2018 National Physician Fee Schedule Relative Value File January Release CPT codes and descriptions only are copyright 2016 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. Dental codes (D codes) are copyright 2017/17 American Dental Association. All Rights Reserved.

RELEASED 12/18/2017

NON-FACILITY HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL 10021 Fna w/o image 3.47 $70.00 $242.90 10022 Fna w/image 4.00 $70.00 $280.00 1003F Level of activity assess 0.00 $70.00 $0.00 10030 Guide cathet fluid drainage 16.04 $70.00 $1,122.80 10035 Perq dev soft tiss 1st imag 14.71 $70.00 $1,029.70 10036 Perq dev soft tiss add imag 12.90 $70.00 $903.00 1004F Clin symp vol ovrld assess 0.00 $70.00 $0.00 10040 Acne surgery 3.13 $70.00 $219.10 1005F Asthma symptoms evaluate 0.00 $70.00 $0.00 1006F Osteoarthritis assess 0.00 $70.00 $0.00 10060 Drainage of skin abscess 3.38 $70.00 $236.60 10061 Drainage of skin abscess 5.87 $70.00 $410.90 1007F Anti-inflm/anlgsc otc assess 0.00 $70.00 $0.00 1008F Gi/renal risk assess 0.00 $70.00 $0.00 10080 Drainage of pilonidal cyst 5.12 $70.00 $358.40 10081 Drainage of pilonidal cyst 7.68 $70.00 $537.60 1010F Severity angina by actvty 0.00 $70.00 $0.00 1011F Angina present 0.00 $70.00 $0.00 1012F Angina absent 0.00 $70.00 $0.00 10120 Remove foreign body 4.38 $70.00 $306.60 10121 Remove foreign body 7.83 $70.00 $548.10 10140 Drainage of hematoma/fluid 4.69 $70.00 $328.30 1015F Copd symptoms assess 0.00 $70.00 $0.00 10160 Puncture drainage of lesion 3.71 $70.00 $259.70 1018F Assess dyspnea not present 0.00 $70.00 $0.00 10180 Complex drainage wound 7.06 $70.00 $494.20 1019F Assess dyspnea present 0.00 $70.00 $0.00 1022F Pneumo imm status assess 0.00 $70.00 $0.00 1026F Co-morbid condition assess 0.00 $70.00 $0.00 1030F Influenza imm status assess 0.00 $70.00 $0.00 1031F Smoking & 2nd hand assessed 0.00 $70.00 $0.00 1032F Smoker/exposed 2nd hnd smoke 0.00 $70.00 $0.00 1033F Tobacco nonsmoker nor 2ndhnd 0.00 $70.00 $0.00 1034F Current tobacco smoker 0.00 $70.00 $0.00 1035F Smokeless tobacco user 0.00 $70.00 $0.00 1036F Tobacco non-user 0.00 $70.00 $0.00 1038F Persistent asthma 0.00 $70.00 $0.00 NON-FACILITY HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL 1039F Intermittent asthma 0.00 $70.00 $0.00 1040F Dsm-5 info mdd docd 0.00 $70.00 $0.00 1050F History of mole changes 0.00 $70.00 $0.00 1052F Type location activityassess 0.00 $70.00 $0.00 1055F Visual funct status assess 0.00 $70.00 $0.00 1060F Doc perm/cont/parox atr fib 0.00 $70.00 $0.00 1061F Doc lack perm+cont+parox fib 0.00 $70.00 $0.00 1065F Ischm stroke symp lt3 hrsb/4 0.00 $70.00 $0.00 1066F Ischm stroke symp ge3 hrsb/4 0.00 $70.00 $0.00 1070F Alarm symp assessed-absent 0.00 $70.00 $0.00 1071F Alarm symp assessed-1+ prsnt 0.00 $70.00 $0.00 1090F Pres/absn urine incon assess 0.00 $70.00 $0.00 1091F Urine incon characterized 0.00 $70.00 $0.00 1100F Ptfalls assess-docd ge2>/yr 0.00 $70.00 $0.00 11000 Debride infected skin 1.56 $70.00 $109.20 11001 Debride infected skin add-on 0.61 $70.00 $42.70 11004 Debride genitalia & perineum 16.69 $70.00 $1,168.30 11005 Debride abdom wall 22.64 $70.00 $1,584.80 11006 Debride genit/per/abdom wall 20.44 $70.00 $1,430.80 11008 Remove mesh from abd wall 7.96 $70.00 $557.20 1101F Pt falls assess-docd le1/yr 0.00 $70.00 $0.00 11010 Debride skin at fx site 14.43 $70.00 $1,010.10 11011 Debride skin musc at fx site 15.48 $70.00 $1,083.60 11012 Deb skin bone at fx site 20.25 $70.00 $1,417.50 11042 Deb subq tissue 20 sq cm/< 3.35 $70.00 $234.50 11043 Deb musc/fascia 20 sq cm/< 6.53 $70.00 $457.10 11044 Deb bone 20 sq cm/< 8.94 $70.00 $625.80 11045 Deb subq tissue add-on 1.18 $70.00 $82.60 11046 Deb musc/fascia add-on 2.09 $70.00 $146.30 11047 Deb bone add-on 3.54 $70.00 $247.80 11055 Trim skin lesion 1.37 $70.00 $95.90 11056 Trim skin lesions 2 to 4 1.67 $70.00 $116.90 11057 Trim skin lesions over 4 1.89 $70.00 $132.30 1110F Pt lft inpt fac w/in 60 days 0.00 $70.00 $0.00 11100 Biopsy skin lesion 3.00 $70.00 $210.00 11101 Biopsy skin add-on 0.93 $70.00 $65.10 1111F Dschrg med/current med merge 0.00 $70.00 $0.00 1116F Auric/peri pain assessed 0.00 $70.00 $0.00 1118F Gerd symps assessed 12 month 0.00 $70.00 $0.00 1119F Init eval for condition 0.00 $70.00 $0.00 11200 Removal of skin tags 2.0 cm 4.45 $70.00 $311.50 11305 Shave skin lesion 0.5 cm/< 2.82 $70.00 $197.40 11306 Shave skin lesion 0.6-1.0 cm 3.48 $70.00 $243.60 11307 Shave skin lesion 1.1-2.0 cm 4.13 $70.00 $289.10 11308 Shave skin lesion >2.0 cm 4.31 $70.00 $301.70 11310 Shave skin lesion 0.5 cm/< 3.25 $70.00 $227.50 11311 Shave skin lesion 0.6-1.0 cm 3.18 $70.00 $222.60 11312 Shave skin lesion 1.1-2.0 cm 4.58 $70.00 $320.60 11313 Shave skin lesion >2.0 cm 5.31 $70.00 $371.70 1134F Epsd bk pain for 6 wks/< 0.00 $70.00 $0.00 1135F Epsd bk pain for >6 wks 0.00 $70.00 $0.00 1136F Epsd bk pain for 12 wks/< 0.00 $70.00 $0.00 1137F Epsd bk pain for >12 wks 0.00 $70.00 $0.00 11400 Exc tr-ext b9+marg 0.5 cm< 3.58 $70.00 $250.60 11401 Exc tr-ext b9+marg 0.6-1 cm 4.27 $70.00 $298.90 11402 Exc tr-ext b9+marg 1.1-2 cm 4.76 $70.00 $333.20 11403 Exc tr-ext b9+marg 2.1-3cm 5.50 $70.00 $385.00 11404 Exc tr-ext b9+marg 3.1-4 cm 6.23 $70.00 $436.10 11406 Exc tr-ext b9+marg >4.0 cm 8.99 $70.00 $629.30 11420 Exc h-f-nk-sp b9+marg 0.5/< 3.50 $70.00 $245.00 11421 Exc h-f-nk-sp b9+marg 0.6-1 4.48 $70.00 $313.60 11422 Exc h-f-nk-sp b9+marg 1.1-2 5.04 $70.00 $352.80 11423 Exc h-f-nk-sp b9+marg 2.1-3 5.74 $70.00 $401.80 11424 Exc h-f-nk-sp b9+marg 3.1-4 6.67 $70.00 $466.90 11426 Exc h-f-nk-sp b9+marg >4 cm 9.56 $70.00 $669.20 11440 Exc face-mm b9+marg 0.5 cm/< 3.87 $70.00 $270.90 11441 Exc face-mm b9+marg 0.6-1 cm 4.80 $70.00 $336.00 11442 Exc face-mm b9+marg 1.1-2 cm 5.37 $70.00 $375.90 11443 Exc face-mm b9+marg 2.1-3 cm 6.38 $70.00 $446.60 11444 Exc face-mm b9+marg 3.1-4 cm 8.02 $70.00 $561.40 11446 Exc face-mm b9+marg >4 cm 11.14 $70.00 $779.80 11450 Removal sweat gland lesion 10.98 $70.00 $768.60 11451 Removal sweat gland lesion 13.90 $70.00 $973.00 11462 Removal sweat gland lesion 10.72 $70.00 $750.40 11463 Removal sweat gland lesion 14.05 $70.00 $983.50 11470 Removal sweat gland lesion 11.82 $70.00 $827.40 11471 Removal sweat gland lesion 14.62 $70.00 $1,023.40 NON-FACILITY HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL 1150F Doc pt rsk death w/in 1yr 0.00 $70.00 $0.00 1151F Doc no pt rsk death w/in 1yr 0.00 $70.00 $0.00 1152F Doc advncd dis comfort 1st 0.00 $70.00 $0.00 1153F Doc advncd dis cmfrt not 1st 0.00 $70.00 $0.00 1157F Advnc care plan in rcrd 0.00 $70.00 $0.00 1158F Advnc care plan tlk docd 0.00 $70.00 $0.00 1159F Med list docd in rcrd 0.00 $70.00 $0.00 1160F Rvw meds by rx/dr in rcrd 0.00 $70.00 $0.00 11600 Exc tr-ext mal+marg 0.5 cm/< 5.52 $70.00 $386.40 11601 Exc tr-ext mal+marg 0.6-1 cm 6.53 $70.00 $457.10 11602 Exc tr-ext mal+marg 1.1-2 cm 7.08 $70.00 $495.60 11603 Exc tr-ext mal+marg 2.1-3 cm 8.11 $70.00 $567.70 11604 Exc tr-ext mal+marg 3.1-4 cm 8.99 $70.00 $629.30 11606 Exc tr-ext mal+marg >4 cm 12.86 $70.00 $900.20 11620 Exc h-f-nk-sp mal+marg 0.5/< 5.56 $70.00 $389.20 11621 Exc s/n/h/f/g mal+mrg 0.6-1 6.56 $70.00 $459.20 11622 Exc s/n/h/f/g mal+mrg 1.1-2 7.32 $70.00 $512.40 11623 Exc s/n/h/f/g mal+mrg 2.1-3 8.59 $70.00 $601.30 11624 Exc s/n/h/f/g mal+mrg 3.1-4 9.68 $70.00 $677.60 11626 Exc s/n/h/f/g mal+mrg >4 cm 11.63 $70.00 $814.10 11640 Exc f/e/e/n/l mal+mrg 0.5cm< 5.73 $70.00 $401.10 11641 Exc f/e/e/n/l mal+mrg 0.6-1 6.78 $70.00 $474.60 11642 Exc f/e/e/n/l mal+mrg 1.1-2 7.74 $70.00 $541.80 11643 Exc f/e/e/n/l mal+mrg 2.1-3 9.12 $70.00 $638.40 11644 Exc f/e/e/n/l mal+mrg 3.1-4 11.26 $70.00 $788.20 11646 Exc f/e/e/n/l mal+mrg >4 cm 14.66 $70.00 $1,026.20 1170F Fxnl status assessed 0.00 $70.00 $0.00 11719 Trim nail(s) any number 0.41 $70.00 $28.70 11720 Debride nail 1-5 0.94 $70.00 $65.80 11721 Debride nail 6 or more 1.29 $70.00 $90.30 11730 Removal of nail plate 3.01 $70.00 $210.70 11732 Remove nail plate add-on 0.90 $70.00 $63.00 11740 Drain blood from under nail 1.43 $70.00 $100.10 1175F Function stat assessed rvwd 0.00 $70.00 $0.00 11750 Removal of nail bed 4.37 $70.00 $305.90 11755 Biopsy nail unit 3.75 $70.00 $262.50 11760 Repair of nail bed 5.35 $70.00 $374.50 11762 Reconstruction of nail bed 7.97 $70.00 $557.90 11765 Excision of nail fold toe 4.77 $70.00 $333.90 11770 Remove pilonidal cyst simple 7.89 $70.00 $552.30 11771 Remove pilonidal cyst exten 16.49 $70.00 $1,154.30 11772 Remove pilonidal cyst compl 19.86 $70.00 $1,390.20 1180F Thromboemb risk assessed 0.00 $70.00 $0.00 1181F Neuropsychia sympts assessed 0.00 $70.00 $0.00 1182F Neuropsychi sympt 1+present 0.00 $70.00 $0.00 NON-FACILITY HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL 1183F Neuropsychiatric symp absent 0.00 $70.00 $0.00 11900 Inject skin lesions 7 2.01 $70.00 $140.70 11920 Correct skin color 6.0 cm/< 4.91 $70.00 $343.70 11921 Correct skn color 6.1-20.0cm 5.63 $70.00 $394.10 11922 Correct skin color ea 20.0cm 1.75 $70.00 $122.50 11950 Tx contour defects 1 cc/< 2.00 $70.00 $140.00 11951 Tx contour defects 1.1-5.0cc 2.88 $70.00 $201.60 11952 Tx contour defects 5.1-10cc 3.72 $70.00 $260.40 11954 Tx contour defects >10.0 cc 4.45 $70.00 $311.50 11960 Insert tissue expander(s) 27.35 $70.00 $1,914.50 11970 Replace tissue expander 17.50 $70.00 $1,225.00 11971 Remove tissue expander(s) 13.42 $70.00 $939.40 11976 Remove contraceptive capsule 4.10 $70.00 $287.00 11980 Implant hormone pellet(s) 2.71 $70.00 $189.70 11981 Insert drug implant device 4.05 $70.00 $283.50 11982 Remove drug implant device 4.53 $70.00 $317.10 11983 Remove/insert drug implant 6.54 $70.00 $457.80 1200F Seizure type& frequ docd 0.00 $70.00 $0.00 12001 Rpr s/n/ax/gen/trnk 2.5cm/< 2.59 $70.00 $181.30 12002 Rpr s/n/ax/gen/trnk2.6-7.5cm 3.15 $70.00 $220.50 12004 Rpr s/n/ax/gen/trk7.6-12.5cm 3.68 $70.00 $257.60 12005 Rpr s/n/a/gen/trk12.6-20.0cm 4.63 $70.00 $324.10 12006 Rpr s/n/a/gen/trk20.1-30.0cm 5.50 $70.00 $385.00 12007 Rpr s/n/ax/gen/trnk >30.0 cm 6.35 $70.00 $444.50 12011 Rpr f/e/e/n/l/m 2.5 cm/< 3.16 $70.00 $221.20 12013 Rpr f/e/e/n/l/m 2.6-5.0 cm 3.31 $70.00 $231.70 12014 Rpr f/e/e/n/l/m 5.1-7.5 cm 3.86 $70.00 $270.20 12015 Rpr f/e/e/n/l/m 7.6-12.5 cm 4.65 $70.00 $325.50 12016 Rpr fe/e/en/l/m 12.6-20.0 cm 5.86 $70.00 $410.20 12017 Rpr fe/e/en/l/m 20.1-30.0 cm 4.39 $70.00 $307.30 12018 Rpr f/e/e/n/l/m >30.0 cm 4.97 $70.00 $347.90 12020 Closure of split wound 8.00 $70.00 $560.00 12021 Closure of split wound 4.67 $70.00 $326.90 12031 Intmd rpr s/a/t/ext 2.5 cm/< 6.78 $70.00 $474.60 12032 Intmd rpr s/a/t/ext 2.6-7.5 8.61 $70.00 $602.70 12034 Intmd rpr s/tr/ext 7.6-12.5 8.92 $70.00 $624.40 12035 Intmd rpr s/a/t/ext 12.6-20 10.85 $70.00 $759.50 12036 Intmd rpr s/a/t/ext 20.1-30 12.06 $70.00 $844.20 12037 Intmd rpr s/tr/ext >30.0 cm 13.72 $70.00 $960.40 12041 Intmd rpr n-hf/genit 2.5cm/< 6.77 $70.00 $473.90 12042 Intmd rpr n-hf/genit2.6-7.5 8.24 $70.00 $576.80 12044 Intmd rpr n-hf/genit7.6-12.5 10.26 $70.00 $718.20 12045 Intmd rpr n-hf/genit12.6-20 11.40 $70.00 $798.00 12046 Intmd rpr n-hf/genit20.1-30 13.70 $70.00 $959.00 NON-FACILITY HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL 12047 Intmd rpr n-hf/genit >30.0cm 15.09 $70.00 $1,056.30 1205F Epi etiol synd rvwd and docd 0.00 $70.00 $0.00 12051 Intmd rpr face/mm 2.5 cm/< 7.36 $70.00 $515.20 12052 Intmd rpr face/mm 2.6-5.0 cm 8.39 $70.00 $587.30 12053 Intmd rpr face/mm 5.1-7.5 cm 9.85 $70.00 $689.50 12054 Intmd rpr face/mm 7.6-12.5cm 10.27 $70.00 $718.90 12055 Intmd rpr face/mm 12.6-20 cm 13.27 $70.00 $928.90 12056 Intmd rpr face/mm 20.1-30.0 15.86 $70.00 $1,110.20 12057 Intmd rpr face/mm >30.0 cm 16.83 $70.00 $1,178.10 1220F Pt screened for depression 0.00 $70.00 $0.00 13100 Cmplx rpr trunk 1.1-2.5 cm 9.54 $70.00 $667.80 13101 Cmplx rpr trunk 2.6-7.5 cm 11.27 $70.00 $788.90 13102 Cmplx rpr trunk addl 5cm/< 3.47 $70.00 $242.90 13120 Cmplx rpr s/a/l 1.1-2.5 cm 9.98 $70.00 $698.60 13121 Cmplx rpr s/a/l 2.6-7.5 cm 12.16 $70.00 $851.20 13122 Cmplx rpr s/a/l addl 5 cm/> 3.79 $70.00 $265.30 13131 Cmplx rpr f/c/c/m/n/ax/g/h/f 10.98 $70.00 $768.60 13132 Cmplx rpr f/c/c/m/n/ax/g/h/f 13.56 $70.00 $949.20 13133 Cmplx rpr f/c/c/m/n/ax/g/h/f 5.08 $70.00 $355.60 13151 Cmplx rpr e/n/e/l 1.1-2.5 cm 12.01 $70.00 $840.70 13152 Cmplx rpr e/n/e/l 2.6-7.5 cm 14.42 $70.00 $1,009.40 13153 Cmplx rpr e/n/e/l addl 5cm/< 5.51 $70.00 $385.70 13160 Late closure of wound 22.98 $70.00 $1,608.60 1400F Prkns diag rviewed 0.00 $70.00 $0.00 14000 Tis trnfr trunk 10 sq cm/< 17.73 $70.00 $1,241.10 14001 Tis trnfr trunk 10.1-30sqcm 22.90 $70.00 $1,603.00 14020 Tis trnfr s/a/l 10 sq cm/< 19.83 $70.00 $1,388.10 14021 Tis trnfr s/a/l 10.1-30 sqcm 24.81 $70.00 $1,736.70 14040 Tis trnfr f/c/c/m/n/a/g/h/f 21.70 $70.00 $1,519.00 14041 Tis trnfr f/c/c/m/n/a/g/h/f 26.88 $70.00 $1,881.60 14060 Tis trnfr e/n/e/l 10 sq cm/< 22.14 $70.00 $1,549.80 14061 Tis trnfr e/n/e/l10.1-30sqcm 28.92 $70.00 $2,024.40 14301 Tis trnfr any 30.1-60 sq cm 30.69 $70.00 $2,148.30 14302 Tis trnfr addl 30 sq cm 6.38 $70.00 $446.60 14350 Filleted finger/toe flap 19.67 $70.00 $1,376.90 1450F Symptoms improved/consist 0.00 $70.00 $0.00 1451F Sympt show clin import drop 0.00 $70.00 $0.00 1460F Qual card diag prior 12 mons 0.00 $70.00 $0.00 1461F No qual card diag prior12mon 0.00 $70.00 $0.00 1490F Dem severity classified mild 0.00 $70.00 $0.00 1491F Dem severity classified mod 0.00 $70.00 $0.00 1493F Dem severity class severe 0.00 $70.00 $0.00 1494F Cognit assessed and reviewed 0.00 $70.00 $0.00 1500F Symptom+sign symm polyneuro 0.00 $70.00 $0.00 15002 Wound prep trk/arm/leg 9.93 $70.00 $695.10 NON-FACILITY HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL 15003 Wound prep addl 100 cm 2.16 $70.00 $151.20 15004 Wound prep f/n/hf/g 11.38 $70.00 $796.60 15005 Wnd prep f/n/hf/g addl cm 3.56 $70.00 $249.20 1501F Not initial eval for cond 0.00 $70.00 $0.00 1502F Pt queried pain fxn w/ instr 0.00 $70.00 $0.00 1503F Pt queried symp resp insuff 0.00 $70.00 $0.00 1504F Pt has resp insufficiency 0.00 $70.00 $0.00 15040 Harvest cultured skin graft 7.16 $70.00 $501.20 1505F Pt has no resp insufficiency 0.00 $70.00 $0.00 15050 Skin pinch graft 15.97 $70.00 $1,117.90 15100 Skin splt grft trnk/arm/leg 24.45 $70.00 $1,711.50 15101 Skin splt grft t/a/l add-on 5.28 $70.00 $369.60 15110 Epidrm autogrft trnk/arm/leg 22.69 $70.00 $1,588.30 15111 Epidrm autogrft t/a/l add-on 3.38 $70.00 $236.60 15115 Epidrm a-grft face/nck/hf/g 22.45 $70.00 $1,571.50 15116 Epidrm a-grft f/n/hf/g addl 4.85 $70.00 $339.50 15120 Skn splt a-grft fac/nck/hf/g 24.21 $70.00 $1,694.70 15121 Skn splt a-grft f/n/hf/g add 5.91 $70.00 $413.70 15130 Derm autograft trnk/arm/leg 18.80 $70.00 $1,316.00 15131 Derm autograft t/a/l add-on 2.87 $70.00 $200.90 15135 Derm autograft face/nck/hf/g 24.19 $70.00 $1,693.30 15136 Derm autograft f/n/hf/g add 2.84 $70.00 $198.80 15150 Cult skin grft t/arm/leg 19.92 $70.00 $1,394.40 15151 Cult skin grft t/a/l addl 3.47 $70.00 $242.90 15152 Cult skin graft t/a/l +% 4.51 $70.00 $315.70 15155 Cult skin graft f/n/hf/g 22.86 $70.00 $1,600.20 15156 Cult skin grft f/n/hfg add 4.65 $70.00 $325.50 15157 Cult epiderm grft f/n/hfg +% 5.19 $70.00 $363.30 15200 Skin full graft trunk 23.74 $70.00 $1,661.80 15201 Skin full graft trunk add-on 4.21 $70.00 $294.70 15220 Skin full graft sclp/arm/leg 21.98 $70.00 $1,538.60 15221 Skin full graft add-on 3.88 $70.00 $271.60 15240 Skin full grft face/genit/hf 26.60 $70.00 $1,862.00 15241 Skin full graft add-on 5.24 $70.00 $366.80 15260 Skin full graft een & lips 28.88 $70.00 $2,021.60 15261 Skin full graft add-on 6.11 $70.00 $427.70 15271 Skin sub graft trnk/arm/leg 4.03 $70.00 $282.10 15272 Skin sub graft t/a/l add-on 0.78 $70.00 $54.60 15273 Skin sub grft t/arm/lg child 8.59 $70.00 $601.30 15274 Skn sub grft t/a/l child add 2.03 $70.00 $142.10 15275 Skin sub graft face/nk/hf/g 4.26 $70.00 $298.20 15276 Skin sub graft f/n/hf/g addl 0.99 $70.00 $69.30 15277 Skn sub grft f/n/hf/g child 9.40 $70.00 $658.00 15278 Skn sub grft f/n/hf/g ch add 2.43 $70.00 $170.10 15570 Skin pedicle flap trunk 26.08 $70.00 $1,825.60 NON-FACILITY HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL 15572 Skin pedicle flap arms/legs 25.38 $70.00 $1,776.60 15574 Pedcle fh/ch/ch/m/n/ax/g/h/f 25.93 $70.00 $1,815.10 15576 Pedicle e/n/e/l/ntroral 22.95 $70.00 $1,606.50 15600 Delay flap trunk 9.22 $70.00 $645.40 15610 Delay flap arms/legs 10.14 $70.00 $709.80 15620 Delay flap f/c/c/n/ax/g/h/f 12.42 $70.00 $869.40 15630 Delay flap eye/nos/ear/lip 13.04 $70.00 $912.80 15650 Transfer skin pedicle flap 14.34 $70.00 $1,003.80 15730 Mdfc flap w/prsrv vasc pedcl 44.24 $70.00 $3,096.80 15731 Forehead flap w/vasc pedicle 31.96 $70.00 $2,237.20 15733 Musc myoq/fscq flp h&n pedcl 30.17 $70.00 $2,111.90 15734 Muscle-skin graft trunk 43.56 $70.00 $3,049.20 15736 Muscle-skin graft arm 35.42 $70.00 $2,479.40 15738 Muscle-skin graft leg 38.08 $70.00 $2,665.60 15740 Island pedicle flap graft 28.95 $70.00 $2,026.50 15750 Neurovascular pedicle flap 26.28 $70.00 $1,839.60 15756 Free myo/skin flap microvasc 66.23 $70.00 $4,636.10 15757 Free skin flap microvasc 65.12 $70.00 $4,558.40 15758 Free fascial flap microvasc 65.77 $70.00 $4,603.90 15760 Composite skin graft 24.25 $70.00 $1,697.50 15770 Derma-fat-fascia graft 19.05 $70.00 $1,333.50 15775 Hair trnspl 1-15 punch grfts 8.64 $70.00 $604.80 15776 Hair trnspl >15 punch grafts 13.80 $70.00 $966.00 15777 Acellular derm matrix implt 6.25 $70.00 $437.50 15780 Dermabrasion total face 26.75 $70.00 $1,872.50 15781 Dermabrasion segmental face 15.85 $70.00 $1,109.50 15782 Dermabrasion other than face 17.25 $70.00 $1,207.50 15783 Dermabrasion suprfl any site 13.86 $70.00 $970.20 15786 Abrasion lesion single 7.11 $70.00 $497.70 15787 Abrasion lesions add-on 1.42 $70.00 $99.40 15788 Chemical peel face epiderm 13.19 $70.00 $923.30 15789 Chemical peel face dermal 15.91 $70.00 $1,113.70 15792 Chemical peel nonfacial 12.49 $70.00 $874.30 15793 Chemical peel nonfacial 14.08 $70.00 $985.60 15819 Plastic surgery neck 22.73 $70.00 $1,591.10 15820 Revision of lower eyelid 15.93 $70.00 $1,115.10 15821 Revision of lower eyelid 17.37 $70.00 $1,215.90 15822 Revision of upper eyelid 12.74 $70.00 $891.80 15823 Revision of upper eyelid 17.37 $70.00 $1,215.90 15824 Removal of forehead wrinkles 0.00 $70.00 $0.00 15825 Removal of neck wrinkles 0.00 $70.00 $0.00 15826 Removal of brow wrinkles 0.00 $70.00 $0.00 15828 Removal of face wrinkles 0.00 $70.00 $0.00 15829 Removal of skin wrinkles 0.00 $70.00 $0.00 15830 Exc skin abd 33.79 $70.00 $2,365.30 NON-FACILITY HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL 15832 Excise excessive skin thigh 26.19 $70.00 $1,833.30 15833 Excise excessive skin leg 25.02 $70.00 $1,751.40 15834 Excise excessive skin hip 25.49 $70.00 $1,784.30 15835 Excise excessive skin buttck 26.92 $70.00 $1,884.40 15836 Excise excessive skin arm 22.66 $70.00 $1,586.20 15837 Excise excess skin arm/hand 24.71 $70.00 $1,729.70 15838 Excise excess skin fat pad 18.30 $70.00 $1,281.00 15839 Excise excess skin & tissue 25.16 $70.00 $1,761.20 15840 Nerve palsy fascial graft 28.66 $70.00 $2,006.20 15841 Nerve palsy muscle graft 51.23 $70.00 $3,586.10 15842 Nerve palsy microsurg graft 78.10 $70.00 $5,467.00 15845 Skin and muscle repair face 28.72 $70.00 $2,010.40 15847 Exc skin abd add-on 0.00 $70.00 $0.00 15850 Remove sutures same surgeon 2.54 $70.00 $177.80 15851 Remove sutures diff surgeon 2.83 $70.00 $198.10 15852 Dressing change not for burn 1.34 $70.00 $93.80 15860 Test for blood flow in graft 3.12 $70.00 $218.40 15876 Suction lipectomy head&neck 0.00 $70.00 $0.00 15877 Suction lipectomy trunk 0.00 $70.00 $0.00 15878 Suction lipectomy upr extrem 0.00 $70.00 $0.00 15879 Suction lipectomy lwr extrem 0.00 $70.00 $0.00 15920 Removal of tail bone ulcer 17.40 $70.00 $1,218.00 15922 Removal of tail bone ulcer 22.42 $70.00 $1,569.40 15931 Remove sacrum pressure sore 19.79 $70.00 $1,385.30 15933 Remove sacrum pressure sore 24.28 $70.00 $1,699.60 15934 Remove sacrum pressure sore 26.88 $70.00 $1,881.60 15935 Remove sacrum pressure sore 31.33 $70.00 $2,193.10 15936 Remove sacrum pressure sore 25.55 $70.00 $1,788.50 15937 Remove sacrum pressure sore 29.66 $70.00 $2,076.20 15940 Remove hip pressure sore 20.02 $70.00 $1,401.40 15941 Remove hip pressure sore 25.86 $70.00 $1,810.20 15944 Remove hip pressure sore 25.47 $70.00 $1,782.90 15945 Remove hip pressure sore 28.25 $70.00 $1,977.50 15946 Remove hip pressure sore 46.91 $70.00 $3,283.70 15950 Remove thigh pressure sore 17.05 $70.00 $1,193.50 15951 Remove thigh pressure sore 25.20 $70.00 $1,764.00 15952 Remove thigh pressure sore 25.94 $70.00 $1,815.80 15953 Remove thigh pressure sore 28.54 $70.00 $1,997.80 15956 Remove thigh pressure sore 33.07 $70.00 $2,314.90 15958 Remove thigh pressure sore 33.81 $70.00 $2,366.70 15999 Removal of pressure sore 0.00 $70.00 $0.00 16000 Initial treatment of burn(s) 1.96 $70.00 $137.20 16020 Dress/debrid p-thick burn s 2.35 $70.00 $164.50 16025 Dress/debrid p-thick burn m 4.22 $70.00 $295.40 16030 Dress/debrid p-thick burn l 5.34 $70.00 $373.80 NON-FACILITY HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL 16035 Incision of burn scab initi 5.61 $70.00 $392.70 16036 Escharotomy addl incision 2.36 $70.00 $165.20 17000 Destruct premalg lesion 1.88 $70.00 $131.60 17003 Destruct premalg les 2-14 0.15 $70.00 $10.50 17004 Destroy premal lesions 15/> 4.11 $70.00 $287.70 17106 Destruction of skin lesions 9.81 $70.00 $686.70 17107 Destruction of skin lesions 12.52 $70.00 $876.40 17108 Destruction of skin lesions 18.42 $70.00 $1,289.40 17110 Destruct b9 lesion 1-14 3.18 $70.00 $222.60 17111 Destruct lesion 15 or more 3.76 $70.00 $263.20 17250 Chem caut of granltj tissue 2.29 $70.00 $160.30 17260 Destruction of skin lesions 2.72 $70.00 $190.40 17261 Destruction of skin lesions 4.11 $70.00 $287.70 17262 Destruction of skin lesions 5.00 $70.00 $350.00 17263 Destruction of skin lesions 5.45 $70.00 $381.50 17264 Destruction of skin lesions 5.85 $70.00 $409.50 17266 Destruction of skin lesions 6.61 $70.00 $462.70 17270 Destruction of skin lesions 4.31 $70.00 $301.70 17271 Destruction of skin lesions 4.66 $70.00 $326.20 17272 Destruction of skin lesions 5.32 $70.00 $372.40 17273 Destruction of skin lesions 5.91 $70.00 $413.70 17274 Destruction of skin lesions 6.99 $70.00 $489.30 17276 Destruction of skin lesions 8.09 $70.00 $566.30 17280 Destruction of skin lesions 4.03 $70.00 $282.10 17281 Destruction of skin lesions 5.08 $70.00 $355.60 17282 Destruction of skin lesions 5.82 $70.00 $407.40 17283 Destruction of skin lesions 6.97 $70.00 $487.90 17284 Destruction of skin lesions 7.98 $70.00 $558.60 17286 Destruction of skin lesions 10.18 $70.00 $712.60 17311 Mohs 1 stage h/n/hf/g 18.82 $70.00 $1,317.40 17312 Mohs addl stage 11.07 $70.00 $774.90 17313 Mohs 1 stage t/a/l 17.60 $70.00 $1,232.00 17314 Mohs addl stage t/a/l 10.57 $70.00 $739.90 17315 Mohs surg addl block 2.28 $70.00 $159.60 17340 Cryotherapy of skin 1.50 $70.00 $105.00 17360 Skin peel therapy 3.65 $70.00 $255.50 17380 Hair removal by electrolysis 0.00 $70.00 $0.00 17999 Skin tissue procedure 0.00 $70.00 $0.00 19000 Drainage of breast lesion 3.20 $70.00 $224.00 19001 Drain breast lesion add-on 0.77 $70.00 $53.90 19020 Incision of breast lesion 13.56 $70.00 $949.20 19030 Injection for breast x-ray 4.68 $70.00 $327.60 19081 Bx breast 1st lesion strtctc 19.63 $70.00 $1,374.10 19082 Bx breast add lesion strtctc 16.21 $70.00 $1,134.70 19083 Bx breast 1st lesion us imag 19.09 $70.00 $1,336.30 NON-FACILITY HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL 19084 Bx breast add lesion us imag 15.56 $70.00 $1,089.20 19085 Bx breast 1st lesion mr imag 28.52 $70.00 $1,996.40 19086 Bx breast add lesion mr imag 23.11 $70.00 $1,617.70 19100 Bx breast percut w/o image 4.29 $70.00 $300.30 19101 Biopsy of breast open 9.74 $70.00 $681.80 19105 Cryosurg ablate fa each 84.20 $70.00 $5,894.00 19110 Nipple exploration 13.93 $70.00 $975.10 19112 Excise breast duct fistula 13.16 $70.00 $921.20 19120 Removal of breast lesion 14.16 $70.00 $991.20 19125 Excision breast lesion 15.68 $70.00 $1,097.60 19126 Excision addl breast lesion 4.67 $70.00 $326.90 19260 Removal of chest wall lesion 34.67 $70.00 $2,426.90 19271 Revision of chest wall 46.77 $70.00 $3,273.90 19272 Extensive chest wall surgery 51.05 $70.00 $3,573.50 19281 Perq device breast 1st imag 6.83 $70.00 $478.10 19282 Perq device breast ea imag 4.74 $70.00 $331.80 19283 Perq dev breast 1st strtctc 7.72 $70.00 $540.40 19284 Perq dev breast add strtctc 5.81 $70.00 $406.70 19285 Perq dev breast 1st us imag 14.73 $70.00 $1,031.10 19286 Perq dev breast add us imag 12.89 $70.00 $902.30 19287 Perq dev breast 1st mr guide 24.43 $70.00 $1,710.10 19288 Perq dev breast add mr guide 19.74 $70.00 $1,381.80 19294 Prep tum cav iort prtl mast 4.72 $70.00 $330.40 19296 Place po breast cath for rad 113.16 $70.00 $7,921.20 19297 Place breast cath for rad 2.74 $70.00 $191.80 19298 Place breast rad tube/caths 28.47 $70.00 $1,992.90 19300 Removal of breast tissue 15.05 $70.00 $1,053.50 19301 Partial mastectomy 18.77 $70.00 $1,313.90 19302 P-mastectomy w/ln removal 25.88 $70.00 $1,811.60 19303 Mast simple complete 27.63 $70.00 $1,934.10 19304 Mast subq 16.60 $70.00 $1,162.00 19305 Mast radical 32.53 $70.00 $2,277.10 19306 Mast rad urban type 34.57 $70.00 $2,419.90 19307 Mast mod rad 34.46 $70.00 $2,412.20 19316 Suspension of breast 22.12 $70.00 $1,548.40 19318 Reduction of large breast 31.66 $70.00 $2,216.20 19324 Enlarge breast 15.23 $70.00 $1,066.10 19325 Enlarge breast with implant 18.44 $70.00 $1,290.80 19328 Removal of breast implant 14.24 $70.00 $996.80 19330 Removal of implant material 18.22 $70.00 $1,275.40 19340 Immediate breast prosthesis 28.81 $70.00 $2,016.70 19342 Delayed breast prosthesis 26.51 $70.00 $1,855.70 19350 Breast reconstruction 23.57 $70.00 $1,649.90 19355 Correct inverted nipple(s) 21.55 $70.00 $1,508.50 19357 Breast reconstruction 43.27 $70.00 $3,028.90 NON-FACILITY HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL 19361 Breast reconstr w/lat flap 45.32 $70.00 $3,172.40 19364 Breast reconstruction 79.39 $70.00 $5,557.30 19366 Breast reconstruction 40.66 $70.00 $2,846.20 19367 Breast reconstruction 51.60 $70.00 $3,612.00 19368 Breast reconstruction 63.37 $70.00 $4,435.90 19369 Breast reconstruction 58.81 $70.00 $4,116.70 19370 Surgery of breast capsule 19.72 $70.00 $1,380.40 19371 Removal of breast capsule 22.52 $70.00 $1,576.40 19380 Revise breast reconstruction 22.23 $70.00 $1,556.10 19396 Design custom breast implant 8.33 $70.00 $583.10 19499 Breast surgery procedure 0.00 $70.00 $0.00 2000F Blood pressure measure 0.00 $70.00 $0.00 20005 I&d abscess subfascial 8.99 $70.00 $629.30 2001F Weight record 0.00 $70.00 $0.00 2002F Clin sign vol ovrld assess 0.00 $70.00 $0.00 2004F Initial exam involved joints 0.00 $70.00 $0.00 2010F Vital signs recorded 0.00 $70.00 $0.00 20100 Explore wound neck 17.46 $70.00 $1,222.20 20101 Explore wound chest 12.91 $70.00 $903.70 20102 Explore wound abdomen 14.00 $70.00 $980.00 20103 Explore wound extremity 16.72 $70.00 $1,170.40 2014F Mental status assess 0.00 $70.00 $0.00 2015F Asthma impairment assessed 0.00 $70.00 $0.00 20150 Excise epiphyseal bar 29.12 $70.00 $2,038.40 2016F Asthma risk assessed 0.00 $70.00 $0.00 2018F Hydration status assess 0.00 $70.00 $0.00 2019F Dilated macul exam done 0.00 $70.00 $0.00 2020F Dilated fundus eval done 0.00 $70.00 $0.00 20200 Muscle biopsy 5.89 $70.00 $412.30 20205 Deep muscle biopsy 8.27 $70.00 $578.90 20206 Needle biopsy muscle 6.70 $70.00 $469.00 2021F Dilat macular exam done 0.00 $70.00 $0.00 2022F Dil retina exam interp rev 0.00 $70.00 $0.00 20220 Bone biopsy trocar/needle 4.77 $70.00 $333.90 20225 Bone biopsy trocar/needle 14.77 $70.00 $1,033.90 2024F 7 field photo interp doc rev 0.00 $70.00 $0.00 20240 Bone biopsy open superficial 4.38 $70.00 $306.60 20245 Bone biopsy open deep 10.17 $70.00 $711.90 20250 Open bone biopsy 11.20 $70.00 $784.00 20251 Open bone biopsy 12.27 $70.00 $858.90 2026F Eye image valid to dx rev 0.00 $70.00 $0.00 2027F Optic nerve head eval done 0.00 $70.00 $0.00 2028F Foot exam performed 0.00 $70.00 $0.00 2029F Complete phys skin exam done 0.00 $70.00 $0.00 2030F H2o stat docd normal 0.00 $70.00 $0.00 NON-FACILITY HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL 2031F H2o stat docd dehydrated 0.00 $70.00 $0.00 2035F Tymp memb motion examd 0.00 $70.00 $0.00 2040F Bk pn xm on init visit date 0.00 $70.00 $0.00 2044F Doc mntl tst b/4 bk trxmnt 0.00 $70.00 $0.00 2050F Wound char size etc docd 0.00 $70.00 $0.00 20500 Injection of sinus tract 3.00 $70.00 $210.00 20501 Inject sinus tract for x-ray 3.35 $70.00 $234.50 20520 Removal of foreign body 5.85 $70.00 $409.50 20525 Removal of foreign body 13.69 $70.00 $958.30 20526 Ther injection carp tunnel 2.21 $70.00 $154.70 20527 Inj dupuytren cord w/enzyme 2.41 $70.00 $168.70 20550 Inj tendon sheath/ligament 1.51 $70.00 $105.70 20551 Inj tendon origin/insertion 1.73 $70.00 $121.10 20552 Inj trigger point 1/2 muscl 1.57 $70.00 $109.90 20553 Inject trigger points 3/> 1.81 $70.00 $126.70 20555 Place ndl musc/tis for rt 9.39 $70.00 $657.30 2060F Pt talk eval hlthwkr re mdd 0.00 $70.00 $0.00 20600 Drain/inj joint/bursa w/o us 1.37 $70.00 $95.90 20604 Drain/inj joint/bursa w/us 2.05 $70.00 $143.50 20605 Drain/inj joint/bursa w/o us 1.44 $70.00 $100.80 20606 Drain/inj joint/bursa w/us 2.28 $70.00 $159.60 20610 Drain/inj joint/bursa w/o us 1.72 $70.00 $120.40 20611 Drain/inj joint/bursa w/us 2.58 $70.00 $180.60 20612 Aspirate/inj ganglion cyst 1.72 $70.00 $120.40 20615 Treatment of bone cyst 6.87 $70.00 $480.90 20650 Insert and remove bone pin 6.05 $70.00 $423.50 20660 Apply rem fixation device 7.12 $70.00 $498.40 20661 Application of head brace 14.49 $70.00 $1,014.30 20662 Application of pelvis brace 14.72 $70.00 $1,030.40 20663 Application of thigh brace 13.50 $70.00 $945.00 20664 Application of halo 25.26 $70.00 $1,768.20 20665 Removal of fixation device 3.07 $70.00 $214.90 20670 Removal of support implant 10.81 $70.00 $756.70 20680 Removal of support implant 17.68 $70.00 $1,237.60 20690 Apply bone fixation device 17.15 $70.00 $1,200.50 20692 Apply bone fixation device 32.18 $70.00 $2,252.60 20693 Adjust bone fixation device 12.75 $70.00 $892.50 20694 Remove bone fixation device 12.19 $70.00 $853.30 20696 Comp multiplane ext fixation 34.68 $70.00 $2,427.60 20697 Comp ext fixate strut change 60.45 $70.00 $4,231.50 20802 Replantation arm complete 79.67 $70.00 $5,576.90 20805 Replant forearm complete 94.88 $70.00 $6,641.60 20808 Replantation hand complete 114.69 $70.00 $8,028.30 20816 Replantation digit complete 59.71 $70.00 $4,179.70 20822 Replantation digit complete 51.29 $70.00 $3,590.30 NON-FACILITY HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL 20824 Replantation thumb complete 59.81 $70.00 $4,186.70 20827 Replantation thumb complete 52.66 $70.00 $3,686.20 20838 Replantation foot complete 73.11 $70.00 $5,117.70 20900 Removal of bone for graft 11.89 $70.00 $832.30 20902 Removal of bone for graft 8.24 $70.00 $576.80 20910 Remove cartilage for graft 13.44 $70.00 $940.80 20912 Remove cartilage for graft 13.52 $70.00 $946.40 20920 Removal of fascia for graft 11.35 $70.00 $794.50 20922 Removal of fascia for graft 16.92 $70.00 $1,184.40 20924 Removal of tendon for graft 14.58 $70.00 $1,020.60 20926 Removal of tissue for graft 12.13 $70.00 $849.10 20930 Sp bone algrft morsel add-on 0.00 $70.00 $0.00 20931 Sp bone algrft struct add-on 3.27 $70.00 $228.90 20936 Sp bone agrft local add-on 0.00 $70.00 $0.00 20937 Sp bone agrft morsel add-on 4.90 $70.00 $343.00 20938 Sp bone agrft struct add-on 5.40 $70.00 $378.00 20939 Bone marrow aspir bone grfg 1.94 $70.00 $135.80 20950 Fluid pressure muscle 7.12 $70.00 $498.40 20955 Fibula bone graft microvasc 71.40 $70.00 $4,998.00 20956 Iliac bone graft microvasc 76.62 $70.00 $5,363.40 20957 Mt bone graft microvasc 79.66 $70.00 $5,576.20 20962 Other bone graft microvasc 77.10 $70.00 $5,397.00 20969 Bone/skin graft microvasc 78.93 $70.00 $5,525.10 20970 Bone/skin graft iliac crest 82.87 $70.00 $5,800.90 20972 Bone/skin graft metatarsal 82.72 $70.00 $5,790.40 20973 Bone/skin graft great toe 87.32 $70.00 $6,112.40 20974 Electrical bone stimulation 2.20 $70.00 $154.00 20975 Electrical bone stimulation 5.17 $70.00 $361.90 20979 Us bone stimulation 1.47 $70.00 $102.90 20982 Ablate bone tumor(s) perq 111.35 $70.00 $7,794.50 20983 Ablate bone tumor(s) perq 170.65 $70.00 $11,945.50 20985 Cptr-asst dir ms px 4.26 $70.00 $298.20 20999 Musculoskeletal surgery 0.00 $70.00 $0.00 21010 Incision of jaw joint 21.95 $70.00 $1,536.50 21011 Exc face les sc <2 cm 9.91 $70.00 $693.70 21012 Exc face les sbq 2 cm/> 9.76 $70.00 $683.20 21013 Exc face tum deep < 2 cm 14.84 $70.00 $1,038.80 21014 Exc face tum deep 2 cm/> 15.03 $70.00 $1,052.10 21015 Resect face/scalp tum < 2 cm 20.35 $70.00 $1,424.50 21016 Resect face/scalp tum 2 cm/> 29.16 $70.00 $2,041.20 21025 Excision of bone lower jaw 25.43 $70.00 $1,780.10 21026 Excision of facial bone(s) 17.61 $70.00 $1,232.70 21029 Contour of face bone lesion 22.08 $70.00 $1,545.60 21030 Excise max/zygoma b9 tumor 14.86 $70.00 $1,040.20 21031 Remove exostosis mandible 11.40 $70.00 $798.00 NON-FACILITY HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL 21032 Remove exostosis maxilla 11.49 $70.00 $804.30 21034 Excise max/zygoma mal tumor 37.33 $70.00 $2,613.10 21040 Excise mandible lesion 14.96 $70.00 $1,047.20 21044 Removal of jaw bone lesion 24.96 $70.00 $1,747.20 21045 Extensive jaw surgery 35.06 $70.00 $2,454.20 21046 Remove mandible cyst complex 32.07 $70.00 $2,244.90 21047 Excise lwr jaw cyst w/repair 37.67 $70.00 $2,636.90 21048 Remove maxilla cyst complex 32.69 $70.00 $2,288.30 21049 Excis uppr jaw cyst w/repair 34.33 $70.00 $2,403.10 21050 Removal of jaw joint 25.94 $70.00 $1,815.80 21060 Remove jaw joint cartilage 23.58 $70.00 $1,650.60 21070 Remove coronoid process 18.49 $70.00 $1,294.30 21073 Mnpj of tmj w/anesth 11.03 $70.00 $772.10 21076 Prepare face/oral prosthesis 28.26 $70.00 $1,978.20 21077 Prepare face/oral prosthesis 71.13 $70.00 $4,979.10 21079 Prepare face/oral prosthesis 48.00 $70.00 $3,360.00 21080 Prepare face/oral prosthesis 54.05 $70.00 $3,783.50 21081 Prepare face/oral prosthesis 49.71 $70.00 $3,479.70 21082 Prepare face/oral prosthesis 46.82 $70.00 $3,277.40 21083 Prepare face/oral prosthesis 44.62 $70.00 $3,123.40 21084 Prepare face/oral prosthesis 51.19 $70.00 $3,583.30 21085 Prepare face/oral prosthesis 21.50 $70.00 $1,505.00 21086 Prepare face/oral prosthesis 52.77 $70.00 $3,693.90 21087 Prepare face/oral prosthesis 52.85 $70.00 $3,699.50 21088 Prepare face/oral prosthesis 0.00 $70.00 $0.00 21089 Prepare face/oral prosthesis 0.00 $70.00 $0.00 21100 Maxillofacial fixation 20.66 $70.00 $1,446.20 21110 Interdental fixation 22.84 $70.00 $1,598.80 21116 Injection jaw joint x-ray 4.68 $70.00 $327.60 21120 Reconstruction of chin 19.68 $70.00 $1,377.60 21121 Reconstruction of chin 22.02 $70.00 $1,541.40 21122 Reconstruction of chin 22.85 $70.00 $1,599.50 21123 Reconstruction of chin 26.45 $70.00 $1,851.50 21125 Augmentation lower jaw bone 84.42 $70.00 $5,909.40 21127 Augmentation lower jaw bone 107.99 $70.00 $7,559.30 21137 Reduction of forehead 21.66 $70.00 $1,516.20 21138 Reduction of forehead 26.47 $70.00 $1,852.90 21139 Reduction of forehead 32.44 $70.00 $2,270.80 21141 Lefort i-1 piece w/o graft 39.21 $70.00 $2,744.70 21142 Lefort i-2 piece w/o graft 40.31 $70.00 $2,821.70 21143 Lefort i-3/> piece w/o graft 42.30 $70.00 $2,961.00 21145 Lefort i-1 piece w/ graft 46.02 $70.00 $3,221.40 21146 Lefort i-2 piece w/ graft 47.98 $70.00 $3,358.60 21147 Lefort i-3/> piece w/ graft 50.58 $70.00 $3,540.60 21150 Lefort ii anterior intrusion 47.56 $70.00 $3,329.20 NON-FACILITY HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL 21151 Lefort ii w/bone grafts 50.95 $70.00 $3,566.50 21154 Lefort iii w/o lefort i 56.27 $70.00 $3,938.90 21155 Lefort iii w/ lefort i 62.41 $70.00 $4,368.70 21159 Lefort iii w/fhdw/o lefort i 74.78 $70.00 $5,234.60 21160 Lefort iii w/fhd w/ lefort i 81.09 $70.00 $5,676.30 21172 Reconstruct orbit/forehead 60.13 $70.00 $4,209.10 21175 Reconstruct orbit/forehead 63.73 $70.00 $4,461.10 21179 Reconstruct entire forehead 43.76 $70.00 $3,063.20 21180 Reconstruct entire forehead 49.03 $70.00 $3,432.10 21181 Contour cranial bone lesion 21.31 $70.00 $1,491.70 21182 Reconstruct cranial bone 61.29 $70.00 $4,290.30 21183 Reconstruct cranial bone 66.79 $70.00 $4,675.30 21184 Reconstruct cranial bone 71.93 $70.00 $5,035.10 21188 Reconstruction of midface 48.59 $70.00 $3,401.30 21193 Reconst lwr jaw w/o graft 36.82 $70.00 $2,577.40 21194 Reconst lwr jaw w/graft 42.17 $70.00 $2,951.90 21195 Reconst lwr jaw w/o fixation 41.33 $70.00 $2,893.10 21196 Reconst lwr jaw w/fixation 42.59 $70.00 $2,981.30 21198 Reconstr lwr jaw segment 33.61 $70.00 $2,352.70 21199 Reconstr lwr jaw w/advance 31.08 $70.00 $2,175.60 21206 Reconstruct upper jaw bone 34.52 $70.00 $2,416.40 21208 Augmentation of facial bones 50.63 $70.00 $3,544.10 21209 Reduction of facial bones 25.38 $70.00 $1,776.60 21210 Face bone graft 63.80 $70.00 $4,466.00 21215 Lower jaw bone graft 111.22 $70.00 $7,785.40 21230 Rib cartilage graft 21.28 $70.00 $1,489.60 21235 Ear cartilage graft 20.63 $70.00 $1,444.10 21240 Reconstruction of jaw joint 32.24 $70.00 $2,256.80 21242 Reconstruction of jaw joint 29.91 $70.00 $2,093.70 21243 Reconstruction of jaw joint 49.27 $70.00 $3,448.90 21244 Reconstruction of lower jaw 30.34 $70.00 $2,123.80 21245 Reconstruction of jaw 34.57 $70.00 $2,419.90 21246 Reconstruction of jaw 25.39 $70.00 $1,777.30 21247 Reconstruct lower jaw bone 47.23 $70.00 $3,306.10 21248 Reconstruction of jaw 31.63 $70.00 $2,214.10 21249 Reconstruction of jaw 44.62 $70.00 $3,123.40 21255 Reconstruct lower jaw bone 41.00 $70.00 $2,870.00 21256 Reconstruction of orbit 35.87 $70.00 $2,510.90 21260 Revise eye sockets 40.59 $70.00 $2,841.30 21261 Revise eye sockets 71.77 $70.00 $5,023.90 21263 Revise eye sockets 66.39 $70.00 $4,647.30 21267 Revise eye sockets 47.52 $70.00 $3,326.40 21268 Revise eye sockets 59.43 $70.00 $4,160.10 21270 Augmentation cheek bone 29.21 $70.00 $2,044.70 21275 Revision orbitofacial bones 24.11 $70.00 $1,687.70 NON-FACILITY HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL 21280 Revision of eyelid 16.33 $70.00 $1,143.10 21282 Revision of eyelid 10.93 $70.00 $765.10 21295 Revision of jaw muscle/bone 5.31 $70.00 $371.70 21296 Revision of jaw muscle/bone 11.80 $70.00 $826.00 21299 Cranio/maxillofacial surgery 0.00 $70.00 $0.00 21310 Closed tx nose fx w/o manj 3.87 $70.00 $270.90 21315 Closed tx nose fx w/o stablj 7.78 $70.00 $544.60 21320 Closed tx nose fx w/ stablj 7.20 $70.00 $504.00 21325 Open tx nose fx uncomplicatd 13.38 $70.00 $936.60 21330 Open tx nose fx w/skele fixj 16.14 $70.00 $1,129.80 21335 Open tx nose & septal fx 20.53 $70.00 $1,437.10 21336 Open tx septal fx w/wo stabj 18.31 $70.00 $1,281.70 21337 Closed tx septal&nose fx 11.47 $70.00 $802.90 21338 Open nasoethmoid fx w/o fixj 18.77 $70.00 $1,313.90 21339 Open nasoethmoid fx w/ fixj 21.32 $70.00 $1,492.40 21340 Perq tx nasoethmoid fx 21.12 $70.00 $1,478.40 21343 Open tx dprsd front sinus fx 30.61 $70.00 $2,142.70 21344 Open tx compl front sinus fx 39.29 $70.00 $2,750.30 21345 Closed tx nose/jaw fx 21.95 $70.00 $1,536.50 21346 Opn tx nasomax fx w/fixj 25.49 $70.00 $1,784.30 21347 Opn tx nasomax fx multple 28.67 $70.00 $2,006.90 21348 Opn tx nasomax fx w/graft 30.66 $70.00 $2,146.20 21355 Perq tx malar fracture 12.03 $70.00 $842.10 21356 Opn tx dprsd zygomatic arch 14.30 $70.00 $1,001.00 21360 Opn tx dprsd malar fracture 15.40 $70.00 $1,078.00 21365 Opn tx complx malar fx 31.94 $70.00 $2,235.80 21366 Opn tx complx malar w/grft 36.74 $70.00 $2,571.80 21385 Opn tx orbit fx transantral 21.98 $70.00 $1,538.60 