y................  .................  A2...............      $510.00      33.2707    $1,377.44      $726.86
                    foot.
64896............  Nerve graft, hand or      Y................  .................  A2...............      $510.00      33.2707    $1,377.44      $726.86
                    foot.
64897............  Nerve graft, arm or leg.  Y................  .................  A2...............      $510.00      33.2707    $1,377.44      $726.86
64898............  Nerve graft, arm or leg.  Y................  .................  A2...............      $510.00      33.2707    $1,377.44      $726.86
64901............  Nerve graft add-on......  Y................  .................  A2...............      $446.00      33.2707    $1,377.44      $678.86
64902............  Nerve graft add-on......  Y................  .................  A2...............      $446.00      33.2707    $1,377.44      $678.86
64905............  Nerve pedicle transfer..  Y................  .................  A2...............      $446.00      33.2707    $1,377.44      $678.86
64907............  Nerve pedicle transfer..  Y................  .................  A2...............      $333.00      33.2707    $1,377.44      $594.11
64910............  Nerve repair w/allograft  Y................  CH...............  G2...............  ...........      18.0518      $747.36      $747.36
65091............  Revise eye..............  Y................  .................  A2...............      $510.00      37.7243    $1,561.82      $772.96
65093............  Revise eye with implant.  Y................  .................  A2...............      $510.00      37.7243    $1,561.82      $772.96
65101............  Removal of eye..........  Y................  .................  A2...............      $510.00      37.7243    $1,561.82      $772.96
65103............  Remove eye/insert         Y................  .................  A2...............      $510.00      37.7243    $1,561.82      $772.96
                    implant.

[[Page 66988]]

 
65105............  Remove eye/attach         Y................  .................  A2...............      $630.00      37.7243    $1,561.82      $862.96
                    implant.
65110............  Removal of eye..........  Y................  .................  A2...............      $717.00      37.7243    $1,561.82      $928.21
65112............  Remove eye/revise socket  Y................  .................  A2...............      $995.00      37.7243    $1,561.82    $1,136.71
65114............  Remove eye/revise socket  Y................  .................  A2...............      $995.00      37.7243    $1,561.82    $1,136.71
65125............  Revise ocular implant...  Y................  .................  G2...............  ...........      18.7307      $775.47      $775.47
65130............  Insert ocular implant...  Y................  .................  A2...............      $510.00      24.3077    $1,006.36      $634.09
65135............  Insert ocular implant...  Y................  .................  A2...............      $446.00      24.3077    $1,006.36      $586.09
65140............  Attach ocular implant...  Y................  .................  A2...............      $510.00      37.7243    $1,561.82      $772.96
65150............  Revise ocular implant...  Y................  .................  A2...............      $446.00      24.3077    $1,006.36      $586.09
65155............  Reinsert ocular implant.  Y................  .................  A2...............      $510.00      37.7243    $1,561.82      $772.96
65175............  Removal of ocular         Y................  .................  A2...............      $333.00      18.7307      $775.47      $443.62
                    implant.
65205............  Remove foreign body from  N................  .................  P3...............  ...........       0.4937       $20.44       $20.44
                    eye.
65210............  Remove foreign body from  N................  .................  P3...............  ...........       0.6253       $25.89       $25.89
                    eye.
65220............  Remove foreign body from  N................  .................  G2...............  ...........       0.8696       $36.00       $36.00
                    eye.
65222............  Remove foreign body from  N................  .................  P3...............  ...........       0.6831       $28.28       $28.28
                    eye.
65235............  Remove foreign body from  Y................  .................  A2...............      $446.00       16.171      $669.50      $501.88
                    eye.
65260............  Remove foreign body from  Y................  .................  A2...............      $510.00       18.235      $754.95      $571.24
                    eye.
65265............  Remove foreign body from  Y................  .................  A2...............      $630.00       27.845    $1,152.81      $760.70
                    eye.
65270............  Repair of eye wound.....  Y................  .................  A2...............      $446.00      18.7307      $775.47      $528.37
65272............  Repair of eye wound.....  Y................  .................  A2...............      $446.00      23.1758      $959.50      $574.38
65275............  Repair of eye wound.....  Y................  .................  A2...............      $630.00      23.1758      $959.50      $712.38
65280............  Repair of eye wound.....  Y................  .................  A2...............      $630.00       18.235      $754.95      $661.24
65285............  Repair of eye wound.....  Y................  .................  A2...............      $630.00      37.2078    $1,540.44      $857.61
65286............  Repair of eye wound.....  Y................  .................  P2...............  ...........       5.1169      $211.84      $211.84
65290............  Repair of eye socket      Y................  .................  A2...............      $510.00      24.1291      $998.97      $632.24
                    wound.
65400............  Removal of eye lesion...  Y................  .................  A2...............      $333.00       16.171      $669.50      $417.13
65410............  Biopsy of cornea........  Y................  .................  A2...............      $446.00       16.171      $669.50      $501.88
65420............  Removal of eye lesion...  Y................  .................  A2...............      $446.00       16.171      $669.50      $501.88
65426............  Removal of eye lesion...  Y................  .................  A2...............      $717.00      23.1758      $959.50      $777.63
65430............  Corneal smear...........  N................  CH...............  P2...............  ...........       0.8696       $36.00       $36.00
65435............  Curette/treat cornea....  Y................  .................  P3...............  ...........       0.7652       $31.68       $31.68
65436............  Curette/treat cornea....  Y................  .................  G2...............  ...........       16.171      $669.50      $669.50
65450............  Treatment of corneal      N................  .................  G2...............  ...........        2.179       $90.21       $90.21
                    lesion.
65600............  Revision of cornea......  Y................  .................  P3...............  ...........       3.8758      $160.46      $160.46
65710............  Corneal transplant......  Y................  .................  A2...............      $995.00      37.4896    $1,552.11    $1,134.28
65730............  Corneal transplant......  Y................  .................  A2...............      $995.00      37.4896    $1,552.11    $1,134.28
65750............  Corneal transplant......  Y................  .................  A2...............      $995.00      37.4896    $1,552.11    $1,134.28
65755............  Corneal transplant......  Y................  .................  A2...............      $995.00      37.4896    $1,552.11    $1,134.28
65770............  Revise cornea with        Y................  .................  A2...............      $995.00      84.8039    $3,510.97    $1,623.99
                    implant.
65772............  Correction of             Y................  .................  A2...............      $630.00       16.171      $669.50      $639.88
                    astigmatism.
65775............  Correction of             Y................  .................  A2...............      $630.00       16.171      $669.50      $639.88
                    astigmatism.
65780............  Ocular reconst,           Y................  .................  A2...............      $717.00      37.4896    $1,552.11      $925.78
                    transplant.
65781............  Ocular reconst,           Y................  .................  A2...............      $717.00      37.4896    $1,552.11      $925.78
                    transplant.
65782............  Ocular reconst,           Y................  .................  A2...............      $717.00      37.4896    $1,552.11      $925.78
                    transplant.
65800............  Drainage of eye.........  Y................  .................  A2...............      $333.00       16.171      $669.50      $417.13
65805............  Drainage of eye.........  Y................  .................  A2...............      $333.00       16.171      $669.50      $417.13
65810............  Drainage of eye.........  Y................  .................  A2...............      $510.00      23.1758      $959.50      $622.38
65815............  Drainage of eye.........  Y................  .................  A2...............      $446.00      23.1758      $959.50      $574.38
65820............  Relieve inner eye         Y................  .................  A2...............      $333.00       5.1169      $211.84      $302.71
                    pressure.
65850............  Incision of eye.........  Y................  .................  A2...............      $630.00      23.1758      $959.50      $712.38
65855............  Laser surgery of eye....  Y................  .................  P3...............  ...........       3.2011      $132.53      $132.53
65860............  Incise inner eye          Y................  .................  P3...............  ...........       2.9953      $124.01      $124.01
                    adhesions.
65865............  Incise inner eye          Y................  .................  A2...............      $333.00       16.171      $669.50      $417.13
                    adhesions.
65870............  Incise inner eye          Y................  .................  A2...............      $630.00      23.1758      $959.50      $712.38
                    adhesions.
65875............  Incise inner eye          Y................  .................  A2...............      $630.00      23.1758      $959.50      $712.38
                    adhesions.
65880............  Incise inner eye          Y................  .................  A2...............      $630.00       16.171      $669.50      $639.88
                    adhesions.
65900............  Remove eye lesion.......  Y................  .................  A2...............      $717.00       16.171      $669.50      $705.13
65920............  Remove implant of eye...  Y................  .................  A2...............      $995.00      23.1758      $959.50      $986.13
65930............  Remove blood clot from    Y................  .................  A2...............      $717.00      23.1758      $959.50      $777.63
                    eye.
66020............  Injection treatment of    Y................  .................  A2...............      $333.00       16.171      $669.50      $417.13
                    eye.
66030............  Injection treatment of    Y................  .................  A2...............      $333.00       5.1169      $211.84      $302.71
                    eye.
66130............  Remove eye lesion.......  Y................  .................  A2...............      $995.00      23.1758      $959.50      $986.13
66150............  Glaucoma surgery........  Y................  .................  A2...............      $630.00      23.1758      $959.50      $712.38
66155............  Glaucoma surgery........  Y................  .................  A2...............      $630.00      23.1758      $959.50      $712.38
66160............  Glaucoma surgery........  Y................  .................  A2...............      $446.00      23.1758      $959.50      $574.38
66165............  Glaucoma surgery........  Y................  .................  A2...............      $630.00      23.1758      $959.50      $712.38
66170............  Glaucoma surgery........  Y................  .................  A2...............      $630.00      23.1758      $959.50      $712.38
66172............  Incision of eye.........  Y................  .................  A2...............      $630.00      23.1758      $959.50      $712.38
66180............  Implant eye shunt.......  Y................  .................  A2...............      $717.00      39.7101    $1,644.04      $948.76
66185............  Revise eye shunt........  Y................  .................  A2...............      $446.00      39.7101    $1,644.04      $745.51
66220............  Repair eye lesion.......  Y................  .................  A2...............      $510.00      37.2078    $1,540.44      $767.61
66225............  Repair/graft eye lesion.  Y................  .................  A2...............      $630.00      39.7101    $1,644.04      $883.51
66250............  Follow-up surgery of eye  Y................  .................  A2...............      $446.00       16.171      $669.50      $501.88

[[Page 66989]]

 
66500............  Incision of iris........  Y................  .................  A2...............      $333.00       5.1169      $211.84      $302.71
66505............  Incision of iris........  Y................  .................  A2...............      $333.00       5.1169      $211.84      $302.71
66600............  Remove iris and lesion..  Y................  .................  A2...............      $510.00      23.1758      $959.50      $622.38
66605............  Removal of iris.........  Y................  .................  A2...............      $510.00      23.1758      $959.50      $622.38
66625............  Removal of iris.........  Y................  .................  A2...............      $372.94       5.1169      $211.84      $332.67
66630............  Removal of iris.........  Y................  .................  A2...............      $510.00      23.1758      $959.50      $622.38
66635............  Removal of iris.........  Y................  .................  A2...............      $510.00      23.1758      $959.50      $622.38
66680............  Repair iris & ciliary     Y................  .................  A2...............      $510.00      23.1758      $959.50      $622.38
                    body.
66682............  Repair iris & ciliary     Y................  .................  A2...............      $446.00      23.1758      $959.50      $574.38
                    body.
66700............  Destruction, ciliary      Y................  .................  A2...............      $446.00       16.171      $669.50      $501.88
                    body.
66710............  Ciliary transsleral       Y................  .................  A2...............      $446.00       16.171      $669.50      $501.88
                    therapy.
66711............  Ciliary endoscopic        Y................  .................  A2...............      $446.00       16.171      $669.50      $501.88
                    ablation.
66720............  Destruction, ciliary      Y................  .................  A2...............      $446.00       16.171      $669.50      $501.88
                    body.
66740............  Destruction, ciliary      Y................  .................  A2...............      $446.00      23.1758      $959.50      $574.38
                    body.
66761............  Revision of iris........  Y................  .................  P3...............  ...........       4.3612      $180.56      $180.56
66762............  Revision of iris........  Y................  .................  P3...............  ...........        4.419      $182.95      $182.95
66770............  Removal of inner eye      Y................  .................  P3...............  ...........       4.7728      $197.60      $197.60
                    lesion.
66820............  Incision, secondary       Y................  .................  G2...............  ...........       5.1169      $211.84      $211.84
                    cataract.
66821............  After cataract laser      Y................  .................  A2...............      $312.50       5.2001      $215.29      $288.20
                    surgery.
66825............  Reposition intraocular    Y................  .................  A2...............      $630.00      23.1758      $959.50      $712.38
                    lens.
66830............  Removal of lens lesion..  Y................  .................  A2...............      $372.94       5.1169      $211.84      $332.67
66840............  Removal of lens material  Y................  .................  A2...............      $630.00      14.9171      $617.58      $626.90
66850............  Removal of lens material  Y................  .................  A2...............      $995.00      28.7035    $1,188.35    $1,043.34
66852............  Removal of lens material  Y................  .................  A2...............      $630.00      28.7035    $1,188.35      $769.59
66920............  Extraction of lens......  Y................  .................  A2...............      $630.00      28.7035    $1,188.35      $769.59
66930............  Extraction of lens......  Y................  .................  A2...............      $717.00      28.7035    $1,188.35      $834.84
66940............  Extraction of lens......  Y................  .................  A2...............      $717.00      14.9171      $617.58      $692.15
66982............  Cataract surgery,         Y................  .................  A2...............      $973.00      23.8649      $988.03      $976.76
                    complex.
66983............  Cataract surg w/iol, 1    Y................  .................  A2...............      $973.00      23.8649      $988.03      $976.76
                    stage.
66984............  Cataract surg w/iol, 1    Y................  .................  A2...............      $973.00      23.8649      $988.03      $976.76
                    stage.
66985............  Insert lens prosthesis..  Y................  .................  A2...............      $826.00      23.8649      $988.03      $866.51
66986............  Exchange lens prosthesis  Y................  .................  A2...............      $826.00      23.8649      $988.03      $866.51
66990............  Ophthalmic endoscope add- N................  .................  N1...............  ...........  ...........  ...........  ...........
                    on.
67005............  Partial removal of eye    Y................  .................  A2...............      $630.00       27.845    $1,152.81      $760.70
                    fluid.
67010............  Partial removal of eye    Y................  .................  A2...............      $630.00       27.845    $1,152.81      $760.70
                    fluid.
67015............  Release of eye fluid....  Y................  .................  A2...............      $333.00       27.845    $1,152.81      $537.95
67025............  Replace eye fluid.......  Y................  .................  A2...............      $333.00       27.845    $1,152.81      $537.95
67027............  Implant eye drug system.  Y................  .................  A2...............      $630.00      37.2078    $1,540.44      $857.61
67028............  Injection eye drug......  N................  .................  P3...............  ...........       1.9915       $82.45       $82.45
67030............  Incise inner eye strands  Y................  .................  A2...............      $333.00       18.235      $754.95      $438.49
67031............  Laser surgery, eye        Y................  .................  A2...............      $312.50       5.2001      $215.29      $288.20
                    strands.
67036............  Removal of inner eye      Y................  .................  A2...............      $630.00      37.2078    $1,540.44      $857.61
                    fluid.
67038............  Strip retinal membrane..  N................  CH...............  D5...............  ...........  ...........  ...........  ...........
67039............  Laser treatment of        Y................  .................  A2...............      $995.00      37.2078    $1,540.44    $1,131.36
                    retina.
67040............  Laser treatment of        Y................  .................  A2...............      $995.00      37.2078    $1,540.44    $1,131.36
                    retina.
67041............  Vit for macular pucker..  Y................  NI...............  G2...............  ...........      37.2078    $1,540.44    $1,540.44
67042............  Vit for macular hole....  Y................  NI...............  G2...............  ...........      37.2078    $1,540.44    $1,540.44
67043............  Vit for membrane dissect  Y................  NI...............  G2...............  ...........      37.2078    $1,540.44    $1,540.44
67101............  Repair detached retina..  Y................  .................  P3...............  ...........       7.2414      $299.80      $299.80
67105............  Repair detached retina..  Y................  .................  P2...............  ...........       5.2001      $215.29      $215.29
67107............  Repair detached retina..  Y................  .................  A2...............      $717.00      37.2078    $1,540.44      $922.86
67108............  Repair detached retina..  Y................  .................  A2...............      $995.00      37.2078    $1,540.44    $1,131.36
67110............  Repair detached retina..  Y................  .................  P3...............  ...........       7.8749      $326.03      $326.03
67112............  Rerepair detached retina  Y................  .................  A2...............      $995.00      37.2078    $1,540.44    $1,131.36
67113............  Repair retinal detach,    Y................  NI...............  G2...............  ...........      37.2078    $1,540.44    $1,540.44
                    cplx.
67115............  Release encircling        Y................  .................  A2...............      $446.00       18.235      $754.95      $523.24
                    material.
67120............  Remove eye implant        Y................  .................  A2...............      $446.00       18.235      $754.95      $523.24
                    material.
67121............  Remove eye implant        Y................  .................  A2...............      $446.00       27.845    $1,152.81      $622.70
                    material.
67141............  Treatment of retina.....  Y................  .................  A2...............      $241.77       4.1331      $171.11      $224.11
67145............  Treatment of retina.....  Y................  .................  P3...............  ...........       4.5506      $188.40      $188.40
67208............  Treatment of retinal      Y................  .................  P3...............  ...........       4.8385      $200.32      $200.32
                    lesion.
67210............  Treatment of retinal      Y................  CH...............  P3...............  ...........       5.1349      $212.59      $212.59
                    lesion.
67218............  Treatment of retinal      Y................  .................  A2...............      $717.00       18.235      $754.95      $726.49
                    lesion.
67220............  Treatment of choroid      Y................  .................  P2...............  ...........       4.1331      $171.11      $171.11
                    lesion.
67221............  Ocular photodynamic ther  Y................  .................  P3...............  ...........       2.9789      $123.33      $123.33
67225............  Eye photodynamic ther     Y................  .................  P3...............  ...........       0.1976        $8.18        $8.18
                    add-on.
67227............  Treatment of retinal      Y................  .................  A2...............      $333.00       27.845    $1,152.81      $537.95
                    lesion.
67228............  Treatment of retinal      Y................  .................  P2...............  ...........       5.2001      $215.29      $215.29
                    lesion.
67229*...........  Tr retinal les preterm    Y................  NI...............  R2...............  ...........       5.2001      $215.29      $215.29
                    inf.
67250............  Reinforce eye wall......  Y................  .................  A2...............      $510.00      18.7307      $775.47      $576.37
67255............  Reinforce/graft eye wall  Y................  .................  A2...............      $510.00       27.845    $1,152.81      $670.70
67311............  Revise eye muscle.......  Y................  .................  A2...............      $510.00      24.1291      $998.97      $632.24
67312............  Revise two eye muscles..  Y................  .................  A2...............      $630.00      24.1291      $998.97      $722.24

[[Page 66990]]

 
67314............  Revise eye muscle.......  Y................  .................  A2...............      $630.00      24.1291      $998.97      $722.24
67316............  Revise two eye muscles..  Y................  .................  A2...............      $630.00      24.1291      $998.97      $722.24
67318............  Revise eye muscle(s)....  Y................  .................  A2...............      $630.00      24.1291      $998.97      $722.24
67320............  Revise eye muscle(s) add- Y................  .................  A2...............      $630.00      24.1291      $998.97      $722.24
                    on.
67331............  Eye surgery follow-up     Y................  .................  A2...............      $630.00      24.1291      $998.97      $722.24
                    add-on.
67332............  Rerevise eye muscles add- Y................  .................  A2...............      $630.00      24.1291      $998.97      $722.24
                    on.
67334............  Revise eye muscle w/      Y................  .................  A2...............      $630.00      24.1291      $998.97      $722.24
                    suture.
67335............  Eye suture during         Y................  .................  A2...............      $630.00      24.1291      $998.97      $722.24
                    surgery.
67340............  Revise eye muscle add-on  Y................  .................  A2...............      $630.00      24.1291      $998.97      $722.24
67343............  Release eye tissue......  Y................  .................  A2...............      $995.00      24.1291      $998.97      $995.99
67345............  Destroy nerve of eye      Y................  .................  P3...............  ...........       1.9584       $81.08       $81.08
                    muscle.
67346............  Biopsy, eye muscle......  Y................  .................  A2...............      $333.00      13.7453      $569.07      $392.02
67400............  Explore/biopsy eye        Y................  .................  A2...............      $510.00      24.3077    $1,006.36      $634.09
                    socket.
67405............  Explore/drain eye socket  Y................  .................  A2...............      $630.00      24.3077    $1,006.36      $724.09
67412............  Explore/treat eye socket  Y................  .................  A2...............      $717.00      24.3077    $1,006.36      $789.34
67413............  Explore/treat eye socket  Y................  .................  A2...............      $717.00      24.3077    $1,006.36      $789.34
67414............  Explr/decompress eye      Y................  .................  G2...............  ...........      37.7243    $1,561.82    $1,561.82
                    socket.
67415............  Aspiration, orbital       Y................  .................  A2...............      $333.00      18.7307      $775.47      $443.62
                    contents.
67420............  Explore/treat eye socket  Y................  .................  A2...............      $717.00      37.7243    $1,561.82      $928.21
67430............  Explore/treat eye socket  Y................  .................  A2...............      $717.00      37.7243    $1,561.82      $928.21
67440............  Explore/drain eye socket  Y................  .................  A2...............      $717.00      37.7243    $1,561.82      $928.21
67445............  Explr/decompress eye      Y................  .................  A2...............      $717.00      37.7243    $1,561.82      $928.21
                    socket.
67450............  Explore/biopsy eye        Y................  .................  A2...............      $717.00      37.7243    $1,561.82      $928.21
                    socket.
67500............  Inject/treat eye socket.  N................  .................  G2...............  ...........        2.179       $90.21       $90.21
67505............  Inject/treat eye socket.  Y................  .................  G2...............  ...........       2.9022      $120.15      $120.15
67515............  Inject/treat eye socket.  Y................  .................  P3...............  ...........       0.5596       $23.17       $23.17
67550............  Insert eye socket         Y................  .................  A2...............      $630.00      37.7243    $1,561.82      $862.96
                    implant.
67560............  Revise eye socket         Y................  .................  A2...............      $446.00      24.3077    $1,006.36      $586.09
                    implant.
67570............  Decompress optic nerve..  Y................  .................  A2...............      $630.00      37.7243    $1,561.82      $862.96
67700............  Drainage of eyelid        Y................  .................  P2...............  ...........       2.9022      $120.15      $120.15
                    abscess.
67710............  Incision of eyelid......  Y................  .................  P3...............  ...........       3.7277      $154.33      $154.33
67715............  Incision of eyelid fold.  Y................  .................  A2...............      $333.00      18.7307      $775.47      $443.62
67800............  Remove eyelid lesion....  Y................  .................  P3...............  ...........       1.2343       $51.10       $51.10
67801............  Remove eyelid lesions...  Y................  .................  P3...............  ...........       1.4975       $62.00       $62.00
67805............  Remove eyelid lesions...  Y................  .................  P3...............  ...........       1.9338       $80.06       $80.06
67808............  Remove eyelid lesion(s).  Y................  .................  A2...............      $446.00      18.7307      $775.47      $528.37
67810............  Biopsy of eyelid........  Y................  .................  P2...............  ...........       2.9022      $120.15      $120.15
67820............  Revise eyelashes........  N................  .................  P3...............  ...........        0.428       $17.72       $17.72
67825............  Revise eyelashes........  Y................  .................  P3...............  ...........        1.292       $53.49       $53.49
67830............  Revise eyelashes........  Y................  .................  A2...............      $446.00       7.2847      $301.59      $409.90
67835............  Revise eyelashes........  Y................  .................  A2...............      $446.00      18.7307      $775.47      $528.37
67840............  Remove eyelid lesion....  Y................  .................  P3...............  ...........       3.8593      $159.78      $159.78
67850............  Treat eyelid lesion.....  Y................  .................  P3...............  ...........       2.7403      $113.45      $113.45
67875............  Closure of eyelid by      Y................  .................  G2...............  ...........       7.2847      $301.59      $301.59
                    suture.
67880............  Revision of eyelid......  Y................  .................  A2...............      $510.00       16.171      $669.50      $549.88
67882............  Revision of eyelid......  Y................  .................  A2...............      $510.00      18.7307      $775.47      $576.37
67900............  Repair brow defect......  Y................  .................  A2...............      $630.00      18.7307      $775.47      $666.37
67901............  Repair eyelid defect....  Y................  .................  A2...............      $717.00      18.7307      $775.47      $731.62
67902............  Repair eyelid defect....  Y................  .................  A2...............      $717.00      18.7307      $775.47      $731.62
67903............  Repair eyelid defect....  Y................  .................  A2...............      $630.00      18.7307      $775.47      $666.37
67904............  Repair eyelid defect....  Y................  .................  A2...............      $630.00      18.7307      $775.47      $666.37
67906............  Repair eyelid defect....  Y................  .................  A2...............      $717.00      18.7307      $775.47      $731.62
67908............  Repair eyelid defect....  Y................  .................  A2...............      $630.00      18.7307      $775.47      $666.37
67909............  Revise eyelid defect....  Y................  .................  A2...............      $630.00      18.7307      $775.47      $666.37
67911............  Revise eyelid defect....  Y................  .................  A2...............      $510.00      18.7307      $775.47      $576.37
67912............  Correction eyelid w/      Y................  .................  A2...............      $510.00      18.7307      $775.47      $576.37
                    implant.
67914............  Repair eyelid defect....  Y................  .................  A2...............      $510.00      18.7307      $775.47      $576.37
67915............  Repair eyelid defect....  Y................  .................  P3...............  ...........       4.2378      $175.45      $175.45
67916............  Repair eyelid defect....  Y................  .................  A2...............      $630.00      18.7307      $775.47      $666.37
67917............  Repair eyelid defect....  Y................  .................  A2...............      $630.00      18.7307      $775.47      $666.37
67921............  Repair eyelid defect....  Y................  .................  A2...............      $510.00      18.7307      $775.47      $576.37
67922............  Repair eyelid defect....  Y................  .................  P3...............  ...........        4.139      $171.36      $171.36
67923............  Repair eyelid defect....  Y................  .................  A2...............      $630.00      18.7307      $775.47      $666.37
67924............  Repair eyelid defect....  Y................  .................  A2...............      $630.00      18.7307      $775.47      $666.37
67930............  Repair eyelid wound.....  Y................  .................  P3...............  ...........       4.1472      $171.70      $171.70
67935............  Repair eyelid wound.....  Y................  .................  A2...............      $446.00      18.7307      $775.47      $528.37
67938............  Remove eyelid foreign     N................  .................  P2...............  ...........        2.179       $90.21       $90.21
                    body.
67950............  Revision of eyelid......  Y................  .................  A2...............      $446.00      18.7307      $775.47      $528.37
67961............  Revision of eyelid......  Y................  .................  A2...............      $510.00      18.7307      $775.47      $576.37
67966............  Revision of eyelid......  Y................  .................  A2...............      $510.00      18.7307      $775.47      $576.37
67971............  Reconstruction of eyelid  Y................  .................  A2...............      $510.00      24.3077    $1,006.36      $634.09
67973............  Reconstruction of eyelid  Y................  .................  A2...............      $510.00      24.3077    $1,006.36      $634.09
67974............  Reconstruction of eyelid  Y................  .................  A2...............      $510.00      24.3077    $1,006.36      $634.09

[[Page 66991]]

 
67975............  Reconstruction of eyelid  Y................  .................  A2...............      $510.00      18.7307      $775.47      $576.37
68020............  Incise/drain eyelid       Y................  .................  P3...............  ...........       1.0862       $44.97       $44.97
                    lining.
68040............  Treatment of eyelid       N................  .................  P3...............  ...........       0.5348       $22.14       $22.14
                    lesions.
68100............  Biopsy of eyelid lining.  Y................  .................  P3...............  ...........       2.3041       $95.39       $95.39
68110............  Remove eyelid lining      Y................  .................  P3...............  ...........       2.9458      $121.96      $121.96
                    lesion.
68115............  Remove eyelid lining      Y................  .................  A2...............      $446.00      18.7307      $775.47      $528.37
                    lesion.
68130............  Remove eyelid lining      Y................  .................  A2...............      $446.00       16.171      $669.50      $501.88
                    lesion.
68135............  Remove eyelid lining      Y................  .................  P3...............  ...........        1.399       $57.92       $57.92
                    lesion.
68200............  Treat eyelid by           N................  .................  P3...............  ...........       0.4031       $16.69       $16.69
                    injection.
68320............  Revise/graft eyelid       Y................  .................  A2...............      $630.00      18.7307      $775.47      $666.37
                    lining.
68325............  Revise/graft eyelid       Y................  .................  A2...............      $630.00      24.3077    $1,006.36      $724.09
                    lining.
68326............  Revise/graft eyelid       Y................  .................  A2...............      $630.00      24.3077    $1,006.36      $724.09
                    lining.
68328............  Revise/graft eyelid       Y................  .................  A2...............      $630.00      24.3077    $1,006.36      $724.09
                    lining.
68330............  Revise eyelid lining....  Y................  .................  A2...............      $630.00      23.1758      $959.50      $712.38
68335............  Revise/graft eyelid       Y................  .................  A2...............      $630.00      24.3077    $1,006.36      $724.09
                    lining.
68340............  Separate eyelid           Y................  .................  A2...............      $630.00      18.7307      $775.47      $666.37
                    adhesions.
68360............  Revise eyelid lining....  Y................  .................  A2...............      $446.00      23.1758      $959.50      $574.38
68362............  Revise eyelid lining....  Y................  .................  A2...............      $446.00      23.1758      $959.50      $574.38
68371............  Harvest eye tissue,       Y................  .................  A2...............      $446.00       16.171      $669.50      $501.88
                    alograft.
68400............  Incise/drain tear gland.  Y................  .................  P2...............  ...........       2.9022      $120.15      $120.15
68420............  Incise/drain tear sac...  Y................  .................  P3...............  ...........       4.4354      $183.63      $183.63
68440............  Incise tear duct opening  Y................  .................  P3...............  ...........       1.3741       $56.89       $56.89
68500............  Removal of tear gland...  Y................  .................  A2...............      $510.00      24.3077    $1,006.36      $634.09
68505............  Partial removal, tear     Y................  .................  A2...............      $510.00      24.3077    $1,006.36      $634.09
                    gland.
68510............  Biopsy of tear gland....  Y................  .................  A2...............      $333.00      18.7307      $775.47      $443.62
68520............  Removal of tear sac.....  Y................  .................  A2...............      $510.00      24.3077    $1,006.36      $634.09
68525............  Biopsy of tear sac......  Y................  .................  A2...............      $333.00      18.7307      $775.47      $443.62
68530............  Clearance of tear duct..  Y................  .................  P3...............  ...........       5.6615      $234.39      $234.39
68540............  Remove tear gland lesion  Y................  .................  A2...............      $510.00      24.3077    $1,006.36      $634.09
68550............  Remove tear gland lesion  Y................  .................  A2...............      $510.00      24.3077    $1,006.36      $634.09
68700............  Repair tear ducts.......  Y................  .................  A2...............      $446.00      24.3077    $1,006.36      $586.09
68705............  Revise tear duct opening  Y................  .................  P2...............  ...........       2.9022      $120.15      $120.15
68720............  Create tear sac drain...  Y................  .................  A2...............      $630.00      24.3077    $1,006.36      $724.09
68745............  Create tear duct drain..  Y................  .................  A2...............      $630.00      24.3077    $1,006.36      $724.09
68750............  Create tear duct drain..  Y................  .................  A2...............      $630.00      24.3077    $1,006.36      $724.09
68760............  Close tear duct opening.  N................  .................  P2...............  ...........        2.179       $90.21       $90.21
68761............  Close tear duct opening.  N................  .................  P3...............  ...........       1.6869       $69.84       $69.84
68770............  Close tear system         Y................  .................  A2...............      $630.00      18.7307      $775.47      $666.37
                    fistula.
68801............  Dilate tear duct opening  N................  .................  P2...............  ...........       0.8696       $36.00       $36.00
68810............  Probe nasolacrimal duct.  N................  .................  A2...............      $131.86        2.179       $90.21      $121.45
68811............  Probe nasolacrimal duct.  Y................  .................  A2...............      $446.00      18.7307      $775.47      $528.37
68815............  Probe nasolacrimal duct.  Y................  .................  A2...............      $446.00      18.7307      $775.47      $528.37
68816*...........  Probe nl duct w/balloon.  Y................  NI...............  P3...............  ...........      10.4754      $433.69      $433.69
68840............  Explore/irrigate tear     N................  CH...............  P3...............  ...........       1.2756       $52.81       $52.81
                    ducts.
68850............  Injection for tear sac x- N................  .................  N1...............  ...........  ...........  ...........  ...........
                    ray.
69000............  Drain external ear        Y................  .................  P2...............  ...........       1.4066       $58.23       $58.23
                    lesion.
69005............  Drain external ear        Y................  .................  P3...............  ...........       2.4357      $100.84      $100.84
                    lesion.
69020............  Drain outer ear canal     Y................  .................  P2...............  ...........       1.4066       $58.23       $58.23
                    lesion.
69100............  Biopsy of external ear..  Y................  .................  P3...............  ...........       1.4647       $60.64       $60.64
69105............  Biopsy of external ear    Y................  .................  P3...............  ...........        2.049       $84.83       $84.83
                    canal.
69110............  Remove external ear,      Y................  .................  A2...............      $333.00      16.1001      $666.56      $416.39
                    partial.
69120............  Removal of external ear.  Y................  .................  A2...............      $446.00      23.9765      $992.65      $582.66
69140............  Remove ear canal          Y................  .................  A2...............      $446.00      23.9765      $992.65      $582.66
                    lesion(s).
69145............  Remove ear canal          Y................  .................  A2...............      $446.00      16.1001      $666.56      $501.14
                    lesion(s).
69150............  Extensive ear canal       Y................  .................  A2...............      $464.15       7.4474      $308.33      $425.20
                    surgery.
69200............  Clear outer ear canal...  N................  .................  P2...............  ...........        0.631       $26.12       $26.12
69205............  Clear outer ear canal...  Y................  .................  A2...............      $333.00      21.1098      $873.97      $468.24
69210............  Remove impacted ear wax.  N................  .................  P3...............  ...........       0.4937       $20.44       $20.44
69220............  Clean out mastoid cavity  Y................  .................  P2...............  ...........        0.793       $32.83       $32.83
69222............  Clean out mastoid cavity  Y................  .................  P3...............  ...........       3.2176      $133.21      $133.21
69300............  Revise external ear.....  Y................  .................  A2...............      $510.00      23.9765      $992.65      $630.66
69310............  Rebuild outer ear canal.  Y................  .................  A2...............      $510.00      39.8776    $1,650.97      $795.24
69320............  Rebuild outer ear canal.  Y................  .................  A2...............      $995.00      39.8776    $1,650.97    $1,158.99
69400............  Inflate middle ear canal  Y................  .................  P3...............  ...........        2.049       $84.83       $84.83
69401............  Inflate middle ear canal  Y................  .................  P3...............  ...........       1.1355       $47.01       $47.01
69405............  Catheterize middle ear    Y................  .................  P3...............  ...........       2.9458      $121.96      $121.96
                    canal.
69420............  Incision of eardrum.....  Y................  .................  P2...............  ...........       2.5002      $103.51      $103.51
69421............  Incision of eardrum.....  Y................  .................  A2...............      $510.00      16.3288      $676.03      $551.51
69424............  Remove ventilating tube.  Y................  .................  P3...............  ...........       1.8596       $76.99       $76.99
69433............  Create eardrum opening..  Y................  .................  P3...............  ...........       2.6333      $109.02      $109.02
69436............  Create eardrum opening..  Y................  .................  A2...............      $510.00      16.3288      $676.03      $551.51
69440............  Exploration of middle     Y................  .................  A2...............      $510.00      23.9765      $992.65      $630.66
                    ear.
69450............  Eardrum revision........  Y................  .................  A2...............      $333.00      39.8776    $1,650.97      $662.49

[[Page 66992]]

 
69501............  Mastoidectomy...........  Y................  .................  A2...............      $995.00      39.8776    $1,650.97    $1,158.99
69502............  Mastoidectomy...........  Y................  .................  A2...............      $995.00      23.9765      $992.65      $994.41
69505............  Remove mastoid            Y................  .................  A2...............      $995.00      39.8776    $1,650.97    $1,158.99
                    structures.
69511............  Extensive mastoid         Y................  .................  A2...............      $995.00      39.8776    $1,650.97    $1,158.99
                    surgery.
69530............  Extensive mastoid         Y................  .................  A2...............      $995.00      39.8776    $1,650.97    $1,158.99
                    surgery.
69540............  Remove ear lesion.......  Y................  .................  P3...............  ...........       3.1434      $130.14      $130.14
69550............  Remove ear lesion.......  Y................  .................  A2...............      $717.00      39.8776    $1,650.97      $950.49
69552............  Remove ear lesion.......  Y................  .................  A2...............      $995.00      39.8776    $1,650.97    $1,158.99
69601............  Mastoid surgery revision  Y................  .................  A2...............      $995.00      39.8776    $1,650.97    $1,158.99
69602............  Mastoid surgery revision  Y................  .................  A2...............      $995.00      39.8776    $1,650.97    $1,158.99
69603............  Mastoid surgery revision  Y................  .................  A2...............      $995.00      39.8776    $1,650.97    $1,158.99
69604............  Mastoid surgery revision  Y................  .................  A2...............      $995.00      39.8776    $1,650.97    $1,158.99
69605............  Mastoid surgery revision  Y................  .................  A2...............      $995.00      39.8776    $1,650.97    $1,158.99
69610............  Repair of eardrum.......  Y................  .................  P3...............  ...........       4.3038      $178.18      $178.18
69620............  Repair of eardrum.......  Y................  .................  A2...............      $446.00      23.9765      $992.65      $582.66
69631............  Repair eardrum            Y................  .................  A2...............      $717.00      39.8776    $1,650.97      $950.49
                    structures.
69632............  Rebuild eardrum           Y................  .................  A2...............      $717.00      39.8776    $1,650.97      $950.49
                    structures.
69633............  Rebuild eardrum           Y................  .................  A2...............      $717.00      39.8776    $1,650.97      $950.49
                    structures.
69635............  Repair eardrum            Y................  .................  A2...............      $995.00      39.8776    $1,650.97    $1,158.99
                    structures.
69636............  Rebuild eardrum           Y................  .................  A2...............      $995.00      39.8776    $1,650.97    $1,158.99
                    structures.
69637............  Rebuild eardrum           Y................  .................  A2...............      $995.00      39.8776    $1,650.97    $1,158.99
                    structures.
69641............  Revise middle ear &       Y................  .................  A2...............      $995.00      39.8776    $1,650.97    $1,158.99
                    mastoid.
69642............  Revise middle ear &       Y................  .................  A2...............      $995.00      39.8776    $1,650.97    $1,158.99
                    mastoid.
69643............  Revise middle ear &       Y................  .................  A2...............      $995.00      39.8776    $1,650.97    $1,158.99
                    mastoid.
69644............  Revise middle ear &       Y................  .................  A2...............      $995.00      39.8776    $1,650.97    $1,158.99
                    mastoid.
69645............  Revise middle ear &       Y................  .................  A2...............      $995.00      39.8776    $1,650.97    $1,158.99
                    mastoid.
69646............  Revise middle ear &       Y................  .................  A2...............      $995.00      39.8776    $1,650.97    $1,158.99
                    mastoid.
69650............  Release middle ear bone.  Y................  .................  A2...............      $995.00      23.9765      $992.65      $994.41
69660............  Revise middle ear bone..  Y................  .................  A2...............      $717.00      39.8776    $1,650.97      $950.49
69661............  Revise middle ear bone..  Y................  .................  A2...............      $717.00      39.8776    $1,650.97      $950.49
69662............  Revise middle ear bone..  Y................  .................  A2...............      $717.00      39.8776    $1,650.97      $950.49
69666............  Repair middle ear         Y................  .................  A2...............      $630.00      39.8776    $1,650.97      $885.24
                    structures.
69667............  Repair middle ear         Y................  .................  A2...............      $630.00      39.8776    $1,650.97      $885.24
                    structures.
69670............  Remove mastoid air cells  Y................  .................  A2...............      $510.00      39.8776    $1,650.97      $795.24
69676............  Remove middle ear nerve.  Y................  .................  A2...............      $510.00      39.8776    $1,650.97      $795.24
69700............  Close mastoid fistula...  Y................  .................  A2...............      $510.00      39.8776    $1,650.97      $795.24
69711............  Remove/repair hearing     Y................  .................  A2...............      $333.00      39.8776    $1,650.97      $662.49
                    aid.
69714............  Implant temple bone w/    Y................  .................  A2...............    $1,339.00      39.8776    $1,650.97    $1,416.99
                    stimul.
69715............  Temple bne implnt w/      Y................  .................  A2...............    $1,339.00      39.8776    $1,650.97    $1,416.99
                    stimulat.
69717............  Temple bone implant       Y................  .................  A2...............    $1,339.00      39.8776    $1,650.97    $1,416.99
                    revision.
69718............  Revise temple bone        Y................  .................  A2...............    $1,339.00      39.8776    $1,650.97    $1,416.99
                    implant.
69720............  Release facial nerve....  Y................  .................  A2...............      $717.00      39.8776    $1,650.97      $950.49
69740............  Repair facial nerve.....  Y................  .................  A2...............      $717.00      39.8776    $1,650.97      $950.49
69745............  Repair facial nerve.....  Y................  .................  A2...............      $717.00      39.8776    $1,650.97      $950.49
69801............  Incise inner ear........  Y................  .................  A2...............      $717.00      39.8776    $1,650.97      $950.49
69802............  Incise inner ear........  Y................  .................  A2...............      $995.00      39.8776    $1,650.97    $1,158.99
69805............  Explore inner ear.......  Y................  .................  A2...............      $995.00      39.8776    $1,650.97    $1,158.99
69806............  Explore inner ear.......  Y................  .................  A2...............      $995.00      39.8776    $1,650.97    $1,158.99
69820............  Establish inner ear       Y................  .................  A2...............      $717.00      39.8776    $1,650.97      $950.49
                    window.
69840............  Revise inner ear window.  Y................  .................  A2...............      $717.00      39.8776    $1,650.97      $950.49
69905............  Remove inner ear........  Y................  .................  A2...............      $995.00      39.8776    $1,650.97    $1,158.99
69910............  Remove inner ear &        Y................  .................  A2...............      $995.00      39.8776    $1,650.97    $1,158.99
                    mastoid.
69915............  Incise inner ear nerve..  Y................  .................  A2...............      $995.00      39.8776    $1,650.97    $1,158.99
69930............  Implant cochlear device.  Y................  .................  H8...............      $995.00     568.8394   $23,550.52   $22,213.76
69990............  Microsurgery add-on.....  N................  .................  N1...............  ...........  ...........  ...........  ...........
C9716............  Radiofrequency energy to  Y................  .................  G2...............  ...........      30.1606    $1,248.68    $1,248.68
                    anu.
C9724............  EPS gast cardia plic....  Y................  .................  G2...............  ...........      25.3233    $1,048.41    $1,048.41
C9725............  Place endorectal app....  N................  .................  G2...............  ...........       8.6351      $357.50      $357.50
C9726............  Rxt breast appl place/    N................  .................  G2...............  ...........      10.2051      $422.50      $422.50
                    remov.
C9727............  Insert palate implants..  N................  .................  G2...............  ...........      13.3451      $552.50      $552.50
C9728............  Place device/marker, non  Y................  CH...............  R2...............  ...........       3.0469      $126.14      $126.14
                    pro.
G0104............  CA screen;flexi           N................  .................  P3...............  ...........       1.9748       $81.76       $81.76
                    sigmoidscope.
G0105............  Colorectal scrn; hi risk  Y................  .................  A2...............      $446.00       7.8504      $325.01      $415.75
                    ind.
G0121............  Colon ca scrn not hi rsk  Y................  .................  A2...............      $446.00       7.8504      $325.01      $415.75
                    ind.
G0127............  Trim nail(s)............  Y................  .................  P3...............  ...........       0.2633       $10.90       $10.90
G0186............  Dstry eye lesn,fdr vssl   Y................  .................  R2...............  ...........       4.1331      $171.11      $171.11
                    tech.
G0247............  Routine footcare pt w     Y................  .................  P3...............  ...........       0.4937       $20.44       $20.44
                    lops.
G0259............  Inject for sacroiliac     N................  .................  N1...............  ...........  ...........  ...........  ...........
                    joint.
G0260............  Inj for sacroiliac jt     Y................  .................  A2...............      $333.00       7.0546      $292.07      $322.77
                    anesth.
G0268............  Removal of impacted wax   N................  CH...............  N1...............  ...........  ...........  ...........  ...........
                    md.
G0269............  Occlusive device in vein  N................  .................  N1...............  ...........  ...........  ...........  ...........
                    art.
G0289............  Arthro, loose body +      N................  .................  N1...............  ...........  ...........  ...........  ...........
                    chondro.
G0364............  Bone marrow aspirate      Y................  .................  P3...............  ...........       0.1234        $5.11        $5.11
                    &biopsy.

[[Page 66993]]

 
G0392............  AV fistula or graft       Y................  .................  A2...............    $1,339.00      45.3845    $1,878.96    $1,473.99
                    arterial.
G0393............  AV fistula or graft       Y................  .................  A2...............    $1,339.00      45.3845    $1,878.96    $1,473.99
                    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 HCPCS 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. 227 / Tuesday, November 27, 2007 / 
Rules and Regulations  


                                                   Addendum B.--OPPS Payment by HCPCS Code for CY 2008
--------------------------------------------------------------------------------------------------------------------------------------------------------
                                                                                                                                  National     Minimum
     HCPCS code           Short descriptor               CI                  SI              APC        Relative     Payment     unadjusted   unadjusted
                                                                                                         weight        rate      copayment    copayment
--------------------------------------------------------------------------------------------------------------------------------------------------------
0001F..............  Heart failure composite...  ..................  M.................  ...........  ...........  ...........  ...........  ...........
0005F..............  Osteoarthritis composite..  ..................  M.................  ...........  ...........  ...........  ...........  ...........
00100..............  Anesth, salivary gland....  ..................  N.................  ...........  ...........  ...........  ...........  ...........
00102..............  Anesth, repair of cleft     ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      lip.
00103..............  Anesth, blepharoplasty....  ..................  N.................  ...........  ...........  ...........  ...........  ...........
00104..............  Anesth, electroshock......  ..................  N.................  ...........  ...........  ...........  ...........  ...........
00120..............  Anesth, ear surgery.......  ..................  N.................  ...........  ...........  ...........  ...........  ...........
00124..............  Anesth, ear exam..........  ..................  N.................  ...........  ...........  ...........  ...........  ...........
00126..............  Anesth, tympanotomy.......  ..................  N.................  ...........  ...........  ...........  ...........  ...........
0012F..............  Cap bacterial assess......  ..................  M.................  ...........  ...........  ...........  ...........  ...........
00140..............  Anesth, procedures on eye.  ..................  N.................  ...........  ...........  ...........  ...........  ...........
00142..............  Anesth, lens surgery......  ..................  N.................  ...........  ...........  ...........  ...........  ...........
00144..............  Anesth, corneal transplant  ..................  N.................  ...........  ...........  ...........  ...........  ...........
00145..............  Anesth, vitreoretinal surg  ..................  N.................  ...........  ...........  ...........  ...........  ...........
00147..............  Anesth, iridectomy........  ..................  N.................  ...........  ...........  ...........  ...........  ...........
00148..............  Anesth, eye exam..........  ..................  N.................  ...........  ...........  ...........  ...........  ...........
0014F..............  Comp preop assess cat surg  NI................  M.................  ...........  ...........  ...........  ...........  ...........
0015F..............  Melan follow-up complete..  NI................  M.................  ...........  ...........  ...........  ...........  ...........
00160..............  Anesth, nose/sinus surgery  ..................  N.................  ...........  ...........  ...........  ...........  ...........
00162..............  Anesth, nose/sinus surgery  ..................  N.................  ...........  ...........  ...........  ...........  ...........
00164..............  Anesth, biopsy of nose....  ..................  N.................  ...........  ...........  ...........  ...........  ...........
0016T..............  Thermotx choroid vasc       ..................  T.................         0235       4.1331      $263.25       $58.93       $52.65
                      lesion.
00170..............  Anesth, procedure on mouth  ..................  N.................  ...........  ...........  ...........  ...........  ...........
00172..............  Anesth, cleft palate        ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      repair.
00174..............  Anesth, pharyngeal surgery  ..................  N.................  ...........  ...........  ...........  ...........  ...........
00176..............  Anesth, pharyngeal surgery  ..................  C.................  ...........  ...........  ...........  ...........  ...........
0017T..............  Photocoagulat macular       ..................  T.................         0235       4.1331      $263.25       $58.93       $52.65
                      drusen.
00190..............  Anesth, face/skull bone     ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      surg.
00192..............  Anesth, facial bone         ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      surgery.
0019T..............  Extracorp shock wv tx,ms    ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      nos.
00210..............  Anesth, open head surgery.  ..................  N.................  ...........  ...........  ...........  ...........  ...........
00212..............  Anesth, skull drainage....  ..................  N.................  ...........  ...........  ...........  ...........  ...........
00214..............  Anesth, skull drainage....  ..................  C.................  ...........  ...........  ...........  ...........  ...........
00215..............  Anesth, skull repair/fract  ..................  C.................  ...........  ...........  ...........  ...........  ...........
00216..............  Anesth, head vessel         ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      surgery.
00218..............  Anesth, special head        ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      surgery.
00220..............  Anesth, intrcrn nerve.....  ..................  N.................  ...........  ...........  ...........  ...........  ...........
00222..............  Anesth, head nerve surgery  ..................  N.................  ...........  ...........  ...........  ...........  ...........
0026T..............  Measure remnant             ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      lipoproteins.
0027T..............  Endoscopic epidural lysis.  ..................  T.................         0220      18.0518    $1,149.79  ...........      $229.96
0028T..............  Dexa body composition       ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      study.
0029T..............  Magnetic tx for             ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      incontinence.
00300..............  Anesth, head/neck/ptrunk..  ..................  N.................  ...........  ...........  ...........  ...........  ...........
0030T..............  Antiprothrombin antibody..  ..................  A.................  ...........  ...........  ...........  ...........  ...........
0031T..............  Speculoscopy..............  ..................  N.................  ...........  ...........  ...........  ...........  ...........
00320..............  Anesth, neck organ, 1 &     ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      over.
00322..............  Anesth, biopsy of thyroid.  ..................  N.................  ...........  ...........  ...........  ...........  ...........
00326..............  Anesth, larynx/trach, < 1   ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      yr.
0032T..............  Speculoscopy w/direct       ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      sample.
00350..............  Anesth, neck vessel         ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      surgery.
00352..............  Anesth, neck vessel         ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      surgery.
00400..............  Anesth, skin, ext/per/      ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      atrunk.
00402..............  Anesth, surgery of breast.  ..................  N.................  ...........  ...........  ...........  ...........  ...........
00404..............  Anesth, surgery of breast.  ..................  N.................  ...........  ...........  ...........  ...........  ...........
00406..............  Anesth, surgery of breast.  ..................  N.................  ...........  ...........  ...........  ...........  ...........
00410..............  Anesth, correct heart       ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      rhythm.
0041T..............  Detect ur infect agnt w/    ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      cpas.
0042T..............  Ct perfusion w/contrast,    ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      cbf.
0043T..............  Co expired gas analysis...  ..................  A.................  ...........  ...........  ...........  ...........  ...........
00450..............  Anesth, surgery of          ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      shoulder.
00452..............  Anesth, surgery of          ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      shoulder.
00454..............  Anesth, collar bone biopsy  ..................  N.................  ...........  ...........  ...........  ...........  ...........

[[Page 66994]]

 
0046T..............  Cath lavage, mammary        ..................  T.................         0021      16.1001    $1,025.48      $219.48      $205.10
                      duct(s).
00470..............  Anesth, removal of rib....  ..................  N.................  ...........  ...........  ...........  ...........  ...........
00472..............  Anesth, chest wall repair.  ..................  N.................  ...........  ...........  ...........  ...........  ...........
00474..............  Anesth, surgery of rib(s).  ..................  C.................  ...........  ...........  ...........  ...........  ...........
0047T..............  Cath lavage, mammary        ..................  T.................         0021      16.1001    $1,025.48      $219.48      $205.10
                      duct(s).
0048T..............  Implant ventricular device  ..................  C.................  ...........  ...........  ...........  ...........  ...........
0049T..............  External circulation        ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      assist.
00500..............  Anesth, esophageal surgery  ..................  N.................  ...........  ...........  ...........  ...........  ...........
0050T..............  Removal circulation assist  ..................  C.................  ...........  ...........  ...........  ...........  ...........
0051T..............  Implant total heart system  ..................  C.................  ...........  ...........  ...........  ...........  ...........
00520..............  Anesth, chest procedure...  ..................  N.................  ...........  ...........  ...........  ...........  ...........
00522..............  Anesth, chest lining        ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      biopsy.
00524..............  Anesth, chest drainage....  ..................  C.................  ...........  ...........  ...........  ...........  ...........
00528..............  Anesth, chest partition     ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      view.
00529..............  Anesth, chest partition     ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      view.
0052T..............  Replace component heart     ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      syst.
00530..............  Anesth, pacemaker           ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      insertion.
00532..............  Anesth, vascular access...  ..................  N.................  ...........  ...........  ...........  ...........  ...........
00534..............  Anesth, cardioverter/defib  ..................  N.................  ...........  ...........  ...........  ...........  ...........
00537..............  Anesth, cardiac             ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      electrophys.
00539..............  Anesth, trach-bronch        ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      reconst.
0053T..............  Replace component heart     ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      syst.
00540..............  Anesth, chest surgery.....  ..................  C.................  ...........  ...........  ...........  ...........  ...........
00541..............  Anesth, one lung            ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      ventilation.
00542..............  Anesth, release of lung...  ..................  C.................  ...........  ...........  ...........  ...........  ...........
00546..............  Anesth, lung,chest wall     ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      surg.
00548..............  Anesth, trachea,bronchi     ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      surg.
0054T..............  Bone surgery using          CH................  D.................  ...........  ...........  ...........  ...........  ...........
                      computer.
00550..............  Anesth, sternal             ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      debridement.
0055T..............  Bone surgery using          CH................  D.................  ...........  ...........  ...........  ...........  ...........
                      computer.
00560..............  Anesth, heart surg w/o      ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      pump.
00561..............  Anesth, heart surg < age 1  ..................  C.................  ...........  ...........  ...........  ...........  ...........
00562..............  Anesth, heart surg w/pump.  ..................  C.................  ...........  ...........  ...........  ...........  ...........
00563..............  Anesth, heart surg w/       ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      arrest.
00566..............  Anesth, cabg w/o pump.....  ..................  N.................  ...........  ...........  ...........  ...........  ...........
0056T..............  Bone surgery using          CH................  D.................  ...........  ...........  ...........  ...........  ...........
                      computer.
00580..............  Anesth, heart/lung          ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      transplnt.
0058T..............  Cryopreservation, ovary     CH................  X.................         0344       0.8167       $52.02       $15.66       $10.40
                      tiss.
0059T..............  Cryopreservation, oocyte..  CH................  X.................         0344       0.8167       $52.02       $15.66       $10.40
00600..............  Anesth, spine, cord         ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      surgery.
00604..............  Anesth, sitting procedure.  ..................  C.................  ...........  ...........  ...........  ...........  ...........
0060T..............  Electrical impedance scan.  ..................  B.................  ...........  ...........  ...........  ...........  ...........
0061T..............  Destruction of tumor,       ..................  B.................  ...........  ...........  ...........  ...........  ...........
                      breast.
00620..............  Anesth, spine, cord         ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      surgery.
00622..............  Anesth, removal of nerves.  ..................  C.................  ...........  ...........  ...........  ...........  ...........
00625..............  Anes spine tranthor w/o     ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      vent.
00626..............  Anes, spine transthor w/    ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      vent.
0062T..............  Rep intradisc annulus;1     ..................  T.................         0050      29.1900    $1,859.23  ...........      $371.85
                      lev.
00630..............  Anesth, spine, cord         ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      surgery.
00632..............  Anesth, removal of nerves.  ..................  C.................  ...........  ...........  ...........  ...........  ...........
00634..............  Anesth for                  ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      chemonucleolysis.
00635..............  Anesth, lumbar puncture...  ..................  N.................  ...........  ...........  ...........  ...........  ...........
0063T..............  Rep intradisc               ..................  T.................         0050      29.1900    $1,859.23  ...........      $371.85
                      annulus;>1lev.
00640..............  Anesth, spine manipulation  ..................  N.................  ...........  ...........  ...........  ...........  ...........
0064T..............  Spectroscop eval expired    ..................  X.................         0367       0.5677       $36.16       $13.76        $7.23
                      gas.
0065T..............  Ocular photoscreen bilat..  CH................  D.................  ...........  ...........  ...........  ...........  ...........
0066T..............  Ct colonography;screen....  ..................  E.................  ...........  ...........  ...........  ...........  ...........
00670..............  Anesth, spine, cord         ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      surgery.
0067T..............  Ct colonography;dx........  CH................  S.................         0332       3.0109      $191.78       $75.24       $38.36
0068T..............  Interp/rept heart sound...  ..................  B.................  ...........  ...........  ...........  ...........  ...........
0069T..............  Analysis only heart sound.  ..................  N.................  ...........  ...........  ...........  ...........  ...........
00700..............  Anesth, abdominal wall      ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      surg.
00702..............  Anesth, for liver biopsy..  ..................  N.................  ...........  ...........  ...........  ...........  ...........
0070T..............  Interp only heart sound...  ..................  B.................  ...........  ...........  ...........  ...........  ...........
0071T..............  U/s leiomyomata ablate      CH................  S.................         0067      61.6965    $3,929.70  ...........      $785.94
                      <200.
0072T..............  U/s leiomyomata ablate      CH................  S.................         0067      61.6965    $3,929.70  ...........      $785.94
                      >200.
00730..............  Anesth, abdominal wall      ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      surg.
0073T..............  Delivery, comp imrt.......  ..................  S.................         0412       5.4582      $347.65  ...........       $69.53
00740..............  Anesth, upper gi visualize  ..................  N.................  ...........  ...........  ...........  ...........  ...........
0074T..............  Online physician e/m......  CH................  D.................  ...........  ...........  ...........  ...........  ...........
00750..............  Anesth, repair of hernia..  ..................  N.................  ...........  ...........  ...........  ...........  ...........
00752..............  Anesth, repair of hernia..  ..................  N.................  ...........  ...........  ...........  ...........  ...........
00754..............  Anesth, repair of hernia..  ..................  N.................  ...........  ...........  ...........  ...........  ...........
00756..............  Anesth, repair of hernia..  ..................  N.................  ...........  ...........  ...........  ...........  ...........
0075T..............  Perq stent/chest vert art.  ..................  C.................  ...........  ...........  ...........  ...........  ...........
0076T..............  S&i stent/chest vert art..  ..................  C.................  ...........  ...........  ...........  ...........  ...........
00770..............  Anesth, blood vessel        ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      repair.
0077T..............  Cereb therm perfusion       ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      probe.
0078T..............  Endovasc aort repr w/       ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      device.
00790..............  Anesth, surg upper abdomen  ..................  N.................  ...........  ...........  ...........  ...........  ...........

[[Page 66995]]

 
00792..............  Anesth, hemorr/excise       ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      liver.
00794..............  Anesth, pancreas removal..  ..................  C.................  ...........  ...........  ...........  ...........  ...........
00796..............  Anesth, for liver           ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      transplant.
00797..............  Anesth, surgery for         ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      obesity.
0079T..............  Endovasc visc extnsn repr.  ..................  C.................  ...........  ...........  ...........  ...........  ...........
00800..............  Anesth, abdominal wall      ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      surg.
00802..............  Anesth, fat layer removal.  ..................  C.................  ...........  ...........  ...........  ...........  ...........
0080T..............  Endovasc aort repr rad s&i  ..................  C.................  ...........  ...........  ...........  ...........  ...........
00810..............  Anesth, low intestine       ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      scope.
0081T..............  Endovasc visc extnsn s&i..  ..................  C.................  ...........  ...........  ...........  ...........  ...........
00820..............  Anesth, abdominal wall      ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      surg.
00830..............  Anesth, repair of hernia..  ..................  N.................  ...........  ...........  ...........  ...........  ...........
00832..............  Anesth, repair of hernia..  ..................  N.................  ...........  ...........  ...........  ...........  ...........
00834..............  Anesth, hernia repair< 1    ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      yr.
00836..............  Anesth hernia repair        ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      preemie.
00840..............  Anesth, surg lower abdomen  ..................  N.................  ...........  ...........  ...........  ...........  ...........
00842..............  Anesth, amniocentesis.....  ..................  N.................  ...........  ...........  ...........  ...........  ...........
00844..............  Anesth, pelvis surgery....  ..................  C.................  ...........  ...........  ...........  ...........  ...........
00846..............  Anesth, hysterectomy......  ..................  C.................  ...........  ...........  ...........  ...........  ...........
00848..............  Anesth, pelvic organ surg.  ..................  C.................  ...........  ...........  ...........  ...........  ...........
0084T..............  Temp prostate urethral      ..................  T.................         0164       2.0077      $127.88  ...........       $25.58
                      stent.
00851..............  Anesth, tubal ligation....  ..................  N.................  ...........  ...........  ...........  ...........  ...........
0085T..............  Breath test heart reject..  ..................  X.................         0340       0.6310       $40.19  ...........        $8.04
00860..............  Anesth, surgery of abdomen  ..................  N.................  ...........  ...........  ...........  ...........  ...........
00862..............  Anesth, kidney/ureter surg  ..................  N.................  ...........  ...........  ...........  ...........  ...........
00864..............  Anesth, removal of bladder  ..................  C.................  ...........  ...........  ...........  ...........  ...........
00865..............  Anesth, removal of          ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      prostate.
00866..............  Anesth, removal of adrenal  ..................  C.................  ...........  ...........  ...........  ...........  ...........
00868..............  Anesth, kidney transplant.  ..................  C.................  ...........  ...........  ...........  ...........  ...........
0086T..............  L ventricle fill pressure.  ..................  N.................  ...........  ...........  ...........  ...........  ...........
00870..............  Anesth, bladder stone surg  ..................  N.................  ...........  ...........  ...........  ...........  ...........
00872..............  Anesth kidney stone         ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      destruct.
00873..............  Anesth kidney stone         ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      destruct.
0087T..............  Sperm eval hyaluronan.....  CH................  X.................         0344       0.8167       $52.02       $15.66       $10.40
00880..............  Anesth, abdomen vessel      ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      surg.
00882..............  Anesth, major vein          ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      ligation.
0088T..............  Rf tongue base vol reduxn.  ..................  T.................         0253      16.3288    $1,040.05      $282.29      $208.01
0089T..............  Actigraphy testing, 3-day.  ..................  S.................         0218       1.1550       $73.57  ...........       $14.71
00902..............  Anesth, anorectal surgery.  ..................  N.................  ...........  ...........  ...........  ...........  ...........
00904..............  Anesth, perineal surgery..  ..................  C.................  ...........  ...........  ...........  ...........  ...........
00906..............  Anesth, removal of vulva..  ..................  N.................  ...........  ...........  ...........  ...........  ...........
00908..............  Anesth, removal of          ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      prostate.
0090T..............  Cervical artific disc.....  ..................  C.................  ...........  ...........  ...........  ...........  ...........
00910..............  Anesth, bladder surgery...  ..................  N.................  ...........  ...........  ...........  ...........  ...........
00912..............  Anesth, bladder tumor surg  ..................  N.................  ...........  ...........  ...........  ...........  ...........
00914..............  Anesth, removal of          ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      prostate.
00916..............  Anesth, bleeding control..  ..................  N.................  ...........  ...........  ...........  ...........  ...........
00918..............  Anesth, stone removal.....  ..................  N.................  ...........  ...........  ...........  ...........  ...........
00920..............  Anesth, genitalia surgery.  ..................  N.................  ...........  ...........  ...........  ...........  ...........
00921..............  Anesth, vasectomy.........  ..................  N.................  ...........  ...........  ...........  ...........  ...........
00922..............  Anesth, sperm duct surgery  ..................  N.................  ...........  ...........  ...........  ...........  ...........
00924..............  Anesth, testis exploration  ..................  N.................  ...........  ...........  ...........  ...........  ...........
00926..............  Anesth, removal of testis.  ..................  N.................  ...........  ...........  ...........  ...........  ...........
00928..............  Anesth, removal of testis.  ..................  N.................  ...........  ...........  ...........  ...........  ...........
0092T..............  Artific disc addl.........  ..................  C.................  ...........  ...........  ...........  ...........  ...........
00930..............  Anesth, testis suspension.  ..................  N.................  ...........  ...........  ...........  ...........  ...........
00932..............  Anesth, amputation of       ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      penis.
00934..............  Anesth, penis, nodes        ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      removal.
00936..............  Anesth, penis, nodes        ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      removal.
00938..............  Anesth, insert penis        ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      device.
0093T..............  Cervical artific            ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      diskectomy.
00940..............  Anesth, vaginal procedures  ..................  N.................  ...........  ...........  ...........  ...........  ...........
00942..............  Anesth, surg on vag/        ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      urethral.
00944..............  Anesth, vaginal             ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      hysterectomy.
00948..............  Anesth, repair of cervix..  ..................  N.................  ...........  ...........  ...........  ...........  ...........
00950..............  Anesth, vaginal endoscopy.  ..................  N.................  ...........  ...........  ...........  ...........  ...........
00952..............  Anesth, hysteroscope/graph  ..................  N.................  ...........  ...........  ...........  ...........  ...........
0095T..............  Artific diskectomy addl...  ..................  C.................  ...........  ...........  ...........  ...........  ...........
0096T..............  Rev cervical artific disc.  ..................  C.................  ...........  ...........  ...........  ...........  ...........
0098T..............  Rev artific disc addl.....  ..................  C.................  ...........  ...........  ...........  ...........  ...........
0099T..............  Implant corneal ring......  ..................  T.................         0233      16.1710    $1,030.00      $266.33      $206.00
0100T..............  Prosth retina receive&gen.  ..................  T.................         0672      37.2078    $2,369.91  ...........      $473.98
0101T..............  Extracorp shockwv tx,hi     ..................  T.................         0050      29.1900    $1,859.23  ...........      $371.85
                      enrg.
0102T..............  Extracorp shockwv           ..................  T.................         0050      29.1900    $1,859.23  ...........      $371.85
                      tx,anesth.
0103T..............  Holotranscobalamin........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
0104T..............  At rest cardio gas          ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      rebreathe.
0105T..............  Exerc cardio gas rebreathe  ..................  A.................  ...........  ...........  ...........  ...........  ...........
0106T..............  Touch quant sensory test..  ..................  X.................         0341       0.0844        $5.38        $2.14        $1.08
0107T..............  Vibrate quant sensory test  ..................  X.................         0341       0.0844        $5.38        $2.14        $1.08
0108T..............  Cool quant sensory test...  ..................  X.................         0341       0.0844        $5.38        $2.14        $1.08

[[Page 66996]]

 
0109T..............  Heat quant sensory test...  ..................  X.................         0341       0.0844        $5.38        $2.14        $1.08
0110T..............  Nos quant sensory test....  ..................  X.................         0341       0.0844        $5.38        $2.14        $1.08
01112..............  Anesth, bone aspirate/bx..  ..................  N.................  ...........  ...........  ...........  ...........  ...........
0111T..............  Rbc membranes fatty acids.  ..................  A.................  ...........  ...........  ...........  ...........  ...........
01120..............  Anesth, pelvis surgery....  ..................  N.................  ...........  ...........  ...........  ...........  ...........
01130..............  Anesth, body cast           ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      procedure.
01140..............  Anesth, amputation at       ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      pelvis.
01150..............  Anesth, pelvic tumor        ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      surgery.
0115T..............  Med tx mngmt 15 min.......  CH................  D.................  ...........  ...........  ...........  ...........  ...........
01160..............  Anesth, pelvis procedure..  ..................  N.................  ...........  ...........  ...........  ...........  ...........
0116T..............  Med tx mngmt subsqt.......  CH................  D.................  ...........  ...........  ...........  ...........  ...........
01170..............  Anesth, pelvis surgery....  ..................  N.................  ...........  ...........  ...........  ...........  ...........
01173..............  Anesth, fx repair, pelvis.  ..................  N.................  ...........  ...........  ...........  ...........  ...........
0117T..............  Med tx mngmt addl 15 min..  CH................  D.................  ...........  ...........  ...........  ...........  ...........
01180..............  Anesth, pelvis nerve        ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      removal.
01190..............  Anesth, pelvis nerve        ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      removal.
01200..............  Anesth, hip joint           ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      procedure.
01202..............  Anesth, arthroscopy of hip  ..................  N.................  ...........  ...........  ...........  ...........  ...........
01210..............  Anesth, hip joint surgery.  ..................  N.................  ...........  ...........  ...........  ...........  ...........
01212..............  Anesth, hip                 ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      disarticulation.
01214..............  Anesth, hip arthroplasty..  ..................  C.................  ...........  ...........  ...........  ...........  ...........
01215..............  Anesth, revise hip repair.  ..................  N.................  ...........  ...........  ...........  ...........  ...........
01220..............  Anesth, procedure on femur  ..................  N.................  ...........  ...........  ...........  ...........  ...........
01230..............  Anesth, surgery of femur..  ..................  N.................  ...........  ...........  ...........  ...........  ...........
01232..............  Anesth, amputation of       ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      femur.
01234..............  Anesth, radical femur surg  ..................  C.................  ...........  ...........  ...........  ...........  ...........
0123T..............  Scleral fistulization.....  ..................  T.................         0234      23.1758    $1,476.16      $511.31      $295.23
0124T..............  Conjunctival drug           ..................  T.................         0232       5.1169      $325.92       $81.65       $65.18
                      placement.
01250..............  Anesth, upper leg surgery.  ..................  N.................  ...........  ...........  ...........  ...........  ...........
01260..............  Anesth, upper leg veins     ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      surg.
0126T..............  Chd risk imt study........  CH................  Q.................         0340       0.6310       $40.19  ...........        $8.04
01270..............  Anesth, thigh arteries      ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      surg.
01272..............  Anesth, femoral artery      ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      surg.
01274..............  Anesth, femoral             ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      embolectomy.
0130T..............  Chron care drug             ..................  B.................  ...........  ...........  ...........  ...........  ...........
                      investigatn.
01320..............  Anesth, knee area surgery.  ..................  N.................  ...........  ...........  ...........  ...........  ...........
01340..............  Anesth, knee area           ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      procedure.
0135T..............  Perq cryoablate renal       CH................  D.................  ...........  ...........  ...........  ...........  ...........
                      tumor.
01360..............  Anesth, knee area surgery.  ..................  N.................  ...........  ...........  ...........  ...........  ...........
0137T..............  Prostate saturation         ..................  T.................         0184      11.0338      $702.79  ...........      $140.56
                      sampling.
01380..............  Anesth, knee joint          ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      procedure.
01382..............  Anesth, dx knee             ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      arthroscopy.
01390..............  Anesth, knee area           ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      procedure.
01392..............  Anesth, knee area surgery.  ..................  N.................  ...........  ...........  ...........  ...........  ...........
01400..............  Anesth, knee joint surgery  ..................  N.................  ...........  ...........  ...........  ...........  ...........
01402..............  Anesth, knee arthroplasty.  ..................  C.................  ...........  ...........  ...........  ...........  ...........
01404..............  Anesth, amputation at knee  ..................  C.................  ...........  ...........  ...........  ...........  ...........
0140T..............  Exhaled breath condensate   ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      ph.
0141T..............  Perq islet transplant.....  ..................  E.................  ...........  ...........  ...........  ...........  ...........
01420..............  Anesth, knee joint casting  ..................  N.................  ...........  ...........  ...........  ...........  ...........
0142T..............  Open islet transplant.....  ..................  E.................  ...........  ...........  ...........  ...........  ...........
01430..............  Anesth, knee veins surgery  ..................  N.................  ...........  ...........  ...........  ...........  ...........
01432..............  Anesth, knee vessel surg..  ..................  N.................  ...........  ...........  ...........  ...........  ...........
0143T..............  Laparoscopic islet          ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      transplnt.
01440..............  Anesth, knee arteries surg  ..................  N.................  ...........  ...........  ...........  ...........  ...........
01442..............  Anesth, knee artery surg..  ..................  C.................  ...........  ...........  ...........  ...........  ...........
01444..............  Anesth, knee artery repair  ..................  C.................  ...........  ...........  ...........  ...........  ...........
0144T..............  CT heart wo dye; qual calc  CH................  S.................         0282       1.5839      $100.88       $37.81       $20.18
0145T..............  CT heart w/wo dye funct...  CH................  S.................         0383       4.7005      $299.39      $117.06       $59.88
01462..............  Anesth, lower leg           ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      procedure.
01464..............  Anesth, ankle/ft            ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      arthroscopy.
0146T..............  CCTA w/wo dye.............  CH................  S.................         0383       4.7005      $299.39      $117.06       $59.88
01470..............  Anesth, lower leg surgery.  ..................  N.................  ...........  ...........  ...........  ...........  ...........
01472..............  Anesth, achilles tendon     ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      surg.
01474..............  Anesth, lower leg surgery.  ..................  N.................  ...........  ...........  ...........  ...........  ...........
0147T..............  CCTA w/wo, quan calcium...  CH................  S.................         0383       4.7005      $299.39      $117.06       $59.88
01480..............  Anesth, lower leg bone      ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      surg.
01482..............  Anesth, radical leg         ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      surgery.
01484..............  Anesth, lower leg revision  ..................  N.................  ...........  ...........  ...........  ...........  ...........
01486..............  Anesth, ankle replacement.  ..................  C.................  ...........  ...........  ...........  ...........  ...........
0148T..............  CCTA w/wo, strxr..........  CH................  S.................         0383       4.7005      $299.39      $117.06       $59.88
01490..............  Anesth, lower leg casting.  ..................  N.................  ...........  ...........  ...........  ...........  ...........
0149T..............  CCTA w/wo, strxr quan calc  CH................  S.................         0383       4.7005      $299.39      $117.06       $59.88
01500..............  Anesth, leg arteries surg.  ..................  N.................  ...........  ...........  ...........  ...........  ...........
01502..............  Anesth, lwr leg             ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      embolectomy.
0150T..............  CCTA w/wo, disease strxr..  CH................  S.................         0383       4.7005      $299.39      $117.06       $59.88
0151T..............  CT heart funct add-on.....  ..................  S.................         0282       1.5839      $100.88       $37.81       $20.18
01520..............  Anesth, lower leg vein      ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      surg.
01522..............  Anesth, lower leg vein      ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      surg.
0153T..............  Tcath sensor aneurysm sac.  CH................  D.................  ...........  ...........  ...........  ...........  ...........

[[Page 66997]]

 
0154T..............  Study sensor aneurysm sac.  CH................  D.................  ...........  ...........  ...........  ...........  ...........
0155T..............  Lap impl gast curve         ..................  T.................         0130      34.3958    $2,190.81      $659.53      $438.16
                      electrd.
0156T..............  Lap remv gast curve         ..................  T.................         0130      34.3958    $2,190.81      $659.53      $438.16
                      electrd.
0157T..............  Open impl gast curve        ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      electrd.
0158T..............  Open remv gast curve        ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      electrd.
0159T..............  Cad breast mri............  ..................  N.................  ...........  ...........  ...........  ...........  ...........
0160T..............  Tcranial magn stim tx plan  ..................  S.................         0216       2.6846      $170.99  ...........       $34.20
01610..............  Anesth, surgery of          ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      shoulder.
0161T..............  Tcranial magn stim tx       ..................  S.................         0216       2.6846      $170.99  ...........       $34.20
                      deliv.
01620..............  Anesth, shoulder procedure  ..................  N.................  ...........  ...........  ...........  ...........  ...........
01622..............  Anes dx shoulder            ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      arthroscopy.
0162T..............  Anal program gast           ..................  S.................         0692       1.8376      $117.04       $29.72       $23.41
                      neurostim.
01630..............  Anesth, surgery of          ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      shoulder.
01632..............  Anesth, surgery of          ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      shoulder.
01634..............  Anesth, shoulder joint      ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      amput.
01636..............  Anesth, forequarter amput.  ..................  C.................  ...........  ...........  ...........  ...........  ...........
01638..............  Anesth, shoulder            ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      replacement.
0163T..............  Lumb artif diskectomy addl  ..................  C.................  ...........  ...........  ...........  ...........  ...........
0164T..............  Remove lumb artif disc      ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      addl.
01650..............  Anesth, shoulder artery     ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      surg.
01652..............  Anesth, shoulder vessel     ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      surg.
01654..............  Anesth, shoulder vessel     ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      surg.
01656..............  Anesth, arm-leg vessel      ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      surg.
0165T..............  Revise lumb artif disc      ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      addl.
0166T..............  Tcath vsd close w/o bypass  ..................  C.................  ...........  ...........  ...........  ...........  ...........
01670..............  Anesth, shoulder vein surg  ..................  N.................  ...........  ...........  ...........  ...........  ...........
0167T..............  Tcath vsd close w bypass..  ..................  C.................  ...........  ...........  ...........  ...........  ...........
01680..............  Anesth, shoulder casting..  ..................  N.................  ...........  ...........  ...........  ...........  ...........
01682..............  Anesth, airplane cast.....  ..................  N.................  ...........  ...........  ...........  ...........  ...........
0168T..............  Rhinophototx light app      ..................  T.................         0251       2.5002      $159.25  ...........       $31.85
                      bilat.
0169T..............  Place stereo cath brain...  ..................  C.................  ...........  ...........  ...........  ...........  ...........
0170T..............  Anorectal fistula plug rpr  ..................  T.................         0150      30.1606    $1,921.05      $437.12      $384.21
01710..............  Anesth, elbow area surgery  ..................  N.................  ...........  ...........  ...........  ...........  ...........
01712..............  Anesth, uppr arm tendon     ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      surg.
01714..............  Anesth, uppr arm tendon     ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      surg.
01716..............  Anesth, biceps tendon       ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      repair.
0171T..............  Lumbar spine proces         ..................  T.................         0050      29.1900    $1,859.23  ...........      $371.85
                      distract.
0172T..............  Lumbar spine process addl.  ..................  T.................         0050      29.1900    $1,859.23  ...........      $371.85
01730..............  Anesth, uppr arm procedure  ..................  N.................  ...........  ...........  ...........  ...........  ...........
01732..............  Anesth, dx elbow            ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      arthroscopy.
0173T..............  Iop monit io pressure.....  ..................  N.................  ...........  ...........  ...........  ...........  ...........
01740..............  Anesth, upper arm surgery.  ..................  N.................  ...........  ...........  ...........  ...........  ...........
01742..............  Anesth, humerus surgery...  ..................  N.................  ...........  ...........  ...........  ...........  ...........
01744..............  Anesth, humerus repair....  ..................  N.................  ...........  ...........  ...........  ...........  ...........
0174T..............  Cad cxr with interp.......  ..................  N.................  ...........  ...........  ...........  ...........  ...........
01756..............  Anesth, radical humerus     ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      surg.
01758..............  Anesth, humeral lesion      ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      surg.
0175T..............  Cad cxr remote............  ..................  N.................  ...........  ...........  ...........  ...........  ...........
01760..............  Anesth, elbow replacement.  ..................  N.................  ...........  ...........  ...........  ...........  ...........
0176T..............  Aqu canal dilat w/o retent  ..................  T.................         0673      39.7101    $2,529.30      $649.56      $505.86
01770..............  Anesth, uppr arm artery     ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      surg.
01772..............  Anesth, uppr arm            ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      embolectomy.
0177T..............  Aqu canal dilat w retent..  ..................  T.................         0673      39.7101    $2,529.30      $649.56      $505.86
01780..............  Anesth, upper arm vein      ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      surg.
01782..............  Anesth, uppr arm vein       ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      repair.
0178T..............  64 lead ecg w i&r.........  NF................  B.................  ...........  ...........  ...........  ...........  ...........
0179T..............  64 lead ecg w tracing.....  NF................  X.................         0100       2.5547      $162.72       $41.44       $32.54
0180T..............  64 lead ecg w i&r only....  NF................  B.................  ...........  ...........  ...........  ...........  ...........
01810..............  Anesth, lower arm surgery.  ..................  N.................  ...........  ...........  ...........  ...........  ...........
0181T..............  Corneal hysteresis........  NF................  S.................         0230       0.5903       $37.60  ...........        $7.52
01820..............  Anesth, lower arm           ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      procedure.
01829..............  Anesth, dx wrist            ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      arthroscopy.
0182T..............  Hdr elect brachytherapy...  NF................  S.................         1519  ...........    $1,750.00  ...........      $350.00
01830..............  Anesth, lower arm surgery.  ..................  N.................  ...........  ...........  ...........  ...........  ...........
01832..............  Anesth, wrist replacement.  ..................  N.................  ...........  ...........  ...........  ...........  ...........
0183T..............  Wound ultrasound..........  NI................  T.................         0015       1.4595       $92.96  ...........       $18.59
01840..............  Anesth, lwr arm artery      ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      surg.
01842..............  Anesth, lwr arm             ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      embolectomy.
01844..............  Anesth, vascular shunt      ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      surg.
0184T..............  Exc rectal tumor            NI................  C.................  ...........  ...........  ...........  ...........  ...........
                      endoscopic.
01850..............  Anesth, lower arm vein      ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      surg.
01852..............  Anesth, lwr arm vein        ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      repair.
0185T..............  Comptr probability          NI................  N.................  ...........  ...........  ...........  ...........  ...........
                      analysis.
01860..............  Anesth, lower arm casting.  ..................  N.................  ...........  ...........  ...........  ...........  ...........
0186T..............  Suprachoroidal drug         NI................  T.................         0236      18.2350    $1,161.46  ...........      $232.29
                      delivery.
0187T..............  Ophthalmic dx image         NI................  S.................         0230       0.5903       $37.60  ...........        $7.52
                      anterior.
01905..............  Anes, spine inject, x-ray/  CH................  D.................  ...........  ...........  ...........  ...........  ...........
                      re.
01916..............  Anesth, dx arteriography..  ..................  N.................  ...........  ...........  ...........  ...........  ...........
01920..............  Anesth, catheterize heart.  ..................  N.................  ...........  ...........  ...........  ...........  ...........
01922..............  Anesth, cat or MRI scan...  ..................  N.................  ...........  ...........  ...........  ...........  ...........

[[Page 66998]]

 
01924..............  Anes, ther interven rad,    ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      art.
01925..............  Anes, ther interven rad,    ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      car.
01926..............  Anes, tx interv rad hrt/    ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      cran.
01930..............  Anes, ther interven rad,    ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      vei.
01931..............  Anes, ther interven rad,    ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      tip.
01932..............  Anes, tx interv rad, th     ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      vein.
01933..............  Anes, tx interv rad, cran   ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      v.
01935..............  Anesth, perc img dx sp      NI................  N.................  ...........  ...........  ...........  ...........  ...........
                      proc.
01936..............  Anesth, perc img tx sp      NI................  N.................  ...........  ...........  ...........  ...........  ...........
                      proc.
01951..............  Anesth, burn, less 4        ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      percent.
01952..............  Anesth, burn, 4-9 percent.  ..................  N.................  ...........  ...........  ...........  ...........  ...........
01953..............  Anesth, burn, each 9        ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      percent.
01958..............  Anesth, antepartum manipul  ..................  N.................  ...........  ...........  ...........  ...........  ...........
01960..............  Anesth, vaginal delivery..  ..................  N.................  ...........  ...........  ...........  ...........  ...........
01961..............  Anesth, cs delivery.......  ..................  N.................  ...........  ...........  ...........  ...........  ...........
01962..............  Anesth, emer hysterectomy.  ..................  N.................  ...........  ...........  ...........  ...........  ...........
01963..............  Anesth, cs hysterectomy...  ..................  N.................  ...........  ...........  ...........  ...........  ...........
01965..............  Anesth, inc/missed ab proc  ..................  N.................  ...........  ...........  ...........  ...........  ...........
01966..............  Anesth, induced ab          ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      procedure.
01967..............  Anesth/analg, vag delivery  ..................  N.................  ...........  ...........  ...........  ...........  ...........
01968..............  Anes/analg cs deliver add-  ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      on.
01969..............  Anesth/analg cs hyst add-   ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      on.
01990..............  Support for organ donor...  ..................  C.................  ...........  ...........  ...........  ...........  ...........
01991..............  Anesth, nerve block/inj...  ..................  N.................  ...........  ...........  ...........  ...........  ...........
01992..............  Anesth, n block/inj, prone  ..................  N.................  ...........  ...........  ...........  ...........  ...........
01996..............  Hosp manage cont drug       ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      admin.
01999..............  Unlisted anesth procedure.  ..................  N.................  ...........  ...........  ...........  ...........  ...........
0500F..............  Initial prenatal care       ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      visit.
0501F..............  Prenatal flow sheet.......  ..................  M.................  ...........  ...........  ...........  ...........  ...........
0502F..............  Subsequent prenatal care..  ..................  M.................  ...........  ...........  ...........  ...........  ...........
0503F..............  Postpartum care visit.....  ..................  M.................  ...........  ...........  ...........  ...........  ...........
0505F..............  Hemodialysis plan doc'd...  ..................  M.................  ...........  ...........  ...........  ...........  ...........
0507F..............  Periton dialysis plan       ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      doc'd.
0509F..............  Urine incon plan doc'd....  ..................  M.................  ...........  ...........  ...........  ...........  ...........
0513F..............  Elev BP plan of care doc'd  NI................  M.................  ...........  ...........  ...........  ...........  ...........
0514F..............  Care plan Hgb doc'd ESA pt  NI................  M.................  ...........  ...........  ...........  ...........  ...........
0516F..............  Anemia plan of care doc'd.  NI................  M.................  ...........  ...........  ...........  ...........  ...........
0517F..............  Glaucoma plan of care       NI................  M.................  ...........  ...........  ...........  ...........  ...........
                      doc'd.
0518F..............  Fall plan of care doc'd...  NI................  M.................  ...........  ...........  ...........  ...........  ...........
0519F..............  Plan'd chemo doc'd b/4      NI................  M.................  ...........  ...........  ...........  ...........  ...........
                      txmnt.
0520F..............  Tissue dose done w/in 5     NI................  M.................  ...........  ...........  ...........  ...........  ...........
                      days.
0521F..............  Plan of care 4 pain doc'd.  NI................  M.................  ...........  ...........  ...........  ...........  ...........
1000F..............  Tobacco use assessed......  ..................  M.................  ...........  ...........  ...........  ...........  ...........
10021..............  Fna w/o image.............  ..................  T.................         0002       1.1097       $70.68  ...........       $14.14
10022..............  Fna w/image...............  CH................  T.................         0004       4.3270      $275.60  ...........       $55.12
1002F..............  Assess anginal symptom/     ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      level.
1003F..............  Level of activity assess..  ..................  M.................  ...........  ...........  ...........  ...........  ...........
10040..............  Acne surgery..............  CH................  T.................         0013       0.7930       $50.51  ...........       $10.10
1004F..............  Clin symp vol ovrld assess  ..................  M.................  ...........  ...........  ...........  ...........  ...........
1005F..............  Asthma symptoms evaluate..  ..................  M.................  ...........  ...........  ...........  ...........  ...........
10060..............  Drainage of skin abscess..  ..................  T.................         0006       1.4066       $89.59  ...........       $17.92
10061..............  Drainage of skin abscess..  ..................  T.................         0006       1.4066       $89.59  ...........       $17.92
1006F..............  Osteoarthritis assess.....  ..................  M.................  ...........  ...........  ...........  ...........  ...........
1007F..............  Anti-inflm/anlgsc otc       ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      assess.
10080..............  Drainage of pilonidal cyst  ..................  T.................         0006       1.4066       $89.59  ...........       $17.92
10081..............  Drainage of pilonidal cyst  ..................  T.................         0007      11.5594      $736.26  ...........      $147.25
1008F..............  Gi/renal risk assess......  ..................  M.................  ...........  ...........  ...........  ...........  ...........
10120..............  Remove foreign body.......  ..................  T.................         0006       1.4066       $89.59  ...........       $17.92
10121..............  Remove foreign body.......  ..................  T.................         0021      16.1001    $1,025.48      $219.48      $205.10
10140..............  Drainage of hematoma/fluid  ..................  T.................         0007      11.5594      $736.26  ...........      $147.25
1015F..............  Copd symptoms assess......  ..................  M.................  ...........  ...........  ...........  ...........  ...........
10160..............  Puncture drainage of        CH................  T.................         0006       1.4066       $89.59  ...........       $17.92
                      lesion.
10180..............  Complex drainage, wound...  ..................  T.................         0008      18.3197    $1,166.85  ...........      $233.37
1018F..............  Assess dyspnea not present  ..................  M.................  ...........  ...........  ...........  ...........  ...........
1019F..............  Assess dyspnea present....  ..................  M.................  ...........  ...........  ...........  ...........  ...........
1022F..............  Pneumo imm status assess..  ..................  M.................  ...........  ...........  ...........  ...........  ...........
1026F..............  Co-morbid condition assess  ..................  M.................  ...........  ...........  ...........  ...........  ...........
1030F..............  Influenza imm status        ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      assess.
1034F..............  Current tobacco smoker....  ..................  M.................  ...........  ...........  ...........  ...........  ...........
1035F..............  Smokeless tobacco user....  ..................  M.................  ...........  ...........  ...........  ...........  ...........
1036F..............  Tobacco non-user..........  ..................  M.................  ...........  ...........  ...........  ...........  ...........
1038F..............  Persistent asthma.........  ..................  M.................  ...........  ...........  ...........  ...........  ...........
1039F..............  Intermittent asthma.......  ..................  M.................  ...........  ...........  ...........  ...........  ...........
1040F..............  DSM-IV info MDD doc'd.....  ..................  M.................  ...........  ...........  ...........  ...........  ...........
1050F..............  History of mole changes...  ..................  M.................  ...........  ...........  ...........  ...........  ...........
1055F..............  Visual funct status assess  ..................  M.................  ...........  ...........  ...........  ...........  ...........
1060F..............  Doc perm/cont/parox atr     ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      fib.
1061F..............  Doc lack perm+cont+parox    ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      fib.
1065F..............  Ischm stroke symp lt3 hrsb/ ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      4.
1066F..............  Ischm stroke symp ge3 hrsb/ ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      4.

[[Page 66999]]

 
1070F..............  Alarm symp assessed-absent  ..................  M.................  ...........  ...........  ...........  ...........  ...........
1071F..............  Alarm symp assessed-1+      ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      prsnt.
1080F..............  Decis mkr/advncd plan       CH................  D.................  ...........  ...........  ...........  ...........  ...........
                      doc'd.
1090F..............  Pres/absn urine incon       ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      assess.
1091F..............  Urine incon characterized.  ..................  M.................  ...........  ...........  ...........  ...........  ...........
11000..............  Debride infected skin.....  ..................  T.................         0013       0.7930       $50.51  ...........       $10.10
11001..............  Debride infected skin add-  CH................  T.................         0013       0.7930       $50.51  ...........       $10.10
                      on.
11004..............  Debride genitalia &         ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      perineum.
11005..............  Debride abdom wall........  ..................  C.................  ...........  ...........  ...........  ...........  ...........
11006..............  Debride genit/per/abdom     ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      wall.
11008..............  Remove mesh from abd wall.  ..................  C.................  ...........  ...........  ...........  ...........  ...........
1100F..............  Ptfalls assess-doc'd ge2+/  ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      yr.
11010..............  Debride skin, fx..........  ..................  T.................         0019       4.3039      $274.13       $71.87       $54.83
11011..............  Debride skin/muscle, fx...  ..................  T.................         0019       4.3039      $274.13       $71.87       $54.83
11012..............  Debride skin/muscle/bone,   ..................  T.................         0019       4.3039      $274.13       $71.87       $54.83
                      fx.
1101F..............  Pt falls assess-doc'd le1/  ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      yr.
11040..............  Debride skin, partial.....  ..................  T.................         0015       1.4595       $92.96  ...........       $18.59
11041..............  Debride skin, full........  ..................  T.................         0015       1.4595       $92.96  ...........       $18.59
11042..............  Debride skin/tissue.......  ..................  T.................         0016       2.6604      $169.45  ...........       $33.89
11043..............  Debride tissue/muscle.....  ..................  T.................         0016       2.6604      $169.45  ...........       $33.89
11044..............  Debride tissue/muscle/bone  ..................  T.................         0682       6.8816      $438.32      $158.65       $87.66
11055..............  Trim skin lesion..........  CH................  T.................         0013       0.7930       $50.51  ...........       $10.10
11056..............  Trim skin lesions, 2 to 4.  CH................  T.................         0013       0.7930       $50.51  ...........       $10.10
11057..............  Trim skin lesions, over 4.  CH................  T.................         0015       1.4595       $92.96  ...........       $18.59
11100..............  Biopsy, skin lesion.......  CH................  T.................         0013       0.7930       $50.51  ...........       $10.10
11101..............  Biopsy, skin add-on.......  CH................  T.................         0013       0.7930       $50.51  ...........       $10.10
1110F..............  Pt lft inpt fac w/in 60     ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      days.
1111F..............  Dschrg med/current med      ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      merge.
1116F..............  Auric/peri pain assessed..  ..................  M.................  ...........  ...........  ...........  ...........  ...........
1118F..............  GERD symps assessed 12      NI................  M.................  ...........  ...........  ...........  ...........  ...........
                      month.
1119F..............  Init. Eval for condition..  NI................  M.................  ...........  ...........  ...........  ...........  ...........
11200..............  Removal of skin tags......  ..................  T.................         0013       0.7930       $50.51  ...........       $10.10
11201..............  Remove skin tags add-on...  ..................  T.................         0015       1.4595       $92.96  ...........       $18.59
1121F..............  Subs. Eval for condition..  NI................  M.................  ...........  ...........  ...........  ...........  ...........
1123F..............  ACP discuss/dscn mkr doc'd  NI................  M.................  ...........  ...........  ...........  ...........  ...........
1124F..............  ACP discuss-no dscnmkr      NI................  M.................  ...........  ...........  ...........  ...........  ...........
                      doc'd.
1125F..............  Amnt Pain noted; pain       NI................  M.................  ...........  ...........  ...........  ...........  ...........
                      prsnt.
1126F..............  Amnt Pain noted; none       NI................  M.................  ...........  ...........  ...........  ...........  ...........
                      prsnt.
1127F..............  New episode for condition.  NI................  M.................  ...........  ...........  ...........  ...........  ...........
1128F..............  Subs. episode for           NI................  M.................  ...........  ...........  ...........  ...........  ...........
                      condition.
11300..............  Shave skin lesion.........  CH................  T.................         0013       0.7930       $50.51  ...........       $10.10
11301..............  Shave skin lesion.........  CH................  T.................         0013       0.7930       $50.51  ...........       $10.10
11302..............  Shave skin lesion.........  ..................  T.................         0013       0.7930       $50.51  ...........       $10.10
11303..............  Shave skin lesion.........  ..................  T.................         0015       1.4595       $92.96  ...........       $18.59
11305..............  Shave skin lesion.........  ..................  T.................         0013       0.7930       $50.51  ...........       $10.10
11306..............  Shave skin lesion.........  ..................  T.................         0013       0.7930       $50.51  ...........       $10.10
11307..............  Shave skin lesion.........  ..................  T.................         0013       0.7930       $50.51  ...........       $10.10
11308..............  Shave skin lesion.........  ..................  T.................         0013       0.7930       $50.51  ...........       $10.10
11310..............  Shave skin lesion.........  ..................  T.................         0013       0.7930       $50.51  ...........       $10.10
11311..............  Shave skin lesion.........  ..................  T.................         0013       0.7930       $50.51  ...........       $10.10
11312..............  Shave skin lesion.........  ..................  T.................         0013       0.7930       $50.51  ...........       $10.10
11313..............  Shave skin lesion.........  CH................  T.................         0013       0.7930       $50.51  ...........       $10.10
11400..............  Exc tr-ext b9+marg 0.5 <    ..................  T.................         0019       4.3039      $274.13       $71.87       $54.83
                      cm.
11401..............  Exc tr-ext b9+marg 0.6-1    ..................  T.................         0019       4.3039      $274.13       $71.87       $54.83
                      cm.
11402..............  Exc tr-ext b9+marg 1.1-2    ..................  T.................         0019       4.3039      $274.13       $71.87       $54.83
                      cm.
11403..............  Exc tr-ext b9+marg 2.1-3    ..................  T.................         0020       8.6850      $553.18  ...........      $110.64
                      cm.
11404..............  Exc tr-ext b9+marg 3.1-4    ..................  T.................         0021      16.1001    $1,025.48      $219.48      $205.10
                      cm.
11406..............  Exc tr-ext b9+marg > 4.0    ..................  T.................         0021      16.1001    $1,025.48      $219.48      $205.10
                      cm.
11420..............  Exc h-f-nk-sp b9+marg 0.5   ..................  T.................         0020       8.6850      $553.18  ...........      $110.64
                      <.
11421..............  Exc h-f-nk-sp b9+marg 0.6-  ..................  T.................         0020       8.6850      $553.18  ...........      $110.64
                      1.
11422..............  Exc h-f-nk-sp b9+marg 1.1-  ..................  T.................         0020       8.6850      $553.18  ...........      $110.64
                      2.
11423..............  Exc h-f-nk-sp b9+marg 2.1-  ..................  T.................         0021      16.1001    $1,025.48      $219.48      $205.10
                      3.
11424..............  Exc h-f-nk-sp b9+marg 3.1-  ..................  T.................         0021      16.1001    $1,025.48      $219.48      $205.10
                      4.
11426..............  Exc h-f-nk-sp b9+marg > 4   ..................  T.................         0022      21.1098    $1,344.57      $354.45      $268.91
                      cm.
11440..............  Exc face-mm b9+marg 0.5 <   ..................  T.................         0019       4.3039      $274.13       $71.87       $54.83
                      cm.
11441..............  Exc face-mm b9+marg 0.6-1   ..................  T.................         0019       4.3039      $274.13       $71.87       $54.83
                      cm.
11442..............  Exc face-mm b9+marg 1.1-2   ..................  T.................         0020       8.6850      $553.18  ...........      $110.64
                      cm.
11443..............  Exc face-mm b9+marg 2.1-3   ..................  T.................         0020       8.6850      $553.18  ...........      $110.64
                      cm.
11444..............  Exc face-mm b9+marg 3.1-4   ..................  T.................         0020       8.6850      $553.18  ...........      $110.64
                      cm.
11446..............  Exc face-mm b9+marg > 4 cm  ..................  T.................         0022      21.1098    $1,344.57      $354.45      $268.91
11450..............  Removal, sweat gland        ..................  T.................         0022      21.1098    $1,344.57      $354.45      $268.91
                      lesion.
11451..............  Removal, sweat gland        ..................  T.................         0022      21.1098    $1,344.57      $354.45      $268.91
                      lesion.
11462..............  Removal, sweat gland        ..................  T.................         0022      21.1098    $1,344.57      $354.45      $268.91
                      lesion.
11463..............  Removal, sweat gland        ..................  T.................         0022      21.1098    $1,344.57      $354.45      $268.91
                      lesion.
11470..............  Removal, sweat gland        ..................  T.................         0022      21.1098    $1,344.57      $354.45      $268.91
                      lesion.
11471..............  Removal, sweat gland        ..................  T.................         0022      21.1098    $1,344.57      $354.45      $268.91
                      lesion.
11600..............  Exc tr-ext mlg+marg 0.5 <   ..................  T.................         0019       4.3039      $274.13       $71.87       $54.83
                      cm.
11601..............  Exc tr-ext mlg+marg 0.6-1   ..................  T.................         0019       4.3039      $274.13       $71.87       $54.83
                      cm.
11602..............  Exc tr-ext mlg+marg 1.1-2   ..................  T.................         0019       4.3039      $274.13       $71.87       $54.83
                      cm.
11603..............  Exc tr-ext mlg+marg 2.1-3   ..................  T.................         0020       8.6850      $553.18  ...........      $110.64
                      cm.

[[Page 67000]]

 
11604..............  Exc tr-ext mlg+marg 3.1-4   ..................  T.................         0020       8.6850      $553.18  ...........      $110.64
                      cm.
11606..............  Exc tr-ext mlg+marg > 4 cm  ..................  T.................         0021      16.1001    $1,025.48      $219.48      $205.10
11620..............  Exc h-f-nk-sp mlg+marg 0.5  ..................  T.................         0020       8.6850      $553.18  ...........      $110.64
                      <.
11621..............  Exc h-f-nk-sp mlg+marg 0.6- ..................  T.................         0019       4.3039      $274.13       $71.87       $54.83
                      1.
11622..............  Exc h-f-nk-sp mlg+marg 1.1- ..................  T.................         0020       8.6850      $553.18  ...........      $110.64
                      2.
11623..............  Exc h-f-nk-sp mlg+marg 2.1- CH................  T.................         0020       8.6850      $553.18  ...........      $110.64
                      3.
11624..............  Exc h-f-nk-sp mlg+marg 3.1- ..................  T.................         0021      16.1001    $1,025.48      $219.48      $205.10
                      4.
11626..............  Exc h-f-nk-sp mlg+mar > 4   ..................  T.................         0022      21.1098    $1,344.57      $354.45      $268.91
                      cm.
11640..............  Exc face-mm malig+marg 0.5  CH................  T.................         0019       4.3039      $274.13       $71.87       $54.83
                      <.
11641..............  Exc face-mm malig+marg 0.6- CH................  T.................         0019       4.3039      $274.13       $71.87       $54.83
                      1.
11642..............  Exc face-mm malig+marg 1.1- ..................  T.................         0020       8.6850      $553.18  ...........      $110.64
                      2.
11643..............  Exc face-mm malig+marg 2.1- ..................  T.................         0020       8.6850      $553.18  ...........      $110.64
                      3.
11644..............  Exc face-mm malig+marg 3.1- ..................  T.................         0021      16.1001    $1,025.48      $219.48      $205.10
                      4.
11646..............  Exc face-mm mlg+marg > 4    ..................  T.................         0022      21.1098    $1,344.57      $354.45      $268.91
                      cm.
11719..............  Trim nail(s)..............  CH................  T.................         0013       0.7930       $50.51  ...........       $10.10
11720..............  Debride nail, 1-5.........  CH................  T.................         0013       0.7930       $50.51  ...........       $10.10
11721..............  Debride nail, 6 or more...  CH................  T.................         0013       0.7930       $50.51  ...........       $10.10
11730..............  Removal of nail plate.....  ..................  T.................         0013       0.7930       $50.51  ...........       $10.10
11732..............  Remove nail plate, add-on.  CH................  T.................         0013       0.7930       $50.51  ...........       $10.10
11740..............  Drain blood from under      CH................  T.................         0012       0.2963       $18.87  ...........        $3.77
                      nail.
11750..............  Removal of nail bed.......  ..................  T.................         0019       4.3039      $274.13       $71.87       $54.83
11752..............  Remove nail bed/finger tip  ..................  T.................         0022      21.1098    $1,344.57      $354.45      $268.91
11755..............  Biopsy, nail unit.........  ..................  T.................         0019       4.3039      $274.13       $71.87       $54.83
11760..............  Repair of nail bed........  CH................  T.................         0134       2.1051      $134.08       $42.24       $26.82
11762..............  Reconstruction of nail bed  CH................  T.................         0136      15.0458      $958.33  ...........      $191.67
11765..............  Excision of nail fold, toe  ..................  T.................         0015       1.4595       $92.96  ...........       $18.59
11770..............  Removal of pilonidal        ..................  T.................         0022      21.1098    $1,344.57      $354.45      $268.91
                      lesion.
11771..............  Removal of pilonidal        ..................  T.................         0022      21.1098    $1,344.57      $354.45      $268.91
                      lesion.
11772..............  Removal of pilonidal        ..................  T.................         0022      21.1098    $1,344.57      $354.45      $268.91
                      lesion.
11900..............  Injection into skin         CH................  T.................         0013       0.7930       $50.51  ...........       $10.10
                      lesions.
11901..............  Added skin lesions          CH................  T.................         0013       0.7930       $50.51  ...........       $10.10
                      injection.
11920..............  Correct skin color defects  CH................  T.................         0134       2.1051      $134.08       $42.24       $26.82
11921..............  Correct skin color defects  CH................  T.................         0134       2.1051      $134.08       $42.24       $26.82
11922..............  Correct skin color defects  CH................  T.................         0134       2.1051      $134.08       $42.24       $26.82
11950..............  Therapy for contour         CH................  T.................         0133       1.2792       $81.48       $25.67       $16.30
                      defects.
11951..............  Therapy for contour         CH................  T.................         0133       1.2792       $81.48       $25.67       $16.30
                      defects.
11952..............  Therapy for contour         CH................  T.................         0133       1.2792       $81.48       $25.67       $16.30
                      defects.
11954..............  Therapy for contour         CH................  T.................         0133       1.2792       $81.48       $25.67       $16.30
                      defects.
11960..............  Insert tissue expander(s).  CH................  T.................         0137      20.2069    $1,287.06  ...........      $257.41
11970..............  Replace tissue expander...  ..................  T.................         0051      42.9850    $2,737.89  ...........      $547.58
11971..............  Remove tissue expander(s).  ..................  T.................         0022      21.1098    $1,344.57      $354.45      $268.91
11975..............  Insert contraceptive cap..  ..................  E.................  ...........  ...........  ...........  ...........  ...........
11976..............  Removal of contraceptive    ..................  T.................         0019       4.3039      $274.13       $71.87       $54.83
                      cap.
11977..............  Removal/reinsert contra     ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      cap.
11980..............  Implant hormone pellet(s).  ..................  X.................         0340       0.6310       $40.19  ...........        $8.04
11981..............  Insert drug implant device  ..................  X.................         0340       0.6310       $40.19  ...........        $8.04
11982..............  Remove drug implant device  ..................  X.................         0340       0.6310       $40.19  ...........        $8.04
11983..............  Remove/insert drug implant  ..................  X.................         0340       0.6310       $40.19  ...........        $8.04
12001..............  Repair superficial          CH................  T.................         0133       1.2792       $81.48       $25.67       $16.30
                      wound(s).
12002..............  Repair superficial          CH................  T.................         0133       1.2792       $81.48       $25.67       $16.30
                      wound(s).
12004..............  Repair superficial          CH................  T.................         0133       1.2792       $81.48       $25.67       $16.30
                      wound(s).
12005..............  Repair superficial          CH................  T.................         0133       1.2792       $81.48       $25.67       $16.30
                      wound(s).
12006..............  Repair superficial          CH................  T.................         0133       1.2792       $81.48       $25.67       $16.30
                      wound(s).
12007..............  Repair superficial          CH................  T.................         0133       1.2792       $81.48       $25.67       $16.30
                      wound(s).
12011..............  Repair superficial          CH................  T.................         0133       1.2792       $81.48       $25.67       $16.30
                      wound(s).
12013..............  Repair superficial          CH................  T.................         0133       1.2792       $81.48       $25.67       $16.30
                      wound(s).
12014..............  Repair superficial          CH................  T.................         0133       1.2792       $81.48       $25.67       $16.30
                      wound(s).
12015..............  Repair superficial          CH................  T.................         0133       1.2792       $81.48       $25.67       $16.30
                      wound(s).
12016..............  Repair superficial          CH................  T.................         0133       1.2792       $81.48       $25.67       $16.30
                      wound(s).
12017..............  Repair superficial          CH................  T.................         0133       1.2792       $81.48       $25.67       $16.30
                      wound(s).
12018..............  Repair superficial          CH................  T.................         0133       1.2792       $81.48       $25.67       $16.30
                      wound(s).
12020..............  Closure of split wound....  CH................  T.................         0135       4.5263      $288.30  ...........       $57.66
12021..............  Closure of split wound....  CH................  T.................         0135       4.5263      $288.30  ...........       $57.66
12031..............  Layer closure of wound(s).  CH................  T.................         0134       2.1051      $134.08       $42.24       $26.82
12032..............  Layer closure of wound(s).  CH................  T.................         0134       2.1051      $134.08       $42.24       $26.82
12034..............  Layer closure of wound(s).  CH................  T.................         0134       2.1051      $134.08       $42.24       $26.82
12035..............  Layer closure of wound(s).  CH................  T.................         0134       2.1051      $134.08       $42.24       $26.82
12036..............  Layer closure of wound(s).  CH................  T.................         0134       2.1051      $134.08       $42.24       $26.82
12037..............  Layer closure of wound(s).  CH................  T.................         0134       2.1051      $134.08       $42.24       $26.82
12041..............  Layer closure of wound(s).  CH................  T.................         0134       2.1051      $134.08       $42.24       $26.82
12042..............  Layer closure of wound(s).  CH................  T.................         0134       2.1051      $134.08       $42.24       $26.82
12044..............  Layer closure of wound(s).  CH................  T.................         0134       2.1051      $134.08       $42.24       $26.82
12045..............  Layer closure of wound(s).  CH................  T.................         0134       2.1051      $134.08       $42.24       $26.82
12046..............  Layer closure of wound(s).  CH................  T.................         0134       2.1051      $134.08       $42.24       $26.82
12047..............  Layer closure of wound(s).  CH................  T.................         0134       2.1051      $134.08       $42.24       $26.82
12051..............  Layer closure of wound(s).  CH................  T.................         0134       2.1051      $134.08       $42.24       $26.82
12052..............  Layer closure of wound(s).  CH................  T.................         0134       2.1051      $134.08       $42.24       $26.82
12053..............  Layer closure of wound(s).  CH................  T.................         0134       2.1051      $134.08       $42.24       $26.82
12054..............  Layer closure of wound(s).  CH................  T.................         0134       2.1051      $134.08       $42.24       $26.82
12055..............  Layer closure of wound(s).  CH................  T.................         0134       2.1051      $134.08       $42.24       $26.82

[[Page 67001]]

 
12056..............  Layer closure of wound(s).  CH................  T.................         0134       2.1051      $134.08       $42.24       $26.82
12057..............  Layer closure of wound(s).  CH................  T.................         0134       2.1051      $134.08       $42.24       $26.82
13100..............  Repair of wound or lesion.  CH................  T.................         0135       4.5263      $288.30  ...........       $57.66
13101..............  Repair of wound or lesion.  CH................  T.................         0135       4.5263      $288.30  ...........       $57.66
13102..............  Repair wound/lesion add-on  CH................  T.................         0135       4.5263      $288.30  ...........       $57.66
13120..............  Repair of wound or lesion.  CH................  T.................         0134       2.1051      $134.08       $42.24       $26.82
13121..............  Repair of wound or lesion.  CH................  T.................         0135       4.5263      $288.30  ...........       $57.66
13122..............  Repair wound/lesion add-on  CH................  T.................         0134       2.1051      $134.08       $42.24       $26.82
13131..............  Repair of wound or lesion.  CH................  T.................         0135       4.5263      $288.30  ...........       $57.66
13132..............  Repair of wound or lesion.  CH................  T.................         0135       4.5263      $288.30  ...........       $57.66
13133..............  Repair wound/lesion add-on  CH................  T.................         0135       4.5263      $288.30  ...........       $57.66
13150..............  Repair of wound or lesion.  CH................  T.................         0135       4.5263      $288.30  ...........       $57.66
13151..............  Repair of wound or lesion.  CH................  T.................         0135       4.5263      $288.30  ...........       $57.66
13152..............  Repair of wound or lesion.  CH................  T.................         0135       4.5263      $288.30  ...........       $57.66
13153..............  Repair wound/lesion add-on  CH................  T.................         0134       2.1051      $134.08       $42.24       $26.82
13160..............  Late closure of wound.....  CH................  T.................         0137      20.2069    $1,287.06  ...........      $257.41
14000..............  Skin tissue rearrangement.  CH................  T.................         0136      15.0458      $958.33  ...........      $191.67
14001..............  Skin tissue rearrangement.  CH................  T.................         0136      15.0458      $958.33  ...........      $191.67
14020..............  Skin tissue rearrangement.  CH................  T.................         0136      15.0458      $958.33  ...........      $191.67
14021..............  Skin tissue rearrangement.  CH................  T.................         0136      15.0458      $958.33  ...........      $191.67
14040..............  Skin tissue rearrangement.  CH................  T.................         0136      15.0458      $958.33  ...........      $191.67
14041..............  Skin tissue rearrangement.  CH................  T.................         0136      15.0458      $958.33  ...........      $191.67
14060..............  Skin tissue rearrangement.  CH................  T.................         0136      15.0458      $958.33  ...........      $191.67
14061..............  Skin tissue rearrangement.  CH................  T.................         0136      15.0458      $958.33  ...........      $191.67
14300..............  Skin tissue rearrangement.  CH................  T.................         0137      20.2069    $1,287.06  ...........      $257.41
14350..............  Skin tissue rearrangement.  CH................  T.................         0137      20.2069    $1,287.06  ...........      $257.41
15002..............  Wnd prep, ch/inf, trk/arm/  CH................  T.................         0135       4.5263      $288.30  ...........       $57.66
                      lg.
15003..............  Wnd prep, ch/inf addl 100   CH................  T.................         0135       4.5263      $288.30  ...........       $57.66
                      cm.
15004..............  Wnd prep ch/inf, f/n/hf/g.  CH................  T.................         0135       4.5263      $288.30  ...........       $57.66
15005..............  Wnd prep, f/n/hf/g, addl    CH................  T.................         0135       4.5263      $288.30  ...........       $57.66
                      cm.
15040..............  Harvest cultured skin       CH................  T.................         0134       2.1051      $134.08       $42.24       $26.82
                      graft.
15050..............  Skin pinch graft..........  CH................  T.................         0135       4.5263      $288.30  ...........       $57.66
15100..............  Skin splt grft, trnk/arm/   CH................  T.................         0137      20.2069    $1,287.06  ...........      $257.41
                      leg.
15101..............  Skin splt grft t/a/l, add-  CH................  T.................         0137      20.2069    $1,287.06  ...........      $257.41
                      on.
15110..............  Epidrm autogrft trnk/arm/   CH................  T.................         0135       4.5263      $288.30  ...........       $57.66
                      leg.
15111..............  Epidrm autogrft t/a/l add-  CH................  T.................         0135       4.5263      $288.30  ...........       $57.66
                      on.
15115..............  Epidrm a-grft face/nck/hf/  CH................  T.................         0135       4.5263      $288.30  ...........       $57.66
                      g.
15116..............  Epidrm a-grft f/n/hf/g      CH................  T.................         0135       4.5263      $288.30  ...........       $57.66
                      addl.
15120..............  Skn splt a-grft fac/nck/hf/ CH................  T.................         0137      20.2069    $1,287.06  ...........      $257.41
                      g.
15121..............  Skn splt a-grft f/n/hf/g    CH................  T.................         0137      20.2069    $1,287.06  ...........      $257.41
                      add.
15130..............  Derm autograft, trnk/arm/   CH................  T.................         0136      15.0458      $958.33  ...........      $191.67
                      leg.
15131..............  Derm autograft t/a/l add-   CH................  T.................         0136      15.0458      $958.33  ...........      $191.67
                      on.
15135..............  Derm autograft face/nck/hf/ CH................  T.................         0136      15.0458      $958.33  ...........      $191.67
                      g.
15136..............  Derm autograft, f/n/hf/g    CH................  T.................         0136      15.0458      $958.33  ...........      $191.67
                      add.
15150..............  Cult epiderm grft t/arm/    CH................  T.................         0135       4.5263      $288.30  ...........       $57.66
                      leg.
15151..............  Cult epiderm grft t/a/l     CH................  T.................         0135       4.5263      $288.30  ...........       $57.66
                      addl.
15152..............  Cult epiderm graft t/a/l    CH................  T.................         0135       4.5263      $288.30  ...........       $57.66
                      +%.
15155..............  Cult epiderm graft, f/n/hf/ CH................  T.................         0135       4.5263      $288.30  ...........       $57.66
                      g.
15156..............  Cult epidrm grft f/n/hfg    CH................  T.................         0135       4.5263      $288.30  ...........       $57.66
                      add.
15157..............  Cult epiderm grft f/n/hfg   CH................  T.................         0135       4.5263      $288.30  ...........       $57.66
                      +%.
15170..............  Acell graft trunk/arms/     CH................  T.................         0134       2.1051      $134.08       $42.24       $26.82
                      legs.
15171..............  Acell graft t/arm/leg add-  CH................  T.................         0134       2.1051      $134.08       $42.24       $26.82
                      on.
15175..............  Acellular graft, f/n/hf/g.  CH................  T.................         0135       4.5263      $288.30  ...........       $57.66
15176..............  Acell graft, f/n/hf/g add-  CH................  T.................         0135       4.5263      $288.30  ...........       $57.66
                      on.
15200..............  Skin full graft, trunk....  CH................  T.................         0136      15.0458      $958.33  ...........      $191.67
15201..............  Skin full graft trunk add-  CH................  T.................         0136      15.0458      $958.33  ...........      $191.67
                      on.
15220..............  Skin full graft sclp/arm/   CH................  T.................         0136      15.0458      $958.33  ...........      $191.67
                      leg.
15221..............  Skin full graft add-on....  CH................  T.................         0135       4.5263      $288.30  ...........       $57.66
15240..............  Skin full grft face/genit/  CH................  T.................         0136      15.0458      $958.33  ...........      $191.67
                      hf.
15241..............  Skin full graft add-on....  CH................  T.................         0135       4.5263      $288.30  ...........       $57.66
15260..............  Skin full graft een & lips  CH................  T.................         0136      15.0458      $958.33  ...........      $191.67
15261..............  Skin full graft add-on....  CH................  T.................         0136      15.0458      $958.33  ...........      $191.67
15300..............  Apply skinallogrft, t/arm/  CH................  T.................         0135       4.5263      $288.30  ...........       $57.66
                      lg.
15301..............  Apply sknallogrft t/a/l     CH................  T.................         0135       4.5263      $288.30  ...........       $57.66
                      addl.
15320..............  Apply skin allogrft f/n/hf/ CH................  T.................         0135       4.5263      $288.30  ...........       $57.66
                      g.
15321..............  Aply sknallogrft f/n/hfg    CH................  T.................         0135       4.5263      $288.30  ...........       $57.66
                      add.
15330..............  Aply acell alogrft t/arm/   CH................  T.................         0135       4.5263      $288.30  ...........       $57.66
                      leg.
15331..............  Aply acell grft t/a/l add-  CH................  T.................         0135       4.5263      $288.30  ...........       $57.66
                      on.
15335..............  Apply acell graft, f/n/hf/  CH................  T.................         0135       4.5263      $288.30  ...........       $57.66
                      g.
15336..............  Aply acell grft f/n/hf/g    CH................  T.................         0135       4.5263      $288.30  ...........       $57.66
                      add.
15340..............  Apply cult skin substitute  CH................  T.................         0134       2.1051      $134.08       $42.24       $26.82
15341..............  Apply cult skin sub add-on  CH................  T.................         0134       2.1051      $134.08       $42.24       $26.82
15360..............  Apply cult derm sub, t/a/l  CH................  T.................         0134       2.1051      $134.08       $42.24       $26.82
15361..............  Aply cult derm sub t/a/l    CH................  T.................         0134       2.1051      $134.08       $42.24       $26.82
                      add.
15365..............  Apply cult derm sub f/n/hf/ CH................  T.................         0134       2.1051      $134.08       $42.24       $26.82
                      g.
15366..............  Apply cult derm f/hf/g add  CH................  T.................         0134       2.1051      $134.08       $42.24       $26.82
15400..............  Apply skin xenograft, t/a/  CH................  T.................         0135       4.5263      $288.30  ...........       $57.66
                      l.
15401..............  Apply skn xenogrft t/a/l    CH................  T.................         0135       4.5263      $288.30  ...........       $57.66
                      add.
15420..............  Apply skin xgraft, f/n/hf/  CH................  T.................         0135       4.5263      $288.30  ...........       $57.66
                      g.
15421..............  Apply skn xgrft f/n/hf/g    CH................  T.................         0135       4.5263      $288.30  ...........       $57.66
                      add.

[[Page 67002]]

 
15430..............  Apply acellular xenograft.  CH................  T.................         0135       4.5263      $288.30  ...........       $57.66
15431..............  Apply acellular xgraft add  CH................  T.................         0135       4.5263      $288.30  ...........       $57.66
15570..............  Form skin pedicle flap....  CH................  T.................         0137      20.2069    $1,287.06  ...........      $257.41
15572..............  Form skin pedicle flap....  CH................  T.................         0137      20.2069    $1,287.06  ...........      $257.41
15574..............  Form skin pedicle flap....  CH................  T.................         0137      20.2069    $1,287.06  ...........      $257.41
15576..............  Form skin pedicle flap....  CH................  T.................         0137      20.2069    $1,287.06  ...........      $257.41
15600..............  Skin graft................  CH................  T.................         0137      20.2069    $1,287.06  ...........      $257.41
15610..............  Skin graft................  CH................  T.................         0137      20.2069    $1,287.06  ...........      $257.41
15620..............  Skin graft................  CH................  T.................         0137      20.2069    $1,287.06  ...........      $257.41
15630..............  Skin graft................  CH................  T.................         0137      20.2069    $1,287.06  ...........      $257.41
15650..............  Transfer skin pedicle flap  CH................  T.................         0137      20.2069    $1,287.06  ...........      $257.41
15731..............  Forehead flap w/vasc        CH................  T.................         0137      20.2069    $1,287.06  ...........      $257.41
                      pedicle.
15732..............  Muscle-skin graft, head/    CH................  T.................         0137      20.2069    $1,287.06  ...........      $257.41
                      neck.
15734..............  Muscle-skin graft, trunk..  CH................  T.................         0137      20.2069    $1,287.06  ...........      $257.41
15736..............  Muscle-skin graft, arm....  CH................  T.................         0137      20.2069    $1,287.06  ...........      $257.41
15738..............  Muscle-skin graft, leg....  CH................  T.................         0137      20.2069    $1,287.06  ...........      $257.41
15740..............  Island pedicle flap graft.  CH................  T.................         0136      15.0458      $958.33  ...........      $191.67
15750..............  Neurovascular pedicle       CH................  T.................         0137      20.2069    $1,287.06  ...........      $257.41
                      graft.
15756..............  Free myo/skin flap          ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      microvasc.
15757..............  Free skin flap, microvasc.  ..................  C.................  ...........  ...........  ...........  ...........  ...........
15758..............  Free fascial flap,          ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      microvasc.
15760..............  Composite skin graft......  CH................  T.................         0137      20.2069    $1,287.06  ...........      $257.41
15770..............  Derma-fat-fascia graft....  CH................  T.................         0137      20.2069    $1,287.06  ...........      $257.41
15775..............  Hair transplant punch       CH................  T.................         0133       1.2792       $81.48       $25.67       $16.30
                      grafts.
15776..............  Hair transplant punch       CH................  T.................         0133       1.2792       $81.48       $25.67       $16.30
                      grafts.
15780..............  Abrasion treatment of skin  ..................  T.................         0022      21.1098    $1,344.57      $354.45      $268.91
15781..............  Abrasion treatment of skin  ..................  T.................         0019       4.3039      $274.13       $71.87       $54.83
15782..............  Abrasion treatment of skin  ..................  T.................         0019       4.3039      $274.13       $71.87       $54.83
15783..............  Abrasion treatment of skin  ..................  T.................         0016       2.6604      $169.45  ...........       $33.89
15786..............  Abrasion, lesion, single..  ..................  T.................         0013       0.7930       $50.51  ...........       $10.10
15787..............  Abrasion, lesions, add-on.  ..................  T.................         0013       0.7930       $50.51  ...........       $10.10
15788..............  Chemical peel, face,        CH................  T.................         0013       0.7930       $50.51  ...........       $10.10
                      epiderm.
15789..............  Chemical peel, face,        ..................  T.................         0015       1.4595       $92.96  ...........       $18.59
                      dermal.
15792..............  Chemical peel, nonfacial..  CH................  T.................         0015       1.4595       $92.96  ...........       $18.59
15793..............  Chemical peel, nonfacial..  CH................  T.................         0013       0.7930       $50.51  ...........       $10.10
15819..............  Plastic surgery, neck.....  CH................  T.................         0134       2.1051      $134.08       $42.24       $26.82
15820..............  Revision of lower eyelid..  CH................  T.................         0137      20.2069    $1,287.06  ...........      $257.41
15821..............  Revision of lower eyelid..  CH................  T.................         0137      20.2069    $1,287.06  ...........      $257.41
15822..............  Revision of upper eyelid..  CH................  T.................         0137      20.2069    $1,287.06  ...........      $257.41
15823..............  Revision of upper eyelid..  CH................  T.................         0137      20.2069    $1,287.06  ...........      $257.41
15824..............  Removal of forehead         CH................  T.................         0137      20.2069    $1,287.06  ...........      $257.41
                      wrinkles.
15825..............  Removal of neck wrinkles..  CH................  T.................         0137      20.2069    $1,287.06  ...........      $257.41
15826..............  Removal of brow wrinkles..  CH................  T.................         0137      20.2069    $1,287.06  ...........      $257.41
15828..............  Removal of face wrinkles..  CH................  T.................         0137      20.2069    $1,287.06  ...........      $257.41
15829..............  Removal of skin wrinkles..  CH................  T.................         0137      20.2069    $1,287.06  ...........      $257.41
15830..............  Exc skin abd..............  ..................  T.................         0022      21.1098    $1,344.57      $354.45      $268.91
15832..............  Excise excessive skin       ..................  T.................         0022      21.1098    $1,344.57      $354.45      $268.91
                      tissue.
15833..............  Excise excessive skin       ..................  T.................         0022      21.1098    $1,344.57      $354.45      $268.91
                      tissue.
15834..............  Excise excessive skin       ..................  T.................         0022      21.1098    $1,344.57      $354.45      $268.91
                      tissue.
15835..............  Excise excessive skin       CH................  T.................         0022      21.1098    $1,344.57      $354.45      $268.91
                      tissue.
15836..............  Excise excessive skin       ..................  T.................         0021      16.1001    $1,025.48      $219.48      $205.10
                      tissue.
15837..............  Excise excessive skin       ..................  T.................         0021      16.1001    $1,025.48      $219.48      $205.10
                      tissue.
15838..............  Excise excessive skin       ..................  T.................         0021      16.1001    $1,025.48      $219.48      $205.10
                      tissue.
15839..............  Excise excessive skin       ..................  T.................         0021      16.1001    $1,025.48      $219.48      $205.10
                      tissue.
15840..............  Graft for face nerve palsy  CH................  T.................         0137      20.2069    $1,287.06  ...........      $257.41
15841..............  Graft for face nerve palsy  CH................  T.................         0137      20.2069    $1,287.06  ...........      $257.41
15842..............  Flap for face nerve palsy.  CH................  T.................         0137      20.2069    $1,287.06  ...........      $257.41
15845..............  Skin and muscle repair,     CH................  T.................         0137      20.2069    $1,287.06  ...........      $257.41
                      face.
15847..............  Exc skin abd add-on.......  ..................  T.................         0022      21.1098    $1,344.57      $354.45      $268.91
15850..............  Removal of sutures........  ..................  T.................         0016       2.6604      $169.45  ...........       $33.89
15851..............  Removal of sutures........  ..................  T.................         0016       2.6604      $169.45  ...........       $33.89
15852..............  Dressing change not for     ..................  X.................         0340       0.6310       $40.19  ...........        $8.04
                      burn.
15860..............  Test for blood flow in      ..................  X.................         0340       0.6310       $40.19  ...........        $8.04
                      graft.
15876..............  Suction assisted lipectomy  CH................  T.................         0137      20.2069    $1,287.06  ...........      $257.41
15877..............  Suction assisted lipectomy  CH................  T.................         0137      20.2069    $1,287.06  ...........      $257.41
15878..............  Suction assisted lipectomy  CH................  T.................         0137      20.2069    $1,287.06  ...........      $257.41
15879..............  Suction assisted lipectomy  CH................  T.................         0137      20.2069    $1,287.06  ...........      $257.41
15920..............  Removal of tail bone ulcer  ..................  T.................         0019       4.3039      $274.13       $71.87       $54.83
15922..............  Removal of tail bone ulcer  CH................  T.................         0137      20.2069    $1,287.06  ...........      $257.41
15931..............  Remove sacrum pressure      ..................  T.................         0022      21.1098    $1,344.57      $354.45      $268.91
                      sore.
15933..............  Remove sacrum pressure      ..................  T.................         0022      21.1098    $1,344.57      $354.45      $268.91
                      sore.
15934..............  Remove sacrum pressure      CH................  T.................         0137      20.2069    $1,287.06  ...........      $257.41
                      sore.
15935..............  Remove sacrum pressure      CH................  T.................         0137      20.2069    $1,287.06  ...........      $257.41
                      sore.
15936..............  Remove sacrum pressure      CH................  T.................         0136      15.0458      $958.33  ...........      $191.67
                      sore.
15937..............  Remove sacrum pressure      CH................  T.................         0137      20.2069    $1,287.06  ...........      $257.41
                      sore.
15940..............  Remove hip pressure sore..  ..................  T.................         0022      21.1098    $1,344.57      $354.45      $268.91
15941..............  Remove hip pressure sore..  ..................  T.................         0022      21.1098    $1,344.57      $354.45      $268.91
15944..............  Remove hip pressure sore..  CH................  T.................         0137      20.2069    $1,287.06  ...........      $257.41
15945..............  Remove hip pressure sore..  CH................  T.................         0137      20.2069    $1,287.06  ...........      $257.41
15946..............  Remove hip pressure sore..  CH................  T.................         0137      20.2069    $1,287.06  ...........      $257.41

[[Page 67003]]

 
15950..............  Remove thigh pressure sore  ..................  T.................         0022      21.1098    $1,344.57      $354.45      $268.91
15951..............  Remove thigh pressure sore  ..................  T.................         0022      21.1098    $1,344.57      $354.45      $268.91
15952..............  Remove thigh pressure sore  CH................  T.................         0136      15.0458      $958.33  ...........      $191.67
15953..............  Remove thigh pressure sore  CH................  T.................         0136      15.0458      $958.33  ...........      $191.67
15956..............  Remove thigh pressure sore  CH................  T.................         0136      15.0458      $958.33  ...........      $191.67
15958..............  Remove thigh pressure sore  CH................  T.................         0136      15.0458      $958.33  ...........      $191.67
15999..............  Removal of pressure sore..  ..................  T.................         0019       4.3039      $274.13       $71.87       $54.83
16000..............  Initial treatment of        CH................  T.................         0013       0.7930       $50.51  ...........       $10.10
                      burn(s).
16020..............  Dress/debrid p-thick burn,  CH................  T.................         0015       1.4595       $92.96  ...........       $18.59
                      s.
16025..............  Dress/debrid p-thick burn,  CH................  T.................         0016       2.6604      $169.45  ...........       $33.89
                      m.
16030..............  Dress/debrid p-thick burn,  CH................  T.................         0016       2.6604      $169.45  ...........       $33.89
                      l.
16035..............  Incision of burn scab,      ..................  T.................         0016       2.6604      $169.45  ...........       $33.89
                      initi.
16036..............  Escharotomy; add'l          ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      incision.
17000..............  Destruct premalg lesion...  CH................  T.................         0013       0.7930       $50.51  ...........       $10.10
17003..............  Destruct premalg les, 2-14  CH................  T.................         0012       0.2963       $18.87  ...........        $3.77
17004..............  Destroy premlg lesions 15+  CH................  T.................         0016       2.6604      $169.45  ...........       $33.89
17106..............  Destruction of skin         CH................  T.................         0016       2.6604      $169.45  ...........       $33.89
                      lesions.
17107..............  Destruction of skin         CH................  T.................         0016       2.6604      $169.45  ...........       $33.89
                      lesions.
17108..............  Destruction of skin         CH................  T.................         0016       2.6604      $169.45  ...........       $33.89
                      lesions.
17110..............  Destruct b9 lesion, 1-14..  CH................  T.................         0013       0.7930       $50.51  ...........       $10.10
17111..............  Destruct lesion, 15 or      CH................  T.................         0015       1.4595       $92.96  ...........       $18.59
                      more.
17250..............  Chemical cautery, tissue..  CH................  T.................         0015       1.4595       $92.96  ...........       $18.59
17260..............  Destruction of skin         ..................  T.................         0015       1.4595       $92.96  ...........       $18.59
                      lesions.
17261..............  Destruction of skin         ..................  T.................         0015       1.4595       $92.96  ...........       $18.59
                      lesions.
17262..............  Destruction of skin         ..................  T.................         0015       1.4595       $92.96  ...........       $18.59
                      lesions.
17263..............  Destruction of skin         ..................  T.................         0015       1.4595       $92.96  ...........       $18.59
                      lesions.
17264..............  Destruction of skin         ..................  T.................         0015       1.4595       $92.96  ...........       $18.59
                      lesions.
17266..............  Destruction of skin         ..................  T.................         0016       2.6604      $169.45  ...........       $33.89
                      lesions.
17270..............  Destruction of skin         ..................  T.................         0015       1.4595       $92.96  ...........       $18.59
                      lesions.
17271..............  Destruction of skin         CH................  T.................         0015       1.4595       $92.96  ...........       $18.59
                      lesions.
17272..............  Destruction of skin         ..................  T.................         0015       1.4595       $92.96  ...........       $18.59
                      lesions.
17273..............  Destruction of skin         CH................  T.................         0016       2.6604      $169.45  ...........       $33.89
                      lesions.
17274..............  Destruction of skin         ..................  T.................         0016       2.6604      $169.45  ...........       $33.89
                      lesions.
17276..............  Destruction of skin         ..................  T.................         0016       2.6604      $169.45  ...........       $33.89
                      lesions.
17280..............  Destruction of skin         ..................  T.................         0015       1.4595       $92.96  ...........       $18.59
                      lesions.
17281..............  Destruction of skin         CH................  T.................         0016       2.6604      $169.45  ...........       $33.89
                      lesions.
17282..............  Destruction of skin         CH................  T.................         0016       2.6604      $169.45  ...........       $33.89
                      lesions.
17283..............  Destruction of skin         CH................  T.................         0016       2.6604      $169.45  ...........       $33.89
                      lesions.
17284..............  Destruction of skin         ..................  T.................         0016       2.6604      $169.45  ...........       $33.89
                      lesions.
17286..............  Destruction of skin         CH................  T.................         0016       2.6604      $169.45  ...........       $33.89
                      lesions.
17311..............  Mohs, 1 stage, h/n/hf/g...  ..................  T.................         0694       3.6321      $231.34       $91.69       $46.27
17312..............  Mohs addl stage...........  ..................  T.................         0694       3.6321      $231.34       $91.69       $46.27
17313..............  Mohs, 1 stage, t/a/l......  ..................  T.................         0694       3.6321      $231.34       $91.69       $46.27
17314..............  Mohs, addl stage, t/a/l...  ..................  T.................         0694       3.6321      $231.34       $91.69       $46.27
17315..............  Mohs surg, addl block.....  ..................  T.................         0694       3.6321      $231.34       $91.69       $46.27
17340..............  Cryotherapy of skin.......  CH................  T.................         0013       0.7930       $50.51  ...........       $10.10
17360..............  Skin peel therapy.........  ..................  T.................         0013       0.7930       $50.51  ...........       $10.10
17380..............  Hair removal by             ..................  T.................         0013       0.7930       $50.51  ...........       $10.10
                      electrolysis.
17999..............  Skin tissue procedure.....  ..................  T.................         0012       0.2963       $18.87  ...........        $3.77
19000..............  Drainage of breast lesion.  ..................  T.................         0004       4.3270      $275.60  ...........       $55.12
19001..............  Drain breast lesion add-on  ..................  T.................         0002       1.1097       $70.68  ...........       $14.14
19020..............  Incision of breast lesion.  ..................  T.................         0008      18.3197    $1,166.85  ...........      $233.37
19030..............  Injection for breast x-ray  ..................  N.................  ...........  ...........  ...........  ...........  ...........
19100..............  Bx breast percut w/o image  CH................  T.................         0004       4.3270      $275.60  ...........       $55.12
19101..............  Biopsy of breast, open....  ..................  T.................         0028      20.6417    $1,314.75      $303.74      $262.95
19102..............  Bx breast percut w/image..  ..................  T.................         0005       7.1147      $453.16  ...........       $90.63
19103..............  Bx breast percut w/device.  CH................  T.................         0037      13.5764      $864.74      $228.76      $172.95
19105..............  Cryosurg ablate fa, each..  ..................  T.................         0029      31.7134    $2,019.95      $581.52      $403.99
19110..............  Nipple exploration........  ..................  T.................         0028      20.6417    $1,314.75      $303.74      $262.95
19112..............  Excise breast duct fistula  ..................  T.................         0028      20.6417    $1,314.75      $303.74      $262.95
19120..............  Removal of breast lesion..  ..................  T.................         0028      20.6417    $1,314.75      $303.74      $262.95
19125..............  Excision, breast lesion...  ..................  T.................         0028      20.6417    $1,314.75      $303.74      $262.95
19126..............  Excision, addl breast       ..................  T.................         0028      20.6417    $1,314.75      $303.74      $262.95
                      lesion.
19260..............  Removal of chest wall       ..................  T.................         0021      16.1001    $1,025.48      $219.48      $205.10
                      lesion.
19271..............  Revision of chest wall....  ..................  C.................  ...........  ...........  ...........  ...........  ...........
19272..............  Extensive chest wall        ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      surgery.
19290..............  Place needle wire, breast.  ..................  N.................  ...........  ...........  ...........  ...........  ...........
19291..............  Place needle wire, breast.  ..................  N.................  ...........  ...........  ...........  ...........  ...........
19295..............  Place breast clip, percut.  CH................  N.................  ...........  ...........  ...........  ...........  ...........
19296..............  Place po breast cath for    ..................  T.................         0648      56.5774    $3,603.64  ...........      $720.73
                      rad.
19297..............  Place breast cath for rad.  ..................  T.................         0648      56.5774    $3,603.64  ...........      $720.73
19298..............  Place breast rad tube/      CH................  T.................         0648      56.5774    $3,603.64  ...........      $720.73
                      caths.
19300..............  Removal of breast tissue..  ..................  T.................         0028      20.6417    $1,314.75      $303.74      $262.95
19301..............  Partical mastectomy.......  ..................  T.................         0028      20.6417    $1,314.75      $303.74      $262.95
19302..............  P-mastectomy w/ln removal.  CH................  T.................         0030      39.8191    $2,536.24      $747.07      $507.25
19303..............  Mast, simple, complete....  ..................  T.................         0029      31.7134    $2,019.95      $581.52      $403.99
19304..............  Mast, subq................  ..................  T.................         0029      31.7134    $2,019.95      $581.52      $403.99
19305..............  Mast, radical.............  ..................  C.................  ...........  ...........  ...........  ...........  ...........
19306..............  Mast, rad, urban type.....  ..................  C.................  ...........  ...........  ...........  ...........  ...........
19307..............  Mast, mod rad.............  ..................  T.................         0030      39.8191    $2,536.24      $747.07      $507.25

[[Page 67004]]

 
19316..............  Suspension of breast......  ..................  T.................         0029      31.7134    $2,019.95      $581.52      $403.99
19318..............  Reduction of large breast.  CH................  T.................         0030      39.8191    $2,536.24      $747.07      $507.25
19324..............  Enlarge breast............  CH................  T.................         0030      39.8191    $2,536.24      $747.07      $507.25
19325..............  Enlarge breast with         ..................  T.................         0648      56.5774    $3,603.64  ...........      $720.73
                      implant.
19328..............  Removal of breast implant.  ..................  T.................         0029      31.7134    $2,019.95      $581.52      $403.99
19330..............  Removal of implant          ..................  T.................         0029      31.7134    $2,019.95      $581.52      $403.99
                      material.
19340..............  Immediate breast            ..................  T.................         0030      39.8191    $2,536.24      $747.07      $507.25
                      prosthesis.
19342..............  Delayed breast prosthesis.  ..................  T.................         0648      56.5774    $3,603.64  ...........      $720.73
19350..............  Breast reconstruction.....  ..................  T.................         0028      20.6417    $1,314.75      $303.74      $262.95
19355..............  Correct inverted nipple(s)  ..................  T.................         0029      31.7134    $2,019.95      $581.52      $403.99
19357..............  Breast reconstruction.....  ..................  T.................         0648      56.5774    $3,603.64  ...........      $720.73
19361..............  Breast reconstr w/lat flap  ..................  C.................  ...........  ...........  ...........  ...........  ...........
19364..............  Breast reconstruction.....  ..................  C.................  ...........  ...........  ...........  ...........  ...........
19366..............  Breast reconstruction.....  ..................  T.................         0029      31.7134    $2,019.95      $581.52      $403.99
19367..............  Breast reconstruction.....  ..................  C.................  ...........  ...........  ...........  ...........  ...........
19368..............  Breast reconstruction.....  ..................  C.................  ...........  ...........  ...........  ...........  ...........
19369..............  Breast reconstruction.....  ..................  C.................  ...........  ...........  ...........  ...........  ...........
19370..............  Surgery of breast capsule.  ..................  T.................         0029      31.7134    $2,019.95      $581.52      $403.99
19371..............  Removal of breast capsule.  ..................  T.................         0029      31.7134    $2,019.95      $581.52      $403.99
19380..............  Revise breast               ..................  T.................         0030      39.8191    $2,536.24      $747.07      $507.25
                      reconstruction.
19396..............  Design custom breast        ..................  T.................         0029      31.7134    $2,019.95      $581.52      $403.99
                      implant.
19499..............  Breast surgery procedure..  ..................  T.................         0028      20.6417    $1,314.75      $303.74      $262.95
20000..............  Incision of abscess.......  ..................  T.................         0006       1.4066       $89.59  ...........       $17.92
20005..............  Incision of deep abscess..  ..................  T.................         0049      21.2689    $1,354.70  ...........      $270.94
2000F..............  Blood pressure measure....  ..................  M.................  ...........  ...........  ...........  ...........  ...........
2001F..............  Weight recorded...........  ..................  M.................  ...........  ...........  ...........  ...........  ...........
2002F..............  Clin sign vol ovrld assess  ..................  M.................  ...........  ...........  ...........  ...........  ...........
2004F..............  Initial exam involved       ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      joints.
20100..............  Explore wound, neck.......  ..................  T.................         0023       9.6341      $613.63  ...........      $122.73
20101..............  Explore wound, chest......  CH................  T.................         0137      20.2069    $1,287.06  ...........      $257.41
20102..............  Explore wound, abdomen....  CH................  T.................         0137      20.2069    $1,287.06  ...........      $257.41
20103..............  Explore wound, extremity..  ..................  T.................         0023       9.6341      $613.63  ...........      $122.73
2010F..............  Vital signs recorded......  ..................  M.................  ...........  ...........  ...........  ...........  ...........
2014F..............  Mental status assess......  ..................  M.................  ...........  ...........  ...........  ...........  ...........
20150..............  Excise epiphyseal bar.....  ..................  T.................         0051      42.9850    $2,737.89  ...........      $547.58
2018F..............  Hydration status assess...  ..................  M.................  ...........  ...........  ...........  ...........  ...........
2019F..............  Dilated macul exam done...  ..................  M.................  ...........  ...........  ...........  ...........  ...........
20200..............  Muscle biopsy.............  ..................  T.................         0021      16.1001    $1,025.48      $219.48      $205.10
20205..............  Deep muscle biopsy........  ..................  T.................         0021      16.1001    $1,025.48      $219.48      $205.10
20206..............  Needle biopsy, muscle.....  ..................  T.................         0005       7.1147      $453.16  ...........       $90.63
2020F..............  Dilated fundus eval done..  ..................  M.................  ...........  ...........  ...........  ...........  ...........
2021F..............  Dilat macul+ exam done....  ..................  M.................  ...........  ...........  ...........  ...........  ...........
20220..............  Bone biopsy, trocar/needle  CH................  T.................         0020       8.6850      $553.18  ...........      $110.64
20225..............  Bone biopsy, trocar/needle  ..................  T.................         0020       8.6850      $553.18  ...........      $110.64
2022F..............  Dil retina exam interp rev  ..................  M.................  ...........  ...........  ...........  ...........  ...........
20240..............  Bone biopsy, excisional...  ..................  T.................         0022      21.1098    $1,344.57      $354.45      $268.91
20245..............  Bone biopsy, excisional...  ..................  T.................         0022      21.1098    $1,344.57      $354.45      $268.91
2024F..............  7 field photo interp doc    ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      rev.
20250..............  Open bone biopsy..........  ..................  T.................         0049      21.2689    $1,354.70  ...........      $270.94
20251..............  Open bone biopsy..........  ..................  T.................         0049      21.2689    $1,354.70  ...........      $270.94
2026F..............  Eye image valid to dx rev.  ..................  M.................  ...........  ...........  ...........  ...........  ...........
2027F..............  Optic nerve head eval done  ..................  M.................  ...........  ...........  ...........  ...........  ...........
2028F..............  Foot exam performed.......  ..................  M.................  ...........  ...........  ...........  ...........  ...........
2029F..............  Complete phys skin exam     ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      done.
2030F..............  H2O stat doc'd, normal....  ..................  M.................  ...........  ...........  ...........  ...........  ...........
2031F..............  H2O stat doc'd, dehydrated  ..................  M.................  ...........  ...........  ...........  ...........  ...........
2035F..............  Tymp memb motion exam'd...  ..................  M.................  ...........  ...........  ...........  ...........  ...........
20500..............  Injection of sinus tract..  ..................  T.................         0251       2.5002      $159.25  ...........       $31.85
20501..............  Inject sinus tract for x-   ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      ray.
20520..............  Removal of foreign body...  ..................  T.................         0019       4.3039      $274.13       $71.87       $54.83
20525..............  Removal of foreign body...  ..................  T.................         0022      21.1098    $1,344.57      $354.45      $268.91
20526..............  Ther injection, carp        ..................  T.................         0204       2.3213      $147.85       $40.13       $29.57
                      tunnel.
20550..............  Inj tendon sheath/ligament  ..................  T.................         0204       2.3213      $147.85       $40.13       $29.57
20551..............  Inj tendon origin/          ..................  T.................         0204       2.3213      $147.85       $40.13       $29.57
                      insertion.
20552..............  Inj trigger point, 1/2      ..................  T.................         0204       2.3213      $147.85       $40.13       $29.57
                      muscl.
20553..............  Inject trigger points, =/>  ..................  T.................         0204       2.3213      $147.85       $40.13       $29.57
                      3.
20555..............  Place ndl musc/tis for rt.  NI................  T.................         0050      29.1900    $1,859.23  ...........      $371.85
20600..............  Drain/inject, joint/bursa.  ..................  T.................         0204       2.3213      $147.85       $40.13       $29.57
20605..............  Drain/inject, joint/bursa.  ..................  T.................         0204       2.3213      $147.85       $40.13       $29.57
20610..............  Drain/inject, joint/bursa.  ..................  T.................         0204       2.3213      $147.85       $40.13       $29.57
20612..............  Aspirate/inj ganglion cyst  ..................  T.................         0204       2.3213      $147.85       $40.13       $29.57
20615..............  Treatment of bone cyst....  ..................  T.................         0004       4.3270      $275.60  ...........       $55.12
20650..............  Insert and remove bone pin  ..................  T.................         0049      21.2689    $1,354.70  ...........      $270.94
20660..............  Apply, rem fixation device  ..................  C.................  ...........  ...........  ...........  ...........  ...........
20661..............  Application of head brace.  ..................  C.................  ...........  ...........  ...........  ...........  ...........
20662..............  Application of pelvis       ..................  T.................         0049      21.2689    $1,354.70  ...........      $270.94
                      brace.
20663..............  Application of thigh brace  ..................  T.................         0049      21.2689    $1,354.70  ...........      $270.94
20664..............  Halo brace application....  ..................  C.................  ...........  ...........  ...........  ...........  ...........
20665..............  Removal of fixation device  ..................  X.................         0340       0.6310       $40.19  ...........        $8.04
20670..............  Removal of support implant  ..................  T.................         0021      16.1001    $1,025.48      $219.48      $205.10

[[Page 67005]]

 
20680..............  Removal of support implant  ..................  T.................         0022      21.1098    $1,344.57      $354.45      $268.91
20690..............  Apply bone fixation device  ..................  T.................         0050      29.1900    $1,859.23  ...........      $371.85
20692..............  Apply bone fixation device  ..................  T.................         0050      29.1900    $1,859.23  ...........      $371.85
20693..............  Adjust bone fixation        ..................  T.................         0049      21.2689    $1,354.70  ...........      $270.94
                      device.
20694..............  Remove bone fixation        ..................  T.................         0049      21.2689    $1,354.70  ...........      $270.94
                      device.
20802..............  Replantation, arm,          ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      complete.
20805..............  Replant forearm, complete.  ..................  C.................  ...........  ...........  ...........  ...........  ...........
20808..............  Replantation hand,          ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      complete.
20816..............  Replantation digit,         ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      complete.
20822..............  Replantation digit,         ..................  T.................         0054      26.3105    $1,675.82  ...........      $335.16
                      complete.
20824..............  Replantation thumb,         ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      complete.
20827..............  Replantation thumb,         ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      complete.
20838..............  Replantation foot,          ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      complete.
20900..............  Removal of bone for graft.  ..................  T.................         0050      29.1900    $1,859.23  ...........      $371.85
20902..............  Removal of bone for graft.  ..................  T.................         0050      29.1900    $1,859.23  ...........      $371.85
20910..............  Remove cartilage for graft  CH................  T.................         0137      20.2069    $1,287.06  ...........      $257.41
20912..............  Remove cartilage for graft  CH................  T.................         0137      20.2069    $1,287.06  ...........      $257.41
20920..............  Removal of fascia for       CH................  T.................         0136      15.0458      $958.33  ...........      $191.67
                      graft.
20922..............  Removal of fascia for       CH................  T.................         0136      15.0458      $958.33  ...........      $191.67
                      graft.
20924..............  Removal of tendon for       ..................  T.................         0050      29.1900    $1,859.23  ...........      $371.85
                      graft.
20926..............  Removal of tissue for       CH................  T.................         0135       4.5263      $288.30  ...........       $57.66
                      graft.
20930..............  Sp bone algrft morsel add-  ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      on.
20931..............  Sp bone algrft struct add-  ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      on.
20936..............  Sp bone agrft local add-on  ..................  C.................  ...........  ...........  ...........  ...........  ...........
20937..............  Sp bone agrft morsel add-   ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      on.
20938..............  Sp bone agrft struct add-   ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      on.
20950..............  Fluid pressure, muscle....  ..................  T.................         0006       1.4066       $89.59  ...........       $17.92
20955..............  Fibula bone graft,          ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      microvasc.
20956..............  Iliac bone graft,           ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      microvasc.
20957..............  Mt bone graft, microvasc..  ..................  C.................  ...........  ...........  ...........  ...........  ...........
20962..............  Other bone graft,           ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      microvasc.
20969..............  Bone/skin graft, microvasc  ..................  C.................  ...........  ...........  ...........  ...........  ...........
20970..............  Bone/skin graft, iliac      ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      crest.
20972..............  Bone/skin graft,            ..................  T.................         0056      44.2687    $2,819.65  ...........      $563.93
                      metatarsal.
20973..............  Bone/skin graft, great toe  ..................  T.................         0056      44.2687    $2,819.65  ...........      $563.93
20974..............  Electrical bone             ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      stimulation.
20975..............  Electrical bone             CH................  N.................  ...........  ...........  ...........  ...........  ...........
                      stimulation.
20979..............  Us bone stimulation.......  ..................  X.................         0340       0.6310       $40.19  ...........        $8.04
20982..............  Ablate, bone tumor(s) perq  ..................  T.................         0051      42.9850    $2,737.89  ...........      $547.58
20985..............  Cptr-asst dir ms px.......  NI................  N.................  ...........  ...........  ...........  ...........  ...........
20986..............  Cptr-asst dir ms px io img  NI................  N.................  ...........  ...........  ...........  ...........  ...........
20987..............  Cptr-asst dir ms px pre     NI................  N.................  ...........  ...........  ...........  ...........  ...........
                      img.
20999..............  Musculoskeletal surgery...  ..................  T.................         0049      21.2689    $1,354.70  ...........      $270.94
21010..............  Incision of jaw joint.....  ..................  T.................         0254      23.9765    $1,527.16      $321.35      $305.43
21015..............  Resection of facial tumor.  ..................  T.................         0253      16.3288    $1,040.05      $282.29      $208.01
21025..............  Excision of bone, lower     ..................  T.................         0256      39.8776    $2,539.96  ...........      $507.99
                      jaw.
21026..............  Excision of facial bone(s)  ..................  T.................         0256      39.8776    $2,539.96  ...........      $507.99
21029..............  Contour of face bone        ..................  T.................         0256      39.8776    $2,539.96  ...........      $507.99
                      lesion.
21030..............  Excise max/zygoma b9 tumor  ..................  T.................         0254      23.9765    $1,527.16      $321.35      $305.43
21031..............  Remove exostosis, mandible  ..................  T.................         0254      23.9765    $1,527.16      $321.35      $305.43
21032..............  Remove exostosis, maxilla.  ..................  T.................         0254      23.9765    $1,527.16      $321.35      $305.43
21034..............  Excise max/zygoma mlg       ..................  T.................         0256      39.8776    $2,539.96  ...........      $507.99
                      tumor.
21040..............  Excise mandible lesion....  ..................  T.................         0254      23.9765    $1,527.16      $321.35      $305.43
21044..............  Removal of jaw bone lesion  ..................  T.................         0256      39.8776    $2,539.96  ...........      $507.99
21045..............  Extensive jaw surgery.....  ..................  C.................  ...........  ...........  ...........  ...........  ...........
21046..............  Remove mandible cyst        ..................  T.................         0256      39.8776    $2,539.96  ...........      $507.99
                      complex.
21047..............  Excise lwr jaw cyst w/      ..................  T.................         0256      39.8776    $2,539.96  ...........      $507.99
                      repair.
21048..............  Remove maxilla cyst         ..................  T.................         0256      39.8776    $2,539.96  ...........      $507.99
                      complex.
21049..............  Excis uppr jaw cyst w/      ..................  T.................         0256      39.8776    $2,539.96  ...........      $507.99
                      repair.
21050..............  Removal of jaw joint......  ..................  T.................         0256      39.8776    $2,539.96  ...........      $507.99
21060..............  Remove jaw joint cartilage  ..................  T.................         0256      39.8776    $2,539.96  ...........      $507.99
21070..............  Remove coronoid process...  ..................  T.................         0256      39.8776    $2,539.96  ...........      $507.99
21073..............  Mnpj of tmj w/anesth......  NI................  T.................         0252       7.4474      $474.35      $109.16       $94.87
21076..............  Prepare face/oral           ..................  T.................         0254      23.9765    $1,527.16      $321.35      $305.43
                      prosthesis.
21077..............  Prepare face/oral           ..................  T.................         0256      39.8776    $2,539.96  ...........      $507.99
                      prosthesis.
21079..............  Prepare face/oral           ..................  T.................         0256      39.8776    $2,539.96  ...........      $507.99
                      prosthesis.
21080..............  Prepare face/oral           ..................  T.................         0256      39.8776    $2,539.96  ...........      $507.99
                      prosthesis.
21081..............  Prepare face/oral           ..................  T.................         0256      39.8776    $2,539.96  ...........      $507.99
                      prosthesis.
21082..............  Prepare face/oral           ..................  T.................         0256      39.8776    $2,539.96  ...........      $507.99
                      prosthesis.
21083..............  Prepare face/oral           ..................  T.................         0256      39.8776    $2,539.96  ...........      $507.99
                      prosthesis.
21084..............  Prepare face/oral           ..................  T.................         0256      39.8776    $2,539.96  ...........      $507.99
                      prosthesis.
21085..............  Prepare face/oral           ..................  T.................         0253      16.3288    $1,040.05      $282.29      $208.01
                      prosthesis.
21086..............  Prepare face/oral           ..................  T.................         0256      39.8776    $2,539.96  ...........      $507.99
                      prosthesis.
21087..............  Prepare face/oral           ..................  T.................         0256      39.8776    $2,539.96  ...........      $507.99
                      prosthesis.
21088..............  Prepare face/oral           ..................  T.................         0256      39.8776    $2,539.96  ...........      $507.99
                      prosthesis.
21089..............  Prepare face/oral           ..................  T.................         0251       2.5002      $159.25  ...........       $31.85
                      prosthesis.
21100..............  Maxillofacial fixation....  ..................  T.................         0256      39.8776    $2,539.96  ...........      $507.99
21110..............  Interdental fixation......  ..................  T.................         0252       7.4474      $474.35      $109.16       $94.87
21116..............  Injection, jaw joint x-ray  ..................  N.................  ...........  ...........  ...........  ...........  ...........
21120..............  Reconstruction of chin....  ..................  T.................         0254      23.9765    $1,527.16      $321.35      $305.43

[[Page 67006]]

 
21121..............  Reconstruction of chin....  ..................  T.................         0254      23.9765    $1,527.16      $321.35      $305.43
21122..............  Reconstruction of chin....  ..................  T.................         0254      23.9765    $1,527.16      $321.35      $305.43
21123..............  Reconstruction of chin....  ..................  T.................         0254      23.9765    $1,527.16      $321.35      $305.43
21125..............  Augmentation, lower jaw     ..................  T.................         0254      23.9765    $1,527.16      $321.35      $305.43
                      bone.
21127..............  Augmentation, lower jaw     ..................  T.................         0256      39.8776    $2,539.96  ...........      $507.99
                      bone.
21137..............  Reduction of forehead.....  ..................  T.................         0254      23.9765    $1,527.16      $321.35      $305.43
21138..............  Reduction of forehead.....  ..................  T.................         0256      39.8776    $2,539.96  ...........      $507.99
21139..............  Reduction of forehead.....  ..................  T.................         0256      39.8776    $2,539.96  ...........      $507.99
21141..............  Reconstruct midface,        ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      lefort.
21142..............  Reconstruct midface,        ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      lefort.
21143..............  Reconstruct midface,        ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      lefort.
21145..............  Reconstruct midface,        ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      lefort.
21146..............  Reconstruct midface,        ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      lefort.
21147..............  Reconstruct midface,        ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      lefort.
21150..............  Reconstruct midface,        ..................  T.................         0256      39.8776    $2,539.96  ...........      $507.99
                      lefort.
21151..............  Reconstruct midface,        ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      lefort.
21154..............  Reconstruct midface,        ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      lefort.
21155..............  Reconstruct midface,        ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      lefort.
21159..............  Reconstruct midface,        ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      lefort.
21160..............  Reconstruct midface,        ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      lefort.
21172..............  Reconstruct orbit/forehead  ..................  C.................  ...........  ...........  ...........  ...........  ...........
21175..............  Reconstruct orbit/forehead  ..................  T.................         0256      39.8776    $2,539.96  ...........      $507.99
21179..............  Reconstruct entire          ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      forehead.
21180..............  Reconstruct entire          ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      forehead.
21181..............  Contour cranial bone        ..................  T.................         0254      23.9765    $1,527.16      $321.35      $305.43
                      lesion.
21182..............  Reconstruct cranial bone..  ..................  C.................  ...........  ...........  ...........  ...........  ...........
21183..............  Reconstruct cranial bone..  ..................  C.................  ...........  ...........  ...........  ...........  ...........
21184..............  Reconstruct cranial bone..  ..................  C.................  ...........  ...........  ...........  ...........  ...........
21188..............  Reconstruction of midface.  ..................  C.................  ...........  ...........  ...........  ...........  ...........
21193..............  Reconst lwr jaw w/o graft.  ..................  C.................  ...........  ...........  ...........  ...........  ...........
21194..............  Reconst lwr jaw w/graft...  ..................  C.................  ...........  ...........  ...........  ...........  ...........
21195..............  Reconst lwr jaw w/o         ..................  T.................         0256      39.8776    $2,539.96  ...........      $507.99
                      fixation.
21196..............  Reconst lwr jaw w/fixation  ..................  C.................  ...........  ...........  ...........  ...........  ...........
21198..............  Reconstr lwr jaw segment..  ..................  T.................         0256      39.8776    $2,539.96  ...........      $507.99
21199..............  Reconstr lwr jaw w/advance  ..................  T.................         0256      39.8776    $2,539.96  ...........      $507.99
21206..............  Reconstruct upper jaw bone  ..................  T.................         0256      39.8776    $2,539.96  ...........      $507.99
21208..............  Augmentation of facial      ..................  T.................         0256      39.8776    $2,539.96  ...........      $507.99
                      bones.
21209..............  Reduction of facial bones.  ..................  T.................         0256      39.8776    $2,539.96  ...........      $507.99
21210..............  Face bone graft...........  ..................  T.................         0256      39.8776    $2,539.96  ...........      $507.99
21215..............  Lower jaw bone graft......  ..................  T.................         0256      39.8776    $2,539.96  ...........      $507.99
21230..............  Rib cartilage graft.......  ..................  T.................         0256      39.8776    $2,539.96  ...........      $507.99
21235..............  Ear cartilage graft.......  ..................  T.................         0254      23.9765    $1,527.16      $321.35      $305.43
21240..............  Reconstruction of jaw       ..................  T.................         0256      39.8776    $2,539.96  ...........      $507.99
                      joint.
21242..............  Reconstruction of jaw       ..................  T.................         0256      39.8776    $2,539.96  ...........      $507.99
                      joint.
21243..............  Reconstruction of jaw       ..................  T.................         0256      39.8776    $2,539.96  ...........      $507.99
                      joint.
21244..............  Reconstruction of lower     ..................  T.................         0256      39.8776    $2,539.96  ...........      $507.99
                      jaw.
21245..............  Reconstruction of jaw.....  ..................  T.................         0256      39.8776    $2,539.96  ...........      $507.99
21246..............  Reconstruction of jaw.....  ..................  T.................         0256      39.8776    $2,539.96  ...........      $507.99
21247..............  Reconstruct lower jaw bone  ..................  C.................  ...........  ...........  ...........  ...........  ...........
21248..............  Reconstruction of jaw.....  ..................  T.................         0256      39.8776    $2,539.96  ...........      $507.99
21249..............  Reconstruction of jaw.....  ..................  T.................         0256      39.8776    $2,539.96  ...........      $507.99
21255..............  Reconstruct lower jaw bone  ..................  C.................  ...........  ...........  ...........  ...........  ...........
21256..............  Reconstruction of orbit...  ..................  C.................  ...........  ...........  ...........  ...........  ...........
21260..............  Revise eye sockets........  ..................  T.................         0256      39.8776    $2,539.96  ...........      $507.99
21261..............  Revise eye sockets........  ..................  T.................         0256      39.8776    $2,539.96  ...........      $507.99
21263..............  Revise eye sockets........  ..................  T.................         0256      39.8776    $2,539.96  ...........      $507.99
21267..............  Revise eye sockets........  ..................  T.................         0256      39.8776    $2,539.96  ...........      $507.99
21268..............  Revise eye sockets........  ..................  C.................  ...........  ...........  ...........  ...........  ...........
21270..............  Augmentation, cheek bone..  ..................  T.................         0256      39.8776    $2,539.96  ...........      $507.99
21275..............  Revision, orbitofacial      ..................  T.................         0256      39.8776    $2,539.96  ...........      $507.99
                      bones.
21280..............  Revision of eyelid........  ..................  T.................         0256      39.8776    $2,539.96  ...........      $507.99
21282..............  Revision of eyelid........  ..................  T.................         0253      16.3288    $1,040.05      $282.29      $208.01
21295..............  Revision of jaw muscle/     ..................  T.................         0252       7.4474      $474.35      $109.16       $94.87
                      bone.
21296..............  Revision of jaw muscle/     ..................  T.................         0254      23.9765    $1,527.16      $321.35      $305.43
                      bone.
21299..............  Cranio/maxillofacial        ..................  T.................         0251       2.5002      $159.25  ...........       $31.85
                      surgery.
21310..............  Treatment of nose fracture  ..................  T.................         0251       2.5002      $159.25  ...........       $31.85
21315..............  Treatment of nose fracture  ..................  T.................         0251       2.5002      $159.25  ...........       $31.85
21320..............  Treatment of nose fracture  CH................  T.................         0253      16.3288    $1,040.05      $282.29      $208.01
21325..............  Treatment of nose fracture  ..................  T.................         0254      23.9765    $1,527.16      $321.35      $305.43
21330..............  Treatment of nose fracture  ..................  T.................         0254      23.9765    $1,527.16      $321.35      $305.43
21335..............  Treatment of nose fracture  ..................  T.................         0254      23.9765    $1,527.16      $321.35      $305.43
21336..............  Treat nasal septal          CH................  T.................         0062      26.1592    $1,666.18      $372.87      $333.24
                      fracture.
21337..............  Treat nasal septal          ..................  T.................         0253      16.3288    $1,040.05      $282.29      $208.01
                      fracture.
21338..............  Treat nasoethmoid fracture  ..................  T.................         0254      23.9765    $1,527.16      $321.35      $305.43
21339..............  Treat nasoethmoid fracture  ..................  T.................         0254      23.9765    $1,527.16      $321.35      $305.43
21340..............  Treatment of nose fracture  ..................  T.................         0256      39.8776    $2,539.96  ...........      $507.99
21343..............  Treatment of sinus          ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      fracture.
21344..............  Treatment of sinus          ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      fracture.
21345..............  Treat nose/jaw fracture...  ..................  T.................         0254      23.9765    $1,527.16      $321.35      $305.43
21346..............  Treat nose/jaw fracture...  ..................  C.................  ...........  ...........  ...........  ...........  ...........

[[Page 67007]]

 
21347..............  Treat nose/jaw fracture...  ..................  C.................  ...........  ...........  ...........  ...........  ...........
21348..............  Treat nose/jaw fracture...  ..................  C.................  ...........  ...........  ...........  ...........  ...........
21355..............  Treat cheek bone fracture.  ..................  T.................         0256      39.8776    $2,539.96  ...........      $507.99
21356..............  Treat cheek bone fracture.  ..................  T.................         0254      23.9765    $1,527.16      $321.35      $305.43
21360..............  Treat cheek bone fracture.  CH................  T.................         0254      23.9765    $1,527.16      $321.35      $305.43
21365..............  Treat cheek bone fracture.  CH................  T.................         0256      39.8776    $2,539.96  ...........      $507.99
21366..............  Treat cheek bone fracture.  ..................  C.................  ...........  ...........  ...........  ...........  ...........
21385..............  Treat eye socket fracture.  CH................  T.................         0256      39.8776    $2,539.96  ...........      $507.99
21386..............  Treat eye socket fracture.  ..................  C.................  ...........  ...........  ...........  ...........  ...........
21387..............  Treat eye socket fracture.  ..................  C.................  ...........  ...........  ...........  ...........  ...........
21390..............  Treat eye socket fracture.  ..................  T.................         0256      39.8776    $2,539.96  ...........      $507.99
21395..............  Treat eye socket fracture.  ..................  C.................  ...........  ...........  ...........  ...........  ...........
21400..............  Treat eye socket fracture.  ..................  T.................         0252       7.4474      $474.35      $109.16       $94.87
21401..............  Treat eye socket fracture.  ..................  T.................         0253      16.3288    $1,040.05      $282.29      $208.01
21406..............  Treat eye socket fracture.  ..................  T.................         0256      39.8776    $2,539.96  ...........      $507.99
21407..............  Treat eye socket fracture.  ..................  T.................         0256      39.8776    $2,539.96  ...........      $507.99
21408..............  Treat eye socket fracture.  ..................  T.................         0256      39.8776    $2,539.96  ...........      $507.99
21421..............  Treat mouth roof fracture.  ..................  T.................         0254      23.9765    $1,527.16      $321.35      $305.43
21422..............  Treat mouth roof fracture.  ..................  C.................  ...........  ...........  ...........  ...........  ...........
21423..............  Treat mouth roof fracture.  ..................  C.................  ...........  ...........  ...........  ...........  ...........
21431..............  Treat craniofacial          ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      fracture.
21432..............  Treat craniofacial          ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      fracture.
21433..............  Treat craniofacial          ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      fracture.
21435..............  Treat craniofacial          ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      fracture.
21436..............  Treat craniofacial          ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      fracture.
21440..............  Treat dental ridge          ..................  T.................         0254      23.9765    $1,527.16      $321.35      $305.43
                      fracture.
21445..............  Treat dental ridge          ..................  T.................         0254      23.9765    $1,527.16      $321.35      $305.43
                      fracture.
21450..............  Treat lower jaw fracture..  ..................  T.................         0251       2.5002      $159.25  ...........       $31.85
21451..............  Treat lower jaw fracture..  ..................  T.................         0252       7.4474      $474.35      $109.16       $94.87
21452..............  Treat lower jaw fracture..  ..................  T.................         0253      16.3288    $1,040.05      $282.29      $208.01
21453..............  Treat lower jaw fracture..  ..................  T.................         0256      39.8776    $2,539.96  ...........      $507.99
21454..............  Treat lower jaw fracture..  ..................  T.................         0254      23.9765    $1,527.16      $321.35      $305.43
21461..............  Treat lower jaw fracture..  ..................  T.................         0256      39.8776    $2,539.96  ...........      $507.99
21462..............  Treat lower jaw fracture..  ..................  T.................         0256      39.8776    $2,539.96  ...........      $507.99
21465..............  Treat lower jaw fracture..  ..................  T.................         0256      39.8776    $2,539.96  ...........      $507.99
21470..............  Treat lower jaw fracture..  ..................  T.................         0256      39.8776    $2,539.96  ...........      $507.99
21480..............  Reset dislocated jaw......  ..................  T.................         0251       2.5002      $159.25  ...........       $31.85
21485..............  Reset dislocated jaw......  ..................  T.................         0253      16.3288    $1,040.05      $282.29      $208.01
21490..............  Repair dislocated jaw.....  ..................  T.................         0256      39.8776    $2,539.96  ...........      $507.99
21495..............  Treat hyoid bone fracture.  ..................  T.................         0253      16.3288    $1,040.05      $282.29      $208.01
21497..............  Interdental wiring........  ..................  T.................         0253      16.3288    $1,040.05      $282.29      $208.01
21499..............  Head surgery procedure....  ..................  T.................         0251       2.5002      $159.25  ...........       $31.85
21501..............  Drain neck/chest lesion...  ..................  T.................         0008      18.3197    $1,166.85  ...........      $233.37
21502..............  Drain chest lesion........  ..................  T.................         0049      21.2689    $1,354.70  ...........      $270.94
21510..............  Drainage of bone lesion...  ..................  C.................  ...........  ...........  ...........  ...........  ...........
21550..............  Biopsy of neck/chest......  ..................  T.................         0020       8.6850      $553.18  ...........      $110.64
21555..............  Remove lesion, neck/chest.  ..................  T.................         0022      21.1098    $1,344.57      $354.45      $268.91
21556..............  Remove lesion, neck/chest.  ..................  T.................         0022      21.1098    $1,344.57      $354.45      $268.91
21557..............  Remove tumor, neck/chest..  ..................  T.................         0022      21.1098    $1,344.57      $354.45      $268.91
21600..............  Partial removal of rib....  ..................  T.................         0050      29.1900    $1,859.23  ...........      $371.85
21610..............  Partial removal of rib....  ..................  T.................         0050      29.1900    $1,859.23  ...........      $371.85
21615..............  Removal of rib............  ..................  C.................  ...........  ...........  ...........  ...........  ...........
21616..............  Removal of rib and nerves.  ..................  C.................  ...........  ...........  ...........  ...........  ...........
21620..............  Partial removal of sternum  ..................  C.................  ...........  ...........  ...........  ...........  ...........
21627..............  Sternal debridement.......  ..................  C.................  ...........  ...........  ...........  ...........  ...........
21630..............  Extensive sternum surgery.  ..................  C.................  ...........  ...........  ...........  ...........  ...........
21632..............  Extensive sternum surgery.  ..................  C.................  ...........  ...........  ...........  ...........  ...........
21685..............  Hyoid myotomy & suspension  ..................  T.................         0252       7.4474      $474.35      $109.16       $94.87
21700..............  Revision of neck muscle...  ..................  T.................         0049      21.2689    $1,354.70  ...........      $270.94
21705..............  Revision of neck muscle/    ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      rib.
21720..............  Revision of neck muscle...  ..................  T.................         0049      21.2689    $1,354.70  ...........      $270.94
21725..............  Revision of neck muscle...  ..................  T.................         0006       1.4066       $89.59  ...........       $17.92
21740..............  Reconstruction of sternum.  ..................  C.................  ...........  ...........  ...........  ...........  ...........
21742..............  Repair stern/nuss w/o       ..................  T.................         0051      42.9850    $2,737.89  ...........      $547.58
                      scope.
21743..............  Repair sternum/nuss w/      ..................  T.................         0051      42.9850    $2,737.89  ...........      $547.58
                      scope.
21750..............  Repair of sternum           ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      separation.
21800..............  Treatment of rib fracture.  ..................  T.................         0043       1.7682      $112.62  ...........       $22.52
21805..............  Treatment of rib fracture.  ..................  T.................         0062      26.1592    $1,666.18      $372.87      $333.24
21810..............  Treatment of rib            ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      fracture(s).
21820..............  Treat sternum fracture....  ..................  T.................         0043       1.7682      $112.62  ...........       $22.52
21825..............  Treat sternum fracture....  ..................  C.................  ...........  ...........  ...........  ...........  ...........
21899..............  Neck/chest surgery          ..................  T.................         0251       2.5002      $159.25  ...........       $31.85
                      procedure.
21920..............  Biopsy soft tissue of back  ..................  T.................         0020       8.6850      $553.18  ...........      $110.64
21925..............  Biopsy soft tissue of back  ..................  T.................         0022      21.1098    $1,344.57      $354.45      $268.91
21930..............  Remove lesion, back or      ..................  T.................         0022      21.1098    $1,344.57      $354.45      $268.91
                      flank.
21935..............  Remove tumor, back........  ..................  T.................         0022      21.1098    $1,344.57      $354.45      $268.91
22010..............  I&d, p-spine, c/t/cerv-     ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      thor.
22015..............  I&d, p-spine, l/s/ls......  ..................  C.................  ...........  ...........  ...........  ...........  ...........
22100..............  Remove part of neck         ..................  T.................         0208      46.7724    $2,979.12  ...........      $595.82
                      vertebra.
22101..............  Remove part, thorax         ..................  T.................         0208      46.7724    $2,979.12  ...........      $595.82
                      vertebra.

[[Page 67008]]

 
22102..............  Remove part, lumbar         ..................  T.................         0208      46.7724    $2,979.12  ...........      $595.82
                      vertebra.
22103..............  Remove extra spine segment  ..................  T.................         0208      46.7724    $2,979.12  ...........      $595.82
22110..............  Remove part of neck         ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      vertebra.
22112..............  Remove part, thorax         ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      vertebra.
22114..............  Remove part, lumbar         ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      vertebra.
22116..............  Remove extra spine segment  ..................  C.................  ...........  ...........  ...........  ...........  ...........
22206..............  Cut spine 3 col, thor.....  NI................  C.................  ...........  ...........  ...........  ...........  ...........
22207..............  Cut spine 3 col, lumb.....  NI................  C.................  ...........  ...........  ...........  ...........  ...........
22208..............  Cut spine 3 col, addl seg.  NI................  C.................  ...........  ...........  ...........  ...........  ...........
22210..............  Revision of neck spine....  ..................  C.................  ...........  ...........  ...........  ...........  ...........
22212..............  Revision of thorax spine..  ..................  C.................  ...........  ...........  ...........  ...........  ...........
22214..............  Revision of lumbar spine..  ..................  C.................  ...........  ...........  ...........  ...........  ...........
22216..............  Revise, extra spine         ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      segment.
22220..............  Revision of neck spine....  ..................  C.................  ...........  ...........  ...........  ...........  ...........
22222..............  Revision of thorax spine..  ..................  T.................         0208      46.7724    $2,979.12  ...........      $595.82
22224..............  Revision of lumbar spine..  ..................  C.................  ...........  ...........  ...........  ...........  ...........
22226..............  Revise, extra spine         ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      segment.
22305..............  Treat spine process         ..................  T.................         0043       1.7682      $112.62  ...........       $22.52
                      fracture.
22310..............  Treat spine fracture......  ..................  T.................         0043       1.7682      $112.62  ...........       $22.52
22315..............  Treat spine fracture......  ..................  T.................         0043       1.7682      $112.62  ...........       $22.52
22318..............  Treat odontoid fx w/o       ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      graft.
22319..............  Treat odontoid fx w/graft.  ..................  C.................  ...........  ...........  ...........  ...........  ...........
22325..............  Treat spine fracture......  ..................  C.................  ...........  ...........  ...........  ...........  ...........
22326..............  Treat neck spine fracture.  ..................  C.................  ...........  ...........  ...........  ...........  ...........
22327..............  Treat thorax spine          ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      fracture.
22328..............  Treat each add spine fx...  ..................  C.................  ...........  ...........  ...........  ...........  ...........
22505..............  Manipulation of spine.....  ..................  T.................         0045      14.7658      $940.49      $268.47      $188.10
22520..............  Percut vertebroplasty thor  ..................  T.................         0050      29.1900    $1,859.23  ...........      $371.85
22521..............  Percut vertebroplasty lumb  ..................  T.................         0050      29.1900    $1,859.23  ...........      $371.85
22522..............  Percut vertebroplasty       ..................  T.................         0050      29.1900    $1,859.23  ...........      $371.85
                      add'l.
22523..............  Percut kyphoplasty, thor..  ..................  T.................         0052      79.4244    $5,058.86  ...........    $1,011.77
22524..............  Percut kyphoplasty, lumbar  ..................  T.................         0052      79.4244    $5,058.86  ...........    $1,011.77
22525..............  Percut kyphoplasty, add-on  ..................  T.................         0052      79.4244    $5,058.86  ...........    $1,011.77
22526..............  Idet, single level........  ..................  T.................         0050      29.1900    $1,859.23  ...........      $371.85
22527..............  Idet, 1 or more levels....  ..................  T.................         0050      29.1900    $1,859.23  ...........      $371.85
22532..............  Lat thorax spine fusion...  ..................  C.................  ...........  ...........  ...........  ...........  ...........
22533..............  Lat lumbar spine fusion...  ..................  C.................  ...........  ...........  ...........  ...........  ...........
22534..............  Lat thor/lumb, add'l seg..  ..................  C.................  ...........  ...........  ...........  ...........  ...........
22548..............  Neck spine fusion.........  ..................  C.................  ...........  ...........  ...........  ...........  ...........
22554..............  Neck spine fusion.........  ..................  C.................  ...........  ...........  ...........  ...........  ...........
22556..............  Thorax spine fusion.......  ..................  C.................  ...........  ...........  ...........  ...........  ...........
22558..............  Lumbar spine fusion.......  ..................  C.................  ...........  ...........  ...........  ...........  ...........
22585..............  Additional spinal fusion..  ..................  C.................  ...........  ...........  ...........  ...........  ...........
22590..............  Spine & skull spinal        ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      fusion.
22595..............  Neck spinal fusion........  ..................  C.................  ...........  ...........  ...........  ...........  ...........
22600..............  Neck spine fusion.........  ..................  C.................  ...........  ...........  ...........  ...........  ...........
22610..............  Thorax spine fusion.......  ..................  C.................  ...........  ...........  ...........  ...........  ...........
22612..............  Lumbar spine fusion.......  ..................  T.................         0208      46.7724    $2,979.12  ...........      $595.82
22614..............  Spine fusion, extra         ..................  T.................         0208      46.7724    $2,979.12  ...........      $595.82
                      segment.
22630..............  Lumbar spine fusion.......  ..................  C.................  ...........  ...........  ...........  ...........  ...........
22632..............  Spine fusion, extra         ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      segment.
22800..............  Fusion of spine...........  ..................  C.................  ...........  ...........  ...........  ...........  ...........
22802..............  Fusion of spine...........  ..................  C.................  ...........  ...........  ...........  ...........  ...........
22804..............  Fusion of spine...........  ..................  C.................  ...........  ...........  ...........  ...........  ...........
22808..............  Fusion of spine...........  ..................  C.................  ...........  ...........  ...........  ...........  ...........
22810..............  Fusion of spine...........  ..................  C.................  ...........  ...........  ...........  ...........  ...........
22812..............  Fusion of spine...........  ..................  C.................  ...........  ...........  ...........  ...........  ...........
22818..............  Kyphectomy, 1-2 segments..  ..................  C.................  ...........  ...........  ...........  ...........  ...........
22819..............  Kyphectomy, 3 or more.....  ..................  C.................  ...........  ...........  ...........  ...........  ...........
22830..............  Exploration of spinal       ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      fusion.
22840..............  Insert spine fixation       ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      device.
22841..............  Insert spine fixation       ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      device.
22842..............  Insert spine fixation       ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      device.
22843..............  Insert spine fixation       ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      device.
22844..............  Insert spine fixation       ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      device.
22845..............  Insert spine fixation       ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      device.
22846..............  Insert spine fixation       ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      device.
22847..............  Insert spine fixation       ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      device.
22848..............  Insert pelv fixation        ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      device.
22849..............  Reinsert spinal fixation..  ..................  C.................  ...........  ...........  ...........  ...........  ...........
22850..............  Remove spine fixation       ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      device.
22851..............  Apply spine prosth device.  ..................  T.................         0049      21.2689    $1,354.70  ...........      $270.94
22852..............  Remove spine fixation       ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      device.
22855..............  Remove spine fixation       ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      device.
22857..............  Lumbar artif diskectomy...  ..................  C.................  ...........  ...........  ...........  ...........  ...........
22862..............  Revise lumbar artif disc..  ..................  C.................  ...........  ...........  ...........  ...........  ...........
22865..............  Remove lumb artif disc....  ..................  C.................  ...........  ...........  ...........  ...........  ...........
22899..............  Spine surgery procedure...  ..................  T.................         0049      21.2689    $1,354.70  ...........      $270.94
22900..............  Remove abdominal wall       ..................  T.................         0022      21.1098    $1,344.57      $354.45      $268.91
                      lesion.
22999..............  Abdomen surgery procedure.  ..................  T.................         0049      21.2689    $1,354.70  ...........      $270.94

[[Page 67009]]

 
23000..............  Removal of calcium          ..................  T.................         0021      16.1001    $1,025.48      $219.48      $205.10
                      deposits.
23020..............  Release shoulder joint....  ..................  T.................         0051      42.9850    $2,737.89  ...........      $547.58
23030..............  Drain shoulder lesion.....  ..................  T.................         0008      18.3197    $1,166.85  ...........      $233.37
23031..............  Drain shoulder bursa......  ..................  T.................         0008      18.3197    $1,166.85  ...........      $233.37
23035..............  Drain shoulder bone lesion  ..................  T.................         0049      21.2689    $1,354.70  ...........      $270.94
23040..............  Exploratory shoulder        ..................  T.................         0050      29.1900    $1,859.23  ...........      $371.85
                      surgery.
23044..............  Exploratory shoulder        ..................  T.................         0050      29.1900    $1,859.23  ...........      $371.85
                      surgery.
23065..............  Biopsy shoulder tissues...  ..................  T.................         0020       8.6850      $553.18  ...........      $110.64
23066..............  Biopsy shoulder tissues...  ..................  T.................         0022      21.1098    $1,344.57      $354.45      $268.91
23075..............  Removal of shoulder lesion  ..................  T.................         0021      16.1001    $1,025.48      $219.48      $205.10
23076..............  Removal of shoulder lesion  ..................  T.................         0022      21.1098    $1,344.57      $354.45      $268.91
23077..............  Remove tumor of shoulder..  ..................  T.................         0022      21.1098    $1,344.57      $354.45      $268.91
23100..............  Biopsy of shoulder joint..  ..................  T.................         0049      21.2689    $1,354.70  ...........      $270.94
23101..............  Shoulder joint surgery....  ..................  T.................         0050      29.1900    $1,859.23  ...........      $371.85
23105..............  Remove shoulder joint       ..................  T.................         0050      29.1900    $1,859.23  ...........      $371.85
                      lining.
23106..............  Incision of collarbone      ..................  T.................         0050      29.1900    $1,859.23  ...........      $371.85
                      joint.
23107..............  Explore treat shoulder      ..................  T.................         0050      29.1900    $1,859.23  ...........      $371.85
                      joint.
23120..............  Partial removal, collar     CH................  T.................         0050      29.1900    $1,859.23  ...........      $371.85
                      bone.
23125..............  Removal of collar bone....  CH................  T.................         0050      29.1900    $1,859.23  ...........      $371.85
23130..............  Remove shoulder bone, part  ..................  T.................         0051      42.9850    $2,737.89  ...........      $547.58
23140..............  Removal of bone lesion....  ..................  T.................         0049      21.2689    $1,354.70  ...........      $270.94
23145..............  Removal of bone lesion....  ..................  T.................         0050      29.1900    $1,859.23  ...........      $371.85
23146..............  Removal of bone lesion....  ..................  T.................         0050      29.1900    $1,859.23  ...........      $371.85
23150..............  Removal of humerus lesion.  ..................  T.................         0050      29.1900    $1,859.23  ...........      $371.85
23155..............  Removal of humerus lesion.  ..................  T.................         0050      29.1900    $1,859.23  ...........      $371.85
23156..............  Removal of humerus lesion.  ..................  T.................         0050      29.1900    $1,859.23  ...........      $371.85
23170..............  Remove collar bone lesion.  ..................  T.................         0050      29.1900    $1,859.23  ...........      $371.85
23172..............  Remove shoulder blade       ..................  T.................         0050      29.1900    $1,859.23  ...........      $371.85
                      lesion.
23174..............  Remove humerus lesion.....  ..................  T.................         0050      29.1900    $1,859.23  ...........      $371.85
23180..............  Remove collar bone lesion.  ..................  T.................         0050      29.1900    $1,859.23  ...........      $371.85
23182..............  Remove shoulder blade       ..................  T.................         0050      29.1900    $1,859.23  ...........      $371.85
                      lesion.
23184..............  Remove humerus lesion.....  ..................  T.................         0050      29.1900    $1,859.23  ...........      $371.85
23190..............  Partial removal of scapula  ..................  T.................         0050      29.1900    $1,859.23  ...........      $371.85
23195..............  Removal of head of humerus  ..................  T.................         0050      29.1900    $1,859.23  ...........      $371.85
23200..............  Removal of collar bone....  ..................  C.................  ...........  ...........  ...........  ...........  ...........
23210..............  Removal of shoulder blade.  ..................  C.................  ...........  ...........  ...........  ...........  ...........
23220..............  Partial removal of humerus  ..................  C.................  ...........  ...........  ...........  ...........  ...........
23221..............  Partial removal of humerus  ..................  C.................  ...........  ...........  ...........  ...........  ...........
23222..............  Partial removal of humerus  ..................  C.................  ...........  ...........  ...........  ...........  ...........
23330..............  Remove shoulder foreign     ..................  T.................         0020       8.6850      $553.18  ...........      $110.64
                      body.
23331..............  Remove shoulder foreign     ..................  T.................         0022      21.1098    $1,344.57      $354.45      $268.91
                      body.
23332..............  Remove shoulder foreign     ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      body.
23350..............  Injection for shoulder x-   ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      ray.
23395..............  Muscle transfer,shoulder/   ..................  T.................         0051      42.9850    $2,737.89  ...........      $547.58
                      arm.
23397..............  Muscle transfers..........  ..................  T.................         0052      79.4244    $5,058.86  ...........    $1,011.77
23400..............  Fixation of shoulder blade  ..................  T.................         0050      29.1900    $1,859.23  ...........      $371.85
23405..............  Incision of tendon &        ..................  T.................         0050      29.1900    $1,859.23  ...........      $371.85
                      muscle.
23406..............  Incise tendon(s) &          ..................  T.................         0050      29.1900    $1,859.23  ...........      $371.85
                      muscle(s).
23410..............  Repair rotator cuff, acute  ..................  T.................         0051      42.9850    $2,737.89  ...........      $547.58
23412..............  Repair rotator cuff,        ..................  T.................         0051      42.9850    $2,737.89  ...........      $547.58
                      chronic.
23415..............  Release of shoulder         ..................  T.................         0051      42.9850    $2,737.89  ...........      $547.58
                      ligament.
23420..............  Repair of shoulder........  ..................  T.................         0051      42.9850    $2,737.89  ...........      $547.58
23430..............  Repair biceps tendon......  ..................  T.................         0051      42.9850    $2,737.89  ...........      $547.58
23440..............  Remove/transplant tendon..  ..................  T.................         0051      42.9850    $2,737.89  ...........      $547.58
23450..............  Repair shoulder capsule...  ..................  T.................         0052      79.4244    $5,058.86  ...........    $1,011.77
23455..............  Repair shoulder capsule...  ..................  T.................         0052      79.4244    $5,058.86  ...........    $1,011.77
23460..............  Repair shoulder capsule...  ..................  T.................         0052      79.4244    $5,058.86  ...........    $1,011.77
23462..............  Repair shoulder capsule...  ..................  T.................         0051      42.9850    $2,737.89  ...........      $547.58
23465..............  Repair shoulder capsule...  ..................  T.................         0052      79.4244    $5,058.86  ...........    $1,011.77
23466..............  Repair shoulder capsule...  ..................  T.................         0051      42.9850    $2,737.89  ...........      $547.58
23470..............  Reconstruct shoulder joint  ..................  T.................         0425     122.2057    $7,783.77  ...........    $1,556.75
23472..............  Reconstruct shoulder joint  ..................  C.................  ...........  ...........  ...........  ...........  ...........
23480..............  Revision of collar bone...  ..................  T.................         0051      42.9850    $2,737.89  ...........      $547.58
23485..............  Revision of collar bone...  ..................  T.................         0052      79.4244    $5,058.86  ...........    $1,011.77
23490..............  Reinforce clavicle........  ..................  T.................         0051      42.9850    $2,737.89  ...........      $547.58
23491..............  Reinforce shoulder bones..  ..................  T.................         0052      79.4244    $5,058.86  ...........    $1,011.77
23500..............  Treat clavicle fracture...  ..................  T.................         0043       1.7682      $112.62  ...........       $22.52
23505..............  Treat clavicle fracture...  ..................  T.................         0043       1.7682      $112.62  ...........       $22.52
23515..............  Treat clavicle fracture...  ..................  T.................         0064      59.2233    $3,772.17      $835.79      $754.43
23520..............  Treat clavicle dislocation  ..................  T.................         0043       1.7682      $112.62  ...........       $22.52
23525..............  Treat clavicle dislocation  ..................  T.................         0043       1.7682      $112.62  ...........       $22.52
23530..............  Treat clavicle dislocation  ..................  T.................         0063      41.1091    $2,618.40      $548.33      $523.68
23532..............  Treat clavicle dislocation  ..................  T.................         0062      26.1592    $1,666.18      $372.87      $333.24
23540..............  Treat clavicle dislocation  ..................  T.................         0043       1.7682      $112.62  ...........       $22.52
23545..............  Treat clavicle dislocation  ..................  T.................         0043       1.7682      $112.62  ...........       $22.52
23550..............  Treat clavicle dislocation  ..................  T.................         0063      41.1091    $2,618.40      $548.33      $523.68
23552..............  Treat clavicle dislocation  ..................  T.................         0063      41.1091    $2,618.40      $548.33      $523.68
23570..............  Treat shoulder blade fx...  ..................  T.................         0043       1.7682      $112.62  ...........       $22.52
23575..............  Treat shoulder blade fx...  ..................  T.................         0043       1.7682      $112.62  ...........       $22.52
23585..............  Treat scapula fracture....  ..................  T.................         0064      59.2233    $3,772.17      $835.79      $754.43

[[Page 67010]]

 
23600..............  Treat humerus fracture....  ..................  T.................         0043       1.7682      $112.62  ...........       $22.52
23605..............  Treat humerus fracture....  ..................  T.................         0043       1.7682      $112.62  ...........       $22.52
23615..............  Treat humerus fracture....  ..................  T.................         0064      59.2233    $3,772.17      $835.79      $754.43
23616..............  Treat humerus fracture....  ..................  T.................         0064      59.2233    $3,772.17      $835.79      $754.43
23620..............  Treat humerus fracture....  ..................  T.................         0043       1.7682      $112.62  ...........       $22.52
23625..............  Treat humerus fracture....  ..................  T.................         0043       1.7682      $112.62  ...........       $22.52
23630..............  Treat humerus fracture....  ..................  T.................         0064      59.2233    $3,772.17      $835.79      $754.43
23650..............  Treat shoulder dislocation  ..................  T.................         0043       1.7682      $112.62  ...........       $22.52
23655..............  Treat shoulder dislocation  ..................  T.................         0045      14.7658      $940.49      $268.47      $188.10
23660..............  Treat shoulder dislocation  ..................  T.................         0063      41.1091    $2,618.40      $548.33      $523.68
23665..............  Treat dislocation/fracture  ..................  T.................         0043       1.7682      $112.62  ...........       $22.52
23670..............  Treat dislocation/fracture  ..................  T.................         0064      59.2233    $3,772.17      $835.79      $754.43
23675..............  Treat dislocation/fracture  ..................  T.................         0043       1.7682      $112.62  ...........       $22.52
23680..............  Treat dislocation/fracture  ..................  T.................         0063      41.1091    $2,618.40      $548.33      $523.68
23700..............  Fixation of shoulder......  ..................  T.................         0045      14.7658      $940.49      $268.47      $188.10
23800..............  Fusion of shoulder joint..  ..................  T.................         0052      79.4244    $5,058.86  ...........    $1,011.77
23802..............  Fusion of shoulder joint..  ..................  T.................         0051      42.9850    $2,737.89  ...........      $547.58
23900..............  Amputation of arm & girdle  ..................  C.................  ...........  ...........  ...........  ...........  ...........
23920..............  Amputation at shoulder      ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      joint.
23921..............  Amputation follow-up        CH................  T.................         0136      15.0458      $958.33  ...........      $191.67
                      surgery.
23929..............  Shoulder surgery procedure  ..................  T.................         0043       1.7682      $112.62  ...........       $22.52
23930..............  Drainage of arm lesion....  ..................  T.................         0008      18.3197    $1,166.85  ...........      $233.37
23931..............  Drainage of arm bursa.....  ..................  T.................         0008      18.3197    $1,166.85  ...........      $233.37
23935..............  Drain arm/elbow bone        ..................  T.................         0049      21.2689    $1,354.70  ...........      $270.94
                      lesion.
24000..............  Exploratory elbow surgery.  ..................  T.................         0050      29.1900    $1,859.23  ...........      $371.85
24006..............  Release elbow joint.......  ..................  T.................         0050      29.1900    $1,859.23  ...........      $371.85
24065..............  Biopsy arm/elbow soft       ..................  T.................         0021      16.1001    $1,025.48      $219.48      $205.10
                      tissue.
24066..............  Biopsy arm/elbow soft       ..................  T.................         0021      16.1001    $1,025.48      $219.48      $205.10
                      tissue.
24075..............  Remove arm/elbow lesion...  ..................  T.................         0021      16.1001    $1,025.48      $219.48      $205.10
24076..............  Remove arm/elbow lesion...  ..................  T.................         0022      21.1098    $1,344.57      $354.45      $268.91
24077..............  Remove tumor of arm/elbow.  ..................  T.................         0022      21.1098    $1,344.57      $354.45      $268.91
24100..............  Biopsy elbow joint lining.  ..................  T.................         0049      21.2689    $1,354.70  ...........      $270.94
24101..............  Explore/treat elbow joint.  ..................  T.................         0050      29.1900    $1,859.23  ...........      $371.85
24102..............  Remove elbow joint lining.  ..................  T.................         0050      29.1900    $1,859.23  ...........      $371.85
24105..............  Removal of elbow bursa....  ..................  T.................         0049      21.2689    $1,354.70  ...........      $270.94
24110..............  Remove humerus lesion.....  ..................  T.................         0049      21.2689    $1,354.70  ...........      $270.94
24115..............  Remove/graft bone lesion..  ..................  T.................         0050      29.1900    $1,859.23  ...........      $371.85
24116..............  Remove/graft bone lesion..  ..................  T.................         0050      29.1900    $1,859.23  ...........      $371.85
24120..............  Remove elbow lesion.......  ..................  T.................         0049      21.2689    $1,354.70  ...........      $270.94
24125..............  Remove/graft bone lesion..  ..................  T.................         0050      29.1900    $1,859.23  ...........      $371.85
24126..............  Remove/graft bone lesion..  ..................  T.................         0050      29.1900    $1,859.23  ...........      $371.85
24130..............  Removal of head of radius.  ..................  T.................         0050      29.1900    $1,859.23  ...........      $371.85
24134..............  Removal of arm bone lesion  ..................  T.................         0050      29.1900    $1,859.23  ...........      $371.85
24136..............  Remove radius bone lesion.  ..................  T.................         0050      29.1900    $1,859.23  ...........      $371.85
24138..............  Remove elbow bone lesion..  ..................  T.................         0050      29.1900    $1,859.23  ...........      $371.85
24140..............  Partial removal of arm      ..................  T.................         0050      29.1900    $1,859.23  ...........      $371.85
                      bone.
24145..............  Partial removal of radius.  ..................  T.................         0050      29.1900    $1,859.23  ...........      $371.85
24147..............  Partial removal of elbow..  ..................  T.................         0050      29.1900    $1,859.23  ...........      $371.85
24149..............  Radical resection of elbow  ..................  T.................         0050      29.1900    $1,859.23  ...........      $371.85
24150..............  Extensive humerus surgery.  ..................  T.................         0051      42.9850    $2,737.89  ...........      $547.58
24151..............  Extensive humerus surgery.  ..................  T.................         0052      79.4244    $5,058.86  ...........    $1,011.77
24152..............  Extensive radius surgery..  ..................  T.................         0051      42.9850    $2,737.89  ...........      $547.58
24153..............  Extensive radius surgery..  ..................  T.................         0052      79.4244    $5,058.86  ...........    $1,011.77
24155..............  Removal of elbow joint....  ..................  T.................         0051      42.9850    $2,737.89  ...........      $547.58
24160..............  Remove elbow joint implant  ..................  T.................         0050      29.1900    $1,859.23  ...........      $371.85
24164..............  Remove radius head implant  ..................  T.................         0050      29.1900    $1,859.23  ...........      $371.85
24200..............  Removal of arm foreign      ..................  T.................         0019       4.3039      $274.13       $71.87       $54.83
                      body.
24201..............  Removal of arm foreign      ..................  T.................         0021      16.1001    $1,025.48      $219.48      $205.10
                      body.
24220..............  Injection for elbow x-ray.  ..................  N.................  ...........  ...........  ...........  ...........  ...........
24300..............  Manipulate elbow w/anesth.  ..................  T.................         0045      14.7658      $940.49      $268.47      $188.10
24301..............  Muscle/tendon transfer....  ..................  T.................         0050      29.1900    $1,859.23  ...........      $371.85
24305..............  Arm tendon lengthening....  ..................  T.................         0050      29.1900    $1,859.23  ...........      $371.85
24310..............  Revision of arm tendon....  ..................  T.................         0049      21.2689    $1,354.70  ...........      $270.94
24320..............  Repair of arm tendon......  ..................  T.................         0051      42.9850    $2,737.89  ...........      $547.58
24330..............  Revision of arm muscles...  ..................  T.................         0052      79.4244    $5,058.86  ...........    $1,011.77
24331..............  Revision of arm muscles...  ..................  T.................         0051      42.9850    $2,737.89  ...........      $547.58
24332..............  Tenolysis, triceps........  ..................  T.................         0049      21.2689    $1,354.70  ...........      $270.94
24340..............  Repair of biceps tendon...  ..................  T.................         0051      42.9850    $2,737.89  ...........      $547.58
24341..............  Repair arm tendon/muscle..  ..................  T.................         0051      42.9850    $2,737.89  ...........      $547.58
24342..............  Repair of ruptured tendon.  ..................  T.................         0051      42.9850    $2,737.89  ...........      $547.58
24343..............  Repr elbow lat ligmnt w/    ..................  T.................         0050      29.1900    $1,859.23  ...........      $371.85
                      tiss.
24344..............  Reconstruct elbow lat       ..................  T.................         0052      79.4244    $5,058.86  ...........    $1,011.77
                      ligmnt.
24345..............  Repr elbw med ligmnt w/     ..................  T.................         0050      29.1900    $1,859.23  ...........      $371.85
                      tissu.
24346..............  Reconstruct elbow med       ..................  T.................         0051      42.9850    $2,737.89  ...........      $547.58
                      ligmnt.
24350..............  Repair of tennis elbow....  CH................  D.................  ...........  ...........  ...........  ...........  ...........
24351..............  Repair of tennis elbow....  CH................  D.................  ...........  ...........  ...........  ...........  ...........
24352..............  Repair of tennis elbow....  CH................  D.................  ...........  ...........  ...........  ...........  ...........
24354..............  Repair of tennis elbow....  CH................  D.................  ...........  ...........  ...........  ...........  ...........
24356..............  Revision of tennis elbow..  CH................  D.................  ...........  ...........  ...........  ...........  ...........
24357..............  Repair elbow, perc........  NI................  T.................         0050      29.1900    $1,859.23  ...........      $371.85

[[Page 67011]]

 
24358..............  Repair elbow w/deb, open..  NI................  T.................         0050      29.1900    $1,859.23  ...........      $371.85
24359..............  Repair elbow deb/attch      NI................  T.................         0050      29.1900    $1,859.23  ...........      $371.85
                      open.
24360..............  Reconstruct elbow joint...  ..................  T.................         0047      35.9040    $2,286.87      $537.03      $457.37
24361..............  Reconstruct elbow joint...  ..................  T.................         0425     122.2057    $7,783.77  ...........    $1,556.75
24362..............  Reconstruct elbow joint...  ..................  T.................         0048      50.8876    $3,241.23  ...........      $648.25
24363..............  Replace elbow joint.......  ..................  T.................         0425     122.2057    $7,783.77  ...........    $1,556.75
24365..............  Reconstruct head of radius  ..................  T.................         0047      35.9040    $2,286.87      $537.03      $457.37
24366..............  Reconstruct head of radius  ..................  T.................         0425     122.2057    $7,783.77  ...........    $1,556.75
24400..............  Revision of humerus.......  ..................  T.................         0050      29.1900    $1,859.23  ...........      $371.85
24410..............  Revision of humerus.......  ..................  T.................         0050      29.1900    $1,859.23  ...........      $371.85
24420..............  Revision of humerus.......  ..................  T.................         0051      42.9850    $2,737.89  ...........      $547.58
24430..............  Repair of humerus.........  ..................  T.................         0052      79.4244    $5,058.86  ...........    $1,011.77
24435..............  Repair humerus with graft.  ..................  T.................         0052      79.4244    $5,058.86  ...........    $1,011.77
24470..............  Revision of elbow joint...  ..................  T.................         0051      42.9850    $2,737.89  ...........      $547.58
24495..............  Decompression of forearm..  ..................  T.................         0050      29.1900    $1,859.23  ...........      $371.85
24498..............  Reinforce humerus.........  ..................  T.................         0052      79.4244    $5,058.86  ...........    $1,011.77
24500..............  Treat humerus fracture....  ..................  T.................         0043       1.7682      $112.62  ...........       $22.52
24505..............  Treat humerus fracture....  ..................  T.................         0043       1.7682      $112.62  ...........       $22.52
24515..............  Treat humerus fracture....  ..................  T.................         0064      59.2233    $3,772.17      $835.79      $754.43
24516..............  Treat humerus fracture....  ..................  T.................         0064      59.2233    $3,772.17      $835.79      $754.43
24530..............  Treat humerus fracture....  ..................  T.................         0043       1.7682      $112.62  ...........       $22.52
24535..............  Treat humerus fracture....  ..................  T.................         0043       1.7682      $112.62  ...........       $22.52
24538..............  Treat humerus fracture....  ..................  T.................         0062      26.1592    $1,666.18      $372.87      $333.24
24545..............  Treat humerus fracture....  ..................  T.................         0064      59.2233    $3,772.17      $835.79      $754.43
24546..............  Treat humerus fracture....  ..................  T.................         0064      59.2233    $3,772.17      $835.79      $754.43
24560..............  Treat humerus fracture....  ..................  T.................         0043       1.7682      $112.62  ...........       $22.52
24565..............  Treat humerus fracture....  ..................  T.................         0043       1.7682      $112.62  ...........       $22.52
24566..............  Treat humerus fracture....  ..................  T.................         0062      26.1592    $1,666.18      $372.87      $333.24
24575..............  Treat humerus fracture....  ..................  T.................         0064      59.2233    $3,772.17      $835.79      $754.43
24576..............  Treat humerus fracture....  ..................  T.................         0043       1.7682      $112.62  ...........       $22.52
24577..............  Treat humerus fracture....  ..................  T.................         0043       1.7682      $112.62  ...........       $22.52
24579..............  Treat humerus fracture....  ..................  T.................         0064      59.2233    $3,772.17      $835.79      $754.43
24582..............  Treat humerus fracture....  ..................  T.................         0062      26.1592    $1,666.18      $372.87      $333.24
24586..............  Treat elbow fracture......  ..................  T.................         0064      59.2233    $3,772.17      $835.79      $754.43
24587..............  Treat elbow fracture......  ..................  T.................         0064      59.2233    $3,772.17      $835.79      $754.43
24600..............  Treat elbow dislocation...  ..................  T.................         0043       1.7682      $112.62  ...........       $22.52
24605..............  Treat elbow dislocation...  ..................  T.................         0045      14.7658      $940.49      $268.47      $188.10
24615..............  Treat elbow dislocation...  ..................  T.................         0064      59.2233    $3,772.17      $835.79      $754.43
24620..............  Treat elbow fracture......  ..................  T.................         0043       1.7682      $112.62  ...........       $22.52
24635..............  Treat elbow fracture......  ..................  T.................         0064      59.2233    $3,772.17      $835.79      $754.43
24640..............  Treat elbow dislocation...  ..................  T.................         0043       1.7682      $112.62  ...........       $22.52
24650..............  Treat radius fracture.....  ..................  T.................         0043       1.7682      $112.62  ...........       $22.52
24655..............  Treat radius fracture.....  ..................  T.................         0043       1.7682      $112.62  ...........       $22.52
24665..............  Treat radius fracture.....  ..................  T.................         0063      41.1091    $2,618.40      $548.33      $523.68
24666..............  Treat radius fracture.....  ..................  T.................         0064      59.2233    $3,772.17      $835.79      $754.43
24670..............  Treat ulnar fracture......  ..................  T.................         0043       1.7682      $112.62  ...........       $22.52
24675..............  Treat ulnar fracture......  ..................  T.................         0043       1.7682      $112.62  ...........       $22.52
24685..............  Treat ulnar fracture......  ..................  T.................         0063      41.1091    $2,618.40      $548.33      $523.68
24800..............  Fusion of elbow joint.....  ..................  T.................         0051      42.9850    $2,737.89  ...........      $547.58
24802..............  Fusion/graft of elbow       ..................  T.................         0051      42.9850    $2,737.89  ...........      $547.58
                      joint.
24900..............  Amputation of upper arm...  ..................  C.................  ...........  ...........  ...........  ...........  ...........
24920..............  Amputation of upper arm...  ..................  C.................  ...........  ...........  ...........  ...........  ...........
24925..............  Amputation follow-up        ..................  T.................         0049      21.2689    $1,354.70  ...........      $270.94
                      surgery.
24930..............  Amputation follow-up        ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      surgery.
24931..............  Amputate upper arm &        ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      implant.
24935..............  Revision of amputation....  ..................  T.................         0052      79.4244    $5,058.86  ...........    $1,011.77
24940..............  Revision of upper arm.....  ..................  C.................  ...........  ...........  ...........  ...........  ...........
24999..............  Upper arm/elbow surgery...  ..................  T.................         0043       1.7682      $112.62  ...........       $22.52
25000..............  Incision of tendon sheath.  ..................  T.................         0049      21.2689    $1,354.70  ...........      $270.94
25001..............  Incise flexor carpi         ..................  T.................         0049      21.2689    $1,354.70  ...........      $270.94
                      radialis.
25020..............  Decompress forearm 1 space  ..................  T.................         0049      21.2689    $1,354.70  ...........      $270.94
25023..............  Decompress forearm 1 space  ..................  T.................         0050      29.1900    $1,859.23  ...........      $371.85
25024..............  Decompress forearm 2        ..................  T.................         0050      29.1900    $1,859.23  ...........      $371.85
                      spaces.
25025..............  Decompress forearm 2        ..................  T.................         0050      29.1900    $1,859.23  ...........      $371.85
                      spaces.
25028..............  Drainage of forearm lesion  ..................  T.................         0049      21.2689    $1,354.70  ...........      $270.94
25031..............  Drainage of forearm bursa.  ..................  T.................         0049      21.2689    $1,354.70  ...........      $270.94
25035..............  Treat forearm bone lesion.  ..................  T.................         0049      21.2689    $1,354.70  ...........      $270.94
25040..............  Explore/treat wrist joint.  ..................  T.................         0050      29.1900    $1,859.23  ...........      $371.85
25065..............  Biopsy forearm soft         ..................  T.................         0020       8.6850      $553.18  ...........      $110.64
                      tissues.
25066..............  Biopsy forearm soft         ..................  T.................         0022      21.1098    $1,344.57      $354.45      $268.91
                      tissues.
25075..............  Removal forearm lesion      ..................  T.................         0021      16.1001    $1,025.48      $219.48      $205.10
                      subcu.
25076..............  Removal forearm lesion      ..................  T.................         0022      21.1098    $1,344.57      $354.45      $268.91
                      deep.
25077..............  Remove tumor, forearm/      ..................  T.................         0022      21.1098    $1,344.57      $354.45      $268.91
                      wrist.
25085..............  Incision of wrist capsule.  ..................  T.................         0049      21.2689    $1,354.70  ...........      $270.94
25100..............  Biopsy of wrist joint.....  ..................  T.................         0049      21.2689    $1,354.70  ...........      $270.94
25101..............  Explore/treat wrist joint.  ..................  T.................         0050      29.1900    $1,859.23  ...........      $371.85
25105..............  Remove wrist joint lining.  ..................  T.................         0050      29.1900    $1,859.23  ...........      $371.85
25107..............  Remove wrist joint          ..................  T.................         0050      29.1900    $1,859.23  ...........      $371.85
                      cartilage.
25109..............  Excise tendon forearm/      ..................  T.................         0049      21.2689    $1,354.70  ...........      $270.94
                      wrist.
25110..............  Remove wrist tendon lesion  ..................  T.................         0049      21.2689    $1,354.70  ...........      $270.94

[[Page 67012]]

 
25111..............  Remove wrist tendon lesion  ..................  T.................         0053      16.4637    $1,048.64      $253.49      $209.73
25112..............  Reremove wrist tendon       ..................  T.................         0053      16.4637    $1,048.64      $253.49      $209.73
                      lesion.
25115..............  Remove wrist/forearm        ..................  T.................         0049      21.2689    $1,354.70  ...........      $270.94
                      lesion.
25116..............  Remove wrist/forearm        ..................  T.................         0049      21.2689    $1,354.70  ...........      $270.94
                      lesion.
25118..............  Excise wrist tendon sheath  ..................  T.................         0050      29.1900    $1,859.23  ...........      $371.85
25119..............  Partial removal of ulna...  ..................  T.................         0050      29.1900    $1,859.23  ...........      $371.85
25120..............  Removal of forearm lesion.  ..................  T.................         0050      29.1900    $1,859.23  ...........      $371.85
25125..............  Remove/graft forearm        ..................  T.................         0050      29.1900    $1,859.23  ...........      $371.85
                      lesion.
25126..............  Remove/graft forearm        ..................  T.................         0050      29.1900    $1,859.23  ...........      $371.85
                      lesion.
25130..............  Removal of wrist lesion...  ..................  T.................         0050      29.1900    $1,859.23  ...........      $371.85
25135..............  Remove & graft wrist        ..................  T.................         0050      29.1900    $1,859.23  ...........      $371.85
                      lesion.
25136..............  Remove & graft wrist        ..................  T.................         0050      29.1900    $1,859.23  ...........      $371.85
                      lesion.
25145..............  Remove forearm bone lesion  ..................  T.................         0050      29.1900    $1,859.23  ...........      $371.85
25150..............  Partial removal of ulna...  ..................  T.................         0050      29.1900    $1,859.23  ...........      $371.85
25151..............  Partial removal of radius.  ..................  T.................         0050      29.1900    $1,859.23  ...........      $371.85
25170..............  Extensive forearm surgery.  ..................  T.................         0051      42.9850    $2,737.89  ...........      $547.58
25210..............  Removal of wrist bone.....  ..................  T.................         0054      26.3105    $1,675.82  ...........      $335.16
25215..............  Removal of wrist bones....  ..................  T.................         0054      26.3105    $1,675.82  ...........      $335.16
25230..............  Partial removal of radius.  ..................  T.................         0050      29.1900    $1,859.23  ...........      $371.85
25240..............  Partial removal of ulna...  ..................  T.................         0050      29.1900    $1,859.23  ...........      $371.85
25246..............  Injection for wrist x-ray.  ..................  N.................  ...........  ...........  ...........  ...........  ...........
25248..............  Remove forearm foreign      ..................  T.................         0049      21.2689    $1,354.70  ...........      $270.94
                      body.
25250..............  Removal of wrist            ..................  T.................         0050      29.1900    $1,859.23  ...........      $371.85
                      prosthesis.
25251..............  Removal of wrist            ..................  T.................         0050      29.1900    $1,859.23  ...........      $371.85
                      prosthesis.
25259..............  Manipulate wrist w/         ..................  T.................         0043       1.7682      $112.62  ...........       $22.52
                      anesthes.
25260..............  Repair forearm tendon/      ..................  T.................         0050      29.1900    $1,859.23  ...........      $371.85
                      muscle.
25263..............  Repair forearm tendon/      ..................  T.................         0050      29.1900    $1,859.23  ...........      $371.85
                      muscle.
25265..............  Repair forearm tendon/      ..................  T.................         0050      29.1900    $1,859.23  ...........      $371.85
                      muscle.
25270..............  Repair forearm tendon/      ..................  T.................         0050      29.1900    $1,859.23  ...........      $371.85
                      muscle.
25272..............  Repair forearm tendon/      ..................  T.................         0050      29.1900    $1,859.23  ...........      $371.85
                      muscle.
25274..............  Repair forearm tendon/      ..................  T.................         0050      29.1900    $1,859.23  ...........      $371.85
                      muscle.
25275..............  Repair forearm tendon       ..................  T.................         0050      29.1900    $1,859.23  ...........      $371.85
                      sheath.
25280..............  Revise wrist/forearm        ..................  T.................         0050      29.1900    $1,859.23  ...........      $371.85
                      tendon.
25290..............  Incise wrist/forearm        ..................  T.................         0050      29.1900    $1,859.23  ...........      $371.85
                      tendon.
25295..............  Release wrist/forearm       ..................  T.................         0049      21.2689    $1,354.70  ...........      $270.94
                      tendon.
25300..............  Fusion of tendons at wrist  ..................  T.................         0050      29.1900    $1,859.23  ...........      $371.85
25301..............  Fusion of tendons at wrist  ..................  T.................         0050      29.1900    $1,859.23  ...........      $371.85
25310..............  Transplant forearm tendon.  ..................  T.................         0051      42.9850    $2,737.89  ...........      $547.58
25312..............  Transplant forearm tendon.  ..................  T.................         0051      42.9850    $2,737.89  ...........      $547.58
25315..............  Revise palsy hand           ..................  T.................         0051      42.9850    $2,737.89  ...........      $547.58
                      tendon(s).
25316..............  Revise palsy hand           ..................  T.................         0052      79.4244    $5,058.86  ...........    $1,011.77
                      tendon(s).
25320..............  Repair/revise wrist joint.  ..................  T.................         0051      42.9850    $2,737.89  ...........      $547.58
25332..............  Revise wrist joint........  ..................  T.................         0047      35.9040    $2,286.87      $537.03      $457.37
25335..............  Realignment of hand.......  ..................  T.................         0051      42.9850    $2,737.89  ...........      $547.58
25337..............  Reconstruct ulna/           ..................  T.................         0051      42.9850    $2,737.89  ...........      $547.58
                      radioulnar.
25350..............  Revision of radius........  ..................  T.................         0052      79.4244    $5,058.86  ...........    $1,011.77
25355..............  Revision of radius........  ..................  T.................         0051      42.9850    $2,737.89  ...........      $547.58
25360..............  Revision of ulna..........  ..................  T.................         0050      29.1900    $1,859.23  ...........      $371.85
25365..............  Revise radius & ulna......  ..................  T.................         0050      29.1900    $1,859.23  ...........      $371.85
25370..............  Revise radius or ulna.....  ..................  T.................         0051      42.9850    $2,737.89  ...........      $547.58
25375..............  Revise radius & ulna......  ..................  T.................         0051      42.9850    $2,737.89  ...........      $547.58
25390..............  Shorten radius or ulna....  ..................  T.................         0050      29.1900    $1,859.23  ...........      $371.85
25391..............  Lengthen radius or ulna...  ..................  T.................         0051      42.9850    $2,737.89  ...........      $547.58
25392..............  Shorten radius & ulna.....  ..................  T.................         0050      29.1900    $1,859.23  ...........      $371.85
25393..............  Lengthen radius & ulna....  ..................  T.................         0051      42.9850    $2,737.89  ...........      $547.58
25394..............  Repair carpal bone,         ..................  T.................         0053      16.4637    $1,048.64      $253.49      $209.73
                      shorten.
25400..............  Repair radius or ulna.....  CH................  T.................         0052      79.4244    $5,058.86  ...........    $1,011.77
25405..............  Repair/graft radius or      CH................  T.................         0052      79.4244    $5,058.86  ...........    $1,011.77
                      ulna.
25415..............  Repair radius & ulna......  CH................  T.................         0052      79.4244    $5,058.86  ...........    $1,011.77
25420..............  Repair/graft radius & ulna  ..................  T.................         0052      79.4244    $5,058.86  ...........    $1,011.77
25425..............  Repair/graft radius or      ..................  T.................         0051      42.9850    $2,737.89  ...........      $547.58
                      ulna.
25426..............  Repair/graft radius & ulna  ..................  T.................         0051      42.9850    $2,737.89  ...........      $547.58
25430..............  Vasc graft into carpal      ..................  T.................         0054      26.3105    $1,675.82  ...........      $335.16
                      bone.
25431..............  Repair nonunion carpal      ..................  T.................         0054      26.3105    $1,675.82  ...........      $335.16
                      bone.
25440..............  Repair/graft wrist bone...  ..................  T.................         0052      79.4244    $5,058.86  ...........    $1,011.77
25441..............  Reconstruct wrist joint...  ..................  T.................         0425     122.2057    $7,783.77  ...........    $1,556.75
25442..............  Reconstruct wrist joint...  ..................  T.................         0425     122.2057    $7,783.77  ...........    $1,556.75
25443..............  Reconstruct wrist joint...  ..................  T.................         0048      50.8876    $3,241.23  ...........      $648.25
25444..............  Reconstruct wrist joint...  ..................  T.................         0048      50.8876    $3,241.23  ...........      $648.25
25445..............  Reconstruct wrist joint...  ..................  T.................         0048      50.8876    $3,241.23  ...........      $648.25
25446..............  Wrist replacement.........  ..................  T.................         0425     122.2057    $7,783.77  ...........    $1,556.75
25447..............  Repair wrist joint(s).....  ..................  T.................         0047      35.9040    $2,286.87      $537.03      $457.37
25449..............  Remove wrist joint implant  ..................  T.................         0047      35.9040    $2,286.87      $537.03      $457.37
25450..............  Revision of wrist joint...  ..................  T.................         0051      42.9850    $2,737.89  ...........      $547.58
25455..............  Revision of wrist joint...  ..................  T.................         0051      42.9850    $2,737.89  ...........      $547.58
25490..............  Reinforce radius..........  ..................  T.................         0051      42.9850    $2,737.89  ...........      $547.58
25491..............  Reinforce ulna............  ..................  T.................         0051      42.9850    $2,737.89  ...........      $547.58
25492..............  Reinforce radius and ulna.  ..................  T.................         0051      42.9850    $2,737.89  ...........      $547.58
25500..............  Treat fracture of radius..  ..................  T.................         0043       1.7682      $112.62  ...........       $22.52
25505..............  Treat fracture of radius..  ..................  T.................         0043       1.7682      $112.62  ...........       $22.52

[[Page 67013]]

 
25515..............  Treat fracture of radius..  ..................  T.................         0063      41.1091    $2,618.40      $548.33      $523.68
25520..............  Treat fracture of radius..  ..................  T.................         0043       1.7682      $112.62  ...........       $22.52
25525..............  Treat fracture of radius..  ..................  T.................         0063      41.1091    $2,618.40      $548.33      $523.68
25526..............  Treat fracture of radius..  ..................  T.................         0063      41.1091    $2,618.40      $548.33      $523.68
25530..............  Treat fracture of ulna....  ..................  T.................         0043       1.7682      $112.62  ...........       $22.52
25535..............  Treat fracture of ulna....  ..................  T.................         0043       1.7682      $112.62  ...........       $22.52
25545..............  Treat fracture of ulna....  ..................  T.................         0063      41.1091    $2,618.40      $548.33      $523.68
25560..............  Treat fracture radius &     ..................  T.................         0043       1.7682      $112.62  ...........       $22.52
                      ulna.
25565..............  Treat fracture radius &     ..................  T.................         0043       1.7682      $112.62  ...........       $22.52
                      ulna.
25574..............  Treat fracture radius &     ..................  T.................         0064      59.2233    $3,772.17      $835.79      $754.43
                      ulna.
25575..............  Treat fracture radius/ulna  ..................  T.................         0064      59.2233    $3,772.17      $835.79      $754.43
25600..............  Treat fracture radius/ulna  ..................  T.................         0043       1.7682      $112.62  ...........       $22.52
25605..............  Treat fracture radius/ulna  ..................  T.................         0043       1.7682      $112.62  ...........       $22.52
25606..............  Treat fx distal radial....  ..................  T.................         0062      26.1592    $1,666.18      $372.87      $333.24
25607..............  Treat fx rad extra-articul  ..................  T.................         0064      59.2233    $3,772.17      $835.79      $754.43
25608..............  Treat fx rad intra-articul  ..................  T.................         0064      59.2233    $3,772.17      $835.79      $754.43
25609..............  Treat fx radial 3+ frag...  ..................  T.................         0064      59.2233    $3,772.17      $835.79      $754.43
25622..............  Treat wrist bone fracture.  ..................  T.................         0043       1.7682      $112.62  ...........       $22.52
25624..............  Treat wrist bone fracture.  ..................  T.................         0043       1.7682      $112.62  ...........       $22.52
25628..............  Treat wrist bone fracture.  ..................  T.................         0063      41.1091    $2,618.40      $548.33      $523.68
25630..............  Treat wrist bone fracture.  ..................  T.................         0043       1.7682      $112.62  ...........       $22.52
25635..............  Treat wrist bone fracture.  ..................  T.................         0043       1.7682      $112.62  ...........       $22.52
25645..............  Treat wrist bone fracture.  ..................  T.................         0063      41.1091    $2,618.40      $548.33      $523.68
25650..............  Treat wrist bone fracture.  ..................  T.................         0043       1.7682      $112.62  ...........       $22.52
25651..............  Pin ulnar styloid fracture  ..................  T.................         0062      26.1592    $1,666.18      $372.87      $333.24
25652..............  Treat fracture ulnar        ..................  T.................         0063      41.1091    $2,618.40      $548.33      $523.68
                      styloid.
25660..............  Treat wrist dislocation...  ..................  T.................         0043       1.7682      $112.62  ...........       $22.52
25670..............  Treat wrist dislocation...  ..................  T.................         0062      26.1592    $1,666.18      $372.87      $333.24
25671..............  Pin radioulnar dislocation  ..................  T.................         0062      26.1592    $1,666.18      $372.87      $333.24
25675..............  Treat wrist dislocation...  ..................  T.................         0043       1.7682      $112.62  ...........       $22.52
25676..............  Treat wrist dislocation...  ..................  T.................         0062      26.1592    $1,666.18      $372.87      $333.24
25680..............  Treat wrist fracture......  ..................  T.................         0043       1.7682      $112.62  ...........       $22.52
25685..............  Treat wrist fracture......  ..................  T.................         0062      26.1592    $1,666.18      $372.87      $333.24
25690..............  Treat wrist dislocation...  ..................  T.................         0043       1.7682      $112.62  ...........       $22.52
25695..............  Treat wrist dislocation...  ..................  T.................         0062      26.1592    $1,666.18      $372.87      $333.24
25800..............  Fusion of wrist joint.....  ..................  T.................         0052      79.4244    $5,058.86  ...........    $1,011.77
25805..............  Fusion/graft of wrist       ..................  T.................         0051      42.9850    $2,737.89  ...........      $547.58
                      joint.
25810..............  Fusion/graft of wrist       ..................  T.................         0052      79.4244    $5,058.86  ...........    $1,011.77
                      joint.
25820..............  Fusion of hand bones......  ..................  T.................         0053      16.4637    $1,048.64      $253.49      $209.73
25825..............  Fuse hand bones with graft  CH................  T.................         0052      79.4244    $5,058.86  ...........    $1,011.77
25830..............  Fusion, radioulnar jnt/     ..................  T.................         0052      79.4244    $5,058.86  ...........    $1,011.77
                      ulna.
25900..............  Amputation of forearm.....  ..................  C.................  ...........  ...........  ...........  ...........  ...........
25905..............  Amputation of forearm.....  ..................  C.................  ...........  ...........  ...........  ...........  ...........
25907..............  Amputation follow-up        ..................  T.................         0049      21.2689    $1,354.70  ...........      $270.94
                      surgery.
25909..............  Amputation follow-up        ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      surgery.
25915..............  Amputation of forearm.....  ..................  C.................  ...........  ...........  ...........  ...........  ...........
25920..............  Amputate hand at wrist....  ..................  C.................  ...........  ...........  ...........  ...........  ...........
25922..............  Amputate hand at wrist....  ..................  T.................         0049      21.2689    $1,354.70  ...........      $270.94
25924..............  Amputation follow-up        ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      surgery.
25927..............  Amputation of hand........  ..................  C.................  ...........  ...........  ...........  ...........  ...........
25929..............  Amputation follow-up        CH................  T.................         0136      15.0458      $958.33  ...........      $191.67
                      surgery.
25931..............  Amputation follow-up        CH................  T.................         0049      21.2689    $1,354.70  ...........      $270.94
                      surgery.
25999..............  Forearm or wrist surgery..  ..................  T.................         0043       1.7682      $112.62  ...........       $22.52
26010..............  Drainage of finger abscess  ..................  T.................         0006       1.4066       $89.59  ...........       $17.92
26011..............  Drainage of finger abscess  ..................  T.................         0007      11.5594      $736.26  ...........      $147.25
26020..............  Drain hand tendon sheath..  ..................  T.................         0053      16.4637    $1,048.64      $253.49      $209.73
26025..............  Drainage of palm bursa....  ..................  T.................         0053      16.4637    $1,048.64      $253.49      $209.73
26030..............  Drainage of palm bursa(s).  ..................  T.................         0053      16.4637    $1,048.64      $253.49      $209.73
26034..............  Treat hand bone lesion....  ..................  T.................         0053      16.4637    $1,048.64      $253.49      $209.73
26035..............  Decompress fingers/hand...  ..................  T.................         0053      16.4637    $1,048.64      $253.49      $209.73
26037..............  Decompress fingers/hand...  ..................  T.................         0053      16.4637    $1,048.64      $253.49      $209.73
26040..............  Release palm contracture..  ..................  T.................         0054      26.3105    $1,675.82  ...........      $335.16
26045..............  Release palm contracture..  ..................  T.................         0054      26.3105    $1,675.82  ...........      $335.16
26055..............  Incise finger tendon        ..................  T.................         0053      16.4637    $1,048.64      $253.49      $209.73
                      sheath.
26060..............  Incision of finger tendon.  ..................  T.................         0053      16.4637    $1,048.64      $253.49      $209.73
26070..............  Explore/treat hand joint..  ..................  T.................         0053      16.4637    $1,048.64      $253.49      $209.73
26075..............  Explore/treat finger joint  ..................  T.................         0053      16.4637    $1,048.64      $253.49      $209.73
26080..............  Explore/treat finger joint  ..................  T.................         0053      16.4637    $1,048.64      $253.49      $209.73
26100..............  Biopsy hand joint lining..  ..................  T.................         0053      16.4637    $1,048.64      $253.49      $209.73
26105..............  Biopsy finger joint lining  ..................  T.................         0053      16.4637    $1,048.64      $253.49      $209.73
26110..............  Biopsy finger joint lining  ..................  T.................         0053      16.4637    $1,048.64      $253.49      $209.73
26115..............  Removal hand lesion subcut  ..................  T.................         0022      21.1098    $1,344.57      $354.45      $268.91
26116..............  Removal hand lesion, deep.  ..................  T.................         0022      21.1098    $1,344.57      $354.45      $268.91
26117..............  Remove tumor, hand/finger.  ..................  T.................         0022      21.1098    $1,344.57      $354.45      $268.91
26121..............  Release palm contracture..  ..................  T.................         0054      26.3105    $1,675.82  ...........      $335.16
26123..............  Release palm contracture..  ..................  T.................         0054      26.3105    $1,675.82  ...........      $335.16
26125..............  Release palm contracture..  ..................  T.................         0053      16.4637    $1,048.64      $253.49      $209.73
26130..............  Remove wrist joint lining.  ..................  T.................         0053      16.4637    $1,048.64      $253.49      $209.73
26135..............  Revise finger joint, each.  ..................  T.................         0054      26.3105    $1,675.82  ...........      $335.16
26140..............  Revise finger joint, each.  ..................  T.................         0053      16.4637    $1,048.64      $253.49      $209.73

[[Page 67014]]

 
26145..............  Tendon excision, palm/      ..................  T.................         0053      16.4637    $1,048.64      $253.49      $209.73
                      finger.
26160..............  Remove tendon sheath        ..................  T.................         0053      16.4637    $1,048.64      $253.49      $209.73
                      lesion.
26170..............  Removal of palm tendon,     ..................  T.................         0053      16.4637    $1,048.64      $253.49      $209.73
                      each.
26180..............  Removal of finger tendon..  ..................  T.................         0053      16.4637    $1,048.64      $253.49      $209.73
26185..............  Remove finger bone........  ..................  T.................         0053      16.4637    $1,048.64      $253.49      $209.73
26200..............  Remove hand bone lesion...  ..................  T.................         0053      16.4637    $1,048.64      $253.49      $209.73
26205..............  Remove/graft bone lesion..  ..................  T.................         0054      26.3105    $1,675.82  ...........      $335.16
26210..............  Removal of finger lesion..  ..................  T.................         0053      16.4637    $1,048.64      $253.49      $209.73
26215..............  Remove/graft finger lesion  ..................  T.................         0053      16.4637    $1,048.64      $253.49      $209.73
26230..............  Partial removal of hand     ..................  T.................         0053      16.4637    $1,048.64      $253.49      $209.73
                      bone.
26235..............  Partial removal, finger     ..................  T.................         0053      16.4637    $1,048.64      $253.49      $209.73
                      bone.
26236..............  Partial removal, finger     ..................  T.................         0053      16.4637    $1,048.64      $253.49      $209.73
                      bone.
26250..............  Extensive hand surgery....  ..................  T.................         0053      16.4637    $1,048.64      $253.49      $209.73
26255..............  Extensive hand surgery....  ..................  T.................         0054      26.3105    $1,675.82  ...........      $335.16
26260..............  Extensive finger surgery..  ..................  T.................         0053      16.4637    $1,048.64      $253.49      $209.73
26261..............  Extensive finger surgery..  ..................  T.................         0053      16.4637    $1,048.64      $253.49      $209.73
26262..............  Partial removal of finger.  ..................  T.................         0053      16.4637    $1,048.64      $253.49      $209.73
26320..............  Removal of implant from     ..................  T.................         0021      16.1001    $1,025.48      $219.48      $205.10
                      hand.
26340..............  Manipulate finger w/anesth  ..................  T.................         0043       1.7682      $112.62  ...........       $22.52
26350..............  Repair finger/hand tendon.  ..................  T.................         0054      26.3105    $1,675.82  ...........      $335.16
26352..............  Repair/graft hand tendon..  ..................  T.................         0054      26.3105    $1,675.82  ...........      $335.16
26356..............  Repair finger/hand tendon.  ..................  T.................         0054      26.3105    $1,675.82  ...........      $335.16
26357..............  Repair finger/hand tendon.  ..................  T.................         0054      26.3105    $1,675.82  ...........      $335.16
26358..............  Repair/graft hand tendon..  ..................  T.................         0054      26.3105    $1,675.82  ...........      $335.16
26370..............  Repair finger/hand tendon.  ..................  T.................         0054      26.3105    $1,675.82  ...........      $335.16
26372..............  Repair/graft hand tendon..  ..................  T.................         0054      26.3105    $1,675.82  ...........      $335.16
26373..............  Repair finger/hand tendon.  ..................  T.................         0054      26.3105    $1,675.82  ...........      $335.16
26390..............  Revise hand/finger tendon.  ..................  T.................         0054      26.3105    $1,675.82  ...........      $335.16
26392..............  Repair/graft hand tendon..  ..................  T.................         0054      26.3105    $1,675.82  ...........      $335.16
26410..............  Repair hand tendon........  ..................  T.................         0053      16.4637    $1,048.64      $253.49      $209.73
26412..............  Repair/graft hand tendon..  ..................  T.................         0054      26.3105    $1,675.82  ...........      $335.16
26415..............  Excision, hand/finger       ..................  T.................         0054      26.3105    $1,675.82  ...........      $335.16
                      tendon.
26416..............  Graft hand or finger        ..................  T.................         0054      26.3105    $1,675.82  ...........      $335.16
                      tendon.
26418..............  Repair finger tendon......  ..................  T.................         0053      16.4637    $1,048.64      $253.49      $209.73
26420..............  Repair/graft finger tendon  ..................  T.................         0054      26.3105    $1,675.82  ...........      $335.16
26426..............  Repair finger/hand tendon.  ..................  T.................         0054      26.3105    $1,675.82  ...........      $335.16
26428..............  Repair/graft finger tendon  ..................  T.................         0054      26.3105    $1,675.82  ...........      $335.16
26432..............  Repair finger tendon......  ..................  T.................         0053      16.4637    $1,048.64      $253.49      $209.73
26433..............  Repair finger tendon......  ..................  T.................         0053      16.4637    $1,048.64      $253.49      $209.73
26434..............  Repair/graft finger tendon  ..................  T.................         0054      26.3105    $1,675.82  ...........      $335.16
26437..............  Realignment of tendons....  ..................  T.................         0053      16.4637    $1,048.64      $253.49      $209.73
26440..............  Release palm/finger tendon  ..................  T.................         0053      16.4637    $1,048.64      $253.49      $209.73
26442..............  Release palm & finger       ..................  T.................         0054      26.3105    $1,675.82  ...........      $335.16
                      tendon.
26445..............  Release hand/finger tendon  ..................  T.................         0053      16.4637    $1,048.64      $253.49      $209.73
26449..............  Release forearm/hand        ..................  T.................         0054      26.3105    $1,675.82  ...........      $335.16
                      tendon.
26450..............  Incision of palm tendon...  ..................  T.................         0053      16.4637    $1,048.64      $253.49      $209.73
26455..............  Incision of finger tendon.  ..................  T.................         0053      16.4637    $1,048.64      $253.49      $209.73
26460..............  Incise hand/finger tendon.  ..................  T.................         0053      16.4637    $1,048.64      $253.49      $209.73
26471..............  Fusion of finger tendons..  ..................  T.................         0053      16.4637    $1,048.64      $253.49      $209.73
26474..............  Fusion of finger tendons..  ..................  T.................         0053      16.4637    $1,048.64      $253.49      $209.73
26476..............  Tendon lengthening........  ..................  T.................         0053      16.4637    $1,048.64      $253.49      $209.73
26477..............  Tendon shortening.........  ..................  T.................         0053      16.4637    $1,048.64      $253.49      $209.73
26478..............  Lengthening of hand tendon  ..................  T.................         0053      16.4637    $1,048.64      $253.49      $209.73
26479..............  Shortening of hand tendon.  ..................  T.................         0053      16.4637    $1,048.64      $253.49      $209.73
26480..............  Transplant hand tendon....  ..................  T.................         0054      26.3105    $1,675.82  ...........      $335.16
26483..............  Transplant/graft hand       ..................  T.................         0054      26.3105    $1,675.82  ...........      $335.16
                      tendon.
26485..............  Transplant palm tendon....  ..................  T.................         0054      26.3105    $1,675.82  ...........      $335.16
26489..............  Transplant/graft palm       ..................  T.................         0054      26.3105    $1,675.82  ...........      $335.16
                      tendon.
26490..............  Revise thumb tendon.......  ..................  T.................         0054      26.3105    $1,675.82  ...........      $335.16
26492..............  Tendon transfer with graft  ..................  T.................         0054      26.3105    $1,675.82  ...........      $335.16
26494..............  Hand tendon/muscle          ..................  T.................         0054      26.3105    $1,675.82  ...........      $335.16
                      transfer.
26496..............  Revise thumb tendon.......  ..................  T.................         0054      26.3105    $1,675.82  ...........      $335.16
26497..............  Finger tendon transfer....  ..................  T.................         0054      26.3105    $1,675.82  ...........      $335.16
26498..............  Finger tendon transfer....  ..................  T.................         0054      26.3105    $1,675.82  ...........      $335.16
26499..............  Revision of finger........  ..................  T.................         0054      26.3105    $1,675.82  ...........      $335.16
26500..............  Hand tendon reconstruction  ..................  T.................         0053      16.4637    $1,048.64      $253.49      $209.73
26502..............  Hand tendon reconstruction  ..................  T.................         0054      26.3105    $1,675.82  ...........      $335.16
26508..............  Release thumb contracture.  ..................  T.................         0053      16.4637    $1,048.64      $253.49      $209.73
26510..............  Thumb tendon transfer.....  ..................  T.................         0054      26.3105    $1,675.82  ...........      $335.16
26516..............  Fusion of knuckle joint...  ..................  T.................         0054      26.3105    $1,675.82  ...........      $335.16
26517..............  Fusion of knuckle joints..  ..................  T.................         0054      26.3105    $1,675.82  ...........      $335.16
26518..............  Fusion of knuckle joints..  ..................  T.................         0054      26.3105    $1,675.82  ...........      $335.16
26520..............  Release knuckle             ..................  T.................         0053      16.4637    $1,048.64      $253.49      $209.73
                      contracture.
26525..............  Release finger contracture  ..................  T.................         0053      16.4637    $1,048.64      $253.49      $209.73
26530..............  Revise knuckle joint......  ..................  T.................         0047      35.9040    $2,286.87      $537.03      $457.37
26531..............  Revise knuckle with         ..................  T.................         0048      50.8876    $3,241.23  ...........      $648.25
                      implant.
26535..............  Revise finger joint.......  ..................  T.................         0047      35.9040    $2,286.87      $537.03      $457.37
26536..............  Revise/implant finger       ..................  T.................         0048      50.8876    $3,241.23  ...........      $648.25
                      joint.
26540..............  Repair hand joint.........  ..................  T.................         0053      16.4637    $1,048.64      $253.49      $209.73
26541..............  Repair hand joint with      ..................  T.................         0054      26.3105    $1,675.82  ...........      $335.16
                      graft.

