Changes to the Reimbursement for Physician Pathology, Medicine and Surgical Services with a Professional (26) and Technical (TC) Component

Connecticut Medical Assistance Program Provider Bulletin 2015-62 Policy Transmittal 2015-28 August 2015

Effective Date: September 7, 2015 Roderick L. Bremby, Commissioner Contact: Nina Holmes @ 860-424-5486

TO: Physicians, Physician Assistants, Advanced Practice Registered Nurses, Certified Nurse Midwives, Optometrists, and Podiatrists RE: Changes to the Reimbursement for Physician Pathology, Medicine and Surgical Services with a Professional (26) and Technical (TC) Component

This policy transmittal is being sent to notify providers Accessing the Fee Schedules that, effective for dates of service September 7, 2015 Fee schedules can be accessed and downloaded by and forward, the Department of Social Services is going to the Connecticut Medical Assistance Web site: revising the reimbursement for the professional and www.ctdssmap.com. From this Web page, go to technical components of select pathology, medicine “Provider”, then to “Provider Fee Schedule and surgical services to 57.5% of the 2007 Medicare Download”, click on the “I accept” button and then Physician Fee Schedule. The Department is proceed to the “Physician Office and Outpatient Fee implementing this change in order to establish a pricing Schedule” or “Physician Surgical Fee Schedule”. To methodology consistent with Medicare, where, for a access the CSV file, press the control key while given service that includes a professional and technical clicking the CSV link, then select “Open”. component, the fee for the professional component, added together with the fee for the technical For questions about billing or if further assistance is component, equals the global fee. needed to access the fee schedule on the Connecticut Medical Assistance Program Web site, please contact The services impacted include select pathology the HP Provider Assistance Center, Monday through services billed under the LAB rate type off of the Friday from 8:00 a.m. to 5:00 p.m. at 1-800-842-8440. Physician Office and Outpatient Fee Schedule, select gastroenterology, ophthalmology, otorhinolaryngology, Posting Instructions: Policy transmittals can be cardiovascular, noninvasive vascular diagnostic downloaded from the Connecticut Medical Assistance studies, pulmonary and neurology & neuromuscular Program Web site at www.ctdssmap.com. procedures and select surgical services that have been identified as including a professional and technical Distribution: This policy transmittal is being component on the Medicare Physician Fee Schedule. distributed to holders of the Connecticut Medical Assistance Program Provider Manual by HP Enterprise Please note, in addition to changes to the professional Services. and technical components, there are 68 codes from the same categories of service outlined above that will also Responsible Unit: DSS, Division of Health Services, have an updated global fee. This update to the global Medical Policy Section; Nina Holmes, Policy fee is necessary because the current fees for the Consultant, (860) 424-5486 professional and technical components, when added together, do not equal the global fee. In order to ensure Date Issued: August 2015 a consistent policy, the Department identified the appropriate year of the Medicare Physician Fee Schedule where the fees for the professional and technical components add up appropriately.

This policy change applies to services reimbursed on the Physician Office and Outpatient Fee Schedule and the Physician Surgical Fee Schedule under the HUSKY Health program (HUSKY A, B, C and D) for dates of service September 7, 2015 and forward.

Department of Social Services Division of Health Services 55Farmington Avenue Hartford, CT 06105 www.ctdssmap.com The following codes will have updated rates for the professional and technical components only. Procedure Proc description Mod1 Mod1 Rate Rate Effective Code desc Type September 7, 2015 87164 Dark field examination 26 LAB $10.72 87207 Smear special stain 26 LAB $11.49 88104 Cytopath fl nongyn smears 26 LAB $17.31 88104 Cytopath fl nongyn smears TC LAB $18.52 88106 Cytopath fl nongyn filter 26 LAB $17.31 88106 Cytopath fl nongyn filter TC LAB $30.27 88108 Cytopath concentrate tech 26 LAB $17.31 88108 Cytopath concentrate tech TC LAB $27.20 88112 Cytopath cell enhance tech 26 LAB $36.11 88112 Cytopath cell enhance tech TC LAB $35.89 88120 Cytp urne 3-5 probes ea spec 26 LAB $31.89 88120 Cytp urne 3-5 probes ea spec TC LAB $271.27 88121 Cytp