21386 Opn tx orbit fx periorbital 20.06 $70.00 $1,404.20 21387 Opn tx orbit fx combined 22.92 $70.00 $1,604.40 21390 Opn tx orbit periorbtl implt 22.84 $70.00 $1,598.80 21395 Opn tx orbit periorbt w/grft 29.06 $70.00 $2,034.20 21400 Closed tx orbit w/o manipulj 5.51 $70.00 $385.70 21401 Closed tx orbit w/manipulj 14.85 $70.00 $1,039.50 21406 Opn tx orbit fx w/o implant 16.51 $70.00 $1,155.70 21407 Opn tx orbit fx w/implant 18.45 $70.00 $1,291.50 21408 Opn tx orbit fx w/bone grft 25.93 $70.00 $1,815.10 21421 Treat mouth roof fracture 21.15 $70.00 $1,480.50 21422 Treat mouth roof fracture 19.31 $70.00 $1,351.70 21423 Treat mouth roof fracture 22.63 $70.00 $1,584.10 21431 Treat craniofacial fracture 20.65 $70.00 $1,445.50 21432 Treat craniofacial fracture 20.69 $70.00 $1,448.30 21433 Treat craniofacial fracture 50.18 $70.00 $3,512.60 21435 Treat craniofacial fracture 40.48 $70.00 $2,833.60 21436 Treat craniofacial fracture 58.90 $70.00 $4,123.00 NON-FACILITY HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL 21440 Treat dental ridge fracture 16.60 $70.00 $1,162.00 21445 Treat dental ridge fracture 22.21 $70.00 $1,554.70 21450 Treat lower jaw fracture 16.17 $70.00 $1,131.90 21451 Treat lower jaw fracture 21.48 $70.00 $1,503.60 21452 Treat lower jaw fracture 18.30 $70.00 $1,281.00 21453 Treat lower jaw fracture 26.13 $70.00 $1,829.10 21454 Treat lower jaw fracture 16.23 $70.00 $1,136.10 21461 Treat lower jaw fracture 61.10 $70.00 $4,277.00 21462 Treat lower jaw fracture 65.16 $70.00 $4,561.20 21465 Treat lower jaw fracture 26.77 $70.00 $1,873.90 21470 Treat lower jaw fracture 34.62 $70.00 $2,423.40 21480 Reset dislocated jaw 2.82 $70.00 $197.40 21485 Reset dislocated jaw 22.25 $70.00 $1,557.50 21490 Repair dislocated jaw 26.42 $70.00 $1,849.40 21497 Interdental wiring 19.23 $70.00 $1,346.10 21499 Head surgery procedure 0.00 $70.00 $0.00 21501 Drain neck/chest lesion 12.94 $70.00 $905.80 21502 Drain chest lesion 14.50 $70.00 $1,015.00 21510 Drainage of bone lesion 12.71 $70.00 $889.70 21550 Biopsy of neck/chest 7.47 $70.00 $522.90 21552 Exc neck les sc 3 cm/> 12.87 $70.00 $900.90 21554 Exc neck tum deep 5 cm/> 21.05 $70.00 $1,473.50 21555 Exc neck les sc < 3 cm 11.88 $70.00 $831.60 21556 Exc neck tum deep < 5 cm 15.13 $70.00 $1,059.10 21557 Resect neck thorax tumor<5cm 27.41 $70.00 $1,918.70 21558 Resect neck tumor 5 cm/> 38.67 $70.00 $2,706.90 21600 Partial removal of rib 15.90 $70.00 $1,113.00 21610 Partial removal of rib 35.05 $70.00 $2,453.50 21615 Removal of rib 17.76 $70.00 $1,243.20 21616 Removal of rib and nerves 20.66 $70.00 $1,446.20 21620 Partial removal of sternum 14.52 $70.00 $1,016.40 21627 Sternal debridement 15.51 $70.00 $1,085.70 21630 Extensive sternum surgery 35.37 $70.00 $2,475.90 21632 Extensive sternum surgery 34.81 $70.00 $2,436.70 21685 Hyoid myotomy & suspension 28.10 $70.00 $1,967.00 21700 Revision of neck muscle 10.39 $70.00 $727.30 21705 Revision of neck muscle/rib 15.53 $70.00 $1,087.10 21720 Revision of neck muscle 15.17 $70.00 $1,061.90 21725 Revision of neck muscle 15.58 $70.00 $1,090.60 21740 Reconstruction of sternum 29.84 $70.00 $2,088.80 21742 Repair stern/nuss w/o scope 0.00 $70.00 $0.00 21743 Repair sternum/nuss w/scope 0.00 $70.00 $0.00 21750 Repair of sternum separation 19.71 $70.00 $1,379.70 21811 Optx of rib fx w/fixj scope 17.27 $70.00 $1,208.90 21812 Treatment of rib fracture 21.03 $70.00 $1,472.10 NON-FACILITY HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL 21813 Treatment of rib fracture 28.66 $70.00 $2,006.20 21820 Treat sternum fracture 4.07 $70.00 $284.90 21825 Treat sternum fracture 15.51 $70.00 $1,085.70 21899 Neck/chest surgery procedure 0.00 $70.00 $0.00 21920 Biopsy soft tissue of back 7.34 $70.00 $513.80 21925 Biopsy soft tissue of back 12.87 $70.00 $900.90 21930 Exc back les sc < 3 cm 13.58 $70.00 $950.60 21931 Exc back les sc 3 cm/> 13.56 $70.00 $949.20 21932 Exc back tum deep < 5 cm 19.08 $70.00 $1,335.60 21933 Exc back tum deep 5 cm/> 21.28 $70.00 $1,489.60 21935 Resect back tum < 5 cm 29.61 $70.00 $2,072.70 21936 Resect back tum 5 cm/> 40.90 $70.00 $2,863.00 22010 I&d p-spine c/t/cerv-thor 27.54 $70.00 $1,927.80 22015 I&d abscess p-spine l/s/ls 27.32 $70.00 $1,912.40 22100 Remove part of neck vertebra 26.25 $70.00 $1,837.50 22101 Remove part thorax vertebra 26.06 $70.00 $1,824.20 22102 Remove part lumbar vertebra 22.93 $70.00 $1,605.10 22103 Remove extra spine segment 4.10 $70.00 $287.00 22110 Remove part of neck vertebra 30.20 $70.00 $2,114.00 22112 Remove part thorax vertebra 32.64 $70.00 $2,284.80 22114 Remove part lumbar vertebra 32.64 $70.00 $2,284.80 22116 Remove extra spine segment 4.13 $70.00 $289.10 22206 Incis spine 3 column thorac 70.90 $70.00 $4,963.00 22207 Incis spine 3 column lumbar 69.79 $70.00 $4,885.30 22208 Incis spine 3 column adl seg 17.33 $70.00 $1,213.10 22210 Incis 1 vertebral seg cerv 52.02 $70.00 $3,641.40 22212 Incis 1 vertebral seg thorac 43.10 $70.00 $3,017.00 22214 Incis 1 vertebral seg lumbar 43.21 $70.00 $3,024.70 22216 Incis addl spine segment 10.61 $70.00 $742.70 22220 Incis w/discectomy cervical 46.50 $70.00 $3,255.00 22222 Incis w/discectomy thoracic 50.90 $70.00 $3,563.00 22224 Incis w/discectomy lumbar 45.92 $70.00 $3,214.40 22226 Revise extra spine segment 10.59 $70.00 $741.30 22310 Closed tx vert fx w/o manj 8.88 $70.00 $621.60 22315 Closed tx vert fx w/manj 25.43 $70.00 $1,780.10 22318 Treat odontoid fx w/o graft 47.61 $70.00 $3,332.70 22319 Treat odontoid fx w/graft 53.44 $70.00 $3,740.80 22325 Treat spine fracture 41.78 $70.00 $2,924.60 22326 Treat neck spine fracture 43.41 $70.00 $3,038.70 22327 Treat thorax spine fracture 43.61 $70.00 $3,052.70 22328 Treat each add spine fx 8.25 $70.00 $577.50 22505 Manipulation of spine 3.81 $70.00 $266.70 22510 Perq cervicothoracic inject 47.99 $70.00 $3,359.30 22511 Perq lumbosacral injection 47.38 $70.00 $3,316.60 22512 Vertebroplasty addl inject 27.18 $70.00 $1,902.60 NON-FACILITY HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL 22513 Perq vertebral augmentation 203.56 $70.00 $14,249.20 22514 Perq vertebral augmentation 202.60 $70.00 $14,182.00 22515 Perq vertebral augmentation 122.65 $70.00 $8,585.50 22526 Idet single level 66.59 $70.00 $4,661.30 22527 Idet 1 or more levels 56.25 $70.00 $3,937.50 22532 Lat thorax spine fusion 52.09 $70.00 $3,646.30 22533 Lat lumbar spine fusion 48.14 $70.00 $3,369.80 22534 Lat thor/lumb addl seg 10.53 $70.00 $737.10 22548 Neck spine fusion 57.39 $70.00 $4,017.30 22551 Neck spine fuse&remov bel c2 49.71 $70.00 $3,479.70 22552 Addl neck spine fusion 11.64 $70.00 $814.80 22554 Neck spine fusion 36.40 $70.00 $2,548.00 22556 Thorax spine fusion 48.47 $70.00 $3,392.90 22558 Lumbar spine fusion 44.54 $70.00 $3,117.80 22585 Additional spinal fusion 9.58 $70.00 $670.60 22586 Prescrl fuse w/ instr l5-s1 58.29 $70.00 $4,080.30 22590 Spine & skull spinal fusion 45.92 $70.00 $3,214.40 22595 Neck spinal fusion 43.83 $70.00 $3,068.10 22600 Neck spine fusion 37.45 $70.00 $2,621.50 22610 Thorax spine fusion 36.71 $70.00 $2,569.70 22612 Lumbar spine fusion 46.10 $70.00 $3,227.00 22614 Spine fusion extra segment 11.43 $70.00 $800.10 22630 Lumbar spine fusion 45.76 $70.00 $3,203.20 22632 Spine fusion extra segment 9.42 $70.00 $659.40 22633 Lumbar spine fusion combined 53.87 $70.00 $3,770.90 22634 Spine fusion extra segment 14.50 $70.00 $1,015.00 22800 Post fusion vert seg 70.48 $70.00 $4,933.60 22808 Ant fusion 2-3 vert seg 53.95 $70.00 $3,776.50 22810 Ant fusion 4-7 vert seg 57.25 $70.00 $4,007.50 22812 Ant fusion 8/> vert seg 64.08 $70.00 $4,485.60 22818 Kyphectomy 1-2 segments 62.96 $70.00 $4,407.20 22819 Kyphectomy 3 or more 72.37 $70.00 $5,065.90 22830 Exploration of spinal fusion 23.60 $70.00 $1,652.00 22840 Insert spine fixation device 22.22 $70.00 $1,555.40 22841 Insert spine fixation device 0.00 $70.00 $0.00 22842 Insert spine fixation device 22.31 $70.00 $1,561.70 22843 Insert spine fixation device 23.87 $70.00 $1,670.90 22844 Insert spine fixation device 28.83 $70.00 $2,018.10 22845 Insert spine fixation device 21.35 $70.00 $1,494.50 22846 Insert spine fixation device 22.16 $70.00 $1,551.20 22847 Insert spine fixation device 23.55 $70.00 $1,648.50 22848 Insert pelv fixation device 10.51 $70.00 $735.70 22849 Reinsert spinal fixation 37.73 $70.00 $2,641.10 NON-FACILITY HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL 22850 Remove spine fixation device 20.96 $70.00 $1,467.20 22852 Remove spine fixation device 20.12 $70.00 $1,408.40 22853 Insj biomechanical device 7.29 $70.00 $510.30 22854 Insj biomechanical device 9.43 $70.00 $660.10 22855 Remove spine fixation device 32.16 $70.00 $2,251.20 22856 Cerv artific diskectomy 47.57 $70.00 $3,329.90 22857 Lumbar artif diskectomy 49.11 $70.00 $3,437.70 22858 Second level cer diskectomy 14.94 $70.00 $1,045.80 22859 Insj biomechanical device 9.43 $70.00 $660.10 22861 Revise cerv artific disc 68.15 $70.00 $4,770.50 22862 Revise lumbar artif disc 67.83 $70.00 $4,748.10 22864 Remove cerv artif disc 60.79 $70.00 $4,255.30 22865 Remove lumb artif disc 59.09 $70.00 $4,136.30 22867 Insj stablj dev w/dcmprn 27.01 $70.00 $1,890.70 22868 Insj stablj dev w/dcmprn 6.88 $70.00 $481.60 22869 Insj stablj dev w/o dcmprn 15.33 $70.00 $1,073.10 22870 Insj stablj dev w/o dcmprn 3.96 $70.00 $277.20 22899 Spine surgery procedure 0.00 $70.00 $0.00 22900 Exc abdl tum deep < 5 cm 16.28 $70.00 $1,139.60 22901 Exc abdl tum deep 5 cm/> 19.22 $70.00 $1,345.40 22902 Exc abd les sc < 3 cm 12.57 $70.00 $879.90 22903 Exc abd les sc 3 cm/> 12.67 $70.00 $886.90 22904 Radical resect abd tumor<5cm 30.33 $70.00 $2,123.10 22905 Rad resect abd tumor 5 cm/> 38.50 $70.00 $2,695.00 22999 Abdomen surgery procedure 0.00 $70.00 $0.00 23000 Removal of calcium deposits 16.63 $70.00 $1,164.10 23020 Release shoulder joint 19.84 $70.00 $1,388.80 23030 Drain shoulder lesion 12.80 $70.00 $896.00 23031 Drain shoulder bursa 11.96 $70.00 $837.20 23035 Drain shoulder bone lesion 19.55 $70.00 $1,368.50 23040 Exploratory shoulder surgery 20.63 $70.00 $1,444.10 23044 Exploratory shoulder surgery 16.29 $70.00 $1,140.30 23065 Biopsy shoulder tissues 6.23 $70.00 $436.10 23066 Biopsy shoulder tissues 16.01 $70.00 $1,120.70 23071 Exc shoulder les sc 3 cm/> 12.11 $70.00 $847.70 23073 Exc shoulder tum deep 5 cm/> 20.02 $70.00 $1,401.40 23075 Exc shoulder les sc < 3 cm 13.52 $70.00 $946.40 23076 Exc shoulder tum deep < 5 cm 15.55 $70.00 $1,088.50 23077 Resect shoulder tumor < 5 cm 32.89 $70.00 $2,302.30 23078 Resect shoulder tumor 5 cm/> 41.50 $70.00 $2,905.00 23100 Biopsy of shoulder joint 14.42 $70.00 $1,009.40 23101 Shoulder joint surgery 13.13 $70.00 $919.10 23105 Remove shoulder joint lining 18.37 $70.00 $1,285.90 23106 Incision of collarbone joint 14.29 $70.00 $1,000.30 23107 Explore treat shoulder joint 19.03 $70.00 $1,332.10 NON-FACILITY HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL 23120 Partial removal collar bone 16.80 $70.00 $1,176.00 23125 Removal of collar bone 20.43 $70.00 $1,430.10 23130 Remove shoulder bone part 17.54 $70.00 $1,227.80 23140 Removal of bone lesion 15.37 $70.00 $1,075.90 23145 Removal of bone lesion 20.01 $70.00 $1,400.70 23146 Removal of bone lesion 17.88 $70.00 $1,251.60 23150 Removal of humerus lesion 19.09 $70.00 $1,336.30 23155 Removal of humerus lesion 22.85 $70.00 $1,599.50 23156 Removal of humerus lesion 19.51 $70.00 $1,365.70 23170 Remove collar bone lesion 16.14 $70.00 $1,129.80 23172 Remove shoulder blade lesion 16.30 $70.00 $1,141.00 23174 Remove humerus lesion 21.83 $70.00 $1,528.10 23180 Remove collar bone lesion 18.83 $70.00 $1,318.10 23182 Remove shoulder blade lesion 18.86 $70.00 $1,320.20 23184 Remove humerus lesion 21.00 $70.00 $1,470.00 23190 Partial removal of scapula 16.46 $70.00 $1,152.20 23195 Removal of head of humerus 21.77 $70.00 $1,523.90 23200 Resect clavicle tumor 43.82 $70.00 $3,067.40 23210 Resect scapula tumor 51.50 $70.00 $3,605.00 23220 Resect prox humerus tumor 56.57 $70.00 $3,959.90 23330 Remove shoulder foreign body 7.83 $70.00 $548.10 23333 Remove shoulder fb deep 13.39 $70.00 $937.30 23334 Shoulder prosthesis removal 31.02 $70.00 $2,171.40 23335 Shoulder prosthesis removal 36.93 $70.00 $2,585.10 23350 Injection for shoulder x-ray 3.70 $70.00 $259.00 23395 Muscle transfer shoulder/arm 36.94 $70.00 $2,585.80 23397 Muscle transfers 32.76 $70.00 $2,293.20 23400 Fixation of shoulder blade 28.00 $70.00 $1,960.00 23405 Incision of tendon & muscle 17.81 $70.00 $1,246.70 23406 Incise tendon(s) & muscle(s) 22.16 $70.00 $1,551.20 23410 Repair rotator cuff acute 23.64 $70.00 $1,654.80 23412 Repair rotator cuff chronic 24.53 $70.00 $1,717.10 23415 Release of shoulder ligament 20.05 $70.00 $1,403.50 23420 Repair of shoulder 27.92 $70.00 $1,954.40 23430 Repair biceps tendon 21.40 $70.00 $1,498.00 23440 Remove/transplant tendon 21.69 $70.00 $1,518.30 23450 Repair shoulder capsule 27.36 $70.00 $1,915.20 23455 Repair shoulder capsule 28.72 $70.00 $2,010.40 23460 Repair shoulder capsule 31.45 $70.00 $2,201.50 23462 Repair shoulder capsule 30.70 $70.00 $2,149.00 23465 Repair shoulder capsule 32.27 $70.00 $2,258.90 23466 Repair shoulder capsule 32.44 $70.00 $2,270.80 23470 Reconstruct shoulder joint 34.58 $70.00 $2,420.60 23472 Reconstruct shoulder joint 42.01 $70.00 $2,940.70 23473 Revis reconst shoulder joint 46.89 $70.00 $3,282.30 NON-FACILITY HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL 23474 Revis reconst shoulder joint 50.64 $70.00 $3,544.80 23480 Revision of collar bone 23.67 $70.00 $1,656.90 23485 Revision of collar bone 27.40 $70.00 $1,918.00 23490 Reinforce clavicle 24.86 $70.00 $1,740.20 23491 Reinforce shoulder bones 29.26 $70.00 $2,048.20 23500 Treat clavicle fracture 6.27 $70.00 $438.90 23505 Treat clavicle fracture 10.10 $70.00 $707.00 23515 Treat clavicle fracture 20.70 $70.00 $1,449.00 23520 Treat clavicle dislocation 6.66 $70.00 $466.20 23525 Treat clavicle dislocation 11.06 $70.00 $774.20 23530 Treat clavicle dislocation 16.47 $70.00 $1,152.90 23532 Treat clavicle dislocation 17.97 $70.00 $1,257.90 23540 Treat clavicle dislocation 6.45 $70.00 $451.50 23545 Treat clavicle dislocation 9.80 $70.00 $686.00 23550 Treat clavicle dislocation 16.16 $70.00 $1,131.20 23552 Treat clavicle dislocation 18.81 $70.00 $1,316.70 23570 Treat shoulder blade fx 6.67 $70.00 $466.90 23575 Treat shoulder blade fx 11.53 $70.00 $807.10 23585 Treat scapula fracture 28.22 $70.00 $1,975.40 23600 Treat humerus fracture 9.36 $70.00 $655.20 23605 Treat humerus fracture 13.27 $70.00 $928.90 23615 Treat humerus fracture 25.47 $70.00 $1,782.90 23616 Treat humerus fracture 35.75 $70.00 $2,502.50 23620 Treat humerus fracture 7.72 $70.00 $540.40 23625 Treat humerus fracture 10.83 $70.00 $758.10 23630 Treat humerus fracture 22.43 $70.00 $1,570.10 23650 Treat shoulder dislocation 9.02 $70.00 $631.40 23655 Treat shoulder dislocation 11.52 $70.00 $806.40 23660 Treat shoulder dislocation 16.76 $70.00 $1,173.20 23665 Treat dislocation/fracture 12.18 $70.00 $852.60 23670 Treat dislocation/fracture 25.17 $70.00 $1,761.90 23675 Treat dislocation/fracture 15.71 $70.00 $1,099.70 23680 Treat dislocation/fracture 26.76 $70.00 $1,873.20 23700 Fixation of shoulder 5.65 $70.00 $395.50 23800 Fusion of shoulder joint 29.58 $70.00 $2,070.60 23802 Fusion of shoulder joint 37.07 $70.00 $2,594.90 23900 Amputation of arm & girdle 40.10 $70.00 $2,807.00 23920 Amputation at shoulder joint 32.55 $70.00 $2,278.50 23921 Amputation follow-up surgery 13.46 $70.00 $942.20 23929 Shoulder surgery procedure 0.00 $70.00 $0.00 23930 Drainage of arm lesion 10.27 $70.00 $718.90 23931 Drainage of arm bursa 8.28 $70.00 $579.60 23935 Drain arm/elbow bone lesion 14.51 $70.00 $1,015.70 24000 Exploratory elbow surgery 13.70 $70.00 $959.00 24006 Release elbow joint 20.43 $70.00 $1,430.10 NON-FACILITY HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL 24065 Biopsy arm/elbow soft tissue 7.35 $70.00 $514.50 24066 Biopsy arm/elbow soft tissue 17.78 $70.00 $1,244.60 24071 Exc arm/elbow les sc 3 cm/> 11.72 $70.00 $820.40 24073 Ex arm/elbow tum deep 5 cm/> 19.99 $70.00 $1,399.30 24075 Exc arm/elbow les sc < 3 cm 14.08 $70.00 $985.60 24076 Ex arm/elbow tum deep < 5 cm 15.67 $70.00 $1,096.90 24077 Resect arm/elbow tum < 5 cm 29.89 $70.00 $2,092.30 24079 Resect arm/elbow tum 5 cm/> 38.35 $70.00 $2,684.50 24100 Biopsy elbow joint lining 12.01 $70.00 $840.70 24101 Explore/treat elbow joint 14.34 $70.00 $1,003.80 24102 Remove elbow joint lining 17.70 $70.00 $1,239.00 24105 Removal of elbow bursa 10.07 $70.00 $704.90 24110 Remove humerus lesion 16.87 $70.00 $1,180.90 24115 Remove/graft bone lesion 21.24 $70.00 $1,486.80 24116 Remove/graft bone lesion 24.85 $70.00 $1,739.50 24120 Remove elbow lesion 15.24 $70.00 $1,066.80 24125 Remove/graft bone lesion 17.86 $70.00 $1,250.20 24126 Remove/graft bone lesion 18.69 $70.00 $1,308.30 24130 Removal of head of radius 14.61 $70.00 $1,022.70 24134 Removal of arm bone lesion 21.53 $70.00 $1,507.10 24136 Remove radius bone lesion 18.16 $70.00 $1,271.20 24138 Remove elbow bone lesion 19.42 $70.00 $1,359.40 24140 Partial removal of arm bone 20.21 $70.00 $1,414.70 24145 Partial removal of radius 17.04 $70.00 $1,192.80 24147 Partial removal of elbow 17.91 $70.00 $1,253.70 24149 Radical resection of elbow 33.84 $70.00 $2,368.80 24150 Resect distal humerus tumor 44.99 $70.00 $3,149.30 24152 Resect radius tumor 39.06 $70.00 $2,734.20 24155 Removal of elbow joint 24.61 $70.00 $1,722.70 24160 Remove elbow joint implant 36.42 $70.00 $2,549.40 24164 Remove radius head implant 21.00 $70.00 $1,470.00 24200 Removal of arm foreign body 5.94 $70.00 $415.80 24201 Removal of arm foreign body 15.80 $70.00 $1,106.00 24220 Injection for elbow x-ray 4.47 $70.00 $312.90 24300 Manipulate elbow w/anesth 11.93 $70.00 $835.10 24301 Muscle/tendon transfer 21.60 $70.00 $1,512.00 24305 Arm tendon lengthening 16.58 $70.00 $1,160.60 24310 Revision of arm tendon 13.46 $70.00 $942.20 24320 Repair of arm tendon 22.50 $70.00 $1,575.00 24330 Revision of arm muscles 20.68 $70.00 $1,447.60 24331 Revision of arm muscles 22.66 $70.00 $1,586.20 24332 Tenolysis triceps 17.63 $70.00 $1,234.10 24340 Repair of biceps tendon 17.62 $70.00 $1,233.40 24341 Repair arm tendon/muscle 21.42 $70.00 $1,499.40 24342 Repair of ruptured tendon 22.31 $70.00 $1,561.70 NON-FACILITY HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL 24343 Repr elbow lat ligmnt w/tiss 20.31 $70.00 $1,421.70 24344 Reconstruct elbow lat ligmnt 31.72 $70.00 $2,220.40 24345 Repr elbw med ligmnt w/tissu 20.20 $70.00 $1,414.00 24346 Reconstruct elbow med ligmnt 31.67 $70.00 $2,216.90 24357 Repair elbow perc 12.05 $70.00 $843.50 24358 Repair elbow w/deb open 15.03 $70.00 $1,052.10 24359 Repair elbow deb/attch open 18.98 $70.00 $1,328.60 24360 Reconstruct elbow joint 25.93 $70.00 $1,815.10 24361 Reconstruct elbow joint 29.02 $70.00 $2,031.40 24362 Reconstruct elbow joint 30.58 $70.00 $2,140.60 24363 Replace elbow joint 42.02 $70.00 $2,941.40 24365 Reconstruct head of radius 18.41 $70.00 $1,288.70 24366 Reconstruct head of radius 19.56 $70.00 $1,369.20 24370 Revise reconst elbow joint 44.55 $70.00 $3,118.50 24371 Revise reconst elbow joint 51.96 $70.00 $3,637.20 24400 Revision of humerus 23.59 $70.00 $1,651.30 24410 Revision of humerus 30.48 $70.00 $2,133.60 24420 Revision of humerus 28.67 $70.00 $2,006.90 24430 Repair of humerus 30.41 $70.00 $2,128.70 24435 Repair humerus with graft 30.97 $70.00 $2,167.90 24470 Revision of elbow joint 19.32 $70.00 $1,352.40 24495 Decompression of forearm 21.22 $70.00 $1,485.40 24498 Reinforce humerus 24.94 $70.00 $1,745.80 24500 Treat humerus fracture 10.28 $70.00 $719.60 24505 Treat humerus fracture 14.22 $70.00 $995.40 24515 Treat humerus fracture 25.22 $70.00 $1,765.40 24516 Treat humerus fracture 24.75 $70.00 $1,732.50 24530 Treat humerus fracture 10.91 $70.00 $763.70 24535 Treat humerus fracture 17.70 $70.00 $1,239.00 24538 Treat humerus fracture 21.40 $70.00 $1,498.00 24545 Treat humerus fracture 26.78 $70.00 $1,874.60 24546 Treat humerus fracture 29.94 $70.00 $2,095.80 24560 Treat humerus fracture 9.21 $70.00 $644.70 24565 Treat humerus fracture 15.32 $70.00 $1,072.40 24566 Treat humerus fracture 20.63 $70.00 $1,444.10 24575 Treat humerus fracture 21.12 $70.00 $1,478.40 24576 Treat humerus fracture 9.76 $70.00 $683.20 24577 Treat humerus fracture 15.79 $70.00 $1,105.30 24579 Treat humerus fracture 24.05 $70.00 $1,683.50 24582 Treat humerus fracture 23.27 $70.00 $1,628.90 24586 Treat elbow fracture 31.24 $70.00 $2,186.80 24587 Treat elbow fracture 31.52 $70.00 $2,206.40 24600 Treat elbow dislocation 10.46 $70.00 $732.20 24605 Treat elbow dislocation 13.50 $70.00 $945.00 24615 Treat elbow dislocation 20.51 $70.00 $1,435.70 NON-FACILITY HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL 24620 Treat elbow fracture 15.82 $70.00 $1,107.40 24635 Treat elbow fracture 19.38 $70.00 $1,356.60 24640 Treat elbow dislocation 2.84 $70.00 $198.80 24650 Treat radius fracture 7.51 $70.00 $525.70 24655 Treat radius fracture 12.55 $70.00 $878.50 24665 Treat radius fracture 18.79 $70.00 $1,315.30 24666 Treat radius fracture 21.08 $70.00 $1,475.60 24670 Treat ulnar fracture 8.34 $70.00 $583.80 24675 Treat ulnar fracture 13.02 $70.00 $911.40 24685 Treat ulnar fracture 18.81 $70.00 $1,316.70 24800 Fusion of elbow joint 23.91 $70.00 $1,673.70 24802 Fusion/graft of elbow joint 28.88 $70.00 $2,021.60 24900 Amputation of upper arm 21.31 $70.00 $1,491.70 24920 Amputation of upper arm 21.10 $70.00 $1,477.00 24925 Amputation follow-up surgery 16.12 $70.00 $1,128.40 24930 Amputation follow-up surgery 22.31 $70.00 $1,561.70 24931 Amputate upper arm & implant 26.91 $70.00 $1,883.70 24935 Revision of amputation 33.23 $70.00 $2,326.10 24940 Revision of upper arm 0.00 $70.00 $0.00 24999 Upper arm/elbow surgery 0.00 $70.00 $0.00 25000 Incision of tendon sheath 9.67 $70.00 $676.90 25001 Incise flexor carpi radialis 9.87 $70.00 $690.90 25020 Decompress forearm 1 space 16.47 $70.00 $1,152.90 25023 Decompress forearm 1 space 31.88 $70.00 $2,231.60 25024 Decompress forearm 2 spaces 22.30 $70.00 $1,561.00 25025 Decompress forearm 2 spaces 34.98 $70.00 $2,448.60 25028 Drainage of forearm lesion 15.10 $70.00 $1,057.00 25031 Drainage of forearm bursa 10.12 $70.00 $708.40 25035 Treat forearm bone lesion 16.81 $70.00 $1,176.70 25040 Explore/treat wrist joint 16.17 $70.00 $1,131.90 25065 Biopsy forearm soft tissues 7.26 $70.00 $508.20 25066 Biopsy forearm soft tissues 10.30 $70.00 $721.00 25071 Exc forearm les sc 3 cm/> 12.25 $70.00 $857.50 25073 Exc forearm tum deep 3 cm/> 15.35 $70.00 $1,074.50 25075 Exc forearm les sc < 3 cm 13.71 $70.00 $959.70 25076 Exc forearm tum deep < 3 cm 14.91 $70.00 $1,043.70 25077 Resect forearm/wrist tum<3cm 25.50 $70.00 $1,785.00 25078 Resect forarm/wrist tum 3cm> 33.63 $70.00 $2,354.10 25085 Incision of wrist capsule 12.91 $70.00 $903.70 25100 Biopsy of wrist joint 9.93 $70.00 $695.10 25101 Explore/treat wrist joint 11.58 $70.00 $810.60 25105 Remove wrist joint lining 13.84 $70.00 $968.80 25107 Remove wrist joint cartilage 17.73 $70.00 $1,241.10 25109 Excise tendon forearm/wrist 15.47 $70.00 $1,082.90 25110 Remove wrist tendon lesion 9.78 $70.00 $684.60 NON-FACILITY HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL 25111 Remove wrist tendon lesion 9.20 $70.00 $644.00 25112 Reremove wrist tendon lesion 11.11 $70.00 $777.70 25115 Remove wrist/forearm lesion 21.84 $70.00 $1,528.80 25116 Remove wrist/forearm lesion 17.26 $70.00 $1,208.20 25118 Excise wrist tendon sheath 10.95 $70.00 $766.50 25119 Partial removal of ulna 14.35 $70.00 $1,004.50 25120 Removal of forearm lesion 14.27 $70.00 $998.90 25125 Remove/graft forearm lesion 17.05 $70.00 $1,193.50 25126 Remove/graft forearm lesion 17.17 $70.00 $1,201.90 25130 Removal of wrist lesion 12.83 $70.00 $898.10 25135 Remove & graft wrist lesion 16.07 $70.00 $1,124.90 25136 Remove & graft wrist lesion 14.18 $70.00 $992.60 25145 Remove forearm bone lesion 14.87 $70.00 $1,040.90 25150 Partial removal of ulna 16.32 $70.00 $1,142.40 25151 Partial removal of radius 16.75 $70.00 $1,172.50 25170 Resect radius/ulnar tumor 42.73 $70.00 $2,991.10 25210 Removal of wrist bone 14.00 $70.00 $980.00 25215 Removal of wrist bones 17.76 $70.00 $1,243.20 25230 Partial removal of radius 12.44 $70.00 $870.80 25240 Partial removal of ulna 12.31 $70.00 $861.70 25246 Injection for wrist x-ray 4.59 $70.00 $321.30 25248 Remove forearm foreign body 11.84 $70.00 $828.80 25250 Removal of wrist prosthesis 15.25 $70.00 $1,067.50 25251 Removal of wrist prosthesis 20.72 $70.00 $1,450.40 25259 Manipulate wrist w/anesthes 11.94 $70.00 $835.80 25260 Repair forearm tendon/muscle 18.10 $70.00 $1,267.00 25263 Repair forearm tendon/muscle 18.04 $70.00 $1,262.80 25265 Repair forearm tendon/muscle 21.77 $70.00 $1,523.90 25270 Repair forearm tendon/muscle 14.08 $70.00 $985.60 25272 Repair forearm tendon/muscle 16.02 $70.00 $1,121.40 25274 Repair forearm tendon/muscle 19.36 $70.00 $1,355.20 25275 Repair forearm tendon sheath 19.30 $70.00 $1,351.00 25280 Revise wrist/forearm tendon 16.20 $70.00 $1,134.00 25290 Incise wrist/forearm tendon 12.54 $70.00 $877.80 25295 Release wrist/forearm tendon 15.08 $70.00 $1,055.60 25300 Fusion of tendons at wrist 19.84 $70.00 $1,388.80 25301 Fusion of tendons at wrist 18.50 $70.00 $1,295.00 25310 Transplant forearm tendon 17.82 $70.00 $1,247.40 25312 Transplant forearm tendon 20.64 $70.00 $1,444.80 25315 Revise palsy hand tendon(s) 22.19 $70.00 $1,553.30 25316 Revise palsy hand tendon(s) 26.32 $70.00 $1,842.40 25320 Repair/revise wrist joint 28.39 $70.00 $1,987.30 25332 Revise wrist joint 24.23 $70.00 $1,696.10 25335 Realignment of hand 27.17 $70.00 $1,901.90 25337 Reconstruct ulna/radioulnar 25.69 $70.00 $1,798.30 NON-FACILITY HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL 25350 Revision of radius 19.40 $70.00 $1,358.00 25355 Revision of radius 22.06 $70.00 $1,544.20 25360 Revision of ulna 18.80 $70.00 $1,316.00 25365 Revise radius & ulna 26.35 $70.00 $1,844.50 25370 Revise radius or ulna 28.98 $70.00 $2,028.60 25375 Revise radius & ulna 27.45 $70.00 $1,921.50 25390 Shorten radius or ulna 22.14 $70.00 $1,549.80 25391 Lengthen radius or ulna 28.69 $70.00 $2,008.30 25392 Shorten radius & ulna 29.21 $70.00 $2,044.70 25393 Lengthen radius & ulna 32.60 $70.00 $2,282.00 25394 Repair carpal bone shorten 22.58 $70.00 $1,580.60 25400 Repair radius or ulna 23.13 $70.00 $1,619.10 25405 Repair/graft radius or ulna 29.84 $70.00 $2,088.80 25415 Repair radius & ulna 27.87 $70.00 $1,950.90 25420 Repair/graft radius & ulna 33.68 $70.00 $2,357.60 25425 Repair/graft radius or ulna 27.73 $70.00 $1,941.10 25426 Repair/graft radius & ulna 32.41 $70.00 $2,268.70 25430 Vasc graft into carpal bone 21.05 $70.00 $1,473.50 25431 Repair nonunion carpal bone 22.73 $70.00 $1,591.10 25440 Repair/graft wrist bone 22.14 $70.00 $1,549.80 25441 Reconstruct wrist joint 26.98 $70.00 $1,888.60 25442 Reconstruct wrist joint 23.18 $70.00 $1,622.60 25443 Reconstruct wrist joint 22.49 $70.00 $1,574.30 25444 Reconstruct wrist joint 23.80 $70.00 $1,666.00 25445 Reconstruct wrist joint 20.77 $70.00 $1,453.90 25446 Wrist replacement 33.78 $70.00 $2,364.60 25447 Repair wrist joints 23.83 $70.00 $1,668.10 25449 Remove wrist joint implant 29.71 $70.00 $2,079.70 25450 Revision of wrist joint 17.72 $70.00 $1,240.40 25455 Revision of wrist joint 20.87 $70.00 $1,460.90 25490 Reinforce radius 20.70 $70.00 $1,449.00 25491 Reinforce ulna 21.29 $70.00 $1,490.30 25492 Reinforce radius and ulna 26.05 $70.00 $1,823.50 25500 Treat fracture of radius 7.84 $70.00 $548.80 25505 Treat fracture of radius 14.24 $70.00 $996.80 25515 Treat fracture of radius 19.24 $70.00 $1,346.80 25520 Treat fracture of radius 16.32 $70.00 $1,142.40 25525 Treat fracture of radius 22.57 $70.00 $1,579.90 25526 Treat fracture of radius 27.51 $70.00 $1,925.70 25530 Treat fracture of ulna 7.54 $70.00 $527.80 25535 Treat fracture of ulna 13.92 $70.00 $974.40 25545 Treat fracture of ulna 17.87 $70.00 $1,250.90 25560 Treat fracture radius & ulna 7.98 $70.00 $558.60 25565 Treat fracture radius & ulna 14.80 $70.00 $1,036.00 25574 Treat fracture radius & ulna 19.36 $70.00 $1,355.20 NON-FACILITY HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL 25575 Treat fracture radius/ulna 25.91 $70.00 $1,813.70 25600 Treat fracture radius/ulna 9.42 $70.00 $659.40 25605 Treat fracture radius/ulna 15.54 $70.00 $1,087.80 25606 Treat fx distal radial 19.06 $70.00 $1,334.20 25607 Treat fx rad extra-articul 21.12 $70.00 $1,478.40 25608 Treat fx rad intra-articul 23.71 $70.00 $1,659.70 25609 Treat fx radial 3+ frag 30.14 $70.00 $2,109.80 25622 Treat wrist bone fracture 8.76 $70.00 $613.20 25624 Treat wrist bone fracture 13.74 $70.00 $961.80 25628 Treat wrist bone fracture 20.69 $70.00 $1,448.30 25630 Treat wrist bone fracture 8.77 $70.00 $613.90 25635 Treat wrist bone fracture 13.09 $70.00 $916.30 25645 Treat wrist bone fracture 16.37 $70.00 $1,145.90 25650 Treat wrist bone fracture 9.16 $70.00 $641.20 25651 Pin ulnar styloid fracture 13.92 $70.00 $974.40 25652 Treat fracture ulnar styloid 17.91 $70.00 $1,253.70 25660 Treat wrist dislocation 11.87 $70.00 $830.90 25670 Treat wrist dislocation 17.35 $70.00 $1,214.50 25671 Pin radioulnar dislocation 15.27 $70.00 $1,068.90 25675 Treat wrist dislocation 12.41 $70.00 $868.70 25676 Treat wrist dislocation 18.10 $70.00 $1,267.00 25680 Treat wrist fracture 14.96 $70.00 $1,047.20 25685 Treat wrist fracture 21.18 $70.00 $1,482.60 25690 Treat wrist dislocation 13.81 $70.00 $966.70 25695 Treat wrist dislocation 18.22 $70.00 $1,275.40 25800 Fusion of wrist joint 21.07 $70.00 $1,474.90 25805 Fusion/graft of wrist joint 24.33 $70.00 $1,703.10 25810 Fusion/graft of wrist joint 24.97 $70.00 $1,747.90 25820 Fusion of hand bones 17.71 $70.00 $1,239.70 25825 Fuse hand bones with graft 21.81 $70.00 $1,526.70 25830 Fusion radioulnar jnt/ulna 27.38 $70.00 $1,916.60 25900 Amputation of forearm 20.31 $70.00 $1,421.70 25905 Amputation of forearm 20.18 $70.00 $1,412.60 25907 Amputation follow-up surgery 17.63 $70.00 $1,234.10 25909 Amputation follow-up surgery 19.70 $70.00 $1,379.00 25915 Amputation of forearm 33.80 $70.00 $2,366.00 25920 Amputate hand at wrist 20.03 $70.00 $1,402.10 25922 Amputate hand at wrist 17.58 $70.00 $1,230.60 25924 Amputation follow-up surgery 19.57 $70.00 $1,369.90 25927 Amputation of hand 23.30 $70.00 $1,631.00 25929 Amputation follow-up surgery 17.16 $70.00 $1,201.20 25931 Amputation follow-up surgery 21.41 $70.00 $1,498.70 25999 Forearm or wrist surgery 0.00 $70.00 $0.00 26010 Drainage of finger abscess 7.58 $70.00 $530.60 26011 Drainage of finger abscess 11.18 $70.00 $782.60 NON-FACILITY HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL 26020 Drain hand tendon sheath 12.44 $70.00 $870.80 26025 Drainage of palm bursa 12.11 $70.00 $847.70 26030 Drainage of palm bursas 14.17 $70.00 $991.90 26034 Treat hand bone lesion 15.57 $70.00 $1,089.90 26035 Decompress fingers/hand 24.70 $70.00 $1,729.00 26037 Decompress fingers/hand 16.28 $70.00 $1,139.60 26040 Release palm contracture 8.95 $70.00 $626.50 26045 Release palm contracture 13.42 $70.00 $939.40 26055 Incise finger tendon sheath 15.97 $70.00 $1,117.90 26060 Incision of finger tendon 7.47 $70.00 $522.90 26070 Explore/treat hand joint 9.16 $70.00 $641.20 26075 Explore/treat finger joint 9.55 $70.00 $668.50 26080 Explore/treat finger joint 11.21 $70.00 $784.70 26100 Biopsy hand joint lining 9.63 $70.00 $674.10 26105 Biopsy finger joint lining 9.69 $70.00 $678.30 26110 Biopsy finger joint lining 9.23 $70.00 $646.10 26111 Exc hand les sc 1.5 cm/> 12.03 $70.00 $842.10 26113 Exc hand tum deep 1.5 cm/> 15.79 $70.00 $1,105.30 26115 Exc hand les sc < 1.5 cm 14.43 $70.00 $1,010.10 26116 Exc hand tum deep < 1.5 cm 15.17 $70.00 $1,061.90 26117 Rad resect hand tumor < 3 cm 21.46 $70.00 $1,502.20 26118 Rad resect hand tumor 3 cm/> 30.33 $70.00 $2,123.10 26121 Release palm contracture 17.19 $70.00 $1,203.30 26123 Release palm contracture 23.99 $70.00 $1,679.30 26125 Release palm contracture 7.92 $70.00 $554.40 26130 Remove wrist joint lining 13.22 $70.00 $925.40 26135 Revise finger joint each 15.84 $70.00 $1,108.80 26140 Revise finger joint each 14.47 $70.00 $1,012.90 26145 Tendon excision palm/finger 14.72 $70.00 $1,030.40 26160 Remove tendon sheath lesion 16.44 $70.00 $1,150.80 26170 Removal of palm tendon each 11.68 $70.00 $817.60 26180 Removal of finger tendon 12.74 $70.00 $891.80 26185 Remove finger bone 15.84 $70.00 $1,108.80 26200 Remove hand bone lesion 12.91 $70.00 $903.70 26205 Remove/graft bone lesion 17.31 $70.00 $1,211.70 26210 Removal of finger lesion 12.70 $70.00 $889.00 26215 Remove/graft finger lesion 16.20 $70.00 $1,134.00 26230 Partial removal of hand bone 14.37 $70.00 $1,005.90 26235 Partial removal finger bone 14.16 $70.00 $991.20 26236 Partial removal finger bone 12.67 $70.00 $886.90 26250 Extensive hand surgery 30.89 $70.00 $2,162.30 26260 Resect prox finger tumor 23.16 $70.00 $1,621.20 26262 Resect distal finger tumor 18.26 $70.00 $1,278.20 26320 Removal of implant from hand 9.95 $70.00 $696.50 26340 Manipulate finger w/anesth 9.55 $70.00 $668.50 NON-FACILITY HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL 26341 Manipulat palm cord post inj 2.84 $70.00 $198.80 26350 Repair finger/hand tendon 20.17 $70.00 $1,411.90 26352 Repair/graft hand tendon 23.20 $70.00 $1,624.00 26356 Repair finger/hand tendon 22.79 $70.00 $1,595.30 26357 Repair finger/hand tendon 25.52 $70.00 $1,786.40 26358 Repair/graft hand tendon 28.26 $70.00 $1,978.20 26370 Repair finger/hand tendon 21.46 $70.00 $1,502.20 26372 Repair/graft hand tendon 25.14 $70.00 $1,759.80 26373 Repair finger/hand tendon 24.12 $70.00 $1,688.40 26390 Revise hand/finger tendon 23.77 $70.00 $1,663.90 26392 Repair/graft hand tendon 27.70 $70.00 $1,939.00 26410 Repair hand tendon 16.01 $70.00 $1,120.70 26412 Repair/graft hand tendon 19.42 $70.00 $1,359.40 26415 Excision hand/finger tendon 23.12 $70.00 $1,618.40 26416 Graft hand or finger tendon 25.16 $70.00 $1,761.20 26418 Repair finger tendon 16.34 $70.00 $1,143.80 26420 Repair/graft finger tendon 20.29 $70.00 $1,420.30 26426 Repair finger/hand tendon 14.38 $70.00 $1,006.60 26428 Repair/graft finger tendon 21.48 $70.00 $1,503.60 26432 Repair finger tendon 14.12 $70.00 $988.40 26433 Repair finger tendon 15.02 $70.00 $1,051.40 26434 Repair/graft finger tendon 18.38 $70.00 $1,286.60 26437 Realignment of tendons 17.65 $70.00 $1,235.50 26440 Release palm/finger tendon 17.55 $70.00 $1,228.50 26442 Release palm & finger tendon 27.37 $70.00 $1,915.90 26445 Release hand/finger tendon 16.33 $70.00 $1,143.10 26449 Release forearm/hand tendon 19.77 $70.00 $1,383.90 26450 Incision of palm tendon 11.54 $70.00 $807.80 26455 Incision of finger tendon 11.44 $70.00 $800.80 26460 Incise hand/finger tendon 11.18 $70.00 $782.60 26471 Fusion of finger tendons 17.47 $70.00 $1,222.90 26474 Fusion of finger tendons 17.05 $70.00 $1,193.50 26476 Tendon lengthening 16.81 $70.00 $1,176.70 26477 Tendon shortening 16.45 $70.00 $1,151.50 26478 Lengthening of hand tendon 17.51 $70.00 $1,225.70 26479 Shortening of hand tendon 17.77 $70.00 $1,243.90 26480 Transplant hand tendon 21.32 $70.00 $1,492.40 26483 Transplant/graft hand tendon 23.89 $70.00 $1,672.30 26485 Transplant palm tendon 22.84 $70.00 $1,598.80 26489 Transplant/graft palm tendon 26.60 $70.00 $1,862.00 26490 Revise thumb tendon 22.62 $70.00 $1,583.40 26492 Tendon transfer with graft 25.09 $70.00 $1,756.30 26494 Hand tendon/muscle transfer 22.73 $70.00 $1,591.10 26496 Revise thumb tendon 24.67 $70.00 $1,726.90 26497 Finger tendon transfer 24.61 $70.00 $1,722.70 NON-FACILITY HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL 26498 Finger tendon transfer 32.55 $70.00 $2,278.50 26499 Revision of finger 23.58 $70.00 $1,650.60 26500 Hand tendon reconstruction 17.66 $70.00 $1,236.20 26502 Hand tendon reconstruction 20.16 $70.00 $1,411.20 26508 Release thumb contracture 17.86 $70.00 $1,250.20 26510 Thumb tendon transfer 16.86 $70.00 $1,180.20 26516 Fusion of knuckle joint 19.85 $70.00 $1,389.50 26517 Fusion of knuckle joints 23.43 $70.00 $1,640.10 26518 Fusion of knuckle joints 23.76 $70.00 $1,663.20 26520 Release knuckle contracture 18.39 $70.00 $1,287.30 26525 Release finger contracture 18.45 $70.00 $1,291.50 26530 Revise knuckle joint 15.46 $70.00 $1,082.20 26531 Revise knuckle with implant 17.94 $70.00 $1,255.80 26535 Revise finger joint 12.23 $70.00 $856.10 26536 Revise/implant finger joint 20.14 $70.00 $1,409.80 26540 Repair hand joint 18.62 $70.00 $1,303.40 26541 Repair hand joint with graft 22.72 $70.00 $1,590.40 26542 Repair hand joint with graft 19.20 $70.00 $1,344.00 26545 Reconstruct finger joint 19.85 $70.00 $1,389.50 26546 Repair nonunion hand 28.20 $70.00 $1,974.00 26548 Reconstruct finger joint 21.58 $70.00 $1,510.60 26550 Construct thumb replacement 46.99 $70.00 $3,289.30 26551 Great toe-hand transfer 94.73 $70.00 $6,631.10 26553 Single transfer toe-hand 94.09 $70.00 $6,586.30 26554 Double transfer toe-hand 109.78 $70.00 $7,684.60 26555 Positional change of finger 39.12 $70.00 $2,738.40 26556 Toe joint transfer 97.75 $70.00 $6,842.50 26560 Repair of web finger 16.76 $70.00 $1,173.20 26561 Repair of web finger 26.90 $70.00 $1,883.00 26562 Repair of web finger 38.29 $70.00 $2,680.30 26565 Correct metacarpal flaw 19.37 $70.00 $1,355.90 26567 Correct finger deformity 19.29 $70.00 $1,350.30 26568 Lengthen metacarpal/finger 25.58 $70.00 $1,790.60 26580 Repair hand deformity 43.20 $70.00 $3,024.00 26587 Reconstruct extra finger 29.92 $70.00 $2,094.40 26590 Repair finger deformity 40.20 $70.00 $2,814.00 26591 Repair muscles of hand 12.37 $70.00 $865.90 26593 Release muscles of hand 17.00 $70.00 $1,190.00 26596 Excision constricting tissue 21.72 $70.00 $1,520.40 26600 Treat metacarpal fracture 8.43 $70.00 $590.10 26605 Treat metacarpal fracture 9.21 $70.00 $644.70 26607 Treat metacarpal fracture 13.16 $70.00 $921.20 26608 Treat metacarpal fracture 13.64 $70.00 $954.80 26615 Treat metacarpal fracture 16.55 $70.00 $1,158.50 26641 Treat thumb dislocation 10.97 $70.00 $767.90 NON-FACILITY HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL 26645 Treat thumb fracture 12.28 $70.00 $859.60 26650 Treat thumb fracture 13.66 $70.00 $956.20 26665 Treat thumb fracture 18.00 $70.00 $1,260.00 26670 Treat hand dislocation 9.79 $70.00 $685.30 26675 Treat hand dislocation 13.05 $70.00 $913.50 26676 Pin hand dislocation 14.37 $70.00 $1,005.90 26685 Treat hand dislocation 16.56 $70.00 $1,159.20 26686 Treat hand dislocation 17.93 $70.00 $1,255.10 26700 Treat knuckle dislocation 9.26 $70.00 $648.20 26705 Treat knuckle dislocation 11.84 $70.00 $828.80 26706 Pin knuckle dislocation 12.60 $70.00 $882.00 26715 Treat knuckle dislocation 16.46 $70.00 $1,152.20 26720 Treat finger fracture each 5.68 $70.00 $397.60 26725 Treat finger fracture each 9.63 $70.00 $674.10 26727 Treat finger fracture each 13.46 $70.00 $942.20 26735 Treat finger fracture each 17.13 $70.00 $1,199.10 26740 Treat finger fracture each 6.61 $70.00 $462.70 26742 Treat finger fracture each 10.60 $70.00 $742.00 26746 Treat finger fracture each 21.34 $70.00 $1,493.80 26750 Treat finger fracture each 5.28 $70.00 $369.60 26755 Treat finger fracture each 9.00 $70.00 $630.00 26756 Pin finger fracture each 11.93 $70.00 $835.10 26765 Treat finger fracture each 14.37 $70.00 $1,005.90 26770 Treat finger dislocation 7.90 $70.00 $553.00 26775 Treat finger dislocation 10.92 $70.00 $764.40 26776 Pin finger dislocation 12.71 $70.00 $889.70 26785 Treat finger dislocation 15.71 $70.00 $1,099.70 26820 Thumb fusion with graft 22.37 $70.00 $1,565.90 26841 Fusion of thumb 20.55 $70.00 $1,438.50 26842 Thumb fusion with graft 22.17 $70.00 $1,551.90 26843 Fusion of hand joint 20.96 $70.00 $1,467.20 26844 Fusion/graft of hand joint 23.27 $70.00 $1,628.90 26850 Fusion of knuckle 19.59 $70.00 $1,371.30 