[[Page 67015]]

 
26542..............  Repair hand joint with      ..................  T.................         0053      16.4637    $1,048.64      $253.49      $209.73
                      graft.
26545..............  Reconstruct finger joint..  ..................  T.................         0054      26.3105    $1,675.82  ...........      $335.16
26546..............  Repair nonunion hand......  ..................  T.................         0054      26.3105    $1,675.82  ...........      $335.16
26548..............  Reconstruct finger joint..  ..................  T.................         0054      26.3105    $1,675.82  ...........      $335.16
26550..............  Construct thumb             ..................  T.................         0054      26.3105    $1,675.82  ...........      $335.16
                      replacement.
26551..............  Great toe-hand transfer...  ..................  C.................  ...........  ...........  ...........  ...........  ...........
26553..............  Single transfer, toe-hand.  ..................  C.................  ...........  ...........  ...........  ...........  ...........
26554..............  Double transfer, toe-hand.  ..................  C.................  ...........  ...........  ...........  ...........  ...........
26555..............  Positional change of        ..................  T.................         0054      26.3105    $1,675.82  ...........      $335.16
                      finger.
26556..............  Toe joint transfer........  ..................  C.................  ...........  ...........  ...........  ...........  ...........
26560..............  Repair of web finger......  ..................  T.................         0053      16.4637    $1,048.64      $253.49      $209.73
26561..............  Repair of web finger......  ..................  T.................         0054      26.3105    $1,675.82  ...........      $335.16
26562..............  Repair of web finger......  ..................  T.................         0054      26.3105    $1,675.82  ...........      $335.16
26565..............  Correct metacarpal flaw...  ..................  T.................         0054      26.3105    $1,675.82  ...........      $335.16
26567..............  Correct finger deformity..  ..................  T.................         0054      26.3105    $1,675.82  ...........      $335.16
26568..............  Lengthen metacarpal/finger  ..................  T.................         0054      26.3105    $1,675.82  ...........      $335.16
26580..............  Repair hand deformity.....  ..................  T.................         0053      16.4637    $1,048.64      $253.49      $209.73
26587..............  Reconstruct extra finger..  ..................  T.................         0053      16.4637    $1,048.64      $253.49      $209.73
26590..............  Repair finger deformity...  ..................  T.................         0053      16.4637    $1,048.64      $253.49      $209.73
26591..............  Repair muscles of hand....  ..................  T.................         0054      26.3105    $1,675.82  ...........      $335.16
26593..............  Release muscles of hand...  ..................  T.................         0053      16.4637    $1,048.64      $253.49      $209.73
26596..............  Excision constricting       ..................  T.................         0053      16.4637    $1,048.64      $253.49      $209.73
                      tissue.
26600..............  Treat metacarpal fracture.  ..................  T.................         0043       1.7682      $112.62  ...........       $22.52
26605..............  Treat metacarpal fracture.  ..................  T.................         0043       1.7682      $112.62  ...........       $22.52
26607..............  Treat metacarpal fracture.  ..................  T.................         0043       1.7682      $112.62  ...........       $22.52
26608..............  Treat metacarpal fracture.  ..................  T.................         0062      26.1592    $1,666.18      $372.87      $333.24
26615..............  Treat metacarpal fracture.  ..................  T.................         0063      41.1091    $2,618.40      $548.33      $523.68
26641..............  Treat thumb dislocation...  ..................  T.................         0043       1.7682      $112.62  ...........       $22.52
26645..............  Treat thumb fracture......  ..................  T.................         0043       1.7682      $112.62  ...........       $22.52
26650..............  Treat thumb fracture......  ..................  T.................         0062      26.1592    $1,666.18      $372.87      $333.24
26665..............  Treat thumb fracture......  ..................  T.................         0063      41.1091    $2,618.40      $548.33      $523.68
26670..............  Treat hand dislocation....  ..................  T.................         0043       1.7682      $112.62  ...........       $22.52
26675..............  Treat hand dislocation....  ..................  T.................         0043       1.7682      $112.62  ...........       $22.52
26676..............  Pin hand dislocation......  ..................  T.................         0062      26.1592    $1,666.18      $372.87      $333.24
26685..............  Treat hand dislocation....  CH................  T.................         0062      26.1592    $1,666.18      $372.87      $333.24
26686..............  Treat hand dislocation....  ..................  T.................         0064      59.2233    $3,772.17      $835.79      $754.43
26700..............  Treat knuckle dislocation.  ..................  T.................         0043       1.7682      $112.62  ...........       $22.52
26705..............  Treat knuckle dislocation.  ..................  T.................         0043       1.7682      $112.62  ...........       $22.52
26706..............  Pin knuckle dislocation...  ..................  T.................         0043       1.7682      $112.62  ...........       $22.52
26715..............  Treat knuckle dislocation.  CH................  T.................         0062      26.1592    $1,666.18      $372.87      $333.24
26720..............  Treat finger fracture,      ..................  T.................         0043       1.7682      $112.62  ...........       $22.52
                      each.
26725..............  Treat finger fracture,      ..................  T.................         0043       1.7682      $112.62  ...........       $22.52
                      each.
26727..............  Treat finger fracture,      ..................  T.................         0062      26.1592    $1,666.18      $372.87      $333.24
                      each.
26735..............  Treat finger fracture,      CH................  T.................         0062      26.1592    $1,666.18      $372.87      $333.24
                      each.
26740..............  Treat finger fracture,      ..................  T.................         0043       1.7682      $112.62  ...........       $22.52
                      each.
26742..............  Treat finger fracture,      ..................  T.................         0043       1.7682      $112.62  ...........       $22.52
                      each.
26746..............  Treat finger fracture,      CH................  T.................         0062      26.1592    $1,666.18      $372.87      $333.24
                      each.
26750..............  Treat finger fracture,      ..................  T.................         0043       1.7682      $112.62  ...........       $22.52
                      each.
26755..............  Treat finger fracture,      ..................  T.................         0043       1.7682      $112.62  ...........       $22.52
                      each.
26756..............  Pin finger fracture, each.  ..................  T.................         0062      26.1592    $1,666.18      $372.87      $333.24
26765..............  Treat finger fracture,      CH................  T.................         0062      26.1592    $1,666.18      $372.87      $333.24
                      each.
26770..............  Treat finger dislocation..  ..................  T.................         0043       1.7682      $112.62  ...........       $22.52
26775..............  Treat finger dislocation..  ..................  T.................         0045      14.7658      $940.49      $268.47      $188.10
26776..............  Pin finger dislocation....  ..................  T.................         0062      26.1592    $1,666.18      $372.87      $333.24
26785..............  Treat finger dislocation..  ..................  T.................         0062      26.1592    $1,666.18      $372.87      $333.24
26820..............  Thumb fusion with graft...  ..................  T.................         0054      26.3105    $1,675.82  ...........      $335.16
26841..............  Fusion of thumb...........  ..................  T.................         0054      26.3105    $1,675.82  ...........      $335.16
26842..............  Thumb fusion with graft...  ..................  T.................         0054      26.3105    $1,675.82  ...........      $335.16
26843..............  Fusion of hand joint......  ..................  T.................         0054      26.3105    $1,675.82  ...........      $335.16
26844..............  Fusion/graft of hand joint  ..................  T.................         0054      26.3105    $1,675.82  ...........      $335.16
26850..............  Fusion of knuckle.........  ..................  T.................         0054      26.3105    $1,675.82  ...........      $335.16
26852..............  Fusion of knuckle with      ..................  T.................         0054      26.3105    $1,675.82  ...........      $335.16
                      graft.
26860..............  Fusion of finger joint....  ..................  T.................         0054      26.3105    $1,675.82  ...........      $335.16
26861..............  Fusion of finger jnt, add-  ..................  T.................         0054      26.3105    $1,675.82  ...........      $335.16
                      on.
26862..............  Fusion/graft of finger      ..................  T.................         0054      26.3105    $1,675.82  ...........      $335.16
                      joint.
26863..............  Fuse/graft added joint....  ..................  T.................         0054      26.3105    $1,675.82  ...........      $335.16
26910..............  Amputate metacarpal bone..  ..................  T.................         0054      26.3105    $1,675.82  ...........      $335.16
26951..............  Amputation of finger/thumb  ..................  T.................         0053      16.4637    $1,048.64      $253.49      $209.73
26952..............  Amputation of finger/thumb  ..................  T.................         0053      16.4637    $1,048.64      $253.49      $209.73
26989..............  Hand/finger surgery.......  ..................  T.................         0043       1.7682      $112.62  ...........       $22.52
26990..............  Drainage of pelvis lesion.  ..................  T.................         0049      21.2689    $1,354.70  ...........      $270.94
26991..............  Drainage of pelvis bursa..  ..................  T.................         0049      21.2689    $1,354.70  ...........      $270.94
26992..............  Drainage of bone lesion...  ..................  C.................  ...........  ...........  ...........  ...........  ...........
27000..............  Incision of hip tendon....  ..................  T.................         0049      21.2689    $1,354.70  ...........      $270.94
27001..............  Incision of hip tendon....  ..................  T.................         0050      29.1900    $1,859.23  ...........      $371.85
27003..............  Incision of hip tendon....  ..................  T.................         0050      29.1900    $1,859.23  ...........      $371.85
27005..............  Incision of hip tendon....  ..................  C.................  ...........  ...........  ...........  ...........  ...........
27006..............  Incision of hip tendons...  CH................  T.................         0050      29.1900    $1,859.23  ...........      $371.85
27025..............  Incision of hip/thigh       ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      fascia.
27030..............  Drainage of hip joint.....  ..................  C.................  ...........  ...........  ...........  ...........  ...........

[[Page 67016]]

 
27033..............  Exploration of hip joint..  ..................  T.................         0051      42.9850    $2,737.89  ...........      $547.58
27035..............  Denervation of hip joint..  ..................  T.................         0051      42.9850    $2,737.89  ...........      $547.58
27036..............  Excision of hip joint/      ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      muscle.
27040..............  Biopsy of soft tissues....  ..................  T.................         0020       8.6850      $553.18  ...........      $110.64
27041..............  Biopsy of soft tissues....  ..................  T.................         0020       8.6850      $553.18  ...........      $110.64
27047..............  Remove hip/pelvis lesion..  ..................  T.................         0022      21.1098    $1,344.57      $354.45      $268.91
27048..............  Remove hip/pelvis lesion..  ..................  T.................         0022      21.1098    $1,344.57      $354.45      $268.91
27049..............  Remove tumor, hip/pelvis..  ..................  T.................         0022      21.1098    $1,344.57      $354.45      $268.91
27050..............  Biopsy of sacroiliac joint  ..................  T.................         0049      21.2689    $1,354.70  ...........      $270.94
27052..............  Biopsy of hip joint.......  ..................  T.................         0049      21.2689    $1,354.70  ...........      $270.94
27054..............  Removal of hip joint        ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      lining.
27060..............  Removal of ischial bursa..  ..................  T.................         0049      21.2689    $1,354.70  ...........      $270.94
27062..............  Remove femur lesion/bursa.  ..................  T.................         0049      21.2689    $1,354.70  ...........      $270.94
27065..............  Removal of hip bone lesion  ..................  T.................         0049      21.2689    $1,354.70  ...........      $270.94
27066..............  Removal of hip bone lesion  ..................  T.................         0050      29.1900    $1,859.23  ...........      $371.85
27067..............  Remove/graft hip bone       ..................  T.................         0050      29.1900    $1,859.23  ...........      $371.85
                      lesion.
27070..............  Partial removal of hip      ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      bone.
27071..............  Partial removal of hip      ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      bone.
27075..............  Extensive hip surgery.....  ..................  C.................  ...........  ...........  ...........  ...........  ...........
27076..............  Extensive hip surgery.....  ..................  C.................  ...........  ...........  ...........  ...........  ...........
27077..............  Extensive hip surgery.....  ..................  C.................  ...........  ...........  ...........  ...........  ...........
27078..............  Extensive hip surgery.....  ..................  C.................  ...........  ...........  ...........  ...........  ...........
27079..............  Extensive hip surgery.....  ..................  C.................  ...........  ...........  ...........  ...........  ...........
27080..............  Removal of tail bone......  ..................  T.................         0050      29.1900    $1,859.23  ...........      $371.85
27086..............  Remove hip foreign body...  ..................  T.................         0020       8.6850      $553.18  ...........      $110.64
27087..............  Remove hip foreign body...  ..................  T.................         0049      21.2689    $1,354.70  ...........      $270.94
27090..............  Removal of hip prosthesis.  ..................  C.................  ...........  ...........  ...........  ...........  ...........
27091..............  Removal of hip prosthesis.  ..................  C.................  ...........  ...........  ...........  ...........  ...........
27093..............  Injection for hip x-ray...  ..................  N.................  ...........  ...........  ...........  ...........  ...........
27095..............  Injection for hip x-ray...  ..................  N.................  ...........  ...........  ...........  ...........  ...........
27096..............  Inject sacroiliac joint...  ..................  B.................  ...........  ...........  ...........  ...........  ...........
27097..............  Revision of hip tendon....  ..................  T.................         0050      29.1900    $1,859.23  ...........      $371.85
27098..............  Transfer tendon to pelvis.  ..................  T.................         0050      29.1900    $1,859.23  ...........      $371.85
27100..............  Transfer of abdominal       ..................  T.................         0051      42.9850    $2,737.89  ...........      $547.58
                      muscle.
27105..............  Transfer of spinal muscle.  ..................  T.................         0051      42.9850    $2,737.89  ...........      $547.58
27110..............  Transfer of iliopsoas       ..................  T.................         0051      42.9850    $2,737.89  ...........      $547.58
                      muscle.
27111..............  Transfer of iliopsoas       ..................  T.................         0051      42.9850    $2,737.89  ...........      $547.58
                      muscle.
27120..............  Reconstruction of hip       ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      socket.
27122..............  Reconstruction of hip       ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      socket.
27125..............  Partial hip replacement...  ..................  C.................  ...........  ...........  ...........  ...........  ...........
27130..............  Total hip arthroplasty....  ..................  C.................  ...........  ...........  ...........  ...........  ...........
27132..............  Total hip arthroplasty....  ..................  C.................  ...........  ...........  ...........  ...........  ...........
27134..............  Revise hip joint            ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      replacement.
27137..............  Revise hip joint            ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      replacement.
27138..............  Revise hip joint            ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      replacement.
27140..............  Transplant femur ridge....  ..................  C.................  ...........  ...........  ...........  ...........  ...........
27146..............  Incision of hip bone......  ..................  C.................  ...........  ...........  ...........  ...........  ...........
27147..............  Revision of hip bone......  ..................  C.................  ...........  ...........  ...........  ...........  ...........
27151..............  Incision of hip bones.....  ..................  C.................  ...........  ...........  ...........  ...........  ...........
27156..............  Revision of hip bones.....  ..................  C.................  ...........  ...........  ...........  ...........  ...........
27158..............  Revision of pelvis........  ..................  C.................  ...........  ...........  ...........  ...........  ...........
27161..............  Incision of neck of femur.  ..................  C.................  ...........  ...........  ...........  ...........  ...........
27165..............  Incision/fixation of femur  ..................  C.................  ...........  ...........  ...........  ...........  ...........
27170..............  Repair/graft femur head/    ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      neck.
27175..............  Treat slipped epiphysis...  ..................  C.................  ...........  ...........  ...........  ...........  ...........
27176..............  Treat slipped epiphysis...  ..................  C.................  ...........  ...........  ...........  ...........  ...........
27177..............  Treat slipped epiphysis...  ..................  C.................  ...........  ...........  ...........  ...........  ...........
27178..............  Treat slipped epiphysis...  ..................  C.................  ...........  ...........  ...........  ...........  ...........
27179..............  Revise head/neck of femur.  ..................  C.................  ...........  ...........  ...........  ...........  ...........
27181..............  Treat slipped epiphysis...  ..................  C.................  ...........  ...........  ...........  ...........  ...........
27185..............  Revision of femur           ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      epiphysis.
27187..............  Reinforce hip bones.......  ..................  C.................  ...........  ...........  ...........  ...........  ...........
27193..............  Treat pelvic ring fracture  ..................  T.................         0043       1.7682      $112.62  ...........       $22.52
27194..............  Treat pelvic ring fracture  ..................  T.................         0045      14.7658      $940.49      $268.47      $188.10
27200..............  Treat tail bone fracture..  ..................  T.................         0043       1.7682      $112.62  ...........       $22.52
27202..............  Treat tail bone fracture..  ..................  T.................         0063      41.1091    $2,618.40      $548.33      $523.68
27215..............  Treat pelvic fracture(s)..  ..................  C.................  ...........  ...........  ...........  ...........  ...........
27216..............  Treat pelvic ring fracture  ..................  T.................         0050      29.1900    $1,859.23  ...........      $371.85
27217..............  Treat pelvic ring fracture  ..................  C.................  ...........  ...........  ...........  ...........  ...........
27218..............  Treat pelvic ring fracture  ..................  C.................  ...........  ...........  ...........  ...........  ...........
27220..............  Treat hip socket fracture.  ..................  T.................         0043       1.7682      $112.62  ...........       $22.52
27222..............  Treat hip socket fracture.  ..................  C.................  ...........  ...........  ...........  ...........  ...........
27226..............  Treat hip wall fracture...  ..................  C.................  ...........  ...........  ...........  ...........  ...........
27227..............  Treat hip fracture(s).....  ..................  C.................  ...........  ...........  ...........  ...........  ...........
27228..............  Treat hip fracture(s).....  ..................  C.................  ...........  ...........  ...........  ...........  ...........
27230..............  Treat thigh fracture......  ..................  T.................         0043       1.7682      $112.62  ...........       $22.52
27232..............  Treat thigh fracture......  ..................  C.................  ...........  ...........  ...........  ...........  ...........
27235..............  Treat thigh fracture......  ..................  T.................         0050      29.1900    $1,859.23  ...........      $371.85
27236..............  Treat thigh fracture......  ..................  C.................  ...........  ...........  ...........  ...........  ...........
27238..............  Treat thigh fracture......  ..................  T.................         0043       1.7682      $112.62  ...........       $22.52

[[Page 67017]]

 
27240..............  Treat thigh fracture......  ..................  C.................  ...........  ...........  ...........  ...........  ...........
27244..............  Treat thigh fracture......  ..................  C.................  ...........  ...........  ...........  ...........  ...........
27245..............  Treat thigh fracture......  ..................  C.................  ...........  ...........  ...........  ...........  ...........
27246..............  Treat thigh fracture......  ..................  T.................         0043       1.7682      $112.62  ...........       $22.52
27248..............  Treat thigh fracture......  ..................  C.................  ...........  ...........  ...........  ...........  ...........
27250..............  Treat hip dislocation.....  ..................  T.................         0043       1.7682      $112.62  ...........       $22.52
27252..............  Treat hip dislocation.....  ..................  T.................         0045      14.7658      $940.49      $268.47      $188.10
27253..............  Treat hip dislocation.....  ..................  C.................  ...........  ...........  ...........  ...........  ...........
27254..............  Treat hip dislocation.....  ..................  C.................  ...........  ...........  ...........  ...........  ...........
27256..............  Treat hip dislocation.....  ..................  T.................         0043       1.7682      $112.62  ...........       $22.52
27257..............  Treat hip dislocation.....  ..................  T.................         0045      14.7658      $940.49      $268.47      $188.10
27258..............  Treat hip dislocation.....  ..................  C.................  ...........  ...........  ...........  ...........  ...........
27259..............  Treat hip dislocation.....  ..................  C.................  ...........  ...........  ...........  ...........  ...........
27265..............  Treat hip dislocation.....  ..................  T.................         0043       1.7682      $112.62  ...........       $22.52
27266..............  Treat hip dislocation.....  ..................  T.................         0045      14.7658      $940.49      $268.47      $188.10
27267..............  Cltx thigh fx.............  NI................  T.................         0043       1.7682      $112.62  ...........       $22.52
27268..............  Cltx thigh fx w/mnpj......  NI................  C.................  ...........  ...........  ...........  ...........  ...........
27269..............  Optx thigh fx.............  NI................  C.................  ...........  ...........  ...........  ...........  ...........
27275..............  Manipulation of hip joint.  ..................  T.................         0045      14.7658      $940.49      $268.47      $188.10
27280..............  Fusion of sacroiliac joint  ..................  C.................  ...........  ...........  ...........  ...........  ...........
27282..............  Fusion of pubic bones.....  ..................  C.................  ...........  ...........  ...........  ...........  ...........
27284..............  Fusion of hip joint.......  ..................  C.................  ...........  ...........  ...........  ...........  ...........
27286..............  Fusion of hip joint.......  ..................  C.................  ...........  ...........  ...........  ...........  ...........
27290..............  Amputation of leg at hip..  ..................  C.................  ...........  ...........  ...........  ...........  ...........
27295..............  Amputation of leg at hip..  ..................  C.................  ...........  ...........  ...........  ...........  ...........
27299..............  Pelvis/hip joint surgery..  ..................  T.................         0043       1.7682      $112.62  ...........       $22.52
27301..............  Drain thigh/knee lesion...  ..................  T.................         0008      18.3197    $1,166.85  ...........      $233.37
27303..............  Drainage of bone lesion...  ..................  C.................  ...........  ...........  ...........  ...........  ...........
27305..............  Incise thigh tendon &       ..................  T.................         0049      21.2689    $1,354.70  ...........      $270.94
                      fascia.
27306..............  Incision of thigh tendon..  ..................  T.................         0049      21.2689    $1,354.70  ...........      $270.94
27307..............  Incision of thigh tendons.  ..................  T.................         0049      21.2689    $1,354.70  ...........      $270.94
27310..............  Exploration of knee joint.  ..................  T.................         0050      29.1900    $1,859.23  ...........      $371.85
27323..............  Biopsy, thigh soft tissues  ..................  T.................         0020       8.6850      $553.18  ...........      $110.64
27324..............  Biopsy, thigh soft tissues  ..................  T.................         0022      21.1098    $1,344.57      $354.45      $268.91
27325..............  Neurectomy, hamstring.....  ..................  T.................         0220      18.0518    $1,149.79  ...........      $229.96
27326..............  Neurectomy, popliteal.....  ..................  T.................         0220      18.0518    $1,149.79  ...........      $229.96
27327..............  Removal of thigh lesion...  ..................  T.................         0022      21.1098    $1,344.57      $354.45      $268.91
27328..............  Removal of thigh lesion...  ..................  T.................         0022      21.1098    $1,344.57      $354.45      $268.91
27329..............  Remove tumor, thigh/knee..  ..................  T.................         0022      21.1098    $1,344.57      $354.45      $268.91
27330..............  Biopsy, knee joint lining.  ..................  T.................         0050      29.1900    $1,859.23  ...........      $371.85
27331..............  Explore/treat knee joint..  ..................  T.................         0050      29.1900    $1,859.23  ...........      $371.85
27332..............  Removal of knee cartilage.  ..................  T.................         0050      29.1900    $1,859.23  ...........      $371.85
27333..............  Removal of knee cartilage.  ..................  T.................         0050      29.1900    $1,859.23  ...........      $371.85
27334..............  Remove knee joint lining..  ..................  T.................         0050      29.1900    $1,859.23  ...........      $371.85
27335..............  Remove knee joint lining..  ..................  T.................         0050      29.1900    $1,859.23  ...........      $371.85
27340..............  Removal of kneecap bursa..  ..................  T.................         0049      21.2689    $1,354.70  ...........      $270.94
27345..............  Removal of knee cyst......  ..................  T.................         0049      21.2689    $1,354.70  ...........      $270.94
27347..............  Remove knee cyst..........  ..................  T.................         0049      21.2689    $1,354.70  ...........      $270.94
27350..............  Removal of kneecap........  ..................  T.................         0050      29.1900    $1,859.23  ...........      $371.85
27355..............  Remove femur lesion.......  ..................  T.................         0050      29.1900    $1,859.23  ...........      $371.85
27356..............  Remove femur lesion/graft.  ..................  T.................         0050      29.1900    $1,859.23  ...........      $371.85
27357..............  Remove femur lesion/graft.  ..................  T.................         0050      29.1900    $1,859.23  ...........      $371.85
27358..............  Remove femur lesion/        ..................  T.................         0050      29.1900    $1,859.23  ...........      $371.85
                      fixation.
27360..............  Partial removal, leg        ..................  T.................         0050      29.1900    $1,859.23  ...........      $371.85
                      bone(s).
27365..............  Extensive leg surgery.....  ..................  C.................  ...........  ...........  ...........  ...........  ...........
27370..............  Injection for knee x-ray..  ..................  N.................  ...........  ...........  ...........  ...........  ...........
27372..............  Removal of foreign body...  ..................  T.................         0022      21.1098    $1,344.57      $354.45      $268.91
27380..............  Repair of kneecap tendon..  ..................  T.................         0049      21.2689    $1,354.70  ...........      $270.94
27381..............  Repair/graft kneecap        ..................  T.................         0049      21.2689    $1,354.70  ...........      $270.94
                      tendon.
27385..............  Repair of thigh muscle....  ..................  T.................         0049      21.2689    $1,354.70  ...........      $270.94
27386..............  Repair/graft of thigh       ..................  T.................         0049      21.2689    $1,354.70  ...........      $270.94
                      muscle.
27390..............  Incision of thigh tendon..  ..................  T.................         0049      21.2689    $1,354.70  ...........      $270.94
27391..............  Incision of thigh tendons.  ..................  T.................         0049      21.2689    $1,354.70  ...........      $270.94
27392..............  Incision of thigh tendons.  ..................  T.................         0049      21.2689    $1,354.70  ...........      $270.94
27393..............  Lengthening of thigh        ..................  T.................         0050      29.1900    $1,859.23  ...........      $371.85
                      tendon.
27394..............  Lengthening of thigh        ..................  T.................         0050      29.1900    $1,859.23  ...........      $371.85
                      tendons.
27395..............  Lengthening of thigh        ..................  T.................         0051      42.9850    $2,737.89  ...........      $547.58
                      tendons.
27396..............  Transplant of thigh tendon  ..................  T.................         0050      29.1900    $1,859.23  ...........      $371.85
27397..............  Transplants of thigh        ..................  T.................         0051      42.9850    $2,737.89  ...........      $547.58
                      tendons.
27400..............  Revise thigh muscles/       ..................  T.................         0051      42.9850    $2,737.89  ...........      $547.58
                      tendons.
27403..............  Repair of knee cartilage..  ..................  T.................         0050      29.1900    $1,859.23  ...........      $371.85
27405..............  Repair of knee ligament...  ..................  T.................         0051      42.9850    $2,737.89  ...........      $547.58
27407..............  Repair of knee ligament...  ..................  T.................         0052      79.4244    $5,058.86  ...........    $1,011.77
27409..............  Repair of knee ligaments..  ..................  T.................         0051      42.9850    $2,737.89  ...........      $547.58
27412..............  Autochondrocyte implant     ..................  T.................         0042      45.7072    $2,911.27      $804.74      $582.25
                      knee.
27415..............  Osteochondral knee          ..................  T.................         0042      45.7072    $2,911.27      $804.74      $582.25
                      allograft.
27416..............  Osteochondral knee          NI................  T.................         0051      42.9850    $2,737.89  ...........      $547.58
                      autograft.
27418..............  Repair degenerated kneecap  ..................  T.................         0051      42.9850    $2,737.89  ...........      $547.58
27420..............  Revision of unstable        ..................  T.................         0051      42.9850    $2,737.89  ...........      $547.58
                      kneecap.
27422..............  Revision of unstable        ..................  T.................         0051      42.9850    $2,737.89  ...........      $547.58
                      kneecap.

[[Page 67018]]

 
27424..............  Revision/removal of         ..................  T.................         0051      42.9850    $2,737.89  ...........      $547.58
                      kneecap.
27425..............  Lat retinacular release     ..................  T.................         0050      29.1900    $1,859.23  ...........      $371.85
                      open.
27427..............  Reconstruction, knee......  ..................  T.................         0051      42.9850    $2,737.89  ...........      $547.58
27428..............  Reconstruction, knee......  ..................  T.................         0052      79.4244    $5,058.86  ...........    $1,011.77
27429..............  Reconstruction, knee......  ..................  T.................         0052      79.4244    $5,058.86  ...........    $1,011.77
27430..............  Revision of thigh muscles.  ..................  T.................         0051      42.9850    $2,737.89  ...........      $547.58
27435..............  Incision of knee joint....  ..................  T.................         0051      42.9850    $2,737.89  ...........      $547.58
27437..............  Revise kneecap............  ..................  T.................         0047      35.9040    $2,286.87      $537.03      $457.37
27438..............  Revise kneecap with         ..................  T.................         0048      50.8876    $3,241.23  ...........      $648.25
                      implant.
27440..............  Revision of knee joint....  ..................  T.................         0047      35.9040    $2,286.87      $537.03      $457.37
27441..............  Revision of knee joint....  ..................  T.................         0047      35.9040    $2,286.87      $537.03      $457.37
27442..............  Revision of knee joint....  ..................  T.................         0047      35.9040    $2,286.87      $537.03      $457.37
27443..............  Revision of knee joint....  ..................  T.................         0047      35.9040    $2,286.87      $537.03      $457.37
27445..............  Revision of knee joint....  ..................  C.................  ...........  ...........  ...........  ...........  ...........
27446..............  Revision of knee joint....  ..................  T.................         0681     274.6715   $17,494.93  ...........    $3,498.99
27447..............  Total knee arthroplasty...  ..................  C.................  ...........  ...........  ...........  ...........  ...........
27448..............  Incision of thigh.........  ..................  C.................  ...........  ...........  ...........  ...........  ...........
27450..............  Incision of thigh.........  ..................  C.................  ...........  ...........  ...........  ...........  ...........
27454..............  Realignment of thigh bone.  ..................  C.................  ...........  ...........  ...........  ...........  ...........
27455..............  Realignment of knee.......  ..................  C.................  ...........  ...........  ...........  ...........  ...........
27457..............  Realignment of knee.......  ..................  C.................  ...........  ...........  ...........  ...........  ...........
27465..............  Shortening of thigh bone..  ..................  C.................  ...........  ...........  ...........  ...........  ...........
27466..............  Lengthening of thigh bone.  ..................  C.................  ...........  ...........  ...........  ...........  ...........
27468..............  Shorten/lengthen thighs...  ..................  C.................  ...........  ...........  ...........  ...........  ...........
27470..............  Repair of thigh...........  ..................  C.................  ...........  ...........  ...........  ...........  ...........
27472..............  Repair/graft of thigh.....  ..................  C.................  ...........  ...........  ...........  ...........  ...........
27475..............  Surgery to stop leg growth  ..................  T.................         0050      29.1900    $1,859.23  ...........      $371.85
27477..............  Surgery to stop leg growth  ..................  C.................  ...........  ...........  ...........  ...........  ...........
27479..............  Surgery to stop leg growth  ..................  C.................  ...........  ...........  ...........  ...........  ...........
27485..............  Surgery to stop leg growth  ..................  C.................  ...........  ...........  ...........  ...........  ...........
27486..............  Revise/replace knee joint.  ..................  C.................  ...........  ...........  ...........  ...........  ...........
27487..............  Revise/replace knee joint.  ..................  C.................  ...........  ...........  ...........  ...........  ...........
27488..............  Removal of knee prosthesis  ..................  C.................  ...........  ...........  ...........  ...........  ...........
27495..............  Reinforce thigh...........  ..................  C.................  ...........  ...........  ...........  ...........  ...........
27496..............  Decompression of thigh/     ..................  T.................         0049      21.2689    $1,354.70  ...........      $270.94
                      knee.
27497..............  Decompression of thigh/     ..................  T.................         0049      21.2689    $1,354.70  ...........      $270.94
                      knee.
27498..............  Decompression of thigh/     ..................  T.................         0049      21.2689    $1,354.70  ...........      $270.94
                      knee.
27499..............  Decompression of thigh/     ..................  T.................         0049      21.2689    $1,354.70  ...........      $270.94
                      knee.
27500..............  Treatment of thigh          ..................  T.................         0043       1.7682      $112.62  ...........       $22.52
                      fracture.
27501..............  Treatment of thigh          ..................  T.................         0043       1.7682      $112.62  ...........       $22.52
                      fracture.
27502..............  Treatment of thigh          ..................  T.................         0043       1.7682      $112.62  ...........       $22.52
                      fracture.
27503..............  Treatment of thigh          ..................  T.................         0043       1.7682      $112.62  ...........       $22.52
                      fracture.
27506..............  Treatment of thigh          ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      fracture.
27507..............  Treatment of thigh          ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      fracture.
27508..............  Treatment of thigh          ..................  T.................         0043       1.7682      $112.62  ...........       $22.52
                      fracture.
27509..............  Treatment of thigh          ..................  T.................         0062      26.1592    $1,666.18      $372.87      $333.24
                      fracture.
27510..............  Treatment of thigh          ..................  T.................         0043       1.7682      $112.62  ...........       $22.52
                      fracture.
27511..............  Treatment of thigh          ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      fracture.
27513..............  Treatment of thigh          ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      fracture.
27514..............  Treatment of thigh          ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      fracture.
27516..............  Treat thigh fx growth       ..................  T.................         0043       1.7682      $112.62  ...........       $22.52
                      plate.
27517..............  Treat thigh fx growth       ..................  T.................         0043       1.7682      $112.62  ...........       $22.52
                      plate.
27519..............  Treat thigh fx growth       ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      plate.
27520..............  Treat kneecap fracture....  ..................  T.................         0043       1.7682      $112.62  ...........       $22.52
27524..............  Treat kneecap fracture....  ..................  T.................         0063      41.1091    $2,618.40      $548.33      $523.68
27530..............  Treat knee fracture.......  ..................  T.................         0043       1.7682      $112.62  ...........       $22.52
27532..............  Treat knee fracture.......  ..................  T.................         0043       1.7682      $112.62  ...........       $22.52
27535..............  Treat knee fracture.......  ..................  C.................  ...........  ...........  ...........  ...........  ...........
27536..............  Treat knee fracture.......  ..................  C.................  ...........  ...........  ...........  ...........  ...........
27538..............  Treat knee fracture(s)....  ..................  T.................         0043       1.7682      $112.62  ...........       $22.52
27540..............  Treat knee fracture.......  ..................  C.................  ...........  ...........  ...........  ...........  ...........
27550..............  Treat knee dislocation....  ..................  T.................         0043       1.7682      $112.62  ...........       $22.52
27552..............  Treat knee dislocation....  ..................  T.................         0045      14.7658      $940.49      $268.47      $188.10
27556..............  Treat knee dislocation....  ..................  C.................  ...........  ...........  ...........  ...........  ...........
27557..............  Treat knee dislocation....  ..................  C.................  ...........  ...........  ...........  ...........  ...........
27558..............  Treat knee dislocation....  ..................  C.................  ...........  ...........  ...........  ...........  ...........
27560..............  Treat kneecap dislocation.  ..................  T.................         0043       1.7682      $112.62  ...........       $22.52
27562..............  Treat kneecap dislocation.  ..................  T.................         0045      14.7658      $940.49      $268.47      $188.10
27566..............  Treat kneecap dislocation.  ..................  T.................         0063      41.1091    $2,618.40      $548.33      $523.68
27570..............  Fixation of knee joint....  ..................  T.................         0045      14.7658      $940.49      $268.47      $188.10
27580..............  Fusion of knee............  ..................  C.................  ...........  ...........  ...........  ...........  ...........
27590..............  Amputate leg at thigh.....  ..................  C.................  ...........  ...........  ...........  ...........  ...........
27591..............  Amputate leg at thigh.....  ..................  C.................  ...........  ...........  ...........  ...........  ...........
27592..............  Amputate leg at thigh.....  ..................  C.................  ...........  ...........  ...........  ...........  ...........
27594..............  Amputation follow-up        ..................  T.................         0049      21.2689    $1,354.70  ...........      $270.94
                      surgery.
27596..............  Amputation follow-up        ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      surgery.
27598..............  Amputate lower leg at knee  ..................  C.................  ...........  ...........  ...........  ...........  ...........
27599..............  Leg surgery procedure.....  ..................  T.................         0043       1.7682      $112.62  ...........       $22.52
27600..............  Decompression of lower leg  ..................  T.................         0049      21.2689    $1,354.70  ...........      $270.94
27601..............  Decompression of lower leg  ..................  T.................         0049      21.2689    $1,354.70  ...........      $270.94

[[Page 67019]]

 
27602..............  Decompression of lower leg  ..................  T.................         0049      21.2689    $1,354.70  ...........      $270.94
27603..............  Drain lower leg lesion....  ..................  T.................         0008      18.3197    $1,166.85  ...........      $233.37
27604..............  Drain lower leg bursa.....  ..................  T.................         0049      21.2689    $1,354.70  ...........      $270.94
27605..............  Incision of achilles        ..................  T.................         0055      20.8284    $1,326.64      $355.34      $265.33
                      tendon.
27606..............  Incision of achilles        ..................  T.................         0049      21.2689    $1,354.70  ...........      $270.94
                      tendon.
27607..............  Treat lower leg bone        ..................  T.................         0049      21.2689    $1,354.70  ...........      $270.94
                      lesion.
27610..............  Explore/treat ankle joint.  ..................  T.................         0050      29.1900    $1,859.23  ...........      $371.85
27612..............  Exploration of ankle joint  ..................  T.................         0050      29.1900    $1,859.23  ...........      $371.85
27613..............  Biopsy lower leg soft       ..................  T.................         0020       8.6850      $553.18  ...........      $110.64
                      tissue.
27614..............  Biopsy lower leg soft       ..................  T.................         0022      21.1098    $1,344.57      $354.45      $268.91
                      tissue.
27615..............  Remove tumor, lower leg...  ..................  T.................         0050      29.1900    $1,859.23  ...........      $371.85
27618..............  Remove lower leg lesion...  ..................  T.................         0021      16.1001    $1,025.48      $219.48      $205.10
27619..............  Remove lower leg lesion...  ..................  T.................         0022      21.1098    $1,344.57      $354.45      $268.91
27620..............  Explore/treat ankle joint.  ..................  T.................         0050      29.1900    $1,859.23  ...........      $371.85
27625..............  Remove ankle joint lining.  ..................  T.................         0050      29.1900    $1,859.23  ...........      $371.85
27626..............  Remove ankle joint lining.  ..................  T.................         0050      29.1900    $1,859.23  ...........      $371.85
27630..............  Removal of tendon lesion..  ..................  T.................         0049      21.2689    $1,354.70  ...........      $270.94
27635..............  Remove lower leg bone       ..................  T.................         0050      29.1900    $1,859.23  ...........      $371.85
                      lesion.
27637..............  Remove/graft leg bone       ..................  T.................         0050      29.1900    $1,859.23  ...........      $371.85
                      lesion.
27638..............  Remove/graft leg bone       ..................  T.................         0050      29.1900    $1,859.23  ...........      $371.85
                      lesion.
27640..............  Partial removal of tibia..  ..................  T.................         0051      42.9850    $2,737.89  ...........      $547.58
27641..............  Partial removal of fibula.  ..................  T.................         0050      29.1900    $1,859.23  ...........      $371.85
27645..............  Extensive lower leg         ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      surgery.
27646..............  Extensive lower leg         ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      surgery.
27647..............  Extensive ankle/heel        ..................  T.................         0051      42.9850    $2,737.89  ...........      $547.58
                      surgery.
27648..............  Injection for ankle x-ray.  ..................  N.................  ...........  ...........  ...........  ...........  ...........
27650..............  Repair achilles tendon....  ..................  T.................         0051      42.9850    $2,737.89  ...........      $547.58
27652..............  Repair/graft achilles       ..................  T.................         0052      79.4244    $5,058.86  ...........    $1,011.77
                      tendon.
27654..............  Repair of achilles tendon.  ..................  T.................         0051      42.9850    $2,737.89  ...........      $547.58
27656..............  Repair leg fascia defect..  ..................  T.................         0049      21.2689    $1,354.70  ...........      $270.94
27658..............  Repair of leg tendon, each  ..................  T.................         0049      21.2689    $1,354.70  ...........      $270.94
27659..............  Repair of leg tendon, each  ..................  T.................         0049      21.2689    $1,354.70  ...........      $270.94
27664..............  Repair of leg tendon, each  ..................  T.................         0049      21.2689    $1,354.70  ...........      $270.94
27665..............  Repair of leg tendon, each  ..................  T.................         0050      29.1900    $1,859.23  ...........      $371.85
27675..............  Repair lower leg tendons..  ..................  T.................         0049      21.2689    $1,354.70  ...........      $270.94
27676..............  Repair lower leg tendons..  ..................  T.................         0050      29.1900    $1,859.23  ...........      $371.85
27680..............  Release of lower leg        ..................  T.................         0050      29.1900    $1,859.23  ...........      $371.85
                      tendon.
27681..............  Release of lower leg        ..................  T.................         0050      29.1900    $1,859.23  ...........      $371.85
                      tendons.
27685..............  Revision of lower leg       ..................  T.................         0050      29.1900    $1,859.23  ...........      $371.85
                      tendon.
27686..............  Revise lower leg tendons..  ..................  T.................         0050      29.1900    $1,859.23  ...........      $371.85
27687..............  Revision of calf tendon...  ..................  T.................         0050      29.1900    $1,859.23  ...........      $371.85
27690..............  Revise lower leg tendon...  ..................  T.................         0051      42.9850    $2,737.89  ...........      $547.58
27691..............  Revise lower leg tendon...  ..................  T.................         0051      42.9850    $2,737.89  ...........      $547.58
27692..............  Revise additional leg       ..................  T.................         0051      42.9850    $2,737.89  ...........      $547.58
                      tendon.
27695..............  Repair of ankle ligament..  ..................  T.................         0050      29.1900    $1,859.23  ...........      $371.85
27696..............  Repair of ankle ligaments.  ..................  T.................         0050      29.1900    $1,859.23  ...........      $371.85
27698..............  Repair of ankle ligament..  ..................  T.................         0050      29.1900    $1,859.23  ...........      $371.85
27700..............  Revision of ankle joint...  ..................  T.................         0047      35.9040    $2,286.87      $537.03      $457.37
27702..............  Reconstruct ankle joint...  ..................  C.................  ...........  ...........  ...........  ...........  ...........
27703..............  Reconstruction, ankle       ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      joint.
27704..............  Removal of ankle implant..  ..................  T.................         0049      21.2689    $1,354.70  ...........      $270.94
27705..............  Incision of tibia.........  ..................  T.................         0051      42.9850    $2,737.89  ...........      $547.58
27707..............  Incision of fibula........  ..................  T.................         0049      21.2689    $1,354.70  ...........      $270.94
27709..............  Incision of tibia & fibula  ..................  T.................         0050      29.1900    $1,859.23  ...........      $371.85
27712..............  Realignment of lower leg..  ..................  C.................  ...........  ...........  ...........  ...........  ...........
27715..............  Revision of lower leg.....  ..................  C.................  ...........  ...........  ...........  ...........  ...........
27720..............  Repair of tibia...........  CH................  T.................         0063      41.1091    $2,618.40      $548.33      $523.68
27722..............  Repair/graft of tibia.....  CH................  T.................         0064      59.2233    $3,772.17      $835.79      $754.43
27724..............  Repair/graft of tibia.....  ..................  C.................  ...........  ...........  ...........  ...........  ...........
27725..............  Repair of lower leg.......  ..................  C.................  ...........  ...........  ...........  ...........  ...........
27726..............  Repair fibula nonunion....  NI................  T.................         0062      26.1592    $1,666.18      $372.87      $333.24
27727..............  Repair of lower leg.......  ..................  C.................  ...........  ...........  ...........  ...........  ...........
27730..............  Repair of tibia epiphysis.  ..................  T.................         0050      29.1900    $1,859.23  ...........      $371.85
27732..............  Repair of fibula epiphysis  ..................  T.................         0050      29.1900    $1,859.23  ...........      $371.85
27734..............  Repair lower leg epiphyses  ..................  T.................         0050      29.1900    $1,859.23  ...........      $371.85
27740..............  Repair of leg epiphyses...  ..................  T.................         0050      29.1900    $1,859.23  ...........      $371.85
27742..............  Repair of leg epiphyses...  ..................  T.................         0051      42.9850    $2,737.89  ...........      $547.58
27745..............  Reinforce tibia...........  ..................  T.................         0052      79.4244    $5,058.86  ...........    $1,011.77
27750..............  Treatment of tibia          ..................  T.................         0043       1.7682      $112.62  ...........       $22.52
                      fracture.
27752..............  Treatment of tibia          ..................  T.................         0043       1.7682      $112.62  ...........       $22.52
                      fracture.
27756..............  Treatment of tibia          ..................  T.................         0062      26.1592    $1,666.18      $372.87      $333.24
                      fracture.
27758..............  Treatment of tibia          ..................  T.................         0063      41.1091    $2,618.40      $548.33      $523.68
                      fracture.
27759..............  Treatment of tibia          ..................  T.................         0064      59.2233    $3,772.17      $835.79      $754.43
                      fracture.
27760..............  Cltx medial ankle fx......  ..................  T.................         0043       1.7682      $112.62  ...........       $22.52
27762..............  Cltx med ankle fx w/mnpj..  ..................  T.................         0043       1.7682      $112.62  ...........       $22.52
27766..............  Optx medial ankle fx......  ..................  T.................         0063      41.1091    $2,618.40      $548.33      $523.68
27767..............  Cltx post ankle fx........  NI................  T.................         0043       1.7682      $112.62  ...........       $22.52
27768..............  Cltx post ankle fx w/mnpj.  NI................  T.................         0043       1.7682      $112.62  ...........       $22.52
27769..............  Optx post ankle fx........  NI................  T.................         0063      41.1091    $2,618.40      $548.33      $523.68
27780..............  Treatment of fibula         ..................  T.................         0043       1.7682      $112.62  ...........       $22.52
                      fracture.

[[Page 67020]]

 
27781..............  Treatment of fibula         ..................  T.................         0043       1.7682      $112.62  ...........       $22.52
                      fracture.
27784..............  Treatment of fibula         ..................  T.................         0063      41.1091    $2,618.40      $548.33      $523.68
                      fracture.
27786..............  Treatment of ankle          ..................  T.................         0043       1.7682      $112.62  ...........       $22.52
                      fracture.
27788..............  Treatment of ankle          ..................  T.................         0043       1.7682      $112.62  ...........       $22.52
                      fracture.
27792..............  Treatment of ankle          ..................  T.................         0063      41.1091    $2,618.40      $548.33      $523.68
                      fracture.
27808..............  Treatment of ankle          ..................  T.................         0043       1.7682      $112.62  ...........       $22.52
                      fracture.
27810..............  Treatment of ankle          ..................  T.................         0043       1.7682      $112.62  ...........       $22.52
                      fracture.
27814..............  Treatment of ankle          ..................  T.................         0063      41.1091    $2,618.40      $548.33      $523.68
                      fracture.
27816..............  Treatment of ankle          ..................  T.................         0043       1.7682      $112.62  ...........       $22.52
                      fracture.
27818..............  Treatment of ankle          ..................  T.................         0043       1.7682      $112.62  ...........       $22.52
                      fracture.
27822..............  Treatment of ankle          ..................  T.................         0063      41.1091    $2,618.40      $548.33      $523.68
                      fracture.
27823..............  Treatment of ankle          ..................  T.................         0064      59.2233    $3,772.17      $835.79      $754.43
                      fracture.
27824..............  Treat lower leg fracture..  ..................  T.................         0043       1.7682      $112.62  ...........       $22.52
27825..............  Treat lower leg fracture..  ..................  T.................         0043       1.7682      $112.62  ...........       $22.52
27826..............  Treat lower leg fracture..  ..................  T.................         0063      41.1091    $2,618.40      $548.33      $523.68
27827..............  Treat lower leg fracture..  ..................  T.................         0064      59.2233    $3,772.17      $835.79      $754.43
27828..............  Treat lower leg fracture..  ..................  T.................         0064      59.2233    $3,772.17      $835.79      $754.43
27829..............  Treat lower leg joint.....  ..................  T.................         0063      41.1091    $2,618.40      $548.33      $523.68
27830..............  Treat lower leg             ..................  T.................         0043       1.7682      $112.62  ...........       $22.52
                      dislocation.
27831..............  Treat lower leg             ..................  T.................         0043       1.7682      $112.62  ...........       $22.52
                      dislocation.
27832..............  Treat lower leg             ..................  T.................         0063      41.1091    $2,618.40      $548.33      $523.68
                      dislocation.
27840..............  Treat ankle dislocation...  ..................  T.................         0043       1.7682      $112.62  ...........       $22.52
27842..............  Treat ankle dislocation...  ..................  T.................         0045      14.7658      $940.49      $268.47      $188.10
27846..............  Treat ankle dislocation...  ..................  T.................         0063      41.1091    $2,618.40      $548.33      $523.68
27848..............  Treat ankle dislocation...  ..................  T.................         0063      41.1091    $2,618.40      $548.33      $523.68
27860..............  Fixation of ankle joint...  ..................  T.................         0045      14.7658      $940.49      $268.47      $188.10
27870..............  Fusion of ankle joint,      ..................  T.................         0052      79.4244    $5,058.86  ...........    $1,011.77
                      open.
27871..............  Fusion of tibiofibular      ..................  T.................         0052      79.4244    $5,058.86  ...........    $1,011.77
                      joint.
27880..............  Amputation of lower leg...  ..................  C.................  ...........  ...........  ...........  ...........  ...........
27881..............  Amputation of lower leg...  ..................  C.................  ...........  ...........  ...........  ...........  ...........
27882..............  Amputation of lower leg...  ..................  C.................  ...........  ...........  ...........  ...........  ...........
27884..............  Amputation follow-up        ..................  T.................         0049      21.2689    $1,354.70  ...........      $270.94
                      surgery.
27886..............  Amputation follow-up        ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      surgery.
27888..............  Amputation of foot at       ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      ankle.
27889..............  Amputation of foot at       ..................  T.................         0050      29.1900    $1,859.23  ...........      $371.85
                      ankle.
27892..............  Decompression of leg......  ..................  T.................         0049      21.2689    $1,354.70  ...........      $270.94
27893..............  Decompression of leg......  ..................  T.................         0049      21.2689    $1,354.70  ...........      $270.94
27894..............  Decompression of leg......  ..................  T.................         0049      21.2689    $1,354.70  ...........      $270.94
27899..............  Leg/ankle surgery           ..................  T.................         0043       1.7682      $112.62  ...........       $22.52
                      procedure.
28001..............  Drainage of bursa of foot.  ..................  T.................         0007      11.5594      $736.26  ...........      $147.25
28002..............  Treatment of foot           ..................  T.................         0049      21.2689    $1,354.70  ...........      $270.94
                      infection.
28003..............  Treatment of foot           ..................  T.................         0049      21.2689    $1,354.70  ...........      $270.94
                      infection.
28005..............  Treat foot bone lesion....  ..................  T.................         0055      20.8284    $1,326.64      $355.34      $265.33
28008..............  Incision of foot fascia...  ..................  T.................         0055      20.8284    $1,326.64      $355.34      $265.33
28010..............  Incision of toe tendon....  ..................  T.................         0055      20.8284    $1,326.64      $355.34      $265.33
28011..............  Incision of toe tendons...  ..................  T.................         0055      20.8284    $1,326.64      $355.34      $265.33
28020..............  Exploration of foot joint.  ..................  T.................         0055      20.8284    $1,326.64      $355.34      $265.33
28022..............  Exploration of foot joint.  ..................  T.................         0055      20.8284    $1,326.64      $355.34      $265.33
28024..............  Exploration of toe joint..  ..................  T.................         0055      20.8284    $1,326.64      $355.34      $265.33
28035..............  Decompression of tibia      ..................  T.................         0220      18.0518    $1,149.79  ...........      $229.96
                      nerve.
28043..............  Excision of foot lesion...  ..................  T.................         0022      21.1098    $1,344.57      $354.45      $268.91
28045..............  Excision of foot lesion...  ..................  T.................         0055      20.8284    $1,326.64      $355.34      $265.33
28046..............  Resection of tumor, foot..  ..................  T.................         0055      20.8284    $1,326.64      $355.34      $265.33
28050..............  Biopsy of foot joint        ..................  T.................         0055      20.8284    $1,326.64      $355.34      $265.33
                      lining.
28052..............  Biopsy of foot joint        ..................  T.................         0055      20.8284    $1,326.64      $355.34      $265.33
                      lining.
28054..............  Biopsy of toe joint lining  ..................  T.................         0055      20.8284    $1,326.64      $355.34      $265.33
28055..............  Neurectomy, foot..........  ..................  T.................         0220      18.0518    $1,149.79  ...........      $229.96
28060..............  Partial removal, foot       ..................  T.................         0055      20.8284    $1,326.64      $355.34      $265.33
                      fascia.
28062..............  Removal of foot fascia....  ..................  T.................         0055      20.8284    $1,326.64      $355.34      $265.33
28070..............  Removal of foot joint       ..................  T.................         0055      20.8284    $1,326.64      $355.34      $265.33
                      lining.
28072..............  Removal of foot joint       ..................  T.................         0055      20.8284    $1,326.64      $355.34      $265.33
                      lining.
28080..............  Removal of foot lesion....  ..................  T.................         0055      20.8284    $1,326.64      $355.34      $265.33
28086..............  Excise foot tendon sheath.  ..................  T.................         0055      20.8284    $1,326.64      $355.34      $265.33
28088..............  Excise foot tendon sheath.  ..................  T.................         0055      20.8284    $1,326.64      $355.34      $265.33
28090..............  Removal of foot lesion....  ..................  T.................         0055      20.8284    $1,326.64      $355.34      $265.33
28092..............  Removal of toe lesions....  ..................  T.................         0055      20.8284    $1,326.64      $355.34      $265.33
28100..............  Removal of ankle/heel       ..................  T.................         0055      20.8284    $1,326.64      $355.34      $265.33
                      lesion.
28102..............  Remove/graft foot lesion..  ..................  T.................         0056      44.2687    $2,819.65  ...........      $563.93
28103..............  Remove/graft foot lesion..  ..................  T.................         0056      44.2687    $2,819.65  ...........      $563.93
28104..............  Removal of foot lesion....  ..................  T.................         0055      20.8284    $1,326.64      $355.34      $265.33
28106..............  Remove/graft foot lesion..  ..................  T.................         0056      44.2687    $2,819.65  ...........      $563.93
28107..............  Remove/graft foot lesion..  ..................  T.................         0056      44.2687    $2,819.65  ...........      $563.93
28108..............  Removal of toe lesions....  ..................  T.................         0055      20.8284    $1,326.64      $355.34      $265.33
28110..............  Part removal of metatarsal  ..................  T.................         0055      20.8284    $1,326.64      $355.34      $265.33
28111..............  Part removal of metatarsal  ..................  T.................         0055      20.8284    $1,326.64      $355.34      $265.33
28112..............  Part removal of metatarsal  ..................  T.................         0055      20.8284    $1,326.64      $355.34      $265.33
28113..............  Part removal of metatarsal  ..................  T.................         0055      20.8284    $1,326.64      $355.34      $265.33
28114..............  Removal of metatarsal       ..................  T.................         0055      20.8284    $1,326.64      $355.34      $265.33
                      heads.
28116..............  Revision of foot..........  ..................  T.................         0055      20.8284    $1,326.64      $355.34      $265.33
28118..............  Removal of heel bone......  ..................  T.................         0055      20.8284    $1,326.64      $355.34      $265.33

[[Page 67021]]

 
28119..............  Removal of heel spur......  ..................  T.................         0055      20.8284    $1,326.64      $355.34      $265.33
28120..............  Part removal of ankle/heel  ..................  T.................         0055      20.8284    $1,326.64      $355.34      $265.33
28122..............  Partial removal of foot     ..................  T.................         0055      20.8284    $1,326.64      $355.34      $265.33
                      bone.
28124..............  Partial removal of toe....  ..................  T.................         0055      20.8284    $1,326.64      $355.34      $265.33
28126..............  Partial removal of toe....  ..................  T.................         0055      20.8284    $1,326.64      $355.34      $265.33
28130..............  Removal of ankle bone.....  ..................  T.................         0055      20.8284    $1,326.64      $355.34      $265.33
28140..............  Removal of metatarsal.....  ..................  T.................         0055      20.8284    $1,326.64      $355.34      $265.33
28150..............  Removal of toe............  ..................  T.................         0055      20.8284    $1,326.64      $355.34      $265.33
28153..............  Partial removal of toe....  ..................  T.................         0055      20.8284    $1,326.64      $355.34      $265.33
28160..............  Partial removal of toe....  ..................  T.................         0055      20.8284    $1,326.64      $355.34      $265.33
28171..............  Extensive foot surgery....  ..................  T.................         0055      20.8284    $1,326.64      $355.34      $265.33
28173..............  Extensive foot surgery....  ..................  T.................         0055      20.8284    $1,326.64      $355.34      $265.33
28175..............  Extensive foot surgery....  ..................  T.................         0055      20.8284    $1,326.64      $355.34      $265.33
28190..............  Removal of foot foreign     ..................  T.................         0019       4.3039      $274.13       $71.87       $54.83
                      body.
28192..............  Removal of foot foreign     ..................  T.................         0021      16.1001    $1,025.48      $219.48      $205.10
                      body.
28193..............  Removal of foot foreign     ..................  T.................         0020       8.6850      $553.18  ...........      $110.64
                      body.
28200..............  Repair of foot tendon.....  ..................  T.................         0055      20.8284    $1,326.64      $355.34      $265.33
28202..............  Repair/graft of foot        ..................  T.................         0055      20.8284    $1,326.64      $355.34      $265.33
                      tendon.
28208..............  Repair of foot tendon.....  ..................  T.................         0055      20.8284    $1,326.64      $355.34      $265.33
28210..............  Repair/graft of foot        ..................  T.................         0056      44.2687    $2,819.65  ...........      $563.93
                      tendon.
28220..............  Release of foot tendon....  ..................  T.................         0055      20.8284    $1,326.64      $355.34      $265.33
28222..............  Release of foot tendons...  ..................  T.................         0055      20.8284    $1,326.64      $355.34      $265.33
28225..............  Release of foot tendon....  ..................  T.................         0055      20.8284    $1,326.64      $355.34      $265.33
28226..............  Release of foot tendons...  ..................  T.................         0055      20.8284    $1,326.64      $355.34      $265.33
28230..............  Incision of foot tendon(s)  ..................  T.................         0055      20.8284    $1,326.64      $355.34      $265.33
28232..............  Incision of toe tendon....  ..................  T.................         0055      20.8284    $1,326.64      $355.34      $265.33
28234..............  Incision of foot tendon...  ..................  T.................         0055      20.8284    $1,326.64      $355.34      $265.33
28238..............  Revision of foot tendon...  ..................  T.................         0056      44.2687    $2,819.65  ...........      $563.93
28240..............  Release of big toe........  ..................  T.................         0055      20.8284    $1,326.64      $355.34      $265.33
28250..............  Revision of foot fascia...  ..................  T.................         0055      20.8284    $1,326.64      $355.34      $265.33
28260..............  Release of midfoot joint..  ..................  T.................         0055      20.8284    $1,326.64      $355.34      $265.33
28261..............  Revision of foot tendon...  ..................  T.................         0055      20.8284    $1,326.64      $355.34      $265.33
28262..............  Revision of foot and ankle  ..................  T.................         0055      20.8284    $1,326.64      $355.34      $265.33
28264..............  Release of midfoot joint..  ..................  T.................         0056      44.2687    $2,819.65  ...........      $563.93
28270..............  Release of foot             ..................  T.................         0055      20.8284    $1,326.64      $355.34      $265.33
                      contracture.
28272..............  Release of toe joint, each  ..................  T.................         0055      20.8284    $1,326.64      $355.34      $265.33
28280..............  Fusion of toes............  ..................  T.................         0055      20.8284    $1,326.64      $355.34      $265.33
28285..............  Repair of hammertoe.......  ..................  T.................         0055      20.8284    $1,326.64      $355.34      $265.33
28286..............  Repair of hammertoe.......  ..................  T.................         0055      20.8284    $1,326.64      $355.34      $265.33
28288..............  Partial removal of foot     ..................  T.................         0055      20.8284    $1,326.64      $355.34      $265.33
                      bone.
28289..............  Repair hallux rigidus.....  ..................  T.................         0055      20.8284    $1,326.64      $355.34      $265.33
28290..............  Correction of bunion......  ..................  T.................         0057      29.4167    $1,873.67      $475.91      $374.73
28292..............  Correction of bunion......  ..................  T.................         0057      29.4167    $1,873.67      $475.91      $374.73
28293..............  Correction of bunion......  ..................  T.................         0057      29.4167    $1,873.67      $475.91      $374.73
28294..............  Correction of bunion......  ..................  T.................         0057      29.4167    $1,873.67      $475.91      $374.73
28296..............  Correction of bunion......  ..................  T.................         0057      29.4167    $1,873.67      $475.91      $374.73
28297..............  Correction of bunion......  ..................  T.................         0057      29.4167    $1,873.67      $475.91      $374.73
28298..............  Correction of bunion......  ..................  T.................         0057      29.4167    $1,873.67      $475.91      $374.73
28299..............  Correction of bunion......  ..................  T.................         0057      29.4167    $1,873.67      $475.91      $374.73
28300..............  Incision of heel bone.....  ..................  T.................         0056      44.2687    $2,819.65  ...........      $563.93
28302..............  Incision of ankle bone....  ..................  T.................         0055      20.8284    $1,326.64      $355.34      $265.33
28304..............  Incision of midfoot bones.  ..................  T.................         0056      44.2687    $2,819.65  ...........      $563.93
28305..............  Incise/graft midfoot bones  ..................  T.................         0056      44.2687    $2,819.65  ...........      $563.93
28306..............  Incision of metatarsal....  ..................  T.................         0055      20.8284    $1,326.64      $355.34      $265.33
28307..............  Incision of metatarsal....  ..................  T.................         0055      20.8284    $1,326.64      $355.34      $265.33
28308..............  Incision of metatarsal....  ..................  T.................         0055      20.8284    $1,326.64      $355.34      $265.33
28309..............  Incision of metatarsals...  ..................  T.................         0056      44.2687    $2,819.65  ...........      $563.93
28310..............  Revision of big toe.......  ..................  T.................         0055      20.8284    $1,326.64      $355.34      $265.33
28312..............  Revision of toe...........  ..................  T.................         0055      20.8284    $1,326.64      $355.34      $265.33
28313..............  Repair deformity of toe...  ..................  T.................         0055      20.8284    $1,326.64      $355.34      $265.33
28315..............  Removal of sesamoid bone..  ..................  T.................         0055      20.8284    $1,326.64      $355.34      $265.33
28320..............  Repair of foot bones......  ..................  T.................         0056      44.2687    $2,819.65  ...........      $563.93
28322..............  Repair of metatarsals.....  ..................  T.................         0056      44.2687    $2,819.65  ...........      $563.93
28340..............  Resect enlarged toe tissue  ..................  T.................         0055      20.8284    $1,326.64      $355.34      $265.33
28341..............  Resect enlarged toe.......  ..................  T.................         0055      20.8284    $1,326.64      $355.34      $265.33
28344..............  Repair extra toe(s).......  ..................  T.................         0055      20.8284    $1,326.64      $355.34      $265.33
28345..............  Repair webbed toe(s)......  ..................  T.................         0055      20.8284    $1,326.64      $355.34      $265.33
28360..............  Reconstruct cleft foot....  ..................  T.................         0056      44.2687    $2,819.65  ...........      $563.93
28400..............  Treatment of heel fracture  ..................  T.................         0043       1.7682      $112.62  ...........       $22.52
28405..............  Treatment of heel fracture  ..................  T.................         0043       1.7682      $112.62  ...........       $22.52
28406..............  Treatment of heel fracture  ..................  T.................         0062      26.1592    $1,666.18      $372.87      $333.24
28415..............  Treat heel fracture.......  CH................  T.................         0064      59.2233    $3,772.17      $835.79      $754.43
28420..............  Treat/graft heel fracture.  ..................  T.................         0063      41.1091    $2,618.40      $548.33      $523.68
28430..............  Treatment of ankle          ..................  T.................         0043       1.7682      $112.62  ...........       $22.52
                      fracture.
28435..............  Treatment of ankle          ..................  T.................         0043       1.7682      $112.62  ...........       $22.52
                      fracture.
28436..............  Treatment of ankle          ..................  T.................         0062      26.1592    $1,666.18      $372.87      $333.24
                      fracture.
28445..............  Treat ankle fracture......  ..................  T.................         0063      41.1091    $2,618.40      $548.33      $523.68
28446..............  Osteochondral talus         NI................  T.................         0056      44.2687    $2,819.65  ...........      $563.93
                      autogrft.
28450..............  Treat midfoot fracture,     ..................  T.................         0043       1.7682      $112.62  ...........       $22.52
                      each.
28455..............  Treat midfoot fracture,     ..................  T.................         0043       1.7682      $112.62  ...........       $22.52
                      each.

[[Page 67022]]

 
28456..............  Treat midfoot fracture....  ..................  T.................         0062      26.1592    $1,666.18      $372.87      $333.24
28465..............  Treat midfoot fracture,     ..................  T.................         0063      41.1091    $2,618.40      $548.33      $523.68
                      each.
28470..............  Treat metatarsal fracture.  ..................  T.................         0043       1.7682      $112.62  ...........       $22.52
28475..............  Treat metatarsal fracture.  ..................  T.................         0043       1.7682      $112.62  ...........       $22.52
28476..............  Treat metatarsal fracture.  ..................  T.................         0062      26.1592    $1,666.18      $372.87      $333.24
28485..............  Treat metatarsal fracture.  ..................  T.................         0063      41.1091    $2,618.40      $548.33      $523.68
28490..............  Treat big toe fracture....  ..................  T.................         0043       1.7682      $112.62  ...........       $22.52
28495..............  Treat big toe fracture....  ..................  T.................         0043       1.7682      $112.62  ...........       $22.52
28496..............  Treat big toe fracture....  ..................  T.................         0062      26.1592    $1,666.18      $372.87      $333.24
28505..............  Treat big toe fracture....  CH................  T.................         0062      26.1592    $1,666.18      $372.87      $333.24
28510..............  Treatment of toe fracture.  ..................  T.................         0043       1.7682      $112.62  ...........       $22.52
28515..............  Treatment of toe fracture.  ..................  T.................         0043       1.7682      $112.62  ...........       $22.52
28525..............  Treat toe fracture........  CH................  T.................         0062      26.1592    $1,666.18      $372.87      $333.24
28530..............  Treat sesamoid bone         ..................  T.................         0043       1.7682      $112.62  ...........       $22.52
                      fracture.
28531..............  Treat sesamoid bone         CH................  T.................         0062      26.1592    $1,666.18      $372.87      $333.24
                      fracture.
28540..............  Treat foot dislocation....  ..................  T.................         0043       1.7682      $112.62  ...........       $22.52
28545..............  Treat foot dislocation....  ..................  T.................         0062      26.1592    $1,666.18      $372.87      $333.24
28546..............  Treat foot dislocation....  ..................  T.................         0062      26.1592    $1,666.18      $372.87      $333.24
28555..............  Repair foot dislocation...  ..................  T.................         0063      41.1091    $2,618.40      $548.33      $523.68
28570..............  Treat foot dislocation....  ..................  T.................         0043       1.7682      $112.62  ...........       $22.52
28575..............  Treat foot dislocation....  ..................  T.................         0043       1.7682      $112.62  ...........       $22.52
28576..............  Treat foot dislocation....  ..................  T.................         0062      26.1592    $1,666.18      $372.87      $333.24
28585..............  Repair foot dislocation...  CH................  T.................         0062      26.1592    $1,666.18      $372.87      $333.24
28600..............  Treat foot dislocation....  ..................  T.................         0043       1.7682      $112.62  ...........       $22.52
28605..............  Treat foot dislocation....  ..................  T.................         0043       1.7682      $112.62  ...........       $22.52
28606..............  Treat foot dislocation....  ..................  T.................         0062      26.1592    $1,666.18      $372.87      $333.24
28615..............  Repair foot dislocation...  ..................  T.................         0063      41.1091    $2,618.40      $548.33      $523.68
28630..............  Treat toe dislocation.....  ..................  T.................         0043       1.7682      $112.62  ...........       $22.52
28635..............  Treat toe dislocation.....  ..................  T.................         0045      14.7658      $940.49      $268.47      $188.10
28636..............  Treat toe dislocation.....  ..................  T.................         0062      26.1592    $1,666.18      $372.87      $333.24
28645..............  Repair toe dislocation....  CH................  T.................         0062      26.1592    $1,666.18      $372.87      $333.24
28660..............  Treat toe dislocation.....  ..................  T.................         0043       1.7682      $112.62  ...........       $22.52
28665..............  Treat toe dislocation.....  ..................  T.................         0045      14.7658      $940.49      $268.47      $188.10
28666..............  Treat toe dislocation.....  ..................  T.................         0062      26.1592    $1,666.18      $372.87      $333.24
28675..............  Repair of toe dislocation.  CH................  T.................         0062      26.1592    $1,666.18      $372.87      $333.24
28705..............  Fusion of foot bones......  ..................  T.................         0056      44.2687    $2,819.65  ...........      $563.93
28715..............  Fusion of foot bones......  CH................  T.................         0052      79.4244    $5,058.86  ...........    $1,011.77
28725..............  Fusion of foot bones......  ..................  T.................         0056      44.2687    $2,819.65  ...........      $563.93
28730..............  Fusion of foot bones......  ..................  T.................         0056      44.2687    $2,819.65  ...........      $563.93
28735..............  Fusion of foot bones......  ..................  T.................         0056      44.2687    $2,819.65  ...........      $563.93
28737..............  Revision of foot bones....  ..................  T.................         0056      44.2687    $2,819.65  ...........      $563.93
28740..............  Fusion of foot bones......  ..................  T.................         0056      44.2687    $2,819.65  ...........      $563.93
28750..............  Fusion of big toe joint...  ..................  T.................         0056      44.2687    $2,819.65  ...........      $563.93
28755..............  Fusion of big toe joint...  ..................  T.................         0055      20.8284    $1,326.64      $355.34      $265.33
28760..............  Fusion of big toe joint...  ..................  T.................         0056      44.2687    $2,819.65  ...........      $563.93
28800..............  Amputation of midfoot.....  ..................  C.................  ...........  ...........  ...........  ...........  ...........
28805..............  Amputation thru metatarsal  ..................  C.................  ...........  ...........  ...........  ...........  ...........
28810..............  Amputation toe &            ..................  T.................         0055      20.8284    $1,326.64      $355.34      $265.33
                      metatarsal.
28820..............  Amputation of toe.........  ..................  T.................         0055      20.8284    $1,326.64      $355.34      $265.33
28825..............  Partial amputation of toe.  ..................  T.................         0055      20.8284    $1,326.64      $355.34      $265.33
28890..............  High energy eswt, plantar   ..................  T.................         0050      29.1900    $1,859.23  ...........      $371.85
                      f.
28899..............  Foot/toes surgery           ..................  T.................         0043       1.7682      $112.62  ...........       $22.52
                      procedure.
29000..............  Application of body cast..  ..................  S.................         0058       1.0931       $69.62  ...........       $13.92
29010..............  Application of body cast..  ..................  S.................         0426       2.2910      $145.92  ...........       $29.18
29015..............  Application of body cast..  ..................  S.................         0426       2.2910      $145.92  ...........       $29.18
29020..............  Application of body cast..  ..................  S.................         0058       1.0931       $69.62  ...........       $13.92
29025..............  Application of body cast..  ..................  S.................         0058       1.0931       $69.62  ...........       $13.92
29035..............  Application of body cast..  ..................  S.................         0426       2.2910      $145.92  ...........       $29.18
29040..............  Application of body cast..  ..................  S.................         0058       1.0931       $69.62  ...........       $13.92
29044..............  Application of body cast..  ..................  S.................         0426       2.2910      $145.92  ...........       $29.18
29046..............  Application of body cast..  ..................  S.................         0426       2.2910      $145.92  ...........       $29.18
29049..............  Application of figure       ..................  S.................         0058       1.0931       $69.62  ...........       $13.92
                      eight.
29055..............  Application of shoulder     ..................  S.................         0426       2.2910      $145.92  ...........       $29.18
                      cast.
29058..............  Application of shoulder     ..................  S.................         0058       1.0931       $69.62  ...........       $13.92
                      cast.
29065..............  Application of long arm     ..................  S.................         0426       2.2910      $145.92  ...........       $29.18
                      cast.
29075..............  Application of forearm      ..................  S.................         0426       2.2910      $145.92  ...........       $29.18
                      cast.
29085..............  Apply hand/wrist cast.....  ..................  S.................         0058       1.0931       $69.62  ...........       $13.92
29086..............  Apply finger cast.........  ..................  S.................         0058       1.0931       $69.62  ...........       $13.92
29105..............  Apply long arm splint.....  ..................  S.................         0058       1.0931       $69.62  ...........       $13.92
29125..............  Apply forearm splint......  ..................  S.................         0058       1.0931       $69.62  ...........       $13.92
29126..............  Apply forearm splint......  ..................  S.................         0058       1.0931       $69.62  ...........       $13.92
29130..............  Application of finger       ..................  S.................         0058       1.0931       $69.62  ...........       $13.92
                      splint.
29131..............  Application of finger       ..................  S.................         0058       1.0931       $69.62  ...........       $13.92
                      splint.
29200..............  Strapping of chest........  ..................  S.................         0058       1.0931       $69.62  ...........       $13.92
29220..............  Strapping of low back.....  ..................  S.................         0058       1.0931       $69.62  ...........       $13.92
29240..............  Strapping of shoulder.....  ..................  S.................         0058       1.0931       $69.62  ...........       $13.92
29260..............  Strapping of elbow or       ..................  S.................         0058       1.0931       $69.62  ...........       $13.92
                      wrist.
29280..............  Strapping of hand or        ..................  S.................         0058       1.0931       $69.62  ...........       $13.92
                      finger.
29305..............  Application of hip cast...  ..................  S.................         0426       2.2910      $145.92  ...........       $29.18
29325..............  Application of hip casts..  ..................  S.................         0426       2.2910      $145.92  ...........       $29.18

[[Page 67023]]

 
29345..............  Application of long leg     ..................  S.................         0426       2.2910      $145.92  ...........       $29.18
                      cast.
29355..............  Application of long leg     ..................  S.................         0426       2.2910      $145.92  ...........       $29.18
                      cast.
29358..............  Apply long leg cast brace.  ..................  S.................         0426       2.2910      $145.92  ...........       $29.18
29365..............  Application of long leg     ..................  S.................         0426       2.2910      $145.92  ...........       $29.18
                      cast.
29405..............  Apply short leg cast......  ..................  S.................         0426       2.2910      $145.92  ...........       $29.18
29425..............  Apply short leg cast......  ..................  S.................         0426       2.2910      $145.92  ...........       $29.18
29435..............  Apply short leg cast......  ..................  S.................         0426       2.2910      $145.92  ...........       $29.18
29440..............  Addition of walker to cast  ..................  S.................         0058       1.0931       $69.62  ...........       $13.92
29445..............  Apply rigid leg cast......  ..................  S.................         0426       2.2910      $145.92  ...........       $29.18
29450..............  Application of leg cast...  ..................  S.................         0058       1.0931       $69.62  ...........       $13.92
29505..............  Application, long leg       ..................  S.................         0058       1.0931       $69.62  ...........       $13.92
                      splint.
29515..............  Application lower leg       ..................  S.................         0058       1.0931       $69.62  ...........       $13.92
                      splint.
29520..............  Strapping of hip..........  ..................  S.................         0058       1.0931       $69.62  ...........       $13.92
29530..............  Strapping of knee.........  ..................  S.................         0058       1.0931       $69.62  ...........       $13.92
29540..............  Strapping of ankle and/or   ..................  S.................         0058       1.0931       $69.62  ...........       $13.92
                      ft.
29550..............  Strapping of toes.........  ..................  S.................         0058       1.0931       $69.62  ...........       $13.92
29580..............  Application of paste boot.  ..................  S.................         0058       1.0931       $69.62  ...........       $13.92
29590..............  Application of foot splint  ..................  S.................         0058       1.0931       $69.62  ...........       $13.92
29700..............  Removal/revision of cast..  ..................  S.................         0058       1.0931       $69.62  ...........       $13.92
29705..............  Removal/revision of cast..  ..................  S.................         0058       1.0931       $69.62  ...........       $13.92
29710..............  Removal/revision of cast..  ..................  S.................         0426       2.2910      $145.92  ...........       $29.18
29715..............  Removal/revision of cast..  ..................  S.................         0058       1.0931       $69.62  ...........       $13.92
29720..............  Repair of body cast.......  ..................  S.................         0058       1.0931       $69.62  ...........       $13.92
29730..............  Windowing of cast.........  ..................  S.................         0058       1.0931       $69.62  ...........       $13.92
29740..............  Wedging of cast...........  ..................  S.................         0058       1.0931       $69.62  ...........       $13.92
29750..............  Wedging of clubfoot cast..  ..................  S.................         0058       1.0931       $69.62  ...........       $13.92
29799..............  Casting/strapping           ..................  S.................         0058       1.0931       $69.62  ...........       $13.92
                      procedure.
29800..............  Jaw arthroscopy/surgery...  ..................  T.................         0041      28.7803    $1,833.13  ...........      $366.63
29804..............  Jaw arthroscopy/surgery...  ..................  T.................         0041      28.7803    $1,833.13  ...........      $366.63
29805..............  Shoulder arthroscopy, dx..  ..................  T.................         0041      28.7803    $1,833.13  ...........      $366.63
29806..............  Shoulder arthroscopy/       ..................  T.................         0042      45.7072    $2,911.27      $804.74      $582.25
                      surgery.
29807..............  Shoulder arthroscopy/       ..................  T.................         0042      45.7072    $2,911.27      $804.74      $582.25
                      surgery.
29819..............  Shoulder arthroscopy/       CH................  T.................         0042      45.7072    $2,911.27      $804.74      $582.25
                      surgery.
29820..............  Shoulder arthroscopy/       CH................  T.................         0042      45.7072    $2,911.27      $804.74      $582.25
                      surgery.
29821..............  Shoulder arthroscopy/       CH................  T.................         0042      45.7072    $2,911.27      $804.74      $582.25
                      surgery.
29822..............  Shoulder arthroscopy/       ..................  T.................         0041      28.7803    $1,833.13  ...........      $366.63
                      surgery.
29823..............  Shoulder arthroscopy/       CH................  T.................         0042      45.7072    $2,911.27      $804.74      $582.25
                      surgery.
29824..............  Shoulder arthroscopy/       ..................  T.................         0041      28.7803    $1,833.13  ...........      $366.63
                      surgery.
29825..............  Shoulder arthroscopy/       CH................  T.................         0042      45.7072    $2,911.27      $804.74      $582.25
                      surgery.
29826..............  Shoulder arthroscopy/       ..................  T.................         0042      45.7072    $2,911.27      $804.74      $582.25
                      surgery.
29827..............  Arthroscop rotator cuff     ..................  T.................         0042      45.7072    $2,911.27      $804.74      $582.25
                      repr.
29828..............  Arthroscopy biceps          NI................  T.................         0042      45.7072    $2,911.27      $804.74      $582.25
                      tenodesis.
29830..............  Elbow arthroscopy.........  ..................  T.................         0041      28.7803    $1,833.13  ...........      $366.63
29834..............  Elbow arthroscopy/surgery.  ..................  T.................         0041      28.7803    $1,833.13  ...........      $366.63
29835..............  Elbow arthroscopy/surgery.  ..................  T.................         0041      28.7803    $1,833.13  ...........      $366.63
29836..............  Elbow arthroscopy/surgery.  ..................  T.................         0041      28.7803    $1,833.13  ...........      $366.63
29837..............  Elbow arthroscopy/surgery.  ..................  T.................         0041      28.7803    $1,833.13  ...........      $366.63
29838..............  Elbow arthroscopy/surgery.  ..................  T.................         0041      28.7803    $1,833.13  ...........      $366.63
29840..............  Wrist arthroscopy.........  ..................  T.................         0041      28.7803    $1,833.13  ...........      $366.63
29843..............  Wrist arthroscopy/surgery.  ..................  T.................         0041      28.7803    $1,833.13  ...........      $366.63
29844..............  Wrist arthroscopy/surgery.  ..................  T.................         0041      28.7803    $1,833.13  ...........      $366.63
29845..............  Wrist arthroscopy/surgery.  ..................  T.................         0041      28.7803    $1,833.13  ...........      $366.63
29846..............  Wrist arthroscopy/surgery.  ..................  T.................         0041      28.7803    $1,833.13  ...........      $366.63
29847..............  Wrist arthroscopy/surgery.  CH................  T.................         0042      45.7072    $2,911.27      $804.74      $582.25
29848..............  Wrist endoscopy/surgery...  ..................  T.................         0041      28.7803    $1,833.13  ...........      $366.63
29850..............  Knee arthroscopy/surgery..  ..................  T.................         0041      28.7803    $1,833.13  ...........      $366.63
29851..............  Knee arthroscopy/surgery..  ..................  T.................         0042      45.7072    $2,911.27      $804.74      $582.25
29855..............  Tibial arthroscopy/surgery  ..................  T.................         0042      45.7072    $2,911.27      $804.74      $582.25
29856..............  Tibial arthroscopy/surgery  CH................  T.................         0042      45.7072    $2,911.27      $804.74      $582.25
29860..............  Hip arthroscopy, dx.......  CH................  T.................         0042      45.7072    $2,911.27      $804.74      $582.25
29861..............  Hip arthroscopy/surgery...  CH................  T.................         0042      45.7072    $2,911.27      $804.74      $582.25
29862..............  Hip arthroscopy/surgery...  ..................  T.................         0042      45.7072    $2,911.27      $804.74      $582.25
29863..............  Hip arthroscopy/surgery...  ..................  T.................         0042      45.7072    $2,911.27      $804.74      $582.25
29866..............  Autgrft implnt, knee w/     ..................  T.................         0042      45.7072    $2,911.27      $804.74      $582.25
                      scope.
29867..............  Allgrft implnt, knee w/     ..................  T.................         0042      45.7072    $2,911.27      $804.74      $582.25
                      scope.
29868..............  Meniscal trnspl, knee w/    ..................  T.................         0042      45.7072    $2,911.27      $804.74      $582.25
                      scpe.
29870..............  Knee arthroscopy, dx......  ..................  T.................         0041      28.7803    $1,833.13  ...........      $366.63
29871..............  Knee arthroscopy/drainage.  ..................  T.................         0041      28.7803    $1,833.13  ...........      $366.63
29873..............  Knee arthroscopy/surgery..  ..................  T.................         0041      28.7803    $1,833.13  ...........      $366.63
29874..............  Knee arthroscopy/surgery..  ..................  T.................         0041      28.7803    $1,833.13  ...........      $366.63
29875..............  Knee arthroscopy/surgery..  ..................  T.................         0041      28.7803    $1,833.13  ...........      $366.63
29876..............  Knee arthroscopy/surgery..  ..................  T.................         0041      28.7803    $1,833.13  ...........      $366.63
29877..............  Knee arthroscopy/surgery..  ..................  T.................         0041      28.7803    $1,833.13  ...........      $366.63
29879..............  Knee arthroscopy/surgery..  ..................  T.................         0041      28.7803    $1,833.13  ...........      $366.63
29880..............  Knee arthroscopy/surgery..  ..................  T.................         0041      28.7803    $1,833.13  ...........      $366.63
29881..............  Knee arthroscopy/surgery..  ..................  T.................         0041      28.7803    $1,833.13  ...........      $366.63
29882..............  Knee arthroscopy/surgery..  ..................  T.................         0041      28.7803    $1,833.13  ...........      $366.63
29883..............  Knee arthroscopy/surgery..  ..................  T.................         0041      28.7803    $1,833.13  ...........      $366.63
29884..............  Knee arthroscopy/surgery..  ..................  T.................         0041      28.7803    $1,833.13  ...........      $366.63
29885..............  Knee arthroscopy/surgery..  ..................  T.................         0042      45.7072    $2,911.27      $804.74      $582.25

[[Page 67024]]

 
29886..............  Knee arthroscopy/surgery..  ..................  T.................         0041      28.7803    $1,833.13  ...........      $366.63
29887..............  Knee arthroscopy/surgery..  ..................  T.................         0041      28.7803    $1,833.13  ...........      $366.63
29888..............  Knee arthroscopy/surgery..  ..................  T.................         0042      45.7072    $2,911.27      $804.74      $582.25
29889..............  Knee arthroscopy/surgery..  ..................  T.................         0042      45.7072    $2,911.27      $804.74      $582.25
29891..............  Ankle arthroscopy/surgery.  CH................  T.................         0042      45.7072    $2,911.27      $804.74      $582.25
29892..............  Ankle arthroscopy/surgery.  CH................  T.................         0042      45.7072    $2,911.27      $804.74      $582.25
29893..............  Scope, plantar fasciotomy.  ..................  T.................         0055      20.8284    $1,326.64      $355.34      $265.33
29894..............  Ankle arthroscopy/surgery.  ..................  T.................         0041      28.7803    $1,833.13  ...........      $366.63
29895..............  Ankle arthroscopy/surgery.  ..................  T.................         0041      28.7803    $1,833.13  ...........      $366.63
29897..............  Ankle arthroscopy/surgery.  ..................  T.................         0041      28.7803    $1,833.13  ...........      $366.63
29898..............  Ankle arthroscopy/surgery.  ..................  T.................         0041      28.7803    $1,833.13  ...........      $366.63
29899..............  Ankle arthroscopy/surgery.  ..................  T.................         0042      45.7072    $2,911.27      $804.74      $582.25
29900..............  Mcp joint arthroscopy, dx.  CH................  T.................         0041      28.7803    $1,833.13  ...........      $366.63
29901..............  Mcp joint arthroscopy,      CH................  T.................         0041      28.7803    $1,833.13  ...........      $366.63
                      surg.
29902..............  Mcp joint arthroscopy,      CH................  T.................         0041      28.7803    $1,833.13  ...........      $366.63
                      surg.
29904..............  Subtalar arthro w/fb rmvl.  NI................  T.................         0041      28.7803    $1,833.13  ...........      $366.63
29905..............  Subtalar arthro w/exc.....  NI................  T.................         0041      28.7803    $1,833.13  ...........      $366.63
29906..............  Subtalar arthro w/deb.....  NI................  T.................         0041      28.7803    $1,833.13  ...........      $366.63
29907..............  Subtalar arthro w/fusion..  NI................  T.................         0042      45.7072    $2,911.27      $804.74      $582.25
29999..............  Arthroscopy of joint......  ..................  T.................         0041      28.7803    $1,833.13  ...........      $366.63
30000..............  Drainage of nose lesion...  ..................  T.................         0251       2.5002      $159.25  ...........       $31.85
30020..............  Drainage of nose lesion...  ..................  T.................         0251       2.5002      $159.25  ...........       $31.85
3006F..............  Cxr doc rev...............  ..................  M.................  ...........  ...........  ...........  ...........  ...........
30100..............  Intranasal biopsy.........  ..................  T.................         0252       7.4474      $474.35      $109.16       $94.87
30110..............  Removal of nose polyp(s)..  ..................  T.................         0253      16.3288    $1,040.05      $282.29      $208.01
30115..............  Removal of nose polyp(s)..  ..................  T.................         0253      16.3288    $1,040.05      $282.29      $208.01
30117..............  Removal of intranasal       ..................  T.................         0253      16.3288    $1,040.05      $282.29      $208.01
                      lesion.
30118..............  Removal of intranasal       ..................  T.................         0254      23.9765    $1,527.16      $321.35      $305.43
                      lesion.
3011F..............  Lipid panel doc rev.......  ..................  M.................  ...........  ...........  ...........  ...........  ...........
30120..............  Revision of nose..........  ..................  T.................         0253      16.3288    $1,040.05      $282.29      $208.01
30124..............  Removal of nose lesion....  ..................  T.................         0252       7.4474      $474.35      $109.16       $94.87
30125..............  Removal of nose lesion....  ..................  T.................         0256      39.8776    $2,539.96  ...........      $507.99
30130..............  Excise inferior turbinate.  ..................  T.................         0253      16.3288    $1,040.05      $282.29      $208.01
30140..............  Resect inferior turbinate.  ..................  T.................         0254      23.9765    $1,527.16      $321.35      $305.43
3014F..............  Screen mammo doc rev......  ..................  M.................  ...........  ...........  ...........  ...........  ...........
30150..............  Partial removal of nose...  ..................  T.................         0256      39.8776    $2,539.96  ...........      $507.99
30160..............  Removal of nose...........  ..................  T.................         0256      39.8776    $2,539.96  ...........      $507.99
3017F..............  Colorectal ca screen doc    ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      rev.
30200..............  Injection treatment of      ..................  T.................         0252       7.4474      $474.35      $109.16       $94.87
                      nose.
3020F..............  Lvf assess................  ..................  M.................  ...........  ...........  ...........  ...........  ...........
30210..............  Nasal sinus therapy.......  ..................  T.................         0252       7.4474      $474.35      $109.16       $94.87
3021F..............  Lvef mod/sever deprs syst.  ..................  M.................  ...........  ...........  ...........  ...........  ...........
30220..............  Insert nasal septal button  ..................  T.................         0252       7.4474      $474.35      $109.16       $94.87
3022F..............  Lvef >=40% systolic.......  ..................  M.................  ...........  ...........  ...........  ...........  ...........
3023F..............  Spirom doc rev............  ..................  M.................  ...........  ...........  ...........  ...........  ...........
3025F..............  Spirom fev/fvc<70% w copd.  ..................  M.................  ...........  ...........  ...........  ...........  ...........
3027F..............  Spirom fev/fvc>=70%/w/o     ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      copd.
3028F..............  O2 saturation doc rev.....  ..................  M.................  ...........  ...........  ...........  ...........  ...........
30300..............  Remove nasal foreign body.  ..................  X.................         0340       0.6310       $40.19  ...........        $8.04
30310..............  Remove nasal foreign body.  ..................  T.................         0253      16.3288    $1,040.05      $282.29      $208.01
30320..............  Remove nasal foreign body.  ..................  T.................         0253      16.3288    $1,040.05      $282.29      $208.01
3035F..............  O2 saturation<=88% /        ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      pao<=55.
3037F..............  O2 saturation >88% /pao>55  ..................  M.................  ...........  ...........  ...........  ...........  ...........
30400..............  Reconstruction of nose....  ..................  T.................         0256      39.8776    $2,539.96  ...........      $507.99
3040F..............  Fev<40% predicted value...  ..................  M.................  ...........  ...........  ...........  ...........  ...........
30410..............  Reconstruction of nose....  ..................  T.................         0256      39.8776    $2,539.96  ...........      $507.99
30420..............  Reconstruction of nose....  ..................  T.................         0256      39.8776    $2,539.96  ...........      $507.99
3042F..............  Fev>= 40% predicted value.  ..................  M.................  ...........  ...........  ...........  ...........  ...........
30430..............  Revision of nose..........  ..................  T.................         0254      23.9765    $1,527.16      $321.35      $305.43
30435..............  Revision of nose..........  ..................  T.................         0256      39.8776    $2,539.96  ...........      $507.99
3044F..............  Hg a1c level lt 7.0%......  ..................  M.................  ...........  ...........  ...........  ...........  ...........
30450..............  Revision of nose..........  ..................  T.................         0256      39.8776    $2,539.96  ...........      $507.99
3045F..............  HG a1c level 7.0-9.0%.....  ..................  M.................  ...........  ...........  ...........  ...........  ...........
30460..............  Revision of nose..........  ..................  T.................         0256      39.8776    $2,539.96  ...........      $507.99
30462..............  Revision of nose..........  ..................  T.................         0256      39.8776    $2,539.96  ...........      $507.99
30465..............  Repair nasal stenosis.....  ..................  T.................         0256      39.8776    $2,539.96  ...........      $507.99
3046F..............  Hemoglobin a1c level >      ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      9.0%.
3048F..............  Ldl-c <100 mg/dl..........  ..................  M.................  ...........  ...........  ...........  ...........  ...........
3049F..............  Ldl-c 100-129 mg/dl.......  ..................  M.................  ...........  ...........  ...........  ...........  ...........
3050F..............  Ldl-c >= 130 mg/dl........  ..................  M.................  ...........  ...........  ...........  ...........  ...........
30520..............  Repair of nasal septum....  ..................  T.................         0254      23.9765    $1,527.16      $321.35      $305.43
30540..............  Repair nasal defect.......  ..................  T.................         0256      39.8776    $2,539.96  ...........      $507.99
30545..............  Repair nasal defect.......  ..................  T.................         0256      39.8776    $2,539.96  ...........      $507.99
30560..............  Release of nasal adhesions  ..................  T.................         0251       2.5002      $159.25  ...........       $31.85
30580..............  Repair upper jaw fistula..  ..................  T.................         0256      39.8776    $2,539.96  ...........      $507.99
30600..............  Repair mouth/nose fistula.  ..................  T.................         0256      39.8776    $2,539.96  ...........      $507.99
3060F..............  Pos microalbuminuria rev..  ..................  M.................  ...........  ...........  ...........  ...........  ...........
3061F..............  Neg microalbuminuria rev..  ..................  M.................  ...........  ...........  ...........  ...........  ...........
30620..............  Intranasal reconstruction.  ..................  T.................         0256      39.8776    $2,539.96  ...........      $507.99
3062F..............  Pos macroalbuminuria rev..  ..................  M.................  ...........  ...........  ...........  ...........  ...........

[[Page 67025]]

 
30630..............  Repair nasal septum defect  ..................  T.................         0254      23.9765    $1,527.16      $321.35      $305.43
3066F..............  Nephropathy doc tx........  ..................  M.................  ...........  ...........  ...........  ...........  ...........
3072F..............  Low risk for retinopathy..  ..................  M.................  ...........  ...........  ...........  ...........  ...........
3073F..............  Pre-surg eye measures       ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      doc'd.
3074F..............  Syst bp lt 130 mm hg......  ..................  M.................  ...........  ...........  ...........  ...........  ...........
3075F..............  Syst bp ge 130 - 139mm hg.  ..................  M.................  ...........  ...........  ...........  ...........  ...........
3077F..............  Syst bp >= 140 mm hg6 it..  ..................  M.................  ...........  ...........  ...........  ...........  ...........
3078F..............  Diast bp < 80 mm hg.......  ..................  M.................  ...........  ...........  ...........  ...........  ...........
3079F..............  Diast bp 80-89 mm hg......  ..................  M.................  ...........  ...........  ...........  ...........  ...........
30801..............  Ablate inf turbinate,       ..................  T.................         0252       7.4474      $474.35      $109.16       $94.87
                      superf.
30802..............  Cauterization, inner nose.  ..................  T.................         0252       7.4474      $474.35      $109.16       $94.87
3080F..............  Diast bp >= 90 mm hg......  ..................  M.................  ...........  ...........  ...........  ...........  ...........
3082F..............  Kt/v lt 1.2...............  ..................  M.................  ...........  ...........  ...........  ...........  ...........
3083F..............  Kt/v ge 1.2 and <1.7......  ..................  M.................  ...........  ...........  ...........  ...........  ...........
3084F..............  Kt/v ge 1.7...............  ..................  M.................  ...........  ...........  ...........  ...........  ...........
3085F..............  Suicide risk assessed.....  ..................  M.................  ...........  ...........  ...........  ...........  ...........
3088F..............  MDD, mild.................  ..................  M.................  ...........  ...........  ...........  ...........  ...........
3089F..............  MDD, moderate.............  ..................  M.................  ...........  ...........  ...........  ...........  ...........
30901..............  Control of nosebleed......  ..................  T.................         0250       1.1251       $71.66       $25.10       $14.33
30903..............  Control of nosebleed......  ..................  T.................         0250       1.1251       $71.66       $25.10       $14.33
30905..............  Control of nosebleed......  ..................  T.................         0250       1.1251       $71.66       $25.10       $14.33
30906..............  Repeat control of           ..................  T.................         0250       1.1251       $71.66       $25.10       $14.33
                      nosebleed.
3090F..............  MDD, severe; w/o psych....  ..................  M.................  ...........  ...........  ...........  ...........  ...........
30915..............  Ligation, nasal sinus       ..................  T.................         0092      25.8410    $1,645.92  ...........      $329.18
                      artery.
3091F..............  Mdd, severe; w/ psych.....  ..................  M.................  ...........  ...........  ...........  ...........  ...........
30920..............  Ligation, upper jaw artery  ..................  T.................         0092      25.8410    $1,645.92  ...........      $329.18
3092F..............  MDD, in remission.........  ..................  M.................  ...........  ...........  ...........  ...........  ...........
30930..............  Ther fx, nasal inf          ..................  T.................         0253      16.3288    $1,040.05      $282.29      $208.01
                      turbinate.
3093F..............  Doc new diag 1st/addl mdd.  ..................  M.................  ...........  ...........  ...........  ...........  ...........
3095F..............  Central dexa results doc'd  ..................  M.................  ...........  ...........  ...........  ...........  ...........
3096F..............  Central dexa ordered......  ..................  M.................  ...........  ...........  ...........  ...........  ...........
30999..............  Nasal surgery procedure...  ..................  T.................         0251       2.5002      $159.25  ...........       $31.85
31000..............  Irrigation, maxillary       ..................  T.................         0251       2.5002      $159.25  ...........       $31.85
                      sinus.
31002..............  Irrigation, sphenoid sinus  ..................  T.................         0252       7.4474      $474.35      $109.16       $94.87
3100F..............  Image test ref carot diam.  ..................  M.................  ...........  ...........  ...........  ...........  ...........
31020..............  Exploration, maxillary      ..................  T.................         0254      23.9765    $1,527.16      $321.35      $305.43
                      sinus.
31030..............  Exploration, maxillary      ..................  T.................         0256      39.8776    $2,539.96  ...........      $507.99
                      sinus.
31032..............  Explore sinus, remove       ..................  T.................         0256      39.8776    $2,539.96  ...........      $507.99
                      polyps.
31040..............  Exploration behind upper    ..................  T.................         0254      23.9765    $1,527.16      $321.35      $305.43
                      jaw.
31050..............  Exploration, sphenoid       ..................  T.................         0256      39.8776    $2,539.96  ...........      $507.99
                      sinus.
31051..............  Sphenoid sinus surgery....  ..................  T.................         0256      39.8776    $2,539.96  ...........      $507.99
31070..............  Exploration of frontal      ..................  T.................         0254      23.9765    $1,527.16      $321.35      $305.43
                      sinus.
31075..............  Exploration of frontal      ..................  T.................         0256      39.8776    $2,539.96  ...........      $507.99
                      sinus.
31080..............  Removal of frontal sinus..  ..................  T.................         0256      39.8776    $2,539.96  ...........      $507.99
31081..............  Removal of frontal sinus..  ..................  T.................         0256      39.8776    $2,539.96  ...........      $507.99
31084..............  Removal of frontal sinus..  ..................  T.................         0256      39.8776    $2,539.96  ...........      $507.99
31085..............  Removal of frontal sinus..  ..................  T.................         0256      39.8776    $2,539.96  ...........      $507.99
31086..............  Removal of frontal sinus..  ..................  T.................         0256      39.8776    $2,539.96  ...........      $507.99
31087..............  Removal of frontal sinus..  ..................  T.................         0256      39.8776    $2,539.96  ...........      $507.99
31090..............  Exploration of sinuses....  ..................  T.................         0256      39.8776    $2,539.96  ...........      $507.99
3110F..............  Pres/absn hmrhg/lesion      ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      doc'd.
3111F..............  Ct/mri brain done w/in      ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      24hrs.
3112F..............  Ct/mri brain done gt 24     ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      hrs.
31200..............  Removal of ethmoid sinus..  ..................  T.................         0256      39.8776    $2,539.96  ...........      $507.99
31201..............  Removal of ethmoid sinus..  ..................  T.................         0256      39.8776    $2,539.96  ...........      $507.99
31205..............  Removal of ethmoid sinus..  ..................  T.................         0256      39.8776    $2,539.96  ...........      $507.99
3120F..............  12-lead ecg performed.....  ..................  M.................  ...........  ...........  ...........  ...........  ...........
31225..............  Removal of upper jaw......  ..................  C.................  ...........  ...........  ...........  ...........  ...........
31230..............  Removal of upper jaw......  ..................  C.................  ...........  ...........  ...........  ...........  ...........
31231..............  Nasal endoscopy, dx.......  ..................  T.................         0072       1.6115      $102.64       $21.27       $20.53
31233..............  Nasal/sinus endoscopy, dx.  ..................  T.................         0072       1.6115      $102.64       $21.27       $20.53
31235..............  Nasal/sinus endoscopy, dx.  ..................  T.................         0074      17.0160    $1,083.82      $292.25      $216.76
31237..............  Nasal/sinus endoscopy,      ..................  T.................         0074      17.0160    $1,083.82      $292.25      $216.76
                      surg.
31238..............  Nasal/sinus endoscopy,      ..................  T.................         0074      17.0160    $1,083.82      $292.25      $216.76
                      surg.
31239..............  Nasal/sinus endoscopy,      ..................  T.................         0075      22.7191    $1,447.07      $445.92      $289.41
                      surg.
31240..............  Nasal/sinus endoscopy,      ..................  T.................         0074      17.0160    $1,083.82      $292.25      $216.76
                      surg.
31254..............  Revision of ethmoid sinus.  ..................  T.................         0075      22.7191    $1,447.07      $445.92      $289.41
31255..............  Removal of ethmoid sinus..  ..................  T.................         0075      22.7191    $1,447.07      $445.92      $289.41
31256..............  Exploration maxillary       ..................  T.................         0075      22.7191    $1,447.07      $445.92      $289.41
                      sinus.
31267..............  Endoscopy, maxillary sinus  ..................  T.................         0075      22.7191    $1,447.07      $445.92      $289.41
31276..............  Sinus endoscopy, surgical.  ..................  T.................         0075      22.7191    $1,447.07      $445.92      $289.41
31287..............  Nasal/sinus endoscopy,      ..................  T.................         0075      22.7191    $1,447.07      $445.92      $289.41
                      surg.
31288..............  Nasal/sinus endoscopy,      ..................  T.................         0075      22.7191    $1,447.07      $445.92      $289.41
                      surg.
31290..............  Nasal/sinus endoscopy,      ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      surg.
31291..............  Nasal/sinus endoscopy,      ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      surg.
31292..............  Nasal/sinus endoscopy,      ..................  T.................         0075      22.7191    $1,447.07      $445.92      $289.41
                      surg.
31293..............  Nasal/sinus endoscopy,      ..................  T.................         0075      22.7191    $1,447.07      $445.92      $289.41
                      surg.
31294..............  Nasal/sinus endoscopy,      ..................  T.................         0075      22.7191    $1,447.07      $445.92      $289.41
                      surg.
31299..............  Sinus surgery procedure...  ..................  T.................         0251       2.5002      $159.25  ...........       $31.85
31300..............  Removal of larynx lesion..  ..................  T.................         0254      23.9765    $1,527.16      $321.35      $305.43

[[Page 67026]]

 
3130F..............  Upper gi endoscopy          ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      performed.
31320..............  Diagnostic incision,        ..................  T.................         0256      39.8776    $2,539.96  ...........      $507.99
                      larynx.
3132F..............  Doc ref upper gi endoscopy  ..................  M.................  ...........  ...........  ...........  ...........  ...........
31360..............  Removal of larynx.........  ..................  C.................  ...........  ...........  ...........  ...........  ...........
31365..............  Removal of larynx.........  ..................  C.................  ...........  ...........  ...........  ...........  ...........
31367..............  Partial removal of larynx.  ..................  C.................  ...........  ...........  ...........  ...........  ...........
31368..............  Partial removal of larynx.  ..................  C.................  ...........  ...........  ...........  ...........  ...........
31370..............  Partial removal of larynx.  ..................  C.................  ...........  ...........  ...........  ...........  ...........
31375..............  Partial removal of larynx.  ..................  C.................  ...........  ...........  ...........  ...........  ...........
31380..............  Partial removal of larynx.  ..................  C.................  ...........  ...........  ...........  ...........  ...........
31382..............  Partial removal of larynx.  ..................  C.................  ...........  ...........  ...........  ...........  ...........
31390..............  Removal of larynx &         ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      pharynx.
31395..............  Reconstruct larynx &        ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      pharynx.
31400..............  Revision of larynx........  ..................  T.................         0256      39.8776    $2,539.96  ...........      $507.99
3140F..............  Upper gi endo shows         ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      barrtt's.
3141F..............  Upper gi endo not barrtt's  ..................  M.................  ...........  ...........  ...........  ...........  ...........
31420..............  Removal of epiglottis.....  ..................  T.................         0256      39.8776    $2,539.96  ...........      $507.99
3142F..............  Barium swallow test         ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      ordered.
31500..............  Insert emergency airway...  ..................  S.................         0094       2.4590      $156.62       $46.29       $31.32
31502..............  Change of windpipe airway.  CH................  S.................         0078       1.3362       $85.11  ...........       $17.02
31505..............  Diagnostic laryngoscopy...  ..................  T.................         0071       0.8224       $52.38       $11.20       $10.48
3150F..............  Forceps esoph biopsy done.  ..................  M.................  ...........  ...........  ...........  ...........  ...........
31510..............  Laryngoscopy with biopsy..  ..................  T.................         0074      17.0160    $1,083.82      $292.25      $216.76
31511..............  Remove foreign body,        ..................  T.................         0072       1.6115      $102.64       $21.27       $20.53
                      larynx.
31512..............  Removal of larynx lesion..  ..................  T.................         0074      17.0160    $1,083.82      $292.25      $216.76
31513..............  Injection into vocal cord.  ..................  T.................         0072       1.6115      $102.64       $21.27       $20.53
31515..............  Laryngoscopy for            ..................  T.................         0074      17.0160    $1,083.82      $292.25      $216.76
                      aspiration.
31520..............  Dx laryngoscopy, newborn..  ..................  T.................         0072       1.6115      $102.64       $21.27       $20.53
31525..............  Dx laryngoscopy excl nb...  ..................  T.................         0074      17.0160    $1,083.82      $292.25      $216.76
31526..............  Dx laryngoscopy w/oper      ..................  T.................         0075      22.7191    $1,447.07      $445.92      $289.41
                      scope.
31527..............  Laryngoscopy for treatment  ..................  T.................         0075      22.7191    $1,447.07      $445.92      $289.41
31528..............  Laryngoscopy and dilation.  ..................  T.................         0074      17.0160    $1,083.82      $292.25      $216.76
31529..............  Laryngoscopy and dilation.  ..................  T.................         0074      17.0160    $1,083.82      $292.25      $216.76
31530..............  Laryngoscopy w/fb removal.  ..................  T.................         0075      22.7191    $1,447.07      $445.92      $289.41
31531..............  Laryngoscopy w/fb & op      ..................  T.................         0075      22.7191    $1,447.07      $445.92      $289.41
                      scope.
31535..............  Laryngoscopy w/biopsy.....  ..................  T.................         0075      22.7191    $1,447.07      $445.92      $289.41
31536..............  Laryngoscopy w/bx & op      ..................  T.................         0075      22.7191    $1,447.07      $445.92      $289.41
                      scope.
31540..............  Laryngoscopy w/exc of       ..................  T.................         0075      22.7191    $1,447.07      $445.92      $289.41
                      tumor.
31541..............  Larynscop w/tumr exc +      ..................  T.................         0075      22.7191    $1,447.07      $445.92      $289.41
                      scope.
31545..............  Remove vc lesion w/scope..  ..................  T.................         0075      22.7191    $1,447.07      $445.92      $289.41
31546..............  Remove vc lesion scope/     ..................  T.................         0075      22.7191    $1,447.07      $445.92      $289.41
                      graft.
3155F..............  Cytogen test marrow b/4 tx  ..................  M.................  ...........  ...........  ...........  ...........  ...........
31560..............  Laryngoscop w/              ..................  T.................         0075      22.7191    $1,447.07      $445.92      $289.41
                      arytenoidectom.
31561..............  Larynscop, remve cart +     ..................  T.................         0075      22.7191    $1,447.07      $445.92      $289.41
                      scop.
31570..............  Laryngoscope w/vc inj.....  ..................  T.................         0074      17.0160    $1,083.82      $292.25      $216.76
31571..............  Laryngoscop w/vc inj +      ..................  T.................         0075      22.7191    $1,447.07      $445.92      $289.41
                      scope.
31575..............  Diagnostic laryngoscopy...  ..................  T.................         0072       1.6115      $102.64       $21.27       $20.53
31576..............  Laryngoscopy with biopsy..  ..................  T.................         0075      22.7191    $1,447.07      $445.92      $289.41
31577..............  Remove foreign body,        ..................  T.................         0073       3.9940      $254.39       $69.15       $50.88
                      larynx.
31578..............  Removal of larynx lesion..  ..................  T.................         0075      22.7191    $1,447.07      $445.92      $289.41
31579..............  Diagnostic laryngoscopy...  ..................  T.................         0073       3.9940      $254.39       $69.15       $50.88
31580..............  Revision of larynx........  ..................  T.................         0256      39.8776    $2,539.96  ...........      $507.99
31582..............  Revision of larynx........  ..................  T.................         0256      39.8776    $2,539.96  ...........      $507.99
31584..............  Treat larynx fracture.....  ..................  C.................  ...........  ...........  ...........  ...........  ...........
31587..............  Revision of larynx........  ..................  C.................  ...........  ...........  ...........  ...........  ...........
31588..............  Revision of larynx........  ..................  T.................         0256      39.8776    $2,539.96  ...........      $507.99
31590..............  Reinnervate larynx........  ..................  T.................         0256      39.8776    $2,539.96  ...........      $507.99
31595..............  Larynx nerve surgery......  ..................  T.................         0256      39.8776    $2,539.96  ...........      $507.99
31599..............  Larynx surgery procedure..  ..................  T.................         0251       2.5002      $159.25  ...........       $31.85
31600..............  Incision of windpipe......  ..................  T.................         0254      23.9765    $1,527.16      $321.35      $305.43
31601..............  Incision of windpipe......  ..................  T.................         0254      23.9765    $1,527.16      $321.35      $305.43
31603..............  Incision of windpipe......  ..................  T.................         0252       7.4474      $474.35      $109.16       $94.87
31605..............  Incision of windpipe......  ..................  T.................         0252       7.4474      $474.35      $109.16       $94.87
3160F..............  Doc fe+ stores b/4 epo thx  ..................  M.................  ...........  ...........  ...........  ...........  ...........
31610..............  Incision of windpipe......  ..................  T.................         0254      23.9765    $1,527.16      $321.35      $305.43
31611..............  Surgery/speech prosthesis.  ..................  T.................         0254      23.9765    $1,527.16      $321.35      $305.43
31612..............  Puncture/clear windpipe...  ..................  T.................         0254      23.9765    $1,527.16      $321.35      $305.43
31613..............  Repair windpipe opening...  ..................  T.................         0254      23.9765    $1,527.16      $321.35      $305.43
31614..............  Repair windpipe opening...  ..................  T.................         0256      39.8776    $2,539.96  ...........      $507.99
31615..............  Visualization of windpipe.  ..................  T.................         0076       9.9575      $634.23      $189.82      $126.85
31620..............  Endobronchial us add-on...  CH................  N.................  ...........  ...........  ...........  ...........  ...........
31622..............  Dx bronchoscope/wash......  ..................  T.................         0076       9.9575      $634.23      $189.82      $126.85
31623..............  Dx bronchoscope/brush.....  ..................  T.................         0076       9.9575      $634.23      $189.82      $126.85
31624..............  Dx bronchoscope/lavage....  ..................  T.................         0076       9.9575      $634.23      $189.82      $126.85
31625..............  Bronchoscopy w/biopsy(s)..  ..................  T.................         0076       9.9575      $634.23      $189.82      $126.85
31628..............  Bronchoscopy/lung bx, each  ..................  T.................         0076       9.9575      $634.23      $189.82      $126.85
31629..............  Bronchoscopy/needle bx,     ..................  T.................         0076       9.9575      $634.23      $189.82      $126.85
                      each.
31630..............  Bronchoscopy dilate/fx      ..................  T.................         0415      24.0654    $1,532.82      $459.92      $306.56
                      repr.
31631..............  Bronchoscopy, dilate w/     ..................  T.................         0415      24.0654    $1,532.82      $459.92      $306.56
                      stent.
31632..............  Bronchoscopy/lung bx,       ..................  T.................         0076       9.9575      $634.23      $189.82      $126.85
                      add'l.

[[Page 67027]]

 
31633..............  Bronchoscopy/needle bx      ..................  T.................         0076       9.9575      $634.23      $189.82      $126.85
                      add'l.
31635..............  Bronchoscopy w/fb removal.  ..................  T.................         0076       9.9575      $634.23      $189.82      $126.85
31636..............  Bronchoscopy, bronch        ..................  T.................         0415      24.0654    $1,532.82      $459.92      $306.56
                      stents.
31637..............  Bronchoscopy, stent add-on  ..................  T.................         0076       9.9575      $634.23      $189.82      $126.85
31638..............  Bronchoscopy, revise stent  ..................  T.................         0415      24.0654    $1,532.82      $459.92      $306.56
31640..............  Bronchoscopy w/tumor        ..................  T.................         0415      24.0654    $1,532.82      $459.92      $306.56
                      excise.
31641..............  Bronchoscopy, treat         ..................  T.................         0415      24.0654    $1,532.82      $459.92      $306.56
                      blockage.
31643..............  Diag bronchoscope/catheter  ..................  T.................         0076       9.9575      $634.23      $189.82      $126.85
31645..............  Bronchoscopy, clear         ..................  T.................         0076       9.9575      $634.23      $189.82      $126.85
                      airways.
31646..............  Bronchoscopy, reclear       ..................  T.................         0076       9.9575      $634.23      $189.82      $126.85
                      airway.
31656..............  Bronchoscopy, inj for x-    ..................  T.................         0076       9.9575      $634.23      $189.82      $126.85
                      ray.
3170F..............  Flow cyto done b/4 tx.....  ..................  M.................  ...........  ...........  ...........  ...........  ...........
31715..............  Injection for bronchus x-   ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      ray.
31717..............  Bronchial brush biopsy....  ..................  T.................         0073       3.9940      $254.39       $69.15       $50.88
31720..............  Clearance of airways......  CH................  S.................         0077       0.3877       $24.69        $7.74        $4.94
31725..............  Clearance of airways......  ..................  C.................  ...........  ...........  ...........  ...........  ...........
31730..............  Intro, windpipe wire/tube.  ..................  T.................         0073       3.9940      $254.39       $69.15       $50.88
31750..............  Repair of windpipe........  ..................  T.................         0256      39.8776    $2,539.96  ...........      $507.99
31755..............  Repair of windpipe........  ..................  T.................         0256      39.8776    $2,539.96  ...........      $507.99
31760..............  Repair of windpipe........  ..................  C.................  ...........  ...........  ...........  ...........  ...........
31766..............  Reconstruction of windpipe  ..................  C.................  ...........  ...........  ...........  ...........  ...........
31770..............  Repair/graft of bronchus..  ..................  C.................  ...........  ...........  ...........  ...........  ...........
31775..............  Reconstruct bronchus......  ..................  C.................  ...........  ...........  ...........  ...........  ...........
31780..............  Reconstruct windpipe......  ..................  C.................  ...........  ...........  ...........  ...........  ...........
31781..............  Reconstruct windpipe......  ..................  C.................  ...........  ...........  ...........  ...........  ...........
31785..............  Remove windpipe lesion....  ..................  T.................         0254      23.9765    $1,527.16      $321.35      $305.43
31786..............  Remove windpipe lesion....  ..................  C.................  ...........  ...........  ...........  ...........  ...........
31800..............  Repair of windpipe injury.  ..................  C.................  ...........  ...........  ...........  ...........  ...........
31805..............  Repair of windpipe injury.  ..................  C.................  ...........  ...........  ...........  ...........  ...........
31820..............  Closure of windpipe lesion  ..................  T.................         0253      16.3288    $1,040.05      $282.29      $208.01
31825..............  Repair of windpipe defect.  ..................  T.................         0254      23.9765    $1,527.16      $321.35      $305.43
31830..............  Revise windpipe scar......  ..................  T.................         0254      23.9765    $1,527.16      $321.35      $305.43
31899..............  Airways surgical procedure  ..................  T.................         0076       9.9575      $634.23      $189.82      $126.85
32000..............  Drainage of chest.........  CH................  D.................  ...........  ...........  ...........  ...........  ...........
32002..............  Treatment of collapsed      CH................  D.................  ...........  ...........  ...........  ...........  ...........
                      lung.
32005..............  Treat lung lining           CH................  D.................  ...........  ...........  ...........  ...........  ...........
                      chemically.
3200F..............  Barium swallow test not     ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      req.
32019..............  Insert pleural catheter...  CH................  D.................  ...........  ...........  ...........  ...........  ...........
32020..............  Insertion of chest tube...  CH................  D.................  ...........  ...........  ...........  ...........  ...........
32035..............  Exploration of chest......  ..................  C.................  ...........  ...........  ...........  ...........  ...........
32036..............  Exploration of chest......  ..................  C.................  ...........  ...........  ...........  ...........  ...........
32095..............  Biopsy through chest wall.  ..................  C.................  ...........  ...........  ...........  ...........  ...........
32100..............  Exploration/biopsy of       ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      chest.
3210F..............  Grp a strep test performed  ..................  M.................  ...........  ...........  ...........  ...........  ...........
32110..............  Explore/repair chest......  ..................  C.................  ...........  ...........  ...........  ...........  ...........
32120..............  Re-exploration of chest...  ..................  C.................  ...........  ...........  ...........  ...........  ...........
32124..............  Explore chest free          ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      adhesions.
32140..............  Removal of lung lesion(s).  ..................  C.................  ...........  ...........  ...........  ...........  ...........
32141..............  Remove/treat lung lesions.  ..................  C.................  ...........  ...........  ...........  ...........  ...........
32150..............  Removal of lung lesion(s).  ..................  C.................  ...........  ...........  ...........  ...........  ...........
32151..............  Remove lung foreign body..  ..................  C.................  ...........  ...........  ...........  ...........  ...........
3215F..............  Pt immunity to hep A doc'd  ..................  M.................  ...........  ...........  ...........  ...........  ...........
32160..............  Open chest heart massage..  ..................  C.................  ...........  ...........  ...........  ...........  ...........
3216F..............  Pt immunity to hep B doc'd  ..................  M.................  ...........  ...........  ...........  ...........  ...........
3218F..............  Rna tstng hep c doc'd-done  ..................  M.................  ...........  ...........  ...........  ...........  ...........
32200..............  Drain, open, lung lesion..  ..................  C.................  ...........  ...........  ...........  ...........  ...........
32201..............  Drain, percut, lung lesion  ..................  T.................         0070       5.2024      $331.36  ...........       $66.27
3220F..............  Hep C quant rna tstng       ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      doc'd.
32215..............  Treat chest lining........  ..................  C.................  ...........  ...........  ...........  ...........  ...........
32220..............  Release of lung...........  ..................  C.................  ...........  ...........  ...........  ...........  ...........
32225..............  Partial release of lung...  ..................  C.................  ...........  ...........  ...........  ...........  ...........
3230F..............  Note hring tst w/in 6 mon.  ..................  M.................  ...........  ...........  ...........  ...........  ...........
32310..............  Removal of chest lining...  ..................  C.................  ...........  ...........  ...........  ...........  ...........
32320..............  Free/remove chest lining..  ..................  C.................  ...........  ...........  ...........  ...........  ...........
32400..............  Needle biopsy chest lining  ..................  T.................         0685       9.3354      $594.61  ...........      $118.92
32402..............  Open biopsy chest lining..  ..................  C.................  ...........  ...........  ...........  ...........  ...........
32405..............  Biopsy, lung or             ..................  T.................         0685       9.3354      $594.61  ...........      $118.92
                      mediastinum.
32420..............  Puncture/clear lung.......  ..................  T.................         0070       5.2024      $331.36  ...........       $66.27
32421..............  Thoracentesis for           NI................  T.................         0070       5.2024      $331.36  ...........       $66.27
                      aspiration.
32422..............  Thoracentesis w/tube        NI................  T.................         0070       5.2024      $331.36  ...........       $66.27
                      insert.
32440..............  Removal of lung...........  ..................  C.................  ...........  ...........  ...........  ...........  ...........
32442..............  Sleeve pneumonectomy......  ..................  C.................  ...........  ...........  ...........  ...........  ...........
32445..............  Removal of lung...........  ..................  C.................  ...........  ...........  ...........  ...........  ...........
32480..............  Partial removal of lung...  ..................  C.................  ...........  ...........  ...........  ...........  ...........
32482..............  Bilobectomy...............  ..................  C.................  ...........  ...........  ...........  ...........  ...........
32484..............  Segmentectomy.............  ..................  C.................  ...........  ...........  ...........  ...........  ...........
32486..............  Sleeve lobectomy..........  ..................  C.................  ...........  ...........  ...........  ...........  ...........
32488..............  Completion pneumonectomy..  ..................  C.................  ...........  ...........  ...........  ...........  ...........
32491..............  Lung volume reduction.....  ..................  C.................  ...........  ...........  ...........  ...........  ...........
32500..............  Partial removal of lung...  ..................  C.................  ...........  ...........  ...........  ...........  ...........

[[Page 67028]]

 
32501..............  Repair bronchus add-on....  ..................  C.................  ...........  ...........  ...........  ...........  ...........
32503..............  Resect apical lung tumor..  ..................  C.................  ...........  ...........  ...........  ...........  ...........
32504..............  Resect apical lung tum/     ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      chest.
32540..............  Removal of lung lesion....  ..................  C.................  ...........  ...........  ...........  ...........  ...........
32550..............  Insert pleural cath.......  NI................  T.................         0652      30.7096    $1,956.02  ...........      $391.20
32551..............  Insertion of chest tube...  NI................  T.................         0070       5.2024      $331.36  ...........       $66.27
32560..............  Treat lung lining           NI................  T.................         0070       5.2024      $331.36  ...........       $66.27
                      chemically.
32601..............  Thoracoscopy, diagnostic..  ..................  T.................         0069      32.5666    $2,074.30      $591.64      $414.86
32602..............  Thoracoscopy, diagnostic..  ..................  T.................         0069      32.5666    $2,074.30      $591.64      $414.86
32603..............  Thoracoscopy, diagnostic..  ..................  T.................         0069      32.5666    $2,074.30      $591.64      $414.86
32604..............  Thoracoscopy, diagnostic..  ..................  T.................         0069      32.5666    $2,074.30      $591.64      $414.86
32605..............  Thoracoscopy, diagnostic..  ..................  T.................         0069      32.5666    $2,074.30      $591.64      $414.86
32606..............  Thoracoscopy, diagnostic..  ..................  T.................         0069      32.5666    $2,074.30      $591.64      $414.86
3260F..............  Pt cat/pn cat/hist grd      ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      doc'd.
32650..............  Thoracoscopy, surgical....  ..................  C.................  ...........  ...........  ...........  ...........  ...........
32651..............  Thoracoscopy, surgical....  ..................  C.................  ...........  ...........  ...........  ...........  ...........
32652..............  Thoracoscopy, surgical....  ..................  C.................  ...........  ...........  ...........  ...........  ...........
32653..............  Thoracoscopy, surgical....  ..................  C.................  ...........  ...........  ...........  ...........  ...........
32654..............  Thoracoscopy, surgical....  ..................  C.................  ...........  ...........  ...........  ...........  ...........
32655..............  Thoracoscopy, surgical....  ..................  C.................  ...........  ...........  ...........  ...........  ...........
32656..............  Thoracoscopy, surgical....  ..................  C.................  ...........  ...........  ...........  ...........  ...........
32657..............  Thoracoscopy, surgical....  ..................  C.................  ...........  ...........  ...........  ...........  ...........
32658..............  Thoracoscopy, surgical....  ..................  C.................  ...........  ...........  ...........  ...........  ...........
32659..............  Thoracoscopy, surgical....  ..................  C.................  ...........  ...........  ...........  ...........  ...........
3265F..............  RNA tstng HepC vir ord/     NI................  M.................  ...........  ...........  ...........  ...........  ...........
                      doc'd.
32660..............  Thoracoscopy, surgical....  ..................  C.................  ...........  ...........  ...........  ...........  ...........
32661..............  Thoracoscopy, surgical....  ..................  C.................  ...........  ...........  ...........  ...........  ...........
32662..............  Thoracoscopy, surgical....  ..................  C.................  ...........  ...........  ...........  ...........  ...........
32663..............  Thoracoscopy, surgical....  ..................  C.................  ...........  ...........  ...........  ...........  ...........
32664..............  Thoracoscopy, surgical....  ..................  C.................  ...........  ...........  ...........  ...........  ...........
32665..............  Thoracoscopy, surgical....  ..................  C.................  ...........  ...........  ...........  ...........  ...........
3266F..............  HepC gn tstng doc'd b/      NI................  M.................  ...........  ...........  ...........  ...........  ...........
                      4txmnt.
3268F..............  PSA/T/G1Sc doc'd b/4 txmnt  NI................  M.................  ...........  ...........  ...........  ...........  ...........
3269F..............  Bone scn b/4 txmnt/aftr Dx  NI................  M.................  ...........  ...........  ...........  ...........  ...........
3270F..............  No bone scn b/4 txmnt/      NI................  M.................  ...........  ...........  ...........  ...........  ...........
                      aftrDx.
3271F..............  Low risk, prostate cancer.  NI................  M.................  ...........  ...........  ...........  ...........  ...........
3272F..............  Med. risk, prostate cancer  NI................  M.................  ...........  ...........  ...........  ...........  ...........
3273F..............  High risk, prostate cancer  NI................  M.................  ...........  ...........  ...........  ...........  ...........
3274F..............  Prost Cncr rsk not lw/md/   NI................  M.................  ...........  ...........  ...........  ...........  ...........
                      hgh.
3278F..............  Serum lvls CA/iPTH/lpd ord  NI................  M.................  ...........  ...........  ...........  ...........  ...........
3279F..............  Hgb lvl >/=13 g/dL........  NI................  M.................  ...........  ...........  ...........  ...........  ...........
32800..............  Repair lung hernia........  ..................  C.................  ...........  ...........  ...........  ...........  ...........
3280F..............  Hgb lvl 11-12.9 g/dL......  NI................  M.................  ...........  ...........  ...........  ...........  ...........
32810..............  Close chest after drainage  ..................  C.................  ...........  ...........  ...........  ...........  ...........
32815..............  Close bronchial fistula...  ..................  C.................  ...........  ...........  ...........  ...........  ...........
3281F..............  Hgb lvl <11 g/dL..........  NI................  M.................  ...........  ...........  ...........  ...........  ...........
32820..............  Reconstruct injured chest.  ..................  C.................  ...........  ...........  ...........  ...........  ...........
3284F..............  IOP down >15% of pre-svc    NI................  M.................  ...........  ...........  ...........  ...........  ...........
                      lvl.
32850..............  Donor pneumonectomy.......  ..................  C.................  ...........  ...........  ...........  ...........  ...........
32851..............  Lung transplant, single...  ..................  C.................  ...........  ...........  ...........  ...........  ...........
32852..............  Lung transplant with        ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      bypass.
32853..............  Lung transplant, double...  ..................  C.................  ...........  ...........  ...........  ...........  ...........
32854..............  Lung transplant with        ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      bypass.
32855..............  Prepare donor lung, single  ..................  C.................  ...........  ...........  ...........  ...........  ...........
32856..............  Prepare donor lung, double  ..................  C.................  ...........  ...........  ...........  ...........  ...........
3285F..............  IOP down <15% of pre-svc    NI................  M.................  ...........  ...........  ...........  ...........  ...........
                      lvl.
3288F..............  Fall risk assessment doc'd  NI................  M.................  ...........  ...........  ...........  ...........  ...........
32900..............  Removal of rib(s).........  ..................  C.................  ...........  ...........  ...........  ...........  ...........
32905..............  Revise & repair chest wall  ..................  C.................  ...........  ...........  ...........  ...........  ...........
32906..............  Revise & repair chest wall  ..................  C.................  ...........  ...........  ...........  ...........  ...........
3290F..............  Pt=D(Rh)- and unsensitized  NI................  M.................  ...........  ...........  ...........  ...........  ...........
3291F..............  Pt=D(Rh)+or sensitized....  NI................  M.................  ...........  ...........  ...........  ...........  ...........
3292F..............  HIV tstng asked/doc'd/      NI................  M.................  ...........  ...........  ...........  ...........  ...........
                      revw'd.
32940..............  Revision of lung..........  ..................  C.................  ...........  ...........  ...........  ...........  ...........
32960..............  Therapeutic pneumothorax..  ..................  T.................         0070       5.2024      $331.36  ...........       $66.27
32997..............  Total lung lavage.........  ..................  C.................  ...........  ...........  ...........  ...........  ...........
32998..............  Perq rf ablate tx, pul      ..................  T.................         0423      42.9980    $2,738.71  ...........      $547.74
                      tumor.
32999..............  Chest surgery procedure...  ..................  T.................         0070       5.2024      $331.36  ...........       $66.27
3300F..............  AJCC stage doc'd b/4 thxpy  NI................  M.................  ...........  ...........  ...........  ...........  ...........
33010..............  Drainage of heart sac.....  ..................  T.................         0070       5.2024      $331.36  ...........       $66.27
33011..............  Repeat drainage of heart    ..................  T.................         0070       5.2024      $331.36  ...........       $66.27
                      sac.
33015..............  Incision of heart sac.....  ..................  C.................  ...........  ...........  ...........  ...........  ...........
3301F..............  Cancer stage doc'd, metast  NI................  M.................  ...........  ...........  ...........  ...........  ...........
33020..............  Incision of heart sac.....  ..................  C.................  ...........  ...........  ...........  ...........  ...........
33025..............  Incision of heart sac.....  ..................  C.................  ...........  ...........  ...........  ...........  ...........
3302F..............  AJCC stage 0 doc'd........  NI................  M.................  ...........  ...........  ...........  ...........  ...........
33030..............  Partial removal of heart    ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      sac.
33031..............  Partial removal of heart    ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      sac.
3303F..............  AJCC stage IA doc'd.......  NI................  M.................  ...........  ...........  ...........  ...........  ...........
3304F..............  AJCC stage IB doc'd.......  NI................  M.................  ...........  ...........  ...........  ...........  ...........

[[Page 67029]]

 
33050..............  Removal of heart sac        ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      lesion.
3305F..............  AJCC stage IC doc'd.......  NI................  M.................  ...........  ...........  ...........  ...........  ...........
3306F..............  AJCC stage IIA doc'd......  NI................  M.................  ...........  ...........  ...........  ...........  ...........
3307F..............  AJCC stage IIB doc'd......  NI................  M.................  ...........  ...........  ...........  ...........  ...........
3308F..............  AJCC stage IIC doc'd......  NI................  M.................  ...........  ...........  ...........  ...........  ...........
3309F..............  AJCC stage IIIA doc'd.....  NI................  M.................  ...........  ...........  ...........  ...........  ...........
3310F..............  AJCC stage IIIB doc'd.....  NI................  M.................  ...........  ...........  ...........  ...........  ...........
3311F..............  AJCC stage IIIC doc'd.....  NI................  M.................  ...........  ...........  ...........  ...........  ...........
33120..............  Removal of heart lesion...  ..................  C.................  ...........  ...........  ...........  ...........  ...........
3312F..............  AJCC stage IVA doc'd......  NI................  M.................  ...........  ...........  ...........  ...........  ...........
33130..............  Removal of heart lesion...  ..................  C.................  ...........  ...........  ...........  ...........  ...........
3313F..............  AJCC stage IVB doc'd......  NI................  M.................  ...........  ...........  ...........  ...........  ...........
33140..............  Heart revascularize (tmr).  ..................  C.................  ...........  ...........  ...........  ...........  ...........
33141..............  Heart tmr w/other           ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      procedure.
3314F..............  AJCC stage IVC doc'd......  NI................  M.................  ...........  ...........  ...........  ...........  ...........
3315F..............  ER +or PR +breast cancer..  NI................  M.................  ...........  ...........  ...........  ...........  ...........
3316F..............  ER- or PR- breast cancer..  NI................  M.................  ...........  ...........  ...........  ...........  ...........
3317F..............  Path rpt malig cancer       NI................  M.................  ...........  ...........  ...........  ...........  ...........
                      doc'd.
3318F..............  Path rpt malig cancer       NI................  M.................  ...........  ...........  ...........  ...........  ...........
                      doc'd.
3319F..............  X-ray/CT/Ultrsnd et al      NI................  M.................  ...........  ...........  ...........  ...........  ...........
                      ord'd.
33202..............  Insert epicard eltrd, open  ..................  C.................  ...........  ...........  ...........  ...........  ...........
33203..............  Insert epicard eltrd, endo  ..................  C.................  ...........  ...........  ...........  ...........  ...........
33206..............  Insertion of heart          ..................  T.................         0089     121.6508    $7,748.43    $1,682.28    $1,549.69
                      pacemaker.
33207..............  Insertion of heart          ..................  T.................         0089     121.6508    $7,748.43    $1,682.28    $1,549.69
                      pacemaker.
33208..............  Insertion of heart          ..................  T.................         0655     140.0317    $8,919.18  ...........    $1,783.84
                      pacemaker.
3320F..............  No Xray/CT/ et al ord'd...  NI................  M.................  ...........  ...........  ...........  ...........  ...........
33210..............  Insertion of heart          ..................  T.................         0106      69.5217    $4,428.12  ...........      $885.62
                      electrode.
33211..............  Insertion of heart          ..................  T.................         0106      69.5217    $4,428.12  ...........      $885.62
                      electrode.
33212..............  Insertion of pulse          ..................  T.................         0090     100.8341    $6,422.53    $1,612.80    $1,284.51
                      generator.
33213..............  Insertion of pulse          ..................  T.................         0654     109.2851    $6,960.81  ...........    $1,392.16
                      generator.
33214..............  Upgrade of pacemaker        ..................  T.................         0655     140.0317    $8,919.18  ...........    $1,783.84
                      system.
33215..............  Reposition pacing-defib     ..................  T.................         0105      23.9802    $1,527.39  ...........      $305.48
                      lead.
33216..............  Insert lead pace-defib,     ..................  T.................         0106      69.5217    $4,428.12  ...........      $885.62
                      one.
33217..............  Insert lead pace-defib,     ..................  T.................         0106      69.5217    $4,428.12  ...........      $885.62
                      dual.
33218..............  Repair lead pace-defib,     ..................  T.................         0105      23.9802    $1,527.39  ...........      $305.48
                      one.
33220..............  Repair lead pace-defib,     ..................  T.................         0105      23.9802    $1,527.39  ...........      $305.48
                      dual.
33222..............  Revise pocket, pacemaker..  CH................  T.................         0136      15.0458      $958.33  ...........      $191.67
33223..............  Revise pocket, pacing-      CH................  T.................         0136      15.0458      $958.33  ...........      $191.67
                      defib.
33224..............  Insert pacing lead &        ..................  T.................         0418     259.7486   $16,544.43  ...........    $3,308.89
                      connect.
33225..............  L ventric pacing lead add-  ..................  T.................         0418     259.7486   $16,544.43  ...........    $3,308.89
                      on.
33226..............  Reposition l ventric lead.  ..................  T.................         0105      23.9802    $1,527.39  ...........      $305.48
33233..............  Removal of pacemaker        ..................  T.................         0105      23.9802    $1,527.39  ...........      $305.48
                      system.
33234..............  Removal of pacemaker        ..................  T.................         0105      23.9802    $1,527.39  ...........      $305.48
                      system.
33235..............  Removal pacemaker           ..................  T.................         0105      23.9802    $1,527.39  ...........      $305.48
                      electrode.
33236..............  Remove electrode/           ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      thoracotomy.
33237..............  Remove electrode/           ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      thoracotomy.
33238..............  Remove electrode/           ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      thoracotomy.
33240..............  Insert pulse generator....  CH................  T.................         0107     333.8096   $21,261.67  ...........    $4,252.33
33241..............  Remove pulse generator....  ..................  T.................         0105      23.9802    $1,527.39  ...........      $305.48
33243..............  Remove eltrd/thoracotomy..  ..................  C.................  ...........  ...........  ...........  ...........  ...........
33244..............  Remove eltrd, transven....  ..................  T.................         0105      23.9802    $1,527.39  ...........      $305.48
33249..............  Eltrd/insert pace-defib...  CH................  T.................         0108     404.8543   $25,786.79  ...........    $5,157.36
33250..............  Ablate heart dysrhythm      ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      focus.
33251..............  Ablate heart dysrhythm      ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      focus.
33254..............  Ablate atria, lmtd........  ..................  C.................  ...........  ...........  ...........  ...........  ...........
33255..............  Ablate atria w/o bypass,    ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      ext.
33256..............  Ablate atria w/bypass,      ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      exten.
33257..............  Ablate atria, lmtd, add-on  NI................  C.................  ...........  ...........  ...........  ...........  ...........
33258..............  Ablate atria, x10sv, add-   NI................  C.................  ...........  ...........  ...........  ...........  ...........
                      on.
33259..............  Ablate atria w/bypass add-  NI................  C.................  ...........  ...........  ...........  ...........  ...........
                      on.
3325F..............  Preop asses 4 cataract      NI................  M.................  ...........  ...........  ...........  ...........  ...........
                      surg.
33261..............  Ablate heart dysrhythm      ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      focus.
33265..............  Ablate atria, lmtd, endo..  ..................  C.................  ...........  ...........  ...........  ...........  ...........
33266..............  Ablate atria, x10sv, endo.  ..................  C.................  ...........  ...........  ...........  ...........  ...........
33282..............  Implant pat-active ht       ..................  S.................         0680      70.6073    $4,497.26  ...........      $899.45
                      record.
33284..............  Remove pat-active ht        CH................  T.................         0020       8.6850      $553.18  ...........      $110.64
                      record.
33300..............  Repair of heart wound.....  ..................  C.................  ...........  ...........  ...........  ...........  ...........
33305..............  Repair of heart wound.....  ..................  C.................  ...........  ...........  ...........  ...........  ...........
33310..............  Exploratory heart surgery.  ..................  C.................  ...........  ...........  ...........  ...........  ...........
33315..............  Exploratory heart surgery.  ..................  C.................  ...........  ...........  ...........  ...........  ...........
33320..............  Repair major blood          ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      vessel(s).
33321..............  Repair major vessel.......  ..................  C.................  ...........  ...........  ...........  ...........  ...........
33322..............  Repair major blood          ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      vessel(s).
33330..............  Insert major vessel graft.  ..................  C.................  ...........  ...........  ...........  ...........  ...........
33332..............  Insert major vessel graft.  ..................  C.................  ...........  ...........  ...........  ...........  ...........
33335..............  Insert major vessel graft.  ..................  C.................  ...........  ...........  ...........  ...........  ...........
33400..............  Repair of aortic valve....  ..................  C.................  ...........  ...........  ...........  ...........  ...........
33401..............  Valvuloplasty, open.......  ..................  C.................  ...........  ...........  ...........  ...........  ...........
33403..............  Valvuloplasty, w/cp bypass  ..................  C.................  ...........  ...........  ...........  ...........  ...........
33404..............  Prepare heart-aorta         ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      conduit.

[[Page 67030]]

 
33405..............  Replacement of aortic       ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      valve.
33406..............  Replacement of aortic       ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      valve.
33410..............  Replacement of aortic       ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      valve.
33411..............  Replacement of aortic       ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      valve.
33412..............  Replacement of aortic       ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      valve.
33413..............  Replacement of aortic       ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      valve.
33414..............  Repair of aortic valve....  ..................  C.................  ...........  ...........  ...........  ...........  ...........
33415..............  Revision, subvalvular       ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      tissue.
33416..............  Revise ventricle muscle...  ..................  C.................  ...........  ...........  ...........  ...........  ...........
33417..............  Repair of aortic valve....  ..................  C.................  ...........  ...........  ...........  ...........  ...........
33420..............  Revision of mitral valve..  ..................  C.................  ...........  ...........  ...........  ...........  ...........
33422..............  Revision of mitral valve..  ..................  C.................  ...........  ...........  ...........  ...........  ...........
33425..............  Repair of mitral valve....  ..................  C.................  ...........  ...........  ...........  ...........  ...........
33426..............  Repair of mitral valve....  ..................  C.................  ...........  ...........  ...........  ...........  ...........
33427..............  Repair of mitral valve....  ..................  C.................  ...........  ...........  ...........  ...........  ...........
33430..............  Replacement of mitral       ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      valve.
33460..............  Revision of tricuspid       ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      valve.
33463..............  Valvuloplasty, tricuspid..  ..................  C.................  ...........  ...........  ...........  ...........  ...........
33464..............  Valvuloplasty, tricuspid..  ..................  C.................  ...........  ...........  ...........  ...........  ...........
33465..............  Replace tricuspid valve...  ..................  C.................  ...........  ...........  ...........  ...........  ...........
33468..............  Revision of tricuspid       ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      valve.
33470..............  Revision of pulmonary       ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      valve.
33471..............  Valvotomy, pulmonary valve  ..................  C.................  ...........  ...........  ...........  ...........  ...........
33472..............  Revision of pulmonary       ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      valve.
33474..............  Revision of pulmonary       ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      valve.
33475..............  Replacement, pulmonary      ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      valve.
33476..............  Revision of heart chamber.  ..................  C.................  ...........  ...........  ...........  ...........  ...........
33478..............  Revision of heart chamber.  ..................  C.................  ...........  ...........  ...........  ...........  ...........
33496..............  Repair, prosth valve clot.  ..................  C.................  ...........  ...........  ...........  ...........  ...........
33500..............  Repair heart vessel         ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      fistula.
33501..............  Repair heart vessel         ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      fistula.
33502..............  Coronary artery correction  ..................  C.................  ...........  ...........  ...........  ...........  ...........
33503..............  Coronary artery graft.....  ..................  C.................  ...........  ...........  ...........  ...........  ...........
33504..............  Coronary artery graft.....  ..................  C.................  ...........  ...........  ...........  ...........  ...........
33505..............  Repair artery w/tunnel....  ..................  C.................  ...........  ...........  ...........  ...........  ...........
33506..............  Repair artery,              ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      translocation.
33507..............  Repair art, intramural....  ..................  C.................  ...........  ...........  ...........  ...........  ...........
33508..............  Endoscopic vein harvest...  ..................  N.................  ...........  ...........  ...........  ...........  ...........
33510..............  CABG, vein, single........  ..................  C.................  ...........  ...........  ...........  ...........  ...........
33511..............  CABG, vein, two...........  ..................  C.................  ...........  ...........  ...........  ...........  ...........
33512..............  CABG, vein, three.........  ..................  C.................  ...........  ...........  ...........  ...........  ...........
33513..............  CABG, vein, four..........  ..................  C.................  ...........  ...........  ...........  ...........  ...........
33514..............  CABG, vein, five..........  ..................  C.................  ...........  ...........  ...........  ...........  ...........
33516..............  Cabg, vein, six or more...  ..................  C.................  ...........  ...........  ...........  ...........  ...........
33517..............  CABG, artery-vein, single.  ..................  C.................  ...........  ...........  ...........  ...........  ...........
33518..............  CABG, artery-vein, two....  ..................  C.................  ...........  ...........  ...........  ...........  ...........
33519..............  CABG, artery-vein, three..  ..................  C.................  ...........  ...........  ...........  ...........  ...........
33521..............  CABG, artery-vein, four...  ..................  C.................  ...........  ...........  ...........  ...........  ...........
33522..............  CABG, artery-vein, five...  ..................  C.................  ...........  ...........  ...........  ...........  ...........
33523..............  Cabg, art-vein, six or      ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      more.
33530..............  Coronary artery, bypass/    ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      reop.
33533..............  CABG, arterial, single....  ..................  C.................  ...........  ...........  ...........  ...........  ...........
33534..............  CABG, arterial, two.......  ..................  C.................  ...........  ...........  ...........  ...........  ...........
33535..............  CABG, arterial, three.....  ..................  C.................  ...........  ...........  ...........  ...........  ...........
33536..............  Cabg, arterial, four or     ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      more.
33542..............  Removal of heart lesion...  ..................  C.................  ...........  ...........  ...........  ...........  ...........
33545..............  Repair of heart damage....  ..................  C.................  ...........  ...........  ...........  ...........  ...........
33548..............  Restore/remodel, ventricle  ..................  C.................  ...........  ...........  ...........  ...........  ...........
33572..............  Open coronary               ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      endarterectomy.
33600..............  Closure of valve..........  ..................  C.................  ...........  ...........  ...........  ...........  ...........
33602..............  Closure of valve..........  ..................  C.................  ...........  ...........  ...........  ...........  ...........
33606..............  Anastomosis/artery-aorta..  ..................  C.................  ...........  ...........  ...........  ...........  ...........
33608..............  Repair anomaly w/conduit..  ..................  C.................  ...........  ...........  ...........  ...........  ...........
33610..............  Repair by enlargement.....  ..................  C.................  ...........  ...........  ...........  ...........  ...........
33611..............  Repair double ventricle...  ..................  C.................  ...........  ...........  ...........  ...........  ...........
33612..............  Repair double ventricle...  ..................  C.................  ...........  ...........  ...........  ...........  ...........
33615..............  Repair, modified fontan...  ..................  C.................  ...........  ...........  ...........  ...........  ...........
33617..............  Repair single ventricle...  ..................  C.................  ...........  ...........  ...........  ...........  ...........
33619..............  Repair single ventricle...  ..................  C.................  ...........  ...........  ...........  ...........  ...........
33641..............  Repair heart septum defect  ..................  C.................  ...........  ...........  ...........  ...........  ...........
33645..............  Revision of heart veins...  ..................  C.................  ...........  ...........  ...........  ...........  ...........
33647..............  Repair heart septum         ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      defects.
33660..............  Repair of heart defects...  ..................  C.................  ...........  ...........  ...........  ...........  ...........
33665..............  Repair of heart defects...  ..................  C.................  ...........  ...........  ...........  ...........  ...........
33670..............  Repair of heart chambers..  ..................  C.................  ...........  ...........  ...........  ...........  ...........
33675..............  Close mult vsd............  ..................  C.................  ...........  ...........  ...........  ...........  ...........
33676..............  Close mult vsd w/resection  ..................  C.................  ...........  ...........  ...........  ...........  ...........
33677..............  Cl mult vsd w/rem pul band  ..................  C.................  ...........  ...........  ...........  ...........  ...........
33681..............  Repair heart septum defect  ..................  C.................  ...........  ...........  ...........  ...........  ...........
33684..............  Repair heart septum defect  ..................  C.................  ...........  ...........  ...........  ...........  ...........

[[Page 67031]]

 
33688..............  Repair heart septum defect  ..................  C.................  ...........  ...........  ...........  ...........  ...........
33690..............  Reinforce pulmonary artery  ..................  C.................  ...........  ...........  ...........  ...........  ...........
33692..............  Repair of heart defects...  ..................  C.................  ...........  ...........  ...........  ...........  ...........
33694..............  Repair of heart defects...  ..................  C.................  ...........  ...........  ...........  ...........  ...........
33697..............  Repair of heart defects...  ..................  C.................  ...........  ...........  ...........  ...........  ...........
33702..............  Repair of heart defects...  ..................  C.................  ...........  ...........  ...........  ...........  ...........
33710..............  Repair of heart defects...  ..................  C.................  ...........  ...........  ...........  ...........  ...........
33720..............  Repair of heart defect....  ..................  C.................  ...........  ...........  ...........  ...........  ...........
33722..............  Repair of heart defect....  ..................  C.................  ...........  ...........  ...........  ...........  ...........
33724..............  Repair venous anomaly.....  ..................  C.................  ...........  ...........  ...........  ...........  ...........
33726..............  Repair pul venous stenosis  ..................  C.................  ...........  ...........  ...........  ...........  ...........
33730..............  Repair heart-vein           ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      defect(s).
33732..............  Repair heart-vein defect..  ..................  C.................  ...........  ...........  ...........  ...........  ...........
33735..............  Revision of heart chamber.  ..................  C.................  ...........  ...........  ...........  ...........  ...........
33736..............  Revision of heart chamber.  ..................  C.................  ...........  ...........  ...........  ...........  ...........
33737..............  Revision of heart chamber.  ..................  C.................  ...........  ...........  ...........  ...........  ...........
33750..............  Major vessel shunt........  ..................  C.................  ...........  ...........  ...........  ...........  ...........
33755..............  Major vessel shunt........  ..................  C.................  ...........  ...........  ...........  ...........  ...........
33762..............  Major vessel shunt........  ..................  C.................  ...........  ...........  ...........  ...........  ...........
33764..............  Major vessel shunt & graft  ..................  C.................  ...........  ...........  ...........  ...........  ...........
33766..............  Major vessel shunt........  ..................  C.................  ...........  ...........  ...........  ...........  ...........
33767..............  Major vessel shunt........  ..................  C.................  ...........  ...........  ...........  ...........  ...........
33768..............  Cavopulmonary shunting....  ..................  C.................  ...........  ...........  ...........  ...........  ...........
33770..............  Repair great vessels        ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      defect.
33771..............  Repair great vessels        ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      defect.
33774..............  Repair great vessels        ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      defect.
33775..............  Repair great vessels        ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      defect.
33776..............  Repair great vessels        ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      defect.
33777..............  Repair great vessels        ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      defect.
33778..............  Repair great vessels        ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      defect.
33779..............  Repair great vessels        ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      defect.
33780..............  Repair great vessels        ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      defect.
33781..............  Repair great vessels        ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      defect.
33786..............  Repair arterial trunk.....  ..................  C.................  ...........  ...........  ...........  ...........  ...........
33788..............  Revision of pulmonary       ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      artery.
33800..............  Aortic suspension.........  ..................  C.................  ...........  ...........  ...........  ...........  ...........
33802..............  Repair vessel defect......  ..................  C.................  ...........  ...........  ...........  ...........  ...........
33803..............  Repair vessel defect......  ..................  C.................  ...........  ...........  ...........  ...........  ...........
33813..............  Repair septal defect......  ..................  C.................  ...........  ...........  ...........  ...........  ...........
33814..............  Repair septal defect......  ..................  C.................  ...........  ...........  ...........  ...........  ...........
33820..............  Revise major vessel.......  ..................  C.................  ...........  ...........  ...........  ...........  ...........
33822..............  Revise major vessel.......  ..................  C.................  ...........  ...........  ...........  ...........  ...........
33824..............  Revise major vessel.......  ..................  C.................  ...........  ...........  ...........  ...........  ...........
33840..............  Remove aorta constriction.  ..................  C.................  ...........  ...........  ...........  ...........  ...........
33845..............  Remove aorta constriction.  ..................  C.................  ...........  ...........  ...........  ...........  ...........
33851..............  Remove aorta constriction.  ..................  C.................  ...........  ...........  ...........  ...........  ...........
33852..............  Repair septal defect......  ..................  C.................  ...........  ...........  ...........  ...........  ...........
33853..............  Repair septal defect......  ..................  C.................  ...........  ...........  ...........  ...........  ...........
33860..............  Ascending aortic graft....  ..................  C.................  ...........  ...........  ...........  ...........  ...........
33861..............  Ascending aortic graft....  ..................  C.................  ...........  ...........  ...........  ...........  ...........
33863..............  Ascending aortic graft....  ..................  C.................  ...........  ...........  ...........  ...........  ...........
33864..............  Ascending aortic graft....  NI................  C.................  ...........  ...........  ...........  ...........  ...........
33870..............  Transverse aortic arch      ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      graft.
33875..............  Thoracic aortic graft.....  ..................  C.................  ...........  ...........  ...........  ...........  ...........
33877..............  Thoracoabdominal graft....  ..................  C.................  ...........  ...........  ...........  ...........  ...........
33880..............  Endovasc taa repr incl      ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      subcl.
33881..............  Endovasc taa repr w/o       ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      subcl.
33883..............  Insert endovasc prosth,     ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      taa.
33884..............  Endovasc prosth, taa, add-  ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      on.
33886..............  Endovasc prosth, delayed..  ..................  C.................  ...........  ...........  ...........  ...........  ...........
33889..............  Artery transpose/endovas    ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      taa.
33891..............  Car-car bp grft/endovas     ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      taa.
33910..............  Remove lung artery emboli.  ..................  C.................  ...........  ...........  ...........  ...........  ...........
33915..............  Remove lung artery emboli.  ..................  C.................  ...........  ...........  ...........  ...........  ...........
33916..............  Surgery of great vessel...  ..................  C.................  ...........  ...........  ...........  ...........  ...........
33917..............  Repair pulmonary artery...  ..................  C.................  ...........  ...........  ...........  ...........  ...........
33920..............  Repair pulmonary atresia..  ..................  C.................  ...........  ...........  ...........  ...........  ...........
33922..............  Transect pulmonary artery.  ..................  C.................  ...........  ...........  ...........  ...........  ...........
33924..............  Remove pulmonary shunt....  ..................  C.................  ...........  ...........  ...........  ...........  ...........
33925..............  Rpr pul art unifocal w/o    ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      cpb.
33926..............  Repr pul art, unifocal w/   ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      cpb.
33930..............  Removal of donor heart/     ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      lung.
33933..............  Prepare donor heart/lung..  ..................  C.................  ...........  ...........  ...........  ...........  ...........
33935..............  Transplantation, heart/     ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      lung.
33940..............  Removal of donor heart....  ..................  C.................  ...........  ...........  ...........  ...........  ...........
33944..............  Prepare donor heart.......  ..................  C.................  ...........  ...........  ...........  ...........  ...........
33945..............  Transplantation of heart..  ..................  C.................  ...........  ...........  ...........  ...........  ...........
33960..............  External circulation        ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      assist.
33961..............  External circulation        ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      assist.
33967..............  Insert ia percut device...  ..................  C.................  ...........  ...........  ...........  ...........  ...........

[[Page 67032]]

 
33968..............  Remove aortic assist        ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      device.
33970..............  Aortic circulation assist.  ..................  C.................  ...........  ...........  ...........  ...........  ...........
33971..............  Aortic circulation assist.  ..................  C.................  ...........  ...........  ...........  ...........  ...........
33973..............  Insert balloon device.....  ..................  C.................  ...........  ...........  ...........  ...........  ...........
33974..............  Remove intra-aortic         ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      balloon.
33975..............  Implant ventricular device  ..................  C.................  ...........  ...........  ...........  ...........  ...........
33976..............  Implant ventricular device  ..................  C.................  ...........  ...........  ...........  ...........  ...........
33977..............  Remove ventricular device.  ..................  C.................  ...........  ...........  ...........  ...........  ...........
33978..............  Remove ventricular device.  ..................  C.................  ...........  ...........  ...........  ...........  ...........
33979..............  Insert intracorporeal       ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      device.
33980..............  Remove intracorporeal       ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      device.
33999..............  Cardiac surgery procedure.  ..................  T.................         0070       5.2024      $331.36  ...........       $66.27
34001..............  Removal of artery clot....  ..................  C.................  ...........  ...........  ...........  ...........  ...........
34051..............  Removal of artery clot....  ..................  C.................  ...........  ...........  ...........  ...........  ...........
34101..............  Removal of artery clot....  ..................  T.................         0088      38.7673    $2,469.24      $655.22      $493.85
34111..............  Removal of arm artery clot  ..................  T.................         0088      38.7673    $2,469.24      $655.22      $493.85
34151..............  Removal of artery clot....  ..................  C.................  ...........  ...........  ...........  ...........  ...........
34201..............  Removal of artery clot....  ..................  T.................         0088      38.7673    $2,469.24      $655.22      $493.85
34203..............  Removal of leg artery clot  ..................  T.................         0088      38.7673    $2,469.24      $655.22      $493.85
34401..............  Removal of vein clot......  ..................  C.................  ...........  ...........  ...........  ...........  ...........
34421..............  Removal of vein clot......  ..................  T.................         0088      38.7673    $2,469.24      $655.22      $493.85
34451..............  Removal of vein clot......  ..................  C.................  ...........  ...........  ...........  ...........  ...........
34471..............  Removal of vein clot......  ..................  T.................         0088      38.7673    $2,469.24      $655.22      $493.85
34490..............  Removal of vein clot......  ..................  T.................         0088      38.7673    $2,469.24      $655.22      $493.85
34501..............  Repair valve, femoral vein  ..................  T.................         0088      38.7673    $2,469.24      $655.22      $493.85
34502..............  Reconstruct vena cava.....  ..................  C.................  ...........  ...........  ...........  ...........  ...........
34510..............  Transposition of vein       ..................  T.................         0088      38.7673    $2,469.24      $655.22      $493.85
                      valve.
34520..............  Cross-over vein graft.....  ..................  T.................         0088      38.7673    $2,469.24      $655.22      $493.85
34530..............  Leg vein fusion...........  ..................  T.................         0088      38.7673    $2,469.24      $655.22      $493.85
34800..............  Endovas aaa repr w/sm tube  ..................  C.................  ...........  ...........  ...........  ...........  ...........
34802..............  Endovas aaa repr w/2-p      ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      part.
34803..............  Endovas aaa repr w/3-p      ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      part.
34804..............  Endovas aaa repr w/1-p      ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      part.
34805..............  Endovas aaa repr w/long     ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      tube.
34806..............  Aneurysm press sensor add-  NI................  C.................  ...........  ...........  ...........  ...........  ...........
                      on.
34808..............  Endovas iliac a device      ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      addon.
34812..............  Xpose for endoprosth,       ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      femorl.
34813..............  Femoral endovas graft add-  ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      on.
34820..............  Xpose for endoprosth,       ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      iliac.
34825..............  Endovasc extend prosth,     ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      init.
34826..............  Endovasc exten prosth,      ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      add'l.
34830..............  Open aortic tube prosth     ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      repr.
34831..............  Open aortoiliac prosth      ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      repr.
34832..............  Open aortofemor prosth      ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      repr.
34833..............  Xpose for endoprosth,       ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      iliac.
34834..............  Xpose, endoprosth,          ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      brachial.
34900..............  Endovasc iliac repr w/      ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      graft.
35001..............  Repair defect of artery...  ..................  C.................  ...........  ...........  ...........  ...........  ...........
35002..............  Repair artery rupture,      ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      neck.
35005..............  Repair defect of artery...  ..................  C.................  ...........  ...........  ...........  ...........  ...........
35011..............  Repair defect of artery...  ..................  T.................         0653      40.4667    $2,577.49  ...........      $515.50
35013..............  Repair artery rupture, arm  ..................  C.................  ...........  ...........  ...........  ...........  ...........
35021..............  Repair defect of artery...  ..................  C.................  ...........  ...........  ...........  ...........  ...........
35022..............  Repair artery rupture,      ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      chest.
35045..............  Repair defect of arm        ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      artery.
35081..............  Repair defect of artery...  ..................  C.................  ...........  ...........  ...........  ...........  ...........
35082..............  Repair artery rupture,      ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      aorta.
35091..............  Repair defect of artery...  ..................  C.................  ...........  ...........  ...........  ...........  ...........
35092..............  Repair artery rupture,      ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      aorta.
35102..............  Repair defect of artery...  ..................  C.................  ...........  ...........  ...........  ...........  ...........
35103..............  Repair artery rupture,      ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      groin.
35111..............  Repair defect of artery...  ..................  C.................  ...........  ...........  ...........  ...........  ...........
35112..............  Repair artery               ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      rupture,spleen.
35121..............  Repair defect of artery...  ..................  C.................  ...........  ...........  ...........  ...........  ...........
35122..............  Repair artery rupture,      ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      belly.
35131..............  Repair defect of artery...  ..................  C.................  ...........  ...........  ...........  ...........  ...........
35132..............  Repair artery rupture,      ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      groin.
35141..............  Repair defect of artery...  ..................  C.................  ...........  ...........  ...........  ...........  ...........
35142..............  Repair artery rupture,      ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      thigh.
35151..............  Repair defect of artery...  ..................  C.................  ...........  ...........  ...........  ...........  ...........
35152..............  Repair artery rupture,      ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      knee.
35180..............  Repair blood vessel lesion  ..................  T.................         0093      30.1294    $1,919.06  ...........      $383.81
35182..............  Repair blood vessel lesion  ..................  C.................  ...........  ...........  ...........  ...........  ...........
35184..............  Repair blood vessel lesion  ..................  T.................         0093      30.1294    $1,919.06  ...........      $383.81
35188..............  Repair blood vessel lesion  ..................  T.................         0088      38.7673    $2,469.24      $655.22      $493.85
35189..............  Repair blood vessel lesion  ..................  C.................  ...........  ...........  ...........  ...........  ...........
35190..............  Repair blood vessel lesion  ..................  T.................         0093      30.1294    $1,919.06  ...........      $383.81
35201..............  Repair blood vessel lesion  ..................  T.................         0093      30.1294    $1,919.06  ...........      $383.81
35206..............  Repair blood vessel lesion  ..................  T.................         0093      30.1294    $1,919.06  ...........      $383.81
35207..............  Repair blood vessel lesion  ..................  T.................         0088      38.7673    $2,469.24      $655.22      $493.85

[[Page 67033]]

 
35211..............  Repair blood vessel lesion  ..................  C.................  ...........  ...........  ...........  ...........  ...........
35216..............  Repair blood vessel lesion  ..................  C.................  ...........  ...........  ...........  ...........  ...........
35221..............  Repair blood vessel lesion  ..................  C.................  ...........  ...........  ...........  ...........  ...........
35226..............  Repair blood vessel lesion  ..................  T.................         0093      30.1294    $1,919.06  ...........      $383.81
35231..............  Repair blood vessel lesion  ..................  T.................         0093      30.1294    $1,919.06  ...........      $383.81
35236..............  Repair blood vessel lesion  ..................  T.................         0093      30.1294    $1,919.06  ...........      $383.81
35241..............  Repair blood vessel lesion  ..................  C.................  ...........  ...........  ...........  ...........  ...........
35246..............  Repair blood vessel lesion  ..................  C.................  ...........  ...........  ...........  ...........  ...........
35251..............  Repair blood vessel lesion  ..................  C.................  ...........  ...........  ...........  ...........  ...........
35256..............  Repair blood vessel lesion  ..................  T.................         0093      30.1294    $1,919.06  ...........      $383.81
35261..............  Repair blood vessel lesion  ..................  T.................         0653      40.4667    $2,577.49  ...........      $515.50
35266..............  Repair blood vessel lesion  ..................  T.................         0653      40.4667    $2,577.49  ...........      $515.50
35271..............  Repair blood vessel lesion  ..................  C.................  ...........  ...........  ...........  ...........  ...........
35276..............  Repair blood vessel lesion  ..................  C.................  ...........  ...........  ...........  ...........  ...........
35281..............  Repair blood vessel lesion  ..................  C.................  ...........  ...........  ...........  ...........  ...........
35286..............  Repair blood vessel lesion  ..................  T.................         0653      40.4667    $2,577.49  ...........      $515.50
35301..............  Rechanneling of artery....  ..................  C.................  ...........  ...........  ...........  ...........  ...........
35302..............  Rechanneling of artery....  ..................  C.................  ...........  ...........  ...........  ...........  ...........
35303..............  Rechanneling of artery....  ..................  C.................  ...........  ...........  ...........  ...........  ...........
35304..............  Rechanneling of artery....  ..................  C.................  ...........  ...........  ...........  ...........  ...........
35305..............  Rechanneling of artery....  ..................  C.................  ...........  ...........  ...........  ...........  ...........
35306..............  Rechanneling of artery....  ..................  C.................  ...........  ...........  ...........  ...........  ...........
35311..............  Rechanneling of artery....  ..................  C.................  ...........  ...........  ...........  ...........  ...........
35321..............  Rechanneling of artery....  ..................  T.................         0093      30.1294    $1,919.06  ...........      $383.81
35331..............  Rechanneling of artery....  ..................  C.................  ...........  ...........  ...........  ...........  ...........
35341..............  Rechanneling of artery....  ..................  C.................  ...........  ...........  ...........  ...........  ...........
35351..............  Rechanneling of artery....  ..................  C.................  ...........  ...........  ...........  ...........  ...........
35355..............  Rechanneling of artery....  ..................  C.................  ...........  ...........  ...........  ...........  ...........
35361..............  Rechanneling of artery....  ..................  C.................  ...........  ...........  ...........  ...........  ...........
35363..............  Rechanneling of artery....  ..................  C.................  ...........  ...........  ...........  ...........  ...........
35371..............  Rechanneling of artery....  ..................  C.................  ...........  ...........  ...........  ...........  ...........
35372..............  Rechanneling of artery....  ..................  C.................  ...........  ...........  ...........  ...........  ...........
35390..............  Reoperation, carotid add-   ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      on.
35400..............  Angioscopy................  ..................  C.................  ...........  ...........  ...........  ...........  ...........
35450..............  Repair arterial blockage..  ..................  C.................  ...........  ...........  ...........  ...........  ...........
35452..............  Repair arterial blockage..  ..................  C.................  ...........  ...........  ...........  ...........  ...........
35454..............  Repair arterial blockage..  ..................  C.................  ...........  ...........  ...........  ...........  ...........
35456..............  Repair arterial blockage..  ..................  C.................  ...........  ...........  ...........  ...........  ...........
35458..............  Repair arterial blockage..  CH................  T.................         0083      45.3845    $2,890.72  ...........      $578.14
35459..............  Repair arterial blockage..  CH................  T.................         0083      45.3845    $2,890.72  ...........      $578.14
35460..............  Repair venous blockage....  CH................  T.................         0083      45.3845    $2,890.72  ...........      $578.14
35470..............  Repair arterial blockage..  CH................  T.................         0083      45.3845    $2,890.72  ...........      $578.14
35471..............  Repair arterial blockage..  CH................  T.................         0083      45.3845    $2,890.72  ...........      $578.14
35472..............  Repair arterial blockage..  CH................  T.................         0083      45.3845    $2,890.72  ...........      $578.14
35473..............  Repair arterial blockage..  CH................  T.................         0083      45.3845    $2,890.72  ...........      $578.14
35474..............  Repair arterial blockage..  CH................  T.................         0083      45.3845    $2,890.72  ...........      $578.14
35475..............  Repair arterial blockage..  CH................  T.................         0083      45.3845    $2,890.72  ...........      $578.14
35476..............  Repair venous blockage....  CH................  T.................         0083      45.3845    $2,890.72  ...........      $578.14
35480..............  Atherectomy, open.........  ..................  C.................  ...........  ...........  ...........  ...........  ...........
35481..............  Atherectomy, open.........  ..................  C.................  ...........  ...........  ...........  ...........  ...........
35482..............  Atherectomy, open.........  ..................  C.................  ...........  ...........  ...........  ...........  ...........
35483..............  Atherectomy, open.........  ..................  C.................  ...........  ...........  ...........  ...........  ...........
35484..............  Atherectomy, open.........  CH................  T.................         0082      87.5137    $5,574.10  ...........    $1,114.82
35485..............  Atherectomy, open.........  CH................  T.................         0082      87.5137    $5,574.10  ...........    $1,114.82
35490..............  Atherectomy, percutaneous.  CH................  T.................         0082      87.5137    $5,574.10  ...........    $1,114.82
35491..............  Atherectomy, percutaneous.  CH................  T.................         0082      87.5137    $5,574.10  ...........    $1,114.82
35492..............  Atherectomy, percutaneous.  CH................  T.................         0082      87.5137    $5,574.10  ...........    $1,114.82
35493..............  Atherectomy, percutaneous.  CH................  T.................         0082      87.5137    $5,574.10  ...........    $1,114.82
35494..............  Atherectomy, percutaneous.  CH................  T.................         0082      87.5137    $5,574.10  ...........    $1,114.82
35495..............  Atherectomy, percutaneous.  CH................  T.................         0082      87.5137    $5,574.10  ...........    $1,114.82
35500..............  Harvest vein for bypass...  CH................  T.................         0103      14.6576      $933.60  ...........      $186.72
35501..............  Artery bypass graft.......  ..................  C.................  ...........  ...........  ...........  ...........  ...........
35506..............  Artery bypass graft.......  ..................  C.................  ...........  ...........  ...........  ...........  ...........
35508..............  Artery bypass graft.......  ..................  C.................  ...........  ...........  ...........  ...........  ...........
35509..............  Artery bypass graft.......  ..................  C.................  ...........  ...........  ...........  ...........  ...........
35510..............  Artery bypass graft.......  ..................  C.................  ...........  ...........  ...........  ...........  ...........
35511..............  Artery bypass graft.......  ..................  C.................  ...........  ...........  ...........  ...........  ...........
35512..............  Artery bypass graft.......  ..................  C.................  ...........  ...........  ...........  ...........  ...........
35515..............  Artery bypass graft.......  ..................  C.................  ...........  ...........  ...........  ...........  ...........
35516..............  Artery bypass graft.......  ..................  C.................  ...........  ...........  ...........  ...........  ...........
35518..............  Artery bypass graft.......  ..................  C.................  ...........  ...........  ...........  ...........  ...........
35521..............  Artery bypass graft.......  ..................  C.................  ...........  ...........  ...........  ...........  ...........
35522..............  Artery bypass graft.......  ..................  C.................  ...........  ...........  ...........  ...........  ...........
35523..............  Artery bypass graft.......  NI................  C.................  ...........  ...........  ...........  ...........  ...........
35525..............  Artery bypass graft.......  ..................  C.................  ...........  ...........  ...........  ...........  ...........
35526..............  Artery bypass graft.......  ..................  C.................  ...........  ...........  ...........  ...........  ...........
35531..............  Artery bypass graft.......  ..................  C.................  ...........  ...........  ...........  ...........  ...........
35533..............  Artery bypass graft.......  ..................  C.................  ...........  ...........  ...........  ...........  ...........
35536..............  Artery bypass graft.......  ..................  C.................  ...........  ...........  ...........  ...........  ...........
35537..............  Artery bypass graft.......  ..................  C.................  ...........  ...........  ...........  ...........  ...........

[[Page 67034]]

 
35538..............  Artery bypass graft.......  ..................  C.................  ...........  ...........  ...........  ...........  ...........
35539..............  Artery bypass graft.......  ..................  C.................  ...........  ...........  ...........  ...........  ...........
35540..............  Artery bypass graft.......  ..................  C.................  ...........  ...........  ...........  ...........  ...........
35548..............  Artery bypass graft.......  ..................  C.................  ...........  ...........  ...........  ...........  ...........
35549..............  Artery bypass graft.......  ..................  C.................  ...........  ...........  ...........  ...........  ...........
35551..............  Artery bypass graft.......  ..................  C.................  ...........  ...........  ...........  ...........  ...........
35556..............  Artery bypass graft.......  ..................  C.................  ...........  ...........  ...........  ...........  ...........
35558..............  Artery bypass graft.......  ..................  C.................  ...........  ...........  ...........  ...........  ...........
35560..............  Artery bypass graft.......  ..................  C.................  ...........  ...........  ...........  ...........  ...........
35563..............  Artery bypass graft.......  ..................  C.................  ...........  ...........  ...........  ...........  ...........
35565..............  Artery bypass graft.......  ..................  C.................  ...........  ...........  ...........  ...........  ...........
35566..............  Artery bypass graft.......  ..................  C.................  ...........  ...........  ...........  ...........  ...........
35571..............  Artery bypass graft.......  ..................  C.................  ...........  ...........  ...........  ...........  ...........
35572..............  Harvest femoropopliteal     ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      vein.
35583..............  Vein bypass graft.........  ..................  C.................  ...........  ...........  ...........  ...........  ...........
35585..............  Vein bypass graft.........  ..................  C.................  ...........  ...........  ...........  ...........  ...........
35587..............  Vein bypass graft.........  ..................  C.................  ...........  ...........  ...........  ...........  ...........
35600..............  Harvest art for cabg add-   ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      on.
35601..............  Artery bypass graft.......  ..................  C.................  ...........  ...........  ...........  ...........  ...........
35606..............  Artery bypass graft.......  ..................  C.................  ...........  ...........  ...........  ...........  ...........
35612..............  Artery bypass graft.......  ..................  C.................  ...........  ...........  ...........  ...........  ...........
35616..............  Artery bypass graft.......  ..................  C.................  ...........  ...........  ...........  ...........  ...........
35621..............  Artery bypass graft.......  ..................  C.................  ...........  ...........  ...........  ...........  ...........
35623..............  Bypass graft, not vein....  ..................  C.................  ...........  ...........  ...........  ...........  ...........
35626..............  Artery bypass graft.......  ..................  C.................  ...........  ...........  ...........  ...........  ...........
35631..............  Artery bypass graft.......  ..................  C.................  ...........  ...........  ...........  ...........  ...........
35636..............  Artery bypass graft.......  ..................  C.................  ...........  ...........  ...........  ...........  ...........
35637..............  Artery bypass graft.......  ..................  C.................  ...........  ...........  ...........  ...........  ...........
35638..............  Artery bypass graft.......  ..................  C.................  ...........  ...........  ...........  ...........  ...........
35642..............  Artery bypass graft.......  ..................  C.................  ...........  ...........  ...........  ...........  ...........
35645..............  Artery bypass graft.......  ..................  C.................  ...........  ...........  ...........  ...........  ...........
35646..............  Artery bypass graft.......  ..................  C.................  ...........  ...........  ...........  ...........  ...........
35647..............  Artery bypass graft.......  ..................  C.................  ...........  ...........  ...........  ...........  ...........
35650..............  Artery bypass graft.......  ..................  C.................  ...........  ...........  ...........  ...........  ...........
35651..............  Artery bypass graft.......  ..................  C.................  ...........  ...........  ...........  ...........  ...........
35654..............  Artery bypass graft.......  ..................  C.................  ...........  ...........  ...........  ...........  ...........
35656..............  Artery bypass graft.......  ..................  C.................  ...........  ...........  ...........  ...........  ...........
35661..............  Artery bypass graft.......  ..................  C.................  ...........  ...........  ...........  ...........  ...........
35663..............  Artery bypass graft.......  ..................  C.................  ...........  ...........  ...........  ...........  ...........
35665..............  Artery bypass graft.......  ..................  C.................  ...........  ...........  ...........  ...........  ...........
35666..............  Artery bypass graft.......  ..................  C.................  ...........  ...........  ...........  ...........  ...........
35671..............  Artery bypass graft.......  ..................  C.................  ...........  ...........  ...........  ...........  ...........
35681..............  Composite bypass graft....  ..................  C.................  ...........  ...........  ...........  ...........  ...........
35682..............  Composite bypass graft....  ..................  C.................  ...........  ...........  ...........  ...........  ...........
35683..............  Composite bypass graft....  ..................  C.................  ...........  ...........  ...........  ...........  ...........
35685..............  Bypass graft patency/patch  ..................  T.................         0093      30.1294    $1,919.06  ...........      $383.81
35686..............  Bypass graft/av fist        ..................  T.................         0093      30.1294    $1,919.06  ...........      $383.81
                      patency.
35691..............  Arterial transposition....  ..................  C.................  ...........  ...........  ...........  ...........  ...........
35693..............  Arterial transposition....  ..................  C.................  ...........  ...........  ...........  ...........  ...........
35694..............  Arterial transposition....  ..................  C.................  ...........  ...........  ...........  ...........  ...........
35695..............  Arterial transposition....  ..................  C.................  ...........  ...........  ...........  ...........  ...........
35697..............  Reimplant artery each.....  ..................  C.................  ...........  ...........  ...........  ...........  ...........
35700..............  Reoperation, bypass graft.  ..................  C.................  ...........  ...........  ...........  ...........  ...........
35701..............  Exploration, carotid        ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      artery.
35721..............  Exploration, femoral        ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      artery.
35741..............  Exploration popliteal       ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      artery.
35761..............  Exploration of artery/vein  ..................  T.................         0115      29.6965    $1,891.49  ...........      $378.30
35800..............  Explore neck vessels......  ..................  C.................  ...........  ...........  ...........  ...........  ...........
35820..............  Explore chest vessels.....  ..................  C.................  ...........  ...........  ...........  ...........  ...........
35840..............  Explore abdominal vessels.  ..................  C.................  ...........  ...........  ...........  ...........  ...........
35860..............  Explore limb vessels......  ..................  T.................         0093      30.1294    $1,919.06  ...........      $383.81
35870..............  Repair vessel graft defect  ..................  C.................  ...........  ...........  ...........  ...........  ...........
35875..............  Removal of clot in graft..  ..................  T.................         0088      38.7673    $2,469.24      $655.22      $493.85
35876..............  Removal of clot in graft..  ..................  T.................         0088      38.7673    $2,469.24      $655.22      $493.85
35879..............  Revise graft w/vein.......  ..................  T.................         0088      38.7673    $2,469.24      $655.22      $493.85
35881..............  Revise graft w/vein.......  ..................  T.................         0088      38.7673    $2,469.24      $655.22      $493.85
35883..............  Revise graft w/nonauto      ..................  T.................         0088      38.7673    $2,469.24      $655.22      $493.85
                      graft.
35884..............  Revise graft w/vein.......  ..................  T.................         0088      38.7673    $2,469.24      $655.22      $493.85
35901..............  Excision, graft, neck.....  ..................  C.................  ...........  ...........  ...........  ...........  ...........
35903..............  Excision, graft, extremity  ..................  T.................         0115      29.6965    $1,891.49  ...........      $378.30
35905..............  Excision, graft, thorax...  ..................  C.................  ...........  ...........  ...........  ...........  ...........
35907..............  Excision, graft, abdomen..  ..................  C.................  ...........  ...........  ...........  ...........  ...........
36000..............  Place needle in vein......  ..................  N.................  ...........  ...........  ...........  ...........  ...........
36002..............  Pseudoaneurysm injection    ..................  S.................         0267       2.3792      $151.54       $60.50       $30.31
                      trt.
36005..............  Injection ext venography..  ..................  N.................  ...........  ...........  ...........  ...........  ...........
36010..............  Place catheter in vein....  ..................  N.................  ...........  ...........  ...........  ...........  ...........
36011..............  Place catheter in vein....  ..................  N.................  ...........  ...........  ...........  ...........  ...........
36012..............  Place catheter in vein....  ..................  N.................  ...........  ...........  ...........  ...........  ...........
36013..............  Place catheter in artery..  ..................  N.................  ...........  ...........  ...........  ...........  ...........
36014..............  Place catheter in artery..  ..................  N.................  ...........  ...........  ...........  ...........  ...........

[[Page 67035]]

 
36015..............  Place catheter in artery..  ..................  N.................  ...........  ...........  ...........  ...........  ...........
36100..............  Establish access to artery  ..................  N.................  ...........  ...........  ...........  ...........  ...........
36120..............  Establish access to artery  ..................  N.................  ...........  ...........  ...........  ...........  ...........
36140..............  Establish access to artery  ..................  N.................  ...........  ...........  ...........  ...........  ...........
36145..............  Artery to vein shunt......  ..................  N.................  ...........  ...........  ...........  ...........  ...........
36160..............  Establish access to aorta.  ..................  N.................  ...........  ...........  ...........  ...........  ...........
36200..............  Place catheter in aorta...  ..................  N.................  ...........  ...........  ...........  ...........  ...........
36215..............  Place catheter in artery..  ..................  N.................  ...........  ...........  ...........  ...........  ...........
36216..............  Place catheter in artery..  ..................  N.................  ...........  ...........  ...........  ...........  ...........
36217..............  Place catheter in artery..  ..................  N.................  ...........  ...........  ...........  ...........  ...........
36218..............  Place catheter in artery..  ..................  N.................  ...........  ...........  ...........  ...........  ...........
36245..............  Place catheter in artery..  ..................  N.................  ...........  ...........  ...........  ...........  ...........
36246..............  Place catheter in artery..  ..................  N.................  ...........  ...........  ...........  ...........  ...........
36247..............  Place catheter in artery..  ..................  N.................  ...........  ...........  ...........  ...........  ...........
36248..............  Place catheter in artery..  ..................  N.................  ...........  ...........  ...........  ...........  ...........
36260..............  Insertion of infusion pump  ..................  T.................         0623      28.8743    $1,839.12  ...........      $367.82
36261..............  Revision of infusion pump.  CH................  T.................         0105      23.9802    $1,527.39  ...........      $305.48
36262..............  Removal of infusion pump..  CH................  T.................         0105      23.9802    $1,527.39  ...........      $305.48
36299..............  Vessel injection procedure  ..................  N.................  ...........  ...........  ...........  ...........  ...........
36400..............  Bl draw < 3 yrs fem/        ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      jugular.
36405..............  Bl draw < 3 yrs scalp vein  ..................  N.................  ...........  ...........  ...........  ...........  ...........
36406..............  Bl draw < 3 yrs other vein  ..................  N.................  ...........  ...........  ...........  ...........  ...........
36410..............  Non-routine bl draw > 3     ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      yrs.
36415..............  Routine venipuncture......  ..................  A.................  ...........  ...........  ...........  ...........  ...........
36416..............  Capillary blood draw......  ..................  N.................  ...........  ...........  ...........  ...........  ...........
36420..............  Vein access cutdown < 1 yr  ..................  T.................         0035       0.2143       $13.65  ...........        $2.73
36425..............  Vein access cutdown > 1 yr  ..................  T.................         0035       0.2143       $13.65  ...........        $2.73
36430..............  Blood transfusion service.  ..................  S.................         0110       3.3967      $216.35  ...........       $43.27
36440..............  Bl push transfuse, 2 yr or  ..................  S.................         0110       3.3967      $216.35  ...........       $43.27
                      <.
36450..............  Bl exchange/transfuse, nb.  ..................  S.................         0110       3.3967      $216.35  ...........       $43.27
36455..............  Bl exchange/transfuse non-  ..................  S.................         0110       3.3967      $216.35  ...........       $43.27
                      nb.
36460..............  Transfusion service, fetal  ..................  S.................         0110       3.3967      $216.35  ...........       $43.27
36468..............  Injection(s), spider veins  CH................  T.................         0013       0.7930       $50.51  ...........       $10.10
36469..............  Injection(s), spider veins  CH................  T.................         0013       0.7930       $50.51  ...........       $10.10
36470..............  Injection therapy of vein.  CH................  T.................         0013       0.7930       $50.51  ...........       $10.10
36471..............  Injection therapy of veins  CH................  T.................         0013       0.7930       $50.51  ...........       $10.10
36475..............  Endovenous rf, 1st vein...  ..................  T.................         0091      42.6114    $2,714.09  ...........      $542.82
36476..............  Endovenous rf, vein add-on  CH................  T.................         0092      25.8410    $1,645.92  ...........      $329.18
36478..............  Endovenous laser, 1st vein  ..................  T.................         0092      25.8410    $1,645.92  ...........      $329.18
36479..............  Endovenous laser vein add-  ..................  T.................         0092      25.8410    $1,645.92  ...........      $329.18
                      on.
36481..............  Insertion of catheter,      ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      vein.
36500..............  Insertion of catheter,      ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      vein.
36510..............  Insertion of catheter,      ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      vein.
36511..............  Apheresis wbc.............  ..................  S.................         0111      11.5058      $732.85      $198.40      $146.57
36512..............  Apheresis rbc.............  ..................  S.................         0111      11.5058      $732.85      $198.40      $146.57
36513..............  Apheresis platelets.......  ..................  S.................         0111      11.5058      $732.85      $198.40      $146.57
36514..............  Apheresis plasma..........  ..................  S.................         0111      11.5058      $732.85      $198.40      $146.57
36515..............  Apheresis, adsorp/reinfuse  ..................  S.................         0112      30.6035    $1,949.26      $433.29      $389.85
36516..............  Apheresis, selective......  ..................  S.................         0112      30.6035    $1,949.26      $433.29      $389.85
36522..............  Photopheresis.............  ..................  S.................         0112      30.6035    $1,949.26      $433.29      $389.85
36540..............  Collect blood venous        CH................  D.................  ...........  ...........  ...........  ...........  ...........
                      device.
36550..............  Declot vascular device....  CH................  D.................  ...........  ...........  ...........  ...........  ...........
36555..............  Insert non-tunnel cv cath.  ..................  T.................         0621      10.9092      $694.85  ...........      $138.97
36556..............  Insert non-tunnel cv cath.  ..................  T.................         0621      10.9092      $694.85  ...........      $138.97
36557..............  Insert tunneled cv cath...  ..................  T.................         0622      24.1069    $1,535.46  ...........      $307.09
36558..............  Insert tunneled cv cath...  ..................  T.................         0622      24.1069    $1,535.46  ...........      $307.09
36560..............  Insert tunneled cv cath...  ..................  T.................         0623      28.8743    $1,839.12  ...........      $367.82
36561..............  Insert tunneled cv cath...  ..................  T.................         0623      28.8743    $1,839.12  ...........      $367.82
36563..............  Insert tunneled cv cath...  ..................  T.................         0623      28.8743    $1,839.12  ...........      $367.82
36565..............  Insert tunneled cv cath...  ..................  T.................         0623      28.8743    $1,839.12  ...........      $367.82
36566..............  Insert tunneled cv cath...  ..................  T.................         0625      81.7482    $5,206.87  ...........    $1,041.37
36568..............  Insert picc cath..........  ..................  T.................         0621      10.9092      $694.85  ...........      $138.97
36569..............  Insert picc cath..........  ..................  T.................         0621      10.9092      $694.85  ...........      $138.97
36570..............  Insert picvad cath........  ..................  T.................         0622      24.1069    $1,535.46  ...........      $307.09
36571..............  Insert picvad cath........  ..................  T.................         0622      24.1069    $1,535.46  ...........      $307.09
36575..............  Repair tunneled cv cath...  CH................  T.................         0109       5.6614      $360.60  ...........       $72.12
36576..............  Repair tunneled cv cath...  ..................  T.................         0621      10.9092      $694.85  ...........      $138.97
36578..............  Replace tunneled cv cath..  ..................  T.................         0622      24.1069    $1,535.46  ...........      $307.09
36580..............  Replace cvad cath.........  ..................  T.................         0621      10.9092      $694.85  ...........      $138.97
36581..............  Replace tunneled cv cath..  ..................  T.................         0622      24.1069    $1,535.46  ...........      $307.09
36582..............  Replace tunneled cv cath..  ..................  T.................         0623      28.8743    $1,839.12  ...........      $367.82
36583..............  Replace tunneled cv cath..  ..................  T.................         0623      28.8743    $1,839.12  ...........      $367.82
36584..............  Replace picc cath.........  ..................  T.................         0621      10.9092      $694.85  ...........      $138.97
36585..............  Replace picvad cath.......  ..................  T.................         0622      24.1069    $1,535.46  ...........      $307.09
36589..............  Removal tunneled cv cath..  CH................  T.................         0109       5.6614      $360.60  ...........       $72.12
36590..............  Removal tunneled cv cath..  ..................  T.................         0621      10.9092      $694.85  ...........      $138.97
36591..............  Draw blood off venous       NI................  Q.................         0624       0.5689       $36.24       $12.65        $7.25
                      device.
36592..............  Collect blood from picc...  NI................  N.................  ...........  ...........  ...........  ...........  ...........
36593..............  Declot vascular device....  NI................  T.................         0676       2.4824      $158.11  ...........       $31.62
36595..............  Mech remov tunneled cv      ..................  T.................         0622      24.1069    $1,535.46  ...........      $307.09
                      cath.

