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Provider Type 72 Nurse Anesthetist Reimbursement Rates

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Provider Type 72 Nurse Anesthetist Reimbursement Rates Provider Type 72 Nurse Anesthetist Reimbursement Rates Updated: May 1, 2015 The information contained in the schedule is made available to provide information and is not a guarantee by the State or the Department or its employees as to the present accuracy of the information contained herein. For example, coverage as well as an actual rate may have been revised or updated and may no longer be the same as posted on the website. Note: Procedure codes with a rate of $0.00 are reimbursed at 62% of Usual and Customary charges unless noted otherwise in Nevada Medicaid policy. CPT codes, descriptions and other data only are copyright © 2008 American Medical Association. All rights reserved. Applicable FARS/DFARS apply. CPT is a registered trademark ® of the American Medical Association. Modifier List Anesthesiology Unit Values Proc Code Description Mod Rate 01953 ANESTH BURN EACH 9 PERCENT 21.12 01996 HOSP MANAGE CONT DRUG ADMIN 63.36 10021 FNA W/O IMAGE TC 12.96 10021 FNA W/O IMAGE 26 48.11 10021 FNA W/O IMAGE 61.32 10022 FNA W/IMAGE TC 17.20 10022 FNA W/IMAGE 26 45.87 10022 FNA W/IMAGE 63.07 10040 ACNE SURGERY 45.12 10060 DRAINAGE OF SKIN ABSCESS 49.86 10061 DRAINAGE OF SKIN ABSCESS 103.70 10080 DRAINAGE OF PILONIDAL CYST 51.35 10081 DRAINAGE OF PILONIDAL CYST 108.69 10120 REMOVE FOREIGN BODY 42.87 10121 REMOVE FOREIGN BODY 122.40 10140 DRAINAGE OF HEMATOMA/FLUID 66.06 10160 PUNCTURE DRAINAGE OF LESION 44.62 10180 COMPLEX DRAINAGE WOUND 98.47 11000 DEBRIDE INFECTED SKIN 22.68 11001 DEBRIDE INFECTED SKIN ADD-ON 10.96 11010 DEBRIDE SKIN AT FX SITE 173.26 11011 DEBRIDE SKIN MUSC AT FX SITE 209.66 11012 DEB SKIN BONE AT FX SITE 311.87 11042 DEB SUBQ TISSUE 20 SQ CM/< 43.62 11043 DEB MUSC/FASCIA 20 SQ CM/< 103.70 11044 DEB BONE 20 SQ CM/< 135.12 11055 TRIM SKIN LESION 16.20 11056 TRIM SKIN LESIONS 2 TO 4 22.93 11057 TRIM SKIN LESIONS OVER 4 29.91 11100 BIOPSY SKIN LESION 31.41 11101 BIOPSY SKIN ADD-ON 15.95 11200 REMOVAL OF SKIN TAGS <W/15 28.66 11201 REMOVE SKIN TAGS ADD-ON 10.96 11300 SHAVE SKIN LESION 0.5 CM/< 19.44 11301 SHAVE SKIN LESION 0.6-1.0 CM 32.65 11302 SHAVE SKIN LESION 1.1-2.0 CM 40.38 11303 SHAVE SKIN LESION >2.0 CM 47.11 11305 SHAVE SKIN LESION 0.5 CM/< 25.42 11306 SHAVE SKIN LESION 0.6-1.0 CM 37.64 11307 