urine 3-5 probes cmptr 26 LAB $28.55 88121 Cytp urine 3-5 probes cmptr TC LAB $227.49 88125 Forensic cytopathology 26 LAB $7.95 88125 Forensic cytopathology TC LAB $4.54 88160 Cytopath smear other source 26 LAB $15.42 88160 Cytopath smear other source TC LAB $17.24 88161 Cytopath smear other source 26 LAB $15.67 88161 Cytopath smear other source TC LAB $20.56 88162 Cytopath smear other source 26 LAB $23.37 88162 Cytopath smear other source TC LAB $19.80 88172 Cytp dx eval fna 1st ea site 26 LAB $18.73 88172 Cytp dx eval fna 1st ea site TC LAB $13.67 88173 Cytopath eval fna report 26 LAB $43.03 88173 Cytopath eval fna report TC LAB $42.27 88177 Cytp fna eval ea addl 26 LAB $13.24 88177 Cytp fna eval ea addl TC LAB $4.32 88182 Cell marker study 26 LAB $23.34 88182 Cell marker study TC LAB $43.94 88300 Surgical path gross 26 LAB $2.54 88300 Surgical path gross TC LAB $11.94 88302 Tissue exam by pathologist 26 LAB $4.44 88302 Tissue exam by pathologist TC LAB $26.94 88304 Tissue exam by pathologist 26 LAB $6.76 88304 Tissue exam by pathologist TC LAB $33.33 88305 Tissue exam by pathologist 26 LAB $23.40 88305 Tissue exam by pathologist TC LAB $43.42 88307 Tissue exam by pathologist 26 LAB $49.59 88307 Tissue exam by pathologist TC LAB $73.95 88309 Tissue exam by pathologist 26 LAB $82.55 88309 Tissue exam by pathologist TC LAB $101.27 88311 Decalcify tissue 26 LAB $7.47 88311 Decalcify tissue TC LAB $3.77 88312 Special stains group 1 26 LAB $16.83 88312 Special stains group 1 TC LAB $39.78 88313 Special stains group 2 26 LAB $7.47 88313 Special stains group 2 TC LAB $34.16 88314 Histochemical stains add-on 26 LAB $14.03 88314 Histochemical stains add-on TC LAB $47.89 88319 Enzyme histochemistry 26 LAB $16.35 88319 Enzyme histochemistry TC LAB $81.09 88323 Microslide consultation 26 LAB $52.08 88323 Microslide consultation TC LAB $34.61 88331 Path consult intraop 1 bloc 26 LAB $37.23 88331 Path consult intraop 1 bloc TC LAB $17.63 88332 Path consult intraop addl 26 LAB $18.25 88332 Path consult intraop addl TC LAB $6.26 88333 Intraop cyto path consult 1 26 LAB $37.71 Procedure Proc description Mod1 Mod1 Rate Rate Effective Code desc Type September 7, 2015 88333 Intraop cyto path consult 1 TC LAB $17.63 88334 Intraop cyto path consult 2 26 LAB $21.70 88334 Intraop cyto path consult 2 TC LAB $10.60 88342 Immunohisto antibody slide 26 LAB $26.20 88342 Immunohisto antibody slide TC LAB $32.82 88346 Immunofluorescent study 26 LAB $26.42 88346 Immunofluorescent study TC LAB $34.61 88347 Immunofluorescent study 26 LAB $25.92 88347 Immunofluorescent study TC LAB $25.16 88348 Electron microscopy 26 LAB $46.73 88348 Electron microscopy TC LAB $279.73 88355 Analysis skeletal muscle 26 LAB $56.52 88355 Analysis skeletal muscle TC LAB $172.78 88356 Analysis nerve 26 LAB $92.95 88356 Analysis nerve TC LAB $94.57 88358 Analysis tumor 26 LAB $29.84 88358 Analysis tumor TC LAB $15.91 88360 Tumor immunohistochem/manual 26 LAB $34.28 88360 Tumor immunohistochem/manual TC LAB $37.42 88361 Tumor immunohistochem/comput 26 LAB $36.89 88361 Tumor immunohistochem/comput TC LAB $65.45 88362 Nerve teasing preparations 26 LAB $67.30 88362 Nerve teasing preparations TC LAB $103.06 88365 Insitu hybridization (fish) 26 LAB $36.24 88365 Insitu hybridization (fish) TC LAB $48.40 88367 Insitu hybridization auto 26 LAB $39.37 88367 Insitu hybridization auto TC LAB $99.49 88368 Insitu hybridization manual 26 LAB $42.43 88368 Insitu hybridization manual TC LAB $63.99 88381 Microdissection manual 26 LAB $33.13 88381 Microdissection manual TC LAB $107.57 91010 Esophagus motility study 26 DEF $38.50 91010 Esophagus motility study TC DEF $96.93 91013 Esophgl motil w/stim/perfus 26 DEF $6.12 91013 Esophgl motil w/stim/perfus TC DEF $8.88 91020 Gastric motility studies 26 DEF $44.04 91020 Gastric motility studies TC DEF $104.85 91022 Duodenal motility study 26 DEF $44.55 91022 Duodenal motility study TC DEF $91.57 91030 Acid perfusion of esophagus 26 DEF $28.26 91030 Acid perfusion of esophagus TC DEF $56.57 91034 Gastroesophageal reflux test 26 DEF $30.03 91034 Gastroesophageal reflux test TC DEF $118.64 91035 G-esoph reflx tst w/electrod 26 DEF $48.83 91035 G-esoph reflx tst w/electrod TC DEF $264.72 91037 Esoph imped function test 26 DEF $30.03 91037 Esoph imped function test TC DEF $69.60 91038 Esoph imped funct test > 1hr 26 DEF $34.28 91038 Esoph imped funct test > 1hr TC DEF $50.70 91040 Esoph balloon distension tst 26 DEF $29.77 91040 Esoph balloon distension tst TC DEF $264.72 91065 Breath hydrogen/methane test 26 DEF $6.05 91065 Breath hydrogen/methane