[[Page 67036]]

 
36596..............  Mech remov tunneled cv      ..................  T.................         0621      10.9092      $694.85  ...........      $138.97
                      cath.
36597..............  Reposition venous catheter  ..................  T.................         0621      10.9092      $694.85  ...........      $138.97
36598..............  Inj w/fluor, eval cv        CH................  T.................         0676       2.4824      $158.11  ...........       $31.62
                      device.
36600..............  Withdrawal of arterial      ..................  Q.................         0035       0.2143       $13.65  ...........        $2.73
                      blood.
36620..............  Insertion catheter, artery  ..................  N.................  ...........  ...........  ...........  ...........  ...........
36625..............  Insertion catheter, artery  ..................  N.................  ...........  ...........  ...........  ...........  ...........
36640..............  Insertion catheter, artery  ..................  T.................         0623      28.8743    $1,839.12  ...........      $367.82
36660..............  Insertion catheter, artery  ..................  C.................  ...........  ...........  ...........  ...........  ...........
36680..............  Insert needle, bone cavity  ..................  T.................         0002       1.1097       $70.68  ...........       $14.14
36800..............  Insertion of cannula......  ..................  T.................         0115      29.6965    $1,891.49  ...........      $378.30
36810..............  Insertion of cannula......  ..................  T.................         0115      29.6965    $1,891.49  ...........      $378.30
36815..............  Insertion of cannula......  ..................  T.................         0115      29.6965    $1,891.49  ...........      $378.30
36818..............  Av fuse, uppr arm,          ..................  T.................         0088      38.7673    $2,469.24      $655.22      $493.85
                      cephalic.
36819..............  Av fuse, uppr arm, basilic  ..................  T.................         0088      38.7673    $2,469.24      $655.22      $493.85
36820..............  Av fusion/forearm vein....  ..................  T.................         0088      38.7673    $2,469.24      $655.22      $493.85
36821..............  Av fusion direct any site.  ..................  T.................         0088      38.7673    $2,469.24      $655.22      $493.85
36822..............  Insertion of cannula(s)...  ..................  C.................  ...........  ...........  ...........  ...........  ...........
36823..............  Insertion of cannula(s)...  ..................  C.................  ...........  ...........  ...........  ...........  ...........
36825..............  Artery-vein autograft.....  ..................  T.................         0088      38.7673    $2,469.24      $655.22      $493.85
36830..............  Artery-vein nonautograft..  ..................  T.................         0088      38.7673    $2,469.24      $655.22      $493.85
36831..............  Open thrombect av fistula.  ..................  T.................         0088      38.7673    $2,469.24      $655.22      $493.85
36832..............  Av fistula revision, open.  ..................  T.................         0088      38.7673    $2,469.24      $655.22      $493.85
36833..............  Av fistula revision.......  ..................  T.................         0088      38.7673    $2,469.24      $655.22      $493.85
36834..............  Repair A-V aneurysm.......  ..................  T.................         0088      38.7673    $2,469.24      $655.22      $493.85
36835..............  Artery to vein shunt......  ..................  T.................         0115      29.6965    $1,891.49  ...........      $378.30
36838..............  Dist revas ligation, hemo.  ..................  T.................         0088      38.7673    $2,469.24      $655.22      $493.85
36860..............  External cannula            ..................  T.................         0676       2.4824      $158.11  ...........       $31.62
                      declotting.
36861..............  Cannula declotting........  ..................  T.................         0115      29.6965    $1,891.49  ...........      $378.30
36870..............  Percut thrombect av         ..................  T.................         0653      40.4667    $2,577.49  ...........      $515.50
                      fistula.
37140..............  Revision of circulation...  ..................  C.................  ...........  ...........  ...........  ...........  ...........
37145..............  Revision of circulation...  ..................  C.................  ...........  ...........  ...........  ...........  ...........
37160..............  Revision of circulation...  ..................  C.................  ...........  ...........  ...........  ...........  ...........
37180..............  Revision of circulation...  ..................  C.................  ...........  ...........  ...........  ...........  ...........
37181..............  Splice spleen/kidney veins  ..................  C.................  ...........  ...........  ...........  ...........  ...........
37182..............  Insert hepatic shunt        ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      (tips).
37183..............  Remove hepatic shunt        ..................  T.................         0229      88.5367    $5,639.26  ...........    $1,127.85
                      (tips).
37184..............  Prim art mech thrombectomy  ..................  T.................         0088      38.7673    $2,469.24      $655.22      $493.85
37185..............  Prim art m-thrombect add-   ..................  T.................         0088      38.7673    $2,469.24      $655.22      $493.85
                      on.
37186..............  Sec art m-thrombect add-on  ..................  T.................         0088      38.7673    $2,469.24      $655.22      $493.85
37187..............  Venous mech thrombectomy..  ..................  T.................         0088      38.7673    $2,469.24      $655.22      $493.85
37188..............  Venous m-thrombectomy add-  ..................  T.................         0088      38.7673    $2,469.24      $655.22      $493.85
                      on.
37195..............  Thrombolytic therapy,       ..................  T.................         0676       2.4824      $158.11  ...........       $31.62
                      stroke.
37200..............  Transcatheter biopsy......  CH................  T.................         0623      28.8743    $1,839.12  ...........      $367.82
37201..............  Transcatheter therapy       CH................  T.................         0103      14.6576      $933.60  ...........      $186.72
                      infuse.
37202..............  Transcatheter therapy       CH................  T.................         0103      14.6576      $933.60  ...........      $186.72
                      infuse.
37203..............  Transcatheter retrieval...  CH................  T.................         0623      28.8743    $1,839.12  ...........      $367.82
37204..............  Transcatheter occlusion...  CH................  T.................         0082      87.5137    $5,574.10  ...........    $1,114.82
37205..............  Transcath iv stent, percut  ..................  T.................         0229      88.5367    $5,639.26  ...........    $1,127.85
37206..............  Transcath iv stent/perc     ..................  T.................         0229      88.5367    $5,639.26  ...........    $1,127.85
                      addl.
37207..............  Transcath iv stent, open..  ..................  T.................         0229      88.5367    $5,639.26  ...........    $1,127.85
37208..............  Transcath iv stent/open     ..................  T.................         0229      88.5367    $5,639.26  ...........    $1,127.85
                      addl.
37209..............  Change iv cath at thromb    CH................  T.................         0623      28.8743    $1,839.12  ...........      $367.82
                      tx.
37210..............  Embolization uterine        CH................  T.................         0229      88.5367    $5,639.26  ...........    $1,127.85
                      fibroid.
37215..............  Transcath stent, cca w/eps  ..................  C.................  ...........  ...........  ...........  ...........  ...........
37216..............  Transcath stent, cca w/o    ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      eps.
37250..............  Iv us first vessel add-on.  CH................  N.................  ...........  ...........  ...........  ...........  ...........
37251..............  Iv us each add vessel add-  CH................  N.................  ...........  ...........  ...........  ...........  ...........
                      on.
37500..............  Endoscopy ligate perf       ..................  T.................         0091      42.6114    $2,714.09  ...........      $542.82
                      veins.
37501..............  Vascular endoscopy          ..................  T.................         0092      25.8410    $1,645.92  ...........      $329.18
                      procedure.
37565..............  Ligation of neck vein.....  ..................  T.................         0093      30.1294    $1,919.06  ...........      $383.81
37600..............  Ligation of neck artery...  ..................  T.................         0093      30.1294    $1,919.06  ...........      $383.81
37605..............  Ligation of neck artery...  ..................  T.................         0091      42.6114    $2,714.09  ...........      $542.82
37606..............  Ligation of neck artery...  ..................  T.................         0092      25.8410    $1,645.92  ...........      $329.18
37607..............  Ligation of a-v fistula...  ..................  T.................         0092      25.8410    $1,645.92  ...........      $329.18
37609..............  Temporal artery procedure.  ..................  T.................         0021      16.1001    $1,025.48      $219.48      $205.10
37615..............  Ligation of neck artery...  ..................  T.................         0092      25.8410    $1,645.92  ...........      $329.18
37616..............  Ligation of chest artery..  ..................  C.................  ...........  ...........  ...........  ...........  ...........
37617..............  Ligation of abdomen artery  ..................  C.................  ...........  ...........  ...........  ...........  ...........
37618..............  Ligation of extremity       ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      artery.
37620..............  Revision of major vein....  ..................  T.................         0091      42.6114    $2,714.09  ...........      $542.82
37650..............  Revision of major vein....  ..................  T.................         0092      25.8410    $1,645.92  ...........      $329.18
37660..............  Revision of major vein....  ..................  C.................  ...........  ...........  ...........  ...........  ...........
37700..............  Revise leg vein...........  CH................  T.................         0092      25.8410    $1,645.92  ...........      $329.18
37718..............  Ligate/strip short leg      CH................  T.................         0092      25.8410    $1,645.92  ...........      $329.18
                      vein.
37722..............  Ligate/strip long leg vein  ..................  T.................         0091      42.6114    $2,714.09  ...........      $542.82
37735..............  Removal of leg veins/       ..................  T.................         0091      42.6114    $2,714.09  ...........      $542.82
                      lesion.
37760..............  Ligation, leg veins, open.  ..................  T.................         0092      25.8410    $1,645.92  ...........      $329.18
37765..............  Phleb veins extrem 10-20..  ..................  T.................         0092      25.8410    $1,645.92  ...........      $329.18
37766..............  Phleb veins extrem 20+....  ..................  T.................         0092      25.8410    $1,645.92  ...........      $329.18
37780..............  Revision of leg vein......  ..................  T.................         0092      25.8410    $1,645.92  ...........      $329.18

[[Page 67037]]

 
37785..............  Ligate/divide/excise vein.  ..................  T.................         0092      25.8410    $1,645.92  ...........      $329.18
37788..............  Revascularization, penis..  ..................  C.................  ...........  ...........  ...........  ...........  ...........
37790..............  Penile venous occlusion...  ..................  T.................         0181      33.9306    $2,161.18      $621.82      $432.24
37799..............  Vascular surgery procedure  ..................  T.................         0103      14.6576      $933.60  ...........      $186.72
38100..............  Removal of spleen, total..  ..................  C.................  ...........  ...........  ...........  ...........  ...........
38101..............  Removal of spleen, partial  ..................  C.................  ...........  ...........  ...........  ...........  ...........
38102..............  Removal of spleen, total..  ..................  C.................  ...........  ...........  ...........  ...........  ...........
38115..............  Repair of ruptured spleen.  ..................  C.................  ...........  ...........  ...........  ...........  ...........
38120..............  Laparoscopy, splenectomy..  ..................  T.................         0131      45.5317    $2,900.10    $1,001.89      $580.02
38129..............  Laparoscope proc, spleen..  ..................  T.................         0130      34.3958    $2,190.81      $659.53      $438.16
38200..............  Injection for spleen x-ray  ..................  N.................  ...........  ...........  ...........  ...........  ...........
38204..............  Bl donor search management  ..................  N.................  ...........  ...........  ...........  ...........  ...........
38205..............  Harvest allogenic stem      ..................  S.................         0111      11.5058      $732.85      $198.40      $146.57
                      cells.
38206..............  Harvest auto stem cells...  ..................  S.................         0111      11.5058      $732.85      $198.40      $146.57
38207..............  Cryopreserve stem cells...  CH................  S.................         0110       3.3967      $216.35  ...........       $43.27
38208..............  Thaw preserved stem cells.  CH................  S.................         0110       3.3967      $216.35  ...........       $43.27
38209..............  Wash harvest stem cells...  CH................  S.................         0110       3.3967      $216.35  ...........       $43.27
38210..............  T-cell depletion of         CH................  S.................         0393       5.6921      $362.55       $82.04       $72.51
                      harvest.
38211..............  Tumor cell deplete of       CH................  S.................         0393       5.6921      $362.55       $82.04       $72.51
                      harvest.
38212..............  Rbc depletion of harvest..  CH................  S.................         0393       5.6921      $362.55       $82.04       $72.51
38213..............  Platelet deplete of         CH................  S.................         0393       5.6921      $362.55       $82.04       $72.51
                      harvest.
38214..............  Volume deplete of harvest.  CH................  S.................         0393       5.6921      $362.55       $82.04       $72.51
38215..............  Harvest stem cell           CH................  S.................         0393       5.6921      $362.55       $82.04       $72.51
                      concentrate.
38220..............  Bone marrow aspiration....  ..................  T.................         0003       3.1008      $197.50  ...........       $39.50
38221..............  Bone marrow biopsy........  ..................  T.................         0003       3.1008      $197.50  ...........       $39.50
38230..............  Bone marrow collection....  CH................  S.................         0112      30.6035    $1,949.26      $433.29      $389.85
38240..............  Bone marrow/stem            CH................  S.................         0112      30.6035    $1,949.26      $433.29      $389.85
                      transplant.
38241..............  Bone marrow/stem            CH................  S.................         0112      30.6035    $1,949.26      $433.29      $389.85
                      transplant.
38242..............  Lymphocyte infuse           ..................  S.................         0111      11.5058      $732.85      $198.40      $146.57
                      transplant.
38300..............  Drainage, lymph node        ..................  T.................         0007      11.5594      $736.26  ...........      $147.25
                      lesion.
38305..............  Drainage, lymph node        ..................  T.................         0008      18.3197    $1,166.85  ...........      $233.37
                      lesion.
38308..............  Incision of lymph channels  ..................  T.................         0113      22.9584    $1,462.31  ...........      $292.46
38380..............  Thoracic duct procedure...  ..................  C.................  ...........  ...........  ...........  ...........  ...........
38381..............  Thoracic duct procedure...  ..................  C.................  ...........  ...........  ...........  ...........  ...........
38382..............  Thoracic duct procedure...  ..................  C.................  ...........  ...........  ...........  ...........  ...........
38500..............  Biopsy/removal, lymph       ..................  T.................         0113      22.9584    $1,462.31  ...........      $292.46
                      nodes.
38505..............  Needle biopsy, lymph nodes  ..................  T.................         0005       7.1147      $453.16  ...........       $90.63
38510..............  Biopsy/removal, lymph       ..................  T.................         0113      22.9584    $1,462.31  ...........      $292.46
                      nodes.
38520..............  Biopsy/removal, lymph       ..................  T.................         0113      22.9584    $1,462.31  ...........      $292.46
                      nodes.
38525..............  Biopsy/removal, lymph       ..................  T.................         0113      22.9584    $1,462.31  ...........      $292.46
                      nodes.
38530..............  Biopsy/removal, lymph       ..................  T.................         0113      22.9584    $1,462.31  ...........      $292.46
                      nodes.
38542..............  Explore deep node(s), neck  ..................  T.................         0114      44.3240    $2,823.17  ...........      $564.63
38550..............  Removal, neck/armpit        ..................  T.................         0113      22.9584    $1,462.31  ...........      $292.46
                      lesion.
38555..............  Removal, neck/armpit        ..................  T.................         0113      22.9584    $1,462.31  ...........      $292.46
                      lesion.
38562..............  Removal, pelvic lymph       ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      nodes.
38564..............  Removal, abdomen lymph      ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      nodes.
38570..............  Laparoscopy, lymph node     ..................  T.................         0131      45.5317    $2,900.10    $1,001.89      $580.02
                      biop.
38571..............  Laparoscopy,                ..................  T.................         0132      69.6652    $4,437.26    $1,239.22      $887.45
                      lymphadenectomy.
38572..............  Laparoscopy,                ..................  T.................         0131      45.5317    $2,900.10    $1,001.89      $580.02
                      lymphadenectomy.
38589..............  Laparoscope proc,           ..................  T.................         0130      34.3958    $2,190.81      $659.53      $438.16
                      lymphatic.
38700..............  Removal of lymph nodes,     ..................  T.................         0113      22.9584    $1,462.31  ...........      $292.46
                      neck.
38720..............  Removal of lymph nodes,     ..................  T.................         0113      22.9584    $1,462.31  ...........      $292.46
                      neck.
38724..............  Removal of lymph nodes,     ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      neck.
38740..............  Remove armpit lymph nodes.  ..................  T.................         0114      44.3240    $2,823.17  ...........      $564.63
38745..............  Remove armpit lymph nodes.  ..................  T.................         0114      44.3240    $2,823.17  ...........      $564.63
38746..............  Remove thoracic lymph       ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      nodes.
38747..............  Remove abdominal lymph      ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      nodes.
38760..............  Remove groin lymph nodes..  ..................  T.................         0113      22.9584    $1,462.31  ...........      $292.46
38765..............  Remove groin lymph nodes..  ..................  C.................  ...........  ...........  ...........  ...........  ...........
38770..............  Remove pelvis lymph nodes.  ..................  C.................  ...........  ...........  ...........  ...........  ...........
38780..............  Remove abdomen lymph nodes  ..................  C.................  ...........  ...........  ...........  ...........  ...........
38790..............  Inject for lymphatic x-ray  ..................  N.................  ...........  ...........  ...........  ...........  ...........
38792..............  Identify sentinel node....  CH................  Q.................         0392       2.9022      $184.85       $49.31       $36.97
38794..............  Access thoracic lymph duct  ..................  N.................  ...........  ...........  ...........  ...........  ...........
38999..............  Blood/lymph system          ..................  S.................         0110       3.3967      $216.35  ...........       $43.27
                      procedure.
39000..............  Exploration of chest......  ..................  C.................  ...........  ...........  ...........  ...........  ...........
39010..............  Exploration of chest......  ..................  C.................  ...........  ...........  ...........  ...........  ...........
39200..............  Removal chest lesion......  ..................  C.................  ...........  ...........  ...........  ...........  ...........
39220..............  Removal chest lesion......  ..................  C.................  ...........  ...........  ...........  ...........  ...........
39400..............  Visualization of chest....  ..................  T.................         0069      32.5666    $2,074.30      $591.64      $414.86
39499..............  Chest procedure...........  ..................  C.................  ...........  ...........  ...........  ...........  ...........
39501..............  Repair diaphragm            ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      laceration.
39502..............  Repair paraesophageal       ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      hernia.
39503..............  Repair of diaphragm hernia  ..................  C.................  ...........  ...........  ...........  ...........  ...........
39520..............  Repair of diaphragm hernia  ..................  C.................  ...........  ...........  ...........  ...........  ...........
39530..............  Repair of diaphragm hernia  ..................  C.................  ...........  ...........  ...........  ...........  ...........
39531..............  Repair of diaphragm hernia  ..................  C.................  ...........  ...........  ...........  ...........  ...........
39540..............  Repair of diaphragm hernia  ..................  C.................  ...........  ...........  ...........  ...........  ...........
39541..............  Repair of diaphragm hernia  ..................  C.................  ...........  ...........  ...........  ...........  ...........
39545..............  Revision of diaphragm.....  ..................  C.................  ...........  ...........  ...........  ...........  ...........

[[Page 67038]]

 
39560..............  Resect diaphragm, simple..  ..................  C.................  ...........  ...........  ...........  ...........  ...........
39561..............  Resect diaphragm, complex.  ..................  C.................  ...........  ...........  ...........  ...........  ...........
39599..............  Diaphragm surgery           ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      procedure.
4000F..............  Tobacco use txmnt           ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      counseling.
4001F..............  Tobacco use txmnt,          ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      pharmacol.
4002F..............  Statin therapy, rx........  ..................  M.................  ...........  ...........  ...........  ...........  ...........
4003F..............  Pt ed write/oral, pts w/    ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      hf.
4005F..............  Pharm thx for op rx'd.....  ..................  M.................  ...........  ...........  ...........  ...........  ...........
4006F..............  Beta-blocker therapy rx...  ..................  M.................  ...........  ...........  ...........  ...........  ...........
4007F..............  Areds/anitox vit/min rx'd.  CH................  D.................  ...........  ...........  ...........  ...........  ...........
4009F..............  Ace/arb inhibitor therapy   ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      rx.
4011F..............  Oral antiplatelet therapy   ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      rx.
4012F..............  Warfarin therapy rx.......  ..................  M.................  ...........  ...........  ...........  ...........  ...........
4014F..............  Written discharge instr     ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      prvd.
4015F..............  Persist asthma medicine     ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      ctrl.
4016F..............  Anti-inflm/anlgsc agent rx  ..................  M.................  ...........  ...........  ...........  ...........  ...........
4017F..............  Gi prophylaxis for nsaid    ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      rx.
4018F..............  Therapy exercise joint rx.  ..................  M.................  ...........  ...........  ...........  ...........  ...........
4019F..............  Doc recpt counsl vit d/     ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      calc+.
4025F..............  Inhaled bronchodilator rx.  ..................  M.................  ...........  ...........  ...........  ...........  ...........
4030F..............  Oxygen therapy rx.........  ..................  M.................  ...........  ...........  ...........  ...........  ...........
4033F..............  Pulmonary rehab rec.......  ..................  M.................  ...........  ...........  ...........  ...........  ...........
4035F..............  Influenza imm rec.........  ..................  M.................  ...........  ...........  ...........  ...........  ...........
4037F..............  Influenza imm order/admin.  ..................  M.................  ...........  ...........  ...........  ...........  ...........
4040F..............  Pneumoc imm order/admin...  ..................  M.................  ...........  ...........  ...........  ...........  ...........
4041F..............  Doc order cefazolin/        ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      cefurox.
4042F..............  Doc antibio not given.....  ..................  M.................  ...........  ...........  ...........  ...........  ...........
4043F..............  Doc order given stop        ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      antibio.
4044F..............  Doc order given vte         ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      prophylx.
4045F..............  Empiric antibiotic rx.....  ..................  M.................  ...........  ...........  ...........  ...........  ...........
4046F..............  Doc antibio given b/4 surg  ..................  M.................  ...........  ...........  ...........  ...........  ...........
4047F..............  Doc antibio given b/4 surg  ..................  M.................  ...........  ...........  ...........  ...........  ...........
4048F..............  Doc antibio given b/4 surg  ..................  M.................  ...........  ...........  ...........  ...........  ...........
40490..............  Biopsy of lip.............  ..................  T.................         0251       2.5002      $159.25  ...........       $31.85
4049F..............  Doc order given stop        ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      antibio.
40500..............  Partial excision of lip...  ..................  T.................         0253      16.3288    $1,040.05      $282.29      $208.01
4050F..............  Ht care plan doc..........  ..................  M.................  ...........  ...........  ...........  ...........  ...........
40510..............  Partial excision of lip...  ..................  T.................         0254      23.9765    $1,527.16      $321.35      $305.43
4051F..............  Referred for an AV fistula  ..................  M.................  ...........  ...........  ...........  ...........  ...........
40520..............  Partial excision of lip...  ..................  T.................         0253      16.3288    $1,040.05      $282.29      $208.01
40525..............  Reconstruct lip with flap.  ..................  T.................         0254      23.9765    $1,527.16      $321.35      $305.43
40527..............  Reconstruct lip with flap.  ..................  T.................         0254      23.9765    $1,527.16      $321.35      $305.43
4052F..............  Hemodialysis via AV         ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      fistula.
40530..............  Partial removal of lip....  ..................  T.................         0254      23.9765    $1,527.16      $321.35      $305.43
4053F..............  Hemodialysis via AV graft.  ..................  M.................  ...........  ...........  ...........  ...........  ...........
4054F..............  Hemodialysis via catheter.  ..................  M.................  ...........  ...........  ...........  ...........  ...........
4055F..............  Pt rcvng periton dialysis.  ..................  M.................  ...........  ...........  ...........  ...........  ...........
4056F..............  Approp oral rehyd recomm'd  ..................  M.................  ...........  ...........  ...........  ...........  ...........
4058F..............  Ped gastro ed given,        ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      caregvr.
4060F..............  Psych svcs provided.......  ..................  M.................  ...........  ...........  ...........  ...........  ...........
4062F..............  Pt referral psych doc'd...  ..................  M.................  ...........  ...........  ...........  ...........  ...........
4064F..............  Antidepressant rx.........  ..................  M.................  ...........  ...........  ...........  ...........  ...........
40650..............  Repair lip................  ..................  T.................         0252       7.4474      $474.35      $109.16       $94.87
40652..............  Repair lip................  ..................  T.................         0252       7.4474      $474.35      $109.16       $94.87
40654..............  Repair lip................  ..................  T.................         0252       7.4474      $474.35      $109.16       $94.87
4065F..............  Antipsychotic rx..........  ..................  M.................  ...........  ...........  ...........  ...........  ...........
4066F..............  ECT provided..............  ..................  M.................  ...........  ...........  ...........  ...........  ...........
4067F..............  Pt referral for ECT doc'd.  ..................  M.................  ...........  ...........  ...........  ...........  ...........
40700..............  Repair cleft lip/nasal....  ..................  T.................         0256      39.8776    $2,539.96  ...........      $507.99
40701..............  Repair cleft lip/nasal....  ..................  T.................         0256      39.8776    $2,539.96  ...........      $507.99
40702..............  Repair cleft lip/nasal....  ..................  T.................         0256      39.8776    $2,539.96  ...........      $507.99
4070F..............  Dvt prophylx recv'd day 2.  ..................  M.................  ...........  ...........  ...........  ...........  ...........
40720..............  Repair cleft lip/nasal....  ..................  T.................         0256      39.8776    $2,539.96  ...........      $507.99
4073F..............  Oral antiplat thx rx        ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      dischrg.
4075F..............  Anticoag thx rx at dischrg  ..................  M.................  ...........  ...........  ...........  ...........  ...........
40761..............  Repair cleft lip/nasal....  ..................  T.................         0256      39.8776    $2,539.96  ...........      $507.99
4077F..............  Doc t-pa admin considered.  ..................  M.................  ...........  ...........  ...........  ...........  ...........
40799..............  Lip surgery procedure.....  ..................  T.................         0251       2.5002      $159.25  ...........       $31.85
4079F..............  Doc rehab svcs considered.  ..................  M.................  ...........  ...........  ...........  ...........  ...........
40800..............  Drainage of mouth lesion..  ..................  T.................         0006       1.4066       $89.59  ...........       $17.92
40801..............  Drainage of mouth lesion..  ..................  T.................         0252       7.4474      $474.35      $109.16       $94.87
40804..............  Removal, foreign body,      ..................  X.................         0340       0.6310       $40.19  ...........        $8.04
                      mouth.
40805..............  Removal, foreign body,      ..................  T.................         0252       7.4474      $474.35      $109.16       $94.87
                      mouth.
40806..............  Incision of lip fold......  ..................  T.................         0251       2.5002      $159.25  ...........       $31.85
40808..............  Biopsy of mouth lesion....  ..................  T.................         0251       2.5002      $159.25  ...........       $31.85
40810..............  Excision of mouth lesion..  ..................  T.................         0253      16.3288    $1,040.05      $282.29      $208.01
40812..............  Excise/repair mouth lesion  ..................  T.................         0253      16.3288    $1,040.05      $282.29      $208.01
40814..............  Excise/repair mouth lesion  ..................  T.................         0253      16.3288    $1,040.05      $282.29      $208.01
40816..............  Excision of mouth lesion..  ..................  T.................         0254      23.9765    $1,527.16      $321.35      $305.43
40818..............  Excise oral mucosa for      ..................  T.................         0251       2.5002      $159.25  ...........       $31.85
                      graft.

[[Page 67039]]

 
40819..............  Excise lip or cheek fold..  ..................  T.................         0252       7.4474      $474.35      $109.16       $94.87
40820..............  Treatment of mouth lesion.  ..................  T.................         0253      16.3288    $1,040.05      $282.29      $208.01
40830..............  Repair mouth laceration...  ..................  T.................         0251       2.5002      $159.25  ...........       $31.85
40831..............  Repair mouth laceration...  ..................  T.................         0252       7.4474      $474.35      $109.16       $94.87
40840..............  Reconstruction of mouth...  ..................  T.................         0254      23.9765    $1,527.16      $321.35      $305.43
40842..............  Reconstruction of mouth...  ..................  T.................         0254      23.9765    $1,527.16      $321.35      $305.43
40843..............  Reconstruction of mouth...  ..................  T.................         0254      23.9765    $1,527.16      $321.35      $305.43
40844..............  Reconstruction of mouth...  ..................  T.................         0256      39.8776    $2,539.96  ...........      $507.99
40845..............  Reconstruction of mouth...  ..................  T.................         0256      39.8776    $2,539.96  ...........      $507.99
4084F..............  Aspirin recv'd w/in 24 hrs  ..................  M.................  ...........  ...........  ...........  ...........  ...........
40899..............  Mouth surgery procedure...  ..................  T.................         0251       2.5002      $159.25  ...........       $31.85
4090F..............  Pt rcvng epo thxpy........  ..................  M.................  ...........  ...........  ...........  ...........  ...........
4095F..............  Pt not rcvng epo thxpy....  ..................  M.................  ...........  ...........  ...........  ...........  ...........
41000..............  Drainage of mouth lesion..  ..................  T.................         0253      16.3288    $1,040.05      $282.29      $208.01
41005..............  Drainage of mouth lesion..  ..................  T.................         0251       2.5002      $159.25  ...........       $31.85
41006..............  Drainage of mouth lesion..  ..................  T.................         0254      23.9765    $1,527.16      $321.35      $305.43
41007..............  Drainage of mouth lesion..  ..................  T.................         0253      16.3288    $1,040.05      $282.29      $208.01
41008..............  Drainage of mouth lesion..  ..................  T.................         0253      16.3288    $1,040.05      $282.29      $208.01
41009..............  Drainage of mouth lesion..  ..................  T.................         0251       2.5002      $159.25  ...........       $31.85
4100F..............  Biphos thxpy vein ord/      ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      rec'vd.
41010..............  Incision of tongue fold...  ..................  T.................         0252       7.4474      $474.35      $109.16       $94.87
41015..............  Drainage of mouth lesion..  ..................  T.................         0251       2.5002      $159.25  ...........       $31.85
41016..............  Drainage of mouth lesion..  ..................  T.................         0252       7.4474      $474.35      $109.16       $94.87
41017..............  Drainage of mouth lesion..  ..................  T.................         0252       7.4474      $474.35      $109.16       $94.87
41018..............  Drainage of mouth lesion..  ..................  T.................         0252       7.4474      $474.35      $109.16       $94.87
41019..............  Place needles h&n for rt..  NI................  T.................         0254      23.9765    $1,527.16      $321.35      $305.43
41100..............  Biopsy of tongue..........  ..................  T.................         0252       7.4474      $474.35      $109.16       $94.87
41105..............  Biopsy of tongue..........  ..................  T.................         0253      16.3288    $1,040.05      $282.29      $208.01
41108..............  Biopsy of floor of mouth..  ..................  T.................         0252       7.4474      $474.35      $109.16       $94.87
4110F..............  Int mam art used for cabg.  ..................  M.................  ...........  ...........  ...........  ...........  ...........
41110..............  Excision of tongue lesion.  ..................  T.................         0253      16.3288    $1,040.05      $282.29      $208.01
41112..............  Excision of tongue lesion.  ..................  T.................         0253      16.3288    $1,040.05      $282.29      $208.01
41113..............  Excision of tongue lesion.  ..................  T.................         0253      16.3288    $1,040.05      $282.29      $208.01
41114..............  Excision of tongue lesion.  ..................  T.................         0254      23.9765    $1,527.16      $321.35      $305.43
41115..............  Excision of tongue fold...  ..................  T.................         0252       7.4474      $474.35      $109.16       $94.87
41116..............  Excision of mouth lesion..  ..................  T.................         0253      16.3288    $1,040.05      $282.29      $208.01
41120..............  Partial removal of tongue.  ..................  T.................         0254      23.9765    $1,527.16      $321.35      $305.43
41130..............  Partial removal of tongue.  ..................  C.................  ...........  ...........  ...........  ...........  ...........
41135..............  Tongue and neck surgery...  ..................  C.................  ...........  ...........  ...........  ...........  ...........
41140..............  Removal of tongue.........  ..................  C.................  ...........  ...........  ...........  ...........  ...........
41145..............  Tongue removal, neck        ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      surgery.
41150..............  Tongue, mouth, jaw surgery  ..................  C.................  ...........  ...........  ...........  ...........  ...........
41153..............  Tongue, mouth, neck         ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      surgery.
41155..............  Tongue, jaw, & neck         ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      surgery.
4115F..............  Beta blckr admin w/in 24    ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      hrs.
4120F..............  Antibiot rx'd/given.......  ..................  M.................  ...........  ...........  ...........  ...........  ...........
4124F..............  Antibiot not rx'd/given...  ..................  M.................  ...........  ...........  ...........  ...........  ...........
41250..............  Repair tongue laceration..  ..................  T.................         0251       2.5002      $159.25  ...........       $31.85
41251..............  Repair tongue laceration..  ..................  T.................         0251       2.5002      $159.25  ...........       $31.85
41252..............  Repair tongue laceration..  ..................  T.................         0252       7.4474      $474.35      $109.16       $94.87
4130F..............  Topical prep rx, AOE......  ..................  M.................  ...........  ...........  ...........  ...........  ...........
4131F..............  Syst antimicrobial thx rx.  ..................  M.................  ...........  ...........  ...........  ...........  ...........
4132F..............  No syst antimicrobial thx   ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      rx.
4133F..............  Antihist/decong rx/recom..  ..................  M.................  ...........  ...........  ...........  ...........  ...........
4134F..............  No antihist/decong rx/      ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      recom.
4135F..............  Systemic corticosteroids    ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      rx.
4136F..............  Syst corticosteroids not    ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      rx.
41500..............  Fixation of tongue........  ..................  T.................         0254      23.9765    $1,527.16      $321.35      $305.43
4150F..............  Pt recvng antivir txmnt     ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      hepc.
41510..............  Tongue to lip surgery.....  ..................  T.................         0253      16.3288    $1,040.05      $282.29      $208.01
4151F..............  Pt not recvng antiv hep c.  ..................  M.................  ...........  ...........  ...........  ...........  ...........
41520..............  Reconstruction, tongue      ..................  T.................         0252       7.4474      $474.35      $109.16       $94.87
                      fold.
4152F..............  Doc'd pegintf/rib thxy      ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      consd.
4153F..............  Combo pegintf/rib rx......  ..................  M.................  ...........  ...........  ...........  ...........  ...........
4154F..............  Hep A vac series            ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      recommended.
4155F..............  Hep A vac series prev       ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      recvd.
4156F..............  Hep B vac series            ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      recommended.
4157F..............  Hep B vac series prev       ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      recvd.
4158F..............  Pt edu re: alcoh drnkng     ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      done.
41599..............  Tongue and mouth surgery..  ..................  T.................         0251       2.5002      $159.25  ...........       $31.85
4159F..............  Contrcp talk b/4 antiv      ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      txmnt.
4163F..............  Pt couns. 4 txmnt opt,      NI................  M.................  ...........  ...........  ...........  ...........  ...........
                      prost.
4164F..............  Adjv hrmnl thxpy Rx'd.....  NI................  M.................  ...........  ...........  ...........  ...........  ...........
4165F..............  3D-CRT/IMRT received......  NI................  M.................  ...........  ...........  ...........  ...........  ...........
4167F..............  Hd Bed tilted, 1st day      NI................  M.................  ...........  ...........  ...........  ...........  ...........
                      vent.
4168F..............  Pt care, ICU&vent w/in      NI................  M.................  ...........  ...........  ...........  ...........  ...........
                      24hrs.
4169F..............  No pt care ICU/vent in      NI................  M.................  ...........  ...........  ...........  ...........  ...........
                      24hrs.
4171F..............  Pt. rcvng ESA thxpy.......  NI................  M.................  ...........  ...........  ...........  ...........  ...........
4172F..............  Pt. not rcvng ESA thxpy...  NI................  M.................  ...........  ...........  ...........  ...........  ...........
4174F..............  Couns., potent. Glauc       NI................  M.................  ...........  ...........  ...........  ...........  ...........
                      impct.

[[Page 67040]]

 
4175F..............  Vis of >=20/40 w/in 90      NI................  M.................  ...........  ...........  ...........  ...........  ...........
                      days.
4176F..............  Talk re UV light, pt/crgvr  NI................  M.................  ...........  ...........  ...........  ...........  ...........
4177F..............  Talk pt/crgvr re:           NI................  M.................  ...........  ...........  ...........  ...........  ...........
                      AREDS,prev.
4178F..............  AntiD glbln rcv'd w/in      NI................  M.................  ...........  ...........  ...........  ...........  ...........
                      26wks.
4179F..............  Tamoxifen/AI prescribed...  NI................  M.................  ...........  ...........  ...........  ...........  ...........
41800..............  Drainage of gum lesion....  ..................  T.................         0006       1.4066       $89.59  ...........       $17.92
41805..............  Removal foreign body, gum.  ..................  T.................         0254      23.9765    $1,527.16      $321.35      $305.43
41806..............  Removal foreign body,       ..................  T.................         0253      16.3288    $1,040.05      $282.29      $208.01
                      jawbone.
4180F..............  Adjv thxpyRx'd/rcv'd Stg3A- NI................  M.................  ...........  ...........  ...........  ...........  ...........
                      C.
4181F..............  Conformal rad'n thxpy       NI................  M.................  ...........  ...........  ...........  ...........  ...........
                      rcv'd.
41820..............  Excision, gum, each         ..................  T.................         0252       7.4474      $474.35      $109.16       $94.87
                      quadrant.
41821..............  Excision of gum flap......  ..................  T.................         0252       7.4474      $474.35      $109.16       $94.87
41822..............  Excision of gum lesion....  ..................  T.................         0253      16.3288    $1,040.05      $282.29      $208.01
41823..............  Excision of gum lesion....  ..................  T.................         0254      23.9765    $1,527.16      $321.35      $305.43
41825..............  Excision of gum lesion....  ..................  T.................         0253      16.3288    $1,040.05      $282.29      $208.01
41826..............  Excision of gum lesion....  ..................  T.................         0253      16.3288    $1,040.05      $282.29      $208.01
41827..............  Excision of gum lesion....  ..................  T.................         0254      23.9765    $1,527.16      $321.35      $305.43
41828..............  Excision of gum lesion....  ..................  T.................         0253      16.3288    $1,040.05      $282.29      $208.01
4182F..............  No conformal rad'n thxpy..  NI................  M.................  ...........  ...........  ...........  ...........  ...........
41830..............  Removal of gum tissue.....  ..................  T.................         0253      16.3288    $1,040.05      $282.29      $208.01
41850..............  Treatment of gum lesion...  ..................  T.................         0253      16.3288    $1,040.05      $282.29      $208.01
4185F..............  Continuous PPI or H2RA      NI................  M.................  ...........  ...........  ...........  ...........  ...........
                      rcv'd.
4186F..............  No Cont. PPI or H2RA rcv'd  NI................  M.................  ...........  ...........  ...........  ...........  ...........
41870..............  Gum graft.................  ..................  T.................         0254      23.9765    $1,527.16      $321.35      $305.43
41872..............  Repair gum................  ..................  T.................         0253      16.3288    $1,040.05      $282.29      $208.01
41874..............  Repair tooth socket.......  ..................  T.................         0254      23.9765    $1,527.16      $321.35      $305.43
4187F..............  Anti rheum DrugthxpyRx'd/   NI................  M.................  ...........  ...........  ...........  ...........  ...........
                      gvn.
4188F..............  Approp ACE/ARB tstng done.  NI................  M.................  ...........  ...........  ...........  ...........  ...........
41899..............  Dental surgery procedure..  ..................  T.................         0251       2.5002      $159.25  ...........       $31.85
4189F..............  Approp dogoxin tstng done.  NI................  M.................  ...........  ...........  ...........  ...........  ...........
4190F..............  Approp diuretic tstng done  NI................  M.................  ...........  ...........  ...........  ...........  ...........
4191F..............  Approp anticonvuls tstng..  NI................  M.................  ...........  ...........  ...........  ...........  ...........
42000..............  Drainage mouth roof lesion  ..................  T.................         0251       2.5002      $159.25  ...........       $31.85
4200F..............  External beam to prost      NI................  M.................  ...........  ...........  ...........  ...........  ...........
                      only.
4201F..............  Extrnl beam other than      NI................  M.................  ...........  ...........  ...........  ...........  ...........
                      prost.
42100..............  Biopsy roof of mouth......  ..................  T.................         0252       7.4474      $474.35      $109.16       $94.87
42104..............  Excision lesion, mouth      ..................  T.................         0253      16.3288    $1,040.05      $282.29      $208.01
                      roof.
42106..............  Excision lesion, mouth      ..................  T.................         0253      16.3288    $1,040.05      $282.29      $208.01
                      roof.
42107..............  Excision lesion, mouth      ..................  T.................         0254      23.9765    $1,527.16      $321.35      $305.43
                      roof.
4210F..............  ACE/ARB thxpy for >= 6      NI................  M.................  ...........  ...........  ...........  ...........  ...........
                      mons.
42120..............  Remove palate/lesion......  ..................  T.................         0256      39.8776    $2,539.96  ...........      $507.99
42140..............  Excision of uvula.........  ..................  T.................         0252       7.4474      $474.35      $109.16       $94.87
42145..............  Repair palate, pharynx/     ..................  T.................         0254      23.9765    $1,527.16      $321.35      $305.43
                      uvula.
42160..............  Treatment mouth roof        ..................  T.................         0253      16.3288    $1,040.05      $282.29      $208.01
                      lesion.
42180..............  Repair palate.............  ..................  T.................         0251       2.5002      $159.25  ...........       $31.85
42182..............  Repair palate.............  ..................  T.................         0256      39.8776    $2,539.96  ...........      $507.99
42200..............  Reconstruct cleft palate..  ..................  T.................         0256      39.8776    $2,539.96  ...........      $507.99
42205..............  Reconstruct cleft palate..  ..................  T.................         0256      39.8776    $2,539.96  ...........      $507.99
4220F..............  Digoxin thxpy for >= 6      NI................  M.................  ...........  ...........  ...........  ...........  ...........
                      mons.
42210..............  Reconstruct cleft palate..  ..................  T.................         0256      39.8776    $2,539.96  ...........      $507.99
42215..............  Reconstruct cleft palate..  ..................  T.................         0256      39.8776    $2,539.96  ...........      $507.99
4221F..............  Diuretic thxpy for >= 6     NI................  M.................  ...........  ...........  ...........  ...........  ...........
                      mons.
42220..............  Reconstruct cleft palate..  ..................  T.................         0256      39.8776    $2,539.96  ...........      $507.99
42225..............  Reconstruct cleft palate..  ..................  T.................         0256      39.8776    $2,539.96  ...........      $507.99
42226..............  Lengthening of palate.....  ..................  T.................         0256      39.8776    $2,539.96  ...........      $507.99
42227..............  Lengthening of palate.....  ..................  T.................         0256      39.8776    $2,539.96  ...........      $507.99
42235..............  Repair palate.............  ..................  T.................         0253      16.3288    $1,040.05      $282.29      $208.01
42260..............  Repair nose to lip fistula  ..................  T.................         0254      23.9765    $1,527.16      $321.35      $305.43
42280..............  Preparation, palate mold..  ..................  T.................         0251       2.5002      $159.25  ...........       $31.85
42281..............  Insertion, palate           ..................  T.................         0253      16.3288    $1,040.05      $282.29      $208.01
                      prosthesis.
42299..............  Palate/uvula surgery......  ..................  T.................         0251       2.5002      $159.25  ...........       $31.85
42300..............  Drainage of salivary gland  ..................  T.................         0253      16.3288    $1,040.05      $282.29      $208.01
42305..............  Drainage of salivary gland  ..................  T.................         0253      16.3288    $1,040.05      $282.29      $208.01
4230F..............  Anticonv thxpy for >= 6     NI................  M.................  ...........  ...........  ...........  ...........  ...........
                      mons.
42310..............  Drainage of salivary gland  ..................  T.................         0251       2.5002      $159.25  ...........       $31.85
42320..............  Drainage of salivary gland  ..................  T.................         0251       2.5002      $159.25  ...........       $31.85
42330..............  Removal of salivary stone.  ..................  T.................         0253      16.3288    $1,040.05      $282.29      $208.01
42335..............  Removal of salivary stone.  ..................  T.................         0253      16.3288    $1,040.05      $282.29      $208.01
42340..............  Removal of salivary stone.  ..................  T.................         0253      16.3288    $1,040.05      $282.29      $208.01
42400..............  Biopsy of salivary gland..  ..................  T.................         0005       7.1147      $453.16  ...........       $90.63
42405..............  Biopsy of salivary gland..  ..................  T.................         0253      16.3288    $1,040.05      $282.29      $208.01
42408..............  Excision of salivary cyst.  ..................  T.................         0253      16.3288    $1,040.05      $282.29      $208.01
42409..............  Drainage of salivary cyst.  ..................  T.................         0253      16.3288    $1,040.05      $282.29      $208.01
42410..............  Excise parotid gland/       ..................  T.................         0256      39.8776    $2,539.96  ...........      $507.99
                      lesion.
42415..............  Excise parotid gland/       ..................  T.................         0256      39.8776    $2,539.96  ...........      $507.99
                      lesion.
42420..............  Excise parotid gland/       ..................  T.................         0256      39.8776    $2,539.96  ...........      $507.99
                      lesion.
42425..............  Excise parotid gland/       ..................  T.................         0256      39.8776    $2,539.96  ...........      $507.99
                      lesion.
42426..............  Excise parotid gland/       ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      lesion.
42440..............  Excise submaxillary gland.  ..................  T.................         0256      39.8776    $2,539.96  ...........      $507.99
42450..............  Excise sublingual gland...  ..................  T.................         0254      23.9765    $1,527.16      $321.35      $305.43

[[Page 67041]]

 
42500..............  Repair salivary duct......  ..................  T.................         0254      23.9765    $1,527.16      $321.35      $305.43
42505..............  Repair salivary duct......  ..................  T.................         0256      39.8776    $2,539.96  ...........      $507.99
42507..............  Parotid duct diversion....  ..................  T.................         0256      39.8776    $2,539.96  ...........      $507.99
42508..............  Parotid duct diversion....  ..................  T.................         0256      39.8776    $2,539.96  ...........      $507.99
42509..............  Parotid duct diversion....  ..................  T.................         0256      39.8776    $2,539.96  ...........      $507.99
42510..............  Parotid duct diversion....  ..................  T.................         0256      39.8776    $2,539.96  ...........      $507.99
42550..............  Injection for salivary x-   ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      ray.
42600..............  Closure of salivary         ..................  T.................         0253      16.3288    $1,040.05      $282.29      $208.01
                      fistula.
42650..............  Dilation of salivary duct.  ..................  T.................         0252       7.4474      $474.35      $109.16       $94.87
42660..............  Dilation of salivary duct.  ..................  T.................         0251       2.5002      $159.25  ...........       $31.85
42665..............  Ligation of salivary duct.  ..................  T.................         0254      23.9765    $1,527.16      $321.35      $305.43
42699..............  Salivary surgery procedure  ..................  T.................         0251       2.5002      $159.25  ...........       $31.85
42700..............  Drainage of tonsil abscess  ..................  T.................         0251       2.5002      $159.25  ...........       $31.85
42720..............  Drainage of throat abscess  ..................  T.................         0253      16.3288    $1,040.05      $282.29      $208.01
42725..............  Drainage of throat abscess  ..................  T.................         0256      39.8776    $2,539.96  ...........      $507.99
42800..............  Biopsy of throat..........  ..................  T.................         0252       7.4474      $474.35      $109.16       $94.87
42802..............  Biopsy of throat..........  ..................  T.................         0253      16.3288    $1,040.05      $282.29      $208.01
42804..............  Biopsy of upper nose/       ..................  T.................         0253      16.3288    $1,040.05      $282.29      $208.01
                      throat.
42806..............  Biopsy of upper nose/       ..................  T.................         0254      23.9765    $1,527.16      $321.35      $305.43
                      throat.
42808..............  Excise pharynx lesion.....  ..................  T.................         0253      16.3288    $1,040.05      $282.29      $208.01
42809..............  Remove pharynx foreign      ..................  X.................         0340       0.6310       $40.19  ...........        $8.04
                      body.
42810..............  Excision of neck cyst.....  ..................  T.................         0254      23.9765    $1,527.16      $321.35      $305.43
42815..............  Excision of neck cyst.....  ..................  T.................         0256      39.8776    $2,539.96  ...........      $507.99
42820..............  Remove tonsils and          ..................  T.................         0258      22.2557    $1,417.55      $437.25      $283.51
                      adenoids.
42821..............  Remove tonsils and          ..................  T.................         0258      22.2557    $1,417.55      $437.25      $283.51
                      adenoids.
42825..............  Removal of tonsils........  ..................  T.................         0258      22.2557    $1,417.55      $437.25      $283.51
42826..............  Removal of tonsils........  ..................  T.................         0258      22.2557    $1,417.55      $437.25      $283.51
42830..............  Removal of adenoids.......  ..................  T.................         0258      22.2557    $1,417.55      $437.25      $283.51
42831..............  Removal of adenoids.......  ..................  T.................         0258      22.2557    $1,417.55      $437.25      $283.51
42835..............  Removal of adenoids.......  ..................  T.................         0258      22.2557    $1,417.55      $437.25      $283.51
42836..............  Removal of adenoids.......  ..................  T.................         0258      22.2557    $1,417.55      $437.25      $283.51
42842..............  Extensive surgery of        ..................  T.................         0254      23.9765    $1,527.16      $321.35      $305.43
                      throat.
42844..............  Extensive surgery of        ..................  T.................         0256      39.8776    $2,539.96  ...........      $507.99
                      throat.
42845..............  Extensive surgery of        ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      throat.
42860..............  Excision of tonsil tags...  ..................  T.................         0258      22.2557    $1,417.55      $437.25      $283.51
42870..............  Excision of lingual tonsil  ..................  T.................         0258      22.2557    $1,417.55      $437.25      $283.51
42890..............  Partial removal of pharynx  ..................  T.................         0256      39.8776    $2,539.96  ...........      $507.99
42892..............  Revision of pharyngeal      ..................  T.................         0256      39.8776    $2,539.96  ...........      $507.99
                      walls.
42894..............  Revision of pharyngeal      ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      walls.
42900..............  Repair throat wound.......  ..................  T.................         0252       7.4474      $474.35      $109.16       $94.87
42950..............  Reconstruction of throat..  ..................  T.................         0254      23.9765    $1,527.16      $321.35      $305.43
42953..............  Repair throat, esophagus..  ..................  C.................  ...........  ...........  ...........  ...........  ...........
42955..............  Surgical opening of throat  ..................  T.................         0254      23.9765    $1,527.16      $321.35      $305.43
42960..............  Control throat bleeding...  ..................  T.................         0250       1.1251       $71.66       $25.10       $14.33
42961..............  Control throat bleeding...  ..................  C.................  ...........  ...........  ...........  ...........  ...........
42962..............  Control throat bleeding...  ..................  T.................         0256      39.8776    $2,539.96  ...........      $507.99
42970..............  Control nose/throat         ..................  T.................         0250       1.1251       $71.66       $25.10       $14.33
                      bleeding.
42971..............  Control nose/throat         ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      bleeding.
42972..............  Control nose/throat         ..................  T.................         0253      16.3288    $1,040.05      $282.29      $208.01
                      bleeding.
42999..............  Throat surgery procedure..  ..................  T.................         0251       2.5002      $159.25  ...........       $31.85
43020..............  Incision of esophagus.....  ..................  T.................         0252       7.4474      $474.35      $109.16       $94.87
43030..............  Throat muscle surgery.....  ..................  T.................         0253      16.3288    $1,040.05      $282.29      $208.01
43045..............  Incision of esophagus.....  ..................  C.................  ...........  ...........  ...........  ...........  ...........
43100..............  Excision of esophagus       ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      lesion.
43101..............  Excision of esophagus       ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      lesion.
43107..............  Removal of esophagus......  ..................  C.................  ...........  ...........  ...........  ...........  ...........
43108..............  Removal of esophagus......  ..................  C.................  ...........  ...........  ...........  ...........  ...........
43112..............  Removal of esophagus......  ..................  C.................  ...........  ...........  ...........  ...........  ...........
43113..............  Removal of esophagus......  ..................  C.................  ...........  ...........  ...........  ...........  ...........
43116..............  Partial removal of          ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      esophagus.
43117..............  Partial removal of          ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      esophagus.
43118..............  Partial removal of          ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      esophagus.
43121..............  Partial removal of          ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      esophagus.
43122..............  Partial removal of          ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      esophagus.
43123..............  Partial removal of          ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      esophagus.
43124..............  Removal of esophagus......  ..................  C.................  ...........  ...........  ...........  ...........  ...........
43130..............  Removal of esophagus pouch  ..................  T.................         0256      39.8776    $2,539.96  ...........      $507.99
43135..............  Removal of esophagus pouch  ..................  C.................  ...........  ...........  ...........  ...........  ...........
43200..............  Esophagus endoscopy.......  ..................  T.................         0141       8.5030      $541.59      $143.38      $108.32
43201..............  Esoph scope w/submucous     ..................  T.................         0141       8.5030      $541.59      $143.38      $108.32
                      inj.
43202..............  Esophagus endoscopy,        ..................  T.................         0141       8.5030      $541.59      $143.38      $108.32
                      biopsy.
43204..............  Esoph scope w/sclerosis     ..................  T.................         0141       8.5030      $541.59      $143.38      $108.32
                      inj.
43205..............  Esophagus endoscopy/        ..................  T.................         0141       8.5030      $541.59      $143.38      $108.32
                      ligation.
43215..............  Esophagus endoscopy.......  ..................  T.................         0141       8.5030      $541.59      $143.38      $108.32
43216..............  Esophagus endoscopy/lesion  ..................  T.................         0141       8.5030      $541.59      $143.38      $108.32
43217..............  Esophagus endoscopy.......  ..................  T.................         0141       8.5030      $541.59      $143.38      $108.32
43219..............  Esophagus endoscopy.......  ..................  T.................         0384      24.9814    $1,591.17  ...........      $318.23
43220..............  Esoph endoscopy, dilation.  ..................  T.................         0141       8.5030      $541.59      $143.38      $108.32
43226..............  Esoph endoscopy, dilation.  ..................  T.................         0141       8.5030      $541.59      $143.38      $108.32
43227..............  Esoph endoscopy, repair...  ..................  T.................         0141       8.5030      $541.59      $143.38      $108.32

[[Page 67042]]

 
43228..............  Esoph endoscopy, ablation.  ..................  T.................         0422      25.3233    $1,612.94      $448.81      $322.59
43231..............  Esoph endoscopy w/us exam.  ..................  T.................         0141       8.5030      $541.59      $143.38      $108.32
43232..............  Esoph endoscopy w/us fn bx  ..................  T.................         0141       8.5030      $541.59      $143.38      $108.32
43234..............  Upper GI endoscopy, exam..  ..................  T.................         0141       8.5030      $541.59      $143.38      $108.32
43235..............  Uppr gi endoscopy,          ..................  T.................         0141       8.5030      $541.59      $143.38      $108.32
                      diagnosis.
43236..............  Uppr gi scope w/submuc inj  ..................  T.................         0141       8.5030      $541.59      $143.38      $108.32
43237..............  Endoscopic us exam, esoph.  ..................  T.................         0141       8.5030      $541.59      $143.38      $108.32
43238..............  Uppr gi endoscopy w/us fn   ..................  T.................         0141       8.5030      $541.59      $143.38      $108.32
                      bx.
43239..............  Upper GI endoscopy, biopsy  ..................  T.................         0141       8.5030      $541.59      $143.38      $108.32
43240..............  Esoph endoscope w/drain     ..................  T.................         0141       8.5030      $541.59      $143.38      $108.32
                      cyst.
43241..............  Upper GI endoscopy with     ..................  T.................         0141       8.5030      $541.59      $143.38      $108.32
                      tube.
43242..............  Uppr gi endoscopy w/us fn   ..................  T.................         0141       8.5030      $541.59      $143.38      $108.32
                      bx.
43243..............  Upper gi endoscopy &        ..................  T.................         0141       8.5030      $541.59      $143.38      $108.32
                      inject.
43244..............  Upper GI endoscopy/         ..................  T.................         0141       8.5030      $541.59      $143.38      $108.32
                      ligation.
43245..............  Uppr gi scope dilate        ..................  T.................         0141       8.5030      $541.59      $143.38      $108.32
                      strictr.
43246..............  Place gastrostomy tube....  ..................  T.................         0141       8.5030      $541.59      $143.38      $108.32
43247..............  Operative upper GI          ..................  T.................         0141       8.5030      $541.59      $143.38      $108.32
                      endoscopy.
43248..............  Uppr gi endoscopy/guide     ..................  T.................         0141       8.5030      $541.59      $143.38      $108.32
                      wire.
43249..............  Esoph endoscopy, dilation.  ..................  T.................         0141       8.5030      $541.59      $143.38      $108.32
43250..............  Upper GI endoscopy/tumor..  ..................  T.................         0141       8.5030      $541.59      $143.38      $108.32
43251..............  Operative upper GI          ..................  T.................         0141       8.5030      $541.59      $143.38      $108.32
                      endoscopy.
43255..............  Operative upper GI          ..................  T.................         0141       8.5030      $541.59      $143.38      $108.32
                      endoscopy.
43256..............  Uppr gi endoscopy w/stent.  ..................  T.................         0384      24.9814    $1,591.17  ...........      $318.23
43257..............  Uppr gi scope w/thrml       ..................  T.................         0422      25.3233    $1,612.94      $448.81      $322.59
                      txmnt.
43258..............  Operative upper GI          ..................  T.................         0141       8.5030      $541.59      $143.38      $108.32
                      endoscopy.
43259..............  Endoscopic ultrasound exam  ..................  T.................         0141       8.5030      $541.59      $143.38      $108.32
43260..............  Endo                        ..................  T.................         0151      20.9510    $1,334.45  ...........      $266.89
                      cholangiopancreatograph.
43261..............  Endo                        ..................  T.................         0151      20.9510    $1,334.45  ...........      $266.89
                      cholangiopancreatograph.
43262..............  Endo                        ..................  T.................         0151      20.9510    $1,334.45  ...........      $266.89
                      cholangiopancreatograph.
43263..............  Endo                        ..................  T.................         0151      20.9510    $1,334.45  ...........      $266.89
                      cholangiopancreatograph.
43264..............  Endo                        ..................  T.................         0151      20.9510    $1,334.45  ...........      $266.89
                      cholangiopancreatograph.
43265..............  Endo                        ..................  T.................         0151      20.9510    $1,334.45  ...........      $266.89
                      cholangiopancreatograph.
43267..............  Endo                        ..................  T.................         0151      20.9510    $1,334.45  ...........      $266.89
                      cholangiopancreatograph.
43268..............  Endo                        ..................  T.................         0384      24.9814    $1,591.17  ...........      $318.23
                      cholangiopancreatograph.
43269..............  Endo                        ..................  T.................         0384      24.9814    $1,591.17  ...........      $318.23
                      cholangiopancreatograph.
43271..............  Endo                        ..................  T.................         0151      20.9510    $1,334.45  ...........      $266.89
                      cholangiopancreatograph.
43272..............  Endo                        ..................  T.................         0151      20.9510    $1,334.45  ...........      $266.89
                      cholangiopancreatograph.
43280..............  Laparoscopy, fundoplasty..  ..................  T.................         0132      69.6652    $4,437.26    $1,239.22      $887.45
43289..............  Laparoscope proc, esoph...  ..................  T.................         0130      34.3958    $2,190.81      $659.53      $438.16
43300..............  Repair of esophagus.......  ..................  C.................  ...........  ...........  ...........  ...........  ...........
43305..............  Repair esophagus and        ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      fistula.
43310..............  Repair of esophagus.......  ..................  C.................  ...........  ...........  ...........  ...........  ...........
43312..............  Repair esophagus and        ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      fistula.
43313..............  Esophagoplasty congenital.  ..................  C.................  ...........  ...........  ...........  ...........  ...........
43314..............  Tracheo-esophagoplasty      ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      cong.
43320..............  Fuse esophagus & stomach..  ..................  C.................  ...........  ...........  ...........  ...........  ...........
43324..............  Revise esophagus & stomach  ..................  C.................  ...........  ...........  ...........  ...........  ...........
43325..............  Revise esophagus & stomach  ..................  C.................  ...........  ...........  ...........  ...........  ...........
43326..............  Revise esophagus & stomach  ..................  C.................  ...........  ...........  ...........  ...........  ...........
43330..............  Repair of esophagus.......  ..................  C.................  ...........  ...........  ...........  ...........  ...........
43331..............  Repair of esophagus.......  ..................  C.................  ...........  ...........  ...........  ...........  ...........
43340..............  Fuse esophagus & intestine  ..................  C.................  ...........  ...........  ...........  ...........  ...........
43341..............  Fuse esophagus & intestine  ..................  C.................  ...........  ...........  ...........  ...........  ...........
43350..............  Surgical opening,           ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      esophagus.
43351..............  Surgical opening,           ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      esophagus.
43352..............  Surgical opening,           ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      esophagus.
43360..............  Gastrointestinal repair...  ..................  C.................  ...........  ...........  ...........  ...........  ...........
43361..............  Gastrointestinal repair...  ..................  C.................  ...........  ...........  ...........  ...........  ...........
43400..............  Ligate esophagus veins....  ..................  C.................  ...........  ...........  ...........  ...........  ...........
43401..............  Esophagus surgery for       ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      veins.
43405..............  Ligate/staple esophagus...  ..................  C.................  ...........  ...........  ...........  ...........  ...........
43410..............  Repair esophagus wound....  ..................  C.................  ...........  ...........  ...........  ...........  ...........
43415..............  Repair esophagus wound....  ..................  C.................  ...........  ...........  ...........  ...........  ...........
43420..............  Repair esophagus opening..  ..................  C.................  ...........  ...........  ...........  ...........  ...........
43425..............  Repair esophagus opening..  ..................  C.................  ...........  ...........  ...........  ...........  ...........
43450..............  Dilate esophagus..........  ..................  T.................         0140       5.8431      $372.17       $91.40       $74.43
43453..............  Dilate esophagus..........  ..................  T.................         0140       5.8431      $372.17       $91.40       $74.43
43456..............  Dilate esophagus..........  ..................  T.................         0140       5.8431      $372.17       $91.40       $74.43
43458..............  Dilate esophagus..........  CH................  T.................         0141       8.5030      $541.59      $143.38      $108.32
43460..............  Pressure treatment          ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      esophagus.
43496..............  Free jejunum flap,          ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      microvasc.
43499..............  Esophagus surgery           ..................  T.................         0141       8.5030      $541.59      $143.38      $108.32
                      procedure.
43500..............  Surgical opening of         ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      stomach.
43501..............  Surgical repair of stomach  ..................  C.................  ...........  ...........  ...........  ...........  ...........
43502..............  Surgical repair of stomach  ..................  C.................  ...........  ...........  ...........  ...........  ...........
43510..............  Surgical opening of         ..................  T.................         0141       8.5030      $541.59      $143.38      $108.32
                      stomach.
43520..............  Incision of pyloric muscle  ..................  C.................  ...........  ...........  ...........  ...........  ...........
43600..............  Biopsy of stomach.........  ..................  T.................         0141       8.5030      $541.59      $143.38      $108.32
43605..............  Biopsy of stomach.........  ..................  C.................  ...........  ...........  ...........  ...........  ...........
43610..............  Excision of stomach lesion  ..................  C.................  ...........  ...........  ...........  ...........  ...........

[[Page 67043]]

 
43611..............  Excision of stomach lesion  ..................  C.................  ...........  ...........  ...........  ...........  ...........
43620..............  Removal of stomach........  ..................  C.................  ...........  ...........  ...........  ...........  ...........
43621..............  Removal of stomach........  ..................  C.................  ...........  ...........  ...........  ...........  ...........
43622..............  Removal of stomach........  ..................  C.................  ...........  ...........  ...........  ...........  ...........
43631..............  Removal of stomach,         ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      partial.
43632..............  Removal of stomach,         ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      partial.
43633..............  Removal of stomach,         ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      partial.
43634..............  Removal of stomach,         ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      partial.
43635..............  Removal of stomach,         ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      partial.
43640..............  Vagotomy & pylorus repair.  ..................  C.................  ...........  ...........  ...........  ...........  ...........
43641..............  Vagotomy & pylorus repair.  ..................  C.................  ...........  ...........  ...........  ...........  ...........
43644..............  Lap gastric bypass/roux-en- ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      y.
43645..............  Lap gastr bypass incl smll  ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      i.
43647..............  Lap impl electrode, antrum  CH................  S.................         0061      82.8597    $5,277.67  ...........    $1,055.53
43648..............  Lap revise/remv eltrd       ..................  T.................         0130      34.3958    $2,190.81      $659.53      $438.16
                      antrum.
43651..............  Laparoscopy, vagus nerve..  ..................  T.................         0132      69.6652    $4,437.26    $1,239.22      $887.45
43652..............  Laparoscopy, vagus nerve..  ..................  T.................         0132      69.6652    $4,437.26    $1,239.22      $887.45
43653..............  Laparoscopy, gastrostomy..  ..................  T.................         0131      45.5317    $2,900.10    $1,001.89      $580.02
43659..............  Laparoscope proc, stom....  ..................  T.................         0130      34.3958    $2,190.81      $659.53      $438.16
43750..............  Place gastrostomy tube....  CH................  D.................  ...........  ...........  ...........  ...........  ...........
43752..............  Nasal/orogastric w/stent..  ..................  X.................         0272       1.3271       $84.53       $31.64       $16.91
43760..............  Change gastrostomy tube...  ..................  T.................         0121       3.2383      $206.26       $43.80       $41.25
43761..............  Reposition gastrostomy      CH................  T.................         0141       8.5030      $541.59      $143.38      $108.32
                      tube.
43770..............  Lap place gastr adj device  ..................  C.................  ...........  ...........  ...........  ...........  ...........
43771..............  Lap revise gastr adj        ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      device.
43772..............  Lap rmvl gastr adj device.  ..................  C.................  ...........  ...........  ...........  ...........  ...........
43773..............  Lap replace gastr adj       ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      device.
43774..............  Lap rmvl gastr adj all      ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      parts.
43800..............  Reconstruction of pylorus.  ..................  C.................  ...........  ...........  ...........  ...........  ...........
43810..............  Fusion of stomach and       ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      bowel.
43820..............  Fusion of stomach and       ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      bowel.
43825..............  Fusion of stomach and       ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      bowel.
43830..............  Place gastrostomy tube....  ..................  T.................         0422      25.3233    $1,612.94      $448.81      $322.59
43831..............  Place gastrostomy tube....  ..................  T.................         0141       8.5030      $541.59      $143.38      $108.32
43832..............  Place gastrostomy tube....  ..................  C.................  ...........  ...........  ...........  ...........  ...........
43840..............  Repair of stomach lesion..  ..................  C.................  ...........  ...........  ...........  ...........  ...........
43842..............  V-band gastroplasty.......  ..................  E.................  ...........  ...........  ...........  ...........  ...........
43843..............  Gastroplasty w/o v-band...  ..................  C.................  ...........  ...........  ...........  ...........  ...........
43845..............  Gastroplasty duodenal       ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      switch.
43846..............  Gastric bypass for obesity  ..................  C.................  ...........  ...........  ...........  ...........  ...........
43847..............  Gastric bypass incl small   ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      i.
43848..............  Revision gastroplasty.....  ..................  C.................  ...........  ...........  ...........  ...........  ...........
43850..............  Revise stomach-bowel        ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      fusion.
43855..............  Revise stomach-bowel        ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      fusion.
43860..............  Revise stomach-bowel        ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      fusion.
43865..............  Revise stomach-bowel        ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      fusion.
43870..............  Repair stomach opening....  ..................  T.................         0141       8.5030      $541.59      $143.38      $108.32
43880..............  Repair stomach-bowel        ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      fistula.
43881..............  Impl/redo electrd, antrum.  ..................  C.................  ...........  ...........  ...........  ...........  ...........
43882..............  Revise/remove electrd       ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      antrum.
43886..............  Revise gastric port, open.  CH................  T.................         0137      20.2069    $1,287.06  ...........      $257.41
43887..............  Remove gastric port, open.  CH................  T.................         0135       4.5263      $288.30  ...........       $57.66
43888..............  Change gastric port, open.  CH................  T.................         0137      20.2069    $1,287.06  ...........      $257.41
43999..............  Stomach surgery procedure.  ..................  T.................         0141       8.5030      $541.59      $143.38      $108.32
44005..............  Freeing of bowel adhesion.  ..................  C.................  ...........  ...........  ...........  ...........  ...........
44010..............  Incision of small bowel...  ..................  C.................  ...........  ...........  ...........  ...........  ...........
44015..............  Insert needle cath bowel..  ..................  C.................  ...........  ...........  ...........  ...........  ...........
44020..............  Explore small intestine...  ..................  C.................  ...........  ...........  ...........  ...........  ...........
44021..............  Decompress small bowel....  ..................  C.................  ...........  ...........  ...........  ...........  ...........
44025..............  Incision of large bowel...  ..................  C.................  ...........  ...........  ...........  ...........  ...........
44050..............  Reduce bowel obstruction..  ..................  C.................  ...........  ...........  ...........  ...........  ...........
44055..............  Correct malrotation of      ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      bowel.
44100..............  Biopsy of bowel...........  ..................  T.................         0141       8.5030      $541.59      $143.38      $108.32
44110..............  Excise intestine lesion(s)  ..................  C.................  ...........  ...........  ...........  ...........  ...........
44111..............  Excision of bowel           ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      lesion(s).
44120..............  Removal of small intestine  ..................  C.................  ...........  ...........  ...........  ...........  ...........
44121..............  Removal of small intestine  ..................  C.................  ...........  ...........  ...........  ...........  ...........
44125..............  Removal of small intestine  ..................  C.................  ...........  ...........  ...........  ...........  ...........
44126..............  Enterectomy w/o taper,      ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      cong.
44127..............  Enterectomy w/taper, cong.  ..................  C.................  ...........  ...........  ...........  ...........  ...........
44128..............  Enterectomy cong, add-on..  ..................  C.................  ...........  ...........  ...........  ...........  ...........
44130..............  Bowel to bowel fusion.....  ..................  C.................  ...........  ...........  ...........  ...........  ...........
44132..............  Enterectomy, cadaver donor  ..................  C.................  ...........  ...........  ...........  ...........  ...........
44133..............  Enterectomy, live donor...  ..................  C.................  ...........  ...........  ...........  ...........  ...........
44135..............  Intestine transplnt,        ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      cadaver.
44136..............  Intestine transplant, live  ..................  C.................  ...........  ...........  ...........  ...........  ...........
44137..............  Remove intestinal           ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      allograft.
44139..............  Mobilization of colon.....  ..................  C.................  ...........  ...........  ...........  ...........  ...........
44140..............  Partial removal of colon..  ..................  C.................  ...........  ...........  ...........  ...........  ...........
44141..............  Partial removal of colon..  ..................  C.................  ...........  ...........  ...........  ...........  ...........

[[Page 67044]]

 
44143..............  Partial removal of colon..  ..................  C.................  ...........  ...........  ...........  ...........  ...........
44144..............  Partial removal of colon..  ..................  C.................  ...........  ...........  ...........  ...........  ...........
44145..............  Partial removal of colon..  ..................  C.................  ...........  ...........  ...........  ...........  ...........
44146..............  Partial removal of colon..  ..................  C.................  ...........  ...........  ...........  ...........  ...........
44147..............  Partial removal of colon..  ..................  C.................  ...........  ...........  ...........  ...........  ...........
44150..............  Removal of colon..........  ..................  C.................  ...........  ...........  ...........  ...........  ...........
44151..............  Removal of colon/ileostomy  ..................  C.................  ...........  ...........  ...........  ...........  ...........
44155..............  Removal of colon/ileostomy  ..................  C.................  ...........  ...........  ...........  ...........  ...........
44156..............  Removal of colon/ileostomy  ..................  C.................  ...........  ...........  ...........  ...........  ...........
44157..............  Colectomy w/ileoanal anast  ..................  C.................  ...........  ...........  ...........  ...........  ...........
44158..............  Colectomy w/neo-rectum      ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      pouch.
44160..............  Removal of colon..........  ..................  C.................  ...........  ...........  ...........  ...........  ...........
44180..............  Lap, enterolysis..........  ..................  T.................         0131      45.5317    $2,900.10    $1,001.89      $580.02
44186..............  Lap, jejunostomy..........  ..................  T.................         0131      45.5317    $2,900.10    $1,001.89      $580.02
44187..............  Lap, ileo/jejuno-stomy....  ..................  C.................  ...........  ...........  ...........  ...........  ...........
44188..............  Lap, colostomy............  ..................  C.................  ...........  ...........  ...........  ...........  ...........
44202..............  Lap, enterectomy..........  ..................  C.................  ...........  ...........  ...........  ...........  ...........
44203..............  Lap resect s/intestine,     ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      addl.
44204..............  Laparo partial colectomy..  ..................  C.................  ...........  ...........  ...........  ...........  ...........
44205..............  Lap colectomy part w/ileum  ..................  C.................  ...........  ...........  ...........  ...........  ...........
44206..............  Lap part colectomy w/stoma  ..................  T.................         0132      69.6652    $4,437.26    $1,239.22      $887.45
44207..............  L colectomy/                ..................  T.................         0132      69.6652    $4,437.26    $1,239.22      $887.45
                      coloproctostomy.
44208..............  L colectomy/                ..................  T.................         0132      69.6652    $4,437.26    $1,239.22      $887.45
                      coloproctostomy.
44210..............  Laparo total                ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      proctocolectomy.
44211..............  Lap colectomy w/            ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      proctectomy.
44212..............  Laparo total                ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      proctocolectomy.
44213..............  Lap, mobil splenic fl add-  ..................  T.................         0130      34.3958    $2,190.81      $659.53      $438.16
                      on.
44227..............  Lap, close enterostomy....  ..................  C.................  ...........  ...........  ...........  ...........  ...........
44238..............  Laparoscope proc,           ..................  T.................         0130      34.3958    $2,190.81      $659.53      $438.16
                      intestine.
44300..............  Open bowel to skin........  ..................  C.................  ...........  ...........  ...........  ...........  ...........
44310..............  Ileostomy/jejunostomy.....  ..................  C.................  ...........  ...........  ...........  ...........  ...........
44312..............  Revision of ileostomy.....  CH................  T.................         0137      20.2069    $1,287.06  ...........      $257.41
44314..............  Revision of ileostomy.....  ..................  C.................  ...........  ...........  ...........  ...........  ...........
44316..............  Devise bowel pouch........  ..................  C.................  ...........  ...........  ...........  ...........  ...........
44320..............  Colostomy.................  ..................  C.................  ...........  ...........  ...........  ...........  ...........
44322..............  Colostomy with biopsies...  ..................  C.................  ...........  ...........  ...........  ...........  ...........
44340..............  Revision of colostomy.....  CH................  T.................         0137      20.2069    $1,287.06  ...........      $257.41
44345..............  Revision of colostomy.....  ..................  C.................  ...........  ...........  ...........  ...........  ...........
44346..............  Revision of colostomy.....  ..................  C.................  ...........  ...........  ...........  ...........  ...........
44360..............  Small bowel endoscopy.....  ..................  T.................         0142       9.5292      $606.95      $152.78      $121.39
44361..............  Small bowel endoscopy/      ..................  T.................         0142       9.5292      $606.95      $152.78      $121.39
                      biopsy.
44363..............  Small bowel endoscopy.....  ..................  T.................         0142       9.5292      $606.95      $152.78      $121.39
44364..............  Small bowel endoscopy.....  ..................  T.................         0142       9.5292      $606.95      $152.78      $121.39
44365..............  Small bowel endoscopy.....  ..................  T.................         0142       9.5292      $606.95      $152.78      $121.39
44366..............  Small bowel endoscopy.....  ..................  T.................         0142       9.5292      $606.95      $152.78      $121.39
44369..............  Small bowel endoscopy.....  ..................  T.................         0142       9.5292      $606.95      $152.78      $121.39
44370..............  Small bowel endoscopy/      ..................  T.................         0384      24.9814    $1,591.17  ...........      $318.23
                      stent.
44372..............  Small bowel endoscopy.....  ..................  T.................         0142       9.5292      $606.95      $152.78      $121.39
44373..............  Small bowel endoscopy.....  ..................  T.................         0142       9.5292      $606.95      $152.78      $121.39
44376..............  Small bowel endoscopy.....  ..................  T.................         0142       9.5292      $606.95      $152.78      $121.39
44377..............  Small bowel endoscopy/      ..................  T.................         0142       9.5292      $606.95      $152.78      $121.39
                      biopsy.
44378..............  Small bowel endoscopy.....  ..................  T.................         0142       9.5292      $606.95      $152.78      $121.39
44379..............  S bowel endoscope w/stent.  ..................  T.................         0384      24.9814    $1,591.17  ...........      $318.23
44380..............  Small bowel endoscopy.....  ..................  T.................         0142       9.5292      $606.95      $152.78      $121.39
44382..............  Small bowel endoscopy.....  ..................  T.................         0142       9.5292      $606.95      $152.78      $121.39
44383..............  Ileoscopy w/stent.........  ..................  T.................         0384      24.9814    $1,591.17  ...........      $318.23
44385..............  Endoscopy of bowel pouch..  ..................  T.................         0143       8.8486      $563.60      $186.06      $112.72
44386..............  Endoscopy, bowel pouch/     ..................  T.................         0143       8.8486      $563.60      $186.06      $112.72
                      biop.
44388..............  Colonoscopy...............  ..................  T.................         0143       8.8486      $563.60      $186.06      $112.72
44389..............  Colonoscopy with biopsy...  ..................  T.................         0143       8.8486      $563.60      $186.06      $112.72
44390..............  Colonoscopy for foreign     ..................  T.................         0143       8.8486      $563.60      $186.06      $112.72
                      body.
44391..............  Colonoscopy for bleeding..  ..................  T.................         0143       8.8486      $563.60      $186.06      $112.72
44392..............  Colonoscopy & polypectomy.  ..................  T.................         0143       8.8486      $563.60      $186.06      $112.72
44393..............  Colonoscopy, lesion         ..................  T.................         0143       8.8486      $563.60      $186.06      $112.72
                      removal.
44394..............  Colonoscopy w/snare.......  ..................  T.................         0143       8.8486      $563.60      $186.06      $112.72
44397..............  Colonoscopy w/stent.......  ..................  T.................         0384      24.9814    $1,591.17  ...........      $318.23
44500..............  Intro, gastrointestinal     ..................  T.................         0121       3.2383      $206.26       $43.80       $41.25
                      tube.
44602..............  Suture, small intestine...  ..................  C.................  ...........  ...........  ...........  ...........  ...........
44603..............  Suture, small intestine...  ..................  C.................  ...........  ...........  ...........  ...........  ...........
44604..............  Suture, large intestine...  ..................  C.................  ...........  ...........  ...........  ...........  ...........
44605..............  Repair of bowel lesion....  ..................  C.................  ...........  ...........  ...........  ...........  ...........
44615..............  Intestinal stricturoplasty  ..................  C.................  ...........  ...........  ...........  ...........  ...........
44620..............  Repair bowel opening......  ..................  C.................  ...........  ...........  ...........  ...........  ...........
44625..............  Repair bowel opening......  ..................  C.................  ...........  ...........  ...........  ...........  ...........
44626..............  Repair bowel opening......  ..................  C.................  ...........  ...........  ...........  ...........  ...........
44640..............  Repair bowel-skin fistula.  ..................  C.................  ...........  ...........  ...........  ...........  ...........
44650..............  Repair bowel fistula......  ..................  C.................  ...........  ...........  ...........  ...........  ...........
44660..............  Repair bowel-bladder        ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      fistula.
44661..............  Repair bowel-bladder        ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      fistula.
44680..............  Surgical revision,          ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      intestine.

[[Page 67045]]

 
44700..............  Suspend bowel w/prosthesis  ..................  C.................  ...........  ...........  ...........  ...........  ...........
44701..............  Intraop colon lavage add-   ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      on.
44715..............  Prepare donor intestine...  ..................  C.................  ...........  ...........  ...........  ...........  ...........
44720..............  Prep donor intestine/       ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      venous.
44721..............  Prep donor intestine/       ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      artery.
44799..............  Unlisted procedure          ..................  T.................         0153      25.6947    $1,636.60      $397.95      $327.32
                      intestine.
44800..............  Excision of bowel pouch...  ..................  C.................  ...........  ...........  ...........  ...........  ...........
44820..............  Excision of mesentery       ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      lesion.
44850..............  Repair of mesentery.......  ..................  C.................  ...........  ...........  ...........  ...........  ...........
44899..............  Bowel surgery procedure...  ..................  C.................  ...........  ...........  ...........  ...........  ...........
44900..............  Drain app abscess, open...  ..................  C.................  ...........  ...........  ...........  ...........  ...........
44901..............  Drain app abscess, percut.  ..................  T.................         0037      13.5764      $864.74      $228.76      $172.95
44950..............  Appendectomy..............  ..................  C.................  ...........  ...........  ...........  ...........  ...........
44955..............  Appendectomy add-on.......  ..................  C.................  ...........  ...........  ...........  ...........  ...........
44960..............  Appendectomy..............  ..................  C.................  ...........  ...........  ...........  ...........  ...........
44970..............  Laparoscopy, appendectomy.  ..................  T.................         0131      45.5317    $2,900.10    $1,001.89      $580.02
44979..............  Laparoscope proc, app.....  ..................  T.................         0130      34.3958    $2,190.81      $659.53      $438.16
45000..............  Drainage of pelvic abscess  CH................  T.................         0155      10.9132      $695.11  ...........      $139.02
45005..............  Drainage of rectal abscess  ..................  T.................         0155      10.9132      $695.11  ...........      $139.02
45020..............  Drainage of rectal abscess  ..................  T.................         0155      10.9132      $695.11  ...........      $139.02
45100..............  Biopsy of rectum..........  ..................  T.................         0149      22.7451    $1,448.73      $293.06      $289.75
45108..............  Removal of anorectal        ..................  T.................         0149      22.7451    $1,448.73      $293.06      $289.75
                      lesion.
45110..............  Removal of rectum.........  ..................  C.................  ...........  ...........  ...........  ...........  ...........
45111..............  Partial removal of rectum.  ..................  C.................  ...........  ...........  ...........  ...........  ...........
45112..............  Removal of rectum.........  ..................  C.................  ...........  ...........  ...........  ...........  ...........
45113..............  Partial proctectomy.......  ..................  C.................  ...........  ...........  ...........  ...........  ...........
45114..............  Partial removal of rectum.  ..................  C.................  ...........  ...........  ...........  ...........  ...........
45116..............  Partial removal of rectum.  ..................  C.................  ...........  ...........  ...........  ...........  ...........
45119..............  Remove rectum w/reservoir.  ..................  C.................  ...........  ...........  ...........  ...........  ...........
45120..............  Removal of rectum.........  ..................  C.................  ...........  ...........  ...........  ...........  ...........
45121..............  Removal of rectum and       ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      colon.
45123..............  Partial proctectomy.......  ..................  C.................  ...........  ...........  ...........  ...........  ...........
45126..............  Pelvic exenteration.......  ..................  C.................  ...........  ...........  ...........  ...........  ...........
45130..............  Excision of rectal          ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      prolapse.
45135..............  Excision of rectal          ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      prolapse.
45136..............  Excise ileoanal reservior.  ..................  C.................  ...........  ...........  ...........  ...........  ...........
45150..............  Excision of rectal          ..................  T.................         0149      22.7451    $1,448.73      $293.06      $289.75
                      stricture.
45160..............  Excision of rectal lesion.  ..................  T.................         0149      22.7451    $1,448.73      $293.06      $289.75
45170..............  Excision of rectal lesion.  ..................  T.................         0149      22.7451    $1,448.73      $293.06      $289.75
45190..............  Destruction, rectal tumor.  ..................  T.................         0149      22.7451    $1,448.73      $293.06      $289.75
45300..............  Proctosigmoidoscopy dx....  ..................  T.................         0146       5.0972      $324.66  ...........       $64.93
45303..............  Proctosigmoidoscopy dilate  ..................  T.................         0147       8.7031      $554.34  ...........      $110.87
45305..............  Proctosigmoidoscopy w/bx..  ..................  T.................         0147       8.7031      $554.34  ...........      $110.87
45307..............  Proctosigmoidoscopy fb....  ..................  T.................         0428      21.4632    $1,367.08  ...........      $273.42
45308..............  Proctosigmoidoscopy         ..................  T.................         0147       8.7031      $554.34  ...........      $110.87
                      removal.
45309..............  Proctosigmoidoscopy         ..................  T.................         0147       8.7031      $554.34  ...........      $110.87
                      removal.
45315..............  Proctosigmoidoscopy         ..................  T.................         0147       8.7031      $554.34  ...........      $110.87
                      removal.
45317..............  Proctosigmoidoscopy bleed.  ..................  T.................         0147       8.7031      $554.34  ...........      $110.87
45320..............  Proctosigmoidoscopy ablate  ..................  T.................         0428      21.4632    $1,367.08  ...........      $273.42
45321..............  Proctosigmoidoscopy volvul  ..................  T.................         0428      21.4632    $1,367.08  ...........      $273.42
45327..............  Proctosigmoidoscopy w/      ..................  T.................         0384      24.9814    $1,591.17  ...........      $318.23
                      stent.
45330..............  Diagnostic sigmoidoscopy..  ..................  T.................         0146       5.0972      $324.66  ...........       $64.93
45331..............  Sigmoidoscopy and biopsy..  ..................  T.................         0146       5.0972      $324.66  ...........       $64.93
45332..............  Sigmoidoscopy w/fb removal  ..................  T.................         0146       5.0972      $324.66  ...........       $64.93
45333..............  Sigmoidoscopy &             ..................  T.................         0147       8.7031      $554.34  ...........      $110.87
                      polypectomy.
45334..............  Sigmoidoscopy for bleeding  ..................  T.................         0147       8.7031      $554.34  ...........      $110.87
45335..............  Sigmoidoscopy w/submuc inj  ..................  T.................         0146       5.0972      $324.66  ...........       $64.93
45337..............  Sigmoidoscopy & decompress  ..................  T.................         0146       5.0972      $324.66  ...........       $64.93
45338..............  Sigmoidoscopy w/tumr        ..................  T.................         0147       8.7031      $554.34  ...........      $110.87
                      remove.
45339..............  Sigmoidoscopy w/ablate      ..................  T.................         0147       8.7031      $554.34  ...........      $110.87
                      tumr.
45340..............  Sig w/balloon dilation....  ..................  T.................         0147       8.7031      $554.34  ...........      $110.87
45341..............  Sigmoidoscopy w/ultrasound  ..................  T.................         0147       8.7031      $554.34  ...........      $110.87
45342..............  Sigmoidoscopy w/us guide    ..................  T.................         0147       8.7031      $554.34  ...........      $110.87
                      bx.
45345..............  Sigmoidoscopy w/stent.....  ..................  T.................         0384      24.9814    $1,591.17  ...........      $318.23
45355..............  Surgical colonoscopy......  ..................  T.................         0143       8.8486      $563.60      $186.06      $112.72
45378..............  Diagnostic colonoscopy....  ..................  T.................         0143       8.8486      $563.60      $186.06      $112.72
45379..............  Colonoscopy w/fb removal..  ..................  T.................         0143       8.8486      $563.60      $186.06      $112.72
45380..............  Colonoscopy and biopsy....  ..................  T.................         0143       8.8486      $563.60      $186.06      $112.72
45381..............  Colonoscopy, submucous inj  ..................  T.................         0143       8.8486      $563.60      $186.06      $112.72
45382..............  Colonoscopy/control         ..................  T.................         0143       8.8486      $563.60      $186.06      $112.72
                      bleeding.
45383..............  Lesion removal colonoscopy  ..................  T.................         0143       8.8486      $563.60      $186.06      $112.72
45384..............  Lesion remove colonoscopy.  ..................  T.................         0143       8.8486      $563.60      $186.06      $112.72
45385..............  Lesion removal colonoscopy  ..................  T.................         0143       8.8486      $563.60      $186.06      $112.72
45386..............  Colonoscopy dilate          ..................  T.................         0143       8.8486      $563.60      $186.06      $112.72
                      stricture.
45387..............  Colonoscopy w/stent.......  ..................  T.................         0384      24.9814    $1,591.17  ...........      $318.23
45391..............  Colonoscopy w/endoscope us  ..................  T.................         0143       8.8486      $563.60      $186.06      $112.72
45392..............  Colonoscopy w/endoscopic    ..................  T.................         0143       8.8486      $563.60      $186.06      $112.72
                      fnb.
45395..............  Lap, removal of rectum....  ..................  C.................  ...........  ...........  ...........  ...........  ...........
45397..............  Lap, remove rectum w/pouch  ..................  C.................  ...........  ...........  ...........  ...........  ...........
45400..............  Laparoscopic proc.........  ..................  C.................  ...........  ...........  ...........  ...........  ...........

[[Page 67046]]

 
45402..............  Lap proctopexy w/sig        ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      resect.
45499..............  Laparoscope proc, rectum..  ..................  T.................         0130      34.3958    $2,190.81      $659.53      $438.16
45500..............  Repair of rectum..........  ..................  T.................         0149      22.7451    $1,448.73      $293.06      $289.75
45505..............  Repair of rectum..........  ..................  T.................         0150      30.1606    $1,921.05      $437.12      $384.21
45520..............  Treatment of rectal         CH................  T.................         0013       0.7930       $50.51  ...........       $10.10
                      prolapse.
45540..............  Correct rectal prolapse...  ..................  C.................  ...........  ...........  ...........  ...........  ...........
45541..............  Correct rectal prolapse...  ..................  T.................         0150      30.1606    $1,921.05      $437.12      $384.21
45550..............  Repair rectum/remove        ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      sigmoid.
45560..............  Repair of rectocele.......  ..................  T.................         0150      30.1606    $1,921.05      $437.12      $384.21
45562..............  Exploration/repair of       ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      rectum.
45563..............  Exploration/repair of       ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      rectum.
45800..............  Repair rect/bladder         ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      fistula.
45805..............  Repair fistula w/colostomy  ..................  C.................  ...........  ...........  ...........  ...........  ...........
45820..............  Repair rectourethral        ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      fistula.
45825..............  Repair fistula w/colostomy  ..................  C.................  ...........  ...........  ...........  ...........  ...........
45900..............  Reduction of rectal         ..................  T.................         0148       4.7935      $305.32  ...........       $61.06
                      prolapse.
45905..............  Dilation of anal sphincter  ..................  T.................         0149      22.7451    $1,448.73      $293.06      $289.75
45910..............  Dilation of rectal          ..................  T.................         0149      22.7451    $1,448.73      $293.06      $289.75
                      narrowing.
45915..............  Remove rectal obstruction.  CH................  T.................         0155      10.9132      $695.11  ...........      $139.02
45990..............  Surg dx exam, anorectal...  CH................  T.................         0149      22.7451    $1,448.73      $293.06      $289.75
45999..............  Rectum surgery procedure..  ..................  T.................         0148       4.7935      $305.32  ...........       $61.06
46020..............  Placement of seton........  ..................  T.................         0149      22.7451    $1,448.73      $293.06      $289.75
46030..............  Removal of rectal marker..  ..................  T.................         0148       4.7935      $305.32  ...........       $61.06
46040..............  Incision of rectal abscess  ..................  T.................         0149      22.7451    $1,448.73      $293.06      $289.75
46045..............  Incision of rectal abscess  ..................  T.................         0149      22.7451    $1,448.73      $293.06      $289.75
46050..............  Incision of anal abscess..  CH................  T.................         0155      10.9132      $695.11  ...........      $139.02
46060..............  Incision of rectal abscess  ..................  T.................         0149      22.7451    $1,448.73      $293.06      $289.75
46070..............  Incision of anal septum...  ..................  T.................         0155      10.9132      $695.11  ...........      $139.02
46080..............  Incision of anal sphincter  ..................  T.................         0149      22.7451    $1,448.73      $293.06      $289.75
46083..............  Incise external hemorrhoid  ..................  T.................         0164       2.0077      $127.88  ...........       $25.58
46200..............  Removal of anal fissure...  ..................  T.................         0149      22.7451    $1,448.73      $293.06      $289.75
46210..............  Removal of anal crypt.....  ..................  T.................         0149      22.7451    $1,448.73      $293.06      $289.75
46211..............  Removal of anal crypts....  ..................  T.................         0149      22.7451    $1,448.73      $293.06      $289.75
46220..............  Removal of anal tag.......  ..................  T.................         0149      22.7451    $1,448.73      $293.06      $289.75
46221..............  Ligation of hemorrhoid(s).  ..................  T.................         0148       4.7935      $305.32  ...........       $61.06
46230..............  Removal of anal tags......  ..................  T.................         0149      22.7451    $1,448.73      $293.06      $289.75
46250..............  Hemorrhoidectomy..........  ..................  T.................         0149      22.7451    $1,448.73      $293.06      $289.75
46255..............  Hemorrhoidectomy..........  ..................  T.................         0149      22.7451    $1,448.73      $293.06      $289.75
46257..............  Remove hemorrhoids &        ..................  T.................         0149      22.7451    $1,448.73      $293.06      $289.75
                      fissure.
46258..............  Remove hemorrhoids &        ..................  T.................         0149      22.7451    $1,448.73      $293.06      $289.75
                      fistula.
46260..............  Hemorrhoidectomy..........  ..................  T.................         0149      22.7451    $1,448.73      $293.06      $289.75
46261..............  Remove hemorrhoids &        ..................  T.................         0149      22.7451    $1,448.73      $293.06      $289.75
                      fissure.
46262..............  Remove hemorrhoids &        ..................  T.................         0149      22.7451    $1,448.73      $293.06      $289.75
                      fistula.
46270..............  Removal of anal fistula...  ..................  T.................         0149      22.7451    $1,448.73      $293.06      $289.75
46275..............  Removal of anal fistula...  ..................  T.................         0149      22.7451    $1,448.73      $293.06      $289.75
46280..............  Removal of anal fistula...  ..................  T.................         0149      22.7451    $1,448.73      $293.06      $289.75
46285..............  Removal of anal fistula...  ..................  T.................         0149      22.7451    $1,448.73      $293.06      $289.75
46288..............  Repair anal fistula.......  ..................  T.................         0149      22.7451    $1,448.73      $293.06      $289.75
46320..............  Removal of hemorrhoid clot  CH................  T.................         0149      22.7451    $1,448.73      $293.06      $289.75
46500..............  Injection into              ..................  T.................         0155      10.9132      $695.11  ...........      $139.02
                      hemorrhoid(s).
46505..............  Chemodenervation anal musc  ..................  T.................         0148       4.7935      $305.32  ...........       $61.06
46600..............  Diagnostic anoscopy.......  ..................  X.................         0340       0.6310       $40.19  ...........        $8.04
46604..............  Anoscopy and dilation.....  ..................  T.................         0147       8.7031      $554.34  ...........      $110.87
46606..............  Anoscopy and biopsy.......  ..................  T.................         0146       5.0972      $324.66  ...........       $64.93
46608..............  Anoscopy, remove for body.  ..................  T.................         0147       8.7031      $554.34  ...........      $110.87
46610..............  Anoscopy, remove lesion...  ..................  T.................         0428      21.4632    $1,367.08  ...........      $273.42
46611..............  Anoscopy..................  ..................  T.................         0147       8.7031      $554.34  ...........      $110.87
46612..............  Anoscopy, remove lesions..  ..................  T.................         0428      21.4632    $1,367.08  ...........      $273.42
46614..............  Anoscopy, control bleeding  ..................  T.................         0146       5.0972      $324.66  ...........       $64.93
46615..............  Anoscopy..................  ..................  T.................         0428      21.4632    $1,367.08  ...........      $273.42
46700..............  Repair of anal stricture..  ..................  T.................         0149      22.7451    $1,448.73      $293.06      $289.75
46705..............  Repair of anal stricture..  ..................  C.................  ...........  ...........  ...........  ...........  ...........
46706..............  Repr of anal fistula w/     ..................  T.................         0150      30.1606    $1,921.05      $437.12      $384.21
                      glue.
46710..............  Repr per/vag pouch sngl     ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      proc.
46712..............  Repr per/vag pouch dbl      ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      proc.
46715..............  Rep perf anoper fistu.....  ..................  C.................  ...........  ...........  ...........  ...........  ...........
46716..............  Rep perf anoper/vestib      ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      fistu.
46730..............  Construction of absent      ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      anus.
46735..............  Construction of absent      ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      anus.
46740..............  Construction of absent      ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      anus.
46742..............  Repair of imperforated      ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      anus.
46744..............  Repair of cloacal anomaly.  ..................  C.................  ...........  ...........  ...........  ...........  ...........
46746..............  Repair of cloacal anomaly.  ..................  C.................  ...........  ...........  ...........  ...........  ...........
46748..............  Repair of cloacal anomaly.  ..................  C.................  ...........  ...........  ...........  ...........  ...........
46750..............  Repair of anal sphincter..  CH................  T.................         0150      30.1606    $1,921.05      $437.12      $384.21
46751..............  Repair of anal sphincter..  ..................  C.................  ...........  ...........  ...........  ...........  ...........
46753..............  Reconstruction of anus....  ..................  T.................         0149      22.7451    $1,448.73      $293.06      $289.75
46754..............  Removal of suture from      ..................  T.................         0149      22.7451    $1,448.73      $293.06      $289.75
                      anus.
46760..............  Repair of anal sphincter..  CH................  T.................         0150      30.1606    $1,921.05      $437.12      $384.21
46761..............  Repair of anal sphincter..  CH................  T.................         0150      30.1606    $1,921.05      $437.12      $384.21

[[Page 67047]]

 
46762..............  Implant artificial          CH................  T.................         0150      30.1606    $1,921.05      $437.12      $384.21
                      sphincter.
46900..............  Destruction, anal           ..................  T.................         0016       2.6604      $169.45  ...........       $33.89
                      lesion(s).
46910..............  Destruction, anal           ..................  T.................         0017      19.9041    $1,267.77  ...........      $253.55
                      lesion(s).
46916..............  Cryosurgery, anal           CH................  T.................         0015       1.4595       $92.96  ...........       $18.59
                      lesion(s).
46917..............  Laser surgery, anal         CH................  T.................         0017      19.9041    $1,267.77  ...........      $253.55
                      lesions.
46922..............  Excision of anal lesion(s)  CH................  T.................         0017      19.9041    $1,267.77  ...........      $253.55
46924..............  Destruction, anal           CH................  T.................         0017      19.9041    $1,267.77  ...........      $253.55
                      lesion(s).
46934..............  Destruction of hemorrhoids  ..................  T.................         0155      10.9132      $695.11  ...........      $139.02
46935..............  Destruction of hemorrhoids  ..................  T.................         0155      10.9132      $695.11  ...........      $139.02
46936..............  Destruction of hemorrhoids  ..................  T.................         0149      22.7451    $1,448.73      $293.06      $289.75
46937..............  Cryotherapy of rectal       ..................  T.................         0149      22.7451    $1,448.73      $293.06      $289.75
                      lesion.
46938..............  Cryotherapy of rectal       ..................  T.................         0150      30.1606    $1,921.05      $437.12      $384.21
                      lesion.
46940..............  Treatment of anal fissure.  ..................  T.................         0149      22.7451    $1,448.73      $293.06      $289.75
46942..............  Treatment of anal fissure.  ..................  T.................         0148       4.7935      $305.32  ...........       $61.06
46945..............  Ligation of hemorrhoids...  ..................  T.................         0155      10.9132      $695.11  ...........      $139.02
46946..............  Ligation of hemorrhoids...  ..................  T.................         0155      10.9132      $695.11  ...........      $139.02
46947..............  Hemorrhoidopexy by          ..................  T.................         0150      30.1606    $1,921.05      $437.12      $384.21
                      stapling.
46999..............  Anus surgery procedure....  ..................  T.................         0148       4.7935      $305.32  ...........       $61.06
47000..............  Needle biopsy of liver....  ..................  T.................         0685       9.3354      $594.61  ...........      $118.92
47001..............  Needle biopsy, liver add-   ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      on.
47010..............  Open drainage, liver        ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      lesion.
47011..............  Percut drain, liver lesion  ..................  T.................         0037      13.5764      $864.74      $228.76      $172.95
47015..............  Inject/aspirate liver cyst  ..................  C.................  ...........  ...........  ...........  ...........  ...........
47100..............  Wedge biopsy of liver.....  ..................  C.................  ...........  ...........  ...........  ...........  ...........
47120..............  Partial removal of liver..  ..................  C.................  ...........  ...........  ...........  ...........  ...........
47122..............  Extensive removal of liver  ..................  C.................  ...........  ...........  ...........  ...........  ...........
47125..............  Partial removal of liver..  ..................  C.................  ...........  ...........  ...........  ...........  ...........
47130..............  Partial removal of liver..  ..................  C.................  ...........  ...........  ...........  ...........  ...........
47133..............  Removal of donor liver....  ..................  C.................  ...........  ...........  ...........  ...........  ...........
47135..............  Transplantation of liver..  ..................  C.................  ...........  ...........  ...........  ...........  ...........
47136..............  Transplantation of liver..  ..................  C.................  ...........  ...........  ...........  ...........  ...........
47140..............  Partial removal, donor      ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      liver.
47141..............  Partial removal, donor      ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      liver.
47142..............  Partial removal, donor      ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      liver.
47143..............  Prep donor liver, whole...  ..................  C.................  ...........  ...........  ...........  ...........  ...........
47144..............  Prep donor liver, 3-        ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      segment.
47145..............  Prep donor liver, lobe      ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      split.
47146..............  Prep donor liver/venous...  ..................  C.................  ...........  ...........  ...........  ...........  ...........
47147..............  Prep donor liver/arterial.  ..................  C.................  ...........  ...........  ...........  ...........  ...........
47300..............  Surgery for liver lesion..  ..................  C.................  ...........  ...........  ...........  ...........  ...........
47350..............  Repair liver wound........  ..................  C.................  ...........  ...........  ...........  ...........  ...........
47360..............  Repair liver wound........  ..................  C.................  ...........  ...........  ...........  ...........  ...........
47361..............  Repair liver wound........  ..................  C.................  ...........  ...........  ...........  ...........  ...........
47362..............  Repair liver wound........  ..................  C.................  ...........  ...........  ...........  ...........  ...........
47370..............  Laparo ablate liver tumor   ..................  T.................         0132      69.6652    $4,437.26    $1,239.22      $887.45
                      rf.
47371..............  Laparo ablate liver         ..................  T.................         0131      45.5317    $2,900.10    $1,001.89      $580.02
                      cryosurg.
47379..............  Laparoscope procedure,      ..................  T.................         0130      34.3958    $2,190.81      $659.53      $438.16
                      liver.
47380..............  Open ablate liver tumor rf  ..................  C.................  ...........  ...........  ...........  ...........  ...........
47381..............  Open ablate liver tumor     ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      cryo.
47382..............  Percut ablate liver rf....  ..................  T.................         0423      42.9980    $2,738.71  ...........      $547.74
47399..............  Liver surgery procedure...  ..................  T.................         0004       4.3270      $275.60  ...........       $55.12
47400..............  Incision of liver duct....  ..................  C.................  ...........  ...........  ...........  ...........  ...........
47420..............  Incision of bile duct.....  ..................  C.................  ...........  ...........  ...........  ...........  ...........
47425..............  Incision of bile duct.....  ..................  C.................  ...........  ...........  ...........  ...........  ...........
47460..............  Incise bile duct sphincter  ..................  C.................  ...........  ...........  ...........  ...........  ...........
47480..............  Incision of gallbladder...  ..................  C.................  ...........  ...........  ...........  ...........  ...........
47490..............  Incision of gallbladder...  ..................  T.................         0152      28.6884    $1,827.28  ...........      $365.46
47500..............  Injection for liver x-rays  ..................  N.................  ...........  ...........  ...........  ...........  ...........
47505..............  Injection for liver x-rays  ..................  N.................  ...........  ...........  ...........  ...........  ...........
47510..............  Insert catheter, bile duct  ..................  T.................         0152      28.6884    $1,827.28  ...........      $365.46
47511..............  Insert bile duct drain....  ..................  T.................         0152      28.6884    $1,827.28  ...........      $365.46
47525..............  Change bile duct catheter.  ..................  T.................         0427      15.3545      $977.99  ...........      $195.60
47530..............  Revise/reinsert bile tube.  ..................  T.................         0427      15.3545      $977.99  ...........      $195.60
47550..............  Bile duct endoscopy add-on  ..................  C.................  ...........  ...........  ...........  ...........  ...........
47552..............  Biliary endoscopy thru      ..................  T.................         0152      28.6884    $1,827.28  ...........      $365.46
                      skin.
47553..............  Biliary endoscopy thru      ..................  T.................         0152      28.6884    $1,827.28  ...........      $365.46
                      skin.
47554..............  Biliary endoscopy thru      ..................  T.................         0152      28.6884    $1,827.28  ...........      $365.46
                      skin.
47555..............  Biliary endoscopy thru      ..................  T.................         0152      28.6884    $1,827.28  ...........      $365.46
                      skin.
47556..............  Biliary endoscopy thru      ..................  T.................         0152      28.6884    $1,827.28  ...........      $365.46
                      skin.
47560..............  Laparoscopy w/cholangio...  ..................  T.................         0130      34.3958    $2,190.81      $659.53      $438.16
47561..............  Laparo w/cholangio/biopsy.  ..................  T.................         0130      34.3958    $2,190.81      $659.53      $438.16
47562..............  Laparoscopic                ..................  T.................         0131      45.5317    $2,900.10    $1,001.89      $580.02
                      cholecystectomy.
47563..............  Laparo cholecystectomy/     ..................  T.................         0131      45.5317    $2,900.10    $1,001.89      $580.02
                      graph.
47564..............  Laparo cholecystectomy/     ..................  T.................         0131      45.5317    $2,900.10    $1,001.89      $580.02
                      explr.
47570..............  Laparo                      ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      cholecystoenterostomy.
47579..............  Laparoscope proc, biliary.  ..................  T.................         0130      34.3958    $2,190.81      $659.53      $438.16
47600..............  Removal of gallbladder....  ..................  C.................  ...........  ...........  ...........  ...........  ...........
47605..............  Removal of gallbladder....  ..................  C.................  ...........  ...........  ...........  ...........  ...........
47610..............  Removal of gallbladder....  ..................  C.................  ...........  ...........  ...........  ...........  ...........
47612..............  Removal of gallbladder....  ..................  C.................  ...........  ...........  ...........  ...........  ...........

[[Page 67048]]

 
47620..............  Removal of gallbladder....  ..................  C.................  ...........  ...........  ...........  ...........  ...........
47630..............  Remove bile duct stone....  ..................  T.................         0152      28.6884    $1,827.28  ...........      $365.46
47700..............  Exploration of bile ducts.  ..................  C.................  ...........  ...........  ...........  ...........  ...........
47701..............  Bile duct revision........  ..................  C.................  ...........  ...........  ...........  ...........  ...........
47711..............  Excision of bile duct       ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      tumor.
47712..............  Excision of bile duct       ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      tumor.
47715..............  Excision of bile duct cyst  ..................  C.................  ...........  ...........  ...........  ...........  ...........
47719..............  Fusion of bile duct cyst..  CH................  D.................  ...........  ...........  ...........  ...........  ...........
47720..............  Fuse gallbladder & bowel..  ..................  C.................  ...........  ...........  ...........  ...........  ...........
47721..............  Fuse upper gi structures..  ..................  C.................  ...........  ...........  ...........  ...........  ...........
47740..............  Fuse gallbladder & bowel..  ..................  C.................  ...........  ...........  ...........  ...........  ...........
47741..............  Fuse gallbladder & bowel..  ..................  C.................  ...........  ...........  ...........  ...........  ...........
47760..............  Fuse bile ducts and bowel.  ..................  C.................  ...........  ...........  ...........  ...........  ...........
47765..............  Fuse liver ducts & bowel..  ..................  C.................  ...........  ...........  ...........  ...........  ...........
47780..............  Fuse bile ducts and bowel.  ..................  C.................  ...........  ...........  ...........  ...........  ...........
47785..............  Fuse bile ducts and bowel.  ..................  C.................  ...........  ...........  ...........  ...........  ...........
47800..............  Reconstruction of bile      ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      ducts.
47801..............  Placement, bile duct        ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      support.
47802..............  Fuse liver duct &           ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      intestine.
47900..............  Suture bile duct injury...  ..................  C.................  ...........  ...........  ...........  ...........  ...........
47999..............  Bile tract surgery          ..................  T.................         0152      28.6884    $1,827.28  ...........      $365.46
                      procedure.
48000..............  Drainage of abdomen.......  ..................  C.................  ...........  ...........  ...........  ...........  ...........
48001..............  Placement of drain,         ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      pancreas.
48020..............  Removal of pancreatic       ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      stone.
48100..............  Biopsy of pancreas, open..  ..................  C.................  ...........  ...........  ...........  ...........  ...........
48102..............  Needle biopsy, pancreas...  ..................  T.................         0685       9.3354      $594.61  ...........      $118.92
48105..............  Resect/debride pancreas...  ..................  C.................  ...........  ...........  ...........  ...........  ...........
48120..............  Removal of pancreas lesion  ..................  C.................  ...........  ...........  ...........  ...........  ...........
48140..............  Partial removal of          ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      pancreas.
48145..............  Partial removal of          ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      pancreas.
48146..............  Pancreatectomy............  ..................  C.................  ...........  ...........  ...........  ...........  ...........
48148..............  Removal of pancreatic duct  ..................  C.................  ...........  ...........  ...........  ...........  ...........
48150..............  Partial removal of          ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      pancreas.
48152..............  Pancreatectomy............  ..................  C.................  ...........  ...........  ...........  ...........  ...........
48153..............  Pancreatectomy............  ..................  C.................  ...........  ...........  ...........  ...........  ...........
48154..............  Pancreatectomy............  ..................  C.................  ...........  ...........  ...........  ...........  ...........
48155..............  Removal of pancreas.......  ..................  C.................  ...........  ...........  ...........  ...........  ...........
48160..............  Pancreas removal/           ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      transplant.
48400..............  Injection, intraop add-on.  ..................  C.................  ...........  ...........  ...........  ...........  ...........
48500..............  Surgery of pancreatic cyst  ..................  C.................  ...........  ...........  ...........  ...........  ...........
48510..............  Drain pancreatic            ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      pseudocyst.
48511..............  Drain pancreatic            ..................  T.................         0037      13.5764      $864.74      $228.76      $172.95
                      pseudocyst.
48520..............  Fuse pancreas cyst and      ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      bowel.
48540..............  Fuse pancreas cyst and      ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      bowel.
48545..............  Pancreatorrhaphy..........  ..................  C.................  ...........  ...........  ...........  ...........  ...........
48547..............  Duodenal exclusion........  ..................  C.................  ...........  ...........  ...........  ...........  ...........
48548..............  Fuse pancreas and bowel...  ..................  C.................  ...........  ...........  ...........  ...........  ...........
48550..............  Donor pancreatectomy......  ..................  E.................  ...........  ...........  ...........  ...........  ...........
48551..............  Prep donor pancreas.......  ..................  C.................  ...........  ...........  ...........  ...........  ...........
48552..............  Prep donor pancreas/venous  ..................  C.................  ...........  ...........  ...........  ...........  ...........
48554..............  Transpl allograft pancreas  ..................  C.................  ...........  ...........  ...........  ...........  ...........
48556..............  Removal, allograft          ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      pancreas.
48999..............  Pancreas surgery procedure  ..................  T.................         0004       4.3270      $275.60  ...........       $55.12
49000..............  Exploration of abdomen....  ..................  C.................  ...........  ...........  ...........  ...........  ...........
49002..............  Reopening of abdomen......  ..................  C.................  ...........  ...........  ...........  ...........  ...........
49010..............  Exploration behind abdomen  ..................  C.................  ...........  ...........  ...........  ...........  ...........
49020..............  Drain abdominal abscess...  ..................  C.................  ...........  ...........  ...........  ...........  ...........
49021..............  Drain abdominal abscess...  ..................  T.................         0037      13.5764      $864.74      $228.76      $172.95
49040..............  Drain, open, abdom abscess  ..................  C.................  ...........  ...........  ...........  ...........  ...........
49041..............  Drain, percut, abdom        ..................  T.................         0037      13.5764      $864.74      $228.76      $172.95
                      abscess.
49060..............  Drain, open, retrop         ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      abscess.
49061..............  Drain, percut, retroper     ..................  T.................         0037      13.5764      $864.74      $228.76      $172.95
                      absc.
49062..............  Drain to peritoneal cavity  ..................  C.................  ...........  ...........  ...........  ...........  ...........
49080..............  Puncture, peritoneal        ..................  T.................         0070       5.2024      $331.36  ...........       $66.27
                      cavity.
49081..............  Removal of abdominal fluid  ..................  T.................         0070       5.2024      $331.36  ...........       $66.27
49180..............  Biopsy, abdominal mass....  ..................  T.................         0685       9.3354      $594.61  ...........      $118.92
49200..............  Removal of abdominal        CH................  D.................  ...........  ...........  ...........  ...........  ...........
                      lesion.
49201..............  Remove abdom lesion,        CH................  D.................  ...........  ...........  ...........  ...........  ...........
                      complex.
49203..............  Exc abd tum 5 cm or less..  NI................  C.................  ...........  ...........  ...........  ...........  ...........
49204..............  Exc abd tum over 5 cm.....  NI................  C.................  ...........  ...........  ...........  ...........  ...........
49205..............  Exc abd tum over 10 cm....  NI................  C.................  ...........  ...........  ...........  ...........  ...........
49215..............  Excise sacral spine tumor.  ..................  C.................  ...........  ...........  ...........  ...........  ...........
49220..............  Multiple surgery, abdomen.  ..................  C.................  ...........  ...........  ...........  ...........  ...........
49250..............  Excision of umbilicus.....  ..................  T.................         0153      25.6947    $1,636.60      $397.95      $327.32
49255..............  Removal of omentum........  ..................  C.................  ...........  ...........  ...........  ...........  ...........
49320..............  Diag laparo separate proc.  ..................  T.................         0130      34.3958    $2,190.81      $659.53      $438.16
49321..............  Laparoscopy, biopsy.......  ..................  T.................         0130      34.3958    $2,190.81      $659.53      $438.16
49322..............  Laparoscopy, aspiration...  ..................  T.................         0130      34.3958    $2,190.81      $659.53      $438.16
49323..............  Laparo drain lymphocele...  ..................  T.................         0130      34.3958    $2,190.81      $659.53      $438.16
49324..............  Lap insertion perm ip cath  ..................  T.................         0130      34.3958    $2,190.81      $659.53      $438.16

[[Page 67049]]

 
49325..............  Lap revision perm ip cath.  ..................  T.................         0130      34.3958    $2,190.81      $659.53      $438.16
49326..............  Lap w/omentopexy add-on...  ..................  T.................         0130      34.3958    $2,190.81      $659.53      $438.16
49329..............  Laparo proc, abdm/per/      ..................  T.................         0130      34.3958    $2,190.81      $659.53      $438.16
                      oment.
49400..............  Air injection into abdomen  ..................  N.................  ...........  ...........  ...........  ...........  ...........
49402..............  Remove foreign body,        ..................  T.................         0153      25.6947    $1,636.60      $397.95      $327.32
                      adbomen.
49419..............  Insrt abdom cath for        ..................  T.................         0115      29.6965    $1,891.49  ...........      $378.30
                      chemotx.
49420..............  Insert abdom drain, temp..  ..................  T.................         0652      30.7096    $1,956.02  ...........      $391.20
49421..............  Insert abdom drain, perm..  ..................  T.................         0652      30.7096    $1,956.02  ...........      $391.20
49422..............  Remove perm cannula/        ..................  T.................         0105      23.9802    $1,527.39  ...........      $305.48
                      catheter.
49423..............  Exchange drainage catheter  ..................  T.................         0427      15.3545      $977.99  ...........      $195.60
49424..............  Assess cyst, contrast       ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      inject.
49425..............  Insert abdomen-venous       ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      drain.
49426..............  Revise abdomen-venous       ..................  T.................         0153      25.6947    $1,636.60      $397.95      $327.32
                      shunt.
49427..............  Injection, abdominal shunt  ..................  N.................  ...........  ...........  ...........  ...........  ...........
49428..............  Ligation of shunt.........  ..................  C.................  ...........  ...........  ...........  ...........  ...........
49429..............  Removal of shunt..........  ..................  T.................         0105      23.9802    $1,527.39  ...........      $305.48
49435..............  Insert subq exten to ip     ..................  T.................         0427      15.3545      $977.99  ...........      $195.60
                      cath.
49436..............  Embedded ip cath exit-site  ..................  T.................         0427      15.3545      $977.99  ...........      $195.60
49440..............  Place gastrostomy tube      NI................  T.................         0141       8.5030      $541.59      $143.38      $108.32
                      perc.
49441..............  Place duod/jej tube perc..  NI................  T.................         0141       8.5030      $541.59      $143.38      $108.32
49442..............  Place cecostomy tube perc.  NI................  T.................         0155      10.9132      $695.11  ...........      $139.02
49446..............  Change g-tube to g-j perc.  NI................  T.................         0141       8.5030      $541.59      $143.38      $108.32
49450..............  Replace g/c tube perc.....  NI................  T.................         0121       3.2383      $206.26       $43.80       $41.25
49451..............  Replace duod/jej tube perc  NI................  T.................         0121       3.2383      $206.26       $43.80       $41.25
49452..............  Replace g-j tube perc.....  NI................  T.................         0121       3.2383      $206.26       $43.80       $41.25
49460..............  Fix g/colon tube w/device.  NI................  T.................         0121       3.2383      $206.26       $43.80       $41.25
49465..............  Fluoro exam of g/colon      NI................  Q.................         0276       1.3834       $88.11       $34.97       $17.62
                      tube.
49491..............  Rpr hern preemie reduc....  ..................  T.................         0154      30.6788    $1,954.06      $464.85      $390.81
49492..............  Rpr ing hern premie,        ..................  T.................         0154      30.6788    $1,954.06      $464.85      $390.81
                      blocked.
49495..............  Rpr ing hernia baby, reduc  ..................  T.................         0154      30.6788    $1,954.06      $464.85      $390.81
49496..............  Rpr ing hernia baby,        ..................  T.................         0154      30.6788    $1,954.06      $464.85      $390.81
                      blocked.
49500..............  Rpr ing hernia, init,       ..................  T.................         0154      30.6788    $1,954.06      $464.85      $390.81
                      reduce.
49501..............  Rpr ing hernia, init        ..................  T.................         0154      30.6788    $1,954.06      $464.85      $390.81
                      blocked.
49505..............  Prp i/hern init reduc >5    ..................  T.................         0154      30.6788    $1,954.06      $464.85      $390.81
                      yr.
49507..............  Prp i/hern init block >5    ..................  T.................         0154      30.6788    $1,954.06      $464.85      $390.81
                      yr.
49520..............  Rerepair ing hernia,        ..................  T.................         0154      30.6788    $1,954.06      $464.85      $390.81
                      reduce.
49521..............  Rerepair ing hernia,        ..................  T.................         0154      30.6788    $1,954.06      $464.85      $390.81
                      blocked.
49525..............  Repair ing hernia, sliding  ..................  T.................         0154      30.6788    $1,954.06      $464.85      $390.81
49540..............  Repair lumbar hernia......  ..................  T.................         0154      30.6788    $1,954.06      $464.85      $390.81
49550..............  Rpr rem hernia, init,       ..................  T.................         0154      30.6788    $1,954.06      $464.85      $390.81
                      reduce.
49553..............  Rpr fem hernia, init        ..................  T.................         0154      30.6788    $1,954.06      $464.85      $390.81
                      blocked.
49555..............  Rerepair fem hernia,        ..................  T.................         0154      30.6788    $1,954.06      $464.85      $390.81
                      reduce.
49557..............  Rerepair fem hernia,        ..................  T.................         0154      30.6788    $1,954.06      $464.85      $390.81
                      blocked.
49560..............  Rpr ventral hern init,      ..................  T.................         0154      30.6788    $1,954.06      $464.85      $390.81
                      reduc.
49561..............  Rpr ventral hern init,      ..................  T.................         0154      30.6788    $1,954.06      $464.85      $390.81
                      block.
49565..............  Rerepair ventrl hern,       ..................  T.................         0154      30.6788    $1,954.06      $464.85      $390.81
                      reduce.
49566..............  Rerepair ventrl hern,       ..................  T.................         0154      30.6788    $1,954.06      $464.85      $390.81
                      block.
49568..............  Hernia repair w/mesh......  ..................  T.................         0154      30.6788    $1,954.06      $464.85      $390.81
49570..............  Rpr epigastric hern,        ..................  T.................         0154      30.6788    $1,954.06      $464.85      $390.81
                      reduce.
49572..............  Rpr epigastric hern,        ..................  T.................         0154      30.6788    $1,954.06      $464.85      $390.81
                      blocked.
49580..............  Rpr umbil hern, reduc < 5   ..................  T.................         0154      30.6788    $1,954.06      $464.85      $390.81
                      yr.
49582..............  Rpr umbil hern, block < 5   ..................  T.................         0154      30.6788    $1,954.06      $464.85      $390.81
                      yr.
49585..............  Rpr umbil hern, reduc > 5   ..................  T.................         0154      30.6788    $1,954.06      $464.85      $390.81
                      yr.
49587..............  Rpr umbil hern, block > 5   ..................  T.................         0154      30.6788    $1,954.06      $464.85      $390.81
                      yr.
49590..............  Repair spigelian hernia...  ..................  T.................         0154      30.6788    $1,954.06      $464.85      $390.81
49600..............  Repair umbilical lesion...  ..................  T.................         0154      30.6788    $1,954.06      $464.85      $390.81
49605..............  Repair umbilical lesion...  ..................  C.................  ...........  ...........  ...........  ...........  ...........
49606..............  Repair umbilical lesion...  ..................  C.................  ...........  ...........  ...........  ...........  ...........
49610..............  Repair umbilical lesion...  ..................  C.................  ...........  ...........  ...........  ...........  ...........
49611..............  Repair umbilical lesion...  ..................  C.................  ...........  ...........  ...........  ...........  ...........
49650..............  Laparo hernia repair        ..................  T.................         0131      45.5317    $2,900.10    $1,001.89      $580.02
                      initial.
49651..............  Laparo hernia repair recur  ..................  T.................         0131      45.5317    $2,900.10    $1,001.89      $580.02
49659..............  Laparo proc, hernia repair  ..................  T.................         0130      34.3958    $2,190.81      $659.53      $438.16
49900..............  Repair of abdominal wall..  ..................  C.................  ...........  ...........  ...........  ...........  ...........
49904..............  Omental flap, extra-abdom.  ..................  C.................  ...........  ...........  ...........  ...........  ...........
49905..............  Omental flap, intra-abdom.  ..................  C.................  ...........  ...........  ...........  ...........  ...........
49906..............  Free omental flap,          ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      microvasc.
49999..............  Abdomen surgery procedure.  ..................  T.................         0153      25.6947    $1,636.60      $397.95      $327.32
50010..............  Exploration of kidney.....  ..................  C.................  ...........  ...........  ...........  ...........  ...........
50020..............  Renal abscess, open drain.  ..................  T.................         0162      24.7749    $1,578.01  ...........      $315.60
50021..............  Renal abscess, percut       ..................  T.................         0037      13.5764      $864.74      $228.76      $172.95
                      drain.
50040..............  Drainage of kidney........  ..................  C.................  ...........  ...........  ...........  ...........  ...........
50045..............  Exploration of kidney.....  ..................  C.................  ...........  ...........  ...........  ...........  ...........
5005F..............  Pt counsld on exam for      ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      moles.
50060..............  Removal of kidney stone...  ..................  C.................  ...........  ...........  ...........  ...........  ...........
50065..............  Incision of kidney........  ..................  C.................  ...........  ...........  ...........  ...........  ...........
50070..............  Incision of kidney........  ..................  C.................  ...........  ...........  ...........  ...........  ...........
50075..............  Removal of kidney stone...  ..................  C.................  ...........  ...........  ...........  ...........  ...........
50080..............  Removal of kidney stone...  ..................  T.................         0429      45.2042    $2,879.24  ...........      $575.85
50081..............  Removal of kidney stone...  ..................  T.................         0429      45.2042    $2,879.24  ...........      $575.85

[[Page 67050]]

 
50100..............  Revise kidney blood         ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      vessels.
5010F..............  Macul+ fndngs to dr mng dm  ..................  M.................  ...........  ...........  ...........  ...........  ...........
50120..............  Exploration of kidney.....  ..................  C.................  ...........  ...........  ...........  ...........  ...........
50125..............  Explore and drain kidney..  ..................  C.................  ...........  ...........  ...........  ...........  ...........
50130..............  Removal of kidney stone...  ..................  C.................  ...........  ...........  ...........  ...........  ...........
50135..............  Exploration of kidney.....  ..................  C.................  ...........  ...........  ...........  ...........  ...........
5015F..............  Doc fx & test/txmnt for op  ..................  M.................  ...........  ...........  ...........  ...........  ...........
50200..............  Biopsy of kidney..........  ..................  T.................         0685       9.3354      $594.61  ...........      $118.92
50205..............  Biopsy of kidney..........  ..................  C.................  ...........  ...........  ...........  ...........  ...........
5020F..............  Txmnts 2 main Dr by 1 mon.  NI................  M.................  ...........  ...........  ...........  ...........  ...........
50220..............  Remove kidney, open.......  ..................  C.................  ...........  ...........  ...........  ...........  ...........
50225..............  Removal kidney open,        ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      complex.
50230..............  Removal kidney open,        ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      radical.
50234..............  Removal of kidney & ureter  ..................  C.................  ...........  ...........  ...........  ...........  ...........
50236..............  Removal of kidney & ureter  ..................  C.................  ...........  ...........  ...........  ...........  ...........
50240..............  Partial removal of kidney.  ..................  C.................  ...........  ...........  ...........  ...........  ...........
50250..............  Cryoablate renal mass open  ..................  C.................  ...........  ...........  ...........  ...........  ...........
50280..............  Removal of kidney lesion..  ..................  C.................  ...........  ...........  ...........  ...........  ...........
50290..............  Removal of kidney lesion..  ..................  C.................  ...........  ...........  ...........  ...........  ...........
50300..............  Remove cadaver donor        ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      kidney.
50320..............  Remove kidney, living       ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      donor.
50323..............  Prep cadaver renal          ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      allograft.
50325..............  Prep donor renal graft....  ..................  C.................  ...........  ...........  ...........  ...........  ...........
50327..............  Prep renal graft/venous...  ..................  C.................  ...........  ...........  ...........  ...........  ...........
50328..............  Prep renal graft/arterial.  ..................  C.................  ...........  ...........  ...........  ...........  ...........
50329..............  Prep renal graft/ureteral.  ..................  C.................  ...........  ...........  ...........  ...........  ...........
50340..............  Removal of kidney.........  ..................  C.................  ...........  ...........  ...........  ...........  ...........
50360..............  Transplantation of kidney.  ..................  C.................  ...........  ...........  ...........  ...........  ...........
50365..............  Transplantation of kidney.  ..................  C.................  ...........  ...........  ...........  ...........  ...........
50370..............  Remove transplanted kidney  ..................  C.................  ...........  ...........  ...........  ...........  ...........
50380..............  Reimplantation of kidney..  ..................  C.................  ...........  ...........  ...........  ...........  ...........
50382..............  Change ureter stent,        CH................  T.................         0162      24.7749    $1,578.01  ...........      $315.60
                      percut.
50384..............  Remove ureter stent,        ..................  T.................         0161      17.9420    $1,142.80      $241.15      $228.56
                      percut.
50385..............  Change stent via            NI................  T.................         0161      17.9420    $1,142.80      $241.15      $228.56
                      transureth.
50386..............  Remove stent via            NI................  T.................         0160       5.9735      $380.48  ...........       $76.10
                      transureth.
50387..............  Change ext/int ureter       CH................  T.................         0427      15.3545      $977.99  ...........      $195.60
                      stent.
50389..............  Remove renal tube w/fluoro  CH................  T.................         0160       5.9735      $380.48  ...........       $76.10
50390..............  Drainage of kidney lesion.  ..................  T.................         0685       9.3354      $594.61  ...........      $118.92
50391..............  Instll rx agnt into rnal    ..................  T.................         0126       1.0356       $65.96       $16.21       $13.19
                      tub.
50392..............  Insert kidney drain.......  ..................  T.................         0161      17.9420    $1,142.80      $241.15      $228.56
50393..............  Insert ureteral tube......  CH................  T.................         0162      24.7749    $1,578.01  ...........      $315.60
50394..............  Injection for kidney x-ray  ..................  N.................  ...........  ...........  ...........  ...........  ...........
50395..............  Create passage to kidney..  ..................  T.................         0161      17.9420    $1,142.80      $241.15      $228.56
50396..............  Measure kidney pressure...  ..................  T.................         0164       2.0077      $127.88  ...........       $25.58
50398..............  Change kidney tube........  CH................  T.................         0427      15.3545      $977.99  ...........      $195.60
50400..............  Revision of kidney/ureter.  ..................  C.................  ...........  ...........  ...........  ...........  ...........
50405..............  Revision of kidney/ureter.  ..................  C.................  ...........  ...........  ...........  ...........  ...........
50500..............  Repair of kidney wound....  ..................  C.................  ...........  ...........  ...........  ...........  ...........
5050F..............  Plan 2 main Dr. by 1 month  NI................  M.................  ...........  ...........  ...........  ...........  ...........
50520..............  Close kidney-skin fistula.  ..................  C.................  ...........  ...........  ...........  ...........  ...........
50525..............  Repair renal-abdomen        ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      fistula.
50526..............  Repair renal-abdomen        ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      fistula.
50540..............  Revision of horseshoe       ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      kidney.
50541..............  Laparo ablate renal cyst..  ..................  T.................         0130      34.3958    $2,190.81      $659.53      $438.16
50542..............  Laparo ablate renal mass..  ..................  T.................         0132      69.6652    $4,437.26    $1,239.22      $887.45
50543..............  Laparo partial nephrectomy  ..................  T.................         0131      45.5317    $2,900.10    $1,001.89      $580.02
50544..............  Laparoscopy, pyeloplasty..  ..................  T.................         0130      34.3958    $2,190.81      $659.53      $438.16
50545..............  Laparo radical nephrectomy  ..................  C.................  ...........  ...........  ...........  ...........  ...........
50546..............  Laparoscopic nephrectomy..  ..................  C.................  ...........  ...........  ...........  ...........  ...........
50547..............  Laparo removal donor        ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      kidney.
50548..............  Laparo remove w/ureter....  ..................  C.................  ...........  ...........  ...........  ...........  ...........
50549..............  Laparoscope proc, renal...  ..................  T.................         0130      34.3958    $2,190.81      $659.53      $438.16
50551..............  Kidney endoscopy..........  ..................  T.................         0160       5.9735      $380.48  ...........       $76.10
50553..............  Kidney endoscopy..........  CH................  T.................         0162      24.7749    $1,578.01  ...........      $315.60
50555..............  Kidney endoscopy & biopsy.  ..................  T.................         0160       5.9735      $380.48  ...........       $76.10
50557..............  Kidney endoscopy &          ..................  T.................         0162      24.7749    $1,578.01  ...........      $315.60
                      treatment.
50561..............  Kidney endoscopy &          CH................  T.................         0162      24.7749    $1,578.01  ...........      $315.60
                      treatment.
50562..............  Renal scope w/tumor resect  ..................  T.................         0160       5.9735      $380.48  ...........       $76.10
50570..............  Kidney endoscopy..........  ..................  T.................         0160       5.9735      $380.48  ...........       $76.10
50572..............  Kidney endoscopy..........  ..................  T.................         0160       5.9735      $380.48  ...........       $76.10
50574..............  Kidney endoscopy & biopsy.  ..................  T.................         0160       5.9735      $380.48  ...........       $76.10
50575..............  Kidney endoscopy..........  ..................  T.................         0163      36.0774    $2,297.91  ...........      $459.58
50576..............  Kidney endoscopy &          ..................  T.................         0161      17.9420    $1,142.80      $241.15      $228.56
                      treatment.
50580..............  Kidney endoscopy &          CH................  T.................         0161      17.9420    $1,142.80      $241.15      $228.56
                      treatment.
50590..............  Fragmenting of kidney       ..................  T.................         0169      41.5299    $2,645.21      $997.74      $529.04
                      stone.
50592..............  Perc rf ablate renal tumor  ..................  T.................         0423      42.9980    $2,738.71  ...........      $547.74
50593..............  Perc cryo ablate renal tum  NI................  T.................         0423      42.9980    $2,738.71  ...........      $547.74
50600..............  Exploration of ureter.....  ..................  C.................  ...........  ...........  ...........  ...........  ...........
50605..............  Insert ureteral support...  ..................  C.................  ...........  ...........  ...........  ...........  ...........
50610..............  Removal of ureter stone...  ..................  C.................  ...........  ...........  ...........  ...........  ...........

[[Page 67051]]

 
50620..............  Removal of ureter stone...  ..................  C.................  ...........  ...........  ...........  ...........  ...........
50630..............  Removal of ureter stone...  ..................  C.................  ...........  ...........  ...........  ...........  ...........
50650..............  Removal of ureter.........  ..................  C.................  ...........  ...........  ...........  ...........  ...........
50660..............  Removal of ureter.........  ..................  C.................  ...........  ...........  ...........  ...........  ...........
50684..............  Injection for ureter x-ray  ..................  N.................  ...........  ...........  ...........  ...........  ...........
50686..............  Measure ureter pressure...  ..................  T.................         0126       1.0356       $65.96       $16.21       $13.19
50688..............  Change of ureter tube/      CH................  T.................         0427      15.3545      $977.99  ...........      $195.60
                      stent.
50690..............  Injection for ureter x-ray  ..................  N.................  ...........  ...........  ...........  ...........  ...........
50700..............  Revision of ureter........  ..................  C.................  ...........  ...........  ...........  ...........  ...........
50715..............  Release of ureter.........  ..................  C.................  ...........  ...........  ...........  ...........  ...........
50722..............  Release of ureter.........  ..................  C.................  ...........  ...........  ...........  ...........  ...........
50725..............  Release/revise ureter.....  ..................  C.................  ...........  ...........  ...........  ...........  ...........
50727..............  Revise ureter.............  ..................  C.................  ...........  ...........  ...........  ...........  ...........
50728..............  Revise ureter.............  ..................  C.................  ...........  ...........  ...........  ...........  ...........
50740..............  Fusion of ureter & kidney.  ..................  C.................  ...........  ...........  ...........  ...........  ...........
50750..............  Fusion of ureter & kidney.  ..................  C.................  ...........  ...........  ...........  ...........  ...........
50760..............  Fusion of ureters.........  ..................  C.................  ...........  ...........  ...........  ...........  ...........
50770..............  Splicing of ureters.......  ..................  C.................  ...........  ...........  ...........  ...........  ...........
50780..............  Reimplant ureter in         ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      bladder.
50782..............  Reimplant ureter in         ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      bladder.
50783..............  Reimplant ureter in         ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      bladder.
50785..............  Reimplant ureter in         ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      bladder.
50800..............  Implant ureter in bowel...  ..................  C.................  ...........  ...........  ...........  ...........  ...........
50810..............  Fusion of ureter & bowel..  ..................  C.................  ...........  ...........  ...........  ...........  ...........
50815..............  Urine shunt to intestine..  ..................  C.................  ...........  ...........  ...........  ...........  ...........
50820..............  Construct bowel bladder...  ..................  C.................  ...........  ...........  ...........  ...........  ...........
50825..............  Construct bowel bladder...  ..................  C.................  ...........  ...........  ...........  ...........  ...........
50830..............  Revise urine flow.........  ..................  C.................  ...........  ...........  ...........  ...........  ...........
50840..............  Replace ureter by bowel...  ..................  C.................  ...........  ...........  ...........  ...........  ...........
50845..............  Appendico-vesicostomy.....  ..................  C.................  ...........  ...........  ...........  ...........  ...........
50860..............  Transplant ureter to skin.  ..................  C.................  ...........  ...........  ...........  ...........  ...........
50900..............  Repair of ureter..........  ..................  C.................  ...........  ...........  ...........  ...........  ...........
50920..............  Closure ureter/skin         ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      fistula.
50930..............  Closure ureter/bowel        ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      fistula.
50940..............  Release of ureter.........  ..................  C.................  ...........  ...........  ...........  ...........  ...........
50945..............  Laparoscopy                 ..................  T.................         0131      45.5317    $2,900.10    $1,001.89      $580.02
                      ureterolithotomy.
50947..............  Laparo new ureter/bladder.  ..................  T.................         0131      45.5317    $2,900.10    $1,001.89      $580.02
50948..............  Laparo new ureter/bladder.  ..................  T.................         0131      45.5317    $2,900.10    $1,001.89      $580.02
50949..............  Laparoscope proc, ureter..  ..................  T.................         0130      34.3958    $2,190.81      $659.53      $438.16
50951..............  Endoscopy of ureter.......  ..................  T.................         0160       5.9735      $380.48  ...........       $76.10
50953..............  Endoscopy of ureter.......  ..................  T.................         0160       5.9735      $380.48  ...........       $76.10
50955..............  Ureter endoscopy & biopsy.  CH................  T.................         0162      24.7749    $1,578.01  ...........      $315.60
50957..............  Ureter endoscopy &          CH................  T.................         0162      24.7749    $1,578.01  ...........      $315.60
                      treatment.
50961..............  Ureter endoscopy &          CH................  T.................         0162      24.7749    $1,578.01  ...........      $315.60
                      treatment.
50970..............  Ureter endoscopy..........  ..................  T.................         0160       5.9735      $380.48  ...........       $76.10
50972..............  Ureter endoscopy &          ..................  T.................         0160       5.9735      $380.48  ...........       $76.10
                      catheter.
50974..............  Ureter endoscopy & biopsy.  ..................  T.................         0161      17.9420    $1,142.80      $241.15      $228.56
50976..............  Ureter endoscopy &          ..................  T.................         0161      17.9420    $1,142.80      $241.15      $228.56
                      treatment.
50980..............  Ureter endoscopy &          CH................  T.................         0162      24.7749    $1,578.01  ...........      $315.60
                      treatment.
51000..............  Drainage of bladder.......  CH................  D.................  ...........  ...........  ...........  ...........  ...........
51005..............  Drainage of bladder.......  CH................  D.................  ...........  ...........  ...........  ...........  ...........
51010..............  Drainage of bladder.......  CH................  D.................  ...........  ...........  ...........  ...........  ...........
51020..............  Incise & treat bladder....  ..................  T.................         0162      24.7749    $1,578.01  ...........      $315.60
51030..............  Incise & treat bladder....  ..................  T.................         0162      24.7749    $1,578.01  ...........      $315.60
51040..............  Incise & drain bladder....  ..................  T.................         0162      24.7749    $1,578.01  ...........      $315.60
51045..............  Incise bladder/drain        ..................  T.................         0160       5.9735      $380.48  ...........       $76.10
                      ureter.
51050..............  Removal of bladder stone..  ..................  T.................         0162      24.7749    $1,578.01  ...........      $315.60
51060..............  Removal of ureter stone...  ..................  C.................  ...........  ...........  ...........  ...........  ...........
51065..............  Remove ureter calculus....  ..................  T.................         0162      24.7749    $1,578.01  ...........      $315.60
51080..............  Drainage of bladder         ..................  T.................         0008      18.3197    $1,166.85  ...........      $233.37
                      abscess.
51100..............  Drain bladder by needle...  NI................  T.................         0164       2.0077      $127.88  ...........       $25.58
51101..............  Drain bladder by trocar/    NI................  T.................         0126       1.0356       $65.96       $16.21       $13.19
                      cath.
51102..............  Drain bl w/cath insertion.  NI................  T.................         0165      19.3414    $1,231.93  ...........      $246.39
51500..............  Removal of bladder cyst...  ..................  T.................         0154      30.6788    $1,954.06      $464.85      $390.81
51520..............  Removal of bladder lesion.  ..................  T.................         0162      24.7749    $1,578.01  ...........      $315.60
51525..............  Removal of bladder lesion.  ..................  C.................  ...........  ...........  ...........  ...........  ...........
51530..............  Removal of bladder lesion.  ..................  C.................  ...........  ...........  ...........  ...........  ...........
51535..............  Repair of ureter lesion...  CH................  T.................         0162      24.7749    $1,578.01  ...........      $315.60
51550..............  Partial removal of bladder  ..................  C.................  ...........  ...........  ...........  ...........  ...........
51555..............  Partial removal of bladder  ..................  C.................  ...........  ...........  ...........  ...........  ...........
51565..............  Revise bladder & ureter(s)  ..................  C.................  ...........  ...........  ...........  ...........  ...........
51570..............  Removal of bladder........  ..................  C.................  ...........  ...........  ...........  ...........  ...........
51575..............  Removal of bladder & nodes  ..................  C.................  ...........  ...........  ...........  ...........  ...........
51580..............  Remove bladder/revise       ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      tract.
51585..............  Removal of bladder & nodes  ..................  C.................  ...........  ...........  ...........  ...........  ...........
51590..............  Remove bladder/revise       ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      tract.
51595..............  Remove bladder/revise       ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      tract.
51596..............  Remove bladder/create       ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      pouch.
51597..............  Removal of pelvic           ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      structures.
51600..............  Injection for bladder x-    ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      ray.

[[Page 67052]]

 
51605..............  Preparation for bladder     ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      xray.
51610..............  Injection for bladder x-    ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      ray.
51700..............  Irrigation of bladder.....  ..................  T.................         0164       2.0077      $127.88  ...........       $25.58
51701..............  Insert bladder catheter...  ..................  X.................         0340       0.6310       $40.19  ...........        $8.04
51702..............  Insert temp bladder cath..  ..................  X.................         0340       0.6310       $40.19  ...........        $8.04
51703..............  Insert bladder cath,        ..................  T.................         0126       1.0356       $65.96       $16.21       $13.19
                      complex.
51705..............  Change of bladder tube....  CH................  T.................         0164       2.0077      $127.88  ...........       $25.58
51710..............  Change of bladder tube....  CH................  T.................         0427      15.3545      $977.99  ...........      $195.60
51715..............  Endoscopic injection/       ..................  T.................         0168      29.7864    $1,897.21      $388.16      $379.44
                      implant.
51720..............  Treatment of bladder        ..................  T.................         0164       2.0077      $127.88  ...........       $25.58
                      lesion.
51725..............  Simple cystometrogram.....  CH................  T.................         0156       3.0469      $194.07  ...........       $38.81
51726..............  Complex cystometrogram....  ..................  T.................         0156       3.0469      $194.07  ...........       $38.81
51736..............  Urine flow measurement....  ..................  T.................         0126       1.0356       $65.96       $16.21       $13.19
51741..............  Electro-uroflowmetry,       ..................  T.................         0126       1.0356       $65.96       $16.21       $13.19
                      first.
51772..............  Urethra pressure profile..  ..................  T.................         0164       2.0077      $127.88  ...........       $25.58
51784..............  Anal/urinary muscle study.  ..................  T.................         0126       1.0356       $65.96       $16.21       $13.19
51785..............  Anal/urinary muscle study.  CH................  T.................         0164       2.0077      $127.88  ...........       $25.58
51792..............  Urinary reflex study......  ..................  T.................         0126       1.0356       $65.96       $16.21       $13.19
51795..............  Urine voiding pressure      ..................  T.................         0164       2.0077      $127.88  ...........       $25.58
                      study.
51797..............  Intraabdominal pressure     ..................  T.................         0164       2.0077      $127.88  ...........       $25.58
                      test.
51798..............  Us urine capacity measure.  ..................  X.................         0340       0.6310       $40.19  ...........        $8.04
51800..............  Revision of bladder/        ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      urethra.
51820..............  Revision of urinary tract.  ..................  C.................  ...........  ...........  ...........  ...........  ...........
51840..............  Attach bladder/urethra....  ..................  C.................  ...........  ...........  ...........  ...........  ...........
51841..............  Attach bladder/urethra....  ..................  C.................  ...........  ...........  ...........  ...........  ...........
51845..............  Repair bladder neck.......  ..................  C.................  ...........  ...........  ...........  ...........  ...........
51860..............  Repair of bladder wound...  ..................  C.................  ...........  ...........  ...........  ...........  ...........
51865..............  Repair of bladder wound...  ..................  C.................  ...........  ...........  ...........  ...........  ...........
51880..............  Repair of bladder opening.  ..................  T.................         0162      24.7749    $1,578.01  ...........      $315.60
51900..............  Repair bladder/vagina       ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      lesion.
51920..............  Close bladder-uterus        ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      fistula.
51925..............  Hysterectomy/bladder        ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      repair.
51940..............  Correction of bladder       ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      defect.
51960..............  Revision of bladder &       ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      bowel.
51980..............  Construct bladder opening.  ..................  C.................  ...........  ...........  ...........  ...........  ...........
51990..............  Laparo urethral suspension  ..................  T.................         0131      45.5317    $2,900.10    $1,001.89      $580.02
51992..............  Laparo sling operation....  ..................  T.................         0131      45.5317    $2,900.10    $1,001.89      $580.02
51999..............  Laparoscope proc, bla.....  ..................  T.................         0130      34.3958    $2,190.81      $659.53      $438.16
52000..............  Cystoscopy................  ..................  T.................         0160       5.9735      $380.48  ...........       $76.10
52001..............  Cystoscopy, removal of      CH................  T.................         0161      17.9420    $1,142.80      $241.15      $228.56
                      clots.
52005..............  Cystoscopy & ureter         ..................  T.................         0161      17.9420    $1,142.80      $241.15      $228.56
                      catheter.
52007..............  Cystoscopy and biopsy.....  CH................  T.................         0162      24.7749    $1,578.01  ...........      $315.60
52010..............  Cystoscopy & duct catheter  ..................  T.................         0160       5.9735      $380.48  ...........       $76.10
52204..............  Cystoscopy w/biopsy(s)....  ..................  T.................         0161      17.9420    $1,142.80      $241.15      $228.56
52214..............  Cystoscopy and treatment..  ..................  T.................         0162      24.7749    $1,578.01  ...........      $315.60
52224..............  Cystoscopy and treatment..  ..................  T.................         0162      24.7749    $1,578.01  ...........      $315.60
52234..............  Cystoscopy and treatment..  ..................  T.................         0162      24.7749    $1,578.01  ...........      $315.60
52235..............  Cystoscopy and treatment..  ..................  T.................         0162      24.7749    $1,578.01  ...........      $315.60
52240..............  Cystoscopy and treatment..  ..................  T.................         0162      24.7749    $1,578.01  ...........      $315.60
52250..............  Cystoscopy and radiotracer  ..................  T.................         0162      24.7749    $1,578.01  ...........      $315.60
52260..............  Cystoscopy and treatment..  ..................  T.................         0161      17.9420    $1,142.80      $241.15      $228.56
52265..............  Cystoscopy and treatment..  ..................  T.................         0160       5.9735      $380.48  ...........       $76.10
52270..............  Cystoscopy & revise         ..................  T.................         0161      17.9420    $1,142.80      $241.15      $228.56
                      urethra.
52275..............  Cystoscopy & revise         CH................  T.................         0162      24.7749    $1,578.01  ...........      $315.60
                      urethra.
52276..............  Cystoscopy and treatment..  CH................  T.................         0162      24.7749    $1,578.01  ...........      $315.60
52277..............  Cystoscopy and treatment..  ..................  T.................         0162      24.7749    $1,578.01  ...........      $315.60
52281..............  Cystoscopy and treatment..  ..................  T.................         0161      17.9420    $1,142.80      $241.15      $228.56
52282..............  Cystoscopy, implant stent.  ..................  T.................         0163      36.0774    $2,297.91  ...........      $459.58
52283..............  Cystoscopy and treatment..  CH................  T.................         0162      24.7749    $1,578.01  ...........      $315.60
52285..............  Cystoscopy and treatment..  ..................  T.................         0161      17.9420    $1,142.80      $241.15      $228.56
52290..............  Cystoscopy and treatment..  ..................  T.................         0161      17.9420    $1,142.80      $241.15      $228.56
52300..............  Cystoscopy and treatment..  CH................  T.................         0162      24.7749    $1,578.01  ...........      $315.60
52301..............  Cystoscopy and treatment..  CH................  T.................         0162      24.7749    $1,578.01  ...........      $315.60
52305..............  Cystoscopy and treatment..  CH................  T.................         0162      24.7749    $1,578.01  ...........      $315.60
52310..............  Cystoscopy and treatment..  CH................  T.................         0161      17.9420    $1,142.80      $241.15      $228.56
52315..............  Cystoscopy and treatment..  CH................  T.................         0162      24.7749    $1,578.01  ...........      $315.60
52317..............  Remove bladder stone......  ..................  T.................         0162      24.7749    $1,578.01  ...........      $315.60
52318..............  Remove bladder stone......  ..................  T.................         0162      24.7749    $1,578.01  ...........      $315.60
52320..............  Cystoscopy and treatment..  ..................  T.................         0162      24.7749    $1,578.01  ...........      $315.60
52325..............  Cystoscopy, stone removal.  ..................  T.................         0162      24.7749    $1,578.01  ...........      $315.60
52327..............  Cystoscopy, inject          ..................  T.................         0162      24.7749    $1,578.01  ...........      $315.60
                      material.
52330..............  Cystoscopy and treatment..  ..................  T.................         0162      24.7749    $1,578.01  ...........      $315.60
52332..............  Cystoscopy and treatment..  ..................  T.................         0162      24.7749    $1,578.01  ...........      $315.60
52334..............  Create passage to kidney..  ..................  T.................         0162      24.7749    $1,578.01  ...........      $315.60
52341..............  Cysto w/ureter stricture    ..................  T.................         0162      24.7749    $1,578.01  ...........      $315.60
                      tx.
52342..............  Cysto w/up stricture tx...  ..................  T.................         0162      24.7749    $1,578.01  ...........      $315.60
52343..............  Cysto w/renal stricture tx  ..................  T.................         0162      24.7749    $1,578.01  ...........      $315.60
52344..............  Cysto/uretero, stricture    ..................  T.................         0162      24.7749    $1,578.01  ...........      $315.60
                      tx.
52345..............  Cysto/uretero w/up          ..................  T.................         0162      24.7749    $1,578.01  ...........      $315.60
                      stricture.
52346..............  Cystouretero w/renal        ..................  T.................         0162      24.7749    $1,578.01  ...........      $315.60
                      strict.

[[Page 67053]]

 
52351..............  Cystouretero & or           CH................  T.................         0162      24.7749    $1,578.01  ...........      $315.60
                      pyeloscope.
52352..............  Cystouretero w/stone        ..................  T.................         0162      24.7749    $1,578.01  ...........      $315.60
                      remove.
52353..............  Cystouretero w/lithotripsy  ..................  T.................         0163      36.0774    $2,297.91  ...........      $459.58
52354..............  Cystouretero w/biopsy.....  ..................  T.................         0162      24.7749    $1,578.01  ...........      $315.60
52355..............  Cystouretero w/excise       ..................  T.................         0162      24.7749    $1,578.01  ...........      $315.60
                      tumor.
52400..............  Cystouretero w/congen repr  ..................  T.................         0162      24.7749    $1,578.01  ...........      $315.60
52402..............  Cystourethro cut ejacul     ..................  T.................         0162      24.7749    $1,578.01  ...........      $315.60
                      duct.
52450..............  Incision of prostate......  ..................  T.................         0162      24.7749    $1,578.01  ...........      $315.60
52500..............  Revision of bladder neck..  ..................  T.................         0162      24.7749    $1,578.01  ...........      $315.60
52510..............  Dilation prostatic urethra  CH................  D.................  ...........  ...........  ...........  ...........  ...........
52601..............  Prostatectomy (TURP)......  ..................  T.................         0163      36.0774    $2,297.91  ...........      $459.58
52606..............  Control postop bleeding...  ..................  T.................         0162      24.7749    $1,578.01  ...........      $315.60
52612..............  Prostatectomy, first stage  ..................  T.................         0163      36.0774    $2,297.91  ...........      $459.58
52614..............  Prostatectomy, second       ..................  T.................         0163      36.0774    $2,297.91  ...........      $459.58
                      stage.
52620..............  Remove residual prostate..  ..................  T.................         0163      36.0774    $2,297.91  ...........      $459.58
52630..............  Remove prostate regrowth..  ..................  T.................         0163      36.0774    $2,297.91  ...........      $459.58
52640..............  Relieve bladder             ..................  T.................         0162      24.7749    $1,578.01  ...........      $315.60
                      contracture.
52647..............  Laser surgery of prostate.  ..................  T.................         0429      45.2042    $2,879.24  ...........      $575.85
52648..............  Laser surgery of prostate.  ..................  T.................         0429      45.2042    $2,879.24  ...........      $575.85
52649..............  Prostate laser enucleation  NI................  T.................         0429      45.2042    $2,879.24  ...........      $575.85
52700..............  Drainage of prostate        ..................  T.................         0162      24.7749    $1,578.01  ...........      $315.60
                      abscess.
53000..............  Incision of urethra.......  ..................  T.................         0166      19.1505    $1,219.77  ...........      $243.95
53010..............  Incision of urethra.......  ..................  T.................         0166      19.1505    $1,219.77  ...........      $243.95
53020..............  Incision of urethra.......  ..................  T.................         0166      19.1505    $1,219.77  ...........      $243.95
53025..............  Incision of urethra.......  ..................  T.................         0166      19.1505    $1,219.77  ...........      $243.95
53040..............  Drainage of urethra         ..................  T.................         0166      19.1505    $1,219.77  ...........      $243.95
                      abscess.
53060..............  Drainage of urethra         ..................  T.................         0166      19.1505    $1,219.77  ...........      $243.95
                      abscess.
53080..............  Drainage of urinary         ..................  T.................         0166      19.1505    $1,219.77  ...........      $243.95
                      leakage.
53085..............  Drainage of urinary         ..................  T.................         0166      19.1505    $1,219.77  ...........      $243.95
                      leakage.
53200..............  Biopsy of urethra.........  ..................  T.................         0166      19.1505    $1,219.77  ...........      $243.95
53210..............  Removal of urethra........  ..................  T.................         0168      29.7864    $1,897.21      $388.16      $379.44
53215..............  Removal of urethra........  ..................  T.................         0166      19.1505    $1,219.77  ...........      $243.95
53220..............  Treatment of urethra        ..................  T.................         0168      29.7864    $1,897.21      $388.16      $379.44
                      lesion.
53230..............  Removal of urethra lesion.  ..................  T.................         0168      29.7864    $1,897.21      $388.16      $379.44
53235..............  Removal of urethra lesion.  ..................  T.................         0166      19.1505    $1,219.77  ...........      $243.95
53240..............  Surgery for urethra pouch.  ..................  T.................         0168      29.7864    $1,897.21      $388.16      $379.44
53250..............  Removal of urethra gland..  ..................  T.................         0166      19.1505    $1,219.77  ...........      $243.95
53260..............  Treatment of urethra        ..................  T.................         0166      19.1505    $1,219.77  ...........      $243.95
                      lesion.
53265..............  Treatment of urethra        ..................  T.................         0166      19.1505    $1,219.77  ...........      $243.95
                      lesion.
53270..............  Removal of urethra gland..  ..................  T.................         0166      19.1505    $1,219.77  ...........      $243.95
53275..............  Repair of urethra defect..  ..................  T.................         0166      19.1505    $1,219.77  ...........      $243.95
53400..............  Revise urethra, stage 1...  ..................  T.................         0168      29.7864    $1,897.21      $388.16      $379.44
53405..............  Revise urethra, stage 2...  ..................  T.................         0168      29.7864    $1,897.21      $388.16      $379.44
53410..............  Reconstruction of urethra.  ..................  T.................         0168      29.7864    $1,897.21      $388.16      $379.44
53415..............  Reconstruction of urethra.  ..................  C.................  ...........  ...........  ...........  ...........  ...........
53420..............  Reconstruct urethra, stage  ..................  T.................         0168      29.7864    $1,897.21      $388.16      $379.44
                      1.
53425..............  Reconstruct urethra, stage  ..................  T.................         0168      29.7864    $1,897.21      $388.16      $379.44
                      2.
53430..............  Reconstruction of urethra.  ..................  T.................         0168      29.7864    $1,897.21      $388.16      $379.44
53431..............  Reconstruct urethra/        ..................  T.................         0168      29.7864    $1,897.21      $388.16      $379.44
                      bladder.
53440..............  Male sling procedure......  ..................  S.................         0385      83.6366    $5,327.15  ...........    $1,065.43
53442..............  Remove/revise male sling..  ..................  T.................         0168      29.7864    $1,897.21      $388.16      $379.44
53444..............  Insert tandem cuff........  ..................  S.................         0385      83.6366    $5,327.15  ...........    $1,065.43
53445..............  Insert uro/ves nck          ..................  S.................         0386     144.1246    $9,179.87  ...........    $1,835.97
                      sphincter.
53446..............  Remove uro sphincter......  ..................  T.................         0168      29.7864    $1,897.21      $388.16      $379.44
53447..............  Remove/replace ur           ..................  S.................         0386     144.1246    $9,179.87  ...........    $1,835.97
                      sphincter.
53448..............  Remov/replc ur sphinctr     ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      comp.
53449..............  Repair uro sphincter......  ..................  T.................         0168      29.7864    $1,897.21      $388.16      $379.44
53450..............  Revision of urethra.......  ..................  T.................         0168      29.7864    $1,897.21      $388.16      $379.44
53460..............  Revision of urethra.......  ..................  T.................         0166      19.1505    $1,219.77  ...........      $243.95
53500..............  Urethrlys, transvag w/      ..................  T.................         0168      29.7864    $1,897.21      $388.16      $379.44
                      scope.
53502..............  Repair of urethra injury..  ..................  T.................         0166      19.1505    $1,219.77  ...........      $243.95
53505..............  Repair of urethra injury..  ..................  T.................         0168      29.7864    $1,897.21      $388.16      $379.44
53510..............  Repair of urethra injury..  ..................  T.................         0166      19.1505    $1,219.77  ...........      $243.95
53515..............  Repair of urethra injury..  ..................  T.................         0168      29.7864    $1,897.21      $388.16      $379.44
53520..............  Repair of urethra defect..  ..................  T.................         0168      29.7864    $1,897.21      $388.16      $379.44
53600..............  Dilate urethra stricture..  ..................  T.................         0156       3.0469      $194.07  ...........       $38.81
53601..............  Dilate urethra stricture..  ..................  T.................         0126       1.0356       $65.96       $16.21       $13.19
53605..............  Dilate urethra stricture..  ..................  T.................         0161      17.9420    $1,142.80      $241.15      $228.56
53620..............  Dilate urethra stricture..  ..................  T.................         0165      19.3414    $1,231.93  ...........      $246.39
53621..............  Dilate urethra stricture..  ..................  T.................         0164       2.0077      $127.88  ...........       $25.58
53660..............  Dilation of urethra.......  ..................  T.................         0126       1.0356       $65.96       $16.21       $13.19
53661..............  Dilation of urethra.......  ..................  T.................         0126       1.0356       $65.96       $16.21       $13.19
53665..............  Dilation of urethra.......  ..................  T.................         0166      19.1505    $1,219.77  ...........      $243.95
53850..............  Prostatic microwave         CH................  T.................         0429      45.2042    $2,879.24  ...........      $575.85
                      thermotx.
53852..............  Prostatic rf thermotx.....  CH................  T.................         0429      45.2042    $2,879.24  ...........      $575.85
53853..............  Prostatic water thermother  ..................  T.................         0162      24.7749    $1,578.01  ...........      $315.60
53899..............  Urology surgery procedure.  ..................  T.................         0126       1.0356       $65.96       $16.21       $13.19
54000..............  Slitting of prepuce.......  ..................  T.................         0166      19.1505    $1,219.77  ...........      $243.95
54001..............  Slitting of prepuce.......  ..................  T.................         0166      19.1505    $1,219.77  ...........      $243.95
54015..............  Drain penis lesion........  ..................  T.................         0008      18.3197    $1,166.85  ...........      $233.37

[[Page 67054]]

 
54050..............  Destruction, penis          CH................  T.................         0015       1.4595       $92.96  ...........       $18.59
                      lesion(s).
54055..............  Destruction, penis          ..................  T.................         0017      19.9041    $1,267.77  ...........      $253.55
                      lesion(s).
54056..............  Cryosurgery, penis          CH................  T.................         0013       0.7930       $50.51  ...........       $10.10
                      lesion(s).
54057..............  Laser surg, penis           ..................  T.................         0017      19.9041    $1,267.77  ...........      $253.55
                      lesion(s).
54060..............  Excision of penis           ..................  T.................         0017      19.9041    $1,267.77  ...........      $253.55
                      lesion(s).
54065..............  Destruction, penis          CH................  T.................         0017      19.9041    $1,267.77  ...........      $253.55
                      lesion(s).
54100..............  Biopsy of penis...........  ..................  T.................         0021      16.1001    $1,025.48      $219.48      $205.10
54105..............  Biopsy of penis...........  ..................  T.................         0022      21.1098    $1,344.57      $354.45      $268.91
54110..............  Treatment of penis lesion.  ..................  T.................         0181      33.9306    $2,161.18      $621.82      $432.24
54111..............  Treat penis lesion, graft.  ..................  T.................         0181      33.9306    $2,161.18      $621.82      $432.24
54112..............  Treat penis lesion, graft.  ..................  T.................         0181      33.9306    $2,161.18      $621.82      $432.24
54115..............  Treatment of penis lesion.  ..................  T.................         0008      18.3197    $1,166.85  ...........      $233.37
54120..............  Partial removal of penis..  ..................  T.................         0181      33.9306    $2,161.18      $621.82      $432.24
54125..............  Removal of penis..........  ..................  C.................  ...........  ...........  ...........  ...........  ...........
54130..............  Remove penis & nodes......  ..................  C.................  ...........  ...........  ...........  ...........  ...........
54135..............  Remove penis & nodes......  ..................  C.................  ...........  ...........  ...........  ...........  ...........
54150..............  Circumcision w/regionl      CH................  T.................         0183      22.3251    $1,421.97  ...........      $284.39
                      block.
54160..............  Circumcision, neonate.....  CH................  T.................         0183      22.3251    $1,421.97  ...........      $284.39
54161..............  Circum 28 days or older...  CH................  T.................         0183      22.3251    $1,421.97  ...........      $284.39
54162..............  Lysis penil circumic        CH................  T.................         0183      22.3251    $1,421.97  ...........      $284.39
                      lesion.
54163..............  Repair of circumcision....  CH................  T.................         0183      22.3251    $1,421.97  ...........      $284.39
54164..............  Frenulotomy of penis......  CH................  T.................         0183      22.3251    $1,421.97  ...........      $284.39
54200..............  Treatment of penis lesion.  ..................  T.................         0164       2.0077      $127.88  ...........       $25.58
54205..............  Treatment of penis lesion.  ..................  T.................         0181      33.9306    $2,161.18      $621.82      $432.24
54220..............  Treatment of penis lesion.  ..................  T.................         0164       2.0077      $127.88  ...........       $25.58
54230..............  Prepare penis study.......  ..................  N.................  ...........  ...........  ...........  ...........  ...........
54231..............  Dynamic cavernosometry....  ..................  T.................         0165      19.3414    $1,231.93  ...........      $246.39
54235..............  Penile injection..........  ..................  T.................         0164       2.0077      $127.88  ...........       $25.58
54240..............  Penis study...............  ..................  T.................         0126       1.0356       $65.96       $16.21       $13.19
54250..............  Penis study...............  ..................  T.................         0164       2.0077      $127.88  ...........       $25.58
54300..............  Revision of penis.........  ..................  T.................         0181      33.9306    $2,161.18      $621.82      $432.24
54304..............  Revision of penis.........  ..................  T.................         0181      33.9306    $2,161.18      $621.82      $432.24
54308..............  Reconstruction of urethra.  ..................  T.................         0181      33.9306    $2,161.18      $621.82      $432.24
54312..............  Reconstruction of urethra.  ..................  T.................         0181      33.9306    $2,161.18      $621.82      $432.24
54316..............  Reconstruction of urethra.  ..................  T.................         0181      33.9306    $2,161.18      $621.82      $432.24
54318..............  Reconstruction of urethra.  ..................  T.................         0181      33.9306    $2,161.18      $621.82      $432.24
54322..............  Reconstruction of urethra.  ..................  T.................         0181      33.9306    $2,161.18      $621.82      $432.24
54324..............  Reconstruction of urethra.  ..................  T.................         0181      33.9306    $2,161.18      $621.82      $432.24
54326..............  Reconstruction of urethra.  ..................  T.................         0181      33.9306    $2,161.18      $621.82      $432.24
54328..............  Revise penis/urethra......  ..................  T.................         0181      33.9306    $2,161.18      $621.82      $432.24
54332..............  Revise penis/urethra......  ..................  C.................  ...........  ...........  ...........  ...........  ...........
54336..............  Revise penis/urethra......  ..................  C.................  ...........  ...........  ...........  ...........  ...........
54340..............  Secondary urethral surgery  ..................  T.................         0181      33.9306    $2,161.18      $621.82      $432.24
54344..............  Secondary urethral surgery  ..................  T.................         0181      33.9306    $2,161.18      $621.82      $432.24
54348..............  Secondary urethral surgery  ..................  T.................         0181      33.9306    $2,161.18      $621.82      $432.24
54352..............  Reconstruct urethra/penis.  ..................  T.................         0181      33.9306    $2,161.18      $621.82      $432.24
54360..............  Penis plastic surgery.....  ..................  T.................         0181      33.9306    $2,161.18      $621.82      $432.24
54380..............  Repair penis..............  ..................  T.................         0181      33.9306    $2,161.18      $621.82      $432.24
54385..............  Repair penis..............  ..................  T.................         0181      33.9306    $2,161.18      $621.82      $432.24
54390..............  Repair penis and bladder..  ..................  C.................  ...........  ...........  ...........  ...........  ...........
54400..............  Insert semi-rigid           ..................  S.................         0385      83.6366    $5,327.15  ...........    $1,065.43
                      prosthesis.
54401..............  Insert self-contd           ..................  S.................         0386     144.1246    $9,179.87  ...........    $1,835.97
                      prosthesis.
54405..............  Insert multi-comp penis     ..................  S.................         0386     144.1246    $9,179.87  ...........    $1,835.97
                      pros.
54406..............  Remove muti-comp penis      ..................  T.................         0181      33.9306    $2,161.18      $621.82      $432.24
                      pros.
54408..............  Repair multi-comp penis     ..................  T.................         0181      33.9306    $2,161.18      $621.82      $432.24
                      pros.
54410..............  Remove/replace penis        ..................  S.................         0386     144.1246    $9,179.87  ...........    $1,835.97
                      prosth.
54411..............  Remov/replc penis pros,     ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      comp.
54415..............  Remove self-contd penis     ..................  T.................         0181      33.9306    $2,161.18      $621.82      $432.24
                      pros.
54416..............  Remv/repl penis contain     ..................  S.................         0386     144.1246    $9,179.87  ...........    $1,835.97
                      pros.
54417..............  Remv/replc penis pros,      ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      compl.
54420..............  Revision of penis.........  ..................  T.................         0181      33.9306    $2,161.18      $621.82      $432.24
54430..............  Revision of penis.........  ..................  C.................  ...........  ...........  ...........  ...........  ...........
54435..............  Revision of penis.........  ..................  T.................         0181      33.9306    $2,161.18      $621.82      $432.24
54440..............  Repair of penis...........  ..................  T.................         0181      33.9306    $2,161.18      $621.82      $432.24
54450..............  Preputial stretching......  ..................  T.................         0156       3.0469      $194.07  ...........       $38.81
54500..............  Biopsy of testis..........  ..................  T.................         0037      13.5764      $864.74      $228.76      $172.95
54505..............  Biopsy of testis..........  ..................  T.................         0183      22.3251    $1,421.97  ...........      $284.39
54512..............  Excise lesion testis......  ..................  T.................         0183      22.3251    $1,421.97  ...........      $284.39
54520..............  Removal of testis.........  ..................  T.................         0183      22.3251    $1,421.97  ...........      $284.39
54522..............  Orchiectomy, partial......  ..................  T.................         0183      22.3251    $1,421.97  ...........      $284.39
54530..............  Removal of testis.........  ..................  T.................         0154      30.6788    $1,954.06      $464.85      $390.81
54535..............  Extensive testis surgery..  ..................  C.................  ...........  ...........  ...........  ...........  ...........
54550..............  Exploration for testis....  ..................  T.................         0154      30.6788    $1,954.06      $464.85      $390.81
54560..............  Exploration for testis....  ..................  T.................         0183      22.3251    $1,421.97  ...........      $284.39
54600..............  Reduce testis torsion.....  ..................  T.................         0183      22.3251    $1,421.97  ...........      $284.39
54620..............  Suspension of testis......  ..................  T.................         0183      22.3251    $1,421.97  ...........      $284.39
54640..............  Suspension of testis......  ..................  T.................         0154      30.6788    $1,954.06      $464.85      $390.81
54650..............  Orchiopexy (Fowler-         ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      Stephens).
54660..............  Revision of testis........  ..................  T.................         0183      22.3251    $1,421.97  ...........      $284.39
54670..............  Repair testis injury......  ..................  T.................         0183      22.3251    $1,421.97  ...........      $284.39

[[Page 67055]]

 
54680..............  Relocation of testis(es)..  ..................  T.................         0183      22.3251    $1,421.97  ...........      $284.39
54690..............  Laparoscopy, orchiectomy..  ..................  T.................         0131      45.5317    $2,900.10    $1,001.89      $580.02
54692..............  Laparoscopy, orchiopexy...  ..................  T.................         0132      69.6652    $4,437.26    $1,239.22      $887.45
54699..............  Laparoscope proc, testis..  ..................  T.................         0130      34.3958    $2,190.81      $659.53      $438.16
54700..............  Drainage of scrotum.......  ..................  T.................         0183      22.3251    $1,421.97  ...........      $284.39
54800..............  Biopsy of epididymis......  ..................  T.................         0004       4.3270      $275.60  ...........       $55.12
54830..............  Remove epididymis lesion..  ..................  T.................         0183      22.3251    $1,421.97  ...........      $284.39
54840..............  Remove epididymis lesion..  ..................  T.................         0183      22.3251    $1,421.97  ...........      $284.39
54860..............  Removal of epididymis.....  ..................  T.................         0183      22.3251    $1,421.97  ...........      $284.39
54861..............  Removal of epididymis.....  ..................  T.................         0183      22.3251    $1,421.97  ...........      $284.39
54865..............  Explore epididymis........  ..................  T.................         0183      22.3251    $1,421.97  ...........      $284.39
54900..............  Fusion of spermatic ducts.  ..................  T.................         0183      22.3251    $1,421.97  ...........      $284.39
54901..............  Fusion of spermatic ducts.  ..................  T.................         0183      22.3251    $1,421.97  ...........      $284.39
55000..............  Drainage of hydrocele.....  ..................  T.................         0004       4.3270      $275.60  ...........       $55.12
55040..............  Removal of hydrocele......  ..................  T.................         0154      30.6788    $1,954.06      $464.85      $390.81
55041..............  Removal of hydroceles.....  ..................  T.................         0154      30.6788    $1,954.06      $464.85      $390.81
55060..............  Repair of hydrocele.......  ..................  T.................         0183      22.3251    $1,421.97  ...........      $284.39
55100..............  Drainage of scrotum         ..................  T.................         0007      11.5594      $736.26  ...........      $147.25
                      abscess.
55110..............  Explore scrotum...........  ..................  T.................         0183      22.3251    $1,421.97  ...........      $284.39
55120..............  Removal of scrotum lesion.  ..................  T.................         0183      22.3251    $1,421.97  ...........      $284.39
55150..............  Removal of scrotum........  ..................  T.................         0183      22.3251    $1,421.97  ...........      $284.39
55175..............  Revision of scrotum.......  ..................  T.................         0183      22.3251    $1,421.97  ...........      $284.39
55180..............  Revision of scrotum.......  ..................  T.................         0183      22.3251    $1,421.97  ...........      $284.39
55200..............  Incision of sperm duct....  ..................  T.................         0183      22.3251    $1,421.97  ...........      $284.39
55250..............  Removal of sperm duct(s)..  ..................  T.................         0183      22.3251    $1,421.97  ...........      $284.39
55300..............  Prepare, sperm duct x-ray.  ..................  N.................  ...........  ...........  ...........  ...........  ...........
55400..............  Repair of sperm duct......  ..................  T.................         0183      22.3251    $1,421.97  ...........      $284.39
55450..............  Ligation of sperm duct....  ..................  T.................         0183      22.3251    $1,421.97  ...........      $284.39
55500..............  Removal of hydrocele......  ..................  T.................         0183      22.3251    $1,421.97  ...........      $284.39
55520..............  Removal of sperm cord       ..................  T.................         0183      22.3251    $1,421.97  ...........      $284.39
                      lesion.
55530..............  Revise spermatic cord       ..................  T.................         0183      22.3251    $1,421.97  ...........      $284.39
                      veins.
55535..............  Revise spermatic cord       ..................  T.................         0154      30.6788    $1,954.06      $464.85      $390.81
                      veins.
55540..............  Revise hernia & sperm       ..................  T.................         0154      30.6788    $1,954.06      $464.85      $390.81
                      veins.
55550..............  Laparo ligate spermatic     ..................  T.................         0131      45.5317    $2,900.10    $1,001.89      $580.02
                      vein.
55559..............  Laparo proc, spermatic      ..................  T.................         0130      34.3958    $2,190.81      $659.53      $438.16
                      cord.
55600..............  Incise sperm duct pouch...  ..................  T.................         0183      22.3251    $1,421.97  ...........      $284.39
55605..............  Incise sperm duct pouch...  ..................  C.................  ...........  ...........  ...........  ...........  ...........
55650..............  Remove sperm duct pouch...  ..................  C.................  ...........  ...........  ...........  ...........  ...........
55680..............  Remove sperm pouch lesion.  ..................  T.................         0183      22.3251    $1,421.97  ...........      $284.39
55700..............  Biopsy of prostate........  ..................  T.................         0184      11.0338      $702.79  ...........      $140.56
55705..............  Biopsy of prostate........  ..................  T.................         0184      11.0338      $702.79  ...........      $140.56
55720..............  Drainage of prostate        ..................  T.................         0162      24.7749    $1,578.01  ...........      $315.60
                      abscess.
55725..............  Drainage of prostate        ..................  T.................         0162      24.7749    $1,578.01  ...........      $315.60
                      abscess.
55801..............  Removal of prostate.......  ..................  C.................  ...........  ...........  ...........  ...........  ...........
55810..............  Extensive prostate surgery  ..................  C.................  ...........  ...........  ...........  ...........  ...........
55812..............  Extensive prostate surgery  ..................  C.................  ...........  ...........  ...........  ...........  ...........
55815..............  Extensive prostate surgery  ..................  C.................  ...........  ...........  ...........  ...........  ...........
55821..............  Removal of prostate.......  ..................  C.................  ...........  ...........  ...........  ...........  ...........
55831..............  Removal of prostate.......  ..................  C.................  ...........  ...........  ...........  ...........  ...........
55840..............  Extensive prostate surgery  ..................  C.................  ...........  ...........  ...........  ...........  ...........
55842..............  Extensive prostate surgery  ..................  C.................  ...........  ...........  ...........  ...........  ...........
55845..............  Extensive prostate surgery  ..................  C.................  ...........  ...........  ...........  ...........  ...........
55860..............  Surgical exposure,          ..................  T.................         0165      19.3414    $1,231.93  ...........      $246.39
                      prostate.
55862..............  Extensive prostate surgery  ..................  C.................  ...........  ...........  ...........  ...........  ...........
55865..............  Extensive prostate surgery  ..................  C.................  ...........  ...........  ...........  ...........  ...........
55866..............  Laparo radical              ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      prostatectomy.
55870..............  Electroejaculation........  CH................  T.................         0189       2.7584      $175.69  ...........       $35.14
55873..............  Cryoablate prostate.......  ..................  T.................         0674     122.7133    $7,816.10  ...........    $1,563.22
55875..............  Transperi needle place,     CH................  Q.................         0163      36.0774    $2,297.91  ...........      $459.58
                      pros.
55876..............  Place rt device/marker,     ..................  T.................         0156       3.0469      $194.07  ...........       $38.81
                      pros.
55899..............  Genital surgery procedure.  ..................  T.................         0126       1.0356       $65.96       $16.21       $13.19
55920..............  Place needles pelvic for    NI................  T.................         0153      25.6947    $1,636.60      $397.95      $327.32
                      rt.
55970..............  Sex transformation, M to F  ..................  E.................  ...........  ...........  ...........  ...........  ...........
55980..............  Sex transformation, F to M  ..................  E.................  ...........  ...........  ...........  ...........  ...........
56405..............  I & D of vulva/perineum...  ..................  T.................         0189       2.7584      $175.69  ...........       $35.14
56420..............  Drainage of gland abscess.  ..................  T.................         0188       1.3520       $86.11  ...........       $17.22
56440..............  Surgery for vulva lesion..  CH................  T.................         0193      19.0203    $1,211.48  ...........      $242.30
56441..............  Lysis of labial lesion(s).  ..................  T.................         0193      19.0203    $1,211.48  ...........      $242.30
56442..............  Hymenotomy................  ..................  T.................         0193      19.0203    $1,211.48  ...........      $242.30
56501..............  Destroy, vulva lesions,     ..................  T.................         0017      19.9041    $1,267.77  ...........      $253.55
                      sim.
56515..............  Destroy vulva lesion/s      CH................  T.................         0017      19.9041    $1,267.77  ...........      $253.55
                      compl.
56605..............  Biopsy of vulva/perineum..  CH................  T.................         0189       2.7584      $175.69  ...........       $35.14
56606..............  Biopsy of vulva/perineum..  CH................  T.................         0188       1.3520       $86.11  ...........       $17.22
56620..............  Partial removal of vulva..  CH................  T.................         0193      19.0203    $1,211.48  ...........      $242.30
56625..............  Complete removal of vulva.  CH................  T.................         0193      19.0203    $1,211.48  ...........      $242.30
56630..............  Extensive vulva surgery...  ..................  C.................  ...........  ...........  ...........  ...........  ...........
56631..............  Extensive vulva surgery...  ..................  C.................  ...........  ...........  ...........  ...........  ...........
56632..............  Extensive vulva surgery...  ..................  C.................  ...........  ...........  ...........  ...........  ...........
56633..............  Extensive vulva surgery...  ..................  C.................  ...........  ...........  ...........  ...........  ...........
56634..............  Extensive vulva surgery...  ..................  C.................  ...........  ...........  ...........  ...........  ...........

[[Page 67056]]

 
56637..............  Extensive vulva surgery...  ..................  C.................  ...........  ...........  ...........  ...........  ...........
56640..............  Extensive vulva surgery...  ..................  C.................  ...........  ...........  ...........  ...........  ...........
56700..............  Partial removal of hymen..  CH................  T.................         0193      19.0203    $1,211.48  ...........      $242.30
56740..............  Remove vagina gland lesion  CH................  T.................         0193      19.0203    $1,211.48  ...........      $242.30
56800..............  Repair of vagina..........  CH................  T.................         0193      19.0203    $1,211.48  ...........      $242.30
56805..............  Repair clitoris...........  ..................  T.................         0193      19.0203    $1,211.48  ...........      $242.30
56810..............  Repair of perineum........  CH................  T.................         0193      19.0203    $1,211.48  ...........      $242.30
56820..............  Exam of vulva w/scope.....  ..................  T.................         0188       1.3520       $86.11  ...........       $17.22
56821..............  Exam/biopsy of vulva w/     CH................  T.................         0188       1.3520       $86.11  ...........       $17.22
                      scope.
57000..............  Exploration of vagina.....  ..................  T.................         0193      19.0203    $1,211.48  ...........      $242.30
57010..............  Drainage of pelvic abscess  ..................  T.................         0193      19.0203    $1,211.48  ...........      $242.30
57020..............  Drainage of pelvic fluid..  ..................  T.................         0192       6.0783      $387.15  ...........       $77.43
57022..............  I & d vaginal hematoma, pp  ..................  T.................         0007      11.5594      $736.26  ...........      $147.25
57023..............  I & d vag hematoma, non-ob  ..................  T.................         0008      18.3197    $1,166.85  ...........      $233.37
57061..............  Destroy vag lesions,        CH................  T.................         0193      19.0203    $1,211.48  ...........      $242.30
                      simple.
57065..............  Destroy vag lesions,        CH................  T.................         0193      19.0203    $1,211.48  ...........      $242.30
                      complex.
57100..............  Biopsy of vagina..........  ..................  T.................         0192       6.0783      $387.15  ...........       $77.43
57105..............  Biopsy of vagina..........  CH................  T.................         0193      19.0203    $1,211.48  ...........      $242.30
57106..............  Remove vagina wall,         CH................  T.................         0193      19.0203    $1,211.48  ...........      $242.30
                      partial.
57107..............  Remove vagina tissue, part  ..................  T.................         0195      32.4237    $2,065.20      $483.80      $413.04
57109..............  Vaginectomy partial w/      ..................  T.................         0195      32.4237    $2,065.20      $483.80      $413.04
                      nodes.
57110..............  Remove vagina wall,         ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      complete.
57111..............  Remove vagina tissue,       ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      compl.
57112..............  Vaginectomy w/nodes, compl  ..................  C.................  ...........  ...........  ...........  ...........  ...........
57120..............  Closure of vagina.........  ..................  T.................         0195      32.4237    $2,065.20      $483.80      $413.04
57130..............  Remove vagina lesion......  CH................  T.................         0193      19.0203    $1,211.48  ...........      $242.30
57135..............  Remove vagina lesion......  CH................  T.................         0193      19.0203    $1,211.48  ...........      $242.30
57150..............  Treat vagina infection....  CH................  T.................         0188       1.3520       $86.11  ...........       $17.22
57155..............  Insert uteri tandems/       ..................  T.................         0192       6.0783      $387.15  ...........       $77.43
                      ovoids.
57160..............  Insert pessary/other        ..................  T.................         0188       1.3520       $86.11  ...........       $17.22
                      device.
57170..............  Fitting of diaphragm/cap..  ..................  T.................         0191       0.1309        $8.34        $2.36        $1.67
57180..............  Treat vaginal bleeding....  CH................  T.................         0188       1.3520       $86.11  ...........       $17.22
57200..............  Repair of vagina..........  CH................  T.................         0193      19.0203    $1,211.48  ...........      $242.30
57210..............  Repair vagina/perineum....  CH................  T.................         0193      19.0203    $1,211.48  ...........      $242.30
57220..............  Revision of urethra.......  ..................  T.................         0202      42.7099    $2,720.36      $981.50      $544.07
57230..............  Repair of urethral lesion.  ..................  T.................         0195      32.4237    $2,065.20      $483.80      $413.04
57240..............  Repair bladder & vagina...  ..................  T.................         0195      32.4237    $2,065.20      $483.80      $413.04
57250..............  Repair rectum & vagina....  ..................  T.................         0195      32.4237    $2,065.20      $483.80      $413.04
57260..............  Repair of vagina..........  ..................  T.................         0195      32.4237    $2,065.20      $483.80      $413.04
57265..............  Extensive repair of vagina  ..................  T.................         0202      42.7099    $2,720.36      $981.50      $544.07
57267..............  Insert mesh/pelvic flr      ..................  T.................         0195      32.4237    $2,065.20      $483.80      $413.04
                      addon.
57268..............  Repair of bowel bulge.....  ..................  T.................         0195      32.4237    $2,065.20      $483.80      $413.04
57270..............  Repair of bowel pouch.....  ..................  C.................  ...........  ...........  ...........  ...........  ...........
57280..............  Suspension of vagina......  ..................  C.................  ...........  ...........  ...........  ...........  ...........
57282..............  Colpopexy, extraperitoneal  ..................  T.................         0202      42.7099    $2,720.36      $981.50      $544.07
57283..............  Colpopexy, intraperitoneal  ..................  T.................         0202      42.7099    $2,720.36      $981.50      $544.07
57284..............  Repair paravag defect,      ..................  T.................         0202      42.7099    $2,720.36      $981.50      $544.07
                      open.
57285..............  Repair paravag defect, vag  NI................  T.................         0195      32.4237    $2,065.20      $483.80      $413.04
57287..............  Revise/remove sling repair  ..................  T.................         0195      32.4237    $2,065.20      $483.80      $413.04
57288..............  Repair bladder defect.....  ..................  T.................         0202      42.7099    $2,720.36      $981.50      $544.07
57289..............  Repair bladder & vagina...  ..................  T.................         0195      32.4237    $2,065.20      $483.80      $413.04
57291..............  Construction of vagina....  ..................  T.................         0195      32.4237    $2,065.20      $483.80      $413.04
57292..............  Construct vagina with       ..................  T.................         0195      32.4237    $2,065.20      $483.80      $413.04
                      graft.
57295..............  Revise vag graft via        CH................  T.................         0193      19.0203    $1,211.48  ...........      $242.30
                      vagina.
57296..............  Revise vag graft, open abd  ..................  C.................  ...........  ...........  ...........  ...........  ...........
57300..............  Repair rectum-vagina        ..................  T.................         0195      32.4237    $2,065.20      $483.80      $413.04
                      fistula.
57305..............  Repair rectum-vagina        ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      fistula.
57307..............  Fistula repair & colostomy  ..................  C.................  ...........  ...........  ...........  ...........  ...........
57308..............  Fistula repair,             ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      transperine.
57310..............  Repair urethrovaginal       ..................  T.................         0202      42.7099    $2,720.36      $981.50      $544.07
                      lesion.
57311..............  Repair urethrovaginal       ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      lesion.
57320..............  Repair bladder-vagina       ..................  T.................         0195      32.4237    $2,065.20      $483.80      $413.04
                      lesion.
57330..............  Repair bladder-vagina       ..................  T.................         0195      32.4237    $2,065.20      $483.80      $413.04
                      lesion.
57335..............  Repair vagina.............  ..................  T.................         0195      32.4237    $2,065.20      $483.80      $413.04
57400..............  Dilation of vagina........  CH................  T.................         0193      19.0203    $1,211.48  ...........      $242.30
57410..............  Pelvic examination........  ..................  T.................         0193      19.0203    $1,211.48  ...........      $242.30
57415..............  Remove vaginal foreign      CH................  T.................         0193      19.0203    $1,211.48  ...........      $242.30
                      body.
57420..............  Exam of vagina w/scope....  ..................  T.................         0189       2.7584      $175.69  ...........       $35.14
57421..............  Exam/biopsy of vag w/scope  ..................  T.................         0189       2.7584      $175.69  ...........       $35.14
57423..............  Repair paravag defect, lap  NI................  T.................         0202      42.7099    $2,720.36      $981.50      $544.07
57425..............  Laparoscopy, surg,          ..................  T.................         0130      34.3958    $2,190.81      $659.53      $438.16
                      colpopexy.
57452..............  Exam of cervix w/scope....  CH................  T.................         0189       2.7584      $175.69  ...........       $35.14
57454..............  Bx/curett of cervix w/      ..................  T.................         0189       2.7584      $175.69  ...........       $35.14
                      scope.
57455..............  Biopsy of cervix w/scope..  ..................  T.................         0189       2.7584      $175.69  ...........       $35.14
57456..............  Endocerv curettage w/scope  ..................  T.................         0189       2.7584      $175.69  ...........       $35.14
57460..............  Bx of cervix w/scope, leep  ..................  T.................         0193      19.0203    $1,211.48  ...........      $242.30
57461..............  Conz of cervix w/scope,     CH................  T.................         0193      19.0203    $1,211.48  ...........      $242.30
                      leep.
57500..............  Biopsy of cervix..........  CH................  T.................         0192       6.0783      $387.15  ...........       $77.43
57505..............  Endocervical curettage....  CH................  T.................         0192       6.0783      $387.15  ...........       $77.43
57510..............  Cauterization of cervix...  ..................  T.................         0193      19.0203    $1,211.48  ...........      $242.30

[[Page 67057]]

 
57511..............  Cryocautery of cervix.....  ..................  T.................         0188       1.3520       $86.11  ...........       $17.22
57513..............  Laser surgery of cervix...  ..................  T.................         0193      19.0203    $1,211.48  ...........      $242.30
57520..............  Conization of cervix......  CH................  T.................         0193      19.0203    $1,211.48  ...........      $242.30
57522..............  Conization of cervix......  CH................  T.................         0193      19.0203    $1,211.48  ...........      $242.30
57530..............  Removal of cervix.........  ..................  T.................         0195      32.4237    $2,065.20      $483.80      $413.04
57531..............  Removal of cervix, radical  ..................  C.................  ...........  ...........  ...........  ...........  ...........
57540..............  Removal of residual cervix  ..................  C.................  ...........  ...........  ...........  ...........  ...........
57545..............  Remove cervix/repair        ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      pelvis.
57550..............  Removal of residual cervix  ..................  T.................         0195      32.4237    $2,065.20      $483.80      $413.04
57555..............  Remove cervix/repair        ..................  T.................         0195      32.4237    $2,065.20      $483.80      $413.04
                      vagina.
57556..............  Remove cervix, repair       ..................  T.................         0202      42.7099    $2,720.36      $981.50      $544.07
                      bowel.
57558..............  D&c of cervical stump.....  CH................  T.................         0193      19.0203    $1,211.48  ...........      $242.30
57700..............  Revision of cervix........  CH................  T.................         0193      19.0203    $1,211.48  ...........      $242.30
57720..............  Revision of cervix........  CH................  T.................         0193      19.0203    $1,211.48  ...........      $242.30
57800..............  Dilation of cervical canal  ..................  T.................         0193      19.0203    $1,211.48  ...........      $242.30
58100..............  Biopsy of uterus lining...  ..................  T.................         0188       1.3520       $86.11  ...........       $17.22
58110..............  Bx done w/colposcopy add-   CH................  N.................  ...........  ...........  ...........  ...........  ...........
                      on.
58120..............  Dilation and curettage....  CH................  T.................         0193      19.0203    $1,211.48  ...........      $242.30
58140..............  Myomectomy abdom method...  ..................  C.................  ...........  ...........  ...........  ...........  ...........
58145..............  Myomectomy vag method.....  ..................  T.................         0195      32.4237    $2,065.20      $483.80      $413.04
58146..............  Myomectomy abdom complex..  ..................  C.................  ...........  ...........  ...........  ...........  ...........
58150..............  Total hysterectomy........  ..................  C.................  ...........  ...........  ...........  ...........  ...........
58152..............  Total hysterectomy........  ..................  C.................  ...........  ...........  ...........  ...........  ...........
58180..............  Partial hysterectomy......  ..................  C.................  ...........  ...........  ...........  ...........  ...........
58200..............  Extensive hysterectomy....  ..................  C.................  ...........  ...........  ...........  ...........  ...........
58210..............  Extensive hysterectomy....  ..................  C.................  ...........  ...........  ...........  ...........  ...........
58240..............  Removal of pelvis contents  ..................  C.................  ...........  ...........  ...........  ...........  ...........
58260..............  Vaginal hysterectomy......  ..................  T.................         0195      32.4237    $2,065.20      $483.80      $413.04
58262..............  Vag hyst including t/o....  ..................  T.................         0195      32.4237    $2,065.20      $483.80      $413.04
58263..............  Vag hyst w/t/o & vag        ..................  T.................         0195      32.4237    $2,065.20      $483.80      $413.04
                      repair.
58267..............  Vag hyst w/urinary repair.  ..................  C.................  ...........  ...........  ...........  ...........  ...........
58270..............  Vag hyst w/enterocele       ..................  T.................         0195      32.4237    $2,065.20      $483.80      $413.04
                      repair.
58275..............  Hysterectomy/revise vagina  ..................  C.................  ...........  ...........  ...........  ...........  ...........
58280..............  Hysterectomy/revise vagina  ..................  C.................  ...........  ...........  ...........  ...........  ...........
58285..............  Extensive hysterectomy....  ..................  C.................  ...........  ...........  ...........  ...........  ...........
58290..............  Vag hyst complex..........  ..................  T.................         0202      42.7099    $2,720.36      $981.50      $544.07
58291..............  Vag hyst incl t/o, complex  ..................  T.................         0202      42.7099    $2,720.36      $981.50      $544.07
58292..............  Vag hyst t/o & repair,      ..................  T.................         0202      42.7099    $2,720.36      $981.50      $544.07
                      compl.
58293..............  Vag hyst w/uro repair,      ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      compl.
58294..............  Vag hyst w/enterocele,      ..................  T.................         0202      42.7099    $2,720.36      $981.50      $544.07
                      compl.
58300..............  Insert intrauterine device  ..................  E.................  ...........  ...........  ...........  ...........  ...........
58301..............  Remove intrauterine device  ..................  T.................         0188       1.3520       $86.11  ...........       $17.22
58321..............  Artificial insemination...  CH................  T.................         0189       2.7584      $175.69  ...........       $35.14
58322..............  Artificial insemination...  CH................  T.................         0189       2.7584      $175.69  ...........       $35.14
58323..............  Sperm washing.............  CH................  T.................         0189       2.7584      $175.69  ...........       $35.14
58340..............  Catheter for hysterography  ..................  N.................  ...........  ...........  ...........  ...........  ...........
58345..............  Reopen fallopian tube.....  ..................  T.................         0193      19.0203    $1,211.48  ...........      $242.30
58346..............  Insert heyman uteri         ..................  T.................         0193      19.0203    $1,211.48  ...........      $242.30
                      capsule.
58350..............  Reopen fallopian tube.....  ..................  T.................         0195      32.4237    $2,065.20      $483.80      $413.04
58353..............  Endometr ablate, thermal..  ..................  T.................         0195      32.4237    $2,065.20      $483.80      $413.04
58356..............  Endometrial cryoablation..  ..................  T.................         0202      42.7099    $2,720.36      $981.50      $544.07
58400..............  Suspension of uterus......  ..................  C.................  ...........  ...........  ...........  ...........  ...........
58410..............  Suspension of uterus......  ..................  C.................  ...........  ...........  ...........  ...........  ...........
58520..............  Repair of ruptured uterus.  ..................  C.................  ...........  ...........  ...........  ...........  ...........
58540..............  Revision of uterus........  ..................  C.................  ...........  ...........  ...........  ...........  ...........
58541..............  Lsh, uterus 250 g or less.  ..................  T.................         0131      45.5317    $2,900.10    $1,001.89      $580.02
58542..............  Lsh w/t/o ut 250 g or less  ..................  T.................         0131      45.5317    $2,900.10    $1,001.89      $580.02
58543..............  Lsh uterus above 250 g....  ..................  T.................         0131      45.5317    $2,900.10    $1,001.89      $580.02
58544..............  Lsh w/t/o uterus above 250  ..................  T.................         0131      45.5317    $2,900.10    $1,001.89      $580.02
                      g.
58545..............  Laparoscopic myomectomy...  ..................  T.................         0130      34.3958    $2,190.81      $659.53      $438.16
58546..............  Laparo-myomectomy, complex  ..................  T.................         0131      45.5317    $2,900.10    $1,001.89      $580.02
58548..............  Lap radical hyst..........  ..................  C.................  ...........  ...........  ...........  ...........  ...........
58550..............  Laparo-asst vag             ..................  T.................         0132      69.6652    $4,437.26    $1,239.22      $887.45
                      hysterectomy.
58552..............  Laparo-vag hyst incl t/o..  ..................  T.................         0131      45.5317    $2,900.10    $1,001.89      $580.02
58553..............  Laparo-vag hyst, complex..  ..................  T.................         0131      45.5317    $2,900.10    $1,001.89      $580.02
58554..............  Laparo-vag hyst w/t/o,      ..................  T.................         0131      45.5317    $2,900.10    $1,001.89      $580.02
                      compl.
58555..............  Hysteroscopy, dx, sep proc  ..................  T.................         0190      21.6576    $1,379.46      $424.28      $275.89
58558..............  Hysteroscopy, biopsy......  ..................  T.................         0190      21.6576    $1,379.46      $424.28      $275.89
58559..............  Hysteroscopy, lysis.......  ..................  T.................         0190      21.6576    $1,379.46      $424.28      $275.89
58560..............  Hysteroscopy, resect        ..................  T.................         0387      34.2048    $2,178.64      $655.55      $435.73
                      septum.
58561..............  Hysteroscopy, remove myoma  ..................  T.................         0387      34.2048    $2,178.64      $655.55      $435.73
58562..............  Hysteroscopy, remove fb...  ..................  T.................         0190      21.6576    $1,379.46      $424.28      $275.89
58563..............  Hysteroscopy, ablation....  ..................  T.................         0387      34.2048    $2,178.64      $655.55      $435.73
58565..............  Hysteroscopy,               ..................  T.................         0202      42.7099    $2,720.36      $981.50      $544.07
                      sterilization.
58570..............  Tlh, uterus 250 g or less.  NI................  T.................         0131      45.5317    $2,900.10    $1,001.89      $580.02
58571..............  Tlh w/t/o 250 g or less...  NI................  T.................         0131      45.5317    $2,900.10    $1,001.89      $580.02
58572..............  Tlh, uterus over 250 g....  NI................  T.................         0131      45.5317    $2,900.10    $1,001.89      $580.02
58573..............  Tlh w/t/o uterus over 250   NI................  T.................         0131      45.5317    $2,900.10    $1,001.89      $580.02
                      g.
58578..............  Laparo proc, uterus.......  ..................  T.................         0130      34.3958    $2,190.81      $659.53      $438.16
58579..............  Hysteroscope procedure....  ..................  T.................         0190      21.6576    $1,379.46      $424.28      $275.89

[[Page 67058]]

 
58600..............  Division of fallopian tube  ..................  T.................         0195      32.4237    $2,065.20      $483.80      $413.04
58605..............  Division of fallopian tube  ..................  C.................  ...........  ...........  ...........  ...........  ...........
58611..............  Ligate oviduct(s) add-on..  ..................  C.................  ...........  ...........  ...........  ...........  ...........
58615..............  Occlude fallopian tube(s).  CH................  T.................         0193      19.0203    $1,211.48  ...........      $242.30
58660..............  Laparoscopy, lysis........  ..................  T.................         0131      45.5317    $2,900.10    $1,001.89      $580.02
58661..............  Laparoscopy, remove adnexa  ..................  T.................         0131      45.5317    $2,900.10    $1,001.89      $580.02
58662..............  Laparoscopy, excise         ..................  T.................         0131      45.5317    $2,900.10    $1,001.89      $580.02
                      lesions.
58670..............  Laparoscopy, tubal cautery  ..................  T.................         0131      45.5317    $2,900.10    $1,001.89      $580.02
58671..............  Laparoscopy, tubal block..  ..................  T.................         0131      45.5317    $2,900.10    $1,001.89      $580.02
58672..............  Laparoscopy, fimbrioplasty  ..................  T.................         0131      45.5317    $2,900.10    $1,001.89      $580.02
58673..............  Laparoscopy, salpingostomy  ..................  T.................         0131      45.5317    $2,900.10    $1,001.89      $580.02
58679..............  Laparo proc, oviduct-ovary  ..................  T.................         0130      34.3958    $2,190.81      $659.53      $438.16
58700..............  Removal of fallopian tube.  ..................  C.................  ...........  ...........  ...........  ...........  ...........
58720..............  Removal of ovary/tube(s)..  ..................  C.................  ...........  ...........  ...........  ...........  ...........
58740..............  Revise fallopian tube(s)..  ..................  C.................  ...........  ...........  ...........  ...........  ...........
58750..............  Repair oviduct............  ..................  C.................  ...........  ...........  ...........  ...........  ...........
58752..............  Revise ovarian tube(s)....  ..................  C.................  ...........  ...........  ...........  ...........  ...........
58760..............  Remove tubal obstruction..  ..................  C.................  ...........  ...........  ...........  ...........  ...........
58770..............  Create new tubal opening..  ..................  T.................         0195      32.4237    $2,065.20      $483.80      $413.04
58800..............  Drainage of ovarian         ..................  T.................         0193      19.0203    $1,211.48  ...........      $242.30
                      cyst(s).
58805..............  Drainage of ovarian         CH................  T.................         0195      32.4237    $2,065.20      $483.80      $413.04
                      cyst(s).
58820..............  Drain ovary abscess, open.  ..................  T.................         0195      32.4237    $2,065.20      $483.80      $413.04
58822..............  Drain ovary abscess,        ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      percut.
58823..............  Drain pelvic abscess,       ..................  T.................         0193      19.0203    $1,211.48  ...........      $242.30
                      percut.
58825..............  Transposition, ovary(s)...  ..................  C.................  ...........  ...........  ...........  ...........  ...........
58900..............  Biopsy of ovary(s)........  ..................  T.................         0193      19.0203    $1,211.48  ...........      $242.30
58920..............  Partial removal of          ..................  T.................         0195      32.4237    $2,065.20      $483.80      $413.04
                      ovary(s).
58925..............  Removal of ovarian cyst(s)  ..................  T.................         0195      32.4237    $2,065.20      $483.80      $413.04
58940..............  Removal of ovary(s).......  ..................  C.................  ...........  ...........  ...........  ...........  ...........
58943..............  Removal of ovary(s).......  ..................  C.................  ...........  ...........  ...........  ...........  ...........
58950..............  Resect ovarian malignancy.  ..................  C.................  ...........  ...........  ...........  ...........  ...........
58951..............  Resect ovarian malignancy.  ..................  C.................  ...........  ...........  ...........  ...........  ...........
58952..............  Resect ovarian malignancy.  ..................  C.................  ...........  ...........  ...........  ...........  ...........
58953..............  Tah, rad dissect for        ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      debulk.
58954..............  Tah rad debulk/lymph        ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      remove.
58956..............  Bso, omentectomy w/tah....  ..................  C.................  ...........  ...........  ...........  ...........  ...........
58957..............  Resect recurrent gyn mal..  ..................  C.................  ...........  ...........  ...........  ...........  ...........
58958..............  Resect recur gyn mal w/lym  ..................  C.................  ...........  ...........  ...........  ...........  ...........
58960..............  Exploration of abdomen....  ..................  C.................  ...........  ...........  ...........  ...........  ...........
58970..............  Retrieval of oocyte.......  CH................  T.................         0189       2.7584      $175.69  ...........       $35.14
58974..............  Transfer of embryo........  CH................  T.................         0189       2.7584      $175.69  ...........       $35.14
58976..............  Transfer of embryo........  CH................  T.................         0189       2.7584      $175.69  ...........       $35.14
58999..............  Genital surgery procedure.  ..................  T.................         0191       0.1309        $8.34        $2.36        $1.67
59000..............  Amniocentesis, diagnostic.  CH................  T.................         0189       2.7584      $175.69  ...........       $35.14
59001..............  Amniocentesis, therapeutic  ..................  T.................         0192       6.0783      $387.15  ...........       $77.43
59012..............  Fetal cord                  CH................  T.................         0189       2.7584      $175.69  ...........       $35.14
                      puncture,prenatal.
59015..............  Chorion biopsy............  CH................  T.................         0189       2.7584      $175.69  ...........       $35.14
59020..............  Fetal contract stress test  CH................  T.................         0188       1.3520       $86.11  ...........       $17.22
59025..............  Fetal non-stress test.....  CH................  T.................         0188       1.3520       $86.11  ...........       $17.22
59030..............  Fetal scalp blood sample..  CH................  T.................         0189       2.7584      $175.69  ...........       $35.14
59050..............  Fetal monitor w/report....  ..................  M.................  ...........  ...........  ...........  ...........  ...........
59051..............  Fetal monitor/interpret     ..................  B.................  ...........  ...........  ...........  ...........  ...........
                      only.
59070..............  Transabdom amnioinfus w/us  CH................  T.................         0189       2.7584      $175.69  ...........       $35.14
59072..............  Umbilical cord occlud w/us  CH................  T.................         0189       2.7584      $175.69  ...........       $35.14
59074..............  Fetal fluid drainage w/us.  CH................  T.................         0189       2.7584      $175.69  ...........       $35.14
59076..............  Fetal shunt placement, w/   CH................  T.................         0189       2.7584      $175.69  ...........       $35.14
                      us.
59100..............  Remove uterus lesion......  ..................  T.................         0195      32.4237    $2,065.20      $483.80      $413.04
59120..............  Treat ectopic pregnancy...  ..................  C.................  ...........  ...........  ...........  ...........  ...........
59121..............  Treat ectopic pregnancy...  ..................  C.................  ...........  ...........  ...........  ...........  ...........
59130..............  Treat ectopic pregnancy...  ..................  C.................  ...........  ...........  ...........  ...........  ...........
59135..............  Treat ectopic pregnancy...  ..................  C.................  ...........  ...........  ...........  ...........  ...........
59136..............  Treat ectopic pregnancy...  ..................  C.................  ...........  ...........  ...........  ...........  ...........
59140..............  Treat ectopic pregnancy...  ..................  C.................  ...........  ...........  ...........  ...........  ...........
59150..............  Treat ectopic pregnancy...  ..................  T.................         0131      45.5317    $2,900.10    $1,001.89      $580.02
59151..............  Treat ectopic pregnancy...  ..................  T.................         0131      45.5317    $2,900.10    $1,001.89      $580.02
59160..............  D & c after delivery......  CH................  T.................         0193      19.0203    $1,211.48  ...........      $242.30
59200..............  Insert cervical dilator...  ..................  T.................         0189       2.7584      $175.69  ...........       $35.14
59300..............  Episiotomy or vaginal       ..................  T.................         0193      19.0203    $1,211.48  ...........      $242.30
                      repair.
59320..............  Revision of cervix........  CH................  T.................         0193      19.0203    $1,211.48  ...........      $242.30
59325..............  Revision of cervix........  ..................  C.................  ...........  ...........  ...........  ...........  ...........
59350..............  Repair of uterus..........  ..................  C.................  ...........  ...........  ...........  ...........  ...........
59400..............  Obstetrical care..........  ..................  B.................  ...........  ...........  ...........  ...........  ...........
59409..............  Obstetrical care..........  CH................  T.................         0193      19.0203    $1,211.48  ...........      $242.30
59410..............  Obstetrical care..........  ..................  B.................  ...........  ...........  ...........  ...........  ...........
59412..............  Antepartum manipulation...  CH................  T.................         0193      19.0203    $1,211.48  ...........      $242.30
59414..............  Deliver placenta..........  ..................  T.................         0193      19.0203    $1,211.48  ...........      $242.30
59425..............  Antepartum care only......  ..................  B.................  ...........  ...........  ...........  ...........  ...........
59426..............  Antepartum care only......  ..................  B.................  ...........  ...........  ...........  ...........  ...........
59430..............  Care after delivery.......  ..................  B.................  ...........  ...........  ...........  ...........  ...........
59510..............  Cesarean delivery.........  ..................  B.................  ...........  ...........  ...........  ...........  ...........

[[Page 67059]]

 
59514..............  Cesarean delivery only....  ..................  C.................  ...........  ...........  ...........  ...........  ...........
59515..............  Cesarean delivery.........  ..................  B.................  ...........  ...........  ...........  ...........  ...........
59525..............  Remove uterus after         ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      cesarean.
59610..............  Vbac delivery.............  ..................  B.................  ...........  ...........  ...........  ...........  ...........
59612..............  Vbac delivery only........  CH................  T.................         0193      19.0203    $1,211.48  ...........      $242.30
59614..............  Vbac care after delivery..  ..................  B.................  ...........  ...........  ...........  ...........  ...........
59618..............  Attempted vbac delivery...  ..................  B.................  ...........  ...........  ...........  ...........  ...........
59620..............  Attempted vbac delivery     ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      only.
59622..............  Attempted vbac after care.  ..................  B.................  ...........  ...........  ...........  ...........  ...........
59812..............  Treatment of miscarriage..  CH................  T.................         0193      19.0203    $1,211.48  ...........      $242.30
59820..............  Care of miscarriage.......  CH................  T.................         0193      19.0203    $1,211.48  ...........      $242.30
59821..............  Treatment of miscarriage..  CH................  T.................         0193      19.0203    $1,211.48  ...........      $242.30
59830..............  Treat uterus infection....  ..................  C.................  ...........  ...........  ...........  ...........  ...........
59840..............  Abortion..................  CH................  T.................         0193      19.0203    $1,211.48  ...........      $242.30
59841..............  Abortion..................  CH................  T.................         0193      19.0203    $1,211.48  ...........      $242.30
59850..............  Abortion..................  ..................  C.................  ...........  ...........  ...........  ...........  ...........
59851..............  Abortion..................  ..................  C.................  ...........  ...........  ...........  ...........  ...........
59852..............  Abortion..................  ..................  C.................  ...........  ...........  ...........  ...........  ...........
59855..............  Abortion..................  ..................  C.................  ...........  ...........  ...........  ...........  ...........
59856..............  Abortion..................  ..................  C.................  ...........  ...........  ...........  ...........  ...........
59857..............  Abortion..................  ..................  C.................  ...........  ...........  ...........  ...........  ...........
59866..............  Abortion (mpr)............  CH................  T.................         0189       2.7584      $175.69  ...........       $35.14
59870..............  Evacuate mole of uterus...  CH................  T.................         0193      19.0203    $1,211.48  ...........      $242.30
59871..............  Remove cerclage suture....  CH................  T.................         0193      19.0203    $1,211.48  ...........      $242.30
59897..............  Fetal invas px w/us.......  CH................  T.................         0189       2.7584      $175.69  ...........       $35.14
59898..............  Laparo proc, ob care/       ..................  T.................         0130      34.3958    $2,190.81      $659.53      $438.16
                      deliver.
59899..............  Maternity care procedure..  CH................  T.................         0191       0.1309        $8.34        $2.36        $1.67
60000..............  Drain thyroid/tongue cyst.  ..................  T.................         0252       7.4474      $474.35      $109.16       $94.87
60001..............  Aspirate/inject thyriod     CH................  D.................  ...........  ...........  ...........  ...........  ...........
                      cyst.
6005F..............  Care level rationale doc..  ..................  M.................  ...........  ...........  ...........  ...........  ...........
60100..............  Biopsy of thyroid.........  ..................  T.................         0004       4.3270      $275.60  ...........       $55.12
6010F..............  Dysphag test done b/4       ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      eating.
6015F..............  Dysphag test done b/4       ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      eating.
60200..............  Remove thyroid lesion.....  ..................  T.................         0114      44.3240    $2,823.17  ...........      $564.63
6020F..............  Npo (nothing-mouth)         ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      ordered.
60210..............  Partial thyroid excision..  ..................  T.................         0114      44.3240    $2,823.17  ...........      $564.63
60212..............  Partial thyroid excision..  ..................  T.................         0114      44.3240    $2,823.17  ...........      $564.63
60220..............  Partial removal of thyroid  ..................  T.................         0114      44.3240    $2,823.17  ...........      $564.63
60225..............  Partial removal of thyroid  ..................  T.................         0114      44.3240    $2,823.17  ...........      $564.63
60240..............  Removal of thyroid........  ..................  T.................         0114      44.3240    $2,823.17  ...........      $564.63
60252..............  Removal of thyroid........  ..................  T.................         0256      39.8776    $2,539.96  ...........      $507.99
60254..............  Extensive thyroid surgery.  ..................  C.................  ...........  ...........  ...........  ...........  ...........
60260..............  Repeat thyroid surgery....  ..................  T.................         0256      39.8776    $2,539.96  ...........      $507.99
60270..............  Removal of thyroid........  ..................  C.................  ...........  ...........  ...........  ...........  ...........
60271..............  Removal of thyroid........  CH................  T.................         0256      39.8776    $2,539.96  ...........      $507.99
60280..............  Remove thyroid duct lesion  ..................  T.................         0114      44.3240    $2,823.17  ...........      $564.63
60281..............  Remove thyroid duct lesion  ..................  T.................         0114      44.3240    $2,823.17  ...........      $564.63
60300..............  Aspir/inj thyroid cyst....  NI................  T.................         0004       4.3270      $275.60  ...........       $55.12
6030F..............  Max sterile barriers        NI................  M.................  ...........  ...........  ...........  ...........  ...........
                      follw'd.
60500..............  Explore parathyroid glands  ..................  T.................         0256      39.8776    $2,539.96  ...........      $507.99
60502..............  Re-explore parathyroids...  ..................  T.................         0256      39.8776    $2,539.96  ...........      $507.99
60505..............  Explore parathyroid glands  ..................  C.................  ...........  ...........  ...........  ...........  ...........
60512..............  Autotransplant parathyroid  ..................  T.................         0022      21.1098    $1,344.57      $354.45      $268.91
60520..............  Removal of thymus gland...  ..................  T.................         0256      39.8776    $2,539.96  ...........      $507.99
60521..............  Removal of thymus gland...  ..................  C.................  ...........  ...........  ...........  ...........  ...........
60522..............  Removal of thymus gland...  ..................  C.................  ...........  ...........  ...........  ...........  ...........
60540..............  Explore adrenal gland.....  ..................  C.................  ...........  ...........  ...........  ...........  ...........
60545..............  Explore adrenal gland.....  ..................  C.................  ...........  ...........  ...........  ...........  ...........
60600..............  Remove carotid body lesion  ..................  C.................  ...........  ...........  ...........  ...........  ...........
60605..............  Remove carotid body lesion  ..................  C.................  ...........  ...........  ...........  ...........  ...........
60650..............  Laparoscopy adrenalectomy.  ..................  C.................  ...........  ...........  ...........  ...........  ...........
60659..............  Laparo proc, endocrine....  ..................  T.................         0130      34.3958    $2,190.81      $659.53      $438.16
60699..............  Endocrine surgery           ..................  T.................         0114      44.3240    $2,823.17  ...........      $564.63
                      procedure.
61000..............  Remove cranial cavity       ..................  T.................         0212       8.5263      $543.07  ...........      $108.61
                      fluid.
61001..............  Remove cranial cavity       ..................  T.................         0212       8.5263      $543.07  ...........      $108.61
                      fluid.
61020..............  Remove brain cavity fluid.  ..................  T.................         0212       8.5263      $543.07  ...........      $108.61
61026..............  Injection into brain canal  ..................  T.................         0212       8.5263      $543.07  ...........      $108.61
61050..............  Remove brain canal fluid..  ..................  T.................         0212       8.5263      $543.07  ...........      $108.61
61055..............  Injection into brain canal  ..................  T.................         0212       8.5263      $543.07  ...........      $108.61
61070..............  Brain canal shunt           CH................  T.................         0121       3.2383      $206.26       $43.80       $41.25
                      procedure.
61105..............  Twist drill hole..........  ..................  C.................  ...........  ...........  ...........  ...........  ...........
61107..............  Drill skull for             ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      implantation.
61108..............  Drill skull for drainage..  ..................  C.................  ...........  ...........  ...........  ...........  ...........
61120..............  Burr hole for puncture....  ..................  C.................  ...........  ...........  ...........  ...........  ...........
61140..............  Pierce skull for biopsy...  ..................  C.................  ...........  ...........  ...........  ...........  ...........
61150..............  Pierce skull for drainage.  ..................  C.................  ...........  ...........  ...........  ...........  ...........
61151..............  Pierce skull for drainage.  ..................  C.................  ...........  ...........  ...........  ...........  ...........
61154..............  Pierce skull & remove clot  ..................  C.................  ...........  ...........  ...........  ...........  ...........
61156..............  Pierce skull for drainage.  ..................  C.................  ...........  ...........  ...........  ...........  ...........
61210..............  Pierce skull, implant       ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      device.