26852 Fusion of knuckle with graft 22.56 $70.00 $1,579.20 26860 Fusion of finger joint 16.00 $70.00 $1,120.00 26861 Fusion of finger jnt add-on 2.98 $70.00 $208.60 26862 Fusion/graft of finger joint 20.59 $70.00 $1,441.30 26863 Fuse/graft added joint 6.65 $70.00 $465.50 26910 Amputate metacarpal bone 20.52 $70.00 $1,436.40 26951 Amputation of finger/thumb 18.48 $70.00 $1,293.60 26952 Amputation of finger/thumb 18.26 $70.00 $1,278.20 26989 Hand/finger surgery 0.00 $70.00 $0.00 26990 Drainage of pelvis lesion 18.04 $70.00 $1,262.80 26991 Drainage of pelvis bursa 20.32 $70.00 $1,422.40 26992 Drainage of bone lesion 27.58 $70.00 $1,930.60 NON-FACILITY HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL 27000 Incision of hip tendon 11.80 $70.00 $826.00 27001 Incision of hip tendon 15.49 $70.00 $1,084.30 27003 Incision of hip tendon 17.15 $70.00 $1,200.50 27005 Incision of hip tendon 20.80 $70.00 $1,456.00 27006 Incision of hip tendons 21.00 $70.00 $1,470.00 27025 Incision of hip/thigh fascia 26.48 $70.00 $1,853.60 27027 Buttock fasciotomy 25.34 $70.00 $1,773.80 27030 Drainage of hip joint 26.97 $70.00 $1,887.90 27033 Exploration of hip joint 27.95 $70.00 $1,956.50 27035 Denervation of hip joint 32.91 $70.00 $2,303.70 27036 Excision of hip joint/muscle 29.13 $70.00 $2,039.10 27040 Biopsy of soft tissues 9.87 $70.00 $690.90 27041 Biopsy of soft tissues 19.99 $70.00 $1,399.30 27043 Exc hip pelvis les sc 3 cm/> 13.54 $70.00 $947.80 27045 Exc hip/pelv tum deep 5 cm/> 21.50 $70.00 $1,505.00 27047 Exc hip/pelvis les sc < 3 cm 13.34 $70.00 $933.80 27048 Exc hip/pelv tum deep < 5 cm 17.58 $70.00 $1,230.60 27049 Resect hip/pelv tum < 5 cm 38.75 $70.00 $2,712.50 27050 Biopsy of sacroiliac joint 11.56 $70.00 $809.20 27052 Biopsy of hip joint 16.68 $70.00 $1,167.60 27054 Removal of hip joint lining 19.69 $70.00 $1,378.30 27057 Buttock fasciotomy w/dbrdmt 29.27 $70.00 $2,048.90 27059 Resect hip/pelv tum 5 cm/> 52.65 $70.00 $3,685.50 27060 Removal of ischial bursa 13.39 $70.00 $937.30 27062 Remove femur lesion/bursa 13.10 $70.00 $917.00 27065 Remove hip bone les super 14.94 $70.00 $1,045.80 27066 Remove hip bone les deep 23.21 $70.00 $1,624.70 27067 Remove/graft hip bone lesion 29.82 $70.00 $2,087.40 27070 Part remove hip bone super 24.32 $70.00 $1,702.40 27071 Part removal hip bone deep 26.39 $70.00 $1,847.30 27075 Resect hip tumor 60.79 $70.00 $4,255.30 27076 Resect hip tum incl acetabul 73.62 $70.00 $5,153.40 27077 Resect hip tum w/innom bone 82.12 $70.00 $5,748.40 27078 Rsect hip tum incl femur 59.94 $70.00 $4,195.80 27080 Removal of tail bone 14.76 $70.00 $1,033.20 27086 Remove hip foreign body 8.51 $70.00 $595.70 27087 Remove hip foreign body 17.58 $70.00 $1,230.60 27090 Removal of hip prosthesis 23.89 $70.00 $1,672.30 27091 Removal of hip prosthesis 46.09 $70.00 $3,226.30 27093 Injection for hip x-ray 5.33 $70.00 $373.10 27095 Injection for hip x-ray 7.00 $70.00 $490.00 27096 Inject sacroiliac joint 4.53 $70.00 $317.10 27097 Revision of hip tendon 19.62 $70.00 $1,373.40 27098 Transfer tendon to pelvis 19.97 $70.00 $1,397.90 27100 Transfer of abdominal muscle 23.80 $70.00 $1,666.00 NON-FACILITY HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL 27105 Transfer of spinal muscle 24.98 $70.00 $1,748.60 27110 Transfer of iliopsoas muscle 27.94 $70.00 $1,955.80 27111 Transfer of iliopsoas muscle 25.93 $70.00 $1,815.10 27120 Reconstruction of hip socket 37.55 $70.00 $2,628.50 27122 Reconstruction of hip socket 31.71 $70.00 $2,219.70 27125 Partial hip replacement 32.71 $70.00 $2,289.70 27130 Total hip arthroplasty 39.16 $70.00 $2,741.20 27132 Total hip arthroplasty 48.36 $70.00 $3,385.20 27134 Revise hip joint replacement 55.36 $70.00 $3,875.20 27137 Revise hip joint replacement 42.53 $70.00 $2,977.10 27138 Revise hip joint replacement 44.20 $70.00 $3,094.00 27140 Transplant femur ridge 25.75 $70.00 $1,802.50 27146 Incision of hip bone 36.99 $70.00 $2,589.30 27147 Revision of hip bone 42.50 $70.00 $2,975.00 27151 Incision of hip bones 46.03 $70.00 $3,222.10 27156 Revision of hip bones 49.63 $70.00 $3,474.10 27158 Revision of pelvis 40.52 $70.00 $2,836.40 27161 Incision of neck of femur 34.99 $70.00 $2,449.30 27165 Incision/fixation of femur 39.53 $70.00 $2,767.10 27170 Repair/graft femur head/neck 33.92 $70.00 $2,374.40 27175 Treat slipped epiphysis 19.21 $70.00 $1,344.70 27176 Treat slipped epiphysis 26.47 $70.00 $1,852.90 27177 Treat slipped epiphysis 32.17 $70.00 $2,251.90 27178 Treat slipped epiphysis 26.47 $70.00 $1,852.90 27179 Revise head/neck of femur 28.16 $70.00 $1,971.20 27181 Treat slipped epiphysis 32.44 $70.00 $2,270.80 27185 Revision of femur epiphysis 20.68 $70.00 $1,447.60 27187 Reinforce hip bones 28.57 $70.00 $1,999.90 27197 Clsd tx pelvic ring fx 3.45 $70.00 $241.50 27198 Clsd tx pelvic ring fx 8.64 $70.00 $604.80 27200 Treat tail bone fracture 5.23 $70.00 $366.10 27202 Treat tail bone fracture 15.35 $70.00 $1,074.50 27215 Treat pelvic fracture(s) 18.03 $70.00 $1,262.10 27216 Treat pelvic ring fracture 26.70 $70.00 $1,869.00 27217 Treat pelvic ring fracture 25.06 $70.00 $1,754.20 27218 Treat pelvic ring fracture 34.60 $70.00 $2,422.00 27220 Treat hip socket fracture 15.28 $70.00 $1,069.60 27222 Treat hip socket fracture 28.02 $70.00 $1,961.40 27226 Treat hip wall fracture 30.36 $70.00 $2,125.20 27227 Treat hip fracture(s) 47.95 $70.00 $3,356.50 27228 Treat hip fracture(s) 54.44 $70.00 $3,810.80 27230 Treat thigh fracture 13.67 $70.00 $956.90 27232 Treat thigh fracture 21.44 $70.00 $1,500.80 27235 Treat thigh fracture 26.21 $70.00 $1,834.70 27236 Treat thigh fracture 34.50 $70.00 $2,415.00 NON-FACILITY HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL 27238 Treat thigh fracture 13.22 $70.00 $925.40 27240 Treat thigh fracture 27.63 $70.00 $1,934.10 27244 Treat thigh fracture 35.52 $70.00 $2,486.40 27245 Treat thigh fracture 35.52 $70.00 $2,486.40 27246 Treat thigh fracture 11.07 $70.00 $774.90 27248 Treat thigh fracture 21.41 $70.00 $1,498.70 27250 Treat hip dislocation 5.18 $70.00 $362.60 27252 Treat hip dislocation 21.79 $70.00 $1,525.30 27253 Treat hip dislocation 27.05 $70.00 $1,893.50 27254 Treat hip dislocation 36.64 $70.00 $2,564.80 27256 Treat hip dislocation 8.70 $70.00 $609.00 27257 Treat hip dislocation 10.50 $70.00 $735.00 27258 Treat hip dislocation 32.05 $70.00 $2,243.50 27259 Treat hip dislocation 44.89 $70.00 $3,142.30 27265 Treat hip dislocation 11.45 $70.00 $801.50 27266 Treat hip dislocation 16.71 $70.00 $1,169.70 27267 Cltx thigh fx 12.42 $70.00 $869.40 27268 Cltx thigh fx w/mnpj 15.51 $70.00 $1,085.70 27269 Optx thigh fx 35.89 $70.00 $2,512.30 27275 Manipulation of hip joint 5.26 $70.00 $368.20 27279 Arthrodesis sacroiliac joint 20.00 $70.00 $1,400.00 27280 Fusion of sacroiliac joint 39.23 $70.00 $2,746.10 27282 Fusion of pubic bones 24.66 $70.00 $1,726.20 27284 Fusion of hip joint 46.84 $70.00 $3,278.80 27286 Fusion of hip joint 47.81 $70.00 $3,346.70 27290 Amputation of leg at hip 46.97 $70.00 $3,287.90 27295 Amputation of leg at hip 36.55 $70.00 $2,558.50 27299 Pelvis/hip joint surgery 0.00 $70.00 $0.00 27301 Drain thigh/knee lesion 19.34 $70.00 $1,353.80 27303 Drainage of bone lesion 18.37 $70.00 $1,285.90 27305 Incise thigh tendon & fascia 13.75 $70.00 $962.50 27306 Incision of thigh tendon 9.98 $70.00 $698.60 27307 Incision of thigh tendons 12.26 $70.00 $858.20 27310 Exploration of knee joint 21.03 $70.00 $1,472.10 27323 Biopsy thigh soft tissues 7.80 $70.00 $546.00 27324 Biopsy thigh soft tissues 11.53 $70.00 $807.10 27325 Neurectomy hamstring 16.04 $70.00 $1,122.80 27326 Neurectomy popliteal 14.79 $70.00 $1,035.30 27327 Exc thigh/knee les sc < 3 cm 13.15 $70.00 $920.50 27328 Exc thigh/knee tum deep <5cm 17.93 $70.00 $1,255.10 27329 Resect thigh/knee tum < 5 cm 29.93 $70.00 $2,095.10 27330 Biopsy knee joint lining 11.94 $70.00 $835.80 27331 Explore/treat knee joint 13.62 $70.00 $953.40 27332 Removal of knee cartilage 18.52 $70.00 $1,296.40 27333 Removal of knee cartilage 16.85 $70.00 $1,179.50 NON-FACILITY HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL 27334 Remove knee joint lining 19.67 $70.00 $1,376.90 27335 Remove knee joint lining 21.94 $70.00 $1,535.80 27337 Exc thigh/knee les sc 3 cm/> 12.07 $70.00 $844.90 27339 Exc thigh/knee tum dep 5cm/> 21.71 $70.00 $1,519.70 27340 Removal of kneecap bursa 10.67 $70.00 $746.90 27345 Removal of knee cyst 13.80 $70.00 $966.00 27347 Remove knee cyst 15.20 $70.00 $1,064.00 27350 Removal of kneecap 18.74 $70.00 $1,311.80 27355 Remove femur lesion 17.35 $70.00 $1,214.50 27356 Remove femur lesion/graft 21.29 $70.00 $1,490.30 27357 Remove femur lesion/graft 23.46 $70.00 $1,642.20 27358 Remove femur lesion/fixation 8.08 $70.00 $565.60 27360 Partial removal leg bone(s) 24.50 $70.00 $1,715.00 27364 Resect thigh/knee tum 5 cm/> 45.22 $70.00 $3,165.40 27365 Resect femur/knee tumor 59.70 $70.00 $4,179.00 27370 Injection for knee x-ray 4.41 $70.00 $308.70 27372 Removal of foreign body 17.04 $70.00 $1,192.80 27380 Repair of kneecap tendon 17.04 $70.00 $1,192.80 27381 Repair/graft kneecap tendon 22.95 $70.00 $1,606.50 27385 Repair of thigh muscle 16.50 $70.00 $1,155.00 27386 Repair/graft of thigh muscle 23.85 $70.00 $1,669.50 27390 Incision of thigh tendon 12.91 $70.00 $903.70 27391 Incision of thigh tendons 16.48 $70.00 $1,153.60 27392 Incision of thigh tendons 20.52 $70.00 $1,436.40 27393 Lengthening of thigh tendon 14.64 $70.00 $1,024.80 27394 Lengthening of thigh tendons 18.47 $70.00 $1,292.90 27395 Lengthening of thigh tendons 25.31 $70.00 $1,771.70 27396 Transplant of thigh tendon 17.72 $70.00 $1,240.40 27397 Transplants of thigh tendons 26.43 $70.00 $1,850.10 27400 Revise thigh muscles/tendons 19.99 $70.00 $1,399.30 27403 Repair of knee cartilage 18.37 $70.00 $1,285.90 27405 Repair of knee ligament 19.40 $70.00 $1,358.00 27407 Repair of knee ligament 22.83 $70.00 $1,598.10 27409 Repair of knee ligaments 27.83 $70.00 $1,948.10 27412 Autochondrocyte implant knee 47.82 $70.00 $3,347.40 27415 Osteochondral knee allograft 39.34 $70.00 $2,753.80 27416 Osteochondral knee autograft 28.29 $70.00 $1,980.30 27418 Repair degenerated kneecap 23.73 $70.00 $1,661.10 27420 Revision of unstable kneecap 21.37 $70.00 $1,495.90 27422 Revision of unstable kneecap 21.36 $70.00 $1,495.20 27424 Revision/removal of kneecap 21.55 $70.00 $1,508.50 27425 Lat retinacular release open 12.88 $70.00 $901.60 27427 Reconstruction knee 20.41 $70.00 $1,428.70 27428 Reconstruction knee 32.21 $70.00 $2,254.70 27429 Reconstruction knee 35.82 $70.00 $2,507.40 NON-FACILITY HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL 27430 Revision of thigh muscles 21.27 $70.00 $1,488.90 27435 Incision of knee joint 23.23 $70.00 $1,626.10 27437 Revise kneecap 19.03 $70.00 $1,332.10 27438 Revise kneecap with implant 24.15 $70.00 $1,690.50 27440 Revision of knee joint 23.01 $70.00 $1,610.70 27441 Revision of knee joint 23.77 $70.00 $1,663.90 27442 Revision of knee joint 25.02 $70.00 $1,751.40 27443 Revision of knee joint 23.42 $70.00 $1,639.40 27445 Revision of knee joint 36.13 $70.00 $2,529.10 27446 Revision of knee joint 33.45 $70.00 $2,341.50 27447 Total knee arthroplasty 39.12 $70.00 $2,738.40 27448 Incision of thigh 22.36 $70.00 $1,565.20 27450 Incision of thigh 28.93 $70.00 $2,025.10 27454 Realignment of thigh bone 37.55 $70.00 $2,628.50 27455 Realignment of knee 27.16 $70.00 $1,901.20 27457 Realignment of knee 27.41 $70.00 $1,918.70 27465 Shortening of thigh bone 34.84 $70.00 $2,438.80 27466 Lengthening of thigh bone 34.18 $70.00 $2,392.60 27468 Shorten/lengthen thighs 38.79 $70.00 $2,715.30 27470 Repair of thigh 33.91 $70.00 $2,373.70 27472 Repair/graft of thigh 36.41 $70.00 $2,548.70 27475 Surgery to stop leg growth 19.05 $70.00 $1,333.50 27477 Surgery to stop leg growth 21.12 $70.00 $1,478.40 27479 Surgery to stop leg growth 26.54 $70.00 $1,857.80 27485 Surgery to stop leg growth 19.30 $70.00 $1,351.00 27486 Revise/replace knee joint 40.60 $70.00 $2,842.00 27487 Revise/replace knee joint 50.78 $70.00 $3,554.60 27488 Removal of knee prosthesis 34.65 $70.00 $2,425.50 27495 Reinforce thigh 32.45 $70.00 $2,271.50 27496 Decompression of thigh/knee 15.66 $70.00 $1,096.20 27497 Decompression of thigh/knee 16.78 $70.00 $1,174.60 27498 Decompression of thigh/knee 18.87 $70.00 $1,320.90 27499 Decompression of thigh/knee 20.17 $70.00 $1,411.90 27500 Treatment of thigh fracture 14.91 $70.00 $1,043.70 27501 Treatment of thigh fracture 14.50 $70.00 $1,015.00 27502 Treatment of thigh fracture 21.83 $70.00 $1,528.10 27503 Treatment of thigh fracture 23.08 $70.00 $1,615.60 27506 Treatment of thigh fracture 38.60 $70.00 $2,702.00 27507 Treatment of thigh fracture 28.04 $70.00 $1,962.80 27508 Treatment of thigh fracture 15.07 $70.00 $1,054.90 27509 Treatment of thigh fracture 18.47 $70.00 $1,292.90 27510 Treatment of thigh fracture 19.64 $70.00 $1,374.80 27511 Treatment of thigh fracture 28.75 $70.00 $2,012.50 27513 Treatment of thigh fracture 35.80 $70.00 $2,506.00 27514 Treatment of thigh fracture 27.88 $70.00 $1,951.60 NON-FACILITY HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL 27516 Treat thigh fx growth plate 14.59 $70.00 $1,021.30 27517 Treat thigh fx growth plate 19.73 $70.00 $1,381.10 27519 Treat thigh fx growth plate 25.74 $70.00 $1,801.80 27520 Treat kneecap fracture 9.27 $70.00 $648.90 27524 Treat kneecap fracture 21.64 $70.00 $1,514.80 27530 Treat knee fracture 8.68 $70.00 $607.60 27532 Treat knee fracture 17.68 $70.00 $1,237.60 27535 Treat knee fracture 25.86 $70.00 $1,810.20 27536 Treat knee fracture 34.31 $70.00 $2,401.70 27538 Treat knee fracture(s) 13.61 $70.00 $952.70 27540 Treat knee fracture 23.25 $70.00 $1,627.50 27550 Treat knee dislocation 14.70 $70.00 $1,029.00 27552 Treat knee dislocation 17.92 $70.00 $1,254.40 27556 Treat knee dislocation 25.31 $70.00 $1,771.70 27557 Treat knee dislocation 30.28 $70.00 $2,119.60 27558 Treat knee dislocation 34.54 $70.00 $2,417.80 27560 Treat kneecap dislocation 10.43 $70.00 $730.10 27562 Treat kneecap dislocation 13.91 $70.00 $973.70 27566 Treat kneecap dislocation 25.80 $70.00 $1,806.00 27570 Fixation of knee joint 4.33 $70.00 $303.10 27580 Fusion of knee 41.44 $70.00 $2,900.80 27590 Amputate leg at thigh 23.06 $70.00 $1,614.20 27591 Amputate leg at thigh 27.89 $70.00 $1,952.30 27592 Amputate leg at thigh 19.65 $70.00 $1,375.50 27594 Amputation follow-up surgery 14.54 $70.00 $1,017.80 27596 Amputation follow-up surgery 20.79 $70.00 $1,455.30 27598 Amputate lower leg at knee 20.65 $70.00 $1,445.50 27599 Leg surgery procedure 0.00 $70.00 $0.00 27600 Decompression of lower leg 11.65 $70.00 $815.50 27601 Decompression of lower leg 12.88 $70.00 $901.60 27602 Decompression of lower leg 14.03 $70.00 $982.10 27603 Drain lower leg lesion 15.16 $70.00 $1,061.20 27604 Drain lower leg bursa 13.72 $70.00 $960.40 27605 Incision of achilles tendon 9.92 $70.00 $694.40 27606 Incision of achilles tendon 8.06 $70.00 $564.20 27607 Treat lower leg bone lesion 17.46 $70.00 $1,222.20 27610 Explore/treat ankle joint 18.69 $70.00 $1,308.30 27612 Exploration of ankle joint 16.15 $70.00 $1,130.50 27613 Biopsy lower leg soft tissue 7.27 $70.00 $508.90 27614 Biopsy lower leg soft tissue 16.68 $70.00 $1,167.60 27615 Resect leg/ankle tum < 5 cm 29.58 $70.00 $2,070.60 27616 Resect leg/ankle tum 5 cm/> 36.71 $70.00 $2,569.70 27618 Exc leg/ankle tum < 3 cm 12.93 $70.00 $905.10 27619 Exc leg/ankle tum deep <5 cm 13.37 $70.00 $935.90 27620 Explore/treat ankle joint 12.89 $70.00 $902.30 NON-FACILITY HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL 27625 Remove ankle joint lining 16.69 $70.00 $1,168.30 27626 Remove ankle joint lining 17.38 $70.00 $1,216.60 27630 Removal of tendon lesion 16.06 $70.00 $1,124.20 27632 Exc leg/ankle les sc 3 cm/> 11.94 $70.00 $835.80 27634 Exc leg/ankle tum dep 5 cm/> 19.64 $70.00 $1,374.80 27635 Remove lower leg bone lesion 16.85 $70.00 $1,179.50 27637 Remove/graft leg bone lesion 22.03 $70.00 $1,542.10 27638 Remove/graft leg bone lesion 22.28 $70.00 $1,559.60 27640 Partial removal of tibia 23.97 $70.00 $1,677.90 27641 Partial removal of fibula 19.17 $70.00 $1,341.90 27645 Resect tibia tumor 51.50 $70.00 $3,605.00 27646 Resect fibula tumor 44.67 $70.00 $3,126.90 27647 Resect talus/calcaneus tum 29.39 $70.00 $2,057.30 27648 Injection for ankle x-ray 4.78 $70.00 $334.60 27650 Repair achilles tendon 18.92 $70.00 $1,324.40 27652 Repair/graft achilles tendon 19.49 $70.00 $1,364.30 27654 Repair of achilles tendon 20.38 $70.00 $1,426.60 27656 Repair leg fascia defect 18.27 $70.00 $1,278.90 27658 Repair of leg tendon each 10.67 $70.00 $746.90 27659 Repair of leg tendon each 13.64 $70.00 $954.80 27664 Repair of leg tendon each 10.40 $70.00 $728.00 27665 Repair of leg tendon each 11.87 $70.00 $830.90 27675 Repair lower leg tendons 14.08 $70.00 $985.60 27676 Repair lower leg tendons 17.43 $70.00 $1,220.10 27680 Release of lower leg tendon 12.26 $70.00 $858.20 27681 Release of lower leg tendons 15.75 $70.00 $1,102.50 27685 Revision of lower leg tendon 19.10 $70.00 $1,337.00 27686 Revise lower leg tendons 15.86 $70.00 $1,110.20 27687 Revision of calf tendon 13.02 $70.00 $911.40 27690 Revise lower leg tendon 18.27 $70.00 $1,278.90 27691 Revise lower leg tendon 21.47 $70.00 $1,502.90 27692 Revise additional leg tendon 3.02 $70.00 $211.40 27695 Repair of ankle ligament 13.70 $70.00 $959.00 27696 Repair of ankle ligaments 16.08 $70.00 $1,125.60 27698 Repair of ankle ligament 18.45 $70.00 $1,291.50 27700 Revision of ankle joint 18.18 $70.00 $1,272.60 27702 Reconstruct ankle joint 27.67 $70.00 $1,936.90 27703 Reconstruction ankle joint 31.90 $70.00 $2,233.00 27704 Removal of ankle implant 16.41 $70.00 $1,148.70 27705 Incision of tibia 21.99 $70.00 $1,539.30 27707 Incision of fibula 11.45 $70.00 $801.50 27709 Incision of tibia & fibula 33.69 $70.00 $2,358.30 27712 Realignment of lower leg 31.92 $70.00 $2,234.40 27715 Revision of lower leg 30.91 $70.00 $2,163.70 27720 Repair of tibia 25.13 $70.00 $1,759.10 NON-FACILITY HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL 27722 Repair/graft of tibia 25.68 $70.00 $1,797.60 27724 Repair/graft of tibia 36.50 $70.00 $2,555.00 27725 Repair of lower leg 35.23 $70.00 $2,466.10 27726 Repair fibula nonunion 27.70 $70.00 $1,939.00 27727 Repair of lower leg 29.92 $70.00 $2,094.40 27730 Repair of tibia epiphysis 16.88 $70.00 $1,181.60 27732 Repair of fibula epiphysis 12.88 $70.00 $901.60 27734 Repair lower leg epiphyses 18.90 $70.00 $1,323.00 27740 Repair of leg epiphyses 20.39 $70.00 $1,427.30 27742 Repair of leg epiphyses 22.43 $70.00 $1,570.10 27745 Reinforce tibia 21.76 $70.00 $1,523.20 27750 Treatment of tibia fracture 9.94 $70.00 $695.80 27752 Treatment of tibia fracture 15.36 $70.00 $1,075.20 27756 Treatment of tibia fracture 16.67 $70.00 $1,166.90 27758 Treatment of tibia fracture 25.67 $70.00 $1,796.90 27759 Treatment of tibia fracture 28.79 $70.00 $2,015.30 27760 Cltx medial ankle fx 9.56 $70.00 $669.20 27762 Cltx med ankle fx w/mnpj 13.47 $70.00 $942.90 27766 Optx medial ankle fx 17.47 $70.00 $1,222.90 27767 Cltx post ankle fx 8.05 $70.00 $563.50 27768 Cltx post ankle fx w/mnpj 12.66 $70.00 $886.20 27769 Optx post ankle fx 21.06 $70.00 $1,474.20 27780 Treatment of fibula fracture 8.79 $70.00 $615.30 27781 Treatment of fibula fracture 12.27 $70.00 $858.90 27784 Treatment of fibula fracture 20.48 $70.00 $1,433.60 27786 Treatment of ankle fracture 9.04 $70.00 $632.80 27788 Treatment of ankle fracture 12.06 $70.00 $844.20 27792 Treatment of ankle fracture 18.70 $70.00 $1,309.00 27808 Treatment of ankle fracture 9.58 $70.00 $670.60 27810 Treatment of ankle fracture 13.35 $70.00 $934.50 27814 Treatment of ankle fracture 22.18 $70.00 $1,552.60 27816 Treatment of ankle fracture 9.23 $70.00 $646.10 27818 Treatment of ankle fracture 13.87 $70.00 $970.90 27822 Treatment of ankle fracture 24.69 $70.00 $1,728.30 27823 Treatment of ankle fracture 27.97 $70.00 $1,957.90 27824 Treat lower leg fracture 9.01 $70.00 $630.70 27825 Treat lower leg fracture 15.70 $70.00 $1,099.00 27826 Treat lower leg fracture 24.30 $70.00 $1,701.00 27827 Treat lower leg fracture 31.63 $70.00 $2,214.10 27828 Treat lower leg fracture 37.81 $70.00 $2,646.70 27829 Treat lower leg joint 20.00 $70.00 $1,400.00 27830 Treat lower leg dislocation 10.98 $70.00 $768.60 27831 Treat lower leg dislocation 11.51 $70.00 $805.70 27832 Treat lower leg dislocation 21.80 $70.00 $1,526.00 27840 Treat ankle dislocation 10.62 $70.00 $743.40 NON-FACILITY HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL 27842 Treat ankle dislocation 14.18 $70.00 $992.60 27846 Treat ankle dislocation 20.69 $70.00 $1,448.30 27848 Treat ankle dislocation 23.02 $70.00 $1,611.40 27860 Fixation of ankle joint 5.02 $70.00 $351.40 27870 Fusion of ankle joint open 29.64 $70.00 $2,074.80 27871 Fusion of tibiofibular joint 19.69 $70.00 $1,378.30 27880 Amputation of lower leg 26.45 $70.00 $1,851.50 27881 Amputation of lower leg 24.98 $70.00 $1,748.60 27882 Amputation of lower leg 17.32 $70.00 $1,212.40 27884 Amputation follow-up surgery 16.51 $70.00 $1,155.70 27886 Amputation follow-up surgery 18.98 $70.00 $1,328.60 27888 Amputation of foot at ankle 19.49 $70.00 $1,364.30 27889 Amputation of foot at ankle 18.76 $70.00 $1,313.20 27892 Decompression of leg 16.11 $70.00 $1,127.70 27893 Decompression of leg 17.56 $70.00 $1,229.20 27894 Decompression of leg 24.20 $70.00 $1,694.00 27899 Leg/ankle surgery procedure 0.00 $70.00 $0.00 28001 Drainage of bursa of foot 7.95 $70.00 $556.50 28002 Treatment of foot infection 12.69 $70.00 $888.30 28003 Treatment of foot infection 20.14 $70.00 $1,409.80 28005 Treat foot bone lesion 16.54 $70.00 $1,157.80 28008 Incision of foot fascia 12.49 $70.00 $874.30 28010 Incision of toe tendon 6.66 $70.00 $466.20 28011 Incision of toe tendons 9.19 $70.00 $643.30 28020 Exploration of foot joint 15.65 $70.00 $1,095.50 28022 Exploration of foot joint 14.00 $70.00 $980.00 28024 Exploration of toe joint 13.27 $70.00 $928.90 28035 Decompression of tibia nerve 15.28 $70.00 $1,069.60 28039 Exc foot/toe tum sc 1.5 cm/> 14.59 $70.00 $1,021.30 28041 Exc foot/toe tum dep 1.5cm/> 13.13 $70.00 $919.10 28043 Exc foot/toe tum sc < 1.5 cm 11.59 $70.00 $811.30 28045 Exc foot/toe tum deep <1.5cm 14.36 $70.00 $1,005.20 28046 Resect foot/toe tumor < 3 cm 21.03 $70.00 $1,472.10 28047 Resect foot/toe tumor 3 cm/> 30.31 $70.00 $2,121.70 28050 Biopsy of foot joint lining 12.25 $70.00 $857.50 28052 Biopsy of foot joint lining 13.05 $70.00 $913.50 28054 Biopsy of toe joint lining 10.85 $70.00 $759.50 28055 Neurectomy foot 10.93 $70.00 $765.10 28060 Partial removal foot fascia 15.00 $70.00 $1,050.00 28062 Removal of foot fascia 16.93 $70.00 $1,185.10 28070 Removal of foot joint lining 15.63 $70.00 $1,094.10 28072 Removal of foot joint lining 14.58 $70.00 $1,020.60 28080 Removal of foot lesion 15.17 $70.00 $1,061.90 28086 Excise foot tendon sheath 15.78 $70.00 $1,104.60 28088 Excise foot tendon sheath 12.98 $70.00 $908.60 NON-FACILITY HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL 28090 Removal of foot lesion 13.61 $70.00 $952.70 28092 Removal of toe lesions 12.27 $70.00 $858.90 28100 Removal of ankle/heel lesion 17.72 $70.00 $1,240.40 28102 Remove/graft foot lesion 17.47 $70.00 $1,222.90 28103 Remove/graft foot lesion 11.25 $70.00 $787.50 28104 Removal of foot lesion 15.30 $70.00 $1,071.00 28106 Remove/graft foot lesion 12.31 $70.00 $861.70 28107 Remove/graft foot lesion 14.90 $70.00 $1,043.00 28108 Removal of toe lesions 12.74 $70.00 $891.80 28110 Part removal of metatarsal 13.44 $70.00 $940.80 28111 Part removal of metatarsal 14.21 $70.00 $994.70 28112 Part removal of metatarsal 14.14 $70.00 $989.80 28113 Part removal of metatarsal 17.06 $70.00 $1,194.20 28114 Removal of metatarsal heads 31.01 $70.00 $2,170.70 28116 Revision of foot 22.33 $70.00 $1,563.10 28118 Removal of heel bone 17.25 $70.00 $1,207.50 28119 Removal of heel spur 15.16 $70.00 $1,061.20 28120 Part removal of ankle/heel 19.56 $70.00 $1,369.20 28122 Partial removal of foot bone 17.32 $70.00 $1,212.40 28124 Partial removal of toe 13.81 $70.00 $966.70 28126 Partial removal of toe 11.46 $70.00 $802.20 28130 Removal of ankle bone 21.01 $70.00 $1,470.70 28140 Removal of metatarsal 17.25 $70.00 $1,207.50 28150 Removal of toe 12.27 $70.00 $858.90 28153 Partial removal of toe 11.95 $70.00 $836.50 28160 Partial removal of toe 12.08 $70.00 $845.60 28171 Resect tarsal tumor 32.25 $70.00 $2,257.50 28173 Resect metatarsal tumor 21.69 $70.00 $1,518.30 28175 Resect phalanx of toe tumor 13.72 $70.00 $960.40 28190 Removal of foot foreign body 7.47 $70.00 $522.90 28192 Removal of foot foreign body 13.54 $70.00 $947.80 28193 Removal of foot foreign body 15.35 $70.00 $1,074.50 28200 Repair of foot tendon 14.28 $70.00 $999.60 28202 Repair/graft of foot tendon 17.34 $70.00 $1,213.80 28208 Repair of foot tendon 13.89 $70.00 $972.30 28210 Repair/graft of foot tendon 17.07 $70.00 $1,194.90 28220 Release of foot tendon 13.03 $70.00 $912.10 28222 Release of foot tendons 14.76 $70.00 $1,033.20 28225 Release of foot tendon 11.97 $70.00 $837.90 28226 Release of foot tendons 17.70 $70.00 $1,239.00 28230 Incision of foot tendon(s) 12.58 $70.00 $880.60 28232 Incision of toe tendon 11.19 $70.00 $783.30 28234 Incision of foot tendon 11.77 $70.00 $823.90 28238 Revision of foot tendon 19.38 $70.00 $1,356.60 28240 Release of big toe 13.33 $70.00 $933.10 NON-FACILITY HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL 28250 Revision of foot fascia 16.83 $70.00 $1,178.10 28260 Release of midfoot joint 19.85 $70.00 $1,389.50 28261 Revision of foot tendon 29.41 $70.00 $2,058.70 28262 Revision of foot and ankle 42.66 $70.00 $2,986.20 28264 Release of midfoot joint 29.21 $70.00 $2,044.70 28270 Release of foot contracture 14.28 $70.00 $999.60 28272 Release of toe joint each 11.37 $70.00 $795.90 28280 Fusion of toes 14.96 $70.00 $1,047.20 28285 Repair of hammertoe 15.49 $70.00 $1,084.30 28286 Repair of hammertoe 13.06 $70.00 $914.20 28288 Partial removal of foot bone 17.50 $70.00 $1,225.00 28289 Corrj halux rigdus w/o implt 21.53 $70.00 $1,507.10 28291 Corrj halux rigdus w/implt 21.01 $70.00 $1,470.70 28292 Correction hallux valgus 21.75 $70.00 $1,522.50 28295 Correction hallux valgus 27.20 $70.00 $1,904.00 28296 Correction hallux valgus 26.35 $70.00 $1,844.50 28297 Correction hallux valgus 30.23 $70.00 $2,116.10 28298 Correction hallux valgus 24.68 $70.00 $1,727.60 28299 Correction hallux valgus 29.12 $70.00 $2,038.40 28300 Incision of heel bone 18.73 $70.00 $1,311.10 28302 Incision of ankle bone 20.63 $70.00 $1,444.10 28304 Incision of midfoot bones 23.92 $70.00 $1,674.40 28305 Incise/graft midfoot bones 19.24 $70.00 $1,346.80 28306 Incision of metatarsal 17.80 $70.00 $1,246.00 28307 Incision of metatarsal 19.27 $70.00 $1,348.90 28308 Incision of metatarsal 16.42 $70.00 $1,149.40 28309 Incision of metatarsals 25.74 $70.00 $1,801.80 28310 Revision of big toe 15.82 $70.00 $1,107.40 28312 Revision of toe 14.65 $70.00 $1,025.50 28313 Repair deformity of toe 15.11 $70.00 $1,057.70 28315 Removal of sesamoid bone 13.98 $70.00 $978.60 28320 Repair of foot bones 17.55 $70.00 $1,228.50 28322 Repair of metatarsals 22.81 $70.00 $1,596.70 28340 Resect enlarged toe tissue 16.72 $70.00 $1,170.40 28341 Resect enlarged toe 19.38 $70.00 $1,356.60 28344 Repair extra toe(s) 13.05 $70.00 $913.50 28345 Repair webbed toe(s) 15.09 $70.00 $1,056.30 28360 Reconstruct cleft foot 31.30 $70.00 $2,191.00 28400 Treatment of heel fracture 7.16 $70.00 $501.20 28405 Treatment of heel fracture 11.22 $70.00 $785.40 28406 Treatment of heel fracture 14.95 $70.00 $1,046.50 28415 Treat heel fracture 32.22 $70.00 $2,255.40 28420 Treat/graft heel fracture 36.51 $70.00 $2,555.70 28430 Treatment of ankle fracture 6.77 $70.00 $473.90 28435 Treatment of ankle fracture 10.41 $70.00 $728.70 NON-FACILITY HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL 28436 Treatment of ankle fracture 12.95 $70.00 $906.50 28445 Treat ankle fracture 30.40 $70.00 $2,128.00 28446 Osteochondral talus autogrft 35.36 $70.00 $2,475.20 28450 Treat midfoot fracture each 6.18 $70.00 $432.60 28455 Treat midfoot fracture each 8.27 $70.00 $578.90 28456 Treat midfoot fracture 9.20 $70.00 $644.00 28465 Treat midfoot fracture each 18.20 $70.00 $1,274.00 28470 Treat metatarsal fracture 6.30 $70.00 $441.00 28475 Treat metatarsal fracture 7.32 $70.00 $512.40 28476 Treat metatarsal fracture 10.07 $70.00 $704.90 28485 Treat metatarsal fracture 15.60 $70.00 $1,092.00 28490 Treat big toe fracture 4.21 $70.00 $294.70 28495 Treat big toe fracture 5.12 $70.00 $358.40 28496 Treat big toe fracture 13.25 $70.00 $927.50 28505 Treat big toe fracture 19.28 $70.00 $1,349.60 28510 Treatment of toe fracture 3.57 $70.00 $249.90 28515 Treatment of toe fracture 4.66 $70.00 $326.20 28525 Treat toe fracture 16.44 $70.00 $1,150.80 28530 Treat sesamoid bone fracture 3.35 $70.00 $234.50 28531 Treat sesamoid bone fracture 9.91 $70.00 $693.70 28540 Treat foot dislocation 5.52 $70.00 $386.40 28545 Treat foot dislocation 8.57 $70.00 $599.90 28546 Treat foot dislocation 16.73 $70.00 $1,171.10 28555 Repair foot dislocation 25.12 $70.00 $1,758.40 28570 Treat foot dislocation 6.51 $70.00 $455.70 28575 Treat foot dislocation 10.55 $70.00 $738.50 28576 Treat foot dislocation 11.41 $70.00 $798.70 28585 Repair foot dislocation 24.93 $70.00 $1,745.10 28600 Treat foot dislocation 6.26 $70.00 $438.20 28605 Treat foot dislocation 9.47 $70.00 $662.90 28606 Treat foot dislocation 11.55 $70.00 $808.50 28615 Repair foot dislocation 23.17 $70.00 $1,621.90 28630 Treat toe dislocation 4.52 $70.00 $316.40 28635 Treat toe dislocation 5.11 $70.00 $357.70 28636 Treat toe dislocation 9.41 $70.00 $658.70 28645 Repair toe dislocation 18.87 $70.00 $1,320.90 28660 Treat toe dislocation 3.34 $70.00 $233.80 28665 Treat toe dislocation 4.48 $70.00 $313.60 28666 Treat toe dislocation 5.16 $70.00 $361.20 28675 Repair of toe dislocation 16.66 $70.00 $1,166.20 28705 Fusion of foot bones 35.98 $70.00 $2,518.60 28715 Fusion of foot bones 27.05 $70.00 $1,893.50 28725 Fusion of foot bones 22.43 $70.00 $1,570.10 28730 Fusion of foot bones 21.19 $70.00 $1,483.30 28735 Fusion of foot bones 22.53 $70.00 $1,577.10 NON-FACILITY HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL 28737 Revision of foot bones 20.03 $70.00 $1,402.10 28740 Fusion of foot bones 24.45 $70.00 $1,711.50 28750 Fusion of big toe joint 23.34 $70.00 $1,633.80 28755 Fusion of big toe joint 14.76 $70.00 $1,033.20 28760 Fusion of big toe joint 23.00 $70.00 $1,610.00 28800 Amputation of midfoot 15.45 $70.00 $1,081.50 28805 Amputation thru metatarsal 21.00 $70.00 $1,470.00 28810 Amputation toe & metatarsal 12.39 $70.00 $867.30 28820 Amputation of toe 16.28 $70.00 $1,139.60 28825 Partial amputation of toe 15.57 $70.00 $1,089.90 28890 Hi enrgy eswt plantar fascia 9.44 $70.00 $660.80 28899 Foot/toes surgery procedure 0.00 $70.00 $0.00 29000 Application of body cast 10.05 $70.00 $703.50 29010 Application of body cast 7.88 $70.00 $551.60 29015 Application of body cast 8.47 $70.00 $592.90 29035 Application of body cast 7.37 $70.00 $515.90 29040 Application of body cast 8.45 $70.00 $591.50 29044 Application of body cast 8.28 $70.00 $579.60 29046 Application of body cast 9.08 $70.00 $635.60 29049 Application of figure eight 2.85 $70.00 $199.50 29055 Application of shoulder cast 6.41 $70.00 $448.70 29058 Application of shoulder cast 3.57 $70.00 $249.90 29065 Application of long arm cast 2.76 $70.00 $193.20 29075 Application of forearm cast 2.49 $70.00 $174.30 29085 Apply hand/wrist cast 2.74 $70.00 $191.80 29086 Apply finger cast 2.29 $70.00 $160.30 29105 Apply long arm splint 2.52 $70.00 $176.40 29125 Apply forearm splint 1.86 $70.00 $130.20 29126 Apply forearm splint 2.21 $70.00 $154.70 29130 Application of finger splint 1.19 $70.00 $83.30 29131 Application of finger splint 1.50 $70.00 $105.00 29200 Strapping of chest 0.89 $70.00 $62.30 29240 Strapping of shoulder 0.86 $70.00 $60.20 29260 Strapping of elbow or wrist 0.85 $70.00 $59.50 29280 Strapping of hand or finger 0.86 $70.00 $60.20 29305 Application of hip cast 7.12 $70.00 $498.40 29325 Application of hip casts 7.89 $70.00 $552.30 29345 Application of long leg cast 3.90 $70.00 $273.00 29355 Application of long leg cast 4.02 $70.00 $281.40 29358 Apply long leg cast brace 4.62 $70.00 $323.40 29365 Application of long leg cast 3.53 $70.00 $247.10 29405 Apply short leg cast 2.33 $70.00 $163.10 29425 Apply short leg cast 2.24 $70.00 $156.80 29435 Apply short leg cast 3.39 $70.00 $237.30 29440 Addition of walker to cast 1.25 $70.00 $87.50 NON-FACILITY HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL 29445 Apply rigid leg cast 3.74 $70.00 $261.80 29450 Application of leg cast 4.18 $70.00 $292.60 29505 Application long leg splint 2.44 $70.00 $170.80 29515 Application lower leg splint 2.06 $70.00 $144.20 29520 Strapping of hip 0.94 $70.00 $65.80 29530 Strapping of knee 0.85 $70.00 $59.50 29540 Strapping of ankle and/or ft 0.75 $70.00 $52.50 29550 Strapping of toes 0.54 $70.00 $37.80 29580 Application of paste boot 1.75 $70.00 $122.50 29581 Apply multlay comprs lwr leg 2.42 $70.00 $169.40 29584 Appl multlay comprs arm/hand 2.25 $70.00 $157.50 29700 Removal/revision of cast 1.86 $70.00 $130.20 29705 Removal/revision of cast 1.90 $70.00 $133.00 29710 Removal/revision of cast 3.56 $70.00 $249.20 29720 Repair of body cast 2.45 $70.00 $171.50 29730 Windowing of cast 1.81 $70.00 $126.70 29740 Wedging of cast 2.86 $70.00 $200.20 29750 Wedging of clubfoot cast 3.10 $70.00 $217.00 29799 Casting/strapping procedure 0.00 $70.00 $0.00 29800 Jaw arthroscopy/surgery 15.22 $70.00 $1,065.40 29804 Jaw arthroscopy/surgery 18.47 $70.00 $1,292.90 29805 Shoulder arthroscopy dx 13.59 $70.00 $951.30 29806 Shoulder arthroscopy/surgery 30.59 $70.00 $2,141.30 29807 Shoulder arthroscopy/surgery 29.88 $70.00 $2,091.60 29819 Shoulder arthroscopy/surgery 16.83 $70.00 $1,178.10 29820 Shoulder arthroscopy/surgery 15.37 $70.00 $1,075.90 29821 Shoulder arthroscopy/surgery 16.84 $70.00 $1,178.80 29822 Shoulder arthroscopy/surgery 16.34 $70.00 $1,143.80 29823 Shoulder arthroscopy/surgery 17.80 $70.00 $1,246.00 29824 Shoulder arthroscopy/surgery 19.19 $70.00 $1,343.30 29825 Shoulder arthroscopy/surgery 16.59 $70.00 $1,161.30 29826 Shoulder arthroscopy/surgery 5.09 $70.00 $356.30 29827 Arthroscop rotator cuff repr 30.37 $70.00 $2,125.90 29828 Arthroscopy biceps tenodesis 26.20 $70.00 $1,834.00 29830 Elbow arthroscopy 13.15 $70.00 $920.50 29834 Elbow arthroscopy/surgery 14.00 $70.00 $980.00 29835 Elbow arthroscopy/surgery 14.65 $70.00 $1,025.50 29836 Elbow arthroscopy/surgery 16.78 $70.00 $1,174.60 29837 Elbow arthroscopy/surgery 15.08 $70.00 $1,055.60 29838 Elbow arthroscopy/surgery 16.94 $70.00 $1,185.80 29840 Wrist arthroscopy 13.02 $70.00 $911.40 29843 Wrist arthroscopy/surgery 13.97 $70.00 $977.90 29844 Wrist arthroscopy/surgery 14.30 $70.00 $1,001.00 29845 Wrist arthroscopy/surgery 16.59 $70.00 $1,161.30 29846 Wrist arthroscopy/surgery 15.00 $70.00 $1,050.00 NON-FACILITY HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL 29847 Wrist arthroscopy/surgery 15.68 $70.00 $1,097.60 29848 Wrist endoscopy/surgery 14.74 $70.00 $1,031.80 29850 Knee arthroscopy/surgery 18.00 $70.00 $1,260.00 29851 Knee arthroscopy/surgery 26.92 $70.00 $1,884.40 29855 Tibial arthroscopy/surgery 22.56 $70.00 $1,579.20 29856 Tibial arthroscopy/surgery 28.78 $70.00 $2,014.60 29860 Hip arthroscopy dx 19.25 $70.00 $1,347.50 29861 Hip arthro w/fb removal 20.80 $70.00 $1,456.00 29862 Hip arthr0 w/debridement 23.21 $70.00 $1,624.70 29863 Hip arthr0 w/synovectomy 23.18 $70.00 $1,622.60 29866 Autgrft implnt knee w/scope 30.31 $70.00 $2,121.70 29867 Allgrft implnt knee w/scope 36.97 $70.00 $2,587.90 29868 Meniscal trnspl knee w/scpe 48.43 $70.00 $3,390.10 29870 Knee arthroscopy dx 16.58 $70.00 $1,160.60 29871 Knee arthroscopy/drainage 14.84 $70.00 $1,038.80 29873 Knee arthroscopy/surgery 15.13 $70.00 $1,059.10 29874 Knee arthroscopy/surgery 15.45 $70.00 $1,081.50 29875 Knee arthroscopy/surgery 14.28 $70.00 $999.60 29876 Knee arthroscopy/surgery 18.95 $70.00 $1,326.50 29877 Knee arthroscopy/surgery 17.90 $70.00 $1,253.00 29879 Knee arthroscopy/surgery 19.09 $70.00 $1,336.30 29880 Knee arthroscopy/surgery 16.21 $70.00 $1,134.70 29881 Knee arthroscopy/surgery 15.60 $70.00 $1,092.00 29882 Knee arthroscopy/surgery 20.16 $70.00 $1,411.20 29883 Knee arthroscopy/surgery 24.32 $70.00 $1,702.40 29884 Knee arthroscopy/surgery 17.68 $70.00 $1,237.60 29885 Knee arthroscopy/surgery 21.75 $70.00 $1,522.50 29886 Knee arthroscopy/surgery 18.39 $70.00 $1,287.30 29887 Knee arthroscopy/surgery 21.65 $70.00 $1,515.50 29888 Knee arthroscopy/surgery 28.38 $70.00 $1,986.60 29889 Knee arthroscopy/surgery 35.35 $70.00 $2,474.50 29891 Ankle arthroscopy/surgery 19.33 $70.00 $1,353.10 29892 Ankle arthroscopy/surgery 19.66 $70.00 $1,376.20 29893 Scope plantar fasciotomy 17.65 $70.00 $1,235.50 29894 Ankle arthroscopy/surgery 14.13 $70.00 $989.10 29895 Ankle arthroscopy/surgery 13.52 $70.00 $946.40 29897 Ankle arthroscopy/surgery 14.46 $70.00 $1,012.20 29898 Ankle arthroscopy/surgery 16.20 $70.00 $1,134.00 29899 Ankle arthroscopy/surgery 29.78 $70.00 $2,084.60 29900 Mcp joint arthroscopy dx 14.28 $70.00 $999.60 29901 Mcp joint arthroscopy surg 15.39 $70.00 $1,077.30 29902 Mcp joint arthroscopy surg 16.35 $70.00 $1,144.50 29904 Subtalar arthro w/fb rmvl 18.42 $70.00 $1,289.40 29905 Subtalar arthro w/exc 15.83 $70.00 $1,108.10 29906 Subtalar arthro w/deb 20.04 $70.00 $1,402.80 NON-FACILITY HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL 29907 Subtalar arthro w/fusion 25.31 $70.00 $1,771.70 29914 Hip arthro w/femoroplasty 28.29 $70.00 $1,980.30 29915 Hip arthro acetabuloplasty 29.00 $70.00 $2,030.00 29916 Hip arthro w/labral repair 29.18 $70.00 $2,042.60 29999 Arthroscopy of joint 0.00 $70.00 $0.00 30000 Drainage of nose lesion 6.45 $70.00 $451.50 30020 Drainage of nose lesion 6.51 $70.00 $455.70 3006F Cxr doc rev 0.00 $70.00 $0.00 3008F Body mass index docd 0.00 $70.00 $0.00 30100 Intranasal biopsy 3.93 $70.00 $275.10 3011F Lipid panel doc rev 0.00 $70.00 $0.00 30110 Removal of nose polyp(s) 6.44 $70.00 $450.80 30115 Removal of nose polyp(s) 12.09 $70.00 $846.30 30117 Removal of intranasal lesion 24.51 $70.00 $1,715.70 30118 Removal of intranasal lesion 21.69 $70.00 $1,518.30 30120 Revision of nose 14.77 $70.00 $1,033.90 30124 Removal of nose lesion 7.98 $70.00 $558.60 30125 Removal of nose lesion 16.99 $70.00 $1,189.30 30130 Excise inferior turbinate 10.68 $70.00 $747.60 3014F Screen mammo doc rev 0.00 $70.00 $0.00 30140 Resect inferior turbinate 7.81 $70.00 $546.70 3015F Cerv cancer screen docd 0.00 $70.00 $0.00 30150 Partial removal of nose 21.61 $70.00 $1,512.70 3016F Pt scrnd unhlthy oh use 0.00 $70.00 $0.00 30160 Removal of nose 21.65 $70.00 $1,515.50 3017F Colorectal ca screen doc rev 0.00 $70.00 $0.00 3018F Pre-prxd rsk et al docd 0.00 $70.00 $0.00 3019F Lvef assess planpost dschrge 0.00 $70.00 $0.00 3020F Lvf assess 0.00 $70.00 $0.00 30200 Injection treatment of nose 3.15 $70.00 $220.50 3021F Lvef mod/sever deprs syst 0.00 $70.00 $0.00 30210 Nasal sinus therapy 4.21 $70.00 $294.70 3022F Lvef >/=40% systolic 0.00 $70.00 $0.00 30220 Insert nasal septal button 8.45 $70.00 $591.50 3023F Spirom doc rev 0.00 $70.00 $0.00 3025F Spirom fev/fvc <70% w/copd 0.00 $70.00 $0.00 3027F Spirom fev/fvc>/=70%/w/ocopd 0.00 $70.00 $0.00 3028F O2 saturation doc rev 0.00 $70.00 $0.00 30300 Remove nasal foreign body 5.02 $70.00 $351.40 30310 Remove nasal foreign body 5.68 $70.00 $397.60 30320 Remove nasal foreign body 12.63 $70.00 $884.10 3035F O2 saturation88%/pao>55 hg 0.00 $70.00 $0.00 3038F Pulm fx w/in 12 mon b/4 surg 0.00 $70.00 $0.00 3040F Fev <40% predicted value 0.00 $70.00 $0.00 NON-FACILITY HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL 30400 Reconstruction of nose 29.87 $70.00 $2,090.90 