test TC DEF $34.86 91110 Gi tract capsule endoscopy 26 DEF $111.20 91110 Gi tract capsule endoscopy TC DEF $521.84 91111 Esophageal capsule endoscopy 26 DEF $32.68 91111 Esophageal capsule endoscopy TC DEF $464.95 91120 Rectal sensation test 26 DEF $29.46 91120 Rectal sensation test TC DEF $260.25 91122 Anal pressure record 26 DEF $53.29 Procedure Proc description Mod1 Mod1 Rate Rate Effective Code desc Type September 7, 2015 91122 Anal pressure record TC DEF $108.30 91200 Liver elastography 26 DEF $8.87 91200 Liver elastography TC DEF $13.85 92025 Corneal topography 26 DEF $10.27 92025 Corneal topography TC DEF $8.37 92060 Special eye evaluation 26 DEF $21.56 92060 Special eye evaluation TC DEF $12.20 92065 Orthoptic/pleoptic training 26 DEF $11.24 92065 Orthoptic/pleoptic training TC DEF $12.45 92081 Visual field examination(s) 26 DEF $11.01 92081 Visual field examination(s) TC DEF $20.88 92082 Visual field examination(s) 26 DEF $13.84 92082 Visual field examination(s) TC DEF $27.77 92083 Visual field examination(s) 26 DEF $15.74 92083 Visual field examination(s) TC DEF $32.12 92132 Cmptr ophth dx img ant segmt 26 DEF $13.17 92132 Cmptr ophth dx img ant segmt TC DEF $10.26 92133 Cmptr ophth img optic nerve 26 DEF $18.24 92133 Cmptr ophth img optic nerve TC DEF $10.26 92134 Cptr ophth dx img post segmt 26 DEF $18.24 92134 Cptr ophth dx img post segmt TC DEF $10.26 92136 Ophthalmic biometry 26 DEF $17.15 92136 Ophthalmic biometry TC DEF $36.34 92145 Corneal hysteresis deter 26 DEF $5.45 92145 Corneal hysteresis deter TC DEF $4.40 92228 Remote retinal imaging mgmt 26 DEF $10.82 92228 Remote retinal imaging mgmt TC DEF $8.43 92235 Eye exam with photos 26 DEF $26.09 92235 Eye exam with photos TC DEF $56.83 92240 Icg angiography 26 DEF $35.23 92240 Icg angiography TC DEF $134.48 92250 Eye exam with photos 26 DEF $13.84 92250 Eye exam with photos TC DEF $33.40 92265 Eye muscle evaluation 26 DEF $24.18 92265 Eye muscle evaluation TC DEF $28.48 92270 Electro-oculography 26 DEF $25.01 92270 Electro-oculography TC DEF $30.78 92275 Electroretinography 26 DEF $31.89 92275 Electroretinography TC DEF $42.78 92283 Color vision examination 26 DEF $5.38 92283 Color vision examination TC DEF $21.14 92284 Dark adaptation eye exam 26 DEF $7.21 92284 Dark adaptation eye exam TC DEF $42.08 92285 Eye photography 26 DEF $6.56 92285 Eye photography TC DEF $22.15 92286 Internal eye photography 26 DEF $20.88 92286 Internal eye photography TC DEF $65.51 92541 Spontaneous nystagmus test 26 DEF $12.87 92541 Spontaneous nystagmus test TC DEF $22.86 92542 Positional nystagmus test 26 DEF $10.56 92542 Positional nystagmus test TC DEF $26.44 92543 Caloric vestibular test 26 DEF $3.51 92543 Caloric vestibular test TC DEF $13.98 92544 Optokinetic nystagmus test 26 DEF $8.21 92544 Optokinetic nystagmus test TC DEF $21.33 92545 Oscillating tracking test 26 DEF $7.50 92545 Oscillating tracking test TC DEF $19.54 92546 Sinusoidal rotational test 26 DEF $9.14 92546 Sinusoidal rotational test TC DEF $46.87 92548 Posturography 26 DEF $16.44 Procedure Proc description Mod1 Mod1 Rate Rate Effective Code desc Type September 7, 2015 92548 Posturography TC DEF $50.27 92585 Auditor evoke potent compre 26 DEF $15.61 92585 Auditor evoke potent compre TC DEF $49.44 92587 Evoked auditory test limited 26 DEF $4.44 92587 Evoked auditory test limited TC DEF $30.98 92588 Evoked auditory tst complete 26 DEF $11.26 92588 Evoked auditory tst complete TC DEF $36.48 93024 Cardiac drug stress test 26 DEF $37.04 93024 Cardiac drug stress test TC DEF $34.86 93025 Microvolt t-wave assess 26 DEF $23.65 93025 Microvolt t-wave assess TC DEF $164.55 93260 Prgrmg dev eval impltbl sys 26 DEF $27.41 93260 Prgrmg dev eval impltbl sys TC DEF $14.54 93261 Interrogate subq defib 26 DEF $23.94 93261 Interrogate subq defib TC DEF $14.54 93278 Ecg/signal-averaged 26 DEF $7.72 93278 Ecg/signal-averaged TC DEF $27.41 93279 Pm device progr eval sngl 26 DEF $22.51 93279 Pm device progr eval sngl TC DEF $13.35 93280 Pm device progr eval dual 26 DEF $27.06 93280 Pm device progr eval dual TC DEF $15.35 93281 Pm device progr eval multi 26 DEF $31.58 93281 Pm device progr eval multi TC DEF $18.01 93282 Prgrmg eval implantable dfb 26 DEF $29.47 93282 Prgrmg eval implantable dfb TC DEF $16.30 93283 Prgrmg eval implantable dfb 26 DEF $37.18 93283 Prgrmg eval implantable dfb TC DEF $18.51 93284 Prgrmg eval implantable dfb 26 DEF $44.19 93284 Prgrmg eval implantable dfb TC DEF $20.96 93285 Ilr device eval progr 26 DEF $18.48 93285 Ilr device eval progr TC DEF $12.61 93286 Peri-px pacemaker