[[Page 67060]]

 
61215..............  Insert brain-fluid device.  ..................  T.................         0224      36.2768    $2,310.61  ...........      $462.12
61250..............  Pierce skull & explore....  ..................  C.................  ...........  ...........  ...........  ...........  ...........
61253..............  Pierce skull & explore....  ..................  C.................  ...........  ...........  ...........  ...........  ...........
61304..............  Open skull for exploration  ..................  C.................  ...........  ...........  ...........  ...........  ...........
61305..............  Open skull for exploration  ..................  C.................  ...........  ...........  ...........  ...........  ...........
61312..............  Open skull for drainage...  ..................  C.................  ...........  ...........  ...........  ...........  ...........
61313..............  Open skull for drainage...  ..................  C.................  ...........  ...........  ...........  ...........  ...........
61314..............  Open skull for drainage...  ..................  C.................  ...........  ...........  ...........  ...........  ...........
61315..............  Open skull for drainage...  ..................  C.................  ...........  ...........  ...........  ...........  ...........
61316..............  Implt cran bone flap to     ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      abdo.
61320..............  Open skull for drainage...  ..................  C.................  ...........  ...........  ...........  ...........  ...........
61321..............  Open skull for drainage...  ..................  C.................  ...........  ...........  ...........  ...........  ...........
61322..............  Decompressive craniotomy..  ..................  C.................  ...........  ...........  ...........  ...........  ...........
61323..............  Decompressive lobectomy...  ..................  C.................  ...........  ...........  ...........  ...........  ...........
61330..............  Decompress eye socket.....  ..................  T.................         0256      39.8776    $2,539.96  ...........      $507.99
61332..............  Explore/biopsy eye socket.  ..................  C.................  ...........  ...........  ...........  ...........  ...........
61333..............  Explore orbit/remove        ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      lesion.
61334..............  Explore orbit/remove        ..................  T.................         0256      39.8776    $2,539.96  ...........      $507.99
                      object.
61340..............  Subtemporal decompression.  ..................  C.................  ...........  ...........  ...........  ...........  ...........
61343..............  Incise skull (press         ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      relief).
61345..............  Relieve cranial pressure..  ..................  C.................  ...........  ...........  ...........  ...........  ...........
61440..............  Incise skull for surgery..  ..................  C.................  ...........  ...........  ...........  ...........  ...........
61450..............  Incise skull for surgery..  ..................  C.................  ...........  ...........  ...........  ...........  ...........
61458..............  Incise skull for brain      ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      wound.
61460..............  Incise skull for surgery..  ..................  C.................  ...........  ...........  ...........  ...........  ...........
61470..............  Incise skull for surgery..  ..................  C.................  ...........  ...........  ...........  ...........  ...........
61480..............  Incise skull for surgery..  ..................  C.................  ...........  ...........  ...........  ...........  ...........
61490..............  Incise skull for surgery..  ..................  C.................  ...........  ...........  ...........  ...........  ...........
61500..............  Removal of skull lesion...  ..................  C.................  ...........  ...........  ...........  ...........  ...........
61501..............  Remove infected skull bone  ..................  C.................  ...........  ...........  ...........  ...........  ...........
61510..............  Removal of brain lesion...  ..................  C.................  ...........  ...........  ...........  ...........  ...........
61512..............  Remove brain lining lesion  ..................  C.................  ...........  ...........  ...........  ...........  ...........
61514..............  Removal of brain abscess..  ..................  C.................  ...........  ...........  ...........  ...........  ...........
61516..............  Removal of brain lesion...  ..................  C.................  ...........  ...........  ...........  ...........  ...........
61517..............  Implt brain chemotx add-on  ..................  C.................  ...........  ...........  ...........  ...........  ...........
61518..............  Removal of brain lesion...  ..................  C.................  ...........  ...........  ...........  ...........  ...........
61519..............  Remove brain lining lesion  ..................  C.................  ...........  ...........  ...........  ...........  ...........
61520..............  Removal of brain lesion...  ..................  C.................  ...........  ...........  ...........  ...........  ...........
61521..............  Removal of brain lesion...  ..................  C.................  ...........  ...........  ...........  ...........  ...........
61522..............  Removal of brain abscess..  ..................  C.................  ...........  ...........  ...........  ...........  ...........
61524..............  Removal of brain lesion...  ..................  C.................  ...........  ...........  ...........  ...........  ...........
61526..............  Removal of brain lesion...  ..................  C.................  ...........  ...........  ...........  ...........  ...........
61530..............  Removal of brain lesion...  ..................  C.................  ...........  ...........  ...........  ...........  ...........
61531..............  Implant brain electrodes..  ..................  C.................  ...........  ...........  ...........  ...........  ...........
61533..............  Implant brain electrodes..  ..................  C.................  ...........  ...........  ...........  ...........  ...........
61534..............  Removal of brain lesion...  ..................  C.................  ...........  ...........  ...........  ...........  ...........
61535..............  Remove brain electrodes...  ..................  C.................  ...........  ...........  ...........  ...........  ...........
61536..............  Removal of brain lesion...  ..................  C.................  ...........  ...........  ...........  ...........  ...........
61537..............  Removal of brain tissue...  ..................  C.................  ...........  ...........  ...........  ...........  ...........
61538..............  Removal of brain tissue...  ..................  C.................  ...........  ...........  ...........  ...........  ...........
61539..............  Removal of brain tissue...  ..................  C.................  ...........  ...........  ...........  ...........  ...........
61540..............  Removal of brain tissue...  ..................  C.................  ...........  ...........  ...........  ...........  ...........
61541..............  Incision of brain tissue..  ..................  C.................  ...........  ...........  ...........  ...........  ...........
61542..............  Removal of brain tissue...  ..................  C.................  ...........  ...........  ...........  ...........  ...........
61543..............  Removal of brain tissue...  ..................  C.................  ...........  ...........  ...........  ...........  ...........
61544..............  Remove & treat brain        ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      lesion.
61545..............  Excision of brain tumor...  ..................  C.................  ...........  ...........  ...........  ...........  ...........
61546..............  Removal of pituitary gland  ..................  C.................  ...........  ...........  ...........  ...........  ...........
61548..............  Removal of pituitary gland  ..................  C.................  ...........  ...........  ...........  ...........  ...........
61550..............  Release of skull seams....  ..................  C.................  ...........  ...........  ...........  ...........  ...........
61552..............  Release of skull seams....  ..................  C.................  ...........  ...........  ...........  ...........  ...........
61556..............  Incise skull/sutures......  ..................  C.................  ...........  ...........  ...........  ...........  ...........
61557..............  Incise skull/sutures......  ..................  C.................  ...........  ...........  ...........  ...........  ...........
61558..............  Excision of skull/sutures.  ..................  C.................  ...........  ...........  ...........  ...........  ...........
61559..............  Excision of skull/sutures.  ..................  C.................  ...........  ...........  ...........  ...........  ...........
61563..............  Excision of skull tumor...  ..................  C.................  ...........  ...........  ...........  ...........  ...........
61564..............  Excision of skull tumor...  ..................  C.................  ...........  ...........  ...........  ...........  ...........
61566..............  Removal of brain tissue...  ..................  C.................  ...........  ...........  ...........  ...........  ...........
61567..............  Incision of brain tissue..  ..................  C.................  ...........  ...........  ...........  ...........  ...........
61570..............  Remove foreign body, brain  ..................  C.................  ...........  ...........  ...........  ...........  ...........
61571..............  Incise skull for brain      ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      wound.
61575..............  Skull base/brainstem        ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      surgery.
61576..............  Skull base/brainstem        ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      surgery.
61580..............  Craniofacial approach,      ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      skull.
61581..............  Craniofacial approach,      ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      skull.
61582..............  Craniofacial approach,      ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      skull.
61583..............  Craniofacial approach,      ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      skull.
61584..............  Orbitocranial approach/     ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      skull.
61585..............  Orbitocranial approach/     ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      skull.
61586..............  Resect nasopharynx, skull.  ..................  C.................  ...........  ...........  ...........  ...........  ...........

[[Page 67061]]

 
61590..............  Infratemporal approach/     ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      skull.
61591..............  Infratemporal approach/     ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      skull.
61592..............  Orbitocranial approach/     ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      skull.
61595..............  Transtemporal approach/     ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      skull.
61596..............  Transcochlear approach/     ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      skull.
61597..............  Transcondylar approach/     ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      skull.
61598..............  Transpetrosal approach/     ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      skull.
61600..............  Resect/excise cranial       ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      lesion.
61601..............  Resect/excise cranial       ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      lesion.
61605..............  Resect/excise cranial       ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      lesion.
61606..............  Resect/excise cranial       ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      lesion.
61607..............  Resect/excise cranial       ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      lesion.
61608..............  Resect/excise cranial       ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      lesion.
61609..............  Transect artery, sinus....  ..................  C.................  ...........  ...........  ...........  ...........  ...........
61610..............  Transect artery, sinus....  ..................  C.................  ...........  ...........  ...........  ...........  ...........
61611..............  Transect artery, sinus....  ..................  C.................  ...........  ...........  ...........  ...........  ...........
61612..............  Transect artery, sinus....  ..................  C.................  ...........  ...........  ...........  ...........  ...........
61613..............  Remove aneurysm, sinus....  ..................  C.................  ...........  ...........  ...........  ...........  ...........
61615..............  Resect/excise lesion,       ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      skull.
61616..............  Resect/excise lesion,       ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      skull.
61618..............  Repair dura...............  ..................  C.................  ...........  ...........  ...........  ...........  ...........
61619..............  Repair dura...............  ..................  C.................  ...........  ...........  ...........  ...........  ...........
61623..............  Endovasc tempory vessel     CH................  T.................         0082      87.5137    $5,574.10  ...........    $1,114.82
                      occl.
61624..............  Transcath occlusion, cns..  ..................  C.................  ...........  ...........  ...........  ...........  ...........
61626..............  Transcath occlusion, non-   CH................  T.................         0082      87.5137    $5,574.10  ...........    $1,114.82
                      cns.
61630..............  Intracranial angioplasty..  ..................  E.................  ...........  ...........  ...........  ...........  ...........
61635..............  Intracran angioplsty w/     ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      stent.
61640..............  Dilate ic vasospasm, init.  ..................  E.................  ...........  ...........  ...........  ...........  ...........
61641..............  Dilate ic vasospasm add-on  ..................  E.................  ...........  ...........  ...........  ...........  ...........
61642..............  Dilate ic vasospasm add-on  ..................  E.................  ...........  ...........  ...........  ...........  ...........
61680..............  Intracranial vessel         ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      surgery.
61682..............  Intracranial vessel         ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      surgery.
61684..............  Intracranial vessel         ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      surgery.
61686..............  Intracranial vessel         ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      surgery.
61690..............  Intracranial vessel         ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      surgery.
61692..............  Intracranial vessel         ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      surgery.
61697..............  Brain aneurysm repr,        ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      complx.
61698..............  Brain aneurysm repr,        ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      complx.
61700..............  Brain aneurysm repr,        ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      simple.
61702..............  Inner skull vessel surgery  ..................  C.................  ...........  ...........  ...........  ...........  ...........
61703..............  Clamp neck artery.........  ..................  C.................  ...........  ...........  ...........  ...........  ...........
61705..............  Revise circulation to head  ..................  C.................  ...........  ...........  ...........  ...........  ...........
61708..............  Revise circulation to head  ..................  C.................  ...........  ...........  ...........  ...........  ...........
61710..............  Revise circulation to head  ..................  C.................  ...........  ...........  ...........  ...........  ...........
61711..............  Fusion of skull arteries..  ..................  C.................  ...........  ...........  ...........  ...........  ...........
61720..............  Incise skull/brain surgery  ..................  T.................         0221      33.2707    $2,119.14      $463.62      $423.83
61735..............  Incise skull/brain surgery  ..................  C.................  ...........  ...........  ...........  ...........  ...........
61750..............  Incise skull/brain biopsy.  ..................  C.................  ...........  ...........  ...........  ...........  ...........
61751..............  Brain biopsy w/ct/mr guide  ..................  C.................  ...........  ...........  ...........  ...........  ...........
61760..............  Implant brain electrodes..  ..................  C.................  ...........  ...........  ...........  ...........  ...........
61770..............  Incise skull for treatment  CH................  T.................         0221      33.2707    $2,119.14      $463.62      $423.83
61790..............  Treat trigeminal nerve....  ..................  T.................         0220      18.0518    $1,149.79  ...........      $229.96
61791..............  Treat trigeminal tract....  CH................  T.................         0203      14.4879      $922.79      $240.33      $184.56
61793..............  Focus radiation beam......  ..................  B.................  ...........  ...........  ...........  ...........  ...........
61795..............  Brain surgery using         CH................  N.................  ...........  ...........  ...........  ...........  ...........
                      computer.
61850..............  Implant neuroelectrodes...  ..................  C.................  ...........  ...........  ...........  ...........  ...........
61860..............  Implant neuroelectrodes...  ..................  C.................  ...........  ...........  ...........  ...........  ...........
61863..............  Implant neuroelectrode....  ..................  C.................  ...........  ...........  ...........  ...........  ...........
61864..............  Implant neuroelectrde,      ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      addl.
61867..............  Implant neuroelectrode....  ..................  C.................  ...........  ...........  ...........  ...........  ...........
61868..............  Implant neuroelectrde,      ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      add'l.
61870..............  Implant neuroelectrodes...  ..................  C.................  ...........  ...........  ...........  ...........  ...........
61875..............  Implant neuroelectrodes...  ..................  C.................  ...........  ...........  ...........  ...........  ...........
61880..............  Revise/remove               ..................  T.................         0687      22.4734    $1,431.42      $438.47      $286.28
                      neuroelectrode.
61885..............  Insrt/redo neurostim 1      ..................  S.................         0039     186.4739   $11,877.27  ...........    $2,375.45
                      array.
61886..............  Implant neurostim arrays..  CH................  S.................         0315     270.0190   $17,198.59  ...........    $3,439.72
61888..............  Revise/remove               ..................  T.................         0688      34.4166    $2,192.13      $874.57      $438.43
                      neuroreceiver.
62000..............  Treat skull fracture......  ..................  T.................         0254      23.9765    $1,527.16      $321.35      $305.43
62005..............  Treat skull fracture......  ..................  C.................  ...........  ...........  ...........  ...........  ...........
62010..............  Treatment of head injury..  ..................  C.................  ...........  ...........  ...........  ...........  ...........
62100..............  Repair brain fluid leakage  ..................  C.................  ...........  ...........  ...........  ...........  ...........
62115..............  Reduction of skull defect.  ..................  C.................  ...........  ...........  ...........  ...........  ...........
62116..............  Reduction of skull defect.  ..................  C.................  ...........  ...........  ...........  ...........  ...........
62117..............  Reduction of skull defect.  ..................  C.................  ...........  ...........  ...........  ...........  ...........
62120..............  Repair skull cavity lesion  ..................  C.................  ...........  ...........  ...........  ...........  ...........
62121..............  Incise skull repair.......  ..................  C.................  ...........  ...........  ...........  ...........  ...........
62140..............  Repair of skull defect....  ..................  C.................  ...........  ...........  ...........  ...........  ...........
62141..............  Repair of skull defect....  ..................  C.................  ...........  ...........  ...........  ...........  ...........
62142..............  Remove skull plate/flap...  ..................  C.................  ...........  ...........  ...........  ...........  ...........
62143..............  Replace skull plate/flap..  ..................  C.................  ...........  ...........  ...........  ...........  ...........

[[Page 67062]]

 
62145..............  Repair of skull & brain...  ..................  C.................  ...........  ...........  ...........  ...........  ...........
62146..............  Repair of skull with graft  ..................  C.................  ...........  ...........  ...........  ...........  ...........
62147..............  Repair of skull with graft  ..................  C.................  ...........  ...........  ...........  ...........  ...........
62148..............  Retr bone flap to fix       ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      skull.
62160..............  Neuroendoscopy add-on.....  CH................  N.................  ...........  ...........  ...........  ...........  ...........
62161..............  Dissect brain w/scope.....  ..................  C.................  ...........  ...........  ...........  ...........  ...........
62162..............  Remove colloid cyst w/      ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      scope.
62163..............  Neuroendoscopy w/fb         ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      removal.
62164..............  Remove brain tumor w/scope  ..................  C.................  ...........  ...........  ...........  ...........  ...........
62165..............  Remove pituit tumor w/      ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      scope.
62180..............  Establish brain cavity      ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      shunt.
62190..............  Establish brain cavity      ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      shunt.
62192..............  Establish brain cavity      ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      shunt.
62194..............  Replace/irrigate catheter.  CH................  T.................         0212       8.5263      $543.07  ...........      $108.61
62200..............  Establish brain cavity      ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      shunt.
62201..............  Brain cavity shunt w/scope  ..................  C.................  ...........  ...........  ...........  ...........  ...........
62220..............  Establish brain cavity      ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      shunt.
62223..............  Establish brain cavity      ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      shunt.
62225..............  Replace/irrigate catheter.  ..................  T.................         0427      15.3545      $977.99  ...........      $195.60
62230..............  Replace/revise brain shunt  ..................  T.................         0224      36.2768    $2,310.61  ...........      $462.12
62252..............  Csf shunt reprogram.......  ..................  S.................         0691       2.3269      $148.21       $50.49       $29.64
62256..............  Remove brain cavity shunt.  ..................  C.................  ...........  ...........  ...........  ...........  ...........
62258..............  Replace brain cavity shunt  ..................  C.................  ...........  ...........  ...........  ...........  ...........
62263..............  Epidural lysis mult         ..................  T.................         0203      14.4879      $922.79      $240.33      $184.56
                      sessions.
62264..............  Epidural lysis on single    ..................  T.................         0203      14.4879      $922.79      $240.33      $184.56
                      day.
62268..............  Drain spinal cord cyst....  ..................  T.................         0212       8.5263      $543.07  ...........      $108.61
62269..............  Needle biopsy, spinal cord  ..................  T.................         0685       9.3354      $594.61  ...........      $118.92
62270..............  Spinal fluid tap,           CH................  T.................         0206       4.0964      $260.92       $56.01       $52.18
                      diagnostic.
62272..............  Drain cerebro spinal fluid  CH................  T.................         0206       4.0964      $260.92       $56.01       $52.18
62273..............  Inject epidural patch.....  ..................  T.................         0206       4.0964      $260.92       $56.01       $52.18
62280..............  Treat spinal cord lesion..  ..................  T.................         0207       7.0546      $449.34  ...........       $89.87
62281..............  Treat spinal cord lesion..  ..................  T.................         0207       7.0546      $449.34  ...........       $89.87
62282..............  Treat spinal canal lesion.  ..................  T.................         0207       7.0546      $449.34  ...........       $89.87
62284..............  Injection for myelogram...  ..................  N.................  ...........  ...........  ...........  ...........  ...........
62287..............  Percutaneous diskectomy...  ..................  T.................         0221      33.2707    $2,119.14      $463.62      $423.83
62290..............  Inject for spine disk x-    ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      ray.
62291..............  Inject for spine disk x-    ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      ray.
62292..............  Injection into disk lesion  ..................  T.................         0212       8.5263      $543.07  ...........      $108.61
62294..............  Injection into spinal       ..................  T.................         0212       8.5263      $543.07  ...........      $108.61
                      artery.
62310..............  Inject spine c/t..........  ..................  T.................         0207       7.0546      $449.34  ...........       $89.87
62311..............  Inject spine l/s (cd).....  ..................  T.................         0207       7.0546      $449.34  ...........       $89.87
62318..............  Inject spine w/cath, c/t..  ..................  T.................         0207       7.0546      $449.34  ...........       $89.87
62319..............  Inject spine w/cath l/s     ..................  T.................         0207       7.0546      $449.34  ...........       $89.87
                      (cd).
62350..............  Implant spinal canal cath.  CH................  T.................         0224      36.2768    $2,310.61  ...........      $462.12
62351..............  Implant spinal canal cath.  ..................  T.................         0208      46.7724    $2,979.12  ...........      $595.82
62355..............  Remove spinal canal         ..................  T.................         0203      14.4879      $922.79      $240.33      $184.56
                      catheter.
62360..............  Insert spine infusion       CH................  T.................         0224      36.2768    $2,310.61  ...........      $462.12
                      device.
62361..............  Implant spine infusion      ..................  T.................         0227     183.8928   $11,712.87  ...........    $2,342.57
                      pump.
62362..............  Implant spine infusion      ..................  T.................         0227     183.8928   $11,712.87  ...........    $2,342.57
                      pump.
62365..............  Remove spine infusion       ..................  T.................         0221      33.2707    $2,119.14      $463.62      $423.83
                      device.
62367..............  Analyze spine infusion      ..................  S.................         0691       2.3269      $148.21       $50.49       $29.64
                      pump.
62368..............  Analyze spine infusion      ..................  S.................         0691       2.3269      $148.21       $50.49       $29.64
                      pump.
63001..............  Removal of spinal lamina..  ..................  T.................         0208      46.7724    $2,979.12  ...........      $595.82
63003..............  Removal of spinal lamina..  ..................  T.................         0208      46.7724    $2,979.12  ...........      $595.82
63005..............  Removal of spinal lamina..  ..................  T.................         0208      46.7724    $2,979.12  ...........      $595.82
63011..............  Removal of spinal lamina..  ..................  T.................         0208      46.7724    $2,979.12  ...........      $595.82
63012..............  Removal of spinal lamina..  ..................  T.................         0208      46.7724    $2,979.12  ...........      $595.82
63015..............  Removal of spinal lamina..  ..................  T.................         0208      46.7724    $2,979.12  ...........      $595.82
63016..............  Removal of spinal lamina..  ..................  T.................         0208      46.7724    $2,979.12  ...........      $595.82
63017..............  Removal of spinal lamina..  ..................  T.................         0208      46.7724    $2,979.12  ...........      $595.82
63020..............  Neck spine disk surgery...  ..................  T.................         0208      46.7724    $2,979.12  ...........      $595.82
63030..............  Low back disk surgery.....  ..................  T.................         0208      46.7724    $2,979.12  ...........      $595.82
63035..............  Spinal disk surgery add-on  ..................  T.................         0208      46.7724    $2,979.12  ...........      $595.82
63040..............  Laminotomy, single          ..................  T.................         0208      46.7724    $2,979.12  ...........      $595.82
                      cervical.
63042..............  Laminotomy, single lumbar.  ..................  T.................         0208      46.7724    $2,979.12  ...........      $595.82
63043..............  Laminotomy, add'l cervical  ..................  C.................  ...........  ...........  ...........  ...........  ...........
63044..............  Laminotomy, add'l lumbar..  ..................  C.................  ...........  ...........  ...........  ...........  ...........
63045..............  Removal of spinal lamina..  ..................  T.................         0208      46.7724    $2,979.12  ...........      $595.82
63046..............  Removal of spinal lamina..  ..................  T.................         0208      46.7724    $2,979.12  ...........      $595.82
63047..............  Removal of spinal lamina..  ..................  T.................         0208      46.7724    $2,979.12  ...........      $595.82
63048..............  Remove spinal lamina add-   ..................  T.................         0208      46.7724    $2,979.12  ...........      $595.82
                      on.
63050..............  Cervical laminoplasty.....  ..................  C.................  ...........  ...........  ...........  ...........  ...........
63051..............  C-laminoplasty w/graft/     ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      plate.
63055..............  Decompress spinal cord....  ..................  T.................         0208      46.7724    $2,979.12  ...........      $595.82
63056..............  Decompress spinal cord....  ..................  T.................         0208      46.7724    $2,979.12  ...........      $595.82
63057..............  Decompress spine cord add-  ..................  T.................         0208      46.7724    $2,979.12  ...........      $595.82
                      on.
63064..............  Decompress spinal cord....  ..................  T.................         0208      46.7724    $2,979.12  ...........      $595.82
63066..............  Decompress spine cord add-  ..................  T.................         0208      46.7724    $2,979.12  ...........      $595.82
                      on.
63075..............  Neck spine disk surgery...  ..................  T.................         0208      46.7724    $2,979.12  ...........      $595.82
63076..............  Neck spine disk surgery...  ..................  C.................  ...........  ...........  ...........  ...........  ...........

[[Page 67063]]

 
63077..............  Spine disk surgery, thorax  ..................  C.................  ...........  ...........  ...........  ...........  ...........
63078..............  Spine disk surgery, thorax  ..................  C.................  ...........  ...........  ...........  ...........  ...........
63081..............  Removal of vertebral body.  ..................  C.................  ...........  ...........  ...........  ...........  ...........
63082..............  Remove vertebral body add-  ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      on.
63085..............  Removal of vertebral body.  ..................  C.................  ...........  ...........  ...........  ...........  ...........
63086..............  Remove vertebral body add-  ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      on.
63087..............  Removal of vertebral body.  ..................  C.................  ...........  ...........  ...........  ...........  ...........
63088..............  Remove vertebral body add-  ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      on.
63090..............  Removal of vertebral body.  ..................  C.................  ...........  ...........  ...........  ...........  ...........
63091..............  Remove vertebral body add-  ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      on.
63101..............  Removal of vertebral body.  ..................  C.................  ...........  ...........  ...........  ...........  ...........
63102..............  Removal of vertebral body.  ..................  C.................  ...........  ...........  ...........  ...........  ...........
63103..............  Remove vertebral body add-  ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      on.
63170..............  Incise spinal cord          ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      tract(s).
63172..............  Drainage of spinal cyst...  ..................  C.................  ...........  ...........  ...........  ...........  ...........
63173..............  Drainage of spinal cyst...  ..................  C.................  ...........  ...........  ...........  ...........  ...........
63180..............  Revise spinal cord          ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      ligaments.
63182..............  Revise spinal cord          ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      ligaments.
63185..............  Incise spinal column/       ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      nerves.
63190..............  Incise spinal column/       ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      nerves.
63191..............  Incise spinal column/       ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      nerves.
63194..............  Incise spinal column &      ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      cord.
63195..............  Incise spinal column &      ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      cord.
63196..............  Incise spinal column &      ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      cord.
63197..............  Incise spinal column &      ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      cord.
63198..............  Incise spinal column &      ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      cord.
63199..............  Incise spinal column &      ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      cord.
63200..............  Release of spinal cord....  ..................  C.................  ...........  ...........  ...........  ...........  ...........
63250..............  Revise spinal cord vessels  ..................  C.................  ...........  ...........  ...........  ...........  ...........
63251..............  Revise spinal cord vessels  ..................  C.................  ...........  ...........  ...........  ...........  ...........
63252..............  Revise spinal cord vessels  ..................  C.................  ...........  ...........  ...........  ...........  ...........
63265..............  Excise intraspinal lesion.  ..................  C.................  ...........  ...........  ...........  ...........  ...........
63266..............  Excise intraspinal lesion.  ..................  C.................  ...........  ...........  ...........  ...........  ...........
63267..............  Excise intraspinal lesion.  ..................  C.................  ...........  ...........  ...........  ...........  ...........
63268..............  Excise intraspinal lesion.  ..................  C.................  ...........  ...........  ...........  ...........  ...........
63270..............  Excise intraspinal lesion.  ..................  C.................  ...........  ...........  ...........  ...........  ...........
63271..............  Excise intraspinal lesion.  ..................  C.................  ...........  ...........  ...........  ...........  ...........
63272..............  Excise intraspinal lesion.  ..................  C.................  ...........  ...........  ...........  ...........  ...........
63273..............  Excise intraspinal lesion.  ..................  C.................  ...........  ...........  ...........  ...........  ...........
63275..............  Biopsy/excise spinal tumor  ..................  C.................  ...........  ...........  ...........  ...........  ...........
63276..............  Biopsy/excise spinal tumor  ..................  C.................  ...........  ...........  ...........  ...........  ...........
63277..............  Biopsy/excise spinal tumor  ..................  C.................  ...........  ...........  ...........  ...........  ...........
63278..............  Biopsy/excise spinal tumor  ..................  C.................  ...........  ...........  ...........  ...........  ...........
63280..............  Biopsy/excise spinal tumor  ..................  C.................  ...........  ...........  ...........  ...........  ...........
63281..............  Biopsy/excise spinal tumor  ..................  C.................  ...........  ...........  ...........  ...........  ...........
63282..............  Biopsy/excise spinal tumor  ..................  C.................  ...........  ...........  ...........  ...........  ...........
63283..............  Biopsy/excise spinal tumor  ..................  C.................  ...........  ...........  ...........  ...........  ...........
63285..............  Biopsy/excise spinal tumor  ..................  C.................  ...........  ...........  ...........  ...........  ...........
63286..............  Biopsy/excise spinal tumor  ..................  C.................  ...........  ...........  ...........  ...........  ...........
63287..............  Biopsy/excise spinal tumor  ..................  C.................  ...........  ...........  ...........  ...........  ...........
63290..............  Biopsy/excise spinal tumor  ..................  C.................  ...........  ...........  ...........  ...........  ...........
63295..............  Repair of laminectomy       ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      defect.
63300..............  Removal of vertebral body.  ..................  C.................  ...........  ...........  ...........  ...........  ...........
63301..............  Removal of vertebral body.  ..................  C.................  ...........  ...........  ...........  ...........  ...........
63302..............  Removal of vertebral body.  ..................  C.................  ...........  ...........  ...........  ...........  ...........
63303..............  Removal of vertebral body.  ..................  C.................  ...........  ...........  ...........  ...........  ...........
63304..............  Removal of vertebral body.  ..................  C.................  ...........  ...........  ...........  ...........  ...........
63305..............  Removal of vertebral body.  ..................  C.................  ...........  ...........  ...........  ...........  ...........
63306..............  Removal of vertebral body.  ..................  C.................  ...........  ...........  ...........  ...........  ...........
63307..............  Removal of vertebral body.  ..................  C.................  ...........  ...........  ...........  ...........  ...........
63308..............  Remove vertebral body add-  ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      on.
63600..............  Remove spinal cord lesion.  ..................  T.................         0220      18.0518    $1,149.79  ...........      $229.96
63610..............  Stimulation of spinal cord  ..................  T.................         0220      18.0518    $1,149.79  ...........      $229.96
63615..............  Remove lesion of spinal     ..................  T.................         0220      18.0518    $1,149.79  ...........      $229.96
                      cord.
63650..............  Implant neuroelectrodes...  ..................  S.................         0040      63.7866    $4,062.82  ...........      $812.56
63655..............  Implant neuroelectrodes...  ..................  S.................         0061      82.8597    $5,277.67  ...........    $1,055.53
63660..............  Revise/remove               ..................  T.................         0687      22.4734    $1,431.42      $438.47      $286.28
                      neuroelectrode.
63685..............  Insrt/redo spine n          CH................  S.................         0222     240.7990   $15,337.45  ...........    $3,067.49
                      generator.
63688..............  Revise/remove               ..................  T.................         0688      34.4166    $2,192.13      $874.57      $438.43
                      neuroreceiver.
63700..............  Repair of spinal            ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      herniation.
63702..............  Repair of spinal            ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      herniation.
63704..............  Repair of spinal            ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      herniation.
63706..............  Repair of spinal            ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      herniation.
63707..............  Repair spinal fluid         ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      leakage.
63709..............  Repair spinal fluid         ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      leakage.
63710..............  Graft repair of spine       ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      defect.
63740..............  Install spinal shunt......  ..................  C.................  ...........  ...........  ...........  ...........  ...........
63741..............  Install spinal shunt......  CH................  T.................         0224      36.2768    $2,310.61  ...........      $462.12
63744..............  Revision of spinal shunt..  CH................  T.................         0224      36.2768    $2,310.61  ...........      $462.12
63746..............  Removal of spinal shunt...  ..................  T.................         0109       5.6614      $360.60  ...........       $72.12

[[Page 67064]]

 
64400..............  N block inj, trigeminal...  ..................  T.................         0204       2.3213      $147.85       $40.13       $29.57
64402..............  N block inj, facial.......  ..................  T.................         0204       2.3213      $147.85       $40.13       $29.57
64405..............  N block inj, occipital....  CH................  T.................         0206       4.0964      $260.92       $56.01       $52.18
64408..............  N block inj, vagus........  CH................  T.................         0206       4.0964      $260.92       $56.01       $52.18
64410..............  N block inj, phrenic......  CH................  T.................         0207       7.0546      $449.34  ...........       $89.87
64412..............  N block inj, spinal         CH................  T.................         0207       7.0546      $449.34  ...........       $89.87
                      accessor.
64413..............  N block inj, cervical       CH................  T.................         0206       4.0964      $260.92       $56.01       $52.18
                      plexus.
64415..............  N block inj, brachial       CH................  T.................         0206       4.0964      $260.92       $56.01       $52.18
                      plexus.
64416..............  N block cont infuse, b      CH................  T.................         0207       7.0546      $449.34  ...........       $89.87
                      plex.
64417..............  N block inj, axillary.....  CH................  T.................         0206       4.0964      $260.92       $56.01       $52.18
64418..............  N block inj, suprascapular  CH................  T.................         0206       4.0964      $260.92       $56.01       $52.18
64420..............  N block inj, intercost,     CH................  T.................         0206       4.0964      $260.92       $56.01       $52.18
                      sng.
64421..............  N block inj, intercost,     ..................  T.................         0206       4.0964      $260.92       $56.01       $52.18
                      mlt.
64425..............  N block inj, ilio-ing/      CH................  T.................         0206       4.0964      $260.92       $56.01       $52.18
                      hypogi.
64430..............  N block inj, pudendal.....  CH................  T.................         0207       7.0546      $449.34  ...........       $89.87
64435..............  N block inj, paracervical.  CH................  T.................         0206       4.0964      $260.92       $56.01       $52.18
64445..............  N block inj, sciatic, sng.  CH................  T.................         0206       4.0964      $260.92       $56.01       $52.18
64446..............  N blk inj, sciatic, cont    CH................  T.................         0203      14.4879      $922.79      $240.33      $184.56
                      inf.
64447..............  N block inj fem, single...  CH................  T.................         0206       4.0964      $260.92       $56.01       $52.18
64448..............  N block inj fem, cont inf.  CH................  T.................         0206       4.0964      $260.92       $56.01       $52.18
64449..............  N block inj, lumbar plexus  CH................  T.................         0207       7.0546      $449.34  ...........       $89.87
64450..............  N block, other peripheral.  CH................  T.................         0206       4.0964      $260.92       $56.01       $52.18
64470..............  Inj paravertebral c/t.....  ..................  T.................         0207       7.0546      $449.34  ...........       $89.87
64472..............  Inj paravertebral c/t add-  ..................  T.................         0206       4.0964      $260.92       $56.01       $52.18
                      on.
64475..............  Inj paravertebral l/s.....  ..................  T.................         0207       7.0546      $449.34  ...........       $89.87
64476..............  Inj paravertebral l/s add-  CH................  T.................         0204       2.3213      $147.85       $40.13       $29.57
                      on.
64479..............  Inj foramen epidural c/t..  ..................  T.................         0207       7.0546      $449.34  ...........       $89.87
64480..............  Inj foramen epidural add-   CH................  T.................         0206       4.0964      $260.92       $56.01       $52.18
                      on.
64483..............  Inj foramen epidural l/s..  ..................  T.................         0207       7.0546      $449.34  ...........       $89.87
64484..............  Inj foramen epidural add-   CH................  T.................         0206       4.0964      $260.92       $56.01       $52.18
                      on.
64505..............  N block, spenopalatine      ..................  T.................         0204       2.3213      $147.85       $40.13       $29.57
                      gangl.
64508..............  N block, carotid sinus s/p  ..................  T.................         0204       2.3213      $147.85       $40.13       $29.57
64510..............  N block, stellate ganglion  ..................  T.................         0207       7.0546      $449.34  ...........       $89.87
64517..............  N block inj, hypogas plxs.  CH................  T.................         0207       7.0546      $449.34  ...........       $89.87
64520..............  N block, lumbar/thoracic..  ..................  T.................         0207       7.0546      $449.34  ...........       $89.87
64530..............  N block inj, celiac pelus.  ..................  T.................         0207       7.0546      $449.34  ...........       $89.87
64550..............  Apply neurostimulator.....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
64553..............  Implant neuroelectrodes...  ..................  S.................         0225     220.7642   $14,061.35  ...........    $2,812.27
64555..............  Implant neuroelectrodes...  ..................  S.................         0040      63.7866    $4,062.82  ...........      $812.56
64560..............  Implant neuroelectrodes...  ..................  S.................         0040      63.7866    $4,062.82  ...........      $812.56
64561..............  Implant neuroelectrodes...  ..................  S.................         0040      63.7866    $4,062.82  ...........      $812.56
64565..............  Implant neuroelectrodes...  ..................  S.................         0040      63.7866    $4,062.82  ...........      $812.56
64573..............  Implant neuroelectrodes...  ..................  S.................         0225     220.7642   $14,061.35  ...........    $2,812.27
64575..............  Implant neuroelectrodes...  ..................  S.................         0061      82.8597    $5,277.67  ...........    $1,055.53
64577..............  Implant neuroelectrodes...  ..................  S.................         0061      82.8597    $5,277.67  ...........    $1,055.53
64580..............  Implant neuroelectrodes...  ..................  S.................         0061      82.8597    $5,277.67  ...........    $1,055.53
64581..............  Implant neuroelectrodes...  ..................  S.................         0061      82.8597    $5,277.67  ...........    $1,055.53
64585..............  Revise/remove               ..................  T.................         0687      22.4734    $1,431.42      $438.47      $286.28
                      neuroelectrode.
64590..............  Insrt/redo pn/gastr stimul  CH................  S.................         0039     186.4739   $11,877.27  ...........    $2,375.45
64595..............  Revise/rmv pn/gastr stimul  ..................  T.................         0688      34.4166    $2,192.13      $874.57      $438.43
64600..............  Injection treatment of      ..................  T.................         0203      14.4879      $922.79      $240.33      $184.56
                      nerve.
64605..............  Injection treatment of      ..................  T.................         0203      14.4879      $922.79      $240.33      $184.56
                      nerve.
64610..............  Injection treatment of      ..................  T.................         0203      14.4879      $922.79      $240.33      $184.56
                      nerve.
64612..............  Destroy nerve, face muscle  ..................  T.................         0204       2.3213      $147.85       $40.13       $29.57
64613..............  Destroy nerve, neck muscle  ..................  T.................         0204       2.3213      $147.85       $40.13       $29.57
64614..............  Destroy nerve, extrem musc  ..................  T.................         0204       2.3213      $147.85       $40.13       $29.57
64620..............  Injection treatment of      CH................  T.................         0207       7.0546      $449.34  ...........       $89.87
                      nerve.
64622..............  Destr paravertebrl nerve l/ ..................  T.................         0203      14.4879      $922.79      $240.33      $184.56
                      s.
64623..............  Destr paravertebral n add-  ..................  T.................         0207       7.0546      $449.34  ...........       $89.87
                      on.
64626..............  Destr paravertebrl nerve c/ ..................  T.................         0203      14.4879      $922.79      $240.33      $184.56
                      t.
64627..............  Destr paravertebral n add-  CH................  T.................         0204       2.3213      $147.85       $40.13       $29.57
                      on.
64630..............  Injection treatment of      CH................  T.................         0207       7.0546      $449.34  ...........       $89.87
                      nerve.
64640..............  Injection treatment of      CH................  T.................         0207       7.0546      $449.34  ...........       $89.87
                      nerve.
64650..............  Chemodenerv eccrine glands  ..................  T.................         0204       2.3213      $147.85       $40.13       $29.57
64653..............  Chemodenerv eccrine glands  ..................  T.................         0204       2.3213      $147.85       $40.13       $29.57
64680..............  Injection treatment of      CH................  T.................         0203      14.4879      $922.79      $240.33      $184.56
                      nerve.
64681..............  Injection treatment of      ..................  T.................         0203      14.4879      $922.79      $240.33      $184.56
                      nerve.
64702..............  Revise finger/toe nerve...  ..................  T.................         0220      18.0518    $1,149.79  ...........      $229.96
64704..............  Revise hand/foot nerve....  ..................  T.................         0220      18.0518    $1,149.79  ...........      $229.96
64708..............  Revise arm/leg nerve......  ..................  T.................         0220      18.0518    $1,149.79  ...........      $229.96
64712..............  Revision of sciatic nerve.  ..................  T.................         0220      18.0518    $1,149.79  ...........      $229.96
64713..............  Revision of arm nerve(s)..  ..................  T.................         0220      18.0518    $1,149.79  ...........      $229.96
64714..............  Revise low back nerve(s)..  ..................  T.................         0220      18.0518    $1,149.79  ...........      $229.96
64716..............  Revision of cranial nerve.  ..................  T.................         0220      18.0518    $1,149.79  ...........      $229.96
64718..............  Revise ulnar nerve at       ..................  T.................         0220      18.0518    $1,149.79  ...........      $229.96
                      elbow.
64719..............  Revise ulnar nerve at       ..................  T.................         0220      18.0518    $1,149.79  ...........      $229.96
                      wrist.
64721..............  Carpal tunnel surgery.....  ..................  T.................         0220      18.0518    $1,149.79  ...........      $229.96
64722..............  Relieve pressure on         ..................  T.................         0220      18.0518    $1,149.79  ...........      $229.96
                      nerve(s).
64726..............  Release foot/toe nerve....  ..................  T.................         0220      18.0518    $1,149.79  ...........      $229.96
64727..............  Internal nerve revision...  ..................  T.................         0220      18.0518    $1,149.79  ...........      $229.96

[[Page 67065]]

 
64732..............  Incision of brow nerve....  ..................  T.................         0220      18.0518    $1,149.79  ...........      $229.96
64734..............  Incision of cheek nerve...  ..................  T.................         0220      18.0518    $1,149.79  ...........      $229.96
64736..............  Incision of chin nerve....  ..................  T.................         0220      18.0518    $1,149.79  ...........      $229.96
64738..............  Incision of jaw nerve.....  ..................  T.................         0220      18.0518    $1,149.79  ...........      $229.96
64740..............  Incision of tongue nerve..  ..................  T.................         0220      18.0518    $1,149.79  ...........      $229.96
64742..............  Incision of facial nerve..  ..................  T.................         0220      18.0518    $1,149.79  ...........      $229.96
64744..............  Incise nerve, back of head  ..................  T.................         0220      18.0518    $1,149.79  ...........      $229.96
64746..............  Incise diaphragm nerve....  ..................  T.................         0220      18.0518    $1,149.79  ...........      $229.96
64752..............  Incision of vagus nerve...  ..................  C.................  ...........  ...........  ...........  ...........  ...........
64755..............  Incision of stomach nerves  ..................  C.................  ...........  ...........  ...........  ...........  ...........
64760..............  Incision of vagus nerve...  ..................  C.................  ...........  ...........  ...........  ...........  ...........
64761..............  Incision of pelvis nerve..  ..................  T.................         0220      18.0518    $1,149.79  ...........      $229.96
64763..............  Incise hip/thigh nerve....  ..................  T.................         0220      18.0518    $1,149.79  ...........      $229.96
64766..............  Incise hip/thigh nerve....  ..................  T.................         0221      33.2707    $2,119.14      $463.62      $423.83
64771..............  Sever cranial nerve.......  ..................  T.................         0220      18.0518    $1,149.79  ...........      $229.96
64772..............  Incision of spinal nerve..  ..................  T.................         0220      18.0518    $1,149.79  ...........      $229.96
64774..............  Remove skin nerve lesion..  ..................  T.................         0220      18.0518    $1,149.79  ...........      $229.96
64776..............  Remove digit nerve lesion.  ..................  T.................         0220      18.0518    $1,149.79  ...........      $229.96
64778..............  Digit nerve surgery add-on  ..................  T.................         0220      18.0518    $1,149.79  ...........      $229.96
64782..............  Remove limb nerve lesion..  ..................  T.................         0220      18.0518    $1,149.79  ...........      $229.96
64783..............  Limb nerve surgery add-on.  ..................  T.................         0220      18.0518    $1,149.79  ...........      $229.96
64784..............  Remove nerve lesion.......  ..................  T.................         0220      18.0518    $1,149.79  ...........      $229.96
64786..............  Remove sciatic nerve        ..................  T.................         0221      33.2707    $2,119.14      $463.62      $423.83
                      lesion.
64787..............  Implant nerve end.........  ..................  T.................         0220      18.0518    $1,149.79  ...........      $229.96
64788..............  Remove skin nerve lesion..  ..................  T.................         0220      18.0518    $1,149.79  ...........      $229.96
64790..............  Removal of nerve lesion...  ..................  T.................         0220      18.0518    $1,149.79  ...........      $229.96
64792..............  Removal of nerve lesion...  ..................  T.................         0221      33.2707    $2,119.14      $463.62      $423.83
64795..............  Biopsy of nerve...........  ..................  T.................         0220      18.0518    $1,149.79  ...........      $229.96
64802..............  Remove sympathetic nerves.  ..................  T.................         0220      18.0518    $1,149.79  ...........      $229.96
64804..............  Remove sympathetic nerves.  ..................  T.................         0220      18.0518    $1,149.79  ...........      $229.96
64809..............  Remove sympathetic nerves.  ..................  C.................  ...........  ...........  ...........  ...........  ...........
64818..............  Remove sympathetic nerves.  ..................  C.................  ...........  ...........  ...........  ...........  ...........
64820..............  Remove sympathetic nerves.  ..................  T.................         0220      18.0518    $1,149.79  ...........      $229.96
64821..............  Remove sympathetic nerves.  ..................  T.................         0054      26.3105    $1,675.82  ...........      $335.16
64822..............  Remove sympathetic nerves.  ..................  T.................         0054      26.3105    $1,675.82  ...........      $335.16
64823..............  Remove sympathetic nerves.  ..................  T.................         0054      26.3105    $1,675.82  ...........      $335.16
64831..............  Repair of digit nerve.....  ..................  T.................         0221      33.2707    $2,119.14      $463.62      $423.83
64832..............  Repair nerve add-on.......  ..................  T.................         0221      33.2707    $2,119.14      $463.62      $423.83
64834..............  Repair of hand or foot      ..................  T.................         0221      33.2707    $2,119.14      $463.62      $423.83
                      nerve.
64835..............  Repair of hand or foot      ..................  T.................         0221      33.2707    $2,119.14      $463.62      $423.83
                      nerve.
64836..............  Repair of hand or foot      ..................  T.................         0221      33.2707    $2,119.14      $463.62      $423.83
                      nerve.
64837..............  Repair nerve add-on.......  ..................  T.................         0221      33.2707    $2,119.14      $463.62      $423.83
64840..............  Repair of leg nerve.......  ..................  T.................         0221      33.2707    $2,119.14      $463.62      $423.83
64856..............  Repair/transpose nerve....  ..................  T.................         0221      33.2707    $2,119.14      $463.62      $423.83
64857..............  Repair arm/leg nerve......  ..................  T.................         0221      33.2707    $2,119.14      $463.62      $423.83
64858..............  Repair sciatic nerve......  ..................  T.................         0221      33.2707    $2,119.14      $463.62      $423.83
64859..............  Nerve surgery.............  ..................  T.................         0221      33.2707    $2,119.14      $463.62      $423.83
64861..............  Repair of arm nerves......  ..................  T.................         0221      33.2707    $2,119.14      $463.62      $423.83
64862..............  Repair of low back nerves.  ..................  T.................         0221      33.2707    $2,119.14      $463.62      $423.83
64864..............  Repair of facial nerve....  ..................  T.................         0221      33.2707    $2,119.14      $463.62      $423.83
64865..............  Repair of facial nerve....  ..................  T.................         0221      33.2707    $2,119.14      $463.62      $423.83
64866..............  Fusion of facial/other      ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      nerve.
64868..............  Fusion of facial/other      ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      nerve.
64870..............  Fusion of facial/other      ..................  T.................         0221      33.2707    $2,119.14      $463.62      $423.83
                      nerve.
64872..............  Subsequent repair of nerve  ..................  T.................         0221      33.2707    $2,119.14      $463.62      $423.83
64874..............  Repair & revise nerve add-  ..................  T.................         0221      33.2707    $2,119.14      $463.62      $423.83
                      on.
64876..............  Repair nerve/shorten bone.  ..................  T.................         0221      33.2707    $2,119.14      $463.62      $423.83
64885..............  Nerve graft, head or neck.  ..................  T.................         0221      33.2707    $2,119.14      $463.62      $423.83
64886..............  Nerve graft, head or neck.  ..................  T.................         0221      33.2707    $2,119.14      $463.62      $423.83
64890..............  Nerve graft, hand or foot.  ..................  T.................         0221      33.2707    $2,119.14      $463.62      $423.83
64891..............  Nerve graft, hand or foot.  ..................  T.................         0221      33.2707    $2,119.14      $463.62      $423.83
64892..............  Nerve graft, arm or leg...  ..................  T.................         0221      33.2707    $2,119.14      $463.62      $423.83
64893..............  Nerve graft, arm or leg...  ..................  T.................         0221      33.2707    $2,119.14      $463.62      $423.83
64895..............  Nerve graft, hand or foot.  ..................  T.................         0221      33.2707    $2,119.14      $463.62      $423.83
64896..............  Nerve graft, hand or foot.  ..................  T.................         0221      33.2707    $2,119.14      $463.62      $423.83
64897..............  Nerve graft, arm or leg...  ..................  T.................         0221      33.2707    $2,119.14      $463.62      $423.83
64898..............  Nerve graft, arm or leg...  ..................  T.................         0221      33.2707    $2,119.14      $463.62      $423.83
64901..............  Nerve graft add-on........  ..................  T.................         0221      33.2707    $2,119.14      $463.62      $423.83
64902..............  Nerve graft add-on........  ..................  T.................         0221      33.2707    $2,119.14      $463.62      $423.83
64905..............  Nerve pedicle transfer....  ..................  T.................         0221      33.2707    $2,119.14      $463.62      $423.83
64907..............  Nerve pedicle transfer....  ..................  T.................         0221      33.2707    $2,119.14      $463.62      $423.83
64910..............  Nerve repair w/allograft..  ..................  T.................         0220      18.0518    $1,149.79  ...........      $229.96
64911..............  Neurorraphy w/vein          ..................  T.................         0220      18.0518    $1,149.79  ...........      $229.96
                      autograft.
64999..............  Nervous system surgery....  ..................  T.................         0204       2.3213      $147.85       $40.13       $29.57
65091..............  Revise eye................  ..................  T.................         0242      37.7243    $2,402.81      $597.36      $480.56
65093..............  Revise eye with implant...  ..................  T.................         0242      37.7243    $2,402.81      $597.36      $480.56
65101..............  Removal of eye............  ..................  T.................         0242      37.7243    $2,402.81      $597.36      $480.56
65103..............  Remove eye/insert implant.  ..................  T.................         0242      37.7243    $2,402.81      $597.36      $480.56
65105..............  Remove eye/attach implant.  ..................  T.................         0242      37.7243    $2,402.81      $597.36      $480.56
65110..............  Removal of eye............  ..................  T.................         0242      37.7243    $2,402.81      $597.36      $480.56

[[Page 67066]]

 
65112..............  Remove eye/revise socket..  ..................  T.................         0242      37.7243    $2,402.81      $597.36      $480.56
65114..............  Remove eye/revise socket..  ..................  T.................         0242      37.7243    $2,402.81      $597.36      $480.56
65125..............  Revise ocular implant.....  ..................  T.................         0240      18.7307    $1,193.03      $309.52      $238.61
65130..............  Insert ocular implant.....  ..................  T.................         0241      24.3077    $1,548.25      $383.45      $309.65
65135..............  Insert ocular implant.....  ..................  T.................         0241      24.3077    $1,548.25      $383.45      $309.65
65140..............  Attach ocular implant.....  ..................  T.................         0242      37.7243    $2,402.81      $597.36      $480.56
65150..............  Revise ocular implant.....  ..................  T.................         0241      24.3077    $1,548.25      $383.45      $309.65
65155..............  Reinsert ocular implant...  ..................  T.................         0242      37.7243    $2,402.81      $597.36      $480.56
65175..............  Removal of ocular implant.  ..................  T.................         0240      18.7307    $1,193.03      $309.52      $238.61
65205..............  Remove foreign body from    ..................  S.................         0698       0.8696       $55.39  ...........       $11.08
                      eye.
65210..............  Remove foreign body from    ..................  S.................         0698       0.8696       $55.39  ...........       $11.08
                      eye.
65220..............  Remove foreign body from    ..................  S.................         0698       0.8696       $55.39  ...........       $11.08
                      eye.
65222..............  Remove foreign body from    ..................  S.................         0698       0.8696       $55.39  ...........       $11.08
                      eye.
65235..............  Remove foreign body from    ..................  T.................         0233      16.1710    $1,030.00      $266.33      $206.00
                      eye.
65260..............  Remove foreign body from    ..................  T.................         0236      18.2350    $1,161.46  ...........      $232.29
                      eye.
65265..............  Remove foreign body from    ..................  T.................         0237      27.8450    $1,773.56  ...........      $354.71
                      eye.
65270..............  Repair of eye wound.......  ..................  T.................         0240      18.7307    $1,193.03      $309.52      $238.61
65272..............  Repair of eye wound.......  ..................  T.................         0234      23.1758    $1,476.16      $511.31      $295.23
65273..............  Repair of eye wound.......  ..................  C.................  ...........  ...........  ...........  ...........  ...........
65275..............  Repair of eye wound.......  ..................  T.................         0234      23.1758    $1,476.16      $511.31      $295.23
65280..............  Repair of eye wound.......  ..................  T.................         0236      18.2350    $1,161.46  ...........      $232.29
65285..............  Repair of eye wound.......  ..................  T.................         0672      37.2078    $2,369.91  ...........      $473.98
65286..............  Repair of eye wound.......  ..................  T.................         0232       5.1169      $325.92       $81.65       $65.18
65290..............  Repair of eye socket wound  ..................  T.................         0243      24.1291    $1,536.88      $430.35      $307.38
65400..............  Removal of eye lesion.....  ..................  T.................         0233      16.1710    $1,030.00      $266.33      $206.00
65410..............  Biopsy of cornea..........  ..................  T.................         0233      16.1710    $1,030.00      $266.33      $206.00
65420..............  Removal of eye lesion.....  ..................  T.................         0233      16.1710    $1,030.00      $266.33      $206.00
65426..............  Removal of eye lesion.....  ..................  T.................         0234      23.1758    $1,476.16      $511.31      $295.23
65430..............  Corneal smear.............  ..................  S.................         0698       0.8696       $55.39  ...........       $11.08
65435..............  Curette/treat cornea......  ..................  T.................         0239       7.2847      $463.99  ...........       $92.80
65436..............  Curette/treat cornea......  ..................  T.................         0233      16.1710    $1,030.00      $266.33      $206.00
65450..............  Treatment of corneal        ..................  S.................         0231       2.1790      $138.79  ...........       $27.76
                      lesion.
65600..............  Revision of cornea........  ..................  T.................         0240      18.7307    $1,193.03      $309.52      $238.61
65710..............  Corneal transplant........  ..................  T.................         0244      37.4896    $2,387.86      $803.26      $477.57
65730..............  Corneal transplant........  ..................  T.................         0244      37.4896    $2,387.86      $803.26      $477.57
65750..............  Corneal transplant........  ..................  T.................         0244      37.4896    $2,387.86      $803.26      $477.57
65755..............  Corneal transplant........  ..................  T.................         0244      37.4896    $2,387.86      $803.26      $477.57
65760..............  Revision of cornea........  ..................  E.................  ...........  ...........  ...........  ...........  ...........
65765..............  Revision of cornea........  ..................  E.................  ...........  ...........  ...........  ...........  ...........
65767..............  Corneal tissue transplant.  ..................  E.................  ...........  ...........  ...........  ...........  ...........
65770..............  Revise cornea with implant  ..................  T.................         0293      84.8039    $5,401.50    $1,128.29    $1,080.30
65771..............  Radial keratotomy.........  ..................  E.................  ...........  ...........  ...........  ...........  ...........
65772..............  Correction of astigmatism.  ..................  T.................         0233      16.1710    $1,030.00      $266.33      $206.00
65775..............  Correction of astigmatism.  ..................  T.................         0233      16.1710    $1,030.00      $266.33      $206.00
65780..............  Ocular reconst, transplant  ..................  T.................         0244      37.4896    $2,387.86      $803.26      $477.57
65781..............  Ocular reconst, transplant  ..................  T.................         0244      37.4896    $2,387.86      $803.26      $477.57
65782..............  Ocular reconst, transplant  ..................  T.................         0244      37.4896    $2,387.86      $803.26      $477.57
65800..............  Drainage of eye...........  ..................  T.................         0233      16.1710    $1,030.00      $266.33      $206.00
65805..............  Drainage of eye...........  ..................  T.................         0233      16.1710    $1,030.00      $266.33      $206.00
65810..............  Drainage of eye...........  ..................  T.................         0234      23.1758    $1,476.16      $511.31      $295.23
65815..............  Drainage of eye...........  ..................  T.................         0234      23.1758    $1,476.16      $511.31      $295.23
65820..............  Relieve inner eye pressure  ..................  T.................         0232       5.1169      $325.92       $81.65       $65.18
65850..............  Incision of eye...........  ..................  T.................         0234      23.1758    $1,476.16      $511.31      $295.23
65855..............  Laser surgery of eye......  ..................  T.................         0247       5.2001      $331.22      $104.31       $66.24
65860..............  Incise inner eye adhesions  ..................  T.................         0247       5.2001      $331.22      $104.31       $66.24
65865..............  Incise inner eye adhesions  ..................  T.................         0233      16.1710    $1,030.00      $266.33      $206.00
65870..............  Incise inner eye adhesions  ..................  T.................         0234      23.1758    $1,476.16      $511.31      $295.23
65875..............  Incise inner eye adhesions  ..................  T.................         0234      23.1758    $1,476.16      $511.31      $295.23
65880..............  Incise inner eye adhesions  ..................  T.................         0233      16.1710    $1,030.00      $266.33      $206.00
65900..............  Remove eye lesion.........  ..................  T.................         0233      16.1710    $1,030.00      $266.33      $206.00
65920..............  Remove implant of eye.....  ..................  T.................         0234      23.1758    $1,476.16      $511.31      $295.23
65930..............  Remove blood clot from eye  ..................  T.................         0234      23.1758    $1,476.16      $511.31      $295.23
66020..............  Injection treatment of eye  ..................  T.................         0233      16.1710    $1,030.00      $266.33      $206.00
66030..............  Injection treatment of eye  ..................  T.................         0232       5.1169      $325.92       $81.65       $65.18
66130..............  Remove eye lesion.........  ..................  T.................         0234      23.1758    $1,476.16      $511.31      $295.23
66150..............  Glaucoma surgery..........  ..................  T.................         0234      23.1758    $1,476.16      $511.31      $295.23
66155..............  Glaucoma surgery..........  ..................  T.................         0234      23.1758    $1,476.16      $511.31      $295.23
66160..............  Glaucoma surgery..........  ..................  T.................         0234      23.1758    $1,476.16      $511.31      $295.23
66165..............  Glaucoma surgery..........  ..................  T.................         0234      23.1758    $1,476.16      $511.31      $295.23
66170..............  Glaucoma surgery..........  ..................  T.................         0234      23.1758    $1,476.16      $511.31      $295.23
66172..............  Incision of eye...........  ..................  T.................         0234      23.1758    $1,476.16      $511.31      $295.23
66180..............  Implant eye shunt.........  ..................  T.................         0673      39.7101    $2,529.30      $649.56      $505.86
66185..............  Revise eye shunt..........  ..................  T.................         0673      39.7101    $2,529.30      $649.56      $505.86
66220..............  Repair eye lesion.........  ..................  T.................         0672      37.2078    $2,369.91  ...........      $473.98
66225..............  Repair/graft eye lesion...  ..................  T.................         0673      39.7101    $2,529.30      $649.56      $505.86
66250..............  Follow-up surgery of eye..  ..................  T.................         0233      16.1710    $1,030.00      $266.33      $206.00
66500..............  Incision of iris..........  ..................  T.................         0232       5.1169      $325.92       $81.65       $65.18
66505..............  Incision of iris..........  ..................  T.................         0232       5.1169      $325.92       $81.65       $65.18
66600..............  Remove iris and lesion....  ..................  T.................         0234      23.1758    $1,476.16      $511.31      $295.23
66605..............  Removal of iris...........  ..................  T.................         0234      23.1758    $1,476.16      $511.31      $295.23

[[Page 67067]]

 
66625..............  Removal of iris...........  ..................  T.................         0232       5.1169      $325.92       $81.65       $65.18
66630..............  Removal of iris...........  ..................  T.................         0234      23.1758    $1,476.16      $511.31      $295.23
66635..............  Removal of iris...........  ..................  T.................         0234      23.1758    $1,476.16      $511.31      $295.23
66680..............  Repair iris & ciliary body  ..................  T.................         0234      23.1758    $1,476.16      $511.31      $295.23
66682..............  Repair iris & ciliary body  ..................  T.................         0234      23.1758    $1,476.16      $511.31      $295.23
66700..............  Destruction, ciliary body.  ..................  T.................         0233      16.1710    $1,030.00      $266.33      $206.00
66710..............  Ciliary transsleral         ..................  T.................         0233      16.1710    $1,030.00      $266.33      $206.00
                      therapy.
66711..............  Ciliary endoscopic          ..................  T.................         0233      16.1710    $1,030.00      $266.33      $206.00
                      ablation.
66720..............  Destruction, ciliary body.  ..................  T.................         0233      16.1710    $1,030.00      $266.33      $206.00
66740..............  Destruction, ciliary body.  ..................  T.................         0234      23.1758    $1,476.16      $511.31      $295.23
66761..............  Revision of iris..........  ..................  T.................         0247       5.2001      $331.22      $104.31       $66.24
66762..............  Revision of iris..........  ..................  T.................         0247       5.2001      $331.22      $104.31       $66.24
66770..............  Removal of inner eye        ..................  T.................         0247       5.2001      $331.22      $104.31       $66.24
                      lesion.
66820..............  Incision, secondary         ..................  T.................         0232       5.1169      $325.92       $81.65       $65.18
                      cataract.
66821..............  After cataract laser        ..................  T.................         0247       5.2001      $331.22      $104.31       $66.24
                      surgery.
66825..............  Reposition intraocular      ..................  T.................         0234      23.1758    $1,476.16      $511.31      $295.23
                      lens.
66830..............  Removal of lens lesion....  ..................  T.................         0232       5.1169      $325.92       $81.65       $65.18
66840..............  Removal of lens material..  ..................  T.................         0245      14.9171      $950.13      $217.05      $190.03
66850..............  Removal of lens material..  ..................  T.................         0249      28.7035    $1,828.24      $524.67      $365.65
66852..............  Removal of lens material..  ..................  T.................         0249      28.7035    $1,828.24      $524.67      $365.65
66920..............  Extraction of lens........  ..................  T.................         0249      28.7035    $1,828.24      $524.67      $365.65
66930..............  Extraction of lens........  ..................  T.................         0249      28.7035    $1,828.24      $524.67      $365.65
66940..............  Extraction of lens........  ..................  T.................         0245      14.9171      $950.13      $217.05      $190.03
66982..............  Cataract surgery, complex.  ..................  T.................         0246      23.8649    $1,520.05      $495.96      $304.01
66983..............  Cataract surg w/iol, 1      ..................  T.................         0246      23.8649    $1,520.05      $495.96      $304.01
                      stage.
66984..............  Cataract surg w/iol, 1      ..................  T.................         0246      23.8649    $1,520.05      $495.96      $304.01
                      stage.
66985..............  Insert lens prosthesis....  ..................  T.................         0246      23.8649    $1,520.05      $495.96      $304.01
66986..............  Exchange lens prosthesis..  ..................  T.................         0246      23.8649    $1,520.05      $495.96      $304.01
66990..............  Ophthalmic endoscope add-   ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      on.
66999..............  Eye surgery procedure.....  ..................  T.................         0232       5.1169      $325.92       $81.65       $65.18
67005..............  Partial removal of eye      ..................  T.................         0237      27.8450    $1,773.56  ...........      $354.71
                      fluid.
67010..............  Partial removal of eye      ..................  T.................         0237      27.8450    $1,773.56  ...........      $354.71
                      fluid.
67015..............  Release of eye fluid......  ..................  T.................         0237      27.8450    $1,773.56  ...........      $354.71
67025..............  Replace eye fluid.........  ..................  T.................         0237      27.8450    $1,773.56  ...........      $354.71
67027..............  Implant eye drug system...  ..................  T.................         0672      37.2078    $2,369.91  ...........      $473.98
67028..............  Injection eye drug........  CH................  S.................         0231       2.1790      $138.79  ...........       $27.76
67030..............  Incise inner eye strands..  ..................  T.................         0236      18.2350    $1,161.46  ...........      $232.29
67031..............  Laser surgery, eye strands  ..................  T.................         0247       5.2001      $331.22      $104.31       $66.24
67036..............  Removal of inner eye fluid  ..................  T.................         0672      37.2078    $2,369.91  ...........      $473.98
67038..............  Strip retinal membrane....  CH................  D.................  ...........  ...........  ...........  ...........  ...........
67039..............  Laser treatment of retina.  ..................  T.................         0672      37.2078    $2,369.91  ...........      $473.98
67040..............  Laser treatment of retina.  ..................  T.................         0672      37.2078    $2,369.91  ...........      $473.98
67041..............  Vit for macular pucker....  NI................  T.................         0672      37.2078    $2,369.91  ...........      $473.98
67042..............  Vit for macular hole......  NI................  T.................         0672      37.2078    $2,369.91  ...........      $473.98
67043..............  Vit for membrane dissect..  NI................  T.................         0672      37.2078    $2,369.91  ...........      $473.98
67101..............  Repair detached retina....  ..................  T.................         0236      18.2350    $1,161.46  ...........      $232.29
67105..............  Repair detached retina....  CH................  T.................         0247       5.2001      $331.22      $104.31       $66.24
67107..............  Repair detached retina....  ..................  T.................         0672      37.2078    $2,369.91  ...........      $473.98
67108..............  Repair detached retina....  ..................  T.................         0672      37.2078    $2,369.91  ...........      $473.98
67110..............  Repair detached retina....  ..................  T.................         0236      18.2350    $1,161.46  ...........      $232.29
67112..............  Rerepair detached retina..  ..................  T.................         0672      37.2078    $2,369.91  ...........      $473.98
67113..............  Repair retinal detach,      NI................  T.................         0672      37.2078    $2,369.91  ...........      $473.98
                      cplx.
67115..............  Release encircling          ..................  T.................         0236      18.2350    $1,161.46  ...........      $232.29
                      material.
67120..............  Remove eye implant          ..................  T.................         0236      18.2350    $1,161.46  ...........      $232.29
                      material.
67121..............  Remove eye implant          ..................  T.................         0237      27.8450    $1,773.56  ...........      $354.71
                      material.
67141..............  Treatment of retina.......  ..................  T.................         0235       4.1331      $263.25       $58.93       $52.65
67145..............  Treatment of retina.......  CH................  T.................         0247       5.2001      $331.22      $104.31       $66.24
67208..............  Treatment of retinal        ..................  T.................         0236      18.2350    $1,161.46  ...........      $232.29
                      lesion.
67210..............  Treatment of retinal        CH................  T.................         0247       5.2001      $331.22      $104.31       $66.24
                      lesion.
67218..............  Treatment of retinal        ..................  T.................         0236      18.2350    $1,161.46  ...........      $232.29
                      lesion.
67220..............  Treatment of choroid        ..................  T.................         0235       4.1331      $263.25       $58.93       $52.65
                      lesion.
67221..............  Ocular photodynamic ther..  ..................  T.................         0235       4.1331      $263.25       $58.93       $52.65
67225..............  Eye photodynamic ther add-  ..................  T.................         0235       4.1331      $263.25       $58.93       $52.65
                      on.
67227..............  Treatment of retinal        ..................  T.................         0237      27.8450    $1,773.56  ...........      $354.71
                      lesion.
67228..............  Treatment of retinal        CH................  T.................         0247       5.2001      $331.22      $104.31       $66.24
                      lesion.
67229..............  Tr retinal les preterm inf  NI................  T.................         0247       5.2001      $331.22      $104.31       $66.24
67250..............  Reinforce eye wall........  ..................  T.................         0240      18.7307    $1,193.03      $309.52      $238.61
67255..............  Reinforce/graft eye wall..  ..................  T.................         0237      27.8450    $1,773.56  ...........      $354.71
67299..............  Eye surgery procedure.....  ..................  T.................         0235       4.1331      $263.25       $58.93       $52.65
67311..............  Revise eye muscle.........  ..................  T.................         0243      24.1291    $1,536.88      $430.35      $307.38
67312..............  Revise two eye muscles....  ..................  T.................         0243      24.1291    $1,536.88      $430.35      $307.38
67314..............  Revise eye muscle.........  ..................  T.................         0243      24.1291    $1,536.88      $430.35      $307.38
67316..............  Revise two eye muscles....  ..................  T.................         0243      24.1291    $1,536.88      $430.35      $307.38
67318..............  Revise eye muscle(s)......  ..................  T.................         0243      24.1291    $1,536.88      $430.35      $307.38
67320..............  Revise eye muscle(s) add-   ..................  T.................         0243      24.1291    $1,536.88      $430.35      $307.38
                      on.
67331..............  Eye surgery follow-up add-  ..................  T.................         0243      24.1291    $1,536.88      $430.35      $307.38
                      on.
67332..............  Rerevise eye muscles add-   ..................  T.................         0243      24.1291    $1,536.88      $430.35      $307.38
                      on.
67334..............  Revise eye muscle w/suture  ..................  T.................         0243      24.1291    $1,536.88      $430.35      $307.38
67335..............  Eye suture during surgery.  ..................  T.................         0243      24.1291    $1,536.88      $430.35      $307.38
67340..............  Revise eye muscle add-on..  ..................  T.................         0243      24.1291    $1,536.88      $430.35      $307.38

[[Page 67068]]

 
67343..............  Release eye tissue........  ..................  T.................         0243      24.1291    $1,536.88      $430.35      $307.38
67345..............  Destroy nerve of eye        ..................  T.................         0238       2.9022      $184.85  ...........       $36.97
                      muscle.
67346..............  Biopsy, eye muscle........  ..................  T.................         0699      13.7453      $875.49  ...........      $175.10
67399..............  Eye muscle surgery          ..................  T.................         0243      24.1291    $1,536.88      $430.35      $307.38
                      procedure.
67400..............  Explore/biopsy eye socket.  ..................  T.................         0241      24.3077    $1,548.25      $383.45      $309.65
67405..............  Explore/drain eye socket..  ..................  T.................         0241      24.3077    $1,548.25      $383.45      $309.65
67412..............  Explore/treat eye socket..  ..................  T.................         0241      24.3077    $1,548.25      $383.45      $309.65
67413..............  Explore/treat eye socket..  ..................  T.................         0241      24.3077    $1,548.25      $383.45      $309.65
67414..............  Explr/decompress eye        ..................  T.................         0242      37.7243    $2,402.81      $597.36      $480.56
                      socket.
67415..............  Aspiration, orbital         ..................  T.................         0240      18.7307    $1,193.03      $309.52      $238.61
                      contents.
67420..............  Explore/treat eye socket..  ..................  T.................         0242      37.7243    $2,402.81      $597.36      $480.56
67430..............  Explore/treat eye socket..  ..................  T.................         0242      37.7243    $2,402.81      $597.36      $480.56
67440..............  Explore/drain eye socket..  ..................  T.................         0242      37.7243    $2,402.81      $597.36      $480.56
67445..............  Explr/decompress eye        ..................  T.................         0242      37.7243    $2,402.81      $597.36      $480.56
                      socket.
67450..............  Explore/biopsy eye socket.  ..................  T.................         0242      37.7243    $2,402.81      $597.36      $480.56
67500..............  Inject/treat eye socket...  ..................  S.................         0231       2.1790      $138.79  ...........       $27.76
67505..............  Inject/treat eye socket...  ..................  T.................         0238       2.9022      $184.85  ...........       $36.97
67515..............  Inject/treat eye socket...  ..................  T.................         0238       2.9022      $184.85  ...........       $36.97
67550..............  Insert eye socket implant.  ..................  T.................         0242      37.7243    $2,402.81      $597.36      $480.56
67560..............  Revise eye socket implant.  ..................  T.................         0241      24.3077    $1,548.25      $383.45      $309.65
67570..............  Decompress optic nerve....  ..................  T.................         0242      37.7243    $2,402.81      $597.36      $480.56
67599..............  Orbit surgery procedure...  ..................  T.................         0238       2.9022      $184.85  ...........       $36.97
67700..............  Drainage of eyelid abscess  ..................  T.................         0238       2.9022      $184.85  ...........       $36.97
67710..............  Incision of eyelid........  ..................  T.................         0239       7.2847      $463.99  ...........       $92.80
67715..............  Incision of eyelid fold...  ..................  T.................         0240      18.7307    $1,193.03      $309.52      $238.61
67800..............  Remove eyelid lesion......  ..................  T.................         0238       2.9022      $184.85  ...........       $36.97
67801..............  Remove eyelid lesions.....  ..................  T.................         0239       7.2847      $463.99  ...........       $92.80
67805..............  Remove eyelid lesions.....  ..................  T.................         0238       2.9022      $184.85  ...........       $36.97
67808..............  Remove eyelid lesion(s)...  ..................  T.................         0240      18.7307    $1,193.03      $309.52      $238.61
67810..............  Biopsy of eyelid..........  ..................  T.................         0238       2.9022      $184.85  ...........       $36.97
67820..............  Revise eyelashes..........  ..................  S.................         0698       0.8696       $55.39  ...........       $11.08
67825..............  Revise eyelashes..........  ..................  T.................         0238       2.9022      $184.85  ...........       $36.97
67830..............  Revise eyelashes..........  ..................  T.................         0239       7.2847      $463.99  ...........       $92.80
67835..............  Revise eyelashes..........  ..................  T.................         0240      18.7307    $1,193.03      $309.52      $238.61
67840..............  Remove eyelid lesion......  ..................  T.................         0239       7.2847      $463.99  ...........       $92.80
67850..............  Treat eyelid lesion.......  ..................  T.................         0239       7.2847      $463.99  ...........       $92.80
67875..............  Closure of eyelid by        ..................  T.................         0239       7.2847      $463.99  ...........       $92.80
                      suture.
67880..............  Revision of eyelid........  ..................  T.................         0233      16.1710    $1,030.00      $266.33      $206.00
67882..............  Revision of eyelid........  ..................  T.................         0240      18.7307    $1,193.03      $309.52      $238.61
67900..............  Repair brow defect........  ..................  T.................         0240      18.7307    $1,193.03      $309.52      $238.61
67901..............  Repair eyelid defect......  ..................  T.................         0240      18.7307    $1,193.03      $309.52      $238.61
67902..............  Repair eyelid defect......  ..................  T.................         0240      18.7307    $1,193.03      $309.52      $238.61
67903..............  Repair eyelid defect......  ..................  T.................         0240      18.7307    $1,193.03      $309.52      $238.61
67904..............  Repair eyelid defect......  ..................  T.................         0240      18.7307    $1,193.03      $309.52      $238.61
67906..............  Repair eyelid defect......  ..................  T.................         0240      18.7307    $1,193.03      $309.52      $238.61
67908..............  Repair eyelid defect......  ..................  T.................         0240      18.7307    $1,193.03      $309.52      $238.61
67909..............  Revise eyelid defect......  ..................  T.................         0240      18.7307    $1,193.03      $309.52      $238.61
67911..............  Revise eyelid defect......  ..................  T.................         0240      18.7307    $1,193.03      $309.52      $238.61
67912..............  Correction eyelid w/        ..................  T.................         0240      18.7307    $1,193.03      $309.52      $238.61
                      implant.
67914..............  Repair eyelid defect......  ..................  T.................         0240      18.7307    $1,193.03      $309.52      $238.61
67915..............  Repair eyelid defect......  ..................  T.................         0240      18.7307    $1,193.03      $309.52      $238.61
67916..............  Repair eyelid defect......  ..................  T.................         0240      18.7307    $1,193.03      $309.52      $238.61
67917..............  Repair eyelid defect......  ..................  T.................         0240      18.7307    $1,193.03      $309.52      $238.61
67921..............  Repair eyelid defect......  ..................  T.................         0240      18.7307    $1,193.03      $309.52      $238.61
67922..............  Repair eyelid defect......  ..................  T.................         0240      18.7307    $1,193.03      $309.52      $238.61
67923..............  Repair eyelid defect......  ..................  T.................         0240      18.7307    $1,193.03      $309.52      $238.61
67924..............  Repair eyelid defect......  ..................  T.................         0240      18.7307    $1,193.03      $309.52      $238.61
67930..............  Repair eyelid wound.......  ..................  T.................         0240      18.7307    $1,193.03      $309.52      $238.61
67935..............  Repair eyelid wound.......  ..................  T.................         0240      18.7307    $1,193.03      $309.52      $238.61
67938..............  Remove eyelid foreign body  CH................  S.................         0231       2.1790      $138.79  ...........       $27.76
67950..............  Revision of eyelid........  ..................  T.................         0240      18.7307    $1,193.03      $309.52      $238.61
67961..............  Revision of eyelid........  ..................  T.................         0240      18.7307    $1,193.03      $309.52      $238.61
67966..............  Revision of eyelid........  ..................  T.................         0240      18.7307    $1,193.03      $309.52      $238.61
67971..............  Reconstruction of eyelid..  ..................  T.................         0241      24.3077    $1,548.25      $383.45      $309.65
67973..............  Reconstruction of eyelid..  ..................  T.................         0241      24.3077    $1,548.25      $383.45      $309.65
67974..............  Reconstruction of eyelid..  ..................  T.................         0241      24.3077    $1,548.25      $383.45      $309.65
67975..............  Reconstruction of eyelid..  ..................  T.................         0240      18.7307    $1,193.03      $309.52      $238.61
67999..............  Revision of eyelid........  ..................  T.................         0238       2.9022      $184.85  ...........       $36.97
68020..............  Incise/drain eyelid lining  ..................  T.................         0240      18.7307    $1,193.03      $309.52      $238.61
68040..............  Treatment of eyelid         ..................  S.................         0698       0.8696       $55.39  ...........       $11.08
                      lesions.
68100..............  Biopsy of eyelid lining...  ..................  T.................         0232       5.1169      $325.92       $81.65       $65.18
68110..............  Remove eyelid lining        ..................  T.................         0699      13.7453      $875.49  ...........      $175.10
                      lesion.
68115..............  Remove eyelid lining        ..................  T.................         0240      18.7307    $1,193.03      $309.52      $238.61
                      lesion.
68130..............  Remove eyelid lining        ..................  T.................         0233      16.1710    $1,030.00      $266.33      $206.00
                      lesion.
68135..............  Remove eyelid lining        ..................  T.................         0239       7.2847      $463.99  ...........       $92.80
                      lesion.
68200..............  Treat eyelid by injection.  CH................  S.................         0698       0.8696       $55.39  ...........       $11.08
68320..............  Revise/graft eyelid lining  ..................  T.................         0240      18.7307    $1,193.03      $309.52      $238.61
68325..............  Revise/graft eyelid lining  ..................  T.................         0241      24.3077    $1,548.25      $383.45      $309.65
68326..............  Revise/graft eyelid lining  ..................  T.................         0241      24.3077    $1,548.25      $383.45      $309.65
68328..............  Revise/graft eyelid lining  ..................  T.................         0241      24.3077    $1,548.25      $383.45      $309.65

[[Page 67069]]

 
68330..............  Revise eyelid lining......  ..................  T.................         0234      23.1758    $1,476.16      $511.31      $295.23
68335..............  Revise/graft eyelid lining  ..................  T.................         0241      24.3077    $1,548.25      $383.45      $309.65
68340..............  Separate eyelid adhesions.  ..................  T.................         0240      18.7307    $1,193.03      $309.52      $238.61
68360..............  Revise eyelid lining......  ..................  T.................         0234      23.1758    $1,476.16      $511.31      $295.23
68362..............  Revise eyelid lining......  ..................  T.................         0234      23.1758    $1,476.16      $511.31      $295.23
68371..............  Harvest eye tissue,         ..................  T.................         0233      16.1710    $1,030.00      $266.33      $206.00
                      alograft.
68399..............  Eyelid lining surgery.....  ..................  T.................         0238       2.9022      $184.85  ...........       $36.97
68400..............  Incise/drain tear gland...  ..................  T.................         0238       2.9022      $184.85  ...........       $36.97
68420..............  Incise/drain tear sac.....  ..................  T.................         0240      18.7307    $1,193.03      $309.52      $238.61
68440..............  Incise tear duct opening..  ..................  T.................         0238       2.9022      $184.85  ...........       $36.97
68500..............  Removal of tear gland.....  ..................  T.................         0241      24.3077    $1,548.25      $383.45      $309.65
68505..............  Partial removal, tear       ..................  T.................         0241      24.3077    $1,548.25      $383.45      $309.65
                      gland.
68510..............  Biopsy of tear gland......  ..................  T.................         0240      18.7307    $1,193.03      $309.52      $238.61
68520..............  Removal of tear sac.......  ..................  T.................         0241      24.3077    $1,548.25      $383.45      $309.65
68525..............  Biopsy of tear sac........  ..................  T.................         0240      18.7307    $1,193.03      $309.52      $238.61
68530..............  Clearance of tear duct....  ..................  T.................         0240      18.7307    $1,193.03      $309.52      $238.61
68540..............  Remove tear gland lesion..  ..................  T.................         0241      24.3077    $1,548.25      $383.45      $309.65
68550..............  Remove tear gland lesion..  ..................  T.................         0241      24.3077    $1,548.25      $383.45      $309.65
68700..............  Repair tear ducts.........  ..................  T.................         0241      24.3077    $1,548.25      $383.45      $309.65
68705..............  Revise tear duct opening..  ..................  T.................         0238       2.9022      $184.85  ...........       $36.97
68720..............  Create tear sac drain.....  ..................  T.................         0241      24.3077    $1,548.25      $383.45      $309.65
68745..............  Create tear duct drain....  ..................  T.................         0241      24.3077    $1,548.25      $383.45      $309.65
68750..............  Create tear duct drain....  ..................  T.................         0241      24.3077    $1,548.25      $383.45      $309.65
68760..............  Close tear duct opening...  ..................  S.................         0231       2.1790      $138.79  ...........       $27.76
68761..............  Close tear duct opening...  ..................  S.................         0231       2.1790      $138.79  ...........       $27.76
68770..............  Close tear system fistula.  ..................  T.................         0240      18.7307    $1,193.03      $309.52      $238.61
68801..............  Dilate tear duct opening..  ..................  S.................         0698       0.8696       $55.39  ...........       $11.08
68810..............  Probe nasolacrimal duct...  ..................  S.................         0231       2.1790      $138.79  ...........       $27.76
68811..............  Probe nasolacrimal duct...  ..................  T.................         0240      18.7307    $1,193.03      $309.52      $238.61
68815..............  Probe nasolacrimal duct...  ..................  T.................         0240      18.7307    $1,193.03      $309.52      $238.61
68816..............  Probe nl duct w/balloon...  NI................  T.................         0240      18.7307    $1,193.03      $309.52      $238.61
68840..............  Explore/irrigate tear       CH................  S.................         0231       2.1790      $138.79  ...........       $27.76
                      ducts.
68850..............  Injection for tear sac x-   ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      ray.
68899..............  Tear duct system surgery..  ..................  T.................         0238       2.9022      $184.85  ...........       $36.97
69000..............  Drain external ear lesion.  ..................  T.................         0006       1.4066       $89.59  ...........       $17.92
69005..............  Drain external ear lesion.  ..................  T.................         0008      18.3197    $1,166.85  ...........      $233.37
69020..............  Drain outer ear canal       ..................  T.................         0006       1.4066       $89.59  ...........       $17.92
                      lesion.
69090..............  Pierce earlobes...........  ..................  E.................  ...........  ...........  ...........  ...........  ...........
69100..............  Biopsy of external ear....  CH................  T.................         0251       2.5002      $159.25  ...........       $31.85
69105..............  Biopsy of external ear      ..................  T.................         0253      16.3288    $1,040.05      $282.29      $208.01
                      canal.
69110..............  Remove external ear,        ..................  T.................         0021      16.1001    $1,025.48      $219.48      $205.10
                      partial.
69120..............  Removal of external ear...  ..................  T.................         0254      23.9765    $1,527.16      $321.35      $305.43
69140..............  Remove ear canal lesion(s)  ..................  T.................         0254      23.9765    $1,527.16      $321.35      $305.43
69145..............  Remove ear canal lesion(s)  ..................  T.................         0021      16.1001    $1,025.48      $219.48      $205.10
69150..............  Extensive ear canal         ..................  T.................         0252       7.4474      $474.35      $109.16       $94.87
                      surgery.
69155..............  Extensive ear/neck surgery  ..................  C.................  ...........  ...........  ...........  ...........  ...........
69200..............  Clear outer ear canal.....  ..................  X.................         0340       0.6310       $40.19  ...........        $8.04
69205..............  Clear outer ear canal.....  ..................  T.................         0022      21.1098    $1,344.57      $354.45      $268.91
69210..............  Remove impacted ear wax...  ..................  X.................         0340       0.6310       $40.19  ...........        $8.04
69220..............  Clean out mastoid cavity..  CH................  T.................         0013       0.7930       $50.51  ...........       $10.10
69222..............  Clean out mastoid cavity..  CH................  T.................         0253      16.3288    $1,040.05      $282.29      $208.01
69300..............  Revise external ear.......  ..................  T.................         0254      23.9765    $1,527.16      $321.35      $305.43
69310..............  Rebuild outer ear canal...  ..................  T.................         0256      39.8776    $2,539.96  ...........      $507.99
69320..............  Rebuild outer ear canal...  ..................  T.................         0256      39.8776    $2,539.96  ...........      $507.99
69399..............  Outer ear surgery           ..................  T.................         0251       2.5002      $159.25  ...........       $31.85
                      procedure.
69400..............  Inflate middle ear canal..  ..................  T.................         0251       2.5002      $159.25  ...........       $31.85
69401..............  Inflate middle ear canal..  ..................  T.................         0251       2.5002      $159.25  ...........       $31.85
69405..............  Catheterize middle ear      ..................  T.................         0252       7.4474      $474.35      $109.16       $94.87
                      canal.
69420..............  Incision of eardrum.......  ..................  T.................         0251       2.5002      $159.25  ...........       $31.85
69421..............  Incision of eardrum.......  ..................  T.................         0253      16.3288    $1,040.05      $282.29      $208.01
69424..............  Remove ventilating tube...  CH................  T.................         0253      16.3288    $1,040.05      $282.29      $208.01
69433..............  Create eardrum opening....  ..................  T.................         0252       7.4474      $474.35      $109.16       $94.87
69436..............  Create eardrum opening....  ..................  T.................         0253      16.3288    $1,040.05      $282.29      $208.01
69440..............  Exploration of middle ear.  ..................  T.................         0254      23.9765    $1,527.16      $321.35      $305.43
69450..............  Eardrum revision..........  ..................  T.................         0256      39.8776    $2,539.96  ...........      $507.99
69501..............  Mastoidectomy.............  ..................  T.................         0256      39.8776    $2,539.96  ...........      $507.99
69502..............  Mastoidectomy.............  ..................  T.................         0254      23.9765    $1,527.16      $321.35      $305.43
69505..............  Remove mastoid structures.  ..................  T.................         0256      39.8776    $2,539.96  ...........      $507.99
69511..............  Extensive mastoid surgery.  ..................  T.................         0256      39.8776    $2,539.96  ...........      $507.99
69530..............  Extensive mastoid surgery.  ..................  T.................         0256      39.8776    $2,539.96  ...........      $507.99
69535..............  Remove part of temporal     ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      bone.
69540..............  Remove ear lesion.........  ..................  T.................         0253      16.3288    $1,040.05      $282.29      $208.01
69550..............  Remove ear lesion.........  ..................  T.................         0256      39.8776    $2,539.96  ...........      $507.99
69552..............  Remove ear lesion.........  ..................  T.................         0256      39.8776    $2,539.96  ...........      $507.99
69554..............  Remove ear lesion.........  ..................  C.................  ...........  ...........  ...........  ...........  ...........
69601..............  Mastoid surgery revision..  ..................  T.................         0256      39.8776    $2,539.96  ...........      $507.99
69602..............  Mastoid surgery revision..  ..................  T.................         0256      39.8776    $2,539.96  ...........      $507.99
69603..............  Mastoid surgery revision..  ..................  T.................         0256      39.8776    $2,539.96  ...........      $507.99
69604..............  Mastoid surgery revision..  ..................  T.................         0256      39.8776    $2,539.96  ...........      $507.99
69605..............  Mastoid surgery revision..  ..................  T.................         0256      39.8776    $2,539.96  ...........      $507.99

[[Page 67070]]

 
69610..............  Repair of eardrum.........  ..................  T.................         0254      23.9765    $1,527.16      $321.35      $305.43
69620..............  Repair of eardrum.........  ..................  T.................         0254      23.9765    $1,527.16      $321.35      $305.43
69631..............  Repair eardrum structures.  ..................  T.................         0256      39.8776    $2,539.96  ...........      $507.99
69632..............  Rebuild eardrum structures  ..................  T.................         0256      39.8776    $2,539.96  ...........      $507.99
69633..............  Rebuild eardrum structures  ..................  T.................         0256      39.8776    $2,539.96  ...........      $507.99
69635..............  Repair eardrum structures.  ..................  T.................         0256      39.8776    $2,539.96  ...........      $507.99
69636..............  Rebuild eardrum structures  ..................  T.................         0256      39.8776    $2,539.96  ...........      $507.99
69637..............  Rebuild eardrum structures  ..................  T.................         0256      39.8776    $2,539.96  ...........      $507.99
69641..............  Revise middle ear &         ..................  T.................         0256      39.8776    $2,539.96  ...........      $507.99
                      mastoid.
69642..............  Revise middle ear &         ..................  T.................         0256      39.8776    $2,539.96  ...........      $507.99
                      mastoid.
69643..............  Revise middle ear &         ..................  T.................         0256      39.8776    $2,539.96  ...........      $507.99
                      mastoid.
69644..............  Revise middle ear &         ..................  T.................         0256      39.8776    $2,539.96  ...........      $507.99
                      mastoid.
69645..............  Revise middle ear &         ..................  T.................         0256      39.8776    $2,539.96  ...........      $507.99
                      mastoid.
69646..............  Revise middle ear &         ..................  T.................         0256      39.8776    $2,539.96  ...........      $507.99
                      mastoid.
69650..............  Release middle ear bone...  ..................  T.................         0254      23.9765    $1,527.16      $321.35      $305.43
69660..............  Revise middle ear bone....  ..................  T.................         0256      39.8776    $2,539.96  ...........      $507.99
69661..............  Revise middle ear bone....  ..................  T.................         0256      39.8776    $2,539.96  ...........      $507.99
69662..............  Revise middle ear bone....  ..................  T.................         0256      39.8776    $2,539.96  ...........      $507.99
69666..............  Repair middle ear           ..................  T.................         0256      39.8776    $2,539.96  ...........      $507.99
                      structures.
69667..............  Repair middle ear           ..................  T.................         0256      39.8776    $2,539.96  ...........      $507.99
                      structures.
69670..............  Remove mastoid air cells..  ..................  T.................         0256      39.8776    $2,539.96  ...........      $507.99
69676..............  Remove middle ear nerve...  ..................  T.................         0256      39.8776    $2,539.96  ...........      $507.99
69700..............  Close mastoid fistula.....  ..................  T.................         0256      39.8776    $2,539.96  ...........      $507.99
69710..............  Implant/replace hearing     ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      aid.
69711..............  Remove/repair hearing aid.  ..................  T.................         0256      39.8776    $2,539.96  ...........      $507.99
69714..............  Implant temple bone w/      ..................  T.................         0256      39.8776    $2,539.96  ...........      $507.99
                      stimul.
69715..............  Temple bne implnt w/        ..................  T.................         0256      39.8776    $2,539.96  ...........      $507.99
                      stimulat.
69717..............  Temple bone implant         ..................  T.................         0256      39.8776    $2,539.96  ...........      $507.99
                      revision.
69718..............  Revise temple bone implant  ..................  T.................         0256      39.8776    $2,539.96  ...........      $507.99
69720..............  Release facial nerve......  ..................  T.................         0256      39.8776    $2,539.96  ...........      $507.99
69725..............  Release facial nerve......  ..................  T.................         0256      39.8776    $2,539.96  ...........      $507.99
69740..............  Repair facial nerve.......  ..................  T.................         0256      39.8776    $2,539.96  ...........      $507.99
69745..............  Repair facial nerve.......  ..................  T.................         0256      39.8776    $2,539.96  ...........      $507.99
69799..............  Middle ear surgery          ..................  T.................         0251       2.5002      $159.25  ...........       $31.85
                      procedure.
69801..............  Incise inner ear..........  ..................  T.................         0256      39.8776    $2,539.96  ...........      $507.99
69802..............  Incise inner ear..........  ..................  T.................         0256      39.8776    $2,539.96  ...........      $507.99
69805..............  Explore inner ear.........  ..................  T.................         0256      39.8776    $2,539.96  ...........      $507.99
69806..............  Explore inner ear.........  ..................  T.................         0256      39.8776    $2,539.96  ...........      $507.99
69820..............  Establish inner ear window  ..................  T.................         0256      39.8776    $2,539.96  ...........      $507.99
69840..............  Revise inner ear window...  ..................  T.................         0256      39.8776    $2,539.96  ...........      $507.99
69905..............  Remove inner ear..........  ..................  T.................         0256      39.8776    $2,539.96  ...........      $507.99
69910..............  Remove inner ear & mastoid  ..................  T.................         0256      39.8776    $2,539.96  ...........      $507.99
69915..............  Incise inner ear nerve....  ..................  T.................         0256      39.8776    $2,539.96  ...........      $507.99
69930..............  Implant cochlear device...  ..................  T.................         0259     393.2242   $25,046.02    $8,543.66    $5,009.20
69949..............  Inner ear surgery           ..................  T.................         0251       2.5002      $159.25  ...........       $31.85
                      procedure.
69950..............  Incise inner ear nerve....  ..................  C.................  ...........  ...........  ...........  ...........  ...........
69955..............  Release facial nerve......  ..................  T.................         0256      39.8776    $2,539.96  ...........      $507.99
69960..............  Release inner ear canal...  ..................  T.................         0256      39.8776    $2,539.96  ...........      $507.99
69970..............  Remove inner ear lesion...  CH................  T.................         0256      39.8776    $2,539.96  ...........      $507.99
69979..............  Temporal bone surgery.....  ..................  T.................         0251       2.5002      $159.25  ...........       $31.85
69990..............  Microsurgery add-on.......  ..................  N.................  ...........  ...........  ...........  ...........  ...........
70010..............  Contrast x-ray of brain...  CH................  Q.................         0274       7.5589      $481.46  ...........       $96.29
70015..............  Contrast x-ray of brain...  CH................  Q.................         0274       7.5589      $481.46  ...........       $96.29
70030..............  X-ray eye for foreign body  ..................  X.................         0260       0.6954       $44.29  ...........        $8.86
70100..............  X-ray exam of jaw.........  ..................  X.................         0260       0.6954       $44.29  ...........        $8.86
7010F..............  Pt info into recall system  NI................  M.................  ...........  ...........  ...........  ...........  ...........
70110..............  X-ray exam of jaw.........  ..................  X.................         0260       0.6954       $44.29  ...........        $8.86
70120..............  X-ray exam of mastoids....  ..................  X.................         0260       0.6954       $44.29  ...........        $8.86
70130..............  X-ray exam of mastoids....  ..................  X.................         0260       0.6954       $44.29  ...........        $8.86
70134..............  X-ray exam of middle ear..  ..................  X.................         0261       1.1570       $73.69  ...........       $14.74
70140..............  X-ray exam of facial bones  ..................  X.................         0260       0.6954       $44.29  ...........        $8.86
70150..............  X-ray exam of facial bones  ..................  X.................         0260       0.6954       $44.29  ...........        $8.86
70160..............  X-ray exam of nasal bones.  ..................  X.................         0260       0.6954       $44.29  ...........        $8.86
70170..............  X-ray exam of tear duct...  CH................  Q.................         0317       5.3623      $341.55       $77.89       $68.31
70190..............  X-ray exam of eye sockets.  ..................  X.................         0260       0.6954       $44.29  ...........        $8.86
70200..............  X-ray exam of eye sockets.  ..................  X.................         0260       0.6954       $44.29  ...........        $8.86
70210..............  X-ray exam of sinuses.....  ..................  X.................         0260       0.6954       $44.29  ...........        $8.86
70220..............  X-ray exam of sinuses.....  ..................  X.................         0260       0.6954       $44.29  ...........        $8.86
70240..............  X-ray exam, pituitary       ..................  X.................         0260       0.6954       $44.29  ...........        $8.86
                      saddle.
70250..............  X-ray exam of skull.......  ..................  X.................         0260       0.6954       $44.29  ...........        $8.86
70260..............  X-ray exam of skull.......  ..................  X.................         0261       1.1570       $73.69  ...........       $14.74
70300..............  X-ray exam of teeth.......  ..................  X.................         0262       0.5749       $36.62  ...........        $7.32
70310..............  X-ray exam of teeth.......  ..................  X.................         0262       0.5749       $36.62  ...........        $7.32
70320..............  Full mouth x-ray of teeth.  ..................  X.................         0262       0.5749       $36.62  ...........        $7.32
70328..............  X-ray exam of jaw joint...  ..................  X.................         0260       0.6954       $44.29  ...........        $8.86
70330..............  X-ray exam of jaw joints..  ..................  X.................         0260       0.6954       $44.29  ...........        $8.86
70332..............  X-ray exam of jaw joint...  CH................  Q.................         0275       4.0031      $254.97       $69.09       $50.99
70336..............  Magnetic image, jaw joint.  ..................  S.................         0335       4.8830      $311.02      $111.92       $62.20
70350..............  X-ray head for orthodontia  ..................  X.................         0260       0.6954       $44.29  ...........        $8.86
70355..............  Panoramic x-ray of jaws...  ..................  X.................         0260       0.6954       $44.29  ...........        $8.86

[[Page 67071]]

 
70360..............  X-ray exam of neck........  ..................  X.................         0260       0.6954       $44.29  ...........        $8.86
70370..............  Throat x-ray & fluoroscopy  ..................  X.................         0272       1.3271       $84.53       $31.64       $16.91
70371..............  Speech evaluation, complex  ..................  X.................         0272       1.3271       $84.53       $31.64       $16.91
70373..............  Contrast x-ray of larynx..  CH................  Q.................         0263       2.6838      $170.94  ...........       $34.19
70380..............  X-ray exam of salivary      ..................  X.................         0260       0.6954       $44.29  ...........        $8.86
                      gland.
70390..............  X-ray exam of salivary      CH................  Q.................         0263       2.6838      $170.94  ...........       $34.19
                      duct.
70450..............  Ct head/brain w/o dye.....  ..................  S.................         0332       3.0109      $191.78       $75.24       $38.36
70460..............  Ct head/brain w/dye.......  ..................  S.................         0283       4.3564      $277.48      $100.37       $55.50
70470..............  Ct head/brain w/o & w/dye.  ..................  S.................         0333       5.1125      $325.64      $119.01       $65.13
70480..............  Ct orbit/ear/fossa w/o dye  ..................  S.................         0332       3.0109      $191.78       $75.24       $38.36
70481..............  Ct orbit/ear/fossa w/dye..  ..................  S.................         0283       4.3564      $277.48      $100.37       $55.50
70482..............  Ct orbit/ear/fossa w/o&w/   ..................  S.................         0333       5.1125      $325.64      $119.01       $65.13
                      dye.
70486..............  Ct maxillofacial w/o dye..  ..................  S.................         0332       3.0109      $191.78       $75.24       $38.36
70487..............  Ct maxillofacial w/dye....  ..................  S.................         0283       4.3564      $277.48      $100.37       $55.50
70488..............  Ct maxillofacial w/o & w/   ..................  S.................         0333       5.1125      $325.64      $119.01       $65.13
                      dye.
70490..............  Ct soft tissue neck w/o     ..................  S.................         0332       3.0109      $191.78       $75.24       $38.36
                      dye.
70491..............  Ct soft tissue neck w/dye.  ..................  S.................         0283       4.3564      $277.48      $100.37       $55.50
70492..............  Ct sft tsue nck w/o & w/    ..................  S.................         0333       5.1125      $325.64      $119.01       $65.13
                      dye.
70496..............  Ct angiography, head......  ..................  S.................         0662       5.1641      $328.92      $118.88       $65.78
70498..............  Ct angiography, neck......  ..................  S.................         0662       5.1641      $328.92      $118.88       $65.78
70540..............  Mri orbit/face/neck w/o     ..................  S.................         0336       5.3933      $343.52      $137.40       $68.70
                      dye.
70542..............  Mri orbit/face/neck w/dye.  ..................  S.................         0284       6.2350      $397.13      $148.40       $79.43
70543..............  Mri orbt/fac/nck w/o & w/   ..................  S.................         0337       8.2463      $525.24      $199.53      $105.05
                      dye.
70544..............  Mr angiography head w/o     ..................  S.................         0336       5.3933      $343.52      $137.40       $68.70
                      dye.
70545..............  Mr angiography head w/dye.  ..................  S.................         0284       6.2350      $397.13      $148.40       $79.43
70546..............  Mr angiograph head w/o&w/   ..................  S.................         0337       8.2463      $525.24      $199.53      $105.05
                      dye.
70547..............  Mr angiography neck w/o     ..................  S.................         0336       5.3933      $343.52      $137.40       $68.70
                      dye.
70548..............  Mr angiography neck w/dye.  ..................  S.................         0284       6.2350      $397.13      $148.40       $79.43
70549..............  Mr angiograph neck w/o&w/   ..................  S.................         0337       8.2463      $525.24      $199.53      $105.05
                      dye.
70551..............  Mri brain w/o dye.........  ..................  S.................         0336       5.3933      $343.52      $137.40       $68.70
70552..............  Mri brain w/dye...........  ..................  S.................         0284       6.2350      $397.13      $148.40       $79.43
70553..............  Mri brain w/o & w/dye.....  ..................  S.................         0337       8.2463      $525.24      $199.53      $105.05
70554..............  Fmri brain by tech........  ..................  S.................         0336       5.3933      $343.52      $137.40       $68.70
70555..............  Fmri brain by phys/psych..  ..................  S.................         0336       5.3933      $343.52      $137.40       $68.70
70557..............  Mri brain w/o dye.........  ..................  S.................         0336       5.3933      $343.52      $137.40       $68.70
70558..............  Mri brain w/dye...........  ..................  S.................         0284       6.2350      $397.13      $148.40       $79.43
70559..............  Mri brain w/o & w/dye.....  ..................  S.................         0337       8.2463      $525.24      $199.53      $105.05
71010..............  Chest x-ray...............  ..................  X.................         0260       0.6954       $44.29  ...........        $8.86
71015..............  Chest x-ray...............  ..................  X.................         0260       0.6954       $44.29  ...........        $8.86
71020..............  Chest x-ray...............  ..................  X.................         0260       0.6954       $44.29  ...........        $8.86
71021..............  Chest x-ray...............  ..................  X.................         0260       0.6954       $44.29  ...........        $8.86
71022..............  Chest x-ray...............  ..................  X.................         0260       0.6954       $44.29  ...........        $8.86
71023..............  Chest x-ray and             ..................  X.................         0272       1.3271       $84.53       $31.64       $16.91
                      fluoroscopy.
71030..............  Chest x-ray...............  ..................  X.................         0260       0.6954       $44.29  ...........        $8.86
71034..............  Chest x-ray and             ..................  X.................         0272       1.3271       $84.53       $31.64       $16.91
                      fluoroscopy.
71035..............  Chest x-ray...............  ..................  X.................         0260       0.6954       $44.29  ...........        $8.86
71040..............  Contrast x-ray of bronchi.  CH................  Q.................         0263       2.6838      $170.94  ...........       $34.19
71060..............  Contrast x-ray of bronchi.  CH................  Q.................         0317       5.3623      $341.55       $77.89       $68.31
71090..............  X-ray & pacemaker           CH................  N.................  ...........  ...........  ...........  ...........  ...........
                      insertion.
71100..............  X-ray exam of ribs........  ..................  X.................         0260       0.6954       $44.29  ...........        $8.86
71101..............  X-ray exam of ribs/chest..  ..................  X.................         0260       0.6954       $44.29  ...........        $8.86
71110..............  X-ray exam of ribs........  ..................  X.................         0260       0.6954       $44.29  ...........        $8.86
71111..............  X-ray exam of ribs/chest..  ..................  X.................         0261       1.1570       $73.69  ...........       $14.74
71120..............  X-ray exam of breastbone..  ..................  X.................         0260       0.6954       $44.29  ...........        $8.86
71130..............  X-ray exam of breastbone..  ..................  X.................         0260       0.6954       $44.29  ...........        $8.86
71250..............  Ct thorax w/o dye.........  ..................  S.................         0332       3.0109      $191.78       $75.24       $38.36
71260..............  Ct thorax w/dye...........  ..................  S.................         0283       4.3564      $277.48      $100.37       $55.50
71270..............  Ct thorax w/o & w/dye.....  ..................  S.................         0333       5.1125      $325.64      $119.01       $65.13
71275..............  Ct angiography, chest.....  ..................  S.................         0662       5.1641      $328.92      $118.88       $65.78
71550..............  Mri chest w/o dye.........  ..................  S.................         0336       5.3933      $343.52      $137.40       $68.70
71551..............  Mri chest w/dye...........  ..................  S.................         0284       6.2350      $397.13      $148.40       $79.43
71552..............  Mri chest w/o & w/dye.....  ..................  S.................         0337       8.2463      $525.24      $199.53      $105.05
71555..............  Mri angio chest w or w/o    ..................  B.................  ...........  ...........  ...........  ...........  ...........
                      dye.
72010..............  X-ray exam of spine.......  ..................  X.................         0260       0.6954       $44.29  ...........        $8.86
72020..............  X-ray exam of spine.......  ..................  X.................         0260       0.6954       $44.29  ...........        $8.86
72040..............  X-ray exam of neck spine..  ..................  X.................         0260       0.6954       $44.29  ...........        $8.86
72050..............  X-ray exam of neck spine..  ..................  X.................         0261       1.1570       $73.69  ...........       $14.74
72052..............  X-ray exam of neck spine..  ..................  X.................         0261       1.1570       $73.69  ...........       $14.74
72069..............  X-ray exam of trunk spine.  ..................  X.................         0260       0.6954       $44.29  ...........        $8.86
72070..............  X-ray exam of thoracic      ..................  X.................         0260       0.6954       $44.29  ...........        $8.86
                      spine.
72072..............  X-ray exam of thoracic      ..................  X.................         0260       0.6954       $44.29  ...........        $8.86
                      spine.
72074..............  X-ray exam of thoracic      ..................  X.................         0260       0.6954       $44.29  ...........        $8.86
                      spine.
72080..............  X-ray exam of trunk spine.  ..................  X.................         0260       0.6954       $44.29  ...........        $8.86
72090..............  X-ray exam of trunk spine.  ..................  X.................         0261       1.1570       $73.69  ...........       $14.74
72100..............  X-ray exam of lower spine.  ..................  X.................         0260       0.6954       $44.29  ...........        $8.86
72110..............  X-ray exam of lower spine.  ..................  X.................         0261       1.1570       $73.69  ...........       $14.74
72114..............  X-ray exam of lower spine.  ..................  X.................         0261       1.1570       $73.69  ...........       $14.74
72120..............  X-ray exam of lower spine.  ..................  X.................         0261       1.1570       $73.69  ...........       $14.74
72125..............  Ct neck spine w/o dye.....  ..................  S.................         0332       3.0109      $191.78       $75.24       $38.36
72126..............  Ct neck spine w/dye.......  ..................  S.................         0283       4.3564      $277.48      $100.37       $55.50

[[Page 67072]]

 
72127..............  Ct neck spine w/o & w/dye.  ..................  S.................         0333       5.1125      $325.64      $119.01       $65.13
72128..............  Ct chest spine w/o dye....  ..................  S.................         0332       3.0109      $191.78       $75.24       $38.36
72129..............  Ct chest spine w/dye......  ..................  S.................         0283       4.3564      $277.48      $100.37       $55.50
72130..............  Ct chest spine w/o & w/dye  ..................  S.................         0333       5.1125      $325.64      $119.01       $65.13
72131..............  Ct lumbar spine w/o dye...  ..................  S.................         0332       3.0109      $191.78       $75.24       $38.36
72132..............  Ct lumbar spine w/dye.....  ..................  S.................         0283       4.3564      $277.48      $100.37       $55.50
72133..............  Ct lumbar spine w/o & w/    ..................  S.................         0333       5.1125      $325.64      $119.01       $65.13
                      dye.
72141..............  Mri neck spine w/o dye....  ..................  S.................         0336       5.3933      $343.52      $137.40       $68.70
72142..............  Mri neck spine w/dye......  ..................  S.................         0284       6.2350      $397.13      $148.40       $79.43
72146..............  Mri chest spine w/o dye...  ..................  S.................         0336       5.3933      $343.52      $137.40       $68.70
72147..............  Mri chest spine w/dye.....  ..................  S.................         0284       6.2350      $397.13      $148.40       $79.43
72148..............  Mri lumbar spine w/o dye..  ..................  S.................         0336       5.3933      $343.52      $137.40       $68.70
72149..............  Mri lumbar spine w/dye....  ..................  S.................         0284       6.2350      $397.13      $148.40       $79.43
72156..............  Mri neck spine w/o & w/dye  ..................  S.................         0337       8.2463      $525.24      $199.53      $105.05
72157..............  Mri chest spine w/o & w/    ..................  S.................         0337       8.2463      $525.24      $199.53      $105.05
                      dye.
72158..............  Mri lumbar spine w/o & w/   ..................  S.................         0337       8.2463      $525.24      $199.53      $105.05
                      dye.
72159..............  Mr angio spine w/o&w/dye..  ..................  E.................  ...........  ...........  ...........  ...........  ...........
72170..............  X-ray exam of pelvis......  ..................  X.................         0260       0.6954       $44.29  ...........        $8.86
72190..............  X-ray exam of pelvis......  ..................  X.................         0260       0.6954       $44.29  ...........        $8.86
72191..............  Ct angiograph pelv w/o&w/   ..................  S.................         0662       5.1641      $328.92      $118.88       $65.78
                      dye.
72192..............  Ct pelvis w/o dye.........  ..................  S.................         0332       3.0109      $191.78       $75.24       $38.36
72193..............  Ct pelvis w/dye...........  ..................  S.................         0283       4.3564      $277.48      $100.37       $55.50
72194..............  Ct pelvis w/o & w/dye.....  ..................  S.................         0333       5.1125      $325.64      $119.01       $65.13
72195..............  Mri pelvis w/o dye........  ..................  S.................         0336       5.3933      $343.52      $137.40       $68.70
72196..............  Mri pelvis w/dye..........  ..................  S.................         0284       6.2350      $397.13      $148.40       $79.43
72197..............  Mri pelvis w/o & w/dye....  ..................  S.................         0337       8.2463      $525.24      $199.53      $105.05
72198..............  Mr angio pelvis w/o & w/    ..................  B.................  ...........  ...........  ...........  ...........  ...........
                      dye.
72200..............  X-ray exam sacroiliac       ..................  X.................         0260       0.6954       $44.29  ...........        $8.86
                      joints.
72202..............  X-ray exam sacroiliac       ..................  X.................         0260       0.6954       $44.29  ...........        $8.86
                      joints.
72220..............  X-ray exam of tailbone....  ..................  X.................         0260       0.6954       $44.29  ...........        $8.86
72240..............  Contrast x-ray of neck      CH................  Q.................         0274       7.5589      $481.46  ...........       $96.29
                      spine.
72255..............  Contrast x-ray, thorax      CH................  Q.................         0274       7.5589      $481.46  ...........       $96.29
                      spine.
72265..............  Contrast x-ray, lower       CH................  Q.................         0274       7.5589      $481.46  ...........       $96.29
                      spine.
72270..............  Contrast x-ray, spine.....  CH................  Q.................         0274       7.5589      $481.46  ...........       $96.29
72275..............  Epidurography.............  CH................  N.................  ...........  ...........  ...........  ...........  ...........
72285..............  X-ray c/t spine disk......  CH................  Q.................         0388      20.1823    $1,285.49      $289.72      $257.10
72291..............  Perq vertebroplasty, fluor  CH................  N.................  ...........  ...........  ...........  ...........  ...........
72292..............  Perq vertebroplasty, ct...  CH................  N.................  ...........  ...........  ...........  ...........  ...........
72295..............  X-ray of lower spine disk.  CH................  Q.................         0388      20.1823    $1,285.49      $289.72      $257.10
73000..............  X-ray exam of collar bone.  ..................  X.................         0260       0.6954       $44.29  ...........        $8.86
73010..............  X-ray exam of shoulder      ..................  X.................         0260       0.6954       $44.29  ...........        $8.86
                      blade.
73020..............  X-ray exam of shoulder....  ..................  X.................         0260       0.6954       $44.29  ...........        $8.86
73030..............  X-ray exam of shoulder....  ..................  X.................         0260       0.6954       $44.29  ...........        $8.86
73040..............  Contrast x-ray of shoulder  CH................  Q.................         0275       4.0031      $254.97       $69.09       $50.99
73050..............  X-ray exam of shoulders...  ..................  X.................         0260       0.6954       $44.29  ...........        $8.86
73060..............  X-ray exam of humerus.....  ..................  X.................         0260       0.6954       $44.29  ...........        $8.86
73070..............  X-ray exam of elbow.......  ..................  X.................         0260       0.6954       $44.29  ...........        $8.86
73080..............  X-ray exam of elbow.......  ..................  X.................         0260       0.6954       $44.29  ...........        $8.86
73085..............  Contrast x-ray of elbow...  CH................  Q.................         0275       4.0031      $254.97       $69.09       $50.99
73090..............  X-ray exam of forearm.....  ..................  X.................         0260       0.6954       $44.29  ...........        $8.86
73092..............  X-ray exam of arm, infant.  ..................  X.................         0260       0.6954       $44.29  ...........        $8.86
73100..............  X-ray exam of wrist.......  ..................  X.................         0260       0.6954       $44.29  ...........        $8.86
73110..............  X-ray exam of wrist.......  ..................  X.................         0260       0.6954       $44.29  ...........        $8.86
73115..............  Contrast x-ray of wrist...  CH................  Q.................         0275       4.0031      $254.97       $69.09       $50.99
73120..............  X-ray exam of hand........  ..................  X.................         0260       0.6954       $44.29  ...........        $8.86
73130..............  X-ray exam of hand........  ..................  X.................         0260       0.6954       $44.29  ...........        $8.86
73140..............  X-ray exam of finger(s)...  ..................  X.................         0260       0.6954       $44.29  ...........        $8.86
73200..............  Ct upper extremity w/o dye  ..................  S.................         0332       3.0109      $191.78       $75.24       $38.36
73201..............  Ct upper extremity w/dye..  ..................  S.................         0283       4.3564      $277.48      $100.37       $55.50
73202..............  Ct uppr extremity w/o&w/    ..................  S.................         0333       5.1125      $325.64      $119.01       $65.13
                      dye.
73206..............  Ct angio upr extrm w/o&w/   ..................  S.................         0662       5.1641      $328.92      $118.88       $65.78
                      dye.
73218..............  Mri upper extremity w/o     ..................  S.................         0336       5.3933      $343.52      $137.40       $68.70
                      dye.
73219..............  Mri upper extremity w/dye.  ..................  S.................         0284       6.2350      $397.13      $148.40       $79.43
73220..............  Mri uppr extremity w/o&w/   ..................  S.................         0337       8.2463      $525.24      $199.53      $105.05
                      dye.
73221..............  Mri joint upr extrem w/o    ..................  S.................         0336       5.3933      $343.52      $137.40       $68.70
                      dye.
73222..............  Mri joint upr extrem w/dye  ..................  S.................         0284       6.2350      $397.13      $148.40       $79.43
73223..............  Mri joint upr extr w/o&w/   ..................  S.................         0337       8.2463      $525.24      $199.53      $105.05
                      dye.
73225..............  Mr angio upr extr w/o&w/    ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      dye.
73500..............  X-ray exam of hip.........  ..................  X.................         0260       0.6954       $44.29  ...........        $8.86
73510..............  X-ray exam of hip.........  ..................  X.................         0260       0.6954       $44.29  ...........        $8.86
73520..............  X-ray exam of hips........  ..................  X.................         0261       1.1570       $73.69  ...........       $14.74
73525..............  Contrast x-ray of hip.....  CH................  Q.................         0275       4.0031      $254.97       $69.09       $50.99
73530..............  X-ray exam of hip.........  CH................  N.................  ...........  ...........  ...........  ...........  ...........
73540..............  X-ray exam of pelvis &      ..................  X.................         0260       0.6954       $44.29  ...........        $8.86
                      hips.
73542..............  X-ray exam, sacroiliac      CH................  Q.................         0275       4.0031      $254.97       $69.09       $50.99
                      joint.
73550..............  X-ray exam of thigh.......  ..................  X.................         0260       0.6954       $44.29  ...........        $8.86
73560..............  X-ray exam of knee, 1 or 2  ..................  X.................         0260       0.6954       $44.29  ...........        $8.86
73562..............  X-ray exam of knee, 3.....  ..................  X.................         0260       0.6954       $44.29  ...........        $8.86
73564..............  X-ray exam, knee, 4 or      ..................  X.................         0260       0.6954       $44.29  ...........        $8.86
                      more.
73565..............  X-ray exam of knees.......  ..................  X.................         0260       0.6954       $44.29  ...........        $8.86

[[Page 67073]]

 
73580..............  Contrast x-ray of knee      CH................  Q.................         0275       4.0031      $254.97       $69.09       $50.99
                      joint.
73590..............  X-ray exam of lower leg...  ..................  X.................         0260       0.6954       $44.29  ...........        $8.86
73592..............  X-ray exam of leg, infant.  ..................  X.................         0260       0.6954       $44.29  ...........        $8.86
73600..............  X-ray exam of ankle.......  ..................  X.................         0260       0.6954       $44.29  ...........        $8.86
73610..............  X-ray exam of ankle.......  ..................  X.................         0260       0.6954       $44.29  ...........        $8.86
73615..............  Contrast x-ray of ankle...  CH................  Q.................         0275       4.0031      $254.97       $69.09       $50.99
73620..............  X-ray exam of foot........  ..................  X.................         0260       0.6954       $44.29  ...........        $8.86
73630..............  X-ray exam of foot........  ..................  X.................         0260       0.6954       $44.29  ...........        $8.86
73650..............  X-ray exam of heel........  ..................  X.................         0260       0.6954       $44.29  ...........        $8.86
73660..............  X-ray exam of toe(s)......  ..................  X.................         0260       0.6954       $44.29  ...........        $8.86
73700..............  Ct lower extremity w/o dye  ..................  S.................         0332       3.0109      $191.78       $75.24       $38.36
73701..............  Ct lower extremity w/dye..  ..................  S.................         0283       4.3564      $277.48      $100.37       $55.50
73702..............  Ct lwr extremity w/o&w/dye  ..................  S.................         0333       5.1125      $325.64      $119.01       $65.13
73706..............  Ct angio lwr extr w/o&w/    ..................  S.................         0662       5.1641      $328.92      $118.88       $65.78
                      dye.
73718..............  Mri lower extremity w/o     ..................  S.................         0336       5.3933      $343.52      $137.40       $68.70
                      dye.
73719..............  Mri lower extremity w/dye.  ..................  S.................         0284       6.2350      $397.13      $148.40       $79.43
73720..............  Mri lwr extremity w/o&w/    ..................  S.................         0337       8.2463      $525.24      $199.53      $105.05
                      dye.
73721..............  Mri jnt of lwr extre w/o    ..................  S.................         0336       5.3933      $343.52      $137.40       $68.70
                      dye.
73722..............  Mri joint of lwr extr w/    ..................  S.................         0284       6.2350      $397.13      $148.40       $79.43
                      dye.
73723..............  Mri joint lwr extr w/o&w/   ..................  S.................         0337       8.2463      $525.24      $199.53      $105.05
                      dye.
73725..............  Mr ang lwr ext w or w/o     ..................  B.................  ...........  ...........  ...........  ...........  ...........
                      dye.
74000..............  X-ray exam of abdomen.....  ..................  X.................         0260       0.6954       $44.29  ...........        $8.86
74010..............  X-ray exam of abdomen.....  ..................  X.................         0260       0.6954       $44.29  ...........        $8.86
74020..............  X-ray exam of abdomen.....  ..................  X.................         0260       0.6954       $44.29  ...........        $8.86
74022..............  X-ray exam series, abdomen  ..................  X.................         0261       1.1570       $73.69  ...........       $14.74
74150..............  Ct abdomen w/o dye........  ..................  S.................         0332       3.0109      $191.78       $75.24       $38.36
74160..............  Ct abdomen w/dye..........  ..................  S.................         0283       4.3564      $277.48      $100.37       $55.50
74170..............  Ct abdomen w/o & w/dye....  ..................  S.................         0333       5.1125      $325.64      $119.01       $65.13
74175..............  Ct angio abdom w/o & w/dye  ..................  S.................         0662       5.1641      $328.92      $118.88       $65.78
74181..............  Mri abdomen w/o dye.......  ..................  S.................         0336       5.3933      $343.52      $137.40       $68.70
74182..............  Mri abdomen w/dye.........  ..................  S.................         0284       6.2350      $397.13      $148.40       $79.43
74183..............  Mri abdomen w/o & w/dye...  ..................  S.................         0337       8.2463      $525.24      $199.53      $105.05
74185..............  Mri angio, abdom w orw/o    ..................  B.................  ...........  ...........  ...........  ...........  ...........
                      dye.
74190..............  X-ray exam of peritoneum..  CH................  Q.................         0317       5.3623      $341.55       $77.89       $68.31
74210..............  Contrst x-ray exam of       ..................  S.................         0276       1.3834       $88.11       $34.97       $17.62
                      throat.
74220..............  Contrast x-ray, esophagus.  ..................  S.................         0276       1.3834       $88.11       $34.97       $17.62
74230..............  Cine/vid x-ray, throat/     ..................  S.................         0276       1.3834       $88.11       $34.97       $17.62
                      esoph.
74235..............  Remove esophagus            CH................  N.................  ...........  ...........  ...........  ...........  ...........
                      obstruction.
74240..............  X-ray exam, upper gi tract  ..................  S.................         0276       1.3834       $88.11       $34.97       $17.62
74241..............  X-ray exam, upper gi tract  ..................  S.................         0276       1.3834       $88.11       $34.97       $17.62
74245..............  X-ray exam, upper gi tract  ..................  S.................         0277       2.2222      $141.54       $54.52       $28.31
74246..............  Contrst x-ray uppr gi       ..................  S.................         0276       1.3834       $88.11       $34.97       $17.62
                      tract.
74247..............  Contrst x-ray uppr gi       ..................  S.................         0276       1.3834       $88.11       $34.97       $17.62
                      tract.
74249..............  Contrst x-ray uppr gi       ..................  S.................         0277       2.2222      $141.54       $54.52       $28.31
                      tract.
74250..............  X-ray exam of small bowel.  ..................  S.................         0276       1.3834       $88.11       $34.97       $17.62
74251..............  X-ray exam of small bowel.  ..................  S.................         0277       2.2222      $141.54       $54.52       $28.31
74260..............  X-ray exam of small bowel.  ..................  S.................         0276       1.3834       $88.11       $34.97       $17.62
74270..............  Contrast x-ray exam of      ..................  S.................         0276       1.3834       $88.11       $34.97       $17.62
                      colon.
74280..............  Contrast x-ray exam of      ..................  S.................         0277       2.2222      $141.54       $54.52       $28.31
                      colon.
74283..............  Contrast x-ray exam of      ..................  S.................         0276       1.3834       $88.11       $34.97       $17.62
                      colon.
74290..............  Contrast x-ray,             ..................  S.................         0276       1.3834       $88.11       $34.97       $17.62
                      gallbladder.
74291..............  Contrast x-rays,            ..................  S.................         0276       1.3834       $88.11       $34.97       $17.62
                      gallbladder.
74300..............  X-ray bile ducts/pancreas.  CH................  N.................  ...........  ...........  ...........  ...........  ...........
74301..............  X-rays at surgery add-on..  CH................  N.................  ...........  ...........  ...........  ...........  ...........
74305..............  X-ray bile ducts/pancreas.  CH................  N.................  ...........  ...........  ...........  ...........  ...........
74320..............  Contrast x-ray of bile      CH................  Q.................         0317       5.3623      $341.55       $77.89       $68.31
                      ducts.
74327..............  X-ray bile stone removal..  CH................  N.................  ...........  ...........  ...........  ...........  ...........
74328..............  X-ray bile duct endoscopy.  ..................  N.................  ...........  ...........  ...........  ...........  ...........
74329..............  X-ray for pancreas          ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      endoscopy.
74330..............  X-ray bile/panc endoscopy.  ..................  N.................  ...........  ...........  ...........  ...........  ...........
74340..............  X-ray guide for GI tube...  CH................  N.................  ...........  ...........  ...........  ...........  ...........
74350..............  X-ray guide, stomach tube.  CH................  D.................  ...........  ...........  ...........  ...........  ...........
74355..............  X-ray guide, intestinal     CH................  N.................  ...........  ...........  ...........  ...........  ...........
                      tube.
74360..............  X-ray guide, GI dilation..  CH................  N.................  ...........  ...........  ...........  ...........  ...........
74363..............  X-ray, bile duct dilation.  CH................  N.................  ...........  ...........  ...........  ...........  ...........
74400..............  Contrst x-ray, urinary      ..................  S.................         0278       2.6121      $166.38       $59.40       $33.28
                      tract.
74410..............  Contrst x-ray, urinary      ..................  S.................         0278       2.6121      $166.38       $59.40       $33.28
                      tract.
74415..............  Contrst x-ray, urinary      ..................  S.................         0278       2.6121      $166.38       $59.40       $33.28
                      tract.
74420..............  Contrst x-ray, urinary      ..................  S.................         0278       2.6121      $166.38       $59.40       $33.28
                      tract.
74425..............  Contrst x-ray, urinary      CH................  Q.................         0278       2.6121      $166.38       $59.40       $33.28
                      tract.
74430..............  Contrast x-ray, bladder...  CH................  Q.................         0278       2.6121      $166.38       $59.40       $33.28
74440..............  X-ray, male genital tract.  CH................  Q.................         0278       2.6121      $166.38       $59.40       $33.28
74445..............  X-ray exam of penis.......  CH................  Q.................         0278       2.6121      $166.38       $59.40       $33.28
74450..............  X-ray, urethra/bladder....  CH................  Q.................         0278       2.6121      $166.38       $59.40       $33.28
74455..............  X-ray, urethra/bladder....  CH................  Q.................         0278       2.6121      $166.38       $59.40       $33.28
74470..............  X-ray exam of kidney        CH................  Q.................         0263       2.6838      $170.94  ...........       $34.19
                      lesion.
74475..............  X-ray control, cath insert  CH................  Q.................         0317       5.3623      $341.55       $77.89       $68.31
74480..............  X-ray control, cath insert  CH................  Q.................         0317       5.3623      $341.55       $77.89       $68.31
74485..............  X-ray guide, GU dilation..  CH................  Q.................         0317       5.3623      $341.55       $77.89       $68.31
74710..............  X-ray measurement of        ..................  X.................         0261       1.1570       $73.69  ...........       $14.74
                      pelvis.

[[Page 67074]]

 
74740..............  X-ray, female genital       CH................  Q.................         0263       2.6838      $170.94  ...........       $34.19
                      tract.
74742..............  X-ray, fallopian tube.....  CH................  N.................  ...........  ...........  ...........  ...........  ...........
74775..............  X-ray exam of perineum....  ..................  S.................         0278       2.6121      $166.38       $59.40       $33.28
75552..............  Heart mri for morph w/o     CH................  D.................  ...........  ...........  ...........  ...........  ...........
                      dye.
75553..............  Heart mri for morph w/dye.  CH................  D.................  ...........  ...........  ...........  ...........  ...........
75554..............  Cardiac MRI/function......  CH................  D.................  ...........  ...........  ...........  ...........  ...........
75555..............  Cardiac MRI/limited study.  CH................  D.................  ...........  ...........  ...........  ...........  ...........
75556..............  Cardiac MRI/flow mapping..  CH................  D.................  ...........  ...........  ...........  ...........  ...........
75557..............  Cardiac mri for morph.....  NI................  S.................         0336       5.3933      $343.52      $137.40       $68.70
75558..............  Cardiac mri flow/velocity.  NI................  E.................  ...........  ...........  ...........  ...........  ...........
75559..............  Cardiac mri w/stress img..  NI................  S.................         0336       5.3933      $343.52      $137.40       $68.70
75560..............  Cardiac mri flow/vel/       NI................  E.................  ...........  ...........  ...........  ...........  ...........
                      stress.
75561..............  Cardiac mri for morph w/    NI................  S.................         0337       8.2463      $525.24      $199.53      $105.05
                      dye.
75562..............  Card mri flow/vel w/dye...  NI................  E.................  ...........  ...........  ...........  ...........  ...........
75563..............  Card mri w/stress img &     NI................  S.................         0337       8.2463      $525.24      $199.53      $105.05
                      dye.
75564..............  Ht mri w/flo/vel/strs &     NI................  E.................  ...........  ...........  ...........  ...........  ...........
                      dye.
75600..............  Contrast x-ray exam of      CH................  Q.................         0279      28.8788    $1,839.41  ...........      $367.88
                      aorta.
75605..............  Contrast x-ray exam of      CH................  Q.................         0279      28.8788    $1,839.41  ...........      $367.88
                      aorta.
75625..............  Contrast x-ray exam of      CH................  Q.................         0279      28.8788    $1,839.41  ...........      $367.88
                      aorta.
75630..............  X-ray aorta, leg arteries.  CH................  Q.................         0279      28.8788    $1,839.41  ...........      $367.88
75635..............  Ct angio abdominal          CH................  Q.................         0662       5.1641      $328.92      $118.88       $65.78
                      arteries.
75650..............  Artery x-rays, head & neck  CH................  Q.................         0280      44.7114    $2,847.85  ...........      $569.57
75658..............  Artery x-rays, arm........  CH................  Q.................         0279      28.8788    $1,839.41  ...........      $367.88
75660..............  Artery x-rays, head & neck  CH................  Q.................         0280      44.7114    $2,847.85  ...........      $569.57
75662..............  Artery x-rays, head & neck  CH................  Q.................         0280      44.7114    $2,847.85  ...........      $569.57
75665..............  Artery x-rays, head & neck  CH................  Q.................         0279      28.8788    $1,839.41  ...........      $367.88
75671..............  Artery x-rays, head & neck  CH................  Q.................         0280      44.7114    $2,847.85  ...........      $569.57
75676..............  Artery x-rays, neck.......  CH................  Q.................         0279      28.8788    $1,839.41  ...........      $367.88
75680..............  Artery x-rays, neck.......  CH................  Q.................         0279      28.8788    $1,839.41  ...........      $367.88
75685..............  Artery x-rays, spine......  CH................  Q.................         0279      28.8788    $1,839.41  ...........      $367.88
75705..............  Artery x-rays, spine......  CH................  Q.................         0279      28.8788    $1,839.41  ...........      $367.88
75710..............  Artery x-rays, arm/leg....  CH................  Q.................         0279      28.8788    $1,839.41  ...........      $367.88
75716..............  Artery x-rays, arms/legs..  CH................  Q.................         0279      28.8788    $1,839.41  ...........      $367.88
75722..............  Artery x-rays, kidney.....  CH................  Q.................         0279      28.8788    $1,839.41  ...........      $367.88
75724..............  Artery x-rays, kidneys....  CH................  Q.................         0279      28.8788    $1,839.41  ...........      $367.88
75726..............  Artery x-rays, abdomen....  CH................  Q.................         0279      28.8788    $1,839.41  ...........      $367.88
75731..............  Artery x-rays, adrenal      CH................  Q.................         0279      28.8788    $1,839.41  ...........      $367.88
                      gland.
75733..............  Artery x-rays, adrenals...  CH................  Q.................         0279      28.8788    $1,839.41  ...........      $367.88
75736..............  Artery x-rays, pelvis.....  CH................  Q.................         0279      28.8788    $1,839.41  ...........      $367.88
75741..............  Artery x-rays, lung.......  CH................  Q.................         0279      28.8788    $1,839.41  ...........      $367.88
75743..............  Artery x-rays, lungs......  CH................  Q.................         0279      28.8788    $1,839.41  ...........      $367.88
75746..............  Artery x-rays, lung.......  CH................  Q.................         0668       9.3506      $595.58  ...........      $119.12
75756..............  Artery x-rays, chest......  CH................  Q.................         0668       9.3506      $595.58  ...........      $119.12
75774..............  Artery x-ray, each vessel.  CH................  N.................  ...........  ...........  ...........  ...........  ...........
75790..............  Visualize A-V shunt.......  CH................  Q.................         0668       9.3506      $595.58  ...........      $119.12
75801..............  Lymph vessel x-ray, arm/    CH................  Q.................         0317       5.3623      $341.55       $77.89       $68.31
                      leg.
75803..............  Lymph vessel x-ray,arms/    CH................  Q.................         0317       5.3623      $341.55       $77.89       $68.31
                      legs.
75805..............  Lymph vessel x-ray, trunk.  CH................  Q.................         0317       5.3623      $341.55       $77.89       $68.31
75807..............  Lymph vessel x-ray, trunk.  CH................  Q.................         0317       5.3623      $341.55       $77.89       $68.31
75809..............  Nonvascular shunt, x-ray..  CH................  Q.................         0263       2.6838      $170.94  ...........       $34.19
75810..............  Vein x-ray, spleen/liver..  CH................  Q.................         0279      28.8788    $1,839.41  ...........      $367.88
75820..............  Vein x-ray, arm/leg.......  CH................  Q.................         0668       9.3506      $595.58  ...........      $119.12
75822..............  Vein x-ray, arms/legs.....  CH................  Q.................         0668       9.3506      $595.58  ...........      $119.12
75825..............  Vein x-ray, trunk.........  CH................  Q.................         0279      28.8788    $1,839.41  ...........      $367.88
75827..............  Vein x-ray, chest.........  CH................  Q.................         0668       9.3506      $595.58  ...........      $119.12
75831..............  Vein x-ray, kidney........  CH................  Q.................         0279      28.8788    $1,839.41  ...........      $367.88
75833..............  Vein x-ray, kidneys.......  CH................  Q.................         0279      28.8788    $1,839.41  ...........      $367.88
75840..............  Vein x-ray, adrenal gland.  CH................  Q.................         0279      28.8788    $1,839.41  ...........      $367.88
75842..............  Vein x-ray, adrenal glands  CH................  Q.................         0279      28.8788    $1,839.41  ...........      $367.88
75860..............  Vein x-ray, neck..........  CH................  Q.................         0668       9.3506      $595.58  ...........      $119.12
75870..............  Vein x-ray, skull.........  CH................  Q.................         0668       9.3506      $595.58  ...........      $119.12
75872..............  Vein x-ray, skull.........  CH................  Q.................         0668       9.3506      $595.58  ...........      $119.12
75880..............  Vein x-ray, eye socket....  CH................  Q.................         0668       9.3506      $595.58  ...........      $119.12
75885..............  Vein x-ray, liver.........  CH................  Q.................         0279      28.8788    $1,839.41  ...........      $367.88
75887..............  Vein x-ray, liver.........  CH................  Q.................         0668       9.3506      $595.58  ...........      $119.12
75889..............  Vein x-ray, liver.........  CH................  Q.................         0279      28.8788    $1,839.41  ...........      $367.88
75891..............  Vein x-ray, liver.........  CH................  Q.................         0279      28.8788    $1,839.41  ...........      $367.88
75893..............  Venous sampling by          CH................  Q.................         0279      28.8788    $1,839.41  ...........      $367.88
                      catheter.
75894..............  X-rays, transcath therapy.  CH................  N.................  ...........  ...........  ...........  ...........  ...........
75896..............  X-rays, transcath therapy.  CH................  N.................  ...........  ...........  ...........  ...........  ...........
75898..............  Follow-up angiography.....  CH................  Q.................         0263       2.6838      $170.94  ...........       $34.19
75900..............  Intravascular cath          ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      exchange.
75901..............  Remove cva device obstruct  CH................  N.................  ...........  ...........  ...........  ...........  ...........
75902..............  Remove cva lumen obstruct.  CH................  N.................  ...........  ...........  ...........  ...........  ...........
75940..............  X-ray placement, vein       CH................  N.................  ...........  ...........  ...........  ...........  ...........
                      filter.
75945..............  Intravascular us..........  CH................  Q.................         0267       2.3792      $151.54       $60.50       $30.31
75946..............  Intravascular us add-on...  CH................  N.................  ...........  ...........  ...........  ...........  ...........
75952..............  Endovasc repair abdom       ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      aorta.
75953..............  Abdom aneurysm endovas rpr  ..................  C.................  ...........  ...........  ...........  ...........  ...........
75954..............  Iliac aneurysm endovas rpr  ..................  C.................  ...........  ...........  ...........  ...........  ...........

[[Page 67075]]

 
75956..............  Xray, endovasc thor ao      ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      repr.
75957..............  Xray, endovasc thor ao      ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      repr.
75958..............  Xray, place prox ext thor   ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      ao.
75959..............  Xray, place dist ext thor   ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      ao.
75960..............  Transcath iv stent rs&i...  CH................  N.................  ...........  ...........  ...........  ...........  ...........
75961..............  Retrieval, broken catheter  CH................  N.................  ...........  ...........  ...........  ...........  ...........
75962..............  Repair arterial blockage..  CH................  Q.................         0083      45.3845    $2,890.72  ...........      $578.14
75964..............  Repair artery blockage,     CH................  N.................  ...........  ...........  ...........  ...........  ...........
                      each.
75966..............  Repair arterial blockage..  CH................  Q.................         0083      45.3845    $2,890.72  ...........      $578.14
75968..............  Repair artery blockage,     CH................  N.................  ...........  ...........  ...........  ...........  ...........
                      each.
75970..............  Vascular biopsy...........  CH................  N.................  ...........  ...........  ...........  ...........  ...........
75978..............  Repair venous blockage....  CH................  Q.................         0083      45.3845    $2,890.72  ...........      $578.14
75980..............  Contrast xray exam bile     CH................  N.................  ...........  ...........  ...........  ...........  ...........
                      duct.
75982..............  Contrast xray exam bile     CH................  N.................  ...........  ...........  ...........  ...........  ...........
                      duct.
75984..............  Xray control catheter       CH................  N.................  ...........  ...........  ...........  ...........  ...........
                      change.
75989..............  Abscess drainage under x-   ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      ray.
75992..............  Atherectomy, x-ray exam...  CH................  N.................  ...........  ...........  ...........  ...........  ...........
75993..............  Atherectomy, x-ray exam...  CH................  N.................  ...........  ...........  ...........  ...........  ...........
75994..............  Atherectomy, x-ray exam...  CH................  N.................  ...........  ...........  ...........  ...........  ...........
75995..............  Atherectomy, x-ray exam...  CH................  N.................  ...........  ...........  ...........  ...........  ...........
75996..............  Atherectomy, x-ray exam...  CH................  N.................  ...........  ...........  ...........  ...........  ...........
76000..............  Fluoroscope examination...  CH................  Q.................         0272       1.3271       $84.53       $31.64       $16.91
76001..............  Fluoroscope exam,           ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      extensive.
76010..............  X-ray, nose to rectum.....  ..................  X.................         0260       0.6954       $44.29  ...........        $8.86
76080..............  X-ray exam of fistula.....  CH................  Q.................         0263       2.6838      $170.94  ...........       $34.19
76098..............  X-ray exam, breast          ..................  X.................         0260       0.6954       $44.29  ...........        $8.86
                      specimen.
76100..............  X-ray exam of body section  ..................  X.................         0261       1.1570       $73.69  ...........       $14.74
76101..............  Complex body section x-ray  ..................  X.................         0263       2.6838      $170.94  ...........       $34.19
76102..............  Complex body section x-     CH................  X.................         0263       2.6838      $170.94  ...........       $34.19
                      rays.
76120..............  Cine/video x-rays.........  ..................  X.................         0272       1.3271       $84.53       $31.64       $16.91
76125..............  Cine/video x-rays add-on..  CH................  N.................  ...........  ...........  ...........  ...........  ...........
76140..............  X-ray consultation........  ..................  E.................  ...........  ...........  ...........  ...........  ...........
76150..............  X-ray exam, dry process...  ..................  X.................         0260       0.6954       $44.29  ...........        $8.86
76350..............  Special x-ray contrast      ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      study.
76376..............  3d render w/o postprocess.  CH................  N.................  ...........  ...........  ...........  ...........  ...........
76377..............  3d rendering w/postprocess  CH................  N.................  ...........  ...........  ...........  ...........  ...........
76380..............  CAT scan follow-up study..  ..................  S.................         0282       1.5839      $100.88       $37.81       $20.18
76390..............  Mr spectroscopy...........  ..................  E.................  ...........  ...........  ...........  ...........  ...........
76496..............  Fluoroscopic procedure....  ..................  X.................         0272       1.3271       $84.53       $31.64       $16.91
76497..............  Ct procedure..............  ..................  S.................         0282       1.5839      $100.88       $37.81       $20.18
76498..............  Mri procedure.............  ..................  S.................         0335       4.8830      $311.02      $111.92       $62.20
76499..............  Radiographic procedure....  ..................  X.................         0260       0.6954       $44.29  ...........        $8.86
76506..............  Echo exam of head.........  ..................  S.................         0265       0.9570       $60.96       $22.35       $12.19
76510..............  Ophth us, b & quant a.....  CH................  T.................         0232       5.1169      $325.92       $81.65       $65.18
76511..............  Ophth us, quant a only....  ..................  S.................         0266       1.5094       $96.14       $37.80       $19.23
76512..............  Ophth us, b w/non-quant a.  ..................  S.................         0266       1.5094       $96.14       $37.80       $19.23
76513..............  Echo exam of eye, water     ..................  S.................         0266       1.5094       $96.14       $37.80       $19.23
                      bath.
76514..............  Echo exam of eye,           CH................  S.................         0230       0.5903       $37.60  ...........        $7.52
                      thickness.
76516..............  Echo exam of eye..........  ..................  S.................         0265       0.9570       $60.96       $22.35       $12.19
76519..............  Echo exam of eye..........  ..................  S.................         0266       1.5094       $96.14       $37.80       $19.23
76529..............  Echo exam of eye..........  ..................  S.................         0265       0.9570       $60.96       $22.35       $12.19
76536..............  Us exam of head and neck..  ..................  S.................         0266       1.5094       $96.14       $37.80       $19.23
76604..............  Us exam, chest............  ..................  S.................         0265       0.9570       $60.96       $22.35       $12.19
76645..............  Us exam, breast(s)........  ..................  S.................         0265       0.9570       $60.96       $22.35       $12.19
76700..............  Us exam, abdom, complete..  ..................  S.................         0266       1.5094       $96.14       $37.80       $19.23
76705..............  Echo exam of abdomen......  ..................  S.................         0266       1.5094       $96.14       $37.80       $19.23
76770..............  Us exam abdo back wall,     ..................  S.................         0266       1.5094       $96.14       $37.80       $19.23
                      comp.
76775..............  Us exam abdo back wall,     ..................  S.................         0266       1.5094       $96.14       $37.80       $19.23
                      lim.
76776..............  Us exam k transpl w/        ..................  S.................         0266       1.5094       $96.14       $37.80       $19.23
                      doppler.
76800..............  Us exam, spinal canal.....  ..................  S.................         0266       1.5094       $96.14       $37.80       $19.23
76801..............  Ob us < 14 wks, single      ..................  S.................         0266       1.5094       $96.14       $37.80       $19.23
                      fetus.
76802..............  Ob us < 14 wks, add'l       ..................  S.................         0265       0.9570       $60.96       $22.35       $12.19
                      fetus.
76805..............  Ob us >/= 14 wks, sngl      ..................  S.................         0266       1.5094       $96.14       $37.80       $19.23
                      fetus.
76810..............  Ob us >/= 14 wks, addl      ..................  S.................         0266       1.5094       $96.14       $37.80       $19.23
                      fetus.
76811..............  Ob us, detailed, sngl       ..................  S.................         0267       2.3792      $151.54       $60.50       $30.31
                      fetus.
76812..............  Ob us, detailed, addl       ..................  S.................         0265       0.9570       $60.96       $22.35       $12.19
                      fetus.
76813..............  Ob us nuchal meas, 1 gest.  ..................  S.................         0266       1.5094       $96.14       $37.80       $19.23
76814..............  Ob us nuchal meas, add-on.  ..................  S.................         0265       0.9570       $60.96       $22.35       $12.19
76815..............  Ob us, limited, fetus(s)..  ..................  S.................         0265       0.9570       $60.96       $22.35       $12.19
76816..............  Ob us, follow-up, per       ..................  S.................         0265       0.9570       $60.96       $22.35       $12.19
                      fetus.
76817..............  Transvaginal us, obstetric  ..................  S.................         0265       0.9570       $60.96       $22.35       $12.19
76818..............  Fetal biophys profile w/    ..................  S.................         0266       1.5094       $96.14       $37.80       $19.23
                      nst.
76819..............  Fetal biophys profil w/o    ..................  S.................         0266       1.5094       $96.14       $37.80       $19.23
                      nst.
76820..............  Umbilical artery echo.....  ..................  S.................         0096       1.4689       $93.56       $37.42       $18.71
76821..............  Middle cerebral artery      ..................  S.................         0096       1.4689       $93.56       $37.42       $18.71
                      echo.
76825..............  Echo exam of fetal heart..  CH................  S.................         0266       1.5094       $96.14       $37.80       $19.23
76826..............  Echo exam of fetal heart..  CH................  S.................         0265       0.9570       $60.96       $22.35       $12.19
76827..............  Echo exam of fetal heart..  CH................  S.................         0265       0.9570       $60.96       $22.35       $12.19
76828..............  Echo exam of fetal heart..  CH................  S.................         0265       0.9570       $60.96       $22.35       $12.19
76830..............  Transvaginal us, non-ob...  ..................  S.................         0266       1.5094       $96.14       $37.80       $19.23

[[Page 67076]]

 
76831..............  Echo exam, uterus.........  ..................  S.................         0267       2.3792      $151.54       $60.50       $30.31
76856..............  Us exam, pelvic, complete.  ..................  S.................         0266       1.5094       $96.14       $37.80       $19.23
76857..............  Us exam, pelvic, limited..  ..................  S.................         0265       0.9570       $60.96       $22.35       $12.19
76870..............  Us exam, scrotum..........  ..................  S.................         0266       1.5094       $96.14       $37.80       $19.23
76872..............  Us, transrectal...........  ..................  S.................         0266       1.5094       $96.14       $37.80       $19.23
76873..............  Echograp trans r, pros      ..................  S.................         0266       1.5094       $96.14       $37.80       $19.23
                      study.
76880..............  Us exam, extremity........  ..................  S.................         0266       1.5094       $96.14       $37.80       $19.23
76885..............  Us exam infant hips,        ..................  S.................         0265       0.9570       $60.96       $22.35       $12.19
                      dynamic.
76886..............  Us exam infant hips,        ..................  S.................         0265       0.9570       $60.96       $22.35       $12.19
                      static.
76930..............  Echo guide, cardiocentesis  CH................  N.................  ...........  ...........  ...........  ...........  ...........
76932..............  Echo guide for heart        CH................  N.................  ...........  ...........  ...........  ...........  ...........
                      biopsy.
76936..............  Echo guide for artery       CH................  N.................  ...........  ...........  ...........  ...........  ...........
                      repair.
76937..............  Us guide, vascular access.  ..................  N.................  ...........  ...........  ...........  ...........  ...........
76940..............  Us guide, tissue ablation.  CH................  N.................  ...........  ...........  ...........  ...........  ...........
76941..............  Echo guide for transfusion  CH................  N.................  ...........  ...........  ...........  ...........  ...........
76942..............  Echo guide for biopsy.....  CH................  N.................  ...........  ...........  ...........  ...........  ...........
76945..............  Echo guide, villus          CH................  N.................  ...........  ...........  ...........  ...........  ...........
                      sampling.
76946..............  Echo guide for              CH................  N.................  ...........  ...........  ...........  ...........  ...........
                      amniocentesis.
76948..............  Echo guide, ova aspiration  CH................  N.................  ...........  ...........  ...........  ...........  ...........
76950..............  Echo guidance radiotherapy  CH................  N.................  ...........  ...........  ...........  ...........  ...........
76965..............  Echo guidance radiotherapy  CH................  N.................  ...........  ...........  ...........  ...........  ...........
76970..............  Ultrasound exam follow-up.  ..................  S.................         0265       0.9570       $60.96       $22.35       $12.19
76975..............  GI endoscopic ultrasound..  CH................  Q.................         0267       2.3792      $151.54       $60.50       $30.31
76977..............  Us bone density measure...  ..................  X.................         0340       0.6310       $40.19  ...........        $8.04
76998..............  Us guide, intraop.........  CH................  N.................  ...........  ...........  ...........  ...........  ...........
76999..............  Echo examination procedure  ..................  S.................         0265       0.9570       $60.96       $22.35       $12.19
77001..............  Fluoroguide for vein        ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      device.
77002..............  Needle localization by      ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      xray.
77003..............  Fluoroguide for spine       ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      inject.
77011..............  Ct scan for localization..  CH................  N.................  ...........  ...........  ...........  ...........  ...........
77012..............  Ct scan for needle biopsy.  CH................  N.................  ...........  ...........  ...........  ...........  ...........
77013..............  Ct guide for tissue         CH................  N.................  ...........  ...........  ...........  ...........  ...........
                      ablation.
77014..............  Ct scan for therapy guide.  CH................  N.................  ...........  ...........  ...........  ...........  ...........
77021..............  Mr guidance for needle      CH................  N.................  ...........  ...........  ...........  ...........  ...........
                      place.
77022..............  Mri for tissue ablation...  CH................  N.................  ...........  ...........  ...........  ...........  ...........
77031..............  Stereotact guide for brst   CH................  N.................  ...........  ...........  ...........  ...........  ...........
                      bx.
77032..............  Guidance for needle,        CH................  N.................  ...........  ...........  ...........  ...........  ...........
                      breast.
77051..............  Computer dx mammogram add-  ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      on.
77052..............  Comp screen mammogram add-  ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      on.
77053..............  X-ray of mammary duct.....  CH................  Q.................         0263       2.6838      $170.94  ...........       $34.19
77054..............  X-ray of mammary ducts....  CH................  Q.................         0263       2.6838      $170.94  ...........       $34.19
77055..............  Mammogram, one breast.....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
77056..............  Mammogram, both breasts...  ..................  A.................  ...........  ...........  ...........  ...........  ...........
77057..............  Mammogram, screening......  ..................  A.................  ...........  ...........  ...........  ...........  ...........
77058..............  Mri, one breast...........  ..................  B.................  ...........  ...........  ...........  ...........  ...........
77059..............  Mri, both breasts.........  ..................  B.................  ...........  ...........  ...........  ...........  ...........
77071..............  X-ray stress view.........  ..................  X.................         0260       0.6954       $44.29  ...........        $8.86
77072..............  X-rays for bone age.......  ..................  X.................         0260       0.6954       $44.29  ...........        $8.86
77073..............  X-rays, bone length         ..................  X.................         0260       0.6954       $44.29  ...........        $8.86
                      studies.
77074..............  X-rays, bone survey,        ..................  X.................         0261       1.1570       $73.69  ...........       $14.74
                      limited.
77075..............  X-rays, bone survey         ..................  X.................         0261       1.1570       $73.69  ...........       $14.74
                      complete.
77076..............  X-rays, bone survey,        ..................  X.................         0260       0.6954       $44.29  ...........        $8.86
                      infant.
77077..............  Joint survey, single view.  ..................  X.................         0260       0.6954       $44.29  ...........        $8.86
77078..............  Ct bone density, axial....  ..................  S.................         0288       1.1384       $72.51       $28.90       $14.50
77079..............  Ct bone density,            ..................  S.................         0282       1.5839      $100.88       $37.81       $20.18
                      peripheral.
77080..............  Dxa bone density, axial...  ..................  S.................         0288       1.1384       $72.51       $28.90       $14.50
77081..............  Dxa bone density/           ..................  S.................         0665       0.5087       $32.40       $12.95        $6.48
                      peripheral.
77082..............  Dxa bone density, vert fx.  ..................  X.................         0260       0.6954       $44.29  ...........        $8.86
77083..............  Radiographic                ..................  X.................         0261       1.1570       $73.69  ...........       $14.74
                      absorptiometry.
77084..............  Magnetic image, bone        ..................  S.................         0335       4.8830      $311.02      $111.92       $62.20
                      marrow.
77261..............  Radiation therapy planning  ..................  B.................  ...........  ...........  ...........  ...........  ...........
77262..............  Radiation therapy planning  ..................  B.................  ...........  ...........  ...........  ...........  ...........
77263..............  Radiation therapy planning  ..................  B.................  ...........  ...........  ...........  ...........  ...........
77280..............  Set radiation therapy       ..................  X.................         0304       1.5576       $99.21       $38.68       $19.84
                      field.
77285..............  Set radiation therapy       ..................  X.................         0305       3.9276      $250.16       $91.38       $50.03
                      field.
77290..............  Set radiation therapy       ..................  X.................         0305       3.9276      $250.16       $91.38       $50.03
                      field.
77295..............  Set radiation therapy       ..................  X.................         0310      13.5621      $863.82      $325.27      $172.76
                      field.
77299..............  Radiation therapy planning  ..................  X.................         0304       1.5576       $99.21       $38.68       $19.84
77300..............  Radiation therapy dose      ..................  X.................         0304       1.5576       $99.21       $38.68       $19.84
                      plan.
77301..............  Radiotherapy dose plan,     ..................  X.................         0310      13.5621      $863.82      $325.27      $172.76
                      imrt.
77305..............  Teletx isodose plan simple  ..................  X.................         0304       1.5576       $99.21       $38.68       $19.84
77310..............  Teletx isodose plan         ..................  X.................         0305       3.9276      $250.16       $91.38       $50.03
                      intermed.
77315..............  Teletx isodose plan         ..................  X.................         0305       3.9276      $250.16       $91.38       $50.03
                      complex.
77321..............  Special teletx port plan..  ..................  X.................         0305       3.9276      $250.16       $91.38       $50.03
77326..............  Brachytx isodose calc simp  ..................  X.................         0304       1.5576       $99.21       $38.68       $19.84
77327..............  Brachytx isodose calc       ..................  X.................         0305       3.9276      $250.16       $91.38       $50.03
                      interm.
77328..............  Brachytx isodose plan       ..................  X.................         0305       3.9276      $250.16       $91.38       $50.03
                      compl.
77331..............  Special radiation           ..................  X.................         0304       1.5576       $99.21       $38.68       $19.84
                      dosimetry.
77332..............  Radiation treatment aid(s)  ..................  X.................         0303       2.8878      $183.94       $66.95       $36.79
77333..............  Radiation treatment aid(s)  ..................  X.................         0303       2.8878      $183.94       $66.95       $36.79

[[Page 67077]]

 
77334..............  Radiation treatment aid(s)  ..................  X.................         0303       2.8878      $183.94       $66.95       $36.79
77336..............  Radiation physics consult.  ..................  X.................         0304       1.5576       $99.21       $38.68       $19.84
77370..............  Radiation physics consult.  ..................  X.................         0304       1.5576       $99.21       $38.68       $19.84
77371..............  Srs, multisource..........  ..................  S.................         0127     126.4653    $8,055.08  ...........    $1,611.02
77372..............  Srs, linear based.........  ..................  B.................  ...........  ...........  ...........  ...........  ...........
77373..............  Sbrt delivery.............  ..................  B.................  ...........  ...........  ...........  ...........  ...........
77399..............  External radiation          ..................  X.................         0304       1.5576       $99.21       $38.68       $19.84
                      dosimetry.
77401..............  Radiation treatment         ..................  S.................         0300       1.4229       $90.63  ...........       $18.13
                      delivery.
77402..............  Radiation treatment         ..................  S.................         0300       1.4229       $90.63  ...........       $18.13
                      delivery.
77403..............  Radiation treatment         ..................  S.................         0300       1.4229       $90.63  ...........       $18.13
                      delivery.
77404..............  Radiation treatment         ..................  S.................         0300       1.4229       $90.63  ...........       $18.13
                      delivery.
77406..............  Radiation treatment         ..................  S.................         0300       1.4229       $90.63  ...........       $18.13
                      delivery.
77407..............  Radiation treatment         ..................  S.................         0300       1.4229       $90.63  ...........       $18.13
                      delivery.
77408..............  Radiation treatment         ..................  S.................         0300       1.4229       $90.63  ...........       $18.13
                      delivery.
77409..............  Radiation treatment         ..................  S.................         0300       1.4229       $90.63  ...........       $18.13
                      delivery.
77411..............  Radiation treatment         ..................  S.................         0301       2.2167      $141.19  ...........       $28.24
                      delivery.
77412..............  Radiation treatment         ..................  S.................         0301       2.2167      $141.19  ...........       $28.24
                      delivery.
77413..............  Radiation treatment         ..................  S.................         0301       2.2167      $141.19  ...........       $28.24
                      delivery.
77414..............  Radiation treatment         ..................  S.................         0301       2.2167      $141.19  ...........       $28.24
                      delivery.
77416..............  Radiation treatment         ..................  S.................         0301       2.2167      $141.19  ...........       $28.24
                      delivery.
77417..............  Radiology port film(s)....  CH................  N.................  ...........  ...........  ...........  ...........  ...........
77418..............  Radiation tx delivery,      ..................  S.................         0412       5.4582      $347.65  ...........       $69.53
                      imrt.
77421..............  Stereoscopic x-ray          CH................  N.................  ...........  ...........  ...........  ...........  ...........
                      guidance.
77422..............  Neutron beam tx, simple...  ..................  S.................         0301       2.2167      $141.19  ...........       $28.24
77423..............  Neutron beam tx, complex..  ..................  S.................         0301       2.2167      $141.19  ...........       $28.24
77427..............  Radiation tx management,    ..................  B.................  ...........  ...........  ...........  ...........  ...........
                      x5.
77431..............  Radiation therapy           ..................  B.................  ...........  ...........  ...........  ...........  ...........
                      management.
77432..............  Stereotactic radiation      ..................  B.................  ...........  ...........  ...........  ...........  ...........
                      trmt.
77435..............  Sbrt management...........  ..................  N.................  ...........  ...........  ...........  ...........  ...........
77470..............  Special radiation           ..................  S.................         0299       5.7996      $369.40  ...........       $73.88
                      treatment.
77499..............  Radiation therapy           ..................  B.................  ...........  ...........  ...........  ...........  ...........
                      management.
77520..............  Proton trmt, simple w/o     ..................  S.................         0664      12.8205      $816.59  ...........      $163.32
                      comp.
77522..............  Proton trmt, simple w/comp  ..................  S.................         0664      12.8205      $816.59  ...........      $163.32
77523..............  Proton trmt, intermediate.  ..................  S.................         0667      15.3404      $977.09  ...........      $195.42
77525..............  Proton treatment, complex.  ..................  S.................         0667      15.3404      $977.09  ...........      $195.42
77600..............  Hyperthermia treatment....  CH................  S.................         0299       5.7996      $369.40  ...........       $73.88
77605..............  Hyperthermia treatment....  CH................  S.................         0299       5.7996      $369.40  ...........       $73.88
77610..............  Hyperthermia treatment....  CH................  S.................         0299       5.7996      $369.40  ...........       $73.88
77615..............  Hyperthermia treatment....  CH................  S.................         0299       5.7996      $369.40  ...........       $73.88
77620..............  Hyperthermia treatment....  CH................  S.................         0299       5.7996      $369.40  ...........       $73.88
77750..............  Infuse radioactive          ..................  S.................         0301       2.2167      $141.19  ...........       $28.24
                      materials.
77761..............  Apply intrcav radiat        ..................  S.................         0312       8.5140      $542.29  ...........      $108.46
                      simple.
77762..............  Apply intrcav radiat        ..................  S.................         0312       8.5140      $542.29  ...........      $108.46
                      interm.
77763..............  Apply intrcav radiat compl  ..................  S.................         0312       8.5140      $542.29  ...........      $108.46
77776..............  Apply interstit radiat      ..................  S.................         0312       8.5140      $542.29  ...........      $108.46
                      simpl.
77777..............  Apply interstit radiat      ..................  S.................         0312       8.5140      $542.29  ...........      $108.46
                      inter.
77778..............  Apply interstit radiat      CH................  Q.................         0651      18.1228    $1,154.31  ...........      $230.86
                      compl.
77781..............  High intensity              ..................  S.................         0313      11.6779      $743.81  ...........      $148.76
                      brachytherapy.
77782..............  High intensity              ..................  S.................         0313      11.6779      $743.81  ...........      $148.76
                      brachytherapy.
77783..............  High intensity              ..................  S.................         0313      11.6779      $743.81  ...........      $148.76
                      brachytherapy.
77784..............  High intensity              ..................  S.................         0313      11.6779      $743.81  ...........      $148.76
                      brachytherapy.
77789..............  Apply surface radiation...  ..................  S.................         0300       1.4229       $90.63  ...........       $18.13
77790..............  Radiation handling........  ..................  N.................  ...........  ...........  ...........  ...........  ...........
77799..............  Radium/radioisotope         ..................  S.................         0312       8.5140      $542.29  ...........      $108.46
                      therapy.
78000..............  Thyroid, single uptake....  ..................  S.................         0389       1.8190      $115.86       $33.81       $23.17
78001..............  Thyroid, multiple uptakes.  ..................  S.................         0389       1.8190      $115.86       $33.81       $23.17
78003..............  Thyroid suppress/stimul...  ..................  S.................         0392       2.9022      $184.85       $49.31       $36.97
78006..............  Thyroid imaging with        CH................  S.................         0391       3.4513      $219.83       $66.18       $43.97
                      uptake.
78007..............  Thyroid image, mult         ..................  S.................         0391       3.4513      $219.83       $66.18       $43.97
                      uptakes.
78010..............  Thyroid imaging...........  ..................  S.................         0390       2.0471      $130.39       $52.15       $26.08
78011..............  Thyroid imaging with flow.  ..................  S.................         0390       2.0471      $130.39       $52.15       $26.08
78015..............  Thyroid met imaging.......  ..................  S.................         0406       5.0681      $322.81       $98.18       $64.56
78016..............  Thyroid met imaging/        ..................  S.................         0406       5.0681      $322.81       $98.18       $64.56
                      studies.
78018..............  Thyroid met imaging, body.  ..................  S.................         0406       5.0681      $322.81       $98.18       $64.56
78020..............  Thyroid met uptake........  CH................  N.................  ...........  ...........  ...........  ...........  ...........
78070..............  Parathyroid nuclear         ..................  S.................         0391       3.4513      $219.83       $66.18       $43.97
                      imaging.
78075..............  Adrenal nuclear imaging...  CH................  S.................         0408      15.4033      $981.10  ...........      $196.22
78099..............  Endocrine nuclear           ..................  S.................         0390       2.0471      $130.39       $52.15       $26.08
                      procedure.
78102..............  Bone marrow imaging, ltd..  ..................  S.................         0400       3.9293      $250.27       $93.22       $50.05
78103..............  Bone marrow imaging, mult.  ..................  S.................         0400       3.9293      $250.27       $93.22       $50.05
78104..............  Bone marrow imaging, body.  ..................  S.................         0400       3.9293      $250.27       $93.22       $50.05
78110..............  Plasma volume, single.....  ..................  S.................         0393       5.6921      $362.55       $82.04       $72.51
78111..............  Plasma volume, multiple...  ..................  S.................         0393       5.6921      $362.55       $82.04       $72.51
78120..............  Red cell mass, single.....  ..................  S.................         0393       5.6921      $362.55       $82.04       $72.51
78121..............  Red cell mass, multiple...  ..................  S.................         0393       5.6921      $362.55       $82.04       $72.51
78122..............  Blood volume..............  ..................  S.................         0393       5.6921      $362.55       $82.04       $72.51
78130..............  Red cell survival study...  ..................  S.................         0393       5.6921      $362.55       $82.04       $72.51
78135..............  Red cell survival kinetics  ..................  S.................         0393       5.6921      $362.55       $82.04       $72.51
78140..............  Red cell sequestration....  ..................  S.................         0393       5.6921      $362.55       $82.04       $72.51
78185..............  Spleen imaging............  ..................  S.................         0400       3.9293      $250.27       $93.22       $50.05

[[Page 67078]]

 
78190..............  Platelet survival,          ..................  S.................         0392       2.9022      $184.85       $49.31       $36.97
                      kinetics.
78191..............  Platelet survival.........  ..................  S.................         0392       2.9022      $184.85       $49.31       $36.97
78195..............  Lymph system imaging......  ..................  S.................         0400       3.9293      $250.27       $93.22       $50.05
78199..............  Blood/lymph nuclear exam..  ..................  S.................         0400       3.9293      $250.27       $93.22       $50.05
78201..............  Liver imaging.............  ..................  S.................         0394       4.4603      $284.09      $102.61       $56.82
78202..............  Liver imaging with flow...  ..................  S.................         0394       4.4603      $284.09      $102.61       $56.82
78205..............  Liver imaging (3D)........  ..................  S.................         0394       4.4603      $284.09      $102.61       $56.82
78206..............  Liver image (3d) with flow  ..................  S.................         0394       4.4603      $284.09      $102.61       $56.82
78215..............  Liver and spleen imaging..  ..................  S.................         0394       4.4603      $284.09      $102.61       $56.82
78216..............  Liver & spleen image/flow.  ..................  S.................         0394       4.4603      $284.09      $102.61       $56.82
78220..............  Liver function study......  ..................  S.................         0394       4.4603      $284.09      $102.61       $56.82
78223..............  Hepatobiliary imaging.....  ..................  S.................         0394       4.4603      $284.09      $102.61       $56.82
78230..............  Salivary gland imaging....  ..................  S.................         0395       3.7911      $241.47       $89.73       $48.29
78231..............  Serial salivary imaging...  ..................  S.................         0395       3.7911      $241.47       $89.73       $48.29
78232..............  Salivary gland function     ..................  S.................         0395       3.7911      $241.47       $89.73       $48.29
                      exam.
78258..............  Esophageal motility study.  ..................  S.................         0395       3.7911      $241.47       $89.73       $48.29
78261..............  Gastric mucosa imaging....  ..................  S.................         0395       3.7911      $241.47       $89.73       $48.29
78262..............  Gastroesophageal reflux     ..................  S.................         0395       3.7911      $241.47       $89.73       $48.29
                      exam.
78264..............  Gastric emptying study....  ..................  S.................         0395       3.7911      $241.47       $89.73       $48.29
78267..............  Breath tst attain/anal c-   ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      14.
78268..............  Breath test analysis, c-14  ..................  A.................  ...........  ...........  ...........  ...........  ...........
78270..............  Vit B-12 absorption exam..  ..................  S.................         0392       2.9022      $184.85       $49.31       $36.97
78271..............  Vit b-12 absrp exam, int    ..................  S.................         0392       2.9022      $184.85       $49.31       $36.97
                      fac.
78272..............  Vit B-12 absorp, combined.  ..................  S.................         0392       2.9022      $184.85       $49.31       $36.97
78278..............  Acute GI blood loss         ..................  S.................         0395       3.7911      $241.47       $89.73       $48.29
                      imaging.
78282..............  GI protein loss exam......  ..................  S.................         0395       3.7911      $241.47       $89.73       $48.29
78290..............  Meckel's divert exam......  ..................  S.................         0395       3.7911      $241.47       $89.73       $48.29
78291..............  Leveen/shunt patency exam.  ..................  S.................         0395       3.7911      $241.47       $89.73       $48.29
78299..............  GI nuclear procedure......  ..................  S.................         0395       3.7911      $241.47       $89.73       $48.29
78300..............  Bone imaging, limited area  ..................  S.................         0396       3.8039      $242.29       $95.02       $48.46
78305..............  Bone imaging, multiple      ..................  S.................         0396       3.8039      $242.29       $95.02       $48.46
                      areas.
78306..............  Bone imaging, whole body..  ..................  S.................         0396       3.8039      $242.29       $95.02       $48.46
78315..............  Bone imaging, 3 phase.....  ..................  S.................         0396       3.8039      $242.29       $95.02       $48.46
78320..............  Bone imaging (3D).........  ..................  S.................         0396       3.8039      $242.29       $95.02       $48.46
78350..............  Bone mineral, single        ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      photon.
78351..............  Bone mineral, dual photon.  ..................  E.................  ...........  ...........  ...........  ...........  ...........
78399..............  Musculoskeletal nuclear     ..................  S.................         0396       3.8039      $242.29       $95.02       $48.46
                      exam.
78414..............  Non-imaging heart function  ..................  S.................         0398       4.8620      $309.68      $100.06       $61.94
78428..............  Cardiac shunt imaging.....  ..................  S.................         0398       4.8620      $309.68      $100.06       $61.94
78445..............  Vascular flow imaging.....  ..................  S.................         0397       3.1433      $200.21       $49.58       $40.04
78456..............  Acute venous thrombus       ..................  S.................         0397       3.1433      $200.21       $49.58       $40.04
                      image.
78457..............  Venous thrombosis imaging.  ..................  S.................         0397       3.1433      $200.21       $49.58       $40.04
78458..............  Ven thrombosis images,      ..................  S.................         0397       3.1433      $200.21       $49.58       $40.04
                      bilat.
78459..............  Heart muscle imaging (PET)  ..................  S.................         0307      21.9955    $1,400.98      $292.49      $280.20
78460..............  Heart muscle blood, single  CH................  S.................         0377      11.8512      $754.85      $158.84      $150.97
78461..............  Heart muscle blood,         CH................  S.................         0377      11.8512      $754.85      $158.84      $150.97
                      multiple.
78464..............  Heart image (3d), single..  CH................  S.................         0377      11.8512      $754.85      $158.84      $150.97
78465..............  Heart image (3d), multiple  ..................  S.................         0377      11.8512      $754.85      $158.84      $150.97
78466..............  Heart infarct image.......  ..................  S.................         0398       4.8620      $309.68      $100.06       $61.94
78468..............  Heart infarct image (ef)..  ..................  S.................         0398       4.8620      $309.68      $100.06       $61.94
78469..............  Heart infarct image (3D)..  ..................  S.................         0398       4.8620      $309.68      $100.06       $61.94
78472..............  Gated heart, planar,        ..................  S.................         0398       4.8620      $309.68      $100.06       $61.94
                      single.
78473..............  Gated heart, multiple.....  CH................  S.................         0398       4.8620      $309.68      $100.06       $61.94
78478..............  Heart wall motion add-on..  CH................  N.................  ...........  ...........  ...........  ...........  ...........
78480..............  Heart function add-on.....  CH................  N.................  ...........  ...........  ...........  ...........  ...........
78481..............  Heart first pass, single..  ..................  S.................         0398       4.8620      $309.68      $100.06       $61.94
78483..............  Heart first pass, multiple  CH................  S.................         0398       4.8620      $309.68      $100.06       $61.94
78491..............  Heart image (pet), single.  ..................  S.................         0307      21.9955    $1,400.98      $292.49      $280.20
78492..............  Heart image (pet),          ..................  S.................         0307      21.9955    $1,400.98      $292.49      $280.20
                      multiple.
78494..............  Heart image, spect........  ..................  S.................         0398       4.8620      $309.68      $100.06       $61.94
78496..............  Heart first pass add-on...  CH................  N.................  ...........  ...........  ...........  ...........  ...........
78499..............  Cardiovascular nuclear      ..................  S.................         0398       4.8620      $309.68      $100.06       $61.94
                      exam.
78580..............  Lung perfusion imaging....  ..................  S.................         0401       3.3954      $216.27       $78.19       $43.25
78584..............  Lung V/Q image single       ..................  S.................         0378       4.9509      $315.34      $125.33       $63.07
                      breath.
78585..............  Lung V/Q imaging..........  ..................  S.................         0378       4.9509      $315.34      $125.33       $63.07
78586..............  Aerosol lung image, single  ..................  S.................         0401       3.3954      $216.27       $78.19       $43.25
78587..............  Aerosol lung image,         ..................  S.................         0401       3.3954      $216.27       $78.19       $43.25
                      multiple.
78588..............  Perfusion lung image......  ..................  S.................         0378       4.9509      $315.34      $125.33       $63.07
78591..............  Vent image, 1 breath, 1     ..................  S.................         0401       3.3954      $216.27       $78.19       $43.25
                      proj.
78593..............  Vent image, 1 proj, gas...  ..................  S.................         0401       3.3954      $216.27       $78.19       $43.25
78594..............  Vent image, mult proj, gas  ..................  S.................         0401       3.3954      $216.27       $78.19       $43.25
78596..............  Lung differential function  ..................  S.................         0378       4.9509      $315.34      $125.33       $63.07
78599..............  Respiratory nuclear exam..  ..................  S.................         0401       3.3954      $216.27       $78.19       $43.25
78600..............  Brain image < 4 views.....  CH................  S.................         0403       3.2295      $205.70       $79.87       $41.14
78601..............  Brain image w/flow < 4      CH................  S.................         0403       3.2295      $205.70       $79.87       $41.14
                      views.
78605..............  Brain image 4+ views......  CH................  S.................         0403       3.2295      $205.70       $79.87       $41.14
78606..............  Brain image w/flow 4 +      ..................  S.................         0402       8.8235      $562.00      $114.12      $112.40
                      views.
78607..............  Brain imaging (3D)........  ..................  S.................         0402       8.8235      $562.00      $114.12      $112.40
78608..............  Brain imaging (PET).......  ..................  S.................         0308      16.6001    $1,057.33  ...........      $211.47
78609..............  Brain imaging (PET).......  ..................  E.................  ...........  ...........  ...........  ...........  ...........

[[Page 67079]]

 
78610..............  Brain flow imaging only...  ..................  S.................         0402       8.8235      $562.00      $114.12      $112.40
78615..............  Cerebral vascular flow      CH................  D.................  ...........  ...........  ...........  ...........  ...........
                      image.
78630..............  Cerebrospinal fluid scan..  CH................  S.................         0402       8.8235      $562.00      $114.12      $112.40
78635..............  CSF ventriculography......  CH................  S.................         0402       8.8235      $562.00      $114.12      $112.40
78645..............  CSF shunt evaluation......  ..................  S.................         0403       3.2295      $205.70       $79.87       $41.14
78647..............  Cerebrospinal fluid scan..  CH................  S.................         0402       8.8235      $562.00      $114.12      $112.40
78650..............  CSF leakage imaging.......  CH................  S.................         0402       8.8235      $562.00      $114.12      $112.40
78660..............  Nuclear exam of tear flow.  ..................  S.................         0403       3.2295      $205.70       $79.87       $41.14
78699..............  Nervous system nuclear      CH................  S.................         0403       3.2295      $205.70       $79.87       $41.14
                      exam.
78700..............  Kidney imaging, morphol...  ..................  S.................         0404       5.0824      $323.72       $84.11       $64.74
78701..............  Kidney imaging with flow..  ..................  S.................         0404       5.0824      $323.72       $84.11       $64.74
78707..............  K flow/funct image w/o      ..................  S.................         0404       5.0824      $323.72       $84.11       $64.74
                      drug.
78708..............  K flow/funct image w/drug.  CH................  S.................         0404       5.0824      $323.72       $84.11       $64.74
78709..............  K flow/funct image,         CH................  S.................         0404       5.0824      $323.72       $84.11       $64.74
                      multiple.
78710..............  Kidney imaging (3D).......  ..................  S.................         0404       5.0824      $323.72       $84.11       $64.74
78725..............  Kidney function study.....  CH................  S.................         0392       2.9022      $184.85       $49.31       $36.97
78730..............  Urinary bladder retention.  CH................  S.................         0389       1.8190      $115.86       $33.81       $23.17
78740..............  Ureteral reflux study.....  ..................  S.................         0404       5.0824      $323.72       $84.11       $64.74
78761..............  Testicular imaging w/flow.  ..................  S.................         0404       5.0824      $323.72       $84.11       $64.74
78799..............  Genitourinary nuclear exam  ..................  S.................         0404       5.0824      $323.72       $84.11       $64.74
78800..............  Tumor imaging, limited      ..................  S.................         0406       5.0681      $322.81       $98.18       $64.56
                      area.
78801..............  Tumor imaging, mult areas.  ..................  S.................         0406       5.0681      $322.81       $98.18       $64.56
78802..............  Tumor imaging, whole body.  CH................  S.................         0414       8.4176      $536.15      $214.44      $107.23
78803..............  Tumor imaging (3D)........  CH................  S.................         0408      15.4033      $981.10  ...........      $196.22
78804..............  Tumor imaging, whole body.  ..................  S.................         0408      15.4033      $981.10  ...........      $196.22
78805..............  Abscess imaging, ltd area.  CH................  S.................         0414       8.4176      $536.15      $214.44      $107.23
78806..............  Abscess imaging, whole      CH................  S.................         0414       8.4176      $536.15      $214.44      $107.23
                      body.
78807..............  Nuclear localization/       CH................  S.................         0414       8.4176      $536.15      $214.44      $107.23
                      abscess.
78811..............  Pet image, ltd area.......  ..................  S.................         0308      16.6001    $1,057.33  ...........      $211.47
78812..............  Pet image, skull-thigh....  ..................  S.................         0308      16.6001    $1,057.33  ...........      $211.47
78813..............  Pet image, full body......  ..................  S.................         0308      16.6001    $1,057.33  ...........      $211.47
78814..............  Pet image w/ct, lmtd......  CH................  S.................         0308      16.6001    $1,057.33  ...........      $211.47
78815..............  Pet image w/ct, skull-      CH................  S.................         0308      16.6001    $1,057.33  ...........      $211.47
                      thigh.
78816..............  Pet image w/ct, full body.  CH................  S.................         0308      16.6001    $1,057.33  ...........      $211.47
78890..............  Nuclear medicine data proc  ..................  N.................  ...........  ...........  ...........  ...........  ...........
78891..............  Nuclear med data proc.....  ..................  N.................  ...........  ...........  ...........  ...........  ...........
78999..............  Nuclear diagnostic exam...  ..................  S.................         0389       1.8190      $115.86       $33.81       $23.17
79005..............  Nuclear rx, oral admin....  ..................  S.................         0407       3.3020      $210.32       $78.13       $42.06
79101..............  Nuclear rx, iv admin......  ..................  S.................         0407       3.3020      $210.32       $78.13       $42.06
79200..............  Nuclear rx, intracav admin  ..................  S.................         0413       5.2741      $335.93  ...........       $67.19
79300..............  Nuclr rx, interstit         ..................  S.................         0407       3.3020      $210.32       $78.13       $42.06
                      colloid.
79403..............  Hematopoietic nuclear tx..  ..................  S.................         0413       5.2741      $335.93  ...........       $67.19
79440..............  Nuclear rx, intra-          ..................  S.................         0413       5.2741      $335.93  ...........       $67.19
                      articular.
79445..............  Nuclear rx, intra-arterial  ..................  S.................         0407       3.3020      $210.32       $78.13       $42.06
79999..............  Nuclear medicine therapy..  ..................  S.................         0407       3.3020      $210.32       $78.13       $42.06
80047..............  Metabolic panel ionized ca  NI................  A.................  ...........  ...........  ...........  ...........  ...........
80048..............  Metabolic panel total ca..  ..................  A.................  ...........  ...........  ...........  ...........  ...........
80050..............  General health panel......  ..................  E.................  ...........  ...........  ...........  ...........  ...........
80051..............  Electrolyte panel.........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
80053..............  Comprehen metabolic panel.  ..................  A.................  ...........  ...........  ...........  ...........  ...........
80055..............  Obstetric panel...........  ..................  E.................  ...........  ...........  ...........  ...........  ...........
80061..............  Lipid panel...............  ..................  A.................  ...........  ...........  ...........  ...........  ...........
80069..............  Renal function panel......  ..................  A.................  ...........  ...........  ...........  ...........  ...........
80074..............  Acute hepatitis panel.....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
80076..............  Hepatic function panel....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
80100..............  Drug screen, qualitate/     ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      multi.
80101..............  Drug screen, single.......  ..................  A.................  ...........  ...........  ...........  ...........  ...........
80102..............  Drug confirmation.........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
80103..............  Drug analysis, tissue prep  ..................  N.................  ...........  ...........  ...........  ...........  ...........
80150..............  Assay of amikacin.........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
80152..............  Assay of amitriptyline....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
80154..............  Assay of benzodiazepines..  ..................  A.................  ...........  ...........  ...........  ...........  ...........
80156..............  Assay, carbamazepine,       ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      total.
80157..............  Assay, carbamazepine, free  ..................  A.................  ...........  ...........  ...........  ...........  ...........
80158..............  Assay of cyclosporine.....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
80160..............  Assay of desipramine......  ..................  A.................  ...........  ...........  ...........  ...........  ...........
80162..............  Assay of digoxin..........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
80164..............  Assay, dipropylacetic acid  ..................  A.................  ...........  ...........  ...........  ...........  ...........
80166..............  Assay of doxepin..........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
80168..............  Assay of ethosuximide.....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
80170..............  Assay of gentamicin.......  ..................  A.................  ...........  ...........  ...........  ...........  ...........
80172..............  Assay of gold.............  ..................  A.................  ...........  ...........  ...........  ...........  ...........
80173..............  Assay of haloperidol......  ..................  A.................  ...........  ...........  ...........  ...........  ...........
80174..............  Assay of imipramine.......  ..................  A.................  ...........  ...........  ...........  ...........  ...........
80176..............  Assay of lidocaine........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
80178..............  Assay of lithium..........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
80182..............  Assay of nortriptyline....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
80184..............  Assay of phenobarbital....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
80185..............  Assay of phenytoin, total.  ..................  A.................  ...........  ...........  ...........  ...........  ...........
80186..............  Assay of phenytoin, free..  ..................  A.................  ...........  ...........  ...........  ...........  ...........

[[Page 67080]]

 
80188..............  Assay of primidone........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
80190..............  Assay of procainamide.....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
80192..............  Assay of procainamide.....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
80194..............  Assay of quinidine........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
80195..............  Assay of sirolimus........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
80196..............  Assay of salicylate.......  ..................  A.................  ...........  ...........  ...........  ...........  ...........
80197..............  Assay of tacrolimus.......  ..................  A.................  ...........  ...........  ...........  ...........  ...........
80198..............  Assay of theophylline.....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
80200..............  Assay of tobramycin.......  ..................  A.................  ...........  ...........  ...........  ...........  ...........
80201..............  Assay of topiramate.......  ..................  A.................  ...........  ...........  ...........  ...........  ...........
80202..............  Assay of vancomycin.......  ..................  A.................  ...........  ...........  ...........  ...........  ...........
80299..............  Quantitative assay, drug..  ..................  A.................  ...........  ...........  ...........  ...........  ...........
80400..............  Acth stimulation panel....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
80402..............  Acth stimulation panel....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
80406..............  Acth stimulation panel....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
80408..............  Aldosterone suppression     ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      eval.
80410..............  Calcitonin stimul panel...  ..................  A.................  ...........  ...........  ...........  ...........  ...........
80412..............  CRH stimulation panel.....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
80414..............  Testosterone response.....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
80415..............  Estradiol response panel..  ..................  A.................  ...........  ...........  ...........  ...........  ...........
80416..............  Renin stimulation panel...  ..................  A.................  ...........  ...........  ...........  ...........  ...........
80417..............  Renin stimulation panel...  ..................  A.................  ...........  ...........  ...........  ...........  ...........
80418..............  Pituitary evaluation panel  ..................  A.................  ...........  ...........  ...........  ...........  ...........
80420..............  Dexamethasone panel.......  ..................  A.................  ...........  ...........  ...........  ...........  ...........
80422..............  Glucagon tolerance panel..  ..................  A.................  ...........  ...........  ...........  ...........  ...........
80424..............  Glucagon tolerance panel..  ..................  A.................  ...........  ...........  ...........  ...........  ...........
80426..............  Gonadotropin hormone panel  ..................  A.................  ...........  ...........  ...........  ...........  ...........
80428..............  Growth hormone panel......  ..................  A.................  ...........  ...........  ...........  ...........  ...........
80430..............  Growth hormone panel......  ..................  A.................  ...........  ...........  ...........  ...........  ...........
80432..............  Insulin suppression panel.  ..................  A.................  ...........  ...........  ...........  ...........  ...........
80434..............  Insulin tolerance panel...  ..................  A.................  ...........  ...........  ...........  ...........  ...........
80435..............  Insulin tolerance panel...  ..................  A.................  ...........  ...........  ...........  ...........  ...........
80436..............  Metyrapone panel..........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
80438..............  TRH stimulation panel.....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
80439..............  TRH stimulation panel.....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
80440..............  TRH stimulation panel.....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
80500..............  Lab pathology consultation  ..................  X.................         0433       0.2397       $15.27        $5.17        $3.05
80502..............  Lab pathology consultation  ..................  X.................         0342       0.0969        $6.17        $2.02        $1.23
81000..............  Urinalysis, nonauto w/      ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      scope.
81001..............  Urinalysis, auto w/scope..  ..................  A.................  ...........  ...........  ...........  ...........  ...........
81002..............  Urinalysis nonauto w/o      ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      scope.
81003..............  Urinalysis, auto, w/o       ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      scope.
81005..............  Urinalysis................  ..................  A.................  ...........  ...........  ...........  ...........  ...........
81007..............  Urine screen for bacteria.  ..................  A.................  ...........  ...........  ...........  ...........  ...........
81015..............  Microscopic exam of urine.  ..................  A.................  ...........  ...........  ...........  ...........  ...........
81020..............  Urinalysis, glass test....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
81025..............  Urine pregnancy test......  ..................  A.................  ...........  ...........  ...........  ...........  ...........
81050..............  Urinalysis, volume measure  ..................  A.................  ...........  ...........  ...........  ...........  ...........
81099..............  Urinalysis test procedure.  ..................  A.................  ...........  ...........  ...........  ...........  ...........
82000..............  Assay of blood              ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      acetaldehyde.
82003..............  Assay of acetaminophen....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
82009..............  Test for acetone/ketones..  ..................  A.................  ...........  ...........  ...........  ...........  ...........
82010..............  Acetone assay.............  ..................  A.................  ...........  ...........  ...........  ...........  ...........
82013..............  Acetylcholinesterase assay  ..................  A.................  ...........  ...........  ...........  ...........  ...........
82016..............  Acylcarnitines, qual......  ..................  A.................  ...........  ...........  ...........  ...........  ...........
82017..............  Acylcarnitines, quant.....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
82024..............  Assay of acth.............  ..................  A.................  ...........  ...........  ...........  ...........  ...........
82030..............  Assay of adp & amp........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
82040..............  Assay of serum albumin....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
82042..............  Assay of urine albumin....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
82043..............  Microalbumin, quantitative  ..................  A.................  ...........  ...........  ...........  ...........  ...........
82044..............  Microalbumin, semiquant...  ..................  A.................  ...........  ...........  ...........  ...........  ...........
82045..............  Albumin, ischemia modified  ..................  A.................  ...........  ...........  ...........  ...........  ...........
82055..............  Assay of ethanol..........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
82075..............  Assay of breath ethanol...  ..................  A.................  ...........  ...........  ...........  ...........  ...........
82085..............  Assay of aldolase.........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
82088..............  Assay of aldosterone......  ..................  A.................  ...........  ...........  ...........  ...........  ...........
82101..............  Assay of urine alkaloids..  ..................  A.................  ...........  ...........  ...........  ...........  ...........
82103..............  Alpha-1-antitrypsin, total  ..................  A.................  ...........  ...........  ...........  ...........  ...........
82104..............  Alpha-1-antitrypsin, pheno  ..................  A.................  ...........  ...........  ...........  ...........  ...........
82105..............  Alpha-fetoprotein, serum..  ..................  A.................  ...........  ...........  ...........  ...........  ...........
82106..............  Alpha-fetoprotein,          ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      amniotic.
82107..............  Alpha-fetoprotein l3......  ..................  A.................  ...........  ...........  ...........  ...........  ...........
82108..............  Assay of aluminum.........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
82120..............  Amines, vaginal fluid qual  ..................  A.................  ...........  ...........  ...........  ...........  ...........
82127..............  Amino acid, single qual...  ..................  A.................  ...........  ...........  ...........  ...........  ...........
82128..............  Amino acids, mult qual....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
82131..............  Amino acids, single quant.  ..................  A.................  ...........  ...........  ...........  ...........  ...........
82135..............  Assay, aminolevulinic acid  ..................  A.................  ...........  ...........  ...........  ...........  ...........
82136..............  Amino acids, quant, 2-5...  ..................  A.................  ...........  ...........  ...........  ...........  ...........

[[Page 67081]]

 
82139..............  Amino acids, quan, 6 or     ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      more.
82140..............  Assay of ammonia..........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
82143..............  Amniotic fluid scan.......  ..................  A.................  ...........  ...........  ...........  ...........  ...........
82145..............  Assay of amphetamines.....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
82150..............  Assay of amylase..........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
82154..............  Androstanediol glucuronide  ..................  A.................  ...........  ...........  ...........  ...........  ...........
82157..............  Assay of androstenedione..  ..................  A.................  ...........  ...........  ...........  ...........  ...........
82160..............  Assay of androsterone.....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
82163..............  Assay of angiotensin II...  ..................  A.................  ...........  ...........  ...........  ...........  ...........
82164..............  Angiotensin I enzyme test.  ..................  A.................  ...........  ...........  ...........  ...........  ...........
82172..............  Assay of apolipoprotein...  ..................  A.................  ...........  ...........  ...........  ...........  ...........
82175..............  Assay of arsenic..........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
82180..............  Assay of ascorbic acid....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
82190..............  Atomic absorption.........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
82205..............  Assay of barbiturates.....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
82232..............  Assay of beta-2 protein...  ..................  A.................  ...........  ...........  ...........  ...........  ...........
82239..............  Bile acids, total.........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
82240..............  Bile acids, cholylglycine.  ..................  A.................  ...........  ...........  ...........  ...........  ...........
82247..............  Bilirubin, total..........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
82248..............  Bilirubin, direct.........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
82252..............  Fecal bilirubin test......  ..................  A.................  ...........  ...........  ...........  ...........  ...........
82261..............  Assay of biotinidase......  ..................  A.................  ...........  ...........  ...........  ...........  ...........
82270..............  Occult blood, feces.......  ..................  A.................  ...........  ...........  ...........  ...........  ...........
82271..............  Occult blood, other         ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      sources.
82272..............  Occult bld feces, 1-3       ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      tests.
82274..............  Assay test for blood,       ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      fecal.
82286..............  Assay of bradykinin.......  ..................  A.................  ...........  ...........  ...........  ...........  ...........
82300..............  Assay of cadmium..........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
82306..............  Assay of vitamin D........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
82307..............  Assay of vitamin D........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
82308..............  Assay of calcitonin.......  ..................  A.................  ...........  ...........  ...........  ...........  ...........
82310..............  Assay of calcium..........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
82330..............  Assay of calcium..........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
82331..............  Calcium infusion test.....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
82340..............  Assay of calcium in urine.  ..................  A.................  ...........  ...........  ...........  ...........  ...........
82355..............  Calculus analysis, qual...  ..................  A.................  ...........  ...........  ...........  ...........  ...........
82360..............  Calculus assay, quant.....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
82365..............  Calculus spectroscopy.....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
82370..............  X-ray assay, calculus.....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
82373..............  Assay, c-d transfer         ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      measure.
82374..............  Assay, blood carbon         ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      dioxide.
82375..............  Assay, blood carbon         ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      monoxide.
82376..............  Test for carbon monoxide..  ..................  A.................  ...........  ...........  ...........  ...........  ...........
82378..............  Carcinoembryonic antigen..  ..................  A.................  ...........  ...........  ...........  ...........  ...........
82379..............  Assay of carnitine........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
82380..............  Assay of carotene.........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
82382..............  Assay, urine                ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      catecholamines.
82383..............  Assay, blood                ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      catecholamines.
82384..............  Assay, three                ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      catecholamines.
82387..............  Assay of cathepsin-d......  ..................  A.................  ...........  ...........  ...........  ...........  ...........
82390..............  Assay of ceruloplasmin....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
82397..............  Chemiluminescent assay....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
82415..............  Assay of chloramphenicol..  ..................  A.................  ...........  ...........  ...........  ...........  ...........
82435..............  Assay of blood chloride...  ..................  A.................  ...........  ...........  ...........  ...........  ...........
82436..............  Assay of urine chloride...  ..................  A.................  ...........  ...........  ...........  ...........  ...........
82438..............  Assay, other fluid          ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      chlorides.
82441..............  Test for                    ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      chlorohydrocarbons.
82465..............  Assay, bld/serum            ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      cholesterol.
82480..............  Assay, serum                ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      cholinesterase.
82482..............  Assay, rbc cholinesterase.  ..................  A.................  ...........  ...........  ...........  ...........  ...........
82485..............  Assay, chondroitin sulfate  ..................  A.................  ...........  ...........  ...........  ...........  ...........
82486..............  Gas/liquid chromatography.  ..................  A.................  ...........  ...........  ...........  ...........  ...........
82487..............  Paper chromatography......  ..................  A.................  ...........  ...........  ...........  ...........  ...........
82488..............  Paper chromatography......  ..................  A.................  ...........  ...........  ...........  ...........  ...........
82489..............  Thin layer chromatography.  ..................  A.................  ...........  ...........  ...........  ...........  ...........
82491..............  Chromotography, quant,      ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      sing.
82492..............  Chromotography, quant,      ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      mult.
82495..............  Assay of chromium.........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
82507..............  Assay of citrate..........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
82520..............  Assay of cocaine..........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
82523..............  Collagen crosslinks.......  ..................  A.................  ...........  ...........  ...........  ...........  ...........
82525..............  Assay of copper...........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
82528..............  Assay of corticosterone...  ..................  A.................  ...........  ...........  ...........  ...........  ...........
82530..............  Cortisol, free............  ..................  A.................  ...........  ...........  ...........  ...........  ...........
82533..............  Total cortisol............  ..................  A.................  ...........  ...........  ...........  ...........  ...........
82540..............  Assay of creatine.........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
82541..............  Column chromotography,      ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      qual.
82542..............  Column chromotography,      ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      quant.
82543..............  Column chromotograph/       ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      isotope.
82544..............  Column chromotograph/       ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      isotope.

[[Page 67082]]

 
82550..............  Assay of ck (cpk).........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
82552..............  Assay of cpk in blood.....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
82553..............  Creatine, MB fraction.....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
82554..............  Creatine, isoforms........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
82565..............  Assay of creatinine.......  ..................  A.................  ...........  ...........  ...........  ...........  ...........
82570..............  Assay of urine creatinine.  ..................  A.................  ...........  ...........  ...........  ...........  ...........
82575..............  Creatinine clearance test.  ..................  A.................  ...........  ...........  ...........  ...........  ...........
82585..............  Assay of cryofibrinogen...  ..................  A.................  ...........  ...........  ...........  ...........  ...........
82595..............  Assay of cryoglobulin.....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
82600..............  Assay of cyanide..........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
82607..............  Vitamin B-12..............  ..................  A.................  ...........  ...........  ...........  ...........  ...........
82608..............  B-12 binding capacity.....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
82610..............  Cystatin c................  NI................  A.................  ...........  ...........  ...........  ...........  ...........
82615..............  Test for urine cystines...  ..................  A.................  ...........  ...........  ...........  ...........  ...........
82626..............  Dehydroepiandrosterone....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
82627..............  Dehydroepiandrosterone....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
82633..............  Desoxycorticosterone......  ..................  A.................  ...........  ...........  ...........  ...........  ...........
82634..............  Deoxycortisol.............  ..................  A.................  ...........  ...........  ...........  ...........  ...........
82638..............  Assay of dibucaine number.  ..................  A.................  ...........  ...........  ...........  ...........  ...........
82646..............  Assay of dihydrocodeinone.  ..................  A.................  ...........  ...........  ...........  ...........  ...........
82649..............  Assay of dihydromorphinone  ..................  A.................  ...........  ...........  ...........  ...........  ...........
82651..............  Assay of                    ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      dihydrotestosterone.
82652..............  Assay of dihydroxyvitamin   ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      d.
82654..............  Assay of dimethadione.....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
82656..............  Pancreatic elastase, fecal  ..................  A.................  ...........  ...........  ...........  ...........  ...........
82657..............  Enzyme cell activity......  ..................  A.................  ...........  ...........  ...........  ...........  ...........
82658..............  Enzyme cell activity, ra..  ..................  A.................  ...........  ...........  ...........  ...........  ...........
82664..............  Electrophoretic test......  ..................  A.................  ...........  ...........  ...........  ...........  ...........
82666..............  Assay of epiandrosterone..  ..................  A.................  ...........  ...........  ...........  ...........  ...........
82668..............  Assay of erythropoietin...  ..................  A.................  ...........  ...........  ...........  ...........  ...........
82670..............  Assay of estradiol........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
82671..............  Assay of estrogens........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
82672..............  Assay of estrogen.........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
82677..............  Assay of estriol..........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
82679..............  Assay of estrone..........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
82690..............  Assay of ethchlorvynol....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
82693..............  Assay of ethylene glycol..  ..................  A.................  ...........  ...........  ...........  ...........  ...........
82696..............  Assay of etiocholanolone..  ..................  A.................  ...........  ...........  ...........  ...........  ...........
82705..............  Fats/lipids, feces, qual..  ..................  A.................  ...........  ...........  ...........  ...........  ...........
82710..............  Fats/lipids, feces, quant.  ..................  A.................  ...........  ...........  ...........  ...........  ...........
82715..............  Assay of fecal fat........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
82725..............  Assay of blood fatty acids  ..................  A.................  ...........  ...........  ...........  ...........  ...........
82726..............  Long chain fatty acids....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
82728..............  Assay of ferritin.........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
82731..............  Assay of fetal fibronectin  ..................  A.................  ...........  ...........  ...........  ...........  ...........
82735..............  Assay of fluoride.........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
82742..............  Assay of flurazepam.......  ..................  A.................  ...........  ...........  ...........  ...........  ...........
82746..............  Blood folic acid serum....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
82747..............  Assay of folic acid, rbc..  ..................  A.................  ...........  ...........  ...........  ...........  ...........
82757..............  Assay of semen fructose...  ..................  A.................  ...........  ...........  ...........  ...........  ...........
82759..............  Assay of rbc galactokinase  ..................  A.................  ...........  ...........  ...........  ...........  ...........
82760..............  Assay of galactose........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
82775..............  Assay galactose             ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      transferase.
82776..............  Galactose transferase test  ..................  A.................  ...........  ...........  ...........  ...........  ...........
82784..............  Assay of gammaglobulin igm  ..................  A.................  ...........  ...........  ...........  ...........  ...........
82785..............  Assay of gammaglobulin ige  ..................  A.................  ...........  ...........  ...........  ...........  ...........
82787..............  Igg 1, 2, 3 or 4, each....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
82800..............  Blood pH..................  ..................  A.................  ...........  ...........  ...........  ...........  ...........
82803..............  Blood gases: pH, pO2 &      ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      pCO2.
82805..............  Blood gases w/o2            ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      saturation.
82810..............  Blood gases, O2 sat only..  ..................  A.................  ...........  ...........  ...........  ...........  ...........
82820..............  Hemoglobin-oxygen affinity  ..................  A.................  ...........  ...........  ...........  ...........  ...........
82926..............  Assay of gastric acid.....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
82928..............  Assay of gastric acid.....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
82938..............  Gastrin test..............  ..................  A.................  ...........  ...........  ...........  ...........  ...........
82941..............  Assay of gastrin..........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
82943..............  Assay of glucagon.........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
82945..............  Glucose other fluid.......  ..................  A.................  ...........  ...........  ...........  ...........  ...........
82946..............  Glucagon tolerance test...  ..................  A.................  ...........  ...........  ...........  ...........  ...........
82947..............  Assay, glucose, blood       ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      quant.
82948..............  Reagent strip/blood         ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      glucose.
82950..............  Glucose test..............  ..................  A.................  ...........  ...........  ...........  ...........  ...........
82951..............  Glucose tolerance test      ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      (GTT).
82952..............  GTT-added samples.........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
82953..............  Glucose-tolbutamide test..  ..................  A.................  ...........  ...........  ...........  ...........  ...........
82955..............  Assay of g6pd enzyme......  ..................  A.................  ...........  ...........  ...........  ...........  ...........
82960..............  Test for G6PD enzyme......  ..................  A.................  ...........  ...........  ...........  ...........  ...........
82962..............  Glucose blood test........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
82963..............  Assay of glucosidase......  ..................  A.................  ...........  ...........  ...........  ...........  ...........
82965..............  Assay of gdh enzyme.......  ..................  A.................  ...........  ...........  ...........  ...........  ...........

[[Page 67083]]

 
82975..............  Assay of glutamine........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
82977..............  Assay of GGT..............  ..................  A.................  ...........  ...........  ...........  ...........  ...........
82978..............  Assay of glutathione......  ..................  A.................  ...........  ...........  ...........  ...........  ...........
82979..............  Assay, rbc glutathione....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
82980..............  Assay of glutethimide.....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
82985..............  Glycated protein..........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
83001..............  Gonadotropin (FSH)........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
83002..............  Gonadotropin (LH).........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
83003..............  Assay, growth hormone       ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      (hgh).
83008..............  Assay of guanosine........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
83009..............  H pylori (c-13), blood....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
83010..............  Assay of haptoglobin,       ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      quant.
83012..............  Assay of haptoglobins.....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
83013..............  H pylori (c-13), breath...  ..................  A.................  ...........  ...........  ...........  ...........  ...........
83014..............  H pylori drug admin.......  ..................  A.................  ...........  ...........  ...........  ...........  ...........
83015..............  Heavy metal screen........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
83018..............  Quantitative screen,        ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      metals.
83020..............  Hemoglobin electrophoresis  ..................  A.................  ...........  ...........  ...........  ...........  ...........
83021..............  Hemoglobin chromotography.  ..................  A.................  ...........  ...........  ...........  ...........  ...........
83026..............  Hemoglobin, copper sulfate  ..................  A.................  ...........  ...........  ...........  ...........  ...........
83030..............  Fetal hemoglobin, chemical  ..................  A.................  ...........  ...........  ...........  ...........  ...........
83033..............  Fetal hemoglobin assay,     ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      qual.
83036..............  Glycosylated hemoglobin     ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      test.
83037..............  Glycosylated hb, home       ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      device.
83045..............  Blood methemoglobin test..  ..................  A.................  ...........  ...........  ...........  ...........  ...........
83050..............  Blood methemoglobin assay.  ..................  A.................  ...........  ...........  ...........  ...........  ...........
83051..............  Assay of plasma hemoglobin  ..................  A.................  ...........  ...........  ...........  ...........  ...........
83055..............  Blood sulfhemoglobin test.  ..................  A.................  ...........  ...........  ...........  ...........  ...........
83060..............  Blood sulfhemoglobin assay  ..................  A.................  ...........  ...........  ...........  ...........  ...........
83065..............  Assay of hemoglobin heat..  ..................  A.................  ...........  ...........  ...........  ...........  ...........
83068..............  Hemoglobin stability        ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      screen.
83069..............  Assay of urine hemoglobin.  ..................  A.................  ...........  ...........  ...........  ...........  ...........
83070..............  Assay of hemosiderin, qual  ..................  A.................  ...........  ...........  ...........  ...........  ...........
83071..............  Assay of hemosiderin,       ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      quant.
83080..............  Assay of b hexosaminidase.  ..................  A.................  ...........  ...........  ...........  ...........  ...........
83088..............  Assay of histamine........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
83090..............  Assay of homocystine......  ..................  A.................  ...........  ...........  ...........  ...........  ...........
83150..............  Assay of for hva..........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
83491..............  Assay of corticosteroids..  ..................  A.................  ...........  ...........  ...........  ...........  ...........
83497..............  Assay of 5-hiaa...........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
83498..............  Assay of progesterone.....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
83499..............  Assay of progesterone.....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
83500..............  Assay, free hydroxyproline  ..................  A.................  ...........  ...........  ...........  ...........  ...........
83505..............  Assay, total                ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      hydroxyproline.
83516..............  Immunoassay, nonantibody..  ..................  A.................  ...........  ...........  ...........  ...........  ...........
83518..............  Immunoassay, dipstick.....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
83519..............  Immunoassay, nonantibody..  ..................  A.................  ...........  ...........  ...........  ...........  ...........
83520..............  Immunoassay, RIA..........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
83525..............  Assay of insulin..........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
83527..............  Assay of insulin..........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
83528..............  Assay of intrinsic factor.  ..................  A.................  ...........  ...........  ...........  ...........  ...........
83540..............  Assay of iron.............  ..................  A.................  ...........  ...........  ...........  ...........  ...........
83550..............  Iron binding test.........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
83570..............  Assay of idh enzyme.......  ..................  A.................  ...........  ...........  ...........  ...........  ...........
83582..............  Assay of ketogenic          ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      steroids.
83586..............  Assay 17- ketosteroids....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
83593..............  Fractionation,              ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      ketosteroids.
83605..............  Assay of lactic acid......  ..................  A.................  ...........  ...........  ...........  ...........  ...........
83615..............  Lactate (LD) (LDH) enzyme.  ..................  A.................  ...........  ...........  ...........  ...........  ...........
83625..............  Assay of ldh enzymes......  ..................  A.................  ...........  ...........  ...........  ...........  ...........
83630..............  Lactoferrin, fecal (qual).  ..................  A.................  ...........  ...........  ...........  ...........  ...........
83631..............  Lactoferrin, fecal (quant)  ..................  A.................  ...........  ...........  ...........  ...........  ...........
83632..............  Placental lactogen........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
83633..............  Test urine for lactose....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
83634..............  Assay of urine for lactose  ..................  A.................  ...........  ...........  ...........  ...........  ...........
83655..............  Assay of lead.............  ..................  A.................  ...........  ...........  ...........  ...........  ...........
83661..............  L/s ratio, fetal lung.....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
83662..............  Foam stability, fetal lung  ..................  A.................  ...........  ...........  ...........  ...........  ...........
83663..............  Fluoro polarize, fetal      ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      lung.
83664..............  Lamellar bdy, fetal lung..  ..................  A.................  ...........  ...........  ...........  ...........  ...........
83670..............  Assay of lap enzyme.......  ..................  A.................  ...........  ...........  ...........  ...........  ...........
83690..............  Assay of lipase...........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
83695..............  Assay of lipoprotein(a)...  ..................  A.................  ...........  ...........  ...........  ...........  ...........
83698..............  Assay lipoprotein pla2....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
83700..............  Lipopro bld,                ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      electrophoretic.
83701..............  Lipoprotein bld, hr         ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      fraction.
83704..............  Lipoprotein, bld, by nmr..  ..................  A.................  ...........  ...........  ...........  ...........  ...........
83718..............  Assay of lipoprotein......  ..................  A.................  ...........  ...........  ...........  ...........  ...........
83719..............  Assay of blood lipoprotein  ..................  A.................  ...........  ...........  ...........  ...........  ...........
83721..............  Assay of blood lipoprotein  ..................  A.................  ...........  ...........  ...........  ...........  ...........

[[Page 67084]]

 
83727..............  Assay of lrh hormone......  ..................  A.................  ...........  ...........  ...........  ...........  ...........
83735..............  Assay of magnesium........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
83775..............  Assay of md enzyme........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
83785..............  Assay of manganese........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
83788..............  Mass spectrometry qual....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
83789..............  Mass spectrometry quant...  ..................  A.................  ...........  ...........  ...........  ...........  ...........
83805..............  Assay of meprobamate......  ..................  A.................  ...........  ...........  ...........  ...........  ...........
83825..............  Assay of mercury..........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
83835..............  Assay of metanephrines....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
83840..............  Assay of methadone........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
83857..............  Assay of methemalbumin....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
83858..............  Assay of methsuximide.....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
83864..............  Mucopolysaccharides.......  ..................  A.................  ...........  ...........  ...........  ...........  ...........
83866..............  Mucopolysaccharides screen  ..................  A.................  ...........  ...........  ...........  ...........  ...........
83872..............  Assay synovial fluid mucin  ..................  A.................  ...........  ...........  ...........  ...........  ...........
83873..............  Assay of csf protein......  ..................  A.................  ...........  ...........  ...........  ...........  ...........
83874..............  Assay of myoglobin........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
83880..............  Natriuretic peptide.......  ..................  A.................  ...........  ...........  ...........  ...........  ...........
83883..............  Assay, nephelometry not     ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      spec.
83885..............  Assay of nickel...........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
83887..............  Assay of nicotine.........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
83890..............  Molecule isolate..........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
83891..............  Molecule isolate nucleic..  ..................  A.................  ...........  ...........  ...........  ...........  ...........
83892..............  Molecular diagnostics.....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
83893..............  Molecule dot/slot/blot....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
83894..............  Molecule gel electrophor..  ..................  A.................  ...........  ...........  ...........  ...........  ...........
83896..............  Molecular diagnostics.....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
83897..............  Molecule nucleic transfer.  ..................  A.................  ...........  ...........  ...........  ...........  ...........
83898..............  Molecule nucleic ampli,     ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      each.
83900..............  Molecule nucleic ampli 2    ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      seq.
83901..............  Molecule nucleic ampli      ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      addon.
83902..............  Molecular diagnostics.....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
83903..............  Molecule mutation scan....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
83904..............  Molecule mutation identify  ..................  A.................  ...........  ...........  ...........  ...........  ...........
83905..............  Molecule mutation identify  ..................  A.................  ...........  ...........  ...........  ...........  ...........
83906..............  Molecule mutation identify  ..................  A.................  ...........  ...........  ...........  ...........  ...........
83907..............  Lyse cells for nucleic ext  ..................  A.................  ...........  ...........  ...........  ...........  ...........
83908..............  Nucleic acid, signal ampli  ..................  A.................  ...........  ...........  ...........  ...........  ...........
83909..............  Nucleic acid, high          ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      resolute.
83912..............  Genetic examination.......  ..................  A.................  ...........  ...........  ...........  ...........  ...........
83913..............  Molecular, rna              ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      stabilization.
83914..............  Mutation ident ola/sbce/    ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      aspe.
83915..............  Assay of nucleotidase.....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
83916..............  Oligoclonal bands.........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
83918..............  Organic acids, total,       ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      quant.
83919..............  Organic acids, qual, each.  ..................  A.................  ...........  ...........  ...........  ...........  ...........
83921..............  Organic acid, single,       ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      quant.
83925..............  Assay of opiates..........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
83930..............  Assay of blood osmolality.  ..................  A.................  ...........  ...........  ...........  ...........  ...........
83935..............  Assay of urine osmolality.  ..................  A.................  ...........  ...........  ...........  ...........  ...........
83937..............  Assay of osteocalcin......  ..................  A.................  ...........  ...........  ...........  ...........  ...........
83945..............  Assay of oxalate..........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
83950..............  Oncoprotein, her-2/neu....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
83970..............  Assay of parathormone.....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
83986..............  Assay of body fluid         ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      acidity.
83992..............  Assay for phencyclidine...  ..................  A.................  ...........  ...........  ...........  ...........  ...........
83993..............  Assay for calprotectin      NI................  A.................  ...........  ...........  ...........  ...........  ...........
                      fecal.
84022..............  Assay of phenothiazine....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
84030..............  Assay of blood pku........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
84035..............  Assay of phenylketones....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
84060..............  Assay acid phosphatase....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
84061..............  Phosphatase, forensic exam  ..................  A.................  ...........  ...........  ...........  ...........  ...........
84066..............  Assay prostate phosphatase  ..................  A.................  ...........  ...........  ...........  ...........  ...........
84075..............  Assay alkaline phosphatase  ..................  A.................  ...........  ...........  ...........  ...........  ...........
84078..............  Assay alkaline phosphatase  ..................  A.................  ...........  ...........  ...........  ...........  ...........
84080..............  Assay alkaline              ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      phosphatases.
84081..............  Amniotic fluid enzyme test  ..................  A.................  ...........  ...........  ...........  ...........  ...........
84085..............  Assay of rbc pg6d enzyme..  ..................  A.................  ...........  ...........  ...........  ...........  ...........
84087..............  Assay phosphohexose         ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      enzymes.
84100..............  Assay of phosphorus.......  ..................  A.................  ...........  ...........  ...........  ...........  ...........
84105..............  Assay of urine phosphorus.  ..................  A.................  ...........  ...........  ...........  ...........  ...........
84106..............  Test for porphobilinogen..  ..................  A.................  ...........  ...........  ...........  ...........  ...........
84110..............  Assay of porphobilinogen..  ..................  A.................  ...........  ...........  ...........  ...........  ...........
84119..............  Test urine for porphyrins.  ..................  A.................  ...........  ...........  ...........  ...........  ...........
84120..............  Assay of urine porphyrins.  ..................  A.................  ...........  ...........  ...........  ...........  ...........
84126..............  Assay of feces porphyrins.  ..................  A.................  ...........  ...........  ...........  ...........  ...........
84127..............  Assay of feces porphyrins.  ..................  A.................  ...........  ...........  ...........  ...........  ...........
84132..............  Assay of serum potassium..  ..................  A.................  ...........  ...........  ...........  ...........  ...........
84133..............  Assay of urine potassium..  ..................  A.................  ...........  ...........  ...........  ...........  ...........
84134..............  Assay of prealbumin.......  ..................  A.................  ...........  ...........  ...........  ...........  ...........

[[Page 67085]]

 
84135..............  Assay of pregnanediol.....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
84138..............  Assay of pregnanetriol....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
84140..............  Assay of pregnenolone.....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
84143..............  Assay of 17-                ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      hydroxypregneno.
84144..............  Assay of progesterone.....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
84146..............  Assay of prolactin........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
84150..............  Assay of prostaglandin....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
84152..............  Assay of psa, complexed...  ..................  A.................  ...........  ...........  ...........  ...........  ...........
84153..............  Assay of psa, total.......  ..................  A.................  ...........  ...........  ...........  ...........  ...........
84154..............  Assay of psa, free........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
84155..............  Assay of protein, serum...  ..................  A.................  ...........  ...........  ...........  ...........  ...........
84156..............  Assay of protein, urine...  ..................  A.................  ...........  ...........  ...........  ...........  ...........
84157..............  Assay of protein, other...  ..................  A.................  ...........  ...........  ...........  ...........  ...........
84160..............  Assay of protein, any       ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      source.
84163..............  Pappa, serum..............  ..................  A.................  ...........  ...........  ...........  ...........  ...........
84165..............  Protein e-phoresis, serum.  ..................  A.................  ...........  ...........  ...........  ...........  ...........
84166..............  Protein e-phoresis/urine/   ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      csf.
84181..............  Western blot test.........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
84182..............  Protein, western blot test  ..................  A.................  ...........  ...........  ...........  ...........  ...........
84202..............  Assay RBC protoporphyrin..  ..................  A.................  ...........  ...........  ...........  ...........  ...........
84203..............  Test RBC protoporphyrin...  ..................  A.................  ...........  ...........  ...........  ...........  ...........
84206..............  Assay of proinsulin.......  ..................  A.................  ...........  ...........  ...........  ...........  ...........
84207..............  Assay of vitamin b-6......  ..................  A.................  ...........  ...........  ...........  ...........  ...........
84210..............  Assay of pyruvate.........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
84220..............  Assay of pyruvate kinase..  ..................  A.................  ...........  ...........  ...........  ...........  ...........
84228..............  Assay of quinine..........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
84233..............  Assay of estrogen.........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
84234..............  Assay of progesterone.....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
84235..............  Assay of endocrine hormone  ..................  A.................  ...........  ...........  ...........  ...........  ...........
84238..............  Assay, nonendocrine         ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      receptor.
84244..............  Assay of renin............  ..................  A.................  ...........  ...........  ...........  ...........  ...........
84252..............  Assay of vitamin b-2......  ..................  A.................  ...........  ...........  ...........  ...........  ...........
84255..............  Assay of selenium.........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
84260..............  Assay of serotonin........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
84270..............  Assay of sex hormone        ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      globul.
84275..............  Assay of sialic acid......  ..................  A.................  ...........  ...........  ...........  ...........  ...........
84285..............  Assay of silica...........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
84295..............  Assay of serum sodium.....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
84300..............  Assay of urine sodium.....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
84302..............  Assay of sweat sodium.....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
84305..............  Assay of somatomedin......  ..................  A.................  ...........  ...........  ...........  ...........  ...........
84307..............  Assay of somatostatin.....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
84311..............  Spectrophotometry.........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
84315..............  Body fluid specific         ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      gravity.
84375..............  Chromatogram assay, sugars  ..................  A.................  ...........  ...........  ...........  ...........  ...........
84376..............  Sugars, single, qual......  ..................  A.................  ...........  ...........  ...........  ...........  ...........
84377..............  Sugars, multiple, qual....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
84378..............  Sugars, single, quant.....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
84379..............  Sugars multiple quant.....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
84392..............  Assay of urine sulfate....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
84402..............  Assay of testosterone.....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
84403..............  Assay of total              ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      testosterone.
84425..............  Assay of vitamin b-1......  ..................  A.................  ...........  ...........  ...........  ...........  ...........
84430..............  Assay of thiocyanate......  ..................  A.................  ...........  ...........  ...........  ...........  ...........
84432..............  Assay of thyroglobulin....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
84436..............  Assay of total thyroxine..  ..................  A.................  ...........  ...........  ...........  ...........  ...........
84437..............  Assay of neonatal           ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      thyroxine.
84439..............  Assay of free thyroxine...  ..................  A.................  ...........  ...........  ...........  ...........  ...........
84442..............  Assay of thyroid activity.  ..................  A.................  ...........  ...........  ...........  ...........  ...........
84443..............  Assay thyroid stim hormone  ..................  A.................  ...........  ...........  ...........  ...........  ...........
84445..............  Assay of tsi..............  ..................  A.................  ...........  ...........  ...........  ...........  ...........
84446..............  Assay of vitamin e........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
84449..............  Assay of transcortin......  ..................  A.................  ...........  ...........  ...........  ...........  ...........
84450..............  Transferase (AST) (SGOT)..  ..................  A.................  ...........  ...........  ...........  ...........  ...........
84460..............  Alanine amino (ALT) (SGPT)  ..................  A.................  ...........  ...........  ...........  ...........  ...........
84466..............  Assay of transferrin......  ..................  A.................  ...........  ...........  ...........  ...........  ...........
84478..............  Assay of triglycerides....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
84479..............  Assay of thyroid (t3 or     ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      t4).
84480..............  Assay, triiodothyronine     ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      (t3).
84481..............  Free assay (FT-3).........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
84482..............  T3 reverse................  ..................  A.................  ...........  ...........  ...........  ...........  ...........
84484..............  Assay of troponin, quant..  ..................  A.................  ...........  ...........  ...........  ...........  ...........
84485..............  Assay duodenal fluid        ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      trypsin.
84488..............  Test feces for trypsin....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
84490..............  Assay of feces for trypsin  ..................  A.................  ...........  ...........  ...........  ...........  ...........
84510..............  Assay of tyrosine.........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
84512..............  Assay of troponin, qual...  ..................  A.................  ...........  ...........  ...........  ...........  ...........
84520..............  Assay of urea nitrogen....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
84525..............  Urea nitrogen semi-quant..  ..................  A.................  ...........  ...........  ...........  ...........  ...........
84540..............  Assay of urine/urea-n.....  ..................  A.................  ...........  ...........  ...........  ...........  ...........