30410 Reconstruction of nose 35.20 $70.00 $2,464.00 3042F Fev >/=40% predicted value 0.00 $70.00 $0.00 30420 Reconstruction of nose 38.41 $70.00 $2,688.70 30430 Revision of nose 26.21 $70.00 $1,834.70 30435 Revision of nose 32.91 $70.00 $2,303.70 3044F Hg a1c level lt 7.0% 0.00 $70.00 $0.00 3045F Hg a1c level 7.0-9.0% 0.00 $70.00 $0.00 30450 Revision of nose 43.68 $70.00 $3,057.60 3046F Hemoglobin a1c level >9.0% 0.00 $70.00 $0.00 30460 Revision of nose 23.31 $70.00 $1,631.70 30462 Revision of nose 44.72 $70.00 $3,130.40 30465 Repair nasal stenosis 27.48 $70.00 $1,923.60 3048F Ldl-c <100 mg/dl 0.00 $70.00 $0.00 3049F Ldl-c 100-129 mg/dl 0.00 $70.00 $0.00 3050F Ldl-c >/= 130 mg/dl 0.00 $70.00 $0.00 30520 Repair of nasal septum 17.43 $70.00 $1,220.10 30540 Repair nasal defect 19.23 $70.00 $1,346.10 30545 Repair nasal defect 26.33 $70.00 $1,843.10 3055F Lvef less than/equal to 35% 0.00 $70.00 $0.00 3056F Lvef greater than 35% 0.00 $70.00 $0.00 30560 Release of nasal adhesions 7.48 $70.00 $523.60 30580 Repair upper jaw fistula 18.46 $70.00 $1,292.20 3060F Pos microalbuminuria rev 0.00 $70.00 $0.00 30600 Repair mouth/nose fistula 16.62 $70.00 $1,163.40 3061F Neg microalbuminuria rev 0.00 $70.00 $0.00 3062F Pos macroalbuminuria rev 0.00 $70.00 $0.00 30620 Intranasal reconstruction 17.43 $70.00 $1,220.10 30630 Repair nasal septum defect 17.42 $70.00 $1,219.40 3066F Nephropathy doc tx 0.00 $70.00 $0.00 3072F Low risk for retinopathy 0.00 $70.00 $0.00 3073F Pre-surg eye measures docd 0.00 $70.00 $0.00 3074F Syst bp lt 130 mm hg 0.00 $70.00 $0.00 3075F Syst bp ge 130 - 139mm hg 0.00 $70.00 $0.00 3077F Syst bp >/= 140 mm hg 0.00 $70.00 $0.00 3078F Diast bp <80 mm hg 0.00 $70.00 $0.00 3079F Diast bp 80-89 mm hg 0.00 $70.00 $0.00 3080F Diast bp >/= 90 mm hg 0.00 $70.00 $0.00 30801 Ablate inf turbinate superf 6.41 $70.00 $448.70 30802 Ablate inf turbinate submuc 8.10 $70.00 $567.00 3082F Kt/v <1.2 0.00 $70.00 $0.00 3083F Kt/v =/> 1.2 & <1.7 0.00 $70.00 $0.00 3084F Kt/v >/= 1.7 0.00 $70.00 $0.00 3085F Suicide risk assessed 0.00 $70.00 $0.00 3088F Mdd mild 0.00 $70.00 $0.00 NON-FACILITY HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL 3089F Mdd moderate 0.00 $70.00 $0.00 3090F Mdd severe w/o psych 0.00 $70.00 $0.00 30901 Control of nosebleed 3.87 $70.00 $270.90 30903 Control of nosebleed 5.95 $70.00 $416.50 30905 Control of nosebleed 9.20 $70.00 $644.00 30906 Repeat control of nosebleed 9.55 $70.00 $668.50 3091F Mdd severe w/psych 0.00 $70.00 $0.00 30915 Ligation nasal sinus artery 16.11 $70.00 $1,127.70 3092F Mdd in remission 0.00 $70.00 $0.00 30920 Ligation upper jaw artery 23.38 $70.00 $1,636.60 3093F Doc new diag 1st/addl mdd 0.00 $70.00 $0.00 30930 Ther fx nasal inf turbinate 3.46 $70.00 $242.20 3095F Central dexa results docd 0.00 $70.00 $0.00 3096F Central dexa ordered 0.00 $70.00 $0.00 30999 Nasal surgery procedure 0.00 $70.00 $0.00 3100F Image test ref carot diam 0.00 $70.00 $0.00 31000 Irrigation maxillary sinus 5.15 $70.00 $360.50 31002 Irrigation sphenoid sinus 5.29 $70.00 $370.30 31020 Exploration maxillary sinus 13.63 $70.00 $954.10 31030 Exploration maxillary sinus 19.37 $70.00 $1,355.90 31032 Explore sinus remove polyps 16.13 $70.00 $1,129.10 31040 Exploration behind upper jaw 21.45 $70.00 $1,501.50 31050 Exploration sphenoid sinus 13.55 $70.00 $948.50 31051 Sphenoid sinus surgery 18.02 $70.00 $1,261.40 31070 Exploration of frontal sinus 12.26 $70.00 $858.20 31075 Exploration of frontal sinus 21.85 $70.00 $1,529.50 31080 Removal of frontal sinus 28.79 $70.00 $2,015.30 31081 Removal of frontal sinus 34.44 $70.00 $2,410.80 31084 Removal of frontal sinus 32.24 $70.00 $2,256.80 31085 Removal of frontal sinus 36.76 $70.00 $2,573.20 31086 Removal of frontal sinus 31.31 $70.00 $2,191.70 31087 Removal of frontal sinus 30.25 $70.00 $2,117.50 31090 Exploration of sinuses 28.77 $70.00 $2,013.90 3110F Pres/absn hmrhg/lesion docd 0.00 $70.00 $0.00 3111F Ct/mri brain done w/in 24hrs 0.00 $70.00 $0.00 3112F Ct/mri brain done 24 hrs 0.00 $70.00 $0.00 3115F Quant results activity &symp 0.00 $70.00 $0.00 3117F Hf assessment tool completed 0.00 $70.00 $0.00 3118F Ny heart assoc class docd 0.00 $70.00 $0.00 3119F No eval activity clin symp 0.00 $70.00 $0.00 3120F 12-lead ecg performed 0.00 $70.00 $0.00 31200 Removal of ethmoid sinus 16.30 $70.00 $1,141.00 31201 Removal of ethmoid sinus 20.94 $70.00 $1,465.80 31205 Removal of ethmoid sinus 25.66 $70.00 $1,796.20 31225 Removal of upper jaw 52.88 $70.00 $3,701.60 NON-FACILITY HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL 31230 Removal of upper jaw 58.25 $70.00 $4,077.50 31231 Nasal endoscopy dx 5.96 $70.00 $417.20 31233 Nasal/sinus endoscopy dx 7.32 $70.00 $512.40 31235 Nasal/sinus endoscopy dx 8.38 $70.00 $586.60 31237 Nasal/sinus endoscopy surg 7.43 $70.00 $520.10 31238 Nasal/sinus endoscopy surg 7.41 $70.00 $518.70 31239 Nasal/sinus endoscopy surg 17.56 $70.00 $1,229.20 31240 Nasal/sinus endoscopy surg 4.54 $70.00 $317.80 31241 Nsl/sins ndsc w/artery lig 12.83 $70.00 $898.10 31253 Nsl/sins ndsc total 14.38 $70.00 $1,006.60 31254 Nsl/sins ndsc w/prtl ethmdct 11.54 $70.00 $807.80 31255 Nsl/sins ndsc w/tot ethmdct 9.29 $70.00 $650.30 31256 Exploration maxillary sinus 5.17 $70.00 $361.90 31257 Nsl/sins ndsc tot w/sphendt 12.80 $70.00 $896.00 31259 Nsl/sins ndsc sphn tiss rmvl 13.57 $70.00 $949.90 3126F Esoph bx rprt w/dyspl info 0.00 $70.00 $0.00 31267 Endoscopy maxillary sinus 7.62 $70.00 $533.40 31276 Nsl/sins ndsc frnt tiss rmvl 10.85 $70.00 $759.50 31287 Nasal/sinus endoscopy surg 5.78 $70.00 $404.60 31288 Nasal/sinus endoscopy surg 6.72 $70.00 $470.40 31290 Nasal/sinus endoscopy surg 32.70 $70.00 $2,289.00 31291 Nasal/sinus endoscopy surg 35.01 $70.00 $2,450.70 31292 Nasal/sinus endoscopy surg 28.14 $70.00 $1,969.80 31293 Nasal/sinus endoscopy surg 30.53 $70.00 $2,137.10 31294 Nasal/sinus endoscopy surg 34.97 $70.00 $2,447.90 31295 Sinus endo w/balloon dil 57.07 $70.00 $3,994.90 31296 Sinus endo w/balloon dil 57.80 $70.00 $4,046.00 31297 Sinus endo w/balloon dil 56.67 $70.00 $3,966.90 31298 Nsl/sins ndsc w/sins dilat 109.84 $70.00 $7,688.80 31299 Sinus surgery procedure 0.00 $70.00 $0.00 3130F Upper gi endoscopy performed 0.00 $70.00 $0.00 31300 Removal of larynx lesion 36.75 $70.00 $2,572.50 3132F Doc ref upper gi endoscopy 0.00 $70.00 $0.00 31360 Removal of larynx 59.70 $70.00 $4,179.00 31365 Removal of larynx 73.57 $70.00 $5,149.90 31367 Partial removal of larynx 63.16 $70.00 $4,421.20 31368 Partial removal of larynx 70.21 $70.00 $4,914.70 31370 Partial removal of larynx 59.40 $70.00 $4,158.00 31375 Partial removal of larynx 56.32 $70.00 $3,942.40 31380 Partial removal of larynx 55.53 $70.00 $3,887.10 31382 Partial removal of larynx 60.97 $70.00 $4,267.90 31390 Removal of larynx & pharynx 81.90 $70.00 $5,733.00 31395 Reconstruct larynx & pharynx 86.69 $70.00 $6,068.30 3140F Upper gi endo shows barrtts 0.00 $70.00 $0.00 31400 Revision of larynx 27.91 $70.00 $1,953.70 NON-FACILITY HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL 3141F Upper gi endo not barrtts 0.00 $70.00 $0.00 3142F Barium swallow test ordered 0.00 $70.00 $0.00 31420 Removal of epiglottis 23.42 $70.00 $1,639.40 3150F Forceps esoph biopsy done 0.00 $70.00 $0.00 31500 Insert emergency airway 4.06 $70.00 $284.20 31502 Change of windpipe airway 1.00 $70.00 $70.00 31505 Diagnostic laryngoscopy 2.33 $70.00 $163.10 31510 Laryngoscopy with biopsy 5.94 $70.00 $415.80 31511 Remove foreign body larynx 5.96 $70.00 $417.20 31512 Removal of larynx lesion 5.79 $70.00 $405.30 31513 Injection into vocal cord 3.74 $70.00 $261.80 31515 Laryngoscopy for aspiration 5.78 $70.00 $404.60 31520 Dx laryngoscopy newborn 4.45 $70.00 $311.50 31525 Dx laryngoscopy excl nb 7.11 $70.00 $497.70 31526 Dx laryngoscopy w/oper scope 4.47 $70.00 $312.90 31527 Laryngoscopy for treatment 5.57 $70.00 $389.90 31528 Laryngoscopy and dilation 4.11 $70.00 $287.70 31529 Laryngoscopy and dilation 4.60 $70.00 $322.00 31530 Laryngoscopy w/fb removal 5.70 $70.00 $399.00 31531 Laryngoscopy w/fb & op scope 6.06 $70.00 $424.20 31535 Laryngoscopy w/biopsy 5.42 $70.00 $379.40 31536 Laryngoscopy w/bx & op scope 6.01 $70.00 $420.70 31540 Laryngoscopy w/exc of tumor 6.89 $70.00 $482.30 31541 Larynscop w/tumr exc + scope 7.52 $70.00 $526.40 31545 Remove vc lesion w/scope 10.33 $70.00 $723.10 31546 Remove vc lesion scope/graft 15.70 $70.00 $1,099.00 3155F Cytogen test marrow b/4 tx 0.00 $70.00 $0.00 31551 Laryngoplasty laryngeal sten 40.96 $70.00 $2,867.20 31552 Laryngoplasty laryngeal sten 41.08 $70.00 $2,875.60 31553 Laryngoplasty laryngeal sten 45.20 $70.00 $3,164.00 31554 Laryngoplasty laryngeal sten 47.16 $70.00 $3,301.20 31560 Laryngoscop w/arytenoidectom 8.93 $70.00 $625.10 31561 Larynscop remve cart + scop 9.76 $70.00 $683.20 31570 Laryngoscope w/vc inj 9.52 $70.00 $666.40 31571 Laryngoscop w/vc inj + scope 7.11 $70.00 $497.70 31572 Largsc w/laser dstrj les 14.00 $70.00 $980.00 31573 Largsc w/ther injection 7.47 $70.00 $522.90 31574 Largsc w/njx augmentation 28.80 $70.00 $2,016.00 31575 Diagnostic laryngoscopy 3.20 $70.00 $224.00 31576 Laryngoscopy with biopsy 7.49 $70.00 $524.30 31577 Largsc w/rmvl foreign bdy(s) 7.78 $70.00 $544.60 31578 Largsc w/removal lesion 8.51 $70.00 $595.70 31579 Laryngoscopy telescopic 5.09 $70.00 $356.30 31580 Laryngoplasty laryngeal web 35.33 $70.00 $2,473.10 31584 Laryngoplasty fx rdctj fixj 39.13 $70.00 $2,739.10 NON-FACILITY HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL 31587 Laryngoplasty cricoid split 32.68 $70.00 $2,287.60 31590 Reinnervate larynx 24.82 $70.00 $1,737.40 31591 Laryngoplasty medialization 29.55 $70.00 $2,068.50 31592 Cricotracheal resection 48.14 $70.00 $3,369.80 31595 Larynx nerve surgery 21.40 $70.00 $1,498.00 31599 Larynx surgery procedure 0.00 $70.00 $0.00 3160F Doc fe+ stores b/4 epo thx 0.00 $70.00 $0.00 31600 Incision of windpipe 9.28 $70.00 $649.60 31601 Incision of windpipe 12.91 $70.00 $903.70 31603 Incision of windpipe 9.27 $70.00 $648.90 31605 Incision of windpipe 9.63 $70.00 $674.10 31610 Incision of windpipe 26.95 $70.00 $1,886.50 31611 Surgery/speech prosthesis 15.15 $70.00 $1,060.50 31612 Puncture/clear windpipe 2.36 $70.00 $165.20 31613 Repair windpipe opening 12.84 $70.00 $898.80 31614 Repair windpipe opening 21.24 $70.00 $1,486.80 31615 Visualization of windpipe 4.76 $70.00 $333.20 31622 Dx bronchoscope/wash 6.86 $70.00 $480.20 31623 Dx bronchoscope/brush 7.75 $70.00 $542.50 31624 Dx bronchoscope/lavage 7.23 $70.00 $506.10 31625 Bronchoscopy w/biopsy(s) 9.45 $70.00 $661.50 31626 Bronchoscopy w/markers 24.12 $70.00 $1,688.40 31627 Navigational bronchoscopy 39.91 $70.00 $2,793.70 31628 Bronchoscopy/lung bx each 10.05 $70.00 $703.50 31629 Bronchoscopy/needle bx each 12.39 $70.00 $867.30 31630 Bronchoscopy dilate/fx repr 5.75 $70.00 $402.50 31631 Bronchoscopy dilate w/stent 6.59 $70.00 $461.30 31632 Bronchoscopy/lung bx addl 1.82 $70.00 $127.40 31633 Bronchoscopy/needle bx addl 2.29 $70.00 $160.30 31634 Bronch w/balloon occlusion 50.69 $70.00 $3,548.30 31635 Bronchoscopy w/fb removal 8.00 $70.00 $560.00 31636 Bronchoscopy bronch stents 6.38 $70.00 $446.60 31637 Bronchoscopy stent add-on 2.14 $70.00 $149.80 31638 Bronchoscopy revise stent 7.21 $70.00 $504.70 31640 Bronchoscopy w/tumor excise 7.25 $70.00 $507.50 31641 Bronchoscopy treat blockage 7.42 $70.00 $519.40 31643 Diag bronchoscope/catheter 5.11 $70.00 $357.70 31645 Brnchsc w/ther aspir 1st 7.38 $70.00 $516.60 31646 Brnchsc w/ther aspir sbsq 4.09 $70.00 $286.30 31647 Bronchial valve init insert 6.13 $70.00 $429.10 31648 Bronchial valve remov init 5.62 $70.00 $393.40 31649 Bronchial valve remov addl 1.95 $70.00 $136.50 31651 Bronchial valve addl insert 2.14 $70.00 $149.80 31652 Bronch ebus samplng 1/2 node 23.63 $70.00 $1,654.10 31653 Bronch ebus samplng 3/> node 24.98 $70.00 $1,748.60 NON-FACILITY HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL 31654 Bronch ebus ivntj perph les 3.58 $70.00 $250.60 31660 Bronch thermoplsty 1 lobe 5.63 $70.00 $394.10 31661 Bronch thermoplsty 2/> lobes 5.96 $70.00 $417.20 3170F Flow cyto done b/4 tx 0.00 $70.00 $0.00 31717 Bronchial brush biopsy 7.65 $70.00 $535.50 31720 Clearance of airways 1.43 $70.00 $100.10 31725 Clearance of airways 2.28 $70.00 $159.60 31730 Intro windpipe wire/tube 35.25 $70.00 $2,467.50 31750 Repair of windpipe 39.73 $70.00 $2,781.10 31755 Repair of windpipe 50.18 $70.00 $3,512.60 31760 Repair of windpipe 39.61 $70.00 $2,772.70 31766 Reconstruction of windpipe 51.41 $70.00 $3,598.70 31770 Repair/graft of bronchus 38.51 $70.00 $2,695.70 31775 Reconstruct bronchus 40.44 $70.00 $2,830.80 31780 Reconstruct windpipe 33.96 $70.00 $2,377.20 31781 Reconstruct windpipe 40.04 $70.00 $2,802.80 31785 Remove windpipe lesion 30.40 $70.00 $2,128.00 31786 Remove windpipe lesion 41.70 $70.00 $2,919.00 31800 Repair of windpipe injury 20.70 $70.00 $1,449.00 31805 Repair of windpipe injury 23.54 $70.00 $1,647.80 31820 Closure of windpipe lesion 12.24 $70.00 $856.80 31825 Repair of windpipe defect 16.91 $70.00 $1,183.70 31830 Revise windpipe scar 12.50 $70.00 $875.00 31899 Airways surgical procedure 0.00 $70.00 $0.00 3200F Barium swallow test not req 0.00 $70.00 $0.00 32035 Thoracostomy w/rib resection 20.97 $70.00 $1,467.90 32036 Thoracostomy w/flap drainage 22.31 $70.00 $1,561.70 32096 Open wedge/bx lung infiltr 23.22 $70.00 $1,625.40 32097 Open wedge/bx lung nodule 23.20 $70.00 $1,624.00 32098 Open biopsy of lung pleura 22.02 $70.00 $1,541.40 3210F Grp a strep test performed 0.00 $70.00 $0.00 32100 Exploration of chest 23.36 $70.00 $1,635.20 32110 Explore/repair chest 42.32 $70.00 $2,962.40 32120 Re-exploration of chest 25.15 $70.00 $1,760.50 32124 Explore chest free adhesions 26.74 $70.00 $1,871.80 32140 Removal of lung lesion(s) 28.67 $70.00 $2,006.90 32141 Remove/treat lung lesions 44.00 $70.00 $3,080.00 3215F Pt immunity to hep a docd 0.00 $70.00 $0.00 32150 Removal of lung lesion(s) 28.93 $70.00 $2,025.10 32151 Remove lung foreign body 29.09 $70.00 $2,036.30 3216F Pt immunity to hep b docd 0.00 $70.00 $0.00 32160 Open chest heart massage 22.81 $70.00 $1,596.70 3218F Rna tstng hep c docd done 0.00 $70.00 $0.00 3220F Hep c quant rna tstng docd 0.00 $70.00 $0.00 32200 Drain open lung lesion 32.91 $70.00 $2,303.70 NON-FACILITY HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL 32215 Treat chest lining 23.23 $70.00 $1,626.10 32220 Release of lung 45.69 $70.00 $3,198.30 32225 Partial release of lung 28.69 $70.00 $2,008.30 3230F Note hring tst w/in 6 mon 0.00 $70.00 $0.00 32310 Removal of chest lining 26.33 $70.00 $1,843.10 32320 Free/remove chest lining 46.06 $70.00 $3,224.20 32400 Needle biopsy chest lining 4.29 $70.00 $300.30 32405 Percut bx lung/mediastinum 11.13 $70.00 $779.10 32440 Remove lung pneumonectomy 45.15 $70.00 $3,160.50 32442 Sleeve pneumonectomy 88.66 $70.00 $6,206.20 32445 Removal of lung extrapleural 102.15 $70.00 $7,150.50 32480 Partial removal of lung 42.66 $70.00 $2,986.20 32482 Bilobectomy 45.65 $70.00 $3,195.50 32484 Segmentectomy 41.43 $70.00 $2,900.10 32486 Sleeve lobectomy 68.01 $70.00 $4,760.70 32488 Completion pneumonectomy 69.38 $70.00 $4,856.60 32491 Lung volume reduction 41.93 $70.00 $2,935.10 3250F Nonprim loc anat bx site tum 0.00 $70.00 $0.00 32501 Repair bronchus add-on 7.08 $70.00 $495.60 32503 Resect apical lung tumor 52.00 $70.00 $3,640.00 32504 Resect apical lung tum/chest 59.25 $70.00 $4,147.50 32505 Wedge resect of lung initial 26.86 $70.00 $1,880.20 32506 Wedge resect of lung add-on 4.53 $70.00 $317.10 32507 Wedge resect of lung diag 4.53 $70.00 $317.10 32540 Removal of lung lesion 49.88 $70.00 $3,491.60 32550 Insert pleural cath 20.21 $70.00 $1,414.70 32551 Insertion of chest tube 4.54 $70.00 $317.80 32552 Remove lung catheter 5.25 $70.00 $367.50 32553 Ins mark thor for rt perq 14.87 $70.00 $1,040.90 32554 Aspirate pleura w/o imaging 5.78 $70.00 $404.60 32555 Aspirate pleura w/ imaging 8.26 $70.00 $578.20 32556 Insert cath pleura w/o image 15.90 $70.00 $1,113.00 32557 Insert cath pleura w/ image 14.54 $70.00 $1,017.80 32560 Treat pleurodesis w/agent 6.99 $70.00 $489.30 32561 Lyse chest fibrin init day 2.66 $70.00 $186.20 32562 Lyse chest fibrin subq day 2.39 $70.00 $167.30 3260F Pt cat/pn cat/hist grd docd 0.00 $70.00 $0.00 32601 Thoracoscopy diagnostic 8.92 $70.00 $624.40 32604 Thoracoscopy wbx sac 13.94 $70.00 $975.80 32606 Thoracoscopy w/bx med space 13.37 $70.00 $935.90 32607 Thoracoscopy w/bx infiltrate 8.91 $70.00 $623.70 32608 Thoracoscopy w/bx nodule 10.92 $70.00 $764.40 32609 Thoracoscopy w/bx pleura 7.47 $70.00 $522.90 3265F Rna tstng hepc vir ord/docd 0.00 $70.00 $0.00 32650 Thoracoscopy w/pleurodesis 19.21 $70.00 $1,344.70 NON-FACILITY HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL 32651 Thoracoscopy remove cortex 31.61 $70.00 $2,212.70 32652 Thoracoscopy rem totl cortex 47.95 $70.00 $3,356.50 32653 Thoracoscopy remov fb/fibrin 30.57 $70.00 $2,139.90 32654 Thoracoscopy contrl bleeding 33.28 $70.00 $2,329.60 32655 Thoracoscopy resect bullae 27.59 $70.00 $1,931.30 32656 Thoracoscopy w/pleurectomy 23.09 $70.00 $1,616.30 32658 Thoracoscopy w/sac fb remove 20.61 $70.00 $1,442.70 32659 Thoracoscopy w/sac drainage 21.07 $70.00 $1,474.90 3266F Hepc gn tstng docd b/4txmnt 0.00 $70.00 $0.00 32661 Thoracoscopy w/pericard exc 23.08 $70.00 $1,615.60 32662 Thoracoscopy w/mediast exc 25.70 $70.00 $1,799.00 32663 Thoracoscopy w/lobectomy 40.41 $70.00 $2,828.70 32664 Thoracoscopy w/ th nrv exc 24.51 $70.00 $1,715.70 32665 Thoracoscop w/esoph musc exc 35.67 $70.00 $2,496.90 32666 Thoracoscopy w/wedge resect 25.12 $70.00 $1,758.40 32667 Thoracoscopy w/w resect addl 4.54 $70.00 $317.80 32668 Thoracoscopy w/w resect diag 4.54 $70.00 $317.80 32669 Thoracoscopy remove segment 38.83 $70.00 $2,718.10 3267F Path rprt w/ pt pn cat et al 0.00 $70.00 $0.00 32670 Thoracoscopy bilobectomy 46.35 $70.00 $3,244.50 32671 Thoracoscopy pneumonectomy 51.47 $70.00 $3,602.90 32672 Thoracoscopy for lvrs 44.17 $70.00 $3,091.90 32673 Thoracoscopy w/thymus resect 35.20 $70.00 $2,464.00 32674 Thoracoscopy lymph node exc 6.23 $70.00 $436.10 3268F Psa/t/glsc docd b/4 txmnt 0.00 $70.00 $0.00 3269F Bone scn b/4 txmnt/aftr dx 0.00 $70.00 $0.00 3270F No bone scn b/4 txmnt/aftrdx 0.00 $70.00 $0.00 32701 Thorax stereo rad targetw/tx 6.20 $70.00 $434.00 3271F Low risk prostate cancer 0.00 $70.00 $0.00 3272F Med risk prostate cancer 0.00 $70.00 $0.00 3273F High risk prostate cancer 0.00 $70.00 $0.00 3274F Prost cncr rsk not lw/md/hgh 0.00 $70.00 $0.00 3278F Serum lvls ca/ipth/lpd ord 0.00 $70.00 $0.00 3279F Hgb lvl >/= 13 g/dl 0.00 $70.00 $0.00 3280F Hgb lvl 11-12.9 g/dl 0.00 $70.00 $0.00 32800 Repair lung hernia 27.25 $70.00 $1,907.50 3281F Hgb lvl <11 g/dl 0.00 $70.00 $0.00 32810 Close chest after drainage 26.04 $70.00 $1,822.80 32815 Close bronchial fistula 80.53 $70.00 $5,637.10 32820 Reconstruct injured chest 38.46 $70.00 $2,692.20 3284F Iop down >15% of pre-svc lvl 0.00 $70.00 $0.00 3285F Iop down <15% of pre-svc lvl 0.00 $70.00 $0.00 32850 Donor pneumonectomy 0.00 $70.00 $0.00 32851 Lung transplant single 95.08 $70.00 $6,655.60 32852 Lung transplant with bypass 103.42 $70.00 $7,239.40 NON-FACILITY HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL 32853 Lung transplant double 132.42 $70.00 $9,269.40 32854 Lung transplant with bypass 140.46 $70.00 $9,832.20 32855 Prepare donor lung single 0.00 $70.00 $0.00 32856 Prepare donor lung double 0.00 $70.00 $0.00 3288F Fall risk assessment docd 0.00 $70.00 $0.00 3290F Pt=d(rh)- and unsensitized 0.00 $70.00 $0.00 32900 Removal of rib(s) 40.95 $70.00 $2,866.50 32905 Revise & repair chest wall 38.68 $70.00 $2,707.60 32906 Revise & repair chest wall 47.76 $70.00 $3,343.20 3291F Pt=d(rh)+ or sensitized 0.00 $70.00 $0.00 3292F Hiv tstng asked/docd/revwd 0.00 $70.00 $0.00 3293F Abo rh blood typing docd 0.00 $70.00 $0.00 3294F Grp b strep screening docd 0.00 $70.00 $0.00 32940 Revision of lung 35.72 $70.00 $2,500.40 32960 Therapeutic pneumothorax 3.62 $70.00 $253.40 32994 Ablate pulm tumor perq crybl 175.17 $70.00 $12,261.90 32997 Total lung lavage 9.86 $70.00 $690.20 32998 Ablate pulm tumor perq rf 102.91 $70.00 $7,203.70 32999 Chest surgery procedure 0.00 $70.00 $0.00 3300F Ajcc stage docd b/4 thxpy 0.00 $70.00 $0.00 3301F Cancer stage docd metast 0.00 $70.00 $0.00 33010 Drainage of heart sac 3.12 $70.00 $218.40 33011 Repeat drainage of heart sac 3.14 $70.00 $219.80 33015 Incision of heart sac 14.79 $70.00 $1,035.30 33020 Incision of heart sac 25.43 $70.00 $1,780.10 33025 Incision of heart sac 23.06 $70.00 $1,614.20 33030 Partial removal of heart sac 57.89 $70.00 $4,052.30 33031 Partial removal of heart sac 71.47 $70.00 $5,002.90 33050 Resect heart sac lesion 29.23 $70.00 $2,046.10 33120 Removal of heart lesion 60.61 $70.00 $4,242.70 33130 Removal of heart lesion 39.81 $70.00 $2,786.70 33140 Heart revascularize (tmr) 45.50 $70.00 $3,185.00 33141 Heart tmr w/other procedure 3.81 $70.00 $266.70 3315F Er+ or pr+ breast cancer 0.00 $70.00 $0.00 3316F Er- or pr- breast cancer 0.00 $70.00 $0.00 3317F Path rpt malig cancer docd 0.00 $70.00 $0.00 3318F Path rpt malig cancer docd 0.00 $70.00 $0.00 3319F X-ray/ct/ultrsnd et al ord 0.00 $70.00 $0.00 3320F No xray/ct/ et al ordd 0.00 $70.00 $0.00 33202 Insert epicard eltrd open 22.46 $70.00 $1,572.20 33203 Insert epicard eltrd endo 23.42 $70.00 $1,639.40 33206 Insert heart pm atrial 13.12 $70.00 $918.40 33207 Insert heart pm ventricular 13.97 $70.00 $977.90 33208 Insrt heart pm atrial & vent 15.13 $70.00 $1,059.10 3321F Ajcc cncr 0/ia melan docd 0.00 $70.00 $0.00 NON-FACILITY HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL 33210 Insert electrd/pm cath sngl 4.78 $70.00 $334.60 33211 Insert card electrodes dual 4.93 $70.00 $345.10 33212 Insert pulse gen sngl lead 9.30 $70.00 $651.00 33213 Insert pulse gen dual leads 9.73 $70.00 $681.10 33214 Upgrade of pacemaker system 13.89 $70.00 $972.30 33215 Reposition pacing-defib lead 9.02 $70.00 $631.40 33216 Insert 1 electrode pm-defib 10.75 $70.00 $752.50 33217 Insert 2 electrode pm-defib 10.56 $70.00 $739.20 33218 Repair lead pace-defib one 11.26 $70.00 $788.20 3322F Melanomaajcc stage 0 or ia 0.00 $70.00 $0.00 33220 Repair lead pace-defib dual 11.36 $70.00 $795.20 33221 Insert pulse gen mult leads 10.45 $70.00 $731.50 33222 Relocation pocket pacemaker 9.79 $70.00 $685.30 33223 Relocate pocket for defib 11.86 $70.00 $830.20 33224 Insert pacing lead & connect 14.99 $70.00 $1,049.30 33225 L ventric pacing lead add-on 13.67 $70.00 $956.90 33226 Reposition l ventric lead 14.41 $70.00 $1,008.70 33227 Remove&replace pm gen singl 9.81 $70.00 $686.70 33228 Remv&replc pm gen dual lead 10.27 $70.00 $718.90 33229 Remv&replc pm gen mult leads 10.87 $70.00 $760.90 3323F Clin node stgng docdb/4 surg 0.00 $70.00 $0.00 33230 Insrt pulse gen w/dual leads 11.09 $70.00 $776.30 33231 Insrt pulse gen w/mult leads 11.65 $70.00 $815.50 33233 Removal of pm generator 6.67 $70.00 $466.90 33234 Removal of pacemaker system 14.08 $70.00 $985.60 33235 Removal pacemaker electrode 18.52 $70.00 $1,296.40 33236 Remove electrode/thoracotomy 22.64 $70.00 $1,584.80 33237 Remove electrode/thoracotomy 24.31 $70.00 $1,701.70 33238 Remove electrode/thoracotomy 27.25 $70.00 $1,907.50 3324F Mri ct scan ord rvwd rqstd 0.00 $70.00 $0.00 33240 Insrt pulse gen w/singl lead 10.61 $70.00 $742.70 33241 Remove pulse generator 6.25 $70.00 $437.50 33243 Remove eltrd/thoracotomy 39.66 $70.00 $2,776.20 33244 Remove elctrd transvenously 24.99 $70.00 $1,749.30 33249 Insj/rplcmt defib w/lead(s) 26.63 $70.00 $1,864.10 3325F Preop asses 4 cataract surg 0.00 $70.00 $0.00 33250 Ablate heart dysrhythm focus 42.43 $70.00 $2,970.10 33251 Ablate heart dysrhythm focus 46.96 $70.00 $3,287.20 33254 Ablate atria lmtd 39.41 $70.00 $2,758.70 33255 Ablate atria w/o bypass ext 47.44 $70.00 $3,320.80 33256 Ablate atria w/bypass exten 56.30 $70.00 $3,941.00 33257 Ablate atria lmtd add-on 16.84 $70.00 $1,178.80 33258 Ablate atria x10sv add-on 19.03 $70.00 $1,332.10 33259 Ablate atria w/bypass add-on 24.43 $70.00 $1,710.10 33261 Ablate heart dysrhythm focus 46.97 $70.00 $3,287.90 NON-FACILITY HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL 33262 Rmvl& replc pulse gen 1 lead 10.81 $70.00 $756.70 33263 Rmvl & rplcmt dfb gen 2 lead 11.28 $70.00 $789.60 33264 Rmvl & rplcmt dfb gen mlt ld 11.75 $70.00 $822.50 33265 Ablate atria lmtd endo 39.31 $70.00 $2,751.70 33266 Ablate atria x10sv endo 53.39 $70.00 $3,737.30 33270 Ins/rep subq defibrillator 16.51 $70.00 $1,155.70 33271 Insj subq impltbl dfb elctrd 13.27 $70.00 $928.90 33272 Rmvl of subq defibrillator 10.15 $70.00 $710.50 33273 Repos prev impltbl subq dfb 11.69 $70.00 $818.30 3328F Prfrmnc docd 2 wks b/4 surg 0.00 $70.00 $0.00 33282 Implant pat-active ht record 6.55 $70.00 $458.50 33284 Remove pat-active ht record 5.74 $70.00 $401.80 3330F Imaging study ordered (bkp) 0.00 $70.00 $0.00 33300 Repair of heart wound 70.88 $70.00 $4,961.60 33305 Repair of heart wound 118.64 $70.00 $8,304.80 3331F Bk imaging tst not ordered 0.00 $70.00 $0.00 33310 Exploratory heart surgery 34.06 $70.00 $2,384.20 33315 Exploratory heart surgery 55.26 $70.00 $3,868.20 33320 Repair major blood vessel(s) 30.56 $70.00 $2,139.20 33321 Repair major vessel 34.61 $70.00 $2,422.70 33322 Repair major blood vessel(s) 40.16 $70.00 $2,811.20 33330 Insert major vessel graft 41.52 $70.00 $2,906.40 33335 Insert major vessel graft 54.75 $70.00 $3,832.50 33340 Perq clsr tcat l atr apndge 23.09 $70.00 $1,616.30 33361 Replace aortic valve perq 39.46 $70.00 $2,762.20 33362 Replace aortic valve open 43.08 $70.00 $3,015.60 33363 Replace aortic valve open 44.68 $70.00 $3,127.60 33364 Replace aortic valve open 47.06 $70.00 $3,294.20 33365 Replace aortic valve open 51.76 $70.00 $3,623.20 33366 Trcath replace aortic valve 55.98 $70.00 $3,918.60 33367 Replace aortic valve w/byp 18.26 $70.00 $1,278.20 33368 Replace aortic valve w/byp 21.70 $70.00 $1,519.00 33369 Replace aortic valve w/byp 28.65 $70.00 $2,005.50 33390 Valvuloplasty aortic valve 54.95 $70.00 $3,846.50 33391 Valvuloplasty aortic valve 65.19 $70.00 $4,563.30 3340F Mammo assess inc xray docd 0.00 $70.00 $0.00 33404 Prepare heart-aorta conduit 50.99 $70.00 $3,569.30 33405 Replacement aortic valve opn 65.62 $70.00 $4,593.40 33406 Replacement aortic valve opn 83.04 $70.00 $5,812.80 3341F Mammo assess negative docd 0.00 $70.00 $0.00 33410 Replacement aortic valve opn 73.60 $70.00 $5,152.00 33411 Replacement of aortic valve 96.94 $70.00 $6,785.80 33412 Replacement of aortic valve 91.94 $70.00 $6,435.80 33413 Replacement of aortic valve 94.04 $70.00 $6,582.80 33414 Repair of aortic valve 62.43 $70.00 $4,370.10 NON-FACILITY HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL 33415 Revision subvalvular tissue 58.73 $70.00 $4,111.10 33416 Revise ventricle muscle 58.65 $70.00 $4,105.50 33417 Repair of aortic valve 48.37 $70.00 $3,385.90 33418 Repair tcat mitral valve 52.32 $70.00 $3,662.40 33419 Repair tcat mitral valve 12.36 $70.00 $865.20 3342F Mammo assess bengn docd 0.00 $70.00 $0.00 33420 Revision of mitral valve 42.27 $70.00 $2,958.90 33422 Revision of mitral valve 48.52 $70.00 $3,396.40 33425 Repair of mitral valve 79.10 $70.00 $5,537.00 33426 Repair of mitral valve 68.91 $70.00 $4,823.70 33427 Repair of mitral valve 70.74 $70.00 $4,951.80 3343F Mammo probably bengn docd 0.00 $70.00 $0.00 33430 Replacement of mitral valve 80.90 $70.00 $5,663.00 3344F Mammo assess susp docd 0.00 $70.00 $0.00 3345F Mammo assess hghlymalig doc 0.00 $70.00 $0.00 33460 Revision of tricuspid valve 70.15 $70.00 $4,910.50 33463 Valvuloplasty tricuspid 89.31 $70.00 $6,251.70 33464 Valvuloplasty tricuspid 70.65 $70.00 $4,945.50 33465 Replace tricuspid valve 79.76 $70.00 $5,583.20 33468 Revision of tricuspid valve 71.18 $70.00 $4,982.60 33470 Revision of pulmonary valve 35.90 $70.00 $2,513.00 33471 Valvotomy pulmonary valve 38.43 $70.00 $2,690.10 33474 Revision of pulmonary valve 63.22 $70.00 $4,425.40 33475 Replacement pulmonary valve 67.75 $70.00 $4,742.50 33476 Revision of heart chamber 44.17 $70.00 $3,091.90 33477 Implant tcat pulm vlv perq 39.65 $70.00 $2,775.50 33478 Revision of heart chamber 45.64 $70.00 $3,194.80 33496 Repair prosth valve clot 48.53 $70.00 $3,397.10 3350F Mammo bx proven malig docd 0.00 $70.00 $0.00 33500 Repair heart vessel fistula 45.50 $70.00 $3,185.00 33501 Repair heart vessel fistula 32.49 $70.00 $2,274.30 33502 Coronary artery correction 37.02 $70.00 $2,591.40 33503 Coronary artery graft 38.48 $70.00 $2,693.60 33504 Coronary artery graft 42.54 $70.00 $2,977.80 33505 Repair artery w/tunnel 59.94 $70.00 $4,195.80 33506 Repair artery translocation 59.69 $70.00 $4,178.30 33507 Repair art intramural 50.07 $70.00 $3,504.90 33508 Endoscopic vein harvest 0.47 $70.00 $32.90 3351F Neg scrn dep symp by deptool 0.00 $70.00 $0.00 33510 Cabg vein single 55.89 $70.00 $3,912.30 33511 Cabg vein two 61.42 $70.00 $4,299.40 33512 Cabg vein three 69.84 $70.00 $4,888.80 33513 Cabg vein four 71.85 $70.00 $5,029.50 33514 Cabg vein five 76.18 $70.00 $5,332.60 33516 Cabg vein six or more 78.88 $70.00 $5,521.60 NON-FACILITY HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL 33517 Cabg artery-vein single 5.43 $70.00 $380.10 33518 Cabg artery-vein two 11.93 $70.00 $835.10 33519 Cabg artery-vein three 15.77 $70.00 $1,103.90 3352F No sig dep symp by dep tool 0.00 $70.00 $0.00 33521 Cabg artery-vein four 18.90 $70.00 $1,323.00 33522 Cabg artery-vein five 21.24 $70.00 $1,486.80 33523 Cabg art-vein six or more 24.23 $70.00 $1,696.10 3353F Mild-mod dep symp by deptool 0.00 $70.00 $0.00 33530 Coronary artery bypass/reop 15.24 $70.00 $1,066.80 33533 Cabg arterial single 54.06 $70.00 $3,784.20 33534 Cabg arterial two 63.60 $70.00 $4,452.00 33535 Cabg arterial three 70.86 $70.00 $4,960.20 33536 Cabg arterial four or more 76.11 $70.00 $5,327.70 3354F Clin sig dep sym by dep tool 0.00 $70.00 $0.00 33542 Removal of heart lesion 75.85 $70.00 $5,309.50 33545 Repair of heart damage 89.51 $70.00 $6,265.70 33548 Restore/remodel ventricle 86.13 $70.00 $6,029.10 33572 Open coronary endarterectomy 6.67 $70.00 $466.90 33600 Closure of valve 49.88 $70.00 $3,491.60 33602 Closure of valve 48.40 $70.00 $3,388.00 33606 Anastomosis/artery-aorta 51.60 $70.00 $3,612.00 33608 Repair anomaly w/conduit 52.25 $70.00 $3,657.50 33610 Repair by enlargement 51.52 $70.00 $3,606.40 33611 Repair double ventricle 56.71 $70.00 $3,969.70 33612 Repair double ventricle 58.20 $70.00 $4,074.00 33615 Repair modified fontan 57.96 $70.00 $4,057.20 33617 Repair single ventricle 62.78 $70.00 $4,394.60 33619 Repair single ventricle 79.10 $70.00 $5,537.00 33620 Apply r&l pulm art bands 47.94 $70.00 $3,355.80 33621 Transthor cath for stent 27.03 $70.00 $1,892.10 33622 Redo compl cardiac anomaly 99.61 $70.00 $6,972.70 33641 Repair heart septum defect 47.62 $70.00 $3,333.40 33645 Revision of heart veins 50.28 $70.00 $3,519.60 33647 Repair heart septum defects 52.80 $70.00 $3,696.00 33660 Repair of heart defects 51.03 $70.00 $3,572.10 33665 Repair of heart defects 55.61 $70.00 $3,892.70 33670 Repair of heart chambers 57.32 $70.00 $4,012.40 33675 Close mult vsd 57.30 $70.00 $4,011.00 33676 Close mult vsd w/resection 58.82 $70.00 $4,117.40 33677 Cl mult vsd w/rem pul band 61.09 $70.00 $4,276.30 33681 Repair heart septum defect 53.38 $70.00 $3,736.60 33684 Repair heart septum defect 54.88 $70.00 $3,841.60 33688 Repair heart septum defect 54.77 $70.00 $3,833.90 33690 Reinforce pulmonary artery 34.82 $70.00 $2,437.40 33692 Repair of heart defects 56.86 $70.00 $3,980.20 NON-FACILITY HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL 33694 Repair of heart defects 56.71 $70.00 $3,969.70 33697 Repair of heart defects 59.74 $70.00 $4,181.80 3370F Ajcc brst cncr stage 0 docd 0.00 $70.00 $0.00 33702 Repair of heart defects 44.88 $70.00 $3,141.60 33710 Repair of heart defects 59.63 $70.00 $4,174.10 3372F Ajcc brst cncr stage 1 docd 0.00 $70.00 $0.00 33720 Repair of heart defect 44.92 $70.00 $3,144.40 33722 Repair of heart defect 47.20 $70.00 $3,304.00 33724 Repair venous anomaly 44.72 $70.00 $3,130.40 33726 Repair pul venous stenosis 59.09 $70.00 $4,136.30 33730 Repair heart-vein defect(s) 58.21 $70.00 $4,074.70 33732 Repair heart-vein defect 47.81 $70.00 $3,346.70 33735 Revision of heart chamber 37.60 $70.00 $2,632.00 33736 Revision of heart chamber 40.79 $70.00 $2,855.30 33737 Revision of heart chamber 37.66 $70.00 $2,636.20 3374F Ajcc brst cncr stage 1 docd 0.00 $70.00 $0.00 33750 Major vessel shunt 36.63 $70.00 $2,564.10 33755 Major vessel shunt 38.22 $70.00 $2,675.40 3376F Ajcc brstcncr stage 2 docd 0.00 $70.00 $0.00 33762 Major vessel shunt 37.22 $70.00 $2,605.40 33764 Major vessel shunt & graft 38.22 $70.00 $2,675.40 33766 Major vessel shunt 38.66 $70.00 $2,706.20 33767 Major vessel shunt 41.31 $70.00 $2,891.70 33768 Cavopulmonary shunting 12.10 $70.00 $847.00 33770 Repair great vessels defect 61.50 $70.00 $4,305.00 33771 Repair great vessels defect 63.30 $70.00 $4,431.00 33774 Repair great vessels defect 52.22 $70.00 $3,655.40 33775 Repair great vessels defect 53.81 $70.00 $3,766.70 33776 Repair great vessels defect 56.89 $70.00 $3,982.30 33777 Repair great vessels defect 54.92 $70.00 $3,844.40 33778 Repair great vessels defect 68.21 $70.00 $4,774.70 33779 Repair great vessels defect 67.56 $70.00 $4,729.20 3378F Ajcc brstcncr stage 3 docd 0.00 $70.00 $0.00 33780 Repair great vessels defect 68.82 $70.00 $4,817.40 33781 Repair great vessels defect 67.18 $70.00 $4,702.60 33782 Nikaidoh proc 93.73 $70.00 $6,561.10 33783 Nikaidoh proc w/ostia implt 101.24 $70.00 $7,086.80 33786 Repair arterial trunk 66.11 $70.00 $4,627.70 33788 Revision of pulmonary artery 44.51 $70.00 $3,115.70 3380F Ajcc brstcncr stage 4 docd 0.00 $70.00 $0.00 33800 Aortic suspension 28.66 $70.00 $2,006.20 33802 Repair vessel defect 31.47 $70.00 $2,202.90 33803 Repair vessel defect 33.41 $70.00 $2,338.70 33813 Repair septal defect 35.97 $70.00 $2,517.90 33814 Repair septal defect 44.22 $70.00 $3,095.40 NON-FACILITY HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL 3382F Ajcc cln cncr stage 0 docd 0.00 $70.00 $0.00 33820 Revise major vessel 28.12 $70.00 $1,968.40 33822 Revise major vessel 29.67 $70.00 $2,076.90 33824 Revise major vessel 34.23 $70.00 $2,396.10 3384F Ajcc cln cncr stage 1 docd 0.00 $70.00 $0.00 33840 Remove aorta constriction 35.95 $70.00 $2,516.50 33845 Remove aorta constriction 38.73 $70.00 $2,711.10 33851 Remove aorta constriction 36.92 $70.00 $2,584.40 33852 Repair septal defect 40.59 $70.00 $2,841.30 33853 Repair septal defect 53.21 $70.00 $3,724.70 3386F Ajcc cln cncr stage 2 docd 0.00 $70.00 $0.00 33860 Ascending aortic graft 92.94 $70.00 $6,505.80 33863 Ascending aortic graft 91.18 $70.00 $6,382.60 33864 Ascending aortic graft 93.38 $70.00 $6,536.60 33870 Transverse aortic arch graft 73.01 $70.00 $5,110.70 33875 Thoracic aortic graft 79.53 $70.00 $5,567.10 33877 Thoracoabdominal graft 104.96 $70.00 $7,347.20 3388F Ajcc cln cncr stage 3 docd 0.00 $70.00 $0.00 33880 Endovasc taa repr incl subcl 52.17 $70.00 $3,651.90 33881 Endovasc taa repr w/o subcl 44.81 $70.00 $3,136.70 33883 Insert endovasc prosth taa 32.53 $70.00 $2,277.10 33884 Endovasc prosth taa add-on 12.08 $70.00 $845.60 33886 Endovasc prosth delayed 28.21 $70.00 $1,974.70 33889 Artery transpose/endovas taa 23.06 $70.00 $1,614.20 33891 Car-car bp grft/endovas taa 28.04 $70.00 $1,962.80 3390F Ajcc cln cncr stage 4 docd 0.00 $70.00 $0.00 33910 Remove lung artery emboli 76.28 $70.00 $5,339.60 33915 Remove lung artery emboli 40.15 $70.00 $2,810.50 33916 Surgery of great vessel 122.44 $70.00 $8,570.80 33917 Repair pulmonary artery 42.30 $70.00 $2,961.00 33920 Repair pulmonary atresia 52.55 $70.00 $3,678.50 33922 Transect pulmonary artery 40.31 $70.00 $2,821.70 33924 Remove pulmonary shunt 8.33 $70.00 $583.10 33925 Rpr pul art unifocal w/o cpb 49.92 $70.00 $3,494.40 33926 Repr pul art unifocal w/cpb 70.21 $70.00 $4,914.70 33927 Impltj tot rplcmt hrt sys 73.83 $70.00 $5,168.10 33928 Rmvl & rplcmt tot hrt sys 0.00 $70.00 $0.00 33929 Rmvl rplcmt hrt sys f/trnspl 0.00 $70.00 $0.00 33930 Removal of donor heart/lung 0.00 $70.00 $0.00 33933 Prepare donor heart/lung 0.00 $70.00 $0.00 33935 Transplantation heart/lung 142.54 $70.00 $9,977.80 3394F Quant her2 ihc eval brst cx 0.00 $70.00 $0.00 33940 Removal of donor heart 0.00 $70.00 $0.00 33944 Prepare donor heart 0.00 $70.00 $0.00 33945 Transplantation of heart 140.18 $70.00 $9,812.60 NON-FACILITY HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL 33946 Ecmo/ecls initiation venous 8.96 $70.00 $627.20 33947 Ecmo/ecls initiation artery 9.99 $70.00 $699.30 33948 Ecmo/ecls daily mgmt-venous 6.94 $70.00 $485.80 33949 Ecmo/ecls daily mgmt artery 6.73 $70.00 $471.10 3395F Quant nonher2 ihc brst cx 0.00 $70.00 $0.00 33951 Ecmo/ecls insj prph cannula 12.38 $70.00 $866.60 33952 Ecmo/ecls insj prph cannula 12.43 $70.00 $870.10 33953 Ecmo/ecls insj prph cannula 13.84 $70.00 $968.80 33954 Ecmo/ecls insj prph cannula 13.89 $70.00 $972.30 33955 Ecmo/ecls insj ctr cannula 24.25 $70.00 $1,697.50 33956 Ecmo/ecls insj ctr cannula 24.20 $70.00 $1,694.00 33957 Ecmo/ecls repos perph cnula 5.39 $70.00 $377.30 33958 Ecmo/ecls repos perph cnula 5.40 $70.00 $378.00 33959 Ecmo/ecls repos perph cnula 6.84 $70.00 $478.80 33962 Ecmo/ecls repos perph cnula 6.86 $70.00 $480.20 33963 Ecmo/ecls repos perph cnula 13.67 $70.00 $956.90 33964 Ecmo/ecls repos perph cnula 14.43 $70.00 $1,010.10 33965 Ecmo/ecls rmvl perph cannula 5.39 $70.00 $377.30 33966 Ecmo/ecls rmvl prph cannula 6.89 $70.00 $482.30 33967 Insert i-aort percut device 7.55 $70.00 $528.50 33968 Remove aortic assist device 0.98 $70.00 $68.60 33969 Ecmo/ecls rmvl perph cannula 7.98 $70.00 $558.60 33970 Aortic circulation assist 10.31 $70.00 $721.70 33971 Aortic circulation assist 20.53 $70.00 $1,437.10 33973 Insert balloon device 15.04 $70.00 $1,052.80 33974 Remove intra-aortic balloon 25.81 $70.00 $1,806.70 33975 Implant ventricular device 37.96 $70.00 $2,657.20 33976 Implant ventricular device 46.38 $70.00 $3,246.60 33977 Remove ventricular device 32.61 $70.00 $2,282.70 33978 Remove ventricular device 38.91 $70.00 $2,723.70 33979 Insert intracorporeal device 56.63 $70.00 $3,964.10 33980 Remove intracorporeal device 51.79 $70.00 $3,625.30 33981 Replace vad pump ext 24.30 $70.00 $1,701.00 33982 Replace vad intra w/o bp 57.09 $70.00 $3,996.30 33983 Replace vad intra w/bp 67.09 $70.00 $4,696.30 33984 Ecmo/ecls rmvl prph cannula 8.28 $70.00 $579.60 33985 Ecmo/ecls rmvl ctr cannula 15.02 $70.00 $1,051.40 33986 Ecmo/ecls rmvl ctr cannula 15.17 $70.00 $1,061.90 33987 Artery expos/graft artery 6.09 $70.00 $426.30 33988 Insertion of left heart vent 22.71 $70.00 $1,589.70 33989 Removal of left heart vent 14.43 $70.00 $1,010.10 33990 Insert vad artery access 12.39 $70.00 $867.30 33991 Insert vad art&vein access 18.27 $70.00 $1,278.90 33992 Remove vad different session 5.82 $70.00 $407.40 33993 Reposition vad diff session 5.09 $70.00 $356.30 NON-FACILITY HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL 33999 Cardiac surgery procedure 0.00 $70.00 $0.00 34001 Removal of artery clot 26.57 $70.00 $1,859.90 34051 Removal of artery clot 28.78 $70.00 $2,014.60 34101 Removal of artery clot 17.43 $70.00 $1,220.10 34111 Removal of arm artery clot 17.42 $70.00 $1,219.40 34151 Removal of artery clot 40.61 $70.00 $2,842.70 34201 Removal of artery clot 29.96 $70.00 $2,097.20 34203 Removal of leg artery clot 27.74 $70.00 $1,941.80 34401 Removal of vein clot 42.82 $70.00 $2,997.40 34421 Removal of vein clot 21.38 $70.00 $1,496.60 34451 Removal of vein clot 41.67 $70.00 $2,916.90 34471 Removal of vein clot 31.30 $70.00 $2,191.00 34490 Removal of vein clot 17.96 $70.00 $1,257.20 3450F Dyspnea scrnd no-mild dysp 0.00 $70.00 $0.00 34501 Repair valve femoral vein 25.89 $70.00 $1,812.30 34502 Reconstruct vena cava 44.86 $70.00 $3,140.20 3451F