device evl 26 DEF $9.32 93286 Peri-px pacemaker device evl TC DEF $8.27 93287 Peri-px device eval & prgr 26 DEF $13.58 93287 Peri-px device eval & prgr TC DEF $9.41 93288 Pm device eval in person 26 DEF $15.11 93288 Pm device eval in person TC DEF $12.86 93289 Interrog device eval heart 26 DEF $27.27 93289 Interrog device eval heart TC DEF $15.35 93290 Icm device eval 26 DEF $13.10 93290 Icm device eval TC DEF $7.20 93291 Ilr device interrogate 26 DEF $15.31 93291 Ilr device interrogate TC DEF $11.43 93292 Wcd device interrogate 26 DEF $15.11 93292 Wcd device interrogate TC DEF $8.92 93293 Pm phone r-strip device eval 26 DEF $10.49 93293 Pm phone r-strip device eval TC DEF $28.78 93303 Echo transthoracic 26 DEF $40.26 93303 Echo transthoracic TC DEF $104.04 93304 Echo transthoracic 26 DEF $22.95 93304 Echo transthoracic TC DEF $57.93 93306 Tte w/doppler complete 26 DEF $44.77 93306 Tte w/doppler complete TC DEF $132.04 93307 Tte w/o doppler complete 26 DEF $29.06 93307 Tte w/o doppler complete TC DEF $99.45 93308 Tte f-up or lmtd 26 DEF $16.86 93308 Tte f-up or lmtd TC DEF $54.61 93312 Echo transesophageal 26 DEF $68.04 93312 Echo transesophageal TC DEF $119.50 93314 Echo transesophageal 26 DEF $38.88 Procedure Proc description Mod1 Mod1 Rate Rate Effective Code desc Type September 7, 2015 93314 Echo transesophageal TC DEF $120.27 93320 Doppler echo exam heart 26 DEF $11.97 93320 Doppler echo exam heart TC DEF $44.71 93321 Doppler echo exam heart 26 DEF $4.92 93321 Doppler echo exam heart TC DEF $26.32 93325 Doppler color flow add-on 26 DEF $2.32 93325 Doppler color flow add-on TC DEF $63.56 93350 Stress tte only 26 DEF $47.14 93350 Stress tte only TC DEF $63.80 93451 Right heart cath 26 DEF $91.68 93451 Right heart cath TC DEF $412.98 93452 Left hrt cath w/ventrclgrphy 26 DEF $160.71 93452 Left hrt cath w/ventrclgrphy TC DEF $394.50 93453 R&l hrt cath w/ventriclgrphy 26 DEF $210.63 93453 R&l hrt cath w/ventriclgrphy TC DEF $515.88 93454 Coronary artery angio s&i 26 DEF $161.97 93454 Coronary artery angio s&i TC DEF $410.92 93455 Coronary art/grft angio s&i 26 DEF $186.93 93455 Coronary art/grft angio s&i TC DEF $481.65 93456 R hrt coronary artery angio 26 DEF $207.27 93456 R hrt coronary artery angio TC DEF $509.26 93457 R hrt art/grft angio 26 DEF $232.46 93457 R hrt art/grft angio TC DEF $579.77 93458 L hrt artery/ventricle angio 26 DEF $197.63 93458 L hrt artery/ventricle angio TC DEF $493.51 93459 L hrt art/grft angio 26 DEF $222.37 93459 L hrt art/grft angio TC DEF $540.52 93460 R&l hrt art/ventricle angio 26 DEF $247.77 93460 R&l hrt art/ventricle angio TC DEF $567.90 93461 R&l hrt art/ventricle angio 26 DEF $273.37 93461 R&l hrt art/ventricle angio TC DEF $662.13 93464 Exercise w/hemodynamic meas 26 DEF $58.62 93464 Exercise w/hemodynamic meas TC DEF $105.41 93642 Electrophysiology evaluation 26 DEF $161.70 93642 Electrophysiology evaluation TC DEF $175.90 93644 Electrophysiology evaluation 26 DEF $121.51 93644 Electrophysiology evaluation TC DEF $68.95 93660 Tilt table evaluation 26 DEF $60.30 93660 Tilt table evaluation TC DEF $45.59 93724 Analyze pacemaker system 26 DEF $155.57 93724 Analyze pacemaker system TC DEF $86.36 93745 Set-up cardiovert-defibrill 26 DEF $32.14 93745 Set-up cardiovert-defibrill TC DEF $20.26 93880 Extracranial bilat study 26 DEF $18.10 93880 Extracranial bilat study TC DEF $146.46 93882 Extracranial uni/ltd study 26 DEF $12.24 93882 Extracranial uni/ltd study TC DEF $93.63 93886 Intracranial complete study 26 DEF $29.33 93886 Intracranial complete study TC DEF $171.49 93888 Intracranial limited study 26 DEF $19.25 93888 Intracranial limited study TC DEF $110.95 93890 Tcd vasoreactivity study 26 DEF $31.22 93890 Tcd vasoreactivity study TC DEF $130.63 93892 Tcd emboli detect w/o inj 26 DEF $35.44 93892 Tcd emboli detect w/o inj TC DEF $137.52 93893 Tcd emboli detect w/inj 26 DEF $35.44 93893 Tcd emboli detect w/inj TC DEF $132.93 93922 Upr/l xtremity art 2 levels 26 DEF $7.41 93922 Upr/l xtremity art 2 levels TC DEF $71.47 93923 Upr/lxtr art stdy 3+ lvls 26 DEF $13.65 Procedure Proc description Mod1 Mod1 Rate Rate Effective Code desc Type September 7, 2015 93923 Upr/lxtr art stdy 3+ lvls TC DEF $107.17 93924 Lwr xtr vasc stdy bilat 26 DEF $15.48 93924 Lwr xtr vasc stdy bilat TC DEF $129.46 93925 Lower extremity study 26 DEF $17.64 93925 Lower extremity study TC DEF $181.70 93926 Lower extremity study 26 DEF $12.01 93926 Lower extremity study TC DEF $111.19 93930 Upper extremity study 26 DEF $14.13 93930 Upper extremity study TC DEF $144.54 93931 Upper extremity study 26 DEF $9.46 93931 Upper extremity study TC DEF $95.04 93965 Extremity study 26 DEF $10.47 93965 Extremity study TC DEF $71.53 93970 Extremity study 26 DEF $20.57 93970 Extremity study TC DEF $141.04 93971 Extremity study 26 DEF $13.46 93971 Extremity study TC DEF $95.11 93975 Vascular study 26 DEF $54.48 93975 Vascular study TC DEF $191.67 93976 Vascular study 26 DEF $35.58 93976 Vascular study TC DEF $106.42 93978 Vascular study 26 DEF $19.90 93978 Vascular study TC DEF $125.39 93979 Vascular study 26 DEF $13.46 93979 Vascular study TC DEF $89.17 93980 Penile vascular study 26 DEF $37.86 93980 Penile vascular study TC DEF $72.71 93981 Penile vascular study 26 DEF $13.27 93981 Penile vascular study TC DEF $74.94 93990 Doppler flow testing 26 DEF $7.60 93990 Doppler flow testing TC DEF $111.71 94010 Breathing capacity test 26 DEF $4.86 94010 Breathing capacity test TC DEF $16.73 94060 Evaluation of wheezing 26 DEF $8.83 94060 Evaluation of wheezing TC DEF $27.72 94070 Evaluation of wheezing 26 DEF $17.14 94070 Evaluation of wheezing TC DEF $19.55 94200 Lung function test (mbc/mvv) 26 DEF $3.22 94200 Lung function test (mbc/mvv) TC DEF $11.11 94250 Expired gas collection 26 DEF $3.22 94250 Expired gas collection TC DEF $15.01 94375 Respiratory flow volume loop 26 DEF $8.83 94375 Respiratory flow volume loop TC DEF $14.18 94400 Co2 breathing response curve 26 DEF $11.79 94400 Co2 breathing response curve TC DEF $20.82 94450 Hypoxia response curve 26 DEF $11.34 94450 Hypoxia response curve TC DEF $20.31 94452 Hast w/report 26 DEF $9.02 94452 Hast w/report TC DEF $24.90 94453 Hast w/oxygen titrate 26 DEF $11.59 94453 Hast w/oxygen titrate TC DEF $36.40 94620 Pulmonary stress test/simple 26 DEF $18.55 94620 Pulmonary stress test/simple TC DEF $49.69 94621 Pulm stress test/complex 26 DEF $41.60 94621 Pulm stress test/complex TC DEF $53.01 94680 Exhaled air analysis o2 26 DEF $7.44 94680 Exhaled air analysis o2 TC DEF $41.77 94681 Exhaled air analysis o2/co2 26 DEF $5.80 94681 Exhaled air analysis o2/co2 TC DEF $55.95 94690 Exhaled air analysis 26 DEF $2.06 Procedure Proc description Mod1 Mod1 Rate Rate Effective Code desc Type September 7, 2015 94690 Exhaled air analysis TC DEF $44.95 94726 Pulm funct tst plethysmograp 26 DEF $7.41 94726 Pulm funct tst plethysmograp TC DEF $26.55 94727 Pulm function test by gas 26 DEF $7.41 94727 Pulm function test by gas TC DEF $19.14 94728 Pulm funct test oscillometry 26 DEF $7.41 94728 Pulm funct test oscillometry TC DEF $19.14 94729 Co/membane diffuse capacity 26 DEF $4.95 94729 Co/membane diffuse capacity TC DEF $28.92 94750 Pulmonary compliance study 26 DEF $6.73 94750 Pulmonary compliance study TC DEF $35.51 94770 Exhaled carbon dioxide test 26 DEF $4.16 94770 Exhaled carbon dioxide test TC DEF $19.74 95800 Slp stdy unattended 26 DEF $36.16 95800 Slp stdy unattended TC DEF $99.02 95801 Slp stdy unatnd w/anal 26 DEF $31.73 95801 Slp stdy unatnd w/anal TC DEF $30.56 95803 Actigraphy testing 26 DEF $26.61 95803 Actigraphy testing TC DEF $77.58 95805 Multiple sleep latency test 26 DEF $55.80 95805 Multiple sleep latency test TC DEF $366.15 95806 Sleep study unatt&resp efft 26 DEF $48.78 95806 Sleep study unatt&resp efft TC DEF $80.82 95807 Sleep study attended 26 DEF $48.27 95807 Sleep study attended TC DEF $296.96 95808 Polysom any age 1-3> param 26 DEF $78.56 95808 Polysom any age 1-3> param TC DEF $338.08 95810 Polysom 6/> yrs 4/> param 26 DEF $103.59 95810 Polysom 6/> yrs 4/> param TC DEF $427.46 95811 Polysom 6/>yrs cpap 4/> parm 26 DEF $111.25 95811 Polysom 6/>yrs cpap 4/> parm TC DEF $471.07 95812 Eeg 41-60 minutes 26 DEF $33.83 95812 Eeg 41-60 minutes TC DEF $106.07 95813 Eeg over 1 hour 26 DEF $53.62 95813 Eeg over 1 hour TC DEF $123.44 95816 Eeg awake and drowsy 26 DEF $33.83 95816 Eeg awake and drowsy TC DEF $95.92 95819 Eeg awake and asleep 26 DEF $33.83 95819 Eeg awake and asleep TC DEF $87.23 95822 Eeg coma or sleep only 26 DEF $33.83 95822 Eeg coma or sleep only TC DEF $114.88 95827 Eeg all night recording 26 DEF $32.61 95827 Eeg all night recording TC DEF $117.89 95829 Surgery electrocorticogram 26 DEF $191.41 95829 Surgery electrocorticogram TC DEF $699.39 95860 Muscle test one limb 26 DEF $30.64 95860 Muscle test one limb TC DEF $24.90 95861 Muscle test 2 limbs 26 DEF $49.14 95861 Muscle test 2 limbs TC DEF $22.61 95863 Muscle test 3 limbs 26 DEF $58.89 95863 Muscle test 3 limbs TC DEF $27.72 95864 Muscle test 4 limbs 26 DEF $62.91 95864 Muscle test 4 limbs TC DEF $46.24 95865 Muscle test larynx 26 DEF $51.31 95865 Muscle test larynx TC DEF $19.22 95866 Muscle test