[[Page 67086]]

 
84545..............  Urea-N clearance test.....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
84550..............  Assay of blood/uric acid..  ..................  A.................  ...........  ...........  ...........  ...........  ...........
84560..............  Assay of urine/uric acid..  ..................  A.................  ...........  ...........  ...........  ...........  ...........
84577..............  Assay of feces/             ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      urobilinogen.
84578..............  Test urine urobilinogen...  ..................  A.................  ...........  ...........  ...........  ...........  ...........
84580..............  Assay of urine              ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      urobilinogen.
84583..............  Assay of urine              ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      urobilinogen.
84585..............  Assay of urine vma........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
84586..............  Assay of vip..............  ..................  A.................  ...........  ...........  ...........  ...........  ...........
84588..............  Assay of vasopressin......  ..................  A.................  ...........  ...........  ...........  ...........  ...........
84590..............  Assay of vitamin a........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
84591..............  Assay of nos vitamin......  ..................  A.................  ...........  ...........  ...........  ...........  ...........
84597..............  Assay of vitamin k........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
84600..............  Assay of volatiles........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
84620..............  Xylose tolerance test.....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
84630..............  Assay of zinc.............  ..................  A.................  ...........  ...........  ...........  ...........  ...........
84681..............  Assay of c-peptide........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
84702..............  Chorionic gonadotropin      ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      test.
84703..............  Chorionic gonadotropin      ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      assay.
84704..............  Hcg, free betachain test..  NI................  A.................  ...........  ...........  ...........  ...........  ...........
84830..............  Ovulation tests...........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
84999..............  Clinical chemistry test...  ..................  A.................  ...........  ...........  ...........  ...........  ...........
85002..............  Bleeding time test........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
85004..............  Automated diff wbc count..  ..................  A.................  ...........  ...........  ...........  ...........  ...........
85007..............  Bl smear w/diff wbc count.  ..................  A.................  ...........  ...........  ...........  ...........  ...........
85008..............  Bl smear w/o diff wbc       ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      count.
85009..............  Manual diff wbc count b-    ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      coat.
85013..............  Spun microhematocrit......  ..................  A.................  ...........  ...........  ...........  ...........  ...........
85014..............  Hematocrit................  ..................  A.................  ...........  ...........  ...........  ...........  ...........
85018..............  Hemoglobin................  ..................  A.................  ...........  ...........  ...........  ...........  ...........
85025..............  Complete cbc w/auto diff    ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      wbc.
85027..............  Complete cbc, automated...  ..................  A.................  ...........  ...........  ...........  ...........  ...........
85032..............  Manual cell count, each...  ..................  A.................  ...........  ...........  ...........  ...........  ...........
85041..............  Automated rbc count.......  ..................  A.................  ...........  ...........  ...........  ...........  ...........
85044..............  Manual reticulocyte count.  ..................  A.................  ...........  ...........  ...........  ...........  ...........
85045..............  Automated reticulocyte      ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      count.
85046..............  Reticyte/hgb concentrate..  ..................  A.................  ...........  ...........  ...........  ...........  ...........
85048..............  Automated leukocyte count.  ..................  A.................  ...........  ...........  ...........  ...........  ...........
85049..............  Automated platelet count..  ..................  A.................  ...........  ...........  ...........  ...........  ...........
85055..............  Reticulated platelet assay  ..................  A.................  ...........  ...........  ...........  ...........  ...........
85060..............  Blood smear interpretation  ..................  B.................  ...........  ...........  ...........  ...........  ...........
85097..............  Bone marrow interpretation  ..................  X.................         0343       0.5142       $32.75       $10.84        $6.55
85130..............  Chromogenic substrate       ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      assay.
85170..............  Blood clot retraction.....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
85175..............  Blood clot lysis time.....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
85210..............  Blood clot factor II test.  ..................  A.................  ...........  ...........  ...........  ...........  ...........
85220..............  Blood clot factor V test..  ..................  A.................  ...........  ...........  ...........  ...........  ...........
85230..............  Blood clot factor VII test  ..................  A.................  ...........  ...........  ...........  ...........  ...........
85240..............  Blood clot factor VIII      ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      test.
85244..............  Blood clot factor VIII      ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      test.
85245..............  Blood clot factor VIII      ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      test.
85246..............  Blood clot factor VIII      ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      test.
85247..............  Blood clot factor VIII      ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      test.
85250..............  Blood clot factor IX test.  ..................  A.................  ...........  ...........  ...........  ...........  ...........
85260..............  Blood clot factor X test..  ..................  A.................  ...........  ...........  ...........  ...........  ...........
85270..............  Blood clot factor XI test.  ..................  A.................  ...........  ...........  ...........  ...........  ...........
85280..............  Blood clot factor XII test  ..................  A.................  ...........  ...........  ...........  ...........  ...........
85290..............  Blood clot factor XIII      ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      test.
85291..............  Blood clot factor XIII      ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      test.
85292..............  Blood clot factor assay...  ..................  A.................  ...........  ...........  ...........  ...........  ...........
85293..............  Blood clot factor assay...  ..................  A.................  ...........  ...........  ...........  ...........  ...........
85300..............  Antithrombin III test.....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
85301..............  Antithrombin III test.....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
85302..............  Blood clot inhibitor        ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      antigen.
85303..............  Blood clot inhibitor test.  ..................  A.................  ...........  ...........  ...........  ...........  ...........
85305..............  Blood clot inhibitor assay  ..................  A.................  ...........  ...........  ...........  ...........  ...........
85306..............  Blood clot inhibitor test.  ..................  A.................  ...........  ...........  ...........  ...........  ...........
85307..............  Assay activated protein c.  ..................  A.................  ...........  ...........  ...........  ...........  ...........
85335..............  Factor inhibitor test.....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
85337..............  Thrombomodulin............  ..................  A.................  ...........  ...........  ...........  ...........  ...........
85345..............  Coagulation time..........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
85347..............  Coagulation time..........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
85348..............  Coagulation time..........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
85360..............  Euglobulin lysis..........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
85362..............  Fibrin degradation          ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      products.
85366..............  Fibrinogen test...........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
85370..............  Fibrinogen test...........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
85378..............  Fibrin degrade, semiquant.  ..................  A.................  ...........  ...........  ...........  ...........  ...........
85379..............  Fibrin degradation, quant.  ..................  A.................  ...........  ...........  ...........  ...........  ...........
85380..............  Fibrin degradation, vte...  ..................  A.................  ...........  ...........  ...........  ...........  ...........

[[Page 67087]]

 
85384..............  Fibrinogen................  ..................  A.................  ...........  ...........  ...........  ...........  ...........
85385..............  Fibrinogen................  ..................  A.................  ...........  ...........  ...........  ...........  ...........
85390..............  Fibrinolysins screen......  ..................  A.................  ...........  ...........  ...........  ...........  ...........
85396..............  Clotting assay, whole       ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      blood.
85400..............  Fibrinolytic plasmin......  ..................  A.................  ...........  ...........  ...........  ...........  ...........
85410..............  Fibrinolytic antiplasmin..  ..................  A.................  ...........  ...........  ...........  ...........  ...........
85415..............  Fibrinolytic plasminogen..  ..................  A.................  ...........  ...........  ...........  ...........  ...........
85420..............  Fibrinolytic plasminogen..  ..................  A.................  ...........  ...........  ...........  ...........  ...........
85421..............  Fibrinolytic plasminogen..  ..................  A.................  ...........  ...........  ...........  ...........  ...........
85441..............  Heinz bodies, direct......  ..................  A.................  ...........  ...........  ...........  ...........  ...........
85445..............  Heinz bodies, induced.....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
85460..............  Hemoglobin, fetal.........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
85461..............  Hemoglobin, fetal.........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
85475..............  Hemolysin.................  ..................  A.................  ...........  ...........  ...........  ...........  ...........
85520..............  Heparin assay.............  ..................  A.................  ...........  ...........  ...........  ...........  ...........
85525..............  Heparin neutralization....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
85530..............  Heparin-protamine           ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      tolerance.
85536..............  Iron stain peripheral       ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      blood.
85540..............  Wbc alkaline phosphatase..  ..................  A.................  ...........  ...........  ...........  ...........  ...........
85547..............  RBC mechanical fragility..  ..................  A.................  ...........  ...........  ...........  ...........  ...........
85549..............  Muramidase................  ..................  A.................  ...........  ...........  ...........  ...........  ...........
85555..............  RBC osmotic fragility.....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
85557..............  RBC osmotic fragility.....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
85576..............  Blood platelet aggregation  ..................  A.................  ...........  ...........  ...........  ...........  ...........
85597..............  Platelet neutralization...  ..................  A.................  ...........  ...........  ...........  ...........  ...........
85610..............  Prothrombin time..........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
85611..............  Prothrombin test..........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
85612..............  Viper venom prothrombin     ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      time.
85613..............  Russell viper venom,        ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      diluted.
85635..............  Reptilase test............  ..................  A.................  ...........  ...........  ...........  ...........  ...........
85651..............  Rbc sed rate, nonautomated  ..................  A.................  ...........  ...........  ...........  ...........  ...........
85652..............  Rbc sed rate, automated...  ..................  A.................  ...........  ...........  ...........  ...........  ...........
85660..............  RBC sickle cell test......  ..................  A.................  ...........  ...........  ...........  ...........  ...........
85670..............  Thrombin time, plasma.....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
85675..............  Thrombin time, titer......  ..................  A.................  ...........  ...........  ...........  ...........  ...........
85705..............  Thromboplastin inhibition.  ..................  A.................  ...........  ...........  ...........  ...........  ...........
85730..............  Thromboplastin time,        ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      partial.
85732..............  Thromboplastin time,        ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      partial.
85810..............  Blood viscosity             ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      examination.
85999..............  Hematology procedure......  ..................  A.................  ...........  ...........  ...........  ...........  ...........
86000..............  Agglutinins, febrile......  ..................  A.................  ...........  ...........  ...........  ...........  ...........
86001..............  Allergen specific igg.....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
86003..............  Allergen specific IgE.....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
86005..............  Allergen specific IgE.....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
86021..............  WBC antibody                ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      identification.
86022..............  Platelet antibodies.......  ..................  A.................  ...........  ...........  ...........  ...........  ...........
86023..............  Immunoglobulin assay......  ..................  A.................  ...........  ...........  ...........  ...........  ...........
86038..............  Antinuclear antibodies....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
86039..............  Antinuclear antibodies      ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      (ANA).
86060..............  Antistreptolysin o, titer.  ..................  A.................  ...........  ...........  ...........  ...........  ...........
86063..............  Antistreptolysin o, screen  ..................  A.................  ...........  ...........  ...........  ...........  ...........
86077..............  Physician blood bank        ..................  X.................         0433       0.2397       $15.27        $5.17        $3.05
                      service.
86078..............  Physician blood bank        ..................  X.................         0343       0.5142       $32.75       $10.84        $6.55
                      service.
86079..............  Physician blood bank        ..................  X.................         0433       0.2397       $15.27        $5.17        $3.05
                      service.
86140..............  C-reactive protein........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
86141..............  C-reactive protein, hs....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
86146..............  Glycoprotein antibody.....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
86147..............  Cardiolipin antibody......  ..................  A.................  ...........  ...........  ...........  ...........  ...........
86148..............  Phospholipid antibody.....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
86155..............  Chemotaxis assay..........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
86156..............  Cold agglutinin, screen...  ..................  A.................  ...........  ...........  ...........  ...........  ...........
86157..............  Cold agglutinin, titer....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
86160..............  Complement, antigen.......  ..................  A.................  ...........  ...........  ...........  ...........  ...........
86161..............  Complement/function         ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      activity.
86162..............  Complement, total (CH50)..  ..................  A.................  ...........  ...........  ...........  ...........  ...........
86171..............  Complement fixation, each.  ..................  A.................  ...........  ...........  ...........  ...........  ...........
86185..............  Counterimmunoelectrophores  ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      is.
86200..............  Ccp antibody..............  ..................  A.................  ...........  ...........  ...........  ...........  ...........
86215..............  Deoxyribonuclease,          ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      antibody.
86225..............  DNA antibody..............  ..................  A.................  ...........  ...........  ...........  ...........  ...........
86226..............  DNA antibody, single        ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      strand.
86235..............  Nuclear antigen antibody..  ..................  A.................  ...........  ...........  ...........  ...........  ...........
86243..............  Fc receptor...............  ..................  A.................  ...........  ...........  ...........  ...........  ...........
86255..............  Fluorescent antibody,       ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      screen.
86256..............  Fluorescent antibody,       ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      titer.
86277..............  Growth hormone antibody...  ..................  A.................  ...........  ...........  ...........  ...........  ...........
86280..............  Hemagglutination            ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      inhibition.
86294..............  Immunoassay, tumor, qual..  ..................  A.................  ...........  ...........  ...........  ...........  ...........
86300..............  Immunoassay, tumor, ca 15-  ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      3.
86301..............  Immunoassay, tumor, ca 19-  ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      9.

[[Page 67088]]

 
86304..............  Immunoassay, tumor, ca 125  ..................  A.................  ...........  ...........  ...........  ...........  ...........
86308..............  Heterophile antibodies....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
86309..............  Heterophile antibodies....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
86310..............  Heterophile antibodies....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
86316..............  Immunoassay, tumor other..  ..................  A.................  ...........  ...........  ...........  ...........  ...........
86317..............  Immunoassay,infectious      ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      agent.
86318..............  Immunoassay,infectious      ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      agent.
86320..............  Serum                       ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      immunoelectrophoresis.
86325..............  Other                       ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      immunoelectrophoresis.
86327..............  Immunoelectrophoresis       ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      assay.
86329..............  Immunodiffusion...........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
86331..............  Immunodiffusion             ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      ouchterlony.
86332..............  Immune complex assay......  ..................  A.................  ...........  ...........  ...........  ...........  ...........
86334..............  Immunofix e-phoresis,       ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      serum.
86335..............  Immunfix e-phorsis/urine/   ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      csf.
86336..............  Inhibin A.................  ..................  A.................  ...........  ...........  ...........  ...........  ...........
86337..............  Insulin antibodies........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
86340..............  Intrinsic factor antibody.  ..................  A.................  ...........  ...........  ...........  ...........  ...........
86341..............  Islet cell antibody.......  ..................  A.................  ...........  ...........  ...........  ...........  ...........
86343..............  Leukocyte histamine         ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      release.
86344..............  Leukocyte phagocytosis....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
86353..............  Lymphocyte transformation.  ..................  A.................  ...........  ...........  ...........  ...........  ...........
86355..............  B cells, total count......  ..................  A.................  ...........  ...........  ...........  ...........  ...........
86356..............  Mononuclear cell antigen..  NI................  A.................  ...........  ...........  ...........  ...........  ...........
86357..............  Nk cells, total count.....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
86359..............  T cells, total count......  ..................  A.................  ...........  ...........  ...........  ...........  ...........
86360..............  T cell, absolute count/     ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      ratio.
86361..............  T cell, absolute count....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
86367..............  Stem cells, total count...  ..................  A.................  ...........  ...........  ...........  ...........  ...........
86376..............  Microsomal antibody.......  ..................  A.................  ...........  ...........  ...........  ...........  ...........
86378..............  Migration inhibitory        ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      factor.
86382..............  Neutralization test, viral  ..................  A.................  ...........  ...........  ...........  ...........  ...........
86384..............  Nitroblue tetrazolium dye.  ..................  A.................  ...........  ...........  ...........  ...........  ...........
86403..............  Particle agglutination      ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      test.
86406..............  Particle agglutination      ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      test.
86430..............  Rheumatoid factor test....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
86431..............  Rheumatoid factor, quant..  ..................  A.................  ...........  ...........  ...........  ...........  ...........
86480..............  Tb test, cell immun         ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      measure.
86485..............  Skin test, candida........  ..................  X.................         0341       0.0844        $5.38        $2.14        $1.08
86486..............  Skin test, nos antigen....  NI................  A.................  ...........  ...........  ...........  ...........  ...........
86490..............  Coccidioidomycosis skin     ..................  X.................         0341       0.0844        $5.38        $2.14        $1.08
                      test.
86510..............  Histoplasmosis skin test..  ..................  X.................         0341       0.0844        $5.38        $2.14        $1.08
86580..............  TB intradermal test.......  ..................  X.................         0341       0.0844        $5.38        $2.14        $1.08
86586..............  Skin test, unlisted.......  CH................  D.................  ...........  ...........  ...........  ...........  ...........
86590..............  Streptokinase, antibody...  ..................  A.................  ...........  ...........  ...........  ...........  ...........
86592..............  Blood serology,             ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      qualitative.
86593..............  Blood serology,             ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      quantitative.
86602..............  Antinomyces antibody......  ..................  A.................  ...........  ...........  ...........  ...........  ...........
86603..............  Adenovirus antibody.......  ..................  A.................  ...........  ...........  ...........  ...........  ...........
86606..............  Aspergillus antibody......  ..................  A.................  ...........  ...........  ...........  ...........  ...........
86609..............  Bacterium antibody........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
86611..............  Bartonella antibody.......  ..................  A.................  ...........  ...........  ...........  ...........  ...........
86612..............  Blastomyces antibody......  ..................  A.................  ...........  ...........  ...........  ...........  ...........
86615..............  Bordetella antibody.......  ..................  A.................  ...........  ...........  ...........  ...........  ...........
86617..............  Lyme disease antibody.....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
86618..............  Lyme disease antibody.....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
86619..............  Borrelia antibody.........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
86622..............  Brucella antibody.........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
86625..............  Campylobacter antibody....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
86628..............  Candida antibody..........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
86631..............  Chlamydia antibody........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
86632..............  Chlamydia igm antibody....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
86635..............  Coccidioides antibody.....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
86638..............  Q fever antibody..........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
86641..............  Cryptococcus antibody.....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
86644..............  CMV antibody..............  ..................  A.................  ...........  ...........  ...........  ...........  ...........
86645..............  CMV antibody, IgM.........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
86648..............  Diphtheria antibody.......  ..................  A.................  ...........  ...........  ...........  ...........  ...........
86651..............  Encephalitis antibody.....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
86652..............  Encephalitis antibody.....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
86653..............  Encephalitis antibody.....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
86654..............  Encephalitis antibody.....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
86658..............  Enterovirus antibody......  ..................  A.................  ...........  ...........  ...........  ...........  ...........
86663..............  Epstein-barr antibody.....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
86664..............  Epstein-barr antibody.....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
86665..............  Epstein-barr antibody.....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
86666..............  Ehrlichia antibody........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
86668..............  Francisella tularensis....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
86671..............  Fungus antibody...........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
86674..............  Giardia lamblia antibody..  ..................  A.................  ...........  ...........  ...........  ...........  ...........

[[Page 67089]]

 
86677..............  Helicobacter pylori.......  ..................  A.................  ...........  ...........  ...........  ...........  ...........
86682..............  Helminth antibody.........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
86684..............  Hemophilus influenza......  ..................  A.................  ...........  ...........  ...........  ...........  ...........
86687..............  Htlv-i antibody...........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
86688..............  Htlv-ii antibody..........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
86689..............  HTLV/HIV confirmatory test  ..................  A.................  ...........  ...........  ...........  ...........  ...........
86692..............  Hepatitis, delta agent....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
86694..............  Herpes simplex test.......  ..................  A.................  ...........  ...........  ...........  ...........  ...........
86695..............  Herpes simplex test.......  ..................  A.................  ...........  ...........  ...........  ...........  ...........
86696..............  Herpes simplex type 2.....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
86698..............  Histoplasma...............  ..................  A.................  ...........  ...........  ...........  ...........  ...........
86701..............  HIV-1.....................  ..................  A.................  ...........  ...........  ...........  ...........  ...........
86702..............  HIV-2.....................  ..................  A.................  ...........  ...........  ...........  ...........  ...........
86703..............  HIV-1/HIV-2, single assay.  ..................  A.................  ...........  ...........  ...........  ...........  ...........
86704..............  Hep b core antibody, total  ..................  A.................  ...........  ...........  ...........  ...........  ...........
86705..............  Hep b core antibody, igm..  ..................  A.................  ...........  ...........  ...........  ...........  ...........
86706..............  Hep b surface antibody....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
86707..............  Hep be antibody...........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
86708..............  Hep a antibody, total.....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
86709..............  Hep a antibody, igm.......  ..................  A.................  ...........  ...........  ...........  ...........  ...........
86710..............  Influenza virus antibody..  ..................  A.................  ...........  ...........  ...........  ...........  ...........
86713..............  Legionella antibody.......  ..................  A.................  ...........  ...........  ...........  ...........  ...........
86717..............  Leishmania antibody.......  ..................  A.................  ...........  ...........  ...........  ...........  ...........
86720..............  Leptospira antibody.......  ..................  A.................  ...........  ...........  ...........  ...........  ...........
86723..............  Listeria monocytogenes ab.  ..................  A.................  ...........  ...........  ...........  ...........  ...........
86727..............  Lymph choriomeningitis ab.  ..................  A.................  ...........  ...........  ...........  ...........  ...........
86729..............  Lympho venereum antibody..  ..................  A.................  ...........  ...........  ...........  ...........  ...........
86732..............  Mucormycosis antibody.....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
86735..............  Mumps antibody............  ..................  A.................  ...........  ...........  ...........  ...........  ...........
86738..............  Mycoplasma antibody.......  ..................  A.................  ...........  ...........  ...........  ...........  ...........
86741..............  Neisseria meningitidis....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
86744..............  Nocardia antibody.........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
86747..............  Parvovirus antibody.......  ..................  A.................  ...........  ...........  ...........  ...........  ...........
86750..............  Malaria antibody..........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
86753..............  Protozoa antibody nos.....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
86756..............  Respiratory virus antibody  ..................  A.................  ...........  ...........  ...........  ...........  ...........
86757..............  Rickettsia antibody.......  ..................  A.................  ...........  ...........  ...........  ...........  ...........
86759..............  Rotavirus antibody........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
86762..............  Rubella antibody..........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
86765..............  Rubeola antibody..........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
86768..............  Salmonella antibody.......  ..................  A.................  ...........  ...........  ...........  ...........  ...........
86771..............  Shigella antibody.........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
86774..............  Tetanus antibody..........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
86777..............  Toxoplasma antibody.......  ..................  A.................  ...........  ...........  ...........  ...........  ...........
86778..............  Toxoplasma antibody, igm..  ..................  A.................  ...........  ...........  ...........  ...........  ...........
86781..............  Treponema pallidum,         ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      confirm.
86784..............  Trichinella antibody......  ..................  A.................  ...........  ...........  ...........  ...........  ...........
86787..............  Varicella-zoster antibody.  ..................  A.................  ...........  ...........  ...........  ...........  ...........
86788..............  West nile virus ab, igm...  ..................  A.................  ...........  ...........  ...........  ...........  ...........
86789..............  West nile virus antibody..  ..................  A.................  ...........  ...........  ...........  ...........  ...........
86790..............  Virus antibody nos........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
86793..............  Yersinia antibody.........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
86800..............  Thyroglobulin antibody....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
86803..............  Hepatitis c ab test.......  ..................  A.................  ...........  ...........  ...........  ...........  ...........
86804..............  Hep c ab test, confirm....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
86805..............  Lymphocytotoxicity assay..  ..................  A.................  ...........  ...........  ...........  ...........  ...........
86806..............  Lymphocytotoxicity assay..  ..................  A.................  ...........  ...........  ...........  ...........  ...........
86807..............  Cytotoxic antibody          ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      screening.
86808..............  Cytotoxic antibody          ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      screening.
86812..............  HLA typing, A, B, or C....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
86813..............  HLA typing, A, B, or C....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
86816..............  HLA typing, DR/DQ.........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
86817..............  HLA typing, DR/DQ.........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
86821..............  Lymphocyte culture, mixed.  ..................  A.................  ...........  ...........  ...........  ...........  ...........
86822..............  Lymphocyte culture, primed  ..................  A.................  ...........  ...........  ...........  ...........  ...........
86849..............  Immunology procedure......  ..................  A.................  ...........  ...........  ...........  ...........  ...........
86850..............  RBC antibody screen.......  ..................  X.................         0345       0.2140       $13.63        $2.87        $2.73
86860..............  RBC antibody elution......  ..................  X.................         0346       0.3346       $21.31        $4.37        $4.26
86870..............  RBC antibody                ..................  X.................         0346       0.3346       $21.31        $4.37        $4.26
                      identification.
86880..............  Coombs test, direct.......  ..................  X.................         0409       0.1190        $7.58        $2.20        $1.52
86885..............  Coombs test, indirect,      ..................  X.................         0409       0.1190        $7.58        $2.20        $1.52
                      qual.
86886..............  Coombs test, indirect,      ..................  X.................         0409       0.1190        $7.58        $2.20        $1.52
                      titer.
86890..............  Autologous blood process..  ..................  X.................         0347       0.7739       $49.29       $11.28        $9.86
86891..............  Autologous blood, op        ..................  X.................         0346       0.3346       $21.31        $4.37        $4.26
                      salvage.
86900..............  Blood typing, ABO.........  ..................  X.................         0409       0.1190        $7.58        $2.20        $1.52
86901..............  Blood typing, Rh (D)......  ..................  X.................         0409       0.1190        $7.58        $2.20        $1.52
86903..............  Blood typing, antigen       ..................  X.................         0345       0.2140       $13.63        $2.87        $2.73
                      screen.
86904..............  Blood typing, patient       ..................  X.................         0346       0.3346       $21.31        $4.37        $4.26
                      serum.
86905..............  Blood typing, RBC antigens  ..................  X.................         0345       0.2140       $13.63        $2.87        $2.73
86906..............  Blood typing, Rh phenotype  ..................  X.................         0345       0.2140       $13.63        $2.87        $2.73

[[Page 67090]]

 
86910..............  Blood typing, paternity     ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      test.
86911..............  Blood typing, antigen       ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      system.
86920..............  Compatibility test, spin..  ..................  X.................         0346       0.3346       $21.31        $4.37        $4.26
86921..............  Compatibility test,         ..................  X.................         0345       0.2140       $13.63        $2.87        $2.73
                      incubate.
86922..............  Compatibility test,         ..................  X.................         0346       0.3346       $21.31        $4.37        $4.26
                      antiglob.
86923..............  Compatibility test,         ..................  X.................         0345       0.2140       $13.63        $2.87        $2.73
                      electric.
86927..............  Plasma, fresh frozen......  ..................  X.................         0345       0.2140       $13.63        $2.87        $2.73
86930..............  Frozen blood prep.........  ..................  X.................         0347       0.7739       $49.29       $11.28        $9.86
86931..............  Frozen blood thaw.........  ..................  X.................         0347       0.7739       $49.29       $11.28        $9.86
86932..............  Frozen blood freeze/thaw..  ..................  X.................         0347       0.7739       $49.29       $11.28        $9.86
86940..............  Hemolysins/agglutinins,     ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      auto.
86941..............  Hemolysins/agglutinins....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
86945..............  Blood product/irradiation.  ..................  X.................         0345       0.2140       $13.63        $2.87        $2.73
86950..............  Leukacyte transfusion.....  ..................  X.................         0345       0.2140       $13.63        $2.87        $2.73
86960..............  Vol reduction of blood/     ..................  X.................         0345       0.2140       $13.63        $2.87        $2.73
                      prod.
86965..............  Pooling blood platelets...  ..................  X.................         0346       0.3346       $21.31        $4.37        $4.26
86970..............  RBC pretreatment..........  ..................  X.................         0345       0.2140       $13.63        $2.87        $2.73
86971..............  RBC pretreatment..........  ..................  X.................         0345       0.2140       $13.63        $2.87        $2.73
86972..............  RBC pretreatment..........  ..................  X.................         0346       0.3346       $21.31        $4.37        $4.26
86975..............  RBC pretreatment, serum...  ..................  X.................         0346       0.3346       $21.31        $4.37        $4.26
86976..............  RBC pretreatment, serum...  ..................  X.................         0345       0.2140       $13.63        $2.87        $2.73
86977..............  RBC pretreatment, serum...  ..................  X.................         0346       0.3346       $21.31        $4.37        $4.26
86978..............  RBC pretreatment, serum...  ..................  X.................         0346       0.3346       $21.31        $4.37        $4.26
86985..............  Split blood or products...  ..................  X.................         0345       0.2140       $13.63        $2.87        $2.73
86999..............  Transfusion procedure.....  ..................  X.................         0345       0.2140       $13.63        $2.87        $2.73
87001..............  Small animal inoculation..  ..................  A.................  ...........  ...........  ...........  ...........  ...........
87003..............  Small animal inoculation..  ..................  A.................  ...........  ...........  ...........  ...........  ...........
87015..............  Specimen concentration....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
87040..............  Blood culture for bacteria  ..................  A.................  ...........  ...........  ...........  ...........  ...........
87045..............  Feces culture, bacteria...  ..................  A.................  ...........  ...........  ...........  ...........  ...........
87046..............  Stool cultr, bacteria,      ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      each.
87070..............  Culture, bacteria, other..  ..................  A.................  ...........  ...........  ...........  ...........  ...........
87071..............  Culture bacteri aerobic     ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      othr.
87073..............  Culture bacteria anaerobic  ..................  A.................  ...........  ...........  ...........  ...........  ...........
87075..............  Cultr bacteria, except      ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      blood.
87076..............  Culture anaerobe ident,     ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      each.
87077..............  Culture aerobic identify..  ..................  A.................  ...........  ...........  ...........  ...........  ...........
87081..............  Culture screen only.......  ..................  A.................  ...........  ...........  ...........  ...........  ...........
87084..............  Culture of specimen by kit  ..................  A.................  ...........  ...........  ...........  ...........  ...........
87086..............  Urine culture/colony count  ..................  A.................  ...........  ...........  ...........  ...........  ...........
87088..............  Urine bacteria culture....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
87101..............  Skin fungi culture........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
87102..............  Fungus isolation culture..  ..................  A.................  ...........  ...........  ...........  ...........  ...........
87103..............  Blood fungus culture......  ..................  A.................  ...........  ...........  ...........  ...........  ...........
87106..............  Fungi identification,       ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      yeast.
87107..............  Fungi identification, mold  ..................  A.................  ...........  ...........  ...........  ...........  ...........
87109..............  Mycoplasma................  ..................  A.................  ...........  ...........  ...........  ...........  ...........
87110..............  Chlamydia culture.........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
87116..............  Mycobacteria culture......  ..................  A.................  ...........  ...........  ...........  ...........  ...........
87118..............  Mycobacteric                ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      identification.
87140..............  Culture type                ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      immunofluoresc.
87143..............  Culture typing, glc/hplc..  ..................  A.................  ...........  ...........  ...........  ...........  ...........
87147..............  Culture type, immunologic.  ..................  A.................  ...........  ...........  ...........  ...........  ...........
87149..............  Culture type, nucleic acid  ..................  A.................  ...........  ...........  ...........  ...........  ...........
87152..............  Culture type pulse field    ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      gel.
87158..............  Culture typing, added       ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      method.
87164..............  Dark field examination....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
87166..............  Dark field examination....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
87168..............  Macroscopic exam arthropod  ..................  A.................  ...........  ...........  ...........  ...........  ...........
87169..............  Macroscopic exam parasite.  ..................  A.................  ...........  ...........  ...........  ...........  ...........
87172..............  Pinworm exam..............  ..................  A.................  ...........  ...........  ...........  ...........  ...........
87176..............  Tissue homogenization,      ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      cultr.
87177..............  Ova and parasites smears..  ..................  A.................  ...........  ...........  ...........  ...........  ...........
87181..............  Microbe susceptible,        ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      diffuse.
87184..............  Microbe susceptible, disk.  ..................  A.................  ...........  ...........  ...........  ...........  ...........
87185..............  Microbe susceptible,        ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      enzyme.
87186..............  Microbe susceptible, mic..  ..................  A.................  ...........  ...........  ...........  ...........  ...........
87187..............  Microbe susceptible, mlc..  ..................  A.................  ...........  ...........  ...........  ...........  ...........
87188..............  Microbe suscept,            ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      macrobroth.
87190..............  Microbe suscept,            ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      mycobacteri.
87197..............  Bactericidal level, serum.  ..................  A.................  ...........  ...........  ...........  ...........  ...........
87205..............  Smear, gram stain.........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
87206..............  Smear, fluorescent/acid     ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      stai.
87207..............  Smear, special stain......  ..................  A.................  ...........  ...........  ...........  ...........  ...........
87209..............  Smear, complex stain......  ..................  A.................  ...........  ...........  ...........  ...........  ...........
87210..............  Smear, wet mount, saline/   ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      ink.
87220..............  Tissue exam for fungi.....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
87230..............  Assay, toxin or antitoxin.  ..................  A.................  ...........  ...........  ...........  ...........  ...........
87250..............  Virus inoculate, eggs/      ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      animal.
87252..............  Virus inoculation, tissue.  ..................  A.................  ...........  ...........  ...........  ...........  ...........

[[Page 67091]]

 
87253..............  Virus inoculate tissue,     ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      addl.
87254..............  Virus inoculation, shell    ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      via.
87255..............  Genet virus isolate, hsv..  ..................  A.................  ...........  ...........  ...........  ...........  ...........
87260..............  Adenovirus ag, if.........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
87265..............  Pertussis ag, if..........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
87267..............  Enterovirus antibody, dfa.  ..................  A.................  ...........  ...........  ...........  ...........  ...........
87269..............  Giardia ag, if............  ..................  A.................  ...........  ...........  ...........  ...........  ...........
87270..............  Chlamydia trachomatis ag,   ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      if.
87271..............  Cytomegalovirus dfa.......  ..................  A.................  ...........  ...........  ...........  ...........  ...........
87272..............  Cryptosporidium ag, if....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
87273..............  Herpes simplex 2, ag, if..  ..................  A.................  ...........  ...........  ...........  ...........  ...........
87274..............  Herpes simplex 1, ag, if..  ..................  A.................  ...........  ...........  ...........  ...........  ...........
87275..............  Influenza b, ag, if.......  ..................  A.................  ...........  ...........  ...........  ...........  ...........
87276..............  Influenza a, ag, if.......  ..................  A.................  ...........  ...........  ...........  ...........  ...........
87277..............  Legionella micdadei, ag,    ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      if.
87278..............  Legion pneumophilia ag, if  ..................  A.................  ...........  ...........  ...........  ...........  ...........
87279..............  Parainfluenza, ag, if.....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
87280..............  Respiratory syncytial ag,   ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      if.
87281..............  Pneumocystis carinii, ag,   ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      if.
87283..............  Rubeola, ag, if...........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
87285..............  Treponema pallidum, ag, if  ..................  A.................  ...........  ...........  ...........  ...........  ...........
87290..............  Varicella zoster, ag, if..  ..................  A.................  ...........  ...........  ...........  ...........  ...........
87299..............  Antibody detection, nos,    ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      if.
87300..............  Ag detection, polyval, if.  ..................  A.................  ...........  ...........  ...........  ...........  ...........
87301..............  Adenovirus ag, eia........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
87305..............  Aspergillus ag, eia.......  ..................  A.................  ...........  ...........  ...........  ...........  ...........
87320..............  Chylmd trach ag, eia......  ..................  A.................  ...........  ...........  ...........  ...........  ...........
87324..............  Clostridium ag, eia.......  ..................  A.................  ...........  ...........  ...........  ...........  ...........
87327..............  Cryptococcus neoform ag,    ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      eia.
87328..............  Cryptosporidium ag, eia...  ..................  A.................  ...........  ...........  ...........  ...........  ...........
87329..............  Giardia ag, eia...........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
87332..............  Cytomegalovirus ag, eia...  ..................  A.................  ...........  ...........  ...........  ...........  ...........
87335..............  E coli 0157 ag, eia.......  ..................  A.................  ...........  ...........  ...........  ...........  ...........
87336..............  Entamoeb hist dispr, ag,    ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      eia.
87337..............  Entamoeb hist group, ag,    ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      eia.
87338..............  Hpylori, stool, eia.......  ..................  A.................  ...........  ...........  ...........  ...........  ...........
87339..............  H pylori ag, eia..........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
87340..............  Hepatitis b surface ag,     ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      eia.
87341..............  Hepatitis b surface, ag,    ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      eia.
87350..............  Hepatitis be ag, eia......  ..................  A.................  ...........  ...........  ...........  ...........  ...........
87380..............  Hepatitis delta ag, eia...  ..................  A.................  ...........  ...........  ...........  ...........  ...........
87385..............  Histoplasma capsul ag, eia  ..................  A.................  ...........  ...........  ...........  ...........  ...........
87390..............  Hiv-1 ag, eia.............  ..................  A.................  ...........  ...........  ...........  ...........  ...........
87391..............  Hiv-2 ag, eia.............  ..................  A.................  ...........  ...........  ...........  ...........  ...........
87400..............  Influenza a/b, ag, eia....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
87420..............  Resp syncytial ag, eia....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
87425..............  Rotavirus ag, eia.........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
87427..............  Shiga-like toxin ag, eia..  ..................  A.................  ...........  ...........  ...........  ...........  ...........
87430..............  Strep a ag, eia...........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
87449..............  Ag detect nos, eia, mult..  ..................  A.................  ...........  ...........  ...........  ...........  ...........
87450..............  Ag detect nos, eia, single  ..................  A.................  ...........  ...........  ...........  ...........  ...........
87451..............  Ag detect polyval, eia,     ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      mult.
87470..............  Bartonella, dna, dir probe  ..................  A.................  ...........  ...........  ...........  ...........  ...........
87471..............  Bartonella, dna, amp probe  ..................  A.................  ...........  ...........  ...........  ...........  ...........
87472..............  Bartonella, dna, quant....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
87475..............  Lyme dis, dna, dir probe..  ..................  A.................  ...........  ...........  ...........  ...........  ...........
87476..............  Lyme dis, dna, amp probe..  ..................  A.................  ...........  ...........  ...........  ...........  ...........
87477..............  Lyme dis, dna, quant......  ..................  A.................  ...........  ...........  ...........  ...........  ...........
87480..............  Candida, dna, dir probe...  ..................  A.................  ...........  ...........  ...........  ...........  ...........
87481..............  Candida, dna, amp probe...  ..................  A.................  ...........  ...........  ...........  ...........  ...........
87482..............  Candida, dna, quant.......  ..................  A.................  ...........  ...........  ...........  ...........  ...........
87485..............  Chylmd pneum, dna, dir      ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      probe.
87486..............  Chylmd pneum, dna, amp      ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      probe.
87487..............  Chylmd pneum, dna, quant..  ..................  A.................  ...........  ...........  ...........  ...........  ...........
87490..............  Chylmd trach, dna, dir      ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      probe.
87491..............  Chylmd trach, dna, amp      ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      probe.
87492..............  Chylmd trach, dna, quant..  ..................  A.................  ...........  ...........  ...........  ...........  ...........
87495..............  Cytomeg, dna, dir probe...  ..................  A.................  ...........  ...........  ...........  ...........  ...........
87496..............  Cytomeg, dna, amp probe...  ..................  A.................  ...........  ...........  ...........  ...........  ...........
87497..............  Cytomeg, dna, quant.......  ..................  A.................  ...........  ...........  ...........  ...........  ...........
87498..............  Enterovirus, dna, amp       ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      probe.
87500..............  Vanomycin, dna, amp probe.  NI................  A.................  ...........  ...........  ...........  ...........  ...........
87510..............  Gardner vag, dna, dir       ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      probe.
87511..............  Gardner vag, dna, amp       ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      probe.
87512..............  Gardner vag, dna, quant...  ..................  A.................  ...........  ...........  ...........  ...........  ...........
87515..............  Hepatitis b, dna, dir       ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      probe.
87516..............  Hepatitis b, dna, amp       ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      probe.
87517..............  Hepatitis b, dna, quant...  ..................  A.................  ...........  ...........  ...........  ...........  ...........
87520..............  Hepatitis c, rna, dir       ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      probe.
87521..............  Hepatitis c, rna, amp       ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      probe.

[[Page 67092]]

 
87522..............  Hepatitis c, rna, quant...  ..................  A.................  ...........  ...........  ...........  ...........  ...........
87525..............  Hepatitis g, dna, dir       ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      probe.
87526..............  Hepatitis g, dna, amp       ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      probe.
87527..............  Hepatitis g, dna, quant...  ..................  A.................  ...........  ...........  ...........  ...........  ...........
87528..............  Hsv, dna, dir probe.......  ..................  A.................  ...........  ...........  ...........  ...........  ...........
87529..............  Hsv, dna, amp probe.......  ..................  A.................  ...........  ...........  ...........  ...........  ...........
87530..............  Hsv, dna, quant...........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
87531..............  Hhv-6, dna, dir probe.....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
87532..............  Hhv-6, dna, amp probe.....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
87533..............  Hhv-6, dna, quant.........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
87534..............  Hiv-1, dna, dir probe.....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
87535..............  Hiv-1, dna, amp probe.....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
87536..............  Hiv-1, dna, quant.........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
87537..............  Hiv-2, dna, dir probe.....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
87538..............  Hiv-2, dna, amp probe.....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
87539..............  Hiv-2, dna, quant.........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
87540..............  Legion pneumo, dna, dir     ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      prob.
87541..............  Legion pneumo, dna, amp     ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      prob.
87542..............  Legion pneumo, dna, quant.  ..................  A.................  ...........  ...........  ...........  ...........  ...........
87550..............  Mycobacteria, dna, dir      ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      probe.
87551..............  Mycobacteria, dna, amp      ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      probe.
87552..............  Mycobacteria, dna, quant..  ..................  A.................  ...........  ...........  ...........  ...........  ...........
87555..............  M.tuberculo, dna, dir       ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      probe.
87556..............  M.tuberculo, dna, amp       ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      probe.
87557..............  M.tuberculo, dna, quant...  ..................  A.................  ...........  ...........  ...........  ...........  ...........
87560..............  M.avium-intra, dna, dir     ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      prob.
87561..............  M.avium-intra, dna, amp     ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      prob.
87562..............  M.avium-intra, dna, quant.  ..................  A.................  ...........  ...........  ...........  ...........  ...........
87580..............  M.pneumon, dna, dir probe.  ..................  A.................  ...........  ...........  ...........  ...........  ...........
87581..............  M.pneumon, dna, amp probe.  ..................  A.................  ...........  ...........  ...........  ...........  ...........
87582..............  M.pneumon, dna, quant.....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
87590..............  N.gonorrhoeae, dna, dir     ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      prob.
87591..............  N.gonorrhoeae, dna, amp     ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      prob.
87592..............  N.gonorrhoeae, dna, quant.  ..................  A.................  ...........  ...........  ...........  ...........  ...........
87620..............  Hpv, dna, dir probe.......  ..................  A.................  ...........  ...........  ...........  ...........  ...........
87621..............  Hpv, dna, amp probe.......  ..................  A.................  ...........  ...........  ...........  ...........  ...........
87622..............  Hpv, dna, quant...........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
87640..............  Staph a, dna, amp probe...  ..................  A.................  ...........  ...........  ...........  ...........  ...........
87641..............  Mr-staph, dna, amp probe..  ..................  A.................  ...........  ...........  ...........  ...........  ...........
87650..............  Strep a, dna, dir probe...  ..................  A.................  ...........  ...........  ...........  ...........  ...........
87651..............  Strep a, dna, amp probe...  ..................  A.................  ...........  ...........  ...........  ...........  ...........
87652..............  Strep a, dna, quant.......  ..................  A.................  ...........  ...........  ...........  ...........  ...........
87653..............  Strep b, dna, amp probe...  ..................  A.................  ...........  ...........  ...........  ...........  ...........
87660..............  Trichomonas vagin, dir      ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      probe.
87797..............  Detect agent nos, dna, dir  ..................  A.................  ...........  ...........  ...........  ...........  ...........
87798..............  Detect agent nos, dna, amp  ..................  A.................  ...........  ...........  ...........  ...........  ...........
87799..............  Detect agent nos, dna,      ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      quant.
87800..............  Detect agnt mult, dna,      ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      direc.
87801..............  Detect agnt mult, dna,      ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      ampli.
87802..............  Strep b assay w/optic.....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
87803..............  Clostridium toxin a w/      ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      optic.
87804..............  Influenza assay w/optic...  ..................  A.................  ...........  ...........  ...........  ...........  ...........
87807..............  Rsv assay w/optic.........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
87808..............  Trichomonas assay w/optic.  ..................  A.................  ...........  ...........  ...........  ...........  ...........
87809..............  Adenovirus assay w/optic..  NI................  A.................  ...........  ...........  ...........  ...........  ...........
87810..............  Chylmd trach assay w/optic  ..................  A.................  ...........  ...........  ...........  ...........  ...........
87850..............  N. gonorrhoeae assay w/     ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      optic.
87880..............  Strep a assay w/optic.....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
87899..............  Agent nos assay w/optic...  ..................  A.................  ...........  ...........  ...........  ...........  ...........
87900..............  Phenotype, infect agent     ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      drug.
87901..............  Genotype, dna, hiv reverse  ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      t.
87902..............  Genotype, dna, hepatitis C  ..................  A.................  ...........  ...........  ...........  ...........  ...........
87903..............  Phenotype, dna hiv w/       ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      culture.
87904..............  Phenotype, dna hiv w/clt    ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      add.
87999..............  Microbiology procedure....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
88000..............  Autopsy (necropsy), gross.  ..................  E.................  ...........  ...........  ...........  ...........  ...........
88005..............  Autopsy (necropsy), gross.  ..................  E.................  ...........  ...........  ...........  ...........  ...........
88007..............  Autopsy (necropsy), gross.  ..................  E.................  ...........  ...........  ...........  ...........  ...........
88012..............  Autopsy (necropsy), gross.  ..................  E.................  ...........  ...........  ...........  ...........  ...........
88014..............  Autopsy (necropsy), gross.  ..................  E.................  ...........  ...........  ...........  ...........  ...........
88016..............  Autopsy (necropsy), gross.  ..................  E.................  ...........  ...........  ...........  ...........  ...........
88020..............  Autopsy (necropsy),         ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      complete.
88025..............  Autopsy (necropsy),         ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      complete.
88027..............  Autopsy (necropsy),         ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      complete.
88028..............  Autopsy (necropsy),         ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      complete.
88029..............  Autopsy (necropsy),         ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      complete.
88036..............  Limited autopsy...........  ..................  E.................  ...........  ...........  ...........  ...........  ...........
88037..............  Limited autopsy...........  ..................  E.................  ...........  ...........  ...........  ...........  ...........
88040..............  Forensic autopsy            ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      (necropsy).
88045..............  Coroner's autopsy           ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      (necropsy).

[[Page 67093]]

 
88099..............  Necropsy (autopsy)          ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      procedure.
88104..............  Cytopath fl nongyn, smears  ..................  X.................         0433       0.2397       $15.27        $5.17        $3.05
88106..............  Cytopath fl nongyn, filter  ..................  X.................         0433       0.2397       $15.27        $5.17        $3.05
88107..............  Cytopath fl nongyn, sm/     CH................  X.................         0343       0.5142       $32.75       $10.84        $6.55
                      fltr.
88108..............  Cytopath, concentrate tech  CH................  X.................         0343       0.5142       $32.75       $10.84        $6.55
88112..............  Cytopath, cell enhance      ..................  X.................         0343       0.5142       $32.75       $10.84        $6.55
                      tech.
88125..............  Forensic cytopathology....  ..................  X.................         0433       0.2397       $15.27        $5.17        $3.05
88130..............  Sex chromatin               ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      identification.
88140..............  Sex chromatin               ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      identification.
88141..............  Cytopath, c/v, interpret..  ..................  N.................  ...........  ...........  ...........  ...........  ...........
88142..............  Cytopath, c/v, thin layer.  ..................  A.................  ...........  ...........  ...........  ...........  ...........
88143..............  Cytopath c/v thin layer     ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      redo.
88147..............  Cytopath, c/v, automated..  ..................  A.................  ...........  ...........  ...........  ...........  ...........
88148..............  Cytopath, c/v, auto         ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      rescreen.
88150..............  Cytopath, c/v, manual.....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
88152..............  Cytopath, c/v, auto redo..  ..................  A.................  ...........  ...........  ...........  ...........  ...........
88153..............  Cytopath, c/v, redo.......  ..................  A.................  ...........  ...........  ...........  ...........  ...........
88154..............  Cytopath, c/v, select.....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
88155..............  Cytopath, c/v, index add-   ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      on.
88160..............  Cytopath smear, other       ..................  X.................         0433       0.2397       $15.27        $5.17        $3.05
                      source.
88161..............  Cytopath smear, other       ..................  X.................         0433       0.2397       $15.27        $5.17        $3.05
                      source.
88162..............  Cytopath smear, other       CH................  X.................         0343       0.5142       $32.75       $10.84        $6.55
                      source.
88164..............  Cytopath tbs, c/v, manual.  ..................  A.................  ...........  ...........  ...........  ...........  ...........
88165..............  Cytopath tbs, c/v, redo...  ..................  A.................  ...........  ...........  ...........  ...........  ...........
88166..............  Cytopath tbs, c/v, auto     ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      redo.
88167..............  Cytopath tbs, c/v, select.  ..................  A.................  ...........  ...........  ...........  ...........  ...........
88172..............  Cytopathology eval of fna.  ..................  X.................         0343       0.5142       $32.75       $10.84        $6.55
88173..............  Cytopath eval, fna, report  ..................  X.................         0343       0.5142       $32.75       $10.84        $6.55
88174..............  Cytopath, c/v auto, in      ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      fluid.
88175..............  Cytopath c/v auto fluid     ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      redo.
88182..............  Cell marker study.........  ..................  X.................         0343       0.5142       $32.75       $10.84        $6.55
88184..............  Flowcytometry/ tc, 1        ..................  X.................         0433       0.2397       $15.27        $5.17        $3.05
                      marker.
88185..............  Flowcytometry/tc, add-on..  ..................  X.................         0433       0.2397       $15.27        $5.17        $3.05
88187..............  Flowcytometry/read, 2-8...  ..................  X.................         0433       0.2397       $15.27        $5.17        $3.05
88188..............  Flowcytometry/read, 9-15..  ..................  X.................         0433       0.2397       $15.27        $5.17        $3.05
88189..............  Flowcytometry/read, 16 & >  ..................  X.................         0343       0.5142       $32.75       $10.84        $6.55
88199..............  Cytopathology procedure...  ..................  X.................         0342       0.0969        $6.17        $2.02        $1.23
88230..............  Tissue culture, lymphocyte  ..................  A.................  ...........  ...........  ...........  ...........  ...........
88233..............  Tissue culture, skin/       ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      biopsy.
88235..............  Tissue culture, placenta..  ..................  A.................  ...........  ...........  ...........  ...........  ...........
88237..............  Tissue culture, bone        ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      marrow.
88239..............  Tissue culture, tumor.....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
88240..............  Cell cryopreserve/storage.  ..................  A.................  ...........  ...........  ...........  ...........  ...........
88241..............  Frozen cell preparation...  ..................  A.................  ...........  ...........  ...........  ...........  ...........
88245..............  Chromosome analysis, 20-25  ..................  A.................  ...........  ...........  ...........  ...........  ...........
88248..............  Chromosome analysis, 50-    ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      100.
88249..............  Chromosome analysis, 100..  ..................  A.................  ...........  ...........  ...........  ...........  ...........
88261..............  Chromosome analysis, 5....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
88262..............  Chromosome analysis, 15-20  ..................  A.................  ...........  ...........  ...........  ...........  ...........
88263..............  Chromosome analysis, 45...  ..................  A.................  ...........  ...........  ...........  ...........  ...........
88264..............  Chromosome analysis, 20-25  ..................  A.................  ...........  ...........  ...........  ...........  ...........
88267..............  Chromosome analys,          ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      placenta.
88269..............  Chromosome analys,          ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      amniotic.
88271..............  Cytogenetics, dna probe...  ..................  A.................  ...........  ...........  ...........  ...........  ...........
88272..............  Cytogenetics, 3-5.........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
88273..............  Cytogenetics, 10-30.......  ..................  A.................  ...........  ...........  ...........  ...........  ...........
88274..............  Cytogenetics, 25-99.......  ..................  A.................  ...........  ...........  ...........  ...........  ...........
88275..............  Cytogenetics, 100-300.....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
88280..............  Chromosome karyotype study  ..................  A.................  ...........  ...........  ...........  ...........  ...........
88283..............  Chromosome banding study..  ..................  A.................  ...........  ...........  ...........  ...........  ...........
88285..............  Chromosome count,           ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      additional.
88289..............  Chromosome study,           ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      additional.
88291..............  Cyto/molecular report.....  ..................  M.................  ...........  ...........  ...........  ...........  ...........
88299..............  Cytogenetic study.........  ..................  X.................         0342       0.0969        $6.17        $2.02        $1.23
88300..............  Surgical path, gross......  ..................  X.................         0433       0.2397       $15.27        $5.17        $3.05
88302..............  Tissue exam by pathologist  ..................  X.................         0433       0.2397       $15.27        $5.17        $3.05
88304..............  Tissue exam by pathologist  ..................  X.................         0343       0.5142       $32.75       $10.84        $6.55
88305..............  Tissue exam by pathologist  ..................  X.................         0343       0.5142       $32.75       $10.84        $6.55
88307..............  Tissue exam by pathologist  ..................  X.................         0344       0.8167       $52.02       $15.66       $10.40
88309..............  Tissue exam by pathologist  ..................  X.................         0344       0.8167       $52.02       $15.66       $10.40
88311..............  Decalcify tissue..........  ..................  X.................         0433       0.2397       $15.27        $5.17        $3.05
88312..............  Special stains............  ..................  X.................         0433       0.2397       $15.27        $5.17        $3.05
88313..............  Special stains............  ..................  X.................         0433       0.2397       $15.27        $5.17        $3.05
88314..............  Histochemical stain.......  CH................  X.................         0433       0.2397       $15.27        $5.17        $3.05
88318..............  Chemical histochemistry...  ..................  X.................         0433       0.2397       $15.27        $5.17        $3.05
88319..............  Enzyme histochemistry.....  CH................  X.................         0433       0.2397       $15.27        $5.17        $3.05
88321..............  Microslide consultation...  ..................  X.................         0433       0.2397       $15.27        $5.17        $3.05
88323..............  Microslide consultation...  ..................  X.................         0343       0.5142       $32.75       $10.84        $6.55
88325..............  Comprehensive review of     ..................  X.................         0344       0.8167       $52.02       $15.66       $10.40
                      data.
88329..............  Path consult introp.......  ..................  X.................         0433       0.2397       $15.27        $5.17        $3.05

[[Page 67094]]

 
88331..............  Path consult intraop, 1     ..................  X.................         0343       0.5142       $32.75       $10.84        $6.55
                      bloc.
88332..............  Path consult intraop,       ..................  X.................         0433       0.2397       $15.27        $5.17        $3.05
                      add'l.
88333..............  Intraop cyto path consult,  ..................  X.................         0343       0.5142       $32.75       $10.84        $6.55
                      1.
88334..............  Intraop cyto path consult,  ..................  X.................         0433       0.2397       $15.27        $5.17        $3.05
                      2.
88342..............  Immunohistochemistry......  ..................  X.................         0343       0.5142       $32.75       $10.84        $6.55
88346..............  Immunofluorescent study...  ..................  X.................         0343       0.5142       $32.75       $10.84        $6.55
88347..............  Immunofluorescent study...  ..................  X.................         0343       0.5142       $32.75       $10.84        $6.55
88348..............  Electron microscopy.......  ..................  X.................         0661       2.6949      $171.65       $62.09       $34.33
88349..............  Scanning electron           ..................  X.................         0661       2.6949      $171.65       $62.09       $34.33
                      microscopy.
88355..............  Analysis, skeletal muscle.  ..................  X.................         0343       0.5142       $32.75       $10.84        $6.55
88356..............  Analysis, nerve...........  ..................  X.................         0344       0.8167       $52.02       $15.66       $10.40
88358..............  Analysis, tumor...........  ..................  X.................         0344       0.8167       $52.02       $15.66       $10.40
88360..............  Tumor immunohistochem/      ..................  X.................         0343       0.5142       $32.75       $10.84        $6.55
                      manual.
88361..............  Tumor immunohistochem/      ..................  X.................         0344       0.8167       $52.02       $15.66       $10.40
                      comput.
88362..............  Nerve teasing preparations  ..................  X.................         0344       0.8167       $52.02       $15.66       $10.40
88365..............  Insitu hybridization        ..................  X.................         0344       0.8167       $52.02       $15.66       $10.40
                      (fish).
88367..............  Insitu hybridization, auto  ..................  X.................         0344       0.8167       $52.02       $15.66       $10.40
88368..............  Insitu hybridization,       CH................  X.................         0343       0.5142       $32.75       $10.84        $6.55
                      manual.
88371..............  Protein, western blot       ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      tissue.
88372..............  Protein analysis w/probe..  ..................  A.................  ...........  ...........  ...........  ...........  ...........
88380..............  Microdissection, laser....  ..................  N.................  ...........  ...........  ...........  ...........  ...........
88381..............  Microdissection, manual...  NI................  N.................  ...........  ...........  ...........  ...........  ...........
88384..............  Eval molecular probes, 11-  ..................  X.................         0433       0.2397       $15.27        $5.17        $3.05
                      50.
88385..............  Eval molecul probes, 51-    ..................  X.................         0343       0.5142       $32.75       $10.84        $6.55
                      250.
88386..............  Eval molecul probes, 251-   ..................  X.................         0344       0.8167       $52.02       $15.66       $10.40
                      500.
88399..............  Surgical pathology          ..................  X.................         0342       0.0969        $6.17        $2.02        $1.23
                      procedure.
88400..............  Bilirubin total transcut..  ..................  A.................  ...........  ...........  ...........  ...........  ...........
89049..............  Chct for mal hyperthermia.  ..................  X.................         0343       0.5142       $32.75       $10.84        $6.55
89050..............  Body fluid cell count.....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
89051..............  Body fluid cell count.....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
89055..............  Leukocyte assessment,       ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      fecal.
89060..............  Exam,synovial fluid         ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      crystals.
89100..............  Sample intestinal contents  ..................  X.................         0360       1.5330       $97.64       $33.88       $19.53
89105..............  Sample intestinal contents  ..................  X.................         0360       1.5330       $97.64       $33.88       $19.53
89125..............  Specimen fat stain........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
89130..............  Sample stomach contents...  ..................  X.................         0360       1.5330       $97.64       $33.88       $19.53
89132..............  Sample stomach contents...  ..................  X.................         0360       1.5330       $97.64       $33.88       $19.53
89135..............  Sample stomach contents...  ..................  X.................         0360       1.5330       $97.64       $33.88       $19.53
89136..............  Sample stomach contents...  ..................  X.................         0360       1.5330       $97.64       $33.88       $19.53
89140..............  Sample stomach contents...  ..................  X.................         0360       1.5330       $97.64       $33.88       $19.53
89141..............  Sample stomach contents...  ..................  X.................         0360       1.5330       $97.64       $33.88       $19.53
89160..............  Exam feces for meat fibers  ..................  A.................  ...........  ...........  ...........  ...........  ...........
89190..............  Nasal smear for             ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      eosinophils.
89220..............  Sputum specimen collection  ..................  X.................         0343       0.5142       $32.75       $10.84        $6.55
89225..............  Starch granules, feces....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
89230..............  Collect sweat for test....  CH................  X.................         0343       0.5142       $32.75       $10.84        $6.55
89235..............  Water load test...........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
89240..............  Pathology lab procedure...  ..................  X.................         0342       0.0969        $6.17        $2.02        $1.23
89250..............  Cultr oocyte/embryo <4      CH................  X.................         0344       0.8167       $52.02       $15.66       $10.40
                      days.
89251..............  Cultr oocyte/embryo <4      CH................  X.................         0344       0.8167       $52.02       $15.66       $10.40
                      days.
89253..............  Embryo hatching...........  CH................  X.................         0344       0.8167       $52.02       $15.66       $10.40
89254..............  Oocyte identification.....  CH................  X.................         0344       0.8167       $52.02       $15.66       $10.40
89255..............  Prepare embryo for          CH................  X.................         0344       0.8167       $52.02       $15.66       $10.40
                      transfer.
89257..............  Sperm identification......  CH................  X.................         0344       0.8167       $52.02       $15.66       $10.40
89258..............  Cryopreservation;           CH................  X.................         0344       0.8167       $52.02       $15.66       $10.40
                      embryo(s).
89259..............  Cryopreservation, sperm...  CH................  X.................         0344       0.8167       $52.02       $15.66       $10.40
89260..............  Sperm isolation, simple...  CH................  X.................         0344       0.8167       $52.02       $15.66       $10.40
89261..............  Sperm isolation, complex..  CH................  X.................         0344       0.8167       $52.02       $15.66       $10.40
89264..............  Identify sperm tissue.....  CH................  X.................         0344       0.8167       $52.02       $15.66       $10.40
89268..............  Insemination of oocytes...  CH................  X.................         0344       0.8167       $52.02       $15.66       $10.40
89272..............  Extended culture of         CH................  X.................         0344       0.8167       $52.02       $15.66       $10.40
                      oocytes.
89280..............  Assist oocyte               CH................  X.................         0344       0.8167       $52.02       $15.66       $10.40
                      fertilization.
89281..............  Assist oocyte               CH................  X.................         0344       0.8167       $52.02       $15.66       $10.40
                      fertilization.
89290..............  Biopsy, oocyte polar body.  CH................  X.................         0344       0.8167       $52.02       $15.66       $10.40
89291..............  Biopsy, oocyte polar body.  CH................  X.................         0344       0.8167       $52.02       $15.66       $10.40
89300..............  Semen analysis w/huhner...  ..................  A.................  ...........  ...........  ...........  ...........  ...........
89310..............  Semen analysis w/count....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
89320..............  Semen anal vol/count/mot..  ..................  A.................  ...........  ...........  ...........  ...........  ...........
89321..............  Semen anal, sperm           ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      detection.
89322..............  Semen anal, strict          NI................  A.................  ...........  ...........  ...........  ...........  ...........
                      criteria.
89325..............  Sperm antibody test.......  ..................  A.................  ...........  ...........  ...........  ...........  ...........
89329..............  Sperm evaluation test.....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
89330..............  Evaluation, cervical mucus  ..................  A.................  ...........  ...........  ...........  ...........  ...........
89331..............  Retrograde ejaculation      NI................  A.................  ...........  ...........  ...........  ...........  ...........
                      anal.
89335..............  Cryopreserve testicular     CH................  X.................         0344       0.8167       $52.02       $15.66       $10.40
                      tiss.
89342..............  Storage/year; embryo(s)...  CH................  X.................         0344       0.8167       $52.02       $15.66       $10.40
89343..............  Storage/year; sperm/semen.  CH................  X.................         0344       0.8167       $52.02       $15.66       $10.40
89344..............  Storage/year; reprod        CH................  X.................         0344       0.8167       $52.02       $15.66       $10.40
                      tissue.
89346..............  Storage/year; oocyte(s)...  CH................  X.................         0344       0.8167       $52.02       $15.66       $10.40
89352..............  Thawing cryopresrved;       CH................  X.................         0344       0.8167       $52.02       $15.66       $10.40
                      embryo.

[[Page 67095]]

 
89353..............  Thawing cryopresrved;       CH................  X.................         0344       0.8167       $52.02       $15.66       $10.40
                      sperm.
89354..............  Thaw cryoprsvrd; reprod     CH................  X.................         0344       0.8167       $52.02       $15.66       $10.40
                      tiss.
89356..............  Thawing cryopresrved;       CH................  X.................         0344       0.8167       $52.02       $15.66       $10.40
                      oocyte.
90281..............  Human ig, im..............  ..................  E.................  ...........  ...........  ...........  ...........  ...........
90283..............  Human ig, iv..............  ..................  E.................  ...........  ...........  ...........  ...........  ...........
90284..............  Human ig, sc..............  NI................  E.................  ...........  ...........  ...........  ...........  ...........
90287..............  Botulinum antitoxin.......  ..................  E.................  ...........  ...........  ...........  ...........  ...........
90288..............  Botulism ig, iv...........  ..................  E.................  ...........  ...........  ...........  ...........  ...........
90291..............  Cmv ig, iv................  ..................  E.................  ...........  ...........  ...........  ...........  ...........
90296..............  Diphtheria antitoxin......  ..................  N.................  ...........  ...........  ...........  ...........  ...........
90371..............  Hep b ig, im..............  ..................  K.................         1630  ...........      $122.02  ...........       $24.40
90375..............  Rabies ig, im/sc..........  ..................  K.................         9133  ...........       $68.22  ...........       $13.64
90376..............  Rabies ig, heat treated...  ..................  K.................         9134  ...........       $71.69  ...........       $14.34
90378..............  Rsv ig, im, 50mg..........  ..................  E.................  ...........  ...........  ...........  ...........  ...........
90379..............  Rsv ig, iv................  ..................  E.................  ...........  ...........  ...........  ...........  ...........
90384..............  Rh ig, full-dose, im......  ..................  E.................  ...........  ...........  ...........  ...........  ...........
90385..............  Rh ig, minidose, im.......  ..................  N.................  ...........  ...........  ...........  ...........  ...........
90386..............  Rh ig, iv.................  ..................  E.................  ...........  ...........  ...........  ...........  ...........
90389..............  Tetanus ig, im............  ..................  E.................  ...........  ...........  ...........  ...........  ...........
90393..............  Vaccina ig, im............  ..................  N.................  ...........  ...........  ...........  ...........  ...........
90396..............  Varicella-zoster ig, im...  ..................  K.................         9135  ...........      $122.74  ...........       $24.55
90399..............  Immune globulin...........  ..................  E.................  ...........  ...........  ...........  ...........  ...........
90465..............  Immune admin 1 inj, < 8     ..................  B.................  ...........  ...........  ...........  ...........  ...........
                      yrs.
90466..............  Immune admin addl inj, < 8  ..................  B.................  ...........  ...........  ...........  ...........  ...........
                      y.
90467..............  Immune admin o or n, < 8    ..................  B.................  ...........  ...........  ...........  ...........  ...........
                      yrs.
90468..............  Immune admin o/n, addl < 8  ..................  B.................  ...........  ...........  ...........  ...........  ...........
                      y.
90471..............  Immunization admin........  ..................  S.................         0437       0.3945       $25.13  ...........        $5.03
90472..............  Immunization admin, each    ..................  S.................         0436       0.2545       $16.21  ...........        $3.24
                      add.
90473..............  Immune admin oral/nasal...  ..................  S.................         0436       0.2545       $16.21  ...........        $3.24
90474..............  Immune admin oral/nasal     ..................  S.................         0436       0.2545       $16.21  ...........        $3.24
                      addl.
90476..............  Adenovirus vaccine, type 4  ..................  N.................  ...........  ...........  ...........  ...........  ...........
90477..............  Adenovirus vaccine, type 7  ..................  N.................  ...........  ...........  ...........  ...........  ...........
90581..............  Anthrax vaccine, sc.......  ..................  N.................  ...........  ...........  ...........  ...........  ...........
90585..............  Bcg vaccine, percut.......  ..................  K.................         9137  ...........      $118.98  ...........       $23.80
90586..............  Bcg vaccine, intravesical.  ..................  B.................  ...........  ...........  ...........  ...........  ...........
90632..............  Hep a vaccine, adult im...  ..................  N.................  ...........  ...........  ...........  ...........  ...........
90633..............  Hep a vacc, ped/adol, 2     ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      dose.
90634..............  Hep a vacc, ped/adol, 3     ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      dose.
90636..............  Hep a/hep b vacc, adult im  ..................  N.................  ...........  ...........  ...........  ...........  ...........
90645..............  Hib vaccine, hboc, im.....  ..................  N.................  ...........  ...........  ...........  ...........  ...........
90646..............  Hib vaccine, prp-d, im....  ..................  N.................  ...........  ...........  ...........  ...........  ...........
90647..............  Hib vaccine, prp-omp, im..  ..................  N.................  ...........  ...........  ...........  ...........  ...........
90648..............  Hib vaccine, prp-t, im....  ..................  N.................  ...........  ...........  ...........  ...........  ...........
90649..............  H papilloma vacc 3 dose im  ..................  B.................  ...........  ...........  ...........  ...........  ...........
90655..............  Flu vaccine no preserv 6-   ..................  L.................  ...........  ...........  ...........  ...........  ...........
                      35m.
90656..............  Flu vaccine no preserv 3 &  ..................  L.................  ...........  ...........  ...........  ...........  ...........
                      >.
90657..............  Flu vaccine, 3 yrs, im....  ..................  L.................  ...........  ...........  ...........  ...........  ...........
90658..............  Flu vaccine, 3 yrs & >, im  ..................  L.................  ...........  ...........  ...........  ...........  ...........
90660..............  Flu vaccine, nasal........  ..................  L.................  ...........  ...........  ...........  ...........  ...........
90661..............  Flu vacc cell cult prsv     NI................  L.................  ...........  ...........  ...........  ...........  ...........
                      free.
90662..............  Flu vacc prsv free inc      NI................  L.................  ...........  ...........  ...........  ...........  ...........
                      antig.
90663..............  Flu vacc pandemic.........  NI................  L.................  ...........  ...........  ...........  ...........  ...........
90665..............  Lyme disease vaccine, im..  ..................  N.................  ...........  ...........  ...........  ...........  ...........
90669..............  Pneumococcal vacc, ped <5.  CH................  L.................  ...........  ...........  ...........  ...........  ...........
90675..............  Rabies vaccine, im........  ..................  K.................         9139  ...........      $150.80  ...........       $30.16
90676..............  Rabies vaccine, id........  ..................  K.................         9140  ...........      $119.86  ...........       $23.97
90680..............  Rotovirus vacc 3 dose,      ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      oral.
90690..............  Typhoid vaccine, oral.....  ..................  N.................  ...........  ...........  ...........  ...........  ...........
90691..............  Typhoid vaccine, im.......  ..................  N.................  ...........  ...........  ...........  ...........  ...........
90692..............  Typhoid vaccine, h-p, sc/   ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      id.
90693..............  Typhoid vaccine, akd, sc..  ..................  B.................  ...........  ...........  ...........  ...........  ...........
90698..............  Dtap-hib-ip vaccine, im...  ..................  N.................  ...........  ...........  ...........  ...........  ...........
90700..............  Dtap vaccine, < 7 yrs, im.  ..................  N.................  ...........  ...........  ...........  ...........  ...........
90701..............  Dtp vaccine, im...........  ..................  N.................  ...........  ...........  ...........  ...........  ...........
90702..............  Dt vaccine < 7, im........  ..................  N.................  ...........  ...........  ...........  ...........  ...........
90703..............  Tetanus vaccine, im.......  ..................  N.................  ...........  ...........  ...........  ...........  ...........
90704..............  Mumps vaccine, sc.........  ..................  N.................  ...........  ...........  ...........  ...........  ...........
90705..............  Measles vaccine, sc.......  ..................  N.................  ...........  ...........  ...........  ...........  ...........
90706..............  Rubella vaccine, sc.......  ..................  N.................  ...........  ...........  ...........  ...........  ...........
90707..............  Mmr vaccine, sc...........  ..................  N.................  ...........  ...........  ...........  ...........  ...........
90708..............  Measles-rubella vaccine,    ..................  K.................         9141  ...........       $45.53  ...........        $9.11
                      sc.
90710..............  Mmrv vaccine, sc..........  ..................  N.................  ...........  ...........  ...........  ...........  ...........
90712..............  Oral poliovirus vaccine...  ..................  N.................  ...........  ...........  ...........  ...........  ...........
90713..............  Poliovirus, ipv, sc/im....  ..................  N.................  ...........  ...........  ...........  ...........  ...........
90714..............  Td vaccine no prsrv >/= 7   ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      im.
90715..............  Tdap vaccine >7 im........  ..................  N.................  ...........  ...........  ...........  ...........  ...........
90716..............  Chicken pox vaccine, sc...  ..................  B.................  ...........  ...........  ...........  ...........  ...........
90717..............  Yellow fever vaccine, sc..  ..................  N.................  ...........  ...........  ...........  ...........  ...........
90718..............  Td vaccine > 7, im........  ..................  N.................  ...........  ...........  ...........  ...........  ...........
90719..............  Diphtheria vaccine, im....  ..................  N.................  ...........  ...........  ...........  ...........  ...........

[[Page 67096]]

 
90720..............  Dtp/hib vaccine, im.......  CH................  N.................  ...........  ...........  ...........  ...........  ...........
90721..............  Dtap/hib vaccine, im......  ..................  N.................  ...........  ...........  ...........  ...........  ...........
90723..............  Dtap-hep b-ipv vaccine, im  ..................  E.................  ...........  ...........  ...........  ...........  ...........
90725..............  Cholera vaccine,            ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      injectable.
90727..............  Plague vaccine, im........  CH................  N.................  ...........  ...........  ...........  ...........  ...........
90732..............  Pneumococcal vaccine......  ..................  L.................  ...........  ...........  ...........  ...........  ...........
90733..............  Meningococcal vaccine, sc.  ..................  K.................         9143  ...........       $85.29  ...........       $17.06
90734..............  Meningococcal vaccine, im.  ..................  K.................         9145  ...........       $82.00  ...........       $16.40
90735..............  Encephalitis vaccine, sc..  ..................  K.................         9144  ...........       $98.17  ...........       $19.63
90736..............  Zoster vacc, sc...........  ..................  B.................  ...........  ...........  ...........  ...........  ...........
90740..............  Hepb vacc, ill pat 3 dose   ..................  F.................  ...........  ...........  ...........  ...........  ...........
                      im.
90743..............  Hep b vacc, adol, 2 dose,   ..................  F.................  ...........  ...........  ...........  ...........  ...........
                      im.
90744..............  Hepb vacc ped/adol 3 dose   ..................  F.................  ...........  ...........  ...........  ...........  ...........
                      im.
90746..............  Hep b vaccine, adult, im..  ..................  F.................  ...........  ...........  ...........  ...........  ...........
90747..............  Hepb vacc, ill pat 4 dose   ..................  F.................  ...........  ...........  ...........  ...........  ...........
                      im.
90748..............  Hep b/hib vaccine, im.....  ..................  E.................  ...........  ...........  ...........  ...........  ...........
90749..............  Vaccine toxoid............  ..................  N.................  ...........  ...........  ...........  ...........  ...........
90760..............  Hydration iv infusion,      ..................  S.................         0440       1.7998      $114.64  ...........       $22.93
                      init.
90761..............  Hydrate iv infusion, add-   ..................  S.................         0437       0.3945       $25.13  ...........        $5.03
                      on.
90765..............  Ther/proph/diag iv inf,     ..................  S.................         0440       1.7998      $114.64  ...........       $22.93
                      init.
90766..............  Ther/proph/dg iv inf, add-  ..................  S.................         0437       0.3945       $25.13  ...........        $5.03
                      on.
90767..............  Tx/proph/dg addl seq iv     ..................  S.................         0437       0.3945       $25.13  ...........        $5.03
                      inf.
90768..............  Ther/diag concurrent inf..  ..................  N.................  ...........  ...........  ...........  ...........  ...........
90769..............  Sc ther infusion, up to 1   NI................  S.................         0440       1.7998      $114.64  ...........       $22.93
                      hr.
90770..............  Sc ther infusion, addl hr.  NI................  S.................         0437       0.3945       $25.13  ...........        $5.03
90771..............  Sc ther infusion, reset     NI................  S.................         0438       0.8041       $51.22  ...........       $10.24
                      pump.
90772..............  Ther/proph/diag inj, sc/im  ..................  S.................         0437       0.3945       $25.13  ...........        $5.03
90773..............  Ther/proph/diag inj, ia...  ..................  S.................         0438       0.8041       $51.22  ...........       $10.24
90774..............  Ther/proph/diag inj, iv     ..................  S.................         0438       0.8041       $51.22  ...........       $10.24
                      push.
90775..............  Tx/pro/dx inj new drug      ..................  S.................         0438       0.8041       $51.22  ...........       $10.24
                      addon.
90776..............  Tx/pro/dx inj same drug     NI................  N.................  ...........  ...........  ...........  ...........  ...........
                      adon.
90779..............  Ther/prop/diag inj/inf      ..................  S.................         0436       0.2545       $16.21  ...........        $3.24
                      proc.
90801..............  Psy dx interview..........  CH................  Q.................         0323       1.6044      $102.19  ...........       $20.44
90802..............  Intac psy dx interview....  CH................  Q.................         0323       1.6044      $102.19  ...........       $20.44
90804..............  Psytx, office, 20-30 min..  CH................  Q.................         0322       1.1729       $74.71  ...........       $14.94
90805..............  Psytx, off, 20-30 min w/    CH................  Q.................         0322       1.1729       $74.71  ...........       $14.94
                      e&m.
90806..............  Psytx, off, 45-50 min.....  CH................  Q.................         0323       1.6044      $102.19  ...........       $20.44
90807..............  Psytx, off, 45-50 min w/    CH................  Q.................         0323       1.6044      $102.19  ...........       $20.44
                      e&m.
90808..............  Psytx, office, 75-80 min..  CH................  Q.................         0323       1.6044      $102.19  ...........       $20.44
90809..............  Psytx, off, 75-80, w/e&m..  CH................  Q.................         0323       1.6044      $102.19  ...........       $20.44
90810..............  Intac psytx, off, 20-30     CH................  Q.................         0322       1.1729       $74.71  ...........       $14.94
                      min.
90811..............  Intac psytx, 20-30, w/e&m.  CH................  Q.................         0322       1.1729       $74.71  ...........       $14.94
90812..............  Intac psytx, off, 45-50     CH................  Q.................         0323       1.6044      $102.19  ...........       $20.44
                      min.
90813..............  Intac psytx, 45-50 min w/   CH................  Q.................         0323       1.6044      $102.19  ...........       $20.44
                      e&m.
90814..............  Intac psytx, off, 75-80     CH................  Q.................         0323       1.6044      $102.19  ...........       $20.44
                      min.
90815..............  Intac psytx, 75-80 w/e&m..  CH................  Q.................         0323       1.6044      $102.19  ...........       $20.44
90816..............  Psytx, hosp, 20-30 min....  CH................  Q.................         0322       1.1729       $74.71  ...........       $14.94
90817..............  Psytx, hosp, 20-30 min w/   CH................  Q.................         0322       1.1729       $74.71  ...........       $14.94
                      e&m.
90818..............  Psytx, hosp, 45-50 min....  CH................  Q.................         0323       1.6044      $102.19  ...........       $20.44
90819..............  Psytx, hosp, 45-50 min w/   CH................  Q.................         0323       1.6044      $102.19  ...........       $20.44
                      e&m.
90821..............  Psytx, hosp, 75-80 min....  CH................  Q.................         0323       1.6044      $102.19  ...........       $20.44
90822..............  Psytx, hosp, 75-80 min w/   CH................  Q.................         0323       1.6044      $102.19  ...........       $20.44
                      e&m.
90823..............  Intac psytx, hosp, 20-30    CH................  Q.................         0322       1.1729       $74.71  ...........       $14.94
                      min.
90824..............  Intac psytx, hsp 20-30 w/   CH................  Q.................         0322       1.1729       $74.71  ...........       $14.94
                      e&m.
90826..............  Intac psytx, hosp, 45-50    CH................  Q.................         0323       1.6044      $102.19  ...........       $20.44
                      min.
90827..............  Intac psytx, hsp 45-50 w/   CH................  Q.................         0323       1.6044      $102.19  ...........       $20.44
                      e&m.
90828..............  Intac psytx, hosp, 75-80    CH................  Q.................         0323       1.6044      $102.19  ...........       $20.44
                      min.
90829..............  Intac psytx, hsp 75-80 w/   CH................  Q.................         0323       1.6044      $102.19  ...........       $20.44
                      e&m.
90845..............  Psychoanalysis............  CH................  Q.................         0323       1.6044      $102.19  ...........       $20.44
90846..............  Family psytx w/o patient..  CH................  Q.................         0324       2.3616      $150.42  ...........       $30.08
90847..............  Family psytx w/patient....  CH................  Q.................         0324       2.3616      $150.42  ...........       $30.08
90849..............  Multiple family group       CH................  Q.................         0325       0.9913       $63.14       $13.81       $12.63
                      psytx.
90853..............  Group psychotherapy.......  CH................  Q.................         0325       0.9913       $63.14       $13.81       $12.63
90857..............  Intac group psytx.........  CH................  Q.................         0325       0.9913       $63.14       $13.81       $12.63
90862..............  Medication management.....  CH................  Q.................         0606       1.3226       $84.24  ...........       $16.85
90865..............  Narcosynthesis............  CH................  Q.................         0323       1.6044      $102.19  ...........       $20.44
90870..............  Electroconvulsive therapy.  ..................  S.................         0320       5.7299      $364.96       $80.06       $72.99
90875..............  Psychophysiological         ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      therapy.
90876..............  Psychophysiological         ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      therapy.
90880..............  Hypnotherapy..............  CH................  Q.................         0323       1.6044      $102.19  ...........       $20.44
90882..............  Environmental manipulation  ..................  E.................  ...........  ...........  ...........  ...........  ...........
90885..............  Psy evaluation of records.  ..................  N.................  ...........  ...........  ...........  ...........  ...........
90887..............  Consultation with family..  ..................  N.................  ...........  ...........  ...........  ...........  ...........
90889..............  Preparation of report.....  ..................  N.................  ...........  ...........  ...........  ...........  ...........
90899..............  Psychiatric service/        CH................  Q.................         0322       1.1729       $74.71  ...........       $14.94
                      therapy.
90901..............  Biofeedback train, any      ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      meth.
90911..............  Biofeedback peri/uro/       CH................  T.................         0126       1.0356       $65.96       $16.21       $13.19
                      rectal.
90918..............  ESRD related services,      ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      month.
90919..............  ESRD related services,      ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      month.
90920..............  ESRD related services,      ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      month.

[[Page 67097]]

 
90921..............  ESRD related services,      ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      month.
90922..............  ESRD related services, day  ..................  E.................  ...........  ...........  ...........  ...........  ...........
90923..............  Esrd related services, day  ..................  E.................  ...........  ...........  ...........  ...........  ...........
90924..............  Esrd related services, day  ..................  E.................  ...........  ...........  ...........  ...........  ...........
90925..............  Esrd related services, day  ..................  E.................  ...........  ...........  ...........  ...........  ...........
90935..............  Hemodialysis, one           ..................  S.................         0170       6.5383      $416.45  ...........       $83.29
                      evaluation.
90937..............  Hemodialysis, repeated      ..................  B.................  ...........  ...........  ...........  ...........  ...........
                      eval.
90940..............  Hemodialysis access study.  ..................  N.................  ...........  ...........  ...........  ...........  ...........
90945..............  Dialysis, one evaluation..  ..................  S.................         0170       6.5383      $416.45  ...........       $83.29
90947..............  Dialysis, repeated eval...  ..................  B.................  ...........  ...........  ...........  ...........  ...........
90989..............  Dialysis training,          ..................  B.................  ...........  ...........  ...........  ...........  ...........
                      complete.
90993..............  Dialysis training, incompl  ..................  B.................  ...........  ...........  ...........  ...........  ...........
90997..............  Hemoperfusion.............  ..................  B.................  ...........  ...........  ...........  ...........  ...........
90999..............  Dialysis procedure........  ..................  B.................  ...........  ...........  ...........  ...........  ...........
91000..............  Esophageal intubation.....  ..................  X.................         0361       3.9276      $250.16       $83.23       $50.03
91010..............  Esophagus motility study..  ..................  X.................         0361       3.9276      $250.16       $83.23       $50.03
91011..............  Esophagus motility study..  ..................  X.................         0361       3.9276      $250.16       $83.23       $50.03
91012..............  Esophagus motility study..  ..................  X.................         0361       3.9276      $250.16       $83.23       $50.03
91020..............  Gastric motility studies..  ..................  X.................         0361       3.9276      $250.16       $83.23       $50.03
91022..............  Duodenal motility study...  ..................  X.................         0361       3.9276      $250.16       $83.23       $50.03
91030..............  Acid perfusion of           ..................  X.................         0361       3.9276      $250.16       $83.23       $50.03
                      esophagus.
91034..............  Gastroesophageal reflux     ..................  X.................         0361       3.9276      $250.16       $83.23       $50.03
                      test.
91035..............  G-esoph reflx tst w/        ..................  X.................         0361       3.9276      $250.16       $83.23       $50.03
                      electrod.
91037..............  Esoph imped function test.  ..................  X.................         0361       3.9276      $250.16       $83.23       $50.03
91038..............  Esoph imped funct test >    ..................  X.................         0361       3.9276      $250.16       $83.23       $50.03
                      1h.
91040..............  Esoph balloon distension    ..................  X.................         0360       1.5330       $97.64       $33.88       $19.53
                      tst.
91052..............  Gastric analysis test.....  ..................  X.................         0361       3.9276      $250.16       $83.23       $50.03
91055..............  Gastric intubation for      ..................  X.................         0360       1.5330       $97.64       $33.88       $19.53
                      smear.
91065..............  Breath hydrogen test......  ..................  X.................         0360       1.5330       $97.64       $33.88       $19.53
91100..............  Pass intestine bleeding     ..................  X.................         0360       1.5330       $97.64       $33.88       $19.53
                      tube.
91105..............  Gastric intubation          ..................  X.................         0360       1.5330       $97.64       $33.88       $19.53
                      treatment.
91110..............  Gi tract capsule endoscopy  ..................  T.................         0142       9.5292      $606.95      $152.78      $121.39
91111..............  Esophageal capsule          ..................  T.................         0141       8.5030      $541.59      $143.38      $108.32
                      endoscopy.
91120..............  Rectal sensation test.....  ..................  T.................         0126       1.0356       $65.96       $16.21       $13.19
91122..............  Anal pressure record......  ..................  T.................         0164       2.0077      $127.88  ...........       $25.58
91123..............  Irrigate fecal impaction..  ..................  N.................  ...........  ...........  ...........  ...........  ...........
91132..............  Electrogastrography.......  ..................  X.................         0360       1.5330       $97.64       $33.88       $19.53
91133..............  Electrogastrography w/test  ..................  X.................         0360       1.5330       $97.64       $33.88       $19.53
91299..............  Gastroenterology procedure  ..................  X.................         0360       1.5330       $97.64       $33.88       $19.53
92002..............  Eye exam, new patient.....  ..................  V.................         0605       0.9964       $63.46  ...........       $12.69
92004..............  Eye exam, new patient.....  ..................  V.................         0606       1.3226       $84.24  ...........       $16.85
92012..............  Eye exam established pat..  ..................  V.................         0604       0.8388       $53.43  ...........       $10.69
92014..............  Eye exam & treatment......  ..................  V.................         0605       0.9964       $63.46  ...........       $12.69
92015..............  Refraction................  ..................  E.................  ...........  ...........  ...........  ...........  ...........
92018..............  New eye exam & treatment..  ..................  T.................         0699      13.7453      $875.49  ...........      $175.10
92019..............  Eye exam & treatment......  ..................  T.................         0699      13.7453      $875.49  ...........      $175.10
92020..............  Special eye evaluation....  ..................  S.................         0230       0.5903       $37.60  ...........        $7.52
92025..............  Corneal topography........  ..................  S.................         0698       0.8696       $55.39  ...........       $11.08
92060..............  Special eye evaluation....  CH................  S.................         0698       0.8696       $55.39  ...........       $11.08
92065..............  Orthoptic/pleoptic          CH................  S.................         0698       0.8696       $55.39  ...........       $11.08
                      training.
92070..............  Fitting of contact lens...  ..................  N.................  ...........  ...........  ...........  ...........  ...........
92081..............  Visual field                ..................  S.................         0230       0.5903       $37.60  ...........        $7.52
                      examination(s).
92082..............  Visual field                CH................  S.................         0698       0.8696       $55.39  ...........       $11.08
                      examination(s).
92083..............  Visual field                CH................  S.................         0698       0.8696       $55.39  ...........       $11.08
                      examination(s).
92100..............  Serial tonometry exam(s)..  ..................  N.................  ...........  ...........  ...........  ...........  ...........
92120..............  Tonography & eye            CH................  S.................         0698       0.8696       $55.39  ...........       $11.08
                      evaluation.
92130..............  Water provocation           ..................  S.................         0230       0.5903       $37.60  ...........        $7.52
                      tonography.
92135..............  Ophth dx imaging post seg.  ..................  S.................         0230       0.5903       $37.60  ...........        $7.52
92136..............  Ophthalmic biometry.......  ..................  S.................         0698       0.8696       $55.39  ...........       $11.08
92140..............  Glaucoma provocative tests  ..................  S.................         0230       0.5903       $37.60  ...........        $7.52
92225..............  Special eye exam, initial.  ..................  S.................         0230       0.5903       $37.60  ...........        $7.52
92226..............  Special eye exam,           CH................  S.................         0698       0.8696       $55.39  ...........       $11.08
                      subsequent.
92230..............  Eye exam with photos......  ..................  S.................         0231       2.1790      $138.79  ...........       $27.76
92235..............  Eye exam with photos......  ..................  S.................         0231       2.1790      $138.79  ...........       $27.76
92240..............  Icg angiography...........  ..................  S.................         0231       2.1790      $138.79  ...........       $27.76
92250..............  Eye exam with photos......  CH................  S.................         0698       0.8696       $55.39  ...........       $11.08
92260..............  Ophthalmoscopy/dynamometry  ..................  S.................         0230       0.5903       $37.60  ...........        $7.52
92265..............  Eye muscle evaluation.....  CH................  S.................         0698       0.8696       $55.39  ...........       $11.08
92270..............  Electro-oculography.......  ..................  S.................         0230       0.5903       $37.60  ...........        $7.52
92275..............  Electroretinography.......  ..................  S.................         0231       2.1790      $138.79  ...........       $27.76
92283..............  Color vision examination..  ..................  S.................         0230       0.5903       $37.60  ...........        $7.52
92284..............  Dark adaptation eye exam..  ..................  S.................         0698       0.8696       $55.39  ...........       $11.08
92285..............  Eye photography...........  CH................  S.................         0698       0.8696       $55.39  ...........       $11.08
92286..............  Internal eye photography..  CH................  S.................         0231       2.1790      $138.79  ...........       $27.76
92287..............  Internal eye photography..  CH................  S.................         0231       2.1790      $138.79  ...........       $27.76
92310..............  Contact lens fitting......  ..................  E.................  ...........  ...........  ...........  ...........  ...........
92311..............  Contact lens fitting......  CH................  S.................         0698       0.8696       $55.39  ...........       $11.08
92312..............  Contact lens fitting......  CH................  S.................         0698       0.8696       $55.39  ...........       $11.08
92313..............  Contact lens fitting......  CH................  S.................         0230       0.5903       $37.60  ...........        $7.52
92314..............  Prescription of contact     ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      lens.

[[Page 67098]]

 
92315..............  Prescription of contact     CH................  S.................         0230       0.5903       $37.60  ...........        $7.52
                      lens.
92316..............  Prescription of contact     CH................  S.................         0698       0.8696       $55.39  ...........       $11.08
                      lens.
92317..............  Prescription of contact     CH................  S.................         0230       0.5903       $37.60  ...........        $7.52
                      lens.
92325..............  Modification of contact     CH................  S.................         0230       0.5903       $37.60  ...........        $7.52
                      lens.
92326..............  Replacement of contact      CH................  S.................         0698       0.8696       $55.39  ...........       $11.08
                      lens.
92340..............  Fitting of spectacles.....  ..................  E.................  ...........  ...........  ...........  ...........  ...........
92341..............  Fitting of spectacles.....  ..................  E.................  ...........  ...........  ...........  ...........  ...........
92342..............  Fitting of spectacles.....  ..................  E.................  ...........  ...........  ...........  ...........  ...........
92352..............  Special spectacles fitting  CH................  S.................         0698       0.8696       $55.39  ...........       $11.08
92353..............  Special spectacles fitting  CH................  S.................         0230       0.5903       $37.60  ...........        $7.52
92354..............  Special spectacles fitting  CH................  S.................         0230       0.5903       $37.60  ...........        $7.52
92355..............  Special spectacles fitting  CH................  S.................         0230       0.5903       $37.60  ...........        $7.52
92358..............  Eye prosthesis service....  CH................  S.................         0230       0.5903       $37.60  ...........        $7.52
92370..............  Repair & adjust spectacles  ..................  E.................  ...........  ...........  ...........  ...........  ...........
92371..............  Repair & adjust spectacles  CH................  S.................         0230       0.5903       $37.60  ...........        $7.52
92499..............  Eye service or procedure..  ..................  S.................         0230       0.5903       $37.60  ...........        $7.52
92502..............  Ear and throat examination  ..................  T.................         0251       2.5002      $159.25  ...........       $31.85
92504..............  Ear microscopy examination  ..................  N.................  ...........  ...........  ...........  ...........  ...........
92506..............  Speech/hearing evaluation.  ..................  A.................  ...........  ...........  ...........  ...........  ...........
92507..............  Speech/hearing therapy....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
92508..............  Speech/hearing therapy....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
92511..............  Nasopharyngoscopy.........  ..................  T.................         0071       0.8224       $52.38       $11.20       $10.48
92512..............  Nasal function studies....  ..................  X.................         0363       0.8067       $51.38       $17.10       $10.28
92516..............  Facial nerve function test  ..................  X.................         0660       1.4312       $91.16       $28.06       $18.23
92520..............  Laryngeal function studies  ..................  X.................         0660       1.4312       $91.16       $28.06       $18.23
92526..............  Oral function therapy.....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
92531..............  Spontaneous nystagmus       ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      study.
92532..............  Positional nystagmus test.  ..................  N.................  ...........  ...........  ...........  ...........  ...........
92533..............  Caloric vestibular test...  ..................  N.................  ...........  ...........  ...........  ...........  ...........
92534..............  Optokinetic nystagmus test  ..................  N.................  ...........  ...........  ...........  ...........  ...........
92541..............  Spontaneous nystagmus test  ..................  X.................         0363       0.8067       $51.38       $17.10       $10.28
92542..............  Positional nystagmus test.  ..................  X.................         0363       0.8067       $51.38       $17.10       $10.28
92543..............  Caloric vestibular test...  ..................  X.................         0660       1.4312       $91.16       $28.06       $18.23
92544..............  Optokinetic nystagmus test  ..................  X.................         0363       0.8067       $51.38       $17.10       $10.28
92545..............  Oscillating tracking test.  ..................  X.................         0363       0.8067       $51.38       $17.10       $10.28
92546..............  Sinusoidal rotational test  ..................  X.................         0660       1.4312       $91.16       $28.06       $18.23
92547..............  Supplemental electrical     CH................  N.................  ...........  ...........  ...........  ...........  ...........
                      test.
92548..............  Posturography.............  ..................  X.................         0660       1.4312       $91.16       $28.06       $18.23
92551..............  Pure tone hearing test,     ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      air.
92552..............  Pure tone audiometry, air.  ..................  X.................         0364       0.4490       $28.60        $7.06        $5.72
92553..............  Audiometry, air & bone....  ..................  X.................         0365       1.2549       $79.93       $18.52       $15.99
92555..............  Speech threshold            ..................  X.................         0364       0.4490       $28.60        $7.06        $5.72
                      audiometry.
92556..............  Speech audiometry,          ..................  X.................         0364       0.4490       $28.60        $7.06        $5.72
                      complete.
92557..............  Comprehensive hearing test  ..................  X.................         0365       1.2549       $79.93       $18.52       $15.99
92559..............  Group audiometric testing.  ..................  E.................  ...........  ...........  ...........  ...........  ...........
92560..............  Bekesy audiometry, screen.  ..................  E.................  ...........  ...........  ...........  ...........  ...........
92561..............  Bekesy audiometry,          ..................  X.................         0364       0.4490       $28.60        $7.06        $5.72
                      diagnosis.
92562..............  Loudness balance test.....  ..................  X.................         0364       0.4490       $28.60        $7.06        $5.72
92563..............  Tone decay hearing test...  ..................  X.................         0364       0.4490       $28.60        $7.06        $5.72
92564..............  Sisi hearing test.........  ..................  X.................         0364       0.4490       $28.60        $7.06        $5.72
92565..............  Stenger test, pure tone...  ..................  X.................         0364       0.4490       $28.60        $7.06        $5.72
92567..............  Tympanometry..............  ..................  X.................         0364       0.4490       $28.60        $7.06        $5.72
92568..............  Acoustic refl threshold     ..................  X.................         0364       0.4490       $28.60        $7.06        $5.72
                      tst.
92569..............  Acoustic reflex decay test  ..................  X.................         0364       0.4490       $28.60        $7.06        $5.72
92571..............  Filtered speech hearing     ..................  X.................         0364       0.4490       $28.60        $7.06        $5.72
                      test.
92572..............  Staggered spondaic word     ..................  X.................         0366       1.7624      $112.25       $25.79       $22.45
                      test.
92575..............  Sensorineural acuity test.  ..................  X.................         0364       0.4490       $28.60        $7.06        $5.72
92576..............  Synthetic sentence test...  ..................  X.................         0364       0.4490       $28.60        $7.06        $5.72
92577..............  Stenger test, speech......  ..................  X.................         0366       1.7624      $112.25       $25.79       $22.45
92579..............  Visual audiometry (vra)...  ..................  X.................         0365       1.2549       $79.93       $18.52       $15.99
92582..............  Conditioning play           ..................  X.................         0365       1.2549       $79.93       $18.52       $15.99
                      audiometry.
92583..............  Select picture audiometry.  ..................  X.................         0364       0.4490       $28.60        $7.06        $5.72
92584..............  Electrocochleography......  CH................  S.................         0216       2.6846      $170.99  ...........       $34.20
92585..............  Auditor evoke potent,       ..................  S.................         0216       2.6846      $170.99  ...........       $34.20
                      compre.
92586..............  Auditor evoke potent,       ..................  S.................         0218       1.1550       $73.57  ...........       $14.71
                      limit.
92587..............  Evoked auditory test......  ..................  X.................         0363       0.8067       $51.38       $17.10       $10.28
92588..............  Evoked auditory test......  ..................  X.................         0660       1.4312       $91.16       $28.06       $18.23
92590..............  Hearing aid exam, one ear.  ..................  E.................  ...........  ...........  ...........  ...........  ...........
92591..............  Hearing aid exam, both      ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      ears.
92592..............  Hearing aid check, one ear  ..................  E.................  ...........  ...........  ...........  ...........  ...........
92593..............  Hearing aid check, both     ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      ears.
92594..............  Electro hearng aid test,    ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      one.
92595..............  Electro hearng aid tst,     ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      both.
92596..............  Ear protector evaluation..  ..................  X.................         0364       0.4490       $28.60        $7.06        $5.72
92597..............  Oral speech device eval...  ..................  A.................  ...........  ...........  ...........  ...........  ...........
92601..............  Cochlear implt f/up exam <  ..................  X.................         0366       1.7624      $112.25       $25.79       $22.45
                      7.
92602..............  Reprogram cochlear implt <  ..................  X.................         0366       1.7624      $112.25       $25.79       $22.45
                      7.
92603..............  Cochlear implt f/up exam 7  ..................  X.................         0366       1.7624      $112.25       $25.79       $22.45
                      >.
92604..............  Reprogram cochlear implt 7  ..................  X.................         0366       1.7624      $112.25       $25.79       $22.45
                      >.
92605..............  Eval for nonspeech device   ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      rx.

[[Page 67099]]

 
92606..............  Non-speech device service.  ..................  A.................  ...........  ...........  ...........  ...........  ...........
92607..............  Ex for speech device rx,    ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      1hr.
92608..............  Ex for speech device rx     ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      addl.
92609..............  Use of speech device        ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      service.
92610..............  Evaluate swallowing         ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      function.
92611..............  Motion fluoroscopy/swallow  ..................  A.................  ...........  ...........  ...........  ...........  ...........
92612..............  Endoscopy swallow tst       ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      (fees).
92613..............  Endoscopy swallow tst       ..................  B.................  ...........  ...........  ...........  ...........  ...........
                      (fees).
92614..............  Laryngoscopic sensory test  ..................  A.................  ...........  ...........  ...........  ...........  ...........
92615..............  Eval laryngoscopy sense     ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      tst.
92616..............  Fees w/laryngeal sense      ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      test.
92617..............  Interprt fees/laryngeal     ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      test.
92620..............  Auditory function, 60 min.  ..................  X.................         0365       1.2549       $79.93       $18.52       $15.99
92621..............  Auditory function, + 15     ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      min.
92625..............  Tinnitus assessment.......  ..................  X.................         0365       1.2549       $79.93       $18.52       $15.99
92626..............  Eval aud rehab status.....  ..................  X.................         0365       1.2549       $79.93       $18.52       $15.99
92627..............  Eval aud status rehab add-  ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      on.
92630..............  Aud rehab pre-ling hear     ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      loss.
92633..............  Aud rehab postling hear     ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      loss.
92640..............  Aud brainstem implt         ..................  X.................         0365       1.2549       $79.93       $18.52       $15.99
                      programg.
92700..............  Ent procedure/service.....  ..................  X.................         0364       0.4490       $28.60        $7.06        $5.72
92950..............  Heart/lung resuscitation    ..................  S.................         0094       2.4590      $156.62       $46.29       $31.32
                      cpr.
92953..............  Temporary external pacing.  ..................  S.................         0094       2.4590      $156.62       $46.29       $31.32
92960..............  Cardioversion electric,     ..................  S.................         0679       5.4502      $347.15       $95.30       $69.43
                      ext.
92961..............  Cardioversion, electric,    ..................  S.................         0679       5.4502      $347.15       $95.30       $69.43
                      int.
92970..............  Cardioassist, internal....  ..................  C.................  ...........  ...........  ...........  ...........  ...........
92971..............  Cardioassist, external....  ..................  C.................  ...........  ...........  ...........  ...........  ...........
92973..............  Percut coronary             ..................  T.................         0088      38.7673    $2,469.24      $655.22      $493.85
                      thrombectomy.
92974..............  Cath place, cardio          ..................  T.................         0103      14.6576      $933.60  ...........      $186.72
                      brachytx.
92975..............  Dissolve clot, heart        ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      vessel.
92977..............  Dissolve clot, heart        ..................  T.................         0676       2.4824      $158.11  ...........       $31.62
                      vessel.
92978..............  Intravasc us, heart add-on  CH................  N.................  ...........  ...........  ...........  ...........  ...........
92979..............  Intravasc us, heart add-on  CH................  N.................  ...........  ...........  ...........  ...........  ...........
92980..............  Insert intracoronary stent  ..................  T.................         0104      89.0159    $5,669.78  ...........    $1,133.96
92981..............  Insert intracoronary stent  ..................  T.................         0104      89.0159    $5,669.78  ...........    $1,133.96
92982..............  Coronary artery dilation..  ..................  T.................         0083      45.3845    $2,890.72  ...........      $578.14
92984..............  Coronary artery dilation..  ..................  T.................         0083      45.3845    $2,890.72  ...........      $578.14
92986..............  Revision of aortic valve..  ..................  T.................         0083      45.3845    $2,890.72  ...........      $578.14
92987..............  Revision of mitral valve..  ..................  T.................         0083      45.3845    $2,890.72  ...........      $578.14
92990..............  Revision of pulmonary       ..................  T.................         0083      45.3845    $2,890.72  ...........      $578.14
                      valve.
92992..............  Revision of heart chamber.  ..................  C.................  ...........  ...........  ...........  ...........  ...........
92993..............  Revision of heart chamber.  ..................  C.................  ...........  ...........  ...........  ...........  ...........
92995..............  Coronary atherectomy......  ..................  T.................         0082      87.5137    $5,574.10  ...........    $1,114.82
92996..............  Coronary atherectomy add-   ..................  T.................         0082      87.5137    $5,574.10  ...........    $1,114.82
                      on.
92997..............  Pul art balloon repr,       CH................  T.................         0083      45.3845    $2,890.72  ...........      $578.14
                      percut.
92998..............  Pul art balloon repr,       CH................  T.................         0083      45.3845    $2,890.72  ...........      $578.14
                      percut.
93000..............  Electrocardiogram,          ..................  B.................  ...........  ...........  ...........  ...........  ...........
                      complete.
93005..............  Electrocardiogram, tracing  ..................  S.................         0099       0.3892       $24.79  ...........        $4.96
93010..............  Electrocardiogram report..  ..................  B.................  ...........  ...........  ...........  ...........  ...........
93012..............  Transmission of ecg.......  ..................  N.................  ...........  ...........  ...........  ...........  ...........
93014..............  Report on transmitted ecg.  ..................  B.................  ...........  ...........  ...........  ...........  ...........
93015..............  Cardiovascular stress test  ..................  B.................  ...........  ...........  ...........  ...........  ...........
93016..............  Cardiovascular stress test  ..................  B.................  ...........  ...........  ...........  ...........  ...........
93017..............  Cardiovascular stress test  ..................  X.................         0100       2.5547      $162.72       $41.44       $32.54
93018..............  Cardiovascular stress test  ..................  B.................  ...........  ...........  ...........  ...........  ...........
93024..............  Cardiac drug stress test..  ..................  X.................         0100       2.5547      $162.72       $41.44       $32.54
93025..............  Microvolt t-wave assess...  ..................  X.................         0100       2.5547      $162.72       $41.44       $32.54
93040..............  Rhythm ECG with report....  ..................  B.................  ...........  ...........  ...........  ...........  ...........
93041..............  Rhythm ECG, tracing.......  ..................  S.................         0099       0.3892       $24.79  ...........        $4.96
93042..............  Rhythm ECG, report........  ..................  B.................  ...........  ...........  ...........  ...........  ...........
93224..............  ECG monitor/report, 24 hrs  ..................  B.................  ...........  ...........  ...........  ...........  ...........
93225..............  ECG monitor/record, 24 hrs  ..................  X.................         0097       1.0015       $63.79       $23.79       $12.76
93226..............  ECG monitor/report, 24 hrs  ..................  X.................         0097       1.0015       $63.79       $23.79       $12.76
93227..............  ECG monitor/review, 24 hrs  ..................  B.................  ...........  ...........  ...........  ...........  ...........
93230..............  ECG monitor/report, 24 hrs  ..................  B.................  ...........  ...........  ...........  ...........  ...........
93231..............  Ecg monitor/record, 24 hrs  ..................  X.................         0097       1.0015       $63.79       $23.79       $12.76
93232..............  ECG monitor/report, 24 hrs  ..................  X.................         0097       1.0015       $63.79       $23.79       $12.76
93233..............  ECG monitor/review, 24 hrs  ..................  B.................  ...........  ...........  ...........  ...........  ...........
93235..............  ECG monitor/report, 24 hrs  ..................  B.................  ...........  ...........  ...........  ...........  ...........
93236..............  ECG monitor/report, 24 hrs  ..................  X.................         0097       1.0015       $63.79       $23.79       $12.76
93237..............  ECG monitor/review, 24 hrs  ..................  B.................  ...........  ...........  ...........  ...........  ...........
93268..............  ECG record/review.........  ..................  B.................  ...........  ...........  ...........  ...........  ...........
93270..............  ECG recording.............  ..................  X.................         0097       1.0015       $63.79       $23.79       $12.76
93271..............  Ecg/monitoring and          CH................  S.................         0663       1.5313       $97.53  ...........       $19.51
                      analysis.
93272..............  Ecg/review, interpret only  ..................  B.................  ...........  ...........  ...........  ...........  ...........
93278..............  ECG/signal-averaged.......  CH................  X.................         0340       0.6310       $40.19  ...........        $8.04
93303..............  Echo transthoracic........  ..................  S.................         0269       6.3751      $406.06  ...........       $81.21
93304..............  Echo transthoracic........  ..................  S.................         0697       3.3401      $212.74  ...........       $42.55
93307..............  Echo exam of heart........  ..................  S.................         0269       6.3751      $406.06  ...........       $81.21
93308..............  Echo exam of heart........  ..................  S.................         0697       3.3401      $212.74  ...........       $42.55

[[Page 67100]]

 
93312..............  Echo transesophageal......  ..................  S.................         0270       8.2165      $523.34      $141.32      $104.67
93313..............  Echo transesophageal......  ..................  S.................         0270       8.2165      $523.34      $141.32      $104.67
93314..............  Echo transesophageal......  ..................  N.................  ...........  ...........  ...........  ...........  ...........
93315..............  Echo transesophageal......  ..................  S.................         0270       8.2165      $523.34      $141.32      $104.67
93316..............  Echo transesophageal......  ..................  S.................         0270       8.2165      $523.34      $141.32      $104.67
93317..............  Echo transesophageal......  ..................  N.................  ...........  ...........  ...........  ...........  ...........
93318..............  Echo transesophageal        ..................  S.................         0270       8.2165      $523.34      $141.32      $104.67
                      intraop.
93320..............  Doppler echo exam, heart..  CH................  N.................  ...........  ...........  ...........  ...........  ...........
93321..............  Doppler echo exam, heart..  CH................  N.................  ...........  ...........  ...........  ...........  ...........
93325..............  Doppler color flow add-on.  CH................  N.................  ...........  ...........  ...........  ...........  ...........
93350..............  Echo transthoracic........  ..................  S.................         0269       6.3751      $406.06  ...........       $81.21
93501..............  Right heart                 ..................  T.................         0080      38.9204    $2,479.00      $838.92      $495.80
                      catheterization.
93503..............  Insert/place heart          ..................  T.................         0103      14.6576      $933.60  ...........      $186.72
                      catheter.
93505..............  Biopsy of heart lining....  ..................  T.................         0103      14.6576      $933.60  ...........      $186.72
93508..............  Cath placement,             ..................  T.................         0080      38.9204    $2,479.00      $838.92      $495.80
                      angiography.
93510..............  Left heart catheterization  ..................  T.................         0080      38.9204    $2,479.00      $838.92      $495.80
93511..............  Left heart catheterization  ..................  T.................         0080      38.9204    $2,479.00      $838.92      $495.80
93514..............  Left heart catheterization  ..................  T.................         0080      38.9204    $2,479.00      $838.92      $495.80
93524..............  Left heart catheterization  ..................  T.................         0080      38.9204    $2,479.00      $838.92      $495.80
93526..............  Rt & Lt heart catheters...  ..................  T.................         0080      38.9204    $2,479.00      $838.92      $495.80
93527..............  Rt & Lt heart catheters...  ..................  T.................         0080      38.9204    $2,479.00      $838.92      $495.80
93528..............  Rt & Lt heart catheters...  ..................  T.................         0080      38.9204    $2,479.00      $838.92      $495.80
93529..............  Rt, lt heart                ..................  T.................         0080      38.9204    $2,479.00      $838.92      $495.80
                      catheterization.
93530..............  Rt heart cath, congenital.  ..................  T.................         0080      38.9204    $2,479.00      $838.92      $495.80
93531..............  R & l heart cath,           ..................  T.................         0080      38.9204    $2,479.00      $838.92      $495.80
                      congenital.
93532..............  R & l heart cath,           ..................  T.................         0080      38.9204    $2,479.00      $838.92      $495.80
                      congenital.
93533..............  R & l heart cath,           ..................  T.................         0080      38.9204    $2,479.00      $838.92      $495.80
                      congenital.
93539..............  Injection, cardiac cath...  ..................  N.................  ...........  ...........  ...........  ...........  ...........
93540..............  Injection, cardiac cath...  ..................  N.................  ...........  ...........  ...........  ...........  ...........
93541..............  Injection for lung          ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      angiogram.
93542..............  Injection for heart x-rays  ..................  N.................  ...........  ...........  ...........  ...........  ...........
93543..............  Injection for heart x-rays  ..................  N.................  ...........  ...........  ...........  ...........  ...........
93544..............  Injection for aortography.  ..................  N.................  ...........  ...........  ...........  ...........  ...........
93545..............  Inject for coronary x-rays  ..................  N.................  ...........  ...........  ...........  ...........  ...........
93555..............  Imaging, cardiac cath.....  ..................  N.................  ...........  ...........  ...........  ...........  ...........
93556..............  Imaging, cardiac cath.....  ..................  N.................  ...........  ...........  ...........  ...........  ...........
93561..............  Cardiac output measurement  ..................  N.................  ...........  ...........  ...........  ...........  ...........
93562..............  Cardiac output measurement  ..................  N.................  ...........  ...........  ...........  ...........  ...........
93571..............  Heart flow reserve measure  CH................  N.................  ...........  ...........  ...........  ...........  ...........
93572..............  Heart flow reserve measure  CH................  N.................  ...........  ...........  ...........  ...........  ...........
93580..............  Transcath closure of asd..  ..................  T.................         0434     132.4129    $8,433.91  ...........    $1,686.78
93581..............  Transcath closure of vsd..  ..................  T.................         0434     132.4129    $8,433.91  ...........    $1,686.78
93600..............  Bundle of His recording...  CH................  S.................         0084       9.5834      $610.41  ...........      $122.08
93602..............  Intra-atrial recording....  CH................  S.................         0084       9.5834      $610.41  ...........      $122.08
93603..............  Right ventricular           CH................  S.................         0084       9.5834      $610.41  ...........      $122.08
                      recording.
93609..............  Map tachycardia, add-on...  CH................  N.................  ...........  ...........  ...........  ...........  ...........
93610..............  Intra-atrial pacing.......  CH................  S.................         0084       9.5834      $610.41  ...........      $122.08
93612..............  Intraventricular pacing...  CH................  S.................         0084       9.5834      $610.41  ...........      $122.08
93613..............  Electrophys map 3d, add-on  CH................  N.................  ...........  ...........  ...........  ...........  ...........
93615..............  Esophageal recording......  CH................  S.................         0084       9.5834      $610.41  ...........      $122.08
93616..............  Esophageal recording......  CH................  S.................         0084       9.5834      $610.41  ...........      $122.08
93618..............  Heart rhythm pacing.......  CH................  S.................         0084       9.5834      $610.41  ...........      $122.08
93619..............  Electrophysiology           CH................  Q.................         0085      47.2949    $3,012.40  ...........      $602.48
                      evaluation.
93620..............  Electrophysiology           CH................  Q.................         0085      47.2949    $3,012.40  ...........      $602.48
                      evaluation.
93621..............  Electrophysiology           CH................  N.................  ...........  ...........  ...........  ...........  ...........
                      evaluation.
93622..............  Electrophysiology           CH................  N.................  ...........  ...........  ...........  ...........  ...........
                      evaluation.
93623..............  Stimulation, pacing heart.  CH................  N.................  ...........  ...........  ...........  ...........  ...........
93624..............  Electrophysiologic study..  ..................  T.................         0085      47.2949    $3,012.40  ...........      $602.48
93631..............  Heart pacing, mapping.....  CH................  N.................  ...........  ...........  ...........  ...........  ...........
93640..............  Evaluation heart device...  ..................  N.................  ...........  ...........  ...........  ...........  ...........
93641..............  Electrophysiology           ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      evaluation.
93642..............  Electrophysiology           ..................  S.................         0084       9.5834      $610.41  ...........      $122.08
                      evaluation.
93650..............  Ablate heart dysrhythm      CH................  Q.................         0085      47.2949    $3,012.40  ...........      $602.48
                      focus.
93651..............  Ablate heart dysrhythm      CH................  Q.................         0086      92.8564    $5,914.40  ...........    $1,182.88
                      focus.
93652..............  Ablate heart dysrhythm      CH................  Q.................         0086      92.8564    $5,914.40  ...........    $1,182.88
                      focus.
93660..............  Tilt table evaluation.....  ..................  S.................         0101       4.1973      $267.34      $100.24       $53.47
93662..............  Intracardiac ecg (ice)....  CH................  N.................  ...........  ...........  ...........  ...........  ...........
93668..............  Peripheral vascular rehab.  ..................  E.................  ...........  ...........  ...........  ...........  ...........
93701..............  Bioimpedance, thoracic....  ..................  S.................         0099       0.3892       $24.79  ...........        $4.96
93720..............  Total body plethysmography  ..................  B.................  ...........  ...........  ...........  ...........  ...........
93721..............  Plethysmography tracing...  ..................  X.................         0368       0.9253       $58.94       $22.77       $11.79
93722..............  Plethysmography report....  ..................  B.................  ...........  ...........  ...........  ...........  ...........
93724..............  Analyze pacemaker system..  ..................  S.................         0690       0.3504       $22.32        $8.67        $4.46
93727..............  Analyze ilr system........  ..................  S.................         0690       0.3504       $22.32        $8.67        $4.46
93731..............  Analyze pacemaker system..  ..................  S.................         0690       0.3504       $22.32        $8.67        $4.46
93732..............  Analyze pacemaker system..  ..................  S.................         0690       0.3504       $22.32        $8.67        $4.46
93733..............  Telephone analy, pacemaker  ..................  S.................         0690       0.3504       $22.32        $8.67        $4.46
93734..............  Analyze pacemaker system..  ..................  S.................         0690       0.3504       $22.32        $8.67        $4.46
93735..............  Analyze pacemaker system..  ..................  S.................         0690       0.3504       $22.32        $8.67        $4.46
93736..............  Telephonic analy,           ..................  S.................         0690       0.3504       $22.32        $8.67        $4.46
                      pacemaker.

[[Page 67101]]

 
93740..............  Temperature gradient        ..................  X.................         0368       0.9253       $58.94       $22.77       $11.79
                      studies.
93741..............  Analyze ht pace device      ..................  S.................         0689       0.5946       $37.87  ...........        $7.57
                      sngl.
93742..............  Analyze ht pace device      ..................  S.................         0689       0.5946       $37.87  ...........        $7.57
                      sngl.
93743..............  Analyze ht pace device      ..................  S.................         0689       0.5946       $37.87  ...........        $7.57
                      dual.
93744..............  Analyze ht pace device      ..................  S.................         0689       0.5946       $37.87  ...........        $7.57
                      dual.
93745..............  Set-up cardiovert-          ..................  S.................         0689       0.5946       $37.87  ...........        $7.57
                      defibrill.
93760..............  Cephalic thermogram.......  ..................  E.................  ...........  ...........  ...........  ...........  ...........
93762..............  Peripheral thermogram.....  ..................  E.................  ...........  ...........  ...........  ...........  ...........
93770..............  Measure venous pressure...  ..................  N.................  ...........  ...........  ...........  ...........  ...........
93784..............  Ambulatory BP monitoring..  ..................  E.................  ...........  ...........  ...........  ...........  ...........
93786..............  Ambulatory BP recording...  ..................  X.................         0097       1.0015       $63.79       $23.79       $12.76
93788..............  Ambulatory BP analysis....  ..................  X.................         0097       1.0015       $63.79       $23.79       $12.76
93790..............  Review/report BP recording  ..................  B.................  ...........  ...........  ...........  ...........  ...........
93797..............  Cardiac rehab.............  ..................  S.................         0095       0.5685       $36.21       $13.86        $7.24
93798..............  Cardiac rehab/monitor.....  ..................  S.................         0095       0.5685       $36.21       $13.86        $7.24
93799..............  Cardiovascular procedure..  ..................  X.................         0097       1.0015       $63.79       $23.79       $12.76
93875..............  Extracranial study........  ..................  S.................         0096       1.4689       $93.56       $37.42       $18.71
93880..............  Extracranial study........  ..................  S.................         0267       2.3792      $151.54       $60.50       $30.31
93882..............  Extracranial study........  ..................  S.................         0267       2.3792      $151.54       $60.50       $30.31
93886..............  Intracranial study........  ..................  S.................         0267       2.3792      $151.54       $60.50       $30.31
93888..............  Intracranial study........  ..................  S.................         0265       0.9570       $60.96       $22.35       $12.19
93890..............  Tcd, vasoreactivity study.  ..................  S.................         0266       1.5094       $96.14       $37.80       $19.23
93892..............  Tcd, emboli detect w/o inj  ..................  S.................         0266       1.5094       $96.14       $37.80       $19.23
93893..............  Tcd, emboli detect w/inj..  ..................  S.................         0266       1.5094       $96.14       $37.80       $19.23
93922..............  Extremity study...........  ..................  S.................         0096       1.4689       $93.56       $37.42       $18.71
93923..............  Extremity study...........  ..................  S.................         0096       1.4689       $93.56       $37.42       $18.71
93924..............  Extremity study...........  ..................  S.................         0096       1.4689       $93.56       $37.42       $18.71
93925..............  Lower extremity study.....  ..................  S.................         0267       2.3792      $151.54       $60.50       $30.31
93926..............  Lower extremity study.....  ..................  S.................         0266       1.5094       $96.14       $37.80       $19.23
93930..............  Upper extremity study.....  ..................  S.................         0267       2.3792      $151.54       $60.50       $30.31
93931..............  Upper extremity study.....  ..................  S.................         0266       1.5094       $96.14       $37.80       $19.23
93965..............  Extremity study...........  ..................  S.................         0096       1.4689       $93.56       $37.42       $18.71
93970..............  Extremity study...........  ..................  S.................         0267       2.3792      $151.54       $60.50       $30.31
93971..............  Extremity study...........  ..................  S.................         0266       1.5094       $96.14       $37.80       $19.23
93975..............  Vascular study............  ..................  S.................         0267       2.3792      $151.54       $60.50       $30.31
93976..............  Vascular study............  ..................  S.................         0267       2.3792      $151.54       $60.50       $30.31
93978..............  Vascular study............  CH................  S.................         0267       2.3792      $151.54       $60.50       $30.31
93979..............  Vascular study............  ..................  S.................         0266       1.5094       $96.14       $37.80       $19.23
93980..............  Penile vascular study.....  ..................  S.................         0267       2.3792      $151.54       $60.50       $30.31
93981..............  Penile vascular study.....  CH................  S.................         0267       2.3792      $151.54       $60.50       $30.31
93982..............  Aneurysm pressure sens      NI................  X.................         0097       1.0015       $63.79       $23.79       $12.76
                      study.
93990..............  Doppler flow testing......  ..................  S.................         0266       1.5094       $96.14       $37.80       $19.23
94002..............  Vent mgmt inpat, init day.  ..................  S.................         0079       2.4783      $157.85  ...........       $31.57
94003..............  Vent mgmt inpat, subq day.  ..................  S.................         0079       2.4783      $157.85  ...........       $31.57
94004..............  Vent mgmt nf per day......  ..................  B.................  ...........  ...........  ...........  ...........  ...........
94005..............  Home vent mgmt supervision  ..................  B.................  ...........  ...........  ...........  ...........  ...........
94010..............  Breathing capacity test...  ..................  X.................         0368       0.9253       $58.94       $22.77       $11.79
94014..............  Patient recorded            ..................  X.................         0367       0.5677       $36.16       $13.76        $7.23
                      spirometry.
94015..............  Patient recorded            ..................  X.................         0367       0.5677       $36.16       $13.76        $7.23
                      spirometry.
94016..............  Review patient spirometry.  ..................  A.................  ...........  ...........  ...........  ...........  ...........
94060..............  Evaluation of wheezing....  ..................  X.................         0368       0.9253       $58.94       $22.77       $11.79
94070..............  Evaluation of wheezing....  ..................  X.................         0369       2.7550      $175.48       $44.18       $35.10
94150..............  Vital capacity test.......  ..................  X.................         0367       0.5677       $36.16       $13.76        $7.23
94200..............  Lung function test (MBC/    ..................  X.................         0367       0.5677       $36.16       $13.76        $7.23
                      MVV).
94240..............  Residual lung capacity....  ..................  X.................         0368       0.9253       $58.94       $22.77       $11.79
94250..............  Expired gas collection....  ..................  X.................         0367       0.5677       $36.16       $13.76        $7.23
94260..............  Thoracic gas volume.......  ..................  X.................         0368       0.9253       $58.94       $22.77       $11.79
94350..............  Lung nitrogen washout       ..................  X.................         0368       0.9253       $58.94       $22.77       $11.79
                      curve.
94360..............  Measure airflow resistance  ..................  X.................         0367       0.5677       $36.16       $13.76        $7.23
94370..............  Breath airway closing       ..................  X.................         0367       0.5677       $36.16       $13.76        $7.23
                      volume.
94375..............  Respiratory flow volume     CH................  X.................         0368       0.9253       $58.94       $22.77       $11.79
                      loop.
94400..............  CO2 breathing response      ..................  X.................         0367       0.5677       $36.16       $13.76        $7.23
                      curve.
94450..............  Hypoxia response curve....  ..................  X.................         0368       0.9253       $58.94       $22.77       $11.79
94452..............  Hast w/report.............  ..................  X.................         0368       0.9253       $58.94       $22.77       $11.79
94453..............  Hast w/oxygen titrate.....  ..................  X.................         0367       0.5677       $36.16       $13.76        $7.23
94610..............  Surfactant admin thru tube  ..................  S.................         0077       0.3877       $24.69        $7.74        $4.94
94620..............  Pulmonary stress test/      ..................  X.................         0368       0.9253       $58.94       $22.77       $11.79
                      simple.
94621..............  Pulm stress test/complex..  ..................  X.................         0369       2.7550      $175.48       $44.18       $35.10
94640..............  Airway inhalation           ..................  S.................         0077       0.3877       $24.69        $7.74        $4.94
                      treatment.
94642..............  Aerosol inhalation          ..................  S.................         0078       1.3362       $85.11  ...........       $17.02
                      treatment.
94644..............  Cbt, 1st hour.............  ..................  S.................         0078       1.3362       $85.11  ...........       $17.02
94645..............  Cbt, each addl hour.......  ..................  S.................         0078       1.3362       $85.11  ...........       $17.02
94660..............  Pos airway pressure, CPAP.  CH................  S.................         0078       1.3362       $85.11  ...........       $17.02
94662..............  Neg press ventilation, cnp  ..................  S.................         0079       2.4783      $157.85  ...........       $31.57
94664..............  Evaluate pt use of inhaler  ..................  S.................         0077       0.3877       $24.69        $7.74        $4.94
94667..............  Chest wall manipulation...  ..................  S.................         0077       0.3877       $24.69        $7.74        $4.94
94668..............  Chest wall manipulation...  ..................  S.................         0077       0.3877       $24.69        $7.74        $4.94
94680..............  Exhaled air analysis, o2..  CH................  X.................         0368       0.9253       $58.94       $22.77       $11.79
94681..............  Exhaled air analysis, o2/   ..................  X.................         0368       0.9253       $58.94       $22.77       $11.79
                      co2.
94690..............  Exhaled air analysis......  ..................  X.................         0367       0.5677       $36.16       $13.76        $7.23

[[Page 67102]]

 
94720..............  Monoxide diffusing          ..................  X.................         0368       0.9253       $58.94       $22.77       $11.79
                      capacity.
94725..............  Membrane diffusion          ..................  X.................         0368       0.9253       $58.94       $22.77       $11.79
                      capacity.
94750..............  Pulmonary compliance study  CH................  X.................         0368       0.9253       $58.94       $22.77       $11.79
94760..............  Measure blood oxygen level  ..................  N.................  ...........  ...........  ...........  ...........  ...........
94761..............  Measure blood oxygen level  ..................  N.................  ...........  ...........  ...........  ...........  ...........
94762..............  Measure blood oxygen level  CH................  Q.................         0097       1.0015       $63.79       $23.79       $12.76
94770..............  Exhaled carbon dioxide      ..................  X.................         0367       0.5677       $36.16       $13.76        $7.23
                      test.
94772..............  Breath recording, infant..  ..................  X.................         0369       2.7550      $175.48       $44.18       $35.10
94774..............  Ped home apnea rec, compl.  ..................  B.................  ...........  ...........  ...........  ...........  ...........
94775..............  Ped home apnea rec, hk-up.  ..................  X.................         0097       1.0015       $63.79       $23.79       $12.76
94776..............  Ped home apnea rec, downld  ..................  X.................         0097       1.0015       $63.79       $23.79       $12.76
94777..............  Ped home apnea rec, report  ..................  B.................  ...........  ...........  ...........  ...........  ...........
94799..............  Pulmonary service/          ..................  X.................         0367       0.5677       $36.16       $13.76        $7.23
                      procedure.
95004..............  Percut allergy skin tests.  ..................  X.................         0381       0.2773       $17.66  ...........        $3.53
95010..............  Percut allergy titrate      ..................  X.................         0381       0.2773       $17.66  ...........        $3.53
                      test.
95012..............  Exhaled nitric oxide meas.  ..................  X.................         0367       0.5677       $36.16       $13.76        $7.23
95015..............  Id allergy titrate-drug/    ..................  X.................         0381       0.2773       $17.66  ...........        $3.53
                      bug.
95024..............  Id allergy test, drug/bug.  ..................  X.................         0381       0.2773       $17.66  ...........        $3.53
95027..............  Id allergy titrate-         ..................  X.................         0381       0.2773       $17.66  ...........        $3.53
                      airborne.
95028..............  Id allergy test-delayed     ..................  X.................         0381       0.2773       $17.66  ...........        $3.53
                      type.
95044..............  Allergy patch tests.......  ..................  X.................         0381       0.2773       $17.66  ...........        $3.53
95052..............  Photo patch test..........  ..................  X.................         0381       0.2773       $17.66  ...........        $3.53
95056..............  Photosensitivity tests....  ..................  X.................         0370       1.0430       $66.43  ...........       $13.29
95060..............  Eye allergy tests.........  ..................  X.................         0370       1.0430       $66.43  ...........       $13.29
95065..............  Nose allergy test.........  ..................  X.................         0381       0.2773       $17.66  ...........        $3.53
95070..............  Bronchial allergy tests...  ..................  X.................         0369       2.7550      $175.48       $44.18       $35.10
95071..............  Bronchial allergy tests...  ..................  X.................         0369       2.7550      $175.48       $44.18       $35.10
95075..............  Ingestion challenge test..  ..................  X.................         0361       3.9276      $250.16       $83.23       $50.03
95115..............  Immunotherapy, one          ..................  S.................         0436       0.2545       $16.21  ...........        $3.24
                      injection.
95117..............  Immunotherapy injections..  ..................  S.................         0437       0.3945       $25.13  ...........        $5.03
95120..............  Immunotherapy, one          CH................  E.................  ...........  ...........  ...........  ...........  ...........
                      injection.
95125..............  Immunotherapy, many         CH................  E.................  ...........  ...........  ...........  ...........  ...........
                      antigens.
95130..............  Immunotherapy, insect       CH................  E.................  ...........  ...........  ...........  ...........  ...........
                      venom.
95131..............  Immunotherapy, insect       CH................  E.................  ...........  ...........  ...........  ...........  ...........
                      venoms.
95132..............  Immunotherapy, insect       CH................  E.................  ...........  ...........  ...........  ...........  ...........
                      venoms.
95133..............  Immunotherapy, insect       CH................  E.................  ...........  ...........  ...........  ...........  ...........
                      venoms.
95134..............  Immunotherapy, insect       CH................  E.................  ...........  ...........  ...........  ...........  ...........
                      venoms.
95144..............  Antigen therapy services..  ..................  S.................         0437       0.3945       $25.13  ...........        $5.03
95145..............  Antigen therapy services..  ..................  S.................         0437       0.3945       $25.13  ...........        $5.03
95146..............  Antigen therapy services..  ..................  S.................         0437       0.3945       $25.13  ...........        $5.03
95147..............  Antigen therapy services..  ..................  S.................         0437       0.3945       $25.13  ...........        $5.03
95148..............  Antigen therapy services..  ..................  S.................         0437       0.3945       $25.13  ...........        $5.03
95149..............  Antigen therapy services..  ..................  S.................         0437       0.3945       $25.13  ...........        $5.03
95165..............  Antigen therapy services..  ..................  S.................         0437       0.3945       $25.13  ...........        $5.03
95170..............  Antigen therapy services..  ..................  S.................         0437       0.3945       $25.13  ...........        $5.03
95180..............  Rapid desensitization.....  ..................  X.................         0370       1.0430       $66.43  ...........       $13.29
95199..............  Allergy immunology          ..................  X.................         0381       0.2773       $17.66  ...........        $3.53
                      services.
95250..............  Glucose monitoring, cont..  CH................  V.................         0607       1.6604      $105.76  ...........       $21.15
95251..............  Gluc monitor, cont, phys    ..................  B.................  ...........  ...........  ...........  ...........  ...........
                      i&r.
95805..............  Multiple sleep latency      ..................  S.................         0209      11.2822      $718.61      $268.73      $143.72
                      test.
95806..............  Sleep study, unattended...  ..................  S.................         0213       2.2980      $146.37       $53.58       $29.27
95807..............  Sleep study, attended.....  ..................  S.................         0209      11.2822      $718.61      $268.73      $143.72
95808..............  Polysomnography, 1-3......  ..................  S.................         0209      11.2822      $718.61      $268.73      $143.72
95810..............  Polysomnography, 4 or more  ..................  S.................         0209      11.2822      $718.61      $268.73      $143.72
95811..............  Polysomnography w/cpap....  ..................  S.................         0209      11.2822      $718.61      $268.73      $143.72
95812..............  Eeg, 41-60 minutes........  ..................  S.................         0213       2.2980      $146.37       $53.58       $29.27
95813..............  Eeg, over 1 hour..........  ..................  S.................         0213       2.2980      $146.37       $53.58       $29.27
95816..............  Eeg, awake and drowsy.....  ..................  S.................         0213       2.2980      $146.37       $53.58       $29.27
95819..............  Eeg, awake and asleep.....  ..................  S.................         0213       2.2980      $146.37       $53.58       $29.27
95822..............  Eeg, coma or sleep only...  ..................  S.................         0213       2.2980      $146.37       $53.58       $29.27
95824..............  Eeg, cerebral death only..  CH................  S.................         0216       2.6846      $170.99  ...........       $34.20
95827..............  Eeg, all night recording..  ..................  S.................         0213       2.2980      $146.37       $53.58       $29.27
95829..............  Surgery electrocorticogram  CH................  N.................  ...........  ...........  ...........  ...........  ...........
95830..............  Insert electrodes for EEG.  ..................  B.................  ...........  ...........  ...........  ...........  ...........
95831..............  Limb muscle testing,        ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      manual.
95832..............  Hand muscle testing,        ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      manual.
95833..............  Body muscle testing,        ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      manual.
95834..............  Body muscle testing,        ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      manual.
95851..............  Range of motion             ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      measurements.
95852..............  Range of motion             ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      measurements.
95857..............  Tensilon test.............  ..................  S.................         0218       1.1550       $73.57  ...........       $14.71
95860..............  Muscle test, one limb.....  ..................  S.................         0218       1.1550       $73.57  ...........       $14.71
95861..............  Muscle test, 2 limbs......  ..................  S.................         0218       1.1550       $73.57  ...........       $14.71
95863..............  Muscle test, 3 limbs......  ..................  S.................         0218       1.1550       $73.57  ...........       $14.71
95864..............  Muscle test, 4 limbs......  ..................  S.................         0218       1.1550       $73.57  ...........       $14.71
95865..............  Muscle test, larynx.......  ..................  S.................         0218       1.1550       $73.57  ...........       $14.71
95866..............  Muscle test, hemidiaphragm  ..................  S.................         0218       1.1550       $73.57  ...........       $14.71
95867..............  Muscle test cran nerv       ..................  S.................         0218       1.1550       $73.57  ...........       $14.71
                      unilat.
95868..............  Muscle test cran nerve      ..................  S.................         0218       1.1550       $73.57  ...........       $14.71
                      bilat.
95869..............  Muscle test, thor           CH................  S.................         0218       1.1550       $73.57  ...........       $14.71
                      paraspinal.

[[Page 67103]]

 
95870..............  Muscle test, nonparaspinal  ..................  S.................         0215       0.5804       $36.97  ...........        $7.39
95872..............  Muscle test, one fiber....  ..................  S.................         0218       1.1550       $73.57  ...........       $14.71
95873..............  Guide nerv destr, elec      CH................  N.................  ...........  ...........  ...........  ...........  ...........
                      stim.
95874..............  Guide nerv destr, needle    CH................  N.................  ...........  ...........  ...........  ...........  ...........
                      emg.
95875..............  Limb exercise test........  ..................  S.................         0215       0.5804       $36.97  ...........        $7.39
95900..............  Motor nerve conduction      ..................  S.................         0215       0.5804       $36.97  ...........        $7.39
                      test.
95903..............  Motor nerve conduction      ..................  S.................         0215       0.5804       $36.97  ...........        $7.39
                      test.
95904..............  Sense nerve conduction      ..................  S.................         0215       0.5804       $36.97  ...........        $7.39
                      test.
95920..............  Intraop nerve test add-on.  CH................  N.................  ...........  ...........  ...........  ...........  ...........
95921..............  Autonomic nerv function     CH................  S.................         0218       1.1550       $73.57  ...........       $14.71
                      test.
95922..............  Autonomic nerv function     CH................  S.................         0218       1.1550       $73.57  ...........       $14.71
                      test.
95923..............  Autonomic nerv function     CH................  S.................         0218       1.1550       $73.57  ...........       $14.71
                      test.
95925..............  Somatosensory testing.....  ..................  S.................         0216       2.6846      $170.99  ...........       $34.20
95926..............  Somatosensory testing.....  ..................  S.................         0216       2.6846      $170.99  ...........       $34.20
95927..............  Somatosensory testing.....  ..................  S.................         0216       2.6846      $170.99  ...........       $34.20
95928..............  C motor evoked, uppr limbs  ..................  S.................         0218       1.1550       $73.57  ...........       $14.71
95929..............  C motor evoked, lwr limbs.  ..................  S.................         0218       1.1550       $73.57  ...........       $14.71
95930..............  Visual evoked potential     ..................  S.................         0216       2.6846      $170.99  ...........       $34.20
                      test.
95933..............  Blink reflex test.........  ..................  S.................         0215       0.5804       $36.97  ...........        $7.39
95934..............  H-reflex test.............  ..................  S.................         0215       0.5804       $36.97  ...........        $7.39
95936..............  H-reflex test.............  ..................  S.................         0215       0.5804       $36.97  ...........        $7.39
95937..............  Neuromuscular junction      CH................  S.................         0218       1.1550       $73.57  ...........       $14.71
                      test.
95950..............  Ambulatory eeg monitoring.  ..................  S.................         0209      11.2822      $718.61      $268.73      $143.72
95951..............  EEG monitoring/videorecord  ..................  S.................         0209      11.2822      $718.61      $268.73      $143.72
95953..............  EEG monitoring/computer...  ..................  S.................         0209      11.2822      $718.61      $268.73      $143.72
95954..............  EEG monitoring/giving       CH................  S.................         0218       1.1550       $73.57  ...........       $14.71
                      drugs.
95955..............  EEG during surgery........  CH................  N.................  ...........  ...........  ...........  ...........  ...........
95956..............  Eeg monitoring, cable/      ..................  S.................         0209      11.2822      $718.61      $268.73      $143.72
                      radio.
95957..............  EEG digital analysis......  CH................  N.................  ...........  ...........  ...........  ...........  ...........
95958..............  EEG monitoring/function     ..................  S.................         0213       2.2980      $146.37       $53.58       $29.27
                      test.
95961..............  Electrode stimulation,      ..................  S.................         0216       2.6846      $170.99  ...........       $34.20
                      brain.
95962..............  Electrode stim, brain add-  ..................  S.................         0216       2.6846      $170.99  ...........       $34.20
                      on.
95965..............  Meg, spontaneous..........  CH................  S.................         0067      61.6965    $3,929.70  ...........      $785.94
95966..............  Meg, evoked, single.......  CH................  S.................         0065      16.5911    $1,056.75  ...........      $211.35
95967..............  Meg, evoked, each add'l...  CH................  S.................         0065      16.5911    $1,056.75  ...........      $211.35
95970..............  Analyze neurostim, no prog  ..................  S.................         0218       1.1550       $73.57  ...........       $14.71
95971..............  Analyze neurostim, simple.  ..................  S.................         0692       1.8376      $117.04       $29.72       $23.41
95972..............  Analyze neurostim, complex  CH................  S.................         0663       1.5313       $97.53  ...........       $19.51
95973..............  Analyze neurostim, complex  ..................  S.................         0663       1.5313       $97.53  ...........       $19.51
95974..............  Cranial neurostim, complex  CH................  S.................         0663       1.5313       $97.53  ...........       $19.51
95975..............  Cranial neurostim, complex  ..................  S.................         0692       1.8376      $117.04       $29.72       $23.41
95978..............  Analyze neurostim brain/1h  ..................  S.................         0692       1.8376      $117.04       $29.72       $23.41
95979..............  Analyz neurostim brain      ..................  S.................         0663       1.5313       $97.53  ...........       $19.51
                      addon.
95980..............  Io anal gast n-stim init..  NI................  N.................  ...........  ...........  ...........  ...........  ...........
95981..............  Io anal gast n-stim subsq.  NI................  S.................         0218       1.1550       $73.57  ...........       $14.71
95982..............  Io ga n-stim subsq w/       NI................  S.................         0692       1.8376      $117.04       $29.72       $23.41
                      reprog.
95990..............  Spin/brain pump refil &     ..................  T.................         0125       2.3544      $149.96  ...........       $29.99
                      main.
95991..............  Spin/brain pump refil &     ..................  T.................         0125       2.3544      $149.96  ...........       $29.99
                      main.
95999..............  Neurological procedure....  ..................  S.................         0215       0.5804       $36.97  ...........        $7.39
96000..............  Motion analysis, video/3d.  ..................  S.................         0216       2.6846      $170.99  ...........       $34.20
96001..............  Motion test w/ft press      ..................  S.................         0216       2.6846      $170.99  ...........       $34.20
                      meas.
96002..............  Dynamic surface emg.......  ..................  S.................         0218       1.1550       $73.57  ...........       $14.71
96003..............  Dynamic fine wire emg.....  ..................  S.................         0215       0.5804       $36.97  ...........        $7.39
96004..............  Phys review of motion       ..................  B.................  ...........  ...........  ...........  ...........  ...........
                      tests.
96020..............  Functional brain mapping..  CH................  N.................  ...........  ...........  ...........  ...........  ...........
96040..............  Genetic counseling, 30 min  ..................  B.................  ...........  ...........  ...........  ...........  ...........
96101..............  Psycho testing by psych/    CH................  Q.................         0382       2.6169      $166.68  ...........       $33.34
                      phys.
96102..............  Psycho testing by           CH................  Q.................         0382       2.6169      $166.68  ...........       $33.34
                      technician.
96103..............  Psycho testing admin by     CH................  Q.................         0373       1.2448       $79.29  ...........       $15.86
                      comp.
96105..............  Assessment of aphasia.....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
96110..............  Developmental test, lim...  CH................  Q.................         0373       1.2448       $79.29  ...........       $15.86
96111..............  Developmental test, extend  CH................  Q.................         0382       2.6169      $166.68  ...........       $33.34
96116..............  Neurobehavioral status      CH................  Q.................         0382       2.6169      $166.68  ...........       $33.34
                      exam.
96118..............  Neuropsych tst by psych/    CH................  Q.................         0382       2.6169      $166.68  ...........       $33.34
                      phys.
96119..............  Neuropsych testing by tec.  CH................  Q.................         0382       2.6169      $166.68  ...........       $33.34
96120..............  Neuropsych tst admin w/     CH................  Q.................         0373       1.2448       $79.29  ...........       $15.86
                      comp.
96125..............  Cognitive test by hc pro..  NI................  A.................  ...........  ...........  ...........  ...........  ...........
96150..............  Assess hlth/behave, init..  CH................  Q.................         0432       0.3128       $19.92  ...........        $3.98
96151..............  Assess hlth/behave, subseq  CH................  Q.................         0432       0.3128       $19.92  ...........        $3.98
96152..............  Intervene hlth/behave,      CH................  Q.................         0432       0.3128       $19.92  ...........        $3.98
                      indiv.
96153..............  Intervene hlth/behave,      CH................  Q.................         0432       0.3128       $19.92  ...........        $3.98
                      group.
96154..............  Interv hlth/behav, fam w/   CH................  Q.................         0432       0.3128       $19.92  ...........        $3.98
                      pt.
96155..............  Interv hlth/behav fam no    ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      pt.
96401..............  Chemo, anti-neopl, sq/im..  ..................  S.................         0438       0.8041       $51.22  ...........       $10.24
96402..............  Chemo hormon antineopl sq/  ..................  S.................         0438       0.8041       $51.22  ...........       $10.24
                      im.
96405..............  Chemo intralesional, up to  ..................  S.................         0438       0.8041       $51.22  ...........       $10.24
                      7.
96406..............  Chemo intralesional over 7  ..................  S.................         0438       0.8041       $51.22  ...........       $10.24
96409..............  Chemo, iv push, sngl drug.  ..................  S.................         0439       1.6544      $105.38  ...........       $21.08
96411..............  Chemo, iv push, addl drug.  ..................  S.................         0439       1.6544      $105.38  ...........       $21.08
96413..............  Chemo, iv infusion, 1 hr..  ..................  S.................         0441       2.3446      $149.34  ...........       $29.87

[[Page 67104]]

 
96415..............  Chemo, iv infusion, addl    ..................  S.................         0438       0.8041       $51.22  ...........       $10.24
                      hr.
96416..............  Chemo prolong infuse w/     ..................  S.................         0441       2.3446      $149.34  ...........       $29.87
                      pump.
96417..............  Chemo iv infus each addl    ..................  S.................         0438       0.8041       $51.22  ...........       $10.24
                      seq.
96420..............  Chemo, ia, push tecnique..  ..................  S.................         0439       1.6544      $105.38  ...........       $21.08
96422..............  Chemo ia infusion up to 1   ..................  S.................         0441       2.3446      $149.34  ...........       $29.87
                      hr.
96423..............  Chemo ia infuse each addl   ..................  S.................         0438       0.8041       $51.22  ...........       $10.24
                      hr.
96425..............  Chemotherapy,infusion       ..................  S.................         0441       2.3446      $149.34  ...........       $29.87
                      method.
96440..............  Chemotherapy,               ..................  S.................         0441       2.3446      $149.34  ...........       $29.87
                      intracavitary.
96445..............  Chemotherapy,               ..................  S.................         0441       2.3446      $149.34  ...........       $29.87
                      intracavitary.
96450..............  Chemotherapy, into CNS....  ..................  S.................         0441       2.3446      $149.34  ...........       $29.87
96521..............  Refill/maint, portable      ..................  S.................         0440       1.7998      $114.64  ...........       $22.93
                      pump.
96522..............  Refill/maint pump/resvr     ..................  S.................         0440       1.7998      $114.64  ...........       $22.93
                      syst.
96523..............  Irrig drug delivery device  ..................  Q.................         0624       0.5689       $36.24       $12.65        $7.25
96542..............  Chemotherapy injection....  ..................  S.................         0438       0.8041       $51.22  ...........       $10.24
96549..............  Chemotherapy, unspecified.  ..................  S.................         0436       0.2545       $16.21  ...........        $3.24
96567..............  Photodynamic tx, skin.....  CH................  T.................         0013       0.7930       $50.51  ...........       $10.10
96570..............  Photodynamic tx, 30 min...  ..................  T.................         0015       1.4595       $92.96  ...........       $18.59
96571..............  Photodynamic tx, addl 15    ..................  T.................         0015       1.4595       $92.96  ...........       $18.59
                      min.
96900..............  Ultraviolet light therapy.  ..................  S.................         0001       0.4806       $30.61        $7.00        $6.12
96902..............  Trichogram................  ..................  N.................  ...........  ...........  ...........  ...........  ...........
96904..............  Whole body photography....  ..................  N.................  ...........  ...........  ...........  ...........  ...........
96910..............  Photochemotherapy with UV-  ..................  S.................         0001       0.4806       $30.61        $7.00        $6.12
                      B.
96912..............  Photochemotherapy with UV-  ..................  S.................         0001       0.4806       $30.61        $7.00        $6.12
                      A.
96913..............  Photochemotherapy, UV-A or  ..................  S.................         0683       2.6045      $165.89  ...........       $33.18
                      B.
96920..............  Laser tx, skin < 250 sq cm  CH................  T.................         0015       1.4595       $92.96  ...........       $18.59
96921..............  Laser tx, skin 250-500 sq   CH................  T.................         0015       1.4595       $92.96  ...........       $18.59
                      cm.
96922..............  Laser tx, skin > 500 sq cm  CH................  T.................         0015       1.4595       $92.96  ...........       $18.59
96999..............  Dermatological procedure..  CH................  T.................         0012       0.2963       $18.87  ...........        $3.77
97001..............  Pt evaluation.............  ..................  A.................  ...........  ...........  ...........  ...........  ...........
97002..............  Pt re-evaluation..........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
97003..............  Ot evaluation.............  ..................  A.................  ...........  ...........  ...........  ...........  ...........
97004..............  Ot re-evaluation..........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
97005..............  Athletic train eval.......  ..................  E.................  ...........  ...........  ...........  ...........  ...........
97006..............  Athletic train reeval.....  ..................  E.................  ...........  ...........  ...........  ...........  ...........
97010..............  Hot or cold packs therapy.  ..................  A.................  ...........  ...........  ...........  ...........  ...........
97012..............  Mechanical traction         ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      therapy.
97014..............  Electric stimulation        ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      therapy.
97016..............  Vasopneumatic device        ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      therapy.
97018..............  Paraffin bath therapy.....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
97022..............  Whirlpool therapy.........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
97024..............  Diathermy eg, microwave...  ..................  A.................  ...........  ...........  ...........  ...........  ...........
97026..............  Infrared therapy..........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
97028..............  Ultraviolet therapy.......  ..................  A.................  ...........  ...........  ...........  ...........  ...........
97032..............  Electrical stimulation....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
97033..............  Electric current therapy..  ..................  A.................  ...........  ...........  ...........  ...........  ...........
97034..............  Contrast bath therapy.....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
97035..............  Ultrasound therapy........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
97036..............  Hydrotherapy..............  ..................  A.................  ...........  ...........  ...........  ...........  ...........
97039..............  Physical therapy treatment  ..................  A.................  ...........  ...........  ...........  ...........  ...........
97110..............  Therapeutic exercises.....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
97112..............  Neuromuscular reeducation.  ..................  A.................  ...........  ...........  ...........  ...........  ...........
97113..............  Aquatic therapy/exercises.  ..................  A.................  ...........  ...........  ...........  ...........  ...........
97116..............  Gait training therapy.....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
97124..............  Massage therapy...........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
97139..............  Physical medicine           ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      procedure.
97140..............  Manual therapy............  ..................  A.................  ...........  ...........  ...........  ...........  ...........
97150..............  Group therapeutic           ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      procedures.
97530..............  Therapeutic activities....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
97532..............  Cognitive skills            ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      development.
97533..............  Sensory integration.......  ..................  A.................  ...........  ...........  ...........  ...........  ...........
97535..............  Self care mngment training  ..................  A.................  ...........  ...........  ...........  ...........  ...........
97537..............  Community/work              ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      reintegration.
97542..............  Wheelchair mngment          ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      training.
97545..............  Work hardening............  ..................  A.................  ...........  ...........  ...........  ...........  ...........
97546..............  Work hardening add-on.....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
97597..............  Active wound care/20 cm or  CH................  T.................         0015       1.4595       $92.96  ...........       $18.59
                      <.
97598..............  Active wound care > 20 cm.  CH................  T.................         0015       1.4595       $92.96  ...........       $18.59
97602..............  Wound(s) care non-          CH................  T.................         0015       1.4595       $92.96  ...........       $18.59
                      selective.
97605..............  Neg press wound tx, < 50    CH................  T.................         0013       0.7930       $50.51  ...........       $10.10
                      cm.
97606..............  Neg press wound tx, > 50    CH................  T.................         0015       1.4595       $92.96  ...........       $18.59
                      cm.
97750..............  Physical performance test.  ..................  A.................  ...........  ...........  ...........  ...........  ...........
97755..............  Assistive technology        ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      assess.
97760..............  Orthotic mgmt and training  ..................  A.................  ...........  ...........  ...........  ...........  ...........
97761..............  Prosthetic training.......  ..................  A.................  ...........  ...........  ...........  ...........  ...........
97762..............  C/o for orthotic/prosth     ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      use.
97799..............  Physical medicine           ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      procedure.
97802..............  Medical nutrition, indiv,   ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      in.
97803..............  Med nutrition, indiv,       ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      subseq.
97804..............  Medical nutrition, group..  ..................  A.................  ...........  ...........  ...........  ...........  ...........
97810..............  Acupunct w/o stimul 15 min  ..................  E.................  ...........  ...........  ...........  ...........  ...........

[[Page 67105]]

 
97811..............  Acupunct w/o stimul addl    ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      15m.
97813..............  Acupunct w/stimul 15 min..  ..................  E.................  ...........  ...........  ...........  ...........  ...........
97814..............  Acupunct w/stimul addl 15m  ..................  E.................  ...........  ...........  ...........  ...........  ...........
98925..............  Osteopathic manipulation..  ..................  S.................         0060       0.4482       $28.55  ...........        $5.71
98926..............  Osteopathic manipulation..  ..................  S.................         0060       0.4482       $28.55  ...........        $5.71
98927..............  Osteopathic manipulation..  ..................  S.................         0060       0.4482       $28.55  ...........        $5.71
98928..............  Osteopathic manipulation..  ..................  S.................         0060       0.4482       $28.55  ...........        $5.71
98929..............  Osteopathic manipulation..  ..................  S.................         0060       0.4482       $28.55  ...........        $5.71
98940..............  Chiropractic manipulation.  ..................  S.................         0060       0.4482       $28.55  ...........        $5.71
98941..............  Chiropractic manipulation.  ..................  S.................         0060       0.4482       $28.55  ...........        $5.71
98942..............  Chiropractic manipulation.  ..................  S.................         0060       0.4482       $28.55  ...........        $5.71
98943..............  Chiropractic manipulation.  ..................  E.................  ...........  ...........  ...........  ...........  ...........
98960..............  Self-mgmt educ & train, 1   ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      pt.
98961..............  Self-mgmt educ/train, 2-4   ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      pt.
98962..............  Self-mgmt educ/train, 5-8   ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      pt.
98966..............  Hc pro phone call 5-10 min  NI................  E.................  ...........  ...........  ...........  ...........  ...........
98967..............  Hc pro phone call 11-20     NI................  E.................  ...........  ...........  ...........  ...........  ...........
                      min.
98968..............  Hc pro phone call 21-30     NI................  E.................  ...........  ...........  ...........  ...........  ...........
                      min.
98969..............  Online service by hc pro..  NI................  E.................  ...........  ...........  ...........  ...........  ...........
99000..............  Specimen handling.........  ..................  E.................  ...........  ...........  ...........  ...........  ...........
99001..............  Specimen handling.........  ..................  E.................  ...........  ...........  ...........  ...........  ...........
99002..............  Device handling...........  ..................  B.................  ...........  ...........  ...........  ...........  ...........
99024..............  Postop follow-up visit....  ..................  B.................  ...........  ...........  ...........  ...........  ...........
99026..............  In-hospital on call         ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      service.
99027..............  Out-of-hosp on call         ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      service.
99050..............  Medical services after hrs  ..................  B.................  ...........  ...........  ...........  ...........  ...........
99051..............  Med serv, eve/wkend/        ..................  B.................  ...........  ...........  ...........  ...........  ...........
                      holiday.
99053..............  Med serv 10pm-8am, 24 hr    ..................  B.................  ...........  ...........  ...........  ...........  ...........
                      fac.
99056..............  Med service out of office.  ..................  B.................  ...........  ...........  ...........  ...........  ...........
99058..............  Office emergency care.....  ..................  B.................  ...........  ...........  ...........  ...........  ...........
99060..............  Out of office emerg med     ..................  B.................  ...........  ...........  ...........  ...........  ...........
                      serv.
99070..............  Special supplies..........  ..................  B.................  ...........  ...........  ...........  ...........  ...........
99071..............  Patient education           ..................  B.................  ...........  ...........  ...........  ...........  ...........
                      materials.
99075..............  Medical testimony.........  ..................  E.................  ...........  ...........  ...........  ...........  ...........
99078..............  Group health education....  ..................  N.................  ...........  ...........  ...........  ...........  ...........
99080..............  Special reports or forms..  ..................  B.................  ...........  ...........  ...........  ...........  ...........
99082..............  Unusual physician travel..  ..................  B.................  ...........  ...........  ...........  ...........  ...........
99090..............  Computer data analysis....  ..................  B.................  ...........  ...........  ...........  ...........  ...........
99091..............  Collect/review data from    ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      pt.
99100..............  Special anesthesia service  ..................  B.................  ...........  ...........  ...........  ...........  ...........
99116..............  Anesthesia with             ..................  B.................  ...........  ...........  ...........  ...........  ...........
                      hypothermia.
99135..............  Special anesthesia          ..................  B.................  ...........  ...........  ...........  ...........  ...........
                      procedure.
99140..............  Emergency anesthesia......  ..................  B.................  ...........  ...........  ...........  ...........  ...........
99143..............  Mod cs by same phys, < 5    ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      yrs.
99144..............  Mod cs by same phys, 5 yrs  ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      +.
99145..............  Mod cs by same phys add-on  ..................  N.................  ...........  ...........  ...........  ...........  ...........
99148..............  Mod cs diff phys < 5 yrs..  ..................  N.................  ...........  ...........  ...........  ...........  ...........
99149..............  Mod cs diff phys 5 yrs +..  ..................  N.................  ...........  ...........  ...........  ...........  ...........
99150..............  Mod cs diff phys add-on...  ..................  N.................  ...........  ...........  ...........  ...........  ...........
99170..............  Anogenital exam, child....  ..................  T.................         0191       0.1309        $8.34        $2.36        $1.67
99172..............  Ocular function screen....  ..................  E.................  ...........  ...........  ...........  ...........  ...........
99173..............  Visual acuity screen......  ..................  E.................  ...........  ...........  ...........  ...........  ...........
99174..............  Ocular photoscreening.....  NI................  E.................  ...........  ...........  ...........  ...........  ...........
99175..............  Induction of vomiting.....  ..................  N.................  ...........  ...........  ...........  ...........  ...........
99183..............  Hyperbaric oxygen therapy.  ..................  B.................  ...........  ...........  ...........  ...........  ...........
99185..............  Regional hypothermia......  ..................  N.................  ...........  ...........  ...........  ...........  ...........
99186..............  Total body hypothermia....  ..................  N.................  ...........  ...........  ...........  ...........  ...........
99190..............  Special pump services.....  ..................  C.................  ...........  ...........  ...........  ...........  ...........
99191..............  Special pump services.....  ..................  C.................  ...........  ...........  ...........  ...........  ...........
99192..............  Special pump services.....  ..................  C.................  ...........  ...........  ...........  ...........  ...........
99195..............  Phlebotomy................  CH................  X.................         0624       0.5689       $36.24       $12.65        $7.25
99199..............  Special service/proc/       ..................  B.................  ...........  ...........  ...........  ...........  ...........
                      report.
99201..............  Office/outpatient visit,    ..................  V.................         0604       0.8388       $53.43  ...........       $10.69
                      new.
99202..............  Office/outpatient visit,    ..................  V.................         0605       0.9964       $63.46  ...........       $12.69
                      new.
99203..............  Office/outpatient visit,    ..................  V.................         0606       1.3226       $84.24  ...........       $16.85
                      new.
99204..............  Office/outpatient visit,    ..................  V.................         0607       1.6604      $105.76  ...........       $21.15
                      new.
99205..............  Office/outpatient visit,    CH................  Q.................         0608       2.1740      $138.47  ...........       $27.69
                      new.
99211..............  Office/outpatient visit,    ..................  V.................         0604       0.8388       $53.43  ...........       $10.69
                      est.
99212..............  Office/outpatient visit,    ..................  V.................         0605       0.9964       $63.46  ...........       $12.69
                      est.
99213..............  Office/outpatient visit,    ..................  V.................         0605       0.9964       $63.46  ...........       $12.69
                      est.
99214..............  Office/outpatient visit,    ..................  V.................         0606       1.3226       $84.24  ...........       $16.85
                      est.
99215..............  Office/outpatient visit,    CH................  Q.................         0607       1.6604      $105.76  ...........       $21.15
                      est.
99217..............  Observation care discharge  ..................  B.................  ...........  ...........  ...........  ...........  ...........
99218..............  Observation care..........  ..................  B.................  ...........  ...........  ...........  ...........  ...........
99219..............  Observation care..........  ..................  B.................  ...........  ...........  ...........  ...........  ...........
99220..............  Observation care..........  ..................  B.................  ...........  ...........  ...........  ...........  ...........
99221..............  Initial hospital care.....  ..................  B.................  ...........  ...........  ...........  ...........  ...........
99222..............  Initial hospital care.....  ..................  B.................  ...........  ...........  ...........  ...........  ...........
99223..............  Initial hospital care.....  ..................  B.................  ...........  ...........  ...........  ...........  ...........
99231..............  Subsequent hospital care..  ..................  B.................  ...........  ...........  ...........  ...........  ...........

[[Page 67106]]

 
99232..............  Subsequent hospital care..  ..................  B.................  ...........  ...........  ...........  ...........  ...........
99233..............  Subsequent hospital care..  ..................  B.................  ...........  ...........  ...........  ...........  ...........
99234..............  Observ/hosp same date.....  ..................  B.................  ...........  ...........  ...........  ...........  ...........
99235..............  Observ/hosp same date.....  ..................  B.................  ...........  ...........  ...........  ...........  ...........
99236..............  Observ/hosp same date.....  ..................  B.................  ...........  ...........  ...........  ...........  ...........
99238..............  Hospital discharge day....  ..................  B.................  ...........  ...........  ...........  ...........  ...........
99239..............  Hospital discharge day....  ..................  B.................  ...........  ...........  ...........  ...........  ...........
99241..............  Office consultation.......  CH................  B.................  ...........  ...........  ...........  ...........  ...........
99242..............  Office consultation.......  CH................  B.................  ...........  ...........  ...........  ...........  ...........
99243..............  Office consultation.......  CH................  B.................  ...........  ...........  ...........  ...........  ...........
99244..............  Office consultation.......  CH................  B.................  ...........  ...........  ...........  ...........  ...........
99245..............  Office consultation.......  CH................  B.................  ...........  ...........  ...........  ...........  ...........
99251..............  Inpatient consultation....  ..................  C.................  ...........  ...........  ...........  ...........  ...........
99252..............  Inpatient consultation....  ..................  C.................  ...........  ...........  ...........  ...........  ...........
99253..............  Inpatient consultation....  ..................  C.................  ...........  ...........  ...........  ...........  ...........
99254..............  Inpatient consultation....  ..................  C.................  ...........  ...........  ...........  ...........  ...........
99255..............  Inpatient consultation....  ..................  C.................  ...........  ...........  ...........  ...........  ...........
99281..............  Emergency dept visit......  ..................  V.................         0609       0.7970       $50.76       $12.70       $10.15
99282..............  Emergency dept visit......  ..................  V.................         0613       1.3137       $83.67       $21.06       $16.73
99283..............  Emergency dept visit......  ..................  V.................         0614       2.0750      $132.17       $34.50       $26.43
99284..............  Emergency dept visit......  CH................  Q.................         0615       3.3377      $212.59       $48.49       $42.52
99285..............  Emergency dept visit......  CH................  Q.................         0616       4.9535      $315.51       $72.86       $63.10
99288..............  Direct advanced life        ..................  B.................  ...........  ...........  ...........  ...........  ...........
                      support.
99289..............  Ped crit care transport...  ..................  N.................  ...........  ...........  ...........  ...........  ...........
99290..............  Ped crit care transport     ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      addl.
99291..............  Critical care, first hour.  CH................  Q.................         0617       7.3166      $466.02      $111.59       $93.20
99292..............  Critical care, add'l 30     ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      min.
99293..............  Ped critical care, initial  ..................  C.................  ...........  ...........  ...........  ...........  ...........
99294..............  Ped critical care, subseq.  ..................  C.................  ...........  ...........  ...........  ...........  ...........
99295..............  Neonate crit care, initial  ..................  C.................  ...........  ...........  ...........  ...........  ...........
99296..............  Neonate critical care       ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      subseq.
99298..............  Ic for lbw infant < 1500    ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      gm.
99299..............  Ic, lbw infant 1500-2500    ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      gm.
99300..............  Ic, infant pbw 2501-5000    ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      gm.
99304..............  Nursing facility care,      ..................  B.................  ...........  ...........  ...........  ...........  ...........
                      init.
99305..............  Nursing facility care,      ..................  B.................  ...........  ...........  ...........  ...........  ...........
                      init.
99306..............  Nursing facility care,      ..................  B.................  ...........  ...........  ...........  ...........  ...........
                      init.
99307..............  Nursing fac care, subseq..  ..................  B.................  ...........  ...........  ...........  ...........  ...........
99308..............  Nursing fac care, subseq..  ..................  B.................  ...........  ...........  ...........  ...........  ...........
99309..............  Nursing fac care, subseq..  ..................  B.................  ...........  ...........  ...........  ...........  ...........
99310..............  Nursing fac care, subseq..  ..................  B.................  ...........  ...........  ...........  ...........  ...........
99315..............  Nursing fac discharge day.  ..................  B.................  ...........  ...........  ...........  ...........  ...........
99316..............  Nursing fac discharge day.  ..................  B.................  ...........  ...........  ...........  ...........  ...........
99318..............  Annual nursing fac          ..................  B.................  ...........  ...........  ...........  ...........  ...........
                      assessmnt.
99324..............  Domicil/r-home visit new    ..................  B.................  ...........  ...........  ...........  ...........  ...........
                      pat.
99325..............  Domicil/r-home visit new    ..................  B.................  ...........  ...........  ...........  ...........  ...........
                      pat.
99326..............  Domicil/r-home visit new    ..................  B.................  ...........  ...........  ...........  ...........  ...........
                      pat.
99327..............  Domicil/r-home visit new    ..................  B.................  ...........  ...........  ...........  ...........  ...........
                      pat.
99328..............  Domicil/r-home visit new    ..................  B.................  ...........  ...........  ...........  ...........  ...........
                      pat.
99334..............  Domicil/r-home visit est    ..................  B.................  ...........  ...........  ...........  ...........  ...........
                      pat.
99335..............  Domicil/r-home visit est    ..................  B.................  ...........  ...........  ...........  ...........  ...........
                      pat.
99336..............  Domicil/r-home visit est    ..................  B.................  ...........  ...........  ...........  ...........  ...........
                      pat.
99337..............  Domicil/r-home visit est    ..................  B.................  ...........  ...........  ...........  ...........  ...........
                      pat.
99339..............  Domicil/r-home care         ..................  B.................  ...........  ...........  ...........  ...........  ...........
                      supervis.
99340..............  Domicil/r-home care         ..................  B.................  ...........  ...........  ...........  ...........  ...........
                      supervis.
99341..............  Home visit, new patient...  ..................  B.................  ...........  ...........  ...........  ...........  ...........
99342..............  Home visit, new patient...  ..................  B.................  ...........  ...........  ...........  ...........  ...........
99343..............  Home visit, new patient...  ..................  B.................  ...........  ...........  ...........  ...........  ...........
99344..............  Home visit, new patient...  ..................  B.................  ...........  ...........  ...........  ...........  ...........
99345..............  Home visit, new patient...  ..................  B.................  ...........  ...........  ...........  ...........  ...........
99347..............  Home visit, est patient...  ..................  B.................  ...........  ...........  ...........  ...........  ...........
99348..............  Home visit, est patient...  ..................  B.................  ...........  ...........  ...........  ...........  ...........
99349..............  Home visit, est patient...  ..................  B.................  ...........  ...........  ...........  ...........  ...........
99350..............  Home visit, est patient...  ..................  B.................  ...........  ...........  ...........  ...........  ...........
99354..............  Prolonged service, office.  ..................  N.................  ...........  ...........  ...........  ...........  ...........
99355..............  Prolonged service, office.  ..................  N.................  ...........  ...........  ...........  ...........  ...........
99356..............  Prolonged service,          ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      inpatient.
99357..............  Prolonged service,          ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      inpatient.
99358..............  Prolonged serv, w/o         ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      contact.
99359..............  Prolonged serv, w/o         ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      contact.
99360..............  Physician standby services  ..................  B.................  ...........  ...........  ...........  ...........  ...........
99361..............  Physician/team conference.  CH................  D.................  ...........  ...........  ...........  ...........  ...........
99362..............  Physician/team conference.  CH................  D.................  ...........  ...........  ...........  ...........  ...........
99363..............  Anticoag mgmt, init.......  ..................  B.................  ...........  ...........  ...........  ...........  ...........
99364..............  Anticoag mgmt, subseq.....  ..................  B.................  ...........  ...........  ...........  ...........  ...........
99366..............  Team conf w/pat by hc pro.  NI................  N.................  ...........  ...........  ...........  ...........  ...........
99367..............  Team conf w/o pat by phys.  NI................  N.................  ...........  ...........  ...........  ...........  ...........
99368..............  Team conf w/o pat by hc     NI................  N.................  ...........  ...........  ...........  ...........  ...........
                      pro.
99371..............  Physician phone             CH................  D.................  ...........  ...........  ...........  ...........  ...........
                      consultation.
99372..............  Physician phone             CH................  D.................  ...........  ...........  ...........  ...........  ...........
                      consultation.

[[Page 67107]]

 
99373..............  Physician phone             CH................  D.................  ...........  ...........  ...........  ...........  ...........
                      consultation.
99374..............  Home health care            ..................  B.................  ...........  ...........  ...........  ...........  ...........
                      supervision.
99375..............  Home health care            ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      supervision.
99377..............  Hospice care supervision..  ..................  B.................  ...........  ...........  ...........  ...........  ...........
99378..............  Hospice care supervision..  ..................  E.................  ...........  ...........  ...........  ...........  ...........
99379..............  Nursing fac care            ..................  B.................  ...........  ...........  ...........  ...........  ...........
                      supervision.
99380..............  Nursing fac care            ..................  B.................  ...........  ...........  ...........  ...........  ...........
                      supervision.
99381..............  Init pm e/m, new pat, inf.  ..................  E.................  ...........  ...........  ...........  ...........  ...........
99382..............  Init pm e/m, new pat 1-4    ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      yrs.
99383..............  Prev visit, new, age 5-11.  ..................  E.................  ...........  ...........  ...........  ...........  ...........
99384..............  Prev visit, new, age 12-17  ..................  E.................  ...........  ...........  ...........  ...........  ...........
99385..............  Prev visit, new, age 18-39  ..................  E.................  ...........  ...........  ...........  ...........  ...........
99386..............  Prev visit, new, age 40-64  ..................  E.................  ...........  ...........  ...........  ...........  ...........
99387..............  Init pm e/m, new pat 65+    ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      yrs.
99391..............  Per pm reeval, est pat,     ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      inf.
99392..............  Prev visit, est, age 1-4..  ..................  E.................  ...........  ...........  ...........  ...........  ...........
99393..............  Prev visit, est, age 5-11.  ..................  E.................  ...........  ...........  ...........  ...........  ...........
99394..............  Prev visit, est, age 12-17  ..................  E.................  ...........  ...........  ...........  ...........  ...........
99395..............  Prev visit, est, age 18-39  ..................  E.................  ...........  ...........  ...........  ...........  ...........
99396..............  Prev visit, est, age 40-64  ..................  E.................  ...........  ...........  ...........  ...........  ...........
99397..............  Per pm reeval est pat 65+   ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      yr.
99401..............  Preventive counseling,      ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      indiv.
99402..............  Preventive counseling,      ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      indiv.
99403..............  Preventive counseling,      ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      indiv.
99404..............  Preventive counseling,      ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      indiv.
99406..............  Behav chng smoking 3-10     NI................  X.................         0031       0.1648       $10.50  ...........        $2.10
                      min.
99407..............  Behav chng smoking < 10     NI................  X.................         0031       0.1648       $10.50  ...........        $2.10
                      min.
99408..............  Audit/dast, 15-30 min.....  NI................  E.................  ...........  ...........  ...........  ...........  ...........
99409..............  Audit/dast, over 30 min...  NI................  E.................  ...........  ...........  ...........  ...........  ...........
99411..............  Preventive counseling,      ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      group.
99412..............  Preventive counseling,      ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      group.
99420..............  Health risk assessment      ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      test.
99429..............  Unlisted preventive         ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      service.
99431..............  Initial care, normal        ..................  V.................         0605       0.9964       $63.46  ...........       $12.69
                      newborn.
99432..............  Newborn care, not in hosp.  ..................  N.................  ...........  ...........  ...........  ...........  ...........
99433..............  Normal newborn care/        ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      hospital.
99435..............  Newborn discharge day hosp  ..................  B.................  ...........  ...........  ...........  ...........  ...........
99436..............  Attendance, birth.........  ..................  N.................  ...........  ...........  ...........  ...........  ...........
99440..............  Newborn resuscitation.....  ..................  S.................         0094       2.4590      $156.62       $46.29       $31.32
99441..............  Phone e/m by phys 5-10 min  NI................  E.................  ...........  ...........  ...........  ...........  ...........
99442..............  Phone e/m by phys 11-20     NI................  E.................  ...........  ...........  ...........  ...........  ...........
                      min.
99443..............  Phone e/m by phys 21-30     NI................  E.................  ...........  ...........  ...........  ...........  ...........
                      min.
99444..............  Online e/m by phys........  NI................  E.................  ...........  ...........  ...........  ...........  ...........
99450..............  Basic life disability exam  ..................  E.................  ...........  ...........  ...........  ...........  ...........
99455..............  Work related disability     ..................  B.................  ...........  ...........  ...........  ...........  ...........
                      exam.
99456..............  Disability examination....  ..................  B.................  ...........  ...........  ...........  ...........  ...........
99477..............  Init day hosp neonate care  NI................  C.................  ...........  ...........  ...........  ...........  ...........
99499..............  Unlisted e&m service......  ..................  B.................  ...........  ...........  ...........  ...........  ...........
99500..............  Home visit, prenatal......  ..................  E.................  ...........  ...........  ...........  ...........  ...........
99501..............  Home visit, postnatal.....  ..................  E.................  ...........  ...........  ...........  ...........  ...........
99502..............  Home visit, nb care.......  ..................  E.................  ...........  ...........  ...........  ...........  ...........
99503..............  Home visit, resp therapy..  ..................  E.................  ...........  ...........  ...........  ...........  ...........
99504..............  Home visit mech ventilator  ..................  E.................  ...........  ...........  ...........  ...........  ...........
99505..............  Home visit, stoma care....  ..................  E.................  ...........  ...........  ...........  ...........  ...........
99506..............  Home visit, im injection..  ..................  E.................  ...........  ...........  ...........  ...........  ...........
99507..............  Home visit, cath maintain.  ..................  E.................  ...........  ...........  ...........  ...........  ...........
99509..............  Home visit day life         ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      activity.
99510..............  Home visit, sing/m/fam      ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      couns.
99511..............  Home visit, fecal/enema     ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      mgmt.
99512..............  Home visit for              ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      hemodialysis.
99600..............  Home visit nos............  ..................  E.................  ...........  ...........  ...........  ...........  ...........
99601..............  Home infusion/visit, 2 hrs  ..................  E.................  ...........  ...........  ...........  ...........  ...........
99602..............  Home infusion, each addtl   ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      hr.
99605..............  Mtms by pharm, np, 15 min.  NI................  E.................  ...........  ...........  ...........  ...........  ...........
99606..............  Mtms by pharm, est, 15 min  NI................  E.................  ...........  ...........  ...........  ...........  ...........
99607..............  Mtms by pharm, addl 15 min  NI................  E.................  ...........  ...........  ...........  ...........  ...........
A0021..............  Outside state ambulance     ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      serv.
A0080..............  Noninterest escort in non   ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      er.
A0090..............  Interest escort in non er.  ..................  E.................  ...........  ...........  ...........  ...........  ...........
A0100..............  Nonemergency transport      ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      taxi.
A0110..............  Nonemergency transport bus  ..................  E.................  ...........  ...........  ...........  ...........  ...........
A0120..............  Noner transport mini-bus..  ..................  E.................  ...........  ...........  ...........  ...........  ...........
A0130..............  Noner transport wheelch     ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      van.
A0140..............  Nonemergency transport air  ..................  E.................  ...........  ...........  ...........  ...........  ...........
A0160..............  Noner transport case        ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      worker.
A0170..............  Transport parking fees/     ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      tolls.
A0180..............  Noner transport lodgng      ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      recip.
A0190..............  Noner transport meals       ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      recip.
A0200..............  Noner transport lodgng      ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      escrt.
A0210..............  Noner transport meals       ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      escort.

[[Page 67108]]

 
A0225..............  Neonatal emergency          CH................  E.................  ...........  ...........  ...........  ...........  ...........
                      transport.
A0380..............  Basic life support mileage  CH................  E.................  ...........  ...........  ...........  ...........  ...........
A0382..............  Basic support routine       ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      suppls.
A0384..............  Bls defibrillation          ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      supplies.
A0390..............  Advanced life support       CH................  E.................  ...........  ...........  ...........  ...........  ...........
                      mileag.
A0392..............  Als defibrillation          ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      supplies.
A0394..............  Als IV drug therapy         ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      supplies.
A0396..............  Als esophageal intub        ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      suppls.
A0398..............  Als routine disposble       ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      suppls.
A0420..............  Ambulance waiting 1/2 hr..  ..................  A.................  ...........  ...........  ...........  ...........  ...........
A0422..............  Ambulance 02 life           ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      sustaining.
A0424..............  Extra ambulance attendant.  ..................  A.................  ...........  ...........  ...........  ...........  ...........
A0425..............  Ground mileage............  ..................  A.................  ...........  ...........  ...........  ...........  ...........
A0426..............  Als 1.....................  ..................  A.................  ...........  ...........  ...........  ...........  ...........
A0427..............  ALS1-emergency............  ..................  A.................  ...........  ...........  ...........  ...........  ...........
A0428..............  bls.......................  ..................  A.................  ...........  ...........  ...........  ...........  ...........
A0429..............  BLS-emergency.............  ..................  A.................  ...........  ...........  ...........  ...........  ...........
A0430..............  Fixed wing air transport..  ..................  A.................  ...........  ...........  ...........  ...........  ...........
A0431..............  Rotary wing air transport.  ..................  A.................  ...........  ...........  ...........  ...........  ...........
A0432..............  PI volunteer ambulance co.  ..................  A.................  ...........  ...........  ...........  ...........  ...........
A0433..............  als 2.....................  ..................  A.................  ...........  ...........  ...........  ...........  ...........
A0434..............  Specialty care transport..  ..................  A.................  ...........  ...........  ...........  ...........  ...........
A0435..............  Fixed wing air mileage....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
A0436..............  Rotary wing air mileage...  ..................  A.................  ...........  ...........  ...........  ...........  ...........
A0888..............  Noncovered ambulance        ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      mileage.
A0998..............  Ambulance response/         ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      treatment.
A0999..............  Unlisted ambulance service  ..................  A.................  ...........  ...........  ...........  ...........  ...........
A4206..............  1 CC sterile                ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      syringe&needle.
A4207..............  2 CC sterile                ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      syringe&needle.
A4208..............  3 CC sterile                ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      syringe&needle.
A4209..............  5+ CC sterile               ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      syringe&needle.
A4210..............  Nonneedle injection device  ..................  E.................  ...........  ...........  ...........  ...........  ...........
A4211..............  Supp for self-adm           ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      injections.
A4212..............  Non coring needle or        ..................  B.................  ...........  ...........  ...........  ...........  ...........
                      stylet.
A4213..............  20+ CC syringe only.......  ..................  E.................  ...........  ...........  ...........  ...........  ...........
A4215..............  Sterile needle............  ..................  E.................  ...........  ...........  ...........  ...........  ...........
A4216..............  Sterile water/saline, 10    ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      ml.
A4217..............  Sterile water/saline, 500   ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      ml.
A4218..............  Sterile saline or water...  ..................  N.................  ...........  ...........  ...........  ...........  ...........
A4220..............  Infusion pump refill kit..  ..................  N.................  ...........  ...........  ...........  ...........  ...........
A4221..............  Maint drug infus cath per   ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      wk.
A4222..............  Infusion supplies with      ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      pump.
A4223..............  Infusion supplies w/o pump  ..................  E.................  ...........  ...........  ...........  ...........  ...........
A4230..............  Infus insulin pump non      ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      needl.
A4231..............  Infusion insulin pump       ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      needle.
A4232..............  Syringe w/needle insulin    ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      3cc.
A4233..............  Alkalin batt for glucose    ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      mon.
A4234..............  J-cell batt for glucose     ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      mon.
A4235..............  Lithium batt for glucose    ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      mon.
A4236..............  Silvr oxide batt glucose    ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      mon.
A4244..............  Alcohol or peroxide per     ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      pint.
A4245..............  Alcohol wipes per box.....  ..................  E.................  ...........  ...........  ...........  ...........  ...........
A4246..............  Betadine/phisohex solution  ..................  E.................  ...........  ...........  ...........  ...........  ...........
A4247..............  Betadine/iodine swabs/      ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      wipes.
A4248..............  Chlorhexidine antisept....  ..................  N.................  ...........  ...........  ...........  ...........  ...........
A4250..............  Urine reagent strips/       ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      tablets.
A4252..............  Blood ketone test or strip  NI................  E.................  ...........  ...........  ...........  ...........  ...........
A4253..............  Blood glucose/reagent       ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      strips.
A4255..............  Glucose monitor platforms.  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
A4256..............  Calibrator solution/chips.  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
A4257..............  Replace Lensshield          ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      Cartridge.
A4258..............  Lancet device each........  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
A4259..............  Lancets per box...........  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
A4261..............  Cervical cap contraceptive  ..................  E.................  ...........  ...........  ...........  ...........  ...........
A4262..............  Temporary tear duct plug..  ..................  N.................  ...........  ...........  ...........  ...........  ...........
A4263..............  Permanent tear duct plug..  ..................  N.................  ...........  ...........  ...........  ...........  ...........
A4265..............  Paraffin..................  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
A4266..............  Diaphragm.................  ..................  E.................  ...........  ...........  ...........  ...........  ...........
A4267..............  Male condom...............  ..................  E.................  ...........  ...........  ...........  ...........  ...........
A4268..............  Female condom.............  ..................  E.................  ...........  ...........  ...........  ...........  ...........
A4269..............  Spermicide................  ..................  E.................  ...........  ...........  ...........  ...........  ...........
A4270..............  Disposable endoscope        ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      sheath.
A4280..............  Brst prsths adhsv attchmnt  ..................  A.................  ...........  ...........  ...........  ...........  ...........
A4281..............  Replacement breastpump      ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      tube.
A4282..............  Replacement breastpump      ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      adpt.
A4283..............  Replacement breastpump cap  ..................  E.................  ...........  ...........  ...........  ...........  ...........
A4284..............  Replcmnt breast pump        ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      shield.
A4285..............  Replcmnt breast pump        ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      bottle.
A4286..............  Replcmnt breastpump lok     ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      ring.
A4290..............  Sacral nerve stim test      ..................  B.................  ...........  ...........  ...........  ...........  ...........
                      lead.

[[Page 67109]]

 
A4300..............  Cath impl vasc access       ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      portal.
A4301..............  Implantable access syst     ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      perc.
A4305..............  Drug delivery system >=50   ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      ML.
A4306..............  Drug delivery system <=50   ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      ml.
A4310..............  Insert tray w/o bag/cath..  ..................  A.................  ...........  ...........  ...........  ...........  ...........
A4311..............  Catheter w/o bag 2-way      ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      latex.
A4312..............  Cath w/o bag 2-way          ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      silicone.
A4313..............  Catheter w/bag 3-way......  ..................  A.................  ...........  ...........  ...........  ...........  ...........
A4314..............  Cath w/drainage 2-way       ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      latex.
A4315..............  Cath w/drainage 2-way       ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      silcne.
A4316..............  Cath w/drainage 3-way.....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
A4320..............  Irrigation tray...........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
A4321..............  Cath therapeutic irrig      ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      agent.
A4322..............  Irrigation syringe........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
A4326..............  Male external catheter....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
A4327..............  Fem urinary collect dev     ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      cup.
A4328..............  Fem urinary collect pouch.  ..................  A.................  ...........  ...........  ...........  ...........  ...........
A4330..............  Stool collection pouch....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
A4331..............  Extension drainage tubing.  ..................  A.................  ...........  ...........  ...........  ...........  ...........
A4332..............  Lube sterile packet.......  ..................  A.................  ...........  ...........  ...........  ...........  ...........
A4333..............  Urinary cath anchor device  ..................  A.................  ...........  ...........  ...........  ...........  ...........
A4334..............  Urinary cath leg strap....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
A4335..............  Incontinence supply.......  ..................  A.................  ...........  ...........  ...........  ...........  ...........
A4338..............  Indwelling catheter latex.  ..................  A.................  ...........  ...........  ...........  ...........  ...........
A4340..............  Indwelling catheter         ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      special.
A4344..............  Cath indw foley 2 way       ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      silicn.
A4346..............  Cath indw foley 3 way.....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
A4349..............  Disposable male external    ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      cat.
A4351..............  Straight tip urine          ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      catheter.
A4352..............  Coude tip urinary catheter  ..................  A.................  ...........  ...........  ...........  ...........  ...........
A4353..............  Intermittent urinary cath.  ..................  A.................  ...........  ...........  ...........  ...........  ...........
A4354..............  Cath insertion tray w/bag.  ..................  A.................  ...........  ...........  ...........  ...........  ...........
A4355..............  Bladder irrigation tubing.  ..................  A.................  ...........  ...........  ...........  ...........  ...........
A4356..............  Ext ureth clmp or compr     ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      dvc.
A4357..............  Bedside drainage bag......  ..................  A.................  ...........  ...........  ...........  ...........  ...........
A4358..............  Urinary leg or abdomen bag  ..................  A.................  ...........  ...........  ...........  ...........  ...........
A4361..............  Ostomy face plate.........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
A4362..............  Solid skin barrier........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
A4363..............  Ostomy clamp, replacement.  ..................  A.................  ...........  ...........  ...........  ...........  ...........
A4364..............  Adhesive, liquid or equal.  ..................  A.................  ...........  ...........  ...........  ...........  ...........
A4365..............  Adhesive remover wipes....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
A4366..............  Ostomy vent...............  ..................  A.................  ...........  ...........  ...........  ...........  ...........
A4367..............  Ostomy belt...............  ..................  A.................  ...........  ...........  ...........  ...........  ...........
A4368..............  Ostomy filter.............  ..................  A.................  ...........  ...........  ...........  ...........  ...........
A4369..............  Skin barrier liquid per oz  ..................  A.................  ...........  ...........  ...........  ...........  ...........
A4371..............  Skin barrier powder per oz  ..................  A.................  ...........  ...........  ...........  ...........  ...........
A4372..............  Skin barrier solid 4x4      ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      equiv.
A4373..............  Skin barrier with flange..  ..................  A.................  ...........  ...........  ...........  ...........  ...........
A4375..............  Drainable plastic pch w     ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      fcpl.
A4376..............  Drainable rubber pch w      ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      fcplt.
A4377..............  Drainable plstic pch w/o    ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      fp.
A4378..............  Drainable rubber pch w/o    ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      fp.
A4379..............  Urinary plastic pouch w     ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      fcpl.
A4380..............  Urinary rubber pouch w      ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      fcplt.
A4381..............  Urinary plastic pouch w/o   ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      fp.
A4382..............  Urinary hvy plstc pch w/o   ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      fp.
A4383..............  Urinary rubber pouch w/o    ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      fp.
A4384..............  Ostomy faceplt/silicone     ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      ring.
A4385..............  Ost skn barrier sld ext     ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      wear.
A4387..............  Ost clsd pouch w att st     ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      barr.
A4388..............  Drainable pch w ex wear     ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      barr.
A4389..............  Drainable pch w st wear     ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      barr.
A4390..............  Drainable pch ex wear       ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      convex.
A4391..............  Urinary pouch w ex wear     ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      barr.
A4392..............  Urinary pouch w st wear     ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      barr.
A4393..............  Urine pch w ex wear bar     ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      conv.
A4394..............  Ostomy pouch liq deodorant  ..................  A.................  ...........  ...........  ...........  ...........  ...........
A4395..............  Ostomy pouch solid          ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      deodorant.
A4396..............  Peristomal hernia supprt    ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      blt.
A4397..............  Irrigation supply sleeve..  ..................  A.................  ...........  ...........  ...........  ...........  ...........
A4398..............  Ostomy irrigation bag.....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
A4399..............  Ostomy irrig cone/cath w    ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      brs.
A4400..............  Ostomy irrigation set.....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
A4402..............  Lubricant per ounce.......  ..................  A.................  ...........  ...........  ...........  ...........  ...........
A4404..............  Ostomy ring each..........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
A4405..............  Nonpectin based ostomy      ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      paste.
A4406..............  Pectin based ostomy paste.  ..................  A.................  ...........  ...........  ...........  ...........  ...........
A4407..............  Ext wear ost skn barr       ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      <=4sq*.
A4408..............  Ext wear ost skn barr >4sq  ..................  A.................  ...........  ...........  ...........  ...........  ...........
A4409..............  Ost skn barr convex <=4 sq  ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      i.

[[Page 67110]]

 
A4410..............  Ost skn barr extnd >4 sq..  ..................  A.................  ...........  ...........  ...........  ...........  ...........
A4411..............  Ost skn barr extnd =4sq...  ..................  A.................  ...........  ...........  ...........  ...........  ...........
A4412..............  Ost pouch drain high        ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      output.
A4413..............  2 pc drainable ost pouch..  ..................  A.................  ...........  ...........  ...........  ...........  ...........
A4414..............  Ost sknbar w/o conv<=4 sq   ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      in.
A4415..............  Ost skn barr w/o conv >4    ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      sqi.
A4416..............  Ost pch clsd w barrier/     ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      filtr.
A4417..............  Ost pch w bar/bltinconv/    ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      fltr.
A4418..............  Ost pch clsd w/o bar w      ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      filtr.
A4419..............  Ost pch for bar w flange/   ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      flt.
A4420..............  Ost pch clsd for bar w lk   ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      fl.
A4421..............  Ostomy supply misc........  ..................  E.................  ...........  ...........  ...........  ...........  ...........
A4422..............  Ost pouch absorbent         ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      material.
A4423..............  Ost pch for bar w lk fl/    ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      fltr.
A4424..............  Ost pch drain w bar &       ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      filter.
A4425..............  Ost pch drain for barrier   ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      fl.
A4426..............  Ost pch drain 2 piece       ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      system.
A4427..............  Ost pch drain/barr lk flng/ ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      f.
A4428..............  Urine ost pouch w faucet/   ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      tap.
A4429..............  Urine ost pouch w           ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      bltinconv.
A4430..............  Ost urine pch w b/bltin     ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      conv.
A4431..............  Ost pch urine w barrier/    ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      tapv.
A4432..............  Os pch urine w bar/fange/   ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      tap.
A4433..............  Urine ost pch bar w lock    ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      fln.
A4434..............  Ost pch urine w lock flng/  ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      ft.
A4450..............  Non-waterproof tape.......  ..................  A.................  ...........  ...........  ...........  ...........  ...........
A4452..............  Waterproof tape...........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
A4455..............  Adhesive remover per ounce  ..................  A.................  ...........  ...........  ...........  ...........  ...........
A4458..............  Reusable enema bag........  ..................  E.................  ...........  ...........  ...........  ...........  ...........
A4461..............  Surgicl dress hold non-     ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      reuse.
A4463..............  Surgical dress holder       ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      reuse.
A4465..............  Non-elastic extremity       ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      binder.
A4470..............  Gravlee jet washer........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
A4480..............  Vabra aspirator...........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
A4481..............  Tracheostoma filter.......  ..................  A.................  ...........  ...........  ...........  ...........  ...........
A4483..............  Moisture exchanger........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
A4490..............  Above knee surgical         ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      stocking.
A4495..............  Thigh length surg stocking  ..................  E.................  ...........  ...........  ...........  ...........  ...........
A4500..............  Below knee surgical         ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      stocking.
A4510..............  Full length surg stocking.  ..................  E.................  ...........  ...........  ...........  ...........  ...........
A4520..............  Incontinence garment        ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      anytype.
A4550..............  Surgical trays............  ..................  B.................  ...........  ...........  ...........  ...........  ...........
A4554..............  Disposable underpads......  ..................  E.................  ...........  ...........  ...........  ...........  ...........
A4556..............  Electrodes, pair..........  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
A4557..............  Lead wires, pair..........  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
A4558..............  Conductive gel or paste...  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
A4559..............  Coupling gel or paste.....  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
A4561..............  Pessary rubber, any type..  ..................  N.................  ...........  ...........  ...........  ...........  ...........
A4562..............  Pessary, non rubber,any     ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      type.
A4565..............  Slings....................  ..................  A.................  ...........  ...........  ...........  ...........  ...........
A4570..............  Splint....................  ..................  E.................  ...........  ...........  ...........  ...........  ...........
A4575..............  Hyperbaric o2 chamber       ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      disps.
A4580..............  Cast supplies (plaster)...  ..................  E.................  ...........  ...........  ...........  ...........  ...........
A4590..............  Special casting material..  ..................  E.................  ...........  ...........  ...........  ...........  ...........
A4595..............  TENS suppl 2 lead per       ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      month.
A4600..............  Sleeve, inter limb comp     ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      dev.
A4601..............  Lith ion batt, non-pros     ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      use.
A4604..............  Tubing with heating         ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      element.
A4605..............  Trach suction cath close    ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      sys.
A4606..............  Oxygen probe used w         ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      oximeter.
A4608..............  Transtracheal oxygen cath.  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
A4611..............  Heavy duty battery........  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
A4612..............  Battery cables............  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
A4613..............  Battery charger...........  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
A4614..............  Hand-held PEFR meter......  ..................  N.................  ...........  ...........  ...........  ...........  ...........
A4615..............  Cannula nasal.............  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
A4616..............  Tubing (oxygen) per foot..  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
A4617..............  Mouth piece...............  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
A4618..............  Breathing circuits........  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
A4619..............  Face tent.................  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
A4620..............  Variable concentration      ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      mask.
A4623..............  Tracheostomy inner cannula  ..................  A.................  ...........  ...........  ...........  ...........  ...........
A4624..............  Tracheal suction tube.....  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
A4625..............  Trach care kit for new      ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      trach.
A4626..............  Tracheostomy cleaning       ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      brush.
A4627..............  Spacer bag/reservoir......  ..................  E.................  ...........  ...........  ...........  ...........  ...........
A4628..............  Oropharyngeal suction cath  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
A4629..............  Tracheostomy care kit.....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
A4630..............  Repl bat t.e.n.s. own by    ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      pt.
A4633..............  Uvl replacement bulb......  ..................  Y.................  ...........  ...........  ...........  ...........  ...........

[[Page 67111]]

 
A4634..............  Replacement bulb th         ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      lightbox.
A4635..............  Underarm crutch pad.......  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
A4636..............  Handgrip for cane etc.....  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
A4637..............  Repl tip cane/crutch/       ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      walker.
A4638..............  Repl batt pulse gen sys...  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
A4639..............  Infrared ht sys replcmnt    ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      pad.
A4640..............  Alternating pressure pad..  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
A4641..............  Radiopharm dx agent noc...  ..................  N.................  ...........  ...........  ...........  ...........  ...........
A4642..............  In111 satumomab...........  CH................  N.................  ...........  ...........  ...........  ...........  ...........
A4648..............  Implantable tissue marker.  NI................  N.................  ...........  ...........  ...........  ...........  ...........
A4649..............  Surgical supplies.........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
A4650..............  Implant radiation           NI................  N.................  ...........  ...........  ...........  ...........  ...........
                      dosimeter.
A4651..............  Calibrated microcap tube..  ..................  A.................  ...........  ...........  ...........  ...........  ...........
A4652..............  Microcapillary tube         ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      sealant.
A4653..............  PD catheter anchor belt...  ..................  A.................  ...........  ...........  ...........  ...........  ...........
A4657..............  Syringe w/wo needle.......  ..................  A.................  ...........  ...........  ...........  ...........  ...........
A4660..............  Sphyg/bp app w cuff and     ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      stet.
A4663..............  Dialysis blood pressure     ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      cuff.
A4670..............  Automatic bp monitor, dial  ..................  E.................  ...........  ...........  ...........  ...........  ...........
A4671..............  Disposable cycler set.....  ..................  B.................  ...........  ...........  ...........  ...........  ...........
A4672..............  Drainage ext line,          ..................  B.................  ...........  ...........  ...........  ...........  ...........
                      dialysis.
A4673..............  Ext line w easy lock        ..................  B.................  ...........  ...........  ...........  ...........  ...........
                      connect.
A4674..............  Chem/antisept solution,     ..................  B.................  ...........  ...........  ...........  ...........  ...........
                      8oz.
A4680..............  Activated carbon filter,    ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      ea.
A4690..............  Dialyzer, each............  ..................  A.................  ...........  ...........  ...........  ...........  ...........
A4706..............  Bicarbonate conc sol per    ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      gal.
A4707..............  Bicarbonate conc pow per    ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      pac.
A4708..............  Acetate conc sol per        ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      gallon.
A4709..............  Acid conc sol per gallon..  ..................  A.................  ...........  ...........  ...........  ...........  ...........
A4714..............  Treated water per gallon..  ..................  A.................  ...........  ...........  ...........  ...........  ...........
A4719..............  Y set tubing.
A4720..............  Dialysat sol fld vol >      ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      249cc.
A4721..............  Dialysat sol fld vol >      ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      999cc.
A4722..............  Dialys sol fld vol >        ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      1999cc.
A4723..............  Dialys sol fld vol >        ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      2999cc.
A4724..............  Dialys sol fld vol >        ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      3999cc.
A4725..............  Dialys sol fld vol >        ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      4999cc.
A4726..............  Dialys sol fld vol >        ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      5999cc.
A4728..............  Dialysate solution, non-    ..................  B.................  ...........  ...........  ...........  ...........  ...........
                      dex.
A4730..............  Fistula cannulation set,    ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      ea.
A4736..............  Topical anesthetic, per     ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      gram.
A4737..............  Inj anesthetic per 10 ml..  ..................  A.................  ...........  ...........  ...........  ...........  ...........
A4740..............  Shunt accessory...........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
A4750..............  Art or venous blood tubing  ..................  A.................  ...........  ...........  ...........  ...........  ...........
A4755..............  Comb art/venous blood       ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      tubing.
A4760..............  Dialysate sol test kit,     ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      each.
A4765..............  Dialysate conc pow per      ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      pack.
A4766..............  Dialysate conc sol add 10   ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      ml.
A4770..............  Blood collection tube/      ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      vacuum.
A4771..............  Serum clotting time tube..  ..................  A.................  ...........  ...........  ...........  ...........  ...........
A4772..............  Blood glucose test strips.  ..................  A.................  ...........  ...........  ...........  ...........  ...........
A4773..............  Occult blood test strips..  ..................  A.................  ...........  ...........  ...........  ...........  ...........
A4774..............  Ammonia test strips.......  ..................  A.................  ...........  ...........  ...........  ...........  ...........
A4802..............  Protamine sulfate per 50    ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      mg.
A4860..............  Disposable catheter tips..  ..................  A.................  ...........  ...........  ...........  ...........  ...........
A4870..............  Plumb/elec wk hm hemo       ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      equip.
A4890..............  Repair/maint cont hemo      ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      equip.
A4911..............  Drain bag/bottle..........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
A4913..............  Misc dialysis supplies noc  ..................  A.................  ...........  ...........  ...........  ...........  ...........
A4918..............  Venous pressure clamp.....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
A4927..............  Non-sterile gloves........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
A4928..............  Surgical mask.............  ..................  A.................  ...........  ...........  ...........  ...........  ...........
A4929..............  Tourniquet for dialysis,    ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      ea.
A4930..............  Sterile, gloves per pair..  ..................  A.................  ...........  ...........  ...........  ...........  ...........
A4931..............  Reusable oral thermometer.  ..................  A.................  ...........  ...........  ...........  ...........  ...........
A4932..............  Reusable rectal             ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      thermometer.
A5051..............  Pouch clsd w barr attached  ..................  A.................  ...........  ...........  ...........  ...........  ...........
A5052..............  Clsd ostomy pouch w/o barr  ..................  A.................  ...........  ...........  ...........  ...........  ...........
A5053..............  Clsd ostomy pouch           ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      faceplate.
A5054..............  Clsd ostomy pouch w/flange  ..................  A.................  ...........  ...........  ...........  ...........  ...........
A5055..............  Stoma cap.................  ..................  A.................  ...........  ...........  ...........  ...........  ...........
A5061..............  Pouch drainable w barrier   ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      at.
A5062..............  Drnble ostomy pouch w/o     ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      barr.
A5063..............  Drain ostomy pouch w/       ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      flange.
A5071..............  Urinary pouch w/barrier...  ..................  A.................  ...........  ...........  ...........  ...........  ...........
A5072..............  Urinary pouch w/o barrier.  ..................  A.................  ...........  ...........  ...........  ...........  ...........
A5073..............  Urinary pouch on barr w/    ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      flng.
A5081..............  Continent stoma plug......  ..................  A.................  ...........  ...........  ...........  ...........  ...........
A5082..............  Continent stoma catheter..  ..................  A.................  ...........  ...........  ...........  ...........  ...........
A5083..............  Stoma absorptive cover....  NI................  A.................  ...........  ...........  ...........  ...........  ...........

[[Page 67112]]

 
A5093..............  Ostomy accessory convex     ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      inse.
A5102..............  Bedside drain btl w/wo      ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      tube.
A5105..............  Urinary suspensory........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
A5112..............  Urinary leg bag...........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
A5113..............  Latex leg strap...........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
A5114..............  Foam/fabric leg strap.....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
A5120..............  Skin barrier, wipe or swab  ..................  A.................  ...........  ...........  ...........  ...........  ...........
A5121..............  Solid skin barrier 6x6....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
A5122..............  Solid skin barrier 8x8....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
A5126..............  Disk/foam pad +or-          ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      adhesive.
A5131..............  Appliance cleaner.........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
A5200..............  Percutaneous catheter       ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      anchor.
A5500..............  Diab shoe for density       ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      insert.
A5501..............  Diabetic custom molded      ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      shoe.
A5503..............  Diabetic shoe w/roller/     ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      rockr.
A5504..............  Diabetic shoe with wedge..  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
A5505..............  Diab shoe w/metatarsal bar  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
A5506..............  Diabetic shoe w/off set     ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      heel.
A5507..............  Modification diabetic shoe  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
A5508..............  Diabetic deluxe shoe......  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
A5510..............  Compression form shoe       ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      insert.
A5512..............  Multi den insert direct     ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      form.
A5513..............  Multi den insert custom     ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      mold.
A6000..............  Wound warming wound cover.  ..................  E.................  ...........  ...........  ...........  ...........  ...........
A6010..............  Collagen based wound        ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      filler.
A6011..............  Collagen gel/paste wound    ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      fil.
A6021..............  Collagen dressing <=16 sq   ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      in.
A6022..............  Collagen drsg>6<=48 sq in.  ..................  A.................  ...........  ...........  ...........  ...........  ...........
A6023..............  Collagen dressing >48 sq    ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      in.
A6024..............  Collagen dsg wound filler.  ..................  A.................  ...........  ...........  ...........  ...........  ...........
A6025..............  Silicone gel sheet, each..  ..................  E.................  ...........  ...........  ...........  ...........  ...........
A6154..............  Wound pouch each..........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
A6196..............  Alginate dressing <=16 sq   ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      in.
A6197..............  Alginate drsg >16 <=48 sq   ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      in.
A6198..............  alginate dressing > 48 sq   ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      in.
A6199..............  Alginate drsg wound filler  ..................  A.................  ...........  ...........  ...........  ...........  ...........
A6200..............  Compos drsg <=16 no border  ..................  E.................  ...........  ...........  ...........  ...........  ...........
A6201..............  Compos drsg >16<=48 no bdr  ..................  E.................  ...........  ...........  ...........  ...........  ...........
A6202..............  Compos drsg >48 no border.  ..................  E.................  ...........  ...........  ...........  ...........  ...........
A6203..............  Composite drsg <= 16 sq in  ..................  A.................  ...........  ...........  ...........  ...........  ...........
A6204..............  Composite drsg >16<=48 sq   ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      in.
A6205..............  Composite drsg > 48 sq in.  ..................  A.................  ...........  ...........  ...........  ...........  ...........
A6206..............  Contact layer <= 16 sq in.  ..................  A.................  ...........  ...........  ...........  ...........  ...........
A6207..............  Contact layer >16<= 48 sq   ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      in.
A6208..............  Contact layer > 48 sq in..  ..................  A.................  ...........  ...........  ...........  ...........  ...........
A6209..............  Foam drsg <=16 sq in w/o    ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      bdr.
A6210..............  Foam drg >16<=48 sq in w/o  ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      b.
A6211..............  Foam drg > 48 sq in w/o     ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      brdr.
A6212..............  Foam drg <=16 sq in w/      ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      border.
A6213..............  Foam drg >16<=48 sq in w/   ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      bdr.
A6214..............  Foam drg > 48 sq in w/      ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      border.
A6215..............  Foam dressing wound filler  ..................  A.................  ...........  ...........  ...........  ...........  ...........
A6216..............  Non-sterile gauze<=16 sq    ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      in.
A6217..............  Non-sterile gauze>16<=48    ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      sq.
A6218..............  Non-sterile gauze > 48 sq   ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      in.
A6219..............  Gauze <= 16 sq in w/border  ..................  A.................  ...........  ...........  ...........  ...........  ...........
A6220..............  Gauze >16 <=48 sq in w/     ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      bordr.
A6221..............  Gauze > 48 sq in w/border.  ..................  A.................  ...........  ...........  ...........  ...........  ...........
A6222..............  Gauze <=16 in no w/sal w/o  ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      b.
A6223..............  Gauze >16<=48 no w/sal w/o  ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      b.
A6224..............  Gauze > 48 in no w/sal w/o  ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      b.
A6228..............  Gauze <= 16 sq in water/    ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      sal.
A6229..............  Gauze >16<=48 sq in watr/   ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      sal.
A6230..............  Gauze > 48 sq in water/     ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      salne.
A6231..............  Hydrogel dsg<=16 sq in....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
A6232..............  Hydrogel dsg>16<=48 sq in.  ..................  A.................  ...........  ...........  ...........  ...........  ...........
A6233..............  Hydrogel dressing >48 sq    ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      in.
A6234..............  Hydrocolld drg <=16 w/o     ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      bdr.
A6235..............  Hydrocolld drg >16<=48 w/o  ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      b.
A6236..............  Hydrocolld drg > 48 in w/o  ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      b.
A6237..............  Hydrocolld drg <=16 in w/   ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      bdr.
A6238..............  Hydrocolld drg >16<=48 w/   ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      bdr.
A6239..............  Hydrocolld drg > 48 in w/   ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      bdr.
A6240..............  Hydrocolld drg filler       ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      paste.
A6241..............  Hydrocolloid drg filler     ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      dry.
A6242..............  Hydrogel drg <=16 in w/o    ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      bdr.
A6243..............  Hydrogel drg >16<=48 w/o    ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      bdr.
A6244..............  Hydrogel drg >48 in w/o     ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      bdr.
A6245..............  Hydrogel drg <= 16 in w/    ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      bdr.
A6246..............  Hydrogel drg >16<=48 in w/  ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      b.

[[Page 67113]]

 
A6247..............  Hydrogel drg > 48 sq in w/  ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      b.
A6248..............  Hydrogel drsg gel filler..  ..................  A.................  ...........  ...........  ...........  ...........  ...........
A6250..............  Skin seal protect           ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      moisturizr.
A6251..............  Absorpt drg <=16 sq in w/o  ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      b.
A6252..............  Absorpt drg >16 <=48 w/o    ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      bdr.
A6253..............  Absorpt drg > 48 sq in w/o  ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      b.
A6254..............  Absorpt drg <=16 sq in w/   ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      bdr.
A6255..............  Absorpt drg >16<=48 in w/   ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      bdr.
A6256..............  Absorpt drg > 48 sq in w/   ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      bdr.
A6257..............  Transparent film <= 16 sq   ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      in.
A6258..............  Transparent film >16<=48    ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      in.
A6259..............  Transparent film > 48 sq    ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      in.
A6260..............  Wound cleanser any type/    ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      size.
A6261..............  Wound filler gel/paste /oz  ..................  A.................  ...........  ...........  ...........  ...........  ...........
A6262..............  Wound filler dry form /     ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      gram.
A6266..............  Impreg gauze no h20/sal/    ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      yard.
A6402..............  Sterile gauze <= 16 sq in.  ..................  A.................  ...........  ...........  ...........  ...........  ...........
A6403..............  Sterile gauze>16 <= 48 sq   ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      in.
A6404..............  Sterile gauze > 48 sq in..  ..................  A.................  ...........  ...........  ...........  ...........  ...........
A6407..............  Packing strips, non-impreg  ..................  A.................  ...........  ...........  ...........  ...........  ...........
A6410..............  Sterile eye pad...........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
A6411..............  Non-sterile eye pad.......  ..................  A.................  ...........  ...........  ...........  ...........  ...........
A6412..............  Occlusive eye patch.......  ..................  E.................  ...........  ...........  ...........  ...........  ...........
A6413..............  Adhesive bandage, first-    NI................  E.................  ...........  ...........  ...........  ...........  ...........
                      aid.
A6441..............  Pad band w>=3/ <5//yd.....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
A6442..............  Conform band n/s w<3//yd..  ..................  A.................  ...........  ...........  ...........  ...........  ...........
A6443..............  Conform band n/s w>=3/<5//  ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      yd.
A6444..............  Conform band n/s w>=5//yd.  ..................  A.................  ...........  ...........  ...........  ...........  ...........
A6445..............  Conform band s w <3//yd...  ..................  A.................  ...........  ...........  ...........  ...........  ...........
A6446..............  Conform band s w>=3/ <5//   ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      yd.
A6447..............  Conform band s w >=5//yd..  ..................  A.................  ...........  ...........  ...........  ...........  ...........
A6448..............  Lt compres band <3//yd....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
A6449..............  Lt compres band >=3/ =5//yd...  ..................  A.................  ...........  ...........  ...........  ...........  ...........
A6451..............  Mod compres band w>=3/<5//  ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      yd.
A6452..............  High compres band w>=3/<5/  ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      yd.
A6453..............  Self-adher band w <3//yd..  ..................  A.................  ...........  ...........  ...........  ...........  ...........
A6454..............  Self-adher band w>=3/ <5//  ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      yd.
A6455..............  Self-adher band >=5//yd...  ..................  A.................  ...........  ...........  ...........  ...........  ...........
A6456..............  Zinc paste band w >=3/<5//  ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      yd.
A6457..............  Tubular dressing..........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
A6501..............  Compres burngarment         ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      bodysuit.
A6502..............  Compres burngarment         ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      chinstrp.
A6503..............  Compres burngarment         ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      facehood.
A6504..............  Cmprsburngarment glove-     ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      wrist.
A6505..............  Cmprsburngarment glove-     ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      elbow.
A6506..............  Cmprsburngrmnt glove-       ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      axilla.
A6507..............  Cmprs burngarment foot-     ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      knee.
A6508..............  Cmprs burngarment foot-     ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      thigh.
A6509..............  Compres burn garment        ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      jacket.
A6510..............  Compres burn garment        ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      leotard.
A6511..............  Compres burn garment panty  ..................  A.................  ...........  ...........  ...........  ...........  ...........
A6512..............  Compres burn garment, noc.  ..................  A.................  ...........  ...........  ...........  ...........  ...........
A6513..............  Compress burn mask face/    ..................  B.................  ...........  ...........  ...........  ...........  ...........
                      neck.
A6530..............  Compression stocking BK18-  ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      30.
A6531..............  Compression stocking BK30-  ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      40.
A6532..............  Compression stocking BK40-  ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      50.
A6533..............  Gc stocking thighlngth 18-  ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      30.
A6534..............  Gc stocking thighlngth 30-  ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      40.
A6535..............  Gc stocking thighlngth 40-  ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      50.
A6536..............  Gc stocking full lngth 18-  ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      30.
A6537..............  Gc stocking full lngth 30-  ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      40.
A6538..............  Gc stocking full lngth 40-  ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      50.
A6539..............  Gc stocking waistlngth 18-  ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      30.
A6540..............  Gc stocking waistlngth 30-  ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      40.
A6541..............  Gc stocking waistlngth 40-  ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      50.
A6542..............  Gc stocking custom made...  ..................  E.................  ...........  ...........  ...........  ...........  ...........
A6543..............  Gc stocking lymphedema....  ..................  E.................  ...........  ...........  ...........  ...........  ...........
A6544..............  Gc stocking garter belt...  ..................  E.................  ...........  ...........  ...........  ...........  ...........
A6549..............  G compression stocking....  ..................  E.................  ...........  ...........  ...........  ...........  ...........
A6550..............  Neg pres wound ther drsg    ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      set.
A7000..............  Disposable canister for     ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      pump.
A7001..............  Nondisposable pump          ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      canister.
A7002..............  Tubing used w suction pump  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
A7003..............  Nebulizer administration    ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      set.
A7004..............  Disposable nebulizer sml    ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      vol.
A7005..............  Nondisposable nebulizer     ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      set.
A7006..............  Filtered nebulizer admin    ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      set.
A7007..............  Lg vol nebulizer            ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      disposable.
A7008..............  Disposable nebulizer        ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      prefill.