SHAVE SKIN LESION 1.1-2.0 CM 43.37 11308 SHAVE SKIN LESION >2.0 CM 53.59 11310 SHAVE SKIN LESION 0.5 CM/< 28.42 11311 SHAVE SKIN LESION 0.6-1.0 CM 41.13 11312 SHAVE SKIN LESION 1.1-2.0 CM 46.86 11313 SHAVE SKIN LESION >2.0 CM 62.57 11400 EXC TR-EXT B9+MARG 0.5 CM< 33.90 11401 EXC TR-EXT B9+MARG 0.6-1 CM 49.61 11402 EXC TR-EXT B9+MARG 1.1-2 CM 69.30 11403 EXC TR-EXT B9+MARG 2.1-3CM/< 82.01 11404 EXC TR-EXT B9+MARG 3.1-4 CM 91.49 11406 EXC TR-EXT B9+MARG >4.0 CM 113.18 11420 EXC H-F-NK-SP B9+MARG 0.5/< 40.38 11421 EXC H-F-NK-SP B9+MARG 0.6-1 58.33 11422 EXC H-F-NK-SP B9+MARG 1.1-2 76.28 11423 EXC H-F-NK-SP B9+MARG 2.1-3 92.24 11424 EXC H-F-NK-SP B9+MARG 3.1-4 108.94 11426 EXC H-F-NK-SP B9+MARG >4 CM 153.81 11440 EXC FACE-MM B9+MARG 0.5 CM/< 44.87 11441 EXC FACE-MM B9+MARG 0.6-1 CM 62.82 11442 EXC FACE-MM B9+MARG 1.1-2 CM 84.76 11443 EXC FACE-MM B9+MARG 2.1-3 CM 110.19 11444 EXC FACE-MM B9+MARG 3.1-4 CM 147.08 11446 EXC FACE-MM B9+MARG >4 CM 188.47 11450 REMOVAL SWEAT GLAND LESION 102.96 11451 REMOVAL SWEAT GLAND LESION 145.09 11462 REMOVAL SWEAT GLAND LESION 95.23 11463 REMOVAL SWEAT GLAND LESION 154.31 11470 REMOVAL SWEAT GLAND LESION 123.15 11471 REMOVAL SWEAT GLAND LESION 167.52 11600 EXC TR-EXT MAL+MARG 0.5 CM/< 66.06 11601 EXC TR-EXT MAL+MARG 0.6-1 CM 87.25 11602 EXC TR-EXT MAL+MARG 1.1-2 CM 92.49 11603 EXC TR-EXT MAL+MARG 2.1-3 CM 102.21 11604 EXC TR-EXT MAL+MARG 3.1-4 CM 110.43 11606 EXC TR-EXT MAL+MARG >4 CM 142.35 11620 EXC H-F-NK-SP MAL+MARG 0.5/< 64.56 11621 EXC S/N/H/F/G MAL+MRG 0.6-1 89.49 11622 EXC S/N/H/F/G MAL+MRG 1.1-2 104.70 11623 EXC S/N/H/F/G MAL+MRG 2.1-3 127.64 11624 EXC S/N/H/F/G MAL+MRG 3.1-4 147.33 11626 EXC S/N/H/F/G MAL+MRG >4 CM 184.73 11640 EXC F/E/E/N/L MAL+MRG 0.5CM< 74.79 11641 EXC F/E/E/N/L MAL+MRG 0.6-1 111.68 11642 EXC F/E/E/N/L MAL+MRG 1.1-2 131.38 11643 EXC F/E/E/N/L MAL+MRG 2.1-3 155.06 11644 EXC F/E/E/N/L MAL+MRG 3.1-4 200.43 11646 EXC F/E/E/N/L MAL+MRG >4 CM 260.51 11719 TRIM NAIL(S) ANY NUMBER 6.48 11720 DEBRIDE NAIL 1-5 11.96 11721 DEBRIDE NAIL 6 OR MORE 20.44 11730 REMOVAL OF NAIL PLATE 42.87 11732 REMOVE NAIL PLATE ADD-ON 21.93 11740 DRAIN BLOOD FROM UNDER NAIL 13.71 11750 REMOVAL OF NAIL BED 71.54 11752 REMOVE NAIL BED/TIP 122.65 11755 BIOPSY NAIL UNIT 50.10 11760 REPAIR OF NAIL BED 77.78 11762 RECONSTRUCTION OF NAIL BED 132.62 11765 EXCISION OF NAIL FOLD TOE 31.91 11770 REMOVE PILONIDAL CYST SIMPLE 105.20 11771 REMOVE PILONIDAL CYST EXTEN 264.50 11772 REMOVE PILONIDAL CYST COMPL 310.37 