hemidiaphragm 26 DEF $39.96 95866 Muscle test hemidiaphragm TC DEF $10.29 95867 Muscle test cran nerv unilat 26 DEF $24.81 95867 Muscle test cran nerv unilat TC DEF $17.63 95868 Muscle test cran nerve bilat 26 DEF $36.94 Procedure Proc description Mod1 Mod1 Rate Rate Effective Code desc Type September 7, 2015 95868 Muscle test cran nerve bilat TC DEF $21.14 95869 Muscle test thor paraspinal 26 DEF $11.68 95869 Muscle test thor paraspinal TC DEF $10.09 95870 Muscle test nonparaspinal 26 DEF $11.68 95870 Muscle test nonparaspinal TC DEF $10.09 95873 Guide nerv destr elec stim 26 DEF $11.68 95873 Guide nerv destr elec stim TC DEF $9.58 95874 Guide nerv destr needle emg 26 DEF $11.94 95874 Guide nerv destr needle emg TC DEF $9.58 95885 Musc tst done w/nerv tst lim 26 DEF $10.73 95885 Musc tst done w/nerv tst lim TC DEF $24.36 95886 Musc test done w/n test comp 26 DEF $28.72 95886 Musc test done w/n test comp TC DEF $25.66 95887 Musc tst done w/n tst nonext 26 DEF $22.50 95887 Musc tst done w/n tst nonext TC DEF $26.09 95921 Autonomic nrv parasym inervj 26 DEF $27.01 95921 Autonomic nrv parasym inervj TC DEF $13.41 95922 Autonomic nrv adrenrg inervj 26 DEF $29.87 95922 Autonomic nrv adrenrg inervj TC DEF $16.47 95923 Autonomic nrv syst funj test 26 DEF $28.23 95923 Autonomic nrv syst funj test TC DEF $42.27 95925 Somatosensory testing 26 DEF $17.22 95925 Somatosensory testing TC DEF $37.43 95926 Somatosensory testing 26 DEF $17.03 95926 Somatosensory testing TC DEF $36.40 95927 Somatosensory testing 26 DEF $17.73 95927 Somatosensory testing TC DEF $36.92 95928 C motor evoked uppr limbs 26 DEF $47.02 95928 C motor evoked uppr limbs TC DEF $68.26 95929 C motor evoked lwr limbs 26 DEF $47.27 95929 C motor evoked lwr limbs TC DEF $73.88 95930 Visual evoked potential test 26 DEF $10.97 95930 Visual evoked potential test TC DEF $56.38 95937 Neuromuscular junction test 26 DEF $21.05 95937 Neuromuscular junction test TC DEF $11.37 95938 Somatosensory testing 26 DEF $26.46 95938 Somatosensory testing TC DEF $161.05 95939 C motor evoked upr&lwr limbs 26 DEF $69.70 95939 C motor evoked upr&lwr limbs TC DEF $222.34 95943 Parasymp&symp hrt rate test 26 DEF $54.38 95943 Parasymp&symp hrt rate test TC DEF $36.58 95950 Ambulatory eeg monitoring 26 DEF $47.37 95950 Ambulatory eeg monitoring TC DEF $99.99 95953 Eeg monitoring/computer 26 DEF $101.36 95953 Eeg monitoring/computer TC DEF $169.45 95954 Eeg monitoring/giving drugs 26 DEF $75.51 95954 Eeg monitoring/giving drugs TC DEF $89.78 95955 Eeg during surgery 26 DEF $30.23 95955 Eeg during surgery TC DEF $56.66 95956 Eeg monitor technol attended 26 DEF $96.39 95956 Eeg monitor technol attended TC DEF $372.74 95957 Eeg digital analysis 26 DEF $62.31 95957 Eeg digital analysis TC DEF $68.47 95965 Meg spontaneous 26 DEF $251.71 95965 Meg spontaneous TC DEF $408.32 95966 Meg evoked single 26 DEF $124.96 95966 Meg evoked single TC DEF $203.81 96020 Functional brain mapping 26 DEF $25.25 51725 Simple cystometrogram 26 SUR $46.10 51725 Simple cystometrogram TC SUR $122.08 Procedure Proc description Mod1 Mod1 Rate Rate Effective Code desc Type September 7, 2015 51726 Complex cystometrogram 26 SUR $52.41 51726 Complex cystometrogram TC SUR $175.15 51736 Urine flow measurement 26 SUR $18.77 51736 Urine flow measurement TC SUR $11.94 51741 Electro-uroflowmetry first 26 SUR $34.99 51741 Electro-uroflowmetry first TC SUR $13.67 51784 Anal/urinary muscle study 26 SUR $46.56 51784 Anal/urinary muscle study TC SUR $88.62 51785 Anal/urinary muscle study 26 SUR $46.62 51785 Anal/urinary muscle study TC SUR $101.40 51792 Urinary reflex study 26 SUR $34.22 51792 Urinary reflex study TC SUR $138.63 51797 Intraabdominal pressure test 26 SUR $48.93 51797 Intraabdominal pressure test TC SUR $128.66 54240 Penis study 26 SUR $40.31 54240 Penis study TC SUR $19.29 54250 Penis study 26 SUR $67.74 54250 Penis study TC SUR $6.51 59020 Fetal contract stress test 26 SUR $22.56 59020 Fetal contract stress test TC SUR $17.51 59025 Fetal non-stress test 26 SUR $18.47 59025 Fetal non-stress test TC SUR $7.79 62252 Csf shunt reprogram 26 SUR $27.76 62252 Csf shunt reprogram TC SUR $31.03