[[Page 67114]]

 
A7009..............  Nebulizer reservoir bottle  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
A7010..............  Disposable corrugated       ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      tubing.
A7011..............  Nondispos corrugated        ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      tubing.
A7012..............  Nebulizer water collec      ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      devic.
A7013..............  Disposable compressor       ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      filter.
A7014..............  Compressor nondispos        ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      filter.
A7015..............  Aerosol mask used w         ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      nebulize.
A7016..............  Nebulizer dome &            ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      mouthpiece.
A7017..............  Nebulizer not used w        ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      oxygen.
A7018..............  Water distilled w/          ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      nebulizer.
A7025..............  Replace chest compress      ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      vest.
A7026..............  Replace chst cmprss sys     ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      hose.
A7027..............  Combination oral/nasal      NI................  Y.................  ...........  ...........  ...........  ...........  ...........
                      mask.
A7028..............  Repl oral cushion combo     NI................  Y.................  ...........  ...........  ...........  ...........  ...........
                      mask.
A7029..............  Repl nasal pillow comb      NI................  Y.................  ...........  ...........  ...........  ...........  ...........
                      mask.
A7030..............  CPAP full face mask.......  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
A7031..............  Replacement facemask        ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      interfa.
A7032..............  Replacement nasal cushion.  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
A7033..............  Replacement nasal pillows.  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
A7034..............  Nasal application device..  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
A7035..............  Pos airway press headgear.  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
A7036..............  Pos airway press chinstrap  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
A7037..............  Pos airway pressure tubing  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
A7038..............  Pos airway pressure filter  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
A7039..............  Filter, non disposable w    ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      pap.
A7040..............  One way chest drain valve.  ..................  A.................  ...........  ...........  ...........  ...........  ...........
A7041..............  Water seal drain container  ..................  A.................  ...........  ...........  ...........  ...........  ...........
A7042..............  Implanted pleural catheter  ..................  A.................  ...........  ...........  ...........  ...........  ...........
A7043..............  Vacuum drainagebottle/      ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      tubing.
A7044..............  PAP oral interface........  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
A7045..............  Repl exhalation port for    ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      PAP.
A7046..............  Repl water chamber, PAP     ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      dev.
A7501..............  Tracheostoma valve w        ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      diaphra.
A7502..............  Replacement diaphragm/      ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      fplate.
A7503..............  HMES filter holder or cap.  ..................  A.................  ...........  ...........  ...........  ...........  ...........
A7504..............  Tracheostoma HMES filter..  ..................  A.................  ...........  ...........  ...........  ...........  ...........
A7505..............  HMES or trach valve         ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      housing.
A7506..............  HMES/trachvalve             ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      adhesivedisk.
A7507..............  Integrated filter & holder  ..................  A.................  ...........  ...........  ...........  ...........  ...........
A7508..............  Housing & Integrated        ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      Adhesiv.
A7509..............  Heat & moisture exchange    ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      sys.
A7520..............  Trach/laryn tube non-       ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      cuffed.
A7521..............  Trach/laryn tube cuffed...  ..................  A.................  ...........  ...........  ...........  ...........  ...........
A7522..............  Trach/laryn tube stainless  ..................  A.................  ...........  ...........  ...........  ...........  ...........
A7523..............  Tracheostomy shower         ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      protect.
A7524..............  Tracheostoma stent/stud/    ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      bttn.
A7525..............  Tracheostomy mask.........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
A7526..............  Tracheostomy tube collar..  ..................  A.................  ...........  ...........  ...........  ...........  ...........
A7527..............  Trach/laryn tube plug/stop  ..................  A.................  ...........  ...........  ...........  ...........  ...........
A8000..............  Soft protect helmet prefab  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
A8001..............  Hard protect helmet prefab  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
A8002..............  Soft protect helmet custom  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
A8003..............  Hard protect helmet custom  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
A8004..............  Repl soft interface,        ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      helmet.
A9150..............  Misc/exper non-prescript    ..................  B.................  ...........  ...........  ...........  ...........  ...........
                      dru.
A9152..............  Single vitamin nos........  ..................  E.................  ...........  ...........  ...........  ...........  ...........
A9153..............  Multi-vitamin nos.........  ..................  E.................  ...........  ...........  ...........  ...........  ...........
A9155..............  Artificial saliva.........  NI................  B.................  ...........  ...........  ...........  ...........  ...........
A9180..............  Lice treatment, topical...  ..................  E.................  ...........  ...........  ...........  ...........  ...........
A9270..............  Non-covered item or         ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      service.
A9274..............  Ext amb insulin delivery    NI................  E.................  ...........  ...........  ...........  ...........  ...........
                      sys.
A9275..............  Disp home glucose monitor.  ..................  E.................  ...........  ...........  ...........  ...........  ...........
A9276..............  Disposable sensor, CGM sys  NI................  E.................  ...........  ...........  ...........  ...........  ...........
A9277..............  External transmitter, CGM.  NI................  E.................  ...........  ...........  ...........  ...........  ...........
A9278..............  External receiver, CGM sys  NI................  E.................  ...........  ...........  ...........  ...........  ...........
A9279..............  Monitoring feature/         ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      deviceNOC.
A9280..............  Alert device, noc.........  ..................  E.................  ...........  ...........  ...........  ...........  ...........
A9281..............  Reaching/grabbing device..  ..................  E.................  ...........  ...........  ...........  ...........  ...........
A9282..............  Wig any type..............  ..................  E.................  ...........  ...........  ...........  ...........  ...........
A9283..............  Foot press off load supp    NI................  E.................  ...........  ...........  ...........  ...........  ...........
                      dev.
A9300..............  Exercise equipment........  ..................  E.................  ...........  ...........  ...........  ...........  ...........
A9500..............  Tc99m sestamibi...........  CH................  N.................  ...........  ...........  ...........  ...........  ...........
A9501..............  Technetium TC-99m           NI................  N.................  ...........  ...........  ...........  ...........  ...........
                      teboroxime.
A9502..............  Tc99m tetrofosmin.........  CH................  N.................  ...........  ...........  ...........  ...........  ...........
A9503..............  Tc99m medronate...........  ..................  N.................  ...........  ...........  ...........  ...........  ...........
A9504..............  Tc99m apcitide............  ..................  N.................  ...........  ...........  ...........  ...........  ...........
A9505..............  TL201 thallium............  CH................  N.................  ...........  ...........  ...........  ...........  ...........
A9507..............  In111 capromab............  CH................  N.................  ...........  ...........  ...........  ...........  ...........
A9508..............  I131 iodobenguate, dx.....  CH................  N.................  ...........  ...........  ...........  ...........  ...........
A9509..............  Iodine I-123 sod iodide     NI................  N.................  ...........  ...........  ...........  ...........  ...........
                      mil.

[[Page 67115]]

 
A9510..............  Tc99m disofenin...........  ..................  N.................  ...........  ...........  ...........  ...........  ...........
A9512..............  Tc99m pertechnetate.......  ..................  N.................  ...........  ...........  ...........  ...........  ...........
A9516..............  Iodine I-123 sod iodide     CH................  N.................  ...........  ...........  ...........  ...........  ...........
                      mic.
A9517..............  I131 iodide cap, rx.......  CH................  K.................         1064       0.2393       $15.24  ...........        $3.05
A9521..............  Tc99m exametazime.........  CH................  N.................  ...........  ...........  ...........  ...........  ...........
A9524..............  I131 serum albumin, dx....  CH................  N.................  ...........  ...........  ...........  ...........  ...........
A9526..............  Nitrogen N-13 ammonia.....  CH................  N.................  ...........  ...........  ...........  ...........  ...........
A9527..............  Iodine I-125 sodium iodide  CH................  K.................         2632       0.4325       $27.55  ...........        $5.51
A9528..............  Iodine I-131 iodide cap,    CH................  N.................  ...........  ...........  ...........  ...........  ...........
                      dx.
A9529..............  I131 iodide sol, dx.......  ..................  N.................  ...........  ...........  ...........  ...........  ...........
A9530..............  I131 iodide sol, rx.......  CH................  K.................         1150       0.1762       $11.22  ...........        $2.24
A9531..............  I131 max 100uCi...........  ..................  N.................  ...........  ...........  ...........  ...........  ...........
A9532..............  I125 serum albumin, dx....  ..................  N.................  ...........  ...........  ...........  ...........  ...........
A9535..............  Injection, methylene blue.  ..................  N.................  ...........  ...........  ...........  ...........  ...........
A9536..............  Tc99m depreotide..........  CH................  N.................  ...........  ...........  ...........  ...........  ...........
A9537..............  Tc99m mebrofenin..........  ..................  N.................  ...........  ...........  ...........  ...........  ...........
A9538..............  Tc99m pyrophosphate.......  ..................  N.................  ...........  ...........  ...........  ...........  ...........
A9539..............  Tc99m pentetate...........  CH................  N.................  ...........  ...........  ...........  ...........  ...........
A9540..............  Tc99m MAA.................  ..................  N.................  ...........  ...........  ...........  ...........  ...........
A9541..............  Tc99m sulfur colloid......  ..................  N.................  ...........  ...........  ...........  ...........  ...........
A9542..............  In111 ibritumomab, dx.....  CH................  N.................  ...........  ...........  ...........  ...........  ...........
A9543..............  Y90 ibritumomab, rx.......  CH................  K.................         1643     235.8764   $15,023.91  ...........    $3,004.78
A9544..............  I131 tositumomab, dx......  CH................  N.................  ...........  ...........  ...........  ...........  ...........
A9545..............  I131 tositumomab, rx......  CH................  K.................         1645     176.8495   $11,264.25  ...........    $2,252.85
A9546..............  Co57/58...................  CH................  N.................  ...........  ...........  ...........  ...........  ...........
A9547..............  In111 oxyquinoline........  CH................  N.................  ...........  ...........  ...........  ...........  ...........
A9548..............  In111 pentetate...........  CH................  N.................  ...........  ...........  ...........  ...........  ...........
A9550..............  Tc99m gluceptate..........  CH................  N.................  ...........  ...........  ...........  ...........  ...........
A9551..............  Tc99m succimer............  CH................  N.................  ...........  ...........  ...........  ...........  ...........
A9552..............  F18 fdg...................  CH................  N.................  ...........  ...........  ...........  ...........  ...........
A9553..............  Cr51 chromate.............  CH................  N.................  ...........  ...........  ...........  ...........  ...........
A9554..............  I125 iothalamate, dx......  ..................  N.................  ...........  ...........  ...........  ...........  ...........
A9555..............  Rb82 rubidium.............  CH................  N.................  ...........  ...........  ...........  ...........  ...........
A9556..............  Ga67 gallium..............  CH................  N.................  ...........  ...........  ...........  ...........  ...........
A9557..............  Tc99m bicisate............  CH................  N.................  ...........  ...........  ...........  ...........  ...........
A9558..............  Xe133 xenon 10mci.........  ..................  N.................  ...........  ...........  ...........  ...........  ...........
A9559..............  Co57 cyano................  CH................  N.................  ...........  ...........  ...........  ...........  ...........
A9560..............  Tc99m labeled rbc.........  CH................  N.................  ...........  ...........  ...........  ...........  ...........
A9561..............  Tc99m oxidronate..........  ..................  N.................  ...........  ...........  ...........  ...........  ...........
A9562..............  Tc99m mertiatide..........  CH................  N.................  ...........  ...........  ...........  ...........  ...........
A9563..............  P32 Na phosphate..........  CH................  K.................         1675       1.7835      $113.60  ...........       $22.72
A9564..............  P32 chromic phosphate.....  CH................  K.................         1676       1.8711      $119.18  ...........       $23.84
A9565..............  In111 pentetreotide.......  CH................  D.................  ...........  ...........  ...........  ...........  ...........
A9566..............  Tc99m fanolesomab.........  CH................  N.................  ...........  ...........  ...........  ...........  ...........
A9567..............  Technetium TC-99m aerosol.  CH................  N.................  ...........  ...........  ...........  ...........  ...........
A9568..............  Technetium tc99m            CH................  N.................  ...........  ...........  ...........  ...........  ...........
                      arcitumomab.
A9569..............  Technetium TC-99m auto WBC  NI................  N.................  ...........  ...........  ...........  ...........  ...........
A9570..............  Indium In-111 auto WBC....  NI................  N.................  ...........  ...........  ...........  ...........  ...........
A9571..............  Indium IN-111 auto          NI................  N.................  ...........  ...........  ...........  ...........  ...........
                      platelet.
A9572..............  Indium In-111               NI................  N.................  ...........  ...........  ...........  ...........  ...........
                      pentetreotide.
A9576..............  Inj prohance multipack....  NI................  N.................  ...........  ...........  ...........  ...........  ...........
A9577..............  Inj multihance............  NI................  N.................  ...........  ...........  ...........  ...........  ...........
A9578..............  Inj multihance multipack..  NI................  N.................  ...........  ...........  ...........  ...........  ...........
A9579..............  Gad-base MR contrast        NI................  N.................  ...........  ...........  ...........  ...........  ...........
                      NOS,1ml.
A9600..............  Sr89 strontium............  CH................  K.................         0701       9.6094      $612.06  ...........      $122.41
A9605..............  Sm 153 lexidronm..........  CH................  K.................         0702      21.3689    $1,361.07  ...........      $272.21
A9698..............  Non-rad contrast            ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      materialNOC.
A9699..............  Radiopharm rx agent noc...  ..................  N.................  ...........  ...........  ...........  ...........  ...........
A9700..............  Echocardiography Contrast.  ..................  B.................  ...........  ...........  ...........  ...........  ...........
A9900..............  Supply/accessory/service..  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
A9901..............  Delivery/set up/dispensing  ..................  A.................  ...........  ...........  ...........  ...........  ...........
A9999..............  DME supply or accessory,    ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      nos.
B4034..............  Enter feed supkit syr by    ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      day.
B4035..............  Enteral feed supp pump per  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      d.
B4036..............  Enteral feed sup kit grav   ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      by.
B4081..............  Enteral ng tubing w/        ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      stylet.
B4082..............  Enteral ng tubing w/o       ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      stylet.
B4083..............  Enteral stomach tube        ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      levine.
B4086..............  Gastrostomy/jejunostomy     CH................  D.................  ...........  ...........  ...........  ...........  ...........
                      tube.
B4087..............  Gastro/jejuno tube, std...  NI................  A.................  ...........  ...........  ...........  ...........  ...........
B4088..............  Gastro/jejuno tube, low-    NI................  A.................  ...........  ...........  ...........  ...........  ...........
                      pro.
B4100..............  Food thickener oral.......  ..................  E.................  ...........  ...........  ...........  ...........  ...........
B4102..............  EF adult fluids and         ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      electro.
B4103..............  EF ped fluid and            ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      electrolyte.
B4104..............  Additive for enteral        ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      formula.
B4149..............  EF blenderized foods......  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
B4150..............  EF complet w/intact         ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      nutrient.
B4152..............  EF calorie dense>/=1.5Kcal  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
B4153..............  EF hydrolyzed/amino acids.  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
B4154..............  EF spec metabolic           ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      noninherit.

[[Page 67116]]

 
B4155..............  EF incomplete/modular.....  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
B4157..............  EF special metabolic        ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      inherit.
B4158..............  EF ped complete intact nut  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
B4159..............  EF ped complete soy based.  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
B4160..............  EF ped caloric dense>/      ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      =0.7kc.
B4161..............  EF ped hydrolyzed/amino     ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      acid.
B4162..............  EF ped specmetabolic        ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      inherit.
B4164..............  Parenteral 50% dextrose     ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      solu.
B4168..............  Parenteral sol amino acid   ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      3..
B4172..............  Parenteral sol amino acid   ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      5..
B4176..............  Parenteral sol amino acid   ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      7-.
B4178..............  Parenteral sol amino acid   ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      >.
B4180..............  Parenteral sol carb > 50%.  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
B4185..............  Parenteral sol 10 gm        ..................  B.................  ...........  ...........  ...........  ...........  ...........
                      lipids.
B4189..............  Parenteral sol amino acid   ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      &.
B4193..............  Parenteral sol 52-73 gm     ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      prot.
B4197..............  Parenteral sol 74-100 gm    ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      pro.
B4199..............  Parenteral sol > 100gm      ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      prote.
B4216..............  Parenteral nutrition        ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      additiv.
B4220..............  Parenteral supply kit       ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      premix.
B4222..............  Parenteral supply kit       ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      homemi.
B4224..............  Parenteral administration   ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      ki.
B5000..............  Parenteral sol renal-       ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      amirosy.
B5100..............  Parenteral sol hepatic-     ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      fream.
B5200..............  Parenteral sol stres-brnch  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      c.
B9000..............  Enter infusion pump w/o     ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      alrm.
B9002..............  Enteral infusion pump w/    ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      ala.
B9004..............  Parenteral infus pump       ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      portab.
B9006..............  Parenteral infus pump       ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      statio.
B9998..............  Enteral supp not otherwise  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      c.
B9999..............  Parenteral supp not othrws  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      c.
C1300..............  HYPERBARIC Oxygen.........  ..................  S.................         0659       1.5579       $99.23  ...........       $19.85
C1713..............  Anchor/screw bn/bn,tis/bn.  ..................  N.................  ...........  ...........  ...........  ...........  ...........
C1714..............  Cath, trans atherectomy,    ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      dir.
C1715..............  Brachytherapy needle......  ..................  N.................  ...........  ...........  ...........  ...........  ...........
C1716..............  Brachytx, non-str, Gold-    CH................  K.................         1716       0.5228       $33.30  ...........        $6.66
                      198.
C1717..............  Brachytx, non-str,HDR Ir-   CH................  K.................         1717       2.7505      $175.19  ...........       $35.04
                      192.
C1719..............  Brachytx, NS, Non-HDRIr-    CH................  K.................         1719       1.0226       $65.13  ...........       $13.03
                      192.
C1721..............  AICD, dual chamber........  ..................  N.................  ...........  ...........  ...........  ...........  ...........
C1722..............  AICD, single chamber......  ..................  N.................  ...........  ...........  ...........  ...........  ...........
C1724..............  Cath, trans                 ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      atherec,rotation.
C1725..............  Cath, translumin non-laser  ..................  N.................  ...........  ...........  ...........  ...........  ...........
C1726..............  Cath, bal dil, non-         ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      vascular.
C1727..............  Cath, bal tis dis, non-vas  ..................  N.................  ...........  ...........  ...........  ...........  ...........
C1728..............  Cath, brachytx seed adm...  ..................  N.................  ...........  ...........  ...........  ...........  ...........
C1729..............  Cath, drainage............  ..................  N.................  ...........  ...........  ...........  ...........  ...........
C1730..............  Cath, EP, 19 or few elect.  ..................  N.................  ...........  ...........  ...........  ...........  ...........
C1731..............  Cath, EP, 20 or more elec.  ..................  N.................  ...........  ...........  ...........  ...........  ...........
C1732..............  Cath, EP, diag/abl, 3D/     ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      vect.
C1733..............  Cath, EP, othr than cool-   ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      tip.
C1750..............  Cath, hemodialysis,long-    ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      term.
C1751..............  Cath, inf, per/cent/        ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      midline.
C1752..............  Cath,hemodialysis,short-    ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      term.
C1753..............  Cath, intravas ultrasound.  ..................  N.................  ...........  ...........  ...........  ...........  ...........
C1754..............  Catheter, intradiscal.....  ..................  N.................  ...........  ...........  ...........  ...........  ...........
C1755..............  Catheter, intraspinal.....  ..................  N.................  ...........  ...........  ...........  ...........  ...........
C1756..............  Cath, pacing, transesoph..  ..................  N.................  ...........  ...........  ...........  ...........  ...........
C1757..............  Cath, thrombectomy/         ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      embolect.
C1758..............  Catheter, ureteral........  ..................  N.................  ...........  ...........  ...........  ...........  ...........
C1759..............  Cath, intra                 ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      echocardiography.
C1760..............  Closure dev, vasc.........  ..................  N.................  ...........  ...........  ...........  ...........  ...........
C1762..............  Conn tiss, human(inc        ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      fascia).
C1763..............  Conn tiss, non-human......  ..................  N.................  ...........  ...........  ...........  ...........  ...........
C1764..............  Event recorder, cardiac...  ..................  N.................  ...........  ...........  ...........  ...........  ...........
C1765..............  Adhesion barrier..........  ..................  N.................  ...........  ...........  ...........  ...........  ...........
C1766..............  Intro/sheath,strble,non-    ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      peel.
C1767..............  Generator, neuro non-       ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      recharg.
C1768..............  Graft, vascular...........  ..................  N.................  ...........  ...........  ...........  ...........  ...........
C1769..............  Guide wire................  ..................  N.................  ...........  ...........  ...........  ...........  ...........
C1770..............  Imaging coil, MR,           ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      insertable.
C1771..............  Rep dev, urinary, w/sling.  ..................  N.................  ...........  ...........  ...........  ...........  ...........
C1772..............  Infusion pump,              ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      programmable.
C1773..............  Ret dev, insertable.......  ..................  N.................  ...........  ...........  ...........  ...........  ...........
C1776..............  Joint device (implantable)  ..................  N.................  ...........  ...........  ...........  ...........  ...........
C1777..............  Lead, AICD, endo single     ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      coil.
C1778..............  Lead, neurostimulator.....  ..................  N.................  ...........  ...........  ...........  ...........  ...........
C1779..............  Lead, pmkr, transvenous     ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      VDD.
C1780..............  Lens, intraocular (new      ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      tech).
C1781..............  Mesh (implantable)........  ..................  N.................  ...........  ...........  ...........  ...........  ...........
C1782..............  Morcellator...............  ..................  N.................  ...........  ...........  ...........  ...........  ...........

[[Page 67117]]

 
C1783..............  Ocular imp, aqueous drain   ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      de.
C1784..............  Ocular dev, intraop, det    ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      ret.
C1785..............  Pmkr, dual, rate-resp.....  ..................  N.................  ...........  ...........  ...........  ...........  ...........
C1786..............  Pmkr, single, rate-resp...  ..................  N.................  ...........  ...........  ...........  ...........  ...........
C1787..............  Patient progr, neurostim..  ..................  N.................  ...........  ...........  ...........  ...........  ...........
C1788..............  Port, indwelling, imp.....  ..................  N.................  ...........  ...........  ...........  ...........  ...........
C1789..............  Prosthesis, breast, imp...  ..................  N.................  ...........  ...........  ...........  ...........  ...........
C1813..............  Prosthesis, penile,         ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      inflatab.
C1814..............  Retinal tamp, silicone oil  ..................  N.................  ...........  ...........  ...........  ...........  ...........
C1815..............  Pros, urinary sph, imp....  ..................  N.................  ...........  ...........  ...........  ...........  ...........
C1816..............  Receiver/transmitter,       ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      neuro.
C1817..............  Septal defect imp sys.....  ..................  N.................  ...........  ...........  ...........  ...........  ...........
C1818..............  Integrated                  ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      keratoprosthesis.
C1819..............  Tissue localization-        ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      excision.
C1820..............  Generator neuro rechg bat   CH................  N.................  ...........  ...........  ...........  ...........  ...........
                      sy.
C1821..............  Interspinous implant......  ..................  H.................         1821  ...........  ...........  ...........  ...........
C1874..............  Stent, coated/cov w/del     ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      sys.
C1875..............  Stent, coated/cov w/o del   ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      sy.
C1876..............  Stent, non-coa/non-cov w/   ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      del.
C1877..............  Stent, non-coat/cov w/o     ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      del.
C1878..............  Matrl for vocal cord......  ..................  N.................  ...........  ...........  ...........  ...........  ...........
C1879..............  Tissue marker, implantable  ..................  N.................  ...........  ...........  ...........  ...........  ...........
C1880..............  Vena cava filter..........  ..................  N.................  ...........  ...........  ...........  ...........  ...........
C1881..............  Dialysis access system....  ..................  N.................  ...........  ...........  ...........  ...........  ...........
C1882..............  AICD, other than sing/dual  ..................  N.................  ...........  ...........  ...........  ...........  ...........
C1883..............  Adapt/ext, pacing/neuro     ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      lead.
C1884..............  Embolization Protect syst.  ..................  N.................  ...........  ...........  ...........  ...........  ...........
C1885..............  Cath, translumin angio      ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      laser.
C1887..............  Catheter, guiding.........  ..................  N.................  ...........  ...........  ...........  ...........  ...........
C1888..............  Endovas non-cardiac abl     ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      cath.
C1891..............  Infusion pump,non-prog,     ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      perm.
C1892..............  Intro/sheath,fixed,peel-    ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      away.
C1893..............  Intro/sheath, fixed,non-    ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      peel.
C1894..............  Intro/sheath, non-laser...  ..................  N.................  ...........  ...........  ...........  ...........  ...........
C1895..............  Lead, AICD, endo dual coil  ..................  N.................  ...........  ...........  ...........  ...........  ...........
C1896..............  Lead, AICD, non sing/dual.  ..................  N.................  ...........  ...........  ...........  ...........  ...........
C1897..............  Lead, neurostim test kit..  ..................  N.................  ...........  ...........  ...........  ...........  ...........
C1898..............  Lead, pmkr, other than      ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      trans.
C1899..............  Lead, pmkr/AICD             ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      combination.
C1900..............  Lead, coronary venous.....  ..................  N.................  ...........  ...........  ...........  ...........  ...........
C2614..............  Probe, perc lumb disc.....  ..................  N.................  ...........  ...........  ...........  ...........  ...........
C2615..............  Sealant, pulmonary, liquid  ..................  N.................  ...........  ...........  ...........  ...........  ...........
C2616..............  Brachytx, non-str,Yttrium-  CH................  K.................         2616     184.7105   $11,764.95  ...........    $2,352.99
                      90.
C2617..............  Stent, non-cor, tem w/o     ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      del.
C2618..............  Probe, cryoablation.......  ..................  N.................  ...........  ...........  ...........  ...........  ...........
C2619..............  Pmkr, dual, non rate-resp.  ..................  N.................  ...........  ...........  ...........  ...........  ...........
C2620..............  Pmkr, single, non rate-     ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      resp.
C2621..............  Pmkr, other than sing/dual  ..................  N.................  ...........  ...........  ...........  ...........  ...........
C2622..............  Prosthesis, penile, non-    ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      inf.
C2625..............  Stent, non-cor, tem w/del   ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      sy.
C2626..............  Infusion pump, non-         ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      prog,temp.
C2627..............  Cath, suprapubic/           ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      cystoscopic.
C2628..............  Catheter, occlusion.......  ..................  N.................  ...........  ...........  ...........  ...........  ...........
C2629..............  Intro/sheath, laser.......  ..................  N.................  ...........  ...........  ...........  ...........  ...........
C2630..............  Cath, EP, cool-tip........  ..................  N.................  ...........  ...........  ...........  ...........  ...........
C2631..............  Rep dev, urinary, w/o       ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      sling.
C2634..............  Brachytx, non-str, HA, I-   CH................  K.................         2634       0.4858       $30.94  ...........        $6.19
                      125.
C2635..............  Brachytx, non-str, HA, P-   CH................  K.................         2635       0.7366       $46.92  ...........        $9.38
                      103.
C2636..............  Brachy linear, non-str,P-   CH................  K.................         2636       0.6600       $42.04  ...........        $8.41
                      103.
C2637..............  Brachy,non-str,Ytterbium-   CH................  B.................  ...........  ...........  ...........  ...........  ...........
                      169.
C2638..............  Brachytx, stranded, I-125.  NF................  K.................         2638       0.7113       $45.31  ...........        $9.06
C2639..............  Brachytx, non-stranded,I-   NF................  K.................         2639       0.5039       $32.10  ...........        $6.42
                      125.
C2640..............  Brachytx, stranded, P-103.  NF................  K.................         2640       1.0308       $65.66  ...........       $13.13
C2641..............  Brachytx, non-stranded,P-   NF................  K.................         2641       0.8077       $51.45  ...........       $10.29
                      103.
C2642..............  Brachytx, stranded, C-131.  NF................  K.................         2642       1.5342       $97.72  ...........       $19.54
C2643..............  Brachytx, non-stranded,C-   NF................  K.................         2643       1.0060       $64.08  ...........       $12.82
                      131.
C2698..............  Brachytx, stranded, NOS...  NF................  K.................         2698       0.7113       $45.31  ...........        $9.06
C2699..............  Brachytx, non-stranded,     NF................  K.................         2699       0.4858       $30.94  ...........        $6.19
                      NOS.
C8900..............  MRA w/cont, abd...........  ..................  S.................         0284       6.2350      $397.13      $148.40       $79.43
C8901..............  MRA w/o cont, abd.........  ..................  S.................         0336       5.3933      $343.52      $137.40       $68.70
C8902..............  MRA w/o fol w/cont, abd...  ..................  S.................         0337       8.2463      $525.24      $199.53      $105.05
C8903..............  MRI w/cont, breast, uni...  ..................  S.................         0284       6.2350      $397.13      $148.40       $79.43
C8904..............  MRI w/o cont, breast, uni.  ..................  S.................         0336       5.3933      $343.52      $137.40       $68.70
C8905..............  MRI w/o fol w/cont, brst,   ..................  S.................         0337       8.2463      $525.24      $199.53      $105.05
                      un.
C8906..............  MRI w/cont, breast, bi....  ..................  S.................         0284       6.2350      $397.13      $148.40       $79.43
C8907..............  MRI w/o cont, breast, bi..  ..................  S.................         0336       5.3933      $343.52      $137.40       $68.70
C8908..............  MRI w/o fol w/cont,         ..................  S.................         0337       8.2463      $525.24      $199.53      $105.05
                      breast,.
C8909..............  MRA w/cont, chest.........  ..................  S.................         0284       6.2350      $397.13      $148.40       $79.43
C8910..............  MRA w/o cont, chest.......  ..................  S.................         0336       5.3933      $343.52      $137.40       $68.70
C8911..............  MRA w/o fol w/cont, chest.  ..................  S.................         0337       8.2463      $525.24      $199.53      $105.05

[[Page 67118]]

 
C8912..............  MRA w/cont, lwr ext.......  ..................  S.................         0284       6.2350      $397.13      $148.40       $79.43
C8913..............  MRA w/o cont, lwr ext.....  ..................  S.................         0336       5.3933      $343.52      $137.40       $68.70
C8914..............  MRA w/o fol w/cont, lwr     ..................  S.................         0337       8.2463      $525.24      $199.53      $105.05
                      ext.
C8918..............  MRA w/cont, pelvis........  ..................  S.................         0284       6.2350      $397.13      $148.40       $79.43
C8919..............  MRA w/o cont, pelvis......  ..................  S.................         0336       5.3933      $343.52      $137.40       $68.70
C8920..............  MRA w/o fol w/cont, pelvis  ..................  S.................         0337       8.2463      $525.24      $199.53      $105.05
C8921..............  Comp transtho echo w/contr  NI................  S.................         0128       8.4896      $540.74      $216.29      $108.15
C8922..............  Limit transtho echo w/      NI................  S.................         0128       8.4896      $540.74      $216.29      $108.15
                      contr.
C8923..............  2D com transtho echo w/     NI................  S.................         0128       8.4896      $540.74      $216.29      $108.15
                      contr.
C8924..............  2D lim transtho echo w/     NI................  S.................         0128       8.4896      $540.74      $216.29      $108.15
                      contr.
C8925..............  2D TEE w/contrast, int/     NI................  S.................         0128       8.4896      $540.74      $216.29      $108.15
                      rept.
C8926..............  Cong TEE w/contr, int/rept  NI................  S.................         0128       8.4896      $540.74      $216.29      $108.15
C8927..............  TEE w/contrast; monitor...  NI................  S.................         0128       8.4896      $540.74      $216.29      $108.15
C8928..............  2D transtho w/contr;        NI................  S.................         0128       8.4896      $540.74      $216.29      $108.15
                      stress.
C8957..............  Prolonged IV inf, req pump  ..................  S.................         0441       2.3446      $149.34  ...........       $29.87
C9003..............  Palivizumab, per 50 mg....  ..................  K.................         9003  ...........      $810.67  ...........      $162.13
C9113..............  Inj pantoprazole sodium,    ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      via.
C9121..............  Injection, argatroban.....  ..................  K.................         9121  ...........       $18.96  ...........        $3.79
C9232..............  Injection, idursulfase....  CH................  D.................  ...........  ...........  ...........  ...........  ...........
C9233..............  Injection, ranibizumab....  CH................  D.................  ...........  ...........  ...........  ...........  ...........
C9234..............  Inj, alglucosidase alfa...  CH................  D.................  ...........  ...........  ...........  ...........  ...........
C9235..............  Injection, panitumumab....  CH................  D.................  ...........  ...........  ...........  ...........  ...........
C9236..............  Injection, eculizumab.....  CH................  D.................  ...........  ...........  ...........  ...........  ...........
C9238..............  Inj, levetiracetam........  NI................  K.................         9238  ...........        $6.30  ...........        $1.26
C9239..............  Inj, temsirolimus.........  NI................  G.................         1168  ...........       $48.41  ...........        $9.68
C9350..............  Porous collagen tube per    CH................  D.................  ...........  ...........  ...........  ...........  ...........
                      cm.
C9351..............  Acellular derm tissue       CH................  D.................  ...........  ...........  ...........  ...........  ...........
                      percm2.
C9352..............  Neuragen nerve guide, per   NI................  G.................         9350  ...........      $482.56  ...........       $96.51
                      cm.
C9353..............  Neurawrap nerve             NI................  G.................         1169  ...........      $482.56  ...........       $96.51
                      protector,cm.
C9399..............  Unclassified drugs or       ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      biolog.
C9716..............  Radiofrequency energy to    ..................  T.................         0150      30.1606    $1,921.05      $437.12      $384.21
                      anu.
C9723..............  Dyn IR Perf Img...........  ..................  S.................         1502  ...........       $75.00  ...........       $15.00
C9724..............  EPS gast cardia plic......  ..................  T.................         0422      25.3233    $1,612.94      $448.81      $322.59
C9725..............  Place endorectal app......  ..................  S.................         1507  ...........      $550.00  ...........      $110.00
C9726..............  Rxt breast appl place/      ..................  S.................         1508  ...........      $650.00  ...........      $130.00
                      remov.
C9727..............  Insert palate implants....  ..................  S.................         1510  ...........      $850.00  ...........      $170.00
C9728..............  Place device/marker, non    NF................  T.................         0156       3.0469      $194.07  ...........       $38.81
                      pro.
D0120..............  Periodic oral evaluation..  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D0140..............  Limit oral eval problm      ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      focus.
D0145..............  Oral evaluation, pt < 3yrs  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D0150..............  Comprehensve oral           ..................  S.................         0330       9.1677      $583.93  ...........      $116.79
                      evaluation.
D0160..............  Extensv oral eval prob      ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      focus.
D0170..............  Re-eval,est pt,problem      ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      focus.
D0180..............  Comp periodontal            ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      evaluation.
D0210..............  Intraor complete film       ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      series.
D0220..............  Intraoral periapical first  ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      f.
D0230..............  Intraoral periapical ea     ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      add.
D0240..............  Intraoral occlusal film...  ..................  S.................         0330       9.1677      $583.93  ...........      $116.79
D0250..............  Extraoral first film......  ..................  S.................         0330       9.1677      $583.93  ...........      $116.79
D0260..............  Extraoral ea additional     ..................  S.................         0330       9.1677      $583.93  ...........      $116.79
                      film.
D0270..............  Dental bitewing single      ..................  S.................         0330       9.1677      $583.93  ...........      $116.79
                      film.
D0272..............  Dental bitewings two films  ..................  S.................         0330       9.1677      $583.93  ...........      $116.79
D0273..............  Bitewings - three films...  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D0274..............  Dental bitewings four       ..................  S.................         0330       9.1677      $583.93  ...........      $116.79
                      films.
D0277..............  Vert bitewings-sev to       ..................  S.................         0330       9.1677      $583.93  ...........      $116.79
                      eight.
D0290..............  Dental film skull/facial    ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      bon.
D0310..............  Dental saliography........  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D0320..............  Dental tmj arthrogram incl  ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      i.
D0321..............  Dental other tmj films....  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D0322..............  Dental tomographic survey.  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D0330..............  Dental panoramic film.....  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D0340..............  Dental cephalometric film.  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D0350..............  Oral/facial photo images..  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D0360..............  Cone beam ct..............  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D0362..............  Cone beam, two dimensional  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D0363..............  Cone beam, three            ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      dimensional.
D0415..............  Collection of               ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      microorganisms.
D0416..............  Viral culture.............  ..................  B.................  ...........  ...........  ...........  ...........  ...........
D0421..............  Gen tst suscept oral        ..................  B.................  ...........  ...........  ...........  ...........  ...........
                      disease.
D0425..............  Caries susceptibility test  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D0431..............  Diag tst detect mucos       ..................  B.................  ...........  ...........  ...........  ...........  ...........
                      abnorm.
D0460..............  Pulp vitality test........  ..................  S.................         0330       9.1677      $583.93  ...........      $116.79
D0470..............  Diagnostic casts..........  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D0472..............  Gross exam, prep & report.  ..................  B.................  ...........  ...........  ...........  ...........  ...........
D0473..............  Micro exam, prep & report.  ..................  B.................  ...........  ...........  ...........  ...........  ...........
D0474..............  Micro w exam of surg        ..................  B.................  ...........  ...........  ...........  ...........  ...........
                      margins.
D0475..............  Decalcification procedure.  ..................  B.................  ...........  ...........  ...........  ...........  ...........
D0476..............  Spec stains for             ..................  B.................  ...........  ...........  ...........  ...........  ...........
                      microorganis.
D0477..............  Spec stains not for         ..................  B.................  ...........  ...........  ...........  ...........  ...........
                      microorg.
D0478..............  Immunohistochemical stains  ..................  B.................  ...........  ...........  ...........  ...........  ...........

[[Page 67119]]

 
D0479..............  Tissue in-situ              ..................  B.................  ...........  ...........  ...........  ...........  ...........
                      hybridization.
D0480..............  Cytopath smear prep &       ..................  B.................  ...........  ...........  ...........  ...........  ...........
                      report.
D0481..............  Electron microscopy         ..................  B.................  ...........  ...........  ...........  ...........  ...........
                      diagnost.
D0482..............  Direct immunofluorescence.  ..................  B.................  ...........  ...........  ...........  ...........  ...........
D0483..............  Indirect                    ..................  B.................  ...........  ...........  ...........  ...........  ...........
                      immunofluorescence.
D0484..............  Consult slides prep         ..................  B.................  ...........  ...........  ...........  ...........  ...........
                      elsewher.
D0485..............  Consult inc prep of slides  ..................  B.................  ...........  ...........  ...........  ...........  ...........
D0486..............  Accession of brush biopsy.  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D0502..............  Other oral pathology        ..................  B.................  ...........  ...........  ...........  ...........  ...........
                      procedu.
D0999..............  Unspecified diagnostic      ..................  B.................  ...........  ...........  ...........  ...........  ...........
                      proce.
D1110..............  Dental prophylaxis adult..  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D1120..............  Dental prophylaxis child..  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D1203..............  Topical fluor w/o prophy    ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      chi.
D1204..............  Topical fluor w/o prophy    ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      adu.
D1206..............  Topical fluoride varnish..  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D1310..............  Nutri counsel-control       ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      caries.
D1320..............  Tobacco counseling........  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D1330..............  Oral hygiene instruction..  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D1351..............  Dental sealant per tooth..  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D1510..............  Space maintainer fxd        ..................  S.................         0330       9.1677      $583.93  ...........      $116.79
                      unilat.
D1515..............  Fixed bilat space           ..................  S.................         0330       9.1677      $583.93  ...........      $116.79
                      maintainer.
D1520..............  Remove unilat space         ..................  S.................         0330       9.1677      $583.93  ...........      $116.79
                      maintain.
D1525..............  Remove bilat space          ..................  S.................         0330       9.1677      $583.93  ...........      $116.79
                      maintain.
D1550..............  Recement space maintainer.  ..................  S.................         0330       9.1677      $583.93  ...........      $116.79
D1555..............  Remove fix space            ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      maintainer.
D2140..............  Amalgam one surface         ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      permanen.
D2150..............  Amalgam two surfaces        ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      permane.
D2160..............  Amalgam three surfaces      ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      perma.
D2161..............  Amalgam 4 or > surfaces     ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      perm.
D2330..............  Resin one surface-anterior  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D2331..............  Resin two surfaces-         ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      anterior.
D2332..............  Resin three surfaces-       ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      anterio.
D2335..............  Resin 4/> surf or w incis   ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      an.
D2390..............  Ant resin-based cmpst       ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      crown.
D2391..............  Post 1 srfc resinbased      ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      cmpst.
D2392..............  Post 2 srfc resinbased      ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      cmpst.
D2393..............  Post 3 srfc resinbased      ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      cmpst.
D2394..............  Post >=4srfc resinbase      ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      cmpst.
D2410..............  Dental gold foil one        ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      surface.
D2420..............  Dental gold foil two        ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      surface.
D2430..............  Dental gold foil three      ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      surfa.
D2510..............  Dental inlay metalic 1      ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      surf.
D2520..............  Dental inlay metallic 2     ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      surf.
D2530..............  Dental inlay metl 3/more    ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      sur.
D2542..............  Dental onlay metallic 2     ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      surf.
D2543..............  Dental onlay metallic 3     ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      surf.
D2544..............  Dental onlay metl 4/more    ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      sur.
D2610..............  Inlay porcelain/ceramic 1   ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      su.
D2620..............  Inlay porcelain/ceramic 2   ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      su.
D2630..............  Dental onlay porc 3/more    ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      sur.
D2642..............  Dental onlay porcelin 2     ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      surf.
D2643..............  Dental onlay porcelin 3     ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      surf.
D2644..............  Dental onlay porc 4/more    ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      sur.
D2650..............  Inlay composite/resin one   ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      su.
D2651..............  Inlay composite/resin two   ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      su.
D2652..............  Dental inlay resin 3/mre    ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      sur.
D2662..............  Dental onlay resin 2        ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      surface.
D2663..............  Dental onlay resin 3        ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      surface.
D2664..............  Dental onlay resin 4/mre    ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      sur.
D2710..............  Crown resin-based indirect  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D2712..............  Crown 3/4 resin-based       ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      compos.
D2720..............  Crown resin w/ high noble   ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      me.
D2721..............  Crown resin w/ base metal.  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D2722..............  Crown resin w/ noble metal  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D2740..............  Crown porcelain/ceramic     ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      subs.
D2750..............  Crown porcelain w/ h noble  ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      m.
D2751..............  Crown porcelain fused base  ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      m.
D2752..............  Crown porcelain w/ noble    ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      met.
D2780..............  Crown 3/4 cast hi noble     ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      met.
D2781..............  Crown 3/4 cast base metal.  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D2782..............  Crown 3/4 cast noble metal  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D2783..............  Crown 3/4 porcelain/        ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      ceramic.
D2790..............  Crown full cast high noble  ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      m.
D2791..............  Crown full cast base metal  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D2792..............  Crown full cast noble       ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      metal.
D2794..............  Crown-titanium............  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D2799..............  Provisional crown.........  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D2910..............  Recement inlay onlay or     ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      part.
D2915..............  Recement cast or prefab     ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      post.
D2920..............  Dental recement crown.....  ..................  E.................  ...........  ...........  ...........  ...........  ...........

[[Page 67120]]

 
D2930..............  Prefab stnlss steel crwn    ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      pri.
D2931..............  Prefab stnlss steel crown   ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      pe.
D2932..............  Prefabricated resin crown.  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D2933..............  Prefab stainless steel      ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      crown.
D2934..............  Prefab steel crown primary  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D2940..............  Dental sedative filling...  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D2950..............  Core build-up incl any      ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      pins.
D2951..............  Tooth pin retention.......  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D2952..............  Post and core cast + crown  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D2953..............  Each addtnl cast post.....  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D2954..............  Prefab post/core + crown..  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D2955..............  Post removal..............  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D2957..............  Each addtnl prefab post...  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D2960..............  Laminate labial veneer....  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D2961..............  Lab labial veneer resin...  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D2962..............  Lab labial veneer           ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      porcelain.
D2970..............  Temp crown (fractured       ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      tooth).
D2971..............  Add proc construct new      ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      crown.
D2975..............  Coping....................  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D2980..............  Crown repair..............  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D2999..............  Dental unspec restorative   ..................  S.................         0330       9.1677      $583.93  ...........      $116.79
                      pr.
D3110..............  Pulp cap direct...........  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D3120..............  Pulp cap indirect.........  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D3220..............  Therapeutic pulpotomy.....  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D3221..............  Gross pulpal debridement..  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D3230..............  Pulpal therapy anterior     ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      prim.
D3240..............  Pulpal therapy posterior    ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      pri.
D3310..............  Anterior..................  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D3320..............  Root canal therapy 2        ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      canals.
D3330..............  Root canal therapy 3        ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      canals.
D3331..............  Non-surg tx root canal obs  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D3332..............  Incomplete endodontic tx..  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D3333..............  Internal root repair......  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D3346..............  Retreat root canal          ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      anterior.
D3347..............  Retreat root canal          ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      bicuspid.
D3348..............  Retreat root canal molar..  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D3351..............  Apexification/recalc        ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      initial.
D3352..............  Apexification/recalc        ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      interim.
D3353..............  Apexification/recalc final  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D3410..............  Apicoect/perirad surg       ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      anter.
D3421..............  Root surgery bicuspid.....  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D3425..............  Root surgery molar........  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D3426..............  Root surgery ea add root..  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D3430..............  Retrograde filling........  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D3450..............  Root amputation...........  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D3460..............  Endodontic endosseous       ..................  S.................         0330       9.1677      $583.93  ...........      $116.79
                      implan.
D3470..............  Intentional replantation..  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D3910..............  Isolation- tooth w rubb     ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      dam.
D3920..............  Tooth splitting...........  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D3950..............  Canal prep/fitting of       ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      dowel.
D3999..............  Endodontic procedure......  ..................  S.................         0330       9.1677      $583.93  ...........      $116.79
D4210..............  Gingivectomy/plasty per     ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      quad.
D4211..............  Gingivectomy/plasty per     ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      toot.
D4230..............  Ana crown exp 4 or> per     ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      quad.
D4231..............  Ana crown exp 1-3 per quad  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D4240..............  Gingival flap proc w/       ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      planin.
D4241..............  Gngvl flap w rootplan 1-3   ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      th.
D4245..............  Apically positioned flap..  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D4249..............  Crown lengthen hard tissue  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D4260..............  Osseous surgery per         ..................  S.................         0330       9.1677      $583.93  ...........      $116.79
                      quadrant.
D4261..............  Osseous surgl-              ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      3teethperquad.
D4263..............  Bone replce graft first     ..................  S.................         0330       9.1677      $583.93  ...........      $116.79
                      site.
D4264..............  Bone replce graft each add  ..................  S.................         0330       9.1677      $583.93  ...........      $116.79
D4265..............  Bio mtrls to aid soft/os    ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      reg.
D4266..............  Guided tiss regen resorble  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D4267..............  Guided tiss regen           ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      nonresorb.
D4268..............  Surgical revision           ..................  S.................         0330       9.1677      $583.93  ...........      $116.79
                      procedure.
D4270..............  Pedicle soft tissue graft   ..................  S.................         0330       9.1677      $583.93  ...........      $116.79
                      pr.
D4271..............  Free soft tissue graft      ..................  S.................         0330       9.1677      $583.93  ...........      $116.79
                      proc.
D4273..............  Subepithelial tissue graft  ..................  S.................         0330       9.1677      $583.93  ...........      $116.79
D4274..............  Distal/proximal wedge proc  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D4275..............  Soft tissue allograft.....  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D4276..............  Con tissue w dble ped       ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      graft.
D4320..............  Provision splnt             ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      intracoronal.
D4321..............  Provisional splint          ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      extracoro.
D4341..............  Periodontal scaling & root  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D4342..............  Periodontal scaling 1-      ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      3teeth.
D4355..............  Full mouth debridement....  ..................  S.................         0330       9.1677      $583.93  ...........      $116.79
D4381..............  Localized delivery          ..................  S.................         0330       9.1677      $583.93  ...........      $116.79
                      antimicro.
D4910..............  Periodontal maint           ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      procedures.

[[Page 67121]]

 
D4920..............  Unscheduled dressing        ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      change.
D4999..............  Unspecified periodontal     ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      proc.
D5110..............  Dentures complete           ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      maxillary.
D5120..............  Dentures complete mandible  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D5130..............  Dentures immediat           ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      maxillary.
D5140..............  Dentures immediat mandible  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D5211..............  Dentures maxill part resin  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D5212..............  Dentures mand part resin..  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D5213..............  Dentures maxill part metal  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D5214..............  Dentures mandibl part       ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      metal.
D5225..............  Maxillary part denture      ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      flex.
D5226..............  Mandibular part denture     ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      flex.
D5281..............  Removable partial denture.  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D5410..............  Dentures adjust cmplt       ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      maxil.
D5411..............  Dentures adjust cmplt mand  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D5421..............  Dentures adjust part        ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      maxill.
D5422..............  Dentures adjust part        ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      mandbl.
D5510..............  Dentur repr broken compl    ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      bas.
D5520..............  Replace denture teeth       ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      complt.
D5610..............  Dentures repair resin base  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D5620..............  Rep part denture cast       ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      frame.
D5630..............  Rep partial denture clasp.  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D5640..............  Replace part denture teeth  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D5650..............  Add tooth to partial        ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      denture.
D5660..............  Add clasp to partial        ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      denture.
D5670..............  Replc tth&acrlc on mtl      ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      frmwk.
D5671..............  Replc tth&acrlc mandibular  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D5710..............  Dentures rebase cmplt       ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      maxil.
D5711..............  Dentures rebase cmplt mand  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D5720..............  Dentures rebase part        ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      maxill.
D5721..............  Dentures rebase part        ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      mandbl.
D5730..............  Denture reln cmplt maxil    ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      ch.
D5731..............  Denture reln cmplt mand     ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      chr.
D5740..............  Denture reln part maxil     ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      chr.
D5741..............  Denture reln part mand chr  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D5750..............  Denture reln cmplt max lab  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D5751..............  Denture reln cmplt mand     ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      lab.
D5760..............  Denture reln part maxil     ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      lab.
D5761..............  Denture reln part mand lab  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D5810..............  Denture interm cmplt        ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      maxill.
D5811..............  Denture interm cmplt        ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      mandbl.
D5820..............  Denture interm part maxill  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D5821..............  Denture interm part mandbl  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D5850..............  Denture tiss conditn        ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      maxill.
D5851..............  Denture tiss condtin        ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      mandbl.
D5860..............  Overdenture complete......  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D5861..............  Overdenture partial.......  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D5862..............  Precision attachment......  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D5867..............  Replacement of precision    ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      att.
D5875..............  Prosthesis modification...  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D5899..............  Removable prosthodontic     ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      proc.
D5911..............  Facial moulage sectional..  ..................  S.................         0330       9.1677      $583.93  ...........      $116.79
D5912..............  Facial moulage complete...  ..................  S.................         0330       9.1677      $583.93  ...........      $116.79
D5913..............  Nasal prosthesis..........  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D5914..............  Auricular prosthesis......  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D5915..............  Orbital prosthesis........  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D5916..............  Ocular prosthesis.........  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D5919..............  Facial prosthesis.........  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D5922..............  Nasal septal prosthesis...  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D5923..............  Ocular prosthesis interim.  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D5924..............  Cranial prosthesis........  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D5925..............  Facial augmentation         ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      implant.
D5926..............  Replacement nasal           ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      prosthesis.
D5927..............  Auricular replacement.....  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D5928..............  Orbital replacement.......  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D5929..............  Facial replacement........  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D5931..............  Surgical obturator........  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D5932..............  Postsurgical obturator....  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D5933..............  Refitting of obturator....  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D5934..............  Mandibular flange           ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      prosthesis.
D5935..............  Mandibular denture prosth.  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D5936..............  Temp obturator prosthesis.  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D5937..............  Trismus appliance.........  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D5951..............  Feeding aid...............  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D5952..............  Pediatric speech aid......  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D5953..............  Adult speech aid..........  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D5954..............  Superimposed prosthesis...  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D5955..............  Palatal lift prosthesis...  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D5958..............  Intraoral con def inter     ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      plt.
D5959..............  Intraoral con def mod       ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      palat.

[[Page 67122]]

 
D5960..............  Modify speech aid           ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      prosthesis.
D5982..............  Surgical stent............  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D5983..............  Radiation applicator......  ..................  S.................         0330       9.1677      $583.93  ...........      $116.79
D5984..............  Radiation shield..........  ..................  S.................         0330       9.1677      $583.93  ...........      $116.79
D5985..............  Radiation cone locator....  ..................  S.................         0330       9.1677      $583.93  ...........      $116.79
D5986..............  Fluoride applicator.......  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D5987..............  Commissure splint.........  ..................  S.................         0330       9.1677      $583.93  ...........      $116.79
D5988..............  Surgical splint...........  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D5999..............  Maxillofacial prosthesis..  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D6010..............  Odontics endosteal implant  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D6012..............  Endosteal implant.........  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D6040..............  Odontics eposteal implant.  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D6050..............  Odontics transosteal        ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      implnt.
D6053..............  Implnt/abtmnt spprt remv    ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      dnt.
D6054..............  Implnt/abtmnt spprt         ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      remvprtl.
D6055..............  Implant connecting bar....  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D6056..............  Prefabricated abutment....  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D6057..............  Custom abutment...........  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D6058..............  Abutment supported crown..  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D6059..............  Abutment supported mtl      ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      crown.
D6060..............  Abutment supported mtl      ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      crown.
D6061..............  Abutment supported mtl      ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      crown.
D6062..............  Abutment supported mtl      ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      crown.
D6063..............  Abutment supported mtl      ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      crown.
D6064..............  Abutment supported mtl      ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      crown.
D6065..............  Implant supported crown...  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D6066..............  Implant supported mtl       ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      crown.
D6067..............  Implant supported mtl       ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      crown.
D6068..............  Abutment supported          ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      retainer.
D6069..............  Abutment supported          ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      retainer.
D6070..............  Abutment supported          ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      retainer.
D6071..............  Abutment supported          ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      retainer.
D6072..............  Abutment supported          ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      retainer.
D6073..............  Abutment supported          ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      retainer.
D6074..............  Abutment supported          ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      retainer.
D6075..............  Implant supported retainer  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D6076..............  Implant supported retainer  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D6077..............  Implant supported retainer  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D6078..............  Implnt/abut suprtd fixd     ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      dent.
D6079..............  Implnt/abut suprtd fixd     ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      dent.
D6080..............  Implant maintenance.......  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D6090..............  Repair implant............  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D6091..............  Repl semi/precision attach  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D6092..............  Recement supp crown.......  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D6093..............  Recement supp part denture  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D6094..............  Abut support crown          ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      titanium.
D6095..............  Odontics repr abutment....  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D6100..............  Removal of implant........  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D6190..............  Radio/surgical implant      ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      index.
D6194..............  Abut support retainer       ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      titani.
D6199..............  Implant procedure.........  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D6205..............  Pontic-indirect resin       ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      based.
D6210..............  Prosthodont high noble      ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      metal.
D6211..............  Bridge base metal cast....  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D6212..............  Bridge noble metal cast...  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D6214..............  Pontic titanium...........  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D6240..............  Bridge porcelain high       ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      noble.
D6241..............  Bridge porcelain base       ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      metal.
D6242..............  Bridge porcelain nobel      ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      metal.
D6245..............  Bridge porcelain/ceramic..  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D6250..............  Bridge resin w/high noble.  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D6251..............  Bridge resin base metal...  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D6252..............  Bridge resin w/noble metal  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D6253..............  Provisional pontic........  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D6545..............  Dental retainr cast metl..  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D6548..............  Porcelain/ceramic retainer  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D6600..............  Porcelain/ceramic inlay     ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      2srf.
D6601..............  Porc/ceram inlay >= 3       ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      surfac.
D6602..............  Cst hgh nble mtl inlay 2    ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      srf.
D6603..............  Cst hgh nble mtl inlay      ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      >=3sr.
D6604..............  Cst bse mtl inlay 2         ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      surfaces.
D6605..............  Cst bse mtl inlay >= 3      ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      surfa.
D6606..............  Cast noble metal inlay 2    ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      sur.
D6607..............  Cst noble mtl inlay >=3     ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      surf.
D6608..............  Onlay porc/crmc 2 surfaces  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D6609..............  Onlay porc/crmc >=3         ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      surfaces.
D6610..............  Onlay cst hgh nbl mtl 2     ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      srfc.
D6611..............  Onlay cst hgh nbl mtl       ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      >=3srf.
D6612..............  Onlay cst base mtl 2        ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      surface.
D6613..............  Onlay cst base mtl >=3      ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      surfa.

[[Page 67123]]

 
D6614..............  Onlay cst nbl mtl 2         ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      surfaces.
D6615..............  Onlay cst nbl mtl >=3       ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      surfac.
D6624..............  Inlay titanium............  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D6634..............  Onlay titanium............  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D6710..............  Crown-indirect resin based  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D6720..............  Retain crown resin w hi     ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      nble.
D6721..............  Crown resin w/base metal..  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D6722..............  Crown resin w/noble metal.  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D6740..............  Crown porcelain/ceramic...  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D6750..............  Crown porcelain high noble  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D6751..............  Crown porcelain base metal  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D6752..............  Crown porcelain noble       ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      metal.
D6780..............  Crown 3/4 high noble metal  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D6781..............  Crown 3/4 cast based metal  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D6782..............  Crown 3/4 cast noble metal  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D6783..............  Crown 3/4 porcelain/        ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      ceramic.
D6790..............  Crown full high noble       ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      metal.
D6791..............  Crown full base metal cast  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D6792..............  Crown full noble metal      ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      cast.
D6793..............  Provisional retainer crown  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D6794..............  Crown titanium............  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D6920..............  Dental connector bar......  ..................  S.................         0330       9.1677      $583.93  ...........      $116.79
D6930..............  Dental recement bridge....  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D6940..............  Stress breaker............  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D6950..............  Precision attachment......  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D6970..............  Post & core plus retainer.  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D6972..............  Prefab post & core plus     ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      reta.
D6973..............  Core build up for retainer  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D6975..............  Coping metal..............  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D6976..............  Each addtnl cast post.....  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D6977..............  Each addtl prefab post....  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D6980..............  Bridge repair.............  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D6985..............  Pediatric partial denture   ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      fx.
D6999..............  Fixed prosthodontic proc..  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D7111..............  Extraction coronal          ..................  S.................         0330       9.1677      $583.93  ...........      $116.79
                      remnants.
D7140..............  Extraction erupted tooth/   ..................  S.................         0330       9.1677      $583.93  ...........      $116.79
                      exr.
D7210..............  Rem imp tooth w mucoper     ..................  S.................         0330       9.1677      $583.93  ...........      $116.79
                      flp.
D7220..............  Impact tooth remov soft     ..................  S.................         0330       9.1677      $583.93  ...........      $116.79
                      tiss.
D7230..............  Impact tooth remov part     ..................  S.................         0330       9.1677      $583.93  ...........      $116.79
                      bony.
D7240..............  Impact tooth remov comp     ..................  S.................         0330       9.1677      $583.93  ...........      $116.79
                      bony.
D7241..............  Impact tooth rem bony w/    ..................  S.................         0330       9.1677      $583.93  ...........      $116.79
                      comp.
D7250..............  Tooth root removal........  ..................  S.................         0330       9.1677      $583.93  ...........      $116.79
D7260..............  Oral antral fistula         ..................  S.................         0330       9.1677      $583.93  ...........      $116.79
                      closure.
D7261..............  Primary closure sinus perf  ..................  S.................         0330       9.1677      $583.93  ...........      $116.79
D7270..............  Tooth reimplantation......  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D7272..............  Tooth transplantation.....  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D7280..............  Exposure impact tooth       ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      orthod.
D7282..............  Mobilize erupted/malpos     ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      toot.
D7283..............  Place device impacted       ..................  B.................  ...........  ...........  ...........  ...........  ...........
                      tooth.
D7285..............  Biopsy of oral tissue hard  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D7286..............  Biopsy of oral tissue soft  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D7287..............  Exfoliative cytolog         ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      collect.
D7288..............  Brush biopsy..............  ..................  B.................  ...........  ...........  ...........  ...........  ...........
D7290..............  Repositioning of teeth....  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D7291..............  Transseptal fiberotomy....  ..................  S.................         0330       9.1677      $583.93  ...........      $116.79
D7292..............  Screw retained plate......  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D7293..............  Temp anchorage dev w flap.  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D7294..............  Temp anchorage dev w/o      ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      flap.
D7310..............  Alveoplasty w/ extraction.  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D7311..............  Alveoloplasty w/extract 1-  ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      3.
D7320..............  Alveoplasty w/o extraction  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D7321..............  Alveoloplasty not w/        ..................  B.................  ...........  ...........  ...........  ...........  ...........
                      extracts.
D7340..............  Vestibuloplasty ridge       ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      extens.
D7350..............  Vestibuloplasty exten       ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      graft.
D7410..............  Rad exc lesion up to 1.25   ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      cm.
D7411..............  Excision benign             ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      lesion>1.25c.
D7412..............  Excision benign lesion      ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      compl.
D7413..............  Excision malig              ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      lesion<=1.25c.
D7414..............  Excision malig              ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      lesion>1.25cm.
D7415..............  Excision malig les          ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      complicat.
D7440..............  Malig tumor exc to 1.25 cm  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D7441..............  Malig tumor > 1.25 cm.....  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D7450..............  Rem odontogen cyst to       ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      1.25cm.
D7451..............  Rem odontogen cyst > 1.25   ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      cm.
D7460..............  Rem nonodonto cyst to       ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      1.25cm.
D7461..............  Rem nonodonto cyst > 1.25   ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      cm.
D7465..............  Lesion destruction........  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D7471..............  Rem exostosis any site....  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D7472..............  Removal of torus palatinus  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D7473..............  Remove torus mandibularis.  ..................  E.................  ...........  ...........  ...........  ...........  ...........

[[Page 67124]]

 
D7485..............  Surg reduct                 ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      osseoustuberosit.
D7490..............  Maxilla or mandible         ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      resectio.
D7510..............  I&d absc intraoral soft     ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      tiss.
D7511..............  Incision/drain abscess      ..................  B.................  ...........  ...........  ...........  ...........  ...........
                      intra.
D7520..............  I&d abscess extraoral.....  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D7521..............  Incision/drain abscess      ..................  B.................  ...........  ...........  ...........  ...........  ...........
                      extra.
D7530..............  Removal fb skin/areolar     ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      tiss.
D7540..............  Removal of fb reaction....  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D7550..............  Removal of sloughed off     ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      bone.
D7560..............  Maxillary sinusotomy......  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D7610..............  Maxilla open reduct simple  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D7620..............  Clsd reduct simpl maxilla   ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      fx.
D7630..............  Open red simpl mandible fx  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D7640..............  Clsd red simpl mandible fx  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D7650..............  Open red simp malar/zygom   ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      fx.
D7660..............  Clsd red simp malar/zygom   ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      fx.
D7670..............  Closd rductn splint         ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      alveolus.
D7671..............  Alveolus open reduction...  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D7680..............  Reduct simple facial bone   ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      fx.
D7710..............  Maxilla open reduct         ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      compound.
D7720..............  Clsd reduct compd maxilla   ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      fx.
D7730..............  Open reduct compd mandble   ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      fx.
D7740..............  Clsd reduct compd mandble   ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      fx.
D7750..............  Open red comp malar/zygma   ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      fx.
D7760..............  Clsd red comp malar/zygma   ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      fx.
D7770..............  Open reduc compd alveolus   ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      fx.
D7771..............  Alveolus clsd reduc stblz   ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      te.
D7780..............  Reduct compnd facial bone   ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      fx.
D7810..............  Tmj open reduct-            ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      dislocation.
D7820..............  Closed tmp manipulation...  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D7830..............  Tmj manipulation under      ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      anest.
D7840..............  Removal of tmj condyle....  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D7850..............  Tmj meniscectomy..........  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D7852..............  Tmj repair of joint disc..  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D7854..............  Tmj excisn of joint         ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      membrane.
D7856..............  Tmj cutting of a muscle...  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D7858..............  Tmj reconstruction........  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D7860..............  Tmj cutting into joint....  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D7865..............  Tmj reshaping components..  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D7870..............  Tmj aspiration joint fluid  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D7871..............  Lysis + lavage w catheters  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D7872..............  Tmj diagnostic arthroscopy  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D7873..............  Tmj arthroscopy lysis       ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      adhesn.
D7874..............  Tmj arthroscopy disc        ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      reposit.
D7875..............  Tmj arthroscopy             ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      synovectomy.
D7876..............  Tmj arthroscopy discectomy  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D7877..............  Tmj arthroscopy             ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      debridement.
D7880..............  Occlusal orthotic           ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      appliance.
D7899..............  Tmj unspecified therapy...  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D7910..............  Dent sutur recent wnd to    ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      5cm.
D7911..............  Dental suture wound to 5    ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      cm.
D7912..............  Suture complicate wnd > 5   ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      cm.
D7920..............  Dental skin graft.........  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D7940..............  Reshaping bone              ..................  S.................         0330       9.1677      $583.93  ...........      $116.79
                      orthognathic.
D7941..............  Bone cutting ramus closed.  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D7943..............  Cutting ramus open w/graft  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D7944..............  Bone cutting segmented....  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D7945..............  Bone cutting body mandible  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D7946..............  Reconstruction maxilla      ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      total.
D7947..............  Reconstruct maxilla         ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      segment.
D7948..............  Reconstruct midface no      ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      graft.
D7949..............  Reconstruct midface w/      ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      graft.
D7950..............  Mandible graft............  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D7951..............  Sinus aug w bone/bone sup.  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D7953..............  Bone replacement graft....  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D7955..............  Repair maxillofacial        ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      defects.
D7960..............  Frenulectomy/frenulotomy..  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D7963..............  Frenuloplasty.............  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D7970..............  Excision hyperplastic       ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      tissue.
D7971..............  Excision pericoronal        ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      gingiva.
D7972..............  Surg redct fibrous          ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      tuberosit.
D7980..............  Sialolithotomy............  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D7981..............  Excision of salivary gland  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D7982..............  Sialodochoplasty..........  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D7983..............  Closure of salivary         ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      fistula.
D7990..............  Emergency tracheotomy.....  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D7991..............  Dental coronoidectomy.....  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D7995..............  Synthetic graft facial      ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      bones.
D7996..............  Implant mandible for        ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      augment.
D7997..............  Appliance removal.........  ..................  E.................  ...........  ...........  ...........  ...........  ...........

[[Page 67125]]

 
D7998..............  Intraoral place of fix dev  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D7999..............  Oral surgery procedure....  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D8010..............  Limited dental tx primary.  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D8020..............  Limited dental tx           ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      transition.
D8030..............  Limited dental tx           ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      adolescent.
D8040..............  Limited dental tx adult...  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D8050..............  Intercep dental tx primary  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D8060..............  Intercep dental tx          ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      transitn.
D8070..............  Compre dental tx            ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      transition.
D8080..............  Compre dental tx            ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      adolescent.
D8090..............  Compre dental tx adult....  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D8210..............  Orthodontic rem appliance   ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      tx.
D8220..............  Fixed appliance therapy     ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      habt.
D8660..............  Preorthodontic tx visit...  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D8670..............  Periodic orthodontc tx      ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      visit.
D8680..............  Orthodontic retention.....  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D8690..............  Orthodontic treatment.....  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D8691..............  Repair ortho appliance....  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D8692..............  Replacement retainer......  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D8693..............  Rebond/cement/repair        ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      retain.
D8999..............  Orthodontic procedure.....  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D9110..............  Tx dental pain minor proc.  ..................  N.................  ...........  ...........  ...........  ...........  ...........
D9120..............  Fix partial denture         ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      section.
D9210..............  Dent anesthesia w/o         ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      surgery.
D9211..............  Regional block anesthesia.  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D9212..............  Trigeminal block            ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      anesthesia.
D9215..............  Local anesthesia..........  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D9220..............  General anesthesia........  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D9221..............  General anesthesia ea ad    ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      15m.
D9230..............  Analgesia.................  ..................  N.................  ...........  ...........  ...........  ...........  ...........
D9241..............  Intravenous sedation......  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D9242..............  IV sedation ea ad 30 m....  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D9248..............  Sedation (non-iv).........  ..................  N.................  ...........  ...........  ...........  ...........  ...........
D9310..............  Dental consultation.......  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D9410..............  Dental house call.........  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D9420..............  Hospital call.............  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D9430..............  Office visit during hours.  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D9440..............  Office visit after hours..  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D9450..............  Case presentation tx plan.  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D9610..............  Dent therapeutic drug       ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      inject.
D9612..............  Thera par drugs 2 or >      ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      admin.
D9630..............  Other drugs/medicaments...  ..................  S.................         0330       9.1677      $583.93  ...........      $116.79
D9910..............  Dent appl desensitizing     ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      med.
D9911..............  Appl desensitizing resin..  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D9920..............  Behavior management.......  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D9930..............  Treatment of complications  ..................  S.................         0330       9.1677      $583.93  ...........      $116.79
D9940..............  Dental occlusal guard.....  ..................  S.................         0330       9.1677      $583.93  ...........      $116.79
D9941..............  Fabrication athletic guard  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D9942..............  Repair/reline occlusal      ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      guard.
D9950..............  Occlusion analysis........  ..................  S.................         0330       9.1677      $583.93  ...........      $116.79
D9951..............  Limited occlusal            ..................  S.................         0330       9.1677      $583.93  ...........      $116.79
                      adjustment.
D9952..............  Complete occlusal           ..................  S.................         0330       9.1677      $583.93  ...........      $116.79
                      adjustment.
D9970..............  Enamel microabrasion......  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D9971..............  Odontoplasty 1-2 teeth....  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D9972..............  Extrnl bleaching per arch.  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D9973..............  Extrnl bleaching per tooth  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D9974..............  Intrnl bleaching per tooth  ..................  E.................  ...........  ...........  ...........  ...........  ...........
D9999..............  Adjunctive procedure......  ..................  E.................  ...........  ...........  ...........  ...........  ...........
E0100..............  Cane adjust/fixed with tip  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
E0105..............  Cane adjust/fixed quad/3    ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      pro.
E0110..............  Crutch forearm pair.......  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
E0111..............  Crutch forearm each.......  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
E0112..............  Crutch underarm pair wood.  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
E0113..............  Crutch underarm each wood.  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
E0114..............  Crutch underarm pair no     ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      wood.
E0116..............  Crutch underarm each no     ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      wood.
E0117..............  Underarm springassist       ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      crutch.
E0118..............  Crutch substitute.........  ..................  E.................  ...........  ...........  ...........  ...........  ...........
E0130..............  Walker rigid adjust/fixed   ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      ht.
E0135..............  Walker folding adjust/      ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      fixed.
E0140..............  Walker w trunk support....  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
E0141..............  Rigid wheeled walker adj/   ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      fix.
E0143..............  Walker folding wheeled w/o  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      s.
E0144..............  Enclosed walker w rear      ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      seat.
E0147..............  Walker variable wheel       ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      resist.
E0148..............  Heavyduty walker no wheels  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
E0149..............  Heavy duty wheeled walker.  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
E0153..............  Forearm crutch platform     ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      atta.
E0154..............  Walker platform attachment  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
E0155..............  Walker wheel                ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      attachment,pair.

[[Page 67126]]

 
E0156..............  Walker seat attachment....  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
E0157..............  Walker crutch attachment..  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
E0158..............  Walker leg extenders set    ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      of4.
E0159..............  Brake for wheeled walker..  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
E0160..............  Sitz type bath or           ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      equipment.
E0161..............  Sitz bath/equipment w/      ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      faucet.
E0162..............  Sitz bath chair...........  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
E0163..............  Commode chair with fixed    ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      arm.
E0165..............  Commode chair with          ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      detacharm.
E0167..............  Commode chair pail or pan.  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
E0168..............  Heavyduty/wide commode      ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      chair.
E0170..............  Commode chair electric....  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
E0171..............  Commode chair non-electric  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
E0172..............  Seat lift mechanism toilet  ..................  E.................  ...........  ...........  ...........  ...........  ...........
E0175..............  Commode chair foot rest...  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
E0181..............  Press pad alternating w/    ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      pum.
E0182..............  Replace pump, alt press     ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      pad.
E0184..............  Dry pressure mattress.....  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
E0185..............  Gel pressure mattress pad.  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
E0186..............  Air pressure mattress.....  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
E0187..............  Water pressure mattress...  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
E0188..............  Synthetic sheepskin pad...  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
E0189..............  Lambswool sheepskin pad...  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
E0190..............  Positioning cushion.......  ..................  E.................  ...........  ...........  ...........  ...........  ...........
E0191..............  Protector heel or elbow...  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
E0193..............  Powered air flotation bed.  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
E0194..............  Air fluidized bed.........  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
E0196..............  Gel pressure mattress.....  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
E0197..............  Air pressure pad for        ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      mattres.
E0198..............  Water pressure pad for      ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      mattr.
E0199..............  Dry pressure pad for        ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      mattres.
E0200..............  Heat lamp without stand...  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
E0202..............  Phototherapy light w/       ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      photom.
E0203..............  Therapeutic lightbox        CH................  E.................  ...........  ...........  ...........  ...........  ...........
                      tabletp.
E0205..............  Heat lamp with stand......  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
E0210..............  Electric heat pad standard  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
E0215..............  Electric heat pad moist...  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
E0217..............  Water circ heat pad w pump  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
E0218..............  Water circ cold pad w pump  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
E0220..............  Hot water bottle..........  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
E0221..............  Infrared heating pad        ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      system.
E0225..............  Hydrocollator unit........  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
E0230..............  Ice cap or collar.........  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
E0231..............  Wound warming device......  ..................  E.................  ...........  ...........  ...........  ...........  ...........
E0232..............  Warming card for NWT......  ..................  E.................  ...........  ...........  ...........  ...........  ...........
E0235..............  Paraffin bath unit          ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      portable.
E0236..............  Pump for water circulating  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      p.
E0238..............  Heat pad non-electric       ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      moist.
E0239..............  Hydrocollator unit          ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      portable.
E0240..............  Bath/shower chair.........  ..................  E.................  ...........  ...........  ...........  ...........  ...........
E0241..............  Bath tub wall rail........  ..................  E.................  ...........  ...........  ...........  ...........  ...........
E0242..............  Bath tub rail floor.......  ..................  E.................  ...........  ...........  ...........  ...........  ...........
E0243..............  Toilet rail...............  ..................  E.................  ...........  ...........  ...........  ...........  ...........
E0244..............  Toilet seat raised........  ..................  E.................  ...........  ...........  ...........  ...........  ...........
E0245..............  Tub stool or bench........  ..................  E.................  ...........  ...........  ...........  ...........  ...........
E0246..............  Transfer tub rail           ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      attachment.
E0247..............  Trans bench w/wo comm open  ..................  E.................  ...........  ...........  ...........  ...........  ...........
E0248..............  HDtrans bench w/wo comm     ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      open.
E0249..............  Pad water circulating heat  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      u.
E0250..............  Hosp bed fixed ht w/        ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      mattres.
E0251..............  Hosp bed fixd ht w/o        ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      mattres.
E0255..............  Hospital bed var ht w/      ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      mattr.
E0256..............  Hospital bed var ht w/o     ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      matt.
E0260..............  Hosp bed semi-electr w/     ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      matt.
E0261..............  Hosp bed semi-electr w/o    ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      mat.
E0265..............  Hosp bed total electr w/    ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      mat.
E0266..............  Hosp bed total elec w/o     ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      matt.
E0270..............  Hospital bed institutional  ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      t.
E0271..............  Mattress innerspring......  ..................  E.................  ...........  ...........  ...........  ...........  ...........
E0272..............  Mattress foam rubber......  ..................  E.................  ...........  ...........  ...........  ...........  ...........
E0273..............  Bed board.................  ..................  E.................  ...........  ...........  ...........  ...........  ...........
E0274..............  Over-bed table............  ..................  E.................  ...........  ...........  ...........  ...........  ...........
E0275..............  Bed pan standard..........  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
E0276..............  Bed pan fracture..........  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
E0277..............  Powered pres-redu air       ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      mattrs.
E0280..............  Bed cradle................  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
E0290..............  Hosp bed fx ht w/o rails w/ ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      m.
E0291..............  Hosp bed fx ht w/o rail w/  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      o.
E0292..............  Hosp bed var ht w/o rail w/ ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      o.
E0293..............  Hosp bed var ht w/o rail w/ ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      .

[[Page 67127]]

 
E0294..............  Hosp bed semi-elect w/      ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      mattr.
E0295..............  Hosp bed semi-elect w/o     ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      matt.
E0296..............  Hosp bed total elect w/     ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      matt.
E0297..............  Hosp bed total elect w/o    ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      mat.
E0300..............  Enclosed ped crib hosp      ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      grade.
E0301..............  HD hosp bed, 350-600 lbs..  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
E0302..............  Ex hd hosp bed > 600 lbs..  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
E0303..............  Hosp bed hvy dty xtra wide  ..................  E.................  ...........  ...........  ...........  ...........  ...........
E0304..............  Hosp bed xtra hvy dty x     ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      wide.
E0305..............  Rails bed side half length  ..................  E.................  ...........  ...........  ...........  ...........  ...........
E0310..............  Rails bed side full length  ..................  E.................  ...........  ...........  ...........  ...........  ...........
E0315..............  Bed accessory brd/tbl/      ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      supprt.
E0316..............  Bed safety enclosure......  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
E0325..............  Urinal male jug-type......  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
E0326..............  Urinal female jug-type....  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
E0328..............  Ped hospital bed, manual..  NI................  Y.................  ...........  ...........  ...........  ...........  ...........
E0329..............  Ped hospital bed semi/      NI................  Y.................  ...........  ...........  ...........  ...........  ...........
                      elect.
E0350..............  Control unit bowel system.  ..................  E.................  ...........  ...........  ...........  ...........  ...........
E0352..............  Disposable pack w/bowel     ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      syst.
E0370..............  Air elevator for heel.....  ..................  E.................  ...........  ...........  ...........  ...........  ...........
E0371..............  Nonpower mattress overlay.  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
E0372..............  Powered air mattress        ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      overlay.
E0373..............  Nonpowered pressure         ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      mattress.
E0424..............  Stationary compressed gas   ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      02.
E0425..............  Gas system stationary       ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      compre.
E0430..............  Oxygen system gas portable  ..................  E.................  ...........  ...........  ...........  ...........  ...........
E0431..............  Portable gaseous 02.......  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
E0434..............  Portable liquid 02........  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
E0435..............  Oxygen system liquid        ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      portabl.
E0439..............  Stationary liquid 02......  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
E0440..............  Oxygen system liquid        ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      station.
E0441..............  Oxygen contents, gaseous..  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
E0442..............  Oxygen contents, liquid...  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
E0443..............  Portable 02 contents, gas.  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
E0444..............  Portable 02 contents,       ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      liquid.
E0445..............  Oximeter non-invasive.....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
E0450..............  Vol control vent invasiv    ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      int.
E0455..............  Oxygen tent excl croup/ped  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      t.
E0457..............  Chest shell...............  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
E0459..............  Chest wrap................  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
E0460..............  Neg press vent portabl/     ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      statn.
E0461..............  Vol control vent noninv     ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      int.
E0462..............  Rocking bed w/ or w/o side  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      r.
E0463..............  Press supp vent invasive    ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      int.
E0464..............  Press supp vent noninv int  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
E0470..............  RAD w/o backup non-inv      ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      intfc.
E0471..............  RAD w/backup non inv        ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      intrfc.
E0472..............  RAD w backup invasive       ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      intrfc.
E0480..............  Percussor elect/pneum home  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      m.
E0481..............  Intrpulmnry percuss vent    ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      sys.
E0482..............  Cough stimulating device..  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
E0483..............  Chest compression gen       ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      system.
E0484..............  Non-elec oscillatory pep    ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      dvc.
E0485..............  Oral device/appliance       ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      prefab.
E0486..............  Oral device/appliance       ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      cusfab.
E0500..............  Ippb all types............  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
E0550..............  Humidif extens supple w     ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      ippb.
E0555..............  Humidifier for use w/       ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      regula.
E0560..............  Humidifier supplemental w/  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      i.
E0561..............  Humidifier nonheated w PAP  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
E0562..............  Humidifier heated used w    ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      PAP.
E0565..............  Compressor air power        ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      source.
E0570..............  Nebulizer with compression  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
E0571..............  Aerosol compressor for      ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      svneb.
E0572..............  Aerosol compressor adjust   ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      pr.
E0574..............  Ultrasonic generator w      ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      svneb.
E0575..............  Nebulizer ultrasonic......  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
E0580..............  Nebulizer for use w/        ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      regulat.
E0585..............  Nebulizer w/ compressor &   ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      he.
E0600..............  Suction pump portab hom     ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      modl.
E0601..............  Cont airway pressure        ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      device.
E0602..............  Manual breast pump........  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
E0603..............  Electric breast pump......  ..................  A.................  ...........  ...........  ...........  ...........  ...........
E0604..............  Hosp grade elec breast      ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      pump.
E0605..............  Vaporizer room type.......  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
E0606..............  Drainage board postural...  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
E0607..............  Blood glucose monitor home  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
E0610..............  Pacemaker monitr audible/   ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      vis.
E0615..............  Pacemaker monitr digital/   ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      vis.
E0616..............  Cardiac event recorder....  ..................  N.................  ...........  ...........  ...........  ...........  ...........

[[Page 67128]]

 
E0617..............  Automatic ext               ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      defibrillator.
E0618..............  Apnea monitor.............  ..................  A.................  ...........  ...........  ...........  ...........  ...........
E0619..............  Apnea monitor w recorder..  ..................  A.................  ...........  ...........  ...........  ...........  ...........
E0620..............  Cap bld skin piercing       ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      laser.
E0621..............  Patient lift sling or seat  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
E0625..............  Patient lift bathroom or    ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      toi.
E0627..............  Seat lift incorp lift-      ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      chair.
E0628..............  Seat lift for pt furn-      ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      electr.
E0629..............  Seat lift for pt furn-non-  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      el.
E0630..............  Patient lift hydraulic....  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
E0635..............  Patient lift electric.....  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
E0636..............  PT support & positioning    ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      sys.
E0637..............  Combination sit to stand    ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      sys.
E0638..............  Standing frame sys........  ..................  E.................  ...........  ...........  ...........  ...........  ...........
E0639..............  Moveable patient lift       ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      system.
E0640..............  Fixed patient lift system.  ..................  E.................  ...........  ...........  ...........  ...........  ...........
E0641..............  Multi-position stnd fram    ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      sys.
E0642..............  Dynamic standing frame....  ..................  E.................  ...........  ...........  ...........  ...........  ...........
E0650..............  Pneuma compresor non-       ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      segment.
E0651..............  Pneum compressor segmental  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
E0652..............  Pneum compres w/cal         ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      pressure.
E0655..............  Pneumatic appliance half    ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      arm.
E0660..............  Pneumatic appliance full    ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      leg.
E0665..............  Pneumatic appliance full    ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      arm.
E0666..............  Pneumatic appliance half    ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      leg.
E0667..............  Seg pneumatic appl full     ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      leg.
E0668..............  Seg pneumatic appl full     ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      arm.
E0669..............  Seg pneumatic appli half    ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      leg.
E0671..............  Pressure pneum appl full    ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      leg.
E0672..............  Pressure pneum appl full    ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      arm.
E0673..............  Pressure pneum appl half    ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      leg.
E0675..............  Pneumatic compression       ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      device.
E0676..............  Inter limb compress dev     ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      NOS.
E0691..............  Uvl pnl 2 sq ft or less...  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
E0692..............  Uvl sys panel 4 ft........  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
E0693..............  Uvl sys panel 6 ft........  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
E0694..............  Uvl md cabinet sys 6 ft...  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
E0700..............  Safety equipment..........  ..................  E.................  ...........  ...........  ...........  ...........  ...........
E0705..............  Transfer device...........  ..................  B.................  ...........  ...........  ...........  ...........  ...........
E0710..............  Restraints any type.......  ..................  E.................  ...........  ...........  ...........  ...........  ...........
E0720..............  Tens two lead.............  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
E0730..............  Tens four lead............  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
E0731..............  Conductive garment for      ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      tens/.
E0740..............  Incontinence treatment      ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      systm.
E0744..............  Neuromuscular stim for      ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      scoli.
E0745..............  Neuromuscular stim for      ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      shock.
E0746..............  Electromyograph             ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      biofeedback.
E0747..............  Elec osteogen stim not      ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      spine.
E0748..............  Elec osteogen stim spinal.  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
E0749..............  Elec osteogen stim          ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      implanted.
E0755..............  Electronic salivary reflex  ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      s.
E0760..............  Osteogen ultrasound         ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      stimltor.
E0761..............  Nontherm electromgntc       ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      device.
E0762..............  Trans elec jt stim dev sys  ..................  B.................  ...........  ...........  ...........  ...........  ...........
E0764..............  Functional                  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      neuromuscularstim.
E0765..............  Nerve stimulator for tx     ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      n&v.
E0769..............  Electric wound treatment    ..................  B.................  ...........  ...........  ...........  ...........  ...........
                      dev.
E0776..............  Iv pole...................  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
E0779..............  Amb infusion pump           ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      mechanical.
E0780..............  Mech amb infusion pump      ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      <8hrs.
E0781..............  External ambulatory infus   ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      pu.
E0782..............  Non-programble infusion     ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      pump.
E0783..............  Programmable infusion pump  ..................  N.................  ...........  ...........  ...........  ...........  ...........
E0784..............  Ext amb infusn pump         ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      insulin.
E0785..............  Replacement impl pump       ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      cathet.
E0786..............  Implantable pump            ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      replacement.
E0791..............  Parenteral infusion pump    ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      sta.
E0830..............  Ambulatory traction device  ..................  N.................  ...........  ...........  ...........  ...........  ...........
E0840..............  Tract frame attach          ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      headboard.
E0849..............  Cervical pneum trac equip.  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
E0850..............  Traction stand free         ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      standing.
E0855..............  Cervical traction           ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      equipment.
E0856..............  Cervic collar w air         NI................  Y.................  ...........  ...........  ...........  ...........  ...........
                      bladder.
E0860..............  Tract equip cervical tract  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
E0870..............  Tract frame attach          ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      footboard.
E0880..............  Trac stand free stand       ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      extrem.
E0890..............  Traction frame attach       ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      pelvic.
E0900..............  Trac stand free stand       ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      pelvic.
E0910..............  Trapeze bar attached to     ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      bed.
E0911..............  HD trapeze bar attach to    ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      bed.

[[Page 67129]]

 
E0912..............  HD trapeze bar free         ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      standing.
E0920..............  Fracture frame attached to  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      b.
E0930..............  Fracture frame free         ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      standing.
E0935..............  Cont pas motion exercise    ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      dev.
E0936..............  CPM device, other than      ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      knee.
E0940..............  Trapeze bar free standing.  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
E0941..............  Gravity assisted traction   ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      de.
E0942..............  Cervical head harness/      ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      halter.
E0944..............  Pelvic belt/harness/boot..  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
E0945..............  Belt/harness extremity....  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
E0946..............  Fracture frame dual w       ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      cross.
E0947..............  Fracture frame attachmnts   ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      pe.
E0948..............  Fracture frame attachmnts   ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      ce.
E0950..............  Tray......................  ..................  A.................  ...........  ...........  ...........  ...........  ...........
E0951..............  Loop heel.................  ..................  A.................  ...........  ...........  ...........  ...........  ...........
E0952..............  Toe loop/holder, each.....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
E0955..............  Cushioned headrest........  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
E0956..............  W/c lateral trunk/hip       ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      suppor.
E0957..............  W/c medial thigh support..  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
E0958..............  Whlchr att- conv 1 arm      ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      drive.
E0959..............  Amputee adapter...........  ..................  B.................  ...........  ...........  ...........  ...........  ...........
E0960..............  W/c shoulder harness/       ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      straps.
E0961..............  Wheelchair brake extension  ..................  B.................  ...........  ...........  ...........  ...........  ...........
E0966..............  Wheelchair head rest        ..................  B.................  ...........  ...........  ...........  ...........  ...........
                      extensi.
E0967..............  Manual wc hand rim w        ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      project.
E0968..............  Wheelchair commode seat...  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
E0969..............  Wheelchair narrowing        ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      device.
E0970..............  Wheelchair no. 2            CH................  E.................  ...........  ...........  ...........  ...........  ...........
                      footplates.
E0971..............  Wheelchair anti-tipping     ..................  B.................  ...........  ...........  ...........  ...........  ...........
                      devi.
E0973..............  W/Ch access det adj         ..................  B.................  ...........  ...........  ...........  ...........  ...........
                      armrest.
E0974..............  W/Ch access anti-rollback.  ..................  B.................  ...........  ...........  ...........  ...........  ...........
E0978..............  W/C acc,saf belt pelv       ..................  B.................  ...........  ...........  ...........  ...........  ...........
                      strap.
E0980..............  Wheelchair safety vest....  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
E0981..............  Seat upholstery,            ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      replacement.
E0982..............  Back upholstery,            ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      replacement.
E0983..............  Add pwr joystick..........  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
E0984..............  Add pwr tiller............  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
E0985..............  W/c seat lift mechanism...  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
E0986..............  Man w/c push-rim pow        ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      assist.
E0990..............  Wheelchair elevating leg    ..................  B.................  ...........  ...........  ...........  ...........  ...........
                      res.
E0992..............  Wheelchair solid seat       ..................  B.................  ...........  ...........  ...........  ...........  ...........
                      insert.
E0994..............  Wheelchair arm rest.......  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
E0995..............  Wheelchair calf rest......  ..................  B.................  ...........  ...........  ...........  ...........  ...........
E1002..............  Pwr seat tilt.............  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
E1003..............  Pwr seat recline..........  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
E1004..............  Pwr seat recline mech.....  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
E1005..............  Pwr seat recline pwr......  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
E1006..............  Pwr seat combo w/o shear..  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
E1007..............  Pwr seat combo w/shear....  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
E1008..............  Pwr seat combo pwr shear..  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
E1009..............  Add mech leg elevation....  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
E1010..............  Add pwr leg elevation.....  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
E1011..............  Ped wc modify width         ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      adjustm.
E1014..............  Reclining back add ped w/c  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
E1015..............  Shock absorber for man w/c  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
E1016..............  Shock absorber for power w/ ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      c.
E1017..............  HD shck absrbr for hd man   ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      wc.
E1018..............  HD shck absrber for hd      ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      powwc.
E1020..............  Residual limb support       ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      system.
E1028..............  W/c manual swingaway......  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
E1029..............  W/c vent tray fixed.......  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
E1030..............  W/c vent tray gimbaled....  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
E1031..............  Rollabout chair with        ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      casters.
E1035..............  Patient transfer system...  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
E1037..............  Transport chair, ped size.  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
E1038..............  Transport chair pt          ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      wt<=300lb.
E1039..............  Transport chair pt wt       ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      >300lb.
E1050..............  Whelchr fxd full length     ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      arms.
E1060..............  Wheelchair detachable arms  ..................  A.................  ...........  ...........  ...........  ...........  ...........
E1070..............  Wheelchair detachable foot  ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      r.
E1083..............  Hemi-wheelchair fixed arms  ..................  A.................  ...........  ...........  ...........  ...........  ...........
E1084..............  Hemi-wheelchair detachable  ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      a.
E1085..............  Hemi-wheelchair fixed arms  CH................  E.................  ...........  ...........  ...........  ...........  ...........
E1086..............  Hemi-wheelchair detachable  CH................  E.................  ...........  ...........  ...........  ...........  ...........
                      a.
E1087..............  Wheelchair lightwt fixed    ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      arm.
E1088..............  Wheelchair lightweight det  ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      a.
E1089..............  Wheelchair lightwt fixed    CH................  E.................  ...........  ...........  ...........  ...........  ...........
                      arm.
E1090..............  Wheelchair lightweight det  CH................  E.................  ...........  ...........  ...........  ...........  ...........
                      a.
E1092..............  Wheelchair wide w/ leg      ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      rests.
E1093..............  Wheelchair wide w/ foot     ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      rest.

[[Page 67130]]

 
E1100..............  Whchr s-recl fxd arm leg    ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      res.
E1110..............  Wheelchair semi-recl        ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      detach.
E1130..............  Whlchr stand fxd arm ft     CH................  E.................  ...........  ...........  ...........  ...........  ...........
                      rest.
E1140..............  Wheelchair standard detach  CH................  E.................  ...........  ...........  ...........  ...........  ...........
                      a.
E1150..............  Wheelchair standard w/ leg  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      r.
E1160..............  Wheelchair fixed arms.....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
E1161..............  Manual adult wc w           ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      tiltinspac.
E1170..............  Whlchr ampu fxd arm leg     ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      rest.
E1171..............  Wheelchair amputee w/o leg  ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      r.
E1172..............  Wheelchair amputee detach   ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      ar.
E1180..............  Wheelchair amputee w/ foot  ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      r.
E1190..............  Wheelchair amputee w/ leg   ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      re.
E1195..............  Wheelchair amputee heavy    ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      dut.
E1200..............  Wheelchair amputee fixed    ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      arm.
E1220..............  Whlchr special size/        ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      constrc.
E1221..............  Wheelchair spec size w      ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      foot.
E1222..............  Wheelchair spec size w/     ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      leg.
E1223..............  Wheelchair spec size w      ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      foot.
E1224..............  Wheelchair spec size w/     ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      leg.
E1225..............  Manual semi-reclining back  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
E1226..............  Manual fully reclining      ..................  B.................  ...........  ...........  ...........  ...........  ...........
                      back.
E1227..............  Wheelchair spec sz spec ht  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      a.
E1228..............  Wheelchair spec sz spec ht  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      b.
E1229..............  Pediatric wheelchair NOS..  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
E1230..............  Power operated vehicle....  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
E1231..............  Rigid ped w/c tilt-in-      ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      space.
E1232..............  Folding ped wc tilt-in-     ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      space.
E1233..............  Rig ped wc tltnspc w/o      ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      seat.
E1234..............  Fld ped wc tltnspc w/o      ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      seat.
E1235..............  Rigid ped wc adjustable...  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
E1236..............  Folding ped wc adjustable.  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
E1237..............  Rgd ped wc adjstabl w/o     ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      seat.
E1238..............  Fld ped wc adjstabl w/o     ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      seat.
E1239..............  Ped power wheelchair NOS..  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
E1240..............  Whchr litwt det arm leg     ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      rest.
E1250..............  Wheelchair lightwt fixed    CH................  E.................  ...........  ...........  ...........  ...........  ...........
                      arm.
E1260..............  Wheelchair lightwt foot     CH................  E.................  ...........  ...........  ...........  ...........  ...........
                      rest.
E1270..............  Wheelchair lightweight leg  ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      r.
E1280..............  Whchr h-duty det arm leg    ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      res.
E1285..............  Wheelchair heavy duty       CH................  E.................  ...........  ...........  ...........  ...........  ...........
                      fixed.
E1290..............  Wheelchair hvy duty detach  CH................  E.................  ...........  ...........  ...........  ...........  ...........
                      a.
E1295..............  Wheelchair heavy duty       ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      fixed.
E1296..............  Wheelchair special seat     ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      heig.
E1297..............  Wheelchair special seat     ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      dept.
E1298..............  Wheelchair spec seat depth/ ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      w.
E1300..............  Whirlpool portable........  ..................  E.................  ...........  ...........  ...........  ...........  ...........
E1310..............  Whirlpool non-portable....  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
E1340..............  Repair for DME, per 15 min  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
E1353..............  Oxygen supplies regulator.  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
E1355..............  Oxygen supplies stand/rack  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
E1372..............  Oxy suppl heater for        ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      nebuliz.
E1390..............  Oxygen concentrator.......  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
E1391..............  Oxygen concentrator, dual.  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
E1392..............  Portable oxygen             ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      concentrator.
E1399..............  Durable medical equipment   ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      mi.
E1405..............  O2/water vapor enrich w/    ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      heat.
E1406..............  O2/water vapor enrich w/o   ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      he.
E1500..............  Centrifuge................  ..................  A.................  ...........  ...........  ...........  ...........  ...........
E1510..............  Kidney dialysate delivry    ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      sys.
E1520..............  Heparin infusion pump.....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
E1530..............  Replacement air bubble      ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      detec.
E1540..............  Replacement pressure alarm  ..................  A.................  ...........  ...........  ...........  ...........  ...........
E1550..............  Bath conductivity meter...  ..................  A.................  ...........  ...........  ...........  ...........  ...........
E1560..............  Replace blood leak          ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      detector.
E1570..............  Adjustable chair for esrd   ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      pt.
E1575..............  Transducer protect/fld bar  ..................  A.................  ...........  ...........  ...........  ...........  ...........
E1580..............  Unipuncture control system  ..................  A.................  ...........  ...........  ...........  ...........  ...........
E1590..............  Hemodialysis machine......  ..................  A.................  ...........  ...........  ...........  ...........  ...........
E1592..............  Auto interm peritoneal      ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      dialy.
E1594..............  Cycler dialysis machine...  ..................  A.................  ...........  ...........  ...........  ...........  ...........
E1600..............  Deli/install chrg hemo      ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      equip.
E1610..............  Reverse osmosis h2o puri    ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      sys.
E1615..............  Deionizer H2O puri system.  ..................  A.................  ...........  ...........  ...........  ...........  ...........
E1620..............  Replacement blood pump....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
E1625..............  Water softening system....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
E1630..............  Reciprocating peritoneal    ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      dia.
E1632..............  Wearable artificial kidney  ..................  A.................  ...........  ...........  ...........  ...........  ...........
E1634..............  Peritoneal dialysis clamp.  ..................  B.................  ...........  ...........  ...........  ...........  ...........
E1635..............  Compact travel              ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      hemodialyzer.
E1636..............  Sorbent cartridges per 10.  ..................  A.................  ...........  ...........  ...........  ...........  ...........

[[Page 67131]]

 
E1637..............  Hemostats for dialysis,     ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      each.
E1639..............  Dialysis scale............  ..................  A.................  ...........  ...........  ...........  ...........  ...........
E1699..............  Dialysis equipment noc....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
E1700..............  Jaw motion rehab system...  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
E1701..............  Repl cushions for jaw       ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      motion.
E1702..............  Repl measr scales jaw       ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      motion.
E1800..............  Adjust elbow ext/flex       ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      device.
E1801..............  SPS elbow device..........  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
E1802..............  Adjst forearm pro/sup       ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      device.
E1805..............  Adjust wrist ext/flex       ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      device.
E1806..............  SPS wrist device..........  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
E1810..............  Adjust knee ext/flex        ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      device.
E1811..............  SPS knee device...........  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
E1812..............  Knee ext/flex w act res     ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      ctrl.
E1815..............  Adjust ankle ext/flex       ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      device.
E1816..............  SPS ankle device..........  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
E1818..............  SPS forearm device........  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
E1820..............  Soft interface material...  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
E1821..............  Replacement interface SPSD  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
E1825..............  Adjust finger ext/flex      ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      devc.
E1830..............  Adjust toe ext/flex device  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
E1840..............  Adj shoulder ext/flex       ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      device.
E1841..............  Static str shldr dev rom    ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      adj.
E1902..............  AAC non-electronic board..  ..................  A.................  ...........  ...........  ...........  ...........  ...........
E2000..............  Gastric suction pump hme    ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      mdl.
E2100..............  Bld glucose monitor w       ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      voice.
E2101..............  Bld glucose monitor w       ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      lance.
E2120..............  Pulse gen sys tx endolymp   ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      fl.
E2201..............  Man w/ch acc seat w>=20/    ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      <24/.
E2202..............  Seat width 24-27 in.......  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
E2203..............  Frame depth less than 22    ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      in.
E2204..............  Frame depth 22 to 25 in...  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
E2205..............  Manual wc accessory,        ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      handrim.
E2206..............  Complete wheel lock         ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      assembly.
E2207..............  Crutch and cane holder....  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
E2208..............  Cylinder tank carrier.....  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
E2209..............  Arm trough each...........  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
E2210..............  Wheelchair bearings.......  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
E2211..............  Pneumatic propulsion tire.  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
E2212..............  Pneumatic prop tire tube..  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
E2213..............  Pneumatic prop tire insert  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
E2214..............  Pneumatic caster tire each  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
E2215..............  Pneumatic caster tire tube  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
E2216..............  Foam filled propulsion      ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      tire.
E2217..............  Foam filled caster tire     ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      each.
E2218..............  Foam propulsion tire each.  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
E2219..............  Foam caster tire any size   ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      ea.
E2220..............  Solid propulsion tire each  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
E2221..............  Solid caster tire each....  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
E2222..............  Solid caster integrated     ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      whl.
E2223..............  Valve replacement only      ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      each.
E2224..............  Propulsion whl excludes     ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      tire.
E2225..............  Caster wheel excludes tire  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
E2226..............  Caster fork replacement     ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      only.
E2227..............  Gear reduction drive wheel  NI................  Y.................  ...........  ...........  ...........  ...........  ...........
E2228..............  Mwc acc, wheelchair brake.  NI................  Y.................  ...........  ...........  ...........  ...........  ...........
E2291..............  Planar back for ped size    ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      wc.
E2292..............  Planar seat for ped size    ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      wc.
E2293..............  Contour back for ped size   ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      wc.
E2294..............  Contour seat for ped size   ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      wc.
E2300..............  Pwr seat elevation sys....  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
E2301..............  Pwr standing..............  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
E2310..............  Electro connect btw         ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      control.
E2311..............  Electro connect btw 2 sys.  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
E2312..............  Mini-prop remote joystick.  NI................  Y.................  ...........  ...........  ...........  ...........  ...........
E2313..............  PWC harness, expand         NI................  Y.................  ...........  ...........  ...........  ...........  ...........
                      control.
E2321..............  Hand interface joystick...  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
E2322..............  Mult mech switches........  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
E2323..............  Special joystick handle...  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
E2324..............  Chin cup interface........  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
E2325..............  Sip and puff interface....  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
E2326..............  Breath tube kit...........  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
E2327..............  Head control interface      ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      mech.
E2328..............  Head/extremity control      ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      inter.
E2329..............  Head control                ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      nonproportional.
E2330..............  Head control proximity      ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      switc.
E2331..............  Attendant control.........  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
E2340..............  W/c wdth 20-23 in seat      ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      frame.
E2341..............  W/c wdth 24-27 in seat      ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      frame.
E2342..............  W/c dpth 20-21 in seat      ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      frame.

[[Page 67132]]

 
E2343..............  W/c dpth 22-25 in seat      ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      frame.
E2351..............  Electronic SGD interface..  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
E2360..............  22nf nonsealed leadacid...  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
E2361..............  22nf sealed leadacid        ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      battery.
E2362..............  Gr24 nonsealed leadacid...  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
E2363..............  Gr24 sealed leadacid        ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      battery.
E2364..............  U1nonsealed leadacid        ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      battery.
E2365..............  U1 sealed leadacid battery  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
E2366..............  Battery charger, single     ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      mode.
E2367..............  Battery charger, dual mode  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
E2368..............  Power wc motor replacement  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
E2369..............  Pwr wc gear box             ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      replacement.
E2370..............  Pwr wc motor/gear box       ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      combo.
E2371..............  Gr27 sealed leadacid        ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      battery.
E2372..............  Gr27 non-sealed leadacid..  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
E2373..............  Hand/chin ctrl spec         ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      joystick.
E2374..............  Hand/chin ctrl std          ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      joystick.
E2375..............  Non-expandable controller.  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
E2376..............  Expandable controller,      ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      repl.
E2377..............  Expandable controller,      ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      initl.
E2381..............  Pneum drive wheel tire....  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
E2382..............  Tube, pneum wheel drive     ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      tire.
E2383..............  Insert, pneum wheel drive.  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
E2384..............  Pneumatic caster tire.....  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
E2385..............  Tube, pneumatic caster      ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      tire.
E2386..............  Foam filled drive wheel     ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      tire.
E2387..............  Foam filled caster tire...  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
E2388..............  Foam drive wheel tire.....  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
E2389..............  Foam caster tire..........  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
E2390..............  Solid drive wheel tire....  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
E2391..............  Solid caster tire.........  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
E2392..............  Solid caster tire,          ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      integrate.
E2393..............  Valve, pneumatic tire tube  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
E2394..............  Drive wheel excludes tire.  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
E2395..............  Caster wheel excludes tire  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
E2396..............  Caster fork...............  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
E2397..............  Pwc acc, lith-based         NI................  Y.................  ...........  ...........  ...........  ...........  ...........
                      battery.
E2399..............  Noc interface.............  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
E2402..............  Neg press wound therapy     ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      pump.
E2500..............  SGD digitized pre-rec       ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      <=8min.
E2502..............  SGD prerec msg >8min        ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      <=20min.
E2504..............  SGD prerec msg>20min        ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      <=40min.
E2506..............  SGD prerec msg > 40 min...  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
E2508..............  SGD spelling phys contact.  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
E2510..............  SGD w multi methods msg/    ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      accs.
E2511..............  SGD sftwre prgrm for PC/    ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      PDA.
E2512..............  SGD accessory, mounting     ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      sys.
E2599..............  SGD accessory noc.........  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
E2601..............  Gen w/c cushion wdth < 22   ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      in.
E2602..............  Gen w/c cushion wdth >=22   ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      in.
E2603..............  Skin protect wc cus wd      ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      <22in.
E2604..............  Skin protect wc cus         ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      wd>=22in.
E2605..............  Position wc cush wdth <22   ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      in.
E2606..............  Position wc cush wdth>=22   ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      in.
E2607..............  Skin pro/pos wc cus wd      ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      <22in.
E2608..............  Skin pro/pos wc cus         ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      wd>=22in.
E2609..............  Custom fabricate w/c        ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      cushion.
E2610..............  Powered w/c cushion.......  ..................  B.................  ...........  ...........  ...........  ...........  ...........
E2611..............  Gen use back cush wdth      ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      <22in.
E2612..............  Gen use back cush           ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      wdth>=22in.
E2613..............  Position back cush wd       ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      <22in.
E2614..............  Position back cush          ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      wd>=22in.
E2615..............  Pos back post/lat wdth      ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      <22in.
E2616..............  Pos back post/lat           ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      wdth>=22in.
E2617..............  Custom fab w/c back         ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      cushion.
E2618..............  Wc acc solid seat supp      CH................  D.................  ...........  ...........  ...........  ...........  ...........
                      base.
E2619..............  Replace cover w/c seat      ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      cush.
E2620..............  WC planar back cush wd      ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      <22in.
E2621..............  WC planar back cush         ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      wd>=22in.
E8000..............  Posterior gait trainer....  ..................  E.................  ...........  ...........  ...........  ...........  ...........
E8001..............  Upright gait trainer......  ..................  E.................  ...........  ...........  ...........  ...........  ...........
E8002..............  Anterior gait trainer.....  ..................  E.................  ...........  ...........  ...........  ...........  ...........
G0008..............  Admin influenza virus vac.  ..................  S.................         0350       0.3945       $25.13  ...........  ...........
G0009..............  Admin pneumococcal vaccine  ..................  S.................         0350       0.3945       $25.13  ...........  ...........
G0010..............  Admin hepatitis b vaccine.  ..................  B.................  ...........  ...........  ...........  ...........  ...........
G0027..............  Semen analysis............  ..................  A.................  ...........  ...........  ...........  ...........  ...........
G0101..............  CA screen;pelvic/breast     ..................  V.................         0604       0.8388       $53.43  ...........       $10.69
                      exam.
G0102..............  Prostate ca screening; dre  ..................  N.................  ...........  ...........  ...........  ...........  ...........
G0103..............  PSA screening.............  ..................  A.................  ...........  ...........  ...........  ...........  ...........
G0104..............  CA screen;flexi             ..................  S.................         0159       4.7010      $299.43  ...........       $74.86
                      sigmoidscope.

[[Page 67133]]

 
G0105..............  Colorectal scrn; hi risk    ..................  T.................         0158       7.8504      $500.02  ...........      $125.01
                      ind.
G0106..............  Colon CA screen;barium      ..................  S.................         0157       2.0651      $131.53  ...........       $26.31
                      enema.
G0108..............  Diab manage trn per indiv.  ..................  A.................  ...........  ...........  ...........  ...........  ...........
G0109..............  Diab manage trn ind/group.  ..................  A.................  ...........  ...........  ...........  ...........  ...........
G0117..............  Glaucoma scrn hgh risk      CH................  S.................         0698       0.8696       $55.39  ...........       $11.08
                      direc.
G0118..............  Glaucoma scrn hgh risk      ..................  S.................         0230       0.5903       $37.60  ...........        $7.52
                      direc.
G0120..............  Colon ca scrn; barium       ..................  S.................         0157       2.0651      $131.53  ...........       $26.31
                      enema.
G0121..............  Colon ca scrn not hi rsk    ..................  T.................         0158       7.8504      $500.02  ...........      $125.01
                      ind.
G0122..............  Colon ca scrn; barium       ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      enema.
G0123..............  Screen cerv/vag thin layer  ..................  A.................  ...........  ...........  ...........  ...........  ...........
G0124..............  Screen c/v thin layer by    ..................  B.................  ...........  ...........  ...........  ...........  ...........
                      MD.
G0127..............  Trim nail(s)..............  CH................  T.................         0013       0.7930       $50.51  ...........       $10.10
G0128..............  CORF skilled nursing        ..................  B.................  ...........  ...........  ...........  ...........  ...........
                      service.
G0129..............  Partial hosp prog service.  ..................  P.................         0033  ...........  ...........  ...........  ...........
G0130..............  Single energy x-ray study.  ..................  X.................         0260       0.6954       $44.29  ...........        $8.86
G0141..............  Scr c/v cyto,autosys and    ..................  B.................  ...........  ...........  ...........  ...........  ...........
                      md.
G0143..............  Scr c/v                     ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      cyto,thinlayer,rescr.
G0144..............  Scr c/v                     ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      cyto,thinlayer,rescr.
G0145..............  Scr c/v                     ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      cyto,thinlayer,rescr.
G0147..............  Scr c/v cyto, automated     ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      sys.
G0148..............  Scr c/v cyto, autosys,      ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      rescr.
G0151..............  HHCP-serv of pt,ea 15 min.  ..................  B.................  ...........  ...........  ...........  ...........  ...........
G0152..............  HHCP-serv of ot,ea 15 min.  ..................  B.................  ...........  ...........  ...........  ...........  ...........
G0153..............  HHCP-svs of s/l path,ea     ..................  B.................  ...........  ...........  ...........  ...........  ...........
                      15mn.
G0154..............  HHCP-svs of rn,ea 15 min..  ..................  B.................  ...........  ...........  ...........  ...........  ...........
G0155..............  HHCP-svs of csw,ea 15 min.  ..................  B.................  ...........  ...........  ...........  ...........  ...........
G0156..............  HHCP-svs of aide,ea 15 min  ..................  B.................  ...........  ...........  ...........  ...........  ...........
G0166..............  Extrnl counterpulse, per    ..................  T.................         0678       1.7187      $109.47  ...........       $21.89
                      tx.
G0168..............  Wound closure by adhesive.  ..................  B.................  ...........  ...........  ...........  ...........  ...........
G0173..............  Linear acc stereo radsur    ..................  S.................         0067      61.6965    $3,929.70  ...........      $785.94
                      com.
G0175..............  OPPS Service,sched team     ..................  V.................         0608       2.1740      $138.47  ...........       $27.69
                      conf.
G0176..............  OPPS/PHP;activity therapy.  ..................  P.................         0033  ...........  ...........  ...........  ...........
G0177..............  OPPS/PHP; train & educ      CH................  N.................  ...........  ...........  ...........  ...........  ...........
                      serv.
G0179..............  MD recertification HHA PT.  ..................  M.................  ...........  ...........  ...........  ...........  ...........
G0180..............  MD certification HHA        ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      patient.
G0181..............  Home health care            ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      supervision.
G0182..............  Hospice care supervision..  ..................  M.................  ...........  ...........  ...........  ...........  ...........
G0186..............  Dstry eye lesn,fdr vssl     ..................  T.................         0235       4.1331      $263.25       $58.93       $52.65
                      tech.
G0202..............  Screeningmammographydigita  ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      l.
G0204..............  Diagnosticmammographydigit  ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      al.
G0206..............  Diagnosticmammographydigit  ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      al.
G0219..............  PET img wholbod melano      ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      nonco.
G0235..............  PET not otherwise           ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      specified.
G0237..............  Therapeutic procd strg      CH................  S.................         0077       0.3877       $24.69        $7.74        $4.94
                      endur.
G0238..............  Oth resp proc, indiv......  CH................  S.................         0077       0.3877       $24.69        $7.74        $4.94
G0239..............  Oth resp proc, group......  CH................  S.................         0077       0.3877       $24.69        $7.74        $4.94
G0245..............  Initial foot exam pt lops.  ..................  V.................         0604       0.8388       $53.43  ...........       $10.69
G0246..............  Followup eval of foot pt    ..................  V.................         0605       0.9964       $63.46  ...........       $12.69
                      lop.
G0247..............  Routine footcare pt w lops  CH................  T.................         0013       0.7930       $50.51  ...........       $10.10
G0248..............  Demonstrate use home inr    CH................  V.................         0607       1.6604      $105.76  ...........       $21.15
                      mon.
G0249..............  Provide test                CH................  V.................         0607       1.6604      $105.76  ...........       $21.15
                      material,equipm.
G0250..............  MD review interpret of      ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      test.
G0251..............  Linear acc based stero      ..................  S.................         0065      16.5911    $1,056.75  ...........      $211.35
                      radio.
G0252..............  PET imaging initial dx....  ..................  E.................  ...........  ...........  ...........  ...........  ...........
G0255..............  Current percep threshold    ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      tst.
G0257..............  Unsched dialysis ESRD pt    ..................  S.................         0170       6.5383      $416.45  ...........       $83.29
                      hos.
G0259..............  Inject for sacroiliac       ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      joint.
G0260..............  Inj for sacroiliac jt       CH................  T.................         0207       7.0546      $449.34  ...........       $89.87
                      anesth.
G0265..............  Cryopresevation             CH................  D.................  ...........  ...........  ...........  ...........  ...........
                      Freeze+stora.
G0266..............  Thawing + expansion froz    CH................  D.................  ...........  ...........  ...........  ...........  ...........
                      cel.
G0267..............  Bone marrow or psc harvest  CH................  D.................  ...........  ...........  ...........  ...........  ...........
G0268..............  Removal of impacted wax md  CH................  N.................  ...........  ...........  ...........  ...........  ...........
G0269..............  Occlusive device in vein    ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      art.
G0270..............  MNT subs tx for change dx.  ..................  A.................  ...........  ...........  ...........  ...........  ...........
G0271..............  Group MNT 2 or more 30      ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      mins.
G0275..............  Renal angio, cardiac cath.  ..................  N.................  ...........  ...........  ...........  ...........  ...........
G0278..............  Iliac art angio,cardiac     ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      cath.
G0281..............  Elec stim unattend for      ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      press.
G0282..............  Elect stim wound care not   ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      pd.
G0283..............  Elec stim other than wound  ..................  A.................  ...........  ...........  ...........  ...........  ...........
G0288..............  Recon, CTA for surg plan..  CH................  N.................  ...........  ...........  ...........  ...........  ...........
G0289..............  Arthro, loose body +        ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      chondro.
G0290..............  Drug-eluting stents,        ..................  T.................         0656     118.4265    $7,543.06  ...........    $1,508.61
                      single.
G0291..............  Drug-eluting stents,each    ..................  T.................         0656     118.4265    $7,543.06  ...........    $1,508.61
                      add.
G0293..............  Non-cov surg proc,clin      ..................  X.................         0340       0.6310       $40.19  ...........        $8.04
                      trial.
G0294..............  Non-cov proc, clinical      ..................  X.................         0340       0.6310       $40.19  ...........        $8.04
                      trial.
G0295..............  Electromagnetic therapy     ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      onc.
G0297..............  Insert single chamber/cd..  CH................  D.................  ...........  ...........  ...........  ...........  ...........
G0298..............  Insert dual chamber/cd....  CH................  D.................  ...........  ...........  ...........  ...........  ...........
G0299..............  Inser/repos single          CH................  D.................  ...........  ...........  ...........  ...........  ...........
                      icd+leads.

[[Page 67134]]

 
G0300..............  Insert reposit lead         CH................  D.................  ...........  ...........  ...........  ...........  ...........
                      dual+gen.
G0302..............  Pre-op service LVRS         CH................  S.................         0209      11.2822      $718.61      $268.73      $143.72
                      complete.
G0303..............  Pre-op service LVRS 10-     CH................  S.................         0209      11.2822      $718.61      $268.73      $143.72
                      15dos.
G0304..............  Pre-op service LVRS 1-9     CH................  S.................         0213       2.2980      $146.37       $53.58       $29.27
                      dos.
G0305..............  Post op service LVRS min 6  CH................  S.................         0213       2.2980      $146.37       $53.58       $29.27
G0306..............  CBC/diffwbc w/o platelet..  ..................  A.................  ...........  ...........  ...........  ...........  ...........
G0307..............  CBC without platelet......  ..................  A.................  ...........  ...........  ...........  ...........  ...........
G0308..............  ESRD related svc 4+mo <     ..................  B.................  ...........  ...........  ...........  ...........  ...........
                      2yrs.
G0309..............  ESRD related svc 2-3mo      ..................  B.................  ...........  ...........  ...........  ...........  ...........
                      <2yrs.
G0310..............  ESRD related svc 1 vst      ..................  B.................  ...........  ...........  ...........  ...........  ...........
                      <2yrs.
G0311..............  ESRD related svs 4+mo 2-    ..................  B.................  ...........  ...........  ...........  ...........  ...........
                      11yr.
G0312..............  ESRD relate svs 2-3 mo 2-   ..................  B.................  ...........  ...........  ...........  ...........  ...........
                      11y.
G0313..............  ESRD related svs 1 mon 2-   ..................  B.................  ...........  ...........  ...........  ...........  ...........
                      11y.
G0314..............  ESRD related svs 4+ mo 12-  ..................  B.................  ...........  ...........  ...........  ...........  ...........
                      19.
G0315..............  ESRD related svs 2-3mo/12-  ..................  B.................  ...........  ...........  ...........  ...........  ...........
                      19.
G0316..............  ESRD related svs 1vis/12-   ..................  B.................  ...........  ...........  ...........  ...........  ...........
                      19y.
G0317..............  ESRD related svs 4+mo       ..................  B.................  ...........  ...........  ...........  ...........  ...........
                      20+yrs.
G0318..............  ESRD related svs 2-3 mo     ..................  B.................  ...........  ...........  ...........  ...........  ...........
                      20+y.
G0319..............  ESRD related svs 1visit     ..................  B.................  ...........  ...........  ...........  ...........  ...........
                      20+y.
G0320..............  ESD related svs home undr   ..................  B.................  ...........  ...........  ...........  ...........  ...........
                      2.
G0321..............  ESRDrelatedsvs home mo 2-   ..................  B.................  ...........  ...........  ...........  ...........  ...........
                      11y.
G0322..............  ESRD related svs hom mo12-  ..................  B.................  ...........  ...........  ...........  ...........  ...........
                      19.
G0323..............  ESRD related svs home mo    ..................  B.................  ...........  ...........  ...........  ...........  ...........
                      20+.
G0324..............  ESRD relate svs home/dy     ..................  B.................  ...........  ...........  ...........  ...........  ...........
                      <2yr.
G0325..............  ESRD relate home/day/ 2-    ..................  B.................  ...........  ...........  ...........  ...........  ...........
                      11yr.
G0326..............  ESRD relate home/dy 12-     ..................  B.................  ...........  ...........  ...........  ...........  ...........
                      19yr.
G0327..............  ESRD relate home/dy 20+yrs  ..................  B.................  ...........  ...........  ...........  ...........  ...........
G0328..............  Fecal blood scrn            ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      immunoassay.
G0329..............  Electromagntic tx for       ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      ulcers.
G0332..............  Preadmin IV immunoglobulin  CH................  S.................         0430       0.5921       $37.71  ...........        $7.54
G0333..............  Dispense fee initial 30     ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      day.
G0337..............  Hospice evaluation          ..................  B.................  ...........  ...........  ...........  ...........  ...........
                      preelecti.
G0339..............  Robot lin-radsurg com,      ..................  S.................         0067      61.6965    $3,929.70  ...........      $785.94
                      first.
G0340..............  Robt lin-radsurg fractx 2-  ..................  S.................         0066      45.0693    $2,870.64  ...........      $574.13
                      5.
G0341..............  Percutaneous islet          ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      celltrans.
G0342..............  Laparoscopy islet cell      ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      trans.
G0343..............  Laparotomy islet cell       ..................  C.................  ...........  ...........  ...........  ...........  ...........
                      transp.
G0344..............  Initial preventive exam...  ..................  V.................         0605       0.9964       $63.46  ...........       $12.69
G0364..............  Bone marrow aspirate        ..................  T.................         0002       1.1097       $70.68  ...........       $14.14
                      &biopsy.
G0365..............  Vessel mapping hemo access  ..................  S.................         0267       2.3792      $151.54       $60.50       $30.31
G0366..............  EKG for initial prevent     ..................  B.................  ...........  ...........  ...........  ...........  ...........
                      exam.
G0367..............  EKG tracing for initial     ..................  S.................         0099       0.3892       $24.79  ...........        $4.96
                      prev.
G0368..............  EKG interpret & report      ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      preve.
G0372..............  MD service required for     ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      PMD.
G0375..............  Smoke/tobacco counselng 3-  CH................  D.................  ...........  ...........  ...........  ...........  ...........
                      10.
G0376..............  Smoke/tobacco counseling    CH................  D.................  ...........  ...........  ...........  ...........  ...........
                      >10.
G0377..............  Administra Part D vaccine.  ..................  S.................         0437       0.3945       $25.13  ...........        $5.03
G0378..............  Hospital observation per    CH................  N.................  ...........  ...........  ...........  ...........  ...........
                      hr.
G0379..............  Direct admit hospital       CH................  Q.................         0604       0.8388       $53.43  ...........       $10.69
                      observ.
G0380..............  Lev 1 hosp type B ED visit  ..................  V.................         0604       0.8388       $53.43  ...........       $10.69
G0381..............  Lev 2 hosp type B ED visit  ..................  V.................         0605       0.9964       $63.46  ...........       $12.69
G0382..............  Lev 3 hosp type B ED visit  ..................  V.................         0606       1.3226       $84.24  ...........       $16.85
G0383..............  Lev 4 hosp type B ED visit  ..................  V.................         0607       1.6604      $105.76  ...........       $21.15
G0384..............  Lev 5 hosp type B ED visit  ..................  V.................         0608       2.1740      $138.47  ...........       $27.69
G0389..............  Ultrasound exam AAA screen  ..................  S.................         0266       1.5094       $96.14       $37.80       $19.23
G0390..............  Trauma Respons w/hosp       ..................  S.................         0618       5.1854      $330.28      $132.11       $66.06
                      criti.
G0392..............  AV fistula or graft         CH................  T.................         0083      45.3845    $2,890.72  ...........      $578.14
                      arterial.
G0393..............  AV fistula or graft venous  CH................  T.................         0083      45.3845    $2,890.72  ...........      $578.14
G0394..............  Blood occult                ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      test,colorectal.
G0396..............  Alcohol/subs interv 15-     NI................  S.................         0432       0.3128       $19.92  ...........        $3.98
                      30mn.
G0397..............  Alcohol/subs interv >30     NI................  S.................         0432       0.3128       $19.92  ...........        $3.98
                      min.
G3001..............  Admin + supply,             ..................  S.................         0442      27.4298    $1,747.11  ...........      $349.42
                      tositumomab.
G8006..............  AMI pt recd aspirin at      ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      arriv.
G8007..............  AMI pt did not receiv       ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      aspiri.
G8008..............  AMI pt ineligible for       ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      aspiri.
G8009..............  AMI pt recd Bblock at arr.  ..................  M.................  ...........  ...........  ...........  ...........  ...........
G8010..............  AMI pt did not rec bblock.  ..................  M.................  ...........  ...........  ...........  ...........  ...........
G8011..............  AMI pt inelig Bbloc at      ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      arriv.
G8012..............  Pneum pt recv antibiotic 4  ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      h.
G8013..............  Pneum pt w/o antibiotic 4   ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      hr.
G8014..............  Pneum pt not elig           ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      antibiotic.
G8015..............  Diabetic pt w/ HBA1c>9%...  ..................  M.................  ...........  ...........  ...........  ...........  ...........
G8016..............  Diabetic pt w/ HBA1c= 100mg/  ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      dl.
G8020..............  Diab pt w/LDL< 100mg/dl...  ..................  M.................  ...........  ...........  ...........  ...........  ...........
G8021..............  Diab pt inelig for LDL      ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      meas.
G8022..............  Care not provided for LDL.  ..................  M.................  ...........  ...........  ...........  ...........  ...........
G8023..............  DM pt w BP>=140/80........  ..................  M.................  ...........  ...........  ...........  ...........  ...........

[[Page 67135]]

 
G8024..............  Diabetic pt wBP<140/80....  ..................  M.................  ...........  ...........  ...........  ...........  ...........
G8025..............  Diabetic pt inelig for BP   ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      me.
G8026..............  Diabet pt w no care re BP   ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      me.
G8027..............  HF p w/LVSD on ACE-I/ARB..  ..................  M.................  ...........  ...........  ...........  ...........  ...........
G8028..............  HF pt w/LVSD not on ACE-I/  ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      AR.
G8029..............  HF pt not elig for ACE-I/   ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      ARB.
G8030..............  HF pt w/LVSD on Bblocker..  ..................  M.................  ...........  ...........  ...........  ...........  ...........
G8031..............  HF pt w/LVSD not on         ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      Bblocker.
G8032..............  HF pt not elig for          ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      Bblocker.
G8033..............  PMI-CAD pt on Bblocker....  ..................  M.................  ...........  ...........  ...........  ...........  ...........
G8034..............  PMI-CAD pt not on Bblocker  ..................  M.................  ...........  ...........  ...........  ...........  ...........
G8035..............  PMI-CAD pt inelig Bblocker  ..................  M.................  ...........  ...........  ...........  ...........  ...........
G8036..............  AMI-CAD pt doc on           ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      antiplatel.
G8037..............  AMI-CAD pt not docu on      ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      antip.
G8038..............  AMI-CAD inelig antiplate    ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      mea.
G8039..............  CAD pt w/LDL>100mg/dl.....  ..................  M.................  ...........  ...........  ...........  ...........  ...........
G8040..............  CAD pt w/LDL=65%.
G8076..............  ESRD pt w/ dialy of         ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      URR<65%.
G8077..............  ESRD pt not elig for URR/   ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      KtV.
G8078..............  ESRD pt w/Hct>or=33.......  ..................  M.................  ...........  ...........  ...........  ...........  ...........
G8079..............  ESRD pt w/Hct<33..........  ..................  M.................  ...........  ...........  ...........  ...........  ...........
G8080..............  ESRD pt inelig for HCT/Hgb  ..................  M.................  ...........  ...........  ...........  ...........  ...........
G8081..............  ESRD pt w/ auto AV fistula  ..................  M.................  ...........  ...........  ...........  ...........  ...........
G8082..............  ESRD pt w other fistula...  ..................  M.................  ...........  ...........  ...........  ...........  ...........
G8085..............  ESRD PT inelig auto AV      ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      FISTU.
G8093..............  COPD pt rec smoking cessat  ..................  M.................  ...........  ...........  ...........  ...........  ...........
G8094..............  COPD pt w/o smoke cessat    ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      int.
G8099..............  Osteopo pt given Ca+VitD    ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      sup.
G8100..............  Osteop pt inelig for        ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      Ca+VitD.
G8103..............  New dx osteo pt w/          ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      antiresorp.
G8104..............  Osteo pt inelig for         ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      antireso.
G8106..............  Bone dens meas test perf..  ..................  M.................  ...........  ...........  ...........  ...........  ...........
G8107..............  Bone dens meas test inelig  ..................  M.................  ...........  ...........  ...........  ...........  ...........
G8108..............  Pt receiv influenza vacc..  ..................  M.................  ...........  ...........  ...........  ...........  ...........
G8109..............  Pt w/o influenza vacc.....  ..................  M.................  ...........  ...........  ...........  ...........  ...........
G8110..............  Pt inelig for influenza     ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      vacc.
G8111..............  Pt receiv mammogram.......  ..................  M.................  ...........  ...........  ...........  ...........  ...........
G8112..............  Pt not doc mammogram......  ..................  M.................  ...........  ...........  ...........  ...........  ...........
G8113..............  Pt ineligible mammography.  ..................  M.................  ...........  ...........  ...........  ...........  ...........
G8114..............  Care not provided for       ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      mamogr.
G8115..............  Pt receiv pneumo vacc.....  ..................  M.................  ...........  ...........  ...........  ...........  ...........
G8116..............  Pt did not rec pneumo vacc  ..................  M.................  ...........  ...........  ...........  ...........  ...........
G8117..............  Pt was inelig for pneumo    ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      vac.
G8126..............  Pt treat w/                 ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      antidepress12wks.
G8127..............  Pt not treat w/             ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      antidepres12w.
G8128..............  Pt inelig for antidepres    ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      med.
G8129..............  Pt treat w/antidepres for   ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      6m.
G8130..............  Pt not treat w/antidepres   ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      6m.
G8131..............  Pt inelig for antidepres    ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      med.
G8152..............  Pt w/AB 1 hr prior to       ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      incisi.
G8153..............  Pt not doc for AB 1 hr      ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      prior.
G8154..............  Pt ineligi for AB therapy.  ..................  M.................  ...........  ...........  ...........  ...........  ...........
G8155..............  Pt recd thromboemb          ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      prophylax.
G8156..............  Pt did not rec thromboembo  ..................  M.................  ...........  ...........  ...........  ...........  ...........
G8157..............  Pt ineligi for thrombolism  ..................  M.................  ...........  ...........  ...........  ...........  ...........
G8159..............  Pt w/CABG w/o IMA.........  ..................  M.................  ...........  ...........  ...........  ...........  ...........
G8162..............  Iso CABG pt w/o preop       ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      Bblock.
G8164..............  Iso CABG pt w/prolng intub  ..................  M.................  ...........  ...........  ...........  ...........  ...........
G8165..............  Iso CABG pt w/o prolng      ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      intub.
G8166..............  Iso CABG req surg rexpo...  ..................  M.................  ...........  ...........  ...........  ...........  ...........
G8167..............  Iso CABG w/o surg explo...  ..................  M.................  ...........  ...........  ...........  ...........  ...........
G8170..............  CEA/ext bypass pt on        ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      aspirin.
G8171..............  Pt w/carot endarct/ext      ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      bypas.
G8172..............  CEA/ext bypass pt not on    ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      asp.
G8182..............  CAD pt care not prov LDL..  ..................  M.................  ...........  ...........  ...........  ...........  ...........
G8183..............  HF/atrial fib pt on         ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      warfarin.

[[Page 67136]]

 
G8184..............  HF/atrial fib pt inelig     ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      warf.
G8185..............  Osteoarth pt w/ assess      ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      pain.
G8186..............  Osteoarth pt inelig assess  ..................  M.................  ...........  ...........  ...........  ...........  ...........
G8193..............  Antibio not doc prior surg  ..................  M.................  ...........  ...........  ...........  ...........  ...........
G8196..............  Antibio not docum prior     ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      surg.
G8200..............  Cefazolin not docum prophy  ..................  M.................  ...........  ...........  ...........  ...........  ...........
G8204..............  MD not doc order to d/c     ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      anti.
G8209..............  Clinician did not doc.....  ..................  M.................  ...........  ...........  ...........  ...........  ...........
G8214..............  Clini not doc order VTE...  ..................  M.................  ...........  ...........  ...........  ...........  ...........
G8217..............  Pt not received DVT proph.  ..................  M.................  ...........  ...........  ...........  ...........  ...........
G8219..............  Received DVT proph day 2..  ..................  M.................  ...........  ...........  ...........  ...........  ...........
G8220..............  Pt not rec DVT proph day 2  ..................  M.................  ...........  ...........  ...........  ...........  ...........
G8221..............  Pt inelig for DVT proph...  ..................  M.................  ...........  ...........  ...........  ...........  ...........
G8223..............  Pt not doc for presc        ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      antipla.
G8226..............  Pt no prescr anticoa at D/  ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      C.
G8231..............  Pt not doc for admin t-PA.  ..................  M.................  ...........  ...........  ...........  ...........  ...........
G8234..............  Pt not doc dysphagia        ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      screen.
G8238..............  Pt not doc to rec rehab     ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      serv.
G8240..............  Inter carotid stenosis30-   ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      99%.
G8243..............  Pt not doc MRI/CT w/o       ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      lesion.
G8246..............  Pt inelig hx w new/chg      ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      mole.
G8248..............  Pt w/one alarm symp not     ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      doc.
G8251..............  Pt not doc w/Barretts,      ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      endo.
G8254..............  Pt w/no doc order for       ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      barium.
G8257..............  Pt not doc rev meds D/C...  ..................  M.................  ...........  ...........  ...........  ...........  ...........
G8260..............  Pt not doc to have dec      ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      maker.
G8263..............  Pt not doc assess urinary   ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      in.
G8266..............  Pt not doc charc urin       ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      incon.
G8268..............  Pt not doc rec care urin    ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      inc.
G8271..............  Pt no doc screen fall.....  ..................  M.................  ...........  ...........  ...........  ...........  ...........
G8274..............  Clini not doc pres/abs      ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      alarm.
G8276..............  Pt not doc mole change....  ..................  M.................  ...........  ...........  ...........  ...........  ...........
G8279..............  Pt not doc rec PE.........  ..................  M.................  ...........  ...........  ...........  ...........  ...........
G8282..............  Pt not doc to rec couns...  ..................  M.................  ...........  ...........  ...........  ...........  ...........
G8285..............  Pt did not rec pres osteo.  ..................  M.................  ...........  ...........  ...........  ...........  ...........
G8289..............  Pt not doc rec Ca/Vit D...  ..................  M.................  ...........  ...........  ...........  ...........  ...........
G8293..............  COPD pt w/o spir results..  ..................  M.................  ...........  ...........  ...........  ...........  ...........
G8296..............  COPD pt not doc bronch      ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      ther.
G8298..............  Pt doc optic nerve eval...  ..................  M.................  ...........  ...........  ...........  ...........  ...........
G8299..............  Pt not doc optic nerv eval  ..................  M.................  ...........  ...........  ...........  ...........  ...........
G8302..............  Pt doc w/ target IOP......  ..................  M.................  ...........  ...........  ...........  ...........  ...........
G8303..............  Pt not doc w/ IOP.........  ..................  M.................  ...........  ...........  ...........  ...........  ...........
G8304..............  Clin doc pt inelig IOP....  ..................  M.................  ...........  ...........  ...........  ...........  ...........
G8305..............  Clin not prov care POAG...  ..................  M.................  ...........  ...........  ...........  ...........  ...........
G8306..............  POAG w/ IOP rec care plan.  ..................  M.................  ...........  ...........  ...........  ...........  ...........
G8307..............  POAG w/ IOP no care plan..  ..................  M.................  ...........  ...........  ...........  ...........  ...........
G8308..............  POAG w/ IOP not doc plan..  ..................  M.................  ...........  ...........  ...........  ...........  ...........
G8310..............  Pt not doc rec antiox.....  ..................  M.................  ...........  ...........  ...........  ...........  ...........
G8314..............  Pt not doc to rec mac exam  ..................  M.................  ...........  ...........  ...........  ...........  ...........
G8318..............  Pt doc not have visual      ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      func.
G8322..............  Pt not doc pre axial leng.  ..................  M.................  ...........  ...........  ...........  ...........  ...........
G8326..............  Pt not doc rec fundus exam  ..................  M.................  ...........  ...........  ...........  ...........  ...........
G8330..............  Pt not doc rec dilated mac  ..................  M.................  ...........  ...........  ...........  ...........  ...........
G8334..............  Doc of macular not giv MD.  ..................  M.................  ...........  ...........  ...........  ...........  ...........
G8338..............  Clin not doc pt test osteo  ..................  M.................  ...........  ...........  ...........  ...........  ...........
G8341..............  Pt not doc for DEXA.......  ..................  M.................  ...........  ...........  ...........  ...........  ...........
G8345..............  Pt not doc have DEXA......  ..................  M.................  ...........  ...........  ...........  ...........  ...........
G8351..............  Pt not doc ECG............  ..................  M.................  ...........  ...........  ...........  ...........  ...........
G8354..............  Pt not rec aspirin prior    ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      ER.
G8357..............  Pt not doc to have ECG....  ..................  M.................  ...........  ...........  ...........  ...........  ...........
G8360..............  Pt not doc vital signs      ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      recor.
G8362..............  Pt not doc 02 SAT assess..  ..................  M.................  ...........  ...........  ...........  ...........  ...........
G8365..............  Pt not doc mental status..  ..................  M.................  ...........  ...........  ...........  ...........  ...........
G8367..............  Pt not doc have empiric AB  ..................  M.................  ...........  ...........  ...........  ...........  ...........
G8370..............  Asthma pt w survey not      ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      docum.
G8371..............  Chemother not rec stg3      ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      colon.
G8372..............  Chemother rec stg 3 colon   ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      ca.
G8373..............  Chemo plan docum prior      ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      chemo.
G8374..............  Chemo plan not doc prior    ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      che.
G8375..............  CLL pt w/o doc flow         ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      cytometr.
G8376..............  Brst ca pt inelig           ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      tamoxifen.
G8377..............  MD doc colon ca pt inelig   ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      ch.
G8378..............  MD doc pt inelig rad        ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      therapy.
G8379..............  Radiat tx recom doc12mo ov  ..................  M.................  ...........  ...........  ...........  ...........  ...........
G8380..............  Pt w stgIC-3Brst ca w/o     ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      tam.
G8381..............  Pt w stgIC-3Brst ca rec     ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      tam.
G8382..............  MM pt w/o doc IV            ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      bisphophon.
G8383..............  Radiation rec not doc 12    ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      mo.
G8384..............  MDS pt w/o base cytogen     ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      test.
G8385..............  Diab pt w nodoc Hgb A1c     ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      12m.

[[Page 67137]]

 
G8386..............  Diab pt w nodoc LDL 12m...  ..................  M.................  ...........  ...........  ...........  ...........  ...........
G8387..............  ESRD pt w Hct/Hgb not       ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      docume.
G8388..............  ESRD pt w URR/Ktv not doc   ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      el.
G8389..............  MDS pt no doc Fe prior EPO  ..................  M.................  ...........  ...........  ...........  ...........  ...........
G8390..............  Diabetic w/o document BP    ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      12m.
G8391..............  Pt w asthma no doc med or   ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      tx.
G8395..............  LVEF>=40% doc normal or     NI................  M.................  ...........  ...........  ...........  ...........  ...........
                      mild.
G8396..............  LVEF not performed........  NI................  M.................  ...........  ...........  ...........  ...........  ...........
G8397..............  Dil macula/fundus exam/w    NI................  M.................  ...........  ...........  ...........  ...........  ...........
                      doc.
G8398..............  Dil macular/fundus not      NI................  M.................  ...........  ...........  ...........  ...........  ...........
                      perfo.
G8399..............  Pt w/DXA document or order  NI................  M.................  ...........  ...........  ...........  ...........  ...........
G8400..............  Pt w/DXA no document or     NI................  M.................  ...........  ...........  ...........  ...........  ...........
                      orde.
G8401..............  Pt inelig osteo screen      NI................  M.................  ...........  ...........  ...........  ...........  ...........
                      measu.
G8402..............  Smoke preven interven       NI................  M.................  ...........  ...........  ...........  ...........  ...........
                      counse.
G8403..............  Smoke preven nocounsel....  NI................  M.................  ...........  ...........  ...........  ...........  ...........
G8404..............  Low extemity neur exam      NI................  M.................  ...........  ...........  ...........  ...........  ...........
                      docum.
G8405..............  Low extemity neur not       NI................  M.................  ...........  ...........  ...........  ...........  ...........
                      perfor.
G8406..............  Pt inelig lower extrem      NI................  M.................  ...........  ...........  ...........  ...........  ...........
                      neuro.
G8407..............  ABI documented............  NI................  M.................  ...........  ...........  ...........  ...........  ...........
G8408..............  ABI not documented........  NI................  M.................  ...........  ...........  ...........  ...........  ...........
G8409..............  Pt inelig for ABI measure.  NI................  M.................  ...........  ...........  ...........  ...........  ...........
G8410..............  Eval on foot documented...  NI................  M.................  ...........  ...........  ...........  ...........  ...........
G8415..............  Eval on foot not performed  NI................  M.................  ...........  ...........  ...........  ...........  ...........
G8416..............  Pt inelig footwear          NI................  M.................  ...........  ...........  ...........  ...........  ...........
                      evaluatio.
G8417..............  BMI >=30 calcuate w/        NI................  M.................  ...........  ...........  ...........  ...........  ...........
                      followup.
G8418..............  BMI < 22 calcuate w/        NI................  M.................  ...........  ...........  ...........  ...........  ...........
                      followup.
G8419..............  BMI>=30or<22 cal no         NI................  M.................  ...........  ...........  ...........  ...........  ...........
                      followup.
G8420..............  BMI<30 and >=22 calc &      NI................  M.................  ...........  ...........  ...........  ...........  ...........
                      docu.
G8421..............  BMI not calculated........  NI................  M.................  ...........  ...........  ...........  ...........  ...........
G8422..............  Pt inelig BMI calculation.  NI................  M.................  ...........  ...........  ...........  ...........  ...........
G8423..............  Pt screen flu vac &         NI................  M.................  ...........  ...........  ...........  ...........  ...........
                      counsel.
G8424..............  Flu vaccine not screen....  NI................  M.................  ...........  ...........  ...........  ...........  ...........
G8425..............  Flu vaccine screen not      NI................  M.................  ...........  ...........  ...........  ...........  ...........
                      curre.
G8426..............  Pt not approp screen &      NI................  M.................  ...........  ...........  ...........  ...........  ...........
                      counc.
G8427..............  Doc meds verified w/pt or   NI................  M.................  ...........  ...........  ...........  ...........  ...........
                      re.
G8428..............  Meds document w/o verifica  NI................  M.................  ...........  ...........  ...........  ...........  ...........
G8429..............  Incomplete doc pt on meds.  NI................  M.................  ...........  ...........  ...........  ...........  ...........
G8430..............  Pt inelig med check.......  NI................  M.................  ...........  ...........  ...........  ...........  ...........
G8431..............  Clin depression screen doc  NI................  M.................  ...........  ...........  ...........  ...........  ...........
G8432..............  Clin depression screen not  NI................  M.................  ...........  ...........  ...........  ...........  ...........
                      d.
G8433..............  Pt inelig for depression    NI................  M.................  ...........  ...........  ...........  ...........  ...........
                      scr.
G8434..............  Cognitive impairment        NI................  M.................  ...........  ...........  ...........  ...........  ...........
                      screen.
G8435..............  Cognitive screen not        NI................  M.................  ...........  ...........  ...........  ...........  ...........
                      documen.
G8436..............  Pt inelig for cognitive     NI................  M.................  ...........  ...........  ...........  ...........  ...........
                      impa.
G8437..............  Tx plan develop & document  NI................  M.................  ...........  ...........  ...........  ...........  ...........
G8438..............  Tx plan develop & not       NI................  M.................  ...........  ...........  ...........  ...........  ...........
                      docum.
G8439..............  Pt inelig for co-develp tx  NI................  M.................  ...........  ...........  ...........  ...........  ...........
                      p.
G8440..............  Pain assessment document..  NI................  M.................  ...........  ...........  ...........  ...........  ...........
G8441..............  No document of pain assess  NI................  M.................  ...........  ...........  ...........  ...........  ...........
G8442..............  Pt inelig pain assessment.  NI................  M.................  ...........  ...........  ...........  ...........  ...........
G8443..............  Prescription by E-Prescrib  NI................  M.................  ...........  ...........  ...........  ...........  ...........
                      s.
G8445..............  Prescrip not gen at         NI................  M.................  ...........  ...........  ...........  ...........  ...........
                      encounte.
G8446..............  Some prescrib handwritten   NI................  M.................  ...........  ...........  ...........  ...........  ...........
                      or.
G8447..............  Pt visit doc using CCHIT    NI................  M.................  ...........  ...........  ...........  ...........  ...........
                      cer.
G8448..............  Pt visit docum w/non-CCHIT  NI................  M.................  ...........  ...........  ...........  ...........  ...........
                      c.
G8449..............  Pt not doc w/EMR due to     NI................  M.................  ...........  ...........  ...........  ...........  ...........
                      syst.
G8450..............  Beta-bloc rx pt w/abn lvef  NI................  M.................  ...........  ...........  ...........  ...........  ...........
G8451..............  Pt w/abn lvef inelig b-     NI................  M.................  ...........  ...........  ...........  ...........  ...........
                      bloc.
G8452..............  Pt w/abn lvef b-bloc no rx  NI................  M.................  ...........  ...........  ...........  ...........  ...........
G8453..............  Tob use cess int counsel..  NI................  M.................  ...........  ...........  ...........  ...........  ...........
G8454..............  Tob use cess int no         NI................  M.................  ...........  ...........  ...........  ...........  ...........
                      counsel.
G8455..............  Current tobacco smoker....  NI................  M.................  ...........  ...........  ...........  ...........  ...........
G8456..............  Smokeless tobacco user....  NI................  M.................  ...........  ...........  ...........  ...........  ...........
G8457..............  Tobacco non-user..........  NI................  M.................  ...........  ...........  ...........  ...........  ...........
G8458..............  Pt inelig geno no antvir    NI................  M.................  ...........  ...........  ...........  ...........  ...........
                      tx.
G8459..............  Doc pt rec antivir treat..  NI................  M.................  ...........  ...........  ...........  ...........  ...........
G8460..............  Pt inelig RNA no antvir tx  NI................  M.................  ...........  ...........  ...........  ...........  ...........
G8461..............  Pt rec antivir treat hep c  NI................  M.................  ...........  ...........  ...........  ...........  ...........
G8462..............  Pt inelig couns no antvir   NI................  M.................  ...........  ...........  ...........  ...........  ...........
                      tx.
G8463..............  Pt rec antiviral treat doc  NI................  M.................  ...........  ...........  ...........  ...........  ...........
G8464..............  Pt inelig; lo to no dter    NI................  M.................  ...........  ...........  ...........  ...........  ...........
                      rsk.
G8465..............  High risk recurrence pro    NI................  M.................  ...........  ...........  ...........  ...........  ...........
                      ca.
G8466..............  Pt inelig suic; MDD remis.  NI................  M.................  ...........  ...........  ...........  ...........  ...........
G8467..............  New dx init/rec episode     NI................  M.................  ...........  ...........  ...........  ...........  ...........
                      MDD.
G8468..............  ACE/ARB rx pt w/abn lvef..  NI................  M.................  ...........  ...........  ...........  ...........  ...........
G8469..............  Pt w/abn lvef inelig ACE/   NI................  M.................  ...........  ...........  ...........  ...........  ...........
                      ARB.
G8470..............  Pt w/ normal lvef.........  NI................  M.................  ...........  ...........  ...........  ...........  ...........
G8471..............  LVEF not performed/doc....  NI................  M.................  ...........  ...........  ...........  ...........  ...........
G8472..............  ACE/ARB no rx pt w/abn      NI................  M.................  ...........  ...........  ...........  ...........  ...........
                      lvef.
G8473..............  ACE/ARB thxpy rx'd........  NI................  M.................  ...........  ...........  ...........  ...........  ...........

[[Page 67138]]

 
G8474..............  ACE/ARB not rx'd; doc reas  NI................  M.................  ...........  ...........  ...........  ...........  ...........
G8475..............  ACE/ARB thxpy not rx'd....  NI................  M.................  ...........  ...........  ...........  ...........  ...........
G8476..............  BP sys <130 and dias <80..  NI................  M.................  ...........  ...........  ...........  ...........  ...........
G8477..............  BP sys>=130 and/or dias     NI................  M.................  ...........  ...........  ...........  ...........  ...........
                      >=80.
G8478..............  BP not performed/doc......  NI................  M.................  ...........  ...........  ...........  ...........  ...........
G8479..............  MD rx'd ACE/ARB thxpy.....  NI................  M.................  ...........  ...........  ...........  ...........  ...........
G8480..............  Pt inelig ACE/ARB thxpy...  NI................  M.................  ...........  ...........  ...........  ...........  ...........
G8481..............  MD not rx'd ACE/ARB thxpy.  NI................  M.................  ...........  ...........  ...........  ...........  ...........
G8482..............  Flu immunize order/admin..  NI................  M.................  ...........  ...........  ...........  ...........  ...........
G8483..............  Flu imm no ord/admin doc    NI................  M.................  ...........  ...........  ...........  ...........  ...........
                      rea.
G8484..............  Flu immunize no order/      NI................  M.................  ...........  ...........  ...........  ...........  ...........
                      admin.
G9001..............  MCCD, initial rate........  ..................  B.................  ...........  ...........  ...........  ...........  ...........
G9002..............  MCCD,maintenance rate.....  ..................  B.................  ...........  ...........  ...........  ...........  ...........
G9003..............  MCCD, risk adj hi, initial  ..................  B.................  ...........  ...........  ...........  ...........  ...........
G9004..............  MCCD, risk adj lo, initial  ..................  B.................  ...........  ...........  ...........  ...........  ...........
G9005..............  MCCD, risk adj,             ..................  B.................  ...........  ...........  ...........  ...........  ...........
                      maintenance.
G9006..............  MCCD, Home monitoring.....  ..................  B.................  ...........  ...........  ...........  ...........  ...........
G9007..............  MCCD, sch team conf.......  ..................  B.................  ...........  ...........  ...........  ...........  ...........
G9008..............  Mccd,phys coor-care         ..................  B.................  ...........  ...........  ...........  ...........  ...........
                      ovrsght.
G9009..............  MCCD, risk adj, level 3...  ..................  B.................  ...........  ...........  ...........  ...........  ...........
G9010..............  MCCD, risk adj, level 4...  ..................  B.................  ...........  ...........  ...........  ...........  ...........
G9011..............  MCCD, risk adj, level 5...  ..................  B.................  ...........  ...........  ...........  ...........  ...........
G9012..............  Other Specified Case Mgmt.  ..................  B.................  ...........  ...........  ...........  ...........  ...........
G9013..............  ESRD demo bundle level I..  ..................  E.................  ...........  ...........  ...........  ...........  ...........
G9014..............  ESRD demo bundle-level II.  ..................  E.................  ...........  ...........  ...........  ...........  ...........
G9016..............  Demo-smoking cessation      ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      coun.
G9017..............  Amantadine HCL 100mg oral.  ..................  A.................  ...........  ...........  ...........  ...........  ...........
G9018..............  Zanamivir,inhalation pwd    ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      10m.
G9019..............  Oseltamivir phosphate 75mg  ..................  A.................  ...........  ...........  ...........  ...........  ...........
G9020..............  Rimantadine HCL 100mg oral  ..................  A.................  ...........  ...........  ...........  ...........  ...........
G9033..............  Amantadine HCL oral brand.  ..................  A.................  ...........  ...........  ...........  ...........  ...........
G9034..............  Zanamivir, inh pwdr, brand  ..................  A.................  ...........  ...........  ...........  ...........  ...........
G9035..............  Oseltamivir phosp, brand..  ..................  A.................  ...........  ...........  ...........  ...........  ...........
G9036..............  Rimantadine HCL, brand....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
G9041..............  Low vision rehab            ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      occupationa.
G9042..............  Low vision rehab orient/    ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      mobi.
G9043..............  Low vision lowvision        ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      therapi.
G9044..............  Low vision rehabilate       ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      teache.
G9050..............  Oncology work-up            ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      evaluation.
G9051..............  Oncology tx decision-mgmt.  ..................  E.................  ...........  ...........  ...........  ...........  ...........
G9052..............  Onc surveillance for        ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      disease.
G9053..............  Onc expectant management    ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      pt.
G9054..............  Onc supervision palliative  ..................  E.................  ...........  ...........  ...........  ...........  ...........
G9055..............  Onc visit unspecified NOS.  ..................  E.................  ...........  ...........  ...........  ...........  ...........
G9056..............  Onc prac mgmt adheres       ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      guide.
G9057..............  Onc pract mgmt differs      ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      trial.
G9058..............  Onc prac mgmt disagree w/   ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      gui.
G9059..............  Onc prac mgmt pt opt        ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      alterna.
G9060..............  Onc prac mgmt dif pt        ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      comorb.
G9061..............  Onc prac cond noadd by      ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      guide.
G9062..............  Onc prac guide differs nos  ..................  E.................  ...........  ...........  ...........  ...........  ...........
G9063..............  Onc dx nsclc stgI no        ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      progres.
G9064..............  Onc dx nsclc stg2 no        ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      progres.
G9065..............  Onc dx nsclc stg3A no       ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      progre.
G9066..............  Onc dx nsclc stg3B-4        ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      metasta.
G9067..............  Onc dx nsclc dx unknown     ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      nos.
G9068..............  Onc dx sclc/nsclc limited.  ..................  M.................  ...........  ...........  ...........  ...........  ...........
G9069..............  Onc dx sclc/nsclc ext at    ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      dx.
G9070..............  Onc dx sclc/nsclc ext       ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      unknwn.
G9071..............  Onc dx brst stg1-2B         ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      HR,nopro.
G9072..............  Onc dx brst stg1-2          ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      noprogres.
G9073..............  Onc dx brst stg3-HR, no     ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      pro.
G9074..............  Onc dx brst stg3-           ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      noprogress.
G9075..............  Onc dx brst metastic/       ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      recur.
G9077..............  Onc dx prostate T1no        ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      progres.
G9078..............  Onc dx prostate T2no        ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      progres.
G9079..............  Onc dx prostate T3b-        ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      T4noprog.
G9080..............  Onc dx prostate w/rise PSA  ..................  M.................  ...........  ...........  ...........  ...........  ...........
G9083..............  Onc dx prostate unknwn nos  ..................  M.................  ...........  ...........  ...........  ...........  ...........
G9084..............  Onc dx colon t1-3,n1-2,no   ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      pr.
G9085..............  Onc dx colon T4, N0 w/o     ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      prog.
G9086..............  Onc dx colon T1-4 no dx     ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      prog.
G9087..............  Onc dx colon metas evid dx  ..................  M.................  ...........  ...........  ...........  ...........  ...........
G9088..............  Onc dx colon metas noevid   ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      dx.
G9089..............  Onc dx colon extent         ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      unknown.
G9090..............  Onc dx rectal T1-2 no       ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      progr.
G9091..............  Onc dx rectal T3 N0 no      ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      prog.
G9092..............  Onc dx rectal T1-3,N1-      ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      2noprg.
G9093..............  Onc dx rectal T4,N,M0 no    ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      prg.
G9094..............  Onc dx rectal M1 w/mets     ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      prog.

[[Page 67139]]

 
G9095..............  Onc dx rectal extent        ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      unknwn.
G9096..............  Onc dx esophag T1-T3        ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      noprog.
G9097..............  Onc dx esophageal T4 no     ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      prog.
G9098..............  Onc dx esophageal mets      ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      recur.
G9099..............  Onc dx esophageal unknown.  ..................  M.................  ...........  ...........  ...........  ...........  ...........
G9100..............  Onc dx gastric no           ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      recurrence.
G9101..............  Onc dx gastric p R1-        ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      R2noprog.
G9102..............  Onc dx gastric              ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      unresectable.
G9103..............  Onc dx gastric recurrent..  ..................  M.................  ...........  ...........  ...........  ...........  ...........
G9104..............  Onc dx gastric unknown NOS  ..................  M.................  ...........  ...........  ...........  ...........  ...........
G9105..............  Onc dx pancreatc p R0 res   ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      no.
G9106..............  Onc dx pancreatc p R1/R2    ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      no.
G9107..............  Onc dx pancreatic           ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      unresectab.
G9108..............  Onc dx pancreatic unknwn    ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      NOS.
G9109..............  Onc dx head/neck T1-T2no    ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      prg.
G9110..............  Onc dx head/neck T3-4       ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      noprog.
G9111..............  Onc dx head/neck M1 mets    ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      rec.
G9112..............  Onc dx head/neck ext        ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      unknown.
G9113..............  Onc dx ovarian stg1A-B no   ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      pr.
G9114..............  Onc dx ovarian stg1A-B or   ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      2.
G9115..............  Onc dx ovarian stg3/4       ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      noprog.
G9116..............  Onc dx ovarian recurrence.  ..................  M.................  ...........  ...........  ...........  ...........  ...........
G9117..............  Onc dx ovarian unknown NOS  ..................  M.................  ...........  ...........  ...........  ...........  ...........
G9123..............  Onc dx CML chronic phase..  ..................  M.................  ...........  ...........  ...........  ...........  ...........
G9124..............  Onc dx CML acceler phase..  ..................  M.................  ...........  ...........  ...........  ...........  ...........
G9125..............  Onc dx CML blast phase....  ..................  M.................  ...........  ...........  ...........  ...........  ...........
G9126..............  Onc dx CML remission......  ..................  M.................  ...........  ...........  ...........  ...........  ...........
G9128..............  Onc dx multi myeloma stage  ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      I.
G9129..............  Onc dx mult myeloma stg2    ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      hig.
G9130..............  Onc dx multi myeloma        ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      unknown.
G9131..............  Onc dx brst unknown NOS...  ..................  M.................  ...........  ...........  ...........  ...........  ...........
G9132..............  Onc dx prostate mets no     ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      cast.
G9133..............  Onc dx prostate clinical    ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      met.
G9134..............  Onc NHLstg 1-2 no relap no  ..................  M.................  ...........  ...........  ...........  ...........  ...........
G9135..............  Onc dx NHL stg 3-4 not      ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      relap.
G9136..............  Onc dx NHL trans to lg      ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      Bcell.
G9137..............  Onc dx NHL relapse/         ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      refractor.
G9138..............  Onc dx NHL stg unknown....  ..................  M.................  ...........  ...........  ...........  ...........  ...........
G9139..............  Onc dx CML dx status        ..................  M.................  ...........  ...........  ...........  ...........  ...........
                      unknown.
G9140..............  Frontier extended stay      NI................  M.................  ...........  ...........  ...........  ...........  ...........
                      demo.
J0120..............  Tetracyclin injection.....  ..................  N.................  ...........  ...........  ...........  ...........  ...........
J0128..............  Abarelix injection........  ..................  K.................         9216  ...........       $67.97  ...........       $13.59
J0129..............  Abatacept injection.......  ..................  G.................         9230  ...........       $18.69  ...........        $3.74
J0130..............  Abciximab injection.......  ..................  K.................         1605  ...........      $420.17  ...........       $84.03
J0132..............  Acetylcysteine injection..  CH................  N.................  ...........  ...........  ...........  ...........  ...........
J0133..............  Acyclovir injection.......  ..................  N.................  ...........  ...........  ...........  ...........  ...........
J0135..............  Adalimumab injection......  ..................  K.................         1083  ...........      $329.58  ...........       $65.92
J0150..............  Injection adenosine 6 MG..  ..................  K.................         0379  ...........       $25.10  ...........        $5.02
J0152..............  Adenosine injection.......  ..................  K.................         0917  ...........       $67.89  ...........       $13.58
J0170..............  Adrenalin epinephrin        ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      inject.
J0180..............  Agalsidase beta injection.  ..................  K.................         9208  ...........      $126.00  ...........       $25.20
J0190..............  Inj biperiden lactate/5 mg  CH................  K.................         0998  ...........       $88.15  ...........       $17.63
J0200..............  Alatrofloxacin mesylate...  ..................  N.................  ...........  ...........  ...........  ...........  ...........
J0205..............  Alglucerase injection.....  ..................  K.................         0900  ...........       $38.85  ...........        $7.77
J0207..............  Amifostine................  ..................  K.................         7000  ...........      $490.93  ...........       $98.19
J0210..............  Methyldopate hcl injection  ..................  K.................         2210  ...........       $13.04  ...........        $2.61
J0215..............  Alefacept.................  ..................  K.................         1633  ...........       $26.47  ...........        $5.29
J0220..............  Aglucosidase alfa           NI................  K.................         9234  ...........      $126.00  ...........       $25.20
                      injection.
J0256..............  Alpha 1 proteinase          ..................  K.................         0901  ...........        $3.28  ...........        $0.66
                      inhibitor.
J0270..............  Alprostadil for injection.  ..................  B.................  ...........  ...........  ...........  ...........  ...........
J0275..............  Alprostadil urethral        ..................  B.................  ...........  ...........  ...........  ...........  ...........
                      suppos.
J0278..............  Amikacin sulfate injection  ..................  N.................  ...........  ...........  ...........  ...........  ...........
J0280..............  Aminophyllin 250 MG inj...  ..................  N.................  ...........  ...........  ...........  ...........  ...........
J0282..............  Amiodarone HCl............  ..................  N.................  ...........  ...........  ...........  ...........  ...........
J0285..............  Amphotericin B............  ..................  N.................  ...........  ...........  ...........  ...........  ...........
J0287..............  Amphotericin b lipid        ..................  K.................         9024  ...........       $10.40  ...........        $2.08
                      complex.
J0288..............  Ampho b cholesteryl         ..................  K.................         0735  ...........       $11.89  ...........        $2.38
                      sulfate.
J0289..............  Amphotericin b liposome     ..................  K.................         0736  ...........       $16.21  ...........        $3.24
                      inj.
J0290..............  Ampicillin 500 MG inj.....  ..................  N.................  ...........  ...........  ...........  ...........  ...........
J0295..............  Ampicillin sodium per 1.5   ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      gm.
J0300..............  Amobarbital 125 MG inj....  ..................  N.................  ...........  ...........  ...........  ...........  ...........
J0330..............  Succinycholine chloride     ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      inj.
J0348..............  Anadulafungin injection...  ..................  G.................         0760  ...........        $1.91  ...........        $0.38
J0350..............  Injection anistreplase 30   ..................  K.................         1606  ...........    $2,693.80  ...........      $538.76
                      u.
J0360..............  Hydralazine hcl injection.  ..................  N.................  ...........  ...........  ...........  ...........  ...........
J0364..............  Apomorphine hydrochloride.  CH................  N.................  ...........  ...........  ...........  ...........  ...........
J0365..............  Aprotonin, 10,000 kiu.....  ..................  K.................         1682  ...........        $2.66  ...........        $0.53
J0380..............  Inj metaraminol bitartrate  CH................  N.................  ...........  ...........  ...........  ...........  ...........
J0390..............  Chloroquine injection.....  ..................  N.................  ...........  ...........  ...........  ...........  ...........
J0395..............  Arbutamine HCl injection..  CH................  N.................  ...........  ...........  ...........  ...........  ...........

[[Page 67140]]

 
J0400..............  Aripiprazole injection....  NI................  K.................         1165  ...........        $0.28  ...........        $0.06
J0456..............  Azithromycin..............  ..................  N.................  ...........  ...........  ...........  ...........  ...........
J0460..............  Atropine sulfate injection  ..................  N.................  ...........  ...........  ...........  ...........  ...........
J0470..............  Dimecaprol injection......  ..................  N.................  ...........  ...........  ...........  ...........  ...........
J0475..............  Baclofen 10 MG injection..  ..................  K.................         9032  ...........      $193.29  ...........       $38.66
J0476..............  Baclofen intrathecal trial  ..................  K.................         1631  ...........       $69.73  ...........       $13.95
J0480..............  Basiliximab...............  ..................  K.................         1683  ...........    $1,541.03  ...........      $308.21
J0500..............  Dicyclomine injection.....  ..................  N.................  ...........  ...........  ...........  ...........  ...........
J0515..............  Inj benztropine mesylate..  ..................  N.................  ...........  ...........  ...........  ...........  ...........
J0520..............  Bethanechol chloride        ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      inject.
J0530..............  Penicillin g benzathine     ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      inj.
J0540..............  Penicillin g benzathine     ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      inj.
J0550..............  Penicillin g benzathine     ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      inj.
J0560..............  Penicillin g benzathine     ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      inj.
J0570..............  Penicillin g benzathine     ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      inj.
J0580..............  Penicillin g benzathine     ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      inj.
J0583..............  Bivalirudin...............  ..................  K.................         3041  ...........        $1.84  ...........        $0.37
J0585..............  Botulinum toxin a per unit  ..................  K.................         0902  ...........        $5.21  ...........        $1.04
J0587..............  Botulinum toxin type B....  ..................  K.................         9018  ...........        $8.63  ...........        $1.73
J0592..............  Buprenorphine               ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      hydrochloride.
J0594..............  Busulfan injection........  ..................  K.................         1178  ...........        $9.17  ...........        $1.83
J0595..............  Butorphanol tartrate 1 mg.  ..................  N.................  ...........  ...........  ...........  ...........  ...........
J0600..............  Edetate calcium disodium    CH................  K.................         0999  ...........       $49.64  ...........        $9.93
                      inj.
J0610..............  Calcium gluconate           ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      injection.
J0620..............  Calcium glycer & lact/10    ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      ML.
J0630..............  Calcitonin salmon           ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      injection.
J0636..............  Inj calcitriol per 0.1 mcg  ..................  N.................  ...........  ...........  ...........  ...........  ...........
J0637..............  Caspofungin acetate.......  ..................  K.................         9019  ...........       $24.05  ...........        $4.81
J0640..............  Leucovorin calcium          ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      injection.
J0670..............  Inj mepivacaine HCL/10 ml.  ..................  N.................  ...........  ...........  ...........  ...........  ...........
J0690..............  Cefazolin sodium injection  ..................  N.................  ...........  ...........  ...........  ...........  ...........
J0692..............  Cefepime HCl for injection  ..................  N.................  ...........  ...........  ...........  ...........  ...........
J0694..............  Cefoxitin sodium injection  ..................  N.................  ...........  ...........  ...........  ...........  ...........
J0696..............  Ceftriaxone sodium          ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      injection.
J0697..............  Sterile cefuroxime          ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      injection.
J0698..............  Cefotaxime sodium           ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      injection.
J0702..............  Betamethasone acet&sod      ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      phosp.
J0704..............  Betamethasone sod phosp/4   ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      MG.
J0706..............  Caffeine citrate injection  CH................  N.................  ...........  ...........  ...........  ...........  ...........
J0710..............  Cephapirin sodium           ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      injection.
J0713..............  Inj ceftazidime per 500 mg  ..................  N.................  ...........  ...........  ...........  ...........  ...........
J0715..............  Ceftizoxime sodium / 500    ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      MG.
J0720..............  Chloramphenicol sodium      ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      injec.
J0725..............  Chorionic gonadotropin/     ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      1000u.
J0735..............  Clonidine hydrochloride...  ..................  K.................         0935  ...........       $62.78  ...........       $12.56
J0740..............  Cidofovir injection.......  ..................  K.................         9033  ...........      $754.39  ...........      $150.88
J0743..............  Cilastatin sodium           ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      injection.
J0744..............  Ciprofloxacin iv..........  ..................  N.................  ...........  ...........  ...........  ...........  ...........
J0745..............  Inj codeine phosphate /30   ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      MG.
J0760..............  Colchicine injection......  ..................  N.................  ...........  ...........  ...........  ...........  ...........
J0770..............  Colistimethate sodium inj.  ..................  N.................  ...........  ...........  ...........  ...........  ...........
J0780..............  Prochlorperazine injection  ..................  N.................  ...........  ...........  ...........  ...........  ...........
J0795..............  Corticorelin ovine          ..................  K.................         1684  ...........        $4.43  ...........        $0.89
                      triflutal.
J0800..............  Corticotropin injection...  ..................  K.................         1280  ...........      $169.77  ...........       $33.95
J0835..............  Inj cosyntropin per 0.25    ..................  K.................         0835  ...........       $64.01  ...........       $12.80
                      MG.
J0850..............  Cytomegalovirus imm IV /    ..................  K.................         0903  ...........      $870.53  ...........      $174.11
                      vial.
J0878..............  Daptomycin injection......  ..................  K.................         9124  ...........        $0.35  ...........        $0.07
J0881..............  Darbepoetin alfa, non-esrd  ..................  K.................         1685  ...........        $2.88  ...........        $0.58
J0882..............  Darbepoetin alfa, esrd use  ..................  A.................  ...........  ...........  ...........  ...........  ...........
J0885..............  Epoetin alfa, non-esrd....  ..................  K.................         1686  ...........        $8.97  ...........        $1.79
J0886..............  Epoetin alfa 1000 units     ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      ESRD.
J0894..............  Decitabine injection......  ..................  G.................         9231  ...........       $26.48  ...........        $5.30
J0895..............  Deferoxamine mesylate inj.  CH................  N.................  ...........  ...........  ...........  ...........  ...........
J0900..............  Testosterone enanthate inj  ..................  N.................  ...........  ...........  ...........  ...........  ...........
J0945..............  Brompheniramine maleate     ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      inj.
J0970..............  Estradiol valerate          ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      injection.
J1000..............  Depo-estradiol cypionate    ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      inj.
J1020..............  Methylprednisolone 20 MG    ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      inj.
J1030..............  Methylprednisolone 40 MG    ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      inj.
J1040..............  Methylprednisolone 80 MG    ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      inj.
J1051..............  Medroxyprogesterone inj...  ..................  N.................  ...........  ...........  ...........  ...........  ...........
J1055..............  Medrxyprogester acetate     ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      inj.
J1056..............  MA/EC                       ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      contraceptiveinjection.
J1060..............  Testosterone cypionate 1    ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      ML.
J1070..............  Testosterone cypionat 100   ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      MG.
J1080..............  Testosterone cypionat 200   ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      MG.
J1094..............  Inj dexamethasone acetate.  ..................  N.................  ...........  ...........  ...........  ...........  ...........
J1100..............  Dexamethasone sodium phos.  ..................  N.................  ...........  ...........  ...........  ...........  ...........
J1110..............  Inj dihydroergotamine       ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      mesylt.
J1120..............  Acetazolamid sodium         ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      injectio.

[[Page 67141]]

 
J1160..............  Digoxin injection.........  ..................  N.................  ...........  ...........  ...........  ...........  ...........
J1162..............  Digoxin immune fab (ovine)  ..................  K.................         1687  ...........      $478.88  ...........       $95.78
J1165..............  Phenytoin sodium injection  ..................  N.................  ...........  ...........  ...........  ...........  ...........
J1170..............  Hydromorphone injection...  ..................  N.................  ...........  ...........  ...........  ...........  ...........
J1180..............  Dyphylline injection......  ..................  N.................  ...........  ...........  ...........  ...........  ...........
J1190..............  Dexrazoxane HCl injection.  ..................  K.................         0726  ...........      $162.11  ...........       $32.42
J1200..............  Diphenhydramine hcl         ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      injectio.
J1205..............  Chlorothiazide sodium inj.  ..................  K.................         0747  ...........      $141.07  ...........       $28.21
J1212..............  Dimethyl sulfoxide 50% 50   ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      ML.
J1230..............  Methadone injection.......  ..................  N.................  ...........  ...........  ...........  ...........  ...........
J1240..............  Dimenhydrinate injection..  ..................  N.................  ...........  ...........  ...........  ...........  ...........
J1245..............  Dipyridamole injection....  ..................  N.................  ...........  ...........  ...........  ...........  ...........
J1250..............  Inj dobutamine HCL/250 mg.  ..................  N.................  ...........  ...........  ...........  ...........  ...........
J1260..............  Dolasetron mesylate.......  ..................  K.................         0750  ...........        $4.66  ...........        $0.93
J1265..............  Dopamine injection........  ..................  N.................  ...........  ...........  ...........  ...........  ...........
J1270..............  Injection, doxercalciferol  ..................  N.................  ...........  ...........  ...........  ...........  ...........
J1300..............  Eculizumab injection......  NI................  G.................         9236  ...........      $176.38  ...........       $35.28
J1320..............  Amitriptyline injection...  ..................  N.................  ...........  ...........  ...........  ...........  ...........
J1324..............  Enfuvirtide injection.....  ..................  K.................         0767  ...........        $0.40  ...........        $0.08
J1325..............  Epoprostenol injection....  ..................  N.................  ...........  ...........  ...........  ...........  ...........
J1327..............  Eptifibatide injection....  ..................  K.................         1607  ...........       $17.67  ...........        $3.53
J1330..............  Ergonovine maleate          CH................  N.................  ...........  ...........  ...........  ...........  ...........
                      injection.
J1335..............  Ertapenem injection.......  ..................  N.................  ...........  ...........  ...........  ...........  ...........
J1364..............  Erythro lactobionate /500   ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      MG.
J1380..............  Estradiol valerate 10 MG    ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      inj.
J1390..............  Estradiol valerate 20 MG    ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      inj.
J1410..............  Inj estrogen conjugate 25   ..................  K.................         9038  ...........       $66.64  ...........       $13.33
                      MG.
J1430..............  Ethanolamine oleate 100 mg  ..................  K.................         1688  ...........       $79.23  ...........       $15.85
J1435..............  Injection estrone per 1 MG  ..................  N.................  ...........  ...........  ...........  ...........  ...........
J1436..............  Etidronate disodium inj...  ..................  K.................         1436  ...........       $70.73  ...........       $14.15
J1438..............  Etanercept injection......  ..................  K.................         1608  ...........      $167.12  ...........       $33.42
J1440..............  Filgrastim 300 mcg          ..................  K.................         0728  ...........      $193.79  ...........       $38.76
                      injection.
J1441..............  Filgrastim 480 mcg          ..................  K.................         7049  ...........      $298.39  ...........       $59.68
                      injection.
J1450..............  Fluconazole...............  ..................  N.................  ...........  ...........  ...........  ...........  ...........
J1451..............  Fomepizole, 15 mg.........  ..................  K.................         1689  ...........       $12.80  ...........        $2.56
J1452..............  Intraocular Fomivirsen na.  CH................  N.................  ...........  ...........  ...........  ...........  ...........
J1455..............  Foscarnet sodium injection  CH................  N.................  ...........  ...........  ...........  ...........  ...........
J1457..............  Gallium nitrate injection.  CH................  K.................         0878  ...........        $1.61  ...........        $0.32
J1458..............  Galsulfase injection......  ..................  K.................         9224  ...........      $306.88  ...........       $61.38
J1460..............  Gamma globulin 1 CC inj...  ..................  K.................         3043  ...........       $11.91  ...........        $2.38
J1470..............  Gamma globulin 2 CC inj...  CH................  K.................         0898  ...........       $23.82  ...........        $4.76
J1480..............  Gamma globulin 3 CC inj...  CH................  K.................         0899  ...........       $35.72  ...........        $7.14
J1490..............  Gamma globulin 4 CC inj...  CH................  K.................         0904  ...........       $47.64  ...........        $9.53
J1500..............  Gamma globulin 5 CC inj...  CH................  K.................         0919  ...........       $59.54  ...........       $11.91
J1510..............  Gamma globulin 6 CC inj...  CH................  K.................         0920  ...........       $71.50  ...........       $14.30
J1520..............  Gamma globulin 7 CC inj...  CH................  K.................         0921  ...........       $83.30  ...........       $16.66
J1530..............  Gamma globulin 8 CC inj...  CH................  K.................         0922  ...........       $95.27  ...........       $19.05
J1540..............  Gamma globulin 9 CC inj...  CH................  K.................         0923  ...........      $107.25  ...........       $21.45
J1550..............  Gamma globulin 10 CC inj..  CH................  K.................         0924  ...........      $119.09  ...........       $23.82
J1560..............  Gamma globulin > 10 CC inj  CH................  K.................         0933  ...........      $119.09  ...........       $23.82
J1561..............  Gamunex injection.........  NI................  K.................         0948  ...........       $32.06  ...........        $6.41
J1562..............  Vivaglobin, inj...........  ..................  K.................         0804  ...........        $7.01  ...........        $1.40
J1565..............  RSV-ivig..................  ..................  K.................         0906  ...........       $16.02  ...........        $3.20
J1566..............  Immune globulin, powder...  ..................  K.................         2731  ...........       $26.89  ...........        $5.38
J1567..............  Immune globulin, liquid...  CH................  D.................  ...........  ...........  ...........  ...........  ...........
J1568..............  Octagam injection.........  NI................  K.................         0943  ...........       $33.19  ...........        $6.64
J1569..............  Gammagard liquid injection  NI................  K.................         0944  ...........       $31.06  ...........        $6.21
J1570..............  Ganciclovir sodium          ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      injection.
J1571..............  HepaGam B IM injection....  NI................  K.................         0946  ...........       $63.51  ...........       $12.70
J1572..............  Flebogamma injection......  NI................  K.................         0947  ...........       $32.27  ...........        $6.45
J1573..............  Hepagam B intravenous, inj  NI................  K.................         1138  ...........       $63.51  ...........       $12.70
J1580..............  Garamycin gentamicin inj..  ..................  N.................  ...........  ...........  ...........  ...........  ...........
J1590..............  Gatifloxacin injection....  ..................  N.................  ...........  ...........  ...........  ...........  ...........
J1595..............  Injection glatiramer        CH................  K.................         1015  ...........       $52.04  ...........       $10.41
                      acetate.
J1600..............  Gold sodium thiomaleate     ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      inj.
J1610..............  Glucagon hydrochloride/1    ..................  K.................         9042  ...........       $68.84  ...........       $13.77
                      MG.
J1620..............  Gonadorelin hydroch/ 100    ..................  K.................         7005  ...........      $178.59  ...........       $35.72
                      mcg.
J1626..............  Granisetron HCl injection.  ..................  K.................         0764  ...........        $5.74  ...........        $1.15
J1630..............  Haloperidol injection.....  ..................  N.................  ...........  ...........  ...........  ...........  ...........
J1631..............  Haloperidol decanoate inj.  ..................  N.................  ...........  ...........  ...........  ...........  ...........
J1640..............  Hemin, 1 mg...............  ..................  K.................         1690  ...........        $7.08  ...........        $1.42
J1642..............  Inj heparin sodium per 10   ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      u.
J1644..............  Inj heparin sodium per      ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      1000u.
J1645..............  Dalteparin sodium.........  ..................  N.................  ...........  ...........  ...........  ...........  ...........
J1650..............  Inj enoxaparin sodium.....  ..................  N.................  ...........  ...........  ...........  ...........  ...........
J1652..............  Fondaparinux sodium.......  CH................  K.................         0883  ...........        $5.92  ...........        $1.18
J1655..............  Tinzaparin sodium           CH................  N.................  ...........  ...........  ...........  ...........  ...........
                      injection.
J1670..............  Tetanus immune globulin     ..................  K.................         1670  ...........      $103.46  ...........       $20.69
                      inj.
J1675..............  Histrelin acetate.........  ..................  B.................  ...........  ...........  ...........  ...........  ...........
J1700..............  Hydrocortisone acetate inj  ..................  N.................  ...........  ...........  ...........  ...........  ...........

[[Page 67142]]

 
J1710..............  Hydrocortisone sodium ph    ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      inj.
J1720..............  Hydrocortisone sodium succ  ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      i.
J1730..............  Diazoxide injection.......  ..................  K.................         1740  ...........      $113.24  ...........       $22.65
J1740..............  Ibandronate sodium          ..................  G.................         9229  ...........      $138.96  ...........       $27.79
                      injection.
J1742..............  Ibutilide fumarate          ..................  K.................         9044  ...........      $287.15  ...........       $57.43
                      injection.
J1743..............  Idursulfase injection.....  NI................  G.................         9232  ...........      $455.03  ...........       $91.01
J1745..............  Infliximab injection......  ..................  K.................         7043  ...........       $54.42  ...........       $10.88
J1751..............  Iron dextran 165 injection  ..................  K.................         1691  ...........       $11.82  ...........        $2.36
J1752..............  Iron dextran 267 injection  ..................  K.................         1692  ...........       $10.30  ...........        $2.06
J1756..............  Iron sucrose injection....  ..................  K.................         9046  ...........        $0.36  ...........        $0.08
J1785..............  Injection imiglucerase /    ..................  K.................         0916  ...........        $3.89  ...........        $0.78
                      unit.
J1790..............  Droperidol injection......  ..................  N.................  ...........  ...........  ...........  ...........  ...........
J1800..............  Propranolol injection.....  ..................  N.................  ...........  ...........  ...........  ...........  ...........
J1810..............  Droperidol/fentanyl inj...  ..................  E.................  ...........  ...........  ...........  ...........  ...........
J1815..............  Insulin injection.........  ..................  N.................  ...........  ...........  ...........  ...........  ...........
J1817..............  Insulin for insulin pump    ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      use.
J1825..............  Interferon beta-1a........  ..................  E.................  ...........  ...........  ...........  ...........  ...........
J1830..............  Interferon beta-1b / .25    ..................  K.................         0910  ...........      $106.57  ...........       $21.31
                      MG.
J1835..............  Itraconazole injection....  ..................  K.................         9047  ...........       $39.68  ...........        $7.94
J1840..............  Kanamycin sulfate 500 MG    ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      inj.
J1850..............  Kanamycin sulfate 75 MG     ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      inj.
J1885..............  Ketorolac tromethamine inj  ..................  N.................  ...........  ...........  ...........  ...........  ...........
J1890..............  Cephalothin sodium          ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      injection.
J1931..............  Laronidase injection......  ..................  K.................         9209  ...........       $23.64  ...........        $4.73
J1940..............  Furosemide injection......  ..................  N.................  ...........  ...........  ...........  ...........  ...........
J1945..............  Lepirudin.................  ..................  K.................         1693  ...........      $159.44  ...........       $31.89
J1950..............  Leuprolide acetate /3.75    ..................  K.................         0800  ...........      $452.58  ...........       $90.52
                      MG.
J1955..............  Inj levocarnitine per 1 gm  ..................  B.................  ...........  ...........  ...........  ...........  ...........
J1956..............  Levofloxacin injection....  ..................  N.................  ...........  ...........  ...........  ...........  ...........
J1960..............  Levorphanol tartrate inj..  ..................  N.................  ...........  ...........  ...........  ...........  ...........
J1980..............  Hyoscyamine sulfate inj...  ..................  N.................  ...........  ...........  ...........  ...........  ...........
J1990..............  Chlordiazepoxide injection  ..................  N.................  ...........  ...........  ...........  ...........  ...........
J2001..............  Lidocaine injection.......  ..................  N.................  ...........  ...........  ...........  ...........  ...........
J2010..............  Lincomycin injection......  ..................  N.................  ...........  ...........  ...........  ...........  ...........
J2020..............  Linezolid injection.......  ..................  K.................         9001  ...........       $25.17  ...........        $5.03
J2060..............  Lorazepam injection.......  ..................  N.................  ...........  ...........  ...........  ...........  ...........
J2150..............  Mannitol injection........  ..................  N.................  ...........  ...........  ...........  ...........  ...........
J2170..............  Mecasermin injection......  ..................  K.................         0805  ...........       $15.62  ...........        $3.12
J2175..............  Meperidine hydrochl /100    ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      MG.
J2180..............  Meperidine/promethazine     ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      inj.
J2185..............  Meropenem.................  CH................  N.................  ...........  ...........  ...........  ...........  ...........
J2210..............  Methylergonovin maleate     ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      inj.
J2248..............  Micafungin sodium           ..................  G.................         9227  ...........        $1.44  ...........        $0.29
                      injection.
J2250..............  Inj midazolam               ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      hydrochloride.
J2260..............  Inj milrinone lactate / 5   ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      MG.
J2270..............  Morphine sulfate injection  ..................  N.................  ...........  ...........  ...........  ...........  ...........
J2271..............  Morphine so4 injection      ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      100mg.
J2275..............  Morphine sulfate injection  ..................  N.................  ...........  ...........  ...........  ...........  ...........
J2278..............  Ziconotide injection......  CH................  K.................         1694  ...........        $6.46  ...........        $1.29
J2280..............  Inj, moxifloxacin 100 mg..  ..................  N.................  ...........  ...........  ...........  ...........  ...........
J2300..............  Inj nalbuphine              ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      hydrochloride.
J2310..............  Inj naloxone hydrochloride  ..................  N.................  ...........  ...........  ...........  ...........  ...........
J2315..............  Naltrexone, depot form....  ..................  K.................         0759  ...........        $1.87  ...........        $0.37
J2320..............  Nandrolone decanoate 50 MG  ..................  N.................  ...........  ...........  ...........  ...........  ...........
J2321..............  Nandrolone decanoate 100    ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      MG.
J2322..............  Nandrolone decanoate 200    ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      MG.
J2323..............  Natalizumab injection.....  NI................  G.................         9126  ...........        $7.51  ...........        $1.50
J2325..............  Nesiritide injection......  ..................  K.................         1695  ...........       $32.95  ...........        $6.59
J2353..............  Octreotide injection,       ..................  K.................         1207  ...........       $99.04  ...........       $19.81
                      depot.
J2354..............  Octreotide inj, non-depot.  ..................  N.................  ...........  ...........  ...........  ...........  ...........
J2355..............  Oprelvekin injection......  ..................  K.................         7011  ...........      $247.02  ...........       $49.40
J2357..............  Omalizumab injection......  ..................  K.................         9300  ...........       $17.12  ...........        $3.42
J2360..............  Orphenadrine injection....  ..................  N.................  ...........  ...........  ...........  ...........  ...........
J2370..............  Phenylephrine hcl           ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      injection.
J2400..............  Chloroprocaine hcl          ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      injection.
J2405..............  Ondansetron hcl injection.  ..................  K.................         0768  ...........        $0.26  ...........        $0.06
J2410..............  Oxymorphone hcl injection.  ..................  N.................  ...........  ...........  ...........  ...........  ...........
J2425..............  Palifermin injection......  ..................  K.................         1696  ...........       $11.24  ...........        $2.25
J2430..............  Pamidronate disodium /30    ..................  K.................         0730  ...........       $28.31  ...........        $5.66
                      MG.
J2440..............  Papaverin hcl injection...  ..................  N.................  ...........  ...........  ...........  ...........  ...........
J2460..............  Oxytetracycline injection.  ..................  N.................  ...........  ...........  ...........  ...........  ...........
J2469..............  Palonosetron HCl..........  ..................  K.................         9210  ...........       $16.45  ...........        $3.29
J2501..............  Paricalcitol..............  ..................  N.................  ...........  ...........  ...........  ...........  ...........
J2503..............  Pegaptanib sodium           CH................  K.................         1697  ...........    $1,035.69  ...........      $207.14
                      injection.
J2504..............  Pegademase bovine, 25 iu..  ..................  K.................         1739  ...........      $197.51  ...........       $39.50
J2505..............  Injection, pegfilgrastim    ..................  K.................         9119  ...........    $2,145.12  ...........      $429.02
                      6mg.
J2510..............  Penicillin g procaine inj.  ..................  N.................  ...........  ...........  ...........  ...........  ...........
J2513..............  Pentastarch 10% solution..  CH................  K.................         0880  ...........       $21.98  ...........        $4.40
J2515..............  Pentobarbital sodium inj..  ..................  N.................  ...........  ...........  ...........  ...........  ...........
J2540..............  Penicillin g potassium inj  ..................  N.................  ...........  ...........  ...........  ...........  ...........

[[Page 67143]]

 
J2543..............  Piperacillin/tazobactam...  ..................  N.................  ...........  ...........  ...........  ...........  ...........
J2545..............  Pentamidine non-comp unit.  ..................  B.................  ...........  ...........  ...........  ...........  ...........
J2550..............  Promethazine hcl injection  ..................  N.................  ...........  ...........  ...........  ...........  ...........
J2560..............  Phenobarbital sodium inj..  ..................  N.................  ...........  ...........  ...........  ...........  ...........
J2590..............  Oxytocin injection........  ..................  N.................  ...........  ...........  ...........  ...........  ...........
J2597..............  Inj desmopressin acetate..  ..................  N.................  ...........  ...........  ...........  ...........  ...........
J2650..............  Prednisolone acetate inj..  ..................  N.................  ...........  ...........  ...........  ...........  ...........
J2670..............  Totazoline hcl injection..  ..................  N.................  ...........  ...........  ...........  ...........  ...........
J2675..............  Inj progesterone per 50 MG  ..................  N.................  ...........  ...........  ...........  ...........  ...........
J2680..............  Fluphenazine decanoate 25   ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      MG.
J2690..............  Procainamide hcl injection  ..................  N.................  ...........  ...........  ...........  ...........  ...........
J2700..............  Oxacillin sodium injeciton  ..................  N.................  ...........  ...........  ...........  ...........  ...........
J2710..............  Neostigmine methylslfte     ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      inj.
J2720..............  Inj protamine sulfate/10    ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      MG.
J2724..............  Protein C concentrate.....  NI................  K.................         1139  ...........       $12.08  ...........        $2.42
J2725..............  Inj protirelin per 250 mcg  ..................  N.................  ...........  ...........  ...........  ...........  ...........
J2730..............  Pralidoxime chloride inj..  CH................  K.................         1023  ...........       $35.20  ...........        $7.04
J2760..............  Phentolaine mesylate inj..  ..................  N.................  ...........  ...........  ...........  ...........  ...........
J2765..............  Metoclopramide hcl          ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      injection.
J2770..............  Quinupristin/dalfopristin.  ..................  K.................         2770  ...........      $126.44  ...........       $25.29
J2778..............  Ranibizumab injection.....  NI................  G.................         9233  ...........    $2,030.23  ...........      $406.05
J2780..............  Ranitidine hydrochloride    ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      inj.
J2783..............  Rasburicase...............  ..................  K.................         0738  ...........      $144.43  ...........       $28.89
J2788..............  Rho d immune globulin 50    ..................  K.................         9023  ...........       $26.41  ...........        $5.28
                      mcg.
J2790..............  Rho d immune globulin inj.  ..................  K.................         0884  ...........       $80.79  ...........       $16.16
J2791..............  Rhophylac injection.......  NI................  K.................         0945  ...........        $5.29  ...........        $1.06
J2792..............  Rho(D) immune globulin h,   ..................  K.................         1609  ...........       $15.62  ...........        $3.12
                      sd.
J2794..............  Risperidone, long acting..  ..................  K.................         9125  ...........        $4.86  ...........        $0.97
J2795..............  Ropivacaine HCl injection.  ..................  N.................  ...........  ...........  ...........  ...........  ...........
J2800..............  Methocarbamol injection...  ..................  N.................  ...........  ...........  ...........  ...........  ...........
J2805..............  Sincalide injection.......  ..................  N.................  ...........  ...........  ...........  ...........  ...........
J2810..............  Inj theophylline per 40 MG  ..................  N.................  ...........  ...........  ...........  ...........  ...........
J2820..............  Sargramostim injection....  ..................  K.................         0731  ...........       $24.86  ...........        $4.97
J2850..............  Inj secretin synthetic      ..................  K.................         1700  ...........       $20.12  ...........        $4.02
                      human.
J2910..............  Aurothioglucose injeciton.  ..................  N.................  ...........  ...........  ...........  ...........  ...........
J2916..............  Na ferric gluconate         ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      complex.
J2920..............  Methylprednisolone          ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      injection.
J2930..............  Methylprednisolone          ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      injection.
J2940..............  Somatrem injection........  ..................  K.................         2940  ...........      $168.90  ...........       $33.78
J2941..............  Somatropin injection......  ..................  K.................         7034  ...........       $48.52  ...........        $9.70
J2950..............  Promazine hcl injection...  ..................  N.................  ...........  ...........  ...........  ...........  ...........
J2993..............  Reteplase injection.......  ..................  K.................         9005  ...........      $841.28  ...........      $168.26
J2995..............  Inj streptokinase /250000   ..................  K.................         0911  ...........      $129.75  ...........       $25.95
                      IU.
J2997..............  Alteplase recombinant.....  ..................  K.................         7048  ...........       $33.39  ...........        $6.68
J3000..............  Streptomycin injection....  ..................  N.................  ...........  ...........  ...........  ...........  ...........
J3010..............  Fentanyl citrate injeciton  ..................  N.................  ...........  ...........  ...........  ...........  ...........
J3030..............  Sumatriptan succinate / 6   ..................  K.................         3030  ...........       $61.27  ...........       $12.25
                      MG.
J3070..............  Pentazocine injection.....  ..................  N.................  ...........  ...........  ...........  ...........  ...........
J3100..............  Tenecteplase injection....  ..................  K.................         9002  ...........    $2,034.65  ...........      $406.93
J3105..............  Terbutaline sulfate inj...  ..................  N.................  ...........  ...........  ...........  ...........  ...........
J3110..............  Teriparatide injection....  ..................  B.................  ...........  ...........  ...........  ...........  ...........
J3120..............  Testosterone enanthate inj  ..................  N.................  ...........  ...........  ...........  ...........  ...........
J3130..............  Testosterone enanthate inj  ..................  N.................  ...........  ...........  ...........  ...........  ...........
J3140..............  Testosterone suspension     ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      inj.
J3150..............  Testosteron propionate inj  ..................  N.................  ...........  ...........  ...........  ...........  ...........
J3230..............  Chlorpromazine hcl          ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      injection.
J3240..............  Thyrotropin injection.....  ..................  K.................         9108  ...........      $834.18  ...........      $166.84
J3243..............  Tigecycline injection.....  ..................  G.................         9228  ...........        $0.96  ...........        $0.19
J3246..............  Tirofiban HCl.............  ..................  K.................         7041  ...........        $7.56  ...........        $1.51
J3250..............  Trimethobenzamide hcl inj.  ..................  N.................  ...........  ...........  ...........  ...........  ...........
J3260..............  Tobramycin sulfate          ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      injection.
J3265..............  Injection torsemide 10 mg/  ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      ml.
J3280..............  Thiethylperazine maleate    ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      inj.
J3285..............  Treprostinil injection....  ..................  K.................         1701  ...........       $55.36  ...........       $11.07
J3301..............  Triamcinolone acetonide     ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      inj.
J3302..............  Triamcinolone diacetate     ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      inj.
J3303..............  Triamcinolone hexacetonl    ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      inj.
J3305..............  Inj trimetrexate            ..................  K.................         7045  ...........      $148.30  ...........       $29.66
                      glucoronate.
J3310..............  Perphenazine injeciton....  ..................  N.................  ...........  ...........  ...........  ...........  ...........
J3315..............  Triptorelin pamoate.......  ..................  K.................         9122  ...........      $159.38  ...........       $31.88
J3320..............  Spectinomycn di-hcl inj...  CH................  N.................  ...........  ...........  ...........  ...........  ...........
J3350..............  Urea injection............  ..................  K.................         9051  ...........       $74.16  ...........       $14.83
J3355..............  Urofollitropin, 75 iu.....  ..................  K.................         1741  ...........       $50.22  ...........       $10.04
J3360..............  Diazepam injection........  ..................  N.................  ...........  ...........  ...........  ...........  ...........
J3364..............  Urokinase 5000 IU           ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      injection.
J3365..............  Urokinase 250,000 IU inj..  ..................  K.................         7036  ...........      $453.41  ...........       $90.68
J3370..............  Vancomycin hcl injection..  ..................  N.................  ...........  ...........  ...........  ...........  ...........
J3396..............  Verteporfin injection.....  ..................  K.................         1203  ...........        $8.99  ...........        $1.80
J3400..............  Triflupromazine hcl inj...  ..................  N.................  ...........  ...........  ...........  ...........  ...........
J3410..............  Hydroxyzine hcl injection.  ..................  N.................  ...........  ...........  ...........  ...........  ...........

[[Page 67144]]

 
J3411..............  Thiamine hcl 100 mg.......  ..................  N.................  ...........  ...........  ...........  ...........  ...........
J3415..............  Pyridoxine hcl 100 mg.....  ..................  N.................  ...........  ...........  ...........  ...........  ...........
J3420..............  Vitamin b12 injection.....  ..................  N.................  ...........  ...........  ...........  ...........  ...........
J3430..............  Vitamin k phytonadione inj  ..................  N.................  ...........  ...........  ...........  ...........  ...........
J3465..............  Injection, voriconazole...  ..................  K.................         1052  ...........        $4.93  ...........        $0.99
J3470..............  Hyaluronidase injection...  ..................  N.................  ...........  ...........  ...........  ...........  ...........
J3471..............  Ovine, up to 999 USP units  ..................  N.................  ...........  ...........  ...........  ...........  ...........
J3472..............  Ovine, 1000 USP units.....  ..................  K.................         1703  ...........      $133.77  ...........       $26.75
J3473..............  Hyaluronidase recombinant.  ..................  G.................         0806  ...........        $0.40  ...........        $0.08
J3475..............  Inj magnesium sulfate.....  ..................  N.................  ...........  ...........  ...........  ...........  ...........
J3480..............  Inj potassium chloride....  ..................  N.................  ...........  ...........  ...........  ...........  ...........
J3485..............  Zidovudine................  ..................  N.................  ...........  ...........  ...........  ...........  ...........
J3486..............  Ziprasidone mesylate......  ..................  N.................  ...........  ...........  ...........  ...........  ...........
J3487..............  Zoledronic acid...........  ..................  K.................         9115  ...........      $205.76  ...........       $41.15
J3488..............  Reclast injection.........  NI................  G.................         0951  ...........      $220.81  ...........       $44.16
J3490..............  Drugs unclassified          ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      injection.
J3520..............  Edetate disodium per 150    ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      mg.
J3530..............  Nasal vaccine inhalation..  ..................  N.................  ...........  ...........  ...........  ...........  ...........
J3535..............  Metered dose inhaler drug.  ..................  E.................  ...........  ...........  ...........  ...........  ...........
J3570..............  Laetrile amygdalin vit B17  ..................  E.................  ...........  ...........  ...........  ...........  ...........
J3590..............  Unclassified biologics....  ..................  N.................  ...........  ...........  ...........  ...........  ...........
J7030..............  Normal saline solution      ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      infus.
J7040..............  Normal saline solution      ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      infus.
J7042..............  5% dextrose/normal saline.  ..................  N.................  ...........  ...........  ...........  ...........  ...........
J7050..............  Normal saline solution      ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      infus.
J7060..............  5% dextrose/water.........  ..................  N.................  ...........  ...........  ...........  ...........  ...........
J7070..............  D5w infusion..............  ..................  N.................  ...........  ...........  ...........  ...........  ...........
J7100..............  Dextran 40 infusion.......  ..................  N.................  ...........  ...........  ...........  ...........  ...........
J7110..............  Dextran 75 infusion.......  ..................  N.................  ...........  ...........  ...........  ...........  ...........
J7120..............  Ringers lactate infusion..  ..................  N.................  ...........  ...........  ...........  ...........  ...........
J7130..............  Hypertonic saline solution  ..................  N.................  ...........  ...........  ...........  ...........  ...........
J7187..............  Humate-P, inj.............  ..................  K.................         1704  ...........        $0.88  ...........        $0.18
J7189..............  Factor viia...............  ..................  K.................         1705  ...........        $1.15  ...........        $0.23
J7190..............  Factor viii...............  ..................  K.................         0925  ...........        $0.75  ...........        $0.15
J7191..............  Factor VIII (porcine).....  CH................  N.................  ...........  ...........  ...........  ...........  ...........
J7192..............  Factor viii recombinant...  ..................  K.................         0927  ...........        $1.07  ...........        $0.21
J7193..............  Factor IX non-recombinant.  ..................  K.................         0931  ...........        $0.89  ...........        $0.18
J7194..............  Factor ix complex.........  ..................  K.................         0928  ...........        $0.80  ...........        $0.16
J7195..............  Factor IX recombinant.....  ..................  K.................         0932  ...........        $0.99  ...........        $0.20
J7197..............  Antithrombin iii injection  ..................  K.................         0930  ...........        $1.82  ...........        $0.36
J7198..............  Anti-inhibitor............  ..................  K.................         0929  ...........        $1.42  ...........        $0.28
J7199..............  Hemophilia clot factor noc  ..................  B.................  ...........  ...........  ...........  ...........  ...........
J7300..............  Intraut copper              ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      contraceptive.
J7302..............  Levonorgestrel iu           ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      contracept.
J7303..............  Contraceptive vaginal ring  ..................  E.................  ...........  ...........  ...........  ...........  ...........
J7304..............  Contraceptive hormone       ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      patch.
J7306..............  Levonorgestrel implant sys  ..................  E.................  ...........  ...........  ...........  ...........  ...........
J7307..............  Etonogestrel implant        NI................  E.................  ...........  ...........  ...........  ...........  ...........
                      system.
J7308..............  Aminolevulinic acid hcl     ..................  K.................         7308  ...........      $109.92  ...........       $21.98
                      top.
J7310..............  Ganciclovir long act        ..................  K.................         0913  ...........    $4,707.90  ...........      $941.58
                      implant.
J7311..............  Fluocinolone acetonide      CH................  K.................         9225  ...........   $19,162.50  ...........    $3,832.50
                      implt.
J7321..............  Hyalgan/supartz inj per     NI................  K.................         0873  ...........      $101.81  ...........       $20.36
                      dose.
J7322..............  Synvisc inj per dose......  NI................  K.................         0874  ...........      $178.11  ...........       $35.62
J7323..............  Euflexxa inj per dose.....  NI................  K.................         0875  ...........      $110.95  ...........       $22.19
J7324..............  Orthovisc inj per dose....  NI................  K.................         0877  ...........      $174.50  ...........       $34.90
J7330..............  Cultured chondrocytes       ..................  B.................  ...........  ...........  ...........  ...........  ...........
                      implnt.
J7340..............  Metabolic active D/E        ..................  K.................         1632  ...........       $28.45  ...........        $5.69
                      tissue.
J7341..............  Non-human, metabolic        CH................  N.................  ...........  ...........  ...........  ...........  ...........
                      tissue.
J7342..............  Metabolically active        ..................  K.................         9054  ...........       $36.40  ...........        $7.28
                      tissue.
J7343..............  Nonmetabolic act d/e        ..................  K.................         1629  ...........       $20.22  ...........        $4.04
                      tissue.
J7344..............  Nonmetabolic active tissue  ..................  K.................         9156  ...........       $94.53  ...........       $18.91
J7345..............  Non-human, non-metab        CH................  D.................  ...........  ...........  ...........  ...........  ...........
                      tissue.
J7346..............  Injectable human tissue...  ..................  K.................         9222  ...........      $774.46  ...........      $154.89
J7347..............  Integra matrix tissue.....  NI................  K.................         1140  ...........       $33.14  ...........        $6.63
J7348..............  Tissuemend tissue.........  NI................  G.................         9351  ...........       $67.96  ...........       $13.59
J7349..............  Primatrix tissue..........  NI................  G.................         1141  ...........       $67.96  ...........       $13.59
J7500..............  Azathioprine oral 50mg....  ..................  N.................  ...........  ...........  ...........  ...........  ...........
J7501..............  Azathioprine parenteral...  ..................  K.................         0887  ...........       $47.88  ...........        $9.58
J7502..............  Cyclosporine oral 100 mg..  ..................  K.................         0888  ...........        $3.52  ...........        $0.70
J7504..............  Lymphocyte immune globulin  ..................  K.................         0890  ...........      $336.10  ...........       $67.22
J7505..............  Monoclonal antibodies.....  ..................  K.................         7038  ...........      $977.75  ...........      $195.55
J7506..............  Prednisone oral...........  ..................  N.................  ...........  ...........  ...........  ...........  ...........
J7507..............  Tacrolimus oral per 1 MG..  ..................  K.................         0891  ...........        $3.69  ...........        $0.74
J7509..............  Methylprednisolone oral...  ..................  N.................  ...........  ...........  ...........  ...........  ...........
J7510..............  Prednisolone oral per 5 mg  ..................  N.................  ...........  ...........  ...........  ...........  ...........
J7511..............  Antithymocyte globuln       ..................  K.................         9104  ...........      $337.82  ...........       $67.56
                      rabbit.
J7513..............  Daclizumab, parenteral....  ..................  K.................         1612  ...........      $322.28  ...........       $64.46
J7515..............  Cyclosporine oral 25 mg...  ..................  N.................  ...........  ...........  ...........  ...........  ...........
J7516..............  Cyclosporin parenteral      ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      250mg.
J7517..............  Mycophenolate mofetil oral  ..................  K.................         9015  ...........        $2.66  ...........        $0.53

[[Page 67145]]

 
J7518..............  Mycophenolic acid.........  ..................  K.................         9219  ...........        $2.41  ...........        $0.48
J7520..............  Sirolimus, oral...........  ..................  K.................         9020  ...........        $7.50  ...........        $1.50
J7525..............  Tacrolimus injection......  ..................  K.................         9006  ...........      $138.64  ...........       $27.73
J7599..............  Immunosuppressive drug noc  ..................  N.................  ...........  ...........  ...........  ...........  ...........
J7602..............  Albuterol inh non-comp con  NI................  M.................  ...........  ...........  ...........  ...........  ...........
J7603..............  Albuterol inh non-comp u d  NI................  M.................  ...........  ...........  ...........  ...........  ...........
J7604..............  Acetylcysteine comp unit..  NI................  M.................  ...........  ...........  ...........  ...........  ...........
J7605..............  Arformoterol non-comp unit  NI................  M.................  ...........  ...........  ...........  ...........  ...........
J7607..............  Levalbuterol comp con.....  CH................  M.................  ...........  ...........  ...........  ...........  ...........
J7608..............  Acetylcysteine non-comp     CH................  M.................  ...........  ...........  ...........  ...........  ...........
                      unit.
J7609..............  Albuterol comp unit.......  CH................  M.................  ...........  ...........  ...........  ...........  ...........
J7610..............  Albuterol comp con........  CH................  M.................  ...........  ...........  ...........  ...........  ...........
J7611..............  Albuterol non-comp con....  CH................  D.................  ...........  ...........  ...........  ...........  ...........
J7612..............  Levalbuterol non-comp con.  CH................  D.................  ...........  ...........  ...........  ...........  ...........
J7613..............  Albuterol non-comp unit...  CH................  D.................  ...........  ...........  ...........  ...........  ...........
J7614..............  Levalbuterol non-comp unit  CH................  D.................  ...........  ...........  ...........  ...........  ...........
J7615..............  Levalbuterol comp unit....  CH................  M.................  ...........  ...........  ...........  ...........  ...........
J7620..............  Albuterol ipratrop non-     CH................  M.................  ...........  ...........  ...........  ...........  ...........
                      comp.
J7622..............  Beclomethasone comp unit..  CH................  M.................  ...........  ...........  ...........  ...........  ...........
J7624..............  Betamethasone comp unit...  CH................  M.................  ...........  ...........  ...........  ...........  ...........
J7626..............  Budesonide non-comp unit..  CH................  M.................  ...........  ...........  ...........  ...........  ...........
J7627..............  Budesonide comp unit......  CH................  M.................  ...........  ...........  ...........  ...........  ...........
J7628..............  Bitolterol mesylate comp    CH................  M.................  ...........  ...........  ...........  ...........  ...........
                      con.
J7629..............  Bitolterol mesylate comp    CH................  M.................  ...........  ...........  ...........  ...........  ...........
                      unt.
J7631..............  Cromolyn sodium noncomp     CH................  M.................  ...........  ...........  ...........  ...........  ...........
                      unit.
J7632..............  Cromolyn sodium comp unit.  NI................  M.................  ...........  ...........  ...........  ...........  ...........
J7633..............  Budesonide non-comp con...  CH................  M.................  ...........  ...........  ...........  ...........  ...........
J7634..............  Budesonide comp con.......  CH................  M.................  ...........  ...........  ...........  ...........  ...........
J7635..............  Atropine comp con.........  CH................  M.................  ...........  ...........  ...........  ...........  ...........
J7636..............  Atropine comp unit........  CH................  M.................  ...........  ...........  ...........  ...........  ...........
J7637..............  Dexamethasone comp con....  CH................  M.................  ...........  ...........  ...........  ...........  ...........
J7638..............  Dexamethasone comp unit...  CH................  M.................  ...........  ...........  ...........  ...........  ...........
J7639..............  Dornase alpha non-comp      CH................  M.................  ...........  ...........  ...........  ...........  ...........
                      unit.
J7640..............  Formoterol comp unit......  ..................  E.................  ...........  ...........  ...........  ...........  ...........
J7641..............  Flunisolide comp unit.....  CH................  M.................  ...........  ...........  ...........  ...........  ...........
J7642..............  Glycopyrrolate comp con...  CH................  M.................  ...........  ...........  ...........  ...........  ...........
J7643..............  Glycopyrrolate comp unit..  CH................  M.................  ...........  ...........  ...........  ...........  ...........
J7644..............  Ipratropium bromide non-    CH................  M.................  ...........  ...........  ...........  ...........  ...........
                      comp.
J7645..............  Ipratropium bromide comp..  CH................  M.................  ...........  ...........  ...........  ...........  ...........
J7647..............  Isoetharine comp con......  CH................  M.................  ...........  ...........  ...........  ...........  ...........
J7648..............  Isoetharine non-comp con..  CH................  M.................  ...........  ...........  ...........  ...........  ...........
J7649..............  Isoetharine non-comp unit.  CH................  M.................  ...........  ...........  ...........  ...........  ...........
J7650..............  Isoetharine comp unit.....  CH................  M.................  ...........  ...........  ...........  ...........  ...........
J7657..............  Isoproterenol comp con....  CH................  M.................  ...........  ...........  ...........  ...........  ...........
J7658..............  Isoproterenol non-comp con  CH................  M.................  ...........  ...........  ...........  ...........  ...........
J7659..............  Isoproterenol non-comp      CH................  M.................  ...........  ...........  ...........  ...........  ...........
                      unit.
J7660..............  Isoproterenol comp unit...  CH................  M.................  ...........  ...........  ...........  ...........  ...........
J7667..............  Metaproterenol comp con...  CH................  M.................  ...........  ...........  ...........  ...........  ...........
J7668..............  Metaproterenol non-comp     CH................  M.................  ...........  ...........  ...........  ...........  ...........
                      con.
J7669..............  Metaproterenol non-comp     CH................  M.................  ...........  ...........  ...........  ...........  ...........
                      unit.
J7670..............  Metaproterenol comp unit..  CH................  M.................  ...........  ...........  ...........  ...........  ...........
J7674..............  Methacholine chloride, neb  ..................  N.................  ...........  ...........  ...........  ...........  ...........
J7676..............  Pentamidine comp unit dose  NI................  M.................  ...........  ...........  ...........  ...........  ...........
J7680..............  Terbutaline sulf comp con.  CH................  M.................  ...........  ...........  ...........  ...........  ...........
J7681..............  Terbutaline sulf comp unit  CH................  M.................  ...........  ...........  ...........  ...........  ...........
J7682..............  Tobramycin non-comp unit..  CH................  M.................  ...........  ...........  ...........  ...........  ...........
J7683..............  Triamcinolone comp con....  CH................  M.................  ...........  ...........  ...........  ...........  ...........
J7684..............  Triamcinolone comp unit...  CH................  M.................  ...........  ...........  ...........  ...........  ...........
J7685..............  Tobramycin comp unit......  CH................  M.................  ...........  ...........  ...........  ...........  ...........
J7699..............  Inhalation solution for     CH................  M.................  ...........  ...........  ...........  ...........  ...........
                      DME.
J7799..............  Non-inhalation drug for     ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      DME.
J8498..............  Antiemetic rectal/supp NOS  ..................  B.................  ...........  ...........  ...........  ...........  ...........
J8499..............  Oral prescrip drug non      ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      chemo.
J8501..............  Oral aprepitant...........  CH................  K.................         0868  ...........        $4.99  ...........        $1.00
J8510..............  Oral busulfan.............  ..................  K.................         7015  ...........        $2.26  ...........        $0.45
J8515..............  Cabergoline, oral 0.25mg..  ..................  E.................  ...........  ...........  ...........  ...........  ...........
J8520..............  Capecitabine, oral, 150 mg  ..................  K.................         7042  ...........        $4.28  ...........        $0.86
J8521..............  Capecitabine, oral, 500 mg  CH................  K.................         0934  ...........       $14.19  ...........        $2.84
J8530..............  Cyclophosphamide oral 25    ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      MG.
J8540..............  Oral dexamethasone........  ..................  N.................  ...........  ...........  ...........  ...........  ...........
J8560..............  Etoposide oral 50 MG......  ..................  K.................         0802  ...........       $29.46  ...........        $5.89
J8565..............  Gefitinib oral............  ..................  E.................  ...........  ...........  ...........  ...........  ...........
J8597..............  Antiemetic drug oral NOS..  ..................  N.................  ...........  ...........  ...........  ...........  ...........
J8600..............  Melphalan oral 2 MG.......  CH................  K.................         0882  ...........        $4.14  ...........        $0.83
J8610..............  Methotrexate oral 2.5 MG..  ..................  N.................  ...........  ...........  ...........  ...........  ...........
J8650..............  Nabilone oral.............  ..................  K.................         0808  ...........       $16.80  ...........        $3.36
J8700..............  Temozolomide..............  ..................  K.................         1086  ...........        $7.49  ...........        $1.50
J8999..............  Oral prescription drug      ..................  B.................  ...........  ...........  ...........  ...........  ...........
                      chemo.
J9000..............  Doxorubic hcl 10 MG vl      CH................  N.................  ...........  ...........  ...........  ...........  ...........
                      chemo.
J9001..............  Doxorubicin hcl liposome    ..................  K.................         7046  ...........      $396.15  ...........       $79.23
                      inj.