Dyspnea scrnd mod-high dysp 0.00 $70.00 $0.00 34510 Transposition of vein valve 29.60 $70.00 $2,072.00 3452F Dyspnea not screened 0.00 $70.00 $0.00 34520 Cross-over vein graft 28.69 $70.00 $2,008.30 34530 Leg vein fusion 27.21 $70.00 $1,904.70 3455F Tb scrng done-interpd 6mon 0.00 $70.00 $0.00 3470F Ra disease activity low 0.00 $70.00 $0.00 34701 Evasc rpr a-ao ndgft 35.72 $70.00 $2,500.40 34702 Evasc rpr a-ao ndgft rpt 53.36 $70.00 $3,735.20 34703 Evasc rpr a-unilac ndgft 40.25 $70.00 $2,817.50 34704 Evasc rpr a-unilac ndgft rpt 66.95 $70.00 $4,686.50 34705 Evac rpr a-biiliac ndgft 44.34 $70.00 $3,103.80 34706 Evasc rpr a-biiliac rpt 66.74 $70.00 $4,671.80 34707 Evasc rpr ilio-iliac ndgft 33.31 $70.00 $2,331.70 34708 Evasc rpr ilio-iliac rpt 53.61 $70.00 $3,752.70 34709 Plmt xtn prosth evasc rpr 9.38 $70.00 $656.60 3471F Ra disease activity mod 0.00 $70.00 $0.00 34710 Dlyd plmt xtn prosth 1st vsl 23.25 $70.00 $1,627.50 34711 Dlyd plmt xtn prosth ea addl 8.66 $70.00 $606.20 34712 Tcat dlvr enhncd fixj dev 19.87 $70.00 $1,390.90 34713 Perq access & clsr fem art 3.74 $70.00 $261.80 34714 Opn fem art expos cndt crtj 7.85 $70.00 $549.50 34715 Opn ax/subcla art expos 8.77 $70.00 $613.90 34716 Opn ax/subcla art expos cndt 10.89 $70.00 $762.30 3472F Ra disease activity high 0.00 $70.00 $0.00 3475F Disease progn ra poor docd 0.00 $70.00 $0.00 3476F Disease progn ra good docd 0.00 $70.00 $0.00 34808 Endovas iliac a device addon 6.06 $70.00 $424.20 34812 Opn fem art expos 6.02 $70.00 $421.40 NON-FACILITY HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL 34813 Femoral endovas graft add-on 6.88 $70.00 $481.60 34820 Opn iliac art expos 10.27 $70.00 $718.90 34830 Open aortic tube prosth repr 51.16 $70.00 $3,581.20 34831 Open aortoiliac prosth repr 56.13 $70.00 $3,929.10 34832 Open aortofemor prosth repr 55.02 $70.00 $3,851.40 34833 Opn ilac art expos cndt crtj 11.78 $70.00 $824.60 34834 Opn brach art expos 3.79 $70.00 $265.30 34839 Plnning pt spec fenest graft 0.00 $70.00 $0.00 34841 Endovasc visc aorta 1 graft 0.00 $70.00 $0.00 34842 Endovasc visc aorta 2 graft 0.00 $70.00 $0.00 34843 Endovasc visc aorta 3 graft 0.00 $70.00 $0.00 34844 Endovasc visc aorta 4 graft 0.00 $70.00 $0.00 34845 Visc & infraren abd 1 prosth 0.00 $70.00 $0.00 34846 Visc & infraren abd 2 prosth 0.00 $70.00 $0.00 34847 Visc & infraren abd 3 prosth 0.00 $70.00 $0.00 34848 Visc & infraren abd 4+ prost 0.00 $70.00 $0.00 3490F History aids-defining cond 0.00 $70.00 $0.00 3491F Hiv unsure baby of hiv+moms 0.00 $70.00 $0.00 3492F History cd4+ cell count <350 0.00 $70.00 $0.00 3493F No hist cd4+ cell count <350 0.00 $70.00 $0.00 3494F Cd4+cell count <200cells/mm3 0.00 $70.00 $0.00 3495F Cd4+cell cnt 200-499 cells 0.00 $70.00 $0.00 3496F Cd4+ cell count >= 500 cells 0.00 $70.00 $0.00 3497F Cd4+ cell percentage <15% 0.00 $70.00 $0.00 3498F Cd4+ cell =15% (hiv) 0.00 $70.00 $0.00 3500F Cd4+cell cnt/% docd as done 0.00 $70.00 $0.00 35001 Repair defect of artery 32.62 $70.00 $2,283.40 35002 Repair artery rupture neck 32.93 $70.00 $2,305.10 35005 Repair defect of artery 28.81 $70.00 $2,016.70 35011 Repair defect of artery 29.24 $70.00 $2,046.80 35013 Repair artery rupture arm 36.56 $70.00 $2,559.20 3502F Hiv rna vrl ld segmt 11.89 $70.00 $832.30 35685 Bypass graft patency/patch 5.78 $70.00 $404.60 35686 Bypass graft/av fist patency 4.69 $70.00 $328.30 35691 Art trnsposj vertbrl carotid 27.44 $70.00 $1,920.80 35693 Art trnsposj subclavian 24.19 $70.00 $1,693.30 35694 Art trnsposj subclav carotid 28.63 $70.00 $2,004.10 35695 Art trnsposj carotid subclav 29.74 $70.00 $2,081.80 35697 Reimplant artery each 4.32 $70.00 $302.40 NON-FACILITY HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL 3570F Rprt bone scint xref w xray 0.00 $70.00 $0.00 35700 Reoperation bypass graft 4.45 $70.00 $311.50 35701 Exploration carotid artery 16.33 $70.00 $1,143.10 3572F Pt consid poss risk fx 0.00 $70.00 $0.00 35721 Exploration femoral artery 13.34 $70.00 $933.80 3573F Pt not consid poss risk fx 0.00 $70.00 $0.00 35741 Exploration popliteal artery 15.01 $70.00 $1,050.70 35761 Exploration of artery/vein 11.38 $70.00 $796.60 35800 Explore neck vessels 20.79 $70.00 $1,455.30 35820 Explore chest vessels 58.33 $70.00 $4,083.10 35840 Explore abdominal vessels 34.71 $70.00 $2,429.70 35860 Explore limb vessels 24.41 $70.00 $1,708.70 35870 Repair vessel graft defect 36.11 $70.00 $2,527.70 35875 Removal of clot in graft 17.37 $70.00 $1,215.90 35876 Removal of clot in graft 27.65 $70.00 $1,935.50 35879 Revise graft w/vein 26.99 $70.00 $1,889.30 35881 Revise graft w/vein 29.68 $70.00 $2,077.60 35883 Revise graft w/nonauto graft 35.10 $70.00 $2,457.00 35884 Revise graft w/vein 36.03 $70.00 $2,522.10 35901 Excision graft neck 13.64 $70.00 $954.80 35903 Excision graft extremity 16.39 $70.00 $1,147.30 35905 Excision graft thorax 48.77 $70.00 $3,413.90 35907 Excision graft abdomen 55.71 $70.00 $3,899.70 36000 Place needle in vein 0.74 $70.00 $51.80 36002 Pseudoaneurysm injection trt 4.59 $70.00 $321.30 36005 Injection ext venography 9.22 $70.00 $645.40 36010 Place catheter in vein 13.67 $70.00 $956.90 36011 Place catheter in vein 23.52 $70.00 $1,646.40 36012 Place catheter in vein 24.12 $70.00 $1,688.40 36013 Place catheter in artery 21.77 $70.00 $1,523.90 36014 Place catheter in artery 22.54 $70.00 $1,577.80 36015 Place catheter in artery 24.51 $70.00 $1,715.70 36100 Establish access to artery 13.77 $70.00 $963.90 36140 Intro ndl icath upr/lxtr art 12.12 $70.00 $848.40 36160 Establish access to aorta 13.97 $70.00 $977.90 36200 Place catheter in aorta 15.90 $70.00 $1,113.00 36215 Place catheter in artery 28.64 $70.00 $2,004.80 36216 Place catheter in artery 31.06 $70.00 $2,174.20 36217 Place catheter in artery 52.75 $70.00 $3,692.50 36218 Place catheter in artery 7.17 $70.00 $501.90 36221 Place cath thoracic aorta 29.11 $70.00 $2,037.70 36222 Place cath carotid/inom art 34.28 $70.00 $2,399.60 36223 Place cath carotid/inom art 42.95 $70.00 $3,006.50 36224 Place cath carotd art 54.56 $70.00 $3,819.20 36225 Place cath subclavian art 41.33 $70.00 $2,893.10 NON-FACILITY HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL 36226 Place cath vertebral art 52.90 $70.00 $3,703.00 36227 Place cath xtrnl carotid 7.31 $70.00 $511.70 36228 Place cath intracranial art 37.57 $70.00 $2,629.90 36245 Ins cath abd/l-ext art 1st 37.14 $70.00 $2,599.80 36246 Ins cath abd/l-ext art 2nd 23.32 $70.00 $1,632.40 36247 Ins cath abd/l-ext art 3rd 42.51 $70.00 $2,975.70 36248 Ins cath abd/l-ext art addl 4.33 $70.00 $303.10 36251 Ins cath ren art 1st unilat 39.23 $70.00 $2,746.10 36252 Ins cath ren art 1st bilat 42.42 $70.00 $2,969.40 36253 Ins cath ren art 2nd+ unilat 62.64 $70.00 $4,384.80 36254 Ins cath ren art 2nd+ bilat 61.26 $70.00 $4,288.20 36260 Insertion of infusion pump 18.73 $70.00 $1,311.10 36261 Revision of infusion pump 11.59 $70.00 $811.30 36262 Removal of infusion pump 8.80 $70.00 $616.00 36299 Vessel injection procedure 0.00 $70.00 $0.00 36400 Bl draw < 3 yrs fem/jugular 0.75 $70.00 $52.50 36405 Bl draw <3 yrs scalp vein 0.66 $70.00 $46.20 36406 Bl draw <3 yrs other vein 0.47 $70.00 $32.90 36410 Non-routine bl draw 3/> yrs 0.48 $70.00 $33.60 36415 Routine venipuncture 0.00 $70.00 $0.00 36416 Capillary blood draw 0.00 $70.00 $0.00 36420 Vein access cutdown < 1 yr 1.35 $70.00 $94.50 36425 Vein access cutdown > 1 yr 1.16 $70.00 $81.20 36430 Blood transfusion service 1.00 $70.00 $70.00 36440 Bl push transfuse 2 yr/< 1.46 $70.00 $102.20 36450 Bl exchange/transfuse nb 4.94 $70.00 $345.80 36455 Bl exchange/transfuse non-nb 3.68 $70.00 $257.60 36456 Prtl exchange transfuse nb 3.13 $70.00 $219.10 36460 Transfusion service fetal 9.89 $70.00 $692.30 36465 Njx noncmpnd sclrsnt 1 vein 45.12 $70.00 $3,158.40 36466 Njx noncmpnd sclrsnt mlt vn 47.14 $70.00 $3,299.80 36468 Njx sclrsnt spider veins 0.00 $70.00 $0.00 36470 Njx sclrsnt 1 incmptnt vein 3.00 $70.00 $210.00 36471 Njx sclrsnt mlt incmptnt vn 5.39 $70.00 $377.30 36473 Endovenous mchnchem 1st vein 42.82 $70.00 $2,997.40 36474 Endovenous mchnchem add-on 7.87 $70.00 $550.90 36475 Endovenous rf 1st vein 43.04 $70.00 $3,012.80 36476 Endovenous rf vein add-on 8.36 $70.00 $585.20 36478 Endovenous laser 1st vein 34.34 $70.00 $2,403.80 36479 Endovenous laser vein addon 8.83 $70.00 $618.10 36481 Insertion of catheter vein 55.78 $70.00 $3,904.60 36482 Endoven ther chem adhes 1st 60.06 $70.00 $4,204.20 36483 Endoven ther chem adhes sbsq 4.08 $70.00 $285.60 3650F Eeg ordered rvwd reqstd 0.00 $70.00 $0.00 36500 Insertion of catheter vein 5.31 $70.00 $371.70 NON-FACILITY HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL 36510 Insertion of catheter vein 2.32 $70.00 $162.40 36511 Apheresis wbc 3.12 $70.00 $218.40 36512 Apheresis rbc 3.13 $70.00 $219.10 36513 Apheresis platelets 3.21 $70.00 $224.70 36514 Apheresis plasma 22.11 $70.00 $1,547.70 36516 Apheresis immunoads slctv 61.99 $70.00 $4,339.30 36522 Photopheresis 70.57 $70.00 $4,939.90 36555 Insert non-tunnel cv cath 5.27 $70.00 $368.90 36556 Insert non-tunnel cv cath 5.97 $70.00 $417.90 36557 Insert tunneled cv cath 26.63 $70.00 $1,864.10 36558 Insert tunneled cv cath 20.30 $70.00 $1,421.00 36560 Insert tunneled cv cath 37.12 $70.00 $2,598.40 36561 Insert tunneled cv cath 30.83 $70.00 $2,158.10 36563 Insert tunneled cv cath 35.07 $70.00 $2,454.90 36565 Insert tunneled cv cath 25.17 $70.00 $1,761.90 36566 Insert tunneled cv cath 146.42 $70.00 $10,249.40 36568 Insert picc cath 6.20 $70.00 $434.00 36569 Insert picc cath 7.03 $70.00 $492.10 36570 Insert picvad cath 39.70 $70.00 $2,779.00 36571 Insert picvad cath 34.78 $70.00 $2,434.60 36575 Repair tunneled cv cath 4.69 $70.00 $328.30 36576 Repair tunneled cv cath 8.96 $70.00 $627.20 36578 Replace tunneled cv cath 12.79 $70.00 $895.30 36580 Replace cvad cath 6.09 $70.00 $426.30 36581 Replace tunneled cv cath 20.05 $70.00 $1,403.50 36582 Replace tunneled cv cath 28.51 $70.00 $1,995.70 36583 Replace tunneled cv cath 36.05 $70.00 $2,523.50 36584 Replace picc cath 5.83 $70.00 $408.10 36585 Replace picvad cath 30.11 $70.00 $2,107.70 36589 Removal tunneled cv cath 4.68 $70.00 $327.60 36590 Removal tunneled cv cath 6.33 $70.00 $443.10 36591 Draw blood off venous device 0.68 $70.00 $47.60 36592 Collect blood from picc 0.76 $70.00 $53.20 36593 Declot vascular device 0.90 $70.00 $63.00 36595 Mech remov tunneled cv cath 16.77 $70.00 $1,173.90 36596 Mech remov tunneled cv cath 3.73 $70.00 $261.10 36597 Reposition venous catheter 3.63 $70.00 $254.10 36598 Inj w/fluor eval cv device 3.18 $70.00 $222.60 36600 Withdrawal of arterial blood 0.93 $70.00 $65.10 36620 Insertion catheter artery 1.27 $70.00 $88.90 36625 Insertion catheter artery 3.04 $70.00 $212.80 36640 Insertion catheter artery 3.30 $70.00 $231.00 36660 Insertion catheter artery 1.98 $70.00 $138.60 36680 Insert needle bone cavity 1.69 $70.00 $118.30 36800 Insertion of cannula 3.54 $70.00 $247.80 NON-FACILITY HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL 36810 Insertion of cannula 6.14 $70.00 $429.80 36815 Insertion of cannula 3.94 $70.00 $275.80 36818 Av fuse uppr arm cephalic 20.21 $70.00 $1,414.70 36819 Av fuse uppr arm basilic 21.29 $70.00 $1,490.30 36820 Av fusion/forearm vein 21.37 $70.00 $1,495.90 36821 Av fusion direct any site 19.33 $70.00 $1,353.10 36823 Insertion of cannula(s) 40.37 $70.00 $2,825.90 36825 Artery-vein autograft 23.22 $70.00 $1,625.40 36830 Artery-vein nonautograft 19.40 $70.00 $1,358.00 36831 Open thrombect av fistula 17.96 $70.00 $1,257.20 36832 Av fistula revision open 22.03 $70.00 $1,542.10 36833 Av fistula revision 23.65 $70.00 $1,655.50 36835 Artery to vein shunt 13.80 $70.00 $966.00 36838 Dist revas ligation hemo 33.37 $70.00 $2,335.90 36860 External cannula declotting 6.30 $70.00 $441.00 36861 Cannula declotting 4.02 $70.00 $281.40 36901 Intro cath dialysis circuit 16.98 $70.00 $1,188.60 36902 Intro cath dialysis circuit 35.34 $70.00 $2,473.80 36903 Intro cath dialysis circuit 159.04 $70.00 $11,132.80 36904 Thrmbc/nfs dialysis circuit 51.36 $70.00 $3,595.20 36905 Thrmbc/nfs dialysis circuit 65.10 $70.00 $4,557.00 36906 Thrmbc/nfs dialysis circuit 193.02 $70.00 $13,511.40 36907 Balo angiop ctr dialysis seg 21.39 $70.00 $1,497.30 36908 Stent plmt ctr dialysis seg 76.75 $70.00 $5,372.50 36909 Dialysis circuit embolj 55.78 $70.00 $3,904.60 3700F Psych disorders assessed 0.00 $70.00 $0.00 37140 Revision of circulation 67.19 $70.00 $4,703.30 37145 Revision of circulation 62.34 $70.00 $4,363.80 37160 Revision of circulation 64.01 $70.00 $4,480.70 37180 Revision of circulation 61.60 $70.00 $4,312.00 37181 Splice spleen/kidney veins 67.19 $70.00 $4,703.30 37182 Insert hepatic shunt (tips) 23.90 $70.00 $1,673.00 37183 Remove hepatic shunt (tips) 164.84 $70.00 $11,538.80 37184 Prim art m-thrmbc 1st vsl 62.80 $70.00 $4,396.00 37185 Prim art m-thrmbc sbsq vsl 19.97 $70.00 $1,397.90 37186 Sec art thrombectomy add-on 37.80 $70.00 $2,646.00 37187 Venous mech thrombectomy 56.24 $70.00 $3,936.80 37188 Venous m-thrombectomy add-on 47.44 $70.00 $3,320.80 37191 Ins endovas vena cava filtr 72.72 $70.00 $5,090.40 37192 Redo endovas vena cava filtr 38.36 $70.00 $2,685.20 37193 Rem endovas vena cava filter 43.40 $70.00 $3,038.00 37195 Thrombolytic therapy stroke 0.00 $70.00 $0.00 37197 Remove intrvas foreign body 41.14 $70.00 $2,879.80 3720F Cognit impairment assessed 0.00 $70.00 $0.00 37200 Transcatheter biopsy 6.31 $70.00 $441.70 NON-FACILITY HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL 37211 Thrombolytic art therapy 11.21 $70.00 $784.70 37212 Thrombolytic venous therapy 9.82 $70.00 $687.40 37213 Thromblytic art/ven therapy 6.79 $70.00 $475.30 37214 Cessj therapy cath removal 3.56 $70.00 $249.20 37215 Transcath stent cca w/eps 29.18 $70.00 $2,042.60 37216 Transcath stent cca w/o eps 29.31 $70.00 $2,051.70 37217 Stent placemt retro carotid 31.53 $70.00 $2,207.10 37218 Stent placemt ante carotid 23.63 $70.00 $1,654.10 37220 Iliac revasc 86.71 $70.00 $6,069.70 37221 Iliac revasc w/stent 128.63 $70.00 $9,004.10 37222 Iliac revasc add-on 24.37 $70.00 $1,705.90 37223 Iliac revasc w/stent add-on 72.08 $70.00 $5,045.60 37224 Fem/popl revas w/tla 105.29 $70.00 $7,370.30 37225 Fem/popl revas w/ather 309.18 $70.00 $21,642.60 37226 Fem/popl revasc w/stent 252.77 $70.00 $17,693.90 37227 Fem/popl revasc stnt & ather 418.38 $70.00 $29,286.60 37228 Tib/per revasc w/tla 150.68 $70.00 $10,547.60 37229 Tib/per revasc w/ather 304.89 $70.00 $21,342.30 37230 Tib/per revasc w/stent 233.03 $70.00 $16,312.10 37231 Tib/per revasc stent & ather 377.93 $70.00 $26,455.10 37232 Tib/per revasc add-on 33.62 $70.00 $2,353.40 37233 Tibper revasc w/ather add-on 40.68 $70.00 $2,847.60 37234 Revsc opn/prq tib/pero stent 110.25 $70.00 $7,717.50 37235 Tib/per revasc stnt & ather 116.51 $70.00 $8,155.70 37236 Open/perq place stent 1st 108.98 $70.00 $7,628.60 37237 Open/perq place stent ea add 68.58 $70.00 $4,800.60 37238 Open/perq place stent same 118.06 $70.00 $8,264.20 37239 Open/perq place stent ea add 57.16 $70.00 $4,001.20 37241 Vasc embolize/occlude venous 134.18 $70.00 $9,392.60 37242 Vasc embolize/occlude artery 207.62 $70.00 $14,533.40 37243 Vasc embolize/occlude organ 275.01 $70.00 $19,250.70 37244 Vasc embolize/occlude bleed 191.70 $70.00 $13,419.00 37246 Trluml balo angiop 1st art 60.61 $70.00 $4,242.70 37247 Trluml balo angiop addl art 24.49 $70.00 $1,714.30 37248 Trluml balo angiop 1st vein 42.05 $70.00 $2,943.50 37249 Trluml balo angiop addl vein 17.99 $70.00 $1,259.30 3725F Screen depression performed 0.00 $70.00 $0.00 37252 Intrvasc us noncoronary 1st 38.83 $70.00 $2,718.10 37253 Intrvasc us noncoronary addl 5.86 $70.00 $410.20 3750F Ptnotrcvngsteroid>/=10mg/day 0.00 $70.00 $0.00 37500 Endoscopy ligate perf veins 18.46 $70.00 $1,292.20 37501 Vascular endoscopy procedure 0.00 $70.00 $0.00 3751F Electrodiag polyneuro 6 mn 0.00 $70.00 $0.00 3752F No electrodiag polyneuro 6mn 0.00 $70.00 $0.00 3753F Pt has symp&signs neuropathy 0.00 $70.00 $0.00 NON-FACILITY HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL 3754F Screening tests dm done 0.00 $70.00 $0.00 3755F Cog&behav imprmnt scrng done 0.00 $70.00 $0.00 3756F Pt w/pseudobulb affect/als 0.00 $70.00 $0.00 37565 Ligation of neck vein 20.97 $70.00 $1,467.90 3757F Pt w/o pseudobulbaffect/als 0.00 $70.00 $0.00 3758F Pt ref pulm fx test/peakflow 0.00 $70.00 $0.00 3759F Pt scrn dysphag/wt loss/nutr 0.00 $70.00 $0.00 3760F Pt w/ dysphag/wt loss/nutr 0.00 $70.00 $0.00 37600 Ligation of neck artery 20.83 $70.00 $1,458.10 37605 Ligation of neck artery 21.44 $70.00 $1,500.80 37606 Ligation of neck artery 20.87 $70.00 $1,460.90 37607 Ligation of a-v fistula 10.90 $70.00 $763.00 37609 Temporal artery procedure 8.83 $70.00 $618.10 3761F Pt w/o dysphag/wt loss/nutr 0.00 $70.00 $0.00 37615 Ligation of neck artery 15.13 $70.00 $1,059.10 37616 Ligation of chest artery 32.26 $70.00 $2,258.20 37617 Ligation of abdomen artery 38.83 $70.00 $2,718.10 37618 Ligation of extremity artery 11.10 $70.00 $777.00 37619 Ligation of inf vena cava 50.00 $70.00 $3,500.00 3762F Patient is dysarthric 0.00 $70.00 $0.00 3763F Patient is not dysarthric 0.00 $70.00 $0.00 37650 Revision of major vein 13.31 $70.00 $931.70 37660 Revision of major vein 38.14 $70.00 $2,669.80 37700 Revise leg vein 7.16 $70.00 $501.20 37718 Ligate/strip short leg vein 12.53 $70.00 $877.10 37722 Ligate/strip long leg vein 13.76 $70.00 $963.20 37735 Removal of leg veins/lesion 16.84 $70.00 $1,178.80 3775F Adenoma detected screening 0.00 $70.00 $0.00 3776F Adenoma not detect screening 0.00 $70.00 $0.00 37760 Ligate leg veins radical 17.92 $70.00 $1,254.40 37761 Ligate leg veins open 15.78 $70.00 $1,104.60 37765 Stab phleb veins xtr 10-20 18.61 $70.00 $1,302.70 37766 Phleb veins - extrem 20+ 22.15 $70.00 $1,550.50 37780 Revision of leg vein 6.79 $70.00 $475.30 37785 Ligate/divide/excise vein 10.10 $70.00 $707.00 37788 Revascularization penis 36.63 $70.00 $2,564.10 37790 Penile venous occlusion 14.13 $70.00 $989.10 37799 Vascular surgery procedure 0.00 $70.00 $0.00 38100 Removal of spleen total 33.40 $70.00 $2,338.00 38101 Removal of spleen partial 33.77 $70.00 $2,363.90 38102 Removal of spleen total 7.65 $70.00 $535.50 38115 Repair of ruptured spleen 36.97 $70.00 $2,587.90 38120 Laparoscopy splenectomy 30.45 $70.00 $2,131.50 38129 Laparoscope proc spleen 0.00 $70.00 $0.00 38200 Injection for spleen x-ray 3.84 $70.00 $268.80 NON-FACILITY HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL 38204 Bl donor search management 3.04 $70.00 $212.80 38205 Harvest allogeneic stem cell 2.41 $70.00 $168.70 38206 Harvest auto stem cells 2.40 $70.00 $168.00 38207 Cryopreserve stem cells 1.36 $70.00 $95.20 38208 Thaw preserved stem cells 0.86 $70.00 $60.20 38209 Wash harvest stem cells 0.36 $70.00 $25.20 38210 T-cell depletion of harvest 2.40 $70.00 $168.00 38211 Tumor cell deplete of harvst 2.17 $70.00 $151.90 38212 Rbc depletion of harvest 1.44 $70.00 $100.80 38213 Platelet deplete of harvest 0.36 $70.00 $25.20 38214 Volume deplete of harvest 1.24 $70.00 $86.80 38215 Harvest stem cell concentrte 1.44 $70.00 $100.80 38220 Dx bone marrow aspirations 4.84 $70.00 $338.80 38221 Dx bone marrow biopsies 4.36 $70.00 $305.20 38222 Dx bone marrow bx & aspir 4.84 $70.00 $338.80 38230 Bone marrow harvest allogen 5.99 $70.00 $419.30 38232 Bone marrow harvest autolog 5.76 $70.00 $403.20 38240 Transplt allo hct/donor 6.52 $70.00 $456.40 38241 Transplt autol hct/donor 4.88 $70.00 $341.60 38242 Transplt allo lymphocytes 3.44 $70.00 $240.80 38243 Transplj hematopoietic boost 3.11 $70.00 $217.70 38300 Drainage lymph node lesion 9.04 $70.00 $632.80 38305 Drainage lymph node lesion 13.95 $70.00 $976.50 38308 Incision of lymph channels 12.87 $70.00 $900.90 38380 Thoracic duct procedure 16.13 $70.00 $1,129.10 38381 Thoracic duct procedure 23.18 $70.00 $1,622.60 38382 Thoracic duct procedure 19.43 $70.00 $1,360.10 38500 Biopsy/removal lymph nodes 9.51 $70.00 $665.70 38505 Needle biopsy lymph nodes 3.58 $70.00 $250.60 38510 Biopsy/removal lymph nodes 14.79 $70.00 $1,035.30 38520 Biopsy/removal lymph nodes 13.36 $70.00 $935.20 38525 Biopsy/removal lymph nodes 12.62 $70.00 $883.40 38530 Biopsy/removal lymph nodes 16.12 $70.00 $1,128.40 38542 Explore deep node(s) neck 14.81 $70.00 $1,036.70 38550 Removal neck/armpit lesion 14.68 $70.00 $1,027.60 38555 Removal neck/armpit lesion 29.12 $70.00 $2,038.40 38562 Removal pelvic lymph nodes 20.39 $70.00 $1,427.30 38564 Removal abdomen lymph nodes 20.32 $70.00 $1,422.40 38570 Laparoscopy lymph node biop 14.66 $70.00 $1,026.20 38571 Laparoscopy lymphadenectomy 19.23 $70.00 $1,346.10 38572 Laparoscopy lymphadenectomy 26.75 $70.00 $1,872.50 38573 Laps pelvic lymphadec 33.59 $70.00 $2,351.30 38589 Laparoscope proc lymphatic 0.00 $70.00 $0.00 38700 Removal of lymph nodes neck 22.93 $70.00 $1,605.10 38720 Removal of lymph nodes neck 38.38 $70.00 $2,686.60 NON-FACILITY HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL 38724 Removal of lymph nodes neck 41.38 $70.00 $2,896.60 38740 Remove armpit lymph nodes 20.07 $70.00 $1,404.90 38745 Remove armpit lymph nodes 25.35 $70.00 $1,774.50 38746 Remove thoracic lymph nodes 6.23 $70.00 $436.10 38747 Remove abdominal lymph nodes 7.75 $70.00 $542.50 38760 Remove groin lymph nodes 24.34 $70.00 $1,703.80 38765 Remove groin lymph nodes 37.44 $70.00 $2,620.80 38770 Remove pelvis lymph nodes 23.40 $70.00 $1,638.00 38780 Remove abdomen lymph nodes 29.68 $70.00 $2,077.60 38790 Inject for lymphatic x-ray 2.40 $70.00 $168.00 38792 Ra tracer id of sentinl node 1.14 $70.00 $79.80 38794 Access thoracic lymph duct 8.62 $70.00 $603.40 38900 Io map of sent lymph node 3.99 $70.00 $279.30 38999 Blood/lymph system procedure 0.00 $70.00 $0.00 39000 Exploration of chest 14.33 $70.00 $1,003.10 39010 Exploration of chest 22.72 $70.00 $1,590.40 39200 Resect mediastinal cyst 25.30 $70.00 $1,771.00 39220 Resect mediastinal tumor 32.87 $70.00 $2,300.90 39401 Mediastinoscpy w/medstnl bx 9.00 $70.00 $630.00 39402 Mediastinoscpy w/lmph nod bx 11.75 $70.00 $822.50 39499 Chest procedure 0.00 $70.00 $0.00 39501 Repair diaphragm laceration 24.56 $70.00 $1,719.20 39503 Repair of diaphragm hernia 167.61 $70.00 $11,732.70 39540 Repair of diaphragm hernia 25.10 $70.00 $1,757.00 39541 Repair of diaphragm hernia 27.10 $70.00 $1,897.00 39545 Revision of diaphragm 25.75 $70.00 $1,802.50 39560 Resect diaphragm simple 23.12 $70.00 $1,618.40 39561 Resect diaphragm complex 35.91 $70.00 $2,513.70 39599 Diaphragm surgery procedure 0.00 $70.00 $0.00 4000F Tobacco use txmnt counseling 0.00 $70.00 $0.00 4001F Tobacco use txmnt pharmacol 0.00 $70.00 $0.00 4003F Pt ed write/oral pts w/ hf 0.00 $70.00 $0.00 4004F Pt tobacco screen rcvd tlk 0.00 $70.00 $0.00 4005F Pharm thx for op rxd 0.00 $70.00 $0.00 4008F Beta-blocker therapy rxd/tkn 0.00 $70.00 $0.00 4010F Ace/arb therapy rxd/taken 0.00 $70.00 $0.00 4011F Oral antiplatelet therapy rx 0.00 $70.00 $0.00 4012F Warfarin therapy rx 0.00 $70.00 $0.00 4013F Statin therapy/currently tkn 0.00 $70.00 $0.00 4014F Written discharge instr prvd 0.00 $70.00 $0.00 4015F Persist asthma medicine ctrl 0.00 $70.00 $0.00 4016F Anti-inflm/anlgsc agent rx 0.00 $70.00 $0.00 4017F Gi prophylaxis for nsaid rx 0.00 $70.00 $0.00 4018F Therapy exercise joint rx 0.00 $70.00 $0.00 4019F Doc recpt counsl vit d/calc+ 0.00 $70.00 $0.00 NON-FACILITY HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL 4025F Inhaled bronchodilator rx 0.00 $70.00 $0.00 4030F Oxygen therapy rx 0.00 $70.00 $0.00 4033F Pulmonary rehab rec 0.00 $70.00 $0.00 4035F Influenza imm rec 0.00 $70.00 $0.00 4037F Influenza imm order/admin 0.00 $70.00 $0.00 4040F Pneumoc vac/admin/rcvd 0.00 $70.00 $0.00 4041F Doc order cefazolin/cefurox 0.00 $70.00 $0.00 4042F Doc antibio not given 0.00 $70.00 $0.00 4043F Doc order given stop antibio 0.00 $70.00 $0.00 4044F Doc order given vte prophylx 0.00 $70.00 $0.00 4045F Empiric antibiotic rx 0.00 $70.00 $0.00 4046F Doc antibio given b/4 surg 0.00 $70.00 $0.00 4047F Doc antibio given b/4 surg 0.00 $70.00 $0.00 4048F Doc antibio given b/4 surg 0.00 $70.00 $0.00 4049F Doc order given stop antibio 0.00 $70.00 $0.00 40490 Biopsy of lip 3.68 $70.00 $257.60 4050F Ht care plan doc 0.00 $70.00 $0.00 40500 Partial excision of lip 14.46 $70.00 $1,012.20 4051F Referred for an av fistula 0.00 $70.00 $0.00 40510 Partial excision of lip 13.80 $70.00 $966.00 4052F Hemodialysis via av fistula 0.00 $70.00 $0.00 40520 Partial excision of lip 13.99 $70.00 $979.30 40525 Reconstruct lip with flap 15.84 $70.00 $1,108.80 40527 Reconstruct lip with flap 17.54 $70.00 $1,227.80 4053F Hemodialysis via av graft 0.00 $70.00 $0.00 40530 Partial removal of lip 15.28 $70.00 $1,069.60 4054F Hemodialysis via catheter 0.00 $70.00 $0.00 4055F Pt rcvng periton dialysis 0.00 $70.00 $0.00 4056F Approp oral rehyd recommd 0.00 $70.00 $0.00 4058F Ped gastro ed given caregvr 0.00 $70.00 $0.00 4060F Psych svcs provided 0.00 $70.00 $0.00 4062F Pt referral psych docd 0.00 $70.00 $0.00 4063F Antidepres rxthxpy not rxd 0.00 $70.00 $0.00 4064F Antidepressant rx 0.00 $70.00 $0.00 4065F Antipsychotic rx 0.00 $70.00 $0.00 40650 Repair lip 12.61 $70.00 $882.70 40652 Repair lip 14.11 $70.00 $987.70 40654 Repair lip 16.40 $70.00 $1,148.00 4066F Ect provided 0.00 $70.00 $0.00 4067F Pt referral for ect docd 0.00 $70.00 $0.00 4069F Vte prophylaxis rcvd 0.00 $70.00 $0.00 4070F Dvt prophylx recvd day 2 0.00 $70.00 $0.00 40700 Repair cleft lip/nasal 29.16 $70.00 $2,041.20 40701 Repair cleft lip/nasal 34.54 $70.00 $2,417.80 40702 Repair cleft lip/nasal 28.99 $70.00 $2,029.30 NON-FACILITY HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL 40720 Repair cleft lip/nasal 29.79 $70.00 $2,085.30 4073F Oral antiplat thx rx dischrg 0.00 $70.00 $0.00 4075F Anticoag thx rx at dischrg 0.00 $70.00 $0.00 40761 Repair cleft lip/nasal 31.42 $70.00 $2,199.40 4077F Doc t-pa admin considered 0.00 $70.00 $0.00 4079F Doc rehab svcs considered 0.00 $70.00 $0.00 40799 Lip surgery procedure 0.00 $70.00 $0.00 40800 Drainage of mouth lesion 6.12 $70.00 $428.40 40801 Drainage of mouth lesion 9.01 $70.00 $630.70 40804 Removal foreign body mouth 5.27 $70.00 $368.90 40805 Removal foreign body mouth 9.19 $70.00 $643.30 40806 Incision of lip fold 2.98 $70.00 $208.60 40808 Biopsy of mouth lesion 5.35 $70.00 $374.50 40810 Excision of mouth lesion 5.93 $70.00 $415.10 40812 Excise/repair mouth lesion 8.30 $70.00 $581.00 40814 Excise/repair mouth lesion 11.11 $70.00 $777.70 40816 Excision of mouth lesion 11.56 $70.00 $809.20 40818 Excise oral mucosa for graft 10.42 $70.00 $729.40 40819 Excise lip or cheek fold 9.15 $70.00 $640.50 40820 Treatment of mouth lesion 7.60 $70.00 $532.00 40830 Repair mouth laceration 7.76 $70.00 $543.20 40831 Repair mouth laceration 9.80 $70.00 $686.00 4084F Aspirin recvd w/in 24 hrs 0.00 $70.00 $0.00 40840 Reconstruction of mouth 23.28 $70.00 $1,629.60 40842 Reconstruction of mouth 22.70 $70.00 $1,589.00 40843 Reconstruction of mouth 30.79 $70.00 $2,155.30 40844 Reconstruction of mouth 38.28 $70.00 $2,679.60 40845 Reconstruction of mouth 41.71 $70.00 $2,919.70 4086F Aspirin/clopidogrel rxd 0.00 $70.00 $0.00 40899 Mouth surgery procedure 0.00 $70.00 $0.00 4090F Pt rcvng epo thxpy 0.00 $70.00 $0.00 4095F Pt not rcvng epo thxpy 0.00 $70.00 $0.00 4100F Biphos thxpy vein ord/recvd 0.00 $70.00 $0.00 41000 Drainage of mouth lesion 4.66 $70.00 $326.20 41005 Drainage of mouth lesion 6.40 $70.00 $448.00 41006 Drainage of mouth lesion 10.38 $70.00 $726.60 41007 Drainage of mouth lesion 10.18 $70.00 $712.60 41008 Drainage of mouth lesion 10.96 $70.00 $767.20 41009 Drainage of mouth lesion 11.68 $70.00 $817.60 41010 Incision of tongue fold 5.77 $70.00 $403.90 41015 Drainage of mouth lesion 12.31 $70.00 $861.70 41016 Drainage of mouth lesion 12.73 $70.00 $891.10 41017 Drainage of mouth lesion 12.92 $70.00 $904.40 41018 Drainage of mouth lesion 14.66 $70.00 $1,026.20 41019 Place needles h&n for rt 13.66 $70.00 $956.20 NON-FACILITY HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL 4110F Int mam art used for cabg 0.00 $70.00 $0.00 41100 Biopsy of tongue 4.83 $70.00 $338.10 41105 Biopsy of tongue 4.92 $70.00 $344.40 41108 Biopsy of floor of mouth 4.26 $70.00 $298.20 41110 Excision of tongue lesion 6.08 $70.00 $425.60 41112 Excision of tongue lesion 9.63 $70.00 $674.10 41113 Excision of tongue lesion 10.54 $70.00 $737.80 41114 Excision of tongue lesion 18.24 $70.00 $1,276.80 41115 Excision of tongue fold 7.03 $70.00 $492.10 41116 Excision of mouth lesion 9.51 $70.00 $665.70 41120 Partial removal of tongue 31.01 $70.00 $2,170.70 41130 Partial removal of tongue 38.18 $70.00 $2,672.60 41135 Tongue and neck surgery 62.74 $70.00 $4,391.80 41140 Removal of tongue 63.00 $70.00 $4,410.00 41145 Tongue removal neck surgery 79.83 $70.00 $5,588.10 4115F Beta blckr admin w/in 24 hrs 0.00 $70.00 $0.00 41150 Tongue mouth jaw surgery 63.43 $70.00 $4,440.10 41153 Tongue mouth neck surgery 68.75 $70.00 $4,812.50 41155 Tongue jaw & neck surgery 87.12 $70.00 $6,098.40 4120F Antibiot rxd/given 0.00 $70.00 $0.00 4124F Antibiot not rxd/given 0.00 $70.00 $0.00 41250 Repair tongue laceration 7.73 $70.00 $541.10 41251 Repair tongue laceration 8.55 $70.00 $598.50 41252 Repair tongue laceration 9.06 $70.00 $634.20 4130F Topical prep rx aoe 0.00 $70.00 $0.00 4131F Syst antimicrobial thx rx 0.00 $70.00 $0.00 4132F No syst antimicrobial thx rx 0.00 $70.00 $0.00 4133F Antihist/decong rx/recom 0.00 $70.00 $0.00 4134F No antihist/decong rx/recom 0.00 $70.00 $0.00 4135F Systemic corticosteroids rx 0.00 $70.00 $0.00 4136F Syst corticosteroids not rx 0.00 $70.00 $0.00 4140F Inhaled corticosteroids rxd 0.00 $70.00 $0.00 4142F Corticoster sparng thrpy rxd 0.00 $70.00 $0.00 4144F Alt long-term cntrl med rxd 0.00 $70.00 $0.00 4145F 2+ anti-hyprtnsv agents tkn 0.00 $70.00 $0.00 4148F Hep a vac injxn admin/recvd 0.00 $70.00 $0.00 4149F Hep b vac injxn admin/recvd 0.00 $70.00 $0.00 4150F Pt recvng antivir txmnt hepc 0.00 $70.00 $0.00 41500 Fixation of tongue 13.52 $70.00 $946.40 4151F Pt not recvng antiv hep c 0.00 $70.00 $0.00 41510 Tongue to lip surgery 13.08 $70.00 $915.60 41512 Tongue suspension 18.94 $70.00 $1,325.80 41520 Reconstruction tongue fold 9.95 $70.00 $696.50 4153F Combo pegintf/rib rx 0.00 $70.00 $0.00 41530 Tongue base vol reduction 27.72 $70.00 $1,940.40 NON-FACILITY HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL 4155F Hep a vac series prev recvd 0.00 $70.00 $0.00 4157F Hep b vac series prev recvd 0.00 $70.00 $0.00 4158F Pt edu re alcoh drnkng done 0.00 $70.00 $0.00 4159F Contrcp talk b/4 antiv txmnt 0.00 $70.00 $0.00 41599 Tongue and mouth surgery 0.00 $70.00 $0.00 4163F Pt couns 4 txmnt opt prost 0.00 $70.00 $0.00 4164F Adjv hrmnl thxpy rxd 0.00 $70.00 $0.00 4165F 3d-crt/imrt received 0.00 $70.00 $0.00 4167F Hd bed tilted 1st day vent 0.00 $70.00 $0.00 4168F Pt care icu&vent w/in 24hrs 0.00 $70.00 $0.00 4169F No pt care icu/vent in 24hrs 0.00 $70.00 $0.00 4171F Pt rcvng esa thxpy 0.00 $70.00 $0.00 4172F Pt not rcvng esa thxpy 0.00 $70.00 $0.00 4174F Couns potent glauc impct 0.00 $70.00 $0.00 4175F Vis 20/40/> w/in 90 days 0.00 $70.00 $0.00 4176F Talk re uv light pt/crgvr 0.00 $70.00 $0.00 4177F Talk pt/crgvr re areds prev 0.00 $70.00 $0.00 4178F Antid glbln rcvd w/in 26wks 0.00 $70.00 $0.00 4179F Tamoxifen/ai prescribed 0.00 $70.00 $0.00 4180F Adjv thxpyrxd/rcvd colon ca 0.00 $70.00 $0.00 41800 Drainage of gum lesion 8.14 $70.00 $569.80 41805 Removal foreign body gum 8.10 $70.00 $567.00 41806 Removal foreign body jawbone 11.22 $70.00 $785.40 4181F Conformal radn thxpy rcvd 0.00 $70.00 $0.00 4182F No conformal radn thxpy 0.00 $70.00 $0.00 41820 Excision gum each quadrant 0.00 $70.00 $0.00 41821 Excision of gum flap 0.00 $70.00 $0.00 41822 Excision of gum lesion 8.71 $70.00 $609.70 41823 Excision of gum lesion 12.85 $70.00 $899.50 41825 Excision of gum lesion 6.12 $70.00 $428.40 41826 Excision of gum lesion 9.12 $70.00 $638.40 41827 Excision of gum lesion 12.68 $70.00 $887.60 41828 Excision of gum lesion 9.07 $70.00 $634.90 41830 Removal of gum tissue 11.61 $70.00 $812.70 4185F Continuous ppi or h2ra rcvd 0.00 $70.00 $0.00 41850 Treatment of gum lesion 0.00 $70.00 $0.00 4186F No cont ppi or h2ra rcvd 0.00 $70.00 $0.00 4187F Anti rheum drugthxpyrxd/gvn 0.00 $70.00 $0.00 41870 Gum graft 0.00 $70.00 $0.00 41872 Repair gum 9.98 $70.00 $698.60 41874 Repair tooth socket 11.07 $70.00 $774.90 4188F Approp ace/arb tstng done 0.00 $70.00 $0.00 4189F Approp digoxin tstng done 0.00 $70.00 $0.00 41899 Dental surgery procedure 0.00 $70.00 $0.00 4190F Approp diuretic tstng done 0.00 $70.00 $0.00 NON-FACILITY HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL 4191F Approp anticonvuls tstng 0.00 $70.00 $0.00 4192F Pt not rcvng glucoco thxpy 0.00 $70.00 $0.00 4193F Pt rcvng<10mg daily predniso 0.00 $70.00 $0.00 4194F Pt rcvng10mg daily predniso 0.00 $70.00 $0.00 4195F Pt rcvng anti-rheum thxpy ra 0.00 $70.00 $0.00 4196F Ptnot rcvng anti-rhm thxpyra 0.00 $70.00 $0.00 4200F External beam to prost only 0.00 $70.00 $0.00 42000 Drainage mouth roof lesion 4.37 $70.00 $305.90 4201F Extrnl beam other than prost 0.00 $70.00 $0.00 4210F Ace/arb thxpy for mos/> 0.00 $70.00 $0.00 42100 Biopsy roof of mouth 4.29 $70.00 $300.30 42104 Excision lesion mouth roof 6.16 $70.00 $431.20 42106 Excision lesion mouth roof 7.88 $70.00 $551.60 42107 Excision lesion mouth roof 13.26 $70.00 $928.20 42120 Remove palate/lesion 29.14 $70.00 $2,039.80 42140 Excision of uvula 7.20 $70.00 $504.00 42145 Repair palate pharynx/uvula 20.05 $70.00 $1,403.50 42160 Treatment mouth roof lesion 6.61 $70.00 $462.70 42180 Repair palate 6.91 $70.00 $483.70 42182 Repair palate 9.08 $70.00 $635.60 4220F Digoxin thxpy for 6 mos/> 0.00 $70.00 $0.00 42200 Reconstruct cleft palate 27.56 $70.00 $1,929.20 42205 Reconstruct cleft palate 28.73 $70.00 $2,011.10 4221F Diuretic thxpy for 6 mos/> 0.00 $70.00 $0.00 42210 Reconstruct cleft palate 31.99 $70.00 $2,239.30 42215 Reconstruct cleft palate 20.95 $70.00 $1,466.50 42220 Reconstruct cleft palate 17.29 $70.00 $1,210.30 42225 Reconstruct cleft palate 28.74 $70.00 $2,011.80 42226 Lengthening of palate 25.34 $70.00 $1,773.80 42227 Lengthening of palate 23.79 $70.00 $1,665.30 42235 Repair palate 20.82 $70.00 $1,457.40 42260 Repair nose to lip fistula 23.03 $70.00 $1,612.10 42280 Preparation palate mold 5.02 $70.00 $351.40 42281 Insertion palate prosthesis 6.51 $70.00 $455.70 42299 Palate/uvula surgery 0.00 $70.00 $0.00 4230F Anticonv thxpy for 6 mos/> 0.00 $70.00 $0.00 42300 Drainage of salivary gland 5.95 $70.00 $416.50 42305 Drainage of salivary gland 12.32 $70.00 $862.40 42310 Drainage of salivary gland 5.09 $70.00 $356.30 42320 Drainage of salivary gland 7.07 $70.00 $494.90 42330 Removal of salivary stone 6.61 $70.00 $462.70 42335 Removal of salivary stone 10.66 $70.00 $746.20 42340 Removal of salivary stone 13.29 $70.00 $930.30 4240F Instr xrcz back pain 12 wks 0.00 $70.00 $0.00 42400 Biopsy of salivary gland 2.98 $70.00 $208.60 NON-FACILITY HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL 42405 Biopsy of salivary gland 8.50 $70.00 $595.00 42408 Excision of salivary cyst 14.29 $70.00 $1,000.30 42409 Drainage of salivary cyst 9.47 $70.00 $662.90 42410 Excise parotid gland/lesion 17.76 $70.00 $1,243.20 42415 Excise parotid gland/lesion 30.07 $70.00 $2,104.90 4242F Sprvsd xrcz back pn >12 wks 0.00 $70.00 $0.00 42420 Excise parotid gland/lesion 33.78 $70.00 $2,364.60 42425 Excise parotid gland/lesion 23.85 $70.00 $1,669.50 42426 Excise parotid gland/lesion 38.47 $70.00 $2,692.90 42440 Excise submaxillary gland 11.74 $70.00 $821.80 4245F Pt instr nrml lifest 0.00 $70.00 $0.00 42450 Excise sublingual gland 12.93 $70.00 $905.10 4248F Pt instr no bd rest 4 days/> 0.00 $70.00 $0.00 4250F Wrmng 4 surg normothermia 0.00 $70.00 $0.00 42500 Repair salivary duct 12.36 $70.00 $865.20 42505 Repair salivary duct 15.82 $70.00 $1,107.40 42507 Parotid duct diversion 14.57 $70.00 $1,019.90 42509 Parotid duct diversion 24.03 $70.00 $1,682.10 42510 Parotid duct diversion 17.85 $70.00 $1,249.50 4255F Anesth 60 min/> as docd 0.00 $70.00 $0.00 42550 Injection for salivary x-ray 3.88 $70.00 $271.60 4256F Anesthe <60 min as docd 0.00 $70.00 $0.00 4260F Wound srfc culturetech used 0.00 $70.00 $0.00 42600 Closure of salivary fistula 13.60 $70.00 $952.00 4261F Tech other than surfc cultr 0.00 $70.00 $0.00 4265F Wet-dry dressings rx recmd 0.00 $70.00 $0.00 42650 Dilation of salivary duct 2.37 $70.00 $165.90 4266F No wet-dry drssings rx recmd 0.00 $70.00 $0.00 42660 Dilation of salivary duct 3.72 $70.00 $260.40 42665 Ligation of salivary duct 8.91 $70.00 $623.70 4267F Comprssion thxpy prescribed 0.00 $70.00 $0.00 4268F Pt ed re comp thxpy rcvd 0.00 $70.00 $0.00 4269F Appropos mthd offloading rxd 0.00 $70.00 $0.00 42699 Salivary surgery procedure 0.00 $70.00 $0.00 4270F Pt rcvng anti r-viral thxpy 0.00 $70.00 $0.00 42700 Drainage of tonsil abscess 5.39 $70.00 $377.30 4271F Pt rcvng anti r-viral thxpy 0.00 $70.00 $0.00 42720 Drainage of throat abscess 12.96 $70.00 $907.20 42725 Drainage of throat abscess 23.48 $70.00 $1,643.60 4274F Flu immuno admind rcvd 0.00 $70.00 $0.00 4276F Potent antivir thxpy rxd 0.00 $70.00 $0.00 4279F Pcp prophylaxis rxd 0.00 $70.00 $0.00 4280F Pcp prophylax rxd 3mon low % 0.00 $70.00 $0.00 42800 Biopsy of throat 4.49 $70.00 $314.30 42804 Biopsy of upper nose/throat 5.52 $70.00 $386.40 NON-FACILITY HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL 42806 Biopsy of upper nose/throat 6.22 $70.00 $435.40 42808 Excise pharynx lesion 6.43 $70.00 $450.10 42809 Remove pharynx foreign body 5.76 $70.00 $403.20 42810 Excision of neck cyst 11.03 $70.00 $772.10 42815 Excision of neck cyst 15.88 $70.00 $1,111.60 42820 Remove tonsils and adenoids 8.25 $70.00 $577.50 42821 Remove tonsils and adenoids 8.56 $70.00 $599.20 42825 Removal of tonsils 7.45 $70.00 $521.50 42826 Removal of tonsils 7.16 $70.00 $501.20 42830 Removal of adenoids 5.89 $70.00 $412.30 42831 Removal of adenoids 6.36 $70.00 $445.20 42835 Removal of adenoids 5.47 $70.00 $382.90 42836 Removal of adenoids 6.85 $70.00 $479.50 42842 Extensive surgery of throat 29.08 $70.00 $2,035.60 42844 Extensive surgery of throat 40.04 $70.00 $2,802.80 42845 Extensive surgery of throat 64.35 $70.00 $4,504.50 42860 Excision of tonsil tags 5.34 $70.00 $373.80 42870 Excision of lingual tonsil 17.09 $70.00 $1,196.30 42890 Partial removal of pharynx 41.32 $70.00 $2,892.40 42892 Revision of pharyngeal walls 54.24 $70.00 $3,796.80 42894 Revision of pharyngeal walls 68.40 $70.00 $4,788.00 4290F Pt scrned for inj drug use 0.00 $70.00 $0.00 42900 Repair throat wound 9.64 $70.00 $674.80 4293F Pt scrnd hgh-risk sex behav 0.00 $70.00 $0.00 42950 Reconstruction of throat 23.48 $70.00 $1,643.60 42953 Repair throat esophagus 28.16 $70.00 $1,971.20 42955 Surgical opening of throat 22.16 $70.00 $1,551.20 42960 Control throat bleeding 4.84 $70.00 $338.80 42961 Control throat bleeding 11.99 $70.00 $839.30 42962 Control throat bleeding 14.80 $70.00 $1,036.00 42970 Control nose/throat bleeding 11.79 $70.00 $825.30 42971 Control nose/throat bleeding 13.01 $70.00 $910.70 42972 Control nose/throat bleeding 14.56 $70.00 $1,019.20 42999 Throat surgery procedure 0.00 $70.00 $0.00 4300F Pt rcvng warf thxpy 0.00 $70.00 $0.00 4301F Pt not rcvng warf thxpy 0.00 $70.00 $0.00 43020 Incision of esophagus 16.11 $70.00 $1,127.70 43030 Throat muscle surgery 14.80 $70.00 $1,036.00 43045 Incision of esophagus 37.64 $70.00 $2,634.80 4305F Pt ed re ft care inspct rcvd 0.00 $70.00 $0.00 4306F Pt tlk psych & rx opd addic 0.00 $70.00 $0.00 43100 Excision of esophagus lesion 17.82 $70.00 $1,247.40 43101 Excision of esophagus lesion 29.10 $70.00 $2,037.00 43107 Removal of esophagus 86.35 $70.00 $6,044.50 43108 Removal of esophagus 128.81 $70.00 $9,016.70 NON-FACILITY HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL 43112 Esphg tot w/thrcm 101.20 $70.00 $7,084.00 43113 