11900 INJECT SKIN LESIONS </W 7 19.69 11901 INJECT SKIN LESIONS >7 30.91 11950 TX CONTOUR DEFECTS 1 CC/< 35.15 11951 TX CONTOUR DEFECTS 1.1-5.0CC 45.62 11952 TX CONTOUR DEFECTS 5.1-10CC 64.07 11954 TX CONTOUR DEFECTS >10.0 CC 77.28 11960 INSERT TISSUE EXPANDER(S) 552.94 11970 REPLACE TISSUE EXPANDER 333.56 11971 REMOVE TISSUE EXPANDER(S) 165.03 11976 REMOVE CONTRACEPTIVE CAPSULE 67.56 11981 INSERT DRUG IMPLANT DEVICE 56.59 11982 REMOVE DRUG IMPLANT DEVICE 68.05 11983 REMOVE/INSERT DRUG IMPLANT 126.14 12001 RPR S/N/AX/GEN/TRNK 2.5CM/< 57.83 12002 RPR S/N/AX/GEN/TRNK2.6-7.5CM 75.78 12004 RPR S/N/AX/GEN/TRK7.6-12.5CM 89.00 12005 RPR S/N/A/GEN/TRK12.6-20.0CM 110.93 12006 RPR S/N/A/GEN/TRK20.1-30.0CM 142.59 12007 RPR S/N/AX/GEN/TRNK >30.0 CM 162.29 12011 RPR F/E/E/N/L/M 2.5 CM/< 60.08 12013 RPR F/E/E/N/L/M 2.6-5.0 CM 80.27 12014 RPR F/E/E/N/L/M 5.1-7.5 CM 95.73 12015 RPR F/E/E/N/L/M 7.6-12.5 CM 121.15 12016 RPR FE/E/EN/L/M 12.6-20.0 CM 149.08 12017 RPR FE/E/EN/L/M 20.1-30.0 CM 179.74 12018 RPR F/E/E/N/L/M >30.0 CM 208.91 12020 CLOSURE OF SPLIT WOUND 110.19 12021 CLOSURE OF SPLIT WOUND 78.28 12031 INTMD RPR S/A/T/EXT 2.5 CM/< 79.27 12032 INTMD RPR S/A/T/EXT 2.6-7.5 101.71 12034 INTMD RPR S/TR/EXT 7.6-12.5 118.66 12035 INTMD RPR S/A/T/EXT 12.6-20 139.85 12036 INTMD RPR S/A/T/EXT 20.1-30 178.49 12037 INTMD RPR S/TR/EXT >30.0 CM 205.92 12041 INTMD RPR N-HF/GENIT 2.5CM/< 87.00 12042 INTMD RPR N-HF/GENIT2.6-7.5 112.43 12044 INTMD RPR N-HF/GENIT7.6-12.5 129.13 12045 INTMD RPR N-HF/GENIT12.6-20 151.32 12046 INTMD RPR N-HF/GENIT20.1-30 186.47 12047 INTMD RPR N-HF/GENIT >30.0CM 202.93 12051 INTMD RPR FACE/MM 2.5 CM/< 105.20 12052 INTMD RPR FACE/MM 2.6-5.0 CM 112.68 12053 INTMD RPR FACE/MM 5.1-7.5 CM 126.39 12054 INTMD RPR FACE/MM 7.6-12.5CM 138.86 12055 INTMD RPR FACE/MM 12.6-20 CM 180.24 12056 INTMD RPR FACE/MM 20.1-30.0 228.60 12057 INTMD RPR FACE/MM >30.0 CM 259.27 13100 CMPLX RPR TRUNK 1.1-2.5 CM 134.37 13101 CMPLX RPR TRUNK 2.6-7.5 CM 166.78 13102 CMPLX RPR TRUNK ADDL 5CM/< 49.61 13120 CMPLX RPR S/A/L 1.1-2.5 CM 140.10 13121 CMPLX RPR S/A/L 2.6-7.5 CM 181.24 13122 CMPLX RPR S/A/L ADDL 5 CM/> 57.08 13131 CMPLX RPR F/C/C/M/N/AX/G/H/F 162.04 13132 CMPLX RPR F/C/C/M/N/AX/G/H/F 246.30 13133 CMPLX RPR F/C/C/M/N/AX/G/H/F 88.00 13151 CMPLX RPR E/N/E/L 1.1-2.5 CM 202.68 13152 CMPLX RPR E/N/E/L 2.6-7.5 CM 277.22 13153 CMPLX RPR E/N/E/L ADDL 5CM/< 96.22 13160 LATE CLOSURE OF WOUND 465.94 14000 TIS TRNFR TRUNK 10 SQ CM/< 286.44 14001 TIS TRNFR