[[Page 67146]]

 
J9010..............  Alemtuzumab injection.....  ..................  K.................         9110  ...........      $549.77  ...........      $109.95
J9015..............  Aldesleukin/single use      ..................  K.................         0807  ...........      $788.84  ...........      $157.77
                      vial.
J9017..............  Arsenic trioxide..........  ..................  K.................         9012  ...........       $34.44  ...........        $6.89
J9020..............  Asparaginase injection....  ..................  K.................         0814  ...........       $54.26  ...........       $10.85
J9025..............  Azacitidine injection.....  ..................  K.................         1709  ...........        $4.35  ...........        $0.87
J9027..............  Clofarabine injection.....  CH................  K.................         1710  ...........      $114.41  ...........       $22.88
J9031..............  Bcg live intravesical vac.  ..................  K.................         0809  ...........      $113.75  ...........       $22.75
J9035..............  Bevacizumab injection.....  ..................  K.................         9214  ...........       $56.93  ...........       $11.39
J9040..............  Bleomycin sulfate           ..................  K.................         0748  ...........       $42.93  ...........        $8.59
                      injection.
J9041..............  Bortezomib injection......  ..................  K.................         9207  ...........       $33.20  ...........        $6.64
J9045..............  Carboplatin injection.....  ..................  K.................         0811  ...........        $7.44  ...........        $1.49
J9050..............  Carmus bischl nitro inj...  ..................  K.................         0812  ...........      $152.24  ...........       $30.45
J9055..............  Cetuximab injection.......  ..................  K.................         9215  ...........       $49.43  ...........        $9.89
J9060..............  Cisplatin 10 MG injection.  ..................  N.................  ...........  ...........  ...........  ...........  ...........
J9062..............  Cisplatin 50 MG injection.  CH................  N.................  ...........  ...........  ...........  ...........  ...........
J9065..............  Inj cladribine per 1 MG...  ..................  K.................         0858  ...........       $32.04  ...........        $6.41
J9070..............  Cyclophosphamide 100 MG     ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      inj.
J9080..............  Cyclophosphamide 200 MG     CH................  N.................  ...........  ...........  ...........  ...........  ...........
                      inj.
J9090..............  Cyclophosphamide 500 MG     CH................  N.................  ...........  ...........  ...........  ...........  ...........
                      inj.
J9091..............  Cyclophosphamide 1.0 grm    CH................  N.................  ...........  ...........  ...........  ...........  ...........
                      inj.
J9092..............  Cyclophosphamide 2.0 grm    CH................  N.................  ...........  ...........  ...........  ...........  ...........
                      inj.
J9093..............  Cyclophosphamide            CH................  N.................  ...........  ...........  ...........  ...........  ...........
                      lyophilized.
J9094..............  Cyclophosphamide            CH................  N.................  ...........  ...........  ...........  ...........  ...........
                      lyophilized.
J9095..............  Cyclophosphamide            CH................  N.................  ...........  ...........  ...........  ...........  ...........
                      lyophilized.
J9096..............  Cyclophosphamide            CH................  N.................  ...........  ...........  ...........  ...........  ...........
                      lyophilized.
J9097..............  Cyclophosphamide            CH................  N.................  ...........  ...........  ...........  ...........  ...........
                      lyophilized.
J9098..............  Cytarabine liposome.......  ..................  K.................         1166  ...........      $412.21  ...........       $82.44
J9100..............  Cytarabine hcl 100 MG inj.  ..................  N.................  ...........  ...........  ...........  ...........  ...........
J9110..............  Cytarabine hcl 500 MG inj.  CH................  N.................  ...........  ...........  ...........  ...........  ...........
J9120..............  Dactinomycin actinomycin d  ..................  K.................         0752  ...........      $488.78  ...........       $97.76
J9130..............  Dacarbazine 100 mg inj....  CH................  N.................  ...........  ...........  ...........  ...........  ...........
J9140..............  Dacarbazine 200 MG inj....  CH................  N.................  ...........  ...........  ...........  ...........  ...........
J9150..............  Daunorubicin..............  ..................  K.................         0820  ...........       $19.33  ...........        $3.87
J9151..............  Daunorubicin citrate        ..................  K.................         0821  ...........       $55.23  ...........       $11.05
                      liposom.
J9160..............  Denileukin diftitox, 300    ..................  K.................         1084  ...........    $1,386.59  ...........      $277.32
                      mcg.
J9165..............  Diethylstilbestrol          ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      injection.
J9170..............  Docetaxel.................  ..................  K.................         0823  ...........      $310.85  ...........       $62.17
J9175..............  Elliotts b solution per ml  ..................  N.................  ...........  ...........  ...........  ...........  ...........
J9178..............  Inj, epirubicin hcl, 2 mg.  ..................  K.................         1167  ...........       $19.79  ...........        $3.96
J9181..............  Etoposide 10 MG inj.......  ..................  N.................  ...........  ...........  ...........  ...........  ...........
J9182..............  Etoposide 100 MG inj......  CH................  N.................  ...........  ...........  ...........  ...........  ...........
J9185..............  Fludarabine phosphate inj.  ..................  K.................         0842  ...........      $226.67  ...........       $45.33
J9190..............  Fluorouracil injection....  ..................  N.................  ...........  ...........  ...........  ...........  ...........
J9200..............  Floxuridine injection.....  ..................  K.................         0827  ...........       $54.63  ...........       $10.93
J9201..............  Gemcitabine HCl...........  ..................  K.................         0828  ...........      $127.31  ...........       $25.46
J9202..............  Goserelin acetate implant.  ..................  K.................         0810  ...........      $192.29  ...........       $38.46
J9206..............  Irinotecan injection......  ..................  K.................         0830  ...........      $124.61  ...........       $24.92
J9208..............  Ifosfomide injection......  ..................  K.................         0831  ...........       $38.13  ...........        $7.63
J9209..............  Mesna injection...........  ..................  K.................         0732  ...........        $7.97  ...........        $1.59
J9211..............  Idarubicin hcl injection..  ..................  K.................         0832  ...........      $302.42  ...........       $60.48
J9212..............  Interferon alfacon-1......  ..................  K.................         0912  ...........        $4.62  ...........        $0.92
J9213..............  Interferon alfa-2a inj....  ..................  K.................         0834  ...........       $41.37  ...........        $8.27
J9214..............  Interferon alfa-2b inj....  ..................  K.................         0836  ...........       $13.92  ...........        $2.78
J9215..............  Interferon alfa-n3 inj....  ..................  K.................         0865  ...........        $9.03  ...........        $1.81
J9216..............  Interferon gamma 1-b inj..  ..................  K.................         0838  ...........      $306.66  ...........       $61.33
J9217..............  Leuprolide acetate          ..................  K.................         9217  ...........      $236.06  ...........       $47.21
                      suspnsion.
J9218..............  Leuprolide acetate          ..................  K.................         0861  ...........        $7.98  ...........        $1.60
                      injeciton.
J9219..............  Leuprolide acetate implant  ..................  K.................         7051  ...........    $1,648.41  ...........      $329.68
J9225..............  Vantas implant............  ..................  K.................         1711  ...........    $1,412.46  ...........      $282.49
J9226..............  Supprelin LA implant......  NI................  K.................         1142  ...........   $14,700.00  ...........    $2,940.00
J9230..............  Mechlorethamine hcl inj...  ..................  K.................         0751  ...........      $143.08  ...........       $28.62
J9245..............  Inj melphalan hydrochl 50   ..................  K.................         0840  ...........    $1,548.88  ...........      $309.78
                      MG.
J9250..............  Methotrexate sodium inj...  ..................  N.................  ...........  ...........  ...........  ...........  ...........
J9260..............  Methotrexate sodium inj...  CH................  N.................  ...........  ...........  ...........  ...........  ...........
J9261..............  Nelarabine injection......  ..................  G.................         0825  ...........       $86.84  ...........       $17.37
J9263..............  Oxaliplatin...............  ..................  K.................         1738  ...........        $9.15  ...........        $1.83
J9264..............  Paclitaxel protein bound..  CH................  K.................         1712  ...........        $8.79  ...........        $1.76
J9265..............  Paclitaxel injection......  ..................  K.................         0863  ...........       $14.57  ...........        $2.91
J9266..............  Pegaspargase/singl dose     ..................  K.................         0843  ...........    $2,080.19  ...........      $416.04
                      vial.
J9268..............  Pentostatin injection.....  ..................  K.................         0844  ...........    $2,051.68  ...........      $410.34
J9270..............  Plicamycin (mithramycin)    CH................  K.................         1041  ...........      $172.41  ...........       $34.48
                      inj.
J9280..............  Mitomycin 5 MG inj........  ..................  K.................         0862  ...........       $14.39  ...........        $2.88
J9290..............  Mitomycin 20 MG inj.......  CH................  K.................         0941  ...........       $57.56  ...........       $11.51
J9291..............  Mitomycin 40 MG inj.......  CH................  K.................         0942  ...........      $115.11  ...........       $23.02
J9293..............  Mitoxantrone hydrochl / 5   ..................  K.................         0864  ...........      $107.96  ...........       $21.59
                      MG.
J9300..............  Gemtuzumab ozogamicin.....  ..................  K.................         9004  ...........    $2,411.98  ...........      $482.40
J9303..............  Panitumumab injection.....  NI................  G.................         9235  ...........       $83.15  ...........       $16.63
J9305..............  Pemetrexed injection......  ..................  K.................         9213  ...........       $44.49  ...........        $8.90
J9310..............  Rituximab cancer treatment  ..................  K.................         0849  ...........      $504.40  ...........      $100.88
J9320..............  Streptozocin injection....  ..................  K.................         0850  ...........      $146.93  ...........       $29.39

[[Page 67147]]

 
J9340..............  Thiotepa injection........  ..................  K.................         0851  ...........       $41.12  ...........        $8.22
J9350..............  Topotecan.................  ..................  K.................         0852  ...........      $859.62  ...........      $171.92
J9355..............  Trastuzumab...............  ..................  K.................         1613  ...........       $58.51  ...........       $11.70
J9357..............  Valrubicin, 200 mg........  ..................  K.................         9167  ...........       $77.96  ...........       $15.59
J9360..............  Vinblastine sulfate inj...  ..................  N.................  ...........  ...........  ...........  ...........  ...........
J9370..............  Vincristine sulfate 1 MG    ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      inj.
J9375..............  Vincristine sulfate 2 MG    CH................  N.................  ...........  ...........  ...........  ...........  ...........
                      inj.
J9380..............  Vincristine sulfate 5 MG    CH................  N.................  ...........  ...........  ...........  ...........  ...........
                      inj.
J9390..............  Vinorelbine tartrate/10 mg  ..................  K.................         0855  ...........       $21.41  ...........        $4.28
J9395..............  Injection, Fulvestrant....  ..................  K.................         9120  ...........       $80.60  ...........       $16.12
J9600..............  Porfimer sodium...........  ..................  K.................         0856  ...........    $2,532.53  ...........      $506.51
J9999..............  Chemotherapy drug.........  ..................  N.................  ...........  ...........  ...........  ...........  ...........
K0001..............  Standard wheelchair.......  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
K0002..............  Stnd hemi (low seat)        ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      whlchr.
K0003..............  Lightweight wheelchair....  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
K0004..............  High strength ltwt whlchr.  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
K0005..............  Ultralightweight            ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      wheelchair.
K0006..............  Heavy duty wheelchair.....  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
K0007..............  Extra heavy duty            ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      wheelchair.
K0009..............  Other manual wheelchair/    ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      base.
K0010..............  Stnd wt frame power whlchr  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
K0011..............  Stnd wt pwr whlchr w        ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      control.
K0012..............  Ltwt portbl power whlchr..  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
K0014..............  Other power whlchr base...  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
K0015..............  Detach non-adjus hght       ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      armrst.
K0017..............  Detach adjust armrest base  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
K0018..............  Detach adjust armrst upper  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
K0019..............  Arm pad each..............  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
K0020..............  Fixed adjust armrest pair.  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
K0037..............  High mount flip-up          ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      footrest.
K0038..............  Leg strap each............  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
K0039..............  Leg strap h style each....  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
K0040..............  Adjustable angle footplate  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
K0041..............  Large size footplate each.  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
K0042..............  Standard size footplate     ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      each.
K0043..............  Ftrst lower extension tube  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
K0044..............  Ftrst upper hanger bracket  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
K0045..............  Footrest complete assembly  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
K0046..............  Elevat legrst low           ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      extension.
K0047..............  Elevat legrst up hangr      ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      brack.
K0050..............  Ratchet assembly..........  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
K0051..............  Cam relese assem ftrst/     ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      lgrst.
K0052..............  Swingaway detach footrest.  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
K0053..............  Elevate footrest            ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      articulate.
K0056..............  Seat ht <17 or >=21 ltwt    ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      wc.
K0065..............  Spoke protectors..........  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
K0069..............  Rear whl complete solid     ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      tire.
K0070..............  Rear whl compl pneum tire.  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
K0071..............  Front castr compl pneum     ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      tire.
K0072..............  Frnt cstr cmpl sem-pneum    ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      tir.
K0073..............  Caster pin lock each......  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
K0077..............  Front caster assem          ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      complete.
K0098..............  Drive belt power            ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      wheelchair.
K0105..............  Iv hanger.................  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
K0108..............  W/c component-accessory     ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      NOS.
K0195..............  Elevating whlchair leg      ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      rests.
K0455..............  Pump uninterrupted          ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      infusion.
K0462..............  Temporary replacement       ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      eqpmnt.
K0552..............  Supply/ext inf pump syr     ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      type.
K0553..............  Combination oral/nasal      CH................  D.................  ...........  ...........  ...........  ...........  ...........
                      mask.
K0554..............  Repl oral cushion combo     CH................  D.................  ...........  ...........  ...........  ...........  ...........
                      mask.
K0555..............  Repl nasal pillow comb      CH................  D.................  ...........  ...........  ...........  ...........  ...........
                      mask.
K0601..............  Repl batt silver oxide 1.5  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      v.
K0602..............  Repl batt silver oxide 3 v  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
K0603..............  Repl batt alkaline 1.5 v..  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
K0604..............  Repl batt lithium 3.6 v...  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
K0605..............  Repl batt lithium 4.5 v...  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
K0606..............  AED garment w elec          ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      analysis.
K0607..............  Repl batt for AED.........  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
K0608..............  Repl garment for AED......  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
K0609..............  Repl electrode for AED....  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
K0669..............  Seat/back cus no sadmerc    ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      ver.
K0730..............  Ctrl dose inh drug deliv    ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      sys.
K0733..............  12-24hr sealed lead acid..  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
K0734..............  Adj skin pro w/c cus        ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      wd<22in.
K0735..............  Adj skin pro wc cus         ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      wd>=22in.
K0736..............  Adj skin pro/pos wc         ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      cus<22in.
K0737..............  Adj skin pro/pos wc         ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      cus>=22''.
K0738..............  Portable gas oxygen system  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
K0800..............  POV group 1 std up to       ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      300lbs.

[[Page 67148]]

 
K0801..............  POV group 1 hd 301-450 lbs  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
K0802..............  POV group 1 vhd 451-600     ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      lbs.
K0806..............  POV group 2 std up to       ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      300lbs.
K0807..............  POV group 2 hd 301-450 lbs  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
K0808..............  POV group 2 vhd 451-600     ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      lbs.
K0812..............  Power operated vehicle NOC  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
K0813..............  PWC gp 1 std port seat/     ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      back.
K0814..............  PWC gp 1 std port cap       ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      chair.
K0815..............  PWC gp 1 std seat/back....  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
K0816..............  PWC gp 1 std cap chair....  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
K0820..............  PWC gp 2 std port seat/     ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      back.
K0821..............  PWC gp 2 std port cap       ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      chair.
K0822..............  PWC gp 2 std seat/back....  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
K0823..............  PWC gp 2 std cap chair....  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
K0824..............  PWC gp 2 hd seat/back.....  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
K0825..............  PWC gp 2 hd cap chair.....  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
K0826..............  PWC gp 2 vhd seat/back....  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
K0827..............  PWC gp vhd cap chair......  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
K0828..............  PWC gp 2 xtra hd seat/back  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
K0829..............  PWC gp 2 xtra hd cap chair  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
K0830..............  PWC gp2 std seat elevate s/ ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      b.
K0831..............  PWC gp2 std seat elevate    ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      cap.
K0835..............  PWC gp2 std sing pow opt s/ ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      b.
K0836..............  PWC gp2 std sing pow opt    ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      cap.
K0837..............  PWC gp 2 hd sing pow opt s/ ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      b.
K0838..............  PWC gp 2 hd sing pow opt    ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      cap.
K0839..............  PWC gp2 vhd sing pow opt s/ ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      b.
K0840..............  PWC gp2 xhd sing pow opt s/ ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      b.
K0841..............  PWC gp2 std mult pow opt s/ ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      b.
K0842..............  PWC gp2 std mult pow opt    ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      cap.
K0843..............  PWC gp2 hd mult pow opt s/  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      b.
K0848..............  PWC gp 3 std seat/back....  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
K0849..............  PWC gp 3 std cap chair....  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
K0850..............  PWC gp 3 hd seat/back.....  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
K0851..............  PWC gp 3 hd cap chair.....  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
K0852..............  PWC gp 3 vhd seat/back....  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
K0853..............  PWC gp 3 vhd cap chair....  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
K0854..............  PWC gp 3 xhd seat/back....  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
K0855..............  PWC gp 3 xhd cap chair....  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
K0856..............  PWC gp3 std sing pow opt s/ ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      b.
K0857..............  PWC gp3 std sing pow opt    ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      cap.
K0858..............  PWC gp3 hd sing pow opt s/  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      b.
K0859..............  PWC gp3 hd sing pow opt     ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      cap.
K0860..............  PWC gp3 vhd sing pow opt s/ ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      b.
K0861..............  PWC gp3 std mult pow opt s/ ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      b.
K0862..............  PWC gp3 hd mult pow opt s/  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      b.
K0863..............  PWC gp3 vhd mult pow opt s/ ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      b.
K0864..............  PWC gp3 xhd mult pow opt s/ ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      b.
K0868..............  PWC gp 4 std seat/back....  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
K0869..............  PWC gp 4 std cap chair....  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
K0870..............  PWC gp 4 hd seat/back.....  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
K0871..............  PWC gp 4 vhd seat/back....  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
K0877..............  PWC gp4 std sing pow opt s/ ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      b.
K0878..............  PWC gp4 std sing pow opt    ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      cap.
K0879..............  PWC gp4 hd sing pow opt s/  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      b.
K0880..............  PWC gp4 vhd sing pow opt s/ ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      b.
K0884..............  PWC gp4 std mult pow opt s/ ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      b.
K0885..............  PWC gp4 std mult pow opt    ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      cap.
K0886..............  PWC gp4 hd mult pow s/b...  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
K0890..............  PWC gp5 ped sing pow opt s/ ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      b.
K0891..............  PWC gp5 ped mult pow opt s/ ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      b.
K0898..............  Power wheelchair NOC......  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
K0899..............  Pow mobil dev no SADMERC..  ..................  Y.................  ...........  ...........  ...........  ...........  ...........
L0112..............  Cranial cervical orthosis.  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L0120..............  Cerv flexible non-          ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      adjustable.
L0130..............  Flex thermoplastic collar   ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      mo.
L0140..............  Cervical semi-rigid         ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      adjustab.
L0150..............  Cerv semi-rig adj molded    ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      chn.
L0160..............  Cerv semi-rig wire occ/     ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      mand.
L0170..............  Cervical collar molded to   ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      pt.
L0172..............  Cerv col thermplas foam 2   ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      pi.
L0174..............  Cerv col foam 2 piece w     ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      thor.
L0180..............  Cer post col occ/man sup    ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      adj.
L0190..............  Cerv collar supp adj cerv   ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      ba.
L0200..............  Cerv col supp adj bar &     ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      thor.
L0210..............  Thoracic rib belt.........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L0220..............  Thor rib belt custom        ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      fabrica.
L0430..............  Dewall posture protector..  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L0450..............  TLSO flex prefab thoracic.  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L0452..............  tlso flex custom fab        ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      thoraci.

[[Page 67149]]

 
L0454..............  TLSO flex prefab sacrococ-  ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      T9.
L0456..............  TLSO flex prefab..........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L0458..............  TLSO 2Mod symphis-xipho     ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      pre.
L0460..............  TLSO2Mod symphysis-stern    ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      pre.
L0462..............  TLSO 3Mod sacro-scap pre..  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L0464..............  TLSO 4Mod sacro-scap pre..  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L0466..............  TLSO rigid frame pre soft   ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      ap.
L0468..............  TLSO rigid frame prefab     ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      pelv.
L0470..............  TLSO rigid frame pre        ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      subclav.
L0472..............  TLSO rigid frame hyperex    ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      pre.
L0480..............  TLSO rigid plastic custom   ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      fa.
L0482..............  TLSO rigid lined custom     ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      fab.
L0484..............  TLSO rigid plastic cust     ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      fab.
L0486..............  TLSO rigidlined cust fab    ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      two.
L0488..............  TLSO rigid lined pre one    ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      pie.
L0490..............  TLSO rigid plastic pre one  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L0491..............  TLSO 2 piece rigid shell..  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L0492..............  TLSO 3 piece rigid shell..  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L0621..............  SIO flex pelvisacral        ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      prefab.
L0622..............  SIO flex pelvisacral        ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      custom.
L0623..............  SIO panel prefab..........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L0624..............  SIO panel custom..........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L0625..............  LO flexibl L1-below L5 pre  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L0626..............  LO sag stays/panels pre-    ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      fab.
L0627..............  LO sagitt rigid panel       ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      prefab.
L0628..............  LO flex w/o rigid stays     ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      pre.
L0629..............  LSO flex w/rigid stays      ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      cust.
L0630..............  LSO post rigid panel pre..  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L0631..............  LSO sag-coro rigid frame    ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      pre.
L0632..............  LSO sag rigid frame cust..  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L0633..............  LSO flexion control prefab  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L0634..............  LSO flexion control custom  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L0635..............  LSO sagit rigid panel       ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      prefab.
L0636..............  LSO sagittal rigid panel    ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      cus.
L0637..............  LSO sag-coronal panel       ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      prefab.
L0638..............  LSO sag-coronal panel       ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      custom.
L0639..............  LSO s/c shell/panel prefab  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L0640..............  LSO s/c shell/panel custom  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L0700..............  Ctlso a-p-l control molded  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L0710..............  Ctlso a-p-l control w/      ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      inter.
L0810..............  Halo cervical into jckt     ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      vest.
L0820..............  Halo cervical into body     ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      jack.
L0830..............  Halo cerv into milwaukee    ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      typ.
L0859..............  MRI compatible system.....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L0861..............  Halo repl liner/interface.  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L0960..............  Post surgical support pads  CH................  D.................  ...........  ...........  ...........  ...........  ...........
L0970..............  Tlso corset front.........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L0972..............  Lso corset front..........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L0974..............  Tlso full corset..........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L0976..............  Lso full corset...........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L0978..............  Axillary crutch extension.  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L0980..............  Peroneal straps pair......  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L0982..............  Stocking supp grips set of  ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      f.
L0984..............  Protective body sock each.  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L0999..............  Add to spinal orthosis NOS  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L1000..............  Ctlso milwauke initial      ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      model.
L1001..............  CTLSO infant immobilizer..  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L1005..............  Tension based scoliosis     ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      orth.
L1010..............  Ctlso axilla sling........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L1020..............  Kyphosis pad..............  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L1025..............  Kyphosis pad floating.....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L1030..............  Lumbar bolster pad........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L1040..............  Lumbar or lumbar rib pad..  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L1050..............  Sternal pad...............  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L1060..............  Thoracic pad..............  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L1070..............  Trapezius sling...........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L1080..............  Outrigger.................  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L1085..............  Outrigger bil w/ vert       ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      extens.
L1090..............  Lumbar sling..............  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L1100..............  Ring flange plastic/        ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      leather.
L1110..............  Ring flange plas/leather    ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      mol.
L1120..............  Covers for upright each...  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L1200..............  Furnsh initial orthosis     ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      only.
L1210..............  Lateral thoracic extension  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L1220..............  Anterior thoracic           ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      extension.
L1230..............  Milwaukee type              ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      superstructur.
L1240..............  Lumbar derotation pad.....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L1250..............  Anterior asis pad.........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L1260..............  Anterior thoracic           ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      derotation.
L1270..............  Abdominal pad.............  ..................  A.................  ...........  ...........  ...........  ...........  ...........

[[Page 67150]]

 
L1280..............  Rib gusset (elastic) each.  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L1290..............  Lateral trochanteric pad..  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L1300..............  Body jacket mold to         ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      patient.
L1310..............  Post-operative body jacket  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L1499..............  Spinal orthosis NOS.......  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L1500..............  Thkao mobility frame......  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L1510..............  Thkao standing frame......  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L1520..............  Thkao swivel walker.......  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L1600..............  Abduct hip flex frejka w    ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      cvr.
L1610..............  Abduct hip flex frejka      ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      covr.
L1620..............  Abduct hip flex pavlik      ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      harne.
L1630..............  Abduct control hip semi-    ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      flex.
L1640..............  Pelv band/spread bar thigh  ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      c.
L1650..............  HO abduction hip            ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      adjustable.
L1652..............  HO bi thighcuffs w sprdr    ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      bar.
L1660..............  HO abduction static         ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      plastic.
L1680..............  Pelvic & hip control thigh  ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      c.
L1685..............  Post-op hip abduct custom   ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      fa.
L1686..............  HO post-op hip abduction..  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L1690..............  Combination bilateral HO..  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L1700..............  Leg perthes orth toronto    ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      typ.
L1710..............  Legg perthes orth           ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      newington.
L1720..............  Legg perthes orthosis       ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      trilat.
L1730..............  Legg perthes orth scottish  ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      r.
L1755..............  Legg perthes patten bottom  ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      t.
L1800..............  Knee orthoses elas w stays  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L1810..............  Ko elastic with joints....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L1815..............  Elastic with condylar pads  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L1820..............  Ko elas w/ condyle pads &   ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      jo.
L1825..............  Ko elastic knee cap.......  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L1830..............  Ko immobilizer canvas       ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      longit.
L1831..............  Knee orth pos locking       ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      joint.
L1832..............  KO adj jnt pos rigid        ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      support.
L1834..............  Ko w/0 joint rigid molded   ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      to.
L1836..............  Rigid KO wo joints........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L1840..............  Ko derot ant cruciate       ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      custom.
L1843..............  KO single upright custom    ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      fit.
L1844..............  Ko w/adj jt rot cntrl       ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      molded.
L1845..............  Ko w/ adj flex/ext rotat    ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      cus.
L1846..............  Ko w adj flex/ext rotat     ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      mold.
L1847..............  KO adjustable w air         ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      chambers.
L1850..............  Ko swedish type...........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L1855..............  Ko plas doub upright jnt    CH................  D.................  ...........  ...........  ...........  ...........  ...........
                      mol.
L1858..............  Ko polycentric pneumatic    CH................  D.................  ...........  ...........  ...........  ...........  ...........
                      pad.
L1860..............  Ko supracondylar socket     ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      mold.
L1870..............  Ko doub upright lacers      CH................  D.................  ...........  ...........  ...........  ...........  ...........
                      molde.
L1880..............  Ko doub upright cuffs/      CH................  D.................  ...........  ...........  ...........  ...........  ...........
                      lacers.
L1900..............  Afo sprng wir drsflx calf   ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      bd.
L1901..............  Prefab ankle orthosis.....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L1902..............  Afo ankle gauntlet........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L1904..............  Afo molded ankle gauntlet.  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L1906..............  Afo multiligamentus ankle   ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      su.
L1907..............  AFO supramalleolar custom.  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L1910..............  Afo sing bar clasp attach   ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      sh.
L1920..............  Afo sing upright w/ adjust  ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      s.
L1930..............  Afo plastic...............  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L1932..............  Afo rig ant tib prefab TCF/ ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      =.
L1940..............  Afo molded to patient       ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      plasti.
L1945..............  Afo molded plas rig ant     ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      tib.
L1950..............  Afo spiral molded to pt     ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      plas.
L1951..............  AFO spiral prefabricated..  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L1960..............  Afo pos solid ank plastic   ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      mo.
L1970..............  Afo plastic molded w/ankle  ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      j.
L1971..............  AFO w/ankle joint, prefab.  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L1980..............  Afo sing solid stirrup      ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      calf.
L1990..............  Afo doub solid stirrup      ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      calf.
L2000..............  Kafo sing fre stirr thi/    ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      calf.
L2005..............  KAFO sng/dbl mechanical     ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      act.
L2010..............  Kafo sng solid stirrup w/o  ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      j.
L2020..............  Kafo dbl solid stirrup      ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      band/.
L2030..............  Kafo dbl solid stirrup w/o  ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      j.
L2034..............  KAFO pla sin up w/wo k/a    ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      cus.
L2035..............  KAFO plastic pediatric      ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      size.
L2036..............  Kafo plas doub free knee    ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      mol.
L2037..............  Kafo plas sing free knee    ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      mol.
L2038..............  Kafo w/o joint multi-axis   ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      an.
L2040..............  Hkafo torsion bil rot       ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      straps.
L2050..............  Hkafo torsion cable hip     ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      pelv.
L2060..............  Hkafo torsion ball bearing  ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      j.
L2070..............  Hkafo torsion unilat rot    ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      str.

[[Page 67151]]

 
L2080..............  Hkafo unilat torsion cable  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L2090..............  Hkafo unilat torsion ball   ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      br.
L2106..............  Afo tib fx cast plaster     ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      mold.
L2108..............  Afo tib fx cast molded to   ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      pt.
L2112..............  Afo tibial fracture soft..  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L2114..............  Afo tib fx semi-rigid.....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L2116..............  Afo tibial fracture rigid.  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L2126..............  Kafo fem fx cast            ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      thermoplas.
L2128..............  Kafo fem fx cast molded to  ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      p.
L2132..............  Kafo femoral fx cast soft.  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L2134..............  Kafo fem fx cast semi-      ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      rigid.
L2136..............  Kafo femoral fx cast rigid  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L2180..............  Plas shoe insert w ank      ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      joint.
L2182..............  Drop lock knee............  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L2184..............  Limited motion knee joint.  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L2186..............  Adj motion knee jnt lerman  ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      t.
L2188..............  Quadrilateral brim........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L2190..............  Waist belt................  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L2192..............  Pelvic band & belt thigh    ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      fla.
L2200..............  Limited ankle motion ea     ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      jnt.
L2210..............  Dorsiflexion assist each    ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      joi.
L2220..............  Dorsi & plantar flex ass/   ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      res.
L2230..............  Split flat caliper stirr &  ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      p.
L2232..............  Rocker bottom, contact AFO  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L2240..............  Round caliper and plate     ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      atta.
L2250..............  Foot plate molded stirrup   ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      at.
L2260..............  Reinforced solid stirrup..  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L2265..............  Long tongue stirrup.......  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L2270..............  Varus/valgus strap padded/  ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      li.
L2275..............  Plastic mod low ext pad/    ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      line.
L2280..............  Molded inner boot.........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L2300..............  Abduction bar jointed       ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      adjust.
L2310..............  Abduction bar-straight....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L2320..............  Non-molded lacer..........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L2330..............  Lacer molded to patient     ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      mode.
L2335..............  Anterior swing band.......  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L2340..............  Pre-tibial shell molded to  ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      p.
L2350..............  Prosthetic type socket      ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      molde.
L2360..............  Extended steel shank......  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L2370..............  Patten bottom.............  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L2375..............  Torsion ank & half solid    ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      sti.
L2380..............  Torsion straight knee       ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      joint.
L2385..............  Straight knee joint heavy   ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      du.
L2387..............  Add LE poly knee custom     ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      KAFO.
L2390..............  Offset knee joint each....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L2395..............  Offset knee joint heavy     ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      duty.
L2397..............  Suspension sleeve lower     ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      ext.
L2405..............  Knee joint drop lock ea     ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      jnt.
L2415..............  Knee joint cam lock each    ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      joi.
L2425..............  Knee disc/dial lock/adj     ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      flex.
L2430..............  Knee jnt ratchet lock ea    ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      jnt.
L2492..............  Knee lift loop drop lock    ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      rin.
L2500..............  Thi/glut/ischia wgt         ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      bearing.
L2510..............  Th/wght bear quad-lat brim  ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      m.
L2520..............  Th/wght bear quad-lat brim  ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      c.
L2525..............  Th/wght bear nar m-l brim   ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      mo.
L2526..............  Th/wght bear nar m-l brim   ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      cu.
L2530..............  Thigh/wght bear lacer non-  ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      mo.
L2540..............  Thigh/wght bear lacer       ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      molded.
L2550..............  Thigh/wght bear high roll   ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      cu.
L2570..............  Hip clevis type 2 posit     ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      jnt.
L2580..............  Pelvic control pelvic       ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      sling.
L2600..............  Hip clevis/thrust bearing   ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      fr.
L2610..............  Hip clevis/thrust bearing   ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      lo.
L2620..............  Pelvic control hip heavy    ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      dut.
L2622..............  Hip joint adjustable        ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      flexion.
L2624..............  Hip adj flex ext abduct     ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      cont.
L2627..............  Plastic mold recipro hip &  ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      c.
L2628..............  Metal frame recipro hip &   ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      ca.
L2630..............  Pelvic control band & belt  ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      u.
L2640..............  Pelvic control band & belt  ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      b.
L2650..............  Pelv & thor control         ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      gluteal.
L2660..............  Thoracic control thoracic   ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      ba.
L2670..............  Thorac cont paraspinal      ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      uprig.
L2680..............  Thorac cont lat support     ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      upri.
L2750..............  Plating chrome/nickel pr    ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      bar.
L2755..............  Carbon graphite lamination  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L2760..............  Extension per extension     ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      per.
L2768..............  Ortho sidebar disconnect..  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L2770..............  Low ext orthosis per bar/   ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      jnt.

[[Page 67152]]

 
L2780..............  Non-corrosive finish......  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L2785..............  Drop lock retainer each...  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L2795..............  Knee control full kneecap.  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L2800..............  Knee cap medial or lateral  ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      p.
L2810..............  Knee control condylar pad.  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L2820..............  Soft interface below knee   ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      se.
L2830..............  Soft interface above knee   ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      se.
L2840..............  Tibial length sock fx or    ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      equ.
L2850..............  Femoral lgth sock fx or     ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      equa.
L2860..............  Torsion mechanism knee/     ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      ankle.
L2999..............  Lower extremity orthosis    ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      NOS.
L3000..............  Ft insert ucb berkeley      ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      shell.
L3001..............  Foot insert remov molded    ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      spe.
L3002..............  Foot insert plastazote or   ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      eq.
L3003..............  Foot insert silicone gel    ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      eac.
L3010..............  Foot longitudinal arch      ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      suppo.
L3020..............  Foot longitud/metatarsal    ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      sup.
L3030..............  Foot arch support remov     ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      prem.
L3031..............  Foot lamin/prepreg          ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      composite.
L3040..............  Ft arch suprt premold       ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      longit.
L3050..............  Foot arch supp premold      ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      metat.
L3060..............  Foot arch supp longitud/    ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      meta.
L3070..............  Arch suprt att to sho       ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      longit.
L3080..............  Arch supp att to shoe       ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      metata.
L3090..............  Arch supp att to shoe long/ ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      m.
L3100..............  Hallus-valgus nght dynamic  ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      s.
L3140..............  Abduction rotation bar      ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      shoe.
L3150..............  Abduct rotation bar w/o     ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      shoe.
L3160..............  Shoe styled positioning     ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      dev.
L3170..............  Foot plastic heel           ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      stabilizer.
L3201..............  Oxford w supinat/pronat     ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      inf.
L3202..............  Oxford w/ supinat/pronator  ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      c.
L3203..............  Oxford w/ supinator/        ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      pronator.
L3204..............  Hightop w/ supp/pronator    ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      inf.
L3206..............  Hightop w/ supp/pronator    ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      chi.
L3207..............  Hightop w/ supp/pronator    ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      jun.
L3208..............  Surgical boot each infant.  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L3209..............  Surgical boot each child..  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L3211..............  Surgical boot each junior.  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L3212..............  Benesch boot pair infant..  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L3213..............  Benesch boot pair child...  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L3214..............  Benesch boot pair junior..  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L3215..............  Orthopedic ftwear ladies    ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      oxf.
L3216..............  Orthoped ladies shoes dpth  CH................  E.................  ...........  ...........  ...........  ...........  ...........
                      i.
L3217..............  Ladies shoes hightop depth  CH................  E.................  ...........  ...........  ...........  ...........  ...........
                      i.
L3219..............  Orthopedic mens shoes       ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      oxford.
L3221..............  Orthopedic mens shoes dpth  CH................  E.................  ...........  ...........  ...........  ...........  ...........
                      i.
L3222..............  Mens shoes hightop depth    CH................  E.................  ...........  ...........  ...........  ...........  ...........
                      inl.
L3224..............  Woman's shoe oxford brace.  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L3225..............  Man's shoe oxford brace...  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L3230..............  Custom shoes depth inlay..  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L3250..............  Custom mold shoe remov      ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      prost.
L3251..............  Shoe molded to pt silicone  ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      s.
L3252..............  Shoe molded plastazote      ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      cust.
L3253..............  Shoe molded plastazote      ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      cust.
L3254..............  Orth foot non-stndard size/ ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      w.
L3255..............  Orth foot non-standard      ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      size/.
L3257..............  Orth foot add charge split  ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      s.
L3260..............  Ambulatory surgical boot    ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      eac.
L3265..............  Plastazote sandal each....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L3300..............  Sho lift taper to           ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      metatarsal.
L3310..............  Shoe lift elev heel/sole    ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      neo.
L3320..............  Shoe lift elev heel/sole    ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      cor.
L3330..............  Lifts elevation metal       ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      extens.
L3332..............  Shoe lifts tapered to one-  ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      ha.
L3334..............  Shoe lifts elevation heel / ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      i.
L3340..............  Shoe wedge sach...........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L3350..............  Shoe heel wedge...........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L3360..............  Shoe sole wedge outside     ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      sole.
L3370..............  Shoe sole wedge between     ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      sole.
L3380..............  Shoe clubfoot wedge.......  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L3390..............  Shoe outflare wedge.......  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L3400..............  Shoe metatarsal bar wedge   ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      ro.
L3410..............  Shoe metatarsal bar         ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      between.
L3420..............  Full sole/heel wedge        ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      btween.
L3430..............  Sho heel count plast        ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      reinfor.
L3440..............  Heel leather reinforced...  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L3450..............  Shoe heel sach cushion      ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      type.
L3455..............  Shoe heel new leather       ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      standa.
L3460..............  Shoe heel new rubber        ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      standar.

[[Page 67153]]

 
L3465..............  Shoe heel thomas with       ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      wedge.
L3470..............  Shoe heel thomas extend to  ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      b.
L3480..............  Shoe heel pad & depress     ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      for.
L3485..............  Shoe heel pad removable     ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      for.
L3500..............  Ortho shoe add leather      ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      insol.
L3510..............  Orthopedic shoe add rub     ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      insl.
L3520..............  O shoe add felt w leath     ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      insl.
L3530..............  Ortho shoe add half sole..  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L3540..............  Ortho shoe add full sole..  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L3550..............  O shoe add standard toe     ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      tap.
L3560..............  O shoe add horseshoe toe    ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      tap.
L3570..............  O shoe add instep           ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      extension.
L3580..............  O shoe add instep velcro    ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      clo.
L3590..............  O shoe convert to sof       ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      counte.
L3595..............  Ortho shoe add march bar..  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L3600..............  Trans shoe calip plate      ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      exist.
L3610..............  Trans shoe caliper plate    ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      new.
L3620..............  Trans shoe solid stirrup    ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      exi.
L3630..............  Trans shoe solid stirrup    ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      new.
L3640..............  Shoe dennis browne splint   ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      bo.
L3649..............  Orthopedic shoe modifica    ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      NOS.
L3650..............  Shlder fig 8 abduct         ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      restrain.
L3651..............  Prefab shoulder orthosis..  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L3652..............  Prefab dbl shoulder         ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      orthosis.
L3660..............  Abduct restrainer           ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      canvas&web.
L3670..............  Acromio/clavicular          ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      canvas&we.
L3671..............  SO cap design w/o jnts CF.  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L3672..............  SO airplane w/o jnts CF...  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L3673..............  SO airplane w/joint CF....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L3675..............  Canvas vest SO............  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L3677..............  SO hard plastic stabilizer  ..................  E.................  ...........  ...........  ...........  ...........  ...........
L3700..............  Elbow orthoses elas w       ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      stays.
L3701..............  Prefab elbow orthosis.....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L3702..............  EO w/o joints CF..........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L3710..............  Elbow elastic with metal    ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      joi.
L3720..............  Forearm/arm cuffs free      ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      motio.
L3730..............  Forearm/arm cuffs ext/flex  ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      a.
L3740..............  Cuffs adj lock w/ active    ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      con.
L3760..............  EO withjoint,               ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      Prefabricated.
L3762..............  Rigid EO wo joints........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L3763..............  EWHO rigid w/o jnts CF....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L3764..............  EWHO w/joint(s) CF........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L3765..............  EWHFO rigid w/o jnts CF...  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L3766..............  EWHFO w/joint(s) CF.......  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L3800..............  Whfo short opponen no       CH................  D.................  ...........  ...........  ...........  ...........  ...........
                      attach.
L3805..............  Whfo long opponens no       CH................  D.................  ...........  ...........  ...........  ...........  ...........
                      attach.
L3806..............  WHFO w/joint(s) custom fab  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L3807..............  WHFO,no joint,              ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      prefabricated.
L3808..............  WHFO, rigid w/o joints....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L3810..............  Whfo thumb abduction bar..  CH................  D.................  ...........  ...........  ...........  ...........  ...........
L3815..............  Whfo second m.p. abduction  CH................  D.................  ...........  ...........  ...........  ...........  ...........
                      a.
L3820..............  Whfo ip ext asst w/ mp ext  CH................  D.................  ...........  ...........  ...........  ...........  ...........
                      s.
L3825..............  Whfo m.p. extension stop..  CH................  D.................  ...........  ...........  ...........  ...........  ...........
L3830..............  Whfo m.p. extension assist  CH................  D.................  ...........  ...........  ...........  ...........  ...........
L3835..............  Whfo m.p. spring extension  CH................  D.................  ...........  ...........  ...........  ...........  ...........
                      a.
L3840..............  Whfo spring swivel thumb..  CH................  D.................  ...........  ...........  ...........  ...........  ...........
L3845..............  Whfo thumb ip ext ass w/    CH................  D.................  ...........  ...........  ...........  ...........  ...........
                      mp.
L3850..............  Action wrist w/ dorsiflex   CH................  D.................  ...........  ...........  ...........  ...........  ...........
                      as.
L3855..............  Whfo adj m.p. flexion       CH................  D.................  ...........  ...........  ...........  ...........  ...........
                      contro.
L3860..............  Whfo adj m.p. flex ctrl &   CH................  D.................  ...........  ...........  ...........  ...........  ...........
                      i.
L3890..............  Torsion mechanism wrist/    ..................  B.................  ...........  ...........  ...........  ...........  ...........
                      elbo.
L3900..............  Hinge extension/flex wrist/ ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      f.
L3901..............  Hinge ext/flex wrist        ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      finger.
L3904..............  Whfo electric custom        ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      fitted.
L3905..............  WHO w/nontorsion jnt(s) CF  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L3906..............  WHO w/o joints CF.........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L3907..............  Whfo wrst gauntlt thmb      CH................  D.................  ...........  ...........  ...........  ...........  ...........
                      spica.
L3908..............  Wrist cock-up non-molded..  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L3909..............  Prefab wrist orthosis.....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L3910..............  Whfo swanson design.......  CH................  D.................  ...........  ...........  ...........  ...........  ...........
L3911..............  Prefab hand finger          ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      orthosis.
L3912..............  Flex glove w/elastic        ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      finger.
L3913..............  HFO w/o joints CF.........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L3915..............  WHO w nontor jnt(s) prefab  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L3916..............  Whfo wrist extens w/        CH................  D.................  ...........  ...........  ...........  ...........  ...........
                      outrigg.
L3917..............  Prefab metacarpl fx         ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      orthosis.
L3918..............  HFO knuckle bender........  CH................  D.................  ...........  ...........  ...........  ...........  ...........
L3919..............  HO w/o joints CF..........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L3920..............  Knuckle bender with         CH................  D.................  ...........  ...........  ...........  ...........  ...........
                      outrigge.
L3921..............  HFO w/joint(s) CF.........  ..................  A.................  ...........  ...........  ...........  ...........  ...........

[[Page 67154]]

 
L3922..............  Knuckle bend 2 seg to flex  CH................  D.................  ...........  ...........  ...........  ...........  ...........
                      j.
L3923..............  HFO w/o joints PF.........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L3924..............  Oppenheimer...............  CH................  D.................  ...........  ...........  ...........  ...........  ...........
L3925..............  FO pip/dip with joint/      NI................  A.................  ...........  ...........  ...........  ...........  ...........
                      spring.
L3926..............  Thomas suspension.........  CH................  D.................  ...........  ...........  ...........  ...........  ...........
L3927..............  FO pip/dip w/o joint/       NI................  A.................  ...........  ...........  ...........  ...........  ...........
                      spring.
L3928..............  Finger extension w/ clock   CH................  D.................  ...........  ...........  ...........  ...........  ...........
                      sp.
L3929..............  HFO nontorsion joint,       NI................  A.................  ...........  ...........  ...........  ...........  ...........
                      prefab.
L3930..............  Finger extension with       CH................  D.................  ...........  ...........  ...........  ...........  ...........
                      wrist.
L3931..............  WHFO nontorsion joint       NI................  A.................  ...........  ...........  ...........  ...........  ...........
                      prefab.
L3932..............  Safety pin spring wire....  CH................  D.................  ...........  ...........  ...........  ...........  ...........
L3933..............  FO w/o joints CF..........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L3934..............  Safety pin modified.......  CH................  D.................  ...........  ...........  ...........  ...........  ...........
L3935..............  FO nontorsion joint CF....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L3936..............  Palmer....................  CH................  D.................  ...........  ...........  ...........  ...........  ...........
L3938..............  Dorsal wrist..............  CH................  D.................  ...........  ...........  ...........  ...........  ...........
L3940..............  Dorsal wrist w/ outrigger   CH................  D.................  ...........  ...........  ...........  ...........  ...........
                      at.
L3942..............  Reverse knuckle bender....  CH................  D.................  ...........  ...........  ...........  ...........  ...........
L3944..............  Reverse knuckle bend w/     CH................  D.................  ...........  ...........  ...........  ...........  ...........
                      outr.
L3946..............  HFO composite elastic.....  CH................  D.................  ...........  ...........  ...........  ...........  ...........
L3948..............  Finger knuckle bender.....  CH................  D.................  ...........  ...........  ...........  ...........  ...........
L3950..............  Oppenheimer w/ knuckle      CH................  D.................  ...........  ...........  ...........  ...........  ...........
                      bend.
L3952..............  Oppenheimer w/ rev knuckle  CH................  D.................  ...........  ...........  ...........  ...........  ...........
                      2.
L3954..............  Spreading hand............  CH................  D.................  ...........  ...........  ...........  ...........  ...........
L3956..............  Add joint upper ext         ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      orthosis.
L3960..............  Sewho airplan desig abdu    ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      pos.
L3961..............  SEWHO cap design w/o jnts   ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      CF.
L3962..............  Sewho erbs palsey design    ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      abd.
L3964..............  Seo mobile arm sup att to   ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      wc.
L3965..............  Arm supp att to wc rancho   ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      ty.
L3966..............  Mobile arm supports         ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      reclinin.
L3967..............  SEWHO airplane w/o jnts CF  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L3968..............  Friction dampening arm      ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      supp.
L3969..............  Monosuspension arm/hand     ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      supp.
L3970..............  Elevat proximal arm         ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      support.
L3971..............  SEWHO cap design w/jnt(s)   ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      CF.
L3972..............  Offset/lat rocker arm w/    ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      ela.
L3973..............  SEWHO airplane w/jnt(s) CF  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L3974..............  Mobile arm support          ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      supinator.
L3975..............  SEWHFO cap design w/o jnt   ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      CF.
L3976..............  SEWHFO airplane w/o jnts    ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      CF.
L3977..............  SEWHFO cap desgn w/jnt(s)   ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      CF.
L3978..............  SEWHFO airplane w/jnt(s)    ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      CF.
L3980..............  Upp ext fx orthosis         ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      humeral.
L3982..............  Upper ext fx orthosis rad/  ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      ul.
L3984..............  Upper ext fx orthosis       ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      wrist.
L3985..............  Forearm hand fx orth w/ wr  CH................  D.................  ...........  ...........  ...........  ...........  ...........
                      h.
L3986..............  Humeral rad/ulna wrist fx   CH................  D.................  ...........  ...........  ...........  ...........  ...........
                      or.
L3995..............  Sock fracture or equal      ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      each.
L3999..............  Upper limb orthosis NOS...  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L4000..............  Repl girdle milwaukee orth  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L4002..............  Replace strap, any          ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      orthosis.
L4010..............  Replace trilateral socket   ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      br.
L4020..............  Replace quadlat socket      ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      brim.
L4030..............  Replace socket brim cust    ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      fit.
L4040..............  Replace molded thigh lacer  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L4045..............  Replace non-molded thigh    ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      lac.
L4050..............  Replace molded calf lacer.  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L4055..............  Replace non-molded calf     ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      lace.
L4060..............  Replace high roll cuff....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L4070..............  Replace prox & dist         ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      upright.
L4080..............  Repl met band kafo-afo      ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      prox.
L4090..............  Repl met band kafo-afo      ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      calf/.
L4100..............  Repl leath cuff kafo prox   ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      th.
L4110..............  Repl leath cuff kafo-afo    ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      cal.
L4130..............  Replace pretibial shell...  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L4205..............  Ortho dvc repair per 15     ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      min.
L4210..............  Orth dev repair/repl minor  ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      p.
L4350..............  Ankle control orthosi       ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      prefab.
L4360..............  Pneumati walking boot       ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      prefab.
L4370..............  Pneumatic full leg splint.  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L4380..............  Pneumatic knee splint.....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L4386..............  Non-pneum walk boot prefab  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L4392..............  Replace AFO soft interface  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L4394..............  Replace foot drop spint...  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L4396..............  Static AFO................  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L4398..............  Foot drop splint recumbent  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L5000..............  Sho insert w arch toe       ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      filler.
L5010..............  Mold socket ank hgt w/ toe  ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      f.
L5020..............  Tibial tubercle hgt w/ toe  ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      f.

[[Page 67155]]

 
L5050..............  Ank symes mold sckt sach    ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      ft.
L5060..............  Symes met fr leath socket   ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      ar.
L5100..............  Molded socket shin sach     ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      foot.
L5105..............  Plast socket jts/thgh       ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      lacer.
L5150..............  Mold sckt ext knee shin     ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      sach.
L5160..............  Mold socket bent knee shin  ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      s.
L5200..............  Kne sing axis fric shin     ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      sach.
L5210..............  No knee/ankle joints w/ ft  ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      b.
L5220..............  No knee joint with artic    ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      ali.
L5230..............  Fem focal defic constant    ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      fri.
L5250..............  Hip canad sing axi cons     ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      fric.
L5270..............  Tilt table locking hip      ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      sing.
L5280..............  Hemipelvect canad sing      ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      axis.
L5301..............  BK mold socket SACH ft      ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      endo.
L5311..............  Knee disart, SACH ft, endo  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L5321..............  AK open end SACH..........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L5331..............  Hip disart canadian SACH    ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      ft.
L5341..............  Hemipelvectomy canadian     ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      SACH.
L5400..............  Postop dress & 1 cast chg   ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      bk.
L5410..............  Postop dsg bk ea add cast   ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      ch.
L5420..............  Postop dsg & 1 cast chg ak/ ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      d.
L5430..............  Postop dsg ak ea add cast   ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      ch.
L5450..............  Postop app non-wgt bear     ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      dsg.
L5460..............  Postop app non-wgt bear     ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      dsg.
L5500..............  Init bk ptb plaster direct  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L5505..............  Init ak ischal plstr        ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      direct.
L5510..............  Prep BK ptb plaster molded  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L5520..............  Perp BK ptb thermopls       ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      direct.
L5530..............  Prep BK ptb thermopls       ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      molded.
L5535..............  Prep BK ptb open end        ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      socket.
L5540..............  Prep BK ptb laminated       ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      socket.
L5560..............  Prep AK ischial plast       ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      molded.
L5570..............  Prep AK ischial direct      ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      form.
L5580..............  Prep AK ischial thermo      ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      mold.
L5585..............  Prep AK ischial open end..  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L5590..............  Prep AK ischial laminated.  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L5595..............  Hip disartic sach           ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      thermopls.
L5600..............  Hip disart sach laminat     ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      mold.
L5610..............  Above knee hydracadence...  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L5611..............  Ak 4 bar link w/fric swing  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L5613..............  Ak 4 bar ling w/hydraul     ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      swig.
L5614..............  4-bar link above knee w/    ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      swng.
L5616..............  Ak univ multiplex sys       ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      frict.
L5617..............  AK/BK self-aligning unit    ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      ea.
L5618..............  Test socket symes.........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L5620..............  Test socket below knee....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L5622..............  Test socket knee            ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      disarticula.
L5624..............  Test socket above knee....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L5626..............  Test socket hip             ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      disarticulat.
L5628..............  Test socket hemipelvectomy  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L5629..............  Below knee acrylic socket.  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L5630..............  Syme typ expandabl wall     ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      sckt.
L5631..............  Ak/knee disartic acrylic    ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      soc.
L5632..............  Symes type ptb brim design  ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      s.
L5634..............  Symes type poster opening   ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      so.
L5636..............  Symes type medial opening   ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      so.
L5637..............  Below knee total contact..  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L5638..............  Below knee leather socket.  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L5639..............  Below knee wood socket....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L5640..............  Knee disarticulat leather   ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      so.
L5642..............  Above knee leather socket.  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L5643..............  Hip flex inner socket ext   ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      fr.
L5644..............  Above knee wood socket....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L5645..............  Bk flex inner socket ext    ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      fra.
L5646..............  Below knee cushion socket.  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L5647..............  Below knee suction socket.  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L5648..............  Above knee cushion socket.  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L5649..............  Isch containmt/narrow m-l   ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      so.
L5650..............  Tot contact ak/knee disart  ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      s.
L5651..............  Ak flex inner socket ext    ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      fra.
L5652..............  Suction susp ak/knee        ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      disart.
L5653..............  Knee disart expand wall     ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      sock.
L5654..............  Socket insert symes.......  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L5655..............  Socket insert below knee..  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L5656..............  Socket insert knee          ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      articulat.
L5658..............  Socket insert above knee..  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L5661..............  Multi-durometer symes.....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L5665..............  Multi-durometer below knee  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L5666..............  Below knee cuff suspension  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L5668..............  Socket insert w/o lock      ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      lower.

[[Page 67156]]

 
L5670..............  Bk molded supracondylar     ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      susp.
L5671..............  BK/AK locking mechanism...  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L5672..............  Bk removable medial brim    ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      sus.
L5673..............  Socket insert w lock mech.  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L5676..............  Bk knee joints single axis  ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      p.
L5677..............  Bk knee joints polycentric  ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      p.
L5678..............  Bk joint covers pair......  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L5679..............  Socket insert w/o lock      ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      mech.
L5680..............  Bk thigh lacer non-molded.  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L5681..............  Intl custm cong/latyp       ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      insert.
L5682..............  Bk thigh lacer glut/ischia  ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      m.
L5683..............  Initial custom socket       ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      insert.
L5684..............  Bk fork strap.............  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L5685..............  Below knee sus/seal sleeve  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L5686..............  Bk back check.............  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L5688..............  Bk waist belt webbing.....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L5690..............  Bk waist belt padded and    ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      lin.
L5692..............  Ak pelvic control belt      ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      light.
L5694..............  Ak pelvic control belt pad/ ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      l.
L5695..............  Ak sleeve susp neoprene/    ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      equa.
L5696..............  Ak/knee disartic pelvic     ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      join.
L5697..............  Ak/knee disartic pelvic     ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      band.
L5698..............  Ak/knee disartic silesian   ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      ba.
L5699..............  Shoulder harness..........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L5700..............  Replace socket below knee.  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L5701..............  Replace socket above knee.  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L5702..............  Replace socket hip........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L5703..............  Symes ankle w/o (SACH)      ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      foot.
L5704..............  Custom shape cover BK.....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L5705..............  Custom shape cover AK.....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L5706..............  Custom shape cvr knee       ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      disart.
L5707..............  Custom shape cvr hip        ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      disart.
L5710..............  Kne-shin exo sng axi mnl    ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      loc.
L5711..............  Knee-shin exo mnl lock      ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      ultra.
L5712..............  Knee-shin exo frict swg &   ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      st.
L5714..............  Knee-shin exo variable      ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      frict.
L5716..............  Knee-shin exo mech stance   ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      ph.
L5718..............  Knee-shin exo frct swg &    ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      sta.
L5722..............  Knee-shin pneum swg frct    ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      exo.
L5724..............  Knee-shin exo fluid swing   ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      ph.
L5726..............  Knee-shin ext jnts fld swg  ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      e.
L5728..............  Knee-shin fluid swg &       ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      stance.
L5780..............  Knee-shin pneum/hydra       ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      pneum.
L5781..............  Lower limb pros vacuum      ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      pump.
L5782..............  HD low limb pros vacuum     ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      pump.
L5785..............  Exoskeletal bk ultralt      ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      mater.
L5790..............  Exoskeletal ak ultra-light  ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      m.
L5795..............  Exoskel hip ultra-light     ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      mate.
L5810..............  Endoskel knee-shin mnl      ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      lock.
L5811..............  Endo knee-shin mnl lck      ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      ultra.
L5812..............  Endo knee-shin frct swg &   ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      st.
L5814..............  Endo knee-shin hydral swg   ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      ph.
L5816..............  Endo knee-shin polyc mch    ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      sta.
L5818..............  Endo knee-shin frct swg &   ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      st.
L5822..............  Endo knee-shin pneum swg    ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      frc.
L5824..............  Endo knee-shin fluid swing  ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      p.
L5826..............  Miniature knee joint......  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L5828..............  Endo knee-shin fluid swg/   ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      sta.
L5830..............  Endo knee-shin pneum/swg    ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      pha.
L5840..............  Multi-axial knee/shin       ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      system.
L5845..............  Knee-shin sys stance        ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      flexion.
L5848..............  Knee-shin sys hydraul       ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      stance.
L5850..............  Endo ak/hip knee extens     ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      assi.
L5855..............  Mech hip extension assist.  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L5856..............  Elec knee-shin swing/       ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      stance.
L5857..............  Elec knee-shin swing only.  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L5858..............  Stance phase only.........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L5910..............  Endo below knee alignable   ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      sy.
L5920..............  Endo ak/hip alignable       ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      system.
L5925..............  Above knee manual lock....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L5930..............  High activity knee frame..  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L5940..............  Endo bk ultra-light         ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      material.
L5950..............  Endo ak ultra-light         ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      material.
L5960..............  Endo hip ultra-light        ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      materia.
L5962..............  Below knee flex cover       ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      system.
L5964..............  Above knee flex cover       ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      system.
L5966..............  Hip flexible cover system.  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L5968..............  Multiaxial ankle w          ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      dorsiflex.
L5970..............  Foot external keel sach     ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      foot.
L5971..............  SACH foot, replacement....  ..................  A.................  ...........  ...........  ...........  ...........  ...........

[[Page 67157]]

 
L5972..............  Flexible keel foot........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L5974..............  Foot single axis ankle/     ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      foot.
L5975..............  Combo ankle/foot            ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      prosthesis.
L5976..............  Energy storing foot.......  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L5978..............  Ft prosth multiaxial ankl/  ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      ft.
L5979..............  Multi-axial ankle/ft        ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      prosth.
L5980..............  Flex foot system..........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L5981..............  Flex-walk sys low ext       ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      prosth.
L5982..............  Exoskeletal axial rotation  ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      u.
L5984..............  Endoskeletal axial          ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      rotation.
L5985..............  Lwr ext dynamic prosth      ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      pylon.
L5986..............  Multi-axial rotation unit.  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L5987..............  Shank ft w vert load pylon  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L5988..............  Vertical shock reducing     ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      pylo.
L5990..............  User adjustable heel        ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      height.
L5993..............  Heavy duty feature, foot..  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L5994..............  Heavy duty feature, knee..  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L5995..............  Lower ext pros heavyduty    ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      fea.
L5999..............  Lowr extremity prosthes     ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      NOS.
L6000..............  Par hand robin-aids thum    ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      rem.
L6010..............  Hand robin-aids little/     ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      ring.
L6020..............  Part hand robin-aids no     ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      fing.
L6025..............  Part hand disart            ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      myoelectric.
L6050..............  Wrst MLd sck flx hng tri    ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      pad.
L6055..............  Wrst mold sock w/exp        ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      interfa.
L6100..............  Elb mold sock flex hinge    ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      pad.
L6110..............  Elbow mold sock suspension  ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      t.
L6120..............  Elbow mold doub splt soc    ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      ste.
L6130..............  Elbow stump activated lock  ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      h.
L6200..............  Elbow mold outsid lock      ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      hinge.
L6205..............  Elbow molded w/ expand      ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      inter.
L6250..............  Elbow inter loc elbow       ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      forarm.
L6300..............  Shlder disart int lock      ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      elbow.
L6310..............  Shoulder passive restor     ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      comp.
L6320..............  Shoulder passive restor     ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      cap.
L6350..............  Thoracic intern lock elbow  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L6360..............  Thoracic passive restor     ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      comp.
L6370..............  Thoracic passive restor     ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      cap.
L6380..............  Postop dsg cast chg wrst/   ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      elb.
L6382..............  Postop dsg cast chg elb     ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      dis/.
L6384..............  Postop dsg cast chg shlder/ ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      t.
L6386..............  Postop ea cast chg &        ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      realign.
L6388..............  Postop applicat rigid dsg   ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      on.
L6400..............  Below elbow prosth tiss     ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      shap.
L6450..............  Elb disart prosth tiss      ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      shap.
L6500..............  Above elbow prosth tiss     ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      shap.
L6550..............  Shldr disar prosth tiss     ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      shap.
L6570..............  Scap thorac prosth tiss     ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      shap.
L6580..............  Wrist/elbow bowden cable    ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      mol.
L6582..............  Wrist/elbow bowden cbl dir  ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      f.
L6584..............  Elbow fair lead cable       ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      molded.
L6586..............  Elbow fair lead cable dir   ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      fo.
L6588..............  Shdr fair lead cable        ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      molded.
L6590..............  Shdr fair lead cable        ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      direct.
L6600..............  Polycentric hinge pair....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L6605..............  Single pivot hinge pair...  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L6610..............  Flexible metal hinge pair.  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L6611..............  Additional switch, ext      ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      power.
L6615..............  Disconnect locking wrist    ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      uni.
L6616..............  Disconnect insert locking   ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      wr.
L6620..............  Flexion/extension wrist     ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      unit.
L6621..............  Flex/ext wrist w/wo         ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      friction.
L6623..............  Spring-ass rot wrst w/      ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      latch.
L6624..............  Flex/ext/rotation wrist     ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      unit.
L6625..............  Rotation wrst w/ cable      ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      lock.
L6628..............  Quick disconn hook adapter  ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      o.
L6629..............  Lamination collar w/        ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      couplin.
L6630..............  Stainless steel any wrist.  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L6632..............  Latex suspension sleeve     ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      each.
L6635..............  Lift assist for elbow.....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L6637..............  Nudge control elbow lock..  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L6638..............  Elec lock on manual pw      ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      elbow.
L6639..............  Heavy duty elbow feature..  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L6640..............  Shoulder abduction joint    ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      pai.
L6641..............  Excursion amplifier pulley  ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      t.
L6642..............  Excursion amplifier lever   ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      ty.
L6645..............  Shoulder flexion-abduction  ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      j.
L6646..............  Multipo locking shoulder    ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      jnt.
L6647..............  Shoulder lock actuator....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L6648..............  Ext pwrd shlder lock/       ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      unlock.

[[Page 67158]]

 
L6650..............  Shoulder universal joint..  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L6655..............  Standard control cable      ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      extra.
L6660..............  Heavy duty control cable..  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L6665..............  Teflon or equal cable       ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      lining.
L6670..............  Hook to hand cable adapter  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L6672..............  Harness chest/shlder        ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      saddle.
L6675..............  Harness figure of 8 sing    ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      con.
L6676..............  Harness figure of 8 dual    ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      con.
L6677..............  UE triple control harness.  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L6680..............  Test sock wrist disart/bel  ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      e.
L6682..............  Test sock elbw disart/      ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      above.
L6684..............  Test socket shldr disart/   ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      tho.
L6686..............  Suction socket............  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L6687..............  Frame typ socket bel elbow/ ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      w.
L6688..............  Frame typ sock above elb/   ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      dis.
L6689..............  Frame typ socket shoulder   ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      di.
L6690..............  Frame typ sock interscap-   ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      tho.
L6691..............  Removable insert each.....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L6692..............  Silicone gel insert or      ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      equal.
L6693..............  Lockingelbow forearm        ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      cntrbal.
L6694..............  Elbow socket ins use w/     ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      lock.
L6695..............  Elbow socket ins use w/o    ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      lck.
L6696..............  Cus elbo skt in for con/    ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      atyp.
L6697..............  Cus elbo skt in not con/    ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      atyp.
L6698..............  Below/above elbow lock      ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      mech.
L6703..............  Term dev, passive hand      ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      mitt.
L6704..............  Term dev, sport/rec/work    ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      att.
L6706..............  Term dev mech hook vol      ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      open.
L6707..............  Term dev mech hook vol      ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      close.
L6708..............  Term dev mech hand vol      ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      open.
L6709..............  Term dev mech hand vol      ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      close.
L6805..............  Term dev modifier wrist     ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      unit.
L6810..............  Term dev precision pinch    ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      dev.
L6881..............  Term dev auto grasp         ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      feature.
L6882..............  Microprocessor control      ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      uplmb.
L6883..............  Replc sockt below e/w disa  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L6884..............  Replc sockt above elbow     ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      disa.
L6885..............  Replc sockt shldr dis/      ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      interc.
L6890..............  Prefab glove for term       ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      device.
L6895..............  Custom glove for term       ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      device.
L6900..............  Hand restorat thumb/1       ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      finger.
L6905..............  Hand restoration multiple   ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      fi.
L6910..............  Hand restoration no         ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      fingers.
L6915..............  Hand restoration replacmnt  ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      g.
L6920..............  Wrist disarticul switch     ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      ctrl.
L6925..............  Wrist disart myoelectronic  ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      c.
L6930..............  Below elbow switch control  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L6935..............  Below elbow myoelectronic   ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      ct.
L6940..............  Elbow disarticulation       ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      switch.
L6945..............  Elbow disart myoelectronic  ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      c.
L6950..............  Above elbow switch control  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L6955..............  Above elbow myoelectronic   ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      ct.
L6960..............  Shldr disartic switch       ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      contro.
L6965..............  Shldr disartic              ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      myoelectronic.
L6970..............  Interscapular-thor switch   ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      ct.
L6975..............  Interscap-thor              ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      myoelectronic.
L7007..............  Adult electric hand.......  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L7008..............  Pediatric electric hand...  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L7009..............  Adult electric hook.......  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L7040..............  Prehensile actuator.......  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L7045..............  Pediatric electric hook...  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L7170..............  Electronic elbow hosmer     ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      swit.
L7180..............  Electronic elbow            ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      sequential.
L7181..............  Electronic elbo             ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      simultaneous.
L7185..............  Electron elbow adolescent   ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      sw.
L7186..............  Electron elbow child        ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      switch.
L7190..............  Elbow adolescent            ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      myoelectron.
L7191..............  Elbow child myoelectronic   ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      ct.
L7260..............  Electron wrist rotator      ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      otto.
L7261..............  Electron wrist rotator      ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      utah.
L7266..............  Servo control steeper or    ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      equ.
L7272..............  Analogue control unb or     ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      equa.
L7274..............  Proportional ctl 12 volt    ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      uta.
L7360..............  Six volt bat otto bock/eq   ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      ea.
L7362..............  Battery chrgr six volt      ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      otto.
L7364..............  Twelve volt battery utah/   ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      equ.
L7366..............  Battery chrgr 12 volt utah/ ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      e.
L7367..............  Replacemnt lithium          ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      ionbatter.
L7368..............  Lithium ion battery         ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      charger.
L7400..............  Add UE prost be/wd,         ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      ultlite.

[[Page 67159]]

 
L7401..............  Add UE prost a/e ultlite    ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      mat.
L7402..............  Add UE prost s/d ultlite    ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      mat.
L7403..............  Add UE prost b/e acrylic..  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L7404..............  Add UE prost a/e acrylic..  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L7405..............  Add UE prost s/d acrylic..  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L7499..............  Upper extremity prosthes    ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      NOS.
L7500..............  Prosthetic dvc repair       ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      hourly.
L7510..............  Prosthetic device repair    ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      rep.
L7520..............  Repair prosthesis per 15    ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      min.
L7600..............  Prosthetic donning sleeve.  ..................  E.................  ...........  ...........  ...........  ...........  ...........
L7611..............  Ped term dev, hook, vol     NI................  A.................  ...........  ...........  ...........  ...........  ...........
                      open.
L7612..............  Ped term dev, hook, vol     NI................  A.................  ...........  ...........  ...........  ...........  ...........
                      clos.
L7613..............  Ped term dev, hand, vol     NI................  A.................  ...........  ...........  ...........  ...........  ...........
                      open.
L7614..............  Ped term dev, hand, vol     NI................  A.................  ...........  ...........  ...........  ...........  ...........
                      clos.
L7621..............  Hook/hand, hvy dty, vol     NI................  A.................  ...........  ...........  ...........  ...........  ...........
                      open.
L7622..............  Hook/hand, hvy dty, vol     NI................  A.................  ...........  ...........  ...........  ...........  ...........
                      clos.
L7900..............  Male vacuum erection        ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      system.
L8000..............  Mastectomy bra............  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L8001..............  Breast prosthesis bra &     ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      form.
L8002..............  Brst prsth bra & bilat      ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      form.
L8010..............  Mastectomy sleeve.........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L8015..............  Ext breastprosthesis        ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      garment.
L8020..............  Mastectomy form...........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L8030..............  Breast prosthesis silicone/ ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      e.
L8035..............  Custom breast prosthesis..  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L8039..............  Breast prosthesis NOS.....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L8040..............  Nasal prosthesis..........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L8041..............  Midfacial prosthesis......  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L8042..............  Orbital prosthesis........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L8043..............  Upper facial prosthesis...  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L8044..............  Hemi-facial prosthesis....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L8045..............  Auricular prosthesis......  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L8046..............  Partial facial prosthesis.  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L8047..............  Nasal septal prosthesis...  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L8048..............  Unspec maxillofacial        ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      prosth.
L8049..............  Repair maxillofacial        ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      prosth.
L8300..............  Truss single w/ standard    ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      pad.
L8310..............  Truss double w/ standard    ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      pad.
L8320..............  Truss addition to std pad   ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      wa.
L8330..............  Truss add to std pad        ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      scrotal.
L8400..............  Sheath below knee.........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L8410..............  Sheath above knee.........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L8415..............  Sheath upper limb.........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L8417..............  Pros sheath/sock w gel      ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      cushn.
L8420..............  Prosthetic sock multi ply   ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      BK.
L8430..............  Prosthetic sock multi ply   ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      AK.
L8435..............  Pros sock multi ply upper   ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      lm.
L8440..............  Shrinker below knee.......  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L8460..............  Shrinker above knee.......  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L8465..............  Shrinker upper limb.......  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L8470..............  Pros sock single ply BK...  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L8480..............  Pros sock single ply AK...  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L8485..............  Pros sock single ply upper  ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      l.
L8499..............  Unlisted misc prosthetic    ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      ser.
L8500..............  Artificial larynx.........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L8501..............  Tracheostomy speaking       ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      valve.
L8505..............  Artificial larynx,          ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      accessory.
L8507..............  Trach-esoph voice pros pt   ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      in.
L8509..............  Trach-esoph voice pros md   ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      in.
L8510..............  Voice amplifier...........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L8511..............  Indwelling trach insert...  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L8512..............  Gel cap for trach voice     ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      pros.
L8513..............  Trach pros cleaning device  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L8514..............  Repl trach puncture         ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      dilator.
L8515..............  Gel cap app device for      ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      trach.
L8600..............  Implant breast silicone/eq  ..................  N.................  ...........  ...........  ...........  ...........  ...........
L8603..............  Collagen imp urinary 2.5    ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      ml.
L8606..............  Synthetic implnt urinary    ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      1ml.
L8609..............  Artificial cornea.........  ..................  N.................  ...........  ...........  ...........  ...........  ...........
L8610..............  Ocular implant............  ..................  N.................  ...........  ...........  ...........  ...........  ...........
L8612..............  Aqueous shunt prosthesis..  ..................  N.................  ...........  ...........  ...........  ...........  ...........
L8613..............  Ossicular implant.........  ..................  N.................  ...........  ...........  ...........  ...........  ...........
L8614..............  Cochlear device...........  ..................  N.................  ...........  ...........  ...........  ...........  ...........
L8615..............  Coch implant headset        ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      replace.
L8616..............  Coch implant microphone     ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      repl.
L8617..............  Coch implant trans coil     ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      repl.
L8618..............  Coch implant tran cable     ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      repl.
L8619..............  Replace cochlear processor  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L8621..............  Repl zinc air battery.....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
L8622..............  Repl alkaline battery.....  ..................  A.................  ...........  ...........  ...........  ...........  ...........

[[Page 67160]]

 
L8623..............  Lith ion batt CID,non-      ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      earlvl.
L8624..............  Lith ion batt CID, ear      ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      level.
L8630..............  Metacarpophalangeal         ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      implant.
L8631..............  MCP joint repl 2 pc or      ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      more.
L8641..............  Metatarsal joint implant..  ..................  N.................  ...........  ...........  ...........  ...........  ...........
L8642..............  Hallux implant............  ..................  N.................  ...........  ...........  ...........  ...........  ...........
L8658..............  Interphalangeal joint       ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      spacer.
L8659..............  Interphalangeal joint repl  ..................  N.................  ...........  ...........  ...........  ...........  ...........
L8670..............  Vascular graft, synthetic.  ..................  N.................  ...........  ...........  ...........  ...........  ...........
L8680..............  Implt neurostim elctr each  ..................  B.................  ...........  ...........  ...........  ...........  ...........
L8681..............  Pt prgrm for implt          ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      neurostim.
L8682..............  Implt neurostim radiofq     ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      rec.
L8683..............  Radiofq trsmtr for implt    ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      neu.
L8684..............  Radiof trsmtr implt scrl    ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      neu.
L8685..............  Implt nrostm pls gen sng    ..................  B.................  ...........  ...........  ...........  ...........  ...........
                      rec.
L8686..............  Implt nrostm pls gen sng    ..................  B.................  ...........  ...........  ...........  ...........  ...........
                      non.
L8687..............  Implt nrostm pls gen dua    ..................  B.................  ...........  ...........  ...........  ...........  ...........
                      rec.
L8688..............  Implt nrostm pls gen dua    ..................  B.................  ...........  ...........  ...........  ...........  ...........
                      non.
L8689..............  External recharg sys        ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      intern.
L8690..............  Aud osseo dev, int/ext      ..................  H.................         1032  ...........  ...........  ...........  ...........
                      comp.
L8691..............  Aud osseo dev ext snd       ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      proces.
L8695..............  External recharg sys        ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      extern.
L8699..............  Prosthetic implant NOS....  ..................  N.................  ...........  ...........  ...........  ...........  ...........
L9900..............  O&P supply/accessory/       ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      service.
M0064..............  Visit for drug monitoring.  CH................  Q.................         0606       1.3226       $84.24  ...........       $16.85
M0075..............  Cellular therapy..........  ..................  E.................  ...........  ...........  ...........  ...........  ...........
M0076..............  Prolotherapy..............  ..................  E.................  ...........  ...........  ...........  ...........  ...........
M0100..............  Intragastric hypothermia..  ..................  E.................  ...........  ...........  ...........  ...........  ...........
M0300..............  IV chelationtherapy.......  ..................  E.................  ...........  ...........  ...........  ...........  ...........
M0301..............  Fabric wrapping of          ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      aneurysm.
P2028..............  Cephalin floculation test.  ..................  A.................  ...........  ...........  ...........  ...........  ...........
P2029..............  Congo red blood test......  ..................  A.................  ...........  ...........  ...........  ...........  ...........
P2031..............  Hair analysis.............  ..................  E.................  ...........  ...........  ...........  ...........  ...........
P2033..............  Blood thymol turbidity....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
P2038..............  Blood mucoprotein.........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
P3000..............  Screen pap by tech w md     ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      supv.
P3001..............  Screening pap smear by      ..................  B.................  ...........  ...........  ...........  ...........  ...........
                      phys.
P7001..............  Culture bacterial urine...  ..................  E.................  ...........  ...........  ...........  ...........  ...........
P9010..............  Whole blood for             ..................  K.................         0950       4.0011      $254.85  ...........       $50.97
                      transfusion.
P9011..............  Blood split unit..........  ..................  K.................         0967       2.3409      $149.10  ...........       $29.82
P9012..............  Cryoprecipitate each unit.  ..................  K.................         0952       0.6474       $41.24  ...........        $8.25
P9016..............  RBC leukocytes reduced....  ..................  K.................         0954       2.9069      $185.15  ...........       $37.03
P9017..............  Plasma 1 donor frz w/in 8   ..................  K.................         9508       1.0524       $67.03  ...........       $13.41
                      hr.
P9019..............  Platelets, each unit......  ..................  K.................         0957       1.0911       $69.50  ...........       $13.90
P9020..............  Plaelet rich plasma unit..  ..................  K.................         0958       5.7070      $363.50  ...........       $72.70
P9021..............  Red blood cells unit......  ..................  K.................         0959       2.0356      $129.66  ...........       $25.93
P9022..............  Washed red blood cells      ..................  K.................         0960       4.3494      $277.03  ...........       $55.41
                      unit.
P9023..............  Frozen plasma, pooled, sd.  ..................  K.................         0949       1.1598       $73.87  ...........       $14.77
P9031..............  Platelets leukocytes        ..................  K.................         1013       1.6879      $107.51  ...........       $21.50
                      reduced.
P9032..............  Platelets, irradiated.....  ..................  K.................         9500       1.9110      $121.72  ...........       $24.34
P9033..............  Platelets leukoreduced      ..................  K.................         0968       2.1971      $139.94  ...........       $27.99
                      irrad.
P9034..............  Platelets, pheresis.......  ..................  K.................         9507       6.9242      $441.03  ...........       $88.21
P9035..............  Platelet pheres             ..................  K.................         9501       7.8426      $499.53  ...........       $99.91
                      leukoreduced.
P9036..............  Platelet pheresis           ..................  K.................         9502       6.5581      $417.71  ...........       $83.54
                      irradiated.
P9037..............  Plate pheres leukoredu      ..................  K.................         1019       9.8923      $630.08  ...........      $126.02
                      irrad.
P9038..............  RBC irradiated............  ..................  K.................         9505       3.0643      $195.18  ...........       $39.04
P9039..............  RBC deglycerolized........  ..................  K.................         9504       5.4516      $347.23  ...........       $69.45
P9040..............  RBC leukoreduced            ..................  K.................         0969       3.7722      $240.27  ...........       $48.05
                      irradiated.
P9041..............  Albumin (human),5%, 50ml..  ..................  K.................         0961       0.3413       $21.74  ...........        $4.35
P9043..............  Plasma protein              ..................  K.................         0956       1.4739       $93.88  ...........       $18.78
                      fract,5%,50ml.
P9044..............  Cryoprecipitatereducedplas  ..................  K.................         1009       1.3139       $83.69  ...........       $16.74
                      ma.
P9045..............  Albumin (human), 5%, 250    ..................  K.................         0963       1.0987       $69.98  ...........       $14.00
                      ml.
P9046..............  Albumin (human), 25%, 20    ..................  K.................         0964       0.4118       $26.23  ...........        $5.25
                      ml.
P9047..............  Albumin (human), 25%, 50ml  ..................  K.................         0965       1.1362       $72.37  ...........       $14.47
P9048..............  Plasmaprotein               ..................  K.................         0966       3.3792      $215.23  ...........       $43.05
                      fract,5%,250ml.
P9050..............  Granulocytes, pheresis      ..................  K.................         9506      21.7847    $1,387.55  ...........      $277.51
                      unit.
P9051..............  Blood, l/r, cmv-neg.......  ..................  K.................         1010       2.3221      $147.90  ...........       $29.58
P9052..............  Platelets, hla-m, l/r,      ..................  K.................         1011      10.1413      $645.94  ...........      $129.19
                      unit.
P9053..............  Plt, pher, l/r cmv-neg,     ..................  K.................         1020      10.7787      $686.54  ...........      $137.31
                      irr.
P9054..............  Blood, l/r, froz/degly/     ..................  K.................         1016       3.4353      $218.81  ...........       $43.76
                      wash.
P9055..............  Plt, aph/pher, l/r, cmv-    ..................  K.................         1017       7.6733      $488.74  ...........       $97.75
                      neg.
P9056..............  Blood, l/r, irradiated....  ..................  K.................         1018       2.3099      $147.13  ...........       $29.43
P9057..............  RBC, frz/deg/wsh, l/r,      ..................  K.................         1021       5.8716      $373.99  ...........       $74.80
                      irrad.
P9058..............  RBC, l/r, cmv-neg, irrad..  ..................  K.................         1022       4.1363      $263.46  ...........       $52.69
P9059..............  Plasma, frz between 8-      ..................  K.................         0955       1.2235       $77.93  ...........       $15.59
                      24hour.
P9060..............  Fr frz plasma donor         ..................  K.................         9503       0.8264       $52.64  ...........       $10.53
                      retested.
P9603..............  One-way allow prorated      ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      miles.
P9604..............  One-way allow prorated      ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      trip.
P9612..............  Catheterize for urine spec  ..................  A.................  ...........  ...........  ...........  ...........  ...........
P9615..............  Urine specimen collect      ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      mult.

[[Page 67161]]

 
Q0035..............  Cardiokymography..........  ..................  X.................         0100       2.5547      $162.72       $41.44       $32.54
Q0081..............  Infusion ther other than    ..................  B.................  ...........  ...........  ...........  ...........  ...........
                      che.
Q0083..............  Chemo by other than         ..................  B.................  ...........  ...........  ...........  ...........  ...........
                      infusion.
Q0084..............  Chemotherapy by infusion..  ..................  B.................  ...........  ...........  ...........  ...........  ...........
Q0085..............  Chemo by both infusion and  ..................  B.................  ...........  ...........  ...........  ...........  ...........
                      o.
Q0091..............  Obtaining screen pap smear  ..................  T.................         0191       0.1309        $8.34        $2.36        $1.67
Q0092..............  Set up port xray equipment  ..................  N.................  ...........  ...........  ...........  ...........  ...........
Q0111..............  Wet mounts/ w preparations  ..................  A.................  ...........  ...........  ...........  ...........  ...........
Q0112..............  Potassium hydroxide preps.  ..................  A.................  ...........  ...........  ...........  ...........  ...........
Q0113..............  Pinworm examinations......  ..................  A.................  ...........  ...........  ...........  ...........  ...........
Q0114..............  Fern test.................  ..................  A.................  ...........  ...........  ...........  ...........  ...........
Q0115..............  Post-coital mucous exam...  ..................  A.................  ...........  ...........  ...........  ...........  ...........
Q0144..............  Azithromycin dihydrate,     ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      oral.
Q0163..............  Diphenhydramine HCl 50mg..  ..................  N.................  ...........  ...........  ...........  ...........  ...........
Q0164..............  Prochlorperazine maleate    ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      5mg.
Q0165..............  Prochlorperazine            ..................  B.................  ...........  ...........  ...........  ...........  ...........
                      maleate10mg.
Q0166..............  Granisetron HCl 1 mg oral.  ..................  K.................         0765  ...........       $49.96  ...........        $9.99
Q0167..............  Dronabinol 2.5mg oral.....  ..................  N.................  ...........  ...........  ...........  ...........  ...........
Q0168..............  Dronabinol 5mg oral.......  ..................  B.................  ...........  ...........  ...........  ...........  ...........
Q0169..............  Promethazine HCl 12.5mg     ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      oral.
Q0170..............  Promethazine HCl 25 mg      ..................  B.................  ...........  ...........  ...........  ...........  ...........
                      oral.
Q0171..............  Chlorpromazine HCl 10mg     ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      oral.
Q0172..............  Chlorpromazine HCl 25mg     ..................  B.................  ...........  ...........  ...........  ...........  ...........
                      oral.
Q0173..............  Trimethobenzamide HCl       ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      250mg.
Q0174..............  Thiethylperazine            ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      maleate10mg.
Q0175..............  Perphenazine 4mg oral.....  ..................  N.................  ...........  ...........  ...........  ...........  ...........
Q0176..............  Perphenazine 8mg oral.....  ..................  B.................  ...........  ...........  ...........  ...........  ...........
Q0177..............  Hydroxyzine pamoate 25mg..  ..................  N.................  ...........  ...........  ...........  ...........  ...........
Q0178..............  Hydroxyzine pamoate 50mg..  ..................  B.................  ...........  ...........  ...........  ...........  ...........
Q0179..............  Ondansetron HCl 8mg oral..  ..................  K.................         0769  ...........       $18.37  ...........        $3.67
Q0180..............  Dolasetron mesylate oral..  ..................  K.................         0763  ...........       $43.77  ...........        $8.75
Q0181..............  Unspecified oral anti-      ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      emetic.
Q0480..............  Driver pneumatic vad, rep.  ..................  A.................  ...........  ...........  ...........  ...........  ...........
Q0481..............  Microprcsr cu elec vad,     ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      rep.
Q0482..............  Microprcsr cu combo vad,    ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      rep.
Q0483..............  Monitor elec vad, rep.....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
Q0484..............  Monitor elec or comb vad    ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      rep.
Q0485..............  Monitor cable elec vad,     ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      rep.
Q0486..............  Mon cable elec/pneum vad    ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      rep.
Q0487..............  Leads any type vad, rep     ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      only.
Q0488..............  Pwr pack base elec vad,     ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      rep.
Q0489..............  Pwr pck base combo vad,     ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      rep.
Q0490..............  Emr pwr source elec vad,    ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      rep.
Q0491..............  Emr pwr source combo vad    ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      rep.
Q0492..............  Emr pwr cbl elec vad, rep.  ..................  A.................  ...........  ...........  ...........  ...........  ...........
Q0493..............  Emr pwr cbl combo vad, rep  ..................  A.................  ...........  ...........  ...........  ...........  ...........
Q0494..............  Emr hd pmp elec/combo, rep  ..................  A.................  ...........  ...........  ...........  ...........  ...........
Q0495..............  Charger elec/combo vad,     ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      rep.
Q0496..............  Battery elec/combo vad,     ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      rep.
Q0497..............  Bat clps elec/comb vad,     ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      rep.
Q0498..............  Holster elec/combo vad,     ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      rep.
Q0499..............  Belt/vest elec/combo vad    ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      rep.
Q0500..............  Filters elec/combo vad,     ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      rep.
Q0501..............  Shwr cov elec/combo vad,    ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      rep.
Q0502..............  Mobility cart pneum vad,    ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      rep.
Q0503..............  Battery pneum vad           ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      replacemnt.
Q0504..............  Pwr adpt pneum vad, rep     ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      veh.
Q0505..............  Miscl supply/accessory vad  ..................  A.................  ...........  ...........  ...........  ...........  ...........
Q0510..............  Dispens fee                 ..................  B.................  ...........  ...........  ...........  ...........  ...........
                      immunosupressive.
Q0511..............  Sup fee                     ..................  B.................  ...........  ...........  ...........  ...........  ...........
                      antiem,antica,immuno.
Q0512..............  Px sup fee anti-can sub     ..................  B.................  ...........  ...........  ...........  ...........  ...........
                      pres.
Q0513..............  Disp fee inhal drugs/30     ..................  B.................  ...........  ...........  ...........  ...........  ...........
                      days.
Q0514..............  Disp fee inhal drugs/90     ..................  B.................  ...........  ...........  ...........  ...........  ...........
                      days.
Q0515..............  Sermorelin acetate          ..................  K.................         3050  ...........        $1.74  ...........        $0.35
                      injection.
Q1003..............  Ntiol category 3..........  ..................  N.................  ...........  ...........  ...........  ...........  ...........
Q1004..............  Ntiol category 4..........  CH................  E.................  ...........  ...........  ...........  ...........  ...........
Q1005..............  Ntiol category 5..........  CH................  E.................  ...........  ...........  ...........  ...........  ...........
Q2004..............  Bladder calculi irrig sol.  ..................  N.................  ...........  ...........  ...........  ...........  ...........
Q2009..............  Fosphenytoin, 50 mg.......  ..................  K.................         7028  ...........        $5.76  ...........        $1.15
Q2017..............  Teniposide, 50 mg.........  ..................  K.................         7035  ...........      $280.26  ...........       $56.05
Q3001..............  Brachytherapy               ..................  B.................  ...........  ...........  ...........  ...........  ...........
                      Radioelements.
Q3014..............  Telehealth facility fee...  ..................  A.................  ...........  ...........  ...........  ...........  ...........
Q3025..............  IM inj interferon beta 1-a  ..................  K.................         9022  ...........      $118.84  ...........       $23.77
Q3026..............  Subc inj interferon beta-   ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      1a.
Q3031..............  Collagen skin test........  ..................  N.................  ...........  ...........  ...........  ...........  ...........
Q4001..............  Cast sup body cast plaster  ..................  B.................  ...........  ...........  ...........  ...........  ...........
Q4002..............  Cast sup body cast          ..................  B.................  ...........  ...........  ...........  ...........  ...........
                      fiberglas.
Q4003..............  Cast sup shoulder cast      ..................  B.................  ...........  ...........  ...........  ...........  ...........
                      plstr.
Q4004..............  Cast sup shoulder cast      ..................  B.................  ...........  ...........  ...........  ...........  ...........
                      fbrgl.
Q4005..............  Cast sup long arm adult     ..................  B.................  ...........  ...........  ...........  ...........  ...........
                      plst.

[[Page 67162]]

 
Q4006..............  Cast sup long arm adult     ..................  B.................  ...........  ...........  ...........  ...........  ...........
                      fbrg.
Q4007..............  Cast sup long arm ped       ..................  B.................  ...........  ...........  ...........  ...........  ...........
                      plster.
Q4008..............  Cast sup long arm ped       ..................  B.................  ...........  ...........  ...........  ...........  ...........
                      fbrgls.
Q4009..............  Cast sup sht arm adult      ..................  B.................  ...........  ...........  ...........  ...........  ...........
                      plstr.
Q4010..............  Cast sup sht arm adult      ..................  B.................  ...........  ...........  ...........  ...........  ...........
                      fbrgl.
Q4011..............  Cast sup sht arm ped        ..................  B.................  ...........  ...........  ...........  ...........  ...........
                      plaster.
Q4012..............  Cast sup sht arm ped        ..................  B.................  ...........  ...........  ...........  ...........  ...........
                      fbrglas.
Q4013..............  Cast sup gauntlet plaster.  ..................  B.................  ...........  ...........  ...........  ...........  ...........
Q4014..............  Cast sup gauntlet           ..................  B.................  ...........  ...........  ...........  ...........  ...........
                      fiberglass.
Q4015..............  Cast sup gauntlet ped       ..................  B.................  ...........  ...........  ...........  ...........  ...........
                      plster.
Q4016..............  Cast sup gauntlet ped       ..................  B.................  ...........  ...........  ...........  ...........  ...........
                      fbrgls.
Q4017..............  Cast sup lng arm splint     ..................  B.................  ...........  ...........  ...........  ...........  ...........
                      plst.
Q4018..............  Cast sup lng arm splint     ..................  B.................  ...........  ...........  ...........  ...........  ...........
                      fbrg.
Q4019..............  Cast sup lng arm splnt ped  ..................  B.................  ...........  ...........  ...........  ...........  ...........
                      p.
Q4020..............  Cast sup lng arm splnt ped  ..................  B.................  ...........  ...........  ...........  ...........  ...........
                      f.
Q4021..............  Cast sup sht arm splint     ..................  B.................  ...........  ...........  ...........  ...........  ...........
                      plst.
Q4022..............  Cast sup sht arm splint     ..................  B.................  ...........  ...........  ...........  ...........  ...........
                      fbrg.
Q4023..............  Cast sup sht arm splnt ped  ..................  B.................  ...........  ...........  ...........  ...........  ...........
                      p.
Q4024..............  Cast sup sht arm splnt ped  ..................  B.................  ...........  ...........  ...........  ...........  ...........
                      f.
Q4025..............  Cast sup hip spica plaster  ..................  B.................  ...........  ...........  ...........  ...........  ...........
Q4026..............  Cast sup hip spica          ..................  B.................  ...........  ...........  ...........  ...........  ...........
                      fiberglas.
Q4027..............  Cast sup hip spica ped      ..................  B.................  ...........  ...........  ...........  ...........  ...........
                      plstr.
Q4028..............  Cast sup hip spica ped      ..................  B.................  ...........  ...........  ...........  ...........  ...........
                      fbrgl.
Q4029..............  Cast sup long leg plaster.  ..................  B.................  ...........  ...........  ...........  ...........  ...........
Q4030..............  Cast sup long leg           ..................  B.................  ...........  ...........  ...........  ...........  ...........
                      fiberglass.
Q4031..............  Cast sup lng leg ped        ..................  B.................  ...........  ...........  ...........  ...........  ...........
                      plaster.
Q4032..............  Cast sup lng leg ped        ..................  B.................  ...........  ...........  ...........  ...........  ...........
                      fbrgls.
Q4033..............  Cast sup lng leg cylinder   ..................  B.................  ...........  ...........  ...........  ...........  ...........
                      pl.
Q4034..............  Cast sup lng leg cylinder   ..................  B.................  ...........  ...........  ...........  ...........  ...........
                      fb.
Q4035..............  Cast sup lngleg cylndr ped  ..................  B.................  ...........  ...........  ...........  ...........  ...........
                      p.
Q4036..............  Cast sup lngleg cylndr ped  ..................  B.................  ...........  ...........  ...........  ...........  ...........
                      f.
Q4037..............  Cast sup shrt leg plaster.  ..................  B.................  ...........  ...........  ...........  ...........  ...........
Q4038..............  Cast sup shrt leg           ..................  B.................  ...........  ...........  ...........  ...........  ...........
                      fiberglass.
Q4039..............  Cast sup shrt leg ped       ..................  B.................  ...........  ...........  ...........  ...........  ...........
                      plster.
Q4040..............  Cast sup shrt leg ped       ..................  B.................  ...........  ...........  ...........  ...........  ...........
                      fbrgls.
Q4041..............  Cast sup lng leg splnt      ..................  B.................  ...........  ...........  ...........  ...........  ...........
                      plstr.
Q4042..............  Cast sup lng leg splnt      ..................  B.................  ...........  ...........  ...........  ...........  ...........
                      fbrgl.
Q4043..............  Cast sup lng leg splnt ped  ..................  B.................  ...........  ...........  ...........  ...........  ...........
                      p.
Q4044..............  Cast sup lng leg splnt ped  ..................  B.................  ...........  ...........  ...........  ...........  ...........
                      f.
Q4045..............  Cast sup sht leg splnt      ..................  B.................  ...........  ...........  ...........  ...........  ...........
                      plstr.
Q4046..............  Cast sup sht leg splnt      ..................  B.................  ...........  ...........  ...........  ...........  ...........
                      fbrgl.
Q4047..............  Cast sup sht leg splnt ped  ..................  B.................  ...........  ...........  ...........  ...........  ...........
                      p.
Q4048..............  Cast sup sht leg splnt ped  ..................  B.................  ...........  ...........  ...........  ...........  ...........
                      f.
Q4049..............  Finger splint, static.....  ..................  B.................  ...........  ...........  ...........  ...........  ...........
Q4050..............  Cast supplies unlisted....  ..................  B.................  ...........  ...........  ...........  ...........  ...........
Q4051..............  Splint supplies misc......  ..................  B.................  ...........  ...........  ...........  ...........  ...........
Q4079..............  Natalizumab injection.....  CH................  D.................  ...........  ...........  ...........  ...........  ...........
Q4080..............  Iloprost non-comp unit      ..................  Y.................  ...........  ...........  ...........  ...........  ...........
                      dose.
Q4081..............  Epoetin alfa, 100 units     ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      ESRD.
Q4082..............  Drug/bio NOC part B drug    ..................  B.................  ...........  ...........  ...........  ...........  ...........
                      CAP.
Q4083..............  Hyalgan/supartz inj per     CH................  D.................  ...........  ...........  ...........  ...........  ...........
                      dose.
Q4084..............  Synvisc inj per dose......  CH................  D.................  ...........  ...........  ...........  ...........  ...........
Q4085..............  Euflexxa inj per dose.....  CH................  D.................  ...........  ...........  ...........  ...........  ...........
Q4086..............  Orthovisc inj per dose....  CH................  D.................  ...........  ...........  ...........  ...........  ...........
Q4087..............  Octagam injection.........  CH................  D.................  ...........  ...........  ...........  ...........  ...........
Q4088..............  Gammagard liquid injection  CH................  D.................  ...........  ...........  ...........  ...........  ...........
Q4089..............  Rhophylac injection.......  CH................  D.................  ...........  ...........  ...........  ...........  ...........
Q4090..............  HepaGam B IM injection....  CH................  D.................  ...........  ...........  ...........  ...........  ...........
Q4091..............  Flebogamma injection......  CH................  D.................  ...........  ...........  ...........  ...........  ...........
Q4092..............  Gamunex injection.........  CH................  D.................  ...........  ...........  ...........  ...........  ...........
Q4093..............  Albuterol inh non-comp con  CH................  D.................  ...........  ...........  ...........  ...........  ...........
Q4094..............  Albuterol inh non-comp u d  CH................  D.................  ...........  ...........  ...........  ...........  ...........
Q4095..............  Reclast injection.........  CH................  D.................  ...........  ...........  ...........  ...........  ...........
Q5001..............  Hospice in patient home...  ..................  B.................  ...........  ...........  ...........  ...........  ...........
Q5002..............  Hospice in assisted living  ..................  B.................  ...........  ...........  ...........  ...........  ...........
Q5003..............  Hospice in LT/non-skilled   ..................  B.................  ...........  ...........  ...........  ...........  ...........
                      NF.
Q5004..............  Hospice in SNF............  ..................  B.................  ...........  ...........  ...........  ...........  ...........
Q5005..............  Hospice, inpatient          ..................  B.................  ...........  ...........  ...........  ...........  ...........
                      hospital.
Q5006..............  Hospice in hospice          ..................  B.................  ...........  ...........  ...........  ...........  ...........
                      facility.
Q5007..............  Hospice in LTCH...........  ..................  B.................  ...........  ...........  ...........  ...........  ...........
Q5008..............  Hospice in inpatient psych  ..................  B.................  ...........  ...........  ...........  ...........  ...........
Q5009..............  Hospice care, NOS.........  ..................  B.................  ...........  ...........  ...........  ...........  ...........
Q9945..............  LOCM <=149 mg/ml iodine,    CH................  D.................  ...........  ...........  ...........  ...........  ...........
                      1ml.
Q9946..............  LOCM 150-199mg/ml           CH................  D.................  ...........  ...........  ...........  ...........  ...........
                      iodine,1ml.
Q9947..............  LOCM 200-249mg/ml           CH................  D.................  ...........  ...........  ...........  ...........  ...........
                      iodine,1ml.
Q9948..............  LOCM 250-299mg/ml           CH................  D.................  ...........  ...........  ...........  ...........  ...........
                      iodine,1ml.
Q9949..............  LOCM 300-349mg/ml           CH................  D.................  ...........  ...........  ...........  ...........  ...........
                      iodine,1ml.
Q9950..............  LOCM 350-399mg/ml           CH................  D.................  ...........  ...........  ...........  ...........  ...........
                      iodine,1ml.
Q9951..............  LOCM >= 400 mg/ml           CH................  N.................  ...........  ...........  ...........  ...........  ...........
                      iodine,1ml.
Q9952..............  Inj Gad-base MR             CH................  D.................  ...........  ...........  ...........  ...........  ...........
                      contrast,1ml.

[[Page 67163]]

 
Q9953..............  Inj Fe-based MR             CH................  N.................  ...........  ...........  ...........  ...........  ...........
                      contrast,1ml.
Q9954..............  Oral MR contrast, 100 ml..  CH................  N.................  ...........  ...........  ...........  ...........  ...........
Q9955..............  Inj perflexane lip          CH................  N.................  ...........  ...........  ...........  ...........  ...........
                      micros,ml.
Q9956..............  Inj octafluoropropane       CH................  N.................  ...........  ...........  ...........  ...........  ...........
                      mic,ml.
Q9957..............  Inj perflutren lip          CH................  N.................  ...........  ...........  ...........  ...........  ...........
                      micros,ml.
Q9958..............  HOCM <=149 mg/ml iodine,    ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      1ml.
Q9959..............  HOCM 150-199mg/ml           ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      iodine,1ml.
Q9960..............  HOCM 200-249mg/ml           ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      iodine,1ml.
Q9961..............  HOCM 250-299mg/ml           ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      iodine,1ml.
Q9962..............  HOCM 300-349mg/ml           ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      iodine,1ml.
Q9963..............  HOCM 350-399mg/ml           ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      iodine,1ml.
Q9964..............  HOCM>= 400mg/ml iodine,     ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      1ml.
Q9965..............  LOCM 100-199mg/ml           NI................  N.................  ...........  ...........  ...........  ...........  ...........
                      iodine,1ml.
Q9966..............  LOCM 200-299mg/ml           NI................  N.................  ...........  ...........  ...........  ...........  ...........
                      iodine,1ml.
Q9967..............  LOCM 300-399mg/ml           NI................  N.................  ...........  ...........  ...........  ...........  ...........
                      iodine,1ml.
R0070..............  Transport portable x-ray..  ..................  B.................  ...........  ...........  ...........  ...........  ...........
R0075..............  Transport port x-ray        ..................  B.................  ...........  ...........  ...........  ...........  ...........
                      multipl.
R0076..............  Transport portable EKG....  ..................  B.................  ...........  ...........  ...........  ...........  ...........
V2020..............  Vision svcs frames          ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      purchases.
V2025..............  Eyeglasses delux frames...  ..................  E.................  ...........  ...........  ...........  ...........  ...........
V2100..............  Lens spher single plano     ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      4.00.
V2101..............  Single visn sphere 4.12-    ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      7.00.
V2102..............  Singl visn sphere 7.12-     ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      20.00.
V2103..............  Spherocylindr 4.00d/12-     ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      2.00d.
V2104..............  Spherocylindr 4.00d/2.12-   ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      4d.
V2105..............  Spherocylinder 4.00d/4.25-  ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      6d.
V2106..............  Spherocylinder 4.00d/       ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      >6.00d.
V2107..............  Spherocylinder 4.25d/12-2d  ..................  A.................  ...........  ...........  ...........  ...........  ...........
V2108..............  Spherocylinder 4.25d/2.12-  ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      4d.
V2109..............  Spherocylinder 4.25d/4.25-  ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      6d.
V2110..............  Spherocylinder 4.25d/over   ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      6d.
V2111..............  Spherocylindr 7.25d/.25-    ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      2.25.
V2112..............  Spherocylindr 7.25d/2.25-   ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      4d.
V2113..............  Spherocylindr 7.25d/4.25-   ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      6d.
V2114..............  Spherocylinder over 12.00d  ..................  A.................  ...........  ...........  ...........  ...........  ...........
V2115..............  Lens lenticular bifocal...  ..................  A.................  ...........  ...........  ...........  ...........  ...........
V2118..............  Lens aniseikonic single...  ..................  A.................  ...........  ...........  ...........  ...........  ...........
V2121..............  Lenticular lens, single...  ..................  A.................  ...........  ...........  ...........  ...........  ...........
V2199..............  Lens single vision not oth  ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      c.
V2200..............  Lens spher bifoc plano      ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      4.00d.
V2201..............  Lens sphere bifocal 4.12-   ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      7.0.
V2202..............  Lens sphere bifocal 7.12-   ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      20.
V2203..............  Lens sphcyl bifocal 4.00d/  ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      .1.
V2204..............  Lens sphcy bifocal 4.00d/   ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      2.1.
V2205..............  Lens sphcy bifocal 4.00d/   ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      4.2.
V2206..............  Lens sphcy bifocal 4.00d/   ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      ove.
V2207..............  Lens sphcy bifocal 4.25-7d/ ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      .
V2208..............  Lens sphcy bifocal 4.25-7/  ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      2.
V2209..............  Lens sphcy bifocal 4.25-7/  ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      4.
V2210..............  Lens sphcy bifocal 4.25-7/  ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      ov.
V2211..............  Lens sphcy bifo 7.25-12/    ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      .25-.
V2212..............  Lens sphcyl bifo 7.25-12/   ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      2.2.
V2213..............  Lens sphcyl bifo 7.25-12/   ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      4.2.
V2214..............  Lens sphcyl bifocal over    ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      12.
V2215..............  Lens lenticular bifocal...  ..................  A.................  ...........  ...........  ...........  ...........  ...........
V2218..............  Lens aniseikonic bifocal..  ..................  A.................  ...........  ...........  ...........  ...........  ...........
V2219..............  Lens bifocal seg width      ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      over.
V2220..............  Lens bifocal add over       ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      3.25d.
V2221..............  Lenticular lens, bifocal..  ..................  A.................  ...........  ...........  ...........  ...........  ...........
V2299..............  Lens bifocal speciality...  ..................  A.................  ...........  ...........  ...........  ...........  ...........
V2300..............  Lens sphere trifocal 4.00d  ..................  A.................  ...........  ...........  ...........  ...........  ...........
V2301..............  Lens sphere trifocal 4.12-  ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      7.
V2302..............  Lens sphere trifocal 7.12-  ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      20.
V2303..............  Lens sphcy trifocal 4.0/    ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      .12-.
V2304..............  Lens sphcy trifocal 4.0/    ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      2.25.
V2305..............  Lens sphcy trifocal 4.0/    ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      4.25.
V2306..............  Lens sphcyl trifocal 4.00/  ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      >6.
V2307..............  Lens sphcy trifocal 4.25-7/ ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      .
V2308..............  Lens sphc trifocal 4.25-7/  ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      2.
V2309..............  Lens sphc trifocal 4.25-7/  ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      4.
V2310..............  Lens sphc trifocal 4.25-7/  ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      >6.
V2311..............  Lens sphc trifo 7.25-12/    ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      .25-.
V2312..............  Lens sphc trifo 7.25-12/    ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      2.25.
V2313..............  Lens sphc trifo 7.25-12/    ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      4.25.
V2314..............  Lens sphcyl trifocal over   ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      12.
V2315..............  Lens lenticular trifocal..  ..................  A.................  ...........  ...........  ...........  ...........  ...........
V2318..............  Lens aniseikonic trifocal.  ..................  A.................  ...........  ...........  ...........  ...........  ...........
V2319..............  Lens trifocal seg width >   ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      28.
V2320..............  Lens trifocal add over      ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      3.25d.
V2321..............  Lenticular lens, trifocal.  ..................  A.................  ...........  ...........  ...........  ...........  ...........

[[Page 67164]]

 
V2399..............  Lens trifocal speciality..  ..................  A.................  ...........  ...........  ...........  ...........  ...........
V2410..............  Lens variab asphericity     ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      sing.
V2430..............  Lens variable asphericity   ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      bi.
V2499..............  Variable asphericity lens.  ..................  A.................  ...........  ...........  ...........  ...........  ...........
V2500..............  Contact lens pmma           ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      spherical.
V2501..............  Cntct lens pmma-toric/      ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      prism.
V2502..............  Contact lens pmma bifocal.  ..................  A.................  ...........  ...........  ...........  ...........  ...........
V2503..............  Cntct lens pmma color       ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      vision.
V2510..............  Cntct gas permeable         ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      sphericl.
V2511..............  Cntct toric prism ballast.  ..................  A.................  ...........  ...........  ...........  ...........  ...........
V2512..............  Cntct lens gas permbl       ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      bifocl.
V2513..............  Contact lens extended wear  ..................  A.................  ...........  ...........  ...........  ...........  ...........
V2520..............  Contact lens hydrophilic..  ..................  A.................  ...........  ...........  ...........  ...........  ...........
V2521..............  Cntct lens hydrophilic      ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      toric.
V2522..............  Cntct lens hydrophil        ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      bifocl.
V2523..............  Cntct lens hydrophil        ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      extend.
V2530..............  Contact lens gas            ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      impermeable.
V2531..............  Contact lens gas permeable  ..................  A.................  ...........  ...........  ...........  ...........  ...........
V2599..............  Contact lens/es other type  ..................  A.................  ...........  ...........  ...........  ...........  ...........
V2600..............  Hand held low vision aids.  ..................  A.................  ...........  ...........  ...........  ...........  ...........
V2610..............  Single lens spectacle       ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      mount.
V2615..............  Telescop/othr compound      ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      lens.
V2623..............  Plastic eye prosth custom.  ..................  A.................  ...........  ...........  ...........  ...........  ...........
V2624..............  Polishing artifical eye...  ..................  A.................  ...........  ...........  ...........  ...........  ...........
V2625..............  Enlargemnt of eye           ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      prosthesis.
V2626..............  Reduction of eye            ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      prosthesis.
V2627..............  Scleral cover shell.......  ..................  A.................  ...........  ...........  ...........  ...........  ...........
V2628..............  Fabrication & fitting.....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
V2629..............  Prosthetic eye other type.  ..................  A.................  ...........  ...........  ...........  ...........  ...........
V2630..............  Anter chamber intraocul     ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      lens.
V2631..............  Iris support intraoclr      ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      lens.
V2632..............  Post chmbr intraocular      ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      lens.
V2700..............  Balance lens..............  ..................  A.................  ...........  ...........  ...........  ...........  ...........
V2702..............  Deluxe lens feature.......  ..................  E.................  ...........  ...........  ...........  ...........  ...........
V2710..............  Glass/plastic slab off      ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      prism.
V2715..............  Prism lens/es.............  ..................  A.................  ...........  ...........  ...........  ...........  ...........
V2718..............  Fresnell prism press-on     ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      lens.
V2730..............  Special base curve........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
V2744..............  Tint photochromatic lens/   ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      es.
V2745..............  Tint, any color/solid/grad  ..................  A.................  ...........  ...........  ...........  ...........  ...........
V2750..............  Anti-reflective coating...  ..................  A.................  ...........  ...........  ...........  ...........  ...........
V2755..............  UV lens/es................  ..................  A.................  ...........  ...........  ...........  ...........  ...........
V2756..............  Eye glass case............  ..................  E.................  ...........  ...........  ...........  ...........  ...........
V2760..............  Scratch resistant coating.  ..................  A.................  ...........  ...........  ...........  ...........  ...........
V2761..............  Mirror coating............  ..................  B.................  ...........  ...........  ...........  ...........  ...........
V2762..............  Polarization, any lens....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
V2770..............  Occluder lens/es..........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
V2780..............  Oversize lens/es..........  ..................  A.................  ...........  ...........  ...........  ...........  ...........
V2781..............  Progressive lens per lens.  ..................  B.................  ...........  ...........  ...........  ...........  ...........
V2782..............  Lens, 1.54-1.65 p/1.60-     ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      1.79g.
V2783..............  Lens, >= 1.66 p/>=1.80 g..  ..................  A.................  ...........  ...........  ...........  ...........  ...........
V2784..............  Lens polycarb or equal....  ..................  A.................  ...........  ...........  ...........  ...........  ...........
V2785..............  Corneal tissue processing.  ..................  F.................  ...........  ...........  ...........  ...........  ...........
V2786..............  Occupational multifocal     ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      lens.
V2787..............  Astigmatism-correct         NI................  E.................  ...........  ...........  ...........  ...........  ...........
                      function.
V2788..............  Presbyopia-correct          ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      function.
V2790..............  Amniotic membrane.........  ..................  N.................  ...........  ...........  ...........  ...........  ...........
V2797..............  Vis item/svc in other code  ..................  A.................  ...........  ...........  ...........  ...........  ...........
V2799..............  Miscellaneous vision        ..................  A.................  ...........  ...........  ...........  ...........  ...........
                      service.
V5008..............  Hearing screening.........  ..................  E.................  ...........  ...........  ...........  ...........  ...........
V5010..............  Assessment for hearing aid  ..................  E.................  ...........  ...........  ...........  ...........  ...........
V5011..............  Hearing aid fitting/        ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      checking.
V5014..............  Hearing aid repair/         ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      modifying.
V5020..............  Conformity evaluation.....  ..................  E.................  ...........  ...........  ...........  ...........  ...........
V5030..............  Body-worn hearing aid air.  ..................  E.................  ...........  ...........  ...........  ...........  ...........
V5040..............  Body-worn hearing aid bone  ..................  E.................  ...........  ...........  ...........  ...........  ...........
V5050..............  Hearing aid monaural in     ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      ear.
V5060..............  Behind ear hearing aid....  ..................  E.................  ...........  ...........  ...........  ...........  ...........
V5070..............  Glasses air conduction....  ..................  E.................  ...........  ...........  ...........  ...........  ...........
V5080..............  Glasses bone conduction...  ..................  E.................  ...........  ...........  ...........  ...........  ...........
V5090..............  Hearing aid dispensing fee  ..................  E.................  ...........  ...........  ...........  ...........  ...........
V5095..............  Implant mid ear hearing     ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      pros.
V5100..............  Body-worn bilat hearing     ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      aid.
V5110..............  Hearing aid dispensing fee  ..................  E.................  ...........  ...........  ...........  ...........  ...........
V5120..............  Body-worn binaur hearing    ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      aid.
V5130..............  In ear binaural hearing     ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      aid.
V5140..............  Behind ear binaur hearing   ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      ai.
V5150..............  Glasses binaural hearing    ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      aid.
V5160..............  Dispensing fee binaural...  ..................  E.................  ...........  ...........  ...........  ...........  ...........
V5170..............  Within ear cros hearing     ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      aid.

[[Page 67165]]

 
V5180..............  Behind ear cros hearing     ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      aid.
V5190..............  Glasses cros hearing aid..  ..................  E.................  ...........  ...........  ...........  ...........  ...........
V5200..............  Cros hearing aid dispens    ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      fee.
V5210..............  In ear bicros hearing aid.  ..................  E.................  ...........  ...........  ...........  ...........  ...........
V5220..............  Behind ear bicros hearing   ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      ai.
V5230..............  Glasses bicros hearing aid  ..................  E.................  ...........  ...........  ...........  ...........  ...........
V5240..............  Dispensing fee bicros.....  ..................  E.................  ...........  ...........  ...........  ...........  ...........
V5241..............  Dispensing fee, monaural..  ..................  E.................  ...........  ...........  ...........  ...........  ...........
V5242..............  Hearing aid, monaural, cic  ..................  E.................  ...........  ...........  ...........  ...........  ...........
V5243..............  Hearing aid, monaural, itc  ..................  E.................  ...........  ...........  ...........  ...........  ...........
V5244..............  Hearing aid, prog, mon,     ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      cic.
V5245..............  Hearing aid, prog, mon,     ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      itc.
V5246..............  Hearing aid, prog, mon,     ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      ite.
V5247..............  Hearing aid, prog, mon,     ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      bte.
V5248..............  Hearing aid, binaural, cic  ..................  E.................  ...........  ...........  ...........  ...........  ...........
V5249..............  Hearing aid, binaural, itc  ..................  E.................  ...........  ...........  ...........  ...........  ...........
V5250..............  Hearing aid, prog, bin,     ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      cic.
V5251..............  Hearing aid, prog, bin,     ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      itc.
V5252..............  Hearing aid, prog, bin,     ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      ite.
V5253..............  Hearing aid, prog, bin,     ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      bte.
V5254..............  Hearing id, digit, mon,     ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      cic.
V5255..............  Hearing aid, digit, mon,    ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      itc.
V5256..............  Hearing aid, digit, mon,    ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      ite.
V5257..............  Hearing aid, digit, mon,    ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      bte.
V5258..............  Hearing aid, digit, bin,    ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      cic.
V5259..............  Hearing aid, digit, bin,    ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      itc.
V5260..............  Hearing aid, digit, bin,    ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      ite.
V5261..............  Hearing aid, digit, bin,    ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      bte.
V5262..............  Hearing aid, disp,          ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      monaural.
V5263..............  Hearing aid, disp,          ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      binaural.
V5264..............  Ear mold/insert...........  ..................  E.................  ...........  ...........  ...........  ...........  ...........
V5265..............  Ear mold/insert, disp.....  ..................  E.................  ...........  ...........  ...........  ...........  ...........
V5266..............  Battery for hearing device  ..................  E.................  ...........  ...........  ...........  ...........  ...........
V5267..............  Hearing aid supply/         ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      accessory.
V5268..............  ALD Telephone Amplifier...  ..................  E.................  ...........  ...........  ...........  ...........  ...........
V5269..............  Alerting device, any type.  ..................  E.................  ...........  ...........  ...........  ...........  ...........
V5270..............  ALD, TV amplifier, any      ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      type.
V5271..............  ALD, TV caption decoder...  ..................  E.................  ...........  ...........  ...........  ...........  ...........
V5272..............  Tdd.......................  ..................  E.................  ...........  ...........  ...........  ...........  ...........
V5273..............  ALD for cochlear implant..  ..................  E.................  ...........  ...........  ...........  ...........  ...........
V5274..............  ALD unspecified...........  ..................  E.................  ...........  ...........  ...........  ...........  ...........
V5275..............  Ear impression............  ..................  E.................  ...........  ...........  ...........  ...........  ...........
V5298..............  Hearing aid noc...........  ..................  E.................  ...........  ...........  ...........  ...........  ...........
V5299..............  Hearing service...........  ..................  B.................  ...........  ...........  ...........  ...........  ...........
V5336..............  Repair communication        ..................  E.................  ...........  ...........  ...........  ...........  ...........
                      device.
V5362..............  Speech screening..........  ..................  E.................  ...........  ...........  ...........  ...........  ...........
V5363..............  Language screening........  ..................  E.................  ...........  ...........  ...........  ...........  ...........
V5364..............  Dysphagia screening.......  ..................  E.................  ...........  ...........  ...........  ...........  ...........
--------------------------------------------------------------------------------------------------------------------------------------------------------


        Addendum BB.--ASC Covered Ancillary Services Integral to Covered Surgical Procedures for CY 2008
                          [Including Ancillary Services for Which Payment Is Packaged]
----------------------------------------------------------------------------------------------------------------
                                                                                          CY 2008
     HCPCS code           Short descriptor       Comment indicator   Payment indicator    payment      CY 2008
                                                                                           weight      payment
----------------------------------------------------------------------------------------------------------------
0028T..............  Dexa body composition      ..................  N1................  ...........  ...........
                      study.
0042T..............  Ct perfusion w/contrast,   ..................  N1................  ...........  ...........
                      cbf.
0054T..............  Bone surgery using         CH................  D5................  ...........  ...........
                      computer.
0055T..............  Bone surgery using         CH................  D5................  ...........  ...........
                      computer.
0056T..............  Bone surgery using         CH................  D5................  ...........  ...........
                      computer.
0067T..............  Ct colonography;dx.......  ..................  Z2................       3.0109      $124.65
0071T..............  U/s leiomyomata ablate     ..................  Z2................      61.6965    $2,554.30
                      <200.
0072T..............  U/s leiomyomata ablate     ..................  Z2................      61.6965    $2,554.30
                      >200.
0073T..............  Delivery, comp imrt......  ..................  Z2................       5.4582      $225.97
0126T..............  Chd risk imt study.......  ..................  N1................  ...........  ...........
0144T..............  Ct heart wo dye; qual      ..................  Z2................       1.5839       $65.58
                      calc.
0145T..............  Ct heart w/wo dye funct..  ..................  Z2................       4.7005      $194.61
0146T..............  Ccta w/wo dye............  ..................  Z2................       4.7005      $194.61
0147T..............  Ccta w/wo, quan calcium..  ..................  Z2................       4.7005      $194.61
0148T..............  Ccta w/wo, strxr.........  ..................  Z2................       4.7005      $194.61
0149T..............  Ccta w/wo, strxr quan      ..................  Z2................       4.7005      $194.61
                      calc.
0150T..............  Ccta w/wo, disease strxr.  ..................  Z2................       4.7005      $194.61
0151T..............  Ct heart funct add-on....  ..................  Z2................       1.5839       $65.58
0159T..............  Cad breast mri...........  ..................  N1................  ...........  ...........

[[Page 67166]]

 
0174T..............  Cad cxr with interp......  ..................  N1................  ...........  ...........
0175T..............  Cad cxr remote...........  ..................  N1................  ...........  ...........
0182T..............  Hdr elect brachytherapy..  CH................  Z2................      27.4752    $1,137.50
0185T..............  Comptr probability         NI................  N1................  ...........  ...........
                      analysis.
70010..............  Contrast x-ray of brain..  CH................  N1................  ...........  ...........
70015..............  Contrast x-ray of brain..  CH................  N1................  ...........  ...........
70030..............  X-ray eye for foreign      ..................  Z3................       0.3949       $16.35
                      body.
70100..............  X-ray exam of jaw........  ..................  Z3................       0.4526       $18.74
70110..............  X-ray exam of jaw........  ..................  Z3................       0.5514       $22.83
70120..............  X-ray exam of mastoids...  ..................  Z3................       0.5183       $21.46
70130..............  X-ray exam of mastoids...  ..................  Z2................       0.6954       $28.79
70134..............  X-ray exam of middle ear.  ..................  Z3................       0.6253       $25.89
70140..............  X-ray exam of facial       ..................  Z3................       0.4609       $19.08
                      bones.
70150..............  X-ray exam of facial       ..................  Z3................       0.6336       $26.23
                      bones.
70160..............  X-ray exam of nasal bones  ..................  Z3................       0.4773       $19.76
70170..............  X-ray exam of tear duct..  CH................  N1................  ...........  ...........
70190..............  X-ray exam of eye sockets  ..................  Z3................       0.5183       $21.46
70200..............  X-ray exam of eye sockets  ..................  Z3................       0.6418       $26.57
70210..............  X-ray exam of sinuses....  ..................  Z3................       0.4691       $19.42
70220..............  X-ray exam of sinuses....  ..................  Z3................       0.5925       $24.53
70240..............  X-ray exam, pituitary      ..................  Z3................       0.3949       $16.35
                      saddle.
70250..............  X-ray exam of skull......  ..................  Z3................       0.5101       $21.12
70260..............  X-ray exam of skull......  ..................  Z3................       0.6831       $28.28
70300..............  X-ray exam of teeth......  ..................  Z3................       0.1894        $7.84
70310..............  X-ray exam of teeth......  ..................  Z3................       0.4855       $20.10
70320..............  Full mouth x-ray of teeth  ..................  Z2................       0.5749       $23.80
70328..............  X-ray exam of jaw joint..  ..................  Z3................       0.4362       $18.06
70330..............  X-ray exam of jaw joints.  CH................  Z2................       0.6954       $28.79
70332..............  X-ray exam of jaw joint..  CH................  N1................  ...........  ...........
70336..............  Magnetic image, jaw joint  ..................  Z2................        4.883      $202.16
70350..............  X-ray head for             ..................  Z3................       0.2715       $11.24
                      orthodontia.
70355..............  Panoramic x-ray of jaws..  ..................  Z3................       0.3292       $13.63
70360..............  X-ray exam of neck.......  ..................  Z3................       0.3785       $15.67
70370..............  Throat x-ray &             ..................  Z3................       1.1768       $48.72
                      fluoroscopy.
70371..............  Speech evaluation,         ..................  Z2................       1.3271       $54.94
                      complex.
70373..............  Contrast x-ray of larynx.  CH................  N1................  ...........  ...........
70380..............  X-ray exam of salivary     ..................  Z3................       0.5925       $24.53
                      gland.
70390..............  X-ray exam of salivary     CH................  N1................  ...........  ...........
                      duct.
70450..............  Ct head/brain w/o dye....  ..................  Z2................       3.0109      $124.65
70460..............  Ct head/brain w/dye......  ..................  Z2................       4.3564      $180.36
70470..............  Ct head/brain w/o & w/dye  ..................  Z2................       5.1125      $211.66
70480..............  Ct orbit/ear/fossa w/o     ..................  Z2................       3.0109      $124.65
                      dye.
70481..............  Ct orbit/ear/fossa w/dye.  ..................  Z2................       4.3564      $180.36
70482..............  Ct orbit/ear/fossa w/o&w/  ..................  Z2................       5.1125      $211.66
                      dye.
70486..............  Ct maxillofacial w/o dye.  ..................  Z2................       3.0109      $124.65
70487..............  Ct maxillofacial w/dye...  ..................  Z2................       4.3564      $180.36
70488..............  Ct maxillofacial w/o & w/  ..................  Z2................       5.1125      $211.66
                      dye.
70490..............  Ct soft tissue neck w/o    ..................  Z2................       3.0109      $124.65
                      dye.
70491..............  Ct soft tissue neck w/dye  ..................  Z2................       4.3564      $180.36
70492..............  Ct sft tsue nck w/o & w/   ..................  Z2................       5.1125      $211.66
                      dye.
70496..............  Ct angiography, head.....  ..................  Z2................       5.1641      $213.80
70498..............  Ct angiography, neck.....  ..................  Z2................       5.1641      $213.80
70540..............  Mri orbit/face/neck w/o    ..................  Z2................       5.3933      $223.29
                      dye.
70542..............  Mri orbit/face/neck w/dye  ..................  Z2................        6.235      $258.14
70543..............  Mri orbt/fac/nck w/o & w/  ..................  Z2................       8.2463      $341.41
                      dye.
70544..............  Mr angiography head w/o    ..................  Z2................       5.3933      $223.29
                      dye.
70545..............  Mr angiography head w/dye  ..................  Z2................        6.235      $258.14
70546..............  Mr angiograph head w/o&w/  ..................  Z2................       8.2463      $341.41
                      dye.
70547..............  Mr angiography neck w/o    ..................  Z2................       5.3933      $223.29
                      dye.
70548..............  Mr angiography neck w/dye  ..................  Z2................        6.235      $258.14
70549..............  Mr angiograph neck w/o&w/  ..................  Z2................       8.2463      $341.41
                      dye.
70551..............  Mri brain w/o dye........  ..................  Z2................       5.3933      $223.29
70552..............  Mri brain w/dye..........  ..................  Z2................        6.235      $258.14
70553..............  Mri brain w/o & w/dye....  ..................  Z2................       8.2463      $341.41
70554..............  Fmri brain by tech.......  ..................  Z2................       5.3933      $223.29
70555..............  Fmri brain by phys/psych.  ..................  Z2................       5.3933      $223.29
70557..............  Mri brain w/o dye........  ..................  Z2................       5.3933      $223.29
70558..............  Mri brain w/dye..........  ..................  Z2................        6.235      $258.14

[[Page 67167]]

 
70559..............  Mri brain w/o & w/dye....  ..................  Z2................       8.2463      $341.41
71010..............  Chest x-ray..............  ..................  Z3................       0.3456       $14.31
71015..............  Chest x-ray..............  ..................  Z3................       0.4196       $17.37
71020..............  Chest x-ray..............  ..................  Z3................       0.4609       $19.08
71021..............  Chest x-ray..............  ..................  Z3................       0.5514       $22.83
71022..............  Chest x-ray..............  ..................  Z3................       0.6253       $25.89
71023..............  Chest x-ray and            ..................  Z3................       0.8968       $37.13
                      fluoroscopy.
71030..............  Chest x-ray..............  ..................  Z3................       0.6582       $27.25
71034..............  Chest x-ray and            ..................  Z2................       1.3271       $54.94
                      fluoroscopy.
71035..............  Chest x-ray..............  ..................  Z3................       0.5101       $21.12
71040..............  Contrast x-ray of bronchi  CH................  N1................  ...........  ...........
71060..............  Contrast x-ray of bronchi  CH................  N1................  ...........  ...........
71090..............  X-ray & pacemaker          CH................  N1................  ...........  ...........
                      insertion.
71100..............  X-ray exam of ribs.......  ..................  Z3................       0.4609       $19.08
71101..............  X-ray exam of ribs/chest.  ..................  Z3................       0.5514       $22.83
71110..............  X-ray exam of ribs.......  ..................  Z3................       0.6007       $24.87
71111..............  X-ray exam of ribs/chest.  ..................  Z3................        0.757       $31.34
71120..............  X-ray exam of breastbone.  ..................  Z3................       0.4937       $20.44
71130..............  X-ray exam of breastbone.  ..................  Z3................       0.5679       $23.51
71250..............  Ct thorax w/o dye........  ..................  Z2................       3.0109      $124.65
71260..............  Ct thorax w/dye..........  ..................  Z2................       4.3564      $180.36
71270..............  Ct thorax w/o & w/dye....  ..................  Z2................       5.1125      $211.66
71275..............  Ct angiography, chest....  ..................  Z2................       5.1641      $213.80
71550..............  Mri chest w/o dye........  ..................  Z2................       5.3933      $223.29
71551..............  Mri chest w/dye..........  ..................  Z2................        6.235      $258.14
71552..............  Mri chest w/o & w/dye....  ..................  Z2................       8.2463      $341.41
72010..............  X-ray exam of spine......  ..................  Z2................       0.6954       $28.79
72020..............  X-ray exam of spine......  ..................  Z3................       0.3456       $14.31
72040..............  X-ray exam of neck spine.  ..................  Z3................       0.5348       $22.14
72050..............  X-ray exam of neck spine.  ..................  Z3................       0.7652       $31.68
72052..............  X-ray exam of neck spine.  ..................  Z3................       0.9874       $40.88
72069..............  X-ray exam of trunk spine  ..................  Z3................       0.4773       $19.76
72070..............  X-ray exam of thoracic     ..................  Z3................       0.5019       $20.78
                      spine.
72072..............  X-ray exam of thoracic     ..................  Z3................       0.5843       $24.19
                      spine.
72074..............  X-ray exam of thoracic     CH................  Z2................       0.6954       $28.79
                      spine.
72080..............  X-ray exam of trunk spine  ..................  Z3................       0.5266       $21.80
72090..............  X-ray exam of trunk spine  ..................  Z3................       0.6418       $26.57
72100..............  X-ray exam of lower spine  ..................  Z3................       0.5761       $23.85
72110..............  X-ray exam of lower spine  ..................  Z3................       0.7983       $33.05
72114..............  X-ray exam of lower spine  ..................  Z3................        1.078       $44.63
72120..............  X-ray exam of lower spine  ..................  Z3................       0.7734       $32.02
72125..............  Ct neck spine w/o dye....  ..................  Z2................       3.0109      $124.65
72126..............  Ct neck spine w/dye......  ..................  Z2................       4.3564      $180.36
72127..............  Ct neck spine w/o & w/dye  ..................  Z2................       5.1125      $211.66
72128..............  Ct chest spine w/o dye...  ..................  Z2................       3.0109      $124.65
72129..............  Ct chest spine w/dye.....  ..................  Z2................       4.3564      $180.36
72130..............  Ct chest spine w/o & w/    ..................  Z2................       5.1125      $211.66
                      dye.
72131..............  Ct lumbar spine w/o dye..  ..................  Z2................       3.0109      $124.65
72132..............  Ct lumbar spine w/dye....  ..................  Z2................       4.3564      $180.36
72133..............  Ct lumbar spine w/o & w/   ..................  Z2................       5.1125      $211.66
                      dye.
72141..............  Mri neck spine w/o dye...  ..................  Z2................       5.3933      $223.29
72142..............  Mri neck spine w/dye.....  ..................  Z2................        6.235      $258.14
72146..............  Mri chest spine w/o dye..  ..................  Z2................       5.3933      $223.29
72147..............  Mri chest spine w/dye....  ..................  Z2................        6.235      $258.14
72148..............  Mri lumbar spine w/o dye.  ..................  Z2................       5.3933      $223.29
72149..............  Mri lumbar spine w/dye...  ..................  Z2................        6.235      $258.14
72156..............  Mri neck spine w/o & w/    ..................  Z2................       8.2463      $341.41
                      dye.
72157..............  Mri chest spine w/o & w/   ..................  Z2................       8.2463      $341.41
                      dye.
72158..............  Mri lumbar spine w/o & w/  ..................  Z2................       8.2463      $341.41
                      dye.
72170..............  X-ray exam of pelvis.....  ..................  Z3................       0.3949       $16.35
72190..............  X-ray exam of pelvis.....  ..................  Z3................       0.5925       $24.53
72191..............  Ct angiograph pelv w/o&w/  ..................  Z2................       5.1641      $213.80
                      dye.
72192..............  Ct pelvis w/o dye........  ..................  Z2................       3.0109      $124.65
72193..............  Ct pelvis w/dye..........  ..................  Z2................       4.3564      $180.36
72194..............  Ct pelvis w/o & w/dye....  ..................  Z2................       5.1125      $211.66
72195..............  Mri pelvis w/o dye.......  ..................  Z2................       5.3933      $223.29
72196..............  Mri pelvis w/dye.........  ..................  Z2................        6.235      $258.14
72197..............  Mri pelvis w/o & w/dye...  ..................  Z2................       8.2463      $341.41

[[Page 67168]]

 
72200..............  X-ray exam sacroiliac      ..................  Z3................       0.4362       $18.06
                      joints.
72202..............  X-ray exam sacroiliac      ..................  Z3................       0.5348       $22.14
                      joints.
72220..............  X-ray exam of tailbone...  ..................  Z3................       0.4526       $18.74
72240..............  Contrast x-ray of neck     CH................  N1................  ...........  ...........
                      spine.
72255..............  Contrast x-ray, thorax     CH................  N1................  ...........  ...........
                      spine.
72265..............  Contrast x-ray, lower      CH................  N1................  ...........  ...........
                      spine.
72270..............  Contrast x-ray, spine....  CH................  N1................  ...........  ...........
72275..............  Epidurography............  CH................  N1................  ...........  ...........
72285..............  X-ray c/t spine disk.....  CH................  N1................  ...........  ...........
72291..............  Perq vertebroplasty,       CH................  N1................  ...........  ...........
                      fluor.
72292..............  Perq vertebroplasty, ct..  CH................  N1................  ...........  ...........
72295..............  X-ray of lower spine disk  CH................  N1................  ...........  ...........
73000..............  X-ray exam of collar bone  ..................  Z3................       0.4196       $17.37
73010..............  X-ray exam of shoulder     ..................  Z3................        0.428       $17.72
                      blade.
73020..............  X-ray exam of shoulder...  ..................  Z3................       0.3539       $14.65
73030..............  X-ray exam of shoulder...  ..................  Z3................       0.4444       $18.40
73040..............  Contrast x-ray of          CH................  N1................  ...........  ...........
                      shoulder.
73050..............  X-ray exam of shoulders..  ..................  Z3................       0.5432       $22.49
73060..............  X-ray exam of humerus....  ..................  Z3................       0.4444       $18.40
73070..............  X-ray exam of elbow......  ..................  Z3................       0.4196       $17.37
73080..............  X-ray exam of elbow......  ..................  Z3................       0.5183       $21.46
73085..............  Contrast x-ray of elbow..  CH................  N1................  ...........  ...........
73090..............  X-ray exam of forearm....  ..................  Z3................       0.4196       $17.37
73092..............  X-ray exam of arm, infant  ..................  Z3................       0.4196       $17.37
73100..............  X-ray exam of wrist......  ..................  Z3................        0.428       $17.72
73110..............  X-ray exam of wrist......  ..................  Z3................       0.5101       $21.12
73115..............  Contrast x-ray of wrist..  CH................  N1................  ...........  ...........
73120..............  X-ray exam of hand.......  ..................  Z3................       0.4113       $17.03
73130..............  X-ray exam of hand.......  ..................  Z3................       0.4609       $19.08
73140..............  X-ray exam of finger(s)..  ..................  Z3................       0.4362       $18.06
73200..............  Ct upper extremity w/o     ..................  Z2................       3.0109      $124.65
                      dye.
73201..............  Ct upper extremity w/dye.  ..................  Z2................       4.3564      $180.36
73202..............  Ct uppr extremity w/o&w/   ..................  Z2................       5.1125      $211.66
                      dye.
73206..............  Ct angio upr extrm w/o&w/  ..................  Z2................       5.1641      $213.80
                      dye.
73218..............  Mri upper extremity w/o    ..................  Z2................       5.3933      $223.29
                      dye.
73219..............  Mri upper extremity w/dye  ..................  Z2................        6.235      $258.14
73220..............  Mri uppr extremity w/o&w/  ..................  Z2................       8.2463      $341.41
                      dye.
73221..............  Mri joint upr extrem w/o   ..................  Z2................       5.3933      $223.29
                      dye.
73222..............  Mri joint upr extrem w/    ..................  Z2................        6.235      $258.14
                      dye.
73223..............  Mri joint upr extr w/o&w/  ..................  Z2................       8.2463      $341.41
                      dye.
73500..............  X-ray exam of hip........  ..................  Z3................       0.3703       $15.33
73510..............  X-ray exam of hip........  ..................  Z3................       0.5266       $21.80
73520..............  X-ray exam of hips.......  ..................  Z3................       0.5596       $23.17
73525..............  Contrast x-ray of hip....  CH................  N1................  ...........  ...........
73530..............  X-ray exam of hip........  CH................  N1................  ...........  ...........
73540..............  X-ray exam of pelvis &     ..................  Z3................       0.5348       $22.14
                      hips.
73542..............  X-ray exam, sacroiliac     CH................  N1................  ...........  ...........
                      joint.
73550..............  X-ray exam of thigh......  ..................  Z3................       0.4362       $18.06
73560..............  X-ray exam of knee, 1 or   ..................  Z3................        0.428       $17.72
                      2.
73562..............  X-ray exam of knee, 3....  ..................  Z3................       0.5101       $21.12
73564..............  X-ray exam, knee, 4 or     ..................  Z3................       0.5761       $23.85
                      more.
73565..............  X-ray exam of knees......  ..................  Z3................       0.4444       $18.40
73580..............  Contrast x-ray of knee     CH................  N1................  ...........  ...........
                      joint.
73590..............  X-ray exam of lower leg..  ..................  Z3................       0.4113       $17.03
73592..............  X-ray exam of leg, infant  ..................  Z3................       0.4196       $17.37
73600..............  X-ray exam of ankle......  ..................  Z3................       0.4113       $17.03
73610..............  X-ray exam of ankle......  ..................  Z3................       0.4691       $19.42
73615..............  Contrast x-ray of ankle..  CH................  N1................  ...........  ...........
73620..............  X-ray exam of foot.......  ..................  Z3................       0.4031       $16.69
73630..............  X-ray exam of foot.......  ..................  Z3................       0.4609       $19.08
73650..............  X-ray exam of heel.......  ..................  Z3................       0.3949       $16.35
73660..............  X-ray exam of toe(s).....  ..................  Z3................       0.4196       $17.37
73700..............  Ct lower extremity w/o     ..................  Z2................       3.0109      $124.65
                      dye.
73701..............  Ct lower extremity w/dye.  ..................  Z2................       4.3564      $180.36
73702..............  Ct lwr extremity w/o&w/    ..................  Z2................       5.1125      $211.66
                      dye.
73706..............  Ct angio lwr extr w/o&w/   ..................  Z2................       5.1641      $213.80
                      dye.
73718..............  Mri lower extremity w/o    ..................  Z2................       5.3933      $223.29
                      dye.
73719..............  Mri lower extremity w/dye  ..................  Z2................        6.235      $258.14

[[Page 67169]]

 
73720..............  Mri lwr extremity w/o&w/   ..................  Z2................       8.2463      $341.41
                      dye.
73721..............  Mri jnt of lwr extre w/o   ..................  Z2................       5.3933      $223.29
                      dye.
73722..............  Mri joint of lwr extr w/   ..................  Z2................        6.235      $258.14
                      dye.
73723..............  Mri joint lwr extr w/o&w/  ..................  Z2................       8.2463      $341.41
                      dye.
74000..............  X-ray exam of abdomen....  ..................  Z3................       0.3785       $15.67
74010..............  X-ray exam of abdomen....  ..................  Z3................       0.5266       $21.80
74020..............  X-ray exam of abdomen....  ..................  Z3................       0.5514       $22.83
74022..............  X-ray exam series,         ..................  Z3................       0.6582       $27.25
                      abdomen.
74150..............  Ct abdomen w/o dye.......  ..................  Z2................       3.0109      $124.65
74160..............  Ct abdomen w/dye.........  ..................  Z2................       4.3564      $180.36
74170..............  Ct abdomen w/o & w/dye...  ..................  Z2................       5.1125      $211.66
74175..............  Ct angio abdom w/o & w/    ..................  Z2................       5.1641      $213.80
                      dye.
74181..............  Mri abdomen w/o dye......  ..................  Z2................       5.3933      $223.29
74182..............  Mri abdomen w/dye........  ..................  Z2................        6.235      $258.14
74183..............  Mri abdomen w/o & w/dye..  ..................  Z2................       8.2463      $341.41
74190..............  X-ray exam of peritoneum.  CH................  N1................  ...........  ...........
74210..............  Contrst x-ray exam of      ..................  Z3................       1.1604       $48.04
                      throat.
74220..............  Contrast x-ray, esophagus  ..................  Z3................       1.2507       $51.78
74230..............  Cine/vid x-ray, throat/    ..................  Z3................       1.2589       $52.12
                      esoph.
74235..............  Remove esophagus           CH................  N1................  ...........  ...........
                      obstruction.
74240..............  X-ray exam, upper gi       CH................  Z2................       1.3834       $57.27
                      tract.
74241..............  X-ray exam, upper gi       ..................  Z2................       1.3834       $57.27
                      tract.
74245..............  X-ray exam, upper gi       ..................  Z2................       2.2222       $92.00
                      tract.
74246..............  Contrst x-ray uppr gi      ..................  Z2................       1.3834       $57.27
                      tract.
74247..............  Contrst x-ray uppr gi      ..................  Z2................       1.3834       $57.27
                      tract.
74249..............  Contrst x-ray uppr gi      ..................  Z2................       2.2222       $92.00
                      tract.
74250..............  X-ray exam of small bowel  CH................  Z2................       1.3834       $57.27
74251..............  X-ray exam of small bowel  ..................  Z2................       2.2222       $92.00
74260..............  X-ray exam of small bowel  ..................  Z2................       1.3834       $57.27
74270..............  Contrast x-ray exam of     ..................  Z2................       1.3834       $57.27
                      colon.
74280..............  Contrast x-ray exam of     ..................  Z2................       2.2222       $92.00
                      colon.
74283..............  Contrast x-ray exam of     ..................  Z2................       1.3834       $57.27
                      colon.
74290..............  Contrast x-ray,            ..................  Z3................       0.9053       $37.48
                      gallbladder.
74291..............  Contrast x-rays,           ..................  Z3................       0.7816       $32.36
                      gallbladder.
74300..............  X-ray bile ducts/pancreas  CH................  N1................  ...........  ...........
74301..............  X-rays at surgery add-on.  CH................  N1................  ...........  ...........
74305..............  X-ray bile ducts/pancreas  CH................  N1................  ...........  ...........
74320..............  Contrast x-ray of bile     CH................  N1................  ...........  ...........
                      ducts.
74327..............  X-ray bile stone removal.  CH................  N1................  ...........  ...........
74328..............  X-ray bile duct endoscopy  ..................  N1................  ...........  ...........
74329..............  X-ray for pancreas         ..................  N1................  ...........  ...........
                      endoscopy.
74330..............  X-ray bile/panc endoscopy  ..................  N1................  ...........  ...........
74340..............  X-ray guide for gi tube..  CH................  N1................  ...........  ...........
74350..............  X-ray guide, stomach tube  CH................  D5................  ...........  ...........
74355..............  X-ray guide, intestinal    CH................  N1................  ...........  ...........
                      tube.
74360..............  X-ray guide, gi dilation.  CH................  N1................  ...........  ...........
74363..............  X-ray, bile duct dilation  CH................  N1................  ...........  ...........
74400..............  Contrst x-ray, urinary     ..................  Z3................       1.6869       $69.84
                      tract.
74410..............  Contrst x-ray, urinary     ..................  Z3................        1.835       $75.97
                      tract.
74415..............  Contrst x-ray, urinary     ..................  Z3................       2.1478       $88.92
                      tract.
74420..............  Contrst x-ray, urinary     ..................  Z2................       2.6121      $108.14
                      tract.
74425..............  Contrst x-ray, urinary     CH................  N1................  ...........  ...........
                      tract.
74430..............  Contrast x-ray, bladder..  CH................  N1................  ...........  ...........
74440..............  X-ray, male genital tract  CH................  N1................  ...........  ...........
74445..............  X-ray exam of penis......  CH................  N1................  ...........  ...........
74450..............  X-ray, urethra/bladder...  CH................  N1................  ...........  ...........
74455..............  X-ray, urethra/bladder...  CH................  N1................  ...........  ...........
74470..............  X-ray exam of kidney       CH................  N1................  ...........  ...........
                      lesion.
74475..............  X-ray control, cath        CH................  N1................  ...........  ...........
                      insert.
74480..............  X-ray control, cath        CH................  N1................  ...........  ...........
                      insert.
74485..............  X-ray guide, gu dilation.  CH................  N1................  ...........  ...........
74710..............  X-ray measurement of       ..................  Z3................         0.65       $26.91
                      pelvis.
74740..............  X-ray, female genital      CH................  N1................  ...........  ...........
                      tract.
74742..............  X-ray, fallopian tube....  CH................  N1................  ...........  ...........
74775..............  X-ray exam of perineum...  ..................  Z2................       2.6121      $108.14
75552..............  Heart mri for morph w/o    CH................  D5................  ...........  ...........
                      dye.
75553..............  Heart mri for morph w/dye  CH................  D5................  ...........  ...........
75554..............  Cardiac MRI/function.....  CH................  D5................  ...........  ...........

[[Page 67170]]

 
75555..............  Cardiac MRI/limited study  CH................  D5................  ...........  ...........
75557..............  Cardiac mri for morph....  NI................  Z2................       5.3933      $223.29
75559..............  Cardiac mri w/stress img.  NI................  Z2................       5.3933      $223.29
75561..............  Cardiac mri for morph w/   NI................  Z2................       8.2463      $341.41
                      dye.
75563..............  Card mri w/stress img &    NI................  Z2................       8.2463      $341.41
                      dye.
75600..............  Contrast x-ray exam of     CH................  N1................  ...........  ...........
                      aorta.
75605..............  Contrast x-ray exam of     CH................  N1................  ...........  ...........
                      aorta.
75625..............  Contrast x-ray exam of     CH................  N1................  ...........  ...........
                      aorta.
75630..............  X-ray aorta, leg arteries  CH................  N1................  ...........  ...........
75635..............  Ct angio abdominal         CH................  N1................  ...........  ...........
                      arteries.
75650..............  Artery x-rays, head &      CH................  N1................  ...........  ...........
                      neck.
75658..............  Artery x-rays, arm.......  CH................  N1................  ...........  ...........
75660..............  Artery x-rays, head &      CH................  N1................  ...........  ...........
                      neck.
75662..............  Artery x-rays, head &      CH................  N1................  ...........  ...........
                      neck.
75665..............  Artery x-rays, head &      CH................  N1................  ...........  ...........
                      neck.
75671..............  Artery x-rays, head &      CH................  N1................  ...........  ...........
                      neck.
75676..............  Artery x-rays, neck......  CH................  N1................  ...........  ...........
75680..............  Artery x-rays, neck......  CH................  N1................  ...........  ...........
75685..............  Artery x-rays, spine.....  CH................  N1................  ...........  ...........
75705..............  Artery x-rays, spine.....  CH................  N1................  ...........  ...........
75710..............  Artery x-rays, arm/leg...  CH................  N1................  ...........  ...........
75716..............  Artery x-rays, arms/legs.  CH................  N1................  ...........  ...........
75722..............  Artery x-rays, kidney....  CH................  N1................  ...........  ...........
75724..............  Artery x-rays, kidneys...  CH................  N1................  ...........  ...........
75726..............  Artery x-rays, abdomen...  CH................  N1................  ...........  ...........
75731..............  Artery x-rays, adrenal     CH................  N1................  ...........  ...........
                      gland.
75733..............  Artery x-rays, adrenals..  CH................  N1................  ...........  ...........
75736..............  Artery x-rays, pelvis....  CH................  N1................  ...........  ...........
75741..............  Artery x-rays, lung......  CH................  N1................  ...........  ...........
75743..............  Artery x-rays, lungs.....  CH................  N1................  ...........  ...........
75746..............  Artery x-rays, lung......  CH................  N1................  ...........  ...........
75756..............  Artery x-rays, chest.....  CH................  N1................  ...........  ...........
75774..............  Artery x-ray, each vessel  CH................  N1................  ...........  ...........
75790..............  Visualize a-v shunt......  CH................  N1................  ...........  ...........
75801..............  Lymph vessel x-ray, arm/   CH................  N1................  ...........  ...........
                      leg.
75803..............  Lymph vessel x-ray,arms/   CH................  N1................  ...........  ...........
                      legs.
75805..............  Lymph vessel x-ray, trunk  CH................  N1................  ...........  ...........
75807..............  Lymph vessel x-ray, trunk  CH................  N1................  ...........  ...........
75809..............  Nonvascular shunt, x-ray.  CH................  N1................  ...........  ...........
75810..............  Vein x-ray, spleen/liver.  CH................  N1................  ...........  ...........
75820..............  Vein x-ray, arm/leg......  CH................  N1................  ...........  ...........
75822..............  Vein x-ray, arms/legs....  CH................  N1................  ...........  ...........
75825..............  Vein x-ray, trunk........  CH................  N1................  ...........  ...........
75827..............  Vein x-ray, chest........  CH................  N1................  ...........  ...........
75831..............  Vein x-ray, kidney.......  CH................  N1................  ...........  ...........
75833..............  Vein x-ray, kidneys......  CH................  N1................  ...........  ...........
75840..............  Vein x-ray, adrenal gland  CH................  N1................  ...........  ...........
75842..............  Vein x-ray, adrenal        CH................  N1................  ...........  ...........
                      glands.
75860..............  Vein x-ray, neck.........  CH................  N1................  ...........  ...........
75870..............  Vein x-ray, skull........  CH................  N1................  ...........  ...........
75872..............  Vein x-ray, skull........  CH................  N1................  ...........  ...........
75880..............  Vein x-ray, eye socket...  CH................  N1................  ...........  ...........
75885..............  Vein x-ray, liver........  CH................  N1................  ...........  ...........
75887..............  Vein x-ray, liver........  CH................  N1................  ...........  ...........
75889..............  Vein x-ray, liver........  CH................  N1................  ...........  ...........
75891..............  Vein x-ray, liver........  CH................  N1................  ...........  ...........
75893..............  Venous sampling by         ..................  N1................  ...........  ...........
                      catheter.
75894..............  X-rays, transcath therapy  CH................  N1................  ...........  ...........
75896..............  X-rays, transcath therapy  CH................  N1................  ...........  ...........
75898..............  Follow-up angiography....  CH................  N1................  ...........  ...........
75901..............  Remove cva device          CH................  N1................  ...........  ...........
                      obstruct.
75902..............  Remove cva lumen obstruct  CH................  N1................  ...........  ...........
75940..............  X-ray placement, vein      CH................  N1................  ...........  ...........
                      filter.
75945..............  Intravascular us.........  CH................  N1................  ...........  ...........
75946..............  Intravascular us add-on..  CH................  N1................  ...........  ...........
75960..............  Transcath iv stent rs&i..  CH................  N1................  ...........  ...........
75961..............  Retrieval, broken          CH................  N1................  ...........  ...........
                      catheter.
75962..............  Repair arterial blockage.  CH................  N1................  ...........  ...........

[[Page 67171]]

 
75964..............  Repair artery blockage,    CH................  N1................  ...........  ...........
                      each.
75966..............  Repair arterial blockage.  CH................  N1................  ...........  ...........
75968..............  Repair artery blockage,    CH................  N1................  ...........  ...........
                      each.
75970..............  Vascular biopsy..........  CH................  N1................  ...........  ...........
75978..............  Repair venous blockage...  CH................  N1................  ...........  ...........
75980..............  Contrast xray exam bile    CH................  N1................  ...........  ...........
                      duct.
75982..............  Contrast xray exam bile    CH................  N1................  ...........  ...........
                      duct.
75984..............  Xray control catheter      CH................  N1................  ...........  ...........
                      change.
75989..............  Abscess drainage under x-  ..................  N1................  ...........  ...........
                      ray.
75992..............  Atherectomy, x-ray exam..  CH................  N1................  ...........  ...........
75993..............  Atherectomy, x-ray exam..  CH................  N1................  ...........  ...........
75994..............  Atherectomy, x-ray exam..  CH................  N1................  ...........  ...........
75995..............  Atherectomy, x-ray exam..  CH................  N1................  ...........  ...........
75996..............  Atherectomy, x-ray exam..  CH................  N1................  ...........  ...........
76000..............  Fluoroscope examination..  CH................  N1................  ...........  ...........
76001..............  Fluoroscope exam,          ..................  N1................  ...........  ...........
                      extensive.
76010..............  X-ray, nose to rectum....  ..................  Z3................       0.4113       $17.03
76080..............  X-ray exam of fistula....  CH................  N1................  ...........  ...........
76098..............  X-ray exam, breast         ..................  Z3................       0.2797       $11.58
                      specimen.
76100..............  X-ray exam of body         ..................  Z2................        1.157       $47.90
                      section.
76101..............  Complex body section x-    CH................  Z3................       2.7485      $113.79
                      ray.
76102..............  Complex body section x-    ..................  Z2................       2.6838      $111.11
                      rays.
76120..............  Cine/video x-rays........  ..................  Z3................       1.1437       $47.35
76125..............  Cine/video x-rays add-on.  CH................  N1................  ...........  ...........
76150..............  X-ray exam, dry process..  ..................  Z3................       0.4526       $18.74
76350..............  Special x-ray contrast     ..................  N1................  ...........  ...........
                      study.
76376..............  3d render w/o postprocess  CH................  N1................  ...........  ...........
76377..............  3d rendering w/            CH................  N1................  ...........  ...........
                      postprocess.
76380..............  Cat scan follow-up study.  ..................  Z2................       1.5839       $65.58
76496..............  Fluoroscopic procedure...  ..................  Z2................       1.3271       $54.94
76497..............  Ct procedure.............  ..................  Z2................       1.5839       $65.58
76498..............  Mri procedure............  ..................  Z2................        4.883      $202.16
76499..............  Radiographic procedure...  ..................  Z2................       0.6954       $28.79
76506..............  Echo exam of head........  ..................  Z2................        0.957       $39.62
76510..............  Ophth us, b & quant a....  CH................  Z3................       1.5963       $66.09
76511..............  Ophth us, quant a only...  ..................  Z3................       1.2507       $51.78
76512..............  Ophth us, b w/non-quant a  ..................  Z3................       1.0862       $44.97
76513..............  Echo exam of eye, water    ..................  Z3................       1.1521       $47.70
                      bath.
76514..............  Echo exam of eye,          ..................  Z3................       0.0659        $2.73
                      thickness.
76516..............  Echo exam of eye.........  ..................  Z3................       0.8968       $37.13
76519..............  Echo exam of eye.........  ..................  Z3................       0.9874       $40.88
76529..............  Echo exam of eye.........  ..................  Z3................       0.8558       $35.43
76536..............  Us exam of head and neck.  CH................  Z2................       1.5094       $62.49
76604..............  Us exam, chest...........  ..................  Z2................        0.957       $39.62
76645..............  Us exam, breast(s).......  ..................  Z2................        0.957       $39.62
76700..............  Us exam, abdom, complete.  ..................  Z2................       1.5094       $62.49
76705..............  Echo exam of abdomen.....  ..................  Z3................       1.4647       $60.64
76770..............  Us exam abdo back wall,    ..................  Z2................       1.5094       $62.49
                      comp.
76775..............  Us exam abdo back wall,    ..................  Z3................       1.4893       $61.66
                      lim.
76776..............  Us exam k transpl w/       ..................  Z2................       1.5094       $62.49
                      doppler.
76800..............  Us exam, spinal canal....  ..................  Z3................       1.4154       $58.60
76801..............  Ob us < 14 wks, single     ..................  Z2................       1.5094       $62.49
                      fetus.
76802..............  Ob us < 14 wks, add'l      ..................  Z3................       0.7241       $29.98
                      fetus.
76805..............  Ob us >/= 14 wks, sngl     ..................  Z2................       1.5094       $62.49
                      fetus.
76810..............  Ob us >/= 14 wks, addl     ..................  Z3................       0.9874       $40.88
                      fetus.
76811..............  Ob us, detailed, sngl      CH................  Z2................       2.3792       $98.50
                      fetus.
76812..............  Ob us, detailed, addl      ..................  Z2................        0.957       $39.62
                      fetus.
76813..............  Ob us nuchal meas, 1 gest  ..................  Z3................       1.4893       $61.66
76814..............  Ob us nuchal meas, add-on  ..................  Z3................       0.7077       $29.30
76815..............  Ob us, limited, fetus(s).  ..................  Z2................        0.957       $39.62
76816..............  Ob us, follow-up, per      ..................  Z2................        0.957       $39.62
                      fetus.
76817..............  Transvaginal us,           ..................  Z2................        0.957       $39.62
                      obstetric.
76818..............  Fetal biophys profile w/   ..................  Z3................       1.4483       $59.96
                      nst.
76819..............  Fetal biophys profil w/o   ..................  Z3................       1.2343       $51.10
                      nst.
76820..............  Umbilical artery echo....  ..................  Z3................       0.8311       $34.41
76821..............  Middle cerebral artery     ..................  Z3................       1.3413       $55.53
                      echo.
76825..............  Echo exam of fetal heart.  ..................  Z2................       1.5094       $62.49
76826..............  Echo exam of fetal heart.  CH................  Z2................        0.957       $39.62

[[Page 67172]]

 
76827..............  Echo exam of fetal heart.  CH................  Z2................        0.957       $39.62
76828..............  Echo exam of fetal heart.  ..................  Z3................         0.65       $26.91
76830..............  Transvaginal us, non-ob..  ..................  Z2................       1.5094       $62.49
76831..............  Echo exam, uterus........  ..................  Z3................       1.6623       $68.82
76856..............  Us exam, pelvic, complete  ..................  Z2................       1.5094       $62.49
76857..............  Us exam, pelvic, limited.  ..................  Z2................        0.957       $39.62
76870..............  Us exam, scrotum.........  ..................  Z2................       1.5094       $62.49
76872..............  Us, transrectal..........  ..................  Z2................       1.5094       $62.49
76873..............  Echograp trans r, pros     ..................  Z2................       1.5094       $62.49
                      study.
76880..............  Us exam, extremity.......  ..................  Z2................       1.5094       $62.49
76885..............  Us exam infant hips,       ..................  Z2................        0.957       $39.62
                      dynamic.
76886..............  Us exam infant hips,       ..................  Z2................        0.957       $39.62
                      static.
76930..............  Echo guide,                CH................  N1................  ...........  ...........
                      cardiocentesis.
76932..............  Echo guide for heart       CH................  N1................  ...........  ...........
                      biopsy.
76936..............  Echo guide for artery      CH................  N1................  ...........  ...........
                      repair.
76937..............  Us guide, vascular access  ..................  N1................  ...........  ...........
76940..............  Us guide, tissue ablation  CH................  N1................  ...........  ...........
76941..............  Echo guide for             CH................  N1................  ...........  ...........
                      transfusion.
76942..............  Echo guide for biopsy....  CH................  N1................  ...........  ...........
76945..............  Echo guide, villus         CH................  N1................  ...........  ...........
                      sampling.
76946..............  Echo guide for             CH................  N1................  ...........  ...........
                      amniocentesis.
76948..............  Echo guide, ova            CH................  N1................  ...........  ...........
                      aspiration.
76950..............  Echo guidance              CH................  N1................  ...........  ...........
                      radiotherapy.
76965..............  Echo guidance              CH................  N1................  ...........  ...........
                      radiotherapy.
76970..............  Ultrasound exam follow-up  ..................  Z2................        0.957       $39.62
76975..............  Gi endoscopic ultrasound.  CH................  N1................  ...........  ...........
76977..............  Us bone density measure..  ..................  Z3................       0.3785       $15.67
76998..............  Us guide, intraop........  CH................  N1................  ...........  ...........
76999..............  Echo examination           ..................  Z2................        0.957       $39.62
                      procedure.
77001..............  Fluoroguide for vein       ..................  N1................  ...........  ...........
                      device.
77002..............  Needle localization by     ..................  N1................  ...........  ...........
                      xray.
77003..............  Fluoroguide for spine      ..................  N1................  ...........  ...........
                      inject.
77011..............  Ct scan for localization.  CH................  N1................  ...........  ...........
77012..............  Ct scan for needle biopsy  CH................  N1................  ...........  ...........
77013..............  Ct guide for tissue        CH................  N1................  ...........  ...........
                      ablation.
77014..............  Ct scan for therapy guide  CH................  N1................  ...........  ...........
77021..............  Mr guidance for needle     CH................  N1................  ...........  ...........
                      place.
77022..............  Mri for tissue ablation..  CH................  N1................  ...........  ...........
77031..............  Stereotact guide for brst  CH................  N1................  ...........  ...........
                      bx.
77032..............  Guidance for needle,       CH................  N1................  ...........  ...........
                      breast.
77053..............  X-ray of mammary duct....  CH................  N1................  ...........  ...........
77054..............  X-ray of mammary ducts...  CH................  N1................  ...........  ...........
77071..............  X-ray stress view........  ..................  Z3................       0.3867       $16.01
77072..............  X-rays for bone age......  ..................  Z3................       0.2961       $12.26
77073..............  X-rays, bone length        ..................  Z3................       0.5514       $22.83
                      studies.
77074..............  X-rays, bone survey,       ..................  Z3................       0.9381       $38.84
                      limited.
77075..............  X-rays, bone survey        ..................  Z2................        1.157       $47.90
                      complete.
77076..............  X-rays, bone survey,       ..................  Z2................       0.6954       $28.79
                      infant.
77077..............  Joint survey, single view  CH................  Z2................       0.6831       $28.28
77078..............  Ct bone density, axial...  ..................  Z2................       1.1384       $47.13
77079..............  Ct bone density,           CH................  Z2................       1.5224       $63.03
                      peripheral.
77080..............  Dxa bone density, axial..  ..................  Z2................       1.1384       $47.13
77081..............  Dxa bone density/          ..................  Z2................       0.4773       $19.76
                      peripheral.
77082..............  Dxa bone density, vert fx  ..................  Z3................       0.5019       $20.78
77083..............  Radiographic               ..................  Z3................       0.4362       $18.06
                      absorptiometry.
77084..............  Magnetic image, bone       ..................  Z2................        4.883      $202.16
                      marrow.
77280..............  Set radiation therapy      ..................  Z2................       1.5576       $64.49
                      field.
77285..............  Set radiation therapy      ..................  Z2................       3.9276      $162.61
                      field.
77290..............  Set radiation therapy      ..................  Z2................       3.9276      $162.61
                      field.
77295..............  Set radiation therapy      CH................  Z2................      13.5621      $561.48
                      field.
77299..............  Radiation therapy          ..................  Z2................       1.5576       $64.49
                      planning.
77300..............  Radiation therapy dose     ..................  Z3................       0.9546       $39.52
                      plan.
77301..............  Radiotherapy dose plan,    ..................  Z2................      13.5621      $561.48
                      imrt.
77305..............  Teletx isodose plan        ..................  Z3................       1.0451       $43.27
                      simple.
77310..............  Teletx isodose plan        ..................  Z3................       1.3331       $55.19
                      intermed.
77315..............  Teletx isodose plan        ..................  Z3................       1.7444       $72.22
                      complex.
77321..............  Special teletx port plan.  ..................  Z3................        2.156       $89.26
77326..............  Brachytx isodose calc      ..................  Z2................       1.5576       $64.49
                      simp.

[[Page 67173]]

 
77327..............  Brachytx isodose calc      ..................  Z3................       2.9212      $120.94
                      interm.
77328..............  Brachytx isodose plan      ..................  Z3................       3.9168      $162.16
                      compl.
77331..............  Special radiation          ..................  Z3................       0.4196       $17.37
                      dosimetry.
77332..............  Radiation treatment        ..................  Z3................       1.1108       $45.99
                      aid(s).
77333..............  Radiation treatment        ..................  Z3................       0.8804       $36.45
                      aid(s).
77334..............  Radiation treatment        ..................  Z3................       2.2876       $94.71
                      aid(s).
77336..............  Radiation physics consult  ..................  Z2................       1.5576       $64.49
77370..............  Radiation physics consult  ..................  Z2................       1.5576       $64.49
77371..............  Srs, multisource.........  ..................  Z3................      24.7441    $1,024.43
77399..............  External radiation         ..................  Z2................       1.5576       $64.49
                      dosimetry.
77401..............  Radiation treatment        ..................  Z3................       0.9217       $38.16
                      delivery.
77402..............  Radiation treatment        ..................  Z2................       1.4229       $58.91
                      delivery.
77403..............  Radiation treatment        ..................  Z2................       1.4229       $58.91
                      delivery.
77404..............  Radiation treatment        ..................  Z2................       1.4229       $58.91
                      delivery.
77406..............  Radiation treatment        ..................  Z2................       1.4229       $58.91
                      delivery.
77407..............  Radiation treatment        ..................  Z2................       1.4229       $58.91
                      delivery.
77408..............  Radiation treatment        ..................  Z2................       1.4229       $58.91
                      delivery.
77409..............  Radiation treatment        ..................  Z2................       1.4229       $58.91
                      delivery.
77411..............  Radiation treatment        ..................  Z2................       2.2167       $91.77
                      delivery.
77412..............  Radiation treatment        ..................  Z2................       2.2167       $91.77
                      delivery.
77413..............  Radiation treatment        ..................  Z2................       2.2167       $91.77
                      delivery.
77414..............  Radiation treatment        ..................  Z2................       2.2167       $91.77
                      delivery.
77416..............  Radiation treatment        ..................  Z2................       2.2167       $91.77
                      delivery.
77417..............  Radiology port film(s)...  CH................  N1................  ...........  ...........
77418..............  Radiation tx delivery,     ..................  Z2................       5.4582      $225.97
                      imrt.
77421..............  Stereoscopic x-ray         CH................  N1................  ...........  ...........
                      guidance.
77422..............  Neutron beam tx, simple..  ..................  Z2................       2.2167       $91.77
77423..............  Neutron beam tx, complex.  ..................  Z2................       2.2167       $91.77
77435..............  Sbrt management..........  ..................  N1................  ...........  ...........
77470..............  Special radiation          ..................  Z3................       5.0936      $210.88
                      treatment.
77520..............  Proton trmt, simple w/o    ..................  Z2................      12.8205      $530.78
                      comp.
77522..............  Proton trmt, simple w/     ..................  Z2................      12.8205      $530.78
                      comp.
77523..............  Proton trmt, intermediate  ..................  Z2................      15.3404      $635.11
77525..............  Proton treatment, complex  ..................  Z2................      15.3404      $635.11
77600..............  Hyperthermia treatment...  CH................  Z3................       5.2583      $217.70
77605..............  Hyperthermia treatment...  ..................  Z2................       5.7996      $240.11
77610..............  Hyperthermia treatment...  ..................  Z2................       5.7996      $240.11
77615..............  Hyperthermia treatment...  ..................  Z2................       5.7996      $240.11
77620..............  Hyperthermia treatment...  CH................  Z3................       5.4064      $223.83
77750..............  Infuse radioactive         ..................  Z3................       1.7529       $72.57
                      materials.
77761..............  Apply intrcav radiat       ..................  Z3................        3.127      $129.46
                      simple.
77762..............  Apply intrcav radiat       ..................  Z3................       3.8511      $159.44
                      interm.
77763..............  Apply intrcav radiat       ..................  Z3................       4.9373      $204.41
                      compl.
77776..............  Apply interstit radiat     ..................  Z3................        3.275      $135.59
                      simpl.
77777..............  Apply interstit radiat     ..................  Z3................        3.991      $165.23
                      inter.
77778..............  Apply interstit radiat     ..................  Z3................       5.2417      $217.01
                      compl.
77781..............  High intensity             ..................  Z3................       9.9981      $413.93
                      brachytherapy.
77782..............  High intensity             ..................  Z2................      11.6779      $483.48
                      brachytherapy.
77783..............  High intensity             ..................  Z2................      11.6779      $483.48
                      brachytherapy.
77784..............  High intensity             ..................  Z2................      11.6779      $483.48
                      brachytherapy.
77789..............  Apply surface radiation..  ..................  Z3................       0.8558       $35.43
77790..............  Radiation handling.......  ..................  N1................  ...........  ...........
77799..............  Radium/radioisotope        ..................  Z2................        8.514      $352.49
                      therapy.
78000..............  Thyroid, single uptake...  ..................  Z3................       1.1355       $47.01
78001..............  Thyroid, multiple uptakes  ..................  Z3................       1.4483       $59.96
78003..............  Thyroid suppress/stimul..  ..................  Z3................       1.1437       $47.35
78006..............  Thyroid imaging with       CH................  Z3................       3.4726      $143.77
                      uptake.
78007..............  Thyroid image, mult        ..................  Z3................       2.2466       $93.01
                      uptakes.
78010..............  Thyroid imaging..........  CH................  Z2................       2.0471       $84.75
78011..............  Thyroid imaging with flow  ..................  Z2................       2.0471       $84.75
78015..............  Thyroid met imaging......  ..................  Z3................       3.1598      $130.82
78016..............  Thyroid met imaging/       CH................  Z3................       4.8221      $199.64
                      studies.
78018..............  Thyroid met imaging, body  ..................  Z2................       5.0681      $209.82
78020..............  Thyroid met uptake.......  CH................  N1................  ...........  ...........
78070..............  Parathyroid nuclear        CH................  Z3................       3.0692      $127.07
                      imaging.
78075..............  Adrenal nuclear imaging..  CH................  Z3................       6.9039      $285.83
78099..............  Endocrine nuclear          ..................  Z2................       2.0471       $84.75
                      procedure.
78102..............  Bone marrow imaging, ltd.  ..................  Z3................        2.477      $102.55

[[Page 67174]]

 
78103..............  Bone marrow imaging, mult  ..................  Z3................       3.4313      $142.06
78104..............  Bone marrow imaging, body  ..................  Z2................       3.9293      $162.68
78110..............  Plasma volume, single....  ..................  Z3................       1.2343       $51.10
78111..............  Plasma volume, multiple..  ..................  Z3................       1.9091       $79.04
78120..............  Red cell mass, single....  ..................  Z3................       1.5471       $64.05
78121..............  Red cell mass, multiple..  ..................  Z3................       2.0572       $85.17
78122..............  Blood volume.............  ..................  Z3................       2.7567      $114.13
78130..............  Red cell survival study..  ..................  Z3................       2.5263      $104.59
78135..............  Red cell survival          CH................  Z3................       5.4803      $226.89
                      kinetics.
78140..............  Red cell sequestration...  ..................  Z3................       2.7321      $113.11
78185..............  Spleen imaging...........  ..................  Z3................       3.0528      $126.39
78190..............  Platelet survival,         ..................  Z2................       2.9022      $120.15
                      kinetics.
78191..............  Platelet survival........  ..................  Z2................       2.9022      $120.15
78195..............  Lymph system imaging.....  ..................  Z2................       3.9293      $162.68
78199..............  Blood/lymph nuclear exam.  ..................  Z2................       3.9293      $162.68
78201..............  Liver imaging............  ..................  Z3................        2.806      $116.17
78202..............  Liver imaging with flow..  ..................  Z3................       3.3161      $137.29
78205..............  Liver imaging (3d).......  ..................  Z3................       4.4929      $186.01
78206..............  Liver image (3d) with      ..................  Z2................       4.4603      $184.66
                      flow.
78215..............  Liver and spleen imaging.  ..................  Z3................       3.1188      $129.12
78216..............  Liver & spleen image/flow  ..................  Z3................       2.5263      $104.59
78220..............  Liver function study.....  ..................  Z3................       2.7238      $112.77
78223..............  Hepatobiliary imaging....  ..................  Z2................       4.4603      $184.66
78230..............  Salivary gland imaging...  ..................  Z3................       2.5509      $105.61
78231..............  Serial salivary imaging..  ..................  Z3................       2.3864       $98.80
78232..............  Salivary gland function    ..................  Z3................       2.5345      $104.93
                      exam.
78258..............  Esophageal motility study  ..................  Z3................        3.341      $138.32
78261..............  Gastric mucosa imaging...  ..................  Z2................       3.7911      $156.96
78262..............  Gastroesophageal reflux    ..................  Z2................       3.7911      $156.96
                      exam.
78264..............  Gastric emptying study...  ..................  Z2................       3.7911      $156.96
78270..............  Vit b-12 absorption exam.  ..................  Z3................       1.4072       $58.26
78271..............  Vit b-12 absrp exam, int   ..................  Z3................       1.4236       $58.94
                      fac.
78272..............  Vit b-12 absorp, combined  ..................  Z3................       1.7693       $73.25
78278..............  Acute gi blood loss        ..................  Z2................       3.7911      $156.96
                      imaging.
78282..............  Gi protein loss exam.....  ..................  Z2................       3.7911      $156.96
78290..............  Meckels divert exam......  ..................  Z2................       3.7911      $156.96
78291..............  Leveen/shunt patency exam  ..................  Z3................       3.6617      $151.60
78299..............  Gi nuclear procedure.....  ..................  Z2................       3.7911      $156.96
78300..............  Bone imaging, limited      ..................  Z3................       2.6743      $110.72
                      area.
78305..............  Bone imaging, multiple     ..................  Z3................       3.6371      $150.58
                      areas.
78306..............  Bone imaging, whole body.  CH................  Z2................       3.8039      $157.49
78315..............  Bone imaging, 3 phase....  ..................  Z2................       3.8039      $157.49
78320..............  Bone imaging (3d)........  ..................  Z2................       3.8039      $157.49
78399..............  Musculoskeletal nuclear    ..................  Z2................       3.8039      $157.49
                      exam.
78414..............  Non-imaging heart          ..................  Z2................        4.862      $201.29
                      function.
78428..............  Cardiac shunt imaging....  ..................  Z3................       2.9458      $121.96
78445..............  Vascular flow imaging....  CH................  Z3................       2.5427      $105.27
78456..............  Acute venous thrombus      ..................  Z2................       3.1433      $130.14
                      image.
78457..............  Venous thrombosis imaging  CH................  Z3................       2.9048      $120.26
78458..............  Ven thrombosis images,     ..................  Z2................       3.1433      $130.14
                      bilat.
78459..............  Heart muscle imaging       ..................  Z2................      21.9955      $910.64
                      (pet).
78460..............  Heart muscle blood,        ..................  Z3................       2.7567      $114.13
                      single.
78461..............  Heart muscle blood,        ..................  Z3................       3.4231      $141.72
                      multiple.
78464..............  Heart image (3d), single.  CH................  Z3................         5.11      $211.56
78465..............  Heart image (3d),          CH................  Z3................       9.2657      $383.61
                      multiple.
78466..............  Heart infarct image......  ..................  Z3................       2.8391      $117.54
78468..............  Heart infarct image (ef).  ..................  Z3................       3.7523      $155.35
78469..............  Heart infarct image (3d).  CH................  Z3................       4.5506      $188.40
78472..............  Gated heart, planar,       CH................  Z3................       4.5753      $189.42
                      single.
78473..............  Gated heart, multiple....  ..................  Z2................        4.862      $201.29
78478..............  Heart wall motion add-on.  CH................  N1................  ...........  ...........
78480..............  Heart function add-on....  CH................  N1................  ...........  ...........
78481..............  Heart first pass, single.  ..................  Z3................        4.032      $166.93
78483..............  Heart first pass,          ..................  Z2................        4.862      $201.29
                      multiple.
78491..............  Heart image (pet), single  ..................  Z2................      21.9955      $910.64
78492..............  Heart image (pet),         ..................  Z2................      21.9955      $910.64
                      multiple.
78494..............  Heart image, spect.......  ..................  Z2................        4.862      $201.29
78496..............  Heart first pass add-on..  CH................  N1................  ...........  ...........

[[Page 67175]]

 
78499..............  Cardiovascular nuclear     ..................  Z2................        4.862      $201.29
                      exam.
78580..............  Lung perfusion imaging...  CH................  Z3................       3.4149      $141.38
78584..............  Lung v/q image single      ..................  Z3................       2.4111       $99.82
                      breath.
78585..............  Lung v/q imaging.........  ..................  Z2................       4.9509      $204.97
78586..............  Aerosol lung image,        ..................  Z3................       2.7238      $112.77
                      single.
78587..............  Aerosol lung image,        ..................  Z3................       3.3161      $137.29
                      multiple.
78588..............  Perfusion lung image.....  ..................  Z3................       4.7233      $195.55
78591..............  Vent image, 1 breath, 1    ..................  Z3................       2.8306      $117.19
                      proj.
78593..............  Vent image, 1 proj, gas..  ..................  Z3................       3.3328      $137.98
78594..............  Vent image, mult proj,     ..................  Z2................       3.3954      $140.57
                      gas.
78596..............  Lung differential          ..................  Z2................       4.9509      $204.97
                      function.
78599..............  Respiratory nuclear exam.  ..................  Z2................       3.3954      $140.57
78600..............  Brain image < 4 views....  ..................  Z3................       2.9294      $121.28
78601..............  Brain image w/flow < 4     CH................  Z2................       3.2295      $133.70
                      views.
78605..............  Brain image 4+ views.....  ..................  Z3................       3.3161      $137.29
78606..............  Brain image w/flow 4 +     CH................  Z3................       5.0115      $207.48
                      views.
78607..............  Brain imaging (3d).......  CH................  Z3................       6.0728      $251.42
78608..............  Brain imaging (pet)......  ..................  Z2................      16.6001      $687.26
78610..............  Brain flow imaging only..  ..................  Z3................       3.3738      $139.68
78615..............  Cerebral vascular flow     CH................  D5................  ...........  ...........
                      image.
78630..............  Cerebrospinal fluid scan.  CH................  Z3................       5.5298      $228.94
78635..............  Csf ventriculography.....  CH................  Z3................       4.5753      $189.42
78645..............  Csf shunt evaluation.....  ..................  Z2................       3.2295      $133.70
78647..............  Cerebrospinal fluid scan.  CH................  Z3................       5.8177      $240.86
78650..............  Csf leakage imaging......  CH................  Z3................       5.3405      $221.10
78660..............  Nuclear exam of tear flow  ..................  Z3................       2.5509      $105.61
78699..............  Nervous system nuclear     ..................  Z2................       3.2295      $133.70
                      exam.
78700..............  Kidney imaging, morphol..  ..................  Z3................       2.9953      $124.01
78701..............  Kidney imaging with flow.  ..................  Z3................       3.6043      $149.22
78707..............  K flow/funct image w/o     CH................  Z3................       3.9581      $163.87
                      drug.
78708..............  K flow/funct image w/drug  ..................  Z3................       3.0941      $128.10
78709..............  K flow/funct image,        ..................  Z2................       5.0824      $210.42
                      multiple.
78710..............  Kidney imaging (3d)......  CH................  Z3................       4.5093      $186.69
78725..............  Kidney function study....  CH................  Z3................       1.6541       $68.48
78730..............  Urinary bladder retention  CH................  Z3................       1.3908       $57.58
78740..............  Ureteral reflux study....  ..................  Z3................       3.1188      $129.12
78761..............  Testicular imaging w/flow  ..................  Z3................       3.2915      $136.27
78799..............  Genitourinary nuclear      ..................  Z2................       5.0824      $210.42
                      exam.
78800..............  Tumor imaging, limited     ..................  Z3................       3.0941      $128.10
                      area.
78801..............  Tumor imaging, mult areas  ..................  Z3................       4.1144      $170.34
78802..............  Tumor imaging, whole body  CH................  Z3................       5.5052      $227.92
78803..............  Tumor imaging (3d).......  CH................  Z3................       6.0564      $250.74
78804..............  Tumor imaging, whole body  CH................  Z3................         10.5      $434.71
78805..............  Abscess imaging, ltd area  ..................  Z3................       3.0364      $125.71
78806..............  Abscess imaging, whole     CH................  Z3................       5.9576      $246.65
                      body.
78807..............  Nuclear localization/      CH................  Z3................       6.0482      $250.40
                      abscess.
78811..............  Pet image, ltd area......  ..................  Z2................      16.6001      $687.26
78812..............  Pet image, skull-thigh...  ..................  Z2................      16.6001      $687.26
78813..............  Pet image, full body.....  ..................  Z2................      16.6001      $687.26
78814..............  Pet image w/ct, lmtd.....  ..................  Z2................      16.6001      $687.26
78815..............  Pet image w/ct, skull-     ..................  Z2................      16.6001      $687.26
                      thigh.
78816..............  Pet image w/ct, full body  ..................  Z2................      16.6001      $687.26
78890..............  Nuclear medicine data      ..................  N1................  ...........  ...........
                      proc.
78891..............  Nuclear med data proc....  ..................  N1................  ...........  ...........
78999..............  Nuclear diagnostic exam..  ..................  Z2................        1.819       $75.31
79005..............  Nuclear rx, oral admin...  ..................  Z3................       1.5963       $66.09
79101..............  Nuclear rx, iv admin.....  ..................  Z3................       1.6623       $68.82
79200..............  Nuclear rx, intracav       ..................  Z3................        1.728       $71.54
                      admin.
79300..............  Nuclr rx, interstit        ..................  Z2................        3.302      $136.71
                      colloid.
79403..............  Hematopoietic nuclear tx.  ..................  Z3................       2.6497      $109.70
79440..............  Nuclear rx, intra-         ..................  Z3................       1.5553       $64.39
                      articular.
79445..............  Nuclear rx, intra-         ..................  Z2................        3.302      $136.71
                      arterial.
79999..............  Nuclear medicine therapy.  ..................  Z2................        3.302      $136.71
90296..............  Diphtheria antitoxin.....  CH................  N1................  ...........  ...........
90371..............  Hep b ig, im.............  ..................  K2................  ...........      $122.02
90375..............  Rabies ig, im/sc.........  ..................  K2................  ...........       $68.22
90376..............  Rabies ig, heat treated..  ..................  K2................  ...........       $71.69
90385..............  Rh ig, minidose, im......  CH................  N1................  ...........  ...........

[[Page 67176]]

 
90393..............  Vaccina ig, im...........  CH................  N1................  ...........  ...........
90396..............  Varicella-zoster ig, im..  ..................  K2................  ...........      $122.74
90476..............  Adenovirus vaccine, type   CH................  N1................  ...........  ...........
                      4.
90477..............  Adenovirus vaccine, type   CH................  N1................  ...........  ...........
                      7.
90581..............  Anthrax vaccine, sc......  CH................  N1................  ...........  ...........
90585..............  Bcg vaccine, percut......  ..................  K2................  ...........      $118.98
90632..............  Hep a vaccine, adult im..  CH................  N1................  ...........  ...........
90633..............  Hep a vacc, ped/adol, 2    CH................  N1................  ...........  ...........
                      dose.
90634..............  Hep a vacc, ped/adol, 3    CH................  N1................  ...........  ...........
                      dose.
90636..............  Hep a/hep b vacc, adult    CH................  N1................  ...........  ...........
                      im.
90645..............  Hib vaccine, hboc, im....  CH................  N1................  ...........  ...........
90646..............  Hib vaccine, prp-d, im...  CH................  N1................  ...........  ...........
90647..............  Hib vaccine, prp-omp, im.  CH................  N1................  ...........  ...........
90648..............  Hib vaccine, prp-t, im...  CH................  N1................  ...........  ...........
90665..............  Lyme disease vaccine, im.  CH................  N1................  ...........  ...........
90675..............  Rabies vaccine, im.......  ..................  K2................  ...........      $150.80
90676..............  Rabies vaccine, id.......  ..................  K2................  ...........      $119.86
90680..............  Rotovirus vacc 3 dose,     CH................  N1................  ...........  ...........
                      oral.
90690..............  Typhoid vaccine, oral....  CH................  N1................  ...........  ...........
90691..............  Typhoid vaccine, im......  CH................  N1................  ...........  ...........
90692..............  Typhoid vaccine, h-p, sc/  CH................  N1................  ...........  ...........
                      id.
90698..............  Dtap-hib-ip vaccine, im..  CH................  N1................  ...........  ...........
90700..............  Dtap vaccine, < 7 yrs, im  CH................  N1................  ...........  ...........
90701..............  Dtp vaccine, im..........  CH................  N1................  ...........  ...........
90702..............  Dt vaccine < 7, im.......  CH................  N1................  ...........  ...........
90703..............  Tetanus vaccine, im......  CH................  N1................  ...........  ...........
90704..............  Mumps vaccine, sc........  CH................  N1................  ...........  ...........
90705..............  Measles vaccine, sc......  CH................  N1................  ...........  ...........
90706..............  Rubella vaccine, sc......  CH................  N1................  ...........  ...........
90707..............  Mmr vaccine, sc..........  CH................  N1................  ...........  ...........
90708..............  Measles-rubella vaccine,   ..................  K2................  ...........       $45.53
                      sc.
90710..............  Mmrv vaccine, sc.........  CH................  N1................  ...........  ...........
90712..............  Oral poliovirus vaccine..  CH................  N1................  ...........  ...........
90713..............  Poliovirus, ipv, sc/im...  CH................  N1................  ...........  ...........
90714..............  Td vaccine no prsrv >/= 7  CH................  N1................  ...........  ...........
                      im.
90715..............  Tdap vaccine >7 im.......  CH................  N1................  ...........  ...........
90717..............  Yellow fever vaccine, sc.  CH................  N1................  ...........  ...........
90718..............  Td vaccine > 7, im.......  CH................  N1................  ...........  ...........
90719..............  Diphtheria vaccine, im...  CH................  N1................  ...........  ...........
90720..............  Dtp/hib vaccine, im......  CH................  N1................  ...........  ...........
90721..............  Dtap/hib vaccine, im.....  CH................  N1................  ...........  ...........
90725..............  Cholera vaccine,           CH................  N1................  ...........  ...........
                      injectable.
90727..............  Plague vaccine, im.......  CH................  N1................  ...........  ...........
90733..............  Meningococcal vaccine, sc  ..................  K2................  ...........       $85.29
90734..............  Meningococcal vaccine, im  ..................  K2................  ...........       $82.00
90735..............  Encephalitis vaccine, sc.  ..................  K2................  ...........       $98.17
90749..............  Vaccine toxoid...........  CH................  N1................  ...........  ...........
A4218..............  Sterile saline or water..  ..................  N1................  ...........  ...........
A4220..............  Infusion pump refill kit.  ..................  N1................  ...........  ...........
A4248..............  Chlorhexidine antisept...  ..................  N1................  ...........  ...........
A4262..............  Temporary tear duct plug.  ..................  N1................  ...........  ...........
A4263..............  Permanent tear duct plug.  ..................  N1................  ...........  ...........
A4270..............  Disposable endoscope       ..................  N1................  ...........  ...........
                      sheath.
A4300..............  Cath impl vasc access      ..................  N1................  ...........  ...........
                      portal.
A4301..............  Implantable access syst    ..................  N1................  ...........  ...........
                      perc.
A4305..............  Drug delivery system >=50  ..................  N1................  ...........  ...........
                      ML.
A4306..............  Drug delivery system <=50  ..................  N1................  ...........  ...........
                      ml.
A4648..............  Implantable tissue marker  NI................  N1................  ...........  ...........
A4650..............  Implant radiation          NI................  N1................  ...........  ...........
                      dosimeter.
A9527..............  Iodine I-125 sodium        CH................  H2................       0.4325       $27.55
                      iodide.
A9535..............  Injection, methylene blue  CH................  N1................  ...........  ...........
A9576..............  Inj prohance multipack...  NI................  N1................  ...........  ...........
A9577..............  Inj multihance...........  NI................  N1................  ...........  ...........
A9578..............  Inj multihance multipack.  NI................  N1................  ...........  ...........
A9579..............  Gad-base MR contrast       NI................  N1................  ...........  ...........
                      NOS,1ml.
A9698..............  Non-rad contrast           ..................  N1................  ...........  ...........
                      materialNOC.
C1713..............  Anchor/screw bn/bn,tis/bn  ..................  N1................  ...........  ...........
C1714..............  Cath, trans atherectomy,   ..................  N1................  ...........  ...........
                      dir.

[[Page 67177]]

 
C1715..............  Brachytherapy needle.....  ..................  N1................  ...........  ...........
C1716..............  Brachytx, non-str, Gold-   CH................  H2................       0.5228       $33.30
                      198.
C1717..............  Brachytx, non-str,HDR Ir-  CH................  H2................       2.7505      $175.19
                      192.
C1719..............  Brachytx, NS, Non-HDRIr-   CH................  H2................       1.0226       $65.13
                      192.
C1721..............  AICD, dual chamber.......  ..................  N1................  ...........  ...........
C1722..............  AICD, single chamber.....  ..................  N1................  ...........  ...........
C1724..............  Cath, trans                ..................  N1................  ...........  ...........
                      atherec,rotation.
C1725..............  Cath, translumin non-      ..................  N1................  ...........  ...........
                      laser.
C1726..............  Cath, bal dil, non-        ..................  N1................  ...........  ...........
                      vascular.
C1727..............  Cath, bal tis dis, non-    ..................  N1................  ...........  ...........
                      vas.
C1728..............  Cath, brachytx seed adm..  ..................  N1................  ...........  ...........
C1729..............  Cath, drainage...........  ..................  N1................  ...........  ...........
C1730..............  Cath, EP, 19 or few elect  ..................  N1................  ...........  ...........
C1731..............  Cath, EP, 20 or more elec  ..................  N1................  ...........  ...........
C1732..............  Cath, EP, diag/abl, 3D/    ..................  N1................  ...........  ...........
                      vect.
C1733..............  Cath, EP, othr than cool-  ..................  N1................  ...........  ...........
                      tip.
C1750..............  Cath, hemodialysis,long-   ..................  N1................  ...........  ...........
                      term.
C1751..............  Cath, inf, per/cent/       ..................  N1................  ...........  ...........
                      midline.
C1752..............  Cath,hemodialysis,short-   ..................  N1................  ...........  ...........
                      term.
C1753..............  Cath, intravas ultrasound  ..................  N1................  ...........  ...........
C1754..............  Catheter, intradiscal....  ..................  N1................  ...........  ...........
C1755..............  Catheter, intraspinal....  ..................  N1................  ...........  ...........
C1756..............  Cath, pacing, transesoph.  ..................  N1................  ...........  ...........
C1757..............  Cath, thrombectomy/        ..................  N1................  ...........  ...........
                      embolect.
C1758..............  Catheter, ureteral.......  ..................  N1................  ...........  ...........
C1759..............  Cath, intra                ..................  N1................  ...........  ...........
                      echocardiography.
C1760..............  Closure dev, vasc........  ..................  N1................  ...........  ...........
C1762..............  Conn tiss, human(inc       ..................  N1................  ...........  ...........
                      fascia).
C1763..............  Conn tiss, non-human.....  ..................  N1................  ...........  ...........
C1764..............  Event recorder, cardiac..  ..................  N1................  ...........  ...........
C1765..............  Adhesion barrier.........  ..................  N1................  ...........  ...........
C1766..............  Intro/sheath,strble,non-   ..................  N1................  ...........  ...........
                      peel.
C1767..............  Generator, neuro non-      ..................  N1................  ...........  ...........
                      recharg.
C1768..............  Graft, vascular..........  ..................  N1................  ...........  ...........
C1769..............  Guide wire...............  ..................  N1................  ...........  ...........
C1770..............  Imaging coil, MR,          ..................  N1................  ...........  ...........
                      insertable.
C1771..............  Rep dev, urinary, w/sling  ..................  N1................  ...........  ...........
C1772..............  Infusion pump,             ..................  N1................  ...........  ...........
                      programmable.
C1773..............  Ret dev, insertable......  ..................  N1................  ...........  ...........
C1776..............  Joint device               ..................  N1................  ...........  ...........
                      (implantable).
C1777..............  Lead, AICD, endo single    ..................  N1................  ...........  ...........
                      coil.
C1778..............  Lead, neurostimulator....  ..................  N1................  ...........  ...........
C1779..............  Lead, pmkr, transvenous    ..................  N1................  ...........  ...........
                      VDD.
C1780..............  Lens, intraocular (new     ..................  N1................  ...........  ...........
                      tech).
C1781..............  Mesh (implantable).......  ..................  N1................  ...........  ...........
C1782..............  Morcellator..............  ..................  N1................  ...........  ...........
C1783..............  Ocular imp, aqueous drain  ..................  N1................  ...........  ...........
                      de.
C1784..............  Ocular dev, intraop, det   ..................  N1................  ...........  ...........
                      ret.
C1785..............  Pmkr, dual, rate-resp....  ..................  N1................  ...........  ...........
C1786..............  Pmkr, single, rate-resp..  ..................  N1................  ...........  ...........
C1787..............  Patient progr, neurostim.  ..................  N1................  ...........  ...........
C1788..............  Port, indwelling, imp....  ..................  N1................  ...........  ...........
C1789..............  Prosthesis, breast, imp..  ..................  N1................  ...........  ...........
C1813..............  Prosthesis, penile,        ..................  N1................  ...........  ...........
                      inflatab.
C1814..............  Retinal tamp, silicone     ..................  N1................  ...........  ...........
                      oil.
C1815..............  Pros, urinary sph, imp...  ..................  N1................  ...........  ...........
C1816..............  Receiver/transmitter,      ..................  N1................  ...........  ...........
                      neuro.
C1817..............  Septal defect imp sys....  ..................  N1................  ...........  ...........
C1818..............  Integrated                 ..................  N1................  ...........  ...........
                      keratoprosthesis.
C1819..............  Tissue localization-       ..................  N1................  ...........  ...........
                      excision.
C1820..............  Generator neuro rechg bat  CH................  N1................  ...........  ...........
                      sy.
C1821..............  Interspinous implant.....  ..................  J7................  ...........  ...........
C1874..............  Stent, coated/cov w/del    ..................  N1................  ...........  ...........
                      sys.
C1875..............  Stent, coated/cov w/o del  ..................  N1................  ...........  ...........
                      sy.
C1876..............  Stent, non-coa/non-cov w/  ..................  N1................  ...........  ...........
                      del.
C1877..............  Stent, non-coat/cov w/o    ..................  N1................  ...........  ...........
                      del.
C1878..............  Matrl for vocal cord.....  ..................  N1................  ...........  ...........
C1879..............  Tissue marker,             ..................  N1................  ...........  ...........
                      implantable.

[[Page 67178]]

 
C1880..............  Vena cava filter.........  ..................  N1................  ...........  ...........
C1881..............  Dialysis access system...  ..................  N1................  ...........  ...........
C1882..............  AICD, other than sing/     ..................  N1................  ...........  ...........
                      dual.
C1883..............  Adapt/ext, pacing/neuro    ..................  N1................  ...........  ...........
                      lead.
C1884..............  Embolization Protect syst  ..................  N1................  ...........  ...........
C1885..............  Cath, translumin angio     ..................  N1................  ...........  ...........
                      laser.
C1887..............  Catheter, guiding........  ..................  N1................  ...........  ...........
C1888..............  Endovas non-cardiac abl    ..................  N1................  ...........  ...........
                      cath.
C1891..............  Infusion pump,non-prog,    ..................  N1................  ...........  ...........
                      perm.
C1892..............  Intro/sheath,fixed,peel-   ..................  N1................  ...........  ...........
                      away.
C1893..............  Intro/sheath, fixed,non-   ..................  N1................  ...........  ...........
                      peel.
C1894..............  Intro/sheath, non-laser..  ..................  N1................  ...........  ...........
C1895..............  Lead, AICD, endo dual      ..................  N1................  ...........  ...........
                      coil.
C1896..............  Lead, AICD, non sing/dual  ..................  N1................  ...........  ...........
C1897..............  Lead, neurostim test kit.  ..................  N1................  ...........  ...........
C1898..............  Lead, pmkr, other than     ..................  N1................  ...........  ...........
                      trans.
C1899..............  Lead, pmkr/AICD            ..................  N1................  ...........  ...........
                      combination.
C1900..............  Lead, coronary venous....  ..................  N1................  ...........  ...........
C2614..............  Probe, perc lumb disc....  ..................  N1................  ...........  ...........
C2615..............  Sealant, pulmonary,        ..................  N1................  ...........  ...........
                      liquid.
C2616..............  Brachytx, non-str,Yttrium- CH................  H2................     184.7105   $11,764.95
                      90.
C2617..............  Stent, non-cor, tem w/o    ..................  N1................  ...........  ...........
                      del.
C2618..............  Probe, cryoablation......  ..................  N1................  ...........  ...........
C2619..............  Pmkr, dual, non rate-resp  ..................  N1................  ...........  ...........
C2620..............  Pmkr, single, non rate-    ..................  N1................  ...........  ...........
                      resp.
C2621..............  Pmkr, other than sing/     ..................  N1................  ...........  ...........
                      dual.
C2622..............  Prosthesis, penile, non-   ..................  N1................  ...........  ...........
                      inf.
C2625..............  Stent, non-cor, tem w/del  ..................  N1................  ...........  ...........
                      sy.
C2626..............  Infusion pump, non-        ..................  N1................  ...........  ...........
                      prog,temp.
C2627..............  Cath, suprapubic/          ..................  N1................  ...........  ...........
                      cystoscopic.
C2628..............  Catheter, occlusion......  ..................  N1................  ...........  ...........
C2629..............  Intro/sheath, laser......  ..................  N1................  ...........  ...........
C2630..............  Cath, EP, cool-tip.......  ..................  N1................  ...........  ...........
C2631..............  Rep dev, urinary, w/o      ..................  N1................  ...........  ...........
                      sling.
C2634..............  Brachytx, non-str, HA, I-  CH................  H2................       0.4858       $30.94
                      125.
C2635..............  Brachytx, non-str, HA, P-  CH................  H2................       0.7366       $46.92
                      103.
C2636..............  Brachy linear, non-str,P-  CH................  H2................         0.66       $42.04
                      103.
C2638..............  Brachytx, stranded, I-125  CH................  H2................       0.7113       $45.31
C2639..............  Brachytx, non-stranded,I-  CH................  H2................       0.5039       $32.10
                      125.
C2640..............  Brachytx, stranded, P-103  CH................  H2................       1.0308       $65.66
C2641..............  Brachytx, non-stranded,P-  CH................  H2................       0.8077       $51.45
                      103.
C2642..............  Brachytx, stranded, C-131  CH................  H2................       1.5342       $97.72
C2643..............  Brachytx, non-stranded,C-  CH................  H2................        1.006       $64.08
                      131.
C2698..............  Brachytx, stranded, NOS..  CH................  H2................       0.7113       $45.31
C2699..............  Brachytx, non-stranded,    CH................  H2................       0.4858       $30.94
                      NOS.
C8900..............  MRA w/cont, abd..........  ..................  Z2................        6.235      $258.14
C8901..............  MRA w/o cont, abd........  ..................  Z2................       5.3933      $223.29
C8902..............  MRA w/o fol w/cont, abd..  ..................  Z2................       8.2463      $341.41
C8903..............  MRI w/cont, breast, uni..  ..................  Z2................        6.235      $258.14
C8904..............  MRI w/o cont, breast, uni  ..................  Z2................       5.3933      $223.29
C8905..............  MRI w/o fol w/cont, brst,  ..................  Z2................       8.2463      $341.41
                      un.
C8906..............  MRI w/cont, breast, bi...  ..................  Z2................        6.235      $258.14
C8907..............  MRI w/o cont, breast, bi.  ..................  Z2................       5.3933      $223.29
C8908..............  MRI w/o fol w/cont,        ..................  Z2................       8.2463      $341.41
                      breast,.
C8909..............  MRA w/cont, chest........  ..................  Z2................        6.235      $258.14
C8910..............  MRA w/o cont, chest......  ..................  Z2................       5.3933      $223.29
C8911..............  MRA w/o fol w/cont, chest  ..................  Z2................       8.2463      $341.41
C8912..............  MRA w/cont, lwr ext......  ..................  Z2................        6.235      $258.14
C8913..............  MRA w/o cont, lwr ext....  ..................  Z2................       5.3933      $223.29
C8914..............  MRA w/o fol w/cont, lwr    ..................  Z2................       8.2463      $341.41
                      ext.
C8918..............  MRA w/cont, pelvis.......  ..................  Z2................        6.235      $258.14
C8919..............  MRA w/o cont, pelvis.....  ..................  Z2................       5.3933      $223.29
C8920..............  MRA w/o fol w/cont,        ..................  Z2................       8.2463      $341.41
                      pelvis.
C9003..............  Palivizumab, per 50 mg...  ..................  K2................  ...........      $810.67
C9113..............  Inj pantoprazole sodium,   ..................  N1................  ...........  ...........
                      via.
C9121..............  Injection, argatroban....  ..................  K2................  ...........       $18.96
C9232..............  Injection, idursulfase...  CH................  D5................  ...........  ...........
C9233..............  Injection, ranibizumab...  CH................  D5................  ...........  ...........

[[Page 67179]]

 
C9234..............  Inj, alglucosidase alfa..  CH................  D5................  ...........  ...........
C9235..............  Injection, panitumumab...  CH................  D5................  ...........  ...........
C9238..............  Inj, levetiracetam.......  NI................  K2................  ...........        $6.30
C9239..............  Inj, temsirolimus........  NI................  K2................  ...........       $48.41
C9350..............  Porous collagen tube per   CH................  D5................  ...........  ...........
                      cm.
C9351..............  Acellular derm tissue      CH................  D5................  ...........  ...........
                      percm2.
C9352..............  Neuragen nerve guide, per  NI................  K2................  ...........      $482.56
                      cm.
C9353..............  Neurawrap nerve            NI................  K2................  ...........      $482.56
                      protector,cm.
C9399..............  Unclassified drugs or      ..................  K7................  ...........  ...........
                      biolog.
E0616..............  Cardiac event recorder...  ..................  N1................  ...........  ...........
E0749..............  Elec osteogen stim         ..................  N1................  ...........  ...........
                      implanted.
E0782..............  Non-programble infusion    ..................  N1................  ...........  ...........
                      pump.
E0783..............  Programmable infusion      ..................  N1................  ...........  ...........
                      pump.
E0785..............  Replacement impl pump      ..................  N1................  ...........  ...........
                      cathet.
E0786..............  Implantable pump           ..................  N1................  ...........  ...........
                      replacement.
G0130..............  Single energy x-ray study  ..................  Z3................       0.5266       $21.80
G0173..............  Linear acc stereo radsur   ..................  Z2................      61.6965    $2,554.30
                      com.
G0251..............  Linear acc based stero     ..................  Z2................      16.5911      $686.89
                      radio.
G0288..............  Recon, CTA for surg plan.  CH................  N1................  ...........  ...........
G0339..............  Robot lin-radsurg com,     ..................  Z2................      61.6965    $2,554.30
                      first.
G0340..............  Robt lin-radsurg fractx 2- ..................  Z2................      45.0693    $1,865.91
                      5.
J0120..............  Tetracyclin injection....  ..................  N1................  ...........  ...........
J0128..............  Abarelix injection.......  ..................  K2................  ...........       $67.97
J0129..............  Abatacept injection......  ..................  K2................  ...........       $18.69
J0130..............  Abciximab injection......  ..................  K2................  ...........      $420.17
J0132..............  Acetylcysteine injection.  CH................  N1................  ...........  ...........
J0133..............  Acyclovir injection......  ..................  N1................  ...........  ...........
J0135..............  Adalimumab injection.....  ..................  K2................  ...........      $329.58
J0150..............  Injection adenosine 6 MG.  ..................  K2................  ...........       $25.10
J0152..............  Adenosine injection......  ..................  K2................  ...........       $67.89
J0170..............  Adrenalin epinephrin       ..................  N1................  ...........  ...........
                      inject.
J0180..............  Agalsidase beta injection  ..................  K2................  ...........      $126.00
J0190..............  Inj biperiden lactate/5    ..................  K2................  ...........       $88.15
                      mg.
J0200..............  Alatrofloxacin mesylate..  ..................  N1................  ...........  ...........
J0205..............  Alglucerase injection....  ..................  K2................  ...........       $38.85
J0207..............  Amifostine...............  ..................  K2................  ...........      $490.93
J0210..............  Methyldopate hcl           ..................  K2................  ...........       $13.04
                      injection.
J0215..............  Alefacept................  ..................  K2................  ...........       $26.47
J0220..............  Aglucosidase alfa          NI................  K2................  ...........      $126.00
                      injection.
J0256..............  Alpha 1 proteinase         ..................  K2................  ...........        $3.28
                      inhibitor.
J0278..............  Amikacin sulfate           ..................  N1................  ...........  ...........
                      injection.
J0280..............  Aminophyllin 250 MG inj..  ..................  N1................  ...........  ...........
J0282..............  Amiodarone HCl...........  ..................  N1................  ...........  ...........
J0285..............  Amphotericin B...........  ..................  N1................  ...........  ...........
J0287..............  Amphotericin b lipid       ..................  K2................  ...........       $10.40
                      complex.
J0288..............  Ampho b cholesteryl        ..................  K2................  ...........       $11.89
                      sulfate.
J0289..............  Amphotericin b liposome    ..................  K2................  ...........       $16.21
                      inj.
J0290..............  Ampicillin 500 MG inj....  ..................  N1................  ...........  ...........
J0295..............  Ampicillin sodium per 1.5  ..................  N1................  ...........  ...........
                      gm.
J0300..............  Amobarbital 125 MG inj...  ..................  N1................  ...........  ...........
J0330..............  Succinycholine chloride    ..................  N1................  ...........  ...........
                      inj.
J0348..............  Anadulafungin injection..  ..................  K2................  ...........        $1.91
J0350..............  Injection anistreplase 30  ..................  K2................  ...........    $2,693.80
                      u.
J0360..............  Hydralazine hcl injection  ..................  N1................  ...........  ...........
J0364..............  Apomorphine hydrochloride  CH................  N1................  ...........  ...........
J0365..............  Aprotonin, 10,000 kiu....  ..................  K2................  ...........        $2.66
J0380..............  Inj metaraminol            CH................  N1................  ...........  ...........
                      bitartrate.
J0390..............  Chloroquine injection....  ..................  N1................  ...........  ...........
J0395..............  Arbutamine HCl injection.  CH................  N1................  ...........  ...........
J0400..............  Aripiprazole injection...  NI................  K2................  ...........        $0.28
J0456..............  Azithromycin.............  ..................  N1................  ...........  ...........
J0460..............  Atropine sulfate           ..................  N1................  ...........  ...........
                      injection.
J0470..............  Dimecaprol injection.....  ..................  N1................  ...........  ...........
J0475..............  Baclofen 10 MG injection.  ..................  K2................  ...........      $193.29
J0476..............  Baclofen intrathecal       ..................  K2................  ...........       $69.73
                      trial.
J0480..............  Basiliximab..............  ..................  K2................  ...........    $1,541.03
J0500..............  Dicyclomine injection....  ..................  N1................  ...........  ...........
J0515..............  Inj benztropine mesylate.  ..................  N1................  ...........  ...........

[[Page 67180]]

 
J0520..............  Bethanechol chloride       ..................  N1................  ...........  ...........
                      inject.
J0530..............  Penicillin g benzathine    ..................  N1................  ...........  ...........
                      inj.
J0540..............  Penicillin g benzathine    ..................  N1................  ...........  ...........
                      inj.
J0550..............  Penicillin g benzathine    ..................  N1................  ...........  ...........
                      inj.
J0560..............  Penicillin g benzathine    ..................  N1................  ...........  ...........
                      inj.
J0570..............  Penicillin g benzathine    ..................  N1................  ...........  ...........
                      inj.
J0580..............  Penicillin g benzathine    ..................  N1................  ...........  ...........
                      inj.
J0583..............  Bivalirudin..............  ..................  K2................  ...........        $1.84
J0585..............  Botulinum toxin a per      ..................  K2................  ...........        $5.21
                      unit.
J0587..............  Botulinum toxin type B...  ..................  K2................  ...........        $8.63
J0592..............  Buprenorphine              ..................  N1................  ...........  ...........
                      hydrochloride.
J0594..............  Busulfan injection.......  ..................  K2................  ...........        $9.17
J0595..............  Butorphanol tartrate 1 mg  ..................  N1................  ...........  ...........
J0600..............  Edetate calcium disodium   ..................  K2................  ...........       $49.64
                      inj.
J0610..............  Calcium gluconate          ..................  N1................  ...........  ...........
                      injection.
J0620..............  Calcium glycer & lact/10   ..................  N1................  ...........  ...........
                      ML.
J0630..............  Calcitonin salmon          ..................  N1................  ...........  ...........
                      injection.
J0636..............  Inj calcitriol per 0.1     ..................  N1................  ...........  ...........
                      mcg.
J0637..............  Caspofungin acetate......  ..................  K2................  ...........       $24.05
J0640..............  Leucovorin calcium         ..................  N1................  ...........  ...........
                      injection.
J0670..............  Inj mepivacaine HCL/10 ml  ..................  N1................  ...........  ...........
J0690..............  Cefazolin sodium           ..................  N1................  ...........  ...........
                      injection.
J0692..............  Cefepime HCl for           ..................  N1................  ...........  ...........
                      injection.
J0694..............  Cefoxitin sodium           ..................  N1................  ...........  ...........
                      injection.
J0696..............  Ceftriaxone sodium         ..................  N1................  ...........  ...........
                      injection.
J0697..............  Sterile cefuroxime         ..................  N1................  ...........  ...........
                      injection.
J0698..............  Cefotaxime sodium          ..................  N1................  ...........  ...........
                      injection.
J0702..............  Betamethasone acet&sod     ..................  N1................  ...........  ...........
                      phosp.
J0704..............  Betamethasone sod phosp/4  ..................  N1................  ...........  ...........
                      MG.
J0706..............  Caffeine citrate           CH................  N1................  ...........  ...........
                      injection.
J0710..............  Cephapirin sodium          ..................  N1................  ...........  ...........
                      injection.
J0713..............  Inj ceftazidime per 500    ..................  N1................  ...........  ...........
                      mg.
J0715..............  Ceftizoxime sodium / 500   ..................  N1................  ...........  ...........
                      MG.
J0720..............  Chloramphenicol sodium     ..................  N1................  ...........  ...........
                      injec.
J0725..............  Chorionic gonadotropin/    ..................  N1................  ...........  ...........
                      1000u.
J0735..............  Clonidine hydrochloride..  ..................  K2................  ...........       $62.78
J0740..............  Cidofovir injection......  ..................  K2................  ...........      $754.39
J0743..............  Cilastatin sodium          ..................  N1................  ...........  ...........
                      injection.
J0744..............  Ciprofloxacin iv.........  ..................  N1................  ...........  ...........
J0745..............  Inj codeine phosphate /30  ..................  N1................  ...........  ...........
                      MG.
J0760..............  Colchicine injection.....  ..................  N1................  ...........  ...........
J0770..............  Colistimethate sodium inj  ..................  N1................  ...........  ...........
J0780..............  Prochlorperazine           ..................  N1................  ...........  ...........
                      injection.
J0795..............  Corticorelin ovine         ..................  K2................  ...........        $4.43
                      triflutal.
J0800..............  Corticotropin injection..  ..................  K2................  ...........      $169.77
J0835..............  Inj cosyntropin per 0.25   ..................  K2................  ...........       $64.01
                      MG.
J0850..............  Cytomegalovirus imm IV /   ..................  K2................  ...........      $870.53
                      vial.
J0878..............  Daptomycin injection.....  ..................  K2................  ...........        $0.35
J0881..............  Darbepoetin alfa, non-     ..................  K2................  ...........        $2.88
                      esrd.
J0885..............  Epoetin alfa, non-esrd...  ..................  K2................  ...........        $8.97
J0894..............  Decitabine injection.....  ..................  K2................  ...........       $26.48
J0895..............  Deferoxamine mesylate inj  CH................  N1................  ...........  ...........
J0900..............  Testosterone enanthate     ..................  N1................  ...........  ...........
                      inj.
J0945..............  Brompheniramine maleate    ..................  N1................  ...........  ...........
                      inj.
J0970..............  Estradiol valerate         ..................  N1................  ...........  ...........
                      injection.
J1000..............  Depo-estradiol cypionate   ..................  N1................  ...........  ...........
                      inj.
J1020..............  Methylprednisolone 20 MG   ..................  N1................  ...........  ...........
                      inj.
J1030..............  Methylprednisolone 40 MG   ..................  N1................  ...........  ...........
                      inj.
J1040..............  Methylprednisolone 80 MG   ..................  N1................  ...........  ...........
                      inj.
J1051..............  Medroxyprogesterone inj..  ..................  N1................  ...........  ...........
J1060..............  Testosterone cypionate 1   ..................  N1................  ...........  ...........
                      ML.
J1070..............  Testosterone cypionat 100  ..................  N1................  ...........  ...........
                      MG.
J1080..............  Testosterone cypionat 200  ..................  N1................  ...........  ...........
                      MG.
J1094..............  Inj dexamethasone acetate  ..................  N1................  ...........  ...........
J1100..............  Dexamethasone sodium phos  ..................  N1................  ...........  ...........
J1110..............  Inj dihydroergotamine      ..................  N1................  ...........  ...........
                      mesylt.
J1120..............  Acetazolamid sodium        ..................  N1................  ...........  ...........
                      injectio.
J1160..............  Digoxin injection........  ..................  N1................  ...........  ...........

[[Page 67181]]

 
J1162..............  Digoxin immune fab         ..................  K2................  ...........      $478.88
                      (ovine).
J1165..............  Phenytoin sodium           ..................  N1................  ...........  ...........
                      injection.
J1170..............  Hydromorphone injection..  ..................  N1................  ...........  ...........
J1180..............  Dyphylline injection.....  ..................  N1................  ...........  ...........
J1190..............  Dexrazoxane HCl injection  ..................  K2................  ...........      $162.11
J1200..............  Diphenhydramine hcl        ..................  N1................  ...........  ...........
                      injectio.
J1205..............  Chlorothiazide sodium inj  ..................  K2................  ...........      $141.07
J1212..............  Dimethyl sulfoxide 50% 50  ..................  N1................  ...........  ...........
                      ML.
J1230..............  Methadone injection......  ..................  N1................  ...........  ...........
J1240..............  Dimenhydrinate injection.  ..................  N1................  ...........  ...........
J1245..............  Dipyridamole injection...  ..................  N1................  ...........  ...........
J1250..............  Inj dobutamine HCL/250 mg  ..................  N1................  ...........  ...........
J1260..............  Dolasetron mesylate......  ..................  K2................  ...........        $4.66
J1265..............  Dopamine injection.......  ..................  N1................  ...........  ...........
J1270..............  Injection,                 ..................  N1................  ...........  ...........
                      doxercalciferol.
J1300..............  Eculizumab injection.....  NI................  K2................  ...........      $176.38
J1320..............  Amitriptyline injection..  ..................  N1................  ...........  ...........
J1324..............  Enfuvirtide injection....  ..................  K2................  ...........        $0.40
J1325..............  Epoprostenol injection...  ..................  N1................  ...........  ...........
J1327..............  Eptifibatide injection...  ..................  K2................  ...........       $17.67
J1330..............  Ergonovine maleate         CH................  N1................  ...........  ...........
                      injection.
J1335..............  Ertapenem injection......  ..................  N1................  ...........  ...........
J1364..............  Erythro lactobionate /500  ..................  N1................  ...........  ...........
                      MG.
J1380..............  Estradiol valerate 10 MG   ..................  N1................  ...........  ...........
                      inj.
J1390..............  Estradiol valerate 20 MG   ..................  N1................  ...........  ...........
                      inj.
J1410..............  Inj estrogen conjugate 25  ..................  K2................  ...........       $66.64
                      MG.
J1430..............  Ethanolamine oleate 100    ..................  K2................  ...........       $79.23
                      mg.
J1435..............  Injection estrone per 1    ..................  N1................  ...........  ...........
                      MG.
J1436..............  Etidronate disodium inj..  ..................  K2................  ...........       $70.73
J1438..............  Etanercept injection.....  ..................  K2................  ...........      $167.12
J1440..............  Filgrastim 300 mcg         ..................  K2................  ...........      $193.79
                      injection.
J1441..............  Filgrastim 480 mcg         ..................  K2................  ...........      $298.39
                      injection.
J1450..............  Fluconazole..............  ..................  N1................  ...........  ...........
J1451..............  Fomepizole, 15 mg........  ..................  K2................  ...........       $12.80
J1452..............  Intraocular Fomivirsen na  CH................  N1................  ...........  ...........
J1455..............  Foscarnet sodium           CH................  N1................  ...........  ...........
                      injection.
J1457..............  Gallium nitrate injection  CH................  K2................  ...........        $1.61
J1458..............  Galsulfase injection.....  ..................  K2................  ...........      $306.88
J1460..............  Gamma globulin 1 CC inj..  ..................  K2................  ...........       $11.91
J1470..............  Gamma globulin 2 CC inj..  CH................  K2................  ...........       $23.82
J1480..............  Gamma globulin 3 CC inj..  CH................  K2................  ...........       $35.72
J1490..............  Gamma globulin 4 CC inj..  CH................  K2................  ...........       $47.64
J1500..............  Gamma globulin 5 CC inj..  CH................  K2................  ...........       $59.54
J1510..............  Gamma globulin 6 CC inj..  CH................  K2................  ...........       $71.50
J1520..............  Gamma globulin 7 CC inj..  CH................  K2................  ...........       $83.30
J1530..............  Gamma globulin 8 CC inj..  CH................  K2................  ...........       $95.27
J1540..............  Gamma globulin 9 CC inj..  CH................  K2................  ...........      $107.25
J1550..............  Gamma globulin 10 CC inj.  CH................  K2................  ...........      $119.09
J1560..............  Gamma globulin > 10 CC     CH................  K2................  ...........      $119.09
                      inj.
J1561..............  Gamunex injection........  NI................  K2................  ...........       $32.06
J1562..............  Vivaglobin, inj..........  ..................  K2................  ...........        $7.01
J1565..............  RSV-ivig.................  ..................  K2................  ...........       $16.02
J1566..............  Immune globulin, powder..  ..................  K2................  ...........       $26.89
J1567..............  Immune globulin, liquid..  CH................  D5................  ...........  ...........
J1568..............  Octagam injection........  NI................  K2................  ...........       $33.19
J1569..............  Gammagard liquid           NI................  K2................  ...........       $31.06
                      injection.
J1570..............  Ganciclovir sodium         ..................  N1................  ...........  ...........
                      injection.
J1571..............  Hepagam B IM injection...  NI................  K2................  ...........       $63.51
J1572..............  Flebogamma injection.....  NI................  K2................  ...........       $32.27
J1573..............  Hepagam B intravenous,     NI................  K2................  ...........       $63.51
                      inj.
J1580..............  Garamycin gentamicin inj.  ..................  N1................  ...........  ...........
J1590..............  Gatifloxacin injection...  ..................  N1................  ...........  ...........
J1595..............  Injection glatiramer       CH................  K2................  ...........       $52.04
                      acetate.
J1600..............  Gold sodium thiomaleate    ..................  N1................  ...........  ...........
                      inj.
J1610..............  Glucagon hydrochloride/1   ..................  K2................  ...........       $68.84
                      MG.
J1620..............  Gonadorelin hydroch/ 100   ..................  K2................  ...........      $178.59
                      mcg.
J1626..............  Granisetron HCl injection  ..................  K2................  ...........        $5.74
J1630..............  Haloperidol injection....  ..................  N1................  ...........  ...........