Removal of esophagus 125.85 $70.00 $8,809.50 43116 Partial removal of esophagus 143.86 $70.00 $10,070.20 43117 Partial removal of esophagus 94.04 $70.00 $6,582.80 43118 Partial removal of esophagus 105.13 $70.00 $7,359.10 43121 Partial removal of esophagus 82.82 $70.00 $5,797.40 43122 Partial removal of esophagus 74.04 $70.00 $5,182.80 43123 Partial removal of esophagus 130.43 $70.00 $9,130.10 43124 Removal of esophagus 110.21 $70.00 $7,714.70 43130 Removal of esophagus pouch 22.46 $70.00 $1,572.20 43135 Removal of esophagus pouch 43.17 $70.00 $3,021.90 43180 Esophagoscopy rigid trnso 15.67 $70.00 $1,096.90 43191 Esophagoscopy rigid trnso dx 4.45 $70.00 $311.50 43192 Esophagoscp rig trnso inject 4.85 $70.00 $339.50 43193 Esophagoscp rig trnso biopsy 4.87 $70.00 $340.90 43194 Esophagoscp rig trnso rem fb 5.57 $70.00 $389.90 43195 Esophagoscopy rigid balloon 5.33 $70.00 $373.10 43196 Esophagoscp guide wire dilat 5.67 $70.00 $396.90 43197 Esophagoscopy flex dx brush 5.45 $70.00 $381.50 43198 Esophagosc flex trnsn biopsy 6.01 $70.00 $420.70 4320F Pt talk psychsoc&rx oh dpnd 0.00 $70.00 $0.00 43200 Esophagoscopy flexible brush 6.13 $70.00 $429.10 43201 Esoph scope w/submucous inj 6.27 $70.00 $438.90 43202 Esophagoscopy flex biopsy 8.75 $70.00 $612.50 43204 Esoph scope w/sclerosis inj 3.97 $70.00 $277.90 43205 Esophagus endoscopy/ligation 4.15 $70.00 $290.50 43206 Esoph optical endomicroscopy 7.60 $70.00 $532.00 43210 Egd esophagogastrc fndoplsty 13.03 $70.00 $912.10 43211 Esophagoscop mucosal resect 6.90 $70.00 $483.00 43212 Esophagoscop stent placement 5.56 $70.00 $389.20 43213 Esophagoscopy retro balloon 32.71 $70.00 $2,289.70 43214 Esophagosc dilate balloon 30 5.64 $70.00 $394.80 43215 Esophagoscopy flex remove fb 10.26 $70.00 $718.20 43216 Esophagoscopy lesion removal 10.20 $70.00 $714.00 43217 Esophagoscopy snare les remv 10.82 $70.00 $757.40 4322F Crgvr prov w/ ed addl rsrcs 0.00 $70.00 $0.00 43220 Esophagoscopy balloon <30mm 30.51 $70.00 $2,135.70 43226 Esoph endoscopy dilation 9.02 $70.00 $631.40 43227 Esophagoscopy control bleed 17.95 $70.00 $1,256.50 43229 Esophagoscopy lesion ablate 18.47 $70.00 $1,292.90 43231 Esophagoscop ultrasound exam 9.54 $70.00 $667.80 43232 Esophagoscopy w/us needle bx 11.56 $70.00 $809.20 43233 Egd balloon dil esoph30 mm/> 6.71 $70.00 $469.70 43235 Egd diagnostic brush wash 7.31 $70.00 $511.70 43236 Uppr gi scope w/submuc inj 9.38 $70.00 $656.60 NON-FACILITY HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL 43237 Endoscopic us exam esoph 5.77 $70.00 $403.90 43238 Egd us fine needle bx/aspir 6.84 $70.00 $478.80 43239 Egd biopsy single/multiple 9.78 $70.00 $684.60 4324F Pt queried prkns complic 0.00 $70.00 $0.00 43240 Egd w/transmural drain cyst 11.53 $70.00 $807.10 43241 Egd tube/cath insertion 4.18 $70.00 $292.60 43242 Egd us fine needle bx/aspir 7.73 $70.00 $541.10 43243 Egd injection varices 6.97 $70.00 $487.90 43244 Egd varices ligation 7.21 $70.00 $504.70 43245 Egd dilate stricture 15.78 $70.00 $1,104.60 43246 Egd place gastrostomy tube 5.88 $70.00 $411.60 43247 Egd remove foreign body 9.98 $70.00 $698.60 43248 Egd guide wire insertion 9.98 $70.00 $698.60 43249 Esoph egd dilation <30 mm 29.03 $70.00 $2,032.10 4325F Med txmnt options rvwd w/pt 0.00 $70.00 $0.00 43250 Egd cautery tumor polyp 11.35 $70.00 $794.50 43251 Egd remove lesion snare 12.58 $70.00 $880.60 43252 Egd optical endomicroscopy 8.65 $70.00 $605.50 43253 Egd us transmural injxn/mark 7.73 $70.00 $541.10 43254 Egd endo mucosal resection 7.95 $70.00 $556.50 43255 Egd control bleeding any 18.98 $70.00 $1,328.60 43257 Egd w/thrml txmnt gerd 6.83 $70.00 $478.10 43259 Egd us exam duodenum/jejunum 6.65 $70.00 $465.50 4326F Pt asked re symp auto dysfxn 0.00 $70.00 $0.00 43260 Ercp w/specimen collection 9.49 $70.00 $664.30 43261 Endo cholangiopancreatograph 9.97 $70.00 $697.90 43262 Endo cholangiopancreatograph 10.50 $70.00 $735.00 43263 Ercp sphincter pressure meas 10.51 $70.00 $735.70 43264 Ercp remove duct calculi 10.71 $70.00 $749.70 43265 Ercp lithotripsy calculi 12.73 $70.00 $891.10 43266 Egd endoscopic stent place 6.41 $70.00 $448.70 43270 Egd lesion ablation 19.04 $70.00 $1,332.80 43273 Endoscopic pancreatoscopy 3.51 $70.00 $245.70 43274 Ercp duct stent placement 13.61 $70.00 $952.70 43275 Ercp remove forgn body duct 11.08 $70.00 $775.60 43276 Ercp stent exchange w/dilate 14.17 $70.00 $991.90 43277 Ercp ea duct/ampulla dilate 11.14 $70.00 $779.80 43278 Ercp lesion ablate w/dilate 12.74 $70.00 $891.80 43279 Lap myotomy heller 37.34 $70.00 $2,613.80 4328F Pt asked re sleep disturb 0.00 $70.00 $0.00 43280 Laparoscopy fundoplasty 31.31 $70.00 $2,191.70 43281 Lap paraesophag hern repair 44.72 $70.00 $3,130.40 43282 Lap paraesoph her rpr w/mesh 50.29 $70.00 $3,520.30 43283 Lap esoph lengthening 4.60 $70.00 $322.00 43284 Laps esophgl sphnctr agmntj 18.83 $70.00 $1,318.10 NON-FACILITY HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL 43285 Rmvl esophgl sphnctr dev 18.04 $70.00 $1,262.80 43286 Esphg tot w/laps moblj 91.06 $70.00 $6,374.20 43287 Esphg dstl 2/3 w/laps moblj 104.00 $70.00 $7,280.00 43288 Esphg thrsc moblj 108.51 $70.00 $7,595.70 43289 Laparoscope proc esoph 0.00 $70.00 $0.00 4330F Cnslng epi spec sfty issues 0.00 $70.00 $0.00 43300 Repair of esophagus 17.50 $70.00 $1,225.00 43305 Repair esophagus and fistula 31.05 $70.00 $2,173.50 43310 Repair of esophagus 42.97 $70.00 $3,007.90 43312 Repair esophagus and fistula 46.28 $70.00 $3,239.60 43313 Esophagoplasty congenital 79.13 $70.00 $5,539.10 43314 Tracheo-esophagoplasty cong 85.18 $70.00 $5,962.60 43320 Fuse esophagus & stomach 40.47 $70.00 $2,832.90 43325 Revise esophagus & stomach 39.37 $70.00 $2,755.90 43327 Esoph fundoplasty lap 23.80 $70.00 $1,666.00 43328 Esoph fundoplasty thor 32.69 $70.00 $2,288.30 43330 Esophagomyotomy abdominal 38.71 $70.00 $2,709.70 43331 Esophagomyotomy thoracic 38.85 $70.00 $2,719.50 43332 Transab esoph hiat hern rpr 33.60 $70.00 $2,352.00 43333 Transab esoph hiat hern rpr 36.61 $70.00 $2,562.70 43334 Transthor diaphrag hern rpr 36.19 $70.00 $2,533.30 43335 Transthor diaphrag hern rpr 38.83 $70.00 $2,718.10 43336 Thorabd diaphr hern repair 43.58 $70.00 $3,050.60 43337 Thorabd diaphr hern repair 44.88 $70.00 $3,141.60 43338 Esoph lengthening 3.37 $70.00 $235.90 43340 Fuse esophagus & intestine 39.97 $70.00 $2,797.90 43341 Fuse esophagus & intestine 40.58 $70.00 $2,840.60 43351 Surgical opening esophagus 38.08 $70.00 $2,665.60 43352 Surgical opening esophagus 30.88 $70.00 $2,161.60 43360 Gastrointestinal repair 65.32 $70.00 $4,572.40 43361 Gastrointestinal repair 78.09 $70.00 $5,466.30 4340F Cnslng chldbrng women epi 0.00 $70.00 $0.00 43400 Ligate esophagus veins 44.13 $70.00 $3,089.10 43401 Esophagus surgery for veins 45.56 $70.00 $3,189.20 43405 Ligate/staple esophagus 42.14 $70.00 $2,949.80 43410 Repair esophagus wound 29.27 $70.00 $2,048.90 43415 Repair esophagus wound 74.82 $70.00 $5,237.40 43420 Repair esophagus opening 28.95 $70.00 $2,026.50 43425 Repair esophagus opening 41.82 $70.00 $2,927.40 43450 Dilate esophagus 1/mult pass 4.48 $70.00 $313.60 43453 Dilate esophagus 25.99 $70.00 $1,819.30 43460 Pressure treatment esophagus 6.27 $70.00 $438.90 43496 Free jejunum flap microvasc 0.00 $70.00 $0.00 43499 Esophagus surgery procedure 0.00 $70.00 $0.00 4350F Cnslng provided symp mngmnt 0.00 $70.00 $0.00 NON-FACILITY HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL 43500 Surgical opening of stomach 22.71 $70.00 $1,589.70 43501 Surgical repair of stomach 38.93 $70.00 $2,725.10 43502 Surgical repair of stomach 44.22 $70.00 $3,095.40 43510 Surgical opening of stomach 27.39 $70.00 $1,917.30 43520 Incision of pyloric muscle 19.78 $70.00 $1,384.60 43605 Biopsy of stomach 24.22 $70.00 $1,695.40 43610 Excision of stomach lesion 28.33 $70.00 $1,983.10 43611 Excision of stomach lesion 35.46 $70.00 $2,482.20 43620 Removal of stomach 57.25 $70.00 $4,007.50 43621 Removal of stomach 65.75 $70.00 $4,602.50 43622 Removal of stomach 67.07 $70.00 $4,694.90 43631 Removal of stomach partial 41.96 $70.00 $2,937.20 43632 Removal of stomach partial 58.88 $70.00 $4,121.60 43633 Removal of stomach partial 55.66 $70.00 $3,896.20 43634 Removal of stomach partial 61.69 $70.00 $4,318.30 43635 Removal of stomach partial 3.28 $70.00 $229.60 43640 Vagotomy & pylorus repair 34.14 $70.00 $2,389.80 43641 Vagotomy & pylorus repair 34.86 $70.00 $2,440.20 43644 Lap gastric bypass/roux-en-y 50.15 $70.00 $3,510.50 43645 Lap gastr bypass incl smll i 53.41 $70.00 $3,738.70 43647 Lap impl electrode antrum 0.00 $70.00 $0.00 43648 Lap revise/remv eltrd antrum 0.00 $70.00 $0.00 43651 Laparoscopy vagus nerve 18.95 $70.00 $1,326.50 43652 Laparoscopy vagus nerve 22.14 $70.00 $1,549.80 43653 Laparoscopy gastrostomy 16.58 $70.00 $1,160.60 43659 Laparoscope proc stom 0.00 $70.00 $0.00 43752 Nasal/orogastric w/tube plmt 1.18 $70.00 $82.60 43753 Tx gastro intub w/asp 0.63 $70.00 $44.10 43754 Dx gastr intub w/asp spec 3.83 $70.00 $268.10 43755 Dx gastr intub w/asp specs 3.92 $70.00 $274.40 43756 Dx duod intub w/asp spec 5.91 $70.00 $413.70 43757 Dx duod intub w/asp specs 8.37 $70.00 $585.90 43760 Change gastrostomy tube 14.10 $70.00 $987.00 43761 Reposition gastrostomy tube 3.37 $70.00 $235.90 43770 Lap place gastr adj device 32.45 $70.00 $2,271.50 43771 Lap revise gastr adj device 36.94 $70.00 $2,585.80 43772 Lap rmvl gastr adj device 27.62 $70.00 $1,933.40 43773 Lap replace gastr adj device 37.03 $70.00 $2,592.10 43774 Lap rmvl gastr adj all parts 27.79 $70.00 $1,945.30 43775 Lap sleeve gastrectomy 32.33 $70.00 $2,263.10 43800 Reconstruction of pylorus 26.89 $70.00 $1,882.30 43810 Fusion of stomach and bowel 29.51 $70.00 $2,065.70 43820 Fusion of stomach and bowel 38.89 $70.00 $2,722.30 43825 Fusion of stomach and bowel 37.95 $70.00 $2,656.50 43830 Place gastrostomy tube 20.24 $70.00 $1,416.80 NON-FACILITY HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL 43831 Place gastrostomy tube 17.20 $70.00 $1,204.00 43832 Place gastrostomy tube 29.99 $70.00 $2,099.30 43840 Repair of stomach lesion 39.37 $70.00 $2,755.90 43842 V-band gastroplasty 34.56 $70.00 $2,419.20 43843 Gastroplasty w/o v-band 37.12 $70.00 $2,598.40 43845 Gastroplasty duodenal switch 57.00 $70.00 $3,990.00 43846 Gastric bypass for obesity 46.87 $70.00 $3,280.90 43847 Gastric bypass incl small i 52.27 $70.00 $3,658.90 43848 Revision gastroplasty 55.75 $70.00 $3,902.50 43850 Revise stomach-bowel fusion 47.23 $70.00 $3,306.10 43855 Revise stomach-bowel fusion 48.99 $70.00 $3,429.30 43860 Revise stomach-bowel fusion 47.41 $70.00 $3,318.70 43865 Revise stomach-bowel fusion 49.58 $70.00 $3,470.60 43870 Repair stomach opening 20.55 $70.00 $1,438.50 43880 Repair stomach-bowel fistula 46.29 $70.00 $3,240.30 43881 Impl/redo electrd antrum 0.00 $70.00 $0.00 43882 Revise/remove electrd antrum 0.00 $70.00 $0.00 43886 Revise gastric port open 10.49 $70.00 $734.30 43887 Remove gastric port open 9.46 $70.00 $662.20 43888 Change gastric port open 13.35 $70.00 $934.50 43999 Stomach surgery procedure 0.00 $70.00 $0.00 4400F Rehab thxpy options w/pt 0.00 $70.00 $0.00 44005 Freeing of bowel adhesion 31.73 $70.00 $2,221.10 44010 Incision of small bowel 24.91 $70.00 $1,743.70 44015 Insert needle cath bowel 4.13 $70.00 $289.10 44020 Explore small intestine 28.17 $70.00 $1,971.90 44021 Decompress small bowel 28.21 $70.00 $1,974.70 44025 Incision of large bowel 28.45 $70.00 $1,991.50 44050 Reduce bowel obstruction 27.05 $70.00 $1,893.50 44055 Correct malrotation of bowel 43.18 $70.00 $3,022.60 44100 Biopsy of bowel 3.16 $70.00 $221.20 44110 Excise intestine lesion(s) 24.61 $70.00 $1,722.70 44111 Excision of bowel lesion(s) 28.43 $70.00 $1,990.10 44120 Removal of small intestine 35.47 $70.00 $2,482.90 44121 Removal of small intestine 7.03 $70.00 $492.10 44125 Removal of small intestine 34.18 $70.00 $2,392.60 44126 Enterectomy w/o taper cong 71.51 $70.00 $5,005.70 44127 Enterectomy w/taper cong 82.69 $70.00 $5,788.30 44128 Enterectomy cong add-on 7.09 $70.00 $496.30 44130 Bowel to bowel fusion 38.03 $70.00 $2,662.10 44132 Enterectomy cadaver donor 0.00 $70.00 $0.00 44133 Enterectomy live donor 0.00 $70.00 $0.00 44135 Intestine transplnt cadaver 0.00 $70.00 $0.00 44136 Intestine transplant live 0.00 $70.00 $0.00 44137 Remove intestinal allograft 0.00 $70.00 $0.00 NON-FACILITY HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL 44139 Mobilization of colon 3.53 $70.00 $247.10 44140 Partial removal of colon 38.87 $70.00 $2,720.90 44141 Partial removal of colon 52.93 $70.00 $3,705.10 44143 Partial removal of colon 48.25 $70.00 $3,377.50 44144 Partial removal of colon 51.27 $70.00 $3,588.90 44145 Partial removal of colon 48.04 $70.00 $3,362.80 44146 Partial removal of colon 61.44 $70.00 $4,300.80 44147 Partial removal of colon 56.27 $70.00 $3,938.90 44150 Removal of colon 54.19 $70.00 $3,793.30 44151 Removal of colon/ileostomy 62.64 $70.00 $4,384.80 44155 Removal of colon/ileostomy 60.34 $70.00 $4,223.80 44156 Removal of colon/ileostomy 67.10 $70.00 $4,697.00 44157 Colectomy w/ileoanal anast 63.59 $70.00 $4,451.30 44158 Colectomy w/neo-rectum pouch 65.21 $70.00 $4,564.70 44160 Removal of colon 35.98 $70.00 $2,518.60 44180 Lap enterolysis 26.63 $70.00 $1,864.10 44186 Lap jejunostomy 18.82 $70.00 $1,317.40 44187 Lap ileo/jejuno-stomy 31.99 $70.00 $2,239.30 44188 Lap colostomy 35.53 $70.00 $2,487.10 44202 Lap enterectomy 40.12 $70.00 $2,808.40 44203 Lap resect s/intestine addl 7.10 $70.00 $497.00 44204 Laparo partial colectomy 44.59 $70.00 $3,121.30 44205 Lap colectomy part w/ileum 38.77 $70.00 $2,713.90 44206 Lap part colectomy w/stoma 50.76 $70.00 $3,553.20 44207 L colectomy/coloproctostomy 52.76 $70.00 $3,693.20 44208 L colectomy/coloproctostomy 57.56 $70.00 $4,029.20 44210 Laparo total proctocolectomy 51.65 $70.00 $3,615.50 44211 Lap colectomy w/proctectomy 62.02 $70.00 $4,341.40 44212 Laparo total proctocolectomy 59.27 $70.00 $4,148.90 44213 Lap mobil splenic fl add-on 5.47 $70.00 $382.90 44227 Lap close enterostomy 48.26 $70.00 $3,378.20 44238 Laparoscope proc intestine 0.00 $70.00 $0.00 44300 Open bowel to skin 24.40 $70.00 $1,708.00 44310 Ileostomy/jejunostomy 30.26 $70.00 $2,118.20 44312 Revision of ileostomy 17.13 $70.00 $1,199.10 44314 Revision of ileostomy 29.11 $70.00 $2,037.70 44316 Devise bowel pouch 41.00 $70.00 $2,870.00 44320 Colostomy 34.81 $70.00 $2,436.70 44322 Colostomy with biopsies 28.99 $70.00 $2,029.30 44340 Revision of colostomy 18.05 $70.00 $1,263.50 44345 Revision of colostomy 30.48 $70.00 $2,133.60 44346 Revision of colostomy 34.30 $70.00 $2,401.00 44360 Small bowel endoscopy 4.22 $70.00 $295.40 44361 Small bowel endoscopy/biopsy 4.66 $70.00 $326.20 44363 Small bowel endoscopy 5.65 $70.00 $395.50 NON-FACILITY HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL 44364 Small bowel endoscopy 6.02 $70.00 $421.40 44365 Small bowel endoscopy 5.33 $70.00 $373.10 44366 Small bowel endoscopy 7.06 $70.00 $494.20 44369 Small bowel endoscopy 7.22 $70.00 $505.40 44370 Small bowel endoscopy/stent 7.83 $70.00 $548.10 44372 Small bowel endoscopy 7.05 $70.00 $493.50 44373 Small bowel endoscopy 5.65 $70.00 $395.50 44376 Small bowel endoscopy 8.36 $70.00 $585.20 44377 Small bowel endoscopy/biopsy 8.81 $70.00 $616.70 44378 Small bowel endoscopy 11.31 $70.00 $791.70 44379 S bowel endoscope w/stent 12.03 $70.00 $842.10 44380 Small bowel endoscopy br/wa 4.80 $70.00 $336.00 44381 Small bowel endoscopy br/wa 26.32 $70.00 $1,842.40 44382 Small bowel endoscopy 7.54 $70.00 $527.80 44384 Small bowel endoscopy 4.49 $70.00 $314.30 44385 Endoscopy of bowel pouch 5.48 $70.00 $383.60 44386 Endoscopy bowel pouch/biop 8.16 $70.00 $571.20 44388 Colonoscopy thru stoma spx 8.25 $70.00 $577.50 44388 53 Colonoscopy thru stoma spx 4.10 $70.00 $287.00 44389 Colonoscopy with biopsy 10.83 $70.00 $758.10 44390 Colonoscopy for foreign body 10.75 $70.00 $752.50 44391 Colonoscopy for bleeding 19.79 $70.00 $1,385.30 44392 Colonoscopy & polypectomy 10.05 $70.00 $703.50 44394 Colonoscopy w/snare 11.54 $70.00 $807.80 44401 Colonoscopy with ablation 91.02 $70.00 $6,371.40 44402 Colonoscopy w/stent plcmt 7.70 $70.00 $539.00 44403 Colonoscopy w/resection 8.94 $70.00 $625.80 44404 Colonoscopy w/injection 10.37 $70.00 $725.90 44405 Colonoscopy w/dilation 15.32 $70.00 $1,072.40 44406 Colonoscopy w/ultrasound 6.76 $70.00 $473.20 44407 Colonoscopy w/ndl aspir/bx 8.11 $70.00 $567.70 44408 Colonoscopy w/decompression 6.82 $70.00 $477.40 4450F Self-care ed provided to pt 0.00 $70.00 $0.00 44500 Intro gastrointestinal tube 0.56 $70.00 $39.20 44602 Suture small intestine 40.90 $70.00 $2,863.00 44603 Suture small intestine 46.97 $70.00 $3,287.90 44604 Suture large intestine 30.67 $70.00 $2,146.90 44605 Repair of bowel lesion 37.78 $70.00 $2,644.60 44615 Intestinal stricturoplasty 31.15 $70.00 $2,180.50 44620 Repair bowel opening 25.14 $70.00 $1,759.80 44625 Repair bowel opening 29.46 $70.00 $2,062.20 44626 Repair bowel opening 46.43 $70.00 $3,250.10 44640 Repair bowel-skin fistula 40.60 $70.00 $2,842.00 44650 Repair bowel fistula 41.88 $70.00 $2,931.60 44660 Repair bowel-bladder fistula 38.71 $70.00 $2,709.70 NON-FACILITY HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL 44661 Repair bowel-bladder fistula 44.96 $70.00 $3,147.20 44680 Surgical revision intestine 30.74 $70.00 $2,151.80 4470F Icd counseling provided 0.00 $70.00 $0.00 44700 Suspend bowel w/prosthesis 29.29 $70.00 $2,050.30 44701 Intraop colon lavage add-on 4.96 $70.00 $347.20 44705 Prepare fecal microbiota 3.27 $70.00 $228.90 44715 Prepare donor intestine 0.00 $70.00 $0.00 44720 Prep donor intestine/venous 7.99 $70.00 $559.30 44721 Prep donor intestine/artery 11.18 $70.00 $782.60 44799 Unlisted px small intestine 0.00 $70.00 $0.00 4480F Pt rcvng ace/arb b-blockertx 0.00 $70.00 $0.00 44800 Excision of bowel pouch 22.10 $70.00 $1,547.00 4481F Pt rcvng ace/arb blker >3mos 0.00 $70.00 $0.00 44820 Excision of mesentery lesion 24.49 $70.00 $1,714.30 44850 Repair of mesentery 21.67 $70.00 $1,516.90 44899 Bowel surgery procedure 0.00 $70.00 $0.00 44900 Drain appendix abscess open 22.45 $70.00 $1,571.50 44950 Appendectomy 18.58 $70.00 $1,300.60 44955 Appendectomy add-on 2.44 $70.00 $170.80 44960 Appendectomy 25.31 $70.00 $1,771.70 44970 Laparoscopy appendectomy 17.40 $70.00 $1,218.00 44979 Laparoscope proc app 0.00 $70.00 $0.00 4500F Ref to outpt card rehab prog 0.00 $70.00 $0.00 45000 Drainage of pelvic abscess 12.33 $70.00 $863.10 45005 Drainage of rectal abscess 7.93 $70.00 $555.10 45020 Drainage of rectal abscess 16.63 $70.00 $1,164.10 4510F Prev cardrehab qualcardevent 0.00 $70.00 $0.00 45100 Biopsy of rectum 8.66 $70.00 $606.20 45108 Removal of anorectal lesion 10.69 $70.00 $748.30 45110 Removal of rectum 53.49 $70.00 $3,744.30 45111 Partial removal of rectum 31.45 $70.00 $2,201.50 45112 Removal of rectum 54.23 $70.00 $3,796.10 45113 Partial proctectomy 55.06 $70.00 $3,854.20 45114 Partial removal of rectum 52.72 $70.00 $3,690.40 45116 Partial removal of rectum 45.31 $70.00 $3,171.70 45119 Remove rectum w/reservoir 55.27 $70.00 $3,868.90 45120 Removal of rectum 46.13 $70.00 $3,229.10 45121 Removal of rectum and colon 50.41 $70.00 $3,528.70 45123 Partial proctectomy 32.53 $70.00 $2,277.10 45126 Pelvic exenteration 79.50 $70.00 $5,565.00 45130 Excision of rectal prolapse 31.55 $70.00 $2,208.50 45135 Excision of rectal prolapse 37.84 $70.00 $2,648.80 45136 Excise ileoanal reservior 52.60 $70.00 $3,682.00 45150 Excision of rectal stricture 12.00 $70.00 $840.00 45160 Excision of rectal lesion 29.62 $70.00 $2,073.40 NON-FACILITY HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL 45171 Exc rect tum transanal part 17.41 $70.00 $1,218.70 45172 Exc rect tum transanal full 23.53 $70.00 $1,647.10 45190 Destruction rectal tumor 20.12 $70.00 $1,408.40 4525F Neuropsychia interven order 0.00 $70.00 $0.00 4526F Neuropsychia interven rcvd 0.00 $70.00 $0.00 45300 Proctosigmoidoscopy dx 3.58 $70.00 $250.60 45303 Proctosigmoidoscopy dilate 25.70 $70.00 $1,799.00 45305 Proctosigmoidoscopy w/bx 4.11 $70.00 $287.70 45307 Proctosigmoidoscopy fb 4.75 $70.00 $332.50 45308 Proctosigmoidoscopy removal 4.61 $70.00 $322.70 45309 Proctosigmoidoscopy removal 4.79 $70.00 $335.30 45315 Proctosigmoidoscopy removal 5.30 $70.00 $371.00 45317 Proctosigmoidoscopy bleed 5.26 $70.00 $368.20 45320 Proctosigmoidoscopy ablate 5.14 $70.00 $359.80 45321 Proctosigmoidoscopy volvul 2.99 $70.00 $209.30 45327 Proctosigmoidoscopy w/stent 3.41 $70.00 $238.70 45330 Diagnostic sigmoidoscopy 4.81 $70.00 $336.70 45331 Sigmoidoscopy and biopsy 7.36 $70.00 $515.20 45332 Sigmoidoscopy w/fb removal 7.19 $70.00 $503.30 45333 Sigmoidoscopy & polypectomy 8.40 $70.00 $588.00 45334 Sigmoidoscopy for bleeding 15.74 $70.00 $1,101.80 45335 Sigmoidoscopy w/submuc inj 6.69 $70.00 $468.30 45337 Sigmoidoscopy & decompress 3.38 $70.00 $236.60 45338 Sigmoidoscopy w/tumr remove 7.68 $70.00 $537.60 45340 Sig w/tndsc balloon dilation 12.34 $70.00 $863.80 45341 Sigmoidoscopy w/ultrasound 3.62 $70.00 $253.40 45342 Sigmoidoscopy w/us guide bx 4.99 $70.00 $349.30 45346 Sigmoidoscopy w/ablation 87.47 $70.00 $6,122.90 45347 Sigmoidoscopy w/plcmt stent 4.53 $70.00 $317.10 45349 Sigmoidoscopy w/resection 5.85 $70.00 $409.50 45350 Sgmdsc w/band ligation 15.06 $70.00 $1,054.20 45378 Diagnostic colonoscopy 9.02 $70.00 $631.40 45378 53 Diagnostic colonoscopy 4.52 $70.00 $316.40 45379 Colonoscopy w/fb removal 11.63 $70.00 $814.10 45380 Colonoscopy and biopsy 11.55 $70.00 $808.50 45381 Colonoscopy submucous njx 11.05 $70.00 $773.50 45382 Colonoscopy w/control bleed 20.57 $70.00 $1,439.90 45384 Colonoscopy w/lesion removal 12.83 $70.00 $898.10 45385 Colonoscopy w/lesion removal 12.13 $70.00 $849.10 45386 Colonoscopy w/balloon dilat 16.69 $70.00 $1,168.30 45388 Colonoscopy w/ablation 91.76 $70.00 $6,423.20 45389 Colonoscopy w/stent plcmt 8.53 $70.00 $597.10 45390 Colonoscopy w/resection 9.79 $70.00 $685.30 45391 Colonoscopy w/endoscope us 7.58 $70.00 $530.60 45392 Colonoscopy w/endoscopic fnb 8.95 $70.00 $626.50 NON-FACILITY HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL 45393 Colonoscopy w/decompression 7.43 $70.00 $520.10 45395 Lap removal of rectum 57.30 $70.00 $4,011.00 45397 Lap remove rectum w/pouch 62.42 $70.00 $4,369.40 45398 Colonoscopy w/band ligation 19.50 $70.00 $1,365.00 45399 Unlisted procedure colon 0.00 $70.00 $0.00 4540F Disease modif pharmacothxpy 0.00 $70.00 $0.00 45400 Laparoscopic proc 33.08 $70.00 $2,315.60 45402 Lap proctopexy w/sig resect 44.03 $70.00 $3,082.10 4541F Pt offered tx for pseudobulb 0.00 $70.00 $0.00 45499 Laparoscope proc rectum 0.00 $70.00 $0.00 4550F Noninvas resp support talk 0.00 $70.00 $0.00 45500 Repair of rectum 16.01 $70.00 $1,120.70 45505 Repair of rectum 17.12 $70.00 $1,198.40 4551F Nutritional support offered 0.00 $70.00 $0.00 4552F Pt ref for speech lang path 0.00 $70.00 $0.00 45520 Treatment of rectal prolapse 4.47 $70.00 $312.90 4553F Pt asst re end life issues 0.00 $70.00 $0.00 4554F Pt recvd inhal anesthetic 0.00 $70.00 $0.00 45540 Correct rectal prolapse 30.61 $70.00 $2,142.70 45541 Correct rectal prolapse 27.25 $70.00 $1,907.50 4555F Pt recvd no inhal anesthic 0.00 $70.00 $0.00 45550 Repair rectum/remove sigmoid 42.27 $70.00 $2,958.90 4556F Pt w/3+ post-op nausea&vom 0.00 $70.00 $0.00 45560 Repair of rectocele 19.80 $70.00 $1,386.00 45562 Exploration/repair of rectum 32.27 $70.00 $2,258.90 45563 Exploration/repair of rectum 47.80 $70.00 $3,346.00 4557F Pt w/o 3+ post-opnausea&vom 0.00 $70.00 $0.00 4558F Pt recvd 2 rx anti-emet agt 0.00 $70.00 $0.00 4559F 1 bodytemp >=35.5cw/in 30min 0.00 $70.00 $0.00 4560F Anesth w/o gen/neurax anesth 0.00 $70.00 $0.00 4561F Pt w/ coronary artery stent 0.00 $70.00 $0.00 4562F Pt w/o coronary artery stent 0.00 $70.00 $0.00 4563F Pt recvd aspirin w/in 24 hrs 0.00 $70.00 $0.00 45800 Repair rect/bladder fistula 36.10 $70.00 $2,527.00 45805 Repair fistula w/colostomy 42.39 $70.00 $2,967.30 45820 Repair rectourethral fistula 36.63 $70.00 $2,564.10 45825 Repair fistula w/colostomy 44.25 $70.00 $3,097.50 45900 Reduction of rectal prolapse 6.10 $70.00 $427.00 45905 Dilation of anal sphincter 4.89 $70.00 $342.30 45910 Dilation of rectal narrowing 5.59 $70.00 $391.30 45915 Remove rectal obstruction 9.60 $70.00 $672.00 45990 Surg dx exam anorectal 3.10 $70.00 $217.00 45999 Rectum surgery procedure 0.00 $70.00 $0.00 46020 Placement of seton 7.94 $70.00 $555.80 46030 Removal of rectal marker 4.02 $70.00 $281.40 NON-FACILITY HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL 46040 Incision of rectal abscess 15.45 $70.00 $1,081.50 46045 Incision of rectal abscess 12.51 $70.00 $875.70 46050 Incision of anal abscess 5.83 $70.00 $408.10 46060 Incision of rectal abscess 13.76 $70.00 $963.20 46070 Incision of anal septum 7.42 $70.00 $519.40 46080 Incision of anal sphincter 7.17 $70.00 $501.90 46083 Incise external hemorrhoid 5.12 $70.00 $358.40 46200 Removal of anal fissure 12.86 $70.00 $900.20 46220 Excise anal ext tag/papilla 5.94 $70.00 $415.80 46221 Ligation of hemorrhoid(s) 7.72 $70.00 $540.40 46230 Removal of anal tags 7.86 $70.00 $550.20 46250 Remove ext hem groups 2+ 13.35 $70.00 $934.50 46255 Remove int/ext hem 1 group 14.58 $70.00 $1,020.60 46257 Remove in/ex hem grp & fiss 12.27 $70.00 $858.90 46258 Remove in/ex hem grp w/fistu 13.45 $70.00 $941.50 46260 Remove in/ex hem groups 2+ 13.75 $70.00 $962.50 46261 Remove in/ex hem grps & fiss 15.13 $70.00 $1,059.10 46262 Remove in/ex hem grps w/fist 15.97 $70.00 $1,117.90 46270 Remove anal fist subq 14.63 $70.00 $1,024.10 46275 Remove anal fist inter 15.53 $70.00 $1,087.10 46280 Remove anal fist complex 13.57 $70.00 $949.90 46285 Remove anal fist 2 stage 15.47 $70.00 $1,082.90 46288 Repair anal fistula 15.84 $70.00 $1,108.80 46320 Removal of hemorrhoid clot 5.31 $70.00 $371.70 46500 Injection into hemorrhoid(s) 5.41 $70.00 $378.70 46505 Chemodenervation anal musc 8.22 $70.00 $575.40 46600 Diagnostic anoscopy spx 2.55 $70.00 $178.50 46601 Diagnostic anoscopy 3.88 $70.00 $271.60 46604 Anoscopy and dilation 17.85 $70.00 $1,249.50 46606 Anoscopy and biopsy 6.53 $70.00 $457.10 46607 Diagnostic anoscopy & biopsy 5.48 $70.00 $383.60 46608 Anoscopy remove for body 6.85 $70.00 $479.50 46610 Anoscopy remove lesion 6.59 $70.00 $461.30 46611 Anoscopy 5.11 $70.00 $357.70 46612 Anoscopy remove lesions 7.92 $70.00 $554.40 46614 Anoscopy control bleeding 3.73 $70.00 $261.10 46615 Anoscopy 4.14 $70.00 $289.80 46700 Repair of anal stricture 18.94 $70.00 $1,325.80 46705 Repair of anal stricture 15.94 $70.00 $1,115.80 46706 Repr of anal fistula w/glue 5.09 $70.00 $356.30 46707 Repair anorectal fist w/plug 13.95 $70.00 $976.50 46710 Repr per/vag pouch sngl proc 32.02 $70.00 $2,241.40 46712 Repr per/vag pouch dbl proc 64.62 $70.00 $4,523.40 46715 Rep perf anoper fistu 15.63 $70.00 $1,094.10 46716 Rep perf anoper/vestib fistu 34.94 $70.00 $2,445.80 NON-FACILITY HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL 46730 Construction of absent anus 56.79 $70.00 $3,975.30 46735 Construction of absent anus 65.53 $70.00 $4,587.10 46740 Construction of absent anus 62.08 $70.00 $4,345.60 46742 Repair of imperforated anus 71.89 $70.00 $5,032.30 46744 Repair of cloacal anomaly 101.90 $70.00 $7,133.00 46746 Repair of cloacal anomaly 112.27 $70.00 $7,858.90 46748 Repair of cloacal anomaly 121.72 $70.00 $8,520.40 46750 Repair of anal sphincter 21.69 $70.00 $1,518.30 46751 Repair of anal sphincter 18.83 $70.00 $1,318.10 46753 Reconstruction of anus 17.64 $70.00 $1,234.80 46754 Removal of suture from anus 8.85 $70.00 $619.50 46760 Repair of anal sphincter 31.67 $70.00 $2,216.90 46761 Repair of anal sphincter 26.49 $70.00 $1,854.30 46762 Implant artificial sphincter 26.74 $70.00 $1,871.80 46900 Destruction anal lesion(s) 6.95 $70.00 $486.50 46910 Destruction anal lesion(s) 7.40 $70.00 $518.00 46916 Cryosurgery anal lesion(s) 6.62 $70.00 $463.40 46917 Laser surgery anal lesions 12.94 $70.00 $905.80 46922 Excision of anal lesion(s) 7.69 $70.00 $538.30 46924 Destruction anal lesion(s) 15.00 $70.00 $1,050.00 46930 Destroy internal hemorrhoids 5.96 $70.00 $417.20 46940 Treatment of anal fissure 6.56 $70.00 $459.20 46942 Treatment of anal fissure 6.26 $70.00 $438.20 46945 Remove by ligat int hem grp 8.88 $70.00 $621.60 46946 Remove by ligat int hem grps 9.03 $70.00 $632.10 46947 Hemorrhoidopexy by stapling 11.05 $70.00 $773.50 46999 Anus surgery procedure 0.00 $70.00 $0.00 47000 Needle biopsy of liver 8.71 $70.00 $609.70 47001 Needle biopsy liver add-on 3.03 $70.00 $212.10 47010 Open drainage liver lesion 34.84 $70.00 $2,438.80 47015 Inject/aspirate liver cyst 33.68 $70.00 $2,357.60 47100 Wedge biopsy of liver 24.42 $70.00 $1,709.40 47120 Partial removal of liver 67.44 $70.00 $4,720.80 47122 Extensive removal of liver 99.04 $70.00 $6,932.80 47125 Partial removal of liver 89.08 $70.00 $6,235.60 47130 Partial removal of liver 95.67 $70.00 $6,696.90 47133 Removal of donor liver 0.00 $70.00 $0.00 47135 Transplantation of liver 154.98 $70.00 $10,848.60 47140 Partial removal donor liver 103.29 $70.00 $7,230.30 47141 Partial removal donor liver 123.31 $70.00 $8,631.70 47142 Partial removal donor liver 135.84 $70.00 $9,508.80 47143 Prep donor liver whole 0.00 $70.00 $0.00 47144 Prep donor liver 3-segment 0.00 $70.00 $0.00 47145 Prep donor liver lobe split 0.00 $70.00 $0.00 47146 Prep donor liver/venous 9.59 $70.00 $671.30 NON-FACILITY HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL 47147 Prep donor liver/arterial 11.14 $70.00 $779.80 47300 Surgery for liver lesion 32.71 $70.00 $2,289.70 47350 Repair liver wound 39.64 $70.00 $2,774.80 47360 Repair liver wound 54.40 $70.00 $3,808.00 47361 Repair liver wound 87.53 $70.00 $6,127.10 47362 Repair liver wound 42.01 $70.00 $2,940.70 47370 Laparo ablate liver tumor rf 36.13 $70.00 $2,529.10 47371 Laparo ablate liver cryosurg 36.41 $70.00 $2,548.70 47379 Laparoscope procedure liver 0.00 $70.00 $0.00 47380 Open ablate liver tumor rf 41.68 $70.00 $2,917.60 47381 Open ablate liver tumor cryo 42.92 $70.00 $3,004.40 47382 Percut ablate liver rf 137.38 $70.00 $9,616.60 47383 Perq abltj lvr cryoablation 195.08 $70.00 $13,655.60 47399 Liver surgery procedure 0.00 $70.00 $0.00 47400 Incision of liver duct 62.47 $70.00 $4,372.90 47420 Incision of bile duct 38.77 $70.00 $2,713.90 47425 Incision of bile duct 39.63 $70.00 $2,774.10 47460 Incise bile duct sphincter 36.75 $70.00 $2,572.50 47480 Incision of gallbladder 25.36 $70.00 $1,775.20 47490 Incision of gallbladder 9.52 $70.00 $666.40 47531 Injection for cholangiogram 9.00 $70.00 $630.00 47532 Injection for cholangiogram 22.64 $70.00 $1,584.80 47533 Plmt biliary drainage cath 35.01 $70.00 $2,450.70 47534 Plmt biliary drainage cath 41.82 $70.00 $2,927.40 47535 Conversion ext bil drg cath 28.88 $70.00 $2,021.60 47536 Exchange biliary drg cath 19.59 $70.00 $1,371.30 47537 Removal biliary drg cath 10.42 $70.00 $729.40 47538 Perq plmt bile duct stent 122.83 $70.00 $8,598.10 47539 Perq plmt bile duct stent 136.09 $70.00 $9,526.30 47540 Perq plmt bile duct stent 139.06 $70.00 $9,734.20 47541 Plmt access bil tree sm bwl 33.36 $70.00 $2,335.20 47542 Dilate biliary duct/ampulla 13.13 $70.00 $919.10 47543 Endoluminal bx biliary tree 13.55 $70.00 $948.50 47544 Removal duct glbldr calculi 30.55 $70.00 $2,138.50 47550 Bile duct endoscopy add-on 4.80 $70.00 $336.00 47552 Biliary endo perq dx w/speci 8.94 $70.00 $625.80 47553 Biliary endoscopy thru skin 8.81 $70.00 $616.70 47554 Biliary endoscopy thru skin 14.99 $70.00 $1,049.30 47555 Biliary endoscopy thru skin 9.43 $70.00 $660.10 47556 Biliary endoscopy thru skin 10.68 $70.00 $747.60 47562 Laparoscopic cholecystectomy 19.04 $70.00 $1,332.80 47563 Laparo cholecystectomy/graph 20.67 $70.00 $1,446.90 47564 Laparo cholecystectomy/explr 32.21 $70.00 $2,254.70 47570 Laparo cholecystoenterostomy 22.46 $70.00 $1,572.20 47579 Laparoscope proc biliary 0.00 $70.00 $0.00 NON-FACILITY HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL 47600 Removal of gallbladder 30.89 $70.00 $2,162.30 47605 Removal of gallbladder 32.53 $70.00 $2,277.10 47610 Removal of gallbladder 36.32 $70.00 $2,542.40 47612 Removal of gallbladder 36.85 $70.00 $2,579.50 47620 Removal of gallbladder 39.96 $70.00 $2,797.20 47700 Exploration of bile ducts 30.47 $70.00 $2,132.90 47701 Bile duct revision 50.27 $70.00 $3,518.90 47711 Excision of bile duct tumor 45.04 $70.00 $3,152.80 47712 Excision of bile duct tumor 57.98 $70.00 $4,058.60 47715 Excision of bile duct cyst 38.55 $70.00 $2,698.50 47720 Fuse gallbladder & bowel 33.43 $70.00 $2,340.10 47721 Fuse upper gi structures 39.25 $70.00 $2,747.50 47740 Fuse gallbladder & bowel 38.04 $70.00 $2,662.80 47741 Fuse gallbladder & bowel 42.79 $70.00 $2,995.30 47760 Fuse bile ducts and bowel 65.40 $70.00 $4,578.00 47765 Fuse liver ducts & bowel 88.09 $70.00 $6,166.30 47780 Fuse bile ducts and bowel 71.69 $70.00 $5,018.30 47785 Fuse bile ducts and bowel 93.70 $70.00 $6,559.00 47800 Reconstruction of bile ducts 45.69 $70.00 $3,198.30 47801 Placement bile duct support 30.97 $70.00 $2,167.90 47802 Fuse liver duct & intestine 44.24 $70.00 $3,096.80 47900 Suture bile duct injury 39.82 $70.00 $2,787.40 47999 Bile tract surgery procedure 0.00 $70.00 $0.00 48000 Drainage of abdomen 54.72 $70.00 $3,830.40 48001 Placement of drain pancreas 66.96 $70.00 $4,687.20 48020 Removal of pancreatic stone 34.12 $70.00 $2,388.40 48100 Biopsy of pancreas open 25.67 $70.00 $1,796.90 48102 Needle biopsy pancreas 15.15 $70.00 $1,060.50 48105 Resect/debride pancreas 82.38 $70.00 $5,766.60 48120 Removal of pancreas lesion 31.94 $70.00 $2,235.80 48140 Partial removal of pancreas 45.28 $70.00 $3,169.60 48145 Partial removal of pancreas 47.35 $70.00 $3,314.50 48146 Pancreatectomy 54.47 $70.00 $3,812.90 48148 Removal of pancreatic duct 36.21 $70.00 $2,534.70 48150 Partial removal of pancreas 90.09 $70.00 $6,306.30 48152 Pancreatectomy 83.66 $70.00 $5,856.20 48153 Pancreatectomy 89.65 $70.00 $6,275.50 48154 Pancreatectomy 84.01 $70.00 $5,880.70 48155 Removal of pancreas 52.63 $70.00 $3,684.10 48160 Pancreas removal/transplant 0.00 $70.00 $0.00 48400 Injection intraop add-on 3.13 $70.00 $219.10 48500 Surgery of pancreatic cyst 33.35 $70.00 $2,334.50 48510 Drain pancreatic pseudocyst 31.80 $70.00 $2,226.00 48520 Fuse pancreas cyst and bowel 31.62 $70.00 $2,213.40 48540 Fuse pancreas cyst and bowel 38.01 $70.00 $2,660.70 NON-FACILITY HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL 48545 Pancreatorrhaphy 39.02 $70.00 $2,731.40 48547 Duodenal exclusion 52.01 $70.00 $3,640.70 48548 Fuse pancreas and bowel 48.10 $70.00 $3,367.00 48550 Donor pancreatectomy 0.00 $70.00 $0.00 48551 Prep donor pancreas 0.00 $70.00 $0.00 48552 Prep donor pancreas/venous 6.86 $70.00 $480.20 48554 Transpl allograft pancreas 73.70 $70.00 $5,159.00 48556 Removal allograft pancreas 36.91 $70.00 $2,583.70 48999 Pancreas surgery procedure 0.00 $70.00 $0.00 49000 Exploration of abdomen 22.27 $70.00 $1,558.90 49002 Reopening of abdomen 30.27 $70.00 $2,118.90 49010 Exploration behind abdomen 26.98 $70.00 $1,888.60 49020 Drainage abdom abscess open 46.03 $70.00 $3,222.10 49040 Drain open abdom abscess 28.93 $70.00 $2,025.10 49060 Drain open retroperi abscess 31.82 $70.00 $2,227.40 49062 Drain to peritoneal cavity 21.68 $70.00 $1,517.60 49082 Abd paracentesis 5.56 $70.00 $389.20 49083 Abd paracentesis w/imaging 8.40 $70.00 $588.00 49084 Peritoneal lavage 3.15 $70.00 $220.50 49180 Biopsy abdominal mass 4.66 $70.00 $326.20 49185 Sclerotx fluid collection 26.92 $70.00 $1,884.40 49203 Exc abd tum 5 cm or less 34.66 $70.00 $2,426.20 49204 Exc abd tum over 5 cm 44.38 $70.00 $3,106.60 49205 Exc abd tum over 10 cm 50.95 $70.00 $3,566.50 49215 Excise sacral spine tumor 64.33 $70.00 $4,503.10 49220 Multiple surgery abdomen 28.13 $70.00 $1,969.10 49250 Excision of umbilicus 16.98 $70.00 $1,188.60 49255 Removal of omentum 22.90 $70.00 $1,603.00 49320 Diag laparo separate proc 9.43 $70.00 $660.10 49321 Laparoscopy biopsy 9.98 $70.00 $698.60 49322 Laparoscopy aspiration 10.69 $70.00 $748.30 49323 Laparo drain lymphocele 18.41 $70.00 $1,288.70 49324 Lap insert tunnel ip cath 11.25 $70.00 $787.50 49325 Lap revision perm ip cath 11.96 $70.00 $837.20 49326 Lap w/omentopexy add-on 5.48 $70.00 $383.60 49327 Lap ins device for rt 3.79 $70.00 $265.30 49329 Laparo proc abdm/per/oment 0.00 $70.00 $0.00 49400 Air injection into abdomen 3.85 $70.00 $269.50 49402 Remove foreign body adbomen 24.79 $70.00 $1,735.30 49405 Image cath fluid colxn visc 22.96 $70.00 $1,607.20 49406 Image cath fluid peri/retro 22.95 $70.00 $1,606.50 49407 Image cath fluid trns/vgnl 18.55 $70.00 $1,298.50 49411 Ins mark abd/pel for rt perq 13.73 $70.00 $961.10 49412 Ins device for rt guide open 2.40 $70.00 $168.00 49418 Insert tun ip cath perc 38.71 $70.00 $2,709.70 NON-FACILITY HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL 49419 Insert tun ip cath w/port 12.85 $70.00 $899.50 49421 Ins tun ip cath for dial opn 6.65 $70.00 $465.50 49422 Remove tunneled ip cath 10.99 $70.00 $769.30 49423 Exchange drainage catheter 15.54 $70.00 $1,087.80 49424 Assess cyst contrast inject 4.15 $70.00 $290.50 49425 Insert abdomen-venous drain 20.68 $70.00 $1,447.60 49426 Revise abdomen-venous shunt 17.76 $70.00 $1,243.20 49427 Injection abdominal shunt 1.33 $70.00 $93.10 49428 Ligation of shunt 12.51 $70.00 $875.70 49429 Removal of shunt 13.30 $70.00 $931.00 49435 Insert subq exten to ip cath 3.46 $70.00 $242.20 49436 Embedded ip cath exit-site 5.38 $70.00 $376.60 49440 Place gastrostomy tube perc 27.48 $70.00 $1,923.60 49441 Place duod/jej tube perc 31.11 $70.00 $2,177.70 49442 Place cecostomy tube perc 25.85 $70.00 $1,809.50 49446 Change g-tube to g-j perc 26.47 $70.00 $1,852.90 49450 Replace g/c tube perc 18.94 $70.00 $1,325.80 49451 Replace duod/jej tube perc 20.68 $70.00 $1,447.60 49452 Replace g-j tube perc 25.59 $70.00 $1,791.30 49460 Fix g/colon tube w/device 20.98 $70.00 $1,468.60 49465 Fluoro exam of g/colon tube 4.66 $70.00 $326.20 49491 Rpr hern preemie reduc 22.96 $70.00 $1,607.20 49492 Rpr ing hern premie blocked 27.69 $70.00 $1,938.30 49495 Rpr ing hernia baby reduc 11.86 $70.00 $830.20 49496 Rpr ing hernia baby blocked 17.77 $70.00 $1,243.90 49500 Rpr ing hernia init reduce 11.91 $70.00 $833.70 49501 Rpr ing hernia init blocked 17.51 $70.00 $1,225.70 49505 Prp i/hern init reduc >5 yr 15.03 $70.00 $1,052.10 49507 Prp i/hern init block >5 yr 16.94 $70.00 $1,185.80 49520 Rerepair ing hernia reduce 18.26 $70.00 $1,278.20 49521 Rerepair ing hernia blocked 20.71 $70.00 $1,449.70 49525 Repair ing hernia sliding 16.54 $70.00 $1,157.80 49540 Repair lumbar hernia 19.42 $70.00 $1,359.40 49550 Rpr rem hernia init reduce 16.64 $70.00 $1,164.80 49553 Rpr fem hernia init blocked 18.26 $70.00 $1,278.20 49555 Rerepair fem hernia reduce 17.30 $70.00 $1,211.00 49557 Rerepair fem hernia blocked 20.92 $70.00 $1,464.40 49560 Rpr ventral hern init reduc 21.33 $70.00 $1,493.10 49561 Rpr ventral hern init block 26.89 $70.00 $1,882.30 49565 Rerepair ventrl hern reduce 22.20 $70.00 $1,554.00 49566 Rerepair ventrl hern block 27.13 $70.00 $1,899.10 49568 Hernia repair w/mesh 7.76 $70.00 $543.20 49570 Rpr epigastric hern reduce 12.07 $70.00 $844.90 49572 Rpr epigastric hern blocked 14.89 $70.00 $1,042.30 49580 Rpr umbil hern reduc < 5 yr 9.61 $70.00 $672.70 NON-FACILITY HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL 49582 Rpr umbil hern block < 5 yr 13.95 $70.00 $976.50 49585 Rpr umbil hern reduc > 5 yr 12.86 $70.00 $900.20 49587 Rpr umbil hern block > 5 yr 13.74 $70.00 $961.80 49590 Repair spigelian hernia 16.54 $70.00 $1,157.80 49600 Repair umbilical lesion 21.13 $70.00 $1,479.10 49605 Repair umbilical lesion 142.63 $70.00 $9,984.10 49606 Repair umbilical lesion 32.81 $70.00 $2,296.70 49610 Repair umbilical lesion 19.88 $70.00 $1,391.60 49611 Repair umbilical lesion 17.52 $70.00 $1,226.40 49650 Lap ing hernia repair init 12.39 $70.00 $867.30 49651 Lap ing hernia repair recur 16.06 $70.00 $1,124.20 49652 Lap vent/abd hernia repair 21.51 $70.00 $1,505.70 49653 Lap vent/abd hern proc comp 26.82 $70.00 $1,877.40 49654 Lap inc hernia repair 24.46 $70.00 $1,712.20 49655 Lap inc hern repair comp 29.85 $70.00 $2,089.50 49656 Lap inc hernia repair recur 26.54 $70.00 $1,857.80 49657 Lap inc hern recur comp 38.18 $70.00 $2,672.60 49659 Laparo proc hernia repair 0.00 $70.00 $0.00 49900 Repair of abdominal wall 23.57 $70.00 $1,649.90 49904 Omental flap extra-abdom 41.01 $70.00 $2,870.70 49905 Omental flap intra-abdom 10.25 $70.00 $717.50 49906 Free omental flap microvasc 0.00 $70.00 $0.00 49999 Abdomen surgery procedure 0.00 $70.00 $0.00 50010 Exploration of kidney 21.20 $70.00 $1,484.00 50020 Renal abscess open drain 29.33 $70.00 $2,053.10 50040 Drainage of kidney 26.78 $70.00 $1,874.60 50045 Exploration of kidney 27.01 $70.00 $1,890.70 5005F Pt counsld on exam for moles 0.00 $70.00 $0.00 50060 Removal of kidney stone 33.05 $70.00 $2,313.50 50065 Incision of kidney 35.06 $70.00 $2,454.20 50070 Incision of kidney 34.37 $70.00 $2,405.90 50075 Removal of kidney stone 42.25 $70.00 $2,957.50 50080 Removal of kidney stone 25.20 $70.00 $1,764.00 50081 Removal of kidney stone 37.01 $70.00 $2,590.70 5010F Macul result phy/qhp mng dm 0.00 $70.00 $0.00 50100 Revise kidney blood vessels 31.24 $70.00 $2,186.80 50120 Exploration of kidney 27.51 $70.00 $1,925.70 50125 Explore and drain kidney 28.47 $70.00 $1,992.90 50130 Removal of kidney stone 29.94 $70.00 $2,095.80 50135 Exploration of kidney 32.53 $70.00 $2,277.10 5015F Doc fx & test/txmnt for op 0.00 $70.00 $0.00 5020F Txmnts 2 phys/qhp by 1 mon 0.00 $70.00 $0.00 50200 Renal biopsy perq 15.28 $70.00 $1,069.60 50205 Renal biopsy open 21.84 $70.00 $1,528.80 50220 Remove kidney open 30.36 $70.00 $2,125.20 NON-FACILITY HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL 50225 Removal kidney open complex 34.80 $70.00 $2,436.00 50230 Removal kidney open radical 37.15 $70.00 $2,600.50 50234 Removal of kidney & ureter 37.71 $70.00 $2,639.70 50236 Removal of kidney & ureter 42.58 $70.00 $2,980.60 50240 Partial removal of kidney 38.38 $70.00 $2,686.60 50250 Cryoablate renal mass open 35.26 $70.00 $2,468.20 50280 Removal of kidney lesion 27.64 $70.00 $1,934.80 50290 Removal of kidney lesion 26.05 $70.00 $1,823.50 50300 Remove cadaver donor kidney 0.00 $70.00 $0.00 50320 Remove kidney living donor 43.50 $70.00 $3,045.00 50323 Prep cadaver renal allograft 0.00 $70.00 $0.00 50325 Prep donor renal graft 0.00 $70.00 $0.00 50327 Prep renal graft/venous 6.29 $70.00 $440.30 50328 Prep renal graft/arterial 5.52 $70.00 $386.40 50329 Prep renal graft/ureteral 5.21 $70.00 $364.70 50340 Removal of kidney 27.40 $70.00 $1,918.00 50360 Transplantation of kidney 69.98 $70.00 $4,898.60 50365 Transplantation of kidney 82.71 $70.00 $5,789.70 50370 Remove transplanted kidney 34.88 $70.00 $2,441.60 50380 Reimplantation of kidney 57.90 $70.00 $4,053.00 50382 Change ureter stent percut 31.63 $70.00 $2,214.10 50384 Remove ureter stent percut 24.84 $70.00 $1,738.80 50385 Change stent via transureth 30.95 $70.00 $2,166.50 50386 Remove stent via transureth 19.97 $70.00 $1,397.90 50387 Change nephroureteral cath 13.94 $70.00 $975.80 50389 Remove renal tube w/fluoro 8.47 $70.00 $592.90 50390 Drainage of kidney lesion 2.78 $70.00 $194.60 50391 Instll rx agnt into rnal tub 3.50 $70.00 $245.00 50395 Create passage to kidney 5.16 $70.00 $361.20 50396 Measure kidney pressure 3.39 $70.00 $237.30 50400 Revision of kidney/ureter 33.60 $70.00 $2,352.00 50405 Revision of kidney/ureter 40.46 $70.00 $2,832.20 50430 Njx px nfrosgrm &/urtrgrm 13.05 $70.00 $913.50 50431 Njx px nfrosgrm &/urtrgrm 4.64 $70.00 $324.80 50432 Plmt nephrostomy catheter 21.96 $70.00 $1,537.20 50433 Plmt nephroureteral catheter 30.03 $70.00 $2,102.10 50434 Convert nephrostomy catheter 23.52 $70.00 $1,646.40 50435 Exchange nephrostomy cath 13.42 $70.00 $939.40 5050F Plan 2 main dr by 1 month 0.00 $70.00 $0.00 50500 Repair of kidney wound 37.24 $70.00 $2,606.80 50520 Close kidney-skin fistula 33.50 $70.00 $2,345.00 50525 Close nephrovisceral fistula 42.54 $70.00 $2,977.80 50526 Close nephrovisceral fistula 45.60 $70.00 $3,192.00 50540 Revision of horseshoe kidney 33.28 $70.00 $2,329.60 50541 Laparo ablate renal cyst 26.64 $70.00 $1,864.80 NON-FACILITY HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL 50542 Laparo ablate renal mass 33.79 $70.00 $2,365.30 50543 Laparo partial nephrectomy 43.13 $70.00 $3,019.10 50544 Laparoscopy pyeloplasty 36.12 $70.00 $2,528.40 50545 Laparo radical nephrectomy 38.85 $70.00 $2,719.50 50546 Laparoscopic nephrectomy 34.88 $70.00 $2,441.60 50547 Laparo removal donor kidney 46.60 $70.00 $3,262.00 50548 Laparo remove w/ureter 39.05 $70.00 $2,733.50 50549 Laparoscope proc renal 0.00 $70.00 $0.00 50551 Kidney endoscopy 10.44 $70.00 $730.80 50553 Kidney endoscopy 11.19 $70.00 $783.30 50555 Kidney endoscopy & biopsy 11.96 $70.00 $837.20 50557 Kidney endoscopy & treatment 12.16 $70.00 $851.20 50561 Kidney endoscopy & treatment 13.78 $70.00 $964.60 50562 Renal scope w/tumor resect 16.88 $70.00 $1,181.60 50570 Kidney endoscopy 14.28 $70.00 $999.60 50572 Kidney endoscopy 15.45 $70.00 $1,081.50 50574 Kidney endoscopy & biopsy 16.43 $70.00 $1,150.10 50575 Kidney endoscopy 20.74 $70.00 $1,451.80 50576 Kidney endoscopy & treatment 16.39 $70.00 $1,147.30 50580 Kidney endoscopy & treatment 17.65 $70.00 $1,235.50 50590 Fragmenting of kidney stone 20.81 $70.00 $1,456.70 50592 Perc rf ablate renal tumor 94.40 $70.00 $6,608.00 50593 Perc cryo ablate renal tum 128.63 $70.00 $9,004.10 5060F Fndngs mammo 2pt w/in 3 days 0.00 $70.00 $0.00 50600 Exploration of ureter 27.21 $70.00 $1,904.70 50605 Insert ureteral support 28.62 $70.00 $2,003.40 50606 Endoluminal bx urtr rnl plvs 19.93 $70.00 $1,395.10 50610 Removal of ureter stone 27.40 $70.00 $1,918.00 5062F Mammo result com to pt 5 day 0.00 $70.00 $0.00 50620 Removal of ureter stone 26.22 $70.00 $1,835.40 50630 Removal of ureter stone 25.89 $70.00 $1,812.30 50650 Removal of ureter 30.04 $70.00 $2,102.80 50660 Removal of ureter 33.16 $70.00 $2,321.20 50684 Injection for ureter x-ray 3.07 $70.00 $214.90 50686 Measure ureter pressure 4.17 $70.00 $291.90 50688 Change of ureter tube/stent 2.28 $70.00 $159.60 50690 Injection for ureter x-ray 2.85 $70.00 $199.50 50693 Plmt ureteral stent prq 28.09 $70.00 $1,966.30 50694 Plmt ureteral stent prq 30.83 $70.00 $2,158.10 50695 Plmt ureteral stent prq 37.86 $70.00 $2,650.20 50700 Revision of ureter 26.82 $70.00 $1,877.40 50705 Ureteral embolization/occl 54.91 $70.00 $3,843.70 50706 Balloon dilate urtrl strix 28.08 $70.00 $1,965.60 50715 Release of ureter 35.30 $70.00 $2,471.00 50722 Release of ureter 29.21 $70.00 $2,044.70 NON-FACILITY HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL 50725 Release/revise ureter 31.96 $70.00 $2,237.20 50727 Revise ureter 14.74 $70.00 $1,031.80 50728 Revise ureter 20.25 $70.00 $1,417.50 50740 Fusion of ureter & kidney 35.43 $70.00 $2,480.10 50750 Fusion of ureter & kidney 33.45 $70.00 $2,341.50 50760 Fusion of ureters 32.58 $70.00 $2,280.60 50770 Splicing of ureters 33.45 $70.00 $2,341.50 50780 Reimplant ureter in bladder 32.11 $70.00 $2,247.70 50782 Reimplant ureter in bladder 31.17 $70.00 $2,181.90 50783 Reimplant ureter in bladder 32.70 $70.00 $2,289.00 50785 Reimplant ureter in bladder 35.16 $70.00 $2,461.20 50800 Implant ureter in bowel 26.80 $70.00 $1,876.00 50810 Fusion of ureter & bowel 40.46 $70.00 $2,832.20 50815 Urine shunt to intestine 35.44 $70.00 $2,480.80 50820 Construct bowel bladder 38.08 $70.00 $2,665.60 50825 Construct bowel bladder 47.82 $70.00 $3,347.40 50830 Revise urine flow 52.25 $70.00 $3,657.50 50840 Replace ureter by bowel 35.63 $70.00 $2,494.10 50845 Appendico-vesicostomy 36.21 $70.00 $2,534.70 50860 Transplant ureter to skin 27.39 $70.00 $1,917.30 50900 Repair of ureter 24.47 $70.00 $1,712.90 50920 Closure ureter/skin fistula 25.55 $70.00 $1,788.50 50930 Closure ureter/bowel fistula 31.95 $70.00 $2,236.50 50940 Release of ureter 25.72 $70.00 $1,800.40 50945 Laparoscopy ureterolithotomy 28.22 $70.00 $1,975.40 50947 Laparo new ureter/bladder 40.16 $70.00 $2,811.20 50948 Laparo new ureter/bladder 36.97 $70.00 $2,587.90 50949 Laparoscope proc ureter 0.00 $70.00 $0.00 50951 Endoscopy of ureter 10.89 $70.00 $762.30 50953 Endoscopy of ureter 11.60 $70.00 $812.00 50955 Ureter endoscopy & biopsy 12.33 $70.00 $863.10 50957 Ureter endoscopy & treatment 12.45 $70.00 $871.50 50961 Ureter endoscopy & treatment 11.23 $70.00 $786.10 50970 Ureter endoscopy 10.77 $70.00 $753.90 50972 Ureter endoscopy & catheter 10.41 $70.00 $728.70 50974 Ureter endoscopy & biopsy 13.74 $70.00 $961.80 50976 Ureter endoscopy & treatment 13.54 $70.00 $947.80 50980 Ureter endoscopy & treatment 10.36 $70.00 $725.20 5100F Rsk fx ref w/n 24 hrs xray 0.00 $70.00 $0.00 51020 Incise & treat bladder 13.60 $70.00 $952.00 51030 Incise & treat bladder 13.64 $70.00 $954.80 51040 Incise & drain bladder 8.39 $70.00 $587.30 51045 Incise bladder/drain ureter 14.16 $70.00 $991.20 51050 Removal of bladder stone 13.70 $70.00 $959.00 51060 Removal of ureter stone 16.84 $70.00 $1,178.80 NON-FACILITY HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL 51065 Remove ureter calculus 16.77 $70.00 $1,173.90 51080 Drainage of bladder abscess 11.85 $70.00 $829.50 51100 Drain bladder by needle 1.77 $70.00 $123.90 51101 Drain bladder by trocar/cath 3.55 $70.00 $248.50 51102 Drain bl w/cath insertion 6.51 $70.00 $455.70 51500 Removal of bladder cyst 18.46 $70.00 $1,292.20 51520 Removal of bladder lesion 17.22 $70.00 $1,205.40 51525 Removal of bladder lesion 24.88 $70.00 $1,741.60 51530 Removal of bladder lesion 22.62 $70.00 $1,583.40 51535 Repair of ureter lesion 22.61 $70.00 $1,582.70 51550 Partial removal of bladder 27.95 $70.00 $1,956.50 51555 Partial removal of bladder 36.68 $70.00 $2,567.60 51565 Revise bladder & ureter(s) 37.39 $70.00 $2,617.30 51570 Removal of bladder 42.78 $70.00 $2,994.60 51575 Removal of bladder & nodes 52.83 $70.00 $3,698.10 51580 Remove bladder/revise tract 54.97 $70.00 $3,847.90 51585 Removal of bladder & nodes 61.21 $70.00 $4,284.70 51590 Remove bladder/revise tract 56.12 $70.00 $3,928.40 51595 Remove bladder/revise tract 63.46 $70.00 $4,442.20 51596 Remove bladder/create pouch 68.23 $70.00 $4,776.10 51597 Removal of pelvic structures 66.60 $70.00 $4,662.00 51600 Injection for bladder x-ray 5.26 $70.00 $368.20 51605 Preparation for bladder xray 1.12 $70.00 $78.40 51610 Injection for bladder x-ray 3.06 $70.00 $214.20 51700 Irrigation of bladder 2.11 $70.00 $147.70 51701 Insert bladder catheter 1.35 $70.00 $94.50 51702 Insert temp bladder cath 1.83 $70.00 $128.10 51703 Insert bladder cath complex 3.62 $70.00 $253.40 51705 Change of bladder tube 2.62 $70.00 $183.40 51710 Change of bladder tube 3.70 $70.00 $259.00 51715 Endoscopic injection/implant 8.38 $70.00 $586.60 51720 Treatment of bladder lesion 2.41 $70.00 $168.70 51725 Simple cystometrogram 5.37 $70.00 $375.90 51725 TC Simple cystometrogram 3.17 $70.00 $221.90 51725 26 Simple cystometrogram 2.20 $70.00 $154.00 51726 Complex cystometrogram 7.59 $70.00 $531.30 51726 TC Complex cystometrogram 5.13 $70.00 $359.10 51726 26 Complex cystometrogram 2.46 $70.00 $172.20 51727 Cystometrogram w/up 8.93 $70.00 $625.10 51727 TC Cystometrogram w/up 5.86 $70.00 $410.20 51727 26 Cystometrogram w/up 3.07 $70.00 $214.90 51728 Cystometrogram w/vp 9.10 $70.00 $637.00 51728 TC Cystometrogram w/vp 6.08 $70.00 $425.60 51728 26 Cystometrogram w/vp 3.02 $70.00 $211.40 51729 Cystometrogram w/vp&up 9.77 $70.00 $683.90 NON-FACILITY HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL 51729 TC Cystometrogram w/vp&up 6.13 $70.00 $429.10 51729 26 Cystometrogram w/vp&up 3.64 $70.00 $254.80 51736 Urine flow measurement 0.44 $70.00 $30.80 51736 TC Urine flow measurement 0.20 $70.00 $14.00 51736 26 Urine flow measurement 0.24 $70.00 $16.80 51741 Electro-uroflowmetry first 0.45 $70.00 $31.50 51741 TC Electro-uroflowmetry first 0.21 $70.00 $14.70 51741 26 Electro-uroflowmetry first 0.24 $70.00 $16.80 51784 Anal/urinary muscle study 1.98 $70.00 $138.60 51784 TC Anal/urinary muscle study 0.90 $70.00 $63.00 51784 26 Anal/urinary muscle study 1.08 $70.00 $75.60 51785 Anal/urinary muscle study 7.86 $70.00 $550.20 51785 TC Anal/urinary muscle study 5.25 $70.00 $367.50 51785 26 Anal/urinary muscle study 2.61 $70.00 $182.70 51792 Urinary reflex study 6.09 $70.00 $426.30 51792 TC Urinary reflex study 4.50 $70.00 $315.00 51792 26 Urinary reflex study 1.59 $70.00 $111.30 51797 Intraabdominal pressure test 3.24 $70.00 $226.80 51797 TC Intraabdominal pressure test 2.08 $70.00 $145.60 51797 26 Intraabdominal pressure test 1.16 $70.00 $81.20 51798 Us urine capacity measure 0.45 $70.00 $31.50 51800 Revision of bladder/urethra 30.15 $70.00 $2,110.50 51820 Revision of urinary tract 31.40 $70.00 $2,198.00 51840 Attach bladder/urethra 18.95 $70.00 $1,326.50 51841 Attach bladder/urethra 22.14 $70.00 $1,549.80 51845 Repair bladder neck 16.91 $70.00 $1,183.70 51860 Repair of bladder wound 21.58 $70.00 $1,510.60 51865 Repair of bladder wound 25.91 $70.00 $1,813.70 51880 Repair of bladder opening 13.52 $70.00 $946.40 51900 Repair bladder/vagina lesion 23.90 $70.00 $1,673.00 51920 Close bladder-uterus fistula 22.13 $70.00 $1,549.10 51925 Hysterectomy/bladder repair 29.04 $70.00 $2,032.80 51940 Correction of bladder defect 47.59 $70.00 $3,331.30 51960 Revision of bladder & bowel 40.17 $70.00 $2,811.90 51980 Construct bladder opening 20.68 $70.00 $1,447.60 51990 Laparo urethral suspension 21.71 $70.00 $1,519.70 51992 Laparo sling operation 24.12 $70.00 $1,688.40 51999 Laparoscope proc bla 0.00 $70.00 $0.00 5200F Eval appros surg thxpy epi 0.00 $70.00 $0.00 52000 Cystoscopy 4.73 $70.00 $331.10 52001 Cystoscopy removal of clots 10.74 $70.00 $751.80 52005 Cystoscopy & ureter catheter 7.67 $70.00 $536.90 52007 Cystoscopy and biopsy 12.79 $70.00 $895.30 52010 Cystoscopy & duct catheter 10.60 $70.00 $742.00 52204 Cystoscopy w/biopsy(s) 10.64 $70.00 $744.80 NON-FACILITY HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL 52214 Cystoscopy and treatment 19.12 $70.00 $1,338.40 52224 Cystoscopy and treatment 19.97 $70.00 $1,397.90 52234 Cystoscopy and treatment 7.15 $70.00 $500.50 52235 Cystoscopy and treatment 8.38 $70.00 $586.60 52240 Cystoscopy and treatment 11.38 $70.00 $796.60 52250 Cystoscopy and radiotracer 6.96 $70.00 $487.20 52260 Cystoscopy and treatment 6.11 $70.00 $427.70 52265 Cystoscopy and treatment 10.48 $70.00 $733.60 52270 Cystoscopy & revise urethra 10.27 $70.00 $718.90 52275 Cystoscopy & revise urethra 13.84 $70.00 $968.80 52276 Cystoscopy and treatment 7.68 $70.00 $537.60 52277 Cystoscopy and treatment 9.39 $70.00 $657.30 52281 Cystoscopy and treatment 7.86 $70.00 $550.20 52282 Cystoscopy implant stent 9.78 $70.00 $684.60 52283 Cystoscopy and treatment 7.99 $70.00 $559.30 52285 Cystoscopy and treatment 8.05 $70.00 $563.50 52287 Cystoscopy chemodenervation 8.97 $70.00 $627.90 52290 Cystoscopy and treatment 7.10 $70.00 $497.00 52300 Cystoscopy and treatment 8.15 $70.00 $570.50 52301 Cystoscopy and treatment 8.43 $70.00 $590.10 52305 Cystoscopy and treatment 8.08 $70.00 $565.60 52310 Cystoscopy and treatment 7.03 $70.00 $492.10 52315 Cystoscopy and treatment 11.93 $70.00 $835.10 52317 Remove bladder stone 23.20 $70.00 $1,624.00 52318 Remove bladder stone 13.75 $70.00 $962.50 52320 Cystoscopy and treatment 7.17 $70.00 $501.90 52325 Cystoscopy stone removal 9.32 $70.00 $652.40 52327 Cystoscopy inject material 7.62 $70.00 $533.40 52330 Cystoscopy and treatment 14.26 $70.00 $998.20 52332 Cystoscopy and treatment 14.11 $70.00 $987.70 52334 Create passage to kidney 7.44 $70.00 $520.80 52341 Cysto w/ureter stricture tx 8.25 $70.00 $577.50 52342 Cysto w/up stricture tx 8.97 $70.00 $627.90 52343 Cysto w/renal stricture tx 10.00 $70.00 $700.00 52344 Cysto/uretero stricture tx 10.74 $70.00 $751.80 52345 Cysto/uretero w/up stricture 11.45 $70.00 $801.50 52346 Cystouretero w/renal strict 12.97 $70.00 $907.90 52351 Cystouretero & or pyeloscope 8.80 $70.00 $616.00 52352 Cystouretero w/stone remove 10.30 $70.00 $721.00 52353 Cystouretero w/lithotripsy 11.38 $70.00 $796.60 52354 Cystouretero w/biopsy 12.12 $70.00 $848.40 52355 Cystouretero w/excise tumor 13.58 $70.00 $950.60 52356 Cysto/uretero w/lithotripsy 12.08 $70.00 $845.60 52400 Cystouretero w/congen repr 13.86 $70.00 $970.20 52402 Cystourethro cut ejacul duct 7.75 $70.00 $542.50 NON-FACILITY HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL 52441 Cystourethro w/implant 35.77 $70.00 $2,503.90 52442 Cystourethro w/addl implant 27.40 $70.00 $1,918.00 52450 Incision of prostate 13.62 $70.00 $953.40 5250F Asthma discharge plan presnt 0.00 $70.00 $0.00 52500 Revision of bladder neck 14.14 $70.00 $989.80 52601 Prostatectomy (turp) 21.15 $70.00 $1,480.50 52630 Remove prostate regrowth 11.60 $70.00 $812.00 52640 Relieve bladder contracture 9.15 $70.00 $640.50 52647 Laser surgery of prostate 51.36 $70.00 $3,595.20 52648 Laser surgery of prostate 52.84 $70.00 $3,698.80 52649 Prostate laser enucleation 23.86 $70.00 $1,670.20 52700 Drainage of prostate abscess 12.78 $70.00 $894.60 53000 Incision of urethra 4.30 $70.00 $301.00 53010 Incision of urethra 8.54 $70.00 $597.80 53020 Incision of urethra 2.82 $70.00 $197.40 53025 Incision of urethra 1.99 $70.00 $139.30 53040 Drainage of urethra abscess 11.38 $70.00 $796.60 53060 Drainage of urethra abscess 5.24 $70.00 $366.80 53080 Drainage of urinary leakage 12.18 $70.00 $852.60 53085 Drainage of urinary leakage 18.81 $70.00 $1,316.70 53200 Biopsy of urethra 4.54 $70.00 $317.80 53210 Removal of urethra 22.32 $70.00 $1,562.40 53215 Removal of urethra 26.89 $70.00 $1,882.30 53220 Treatment of urethra lesion 13.09 $70.00 $916.30 53230 Removal of urethra lesion 17.53 $70.00 $1,227.10 53235 Removal of urethra lesion 18.35 $70.00 $1,284.50 53240 Surgery for urethra pouch 12.32 $70.00 $862.40 53250 Removal of urethra gland 11.47 $70.00 $802.90 53260 Treatment of urethra lesion 5.81 $70.00 $406.70 53265 Treatment of urethra lesion 6.30 $70.00 $441.00 53270 Removal of urethra gland 5.96 $70.00 $417.20 53275 Repair of urethra defect 7.61 $70.00 $532.70 53400 Revise urethra stage 1 23.18 $70.00 $1,622.60 53405 Revise urethra stage 2 25.32 $70.00 $1,772.40 53410 Reconstruction of urethra 28.35 $70.00 $1,984.50 53415 Reconstruction of urethra 32.80 $70.00 $2,296.00 53420 Reconstruct urethra stage 1 24.39 $70.00 $1,707.30 53425 Reconstruct urethra stage 2 27.14 $70.00 $1,899.80 53430 Reconstruction of urethra 28.06 $70.00 $1,964.20 53431 Reconstruct urethra/bladder 33.47 $70.00 $2,342.90 53440 Male sling procedure 21.83 $70.00 $1,528.10 53442 Remove/revise male sling 22.70 $70.00 $1,589.00 53444 Insert tandem cuff 22.99 $70.00 $1,609.30 53445 Insert uro/ves nck sphincter 21.84 $70.00 $1,528.80 53446 Remove uro sphincter 18.61 $70.00 $1,302.70 NON-FACILITY HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL 53447 Remove/replace ur sphincter 23.44 $70.00 $1,640.80 53448 Remov/replc ur sphinctr comp 37.12 $70.00 $2,598.40 53449 Repair uro sphincter 17.72 $70.00 $1,240.40 53450 Revision of urethra 11.85 $70.00 $829.50 53460 Revision of urethra 13.29 $70.00 $930.30 53500 Urethrlys transvag w/ scope 21.62 $70.00 $1,513.40 53502 Repair of urethra injury 14.09 $70.00 $986.30 53505 Repair of urethra injury 14.08 $70.00 $985.60 53510 Repair of urethra injury 18.31 $70.00 $1,281.70 53515 Repair of urethra injury 23.06 $70.00 $1,614.20 53520 Repair of urethra defect 16.13 $70.00 $1,129.10 53600 Dilate urethra stricture 2.39 $70.00 $167.30 53601 Dilate urethra stricture 2.34 $70.00 $163.80 53605 Dilate urethra stricture 1.88 $70.00 $131.60 53620 Dilate urethra stricture 3.35 $70.00 $234.50 53621 Dilate urethra stricture 3.15 $70.00 $220.50 53660 Dilation of urethra 2.03 $70.00 $142.10 53661 Dilation of urethra 1.99 $70.00 $139.30 53665 Dilation of urethra 1.12 $70.00 $78.40 53850 Prostatic microwave thermotx 59.74 $70.00 $4,181.80 53852 Prostatic rf thermotx 55.14 $70.00 $3,859.80 53855 Insert prost urethral stent 22.45 $70.00 $1,571.50 53860 Transurethral rf treatment 45.29 $70.00 $3,170.30 53899 Urology surgery procedure 0.00 $70.00 $0.00 54000 Slitting of prepuce 4.30 $70.00 $301.00 54001 Slitting of prepuce 5.34 $70.00 $373.80 54015 Drain penis lesion 8.90 $70.00 $623.00 54050 Destruction penis lesion(s) 3.83 $70.00 $268.10 54055 Destruction penis lesion(s) 3.44 $70.00 $240.80 54056 Cryosurgery penis lesion(s) 4.09 $70.00 $286.30 54057 Laser surg penis lesion(s) 4.00 $70.00 $280.00 54060 Excision of penis lesion(s) 5.20 $70.00 $364.00 54065 Destruction penis lesion(s) 6.30 $70.00 $441.00 54100 Biopsy of penis 5.71 $70.00 $399.70 54105 Biopsy of penis 7.65 $70.00 $535.50 54110 Treatment of penis lesion 18.10 $70.00 $1,267.00 54111 Treat penis lesion graft 23.21 $70.00 $1,624.70 54112 Treat penis lesion graft 27.17 $70.00 $1,901.90 54115 Treatment of penis lesion 13.10 $70.00 $917.00 54120 Partial removal of penis 18.34 $70.00 $1,283.80 54125 Removal of penis 23.57 $70.00 $1,649.90 54130 Remove penis & nodes 34.59 $70.00 $2,421.30 54135 Remove penis & nodes 43.84 $70.00 $3,068.80 54150 Circumcision w/regionl block 4.48 $70.00 $313.60 54160 Circumcision neonate 6.34 $70.00 $443.80 NON-FACILITY HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL 54161 Circum 28 days or older 5.70 $70.00 $399.00 54162 Lysis penil circumic lesion 7.44 $70.00 $520.80 54163 Repair of circumcision 6.34 $70.00 $443.80 54164 Frenulotomy of penis 5.61 $70.00 $392.70 54200 Treatment of penis lesion 3.12 $70.00 $218.40 54205 Treatment of penis lesion 15.43 $70.00 $1,080.10 54220 Treatment of penis lesion 5.93 $70.00 $415.10 54230 Prepare penis study 2.82 $70.00 $197.40 54231 Dynamic cavernosometry 4.08 $70.00 $285.60 54235 Penile injection 2.63 $70.00 $184.10 54240 Penis study 3.04 $70.00 $212.80 54240 TC Penis study 1.04 $70.00 $72.80 54240 26 Penis study 2.00 $70.00 $140.00 54250 Penis study 3.49 $70.00 $244.30 54250 TC Penis study 0.32 $70.00 $22.40 54250 26 Penis study 3.17 $70.00 $221.90 54300 Revision of penis 18.62 $70.00 $1,303.40 54304 Revision of penis 21.76 $70.00 $1,523.20 54308 Reconstruction of urethra 20.74 $70.00 $1,451.80 54312 Reconstruction of urethra 23.72 $70.00 $1,660.40 54316 Reconstruction of urethra 28.94 $70.00 $2,025.80 54318 Reconstruction of urethra 20.62 $70.00 $1,443.40 54322 Reconstruction of urethra 22.63 $70.00 $1,584.10 54324 Reconstruction of urethra 28.07 $70.00 $1,964.90 54326 Reconstruction of urethra 27.41 $70.00 $1,918.70 54328 Revise penis/urethra 27.23 $70.00 $1,906.10 54332 Revise penis/urethra 29.41 $70.00 $2,058.70 54336 Revise penis/urethra 34.49 $70.00 $2,414.30 54340 Secondary urethral surgery 16.53 $70.00 $1,157.10 54344 Secondary urethral surgery 27.47 $70.00 $1,922.90 54348 Secondary urethral surgery 29.41 $70.00 $2,058.70 54352 Reconstruct urethra/penis 41.05 $70.00 $2,873.50 54360 Penis plastic surgery 20.89 $70.00 $1,462.30 54380 Repair penis 23.17 $70.00 $1,621.90 54385 Repair penis 26.90 $70.00 $1,883.00 54390 Repair penis and bladder 35.96 $70.00 $2,517.20 54400 Insert semi-rigid prosthesis 15.35 $70.00 $1,074.50 54401 Insert self-contd prosthesis 19.01 $70.00 $1,330.70 54405 Insert multi-comp penis pros 23.43 $70.00 $1,640.10 54406 Remove muti-comp penis pros 21.19 $70.00 $1,483.30 54408 Repair multi-comp penis pros 22.90 $70.00 $1,603.00 54410 Remove/replace penis prosth 24.91 $70.00 $1,743.70 54411 Remov/replc penis pros comp 29.73 $70.00 $2,081.10 54415 Remove self-contd penis pros 15.32 $70.00 $1,072.40 54416 Remv/repl penis contain pros 20.59 $70.00 $1,441.30 NON-FACILITY HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL 54417 Remv/replc penis pros compl 26.06 $70.00 $1,824.20 54420 Revision of penis 20.44 $70.00 $1,430.80 54430 Revision of penis 18.57 $70.00 $1,299.90 54435 Revision of penis 12.09 $70.00 $846.30 54437 Repair corporeal tear 19.54 $70.00 $1,367.80 54438 Replantation of penis 38.77 $70.00 $2,713.90 54440 Repair of penis 0.00 $70.00 $0.00 54450 Preputial stretching 2.04 $70.00 $142.80 54500 Biopsy of testis 2.17 $70.00 $151.90 54505 Biopsy of testis 6.08 $70.00 $425.60 54512 Excise lesion testis 15.67 $70.00 $1,096.90 54520 Removal of testis 9.47 $70.00 $662.90 54522 Orchiectomy partial 17.12 $70.00 $1,198.40 54530 Removal of testis 14.65 $70.00 $1,025.50 54535 Extensive testis surgery 21.58 $70.00 $1,510.60 54550 Exploration for testis 14.26 $70.00 $998.20 54560 Exploration for testis 19.91 $70.00 $1,393.70 54600 Reduce testis torsion 13.16 $70.00 $921.20 54620 Suspension of testis 8.69 $70.00 $608.30 54640 Suspension of testis 13.88 $70.00 $971.60 54650 Orchiopexy (fowler-stephens) 20.64 $70.00 $1,444.80 54660 Revision of testis 10.36 $70.00 $725.20 54670 Repair testis injury 11.76 $70.00 $823.20 54680 Relocation of testis(es) 22.82 $70.00 $1,597.40 54690 Laparoscopy orchiectomy 19.08 $70.00 $1,335.60 54692 Laparoscopy orchiopexy 22.01 $70.00 $1,540.70 54699 Laparoscope proc testis 0.00 $70.00 $0.00 54700 Drainage of scrotum 6.19 $70.00 $433.30 54800 Biopsy of epididymis 3.66 $70.00 $256.20 54830 Remove epididymis lesion 10.81 $70.00 $756.70 54840 Remove epididymis lesion 9.32 $70.00 $652.40 54860 Removal of epididymis 12.16 $70.00 $851.20 54861 Removal of epididymis 16.42 $70.00 $1,149.40 54865 Explore epididymis 10.41 $70.00 $728.70 54900 Fusion of spermatic ducts 23.21 $70.00 $1,624.70 54901 Fusion of spermatic ducts 30.62 $70.00 $2,143.40 55000 Drainage of hydrocele 3.41 $70.00 $238.70 55040 Removal of hydrocele 9.80 $70.00 $686.00 55041 Removal of hydroceles 14.78 $70.00 $1,034.60 55060 Repair of hydrocele 11.04 $70.00 $772.80 55100 Drainage of scrotum abscess 6.23 $70.00 $436.10 55110 Explore scrotum 11.24 $70.00 $786.80 55120 Removal of scrotum lesion 10.26 $70.00 $718.20 55150 Removal of scrotum 14.24 $70.00 $996.80 55175 Revision of scrotum 10.53 $70.00 $737.10 NON-FACILITY HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL 55180 Revision of scrotum 19.86 $70.00 $1,390.20 55200 Incision of sperm duct 12.61 $70.00 $882.70 55250 Removal of sperm duct(s) 11.12 $70.00 $778.40 55300 Prepare sperm duct x-ray 5.43 $70.00 $380.10 55400 Repair of sperm duct 14.45 $70.00 $1,011.50 55500 Removal of hydrocele 11.45 $70.00 $801.50 55520 Removal of sperm cord lesion 13.09 $70.00 $916.30 55530 Revise spermatic cord veins 10.20 $70.00 $714.00 55535 Revise spermatic cord veins 12.48 $70.00 $873.60 55540 Revise hernia & sperm veins 15.97 $70.00 $1,117.90 55550 Laparo ligate spermatic vein 12.43 $70.00 $870.10 55559 Laparo proc spermatic cord 0.00 $70.00 $0.00 55600 Incise sperm duct pouch 12.23 $70.00 $856.10 55605 Incise sperm duct pouch 15.11 $70.00 $1,057.70 55650 Remove sperm duct pouch 20.80 $70.00 $1,456.00 55680 Remove sperm pouch lesion 10.04 $70.00 $702.80 55700 Biopsy of prostate 7.14 $70.00 $499.80 55705 Biopsy of prostate 7.71 $70.00 $539.70 55706 Prostate saturation sampling 10.79 $70.00 $755.30 55720 Drainage of prostate abscess 13.12 $70.00 $918.40 55725 Drainage of prostate abscess 17.20 $70.00 $1,204.00 55801 Removal of prostate 31.71 $70.00 $2,219.70 55810 Extensive prostate surgery 38.01 $70.00 $2,660.70 55812 Extensive prostate surgery 46.66 $70.00 $3,266.20 55815 Extensive prostate surgery 51.12 $70.00 $3,578.40 55821 Removal of prostate 25.32 $70.00 $1,772.40 55831 Removal of prostate 27.39 $70.00 $1,917.30 55840 Extensive prostate surgery 33.98 $70.00 $2,378.60 55842 Extensive prostate surgery 33.99 $70.00 $2,379.30 55845 Extensive prostate surgery 39.54 $70.00 $2,767.80 55860 Surgical exposure prostate 25.37 $70.00 $1,775.90 55862 Extensive prostate surgery 31.80 $70.00 $2,226.00 55865 Extensive prostate surgery 38.68 $70.00 $2,707.60 55866 Laparo radical prostatectomy 41.87 $70.00 $2,930.90 55870 Electroejaculation 5.07 $70.00 $354.90 55873 Cryoablate prostate 203.62 $70.00 $14,253.40 55874 Tprnl plmt biodegrdabl matrl 105.48 $70.00 $7,383.60 55875 Transperi needle place pros 22.14 $70.00 $1,549.80 55876 Place rt device/marker pros 3.94 $70.00 $275.80 55899 Genital surgery procedure 0.00 $70.00 $0.00 55920 Place needles pelvic for rt 12.97 $70.00 $907.90 55970 Sex transformation m to f 0.00 $70.00 $0.00 55980 Sex transformation f to m 0.00 $70.00 $0.00 56405 I & d of vulva/perineum 3.10 $70.00 $217.00 56420 Drainage of gland abscess 3.47 $70.00 $242.90 NON-FACILITY HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL 56440 Surgery for vulva lesion 5.16 $70.00 $361.20 56441 Lysis of labial lesion(s) 4.12 $70.00 $288.40 56442 Hymenotomy 1.36 $70.00 $95.20 56501 Destroy vulva lesions sim 3.75 $70.00 $262.50 56515 Destroy vulva lesion/s compl 6.45 $70.00 $451.50 56605 Biopsy of vulva/perineum 2.33 $70.00 $163.10 56606 Biopsy of vulva/perineum 1.08 $70.00 $75.60 56620 Partial removal of vulva 14.96 $70.00 $1,047.20 56625 Complete removal of vulva 18.12 $70.00 $1,268.40 56630 Extensive vulva surgery 26.80 $70.00 $1,876.00 56631 Extensive vulva surgery 34.24 $70.00 $2,396.80 56632 Extensive vulva surgery 39.85 $70.00 $2,789.50 56633 Extensive vulva surgery 34.93 $70.00 $2,445.10 56634 Extensive vulva surgery 37.86 $70.00 $2,650.20 56637 Extensive vulva surgery 44.30 $70.00 $3,101.00 56640 Extensive vulva surgery 44.32 $70.00 $3,102.40 56700 Partial removal of hymen 5.27 $70.00 $368.90 56740 Remove vagina gland lesion 8.53 $70.00 $597.10 56800 Repair of vagina 6.82 $70.00 $477.40 56805 Repair clitoris 32.21 $70.00 $2,254.70 56810 Repair of perineum 7.37 $70.00 $515.90 56820 Exam of vulva w/scope 3.20 $70.00 $224.00 56821 Exam/biopsy of vulva w/scope 4.20 $70.00 $294.00 57000 Exploration of vagina 5.33 $70.00 $373.10 57010 Drainage of pelvic abscess 12.22 $70.00 $855.40 57020 Drainage of pelvic fluid 2.62 $70.00 $183.40 57022 I & d vaginal hematoma pp 4.73 $70.00 $331.10 57023 I & d vag hematoma non-ob 8.74 $70.00 $611.80 57061 Destroy vag lesions simple 3.24 $70.00 $226.80 57065 Destroy vag lesions complex 5.55 $70.00 $388.50 57100 Biopsy of vagina 2.54 $70.00 $177.80 57105 Biopsy of vagina 3.88 $70.00 $271.60 57106 Remove vagina wall partial 14.12 $70.00 $988.40 57107 Remove vagina tissue part 41.46 $70.00 $2,902.20 57109 Vaginectomy partial w/nodes 50.68 $70.00 $3,547.60 57110 Remove vagina wall complete 25.23 $70.00 $1,766.10 57111 Remove vagina tissue compl 50.68 $70.00 $3,547.60 57112 Vaginectomy w/nodes compl 54.27 $70.00 $3,798.90 57120 Closure of vagina 14.38 $70.00 $1,006.60 57130 Remove vagina lesion 5.00 $70.00 $350.00 57135 Remove vagina lesion 5.46 $70.00 $382.20 57150 Treat vagina infection 1.28 $70.00 $89.60 57155 Insert uteri tandem/ovoids 10.49 $70.00 $734.30 57156 Ins vag brachytx device 5.71 $70.00 $399.70 57160 Insert pessary/other device 2.15 $70.00 $150.50 NON-FACILITY HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL 57170 Fitting of diaphragm/cap 1.71 $70.00 $119.70 57180 Treat vaginal bleeding 3.98 $70.00 $278.60 57200 Repair of vagina 8.59 $70.00 $601.30 57210 Repair vagina/perineum 10.42 $70.00 $729.40 57220 Revision of urethra 9.02 $70.00 $631.40 57230 Repair of urethral lesion 11.12 $70.00 $778.40 57240 Anterior colporrhaphy 16.77 $70.00 $1,173.90 57250 Repair rectum & vagina 16.84 $70.00 $1,178.80 57260 Cmbn ant pst colprhy 21.58 $70.00 $1,510.60 57265 Cmbn ap colprhy w/ntrcl rpr 24.24 $70.00 $1,696.80 57267 Insert mesh/pelvic flr addon 7.29 $70.00 $510.30 57268 Repair of bowel bulge 13.71 $70.00 $959.70 57270 Repair of bowel pouch 22.82 $70.00 $1,597.40 57280 Suspension of vagina 27.06 $70.00 $1,894.20 57282 Colpopexy extraperitoneal 14.19 $70.00 $993.30 57283 Colpopexy intraperitoneal 19.46 $70.00 $1,362.20 57284 Repair paravag defect open 23.14 $70.00 $1,619.80 57285 Repair paravag defect vag 19.08 $70.00 $1,335.60 57287 Revise/remove sling repair 19.43 $70.00 $1,360.10 57288 Repair bladder defect 20.40 $70.00 $1,428.00 57289 Repair bladder & vagina 21.46 $70.00 $1,502.20 57291 Construction of vagina 14.91 $70.00 $1,043.70 57292 Construct vagina with graft 22.98 $70.00 $1,608.60 57295 Revise vag graft via vagina 13.55 $70.00 $948.50 57296 Revise vag graft open abd 26.65 $70.00 $1,865.50 57300 Repair rectum-vagina fistula 16.07 $70.00 $1,124.90 57305 Repair rectum-vagina fistula 26.78 $70.00 $1,874.60 57307 Fistula repair & colostomy 29.37 $70.00 $2,055.90 57308 Fistula repair transperine 18.99 $70.00 $1,329.30 57310 Repair urethrovaginal lesion 13.36 $70.00 $935.20 57311 Repair urethrovaginal lesion 15.19 $70.00 $1,063.30 57320 Repair bladder-vagina lesion 15.26 $70.00 $1,068.20 57330 Repair bladder-vagina lesion 21.43 $70.00 $1,500.10 57335 Repair vagina 32.53 $70.00 $2,277.10 57400 Dilation of vagina 3.78 $70.00 $264.60 57410 Pelvic examination 3.07 $70.00 $214.90 57415 Remove vaginal foreign body 4.56 $70.00 $319.20 57420 Exam of vagina w/scope 3.36 $70.00 $235.20 57421 Exam/biopsy of vag w/scope 4.48 $70.00 $313.60 57423 Repair paravag defect lap 25.85 $70.00 $1,809.50 57425 Laparoscopy surg colpopexy 27.50 $70.00 $1,925.00 57426 Revise prosth vag graft lap 23.77 $70.00 $1,663.90 57452 Exam of cervix w/scope 3.09 $70.00 $216.30 57454 Bx/curett of cervix w/scope 4.31 $70.00 $301.70 57455 Biopsy of cervix w/scope 4.04 $70.00 $282.80 NON-FACILITY HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL 57456 Endocerv curettage w/scope 3.81 $70.00 $266.70 57460 Bx of cervix w/scope leep 7.97 $70.00 $557.90 57461 Conz of cervix w/scope leep 9.02 $70.00 $631.40 57500 Biopsy of cervix 3.61 $70.00 $252.70 57505 Endocervical curettage 2.91 $70.00 $203.70 57510 Cauterization of cervix 3.73 $70.00 $261.10 57511 Cryocautery of cervix 4.12 $70.00 $288.40 57513 Laser surgery of cervix 4.16 $70.00 $291.20 57520 Conization of cervix 8.75 $70.00 $612.50 57522 Conization of cervix 7.47 $70.00 $522.90 57530 Removal of cervix 9.82 $70.00 $687.40 57531 Removal of cervix radical 47.62 $70.00 $3,333.40 57540 Removal of residual cervix 21.91 $70.00 $1,533.70 57545 Remove cervix/repair pelvis 23.12 $70.00 $1,618.40 57550 Removal of residual cervix 11.47 $70.00 $802.90 57555 Remove cervix/repair vagina 16.91 $70.00 $1,183.70 57556 Remove cervix repair bowel 16.00 $70.00 $1,120.00 57558 D&c of cervical stump 3.51 $70.00 $245.70 57700 Revision of cervix 8.75 $70.00 $612.50 57720 Revision of cervix 8.65 $70.00 $605.50 57800 Dilation of cervical canal 1.70 $70.00 $119.00 58100 Biopsy of uterus lining 3.08 $70.00 $215.60 58110 Bx done w/colposcopy add-on 1.37 $70.00 $95.90 58120 Dilation and curettage 7.34 $70.00 $513.80 58140 Myomectomy abdom method 25.97 $70.00 $1,817.90 58145 Myomectomy vag method 15.58 $70.00 $1,090.60 58146 Myomectomy abdom complex 32.42 $70.00 $2,269.40 58150 Total hysterectomy 28.95 $70.00 $2,026.50 58152 Total hysterectomy 35.40 $70.00 $2,478.00 58180 Partial hysterectomy 27.31 $70.00 $1,911.70 58200 Extensive hysterectomy 39.54 $70.00 $2,767.80 58210 Extensive hysterectomy 53.26 $70.00 $3,728.20 58240 Removal of pelvis contents 83.79 $70.00 $5,865.30 58260 Vaginal hysterectomy 23.31 $70.00 $1,631.70 58262 Vag hyst including t/o 25.97 $70.00 $1,817.90 58263 Vag hyst w/t/o & vag repair 27.90 $70.00 $1,953.00 58267 Vag hyst w/urinary repair 29.64 $70.00 $2,074.80 58270 Vag hyst w/enterocele repair 24.89 $70.00 $1,742.30 58275 Hysterectomy/revise vagina 27.80 $70.00 $1,946.00 58280 Hysterectomy/revise vagina 29.56 $70.00 $2,069.20 58285 Extensive hysterectomy 41.41 $70.00 $2,898.70 58290 Vag hyst complex 32.38 $70.00 $2,266.60 58291 Vag hyst incl t/o complex 35.14 $70.00 $2,459.80 58292 Vag hyst t/o & repair compl 36.93 $70.00 $2,585.10 58293 Vag hyst w/uro repair compl 38.40 $70.00 $2,688.00 NON-FACILITY HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL 58294 Vag hyst w/enterocele compl 34.22 $70.00 $2,395.40 58300 Insert intrauterine device 2.09 $70.00 $146.30 58301 Remove intrauterine device 2.70 $70.00 $189.00 58321 Artificial insemination 2.17 $70.00 $151.90 58322 Artificial insemination 2.44 $70.00 $170.80 58323 Sperm washing 0.44 $70.00 $30.80 58340 Catheter for hysterography 3.40 $70.00 $238.00 58345 Reopen fallopian tube 7.84 $70.00 $548.80 58346 Insert heyman uteri capsule 12.90 $70.00 $903.00 58350 Reopen fallopian tube 2.74 $70.00 $191.80 58353 Endometr ablate thermal 28.41 $70.00 $1,988.70 58356 Endometrial cryoablation 52.93 $70.00 $3,705.10 58400 Suspension of uterus 12.49 $70.00 $874.30 58410 Suspension of uterus 22.61 $70.00 $1,582.70 58520 Repair of ruptured uterus 22.13 $70.00 $1,549.10 58540 Revision of uterus 25.53 $70.00 $1,787.10 58541 Lsh uterus 250 g or less 20.24 $70.00 $1,416.80 58542 Lsh w/t/o ut 250 g or less 23.09 $70.00 $1,616.30 58543 Lsh uterus above 250 g 23.37 $70.00 $1,635.90 58544 Lsh w/t/o uterus above 250 g 25.43 $70.00 $1,780.10 58545 Laparoscopic myomectomy 25.57 $70.00 $1,789.90 58546 Laparo-myomectomy complex 31.63 $70.00 $2,214.10 58548 Lap radical hyst 54.73 $70.00 $3,831.10 58550 Laparo-asst vag hysterectomy 24.89 $70.00 $1,742.30 58552 Laparo-vag hyst incl t/o 28.00 $70.00 $1,960.00 58553 Laparo-vag hyst complex 31.81 $70.00 $2,226.70 58554 Laparo-vag hyst w/t/o compl 37.62 $70.00 $2,633.40 58555 Hysteroscopy dx sep proc 7.60 $70.00 $532.00 58558 Hysteroscopy biopsy 38.52 $70.00 $2,696.40 58559 Hysteroscopy lysis 8.26 $70.00 $578.20 58560 Hysteroscopy resect septum 9.00 $70.00 $630.00 58561 Hysteroscopy remove myoma 10.30 $70.00 $721.00 58562 Hysteroscopy remove fb 9.62 $70.00 $673.40 58563 Hysteroscopy ablation 44.95 $70.00 $3,146.50 58565 Hysteroscopy sterilization 52.68 $70.00 $3,687.60 58570 Tlh uterus 250 g or less 22.13 $70.00 $1,549.10 58571 Tlh w/t/o 250 g or less 25.56 $70.00 $1,789.20 58572 Tlh uterus over 250 g 29.11 $70.00 $2,037.70 58573 Tlh w/t/o uterus over 250 g 34.70 $70.00 $2,429.00 58575 Laps tot hyst resj mal 53.62 $70.00 $3,753.40 58578 Laparo proc uterus 0.00 $70.00 $0.00 58579 Hysteroscope procedure 0.00 $70.00 $0.00 58600 Division of fallopian tube 10.25 $70.00 $717.50 58605 Division of fallopian tube 9.27 $70.00 $648.90 58611 Ligate oviduct(s) add-on 2.18 $70.00 $152.60 NON-FACILITY HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL 58615 Occlude fallopian tube(s) 6.86 $70.00 $480.20 58660 Laparoscopy lysis 19.09 $70.00 $1,336.30 58661 Laparoscopy remove adnexa 18.45 $70.00 $1,291.50 58662 Laparoscopy excise lesions 20.15 $70.00 $1,410.50 58670 Laparoscopy tubal cautery 10.28 $70.00 $719.60 58671 Laparoscopy tubal block 10.26 $70.00 $718.20 58672 Laparoscopy fimbrioplasty 20.67 $70.00 $1,446.90 58673 Laparoscopy salpingostomy 22.47 $70.00 $1,572.90 58674 Laps abltj uterine fibroids 22.97 $70.00 $1,607.90 58679 Laparo proc oviduct-ovary 0.00 $70.00 $0.00 58700 Removal of fallopian tube 22.13 $70.00 $1,549.10 58720 Removal of ovary/tube(s) 21.01 $70.00 $1,470.70 58740 Adhesiolysis tube ovary 25.24 $70.00 $1,766.80 58750 Repair oviduct 25.33 $70.00 $1,773.10 58752 Revise ovarian tube(s) 25.26 $70.00 $1,768.20 58760 Fimbrioplasty 22.76 $70.00 $1,593.20 58770 Create new tubal opening 23.96 $70.00 $1,677.20 58800 Drainage of ovarian cyst(s) 8.97 $70.00 $627.90 58805 Drainage of ovarian cyst(s) 11.38 $70.00 $796.60 58820 Drain ovary abscess open 8.78 $70.00 $614.60 58822 Drain ovary abscess percut 19.68 $70.00 $1,377.60 58825 Transposition ovary(s) 19.54 $70.00 $1,367.80 58900 Biopsy of ovary(s) 11.64 $70.00 $814.80 58920 Partial removal of ovary(s) 19.69 $70.00 $1,378.30 58925 Removal of ovarian cyst(s) 21.22 $70.00 $1,485.40 58940 Removal of ovary(s) 15.03 $70.00 $1,052.10 58943 Removal of ovary(s) 33.80 $70.00 $2,366.00 58950 Resect ovarian malignancy 32.60 $70.00 $2,282.00 58951 Resect ovarian malignancy 41.93 $70.00 $2,935.10 58952 Resect ovarian malignancy 47.37 $70.00 $3,315.90 58953 Tah rad dissect for debulk 58.72 $70.00 $4,110.40 58954 Tah rad debulk/lymph remove 63.86 $70.00 $4,470.20 58956 Bso omentectomy w/tah 39.84 $70.00 $2,788.80 