The following codes will have updated rates for the global, professional and technical components Procedure Proc description Mod1 Mod1 Rate Rate Effective Code desc Type September 7, 2015 88364 Insitu hybridization (fish) LAB $61.67 88364 Insitu hybridization (fish) 26 LAB $16.48 88364 Insitu hybridization (fish) TC LAB $45.20 88366 Insitu hybridization (fish) LAB $93.91 88366 Insitu hybridization (fish) 26 LAB $38.11 88366 Insitu hybridization (fish) TC LAB $55.80 88369 M/phmtrc alysishquant/semiq LAB $46.47 88369 M/phmtrc alysishquant/semiq 26 LAB $15.10 88369 M/phmtrc alysishquant/semiq TC LAB $31.37 88373 M/phmtrc alys ishquant/semiq LAB $38.13 88373 M/phmtrc alys ishquant/semiq 26 LAB $12.77 88373 M/phmtrc alys ishquant/semiq TC LAB $25.37 88374 M/phmtrc alys ishquant/semiq LAB $130.02 88374 M/phmtrc alys ishquant/semiq 26 LAB $27.21 88374 M/phmtrc alys ishquant/semiq TC LAB $102.81 88377 M/phmtrc alys ishquant/semiq LAB $135.07 88377 M/phmtrc alys ishquant/semiq 26 LAB $39.40 88377 M/phmtrc alys ishquant/semiq TC LAB $95.67 88380 Microdissection laser LAB $102.69 88380 Microdissection laser 26 LAB $43.68 88380 Microdissection laser TC LAB $59.01 88387 Tiss exam molecular study LAB $24.82 88387 Tiss exam molecular study 26 LAB $19.45 88387 Tiss exam molecular study TC LAB $5.36 88388 Tiss ex molecul study add-on LAB $14.52 88388 Tiss ex molecul study add-on 26 LAB $11.86 88388 Tiss ex molecul study add-on TC LAB $2.66 91112 Gi wireless capsule measure DEF $754.35 91112 Gi wireless capsule measure 26 DEF $68.13 91112 Gi wireless capsule measure TC DEF $686.22 91132 Electrogastrography DEF $131.77 Procedure Proc description Mod1 Mod1 Rate Rate Effective Code desc Type September 7, 2015 91132 Electrogastrography 26 DEF $38.89 91132 Electrogastrography TC DEF $92.89 91133 Electrogastrography w/test DEF $55.32 91133 Electrogastrography w/test 26 DEF $22.44 91133 Electrogastrography w/test TC DEF $33.19 92540 Basic vestibular evaluation DEF $61.18 92540 Basic vestibular evaluation 26 DEF $48.65 92540 Basic vestibular evaluation TC DEF $12.54 92978 Intravasc us heart add-on DEF $180.13 92978 Intravasc us heart add-on 26 DEF $62.08 92978 Intravasc us heart add-on TC DEF $123.30 92979 Intravasc us heart add-on DEF $107.73 92979 Intravasc us heart add-on 26 DEF $50.16 92979 Intravasc us heart add-on TC DEF $62.23 93315 Echo transesophageal DEF $232.83 93315 Echo transesophageal 26 DEF $92.39 93315 Echo transesophageal TC DEF $139.70 93317 Echo transesophageal DEF $153.73 93317 Echo transesophageal 26 DEF $56.99 93317 Echo transesophageal TC DEF $92.24 93318 Echo transesophageal intraop DEF $162.42 93318 Echo transesophageal intraop 26 DEF $69.62 93318 Echo transesophageal intraop TC DEF $97.45 93351 Stress tte complete DEF $159.11 93351 Stress tte complete 26 DEF $59.39 93351 Stress tte complete TC DEF $99.72 93505 Biopsy of heart lining DEF $414.26 93505 Biopsy of heart lining 26 DEF $144.78 93505 Biopsy of heart lining TC DEF $269.48 93530 Rt heart cath congenital DEF $602.86 93530 Rt heart cath congenital 26 DEF $145.64 93530 Rt heart cath congenital TC DEF $460.01 93531 R & l heart cath congenital DEF $1,593.09 93531 R & l heart cath congenital 26 DEF $284.95 93531 R & l heart cath congenital TC DEF $1,315.16 93532 R & l heart cath congenital DEF $1,628.14 93532 R & l heart cath congenital 26 DEF $353.57 93532 R & l heart cath congenital TC DEF $1,165.55 93533 R & l heart cath congenital DEF $1,380.86 93533 R & l heart cath congenital 26 DEF $237.59 93533 R & l heart cath congenital TC DEF $1,148.57 93561 Cardiac output measurement DEF $29.55 93561 Cardiac output measurement 26 DEF $14.61 93561 Cardiac output measurement TC DEF $14.67 93562 Card output measure subsq DEF $13.79 93562 Card output measure subsq 26 DEF $4.63 93562 Card output measure subsq TC DEF $9.09 93571 Heart flow reserve measure DEF $181.30 93571 Heart flow reserve measure 26 DEF $61.84 93571 Heart flow reserve measure TC DEF $123.17 93572 Heart flow reserve measure DEF $104.40 93572 Heart flow reserve measure 26 DEF $47.12 93572 Heart flow reserve measure TC DEF $54.80 93600 Bundle of his recording DEF $132.13 93600 Bundle of his recording 26 DEF $76.12 93600 Bundle of his recording TC DEF $56.30 93602 Intra-atrial recording DEF $98.64 93602 Intra-atrial recording 26 DEF $73.91 93602 Intra-atrial recording TC DEF $30.18 93603 Right ventricular recording DEF $114.15 Procedure Proc description Mod1 Mod1 Rate Rate Effective Code desc Type September 7, 2015 93603 Right ventricular recording 26 DEF $74.12 93603 Right ventricular recording TC DEF $45.75 93609 Map tachycardia add-on DEF $235.12 93609 Map tachycardia add-on 26 DEF $174.98 93609 Map tachycardia add-on TC DEF $74.17 93610 Intra-atrial pacing DEF $134.27 93610 Intra-atrial pacing 26 DEF $105.03 93610 Intra-atrial pacing TC DEF $37.00 93612 Intraventricular pacing DEF $141.41 93612 Intraventricular pacing 26 DEF $104.49 93612 Intraventricular pacing TC DEF $43.94 93615 Esophageal recording DEF $36.77 93615 