TRUNK 10.1-30SQCM 391.89 14020 TIS TRNFR S/A/L 10 SQ CM/< 324.09 14021 TIS TRNFR S/A/L 10.1-30 SQCM 463.94 14040 TIS TRNFR F/C/C/M/N/A/G/H/F 375.44 14041 TIS TRNFR F/C/C/M/N/A/G/H/F 520.03 14060 TIS TRNFR E/N/E/L 10 SQ CM/< 415.33 14061 TIS TRNFR E/N/E/L10.1-30SQCM 565.66 14350 FILLETED FINGER/TOE FLAP 441.51 15002 WOUND PREP TRK/ARM/LEG 138.09 15003 WOUND PREP ADDL 100 CM 28.23 15004 WOUND PREP F/N/HF/G 170.90 15005 WND PREP F/N/HF/G ADDL CM 56.46 15040 HARVEST CULTURED SKIN GRAFT 85.94 15050 SKIN PINCH GRAFT 228.35 15100 SKIN SPLT GRFT TRNK/ARM/LEG 417.32 15101 SKIN SPLT GRFT T/A/L ADD-ON 68.30 15110 EPIDRM AUTOGRFT TRNK/ARM/LEG 455.82 15111 EPIDRM AUTOGRFT T/A/L ADD-ON 73.86 15115 EPIDRM A-GRFT FACE/NCK/HF/G 468.44 15116 EPIDRM A-GRFT F/N/HF/G ADDL 100.61 15120 SKN SPLT A-GRFT FAC/NCK/HF/G 452.97 15121 SKN SPLT A-GRFT F/N/HF/G ADD 106.94 15130 DERM AUTOGRAFT TRNK/ARM/LEG 366.93 15131 DERM AUTOGRAFT T/A/L ADD-ON 59.85 15135 DERM AUTOGRAFT FACE/NCK/HF/G 508.18 15136 DERM AUTOGRAFT F/N/HF/G ADD 60.37 15150 CULT SKIN GRFT T/ARM/LEG 405.38 15151 CULT SKIN GRFT T/A/L ADDL 79.72 15152 CULT SKIN GRAFT T/A/L +% 99.58 15155 CULT SKIN GRAFT F/N/HF/G 435.32 15156 CULT SKIN GRFT F/N/HFG ADD 110.80 15157 CULT EPIDERM GRFT F/N/HFG +% 120.73 15200 SKIN FULL GRAFT TRUNK 369.21 15201 SKIN FULL GRAFT TRUNK ADD-ON 54.84 15220 SKIN FULL GRAFT SCLP/ARM/LEG 385.16 15221 SKIN FULL GRAFT ADD-ON 48.86 15240 SKIN FULL GRFT FACE/GENIT/HF 438.02 15241 SKIN FULL GRAFT ADD-ON 76.28 15260 SKIN FULL GRAFT EEN & LIPS 471.42 15261 SKIN FULL GRAFT ADD-ON 90.99 15570 SKIN PEDICLE FLAP TRUNK 424.80 15572 SKIN PEDICLE FLAP ARMS/LEGS 424.55 15574 PEDCLE FH/CH/CH/M/N/AX/G/H/F 460.20 15576 PEDICLE E/N/E/L/NTRORAL 409.10 15600 DELAY FLAP TRUNK 118.66 15610 DELAY FLAP ARMS/LEGS 137.36 15620 DELAY FLAP F/C/C/N/AX/G/H/F 173.76 15630 DELAY FLAP EYE/NOS/EAR/LIP 189.46 15650 TRANSFER SKIN PEDICLE FLAP 213.65 15731 FOREHEAD FLAP W/VASC PEDICLE 601.26 15732 MUSCLE-SKIN GRAFT HEAD/NECK 793.52 15734 MUSCLE-SKIN GRAFT TRUNK 801.00 15736 MUSCLE-SKIN GRAFT ARM 749.89 15738 MUSCLE-SKIN GRAFT LEG 804.74 15740 ISLAND PEDICLE FLAP GRAFT 461.95 15750 NEUROVASCULAR PEDICLE FLAP 538.48 15756 FREE MYO/SKIN FLAP MICROVASC 1559.12 15757 FREE SKIN FLAP MICROVASC 1568.09 15758 FREE FASCIAL FLAP MICROVASC 1574.82 15760 COMPOSITE SKIN GRAFT 420.07 15770 DERMA-FAT-FASCIA GRAFT 370.95 15786 ABRASION LESION SINGLE 87.50 15787 ABRASION LESIONS
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