[[Page 67182]]

 
J1631..............  Haloperidol decanoate inj  ..................  N1................  ...........  ...........
J1640..............  Hemin, 1 mg..............  ..................  K2................  ...........        $7.08
J1642..............  Inj heparin sodium per 10  ..................  N1................  ...........  ...........
                      u.
J1644..............  Inj heparin sodium per     ..................  N1................  ...........  ...........
                      1000u.
J1645..............  Dalteparin sodium........  ..................  N1................  ...........  ...........
J1650..............  Inj enoxaparin sodium....  ..................  N1................  ...........  ...........
J1652..............  Fondaparinux sodium......  CH................  K2................  ...........        $5.92
J1655..............  Tinzaparin sodium          CH................  N1................  ...........  ...........
                      injection.
J1670..............  Tetanus immune globulin    ..................  K2................  ...........      $103.46
                      inj.
J1700..............  Hydrocortisone acetate     ..................  N1................  ...........  ...........
                      inj.
J1710..............  Hydrocortisone sodium ph   ..................  N1................  ...........  ...........
                      inj.
J1720..............  Hydrocortisone sodium      ..................  N1................  ...........  ...........
                      succ i.
J1730..............  Diazoxide injection......  ..................  K2................  ...........      $113.24
J1740..............  Ibandronate sodium         ..................  K2................  ...........      $138.96
                      injection.
J1742..............  Ibutilide fumarate         ..................  K2................  ...........      $287.15
                      injection.
J1743..............  Idursulfase injection....  NI................  K2................  ...........      $455.03
J1745..............  Infliximab injection.....  ..................  K2................  ...........       $54.42
J1751..............  Iron dextran 165           ..................  K2................  ...........       $11.82
                      injection.
J1752..............  Iron dextran 267           ..................  K2................  ...........       $10.30
                      injection.
J1756..............  Iron sucrose injection...  ..................  K2................  ...........        $0.36
J1785..............  Injection imiglucerase /   ..................  K2................  ...........        $3.89
                      unit.
J1790..............  Droperidol injection.....  ..................  N1................  ...........  ...........
J1800..............  Propranolol injection....  ..................  N1................  ...........  ...........
J1815..............  Insulin injection........  ..................  N1................  ...........  ...........
J1817..............  Insulin for insulin pump   ..................  N1................  ...........  ...........
                      use.
J1830..............  Interferon beta-1b / .25   ..................  K2................  ...........      $106.57
                      MG.
J1835..............  Itraconazole injection...  ..................  K2................  ...........       $39.68
J1840..............  Kanamycin sulfate 500 MG   ..................  N1................  ...........  ...........
                      inj.
J1850..............  Kanamycin sulfate 75 MG    ..................  N1................  ...........  ...........
                      inj.
J1885..............  Ketorolac tromethamine     ..................  N1................  ...........  ...........
                      inj.
J1890..............  Cephalothin sodium         ..................  N1................  ...........  ...........
                      injection.
J1931..............  Laronidase injection.....  ..................  K2................  ...........       $23.64
J1940..............  Furosemide injection.....  ..................  N1................  ...........  ...........
J1945..............  Lepirudin................  ..................  K2................  ...........      $159.44
J1950..............  Leuprolide acetate /3.75   ..................  K2................  ...........      $452.58
                      MG.
J1956..............  Levofloxacin injection...  ..................  N1................  ...........  ...........
J1960..............  Levorphanol tartrate inj.  ..................  N1................  ...........  ...........
J1980..............  Hyoscyamine sulfate inj..  ..................  N1................  ...........  ...........
J1990..............  Chlordiazepoxide           ..................  N1................  ...........  ...........
                      injection.
J2001..............  Lidocaine injection......  ..................  N1................  ...........  ...........
J2010..............  Lincomycin injection.....  ..................  N1................  ...........  ...........
J2020..............  Linezolid injection......  ..................  K2................  ...........       $25.17
J2060..............  Lorazepam injection......  ..................  N1................  ...........  ...........
J2150..............  Mannitol injection.......  ..................  N1................  ...........  ...........
J2170..............  Mecasermin injection.....  ..................  K2................  ...........       $15.62
J2175..............  Meperidine hydrochl /100   ..................  N1................  ...........  ...........
                      MG.
J2180..............  Meperidine/promethazine    ..................  N1................  ...........  ...........
                      inj.
J2185..............  Meropenem................  CH................  N1................  ...........  ...........
J2210..............  Methylergonovin maleate    ..................  N1................  ...........  ...........
                      inj.
J2248..............  Micafungin sodium          ..................  K2................  ...........        $1.44
                      injection.
J2250..............  Inj midazolam              ..................  N1................  ...........  ...........
                      hydrochloride.
J2260..............  Inj milrinone lactate / 5  ..................  N1................  ...........  ...........
                      MG.
J2270..............  Morphine sulfate           ..................  N1................  ...........  ...........
                      injection.
J2271..............  Morphine so4 injection     ..................  N1................  ...........  ...........
                      100mg.
J2275..............  Morphine sulfate           ..................  N1................  ...........  ...........
                      injection.
J2278..............  Ziconotide injection.....  ..................  K2................  ...........        $6.46
J2280..............  Inj, moxifloxacin 100 mg.  ..................  N1................  ...........  ...........
J2300..............  Inj nalbuphine             ..................  N1................  ...........  ...........
                      hydrochloride.
J2310..............  Inj naloxone               ..................  N1................  ...........  ...........
                      hydrochloride.
J2315..............  Naltrexone, depot form...  ..................  K2................  ...........        $1.87
J2320..............  Nandrolone decanoate 50    ..................  N1................  ...........  ...........
                      MG.
J2321..............  Nandrolone decanoate 100   ..................  N1................  ...........  ...........
                      MG.
J2322..............  Nandrolone decanoate 200   ..................  N1................  ...........  ...........
                      MG.
J2323..............  Natalizumab injection....  NI................  K2................  ...........        $7.51
J2325..............  Nesiritide injection.....  ..................  K2................  ...........       $32.95
J2353..............  Octreotide injection,      ..................  K2................  ...........       $99.04
                      depot.
J2354..............  Octreotide inj, non-depot  ..................  N1................  ...........  ...........
J2355..............  Oprelvekin injection.....  ..................  K2................  ...........      $247.02

[[Page 67183]]

 
J2357..............  Omalizumab injection.....  ..................  K2................  ...........       $17.12
J2360..............  Orphenadrine injection...  ..................  N1................  ...........  ...........
J2370..............  Phenylephrine hcl          ..................  N1................  ...........  ...........
                      injection.
J2400..............  Chloroprocaine hcl         ..................  N1................  ...........  ...........
                      injection.
J2405..............  Ondansetron hcl injection  ..................  K2................  ...........        $0.26
J2410..............  Oxymorphone hcl injection  ..................  N1................  ...........  ...........
J2425..............  Palifermin injection.....  ..................  K2................  ...........       $11.24
J2430..............  Pamidronate disodium /30   ..................  K2................  ...........       $28.31
                      MG.
J2440..............  Papaverin hcl injection..  ..................  N1................  ...........  ...........
J2460..............  Oxytetracycline injection  ..................  N1................  ...........  ...........
J2469..............  Palonosetron HCl.........  ..................  K2................  ...........       $16.45
J2501..............  Paricalcitol.............  ..................  N1................  ...........  ...........
J2503..............  Pegaptanib sodium          ..................  K2................  ...........    $1,035.69
                      injection.
J2504..............  Pegademase bovine, 25 iu.  ..................  K2................  ...........      $197.51
J2505..............  Injection, pegfilgrastim   ..................  K2................  ...........    $2,145.12
                      6mg.
J2510..............  Penicillin g procaine inj  ..................  N1................  ...........  ...........
J2513..............  Pentastarch 10% solution.  CH................  K2................  ...........       $21.98
J2515..............  Pentobarbital sodium inj.  ..................  N1................  ...........  ...........
J2540..............  Penicillin g potassium     ..................  N1................  ...........  ...........
                      inj.
J2543..............  Piperacillin/tazobactam..  ..................  N1................  ...........  ...........
J2550..............  Promethazine hcl           ..................  N1................  ...........  ...........
                      injection.
J2560..............  Phenobarbital sodium inj.  ..................  N1................  ...........  ...........
J2590..............  Oxytocin injection.......  ..................  N1................  ...........  ...........
J2597..............  Inj desmopressin acetate.  ..................  N1................  ...........  ...........
J2650..............  Prednisolone acetate inj.  ..................  N1................  ...........  ...........
J2670..............  Totazoline hcl injection.  ..................  N1................  ...........  ...........
J2675..............  Inj progesterone per 50    ..................  N1................  ...........  ...........
                      MG.
J2680..............  Fluphenazine decanoate 25  ..................  N1................  ...........  ...........
                      MG.
J2690..............  Procainamide hcl           ..................  N1................  ...........  ...........
                      injection.
J2700..............  Oxacillin sodium           ..................  N1................  ...........  ...........
                      injeciton.
J2710..............  Neostigmine methylslfte    ..................  N1................  ...........  ...........
                      inj.
J2720..............  Inj protamine sulfate/10   ..................  N1................  ...........  ...........
                      MG.
J2724..............  Protein C concentrate....  NI................  K2................  ...........       $12.08
J2725..............  Inj protirelin per 250     ..................  N1................  ...........  ...........
                      mcg.
J2730..............  Pralidoxime chloride inj.  CH................  K2................  ...........       $35.20
J2760..............  Phentolaine mesylate inj.  ..................  N1................  ...........  ...........
J2765..............  Metoclopramide hcl         ..................  N1................  ...........  ...........
                      injection.
J2770..............  Quinupristin/dalfopristin  ..................  K2................  ...........      $126.44
J2778..............  Ranibizumab injection....  NI................  K2................  ...........    $2,030.23
J2780..............  Ranitidine hydrochloride   ..................  N1................  ...........  ...........
                      inj.
J2783..............  Rasburicase..............  ..................  K2................  ...........      $144.43
J2788..............  Rho d immune globulin 50   ..................  K2................  ...........       $26.41
                      mcg.
J2790..............  Rho d immune globulin inj  ..................  K2................  ...........       $80.79
J2791..............  Rhophylac injection......  NI................  K2................  ...........        $5.29
J2792..............  Rho(D) immune globulin h,  ..................  K2................  ...........       $15.62
                      sd.
J2794..............  Risperidone, long acting.  ..................  K2................  ...........        $4.86
J2795..............  Ropivacaine HCl injection  ..................  N1................  ...........  ...........
J2800..............  Methocarbamol injection..  ..................  N1................  ...........  ...........
J2805..............  Sincalide injection......  ..................  N1................  ...........  ...........
J2810..............  Inj theophylline per 40    ..................  N1................  ...........  ...........
                      MG.
J2820..............  Sargramostim injection...  ..................  K2................  ...........       $24.86
J2850..............  Inj secretin synthetic     ..................  K2................  ...........       $20.12
                      human.
J2910..............  Aurothioglucose injeciton  ..................  N1................  ...........  ...........
J2916..............  Na ferric gluconate        ..................  N1................  ...........  ...........
                      complex.
J2920..............  Methylprednisolone         ..................  N1................  ...........  ...........
                      injection.
J2930..............  Methylprednisolone         ..................  N1................  ...........  ...........
                      injection.
J2940..............  Somatrem injection.......  ..................  K2................  ...........      $168.90
J2941..............  Somatropin injection.....  ..................  K2................  ...........       $48.52
J2950..............  Promazine hcl injection..  ..................  N1................  ...........  ...........
J2993..............  Reteplase injection......  ..................  K2................  ...........      $841.28
J2995..............  Inj streptokinase /250000  ..................  K2................  ...........      $129.75
                      IU.
J2997..............  Alteplase recombinant....  ..................  K2................  ...........       $33.39
J3000..............  Streptomycin injection...  ..................  N1................  ...........  ...........
J3010..............  Fentanyl citrate           ..................  N1................  ...........  ...........
                      injeciton.
J3030..............  Sumatriptan succinate / 6  ..................  K2................  ...........       $61.27
                      MG.
J3070..............  Pentazocine injection....  ..................  N1................  ...........  ...........
J3100..............  Tenecteplase injection...  ..................  K2................  ...........    $2,034.65
J3105..............  Terbutaline sulfate inj..  ..................  N1................  ...........  ...........

[[Page 67184]]

 
J3120..............  Testosterone enanthate     ..................  N1................  ...........  ...........
                      inj.
J3130..............  Testosterone enanthate     ..................  N1................  ...........  ...........
                      inj.
J3140..............  Testosterone suspension    ..................  N1................  ...........  ...........
                      inj.
J3150..............  Testosteron propionate     ..................  N1................  ...........  ...........
                      inj.
J3230..............  Chlorpromazine hcl         ..................  N1................  ...........  ...........
                      injection.
J3240..............  Thyrotropin injection....  ..................  K2................  ...........      $834.18
J3243..............  Tigecycline injection....  ..................  K2................  ...........        $0.96
J3246..............  Tirofiban HCl............  ..................  K2................  ...........        $7.56
J3250..............  Trimethobenzamide hcl inj  ..................  N1................  ...........  ...........
J3260..............  Tobramycin sulfate         ..................  N1................  ...........  ...........
                      injection.
J3265..............  Injection torsemide 10 mg/ ..................  N1................  ...........  ...........
                      ml.
J3280..............  Thiethylperazine maleate   ..................  N1................  ...........  ...........
                      inj.
J3285..............  Treprostinil injection...  ..................  K2................  ...........       $55.36
J3301..............  Triamcinolone acetonide    ..................  N1................  ...........  ...........
                      inj.
J3302..............  Triamcinolone diacetate    ..................  N1................  ...........  ...........
                      inj.
J3303..............  Triamcinolone hexacetonl   ..................  N1................  ...........  ...........
                      inj.
J3305..............  Inj trimetrexate           ..................  K2................  ...........      $148.30
                      glucoronate.
J3310..............  Perphenazine injeciton...  ..................  N1................  ...........  ...........
J3315..............  Triptorelin pamoate......  ..................  K2................  ...........      $159.38
J3320..............  Spectinomycn di-hcl inj..  CH................  N1................  ...........  ...........
J3350..............  Urea injection...........  ..................  K2................  ...........       $74.16
J3355..............  Urofollitropin, 75 iu....  ..................  K2................  ...........       $50.22
J3360..............  Diazepam injection.......  ..................  N1................  ...........  ...........
J3364..............  Urokinase 5000 IU          ..................  N1................  ...........  ...........
                      injection.
J3365..............  Urokinase 250,000 IU inj.  ..................  K2................  ...........      $453.41
J3370..............  Vancomycin hcl injection.  ..................  N1................  ...........  ...........
J3396..............  Verteporfin injection....  ..................  K2................  ...........        $8.99
J3400..............  Triflupromazine hcl inj..  ..................  N1................  ...........  ...........
J3410..............  Hydroxyzine hcl injection  ..................  N1................  ...........  ...........
J3411..............  Thiamine hcl 100 mg......  ..................  N1................  ...........  ...........
J3415..............  Pyridoxine hcl 100 mg....  ..................  N1................  ...........  ...........
J3420..............  Vitamin b12 injection....  ..................  N1................  ...........  ...........
J3430..............  Vitamin k phytonadione     ..................  N1................  ...........  ...........
                      inj.
J3465..............  Injection, voriconazole..  ..................  K2................  ...........        $4.93
J3470..............  Hyaluronidase injection..  ..................  N1................  ...........  ...........
J3471..............  Ovine, up to 999 USP       ..................  N1................  ...........  ...........
                      units.
J3472..............  Ovine, 1000 USP units....  ..................  K2................  ...........      $133.77
J3473..............  Hyaluronidase recombinant  ..................  K2................  ...........        $0.40
J3475..............  Inj magnesium sulfate....  ..................  N1................  ...........  ...........
J3480..............  Inj potassium chloride...  ..................  N1................  ...........  ...........
J3485..............  Zidovudine...............  ..................  N1................  ...........  ...........
J3486..............  Ziprasidone mesylate.....  ..................  N1................  ...........  ...........
J3487..............  Zoledronic acid..........  ..................  K2................  ...........      $205.76
J3488..............  Reclast injection........  NI................  K2................  ...........      $220.81
J3490..............  Drugs unclassified         ..................  N1................  ...........  ...........
                      injection.
J3530..............  Nasal vaccine inhalation.  ..................  N1................  ...........  ...........
J3590..............  Unclassified biologics...  ..................  N1................  ...........  ...........
J7030..............  Normal saline solution     ..................  N1................  ...........  ...........
                      infus.
J7040..............  Normal saline solution     ..................  N1................  ...........  ...........
                      infus.
J7042..............  5% dextrose/normal saline  ..................  N1................  ...........  ...........
J7050..............  Normal saline solution     ..................  N1................  ...........  ...........
                      infus.
J7060..............  5% dextrose/water........  ..................  N1................  ...........  ...........
J7070..............  D5w infusion.............  ..................  N1................  ...........  ...........
J7100..............  Dextran 40 infusion......  ..................  N1................  ...........  ...........
J7110..............  Dextran 75 infusion......  ..................  N1................  ...........  ...........
J7120..............  Ringers lactate infusion.  ..................  N1................  ...........  ...........
J7130..............  Hypertonic saline          ..................  N1................  ...........  ...........
                      solution.
J7187..............  Humate-P, inj............  ..................  K2................  ...........        $0.88
J7189..............  Factor viia..............  ..................  K2................  ...........        $1.15
J7190..............  Factor viii..............  ..................  K2................  ...........        $0.75
J7191..............  Factor VIII (porcine)....  CH................  N1................  ...........  ...........
J7192..............  Factor viii recombinant..  ..................  K2................  ...........        $1.07
J7193..............  Factor IX non-recombinant  ..................  K2................  ...........        $0.89
J7194..............  Factor ix complex........  ..................  K2................  ...........        $0.80
J7195..............  Factor IX recombinant....  ..................  K2................  ...........        $0.99
J7197..............  Antithrombin iii           ..................  K2................  ...........        $1.82
                      injection.
J7198..............  Anti-inhibitor...........  ..................  K2................  ...........        $1.42
J7308..............  Aminolevulinic acid hcl    ..................  K2................  ...........      $109.92
                      top.

[[Page 67185]]

 
J7310..............  Ganciclovir long act       ..................  K2................  ...........    $4,707.90
                      implant.
J7311..............  Fluocinolone acetonide     ..................  K2................  ...........   $19,162.50
                      implt.
J7321..............  Hyalgan/supartz inj per    NI................  K2................  ...........      $101.81
                      dose.
J7322..............  Synvisc inj per dose.....  NI................  K2................  ...........      $178.11
J7323..............  Euflexxa inj per dose....  NI................  K2................  ...........      $110.95
J7324..............  Orthovisc inj per dose...  NI................  K2................  ...........      $174.50
J7340..............  Metabolic active D/E       ..................  K2................  ...........       $28.45
                      tissue.
J7341..............  Non-human, metabolic       CH................  N1................  ...........  ...........
                      tissue.
J7342..............  Metabolically active       ..................  K2................  ...........       $36.40
                      tissue.
J7343..............  Nonmetabolic act d/e       ..................  K2................  ...........       $20.22
                      tissue.
J7344..............  Nonmetabolic active        ..................  K2................  ...........       $94.53
                      tissue.
J7345..............  Non-human, non-metab       CH................  D5................  ...........  ...........
                      tissue.
J7346..............  Injectable human tissue..  ..................  K2................  ...........      $774.46
J7347..............  Integra matrix tissue....  NI................  K2................  ...........       $33.14
J7348..............  Tissuemend tissue........  NI................  K2................  ...........       $67.96
J7349..............  Primatrix tissue.........  NI................  K2................  ...........       $67.96
J7500..............  Azathioprine oral 50mg...  ..................  N1................  ...........  ...........
J7501..............  Azathioprine parenteral..  ..................  K2................  ...........       $47.88
J7502..............  Cyclosporine oral 100 mg.  ..................  K2................  ...........        $3.52
J7504..............  Lymphocyte immune          ..................  K2................  ...........      $336.10
                      globulin.
J7505..............  Monoclonal antibodies....  ..................  K2................  ...........      $977.75
J7506..............  Prednisone oral..........  ..................  N1................  ...........  ...........
J7507..............  Tacrolimus oral per 1 MG.  ..................  K2................  ...........        $3.69
J7509..............  Methylprednisolone oral..  ..................  N1................  ...........  ...........
J7510..............  Prednisolone oral per 5    ..................  N1................  ...........  ...........
                      mg.
J7511..............  Antithymocyte globuln      ..................  K2................  ...........      $337.82
                      rabbit.
J7513..............  Daclizumab, parenteral...  ..................  K2................  ...........      $322.28
J7515..............  Cyclosporine oral 25 mg..  ..................  N1................  ...........  ...........
J7516..............  Cyclosporin parenteral     ..................  N1................  ...........  ...........
                      250mg.
J7517..............  Mycophenolate mofetil      ..................  K2................  ...........        $2.66
                      oral.
J7518..............  Mycophenolic acid........  ..................  K2................  ...........        $2.41
J7520..............  Sirolimus, oral..........  ..................  K2................  ...........        $7.50
J7525..............  Tacrolimus injection.....  ..................  K2................  ...........      $138.64
J7599..............  Immunosuppressive drug     ..................  N1................  ...........  ...........
                      noc.
J7674..............  Methacholine chloride,     ..................  N1................  ...........  ...........
                      neb.
J7799..............  Non-inhalation drug for    ..................  N1................  ...........  ...........
                      DME.
J8501..............  Oral aprepitant..........  ..................  K2................  ...........        $4.99
J8510..............  Oral busulfan............  ..................  K2................  ...........        $2.26
J8520..............  Capecitabine, oral, 150    ..................  K2................  ...........        $4.28
                      mg.
J8521..............  Capecitabine, oral, 500    CH................  K2................  ...........       $14.19
                      mg.
J8530..............  Cyclophosphamide oral 25   ..................  N1................  ...........  ...........
                      MG.
J8540..............  Oral dexamethasone.......  ..................  N1................  ...........  ...........
J8560..............  Etoposide oral 50 MG.....  ..................  K2................  ...........       $29.46
J8597..............  Antiemetic drug oral NOS.  ..................  N1................  ...........  ...........
J8600..............  Melphalan oral 2 MG......  CH................  K2................  ...........        $4.14
J8610..............  Methotrexate oral 2.5 MG.  ..................  N1................  ...........  ...........
J8650..............  Nabilone oral............  ..................  K2................  ...........       $16.80
J8700..............  Temozolomide.............  ..................  K2................  ...........        $7.49
J9000..............  Doxorubic hcl 10 MG vl     CH................  N1................  ...........  ...........
                      chemo.
J9001..............  Doxorubicin hcl liposome   ..................  K2................  ...........      $396.15
                      inj.
J9010..............  Alemtuzumab injection....  ..................  K2................  ...........      $549.77
J9015..............  Aldesleukin/single use     ..................  K2................  ...........      $788.84
                      vial.
J9017..............  Arsenic trioxide.........  ..................  K2................  ...........       $34.44
J9020..............  Asparaginase injection...  ..................  K2................  ...........       $54.26
J9025..............  Azacitidine injection....  ..................  K2................  ...........        $4.35
J9027..............  Clofarabine injection....  ..................  K2................  ...........      $114.41
J9031..............  Bcg live intravesical vac  ..................  K2................  ...........      $113.75
J9035..............  Bevacizumab injection....  ..................  K2................  ...........       $56.93
J9040..............  Bleomycin sulfate          ..................  K2................  ...........       $42.93
                      injection.
J9041..............  Bortezomib injection.....  ..................  K2................  ...........       $33.20
J9045..............  Carboplatin injection....  ..................  K2................  ...........        $7.44
J9050..............  Carmus bischl nitro inj..  ..................  K2................  ...........      $152.24
J9055..............  Cetuximab injection......  ..................  K2................  ...........       $49.43
J9060..............  Cisplatin 10 MG injection  ..................  N1................  ...........  ...........
J9062..............  Cisplatin 50 MG injection  CH................  N1................  ...........  ...........
J9065..............  Inj cladribine per 1 MG..  ..................  K2................  ...........       $32.04
J9070..............  Cyclophosphamide 100 MG    ..................  N1................  ...........  ...........
                      inj.
J9080..............  Cyclophosphamide 200 MG    CH................  N1................  ...........  ...........
                      inj.

[[Page 67186]]

 
J9090..............  Cyclophosphamide 500 MG    CH................  N1................  ...........  ...........
                      inj.
J9091..............  Cyclophosphamide 1.0 grm   CH................  N1................  ...........  ...........
                      inj.
J9092..............  Cyclophosphamide 2.0 grm   CH................  N1................  ...........  ...........
                      inj.
J9093..............  Cyclophosphamide           CH................  N1................  ...........  ...........
                      lyophilized.
J9094..............  Cyclophosphamide           CH................  N1................  ...........  ...........
                      lyophilized.
J9095..............  Cyclophosphamide           CH................  N1................  ...........  ...........
                      lyophilized.
J9096..............  Cyclophosphamide           CH................  N1................  ...........  ...........
                      lyophilized.
J9097..............  Cyclophosphamide           CH................  N1................  ...........  ...........
                      lyophilized.
J9098..............  Cytarabine liposome......  ..................  K2................  ...........      $412.21
J9100..............  Cytarabine hcl 100 MG inj  ..................  N1................  ...........  ...........
J9110..............  Cytarabine hcl 500 MG inj  CH................  N1................  ...........  ...........
J9120..............  Dactinomycin actinomycin   ..................  K2................  ...........      $488.78
                      d.
J9130..............  Dacarbazine 100 mg inj...  CH................  N1................  ...........  ...........
J9140..............  Dacarbazine 200 MG inj...  CH................  N1................  ...........  ...........
J9150..............  Daunorubicin.............  ..................  K2................  ...........       $19.33
J9151..............  Daunorubicin citrate       ..................  K2................  ...........       $55.23
                      liposom.
J9160..............  Denileukin diftitox, 300   ..................  K2................  ...........    $1,386.59
                      mcg.
J9165..............  Diethylstilbestrol         ..................  N1................  ...........  ...........
                      injection.
J9170..............  Docetaxel................  ..................  K2................  ...........      $310.85
J9175..............  Elliotts b solution per    ..................  N1................  ...........  ...........
                      ml.
J9178..............  Inj, epirubicin hcl, 2 mg  ..................  K2................  ...........       $19.79
J9181..............  Etoposide 10 MG inj......  ..................  N1................  ...........  ...........
J9182..............  Etoposide 100 MG inj.....  CH................  N1................  ...........  ...........
J9185..............  Fludarabine phosphate inj  ..................  K2................  ...........      $226.67
J9190..............  Fluorouracil injection...  ..................  N1................  ...........  ...........
J9200..............  Floxuridine injection....  ..................  K2................  ...........       $54.63
J9201..............  Gemcitabine HCl..........  ..................  K2................  ...........      $127.31
J9202..............  Goserelin acetate implant  ..................  K2................  ...........      $192.29
J9206..............  Irinotecan injection.....  ..................  K2................  ...........      $124.61
J9208..............  Ifosfomide injection.....  ..................  K2................  ...........       $38.13
J9209..............  Mesna injection..........  ..................  K2................  ...........        $7.97
J9211..............  Idarubicin hcl injection.  ..................  K2................  ...........      $302.42
J9212..............  Interferon alfacon-1.....  ..................  K2................  ...........        $4.62
J9213..............  Interferon alfa-2a inj...  ..................  K2................  ...........       $41.37
J9214..............  Interferon alfa-2b inj...  ..................  K2................  ...........       $13.92
J9215..............  Interferon alfa-n3 inj...  ..................  K2................  ...........        $9.03
J9216..............  Interferon gamma 1-b inj.  ..................  K2................  ...........      $306.66
J9217..............  Leuprolide acetate         ..................  K2................  ...........      $236.06
                      suspnsion.
J9218..............  Leuprolide acetate         ..................  K2................  ...........        $7.98
                      injeciton.
J9219..............  Leuprolide acetate         ..................  K2................  ...........    $1,648.41
                      implant.
J9225..............  Vantas implant...........  ..................  K2................  ...........    $1,412.46
J9226..............  Supprelin LA implant.....  NI................  K2................  ...........   $14,700.00
J9230..............  Mechlorethamine hcl inj..  ..................  K2................  ...........      $143.08
J9245..............  Inj melphalan hydrochl 50  ..................  K2................  ...........    $1,548.88
                      MG.
J9250..............  Methotrexate sodium inj..  ..................  N1................  ...........  ...........
J9260..............  Methotrexate sodium inj..  CH................  N1................  ...........  ...........
J9261..............  Nelarabine injection.....  ..................  K2................  ...........       $86.84
J9263..............  Oxaliplatin..............  ..................  K2................  ...........        $9.15
J9264..............  Paclitaxel protein bound.  ..................  K2................  ...........        $8.79
J9265..............  Paclitaxel injection.....  ..................  K2................  ...........       $14.57
J9266..............  Pegaspargase/singl dose    ..................  K2................  ...........    $2,080.19
                      vial.
J9268..............  Pentostatin injection....  ..................  K2................  ...........    $2,051.68
J9270..............  Plicamycin (mithramycin)   ..................  K2................  ...........      $172.41
                      inj.
J9280..............  Mitomycin 5 MG inj.......  ..................  K2................  ...........       $14.39
J9290..............  Mitomycin 20 MG inj......  CH................  K2................  ...........       $57.56
J9291..............  Mitomycin 40 MG inj......  CH................  K2................  ...........      $115.11
J9293..............  Mitoxantrone hydrochl / 5  ..................  K2................  ...........      $107.96
                      MG.
J9300..............  Gemtuzumab ozogamicin....  ..................  K2................  ...........    $2,411.98
J9303..............  Panitumumab injection....  NI................  K2................  ...........       $83.15
J9305..............  Pemetrexed injection.....  ..................  K2................  ...........       $44.49
J9310..............  Rituximab cancer           ..................  K2................  ...........      $504.40
                      treatment.
J9320..............  Streptozocin injection...  ..................  K2................  ...........      $146.93
J9340..............  Thiotepa injection.......  ..................  K2................  ...........       $41.12
J9350..............  Topotecan................  ..................  K2................  ...........      $859.62
J9355..............  Trastuzumab..............  ..................  K2................  ...........       $58.51
J9357..............  Valrubicin, 200 mg.......  ..................  K2................  ...........       $77.96
J9360..............  Vinblastine sulfate inj..  ..................  N1................  ...........  ...........
J9370..............  Vincristine sulfate 1 MG   ..................  N1................  ...........  ...........
                      inj.

[[Page 67187]]

 
J9375..............  Vincristine sulfate 2 MG   CH................  N1................  ...........  ...........
                      inj.
J9380..............  Vincristine sulfate 5 MG   CH................  N1................  ...........  ...........
                      inj.
J9390..............  Vinorelbine tartrate/10    ..................  K2................  ...........       $21.41
                      mg.
J9395..............  Injection, Fulvestrant...  ..................  K2................  ...........       $80.60
J9600..............  Porfimer sodium..........  ..................  K2................  ...........    $2,532.53
J9999..............  Chemotherapy drug........  ..................  N1................  ...........  ...........
L8600..............  Implant breast silicone/   ..................  N1................  ...........  ...........
                      eq.
L8603..............  Collagen imp urinary 2.5   ..................  N1................  ...........  ...........
                      ml.
L8606..............  Synthetic implnt urinary   ..................  N1................  ...........  ...........
                      1ml.
L8609..............  Artificial cornea........  ..................  N1................  ...........  ...........
L8610..............  Ocular implant...........  ..................  N1................  ...........  ...........
L8612..............  Aqueous shunt prosthesis.  ..................  N1................  ...........  ...........
L8613..............  Ossicular implant........  ..................  N1................  ...........  ...........
L8614..............  Cochlear device..........  ..................  N1................  ...........  ...........
L8630..............  Metacarpophalangeal        ..................  N1................  ...........  ...........
                      implant.
L8631..............  MCP joint repl 2 pc or     ..................  N1................  ...........  ...........
                      more.
L8641..............  Metatarsal joint implant.  ..................  N1................  ...........  ...........
L8642..............  Hallux implant...........  ..................  N1................  ...........  ...........
L8658..............  Interphalangeal joint      ..................  N1................  ...........  ...........
                      spacer.
L8659..............  Interphalangeal joint      ..................  N1................  ...........  ...........
                      repl.
L8670..............  Vascular graft, synthetic  ..................  N1................  ...........  ...........
L8682..............  Implt neurostim radiofq    ..................  N1................  ...........  ...........
                      rec.
L8690..............  Aud osseo dev, int/ext     ..................  J7................  ...........  ...........
                      comp.
L8699..............  Prosthetic implant NOS...  ..................  N1................  ...........  ...........
P9041..............  Albumin (human),5%, 50ml.  CH................  K2................       0.3413       $21.74
P9045..............  Albumin (human), 5%, 250   CH................  K2................       1.0987       $69.98
                      ml.
P9046..............  Albumin (human), 25%, 20   CH................  K2................       0.4118       $26.23
                      ml.
P9047..............  Albumin (human), 25%,      CH................  K2................       1.1362       $72.37
                      50ml.
Q0163..............  Diphenhydramine HCl 50mg.  ..................  N1................  ...........  ...........
Q0164..............  Prochlorperazine maleate   ..................  N1................  ...........  ...........
                      5mg.
Q0166..............  Granisetron HCl 1 mg oral  ..................  K2................  ...........       $49.96
Q0167..............  Dronabinol 2.5mg oral....  ..................  N1................  ...........  ...........
Q0169..............  Promethazine HCl 12.5mg    ..................  N1................  ...........  ...........
                      oral.
Q0171..............  Chlorpromazine HCl 10mg    ..................  N1................  ...........  ...........
                      oral.
Q0173..............  Trimethobenzamide HCl      ..................  N1................  ...........  ...........
                      250mg.
Q0174..............  Thiethylperazine           ..................  N1................  ...........  ...........
                      maleate10mg.
Q0175..............  Perphenazine 4mg oral....  ..................  N1................  ...........  ...........
Q0177..............  Hydroxyzine pamoate 25mg.  ..................  N1................  ...........  ...........
Q0179..............  Ondansetron HCl 8mg oral.  ..................  K2................  ...........       $18.37
Q0180..............  Dolasetron mesylate oral.  ..................  K2................  ...........       $43.77
Q0515..............  Sermorelin acetate         ..................  K2................  ...........        $1.74
                      injection.
Q1003..............  Ntiol category 3.........  ..................  L6................  ...........       $50.00
Q2004..............  Bladder calculi irrig sol  ..................  N1................  ...........  ...........
Q2009..............  Fosphenytoin, 50 mg......  ..................  K2................  ...........        $5.76
Q2017..............  Teniposide, 50 mg........  ..................  K2................  ...........      $280.26
Q3025..............  IM inj interferon beta 1-  ..................  K2................  ...........      $118.84
                      a.
Q4079..............  Natalizumab injection....  CH................  D5................  ...........  ...........
Q4083..............  Hyalgan/supartz inj per    CH................  D5................  ...........  ...........
                      dose.
Q4084..............  Synvisc inj per dose.....  CH................  D5................  ...........  ...........
Q4085..............  Euflexxa inj per dose....  CH................  D5................  ...........  ...........
Q4086..............  Orthovisc inj per dose...  CH................  D5................  ...........  ...........
Q4087..............  Octagam injection........  CH................  D5................  ...........  ...........
Q4088..............  Gammagard liquid           CH................  D5................  ...........  ...........
                      injection.
Q4089..............  Rhophylac injection......  CH................  D5................  ...........  ...........
Q4090..............  Hepagam B IM injection...  CH................  D5................  ...........  ...........
Q4091..............  Flebogamma injection.....  CH................  D5................  ...........  ...........
Q4092..............  Gamunex injection........  CH................  D5................  ...........  ...........
Q4095..............  Reclast injection........  CH................  D5................  ...........  ...........
Q9945..............  LOCM <=149 mg/ml iodine,   CH................  D5................  ...........  ...........
                      1ml.
Q9946..............  LOCM 150-199mg/ml          CH................  D5................  ...........  ...........
                      iodine,1ml.
Q9947..............  LOCM 200-249mg/ml          CH................  D5................  ...........  ...........
                      iodine,1ml.
Q9948..............  LOCM 250-299mg/ml          CH................  D5................  ...........  ...........
                      iodine,1ml.
Q9949..............  LOCM 300-349mg/ml          CH................  D5................  ...........  ...........
                      iodine,1ml.
Q9950..............  LOCM 350-399mg/ml          CH................  D5................  ...........  ...........
                      iodine,1ml.
Q9951..............  LOCM >= 400 mg/ml          CH................  N1................  ...........  ...........
                      iodine,1ml.
Q9952..............  Inj Gad-base MR            CH................  D5................  ...........  ...........
                      contrast,1ml.
Q9953..............  Inj Fe-based MR            CH................  N1................  ...........  ...........
                      contrast,1ml.
Q9954..............  Oral MR contrast,100 ml..  CH................  N1................  ...........  ...........

[[Page 67188]]

 
Q9955..............  Inj perflexane lip         CH................  N1................  ...........  ...........
                      micros,ml.
Q9956..............  Inj octafluoropropane      CH................  N1................  ...........  ...........
                      mic,ml.
Q9957..............  Inj perflutren lip         CH................  N1................  ...........  ...........
                      micros,ml.
Q9958..............  HOCM <=149 mg/ml           ..................  N1................  ...........  ...........
                      iodine,1ml.
Q9959..............  HOCM 150-199mg/ml          ..................  N1................  ...........  ...........
                      iodine,1ml.
Q9960..............  HOCM 200-249mg/ml          ..................  N1................  ...........  ...........
                      iodine,1ml.
Q9961..............  HOCM 250-299mg/ml          ..................  N1................  ...........  ...........
                      iodine,1ml.
Q9962..............  HOCM 300-349mg/ml          ..................  N1................  ...........  ...........
                      iodine,1ml.
Q9963..............  HOCM 350-399mg/ml          ..................  N1................  ...........  ...........
                      iodine,1ml.
Q9964..............  HOCM>= 400mg/ml            ..................  N1................  ...........  ...........
                      iodine,1ml.
Q9965..............  LOCM 100-199mg/ml          NI................  N1................  ...........  ...........
                      iodine,1ml.
Q9966..............  LOCM 200-299mg/ml          NI................  N1................  ...........  ...........
                      iodine,1ml.
Q9967..............  LOCM 300-399mg/ml          NI................  N1................  ...........  ...........
                      iodine,1ml.
V2630..............  Anter chamber intraocul    ..................  N1................  ...........  ...........
                      lens.
V2631..............  Iris support intraoclr     ..................  N1................  ...........  ...........
                      lens.
V2632..............  Post chmbr intraocular     ..................  N1................  ...........  ...........
                      lens.
V2785..............  Corneal tissue processing  ..................  F4................  ...........  ...........
V2790..............  Amniotic membrane........  ..................  N1................  ...........  ...........
----------------------------------------------------------------------------------------------------------------


              Addendum D1.--OPPS Payment Status Indicators
------------------------------------------------------------------------
                                                         OPPS payment
            Indicator              Item/code/service        status
------------------------------------------------------------------------
A...............................  Services furnished  Not paid under
                                   to a hospital       OPPS. Paid by
                                   outpatient that     fiscal
                                   are paid under a    intermediaries/
                                   fee schedule or     MACs under a fee
                                   payment system      schedule or
                                   other than OPPS,    payment system
                                   for example:        other than OPPS.
                                   Ambulance
                                   Services.
                                   Clinical   Not subject to
                                   Diagnostic          deductible or
                                   Laboratory          coinsurance.
                                   Services.
                                   Non-
                                   Implantable
                                   Prosthetic and
                                   Orthotic Devices.
                                   EPO for
                                   ESRD Patients.
                                   Physical,
                                   Occupational, and
                                   Speech Therapy.
                                   Routine
                                   Dialysis Services
                                   for ESRD Patients
                                   Provided in a
                                   Certified
                                   Dialysis Unit of
                                   a Hospital.
                                  
                                   Diagnostic
                                   Mammography.
                                   Screening  Not subject to
                                   Mammography.        deductible.
------------------------------------------------------------------------
B...............................  Codes that are not  Not paid under
                                   recognized by       OPPS.
                                   OPPS when
                                   submitted on an
                                   outpatient
                                   hospital Part B
                                   bill type (12x
                                   and 13x).
                                                       May be
                                                       paid by fiscal
                                                       intermediaries/
                                                       MACs when
                                                       submitted on a
                                                       different bill
                                                       type, for
                                                       example, 75x
                                                       (CORF), but not
                                                       paid under OPPS.
                                                       An
                                                       alternate code
                                                       that is
                                                       recognized by
                                                       OPPS when
                                                       submitted on an
                                                       outpatient
                                                       hospital Part B
                                                       bill type (12x
                                                       and 13x) may be
                                                       available.
------------------------------------------------------------------------
C...............................  Inpatient           Not paid under
                                   Procedures.         OPPS. Admit
                                                       patient. Bill as
                                                       inpatient.
------------------------------------------------------------------------
D...............................  Discontinued Codes  Not paid under
                                                       OPPS or any other
                                                       Medicare payment
                                                       system.
------------------------------------------------------------------------
E...............................  Items, Codes, and   Not paid under
                                   Services:           OPPS or any other
                                                       Medicare payment
                                                       system.
                                   That are
                                   not covered by
                                   Medicare based on
                                   statutory
                                   exclusion.
                                   That are
                                   not covered by
                                   Medicare for
                                   reasons other
                                   than statutory
                                   exclusion.
                                   That are
                                   not recognized by
                                   Medicare but for
                                   which an
                                   alternate code
                                   for the same item
                                   or service may be
                                   available.
                                   For which
                                   separate payment
                                   is not provided
                                   by Medicare.
------------------------------------------------------------------------
F...............................  Corneal Tissue      Not paid under
                                   Acquisition;        OPPS. Paid at
                                   Certain CRNA        reasonable cost.
                                   Services and
                                   Hepatitis B
                                   Vaccines.
------------------------------------------------------------------------
G...............................  Pass-Through Drugs  Paid under OPPS;
                                   and Biologicals.    separate APC
                                                       payment includes
                                                       pass-through
                                                       amount.
------------------------------------------------------------------------

[[Page 67189]]

 
H...............................  Pass-Through        Separate cost-
                                   Device Categories.  based pass-
                                                       through payment;
                                                       not subject to
                                                       copayment.
------------------------------------------------------------------------
K...............................  (1) Nonpass-        (1) Paid under
                                   Through Drugs and   OPPS; separate
                                   Biologicals.        APC payment.
                                  (2) Therapeutic     (2) Paid under
                                   Radiopharmaceutic   OPPS; separate
                                   als.                APC payment.
                                  (3) Brachytherapy   (3) Paid under
                                   Sources.            OPPS; separate
                                                       APC payment.
                                  (4) Blood and       (4) Paid under
                                   Blood Products.     OPPS; separate
                                                       APC payment.
------------------------------------------------------------------------
L...............................  Influenza Vaccine;  Not paid under
                                   Pneumococcal        OPPS. Paid at
                                   Pneumonia Vaccine.  reasonable cost;
                                                       not subject to
                                                       deductible or
                                                       coinsurance.
------------------------------------------------------------------------
M...............................  Items and Services  Not paid under
                                   Not Billable to     OPPS.
                                   the Fiscal
                                   Intermediary/MAC.
------------------------------------------------------------------------
N...............................  Items and Services  Paid under OPPS;
                                   Packaged into APC   payment is
                                   Rates.              packaged into
                                                       payment for other
                                                       services,
                                                       including
                                                       outliers.
                                                       Therefore, there
                                                       is no separate
                                                       APC payment.
------------------------------------------------------------------------
P...............................  Partial             Paid under OPPS;
                                   Hospitalization.    per diem APC
                                                       payment.
------------------------------------------------------------------------
Q...............................  Packaged Services   Paid under OPPS;
                                   Subject to          Addendum B
                                   Separate Payment    displays APC
                                   under OPPS          assignments when
                                   Payment Criteria.   services are
                                                       separately
                                                       payable.
                                                      (1) Separate APC
                                                       payment based on
                                                       OPPS payment
                                                       criteria.
                                                      (2) If criteria
                                                       are not met,
                                                       payment is
                                                       packaged into
                                                       payment for other
                                                       services,
                                                       including
                                                       outliers.
                                                       Therefore, there
                                                       is no separate
                                                       APC payment.
------------------------------------------------------------------------
S...............................  Significant         Paid under OPPS;
                                   Procedure, Not      separate APC
                                   Discounted when     payment.
                                   Multiple.
------------------------------------------------------------------------
T...............................  Significant         Paid under OPPS;
                                   Procedure,          separate APC
                                   Multiple            payment.
                                   Reduction Applies.
------------------------------------------------------------------------
V...............................  Clinic or           Paid under OPPS;
                                   Emergency           separate APC
                                   Department Visit.   payment.
------------------------------------------------------------------------
X...............................  Ancillary Services  Paid under OPPS;
                                                       separate APC
                                                       payment.
------------------------------------------------------------------------
Y...............................  Non-Implantable     Not paid under
                                   Durable Medical     OPPS. All
                                   Equipment.          institutional
                                                       providers other
                                                       than home health
                                                       agencies bill to
                                                       DMERC.
------------------------------------------------------------------------


                  Addendum DD1.--ASC Payment Indicators
------------------------------------------------------------------------
       Indicator                  Payment indicator definition
------------------------------------------------------------------------
A2....................  Surgical procedure on ASC list in CY 2007;
                         payment based on OPPS relative payment weight.
D5....................  Deleted/discontinued code; no payment made.
F4....................  Corneal tissue acquisition; paid at reasonable
                         cost.
G2....................  Non office-based surgical procedure added in CY
                         2008 or later; payment based on OPPS relative
                         payment weight.
H2....................  Brachytherapy source paid separately when
                         provided integral to a surgical procedure on
                         ASC list; payment based on OPPS rate.
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 service/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.
------------------------------------------------------------------------


[[Page 67190]]


                 Addendum DD2.--OPPS Comment Indicators
------------------------------------------------------------------------
   Comment indicator                       Descriptor
------------------------------------------------------------------------
CH....................  Active HCPCS code in current year and next
                         calendar year, status indicator and/or APC
                         assignment has changed; or active HCPCS code
                         that will be discontinued at the end of the
                         current calendar year.
NI....................  New code, interim APC assignment; comments will
                         be accepted on the interim APC assignment for
                         the new code.
------------------------------------------------------------------------


                  Addendum DD2.--ASC Comment Indicators
------------------------------------------------------------------------
   Comment indicator                       Descriptor
------------------------------------------------------------------------
CH....................  Active HCPCS code in current year and next
                         calendar year, payment indicator has changed;
                         or active HCPCS code that is newly recognized
                         as payable in an ASC; or active HCPCS code that
                         will be discontinued at the end of the current
                         calendar year.
NI....................  New code, interim payment; comments will be
                         accepted on the interim payment indicator for
                         the new code.
------------------------------------------------------------------------


 Addendum E.--HCPCS Codes That Are Paid Only as Inpatient Procedures for
                                 CY 2008
------------------------------------------------------------------------
   HCPCS code       Short descriptor            SI              CI
------------------------------------------------------------------------
00176..........  Anesth, pharyngeal      C..............  ..............
                  surgery.
00192..........  Anesth, facial bone     C..............  ..............
                  surgery.
00214..........  Anesth, skull drainage  C..............  ..............
00215..........  Anesth, skull repair/   C..............  ..............
                  fract.
00452..........  Anesth, surgery of      C..............  ..............
                  shoulder.
00474..........  Anesth, surgery of      C..............  ..............
                  rib(s).
00524..........  Anesth, chest drainage  C..............  ..............
00540..........  Anesth, chest surgery.  C..............  ..............
00542..........  Anesth, release of      C..............  ..............
                  lung.
00546..........  Anesth, lung,chest      C..............  ..............
                  wall surg.
00560..........  Anesth, heart surg w/o  C..............  ..............
                  pump.
00561..........  Anesth, heart surg <    C..............  ..............
                  age 1.
00562..........  Anesth, heart surg w/   C..............  ..............
                  pump.
00580..........  Anesth, heart/lung      C..............  ..............
                  transplnt.
00604..........  Anesth, sitting         C..............  ..............
                  procedure.
00622..........  Anesth, removal of      C..............  ..............
                  nerves.
00632..........  Anesth, removal of      C..............  ..............
                  nerves.
00670..........  Anesth, spine, cord     C..............  ..............
                  surgery.
00792..........  Anesth, hemorr/excise   C..............  ..............
                  liver.
00794..........  Anesth, pancreas        C..............  ..............
                  removal.
00796..........  Anesth, for liver       C..............  ..............
                  transplant.
00802..........  Anesth, fat layer       C..............  ..............
                  removal.
00844..........  Anesth, pelvis surgery  C..............  ..............
00846..........  Anesth, hysterectomy..  C..............  ..............
00848..........  Anesth, pelvic organ    C..............  ..............
                  surg.
00864..........  Anesth, removal of      C..............  ..............
                  bladder.
00865..........  Anesth, removal of      C..............  ..............
                  prostate.
00866..........  Anesth, removal of      C..............  ..............
                  adrenal.
00868..........  Anesth, kidney          C..............  ..............
                  transplant.
00882..........  Anesth, major vein      C..............  ..............
                  ligation.
00904..........  Anesth, perineal        C..............  ..............
                  surgery.
00908..........  Anesth, removal of      C..............  ..............
                  prostate.
00932..........  Anesth, amputation of   C..............  ..............
                  penis.
00934..........  Anesth, penis, nodes    C..............  ..............
                  removal.
00936..........  Anesth, penis, nodes    C..............  ..............
                  removal.
00944..........  Anesth, vaginal         C..............  ..............
                  hysterectomy.
01140..........  Anesth, amputation at   C..............  ..............
                  pelvis.
01150..........  Anesth, pelvic tumor    C..............  ..............
                  surgery.
01212..........  Anesth, hip             C..............  ..............
                  disarticulation.
01214..........  Anesth, hip             C..............  ..............
                  arthroplasty.
01232..........  Anesth, amputation of   C..............  ..............
                  femur.
01234..........  Anesth, radical femur   C..............  ..............
                  surg.
01272..........  Anesth, femoral artery  C..............  ..............
                  surg.
01274..........  Anesth, femoral         C..............  ..............
                  embolectomy.
01402..........  Anesth, knee            C..............  ..............
                  arthroplasty.
01404..........  Anesth, amputation at   C..............  ..............
                  knee.
01442..........  Anesth, knee artery     C..............  ..............
                  surg.
01444..........  Anesth, knee artery     C..............  ..............
                  repair.
01486..........  Anesth, ankle           C..............  ..............
                  replacement.
01502..........  Anesth, lwr leg         C..............  ..............
                  embolectomy.
01632..........  Anesth, surgery of      C..............  ..............
                  shoulder.

[[Page 67191]]

 
01634..........  Anesth, shoulder joint  C..............  ..............
                  amput.
01636..........  Anesth, forequarter     C..............  ..............
                  amput.
01638..........  Anesth, shoulder        C..............  ..............
                  replacement.
01652..........  Anesth, shoulder        C..............  ..............
                  vessel surg.
01654..........  Anesth, shoulder        C..............  ..............
                  vessel surg.
01656..........  Anesth, arm-leg vessel  C..............  ..............
                  surg.
01756..........  Anesth, radical         C..............  ..............
                  humerus surg.
01990..........  Support for organ       C..............  ..............
                  donor.
11004..........  Debride genitalia &     C..............  ..............
                  perineum.
11005..........  Debride abdom wall....  C..............  ..............
11006..........  Debride genit/per/      C..............  ..............
                  abdom wall.
11008..........  Remove mesh from abd    C..............  ..............
                  wall.
15756..........  Free myo/skin flap      C..............  ..............
                  microvasc.
15757..........  Free skin flap,         C..............  ..............
                  microvasc.
15758..........  Free fascial flap,      C..............  ..............
                  microvasc.
16036..........  Escharotomy; add'l      C..............  ..............
                  incision.
19271..........  Revision of chest wall  C..............  ..............
19272..........  Extensive chest wall    C..............  ..............
                  surgery.
19305..........  Mast, radical.........  C..............  ..............
19306..........  Mast, rad, urban type.  C..............  ..............
19361..........  Breast reconstr w/lat   C..............  ..............
                  flap.
19364..........  Breast reconstruction.  C..............  ..............
19367..........  Breast reconstruction.  C..............  ..............
19368..........  Breast reconstruction.  C..............  ..............
19369..........  Breast reconstruction.  C..............  ..............
20660..........  Apply, rem fixation     C..............  ..............
                  device.
20661..........  Application of head     C..............  ..............
                  brace.
20664..........  Halo brace application  C..............  ..............
20802..........  Replantation, arm,      C..............  ..............
                  complete.
20805..........  Replant forearm,        C..............  ..............
                  complete.
20808..........  Replantation hand,      C..............  ..............
                  complete.
20816..........  Replantation digit,     C..............  ..............
                  complete.
20824..........  Replantation thumb,     C..............  ..............
                  complete.
20827..........  Replantation thumb,     C..............  ..............
                  complete.
20838..........  Replantation foot,      C..............  ..............
                  complete.
20930..........  Sp bone algrft morsel   C..............  ..............
                  add-on.
20931..........  Sp bone algrft struct   C..............  ..............
                  add-on.
20936..........  Sp bone agrft local     C..............  ..............
                  add-on.
20937..........  Sp bone agrft morsel    C..............  ..............
                  add-on.
20938..........  Sp bone agrft struct    C..............  ..............
                  add-on.
20955..........  Fibula bone graft,      C..............  ..............
                  microvasc.
20956..........  Iliac bone graft,       C..............  ..............
                  microvasc.
20957..........  Mt bone graft,          C..............  ..............
                  microvasc.
20962..........  Other bone graft,       C..............  ..............
                  microvasc.
20969..........  Bone/skin graft,        C..............  ..............
                  microvasc.
20970..........  Bone/skin graft, iliac  C..............  ..............
                  crest.
21045..........  Extensive jaw surgery.  C..............  ..............
21141..........  Reconstruct midface,    C..............  ..............
                  lefort.
21142..........  Reconstruct midface,    C..............  ..............
                  lefort.
21143..........  Reconstruct midface,    C..............  ..............
                  lefort.
21145..........  Reconstruct midface,    C..............  ..............
                  lefort.
21146..........  Reconstruct midface,    C..............  ..............
                  lefort.
21147..........  Reconstruct midface,    C..............  ..............
                  lefort.
21151..........  Reconstruct midface,    C..............  ..............
                  lefort.
21154..........  Reconstruct midface,    C..............  ..............
                  lefort.
21155..........  Reconstruct midface,    C..............  ..............
                  lefort.
21159..........  Reconstruct midface,    C..............  ..............
                  lefort.
21160..........  Reconstruct midface,    C..............  ..............
                  lefort.
21172..........  Reconstruct orbit/      C..............  ..............
                  forehead.
21179..........  Reconstruct entire      C..............  ..............
                  forehead.
21180..........  Reconstruct entire      C..............  ..............
                  forehead.
21182..........  Reconstruct cranial     C..............  ..............
                  bone.
21183..........  Reconstruct cranial     C..............  ..............
                  bone.
21184..........  Reconstruct cranial     C..............  ..............
                  bone.
21188..........  Reconstruction of       C..............  ..............
                  midface.
21193..........  Reconst lwr jaw w/o     C..............  ..............
                  graft.
21194..........  Reconst lwr jaw w/      C..............  ..............
                  graft.
21196..........  Reconst lwr jaw w/      C..............  ..............
                  fixation.
21247..........  Reconstruct lower jaw   C..............  ..............
                  bone.
21255..........  Reconstruct lower jaw   C..............  ..............
                  bone.
21256..........  Reconstruction of       C..............  ..............
                  orbit.

[[Page 67192]]

 
21268..........  Revise eye sockets....  C..............  ..............
21343..........  Treatment of sinus      C..............  ..............
                  fracture.
21344..........  Treatment of sinus      C..............  ..............
                  fracture.
21346..........  Treat nose/jaw          C..............  ..............
                  fracture.
21347..........  Treat nose/jaw          C..............  ..............
                  fracture.
21348..........  Treat nose/jaw          C..............  ..............
                  fracture.
21366..........  Treat cheek bone        C..............  ..............
                  fracture.
21386..........  Treat eye socket        C..............  ..............
                  fracture.
21387..........  Treat eye socket        C..............  ..............
                  fracture.
21395..........  Treat eye socket        C..............  ..............
                  fracture.
21422..........  Treat mouth roof        C..............  ..............
                  fracture.
21423..........  Treat mouth roof        C..............  ..............
                  fracture.
21431..........  Treat craniofacial      C..............  ..............
                  fracture.
21432..........  Treat craniofacial      C..............  ..............
                  fracture.
21433..........  Treat craniofacial      C..............  ..............
                  fracture.
21435..........  Treat craniofacial      C..............  ..............
                  fracture.
21436..........  Treat craniofacial      C..............  ..............
                  fracture.
21510..........  Drainage of bone        C..............  ..............
                  lesion.
21615..........  Removal of rib........  C..............  ..............
21616..........  Removal of rib and      C..............  ..............
                  nerves.
21620..........  Partial removal of      C..............  ..............
                  sternum.
21627..........  Sternal debridement...  C..............  ..............
21630..........  Extensive sternum       C..............  ..............
                  surgery.
21632..........  Extensive sternum       C..............  ..............
                  surgery.
21705..........  Revision of neck        C..............  ..............
                  muscle/rib.
21740..........  Reconstruction of       C..............  ..............
                  sternum.
21750..........  Repair of sternum       C..............  ..............
                  separation.
21810..........  Treatment of rib        C..............  ..............
                  fracture(s).
21825..........  Treat sternum fracture  C..............  ..............
22010..........  I&d, p-spine, c/t/cerv- C..............  ..............
                  thor.
22015..........  I&d, p-spine, l/s/ls..  C..............  ..............
22110..........  Remove part of neck     C..............  ..............
                  vertebra.
22112..........  Remove part, thorax     C..............  ..............
                  vertebra.
22114..........  Remove part, lumbar     C..............  ..............
                  vertebra.
22116..........  Remove extra spine      C..............  ..............
                  segment.
22206..........  Cut spine 3 col, thor.  C..............  NI
22207..........  Cut spine 3 col, lumb.  C..............  NI
22208..........  Cut spine 3 col, addl   C..............  NI
                  seg.
22210..........  Revision of neck spine  C..............  ..............
22212..........  Revision of thorax      C..............  ..............
                  spine.
22214..........  Revision of lumbar      C..............  ..............
                  spine.
22216..........  Revise, extra spine     C..............  ..............
                  segment.
22220..........  Revision of neck spine  C..............  ..............
22224..........  Revision of lumbar      C..............  ..............
                  spine.
22226..........  Revise, extra spine     C..............  ..............
                  segment.
22318..........  Treat odontoid fx w/o   C..............  ..............
                  graft.
22319..........  Treat odontoid fx w/    C..............  ..............
                  graft.
22325..........  Treat spine fracture..  C..............  ..............
22326..........  Treat neck spine        C..............  ..............
                  fracture.
22327..........  Treat thorax spine      C..............  ..............
                  fracture.
22328..........  Treat each add spine    C..............  ..............
                  fx.
22532..........  Lat thorax spine        C..............  ..............
                  fusion.
22533..........  Lat lumbar spine        C..............  ..............
                  fusion.
22534..........  Lat thor/lumb, add'l    C..............  ..............
                  seg.
22548..........  Neck spine fusion.....  C..............  ..............
22554..........  Neck spine fusion.....  C..............  ..............
22556..........  Thorax spine fusion...  C..............  ..............
22558..........  Lumbar spine fusion...  C..............  ..............
22585..........  Additional spinal       C..............  ..............
                  fusion.
22590..........  Spine & skull spinal    C..............  ..............
                  fusion.
22595..........  Neck spinal fusion....  C..............  ..............
22600..........  Neck spine fusion.....  C..............  ..............
22610..........  Thorax spine fusion...  C..............  ..............
22630..........  Lumbar spine fusion...  C..............  ..............
22632..........  Spine fusion, extra     C..............  ..............
                  segment.
22800..........  Fusion of spine.......  C..............  ..............
22802..........  Fusion of spine.......  C..............  ..............
22804..........  Fusion of spine.......  C..............  ..............
22808..........  Fusion of spine.......  C..............  ..............
22810..........  Fusion of spine.......  C..............  ..............
22812..........  Fusion of spine.......  C..............  ..............

[[Page 67193]]

 
22818..........  Kyphectomy, 1-2         C..............  ..............
                  segments.
22819..........  Kyphectomy, 3 or more.  C..............  ..............
22830..........  Exploration of spinal   C..............  ..............
                  fusion.
22840..........  Insert spine fixation   C..............  ..............
                  device.
22841..........  Insert spine fixation   C..............  ..............
                  device.
22842..........  Insert spine fixation   C..............  ..............
                  device.
22843..........  Insert spine fixation   C..............  ..............
                  device.
22844..........  Insert spine fixation   C..............  ..............
                  device.
22845..........  Insert spine fixation   C..............  ..............
                  device.
22846..........  Insert spine fixation   C..............  ..............
                  device.
22847..........  Insert spine fixation   C..............  ..............
                  device.
22848..........  Insert pelv fixation    C..............  ..............
                  device.
22849..........  Reinsert spinal         C..............  ..............
                  fixation.
22850..........  Remove spine fixation   C..............  ..............
                  device.
22852..........  Remove spine fixation   C..............  ..............
                  device.
22855..........  Remove spine fixation   C..............  ..............
                  device.
22857..........  Lumbar artif            C..............  ..............
                  diskectomy.
22862..........  Revise lumbar artif     C..............  ..............
                  disc.
22865..........  Remove lumb artif disc  C..............  ..............
23200..........  Removal of collar bone  C..............  ..............
23210..........  Removal of shoulder     C..............  ..............
                  blade.
23220..........  Partial removal of      C..............  ..............
                  humerus.
23221..........  Partial removal of      C..............  ..............
                  humerus.
23222..........  Partial removal of      C..............  ..............
                  humerus.
23332..........  Remove shoulder         C..............  ..............
                  foreign body.
23472..........  Reconstruct shoulder    C..............  ..............
                  joint.
23900..........  Amputation of arm &     C..............  ..............
                  girdle.
23920..........  Amputation at shoulder  C..............  ..............
                  joint.
24900..........  Amputation of upper     C..............  ..............
                  arm.
24920..........  Amputation of upper     C..............  ..............
                  arm.
24930..........  Amputation follow-up    C..............  ..............
                  surgery.
24931..........  Amputate upper arm &    C..............  ..............
                  implant.
24940..........  Revision of upper arm.  C..............  ..............
25900..........  Amputation of forearm.  C..............  ..............
25905..........  Amputation of forearm.  C..............  ..............
25909..........  Amputation follow-up    C..............  ..............
                  surgery.
25915..........  Amputation of forearm.  C..............  ..............
25920..........  Amputate hand at wrist  C..............  ..............
25924..........  Amputation follow-up    C..............  ..............
                  surgery.
25927..........  Amputation of hand....  C..............  ..............
26551..........  Great toe-hand          C..............  ..............
                  transfer.
26553..........  Single transfer, toe-   C..............  ..............
                  hand.
26554..........  Double transfer, toe-   C..............  ..............
                  hand.
26556..........  Toe joint transfer....  C..............  ..............
26992..........  Drainage of bone        C..............  ..............
                  lesion.
27005..........  Incision of hip tendon  C..............  ..............
27025..........  Incision of hip/thigh   C..............  ..............
                  fascia.
27030..........  Drainage of hip joint.  C..............  ..............
27036..........  Excision of hip joint/  C..............  ..............
                  muscle.
27054..........  Removal of hip joint    C..............  ..............
                  lining.
27070..........  Partial removal of hip  C..............  ..............
                  bone.
27071..........  Partial removal of hip  C..............  ..............
                  bone.
27075..........  Extensive hip surgery.  C..............  ..............
27076..........  Extensive hip surgery.  C..............  ..............
27077..........  Extensive hip surgery.  C..............  ..............
27078..........  Extensive hip surgery.  C..............  ..............
27079..........  Extensive hip surgery.  C..............  ..............
27090..........  Removal of hip          C..............  ..............
                  prosthesis.
27091..........  Removal of hip          C..............  ..............
                  prosthesis.
27120..........  Reconstruction of hip   C..............  ..............
                  socket.
27122..........  Reconstruction of hip   C..............  ..............
                  socket.
27125..........  Partial hip             C..............  ..............
                  replacement.
27130..........  Total hip arthroplasty  C..............  ..............
27132..........  Total hip arthroplasty  C..............  ..............
27134..........  Revise hip joint        C..............  ..............
                  replacement.
27137..........  Revise hip joint        C..............  ..............
                  replacement.
27138..........  Revise hip joint        C..............  ..............
                  replacement.
27140..........  Transplant femur ridge  C..............  ..............
27146..........  Incision of hip bone..  C..............  ..............
27147..........  Revision of hip bone..  C..............  ..............
27151..........  Incision of hip bones.  C..............  ..............

[[Page 67194]]

 
27156..........  Revision of hip bones.  C..............  ..............
27158..........  Revision of pelvis....  C..............  ..............
27161..........  Incision of neck of     C..............  ..............
                  femur.
27165..........  Incision/fixation of    C..............  ..............
                  femur.
27170..........  Repair/graft femur      C..............  ..............
                  head/neck.
27175..........  Treat slipped           C..............  ..............
                  epiphysis.
27176..........  Treat slipped           C..............  ..............
                  epiphysis.
27177..........  Treat slipped           C..............  ..............
                  epiphysis.
27178..........  Treat slipped           C..............  ..............
                  epiphysis.
27179..........  Revise head/neck of     C..............  ..............
                  femur.
27181..........  Treat slipped           C..............  ..............
                  epiphysis.
27185..........  Revision of femur       C..............  ..............
                  epiphysis.
27187..........  Reinforce hip bones...  C..............  ..............
27215..........  Treat pelvic            C..............  ..............
                  fracture(s).
27217..........  Treat pelvic ring       C..............  ..............
                  fracture.
27218..........  Treat pelvic ring       C..............  ..............
                  fracture.
27222..........  Treat hip socket        C..............  ..............
                  fracture.
27226..........  Treat hip wall          C..............  ..............
                  fracture.
27227..........  Treat hip fracture(s).  C..............  ..............
27228..........  Treat hip fracture(s).  C..............  ..............
27232..........  Treat thigh fracture..  C..............  ..............
27236..........  Treat thigh fracture..  C..............  ..............
27240..........  Treat thigh fracture..  C..............  ..............
27244..........  Treat thigh fracture..  C..............  ..............
27245..........  Treat thigh fracture..  C..............  ..............
27248..........  Treat thigh fracture..  C..............  ..............
27253..........  Treat hip dislocation.  C..............  ..............
27254..........  Treat hip dislocation.  C..............  ..............
27258..........  Treat hip dislocation.  C..............  ..............
27259..........  Treat hip dislocation.  C..............  ..............
27268..........  Cltx thigh fx w/mnpj..  C..............  NI
27269..........  Optx thigh fx.........  C..............  NI
27280..........  Fusion of sacroiliac    C..............  ..............
                  joint.
27282..........  Fusion of pubic bones.  C..............  ..............
27284..........  Fusion of hip joint...  C..............  ..............
27286..........  Fusion of hip joint...  C..............  ..............
27290..........  Amputation of leg at    C..............  ..............
                  hip.
27295..........  Amputation of leg at    C..............  ..............
                  hip.
27303..........  Drainage of bone        C..............  ..............
                  lesion.
27365..........  Extensive leg surgery.  C..............  ..............
27445..........  Revision of knee joint  C..............  ..............
27447..........  Total knee              C..............  ..............
                  arthroplasty.
27448..........  Incision of thigh.....  C..............  ..............
27450..........  Incision of thigh.....  C..............  ..............
27454..........  Realignment of thigh    C..............  ..............
                  bone.
27455..........  Realignment of knee...  C..............  ..............
27457..........  Realignment of knee...  C..............  ..............
27465..........  Shortening of thigh     C..............  ..............
                  bone.
27466..........  Lengthening of thigh    C..............  ..............
                  bone.
27468..........  Shorten/lengthen        C..............  ..............
                  thighs.
27470..........  Repair of thigh.......  C..............  ..............
27472..........  Repair/graft of thigh.  C..............  ..............
27477..........  Surgery to stop leg     C..............  ..............
                  growth.
27479..........  Surgery to stop leg     C..............  ..............
                  growth.
27485..........  Surgery to stop leg     C..............  ..............
                  growth.
27486..........  Revise/replace knee     C..............  ..............
                  joint.
27487..........  Revise/replace knee     C..............  ..............
                  joint.
27488..........  Removal of knee         C..............  ..............
                  prosthesis.
27495..........  Reinforce thigh.......  C..............  ..............
27506..........  Treatment of thigh      C..............  ..............
                  fracture.
27507..........  Treatment of thigh      C..............  ..............
                  fracture.
27511..........  Treatment of thigh      C..............  ..............
                  fracture.
27513..........  Treatment of thigh      C..............  ..............
                  fracture.
27514..........  Treatment of thigh      C..............  ..............
                  fracture.
27519..........  Treat thigh fx growth   C..............  ..............
                  plate.
27535..........  Treat knee fracture...  C..............  ..............
27536..........  Treat knee fracture...  C..............  ..............
27540..........  Treat knee fracture...  C..............  ..............
27556..........  Treat knee dislocation  C..............  ..............
27557..........  Treat knee dislocation  C..............  ..............
27558..........  Treat knee dislocation  C..............  ..............

[[Page 67195]]

 
27580..........  Fusion of knee........  C..............  ..............
27590..........  Amputate leg at thigh.  C..............  ..............
27591..........  Amputate leg at thigh.  C..............  ..............
27592..........  Amputate leg at thigh.  C..............  ..............
27596..........  Amputation follow-up    C..............  ..............
                  surgery.
27598..........  Amputate lower leg at   C..............  ..............
                  knee.
27645..........  Extensive lower leg     C..............  ..............
                  surgery.
27646..........  Extensive lower leg     C..............  ..............
                  surgery.
27702..........  Reconstruct ankle       C..............  ..............
                  joint.
27703..........  Reconstruction, ankle   C..............  ..............
                  joint.
27712..........  Realignment of lower    C..............  ..............
                  leg.
27715..........  Revision of lower leg.  C..............  ..............
27724..........  Repair/graft of tibia.  C..............  ..............
27725..........  Repair of lower leg...  C..............  ..............
27727..........  Repair of lower leg...  C..............  ..............
27880..........  Amputation of lower     C..............  ..............
                  leg.
27881..........  Amputation of lower     C..............  ..............
                  leg.
27882..........  Amputation of lower     C..............  ..............
                  leg.
27886..........  Amputation follow-up    C..............  ..............
                  surgery.
27888..........  Amputation of foot at   C..............  ..............
                  ankle.
28800..........  Amputation of midfoot.  C..............  ..............
28805..........  Amputation thru         C..............  ..............
                  metatarsal.
31225..........  Removal of upper jaw..  C..............  ..............
31230..........  Removal of upper jaw..  C..............  ..............
31290..........  Nasal/sinus endoscopy,  C..............  ..............
                  surg.
31291..........  Nasal/sinus endoscopy,  C..............  ..............
                  surg.
31360..........  Removal of larynx.....  C..............  ..............
31365..........  Removal of larynx.....  C..............  ..............
31367..........  Partial removal of      C..............  ..............
                  larynx.
31368..........  Partial removal of      C..............  ..............
                  larynx.
31370..........  Partial removal of      C..............  ..............
                  larynx.
31375..........  Partial removal of      C..............  ..............
                  larynx.
31380..........  Partial removal of      C..............  ..............
                  larynx.
31382..........  Partial removal of      C..............  ..............
                  larynx.
31390..........  Removal of larynx &     C..............  ..............
                  pharynx.
31395..........  Reconstruct larynx &    C..............  ..............
                  pharynx.
31584..........  Treat larynx fracture.  C..............  ..............
31587..........  Revision of larynx....  C..............  ..............
31725..........  Clearance of airways..  C..............  ..............
31760..........  Repair of windpipe....  C..............  ..............
31766..........  Reconstruction of       C..............  ..............
                  windpipe.
31770..........  Repair/graft of         C..............  ..............
                  bronchus.
31775..........  Reconstruct bronchus..  C..............  ..............
31780..........  Reconstruct windpipe..  C..............  ..............
31781..........  Reconstruct windpipe..  C..............  ..............
31786..........  Remove windpipe lesion  C..............  ..............
31800..........  Repair of windpipe      C..............  ..............
                  injury.
31805..........  Repair of windpipe      C..............  ..............
                  injury.
32035..........  Exploration of chest..  C..............  ..............
32036..........  Exploration of chest..  C..............  ..............
32095..........  Biopsy through chest    C..............  ..............
                  wall.
32100..........  Exploration/biopsy of   C..............  ..............
                  chest.
32110..........  Explore/repair chest..  C..............  ..............
32120..........  Re-exploration of       C..............  ..............
                  chest.
32124..........  Explore chest free      C..............  ..............
                  adhesions.
32140..........  Removal of lung         C..............  ..............
                  lesion(s).
32141..........  Remove/treat lung       C..............  ..............
                  lesions.
32150..........  Removal of lung         C..............  ..............
                  lesion(s).
32151..........  Remove lung foreign     C..............  ..............
                  body.
32160..........  Open chest heart        C..............  ..............
                  massage.
32200..........  Drain, open, lung       C..............  ..............
                  lesion.
32215..........  Treat chest lining....  C..............  ..............
32220..........  Release of lung.......  C..............  ..............
32225..........  Partial release of      C..............  ..............
                  lung.
32310..........  Removal of chest        C..............  ..............
                  lining.
32320..........  Free/remove chest       C..............  ..............
                  lining.
32402..........  Open biopsy chest       C..............  ..............
                  lining.
32440..........  Removal of lung.......  C..............  ..............
32442..........  Sleeve pneumonectomy..  C..............  ..............
32445..........  Removal of lung.......  C..............  ..............
32480..........  Partial removal of      C..............  ..............
                  lung.

[[Page 67196]]

 
32482..........  Bilobectomy...........  C..............  ..............
32484..........  Segmentectomy.........  C..............  ..............
32486..........  Sleeve lobectomy......  C..............  ..............
32488..........  Completion              C..............  ..............
                  pneumonectomy.
32491..........  Lung volume reduction.  C..............  ..............
32500..........  Partial removal of      C..............  ..............
                  lung.
32501..........  Repair bronchus add-on  C..............  ..............
32503..........  Resect apical lung      C..............  ..............
                  tumor.
32504..........  Resect apical lung tum/ C..............  ..............
                  chest.
32540..........  Removal of lung lesion  C..............  ..............
32650..........  Thoracoscopy, surgical  C..............  ..............
32651..........  Thoracoscopy, surgical  C..............  ..............
32652..........  Thoracoscopy, surgical  C..............  ..............
32653..........  Thoracoscopy, surgical  C..............  ..............
32654..........  Thoracoscopy, surgical  C..............  ..............
32655..........  Thoracoscopy, surgical  C..............  ..............
32656..........  Thoracoscopy, surgical  C..............  ..............
32657..........  Thoracoscopy, surgical  C..............  ..............
32658..........  Thoracoscopy, surgical  C..............  ..............
32659..........  Thoracoscopy, surgical  C..............  ..............
32660..........  Thoracoscopy, surgical  C..............  ..............
32661..........  Thoracoscopy, surgical  C..............  ..............
32662..........  Thoracoscopy, surgical  C..............  ..............
32663..........  Thoracoscopy, surgical  C..............  ..............
32664..........  Thoracoscopy, surgical  C..............  ..............
32665..........  Thoracoscopy, surgical  C..............  ..............
32800..........  Repair lung hernia....  C..............  ..............
32810..........  Close chest after       C..............  ..............
                  drainage.
32815..........  Close bronchial         C..............  ..............
                  fistula.
32820..........  Reconstruct injured     C..............  ..............
                  chest.
32850..........  Donor pneumonectomy...  C..............  ..............
32851..........  Lung transplant,        C..............  ..............
                  single.
32852..........  Lung transplant with    C..............  ..............
                  bypass.
32853..........  Lung transplant,        C..............  ..............
                  double.
32854..........  Lung transplant with    C..............  ..............
                  bypass.
32855..........  Prepare donor lung,     C..............  ..............
                  single.
32856..........  Prepare donor lung,     C..............  ..............
                  double.
32900..........  Removal of rib(s).....  C..............  ..............
32905..........  Revise & repair chest   C..............  ..............
                  wall.
32906..........  Revise & repair chest   C..............  ..............
                  wall.
32940..........  Revision of lung......  C..............  ..............
32997..........  Total lung lavage.....  C..............  ..............
33015..........  Incision of heart sac.  C..............  ..............
33020..........  Incision of heart sac.  C..............  ..............
33025..........  Incision of heart sac.  C..............  ..............
33030..........  Partial removal of      C..............  ..............
                  heart sac.
33031..........  Partial removal of      C..............  ..............
                  heart sac.
33050..........  Removal of heart sac    C..............  ..............
                  lesion.
33120..........  Removal of heart        C..............  ..............
                  lesion.
33130..........  Removal of heart        C..............  ..............
                  lesion.
33140..........  Heart revascularize     C..............  ..............
                  (tmr).
33141..........  Heart tmr w/other       C..............  ..............
                  procedure.
33202..........  Insert epicard eltrd,   C..............  ..............
                  open.
33203..........  Insert epicard eltrd,   C..............  ..............
                  endo.
33236..........  Remove electrode/       C..............  ..............
                  thoracotomy.
33237..........  Remove electrode/       C..............  ..............
                  thoracotomy.
33238..........  Remove electrode/       C..............  ..............
                  thoracotomy.
33243..........  Remove eltrd/           C..............  ..............
                  thoracotomy.
33250..........  Ablate heart dysrhythm  C..............  ..............
                  focus.
33251..........  Ablate heart dysrhythm  C..............  ..............
                  focus.
33254..........  Ablate atria, lmtd....  C..............  ..............
33255..........  Ablate atria w/o        C..............  ..............
                  bypass, ext.
33256..........  Ablate atria w/bypass,  C..............  ..............
                  exten.
33257..........  Ablate atria, lmtd,     C..............  NI
                  add-on.
33258..........  Ablate atria, x10sv,    C..............  NI
                  add-on.
33259..........  Ablate atria w/bypass   C..............  NI
                  add-on.
33261..........  Ablate heart dysrhythm  C..............  ..............
                  focus.
33265..........  Ablate atria, lmtd,     C..............  ..............
                  endo.
33266..........  Ablate atria, x10sv,    C..............  ..............
                  endo.
33300..........  Repair of heart wound.  C..............  ..............
33305..........  Repair of heart wound.  C..............  ..............

[[Page 67197]]

 
33310..........  Exploratory heart       C..............  ..............
                  surgery.
33315..........  Exploratory heart       C..............  ..............
                  surgery.
33320..........  Repair major blood      C..............  ..............
                  vessel(s).
33321..........  Repair major vessel...  C..............  ..............
33322..........  Repair major blood      C..............  ..............
                  vessel(s).
33330..........  Insert major vessel     C..............  ..............
                  graft.
33332..........  Insert major vessel     C..............  ..............
                  graft.
33335..........  Insert major vessel     C..............  ..............
                  graft.
33400..........  Repair of aortic valve  C..............  ..............
33401..........  Valvuloplasty, open...  C..............  ..............
33403..........  Valvuloplasty, w/cp     C..............  ..............
                  bypass.
33404..........  Prepare heart-aorta     C..............  ..............
                  conduit.
33405..........  Replacement of aortic   C..............  ..............
                  valve.
33406..........  Replacement of aortic   C..............  ..............
                  valve.
33410..........  Replacement of aortic   C..............  ..............
                  valve.
33411..........  Replacement of aortic   C..............  ..............
                  valve.
33412..........  Replacement of aortic   C..............  ..............
                  valve.
33413..........  Replacement of aortic   C..............  ..............
                  valve.
33414..........  Repair of aortic valve  C..............  ..............
33415..........  Revision, subvalvular   C..............  ..............
                  tissue.
33416..........  Revise ventricle        C..............  ..............
                  muscle.
33417..........  Repair of aortic valve  C..............  ..............
33420..........  Revision of mitral      C..............  ..............
                  valve.
33422..........  Revision of mitral      C..............  ..............
                  valve.
33425..........  Repair of mitral valve  C..............  ..............
33426..........  Repair of mitral valve  C..............  ..............
33427..........  Repair of mitral valve  C..............  ..............
33430..........  Replacement of mitral   C..............  ..............
                  valve.
33460..........  Revision of tricuspid   C..............  ..............
                  valve.
33463..........  Valvuloplasty,          C..............  ..............
                  tricuspid.
33464..........  Valvuloplasty,          C..............  ..............
                  tricuspid.
33465..........  Replace tricuspid       C..............  ..............
                  valve.
33468..........  Revision of tricuspid   C..............  ..............
                  valve.
33470..........  Revision of pulmonary   C..............  ..............
                  valve.
33471..........  Valvotomy, pulmonary    C..............  ..............
                  valve.
33472..........  Revision of pulmonary   C..............  ..............
                  valve.
33474..........  Revision of pulmonary   C..............  ..............
                  valve.
33475..........  Replacement, pulmonary  C..............  ..............
                  valve.
33476..........  Revision of heart       C..............  ..............
                  chamber.
33478..........  Revision of heart       C..............  ..............
                  chamber.
33496..........  Repair, prosth valve    C..............  ..............
                  clot.
33500..........  Repair heart vessel     C..............  ..............
                  fistula.
33501..........  Repair heart vessel     C..............  ..............
                  fistula.
33502..........  Coronary artery         C..............  ..............
                  correction.
33503..........  Coronary artery graft.  C..............  ..............
33504..........  Coronary artery graft.  C..............  ..............
33505..........  Repair artery w/tunnel  C..............  ..............
33506..........  Repair artery,          C..............  ..............
                  translocation.
33507..........  Repair art, intramural  C..............  ..............
33510..........  CABG, vein, single....  C..............  ..............
33511..........  CABG, vein, two.......  C..............  ..............
33512..........  CABG, vein, three.....  C..............  ..............
33513..........  CABG, vein, four......  C..............  ..............
33514..........  CABG, vein, five......  C..............  ..............
33516..........  Cabg, vein, six or      C..............  ..............
                  more.
33517..........  CABG, artery-vein,      C..............  ..............
                  single.
33518..........  CABG, artery-vein, two  C..............  ..............
33519..........  CABG, artery-vein,      C..............  ..............
                  three.
33521..........  CABG, artery-vein,      C..............  ..............
                  four.
33522..........  CABG, artery-vein,      C..............  ..............
                  five.
33523..........  Cabg, art-vein, six or  C..............  ..............
                  more.
33530..........  Coronary artery,        C..............  ..............
                  bypass/reop.
33533..........  CABG, arterial, single  C..............  ..............
33534..........  CABG, arterial, two...  C..............  ..............
33535..........  CABG, arterial, three.  C..............  ..............
33536..........  Cabg, arterial, four    C..............  ..............
                  or more.
33542..........  Removal of heart        C..............  ..............
                  lesion.
33545..........  Repair of heart damage  C..............  ..............
33548..........  Restore/remodel,        C..............  ..............
                  ventricle.
33572..........  Open coronary           C..............  ..............
                  endarterectomy.
33600..........  Closure of valve......  C..............  ..............

[[Page 67198]]

 
33602..........  Closure of valve......  C..............  ..............
33606..........  Anastomosis/artery-     C..............  ..............
                  aorta.
33608..........  Repair anomaly w/       C..............  ..............
                  conduit.
33610..........  Repair by enlargement.  C..............  ..............
33611..........  Repair double           C..............  ..............
                  ventricle.
33612..........  Repair double           C..............  ..............
                  ventricle.
33615..........  Repair, modified        C..............  ..............
                  fontan.
33617..........  Repair single           C..............  ..............
                  ventricle.
33619..........  Repair single           C..............  ..............
                  ventricle.
33641..........  Repair heart septum     C..............  ..............
                  defect.
33645..........  Revision of heart       C..............  ..............
                  veins.
33647..........  Repair heart septum     C..............  ..............
                  defects.
33660..........  Repair of heart         C..............  ..............
                  defects.
33665..........  Repair of heart         C..............  ..............
                  defects.
33670..........  Repair of heart         C..............  ..............
                  chambers.
33675..........  Close mult vsd........  C..............  ..............
33676..........  Close mult vsd w/       C..............  ..............
                  resection.
33677..........  Cl mult vsd w/rem pul   C..............  ..............
                  band.
33681..........  Repair heart septum     C..............  ..............
                  defect.
33684..........  Repair heart septum     C..............  ..............
                  defect.
33688..........  Repair heart septum     C..............  ..............
                  defect.
33690..........  Reinforce pulmonary     C..............  ..............
                  artery.
33692..........  Repair of heart         C..............  ..............
                  defects.
33694..........  Repair of heart         C..............  ..............
                  defects.
33697..........  Repair of heart         C..............  ..............
                  defects.
33702..........  Repair of heart         C..............  ..............
                  defects.
33710..........  Repair of heart         C..............  ..............
                  defects.
33720..........  Repair of heart defect  C..............  ..............
33722..........  Repair of heart defect  C..............  ..............
33724..........  Repair venous anomaly.  C..............  ..............
33726..........  Repair pul venous       C..............  ..............
                  stenosis.
33730..........  Repair heart-vein       C..............  ..............
                  defect(s).
33732..........  Repair heart-vein       C..............  ..............
                  defect.
33735..........  Revision of heart       C..............  ..............
                  chamber.
33736..........  Revision of heart       C..............  ..............
                  chamber.
33737..........  Revision of heart       C..............  ..............
                  chamber.
33750..........  Major vessel shunt....  C..............  ..............
33755..........  Major vessel shunt....  C..............  ..............
33762..........  Major vessel shunt....  C..............  ..............
33764..........  Major vessel shunt &    C..............  ..............
                  graft.
33766..........  Major vessel shunt....  C..............  ..............
33767..........  Major vessel shunt....  C..............  ..............
33768..........  Cavopulmonary shunting  C..............  ..............
33770..........  Repair great vessels    C..............  ..............
                  defect.
33771..........  Repair great vessels    C..............  ..............
                  defect.
33774..........  Repair great vessels    C..............  ..............
                  defect.
33775..........  Repair great vessels    C..............  ..............
                  defect.
33776..........  Repair great vessels    C..............  ..............
                  defect.
33777..........  Repair great vessels    C..............  ..............
                  defect.
33778..........  Repair great vessels    C..............  ..............
                  defect.
33779..........  Repair great vessels    C..............  ..............
                  defect.
33780..........  Repair great vessels    C..............  ..............
                  defect.
33781..........  Repair great vessels    C..............  ..............
                  defect.
33786..........  Repair arterial trunk.  C..............  ..............
33788..........  Revision of pulmonary   C..............  ..............
                  artery.
33800..........  Aortic suspension.....  C..............  ..............
33802..........  Repair vessel defect..  C..............  ..............
33803..........  Repair vessel defect..  C..............  ..............
33813..........  Repair septal defect..  C..............  ..............
33814..........  Repair septal defect..  C..............  ..............
33820..........  Revise major vessel...  C..............  ..............
33822..........  Revise major vessel...  C..............  ..............
33824..........  Revise major vessel...  C..............  ..............
33840..........  Remove aorta            C..............  ..............
                  constriction.
33845..........  Remove aorta            C..............  ..............
                  constriction.
33851..........  Remove aorta            C..............  ..............
                  constriction.
33852..........  Repair septal defect..  C..............  ..............
33853..........  Repair septal defect..  C..............  ..............
33860..........  Ascending aortic graft  C..............  ..............
33861..........  Ascending aortic graft  C..............  ..............
33863..........  Ascending aortic graft  C..............  ..............

[[Page 67199]]

 
33864..........  Ascending aortic graft  C..............  NI
33870..........  Transverse aortic arch  C..............  ..............
                  graft.
33875..........  Thoracic aortic graft.  C..............  ..............
33877..........  Thoracoabdominal graft  C..............  ..............
33880..........  Endovasc taa repr incl  C..............  ..............
                  subcl.
33881..........  Endovasc taa repr w/o   C..............  ..............
                  subcl.
33883..........  Insert endovasc         C..............  ..............
                  prosth, taa.
33884..........  Endovasc prosth, taa,   C..............  ..............
                  add-on.
33886..........  Endovasc prosth,        C..............  ..............
                  delayed.
33889..........  Artery transpose/       C..............  ..............
                  endovas taa.
33891..........  Car-car bp grft/        C..............  ..............
                  endovas taa.
33910..........  Remove lung artery      C..............  ..............
                  emboli.
33915..........  Remove lung artery      C..............  ..............
                  emboli.
33916..........  Surgery of great        C..............  ..............
                  vessel.
33917..........  Repair pulmonary        C..............  ..............
                  artery.
33920..........  Repair pulmonary        C..............  ..............
                  atresia.
33922..........  Transect pulmonary      C..............  ..............
                  artery.
33924..........  Remove pulmonary shunt  C..............  ..............
33925..........  Rpr pul art unifocal w/ C..............  ..............
                  o cpb.
33926..........  Repr pul art, unifocal  C..............  ..............
                  w/cpb.
33930..........  Removal of donor heart/ C..............  ..............
                  lung.
33933..........  Prepare donor heart/    C..............  ..............
                  lung.
33935..........  Transplantation, heart/ C..............  ..............
                  lung.
33940..........  Removal of donor heart  C..............  ..............
33944..........  Prepare donor heart...  C..............  ..............
33945..........  Transplantation of      C..............  ..............
                  heart.
33960..........  External circulation    C..............  ..............
                  assist.
33961..........  External circulation    C..............  ..............
                  assist.
33967..........  Insert ia percut        C..............  ..............
                  device.
33968..........  Remove aortic assist    C..............  ..............
                  device.
33970..........  Aortic circulation      C..............  ..............
                  assist.
33971..........  Aortic circulation      C..............  ..............
                  assist.
33973..........  Insert balloon device.  C..............  ..............
33974..........  Remove intra-aortic     C..............  ..............
                  balloon.
33975..........  Implant ventricular     C..............  ..............
                  device.
33976..........  Implant ventricular     C..............  ..............
                  device.
33977..........  Remove ventricular      C..............  ..............
                  device.
33978..........  Remove ventricular      C..............  ..............
                  device.
33979..........  Insert intracorporeal   C..............  ..............
                  device.
33980..........  Remove intracorporeal   C..............  ..............
                  device.
34001..........  Removal of artery clot  C..............  ..............
34051..........  Removal of artery clot  C..............  ..............
34151..........  Removal of artery clot  C..............  ..............
34401..........  Removal of vein clot..  C..............  ..............
34451..........  Removal of vein clot..  C..............  ..............
34502..........  Reconstruct vena cava.  C..............  ..............
34800..........  Endovas aaa repr w/sm   C..............  ..............
                  tube.
34802..........  Endovas aaa repr w/2-p  C..............  ..............
                  part.
34803..........  Endovas aaa repr w/3-p  C..............  ..............
                  part.
34804..........  Endovas aaa repr w/1-p  C..............  ..............
                  part.
34805..........  Endovas aaa repr w/     C..............  ..............
                  long tube.
34806..........  Aneurysm press sensor   C..............  NI
                  add-on.
34808..........  Endovas iliac a device  C..............  ..............
                  addon.
34812..........  Xpose for endoprosth,   C..............  ..............
                  femorl.
34813..........  Femoral endovas graft   C..............  ..............
                  add-on.
34820..........  Xpose for endoprosth,   C..............  ..............
                  iliac.
34825..........  Endovasc extend         C..............  ..............
                  prosth, init.
34826..........  Endovasc exten prosth,  C..............  ..............
                  add'l.
34830..........  Open aortic tube        C..............  ..............
                  prosth repr.
34831..........  Open aortoiliac prosth  C..............  ..............
                  repr.
34832..........  Open aortofemor prosth  C..............  ..............
                  repr.
34833..........  Xpose for endoprosth,   C..............  ..............
                  iliac.
34834..........  Xpose, endoprosth,      C..............  ..............
                  brachial.
34900..........  Endovasc iliac repr w/  C..............  ..............
                  graft.
35001..........  Repair defect of        C..............  ..............
                  artery.
35002..........  Repair artery rupture,  C..............  ..............
                  neck.
35005..........  Repair defect of        C..............  ..............
                  artery.
35013..........  Repair artery rupture,  C..............  ..............
                  arm.
35021..........  Repair defect of        C..............  ..............
                  artery.
35022..........  Repair artery rupture,  C..............  ..............
                  chest.
35045..........  Repair defect of arm    C..............  ..............
                  artery.

[[Page 67200]]

 
35081..........  Repair defect of        C..............  ..............
                  artery.
35082..........  Repair artery rupture,  C..............  ..............
                  aorta.
35091..........  Repair defect of        C..............  ..............
                  artery.
35092..........  Repair artery rupture,  C..............  ..............
                  aorta.
35102..........  Repair defect of        C..............  ..............
                  artery.
35103..........  Repair artery rupture,  C..............  ..............
                  groin.
35111..........  Repair defect of        C..............  ..............
                  artery.
35112..........  Repair artery           C..............  ..............
                  rupture,spleen.
35121..........  Repair defect of        C..............  ..............
                  artery.
35122..........  Repair artery rupture,  C..............  ..............
                  belly.
35131..........  Repair defect of        C..............  ..............
                  artery.
35132..........  Repair artery rupture,  C..............  ..............
                  groin.
35141..........  Repair defect of        C..............  ..............
                  artery.
35142..........  Repair artery rupture,  C..............  ..............
                  thigh.
35151..........  Repair defect of        C..............  ..............
                  artery.
35152..........  Repair artery rupture,  C..............  ..............
                  knee.
35182..........  Repair blood vessel     C..............  ..............
                  lesion.
35189..........  Repair blood vessel     C..............  ..............
                  lesion.
35211..........  Repair blood vessel     C..............  ..............
                  lesion.
35216..........  Repair blood vessel     C..............  ..............
                  lesion.
35221..........  Repair blood vessel     C..............  ..............
                  lesion.
35241..........  Repair blood vessel     C..............  ..............
                  lesion.
35246..........  Repair blood vessel     C..............  ..............
                  lesion.
35251..........  Repair blood vessel     C..............  ..............
                  lesion.
35271..........  Repair blood vessel     C..............  ..............
                  lesion.
35276..........  Repair blood vessel     C..............  ..............
                  lesion.
35281..........  Repair blood vessel     C..............  ..............
                  lesion.
35301..........  Rechanneling of artery  C..............  ..............
35302..........  Rechanneling of artery  C..............  ..............
35303..........  Rechanneling of artery  C..............  ..............
35304..........  Rechanneling of artery  C..............  ..............
35305..........  Rechanneling of artery  C..............  ..............
35306..........  Rechanneling of artery  C..............  ..............
35311..........  Rechanneling of artery  C..............  ..............
35331..........  Rechanneling of artery  C..............  ..............
35341..........  Rechanneling of artery  C..............  ..............
35351..........  Rechanneling of artery  C..............  ..............
35355..........  Rechanneling of artery  C..............  ..............
35361..........  Rechanneling of artery  C..............  ..............
35363..........  Rechanneling of artery  C..............  ..............
35371..........  Rechanneling of artery  C..............  ..............
35372..........  Rechanneling of artery  C..............  ..............
35390..........  Reoperation, carotid    C..............  ..............
                  add-on.
35400..........  Angioscopy............  C..............  ..............
35450..........  Repair arterial         C..............  ..............
                  blockage.
35452..........  Repair arterial         C..............  ..............
                  blockage.
35454..........  Repair arterial         C..............  ..............
                  blockage.
35456..........  Repair arterial         C..............  ..............
                  blockage.
35480..........  Atherectomy, open.....  C..............  ..............
35481..........  Atherectomy, open.....  C..............  ..............
35482..........  Atherectomy, open.....  C..............  ..............
35483..........  Atherectomy, open.....  C..............  ..............
35501..........  Artery bypass graft...  C..............  ..............
35506..........  Artery bypass graft...  C..............  ..............
35508..........  Artery bypass graft...  C..............  ..............
35509..........  Artery bypass graft...  C..............  ..............
35510..........  Artery bypass graft...  C..............  ..............
35511..........  Artery bypass graft...  C..............  ..............
35512..........  Artery bypass graft...  C..............  ..............
35515..........  Artery bypass graft...  C..............  ..............
35516..........  Artery bypass graft...  C..............  ..............
35518..........  Artery bypass graft...  C..............  ..............
35521..........  Artery bypass graft...  C..............  ..............
35522..........  Artery bypass graft...  C..............  ..............
35523..........  Artery bypass graft...  C..............  NI
35525..........  Artery bypass graft...  C..............  ..............
35526..........  Artery bypass graft...  C..............  ..............
35531..........  Artery bypass graft...  C..............  ..............
35533..........  Artery bypass graft...  C..............  ..............
35536..........  Artery bypass graft...  C..............  ..............
35537..........  Artery bypass graft...  C..............  ..............

[[Page 67201]]

 
35538..........  Artery bypass graft...  C..............  ..............
35539..........  Artery bypass graft...  C..............  ..............
35540..........  Artery bypass graft...  C..............  ..............
35548..........  Artery bypass graft...  C..............  ..............
35549..........  Artery bypass graft...  C..............  ..............
35551..........  Artery bypass graft...  C..............  ..............
35556..........  Artery bypass graft...  C..............  ..............
35558..........  Artery bypass graft...  C..............  ..............
35560..........  Artery bypass graft...  C..............  ..............
35563..........  Artery bypass graft...  C..............  ..............
35565..........  Artery bypass graft...  C..............  ..............
35566..........  Artery bypass graft...  C..............  ..............
35571..........  Artery bypass graft...  C..............  ..............
35583..........  Vein bypass graft.....  C..............  ..............
35585..........  Vein bypass graft.....  C..............  ..............
35587..........  Vein bypass graft.....  C..............  ..............
35600..........  Harvest art for cabg    C..............  ..............
                  add-on.
35601..........  Artery bypass graft...  C..............  ..............
35606..........  Artery bypass graft...  C..............  ..............
35612..........  Artery bypass graft...  C..............  ..............
35616..........  Artery bypass graft...  C..............  ..............
35621..........  Artery bypass graft...  C..............  ..............
35623..........  Bypass graft, not vein  C..............  ..............
35626..........  Artery bypass graft...  C..............  ..............
35631..........  Artery bypass graft...  C..............  ..............
35636..........  Artery bypass graft...  C..............  ..............
35637..........  Artery bypass graft...  C..............  ..............
35638..........  Artery bypass graft...  C..............  ..............
35642..........  Artery bypass graft...  C..............  ..............
35645..........  Artery bypass graft...  C..............  ..............
35646..........  Artery bypass graft...  C..............  ..............
35647..........  Artery bypass graft...  C..............  ..............
35650..........  Artery bypass graft...  C..............  ..............
35651..........  Artery bypass graft...  C..............  ..............
35654..........  Artery bypass graft...  C..............  ..............
35656..........  Artery bypass graft...  C..............  ..............
35661..........  Artery bypass graft...  C..............  ..............
35663..........  Artery bypass graft...  C..............  ..............
35665..........  Artery bypass graft...  C..............  ..............
35666..........  Artery bypass graft...  C..............  ..............
35671..........  Artery bypass graft...  C..............  ..............
35681..........  Composite bypass graft  C..............  ..............
35682..........  Composite bypass graft  C..............  ..............
35683..........  Composite bypass graft  C..............  ..............
35691..........  Arterial transposition  C..............  ..............
35693..........  Arterial transposition  C..............  ..............
35694..........  Arterial transposition  C..............  ..............
35695..........  Arterial transposition  C..............  ..............
35697..........  Reimplant artery each.  C..............  ..............
35700..........  Reoperation, bypass     C..............  ..............
                  graft.
35701..........  Exploration, carotid    C..............  ..............
                  artery.
35721..........  Exploration, femoral    C..............  ..............
                  artery.
35741..........  Exploration popliteal   C..............  ..............
                  artery.
35800..........  Explore neck vessels..  C..............  ..............
35820..........  Explore chest vessels.  C..............  ..............
35840..........  Explore abdominal       C..............  ..............
                  vessels.
35870..........  Repair vessel graft     C..............  ..............
                  defect.
35901..........  Excision, graft, neck.  C..............  ..............
35905..........  Excision, graft,        C..............  ..............
                  thorax.
35907..........  Excision, graft,        C..............  ..............
                  abdomen.
36660..........  Insertion catheter,     C..............  ..............
                  artery.
36822..........  Insertion of            C..............  ..............
                  cannula(s).
36823..........  Insertion of            C..............  ..............
                  cannula(s).
37140..........  Revision of             C..............  ..............
                  circulation.
37145..........  Revision of             C..............  ..............
                  circulation.
37160..........  Revision of             C..............  ..............
                  circulation.
37180..........  Revision of             C..............  ..............
                  circulation.
37181..........  Splice spleen/kidney    C..............  ..............
                  veins.
37182..........  Insert hepatic shunt    C..............  ..............
                  (tips).
37215..........  Transcath stent, cca w/ C..............  ..............
                  eps.
37616..........  Ligation of chest       C..............  ..............
                  artery.

[[Page 67202]]

 
37617..........  Ligation of abdomen     C..............  ..............
                  artery.
37618..........  Ligation of extremity   C..............  ..............
                  artery.
37660..........  Revision of major vein  C..............  ..............
37788..........  Revascularization,      C..............  ..............
                  penis.
38100..........  Removal of spleen,      C..............  ..............
                  total.
38101..........  Removal of spleen,      C..............  ..............
                  partial.
38102..........  Removal of spleen,      C..............  ..............
                  total.
38115..........  Repair of ruptured      C..............  ..............
                  spleen.
38380..........  Thoracic duct           C..............  ..............
                  procedure.
38381..........  Thoracic duct           C..............  ..............
                  procedure.
38382..........  Thoracic duct           C..............  ..............
                  procedure.
38562..........  Removal, pelvic lymph   C..............  ..............
                  nodes.
38564..........  Removal, abdomen lymph  C..............  ..............
                  nodes.
38724..........  Removal of lymph        C..............  ..............
                  nodes, neck.
38746..........  Remove thoracic lymph   C..............  ..............
                  nodes.
38747..........  Remove abdominal lymph  C..............  ..............
                  nodes.
38765..........  Remove groin lymph      C..............  ..............
                  nodes.
38770..........  Remove pelvis lymph     C..............  ..............
                  nodes.
38780..........  Remove abdomen lymph    C..............  ..............
                  nodes.
39000..........  Exploration of chest..  C..............  ..............
39010..........  Exploration of chest..  C..............  ..............
39200..........  Removal chest lesion..  C..............  ..............
39220..........  Removal chest lesion..  C..............  ..............
39499..........  Chest procedure.......  C..............  ..............
39501..........  Repair diaphragm        C..............  ..............
                  laceration.
39502..........  Repair paraesophageal   C..............  ..............
                  hernia.
39503..........  Repair of diaphragm     C..............  ..............
                  hernia.
39520..........  Repair of diaphragm     C..............  ..............
                  hernia.
39530..........  Repair of diaphragm     C..............  ..............
                  hernia.
39531..........  Repair of diaphragm     C..............  ..............
                  hernia.
39540..........  Repair of diaphragm     C..............  ..............
                  hernia.
39541..........  Repair of diaphragm     C..............  ..............
                  hernia.
39545..........  Revision of diaphragm.  C..............  ..............
39560..........  Resect diaphragm,       C..............  ..............
                  simple.
39561..........  Resect diaphragm,       C..............  ..............
                  complex.
39599..........  Diaphragm surgery       C..............  ..............
                  procedure.
41130..........  Partial removal of      C..............  ..............
                  tongue.
41135..........  Tongue and neck         C..............  ..............
                  surgery.
41140..........  Removal of tongue.....  C..............  ..............
41145..........  Tongue removal, neck    C..............  ..............
                  surgery.
41150..........  Tongue, mouth, jaw      C..............  ..............
                  surgery.
41153..........  Tongue, mouth, neck     C..............  ..............
                  surgery.
41155..........  Tongue, jaw, & neck     C..............  ..............
                  surgery.
42426..........  Excise parotid gland/   C..............  ..............
                  lesion.
42845..........  Extensive surgery of    C..............  ..............
                  throat.
42894..........  Revision of pharyngeal  C..............  ..............
                  walls.
42953..........  Repair throat,          C..............  ..............
                  esophagus.
42961..........  Control throat          C..............  ..............
                  bleeding.
42971..........  Control nose/throat     C..............  ..............
                  bleeding.
43045..........  Incision of esophagus.  C..............  ..............
43100..........  Excision of esophagus   C..............  ..............
                  lesion.
43101..........  Excision of esophagus   C..............  ..............
                  lesion.
43107..........  Removal of esophagus..  C..............  ..............
43108..........  Removal of esophagus..  C..............  ..............
43112..........  Removal of esophagus..  C..............  ..............
43113..........  Removal of esophagus..  C..............  ..............
43116..........  Partial removal of      C..............  ..............
                  esophagus.
43117..........  Partial removal of      C..............  ..............
                  esophagus.
43118..........  Partial removal of      C..............  ..............
                  esophagus.
43121..........  Partial removal of      C..............  ..............
                  esophagus.
43122..........  Partial removal of      C..............  ..............
                  esophagus.
43123..........  Partial removal of      C..............  ..............
                  esophagus.
43124..........  Removal of esophagus..  C..............  ..............
43135..........  Removal of esophagus    C..............  ..............
                  pouch.
43300..........  Repair of esophagus...  C..............  ..............
43305..........  Repair esophagus and    C..............  ..............
                  fistula.
43310..........  Repair of esophagus...  C..............  ..............
43312..........  Repair esophagus and    C..............  ..............
                  fistula.
43313..........  Esophagoplasty          C..............  ..............
                  congenital.
43314..........  Tracheo-esophagoplasty  C..............  ..............
                  cong.
43320..........  Fuse esophagus &        C..............  ..............
                  stomach.

[[Page 67203]]

 
43324..........  Revise esophagus &      C..............  ..............
                  stomach.
43325..........  Revise esophagus &      C..............  ..............
                  stomach.
43326..........  Revise esophagus &      C..............  ..............
                  stomach.
43330..........  Repair of esophagus...  C..............  ..............
43331..........  Repair of esophagus...  C..............  ..............
43340..........  Fuse esophagus &        C..............  ..............
                  intestine.
43341..........  Fuse esophagus &        C..............  ..............
                  intestine.
43350..........  Surgical opening,       C..............  ..............
                  esophagus.
43351..........  Surgical opening,       C..............  ..............
                  esophagus.
43352..........  Surgical opening,       C..............  ..............
                  esophagus.
43360..........  Gastrointestinal        C..............  ..............
                  repair.
43361..........  Gastrointestinal        C..............  ..............
                  repair.
43400..........  Ligate esophagus veins  C..............  ..............
43401..........  Esophagus surgery for   C..............  ..............
                  veins.
43405..........  Ligate/staple           C..............  ..............
                  esophagus.
43410..........  Repair esophagus wound  C..............  ..............
43415..........  Repair esophagus wound  C..............  ..............
43420..........  Repair esophagus        C..............  ..............
                  opening.
43425..........  Repair esophagus        C..............  ..............
                  opening.
43460..........  Pressure treatment      C..............  ..............
                  esophagus.
43496..........  Free jejunum flap,      C..............  ..............
                  microvasc.
43500..........  Surgical opening of     C..............  ..............
                  stomach.
43501..........  Surgical repair of      C..............  ..............
                  stomach.
43502..........  Surgical repair of      C..............  ..............
                  stomach.
43520..........  Incision of pyloric     C..............  ..............
                  muscle.
43605..........  Biopsy of stomach.....  C..............  ..............
43610..........  Excision of stomach     C..............  ..............
                  lesion.
43611..........  Excision of stomach     C..............  ..............
                  lesion.
43620..........  Removal of stomach....  C..............  ..............
43621..........  Removal of stomach....  C..............  ..............
43622..........  Removal of stomach....  C..............  ..............
43631..........  Removal of stomach,     C..............  ..............
                  partial.
43632..........  Removal of stomach,     C..............  ..............
                  partial.
43633..........  Removal of stomach,     C..............  ..............
                  partial.
43634..........  Removal of stomach,     C..............  ..............
                  partial.
43635..........  Removal of stomach,     C..............  ..............
                  partial.
43640..........  Vagotomy & pylorus      C..............  ..............
                  repair.
43641..........  Vagotomy & pylorus      C..............  ..............
                  repair.
43644..........  Lap gastric bypass/     C..............  ..............
                  roux-en-y.
43645..........  Lap gastr bypass incl   C..............  ..............
                  smll i.
43770..........  Lap place gastr adj     C..............  ..............
                  device.
43771..........  Lap revise gastr adj    C..............  ..............
                  device.
43772..........  Lap rmvl gastr adj      C..............  ..............
                  device.
43773..........  Lap replace gastr adj   C..............  ..............
                  device.
43774..........  Lap rmvl gastr adj all  C..............  ..............
                  parts.
43800..........  Reconstruction of       C..............  ..............
                  pylorus.
43810..........  Fusion of stomach and   C..............  ..............
                  bowel.
43820..........  Fusion of stomach and   C..............  ..............
                  bowel.
43825..........  Fusion of stomach and   C..............  ..............
                  bowel.
43832..........  Place gastrostomy tube  C..............  ..............
43840..........  Repair of stomach       C..............  ..............
                  lesion.
43843..........  Gastroplasty w/o v-     C..............  ..............
                  band.
43845..........  Gastroplasty duodenal   C..............  ..............
                  switch.
43846..........  Gastric bypass for      C..............  ..............
                  obesity.
43847..........  Gastric bypass incl     C..............  ..............
                  small i.
43848..........  Revision gastroplasty.  C..............  ..............
43850..........  Revise stomach-bowel    C..............  ..............
                  fusion.
43855..........  Revise stomach-bowel    C..............  ..............
                  fusion.
43860..........  Revise stomach-bowel    C..............  ..............
                  fusion.
43865..........  Revise stomach-bowel    C..............  ..............
                  fusion.
43880..........  Repair stomach-bowel    C..............  ..............
                  fistula.
43881..........  Impl/redo electrd,      C..............  ..............
                  antrum.
43882..........  Revise/remove electrd   C..............  ..............
                  antrum.
44005..........  Freeing of bowel        C..............  ..............
                  adhesion.
44010..........  Incision of small       C..............  ..............
                  bowel.
44015..........  Insert needle cath      C..............  ..............
                  bowel.
44020..........  Explore small           C..............  ..............
                  intestine.
44021..........  Decompress small bowel  C..............  ..............
44025..........  Incision of large       C..............  ..............
                  bowel.
44050..........  Reduce bowel            C..............  ..............
                  obstruction.
44055..........  Correct malrotation of  C..............  ..............
                  bowel.

[[Page 67204]]

 
44110..........  Excise intestine        C..............  ..............
                  lesion(s).
44111..........  Excision of bowel       C..............  ..............
                  lesion(s).
44120..........  Removal of small        C..............  ..............
                  intestine.
44121..........  Removal of small        C..............  ..............
                  intestine.
44125..........  Removal of small        C..............  ..............
                  intestine.
44126..........  Enterectomy w/o taper,  C..............  ..............
                  cong.
44127..........  Enterectomy w/taper,    C..............  ..............
                  cong.
44128..........  Enterectomy cong, add-  C..............  ..............
                  on.
44130..........  Bowel to bowel fusion.  C..............  ..............
44132..........  Enterectomy, cadaver    C..............  ..............
                  donor.
44133..........  Enterectomy, live       C..............  ..............
                  donor.
44135..........  Intestine transplnt,    C..............  ..............
                  cadavel colectomy.
44205..........  Lap colectomy part w/   C..............  ..............
                  ileum.
44210..........  Laparo total            C..............  ..............
                  proctocolectomy.
44211..........  Lap colectomy w/        C..............  ..............
                  proctectomy.
44212..........  Laparo total            C..............  ..............
                  proctocolectomy.
44227..........  Lap, close enterostomy  C..............  ..............
44300..........  Open bowel to skin....  C..............  ..............
44310..........  Ileostomy/jejunostomy.  C..............  ..............
44314..........  Revision of ileostomy.  C..............  ..............
44316..........  Devise bowel pouch....  C..............  ..............
44320..........  Colostomy.............  C..............  ..............
44322..........  Colostomy with          C..............  ..............
                  biopsies.
44345..........  Revision of colostomy.  C..............  ..............
44346..........  Revision of colostomy.  C..............  ..............
44602..........  Suture, small           C..............  ..............
                  intestine.
44603..........  Suture, small           C..............  ..............
                  intestine.
44604..........  Suture, large           C..............  ..............
                  intestine.
44605..........  Repair of bowel lesion  C..............  ..............
44615..........  Intestinal              C..............  ..............
                  stricturoplasty.
44620..........  Repair bowel opening..  C..............  ..............
44625..........  Repair bowel opening..  C..............  ..............
44626..........  Repair bowel opening..  C..............  ..............
44640..........  Repair bowel-skin       C..............  ..............
                  fistula.
44650..........  Repair bowel fistula..  C..............  ..............
44660..........  Repair bowel-bladder    C..............  ..............
                  fistula.
44661..........  Repair bowel-bladder    C..............  ..............
                  fistula.
44680..........  Surgical revision,      C..............  ..............
                  intestine.
44700..........  Suspend bowel w/        C..............  ..............
                  prosthesis.
44715..........  Prepare donor           C..............  ..............
                  intestine.
44720..........  Prep donor intestine/   C..............  ..............
                  venous.
44721..........  Prep donor intestine/   C..............  ..............
                  artery.
44800..........  Excision of bowel       C..............  ..............
                  pouch.
44820..........  Excision of mesentery   C..............  ..............
                  lesion.
44850..........  Repair of mesentery...  C..............  ..............
44899..........  Bowel surgery           C..............  ..............
                  procedure.
44900..........  Drain app abscess,      C..............  ..............
                  open.
44950..........  Appendectomy..........  C..............  ..............
44955..........  Appendectomy add-on...  C..............  ..............
44960..........  Appendectomy..........  C..............  ..............
45110..........  Removal of rectum.....  C..............  ..............
45111..........  Partial removal of      C..............  ..............
                  rectum.
45112..........  Removal of rectum.....  C..............  ..............
45113..........  Partial proctectomy...  C..............  ..............
45114..........  Partial removal of      C..............  ..............
                  rectum.
45116..........  Partial removal of      C..............  ..............
                  rectum.
45119..........  Remove rectum w/        C..............  ..............
                  reservoir.
45120..........  Removal of rectum.....  C..............  ..............
45121..........  Removal of rectum and   C..............  ..............
                  colon.
45123..........  Partial proctectomy...  C..............  ..............
45126..........  Pelvic exenteration...  C..............  ..............
45130..........  Excision of rectal      C..............  ..............
                  prolapse.
45135..........  Excision of rectal      C..............  ..............
                  prolapse.
45136..........  Excise ileoanal         C..............  ..............
                  reservior.
45395..........  Lap, removal of rectum  C..............  ..............
45397..........  Lap, remove rectum w/   C..............  ..............
                  pouch.
45400..........  Laparoscopic proc.....  C..............  ..............
45402..........  Lap proctopexy w/sig    C..............  ..............
                  resect.
45540..........  Correct rectal          C..............  ..............
                  prolapse.
45550..........  Repair rectum/remove    C..............  ..............
                  sigmoid.
45562..........  Exploration/repair of   C..............  ..............
                  rectum.

[[Page 67205]]

 
45563..........  Exploration/repair of   C..............  ..............
                  rectum.
45800..........  Repair rect/bladder     C..............  ..............
                  fistula.
45805..........  Repair fistula w/       C..............  ..............
                  colostomy.
45820..........  Repair rectourethral    C..............  ..............
                  fistula.
45825..........  Repair fistula w/       C..............  ..............
                  colostomy.
46705..........  Repair of anal          C..............  ..............
                  stricture.
46710..........  Repr per/vag pouch      C..............  ..............
                  sngl proc.
46712..........  Repr per/vag pouch dbl  C..............  ..............
                  proc.
46715..........  Rep perf anoper fistu.  C..............  ..............
46716..........  Rep perf anoper/vestib  C..............  ..............
                  fistu.
46730..........  Construction of absent  C..............  ..............
                  anus.
46735..........  Construction of absent  C..............  ..............
                  anus.
46740..........  Construction of absent  C..............  ..............
                  anus.
46742..........  Repair of imperforated  C..............  ..............
                  anus.
46744..........  Repair of cloacal       C..............  ..............
                  anomaly.
46746..........  Repair of cloacal       C..............  ..............
                  anomaly.
46748..........  Repair of cloacal       C..............  ..............
                  anomaly.
46751..........  Repair of anal          C..............  ..............
                  sphincter.
47010..........  Open drainage, liver    C..............  ..............
                  lesion.
47015..........  Inject/aspirate liver   C..............  ..............
                  cyst.
47100..........  Wedge biopsy of liver.  C..............  ..............
47120..........  Partial removal of      C..............  ..............
                  liver.
47122..........  Extensive removal of    C..............  ..............
                  liver.
47125..........  Partial removal of      C..............  ..............
                  liver.
47130..........  Partial removal of      C..............  ..............
                  liver.
47133..........  Removal of donor liver  C..............  ..............
47135..........  Transplantation of      C..............  ..............
                  liver.
47136..........  Transplantation of      C..............  ..............
                  liver.
47140..........  Partial removal, donor  C..............  ..............
                  liver.
47141..........  Partial removal, donor  C..............  ..............
                  liver.
47142..........  Partial removal, donor  C..............  ..............
                  liver.
47143..........  Prep donor liver,       C..............  ..............
                  whole.
47144..........  Prep donor liver, 3-    C..............  ..............
                  segment.
47145..........  Prep donor liver, lobe  C..............  ..............
                  split.
47146..........  Prep donor liver/       C..............  ..............
                  venous.
47147..........  Prep donor liver/       C..............  ..............
                  arterial.
47300..........  Surgery for liver       C..............  ..............
                  lesion.
47350..........  Repair liver wound....  C..............  ..............
47360..........  Repair liver wound....  C..............  ..............
47361..........  Repair liver wound....  C..............  ..............
47362..........  Repair liver wound....  C..............  ..............
47380..........  Open ablate liver       C..............  ..............
                  tumor rf.
47381..........  Open ablate liver       C..............  ..............
                  tumor cryo.
47400..........  Incision of liver duct  C..............  ..............
47420..........  Incision of bile duct.  C..............  ..............
47425..........  Incision of bile duct.  C..............  ..............
47460..........  Incise bile duct        C..............  ..............
                  sphincter.
47480..........  Incision of             C..............  ..............
                  gallbladder.
47550..........  Bile duct endoscopy     C..............  ..............
                  add-on.
47570..........  Laparo                  C..............  ..............
                  cholecystoenterostomy.
47600..........  Removal of gallbladder  C..............  ..............
47605..........  Removal of gallbladder  C..............  ..............
47610..........  Removal of gallbladder  C..............  ..............
47612..........  Removal of gallbladder  C..............  ..............
47620..........  Removal of gallbladder  C..............  ..............
47700..........  Exploration of bile     C..............  ..............
                  ducts.
47701..........  Bile duct revision....  C..............  ..............
47711..........  Excision of bile duct   C..............  ..............
                  tumor.
47712..........  Excision of bile duct   C..............  ..............
                  tumor.
47715..........  Excision of bile duct   C..............  ..............
                  cyst.
47720..........  Fuse gallbladder &      C..............  ..............
                  bowel.
47721..........  Fuse upper gi           C..............  ..............
                  structures.
47740..........  Fuse gallbladder &      C..............  ..............
                  bowel.
47741..........  Fuse gallbladder &      C..............  ..............
                  bowel.
47760..........  Fuse bile ducts and     C..............  ..............
                  bowel.
47765..........  Fuse liver ducts &      C..............  ..............
                  bowel.
47780..........  Fuse bile ducts and     C..............  ..............
                  bowel.
47785..........  Fuse bile ducts and     C..............  ..............
                  bowel.
47800..........  Reconstruction of bile  C..............  ..............
                  ducts.
47801..........  Placement, bile duct    C..............  ..............
                  support.
47802..........  Fuse liver duct &       C..............  ..............
                  intestine.

[[Page 67206]]

 
47900..........  Suture bile duct        C..............  ..............
                  injury.
48000..........  Drainage of abdomen...  C..............  ..............
48001..........  Placement of drain,     C..............  ..............
                  pancreas.
48020..........  Removal of pancreatic   C..............  ..............
                  stone.
48100..........  Biopsy of pancreas,     C..............  ..............
                  open.
48105..........  Resect/debride          C..............  ..............
                  pancreas.
48120..........  Removal of pancreas     C..............  ..............
                  lesion.
48140..........  Partial removal of      C..............  ..............
                  pancreas.
48145..........  Partial removal of      C..............  ..............
                  pancreas.
48146..........  Pancreatectomy........  C..............  ..............
48148..........  Removal of pancreatic   C..............  ..............
                  duct.
48150..........  Partial removal of      C..............  ..............
                  pancreas.
48152..........  Pancreatectomy........  C..............  ..............
48153..........  Pancreatectomy........  C..............  ..............
48154..........  Pancreatectomy........  C..............  ..............
48155..........  Removal of pancreas...  C..............  ..............
48400..........  Injection, intraop add- C..............  ..............
                  on.
48500..........  Surgery of pancreatic   C..............  ..............
                  cyst.
48510..........  Drain pancreatic        C..............  ..............
                  pseudocyst.
48520..........  Fuse pancreas cyst and  C..............  ..............
                  bowel.
48540..........  Fuse pancreas cyst and  C..............  ..............
                  bowel.
48545..........  Pancreatorrhaphy......  C..............  ..............
48547..........  Duodenal exclusion....  C..............  ..............
48548..........  Fuse pancreas and       C..............  ..............
                  bowel.
48551..........  Prep donor pancreas...  C..............  ..............
48552..........  Prep donor pancreas/    C..............  ..............
                  venous.
48554..........  Transpl allograft       C..............  ..............
                  pancreas.
48556..........  Removal, allograft      C..............  ..............
                  pancreas.
49000..........  Exploration of abdomen  C..............  ..............
49002..........  Reopening of abdomen..  C..............  ..............
49010..........  Exploration behind      C..............  ..............
                  abdomen.
49020..........  Drain abdominal         C..............  ..............
                  abscess.
49040..........  Drain, open, abdom      C..............  ..............
                  abscess.
49060..........  Drain, open, retrop     C..............  ..............
                  abscess.
49062..........  Drain to peritoneal     C..............  ..............
                  cavity.
49203..........  Exc abd tum 5 cm or     C..............  NI
                  less.
49204..........  Exc abd tum over 5 cm.  C..............  NI
49205..........  Exc abd tum over 10 cm  C..............  NI
49215..........  Excise sacral spine     C..............  ..............
                  tumor.
49220..........  Multiple surgery,       C..............  ..............
                  abdomen.
49255..........  Removal of omentum....  C..............  ..............
49425..........  Insert abdomen-venous   C..............  ..............
                  drain.
49428..........  Ligation of shunt.....  C..............  ..............
49605..........  Repair umbilical        C..............  ..............
                  lesion.
49606..........  Repair umbilical        C..............  ..............
                  lesion.
49610..........  Repair umbilical        C..............  ..............
                  lesion.
49611..........  Repair umbilical        C..............  ..............
                  lesion.
49900..........  Repair of abdominal     C..............  ..............
                  wall.
49904..........  Omental flap, extra-    C..............  ..............
                  abdom.
49905..........  Omental flap, intra-    C..............  ..............
                  abdom.
49906..........  Free omental flap,      C..............  ..............
                  microvasc.
50010..........  Exploration of kidney.  C..............  ..............
50040..........  Drainage of kidney....  C..............  ..............
50045..........  Exploration of kidney.  C..............  ..............
50060..........  Removal of kidney       C..............  ..............
                  stone.
50065..........  Incision of kidney....  C..............  ..............
50070..........  Incision of kidney....  C..............  ..............
50075..........  Removal of kidney       C..............  ..............
                  stone.
50100..........  Revise kidney blood     C..............  ..............
                  vessels.
50120..........  Exploration of kidney.  C..............  ..............
50125..........  Explore and drain       C..............  ..............
                  kidney.
50130..........  Removal of kidney       C..............  ..............
                  stone.
50135..........  Exploration of kidney.  C..............  ..............
50205..........  Biopsy of kidney......  C..............  ..............
50220..........  Remove kidney, open...  C..............  ..............
50225..........  Removal kidney open,    C..............  ..............
                  complex.
50230..........  Removal kidney open,    C..............  ..............
                  radical.
50234..........  Removal of kidney &     C..............  ..............
                  ureter.
50236..........  Removal of kidney &     C..............  ..............
                  ureter.
50240..........  Partial removal of      C..............  ..............
                  kidney.
50250..........  Cryoablate renal mass   C..............  ..............
                  open.

[[Page 67207]]

 
50280..........  Removal of kidney       C..............  ..............
                  lesion.
50290..........  Removal of kidney       C..............  ..............
                  lesion.
50300..........  Remove cadaver donor    C..............  ..............
                  kidney.
50320..........  Remove kidney, living   C..............  ..............
                  donor.
50323..........  Prep cadaver renal      C..............  ..............
                  allograft.
50325..........  Prep donor renal graft  C..............  ..............
50327..........  Prep renal graft/       C..............  ..............
                  venous.
50328..........  Prep renal graft/       C..............  ..............
                  arterial.
50329..........  Prep renal graft/       C..............  ..............
                  ureteral.
50340..........  Removal of kidney.....  C..............  ..............
50360..........  Transplantation of      C..............  ..............
                  kidney.
50365..........  Transplantation of      C..............  ..............
                  kidney.
50370..........  Remove transplanted     C..............  ..............
                  kidney.
50380..........  Reimplantation of       C..............  ..............
                  kidney.
50400..........  Revision of kidney/     C..............  ..............
                  ureter.
50405..........  Revision of kidney/     C..............  ..............
                  ureter.
50500..........  Repair of kidney wound  C..............  ..............
50520..........  Close kidney-skin       C..............  ..............
                  fistula.
50525..........  Repair renal-abdomen    C..............  ..............
                  fistula.
50526..........  Repair renal-abdomen    C..............  ..............
                  fistula.
50540..........  Revision of horseshoe   C..............  ..............
                  kidney.
50545..........  Laparo radical          C..............  ..............
                  nephrectomy.
50546..........  Laparoscopic            C..............  ..............
                  nephrectomy.
50547..........  Laparo removal donor    C..............  ..............
                  kidney.
50548..........  Laparo remove w/ureter  C..............  ..............
50600..........  Exploration of ureter.  C..............  ..............
50605..........  Insert ureteral         C..............  ..............
                  support.
50610..........  Removal of ureter       C..............  ..............
                  stone.
50620..........  Removal of ureter       C..............  ..............
                  stone.
50630..........  Removal of ureter       C..............  ..............
                  stone.
50650..........  Removal of ureter.....  C..............  ..............
50660..........  Removal of ureter.....  C..............  ..............
50700..........  Revision of ureter....  C..............  ..............
50715..........  Release of ureter.....  C..............  ..............
50722..........  Release of ureter.....  C..............  ..............
50725..........  Release/revise ureter.  C..............  ..............
50727..........  Revise ureter.........  C..............  ..............
50728..........  Revise ureter.........  C..............  ..............
50740..........  Fusion of ureter &      C..............  ..............
                  kidney.
50750..........  Fusion of ureter &      C..............  ..............
                  kidney.
50760..........  Fusion of ureters.....  C..............  ..............
50770..........  Splicing of ureters...  C..............  ..............
50780..........  Reimplant ureter in     C..............  ..............
                  bladder.
50782..........  Reimplant ureter in     C..............  ..............
                  bladder.
50783..........  Reimplant ureter in     C..............  ..............
                  bladder.
50785..........  Reimplant ureter in     C..............  ..............
                  bladder.
50800..........  Implant ureter in       C..............  ..............
                  bowel.
50810..........  Fusion of ureter &      C..............  ..............
                  bowel.
50815..........  Urine shunt to          C..............  ..............
                  intestine.
50820..........  Construct bowel         C..............  ..............
                  bladder.
50825..........  Construct bowel         C..............  ..............
                  bladder.
50830..........  Revise urine flow.....  C..............  ..............
50840..........  Replace ureter by       C..............  ..............
                  bowel.
50845..........  Appendico-vesicostomy.  C..............  ..............
50860..........  Transplant ureter to    C..............  ..............
                  skin.
50900..........  Repair of ureter......  C..............  ..............
50920..........  Closure ureter/skin     C..............  ..............
                  fistula.
50930..........  Closure ureter/bowel    C..............  ..............
                  fistula.
50940..........  Release of ureter.....  C..............  ..............
51060..........  Removal of ureter       C..............  ..............
                  stone.
51525..........  Removal of bladder      C..............  ..............
                  lesion.
51530..........  Removal of bladder      C..............  ..............
                  lesion.
51550..........  Partial removal of      C..............  ..............
                  bladder.
51555..........  Partial removal of      C..............  ..............
                  bladder.
51565..........  Revise bladder &        C..............  ..............
                  ureter(s).
51570..........  Removal of bladder....  C..............  ..............
51575..........  Removal of bladder &    C..............  ..............
                  nodes.
51580..........  Remove bladder/revise   C..............  ..............
                  tract.
51585..........  Removal of bladder &    C..............  ..............
                  nodes.
51590..........  Remove bladder/revise   C..............  ..............
                  tract.
51595..........  Remove bladder/revise   C..............  ..............
                  tract.

[[Page 67208]]

 
51596..........  Remove bladder/create   C..............  ..............
                  pouch.
51597..........  Removal of pelvic       C..............  ..............
                  structures.
51800..........  Revision of bladder/    C..............  ..............
                  urethra.
51820..........  Revision of urinary     C..............  ..............
                  tract.
51840..........  Attach bladder/urethra  C..............  ..............
51841..........  Attach bladder/urethra  C..............  ..............
51845..........  Repair bladder neck...  C..............  ..............
51860..........  Repair of bladder       C..............  ..............
                  wound.
51865..........  Repair of bladder       C..............  ..............
                  wound.
51900..........  Repair bladder/vagina   C..............  ..............
                  lesion.
51920..........  Close bladder-uterus    C..............  ..............
                  fistula.
51925..........  Hysterectomy/bladder    C..............  ..............
                  repair.
51940..........  Correction of bladder   C..............  ..............
                  defect.
51960..........  Revision of bladder &   C..............  ..............
                  bowel.
51980..........  Construct bladder       C..............  ..............
                  opening.
53415..........  Reconstruction of       C..............  ..............
                  urethra.
53448..........  Remov/replc ur          C..............  ..............
                  sphinctr comp.
54125..........  Removal of penis......  C..............  ..............
54130..........  Remove penis & nodes..  C..............  ..............
54135..........  Remove penis & nodes..  C..............  ..............
54332..........  Revise penis/urethra..  C..............  ..............
54336..........  Revise penis/urethra..  C..............  ..............
54390..........  Repair penis and        C..............  ..............
                  bladder.
54411..........  Remov/replc penis       C..............  ..............
                  pros, comp.
54417..........  Remv/replc penis pros,  C..............  ..............
                  compl.
54430..........  Revision of penis.....  C..............  ..............
54535..........  Extensive testis        C..............  ..............
                  surgery.
54650..........  Orchiopexy (Fowler-     C..............  ..............
                  Stephens).
55605..........  Incise sperm duct       C..............  ..............
                  pouch.
55650..........  Remove sperm duct       C..............  ..............
                  pouch.
55801..........  Removal of prostate...  C..............  ..............
55810..........  Extensive prostate      C..............  ..............
                  surgery.
55812..........  Extensive prostate      C..............  ..............
                  surgery.
55815..........  Extensive prostate      C..............  ..............
                  surgery.
55821..........  Removal of prostate...  C..............  ..............
55831..........  Removal of prostate...  C..............  ..............
55840..........  Extensive prostate      C..............  ..............
                  surgery.
55842..........  Extensive prostate      C..............  ..............
                  surgery.
55845..........  Extensive prostate      C..............  ..............
                  surgery.
55862..........  Extensive prostate      C..............  ..............
                  surgery.
55865..........  Extensive prostate      C..............  ..............
                  surgery.
55866..........  Laparo radical          C..............  ..............
                  prostatectomy.
56630..........  Extensive vulva         C..............  ..............
                  surgery.
56631..........  Extensive vulva         C..............  ..............
                  surgery.
56632..........  Extensive vulva         C..............  ..............
                  surgery.
56633..........  Extensive vulva         C..............  ..............
                  surgery.
56634..........  Extensive vulva         C..............  ..............
                  surgery.
56637..........  Extensive vulva         C..............  ..............
                  surgery.
56640..........  Extensive vulva         C..............  ..............
                  surgery.
57110..........  Remove vagina wall,     C..............  ..............
                  complete.
57111..........  Remove vagina tissue,   C..............  ..............
                  compl.
57112..........  Vaginectomy w/nodes,    C..............  ..............
                  compl.
57270..........  Repair of bowel pouch.  C..............  ..............
57280..........  Suspension of vagina..  C..............  ..............
57296..........  Revise vag graft, open  C..............  ..............
                  abd.
57305..........  Repair rectum-vagina    C..............  ..............
                  fistula.
57307..........  Fistula repair &        C..............  ..............
                  colostomy.
57308..........  Fistula repair,         C..............  ..............
                  transperine.
57311..........  Repair urethrovaginal   C..............  ..............
                  lesion.
57531..........  Removal of cervix,      C..............  ..............
                  radical.
57540..........  Removal of residual     C..............  ..............
                  cervix.
57545..........  Remove cervix/repair    C..............  ..............
                  pelvis.
58140..........  Myomectomy abdom        C..............  ..............
                  method.
58146..........  Myomectomy abdom        C..............  ..............
                  complex.
58150..........  Total hysterectomy....  C..............  ..............
58152..........  Total hysterectomy....  C..............  ..............
58180..........  Partial hysterectomy..  C..............  ..............
58200..........  Extensive hysterectomy  C..............  ..............
58210..........  Extensive hysterectomy  C..............  ..............
58240..........  Removal of pelvis       C..............  ..............
                  contents.
58267..........  Vag hyst w/urinary      C..............  ..............
                  repair.

[[Page 67209]]

 
58275..........  Hysterectomy/revise     C..............  ..............
                  vagina.
58280..........  Hysterectomy/revise     C..............  ..............
                  vagina.
58285..........  Extensive hysterectomy  C..............  ..............
58293..........  Vag hyst w/uro repair,  C..............  ..............
                  compl.
58400..........  Suspension of uterus..  C..............  ..............
58410..........  Suspension of uterus..  C..............  ..............
58520..........  Repair of ruptured      C..............  ..............
                  uterus.
58540..........  Revision of uterus....  C..............  ..............
58548..........  Lap radical hyst......  C..............  ..............
58605..........  Division of fallopian   C..............  ..............
                  tube.
58611..........  Ligate oviduct(s) add-  C..............  ..............
                  on.
58700..........  Removal of fallopian    C..............  ..............
                  tube.
58720..........  Removal of ovary/       C..............  ..............
                  tube(s).
58740..........  Revise fallopian        C..............  ..............
                  tube(s).
58750..........  Repair oviduct........  C..............  ..............
58752..........  Revise ovarian tube(s)  C..............  ..............
58760..........  Remove tubal            C..............  ..............
                  obstruction.
58822..........  Drain ovary abscess,    C..............  ..............
                  percut.
58825..........  Transposition,          C..............  ..............
                  ovary(s).
58940..........  Removal of ovary(s)...  C..............  ..............
58943..........  Removal of ovary(s)...  C..............  ..............
58950..........  Resect ovarian          C..............  ..............
                  malignancy.
58951..........  Resect ovarian          C..............  ..............
                  malignancy.
58952..........  Resect ovarian          C..............  ..............
                  malignancy.
58953..........  Tah, rad dissect for    C..............  ..............
                  debulk.
58954..........  Tah rad debulk/lymph    C..............  ..............
                  remove.
58956..........  Bso, omentectomy w/tah  C..............  ..............
58957..........  Resect recurrent gyn    C..............  ..............
                  mal.
58958..........  Resect recur gyn mal w/ C..............  ..............
                  lym.
58960..........  Exploration of abdomen  C..............  ..............
59120..........  Treat ectopic           C..............  ..............
                  pregnancy.
59121..........  Treat ectopic           C..............  ..............
                  pregnancy.
59130..........  Treat ectopic           C..............  ..............
                  pregnancy.
59135..........  Treat ectopic           C..............  ..............
                  pregnancy.
59136..........  Treat ectopic           C..............  ..............
                  pregnancy.
59140..........  Treat ectopic           C..............  ..............
                  pregnancy.
59325..........  Revision of cervix....  C..............  ..............
59350..........  Repair of uterus......  C..............  ..............
59514..........  Cesarean delivery only  C..............  ..............
59525..........  Remove uterus after     C..............  ..............
                  cesarean.
59620..........  Attempted vbac          C..............  ..............
                  delivery only.
59830..........  Treat uterus infection  C..............  ..............
59850..........  Abortion..............  C..............  ..............
59851..........  Abortion..............  C..............  ..............
59852..........  Abortion..............  C..............  ..............
59855..........  Abortion..............  C..............  ..............
59856..........  Abortion..............  C..............  ..............
59857..........  Abortion..............  C..............  ..............
60254..........  Extensive thyroid       C..............  ..............
                  surgery.
60270..........  Removal of thyroid....  C..............  ..............
60505..........  Explore parathyroid     C..............  ..............
                  glands.
60521..........  Removal of thymus       C..............  ..............
                  gland.
60522..........  Removal of thymus       C..............  ..............
                  gland.
60540..........  Explore adrenal gland.  C..............  ..............
60545..........  Explore adrenal gland.  C..............  ..............
60600..........  Remove carotid body     C..............  ..............
                  lesion.
60605..........  Remove carotid body     C..............  ..............
                  lesion.
60650..........  Laparoscopy             C..............  ..............
                  adrenalectomy.
61105..........  Twist drill hole......  C..............  ..............
61107..........  Drill skull for         C..............  ..............
                  implantation.
61108..........  Drill skull for         C..............  ..............
                  drainage.
61120..........  Burr hole for puncture  C..............  ..............
61140..........  Pierce skull for        C..............  ..............
                  biopsy.
61150..........  Pierce skull for        C..............  ..............
                  drainage.
61151..........  Pierce skull for        C..............  ..............
                  drainage.
61154..........  Pierce skull & remove   C..............  ..............
                  clot.
61156..........  Pierce skull for        C..............  ..............
                  drainage.
61210..........  Pierce skull, implant   C..............  ..............
                  device.
61250..........  Pierce skull & explore  C..............  ..............
61253..........  Pierce skull & explore  C..............  ..............
61304..........  Open skull for          C..............  ..............
                  exploration.

[[Page 67210]]

 
61305..........  Open skull for          C..............  ..............
                  exploration.
61312..........  Open skull for          C..............  ..............
                  drainage.
61313..........  Open skull for          C..............  ..............
                  drainage.
61314..........  Open skull for          C..............  ..............
                  drainage.
61315..........  Open skull for          C..............  ..............
                  drainage.
61316..........  Implt cran bone flap    C..............  ..............
                  to abdo.
61320..........  Open skull for          C..............  ..............
                  drainage.
61321..........  Open skull for          C..............  ..............
                  drainage.
61322..........  Decompressive           C..............  ..............
                  craniotomy.
61323..........  Decompressive           C..............  ..............
                  lobectomy.
61332..........  Explore/biopsy eye      C..............  ..............
                  socket.
61333..........  Explore orbit/remove    C..............  ..............
                  lesion.
61340..........  Subtemporal             C..............  ..............
                  decompression.
61343..........  Incise skull (press     C..............  ..............
                  relief).
61345..........  Relieve cranial         C..............  ..............
                  pressure.
61440..........  Incise skull for        C..............  ..............
                  surgery.
61450..........  Incise skull for        C..............  ..............
                  surgery.
61458..........  Incise skull for brain  C..............  ..............
                  wound.
61460..........  Incise skull for        C..............  ..............
                  surgery.
61470..........  Incise skull for        C..............  ..............
                  surgery.
61480..........  Incise skull for        C..............  ..............
                  surgery.
61490..........  Incise skull for        C..............  ..............
                  surgery.
61500..........  Removal of skull        C..............  ..............
                  lesion.
61501..........  Remove infected skull   C..............  ..............
                  bone.
61510..........  Removal of brain        C..............  ..............
                  lesion.
61512..........  Remove brain lining     C..............  ..............
                  lesion.
61514..........  Removal of brain        C..............  ..............
                  abscess.
61516..........  Removal of brain        C..............  ..............
                  lesion.
61517..........  Implt brain chemotx     C..............  ..............
                  add-on.
61518..........  Removal of brain        C..............  ..............
                  lesion.
61519..........  Remove brain lining     C..............  ..............
                  lesion.
61520..........  Removal of brain        C..............  ..............
                  lesion.
61521..........  Removal of brain        C..............  ..............
                  lesion.
61522..........  Removal of brain        C..............  ..............
                  abscess.
61524..........  Removal of brain        C..............  ..............
                  lesion.
61526..........  Removal of brain        C..............  ..............
                  lesion.
61530..........  Removal of brain        C..............  ..............
                  lesion.
61531..........  Implant brain           C..............  ..............
                  electrodes.
61533..........  Implant brain           C..............  ..............
                  electrodes.
61534..........  Removal of brain        C..............  ..............
                  lesion.
61535..........  Remove brain            C..............  ..............
                  electrodes.
61536..........  Removal of brain        C..............  ..............
                  lesion.
61537..........  Removal of brain        C..............  ..............
                  tissue.
61538..........  Removal of brain        C..............  ..............
                  tissue.
61539..........  Removal of brain        C..............  ..............
                  tissue.
61540..........  Removal of brain        C..............  ..............
                  tissue.
61541..........  Incision of brain       C..............  ..............
                  tissue.
61542..........  Removal of brain        C..............  ..............
                  tissue.
61543..........  Removal of brain        C..............  ..............
                  tissue.
61544..........  Remove & treat brain    C..............  ..............
                  lesion.
61545..........  Excision of brain       C..............  ..............
                  tumor.
61546..........  Removal of pituitary    C..............  ..............
                  gland.
61548..........  Removal of pituitary    C..............  ..............
                  gland.
61550..........  Release of skull seams  C..............  ..............
61552..........  Release of skull seams  C..............  ..............
61556..........  Incise skull/sutures..  C..............  ..............
61557..........  Incise skull/sutures..  C..............  ..............
61558..........  Excision of skull/      C..............  ..............
                  sutures.
61559..........  Excision of skull/      C..............  ..............
                  sutures.
61563..........  Excision of skull       C..............  ..............
                  tumor.
61564..........  Excision of skull       C..............  ..............
                  tumor.
61566..........  Removal of brain        C..............  ..............
                  tissue.
61567..........  Incision of brain       C..............  ..............
                  tissue.
61570..........  Remove foreign body,    C..............  ..............
                  brain.
61571..........  Incise skull for brain  C..............  ..............
                  wound.
61575..........  Skull base/brainstem    C..............  ..............
                  surgery.
61576..........  Skull base/brainstem    C..............  ..............
                  surgery.
61580..........  Craniofacial approach,  C..............  ..............
                  skull.
61581..........  Craniofacial approach,  C..............  ..............
                  skull.
61582..........  Craniofacial approach,  C..............  ..............
                  skull.
61583..........  Craniofacial approach,  C..............  ..............
                  skull.

[[Page 67211]]

 
61584..........  Orbitocranial approach/ C..............  ..............
                  skull.
61585..........  Orbitocranial approach/ C..............  ..............
                  skull.
61586..........  Resect nasopharynx,     C..............  ..............
                  skull.
61590..........  Infratemporal approach/ C..............  ..............
                  skull.
61591..........  Infratemporal approach/ C..............  ..............
                  skull.
61592..........  Orbitocranial approach/ C..............  ..............
                  skull.
61595..........  Transtemporal approach/ C..............  ..............
                  skull.
61596..........  Transcochlear approach/ C..............  ..............
                  skull.
61597..........  Transcondylar approach/ C..............  ..............
                  skull.
61598..........  Transpetrosal approach/ C..............  ..............
                  skull.
61600..........  Resect/excise cranial   C..............  ..............
                  lesion.
61601..........  Resect/excise cranial   C..............  ..............
                  lesion.
61605..........  Resect/excise cranial   C..............  ..............
                  lesion.
61606..........  Resect/excise cranial   C..............  ..............
                  lesion.
61607..........  Resect/excise cranial   C..............  ..............
                  lesion.
61608..........  Resect/excise cranial   C..............  ..............
                  lesion.
61609..........  Transect artery, sinus  C..............  ..............
61610..........  Transect artery, sinus  C..............  ..............
61611..........  Transect artery, sinus  C..............  ..............
61612..........  Transect artery, sinus  C..............  ..............
61613..........  Remove aneurysm, sinus  C..............  ..............
61615..........  Resect/excise lesion,   C..............  ..............
                  skull.
61616..........  Resect/excise lesion,   C..............  ..............
                  skull.
61618..........  Repair dura...........  C..............  ..............
61619..........  Repair dura...........  C..............  ..............
61624..........  Transcath occlusion,    C..............  ..............
                  cns.
61680..........  Intracranial vessel     C..............  ..............
                  surgery.
61682..........  Intracranial vessel     C..............  ..............
                  surgery.
61684..........  Intracranial vessel     C..............  ..............
                  surgery.
61686..........  Intracranial vessel     C..............  ..............
                  surgery.
61690..........  Intracranial vessel     C..............  ..............
                  surgery.
61692..........  Intracranial vessel     C..............  ..............
                  surgery.
61697..........  Brain aneurysm repr,    C..............  ..............
                  complx.
61698..........  Brain aneurysm repr,    C..............  ..............
                  complx.
61700..........  Brain aneurysm repr,    C..............  ..............
                  simple.
61702..........  Inner skull vessel      C..............  ..............
                  surgery.
61703..........  Clamp neck artery.....  C..............  ..............
61705..........  Revise circulation to   C..............  ..............
                  head.
61708..........  Revise circulation to   C..............  ..............
                  head.
61710..........  Revise circulation to   C..............  ..............
                  head.
61711..........  Fusion of skull         C..............  ..............
                  arteries.
61735..........  Incise skull/brain      C..............  ..............
                  surgery.
61750..........  Incise skull/brain      C..............  ..............
                  biopsy.
61751..........  Brain biopsy w/ct/mr    C..............  ..............
                  guide.
61760..........  Implant brain           C..............  ..............
                  electrodes.
61850..........  Implant                 C..............  ..............
                  neuroelectrodes.
61860..........  Implant                 C..............  ..............
                  neuroelectrodes.
61863..........  Implant neuroelectrode  C..............  ..............
61864..........  Implant neuroelectrde,  C..............  ..............
                  addl.
61867..........  Implant neuroelectrode  C..............  ..............
61868..........  Implant neuroelectrde,  C..............  ..............
                  add'l.
61870..........  Implant                 C..............  ..............
                  neuroelectrodes.
61875..........  Implant                 C..............  ..............
                  neuroelectrodes.
62005..........  Treat skull fracture..  C..............  ..............
62010..........  Treatment of head       C..............  ..............
                  injury.
62100..........  Repair brain fluid      C..............  ..............
                  leakage.
62115..........  Reduction of skull      C..............  ..............
                  defect.
62116..........  Reduction of skull      C..............  ..............
                  defect.
62117..........  Reduction of skull      C..............  ..............
                  defect.
62120..........  Repair skull cavity     C..............  ..............
                  lesion.
62121..........  Incise skull repair...  C..............  ..............
62140..........  Repair of skull defect  C..............  ..............
62141..........  Repair of skull defect  C..............  ..............
62142..........  Remove skull plate/     C..............  ..............
                  flap.
62143..........  Replace skull plate/    C..............  ..............
                  flap.
62145..........  Repair of skull &       C..............  ..............
                  brain.
62146..........  Repair of skull with    C..............  ..............
                  graft.
62147..........  Repair of skull with    C..............  ..............
                  graft.
62148..........  Retr bone flap to fix   C..............  ..............
                  skull.
62161..........  Dissect brain w/scope.  C..............  ..............
62162..........  Remove colloid cyst w/  C..............  ..............
                  scope.

[[Page 67212]]

 
62163..........  Neuroendoscopy w/fb     C..............  ..............
                  removal.
62164..........  Remove brain tumor w/   C..............  ..............
                  scope.
62165..........  Remove pituit tumor w/  C..............  ..............
                  scope.
62180..........  Establish brain cavity  C..............  ..............
                  shunt.
62190..........  Establish brain cavity  C..............  ..............
                  shunt.
62192..........  Establish brain cavity  C..............  ..............
                  shunt.
62200..........  Establish brain cavity  C..............  ..............
                  shunt.
62201..........  Brain cavity shunt w/   C..............  ..............
                  scope.
62220..........  Establish brain cavity  C..............  ..............
                  shunt.
62223..........  Establish brain cavity  C..............  ..............
                  shunt.
62256..........  Remove brain cavity     C..............  ..............
                  shunt.
62258..........  Replace brain cavity    C..............  ..............
                  shunt.
63043..........  Laminotomy, add'l       C..............  ..............
                  cervical.
63044..........  Laminotomy, add'l       C..............  ..............
                  lumbar.
63050..........  Cervical laminoplasty.  C..............  ..............
63051..........  C-laminoplasty w/graft/ C..............  ..............
                  plate.
63076..........  Neck spine disk         C..............  ..............
                  surgery.
63077..........  Spine disk surgery,     C..............  ..............
                  thorax.
63078..........  Spine disk surgery,     C..............  ..............
                  thorax.
63081..........  Removal of vertebral    C..............  ..............
                  body.
63082..........  Remove vertebral body   C..............  ..............
                  add-on.
63085..........  Removal of vertebral    C..............  ..............
                  body.
63086..........  Remove vertebral body   C..............  ..............
                  add-on.
63087..........  Removal of vertebral    C..............  ..............
                  body.
63088..........  Remove vertebral body   C..............  ..............
                  add-on.
63090..........  Removal of vertebral    C..............  ..............
                  body.
63091..........  Remove vertebral body   C..............  ..............
                  add-on.
63101..........  Removal of vertebral    C..............  ..............
                  body.
63102..........  Removal of vertebral    C..............  ..............
                  body.
63103..........  Remove vertebral body   C..............  ..............
                  add-on.
63170..........  Incise spinal cord      C..............  ..............
                  tract(s).
63172..........  Drainage of spinal      C..............  ..............
                  cyst.
63173..........  Drainage of spinal      C..............  ..............
                  cyst.
63180..........  Revise spinal cord      C..............  ..............
                  ligaments.
63182..........  Revise spinal cord      C..............  ..............
                  ligaments.
63185..........  Incise spinal column/   C..............  ..............
                  nerves.
63190..........  Incise spinal column/   C..............  ..............
                  nerves.
63191..........  Incise spinal column/   C..............  ..............
                  nerves.
63194..........  Incise spinal column &  C..............  ..............
                  cord.
63195..........  Incise spinal column &  C..............  ..............
                  cord.
63196..........  Incise spinal column &  C..............  ..............
                  cord.
63197..........  Incise spinal column &  C..............  ..............
                  cord.
63198..........  Incise spinal column &  C..............  ..............
                  cord.
63199..........  Incise spinal column &  C..............  ..............
                  cord.
63200..........  Release of spinal cord  C..............  ..............
63250..........  Revise spinal cord      C..............  ..............
                  vessels.
63251..........  Revise spinal cord      C..............  ..............
                  vessels.
63252..........  Revise spinal cord      C..............  ..............
                  vessels.
63265..........  Excise intraspinal      C..............  ..............
                  lesion.
63266..........  Excise intraspinal      C..............  ..............
                  lesion.
63267..........  Excise intraspinal      C..............  ..............
                  lesion.
63268..........  Excise intraspinal      C..............  ..............
                  lesion.
63270..........  Excise intraspinal      C..............  ..............
                  lesion.
63271..........  Excise intraspinal      C..............  ..............
                  lesion.
63272..........  Excise intraspinal      C..............  ..............
                  lesion.
63273..........  Excise intraspinal      C..............  ..............
                  lesion.
63275..........  Biopsy/excise spinal    C..............  ..............
                  tumor.
63276..........  Biopsy/excise spinal    C..............  ..............
                  tumor.
63277..........  Biopsy/excise spinal    C..............  ..............
                  tumor.
63278..........  Biopsy/excise spinal    C..............  ..............
                  tumor.
63280..........  Biopsy/excise spinal    C..............  ..............
                  tumor.
63281..........  Biopsy/excise spinal    C..............  ..............
                  tumor.
63282..........  Biopsy/excise spinal    C..............  ..............
                  tumor.
63283..........  Biopsy/excise spinal    C..............  ..............
                  tumor.
63285..........  Biopsy/excise spinal    C..............  ..............
                  tumor.
63286..........  Biopsy/excise spinal    C..............  ..............
                  tumor.
63287..........  Biopsy/excise spinal    C..............  ..............
                  tumor.
63290..........  Biopsy/excise spinal    C..............  ..............
                  tumor.
63295..........  Repair of laminectomy   C..............  ..............
                  defect.
63300..........  Removal of vertebral    C..............  ..............
                  body.
63301..........  Removal of vertebral    C..............  ..............
                  body.

[[Page 67213]]

 
63302..........  Removal of vertebral    C..............  ..............
                  body.
63303..........  Removal of vertebral    C..............  ..............
                  body.
63304..........  Removal of vertebral    C..............  ..............
                  body.
63305..........  Removal of vertebral    C..............  ..............
                  body.
63306..........  Removal of vertebral    C..............  ..............
                  body.
63307..........  Removal of vertebral    C..............  ..............
                  body.
63308..........  Remove vertebral body   C..............  ..............
                  add-on.
63700..........  Repair of spinal        C..............  ..............
                  herniation.
63702..........  Repair of spinal        C..............  ..............
                  herniation.
63704..........  Repair of spinal        C..............  ..............
                  herniation.
63706..........  Repair of spinal        C..............  ..............
                  herniation.
63707..........  Repair spinal fluid     C..............  ..............
                  leakage.
63709..........  Repair spinal fluid     C..............  ..............
                  leakage.
63710..........  Graft repair of spine   C..............  ..............
                  defect.
63740..........  Install spinal shunt..  C..............  ..............
64752..........  Incision of vagus       C..............  ..............
                  nerve.
64755..........  Incision of stomach     C..............  ..............
                  nerves.
64760..........  Incision of vagus       C..............  ..............
                  nerve.
64809..........  Remove sympathetic      C..............  ..............
                  nerves.
64818..........  Remove sympathetic      C..............  ..............
                  nerves.
64866..........  Fusion of facial/other  C..............  ..............
                  nerve.
64868..........  Fusion of facial/other  C..............  ..............
                  nerve.
65273..........  Repair of eye wound...  C..............  ..............
69155..........  Extensive ear/neck      C..............  ..............
                  surgery.
69535..........  Remove part of          C..............  ..............
                  temporal bone.
69554..........  Remove ear lesion.....  C..............  ..............
69950..........  Incise inner ear nerve  C..............  ..............
75900..........  Intravascular cath      C..............  ..............
                  exchange.
75952..........  Endovasc repair abdom   C..............  ..............
                  aorta.
75953..........  Abdom aneurysm endovas  C..............  ..............
                  rpr.
75954..........  Iliac aneurysm endovas  C..............  ..............
                  rpr.
75956..........  Xray, endovasc thor ao  C..............  ..............
                  repr.
75957..........  Xray, endovasc thor ao  C..............  ..............
                  repr.
75958..........  Xray, place prox ext    C..............  ..............
                  thor ao.
75959..........  Xray, place dist ext    C..............  ..............
                  thor ao.
92970..........  Cardioassist, internal  C..............  ..............
92971..........  Cardioassist, external  C..............  ..............
92975..........  Dissolve clot, heart    C..............  ..............
                  vessel.
92992..........  Revision of heart       C..............  ..............
                  chamber.
92993..........  Revision of heart       C..............  ..............
                  chamber.
99190..........  Special pump services.  C..............  ..............
99191..........  Special pump services.  C..............  ..............
99192..........  Special pump services.  C..............  ..............
99251..........  Inpatient consultation  C..............  ..............
99252..........  Inpatient consultation  C..............  ..............
99253..........  Inpatient consultation  C..............  ..............
99254..........  Inpatient consultation  C..............  ..............
99255..........  Inpatient consultation  C..............  ..............
99293..........  Ped critical care,      C..............  ..............
                  initial.
99294..........  Ped critical care,      C..............  ..............
                  subseq.
99295..........  Neonate crit care,      C..............  ..............
                  initial.
99296..........  Neonate critical care   C..............  ..............
                  subseq.
99298..........  Ic for lbw infant <     C..............  ..............
                  1500 gm.
99299..........  Ic, lbw infant 1500-    C..............  ..............
                  2500 gm.
99356..........  Prolonged service,      C..............  ..............
                  inpatient.
99357..........  Prolonged service,      C..............  ..............
                  inpatient.
99433..........  Normal newborn care/    C..............  ..............
                  hospital.
99477..........  Init day hosp neonate   C..............  NI
                  care.
0048T..........  Implant ventricular     C..............  ..............
                  device.
0049T..........  External circulation    C..............  ..............
                  assist.
0050T..........  Removal circulation     C..............  ..............
                  assist.
0051T..........  Implant total heart     C..............  ..............
                  system.
0052T..........  Replace component       C..............  ..............
                  heart syst.
0053T..........  Replace component       C..............  ..............
                  heart syst.
0075T..........  Perq stent/chest vert   C..............  ..............
                  art.
0076T..........  S&i stent/chest vert    C..............  ..............
                  art.
0077T..........  Cereb therm perfusion   C..............  ..............
                  probe.
0078T..........  Endovasc aort repr w/   C..............  ..............
                  device.
0079T..........  Endovasc visc extnsn    C..............  ..............
                  repr.
0080T..........  Endovasc aort repr rad  C..............  ..............
                  s&i.
0081T..........  Endovasc visc extnsn    C..............  ..............
                  s&i.

[[Page 67214]]

 
0090T..........  Cervical artific disc.  C..............  ..............
0092T..........  Artific disc addl.....  C..............  ..............
0093T..........  Cervical artific        C..............  ..............
                  diskectomy.
0095T..........  Artific diskectomy      C..............  ..............
                  addl.
0096T..........  Rev cervical artific    C..............  ..............
                  disc.
0098T..........  Rev artific disc addl.  C..............  ..............
0157T..........  Open impl gast curve    C..............  ..............
                  electrd.
0158T..........  Open remv gast curve    C..............  ..............
                  electrd.
0163T..........  Lumb artif diskectomy   C..............  ..............
                  addl.
0164T..........  Remove lumb artif disc  C..............  ..............
                  addl.
0165T..........  Revise lumb artif disc  C..............  ..............
                  addl.
0166T..........  Tcath vsd close w/o     C..............  ..............
                  bypass.
0167T..........  Tcath vsd close w       C..............  ..............
                  bypass.
0169T..........  Place stereo cath       C..............  ..............
                  brain.
0184T..........  Exc rectal tumor        C..............  NI
                  endoscopic.
G0341..........  Percutaneous islet      C..............  ..............
                  celltrans.
G0342..........  Laparoscopy islet cell  C..............  ..............
                  trans.
G0343..........  Laparotomy islet cell   C..............  ..............
                  transp.
------------------------------------------------------------------------


                                      Addendum L.--Out-Migration adjustment
----------------------------------------------------------------------------------------------------------------
                                      Reclassified for FY    Out-migration    Qualifying county
           Provider No.                      2008             adjustment            name            County code
----------------------------------------------------------------------------------------------------------------
010005............................  *.....................          0.0296  MARSHALL............           01470
010008............................  ......................          0.0174  CRENSHAW............           01200
010009............................  *.....................          0.0092  MORGAN..............           01510
010010............................  *.....................          0.0296  MARSHALL............           01470
010012............................  *.....................          0.0186  DE KALB.............           01240
010015............................  ......................          0.0046  CLARKE..............           01120
010022............................  *.....................          0.1128  CHEROKEE............           01090
010025............................  *.....................          0.0235  CHAMBERS............           01080
010029............................  *.....................          0.0289  LEE.................           01400
010032............................  ......................          0.0325  RANDOLPH............           01550
010035............................  *.....................          0.0254  CULLMAN.............           01210
010038............................  ......................          0.0047  CALHOUN.............           01070
010045............................  *.....................          0.0222  FAYETTE.............           01280
010047............................  ......................          0.0127  BUTLER..............           01060
010052............................  ......................          0.0103  TALLAPOOSA..........           01610
010054............................  *.....................          0.0092  MORGAN..............           01510
010061............................  ......................          0.0542  JACKSON.............           01350
010065............................  *.....................          0.0103  TALLAPOOSA..........           01610
010078............................  ......................          0.0047  CALHOUN.............           01070
010083............................  *.....................          0.0134  BALDWIN.............           01010
010085............................  *.....................          0.0092  MORGAN..............           01510
010091............................  ......................          0.0046  CLARKE..............           01120
010100............................  *.....................          0.0134  BALDWIN.............           01010
010101............................  *.....................          0.0211  TALLADEGA...........           01600
010109............................  ......................          0.0451  PICKENS.............           01530
010110............................  ......................          0.0215  BULLOCK.............           01050
010125............................  ......................          0.0476  WINSTON.............           01660
010128............................  ......................          0.0046  CLARKE..............           01120
010129............................  ......................          0.0134  BALDWIN.............           01010
010138............................  ......................          0.0066  SUMTER..............           01590
010143............................  *.....................          0.0254  CULLMAN.............           01210
010146............................  ......................          0.0047  CALHOUN.............           01070
010150............................  *.....................          0.0127  BUTLER..............           01060
010158............................  *.....................          0.0023  FRANKLIN............           01290
010164............................  *.....................          0.0211  TALLADEGA...........           01600
013027............................  ......................          0.0134  BALDWIN.............           01010
014009............................  ......................          0.0092  MORGAN..............           01510
030067............................  ......................          0.0298  LAPAZ...............           03055
040014............................  *.....................          0.0199  WHITE...............           04720
040019............................  *.....................          0.0258  ST. FRANCIS.........           04610
040039............................  *.....................          0.0172  GREENE..............           04270
040047............................  ......................          0.0117  RANDOLPH............           04600
040067............................  ......................          0.0007  COLUMBIA............           04130
040071............................  *.....................          0.0149  JEFFERSON...........           04340
040076............................  *.....................          0.1000  HOT SPRING..........           04290
040081............................  ......................          0.0357  PIKE................           04540

[[Page 67215]]

 
040100............................  *.....................          0.0199  WHITE...............           04720
042007............................  ......................          0.0149  JEFFERSON...........           04340
043034............................  ......................          0.0036  CHICOT..............           04080
050002............................  ......................          0.0010  ALAMEDA.............           05000
050007............................  ......................          0.0146  SAN MATEO...........           05510
050008............................  ......................          0.0026  SAN FRANCISCO.......           05480
050009............................  *.....................          0.0180  NAPA................           05380
050013............................  *.....................          0.0180  NAPA................           05380
050014............................  *.....................          0.0139  AMADOR..............           05020
050016............................  ......................          0.0103  SAN LUIS OBISPO.....           05500
050042............................  *.....................          0.0162  TEHAMA..............           05620
050043............................  ......................          0.0010  ALAMEDA.............           05000
050047............................  ......................          0.0026  SAN FRANCISCO.......           05480
050055............................  ......................          0.0026  SAN FRANCISCO.......           05480
050070............................  ......................          0.0146  SAN MATEO...........           05510
050073............................  *.....................          0.0171  SOLANO..............           05580
050075............................  ......................          0.0010  ALAMEDA.............           05000
050076............................  *.....................          0.0026  SAN FRANCISCO.......           05480
050084............................  ......................          0.0132  SAN JOAQUIN.........           05490
050090............................  *.....................          0.0058  SONOMA..............           05590
050101............................  *.....................          0.0171  SOLANO..............           05580
050113............................  ......................          0.0146  SAN MATEO...........           05510
050118............................  *.....................          0.0132  SAN JOAQUIN.........           05490
050122............................  ......................          0.0132  SAN JOAQUIN.........           05490
050133............................  *.....................          0.0178  YUBA................           05680
050136............................  *.....................          0.0058  SONOMA..............           05590
050150............................  *.....................          0.0342  NEVADA..............           05390
050152............................  ......................          0.0026  SAN FRANCISCO.......           05480
050167............................  ......................          0.0132  SAN JOAQUIN.........           05490
050174............................  *.....................          0.0058  SONOMA..............           05590
050194............................  ......................          0.0052  SANTA CRUZ..........           05540
050195............................  ......................          0.0010  ALAMEDA.............           05000
050197............................  *.....................          0.0146  SAN MATEO...........           05510
050211............................  ......................          0.0010  ALAMEDA.............           05000
050228............................  ......................          0.0026  SAN FRANCISCO.......           05480
050232............................  ......................          0.0103  SAN LUIS OBISPO.....           05500
050242............................  ......................          0.0052  SANTA CRUZ..........           05540
050264............................  ......................          0.0010  ALAMEDA.............           05000
050283............................  ......................          0.0010  ALAMEDA.............           05000
050289............................  ......................          0.0146  SAN MATEO...........           05510
050291............................  *.....................          0.0058  SONOMA..............           05590
050305............................  ......................          0.0010  ALAMEDA.............           05000
050313............................  ......................          0.0132  SAN JOAQUIN.........           05490
050320............................  ......................          0.0010  ALAMEDA.............           05000
050325............................  ......................          0.0033  TUOLUMNE............           05650
050335............................  ......................          0.0033  TUOLUMNE............           05650
050336............................  ......................          0.0132  SAN JOAQUIN.........           05490
050366............................  ......................          0.0015  CALAVERAS...........           05040
050367............................  *.....................          0.0171  SOLANO..............           05580
050385............................  *.....................          0.0058  SONOMA..............           05590
050407............................  ......................          0.0026  SAN FRANCISCO.......           05480
050444............................  ......................          0.0233  MERCED..............           05340
050454............................  ......................          0.0026  SAN FRANCISCO.......           05480
050457............................  ......................          0.0026  SAN FRANCISCO.......           05480
050476............................  *.....................          0.0278  LAKE................           05160
050488............................  ......................          0.0010  ALAMEDA.............           05000
050494............................  *.....................          0.0342  NEVADA..............           05390
050506............................  ......................          0.0103  SAN LUIS OBISPO.....           05500
050512............................  ......................          0.0010  ALAMEDA.............           05000
050528............................  *.....................          0.0233  MERCED..............           05340
050541............................  *.....................          0.0146  SAN MATEO...........           05510
050547............................  *.....................          0.0058  SONOMA..............           05590
050633............................  ......................          0.0103  SAN LUIS OBISPO.....           05500
050667............................  *.....................          0.0180  NAPA................           05380
050668............................  ......................          0.0026  SAN FRANCISCO.......           05480
050680............................  *.....................          0.0171  SOLANO..............           05580
050690............................  *.....................          0.0058  SONOMA..............           05590
050707............................  ......................          0.0146  SAN MATEO...........           05510
050714............................  ......................          0.0052  SANTA CRUZ..........           05540
050748............................  ......................          0.0132  SAN JOAQUIN.........           05490
050754............................  ......................          0.0146  SAN MATEO...........           05510

[[Page 67216]]

 
052034............................  ......................          0.0010  ALAMEDA.............           05000
053301............................  ......................          0.0010  ALAMEDA.............           05000
054003............................  ......................          0.0146  SAN MATEO...........           05510
054020............................  ......................          0.0026  SAN FRANCISCO.......           05480
054074............................  ......................          0.0171  SOLANO..............           05580
054089............................  ......................          0.0026  SAN FRANCISCO.......           05480
054110............................  ......................          0.0010  ALAMEDA.............           05000
054122............................  ......................          0.0180  NAPA................           05380
054123............................  ......................          0.0132  SAN JOAQUIN.........           05490
054141............................  ......................          0.0171  SOLANO..............           05580
054144............................  ......................          0.0026  SAN FRANCISCO.......           05480
060001............................  *.....................          0.0042  WELD................           06610
060003............................  *.....................          0.0069  BOULDER.............           06060
060010............................  ......................          0.0153  LARIMER.............           06340
060027............................  *.....................          0.0069  BOULDER.............           06060
060030............................  ......................          0.0153  LARIMER.............           06340
060103............................  *.....................          0.0069  BOULDER.............           06060
060116............................  *.....................          0.0069  BOULDER.............           06060
063033............................  ......................          0.0153  LARIMER.............           06340
064007............................  ......................          0.0069  BOULDER.............           06060
064016............................  ......................          0.0153  LARIMER.............           06340
070006............................  *.....................          0.0045  FAIRFIELD...........           07000
070010............................  *.....................          0.0045  FAIRFIELD...........           07000
070018............................  *.....................          0.0045  FAIRFIELD...........           07000
070028............................  *.....................          0.0045  FAIRFIELD...........           07000
070033............................  *.....................          0.0045  FAIRFIELD...........           07000
070034............................  *.....................          0.0045  FAIRFIELD...........           07000
074000............................  ......................          0.0045  FAIRFIELD...........           07000
074012............................  ......................          0.0045  FAIRFIELD...........           07000
074014............................  ......................          0.0045  FAIRFIELD...........           07000
080001............................  *.....................          0.0063  NEW CASTLE..........           08010
080003............................  *.....................          0.0063  NEW CASTLE..........           08010
082000............................  ......................          0.0063  NEW CASTLE..........           08010
083300............................  ......................          0.0063  NEW CASTLE..........           08010
084001............................  ......................          0.0063  NEW CASTLE..........           08010
084002............................  ......................          0.0063  NEW CASTLE..........           08010
084003............................  ......................          0.0063  NEW CASTLE..........           08010
100014............................  *.....................          0.0047  VOLUSIA.............           10630
100017............................  *.....................          0.0047  VOLUSIA.............           10630
100045............................  *.....................          0.0047  VOLUSIA.............           10630
100047............................  *.....................          0.0028  CHARLOTTE...........           10070
100068............................  *.....................          0.0047  VOLUSIA.............           10630
100072............................  *.....................          0.0047  VOLUSIA.............           10630
100077............................  *.....................          0.0028  CHARLOTTE...........           10070
100102............................  ......................          0.0125  COLUMBIA............           10110
100118............................  *.....................          0.0177  FLAGLER.............           10170
100156............................  *.....................          0.0125  COLUMBIA............           10110
100232............................  *.....................          0.0054  PUTNAM..............           10530
100236............................  *.....................          0.0028  CHARLOTTE...........           10070
100252............................  *.....................          0.0151  OKEECHOBEE..........           10460
100290............................  ......................          0.0582  SUMTER..............           10590
110023............................  *.....................          0.0416  GORDON..............           11500
110029............................  *.....................          0.0052  HALL................           11550
110040............................  *.....................          0.1455  JACKSON.............           11610
110041............................  *.....................          0.0623  HABERSHAM...........           11540
110100............................  ......................          0.0790  JEFFERSON...........           11620
110101............................  ......................          0.0067  COOK................           11311
110142............................  ......................          0.0185  EVANS...............           11441
110146............................  *.....................          0.0805  CAMDEN..............           11170
110150............................  *.....................          0.0227  BALDWIN.............           11030
110187............................  *.....................          0.0643  LUMPKIN.............           11701
110189............................  *.....................          0.0066  FANNIN..............           11450
110190............................  ......................          0.0241  MACON...............           11710
110205............................  ......................          0.0507  GILMER..............           11471
114018............................  ......................          0.0227  BALDWIN.............           11030
130003............................  *.....................          0.0235  NEZ PERCE...........           13340
130024............................  ......................          0.0675  BONNER..............           13080
130049............................  *.....................          0.0319  KOOTENAI............           13270
130066............................  ......................          0.0319  KOOTENAI............           13270
130067............................  *.....................          0.0725  BINGHAM.............           13050
130068............................  ......................          0.0319  KOOTENAI............           13270

[[Page 67217]]

 
132001............................  ......................          0.0319  KOOTENAI............           13270
134010............................  ......................          0.0725  BINGHAM.............           13050
140001............................  ......................          0.0369  FULTON..............           14370
140026............................  ......................          0.0315  LA SALLE............           14580
140043............................  *.....................          0.0056  WHITESIDE...........           14988
140058............................  *.....................          0.0126  MORGAN..............           14770
140110............................  *.....................          0.0315  LA SALLE............           14580
140160............................  *.....................          0.0332  STEPHENSON..........           14970
140161............................  *.....................          0.0168  LIVINGSTON..........           14610
140167............................  *.....................          0.0632  IROQUOIS............           14460
140234............................  ......................          0.0315  LA SALLE............           14580
150006............................  *.....................          0.0113  LA PORTE............           15450
150015............................  ......................          0.0113  LA PORTE............           15450
150022............................  ......................          0.0158  MONTGOMERY..........           15530
150030............................  *.....................          0.0192  HENRY...............           15320
150072............................  ......................          0.0105  CASS................           15080
150076............................  *.....................          0.0215  MARSHALL............           15490
150088............................  *.....................          0.0111  MADISON.............           15470
150091............................  *.....................          0.0050  HUNTINGTON..........           15340
150102............................  *.....................          0.0108  STARKE..............           15740
150113............................  *.....................          0.0111  MADISON.............           15470
150133............................  *.....................          0.0193  KOSCIUSKO...........           15420
150146............................  *.....................          0.0319  NOBLE...............           15560
153040............................  ......................          0.0215  MARSHALL............           15490
154014............................  ......................          0.0193  KOSCIUSKO...........           15420
154035............................  ......................          0.0105  CASS................           15080
154047............................  ......................          0.0215  MARSHALL............           15490
160013............................  ......................          0.0179  MUSCATINE...........           16690
160030............................  ......................          0.0040  STORY...............           16840
160032............................  ......................          0.0235  JASPER..............           16490
160080............................  *.....................          0.0066  CLINTON.............           16220
170137............................  *.....................          0.0336  DOUGLAS.............           17220
170150............................  ......................          0.0166  COWLEY..............           17170
180012............................  *.....................          0.0080  HARDIN..............           18460
180017............................  *.....................          0.0035  BARREN..............           18040
180049............................  *.....................          0.0488  MADISON.............           18750
180064............................  ......................          0.0314  MONTGOMERY..........           18860
180066............................  *.....................          0.0439  LOGAN...............           18700
180070............................  ......................          0.0240  GRAYSON.............           18420
180079............................  ......................          0.0259  HARRISON............           18480
183028............................  ......................          0.0080  HARDIN..............           18460
184012............................  ......................          0.0080  HARDIN..............           18460
190003............................  *.....................          0.0085  IBERIA..............           19220
190015............................  *.....................          0.0243  TANGIPAHOA..........           19520
190017............................  ......................          0.0187  ST. LANDRY..........           19480
190034............................  ......................          0.0189  VERMILION...........           19560
190044............................  ......................          0.0261  ACADIA..............           19000
190050............................  ......................          0.0044  BEAUREGARD..........           19050
190053............................  ......................          0.0101  JEFFRSON DAVIS......           19260
190054............................  ......................          0.0085  IBERIA..............           19220
190078............................  ......................          0.0187  ST. LANDRY..........           19480
190086............................  *.....................          0.0061  LINCOLN.............           19300
190088............................  *.....................          0.0387  WEBSTER.............           19590
190099............................  *.....................          0.0189  AVOYELLES...........           19040
190106............................  *.....................          0.0102  ALLEN...............           19010
190116............................  ......................          0.0085  MOREHOUSE...........           19330
190133............................  ......................          0.0102  ALLEN...............           19010
190140............................  ......................          0.0035  FRANKLIN............           19200
190144............................  *.....................          0.0387  WEBSTER.............           19590
190145............................  ......................          0.0090  LA SALLE............           19290
190184............................  *.....................          0.0161  CALDWELL............           19100
190190............................  ......................          0.0161  CALDWELL............           19100
190191............................  *.....................          0.0187  ST. LANDRY..........           19480
190246............................  ......................          0.0161  CALDWELL............           19100
190257............................  ......................          0.0061  LINCOLN.............           19300
192022............................  ......................          0.0061  LINCOLN.............           19300
192026............................  ......................          0.0387  WEBSTER.............           19590
192034............................  ......................          0.0187  ST. LANDRY..........           19480
192036............................  ......................          0.0243  TANGIPAHOA..........           19520
192040............................  ......................          0.0243  TANGIPAHOA..........           19520
192050............................  ......................          0.0261  ACADIA..............           19000

[[Page 67218]]

 
193036............................  ......................          0.0187  ST. LANDRY..........           19480
193044............................  ......................          0.0243  TANGIPAHOA..........           19520
193047............................  ......................          0.0189  VERMILION...........           19560
193049............................  ......................          0.0189  VERMILION...........           19560
193055............................  ......................          0.0161  CALDWELL............           19100
193058............................  ......................          0.0085  MOREHOUSE...........           19330
193063............................  ......................          0.0243  TANGIPAHOA..........           19520
193067............................  ......................          0.0101  JEFFRSON DAVIS......           19260
193068............................  ......................          0.0243  TANGIPAHOA..........           19520
193069............................  ......................          0.0085  MOREHOUSE...........           19330
193073............................  ......................          0.0187  ST. LANDRY..........           19480
193079............................  ......................          0.0243  TANGIPAHOA..........           19520
193081............................  ......................          0.0261  ACADIA..............           19000
193088............................  ......................          0.0261  ACADIA..............           19000
193091............................  ......................          0.0085  IBERIA..............           19220
194047............................  ......................          0.0387  WEBSTER.............           19590
194065............................  ......................          0.0061  LINCOLN.............           19300
194075............................  ......................          0.0101  JEFFRSON DAVIS......           19260
194077............................  ......................          0.0061  LINCOLN.............           19300
194081............................  ......................          0.0044  BEAUREGARD..........           19050
194082............................  ......................          0.0101  JEFFRSON DAVIS......           19260
194083............................  ......................          0.0085  MOREHOUSE...........           19330
194085............................  ......................          0.0261  ACADIA..............           19000
194087............................  ......................          0.0061  LINCOLN.............           19300
200024............................  *.....................          0.0094  ANDROSCOGGIN........           20000
200032............................  ......................          0.0466  OXFORD..............           20080
200034............................  *.....................          0.0094  ANDROSCOGGIN........           20000
200050............................  *.....................          0.0227  HANCOCK.............           20040
210001............................  ......................          0.0187  WASHINGTON..........           21210
210023............................  ......................          0.0079  ANNE ARUNDEL........           21010
210028............................  ......................          0.0512  ST. MARYS...........           21180
210043............................  ......................          0.0079  ANNE ARUNDEL........           21010
212002............................  ......................          0.0187  WASHINGTON..........           21210
214001............................  ......................          0.0079  ANNE ARUNDEL........           21010
214003............................  ......................          0.0187  WASHINGTON..........           21210
220002............................  ......................          0.0271  MIDDLESEX...........           22090
220010............................  *.....................          0.0355  ESSEX...............           22040
220011............................  ......................          0.0271  MIDDLESEX...........           22090
220029............................  *.....................          0.0355  ESSEX...............           22040
220033............................  *.....................          0.0355  ESSEX...............           22040
220035............................  *.....................          0.0355  ESSEX...............           22040
220049............................  ......................          0.0271  MIDDLESEX...........           22090
220063............................  ......................          0.0271  MIDDLESEX...........           22090
220070............................  ......................          0.0271  MIDDLESEX...........           22090
220080............................  *.....................          0.0355  ESSEX...............           22040
220082............................  ......................          0.0271  MIDDLESEX...........           22090
220084............................  ......................          0.0271  MIDDLESEX...........           22090
220098............................  ......................          0.0271  MIDDLESEX...........           22090
220101............................  ......................          0.0271  MIDDLESEX...........           22090
220105............................  ......................          0.0271  MIDDLESEX...........           22090
220171............................  ......................          0.0271  MIDDLESEX...........           22090
220174............................  *.....................          0.0355  ESSEX...............           22040
222000............................  ......................          0.0271  MIDDLESEX...........           22090
222003............................  ......................          0.0271  MIDDLESEX...........           22090
222024............................  ......................          0.0271  MIDDLESEX...........           22090
222026............................  ......................          0.0355  ESSEX...............           22040
222044............................  ......................          0.0355  ESSEX...............           22040
222047............................  ......................          0.0355  ESSEX...............           22040
223026............................  ......................          0.0271  MIDDLESEX...........           22090
223028............................  ......................          0.0355  ESSEX...............           22040
224007............................  ......................          0.0271  MIDDLESEX...........           22090
224022............................  ......................          0.0271  MIDDLESEX...........           22090
224033............................  ......................          0.0355  ESSEX...............           22040
224038............................  ......................          0.0271  MIDDLESEX...........           22090
230003............................  *.....................          0.0220  OTTAWA..............           23690
230005............................  ......................          0.0473  LENAWEE.............           23450
230013............................  *.....................          0.0025  OAKLAND.............           23620
230015............................  ......................          0.0295  ST. JOSEPH..........           23740
230019............................  *.....................          0.0025  OAKLAND.............           23620
230021............................  *.....................          0.0101  BERRIEN.............           23100
230022............................  *.....................          0.0212  BRANCH..............           23110

[[Page 67219]]

 
230029............................  *.....................          0.0025  OAKLAND.............           23620
230035............................  *.....................          0.0095  MONTCALM............           23580
230037............................  *.....................          0.0210  HILLSDALE...........           23290
230047............................  *.....................          0.0021  MACOMB..............           23490
230069............................  *.....................          0.0210  LIVINGSTON..........           23460
230071............................  *.....................          0.0025  OAKLAND.............           23620
230072............................  *.....................          0.0220  OTTAWA..............           23690
230075............................  ......................          0.0047  CALHOUN.............           23120
230078............................  *.....................          0.0101  BERRIEN.............           23100
230092............................  *.....................          0.0223  JACKSON.............           23370
230093............................  ......................          0.0058  MECOSTA.............           23530
230096............................  *.....................          0.0295  ST. JOSEPH..........           23740
230099............................  *.....................          0.0231  MONROE..............           23570
230121............................  *.....................          0.0678  SHIAWASSEE..........           23770
230130............................  *.....................          0.0025  OAKLAND.............           23620
230151............................  *.....................          0.0025  OAKLAND.............           23620
230174............................  *.....................          0.0220  OTTAWA..............           23690
230195............................  *.....................          0.0021  MACOMB..............           23490
230204............................  *.....................          0.0021  MACOMB..............           23490
230207............................  *.....................          0.0025  OAKLAND.............           23620
230208............................  *.....................          0.0095  MONTCALM............           23580
230217............................  ......................          0.0047  CALHOUN.............           23120
230222............................  *.....................          0.0035  MIDLAND.............           23550
230223............................  *.....................          0.0025  OAKLAND.............           23620
230227............................  *.....................          0.0021  MACOMB..............           23490
230254............................  *.....................          0.0025  OAKLAND.............           23620
230257............................  *.....................          0.0021  MACOMB..............           23490
230264............................  *.....................          0.0021  MACOMB..............           23490
230269............................  *.....................          0.0025  OAKLAND.............           23620
230277............................  *.....................          0.0025  OAKLAND.............           23620
230279............................  *.....................          0.0210  LIVINGSTON..........           23460
232023............................  ......................          0.0021  MACOMB..............           23490
232025............................  ......................          0.0101  BERRIEN.............           23100
232028............................  ......................          0.0047  CALHOUN.............           23120
232030............................  ......................          0.0025  OAKLAND.............           23620
232034............................  ......................          0.0435  ALLEGAN.............           23020
232036............................  ......................          0.0223  JACKSON.............           23370
233025............................  ......................          0.0047  CALHOUN.............           23120
233028............................  ......................          0.0025  OAKLAND.............           23620
233031............................  ......................          0.0021  MACOMB..............           23490
234011............................  ......................          0.0025  OAKLAND.............           23620
234021............................  ......................          0.0021  MACOMB..............           23490
234023............................  ......................          0.0025  OAKLAND.............           23620
234024............................  ......................          0.0021  MACOMB..............           23490
234025............................  ......................          0.0276  TUSCOLA.............           23780
234037............................  ......................          0.0047  CALHOUN.............           23120
234039............................  ......................          0.0021  MACOMB..............           23490
240018............................  ......................          0.0805  GOODHUE.............           24240
240044............................  ......................          0.0625  WINONA..............           24840
240064............................  *.....................          0.0134  ITASCA..............           24300
240069............................  *.....................          0.0267  STEELE..............           24730
240071............................  *.....................          0.0385  RICE................           24650
240117............................  ......................          0.0527  MOWER...............           24490
240211............................  ......................          0.0812  PINE................           24570
250023............................  *.....................          0.0541  PEARL RIVER.........           25540
250040............................  *.....................          0.0021  JACKSON.............           25290
250117............................  *.....................          0.0541  PEARL RIVER.........           25540
250128............................  ......................          0.0446  PANOLA..............           25530
250160............................  ......................          0.0446  PANOLA..............           25530
252011............................  ......................          0.0446  PANOLA..............           25530
260059............................  ......................          0.0077  LACLEDE.............           26520
260064............................  *.....................          0.0089  AUDRAIN.............           26030
260097............................  ......................          0.0300  JOHNSON.............           26500
260116............................  ......................          0.0087  ST. FRANCOIS........           26930
260163............................  ......................          0.0087  ST. FRANCOIS........           26930
264005............................  ......................          0.0087  ST. FRANCOIS........           26930
264027............................  ......................          0.0087  CEDAR...............           26190
270081............................  ......................          0.0234  MUSSELSHELL.........           27320
280077............................  ......................          0.0080  DODGE...............           28260
280123............................  ......................          0.0123  GAGE................           28330
290002............................  *.....................          0.0277  LYON................           29090

[[Page 67220]]

 
300011............................  ......................          0.0069  HILLSBOROUGH........           30050
300012............................  ......................          0.0069  HILLSBOROUGH........           30050
300020............................  ......................          0.0069  HILLSBOROUGH........           30050
300034............................  ......................          0.0069  HILLSBOROUGH........           30050
310002............................  *.....................          0.0268  ESSEX...............           31200
310009............................  *.....................          0.0268  ESSEX...............           31200
310010............................  ......................          0.0092  MERCER..............           31260
310011............................  ......................          0.0115  CAPE MAY............           31180
310013............................  *.....................          0.0268  ESSEX...............           31200
310018............................  *.....................          0.0268  ESSEX...............           31200
310021............................  *.....................          0.0092  MERCER..............           31260
310038............................  *.....................          0.0209  MIDDLESEX...........           31270
310039............................  *.....................          0.0209  MIDDLESEX...........           31270
310044............................  ......................          0.0092  MERCER..............           31260
310054............................  *.....................          0.0268  ESSEX...............           31200
310070............................  *.....................          0.0209  MIDDLESEX...........           31270
310076............................  *.....................          0.0268  ESSEX...............           31200
310083............................  *.....................          0.0268  ESSEX...............           31200
310092............................  ......................          0.0092  MERCER..............           31260
310093............................  *.....................          0.0268  ESSEX...............           31200
310096............................  *.....................          0.0268  ESSEX...............           31200
310108............................  *.....................          0.0209  MIDDLESEX...........           31270
310110............................  ......................          0.0092  MERCER..............           31260
310119............................  *.....................          0.0268  ESSEX...............           31200
312018............................  ......................          0.0209  MIDDLESEX...........           31270
313025............................  ......................          0.0268  ESSEX...............           31200
313027............................  ......................          0.0092  MERCER..............           31260
314010............................  ......................          0.0268  ESSEX...............           31200
314011............................  ......................          0.0209  MIDDLESEX...........           31270
314013............................  ......................          0.0092  MERCER..............           31260
314020............................  ......................          0.0268  ESSEX...............           31200
314025............................  ......................          0.0092  MERCER..............           31260
320003............................  *.....................          0.0629  SAN MIGUEL..........           32230
320011............................  ......................          0.0442  RIO ARRIBA..........           32190
320018............................  ......................          0.0024  DONA ANA............           32060
320085............................  ......................          0.0024  DONA ANA............           32060
322001............................  ......................          0.0629  SAN MIGUEL..........           32230
323025............................  ......................          0.0629  SAN MIGUEL..........           32230
323032............................  ......................          0.0024  DONA ANA............           32060
324007............................  ......................          0.0024  DONA ANA............           32060
324009............................  ......................          0.0024  DONA ANA............           32060
324010............................  ......................          0.0024  DONA ANA............           32060
324011............................  ......................          0.0442  RIO ARRIBA..........           32190
324012............................  ......................          0.0024  DONA ANA............           32060
330004............................  *.....................          0.0633  ULSTER..............           33740
330008............................  *.....................          0.0126  WYOMING.............           33900
330010............................  ......................          0.0067  MONTGOMERY..........           33380
330027............................  *.....................          0.0123  NASSAU..............           33400
330033............................  ......................          0.0223  CHENANGO............           33080
330047............................  ......................          0.0067  MONTGOMERY..........           33380
330073............................  *.....................          0.0151  GENESEE.............           33290
330094............................  *.....................          0.0503  COLUMBIA............           33200
330103............................  *.....................          0.0131  CATTARAUGUS.........           33040
330106............................  *.....................          0.0123  NASSAU..............           33400
330126............................  *.....................          0.0642  ORANGE..............           33540
330132............................  ......................          0.0131  CATTARAUGUS.........           33040
330135............................  ......................          0.0642  ORANGE..............           33540
330167............................  *.....................          0.0123  NASSAU..............           33400
330175............................  ......................          0.0260  CORTLAND............           33210
330181............................  *.....................          0.0123  NASSAU..............           33400
330182............................  *.....................          0.0123  NASSAU..............           33400
330191............................  *.....................          0.0017  WARREN..............           33750
330198............................  *.....................          0.0123  NASSAU..............           33400
330205............................  ......................          0.0642  ORANGE..............           33540
330224............................  *.....................          0.0633  ULSTER..............           33740
330225............................  *.....................          0.0123  NASSAU..............           33400
330235............................  *.....................          0.0306  CAYUGA..............           33050
330259............................  *.....................          0.0123  NASSAU..............           33400
330264............................  ......................          0.0642  ORANGE..............           33540
330276............................  ......................          0.0036  FULTON..............           33280
330331............................  *.....................          0.0123  NASSAU..............           33400

[[Page 67221]]

 
330332............................  *.....................          0.0123  NASSAU..............           33400
330372............................  *.....................          0.0123  NASSAU..............           33400
330386............................  *.....................          0.0745  SULLIVAN............           33710
334017............................  ......................          0.0642  ORANGE..............           33540
334061............................  ......................          0.0642  ORANGE..............           33540
340020............................  ......................          0.0156  LEE.................           34520
340021............................  *.....................          0.0162  CLEVELAND...........           34220
340024............................  ......................          0.0177  SAMPSON.............           34810
340027............................  *.....................          0.0128  LENOIR..............           34530
340037............................  ......................          0.0162  CLEVELAND...........           34220
340038............................  ......................          0.0253  BEAUFORT............           34060
340039............................  *.....................          0.0101  IREDELL.............           34480
340068............................  *.....................          0.0087  COLUMBUS............           34230
340069............................  *.....................          0.0015  WAKE................           34910
340070............................  *.....................          0.0395  ALAMANCE............           34000
340071............................  *.....................          0.0226  HARNETT.............           34420
340073............................  *.....................          0.0015  WAKE................           34910
340085............................  *.....................          0.0250  DAVIDSON............           34280
340096............................  *.....................          0.0250  DAVIDSON............           34280
340104............................  ......................          0.0162  CLEVELAND...........           34220
340114............................  *.....................          0.0015  WAKE................           34910
340124............................  *.....................          0.0226  HARNETT.............           34420
340126............................  *.....................          0.0100  WILSON..............           34970
340129............................  *.....................          0.0101  IREDELL.............           34480
340133............................  ......................          0.0308  MARTIN..............           34580
340138............................  *.....................          0.0015  WAKE................           34910
340144............................  *.....................          0.0101  IREDELL.............           34480
340145............................  *.....................          0.0336  LINCOLN.............           34540
340151............................  ......................          0.0052  HALIFAX.............           34410
340173............................  *.....................          0.0015  WAKE................           34910
344001............................  ......................          0.0015  WAKE................           34910
344011............................  ......................          0.0015  WAKE................           34910
344014............................  ......................          0.0015  WAKE................           34910
360002............................  ......................          0.0141  ASHLAND.............           36020
360010............................  *.....................          0.0074  TUSCARAWAS..........           36800
360013............................  *.....................          0.0135  SHELBY..............           36760
360025............................  *.....................          0.0077  ERIE................           36220
360036............................  *.....................          0.0126  WAYNE...............           36860
360040............................  ......................          0.0387  KNOX................           36430
360044............................  ......................          0.0127  DARKE...............           36190
360065............................  *.....................          0.0075  HURON...............           36400
360071............................  ......................          0.0035  VAN WERT............           36820
360086............................  *.....................          0.0186  CLARK...............           36110
360096............................  *.....................          0.0071  COLUMBIANA..........           36140
360107............................  *.....................          0.0119  SANDUSKY............           36730
360125............................  *.....................          0.0133  ASHTABULA...........           36030
360156............................  ......................          0.0119  SANDUSKY............           36730
360175............................  *.....................          0.0183  CLINTON.............           36130
360185............................  *.....................          0.0071  COLUMBIANA..........           36140
360187............................  *.....................          0.0186  CLARK...............           36110
360245............................  *.....................          0.0133  ASHTABULA...........           36030
362007............................  ......................          0.0119  SANDUSKY............           36730
364040............................  ......................          0.0186  CLARK...............           36110
370014............................  *.....................          0.0361  BRYAN...............           37060
370015............................  *.....................          0.0366  MAYES...............           37480
370023............................  ......................          0.0090  STEPHENS............           37680
370065............................  ......................          0.0096  CRAIG...............           37170
370072............................  ......................          0.0258  LATIMER.............           37380
370083............................  ......................          0.0051  PUSHMATAHA..........           37630
370100............................  ......................          0.0100  CHOCTAW.............           37110
370149............................  *.....................          0.0302  POTTAWATOMIE........           37620
370156............................  ......................          0.0121  GARVIN..............           37240
370169............................  ......................          0.0163  MCINTOSH............           37450
370172............................  ......................          0.0258  LATIMER.............           37380
370214............................  ......................          0.0121  GARVIN..............           37240
372017............................  ......................          0.0100  CHOCTAW.............           37110
372019............................  ......................          0.0302  POTTAWATOMIE........           37620
373032............................  ......................          0.0100  CHOCTAW.............           37110
380022............................  *.....................          0.0067  LINN................           38210
380029............................  ......................          0.0075  MARION..............           38230
380051............................  ......................          0.0075  MARION..............           38230

[[Page 67222]]

 
380056............................  ......................          0.0075  MARION..............           38230
384008............................  ......................          0.0075  MARION..............           38230
384011............................  ......................          0.0107  UMATILLA............           38290
390008............................  ......................          0.0060  LAWRENCE............           39450
390016............................  *.....................          0.0060  LAWRENCE............           39450
390030............................  *.....................          0.0284  SCHUYLKILL..........           39650
390031............................  *.....................          0.0284  SCHUYLKILL..........           39650
390044............................  *.....................          0.0191  BERKS...............           39110
390052............................  ......................          0.0047  CLEARFIELD..........           39230
390056............................  ......................          0.0036  HUNTINGDON..........           39380
390065............................  *.....................          0.0532  ADAMS...............           39000
390066............................  *.....................          0.0372  LEBANON.............           39460
390079............................  *.....................          0.0003  BRADFORD............           39130
390086............................  *.....................          0.0047  CLEARFIELD..........           39230
390096............................  *.....................          0.0191  BERKS...............           39110
390110............................  *.....................          0.0003  CAMBRIA.............           39160
390113............................  *.....................          0.0053  CRAWFORD............           39260
390117............................  ......................          0.0002  BEDFORD.............           39100
390122............................  ......................          0.0053  CRAWFORD............           39260
390125............................  ......................          0.0022  WAYNE...............           39760
390130............................  *.....................          0.0003  CAMBRIA.............           39160
390138............................  *.....................          0.0218  FRANKLIN............           39350
390146............................  ......................          0.0022  WARREN..............           39740
390150............................  ......................          0.0031  GREENE..............           39370
390151............................  *.....................          0.0218  FRANKLIN............           39350
390162............................  *.....................          0.0200  NORTHAMPTON.........           39590
390181............................  ......................          0.0284  SCHUYLKILL..........           39650
390183............................  *.....................          0.0284  SCHUYLKILL..........           39650
390201............................  ......................          0.1170  MONROE..............           39550
390236............................  ......................          0.0003  BRADFORD............           39130
390313............................  *.....................          0.0284  SCHUYLKILL..........           39650
392030............................  ......................          0.0532  ADAMS...............           39000
392031............................  ......................          0.0003  CAMBRIA.............           39160
392034............................  ......................          0.0200  NORTHAMPTON.........           39590
393026............................  ......................          0.0191  BERKS...............           39110
393050............................  ......................          0.0200  NORTHAMPTON.........           39590
394014............................  ......................          0.0191  BERKS...............           39110
394016............................  ......................          0.0022  WARREN..............           39740
394020............................  ......................          0.0372  LEBANON.............           39460
420007............................  *.....................          0.0027  SPARTANBURG.........           42410
420009............................  *.....................          0.0113  OCONEE..............           42360
420019............................  ......................          0.0158  CHESTER.............           42110
420027............................  *.....................          0.0108  ANDERSON............           42030
420030............................  *.....................          0.0069  COLLETON............           42140
420036............................  *.....................          0.0064  LANCASTER...........           42280
420039............................  *.....................          0.0153  UNION...............           42430
420043............................  ......................          0.0157  CHEROKEE............           42100
420053............................  ......................          0.0035  NEWBERRY............           42350
420062............................  *.....................          0.0109  CHESTERFIELD........           42120
420068............................  *.....................          0.0027  ORANGEBURG..........           42370
420069............................  *.....................          0.0052  CLARENDON...........           42130
420083............................  *.....................          0.0027  SPARTANBURG.........           42410
422004............................  ......................          0.0158  CHESTER.............           42110
423029............................  ......................          0.0108  ANDERSON............           42030
424011............................  ......................          0.0108  ANDERSON............           42030
430008............................  ......................          0.0535  BROOKINGS...........           43050
430048............................  ......................          0.0129  LAWRENCE............           43400
430094............................  ......................          0.0129  LAWRENCE............           43400
440007............................  ......................          0.0219  COFFEE..............           44150
440008............................  *.....................          0.0449  HENDERSON...........           44380
440016............................  ......................          0.0144  CARROLL.............           44080
440024............................  *.....................          0.0230  BRADLEY.............           44050
440030............................  ......................          0.0056  HAMBLEN.............           44310
440031............................  ......................          0.0019  ROANE...............           44720
440033............................  ......................          0.0027  CAMPBELL............           44060
440035............................  *.....................          0.0301  MONTGOMERY..........           44620
440047............................  ......................          0.0338  GIBSON..............           44260
440051............................  ......................          0.0082  MC NAIRY............           44540
440057............................  ......................          0.0021  CLAIBORNE...........           44120
440060............................  *.....................          0.0338  GIBSON..............           44260
440067............................  ......................          0.0056  HAMBLEN.............           44310

[[Page 67223]]

 
440070............................  ......................          0.0109  DECATUR.............           44190
440081............................  ......................          0.0052  SEVIER..............           44770
440084............................  ......................          0.0025  MONROE..............           44610
440109............................  ......................          0.0070  HARDIN..............           44350
440115............................  ......................          0.0338  GIBSON..............           44260
440137............................  ......................          0.0738  BEDFORD.............           44010
440144............................  *.....................          0.0219  COFFEE..............           44150
440148............................  *.....................          0.0296  DE KALB.............           44200
440153............................  ......................          0.0007  COCKE...............           44140
440174............................  ......................          0.0312  HAYWOOD.............           44370
440180............................  ......................          0.0027  CAMPBELL............           44060
440181............................  ......................          0.0365  HARDEMAN............           44340
440182............................  ......................          0.0144  CARROLL.............           44080
440185............................  *.....................          0.0230  BRADLEY.............           44050
444008............................  ......................          0.0365  HARDEMAN............           44340
450032............................  *.....................          0.0254  HARRISON............           45620
450039............................  *.....................          0.0024  TARRANT.............           45910
450052............................  *.....................          0.0276  BOSQUE..............           45160
450059............................  *.....................          0.0075  COMAL...............           45320
450064............................  *.....................          0.0024  TARRANT.............           45910
450087............................  *.....................          0.0024  TARRANT.............           45910
450090............................  ......................          0.0650  COOKE...............           45340
450099............................  *.....................          0.0145  GRAY................           45563
450135............................  *.....................          0.0024  TARRANT.............           45910
450137............................  *.....................          0.0024  TARRANT.............           45910
450144............................  ......................          0.0559  ANDREWS.............           45010
450163............................  ......................          0.0054  KLEBERG.............           45743
450192............................  ......................          0.0271  HILL................           45651
450194............................  ......................          0.0213  CHEROKEE............           45281
450210............................  ......................          0.0151  PANOLA..............           45842
450224............................  *.....................          0.0195  WOOD................           45974
450236............................  ......................          0.0389  HOPKINS.............           45654
450270............................  ......................          0.0271  HILL................           45651
450283............................  *.....................          0.0653  VAN ZANDT...........           45947
450324............................  *.....................          0.0132  GRAYSON.............           45564
450347............................  *.....................          0.0370  WALKER..............           45949
450348............................  *.....................          0.0059  FALLS...............           45500
450370............................  ......................          0.0235  COLORADO............           45312
450389............................  *.....................          0.0618  HENDERSON...........           45640
450393............................  *.....................          0.0132  GRAYSON.............           45564
450395............................  *.....................          0.0441  POLK................           45850
450419............................  *.....................          0.0024  TARRANT.............           45910
450438............................  *.....................          0.0235  COLORADO............           45312
450451............................  ......................          0.0536  SOMERVELL...........           45893
450460............................  ......................          0.0053  TYLER...............           45942
450469............................  *.....................          0.0132  GRAYSON.............           45564
450497............................  ......................          0.0375  MONTAGUE............           45800
450539............................  ......................          0.0067  HALE................           45582
450547............................  ......................          0.0195  WOOD................           45974
450563............................  *.....................          0.0024  TARRANT.............           45910
450565............................  ......................          0.0486  PALO PINTO..........           45841
450573............................  ......................          0.0126  JASPER..............           45690
450596............................  *.....................          0.0743  HOOD................           45653
450639............................  *.....................          0.0024  TARRANT.............           45910
450641............................  ......................          0.0375  MONTAGUE............           45800
450672............................  *.....................          0.0024  TARRANT.............           45910
450675............................  *.....................          0.0024  TARRANT.............           45910
450677............................  *.....................          0.0024  TARRANT.............           45910
450698............................  ......................          0.0127  LAMB................           45751
450747............................  *.....................          0.0126  ANDERSON............           45000
450755............................  ......................          0.0276  HOCKLEY.............           45652
450770............................  *.....................          0.0182  MILAM...............           45795
450779............................  *.....................          0.0024  TARRANT.............           45910
450813............................  *.....................          0.0126  ANDERSON............           45000
450838............................  ......................          0.0126  JASPER..............           45690
450872............................  *.....................          0.0024  TARRANT.............           45910
450880............................  *.....................          0.0024  TARRANT.............           45910
450884............................  ......................          0.0049  UPSHUR..............           45943
450886............................  ......................          0.0024  TARRANT.............           45910
450888............................  ......................          0.0024  TARRANT.............           45910
452018............................  ......................          0.0024  TARRANT.............           45910

[[Page 67224]]

 
452019............................  ......................          0.0024  TARRANT.............           45910
452028............................  ......................          0.0024  TARRANT.............           45910
452041............................  ......................          0.0132  GRAYSON.............           45564
452088............................  ......................          0.0024  TARRANT.............           45910
453040............................  ......................          0.0024  TARRANT.............           45910
453041............................  ......................          0.0024  TARRANT.............           45910
453042............................  ......................          0.0024  TARRANT.............           45910
453089............................  ......................          0.0126  ANDERSON............           45000
453094............................  ......................          0.0024  TARRANT.............           45910
453300............................  ......................          0.0024  TARRANT.............           45910
453303............................  ......................          0.0024  TARRANT.............           45910
454009............................  ......................          0.0213  CHEROKEE............           45281
454012............................  ......................          0.0024  TARRANT.............           45910
454019............................  ......................          0.0024  TARRANT.............           45910
454051............................  ......................          0.0024  TARRANT.............           45910
454052............................  ......................          0.0024  TARRANT.............           45910
454061............................  ......................          0.0024  TARRANT.............           45910
454072............................  ......................          0.0024  TARRANT.............           45910
454086............................  ......................          0.0024  TARRANT.............           45910
454101............................  ......................          0.0067  HALE................           45582
460017............................  ......................          0.0383  BOX ELDER...........           46010
460039............................  *.....................          0.0383  BOX ELDER...........           46010
490019............................  *.....................          0.1088  CULPEPER............           49230
490084............................  ......................          0.0187  ESSEX...............           49280
490110............................  ......................          0.0185  MONTGOMERY..........           49600
500003............................  *.....................          0.0166  SKAGIT..............           50280
500007............................  *.....................          0.0166  SKAGIT..............           50280
500019............................  ......................          0.0131  LEWIS...............           50200
500039............................  *.....................          0.0094  KITSAP..............           50170
500041............................  *.....................          0.0020  COWLITZ.............           50070
510012............................  ......................          0.0124  MASON...............           51260
510018............................  *.....................          0.0188  JACKSON.............           51170
510047............................  *.....................          0.0269  MARION..............           51240
510077............................  *.....................          0.0021  MINGO...............           51290
520028............................  *.....................          0.0286  GREEN...............           52220
520035............................  ......................          0.0076  SHEBOYGAN...........           52580
520044............................  ......................          0.0076  SHEBOYGAN...........           52580
520057............................  ......................          0.0193  SAUK................           52550
520059............................  *.....................          0.0195  RACINE..............           52500
520071............................  *.....................          0.0161  JEFFERSON...........           52270
520076............................  *.....................          0.0146  DODGE...............           52130
520095............................  *.....................          0.0193  SAUK................           52550
520096............................  ......................          0.0195  RACINE..............           52500
520102............................  *.....................          0.0242  WALWORTH............           52630
520116............................  *.....................          0.0161  JEFFERSON...........           52270
522005............................  ......................          0.0195  RACINE..............           52500
523026............................  ......................          0.0195  RACINE..............           52500
524020............................  ......................          0.0193  SAUK................           52550
524021............................  ......................          0.0242  WALWORTH............           52630
524022............................  ......................          0.0146  DODGE...............           52130
----------------------------------------------------------------------------------------------------------------


                      Addendum M.--HCPCS Codes for Assignment to Composite APCS for CY 2008
----------------------------------------------------------------------------------------------------------------
                                                                             Single code APC     Composite APC
     HCPCS code         Short descriptor          CI              SI            assignment         assignment
----------------------------------------------------------------------------------------------------------------
90801..............  Psy dx interview.....  CH............  Q.............               0323               0034
90802..............  Intac psy dx           CH............  Q.............               0323               0034
                      interview.
90804..............  Psytx, office, 20-30   CH............  Q.............               0322               0034
                      min.
90805..............  Psytx, off, 20-30 min  CH............  Q.............               0322               0034
                      w/e&m.
90806..............  Psytx, off, 45-50 min  CH............  Q.............               0323               0034
90807..............  Psytx, off, 45-50 min  CH............  Q.............               0323               0034
                      w/e&m.
90808..............  Psytx, office, 75-80   CH............  Q.............               0323               0034
                      min.
90809..............  Psytx, off, 75-80, w/  CH............  Q.............               0323               0034
                      e&m.
90810..............  Intac psytx, off, 20-  CH............  Q.............               0322               0034
                      30 min.
90811..............  Intac psytx, 20-30, w/ CH............  Q.............               0322               0034
                      e&m.
90812..............  Intac psytx, off, 45-  CH............  Q.............               0323               0034
                      50 min.
90813..............  Intac psytx, 45-50     CH............  Q.............               0323               0034
                      min w/e&m.
90814..............  Intac psytx, off, 75-  CH............  Q.............               0323               0034
                      80 min.
90815..............  Intac psytx, 75-80 w/  CH............  Q.............               0323               0034
                      e&m.

[[Page 67225]]

 
90816..............  Psytx, hosp, 20-30     CH............  Q.............               0322               0034
                      min.
90817..............  Psytx, hosp, 20-30     CH............  Q.............               0322               0034
                      min w/e&m.
90818..............  Psytx, hosp, 45-50     CH............  Q.............               0323               0034
                      min.
90819..............  Psytx, hosp, 45-50     CH............  Q.............               0323               0034
                      min w/e&m.
90821..............  Psytx, hosp, 75-80     CH............  Q.............               0323               0034
                      min.
90822..............  Psytx, hosp, 75-80     CH............  Q.............               0323               0034
                      min w/e&m.
90823..............  Intac psytx, hosp, 20- CH............  Q.............               0322               0034
                      30 min.
90824..............  Intac psytx, hsp 20-   CH............  Q.............               0322               0034
                      30 w/e&m.
90826..............  Intac psytx, hosp, 45- CH............  Q.............               0323               0034
                      50 min.
90827..............  Intac psytx, hsp 45-   CH............  Q.............               0323               0034
                      50 w/e&m.
90828..............  Intac psytx, hosp, 75- CH............  Q.............               0323               0034
                      80 min.
90829..............  Intac psytx, hsp 75-   CH............  Q.............               0323               0034
                      80 w/e&m.
90845..............  Psychoanalysis.......  CH............  Q.............               0323               0034
90846..............  Family psytx w/o       CH............  Q.............               0324               0034
                      patient.
90847..............  Family psytx w/        CH............  Q.............               0324               0034
                      patient.
90849..............  Multiple family group  CH............  Q.............               0325               0034
                      psytx.
90853..............  Group psychotherapy..  CH............  Q.............               0325               0034
90857..............  Intac group psytx....  CH............  Q.............               0325               0034
90862..............  Medication management  CH............  Q.............               0605               0034
90865..............  Narcosynthesis.......  CH............  Q.............               0323               0034
90880..............  Hypnotherapy.........  CH............  Q.............               0323               0034
90899..............  Psychiatric service/   CH............  Q.............               0322               0034
                      therapy.
96101..............  Psycho testing by      CH............  Q.............               0382               0034
                      pscy/phys.
96102..............  Psycho testing by      CH............  Q.............               0373               0034
                      technician.
96103..............  Psycho testing admin   CH............  Q.............               0373               0034
                      by comp.
96110..............  Developmental test,    CH............  Q.............               0373               0034
                      lim.
96111..............  Developmental test,    CH............  Q.............               0382               0034
                      exten.
96116..............  Neurobehavioral        CH............  Q.............               0382               0034
                      status exam.
96118..............  Neuropsych test by     CH............  Q.............               0382               0034
                      pscyh/phys.
96119..............  Neuropsych testing by  CH............  Q.............               0382               0034
                      tec.
96120..............  Neuropsych tst admin   CH............  Q.............               0373               0034
                      w/comp.
96150..............  Assess hlth/behave,    CH............  Q.............               0432               0034
                      initi.
96151..............  Assess hlth/behave,    CH............  Q.............               0432               0034
                      subseq.
96152..............  Intervene hlth/        CH............  Q.............               0432               0034
                      behave,indiv.
96153..............  Intervene hlth/bhave,  CH............  Q.............               0432               0034
                      group.
96154..............  Intevene hlth/behave,  CH............  Q.............               0432               0034
                      fam w/pt.
M0064..............  Visit for drug         CH............  Q.............               0605               0034
                      monitoring.
93619..............  Electrophysiology      CH............  Q.............               0085               8000
                      evaluation.
93620..............  Electrophysiology      CH............  Q.............               0085               8000
                      evaluation.
93650..............  Ablate heart           CH............  Q.............               0085               8000
                      dysrhythm focus.
93651..............  Ablate heart           CH............  Q.............               0086               8000
                      dysrhythm focus.
93652..............  Ablate heart           CH............  Q.............               0086               8000
                      dysrhythm focus.
55875..............  Transperi needle       CH............  Q.............               0163               8001
                      place, pros.
77778..............  Apply interstit        CH............  Q.............               0651               8001
                      radiat compl.
99205..............  Office/outpatient      CH............  Q.............               0608               8002
                      visit, new.
99215..............  Office/outpatient      CH............  Q.............               0607               8002
                      visit, est.
G0379..............  Direct admit hospital  CH............  Q.............               0604               8002
                      observ.
99284..............  Emergency dept visit.  CH............  Q.............               0615               8003
99285..............  Emergency dept visit.  CH............  Q.............               0616               8003
99291..............  Critical care, first   CH............  Q.............               0617               8003
                      hour.
----------------------------------------------------------------------------------------------------------------

[FR Doc. 07-5507 Filed 11-1-07; 4:00 pm]
BILLING CODE 4120-01-P