Esophageal recording 26 DEF $33.47 93615 Esophageal recording TC DEF $8.69 93616 Esophageal recording DEF $54.62 93616 Esophageal recording 26 DEF $41.83 93616 Esophageal recording TC DEF $12.12 93618 Heart rhythm pacing DEF $244.85 93618 Heart rhythm pacing 26 DEF $150.42 93618 Heart rhythm pacing TC DEF $107.73 93619 Electrophysiology evaluation DEF $453.53 93619 Electrophysiology evaluation 26 DEF $259.88 93619 Electrophysiology evaluation TC DEF $209.55 93620 Electrophysiology evaluation DEF $1,001.31 93620 Electrophysiology evaluation 26 DEF $408.10 93620 Electrophysiology evaluation TC DEF $600.78 93621 Electrophysiology evaluation DEF $183.82 93621 Electrophysiology evaluation 26 DEF $73.81 93621 Electrophysiology evaluation TC DEF $110.29 93622 Electrophysiology evaluation DEF $294.70 93622 Electrophysiology evaluation 26 DEF $107.82 93622 Electrophysiology evaluation TC DEF $176.82 93623 Stimulation pacing heart DEF $245.96 93623 Stimulation pacing heart 26 DEF $100.07 93623 Stimulation pacing heart TC DEF $147.57 93624 Electrophysiologic study DEF $217.04 93624 Electrophysiologic study 26 DEF $170.73 93624 Electrophysiologic study TC DEF $54.19 93631 Heart pacing mapping DEF $415.40 93631 Heart pacing mapping 26 DEF $256.86 93631 Heart pacing mapping TC DEF $164.48 93640 Evaluation heart device DEF $307.41 93640 Evaluation heart device 26 DEF $122.71 93640 Evaluation heart device TC DEF $194.82 93641 Electrophysiology evaluation DEF $385.50 93641 Electrophysiology evaluation 26 DEF $207.77 93641 Electrophysiology evaluation TC DEF $194.82 93662 Intracardiac ecg (ice) DEF $253.77 93662 Intracardiac ecg (ice) 26 DEF $96.01 93662 Intracardiac ecg (ice) TC DEF $152.26 95782 Polysom <6 yrs 4/> paramtrs DEF $663.42 95782 Polysom <6 yrs 4/> paramtrs 26 DEF $77.30 95782 Polysom <6 yrs 4/> paramtrs TC DEF $586.12 95783 Polysom <6 yrs cpap/bilvl DEF $708.08 95783 Polysom <6 yrs cpap/bilvl 26 DEF $84.57 95783 Polysom <6 yrs cpap/bilvl TC DEF $623.52 95872 Muscle test one fiber DEF $95.57 95872 Muscle test one fiber 26 DEF $78.26 95872 Muscle test one fiber TC DEF $17.31 95875 Limb exercise test DEF Procedure Proc description Mod1 Mod1 Rate Rate Effective Code desc Type September 7, 2015 95875 Limb exercise test 26 DEF $34.34 95875 Limb exercise test TC DEF $26.19 95905 Motor &/ sens nrve cndj test DEF $51.39 95905 Motor &/ sens nrve cndj test 26 DEF $1.77 95905 Motor &/ sens nrve cndj test TC DEF $49.62 95907 Nvr cndj tst 1-2 studies DEF $58.83 95907 Nvr cndj tst 1-2 studies 26 DEF $31.40 95907 Nvr cndj tst 1-2 studies TC DEF $27.43 95908 Nrv cndj tst 3-4 studies DEF $72.55 95908 Nrv cndj tst 3-4 studies 26 DEF $39.47 95908 Nrv cndj tst 3-4 studies TC DEF $33.08 95909 Nrv cndj tst 5-6 studies DEF $86.95 95909 Nrv cndj tst 5-6 studies 26 DEF $47.09 95909 Nrv cndj tst 5-6 studies TC DEF $39.86 95910 Nrv cndj test 7-8 studies DEF $114.41 95910 Nrv cndj test 7-8 studies 26 DEF $63.01 95910 Nrv cndj test 7-8 studies TC DEF $51.39 95911 Nrv cndj test 9-10 studies DEF $138.40 95911 Nrv cndj test 9-10 studies 26 DEF $78.70 95911 Nrv cndj test 9-10 studies TC DEF $59.70 95912 Nrv cndj test 11-12 studies DEF $161.95 95912 Nrv cndj test 11-12 studies 26 DEF $94.41 95912 Nrv cndj test 11-12 studies TC DEF $67.54 95913 Nrv cndj test 13/> studies DEF $187.57 95913 Nrv cndj test 13/> studies 26 DEF $111.95 95913 Nrv cndj test 13/> studies TC DEF $75.62 95924 Ans parasymp & symp w/tilt DEF $91.55 95924 Ans parasymp & symp w/tilt 26 DEF $52.66 95924 Ans parasymp & symp w/tilt TC DEF $38.89 95951 Eeg monitoring/videorecord DEF $527.06 95951 Eeg monitoring/videorecord 26 DEF $183.61 95951 Eeg monitoring/videorecord TC DEF $316.24 95958 Eeg monitoring/function test DEF $201.28 95958 Eeg monitoring/function test 26 DEF $131.35 95958 Eeg monitoring/function test TC DEF $69.93 95961 Electrode stimulation brain DEF $141.24 95961 Electrode stimulation brain 26 DEF $100.82 95961 Electrode stimulation brain TC DEF $40.43 95962 Electrode stim brain add-on DEF $139.05 95962 Electrode stim brain add-on 26 DEF $104.24 95962 Electrode stim brain add-on TC DEF $34.81 95967 Meg evoked each addl DEF $297.40 95967 Meg evoked each addl 26 DEF $106.89 95967 Meg evoked each addl TC DEF $178.44 51727 Cystometrogram w/up SUR $190.99 51727 Cystometrogram w/up 26 SUR $67.13 51727 Cystometrogram w/up TC SUR $123.86 51728 Cystometrogram w/vp SUR $190.13 51728 Cystometrogram w/vp 26 SUR $66.03 51728 Cystometrogram w/vp TC SUR $124.10 51729 Cystometrogram w/vp&up SUR $207.38 51729 Cystometrogram w/vp&up 26 SUR $79.59 51729 Cystometrogram w/vp&up TC SUR $127.79