58957 Resect recurrent gyn mal 45.80 $70.00 $3,206.00 58958 Resect recur gyn mal w/lym 47.80 $70.00 $3,346.00 58960 Exploration of abdomen 28.04 $70.00 $1,962.80 58970 Retrieval of oocyte 6.27 $70.00 $438.90 58974 Transfer of embryo 0.00 $70.00 $0.00 58976 Transfer of embryo 6.96 $70.00 $487.20 58999 Genital surgery procedure 0.00 $70.00 $0.00 59000 Amniocentesis diagnostic 3.61 $70.00 $252.70 59001 Amniocentesis therapeutic 5.18 $70.00 $362.60 59012 Fetal cord puncture prenatal 5.84 $70.00 $408.80 59015 Chorion biopsy 4.49 $70.00 $314.30 59020 Fetal contract stress test 2.02 $70.00 $141.40 NON-FACILITY HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL 59020 TC Fetal contract stress test 0.95 $70.00 $66.50 59020 26 Fetal contract stress test 1.07 $70.00 $74.90 59025 Fetal non-stress test 1.38 $70.00 $96.60 59025 TC Fetal non-stress test 0.52 $70.00 $36.40 59025 26 Fetal non-stress test 0.86 $70.00 $60.20 59030 Fetal scalp blood sample 3.26 $70.00 $228.20 59050 Fetal monitor w/report 1.47 $70.00 $102.90 59051 Fetal monitor/interpret only 1.22 $70.00 $85.40 59070 Transabdom amnioinfus w/us 11.64 $70.00 $814.80 59072 Umbilical cord occlud w/us 15.12 $70.00 $1,058.40 59074 Fetal fluid drainage w/us 11.23 $70.00 $786.10 59076 Fetal shunt placement w/us 15.12 $70.00 $1,058.40 59100 Remove uterus lesion 23.98 $70.00 $1,678.60 59120 Treat ectopic pregnancy 22.83 $70.00 $1,598.10 59121 Treat ectopic pregnancy 22.86 $70.00 $1,600.20 59130 Treat ectopic pregnancy 26.70 $70.00 $1,869.00 59135 Treat ectopic pregnancy 26.38 $70.00 $1,846.60 59136 Treat ectopic pregnancy 25.27 $70.00 $1,768.90 59140 Treat ectopic pregnancy 11.51 $70.00 $805.70 59150 Treat ectopic pregnancy 22.14 $70.00 $1,549.80 59151 Treat ectopic pregnancy 21.47 $70.00 $1,502.90 59160 D & c after delivery 5.87 $70.00 $410.90 59200 Insert cervical dilator 2.07 $70.00 $144.90 59300 Episiotomy or vaginal repair 5.56 $70.00 $389.20 59320 Revision of cervix 4.40 $70.00 $308.00 59325 Revision of cervix 7.00 $70.00 $490.00 59350 Repair of uterus 8.12 $70.00 $568.40 59400 Obstetrical care 59.92 $70.00 $4,194.40 59409 Obstetrical care 23.44 $70.00 $1,640.80 59410 Obstetrical care 29.94 $70.00 $2,095.80 59412 Antepartum manipulation 2.98 $70.00 $208.60 59414 Deliver placenta 2.65 $70.00 $185.50 59425 Antepartum care only 13.02 $70.00 $911.40 59426 Antepartum care only 23.27 $70.00 $1,628.90 59430 Care after delivery 5.27 $70.00 $368.90 59510 Cesarean delivery 66.46 $70.00 $4,652.20 59514 Cesarean delivery only 26.39 $70.00 $1,847.30 59515 Cesarean delivery 36.37 $70.00 $2,545.90 59525 Remove uterus after cesarean 14.01 $70.00 $980.70 59610 Vbac delivery 63.08 $70.00 $4,415.60 59612 Vbac delivery only 26.41 $70.00 $1,848.70 59614 Vbac care after delivery 32.84 $70.00 $2,298.80 59618 Attempted vbac delivery 67.32 $70.00 $4,712.40 59620 Attempted vbac delivery only 27.35 $70.00 $1,914.50 59622 Attempted vbac after care 37.29 $70.00 $2,610.30 NON-FACILITY HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL 59812 Treatment of miscarriage 9.11 $70.00 $637.70 59820 Care of miscarriage 10.89 $70.00 $762.30 59821 Treatment of miscarriage 10.98 $70.00 $768.60 59830 Treat uterus infection 12.53 $70.00 $877.10 59840 Abortion 6.24 $70.00 $436.80 59841 Abortion 10.98 $70.00 $768.60 59850 Abortion 10.91 $70.00 $763.70 59851 Abortion 11.44 $70.00 $800.80 59852 Abortion 14.55 $70.00 $1,018.50 59855 Abortion 11.93 $70.00 $835.10 59856 Abortion 14.02 $70.00 $981.40 59857 Abortion 14.93 $70.00 $1,045.10 59866 Abortion (mpr) 6.25 $70.00 $437.50 59870 Evacuate mole of uterus 13.54 $70.00 $947.80 59871 Remove cerclage suture 3.85 $70.00 $269.50 59897 Fetal invas px w/us 0.00 $70.00 $0.00 59898 Laparo proc ob care/deliver 0.00 $70.00 $0.00 59899 Maternity care procedure 0.00 $70.00 $0.00 60000 Drain thyroid/tongue cyst 4.81 $70.00 $336.70 6005F Care level rationale doc 0.00 $70.00 $0.00 6010F Dysphag test done b/4 eating 0.00 $70.00 $0.00 60100 Biopsy of thyroid 3.22 $70.00 $225.40 6015F Dysphag test done b/4 eating 0.00 $70.00 $0.00 6020F Npo (nothing-mouth) ordered 0.00 $70.00 $0.00 60200 Remove thyroid lesion 18.87 $70.00 $1,320.90 60210 Partial thyroid excision 20.26 $70.00 $1,418.20 60212 Partial thyroid excision 29.71 $70.00 $2,079.70 60220 Partial removal of thyroid 20.18 $70.00 $1,412.60 60225 Partial removal of thyroid 26.64 $70.00 $1,864.80 60240 Removal of thyroid 26.33 $70.00 $1,843.10 60252 Removal of thyroid 37.85 $70.00 $2,649.50 60254 Extensive thyroid surgery 47.75 $70.00 $3,342.50 60260 Repeat thyroid surgery 31.29 $70.00 $2,190.30 60270 Removal of thyroid 39.26 $70.00 $2,748.20 60271 Removal of thyroid 30.27 $70.00 $2,118.90 60280 Remove thyroid duct lesion 12.54 $70.00 $877.80 60281 Remove thyroid duct lesion 16.63 $70.00 $1,164.10 6030F Max sterile barriers follwd 0.00 $70.00 $0.00 60300 Aspir/inj thyroid cyst 3.36 $70.00 $235.20 6040F Appro rad ds dvcs techs docd 0.00 $70.00 $0.00 6045F Radxps in end rprt4fluro pxd 0.00 $70.00 $0.00 60500 Explore parathyroid glands 27.73 $70.00 $1,941.10 60502 Re-explore parathyroids 37.05 $70.00 $2,593.50 60505 Explore parathyroid glands 39.76 $70.00 $2,783.20 60512 Autotransplant parathyroid 7.01 $70.00 $490.70 NON-FACILITY HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL 60520 Removal of thymus gland 30.20 $70.00 $2,114.00 60521 Removal of thymus gland 32.34 $70.00 $2,263.80 60522 Removal of thymus gland 39.40 $70.00 $2,758.00 60540 Explore adrenal gland 30.69 $70.00 $2,148.30 60545 Explore adrenal gland 35.14 $70.00 $2,459.80 60600 Remove carotid body lesion 39.84 $70.00 $2,788.80 60605 Remove carotid body lesion 48.28 $70.00 $3,379.60 60650 Laparoscopy adrenalectomy 34.49 $70.00 $2,414.30 60659 Laparo proc endocrine 0.00 $70.00 $0.00 60699 Endocrine surgery procedure 0.00 $70.00 $0.00 6070F Pt asked/cnsld aed effects 0.00 $70.00 $0.00 6080F Pt/caregiver queried falls 0.00 $70.00 $0.00 6090F Pt/caregiver counsel safety 0.00 $70.00 $0.00 6100F Verify pt site pxd docd 0.00 $70.00 $0.00 61000 Remove cranial cavity fluid 3.34 $70.00 $233.80 61001 Remove cranial cavity fluid 3.17 $70.00 $221.90 6101F Safety counseling dementia 0.00 $70.00 $0.00 6102F Safety counseling dem order 0.00 $70.00 $0.00 61020 Remove brain cavity fluid 2.87 $70.00 $200.90 61026 Injection into brain canal 3.04 $70.00 $212.80 61050 Remove brain canal fluid 2.49 $70.00 $174.30 61055 Injection into brain canal 3.58 $70.00 $250.60 61070 Brain canal shunt procedure 1.65 $70.00 $115.50 6110F Counsel prov driving risks 0.00 $70.00 $0.00 61105 Twist drill hole 13.55 $70.00 $948.50 61107 Drill skull for implantation 9.21 $70.00 $644.70 61108 Drill skull for drainage 26.16 $70.00 $1,831.20 61120 Burr hole for puncture 21.87 $70.00 $1,530.90 61140 Pierce skull for biopsy 36.89 $70.00 $2,582.30 61150 Pierce skull for drainage 39.76 $70.00 $2,783.20 61151 Pierce skull for drainage 29.15 $70.00 $2,040.50 61154 Pierce skull & remove clot 37.09 $70.00 $2,596.30 61156 Pierce skull for drainage 36.57 $70.00 $2,559.90 61210 Pierce skull implant device 10.86 $70.00 $760.20 61215 Insert brain-fluid device 14.79 $70.00 $1,035.30 61250 Pierce skull & explore 25.41 $70.00 $1,778.70 61253 Pierce skull & explore 29.15 $70.00 $2,040.50 61304 Open skull for exploration 47.82 $70.00 $3,347.40 61305 Open skull for exploration 58.96 $70.00 $4,127.20 61312 Open skull for drainage 60.74 $70.00 $4,251.80 61313 Open skull for drainage 57.90 $70.00 $4,053.00 61314 Open skull for drainage 53.43 $70.00 $3,740.10 61315 Open skull for drainage 60.39 $70.00 $4,227.30 61316 Implt cran bone flap to abdo 2.60 $70.00 $182.00 61320 Open skull for drainage 55.54 $70.00 $3,887.80 NON-FACILITY HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL 61321 Open skull for drainage 62.48 $70.00 $4,373.60 61322 Decompressive craniotomy 69.36 $70.00 $4,855.20 61323 Decompressive lobectomy 70.20 $70.00 $4,914.00 61330 Decompress eye socket 52.68 $70.00 $3,687.60 61332 Explore/biopsy eye socket 58.25 $70.00 $4,077.50 61333 Explore orbit/remove lesion 59.52 $70.00 $4,166.40 61340 Subtemporal decompression 42.42 $70.00 $2,969.40 61343 Incise skull (press relief) 64.10 $70.00 $4,487.00 61345 Relieve cranial pressure 59.87 $70.00 $4,190.90 61450 Incise skull for surgery 56.45 $70.00 $3,951.50 61458 Incise skull for brain wound 58.71 $70.00 $4,109.70 61460 Incise skull for surgery 61.75 $70.00 $4,322.50 61480 Incise skull for surgery 56.97 $70.00 $3,987.90 6150F Pt notrcvng1st antitnf txmnt 0.00 $70.00 $0.00 61500 Removal of skull lesion 38.28 $70.00 $2,679.60 61501 Remove infected skull bone 33.01 $70.00 $2,310.70 61510 Removal of brain lesion 63.77 $70.00 $4,463.90 61512 Remove brain lining lesion 74.37 $70.00 $5,205.90 61514 Removal of brain abscess 55.50 $70.00 $3,885.00 61516 Removal of brain lesion 54.42 $70.00 $3,809.40 61517 Implt brain chemotx add-on 2.59 $70.00 $181.30 61518 Removal of brain lesion 80.36 $70.00 $5,625.20 61519 Remove brain lining lesion 85.68 $70.00 $5,997.60 61520 Removal of brain lesion 108.84 $70.00 $7,618.80 61521 Removal of brain lesion 93.19 $70.00 $6,523.30 61522 Removal of brain abscess 64.17 $70.00 $4,491.90 61524 Removal of brain lesion 61.09 $70.00 $4,276.30 61526 Removal of brain lesion 103.60 $70.00 $7,252.00 61530 Removal of brain lesion 90.09 $70.00 $6,306.30 61531 Implant brain electrodes 35.81 $70.00 $2,506.70 61533 Implant brain electrodes 44.55 $70.00 $3,118.50 61534 Removal of brain lesion 48.26 $70.00 $3,378.20 61535 Remove brain electrodes 29.31 $70.00 $2,051.70 61536 Removal of brain lesion 75.63 $70.00 $5,294.10 61537 Removal of brain tissue 72.04 $70.00 $5,042.80 61538 Removal of brain tissue 78.27 $70.00 $5,478.90 61539 Removal of brain tissue 69.25 $70.00 $4,847.50 61540 Removal of brain tissue 64.04 $70.00 $4,482.80 61541 Incision of brain tissue 63.04 $70.00 $4,412.80 61543 Removal of brain tissue 63.73 $70.00 $4,461.10 61544 Remove & treat brain lesion 55.84 $70.00 $3,908.80 61545 Excision of brain tumor 93.15 $70.00 $6,520.50 61546 Removal of pituitary gland 67.69 $70.00 $4,738.30 61548 Removal of pituitary gland 45.80 $70.00 $3,206.00 61550 Release of skull seams 34.72 $70.00 $2,430.40 NON-FACILITY HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL 61552 Release of skull seams 43.40 $70.00 $3,038.00 61556 Incise skull/sutures 49.99 $70.00 $3,499.30 61557 Incise skull/sutures 49.28 $70.00 $3,449.60 61558 Excision of skull/sutures 55.09 $70.00 $3,856.30 61559 Excision of skull/sutures 70.10 $70.00 $4,907.00 61563 Excision of skull tumor 58.10 $70.00 $4,067.00 61564 Excision of skull tumor 70.58 $70.00 $4,940.60 61566 Removal of brain tissue 65.95 $70.00 $4,616.50 61567 Incision of brain tissue 75.10 $70.00 $5,257.00 61570 Remove foreign body brain 54.79 $70.00 $3,835.30 61571 Incise skull for brain wound 58.35 $70.00 $4,084.50 61575 Skull base/brainstem surgery 73.47 $70.00 $5,142.90 61576 Skull base/brainstem surgery 122.33 $70.00 $8,563.10 61580 Craniofacial approach skull 70.23 $70.00 $4,916.10 61581 Craniofacial approach skull 74.89 $70.00 $5,242.30 61582 Craniofacial approach skull 87.72 $70.00 $6,140.40 61583 Craniofacial approach skull 83.41 $70.00 $5,838.70 61584 Orbitocranial approach/skull 82.80 $70.00 $5,796.00 61585 Orbitocranial approach/skull 93.85 $70.00 $6,569.50 61586 Resect nasopharynx skull 70.47 $70.00 $4,932.90 61590 Infratemporal approach/skull 87.67 $70.00 $6,136.90 61591 Infratemporal approach/skull 88.33 $70.00 $6,183.10 61592 Orbitocranial approach/skull 91.70 $70.00 $6,419.00 61595 Transtemporal approach/skull 67.03 $70.00 $4,692.10 61596 Transcochlear approach/skull 69.42 $70.00 $4,859.40 61597 Transcondylar approach/skull 86.74 $70.00 $6,071.80 61598 Transpetrosal approach/skull 82.85 $70.00 $5,799.50 61600 Resect/excise cranial lesion 61.17 $70.00 $4,281.90 61601 Resect/excise cranial lesion 69.41 $70.00 $4,858.70 61605 Resect/excise cranial lesion 61.57 $70.00 $4,309.90 61606 Resect/excise cranial lesion 85.21 $70.00 $5,964.70 61607 Resect/excise cranial lesion 83.57 $70.00 $5,849.90 61608 Resect/excise cranial lesion 94.32 $70.00 $6,602.40 61610 Transect artery sinus 55.41 $70.00 $3,878.70 61611 Transect artery sinus 13.87 $70.00 $970.90 61612 Transect artery sinus 52.06 $70.00 $3,644.20 61613 Remove aneurysm sinus 95.89 $70.00 $6,712.30 61615 Resect/excise lesion skull 81.71 $70.00 $5,719.70 61616 Resect/excise lesion skull 96.37 $70.00 $6,745.90 61618 Repair dura 37.51 $70.00 $2,625.70 61619 Repair dura 41.52 $70.00 $2,906.40 61623 Endovasc tempory vessel occl 16.80 $70.00 $1,176.00 61624 Transcath occlusion cns 33.58 $70.00 $2,350.60 61626 Transcath occlusion non-cns 25.19 $70.00 $1,763.30 61630 Intracranial angioplasty 39.81 $70.00 $2,786.70 NON-FACILITY HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL 61635 Intracran angioplsty w/stent 42.42 $70.00 $2,969.40 61640 Dilate ic vasospasm init 14.01 $70.00 $980.70 61641 Dilate ic vasospasm add-on 4.92 $70.00 $344.40 61642 Dilate ic vasospasm add-on 9.84 $70.00 $688.80 61645 Perq art m-thrombect &/nfs 24.04 $70.00 $1,682.80 61650 Evasc prlng admn rx agnt 1st 15.66 $70.00 $1,096.20 61651 Evasc prlng admn rx agnt add 6.65 $70.00 $465.50 61680 Intracranial vessel surgery 65.48 $70.00 $4,583.60 61682 Intracranial vessel surgery 121.24 $70.00 $8,486.80 61684 Intracranial vessel surgery 83.31 $70.00 $5,831.70 61686 Intracranial vessel surgery 129.53 $70.00 $9,067.10 61690 Intracranial vessel surgery 64.13 $70.00 $4,489.10 61692 Intracranial vessel surgery 106.89 $70.00 $7,482.30 61697 Brain aneurysm repr complx 122.50 $70.00 $8,575.00 61698 Brain aneurysm repr complx 132.81 $70.00 $9,296.70 61700 Brain aneurysm repr simple 99.32 $70.00 $6,952.40 61702 Inner skull vessel surgery 117.23 $70.00 $8,206.10 61703 Clamp neck artery 39.85 $70.00 $2,789.50 61705 Revise circulation to head 76.33 $70.00 $5,343.10 61708 Revise circulation to head 74.66 $70.00 $5,226.20 61710 Revise circulation to head 62.82 $70.00 $4,397.40 61711 Fusion of skull arteries 76.26 $70.00 $5,338.20 61720 Incise skull/brain surgery 37.26 $70.00 $2,608.20 61735 Incise skull/brain surgery 46.62 $70.00 $3,263.40 61750 Incise skull/brain biopsy 41.34 $70.00 $2,893.80 61751 Brain biopsy w/ct/mr guide 40.39 $70.00 $2,827.30 61760 Implant brain electrodes 46.23 $70.00 $3,236.10 61770 Incise skull for treatment 47.66 $70.00 $3,336.20 61781 Scan proc cranial intra 6.95 $70.00 $486.50 61782 Scan proc cranial extra 5.01 $70.00 $350.70 61783 Scan proc spinal 6.81 $70.00 $476.70 61790 Treat trigeminal nerve 25.71 $70.00 $1,799.70 61791 Treat trigeminal tract 32.97 $70.00 $2,307.90 61796 Srs cranial lesion simple 29.69 $70.00 $2,078.30 61797 Srs cran les simple addl 6.52 $70.00 $456.40 61798 Srs cranial lesion complex 40.45 $70.00 $2,831.50 61799 Srs cran les complex addl 8.96 $70.00 $627.20 61800 Apply srs headframe add-on 4.53 $70.00 $317.10 61850 Implant neuroelectrodes 28.79 $70.00 $2,015.30 61860 Implant neuroelectrodes 45.91 $70.00 $3,213.70 61863 Implant neuroelectrode 43.89 $70.00 $3,072.30 61864 Implant neuroelectrde addl 8.37 $70.00 $585.90 61867 Implant neuroelectrode 66.69 $70.00 $4,668.30 61868 Implant neuroelectrde addl 14.73 $70.00 $1,031.10 61870 Implant neuroelectrodes 34.70 $70.00 $2,429.00 NON-FACILITY HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL 61880 Revise/remove neuroelectrode 16.55 $70.00 $1,158.50 61885 Insrt/redo neurostim 1 array 14.94 $70.00 $1,045.80 61886 Implant neurostim arrays 24.58 $70.00 $1,720.60 61888 Revise/remove neuroreceiver 11.58 $70.00 $810.60 62000 Treat skull fracture 30.19 $70.00 $2,113.30 62005 Treat skull fracture 37.27 $70.00 $2,608.90 62010 Treatment of head injury 44.94 $70.00 $3,145.80 62100 Repair brain fluid leakage 46.08 $70.00 $3,225.60 62115 Reduction of skull defect 49.01 $70.00 $3,430.70 62117 Reduction of skull defect 57.60 $70.00 $4,032.00 62120 Repair skull cavity lesion 62.23 $70.00 $4,356.10 62121 Incise skull repair 49.45 $70.00 $3,461.50 62140 Repair of skull defect 29.86 $70.00 $2,090.20 62141 Repair of skull defect 33.08 $70.00 $2,315.60 62142 Remove skull plate/flap 25.82 $70.00 $1,807.40 62143 Replace skull plate/flap 30.29 $70.00 $2,120.30 62145 Repair of skull & brain 41.15 $70.00 $2,880.50 62146 Repair of skull with graft 36.00 $70.00 $2,520.00 62147 Repair of skull with graft 42.80 $70.00 $2,996.00 62148 Retr bone flap to fix skull 3.74 $70.00 $261.80 62160 Neuroendoscopy add-on 5.61 $70.00 $392.70 62161 Dissect brain w/scope 44.46 $70.00 $3,112.20 62162 Remove colloid cyst w/scope 55.45 $70.00 $3,881.50 62163 Zneuroendoscopy w/fb removal 35.87 $70.00 $2,510.90 62164 Remove brain tumor w/scope 61.28 $70.00 $4,289.60 62165 Remove pituit tumor w/scope 44.46 $70.00 $3,112.20 62180 Establish brain cavity shunt 46.96 $70.00 $3,287.20 62190 Establish brain cavity shunt 27.06 $70.00 $1,894.20 62192 Establish brain cavity shunt 28.54 $70.00 $1,997.80 62194 Replace/irrigate catheter 14.21 $70.00 $994.70 62200 Establish brain cavity shunt 40.39 $70.00 $2,827.30 62201 Brain cavity shunt w/scope 35.20 $70.00 $2,464.00 62220 Establish brain cavity shunt 29.51 $70.00 $2,065.70 62223 Establish brain cavity shunt 30.39 $70.00 $2,127.30 62225 Replace/irrigate catheter 15.19 $70.00 $1,063.30 62230 Replace/revise brain shunt 24.51 $70.00 $1,715.70 62252 Csf shunt reprogram 2.43 $70.00 $170.10 62252 TC Csf shunt reprogram 1.08 $70.00 $75.60 62252 26 Csf shunt reprogram 1.35 $70.00 $94.50 62256 Remove brain cavity shunt 17.45 $70.00 $1,221.50 62258 Replace brain cavity shunt 32.55 $70.00 $2,278.50 62263 Epidural lysis mult sessions 17.01 $70.00 $1,190.70 62264 Epidural lysis on single day 11.95 $70.00 $836.50 62267 Interdiscal perq aspir dx 7.07 $70.00 $494.90 62268 Drain spinal cord cyst 7.44 $70.00 $520.80 NON-FACILITY HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL 62269 Needle biopsy spinal cord 7.54 $70.00 $527.80 62270 Spinal fluid tap diagnostic 4.51 $70.00 $315.70 62272 Drain cerebro spinal fluid 5.78 $70.00 $404.60 62273 Inject epidural patch 4.95 $70.00 $346.50 62280 Treat spinal cord lesion 8.93 $70.00 $625.10 62281 Treat spinal cord lesion 6.81 $70.00 $476.70 62282 Treat spinal canal lesion 8.25 $70.00 $577.50 62284 Injection for myelogram 5.41 $70.00 $378.70 62287 Percutaneous diskectomy 16.54 $70.00 $1,157.80 62290 Njx px discography lumbar 9.28 $70.00 $649.60 62291 Njx px discography crv/thrc 9.22 $70.00 $645.40 62292 Njx chemonucleolysis lmbr 16.51 $70.00 $1,155.70 62294 Injection into spinal artery 27.83 $70.00 $1,948.10 62302 Myelography lumbar injection 6.91 $70.00 $483.70 62303 Myelography lumbar injection 7.07 $70.00 $494.90 62304 Myelography lumbar injection 6.82 $70.00 $477.40 62305 Myelography lumbar injection 7.42 $70.00 $519.40 62320 Njx interlaminar crv/thrc 4.73 $70.00 $331.10 62321 Njx interlaminar crv/thrc 7.05 $70.00 $493.50 62322 Njx interlaminar lmbr/sac 4.44 $70.00 $310.80 62323 Njx interlaminar lmbr/sac 6.96 $70.00 $487.20 62324 Njx interlaminar crv/thrc 4.14 $70.00 $289.80 62325 Njx interlaminar crv/thrc 6.27 $70.00 $438.90 62326 Njx interlaminar lmbr/sac 4.36 $70.00 $305.20 62327 Njx interlaminar lmbr/sac 6.39 $70.00 $447.30 62350 Implant spinal canal cath 11.51 $70.00 $805.70 62351 Implant spinal canal cath 24.86 $70.00 $1,740.20 62355 Remove spinal canal catheter 7.73 $70.00 $541.10 62360 Insert spine infusion device 8.99 $70.00 $629.30 62361 Implant spine infusion pump 12.46 $70.00 $872.20 62362 Implant spine infusion pump 11.07 $70.00 $774.90 62365 Remove spine infusion device 8.55 $70.00 $598.50 62367 Analyze spine infus pump 1.21 $70.00 $84.70 62368 Analyze sp inf pump w/reprog 1.63 $70.00 $114.10 62369 Anal sp inf pmp w/reprg&fill 3.41 $70.00 $238.70 62370 Anl sp inf pmp w/mdreprg&fil 3.60 $70.00 $252.00 62380 Ndsc dcmprn 1 ntrspc lumbar 0.00 $70.00 $0.00 63001 Remove spine lamina 1/2 crvl 36.08 $70.00 $2,525.60 63003 Remove spine lamina 1/2 thrc 36.16 $70.00 $2,531.20 63005 Remove spine lamina 1/2 lmbr 34.38 $70.00 $2,406.60 63011 Remove spine lamina 1/2 scrl 31.65 $70.00 $2,215.50 63012 Remove lamina/facets lumbar 34.64 $70.00 $2,424.80 63015 Remove spine lamina >2 crvcl 43.16 $70.00 $3,021.20 63016 Remove spine lamina >2 thrc 44.52 $70.00 $3,116.40 63017 Remove spine lamina >2 lmbr 36.57 $70.00 $2,559.90 NON-FACILITY HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL 63020 Neck spine disk surgery 33.67 $70.00 $2,356.90 63030 Low back disk surgery 28.19 $70.00 $1,973.30 63035 Spinal disk surgery add-on 5.58 $70.00 $390.60 63040 Laminotomy single cervical 40.67 $70.00 $2,846.90 63042 Laminotomy single lumbar 37.66 $70.00 $2,636.20 63043 Laminotomy addl cervical 0.00 $70.00 $0.00 63044 Laminotomy addl lumbar 0.00 $70.00 $0.00 63045 Remove spine lamina 1 crvl 37.38 $70.00 $2,616.60 63046 Remove spine lamina 1 thrc 35.58 $70.00 $2,490.60 63047 Remove spine lamina 1 lmbr 32.00 $70.00 $2,240.00 63048 Remove spinal lamina add-on 6.18 $70.00 $432.60 63050 Cervical laminoplsty 2/> seg 46.02 $70.00 $3,221.40 63051 C-laminoplasty w/graft/plate 49.64 $70.00 $3,474.80 63055 Decompress spinal cord thrc 47.35 $70.00 $3,314.50 63056 Decompress spinal cord lmbr 43.23 $70.00 $3,026.10 63057 Decompress spine cord add-on 9.35 $70.00 $654.50 63064 Decompress spinal cord thrc 51.83 $70.00 $3,628.10 63066 Decompress spine cord add-on 6.11 $70.00 $427.70 63075 Neck spine disk surgery 39.26 $70.00 $2,748.20 63076 Neck spine disk surgery 7.21 $70.00 $504.70 63077 Spine disk surgery thorax 43.27 $70.00 $3,028.90 63078 Spine disk surgery thorax 6.14 $70.00 $429.80 63081 Remove vert body dcmprn crvl 51.13 $70.00 $3,579.10 63082 Remove vertebral body add-on 7.79 $70.00 $545.30 63085 Remove vert body dcmprn thrc 55.57 $70.00 $3,889.90 63086 Remove vertebral body add-on 5.57 $70.00 $389.90 63087 Remov vertbr dcmprn thrclmbr 70.25 $70.00 $4,917.50 63088 Remove vertebral body add-on 7.21 $70.00 $504.70 63090 Remove vert body dcmprn lmbr 56.99 $70.00 $3,989.30 63091 Remove vertebral body add-on 5.19 $70.00 $363.30 63101 Remove vert body dcmprn thrc 67.61 $70.00 $4,732.70 63102 Remove vert body dcmprn lmbr 65.90 $70.00 $4,613.00 63103 Remove vertebral body add-on 8.59 $70.00 $601.30 63170 Incise spinal cord tract(s) 46.70 $70.00 $3,269.00 63172 Drainage of spinal cyst 41.40 $70.00 $2,898.00 63173 Drainage of spinal cyst 50.63 $70.00 $3,544.10 63180 Revise spinal cord ligaments 43.59 $70.00 $3,051.30 63182 Revise spinal cord ligaments 47.86 $70.00 $3,350.20 63185 Incise spine nrv half segmnt 32.92 $70.00 $2,304.40 63190 Incise spine nrv >2 segmnts 36.14 $70.00 $2,529.80 63191 Incise spine accessory nerve 40.41 $70.00 $2,828.70 63194 Incise spine & cord cervical 46.85 $70.00 $3,279.50 63195 Incise spine & cord thoracic 45.12 $70.00 $3,158.40 63196 Incise spine&cord 2 trx crvl 52.28 $70.00 $3,659.60 63197 Incise spine&cord 2 trx thrc 50.20 $70.00 $3,514.00 NON-FACILITY HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL 63198 Incise spin&cord 2 stgs crvl 61.37 $70.00 $4,295.90 63199 Incise spin&cord 2 stgs thrc 64.30 $70.00 $4,501.00 63200 Release spinal cord lumbar 44.72 $70.00 $3,130.40 63250 Revise spinal cord vsls crvl 86.94 $70.00 $6,085.80 63251 Revise spinal cord vsls thrc 88.83 $70.00 $6,218.10 63252 Revise spine cord vsl thrlmb 88.82 $70.00 $6,217.40 63265 Excise intraspinl lesion crv 48.69 $70.00 $3,408.30 63266 Excise intrspinl lesion thrc 50.10 $70.00 $3,507.00 63267 Excise intrspinl lesion lmbr 39.80 $70.00 $2,786.00 63268 Excise intrspinl lesion scrl 42.24 $70.00 $2,956.80 63270 Excise intrspinl lesion crvl 60.94 $70.00 $4,265.80 63271 Excise intrspinl lesion thrc 60.29 $70.00 $4,220.30 63272 Excise intrspinl lesion lmbr 55.27 $70.00 $3,868.90 63273 Excise intrspinl lesion scrl 54.71 $70.00 $3,829.70 63275 Bx/exc xdrl spine lesn crvl 52.48 $70.00 $3,673.60 63276 Bx/exc xdrl spine lesn thrc 52.00 $70.00 $3,640.00 63277 Bx/exc xdrl spine lesn lmbr 45.21 $70.00 $3,164.70 63278 Bx/exc xdrl spine lesn scrl 46.60 $70.00 $3,262.00 63280 Bx/exc idrl spine lesn crvl 61.67 $70.00 $4,316.90 63281 Bx/exc idrl spine lesn thrc 61.07 $70.00 $4,274.90 63282 Bx/exc idrl spine lesn lmbr 57.42 $70.00 $4,019.40 63283 Bx/exc idrl spine lesn scrl 55.73 $70.00 $3,901.10 63285 Bx/exc idrl imed lesn cervl 76.68 $70.00 $5,367.60 63286 Bx/exc idrl imed lesn thrc 75.74 $70.00 $5,301.80 63287 Bx/exc idrl imed lesn thrlmb 80.44 $70.00 $5,630.80 63290 Bx/exc xdrl/idrl lsn any lvl 81.79 $70.00 $5,725.30 63295 Repair laminectomy defect 9.83 $70.00 $688.10 63300 Remove vert xdrl body crvcl 53.35 $70.00 $3,734.50 63301 Remove vert xdrl body thrc 64.70 $70.00 $4,529.00 63302 Remove vert xdrl body thrlmb 63.89 $70.00 $4,472.30 63303 Remov vert xdrl bdy lmbr/sac 67.89 $70.00 $4,752.30 63304 Remove vert idrl body crvcl 68.92 $70.00 $4,824.40 63305 Remove vert idrl body thrc 73.34 $70.00 $5,133.80 63306 Remov vert idrl bdy thrclmbr 72.07 $70.00 $5,044.90 63307 Remov vert idrl bdy lmbr/sac 70.59 $70.00 $4,941.30 63308 Remove vertebral body add-on 9.39 $70.00 $657.30 63600 Remove spinal cord lesion 30.41 $70.00 $2,128.70 63610 Stimulation of spinal cord 17.17 $70.00 $1,201.90 63615 Remove lesion of spinal cord 36.31 $70.00 $2,541.70 63620 Srs spinal lesion 32.81 $70.00 $2,296.70 63621 Srs spinal lesion addl 7.50 $70.00 $525.00 63650 Implant neuroelectrodes 37.59 $70.00 $2,631.30 63655 Implant neuroelectrodes 24.07 $70.00 $1,684.90 63661 Remove spine eltrd perq aray 16.73 $70.00 $1,171.10 63662 Remove spine eltrd plate 24.33 $70.00 $1,703.10 NON-FACILITY HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL 63663 Revise spine eltrd perq aray 22.49 $70.00 $1,574.30 63664 Revise spine eltrd plate 25.33 $70.00 $1,773.10 63685 Insrt/redo spine n generator 10.47 $70.00 $732.90 63688 Revise/remove neuroreceiver 10.76 $70.00 $753.20 63700 Repair of spinal herniation 38.05 $70.00 $2,663.50 63702 Repair of spinal herniation 41.68 $70.00 $2,917.60 63704 Repair of spinal herniation 48.31 $70.00 $3,381.70 63706 Repair of spinal herniation 53.79 $70.00 $3,765.30 63707 Repair spinal fluid leakage 26.81 $70.00 $1,876.70 63709 Repair spinal fluid leakage 31.94 $70.00 $2,235.80 63710 Graft repair of spine defect 31.43 $70.00 $2,200.10 63740 Install spinal shunt 28.47 $70.00 $1,992.90 63741 Install spinal shunt 19.74 $70.00 $1,381.80 63744 Revision of spinal shunt 19.13 $70.00 $1,339.10 63746 Removal of spinal shunt 17.54 $70.00 $1,227.80 64400 N block inj trigeminal 3.74 $70.00 $261.80 64402 N block inj facial 4.02 $70.00 $281.40 64405 N block inj occipital 2.93 $70.00 $205.10 64408 N block inj vagus 3.31 $70.00 $231.70 64410 N block inj phrenic 4.40 $70.00 $308.00 64413 N block inj cervical plexus 3.63 $70.00 $254.10 64415 N block inj brachial plexus 3.37 $70.00 $235.90 64416 N block cont infuse b plex 2.27 $70.00 $158.90 64417 N block inj axillary 3.69 $70.00 $258.30 64418 N block inj suprascapular 3.34 $70.00 $233.80 64420 N block inj intercost sng 3.18 $70.00 $222.60 64421 N block inj intercost mlt 4.30 $70.00 $301.00 64425 N block inj ilio-ing/hypogi 3.82 $70.00 $267.40 64430 N block inj pudendal 3.91 $70.00 $273.70 64435 N block inj paracervical 3.89 $70.00 $272.30 64445 N block inj sciatic sng 3.91 $70.00 $273.70 64446 N blk inj sciatic cont inf 2.27 $70.00 $158.90 64447 N block inj fem single 3.46 $70.00 $242.20 64448 N block inj fem cont inf 2.05 $70.00 $143.50 64449 N block inj lumbar plexus 2.43 $70.00 $170.10 64450 N block other peripheral 2.28 $70.00 $159.60 64455 N block inj plantar digit 1.36 $70.00 $95.20 64461 Pvb thoracic single inj site 4.22 $70.00 $295.40 64462 Pvb thoracic 2nd+ inj site 2.32 $70.00 $162.40 64463 Pvb thoracic cont infusion 4.51 $70.00 $315.70 64479 Inj foramen epidural c/t 6.68 $70.00 $467.60 64480 Inj foramen epidural add-on 3.22 $70.00 $225.40 64483 Inj foramen epidural l/s 6.20 $70.00 $434.00 64484 Inj foramen epidural add-on 2.62 $70.00 $183.40 64486 Tap block unil by injection 3.33 $70.00 $233.10 NON-FACILITY HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL 64487 Tap block uni by infusion 3.80 $70.00 $266.00 64488 Tap block bi injection 3.83 $70.00 $268.10 64489 Tap block bi by infusion 5.19 $70.00 $363.30 64490 Inj paravert f jnt c/t 1 lev 5.38 $70.00 $376.60 64491 Inj paravert f jnt c/t 2 lev 2.65 $70.00 $185.50 64492 Inj paravert f jnt c/t 3 lev 2.67 $70.00 $186.90 64493 Inj paravert f jnt l/s 1 lev 4.88 $70.00 $341.60 64494 Inj paravert f jnt l/s 2 lev 2.45 $70.00 $171.50 64495 Inj paravert f jnt l/s 3 lev 2.45 $70.00 $171.50 64505 N block spenopalatine gangl 3.12 $70.00 $218.40 64508 N block carotid sinus s/p 1.41 $70.00 $98.70 64510 N block stellate ganglion 3.62 $70.00 $253.40 64517 N block inj hypogas plxs 5.41 $70.00 $378.70 64520 N block lumbar/thoracic 5.33 $70.00 $373.10 64530 N block inj celiac pelus 5.36 $70.00 $375.20 64550 Appl surface neurostimulator 0.51 $70.00 $35.70 64553 Implant neuroelectrodes 32.14 $70.00 $2,249.80 64555 Implant neuroelectrodes 34.35 $70.00 $2,404.50 64561 Implant neuroelectrodes 23.69 $70.00 $1,658.30 64566 Neuroeltrd stim post tibial 3.68 $70.00 $257.60 64568 Inc for vagus n elect impl 18.52 $70.00 $1,296.40 64569 Revise/repl vagus n eltrd 22.34 $70.00 $1,563.80 64570 Remove vagus n eltrd 21.48 $70.00 $1,503.60 64575 Implant neuroelectrodes 9.28 $70.00 $649.60 64580 Implant neuroelectrodes 8.81 $70.00 $616.70 64581 Implant neuroelectrodes 19.18 $70.00 $1,342.60 64585 Revise/remove neuroelectrode 7.00 $70.00 $490.00 64590 Insrt/redo pn/gastr stimul 7.62 $70.00 $533.40 64595 Revise/rmv pn/gastr stimul 7.03 $70.00 $492.10 64600 Injection treatment of nerve 11.57 $70.00 $809.90 64605 Injection treatment of nerve 15.53 $70.00 $1,087.10 64610 Injection treatment of nerve 21.19 $70.00 $1,483.30 64611 Chemodenerv saliv glands 3.45 $70.00 $241.50 64612 Destroy nerve face muscle 3.81 $70.00 $266.70 64615 Chemodenerv musc migraine 4.21 $70.00 $294.70 64616 Chemodenerv musc neck dyston 3.74 $70.00 $261.80 64617 Chemodener muscle larynx emg 4.58 $70.00 $320.60 64620 Injection treatment of nerve 5.84 $70.00 $408.80 64630 Injection treatment of nerve 6.56 $70.00 $459.20 64632 N block inj common digit 2.44 $70.00 $170.80 64633 Destroy cerv/thor facet jnt 11.92 $70.00 $834.40 64634 Destroy c/th facet jnt addl 5.36 $70.00 $375.20 64635 Destroy lumb/sac facet jnt 11.79 $70.00 $825.30 64636 Destroy l/s facet jnt addl 4.87 $70.00 $340.90 64640 Injection treatment of nerve 3.77 $70.00 $263.90 NON-FACILITY HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL 64642 Chemodenerv 1 extremity 1-4 4.12 $70.00 $288.40 64643 Chemodenerv 1 extrem 1-4 ea 2.65 $70.00 $185.50 64644 Chemodenerv 1 extrem 5/> mus 4.71 $70.00 $329.70 64645 Chemodenerv 1 extrem 5/> ea 3.27 $70.00 $228.90 64646 Chemodenerv trunk musc 1-5 4.30 $70.00 $301.00 64647 Chemodenerv trunk musc 6/> 5.11 $70.00 $357.70 64650 Chemodenerv eccrine glands 2.23 $70.00 $156.10 64653 Chemodenerv eccrine glands 2.74 $70.00 $191.80 64680 Injection treatment of nerve 8.61 $70.00 $602.70 64681 Injection treatment of nerve 14.79 $70.00 $1,035.30 64702 Revise finger/toe nerve 14.39 $70.00 $1,007.30 64704 Revise hand/foot nerve 9.17 $70.00 $641.90 64708 Revise arm/leg nerve 14.35 $70.00 $1,004.50 64712 Revision of sciatic nerve 16.63 $70.00 $1,164.10 64713 Revision of arm nerve(s) 22.13 $70.00 $1,549.10 64714 Revise low back nerve(s) 20.46 $70.00 $1,432.20 64716 Revision of cranial nerve 15.18 $70.00 $1,062.60 64718 Revise ulnar nerve at elbow 17.04 $70.00 $1,192.80 64719 Revise ulnar nerve at wrist 11.51 $70.00 $805.70 64721 Carpal tunnel surgery 12.34 $70.00 $863.80 64722 Relieve pressure on nerve(s) 10.30 $70.00 $721.00 64726 Release foot/toe nerve 7.79 $70.00 $545.30 64727 Internal nerve revision 5.33 $70.00 $373.10 64732 Incision of brow nerve 12.82 $70.00 $897.40 64734 Incision of cheek nerve 14.52 $70.00 $1,016.40 64736 Incision of chin nerve 11.14 $70.00 $779.80 64738 Incision of jaw nerve 13.34 $70.00 $933.80 64740 Incision of tongue nerve 14.18 $70.00 $992.60 64742 Incision of facial nerve 14.14 $70.00 $989.80 64744 Incise nerve back of head 14.37 $70.00 $1,005.90 64746 Incise diaphragm nerve 12.39 $70.00 $867.30 64755 Incision of stomach nerves 26.60 $70.00 $1,862.00 64760 Incision of vagus nerve 14.85 $70.00 $1,039.50 64763 Incise hip/thigh nerve 14.70 $70.00 $1,029.00 64766 Incise hip/thigh nerve 18.11 $70.00 $1,267.70 64771 Sever cranial nerve 17.09 $70.00 $1,196.30 64772 Incision of spinal nerve 16.27 $70.00 $1,138.90 64774 Remove skin nerve lesion 11.85 $70.00 $829.50 64776 Remove digit nerve lesion 11.24 $70.00 $786.80 64778 Digit nerve surgery add-on 5.31 $70.00 $371.70 64782 Remove limb nerve lesion 13.11 $70.00 $917.70 64783 Limb nerve surgery add-on 6.35 $70.00 $444.50 64784 Remove nerve lesion 20.92 $70.00 $1,464.40 64786 Remove sciatic nerve lesion 28.92 $70.00 $2,024.40 64787 Implant nerve end 6.98 $70.00 $488.60 NON-FACILITY HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL 64788 Remove skin nerve lesion 11.38 $70.00 $796.60 64790 Removal of nerve lesion 24.25 $70.00 $1,697.50 64792 Removal of nerve lesion 34.81 $70.00 $2,436.70 64795 Biopsy of nerve 5.64 $70.00 $394.80 64802 Sympathectomy cervical 24.25 $70.00 $1,697.50 64804 Remove sympathetic nerves 34.60 $70.00 $2,422.00 64809 Remove sympathetic nerves 31.81 $70.00 $2,226.70 64818 Remove sympathetic nerves 18.18 $70.00 $1,272.60 64820 Sympathectomy digital artery 20.50 $70.00 $1,435.00 64821 Remove sympathetic nerves 19.96 $70.00 $1,397.20 64822 Remove sympathetic nerves 19.96 $70.00 $1,397.20 64823 Sympathectomy supfc palmar 22.73 $70.00 $1,591.10 64831 Repair of digit nerve 19.77 $70.00 $1,383.90 64832 Repair nerve add-on 9.78 $70.00 $684.60 64834 Repair of hand or foot nerve 21.32 $70.00 $1,492.40 64835 Repair of hand or foot nerve 23.52 $70.00 $1,646.40 64836 Repair of hand or foot nerve 23.52 $70.00 $1,646.40 64837 Repair nerve add-on 10.70 $70.00 $749.00 64840 Repair of leg nerve 27.78 $70.00 $1,944.60 64856 Repair/transpose nerve 29.23 $70.00 $2,046.10 64857 Repair arm/leg nerve 30.55 $70.00 $2,138.50 64858 Repair sciatic nerve 34.06 $70.00 $2,384.20 64859 Nerve surgery 7.27 $70.00 $508.90 64861 Repair of arm nerves 44.37 $70.00 $3,105.90 64862 Repair of low back nerves 39.89 $70.00 $2,792.30 64864 Repair of facial nerve 25.13 $70.00 $1,759.10 64865 Repair of facial nerve 31.38 $70.00 $2,196.60 64866 Fusion of facial/other nerve 37.09 $70.00 $2,596.30 64868 Fusion of facial/other nerve 28.73 $70.00 $2,011.10 64872 Subsequent repair of nerve 3.39 $70.00 $237.30 64874 Repair & revise nerve add-on 5.10 $70.00 $357.00 64876 Repair nerve/shorten bone 5.77 $70.00 $403.90 64885 Nerve graft head/neck 4 cm 36.97 $70.00 $2,587.90 64890 Nerve graft hand/foot 4 cm 33.24 $70.00 $2,326.80 64892 Nerve graft arm/leg <4 cm 30.38 $70.00 $2,126.60 64893 Nerve graft arm/leg >4 cm 32.43 $70.00 $2,270.10 64895 Nerve graft hand/foot 4 cm 41.47 $70.00 $2,902.90 64897 Nerve graft arm/leg 4 cm 39.81 $70.00 $2,786.70 64901 Nerve graft add-on 17.44 $70.00 $1,220.80 64902 Nerve graft add-on 20.19 $70.00 $1,413.30 64905 Nerve pedicle transfer 29.30 $70.00 $2,051.00 NON-FACILITY HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL 64907 Nerve pedicle transfer 37.71 $70.00 $2,639.70 64910 Nerve repair w/allograft 23.09 $70.00 $1,616.30 64911 Neurorraphy w/vein autograft 29.62 $70.00 $2,073.40 64912 Nrv rpr w/nrv algrft 1st 22.39 $70.00 $1,567.30 64913 Nrv rpr w/nrv algrft ea addl 4.54 $70.00 $317.80 64999 Nervous system surgery 0.00 $70.00 $0.00 65091 Revise eye 18.09 $70.00 $1,266.30 65093 Revise eye with implant 17.89 $70.00 $1,252.30 65101 Removal of eye 21.02 $70.00 $1,471.40 65103 Remove eye/insert implant 21.94 $70.00 $1,535.80 65105 Remove eye/attach implant 24.18 $70.00 $1,692.60 65110 Removal of eye 34.77 $70.00 $2,433.90 65112 Remove eye/revise socket 40.33 $70.00 $2,823.10 65114 Remove eye/revise socket 42.29 $70.00 $2,960.30 65125 Revise ocular implant 13.07 $70.00 $914.90 65130 Insert ocular implant 20.85 $70.00 $1,459.50 65135 Insert ocular implant 21.15 $70.00 $1,480.50 65140 Attach ocular implant 22.99 $70.00 $1,609.30 65150 Revise ocular implant 16.46 $70.00 $1,152.20 65155 Reinsert ocular implant 24.09 $70.00 $1,686.30 65175 Removal of ocular implant 18.71 $70.00 $1,309.70 65205 Remove foreign body from eye 1.62 $70.00 $113.40 65210 Remove foreign body from eye 1.97 $70.00 $137.90 65220 Remove foreign body from eye 1.69 $70.00 $118.30 65222 Remove foreign body from eye 1.93 $70.00 $135.10 65235 Remove foreign body from eye 20.24 $70.00 $1,416.80 65260 Remove foreign body from eye 27.37 $70.00 $1,915.90 65265 Remove foreign body from eye 30.71 $70.00 $2,149.70 65270 Repair of eye wound 7.65 $70.00 $535.50 65272 Repair of eye wound 14.35 $70.00 $1,004.50 65273 Repair of eye wound 10.85 $70.00 $759.50 65275 Repair of eye wound 16.51 $70.00 $1,155.70 65280 Repair of eye wound 19.15 $70.00 $1,340.50 65285 Repair of eye wound 31.60 $70.00 $2,212.00 65286 Repair of eye wound 20.12 $70.00 $1,408.40 65290 Repair of eye socket wound 13.99 $70.00 $979.30 65400 Removal of eye lesion 19.40 $70.00 $1,358.00 65410 Biopsy of cornea 4.11 $70.00 $287.70 65420 Removal of eye lesion 14.76 $70.00 $1,033.20 65426 Removal of eye lesion 18.62 $70.00 $1,303.40 65430 Corneal smear 3.30 $70.00 $231.00 65435 Curette/treat cornea 2.32 $70.00 $162.40 65436 Curette/treat cornea 11.07 $70.00 $774.90 65450 Treatment of corneal lesion 9.31 $70.00 $651.70 65600 Revision of cornea 11.25 $70.00 $787.50 NON-FACILITY HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL 65710 Corneal transplant 31.49 $70.00 $2,204.30 65730 Corneal transplant 34.97 $70.00 $2,447.90 65750 Corneal transplant 35.13 $70.00 $2,459.10 65755 Corneal transplant 34.96 $70.00 $2,447.20 65756 Corneal trnspl endothelial 33.75 $70.00 $2,362.50 65757 Prep corneal endo allograft 0.00 $70.00 $0.00 65760 Revision of cornea 0.00 $70.00 $0.00 65765 Revision of cornea 0.00 $70.00 $0.00 65767 Corneal tissue transplant 0.00 $70.00 $0.00 65770 Revise cornea with implant 39.92 $70.00 $2,794.40 65771 Radial keratotomy 0.00 $70.00 $0.00 65772 Correction of astigmatism 12.88 $70.00 $901.60 65775 Correction of astigmatism 15.72 $70.00 $1,100.40 65778 Cover eye w/membrane 40.21 $70.00 $2,814.70 65779 Cover eye w/membrane suture 34.46 $70.00 $2,412.20 65780 Ocular reconst transplant 19.00 $70.00 $1,330.00 65781 Ocular reconst transplant 38.01 $70.00 $2,660.70 65782 Ocular reconst transplant 32.80 $70.00 $2,296.00 65785 Impltj ntrstrml crnl rng seg 71.47 $70.00 $5,002.90 65800 Drainage of eye 3.42 $70.00 $239.40 65810 Drainage of eye 13.27 $70.00 $928.90 65815 Drainage of eye 18.23 $70.00 $1,276.10 65820 Relieve inner eye pressure 21.35 $70.00 $1,494.50 65850 Incision of eye 23.92 $70.00 $1,674.40 65855 Trabeculoplasty laser surg 7.00 $70.00 $490.00 65860 Incise inner eye adhesions 8.83 $70.00 $618.10 65865 Incise inner eye adhesions 13.48 $70.00 $943.60 65870 Incise inner eye adhesions 16.84 $70.00 $1,178.80 65875 Incise inner eye adhesions 17.97 $70.00 $1,257.90 65880 Incise inner eye adhesions 18.91 $70.00 $1,323.70 65900 Remove eye lesion 27.46 $70.00 $1,922.20 65920 Remove implant of eye 22.46 $70.00 $1,572.20 65930 Remove blood clot from eye 18.16 $70.00 $1,271.20 66020 Injection treatment of eye 5.34 $70.00 $373.80 66030 Injection treatment of eye 4.77 $70.00 $333.90 66130 Remove eye lesion 19.87 $70.00 $1,390.90 66150 Glaucoma surgery 24.99 $70.00 $1,749.30 66155 Glaucoma surgery 24.97 $70.00 $1,747.90 66160 Glaucoma surgery 28.15 $70.00 $1,970.50 66170 Glaucoma surgery 31.18 $70.00 $2,182.60 66172 Incision of eye 33.96 $70.00 $2,377.20 66174 Translum dil eye canal 27.01 $70.00 $1,890.70 66175 Trnslum dil eye canal w/stnt 28.28 $70.00 $1,979.60 66179 Aqueous shunt eye w/o graft 30.72 $70.00 $2,150.40 66180 Aqueous shunt eye w/graft 32.41 $70.00 $2,268.70 NON-FACILITY HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL 66183 Insert ant drainage device 29.36 $70.00 $2,055.20 66184 Revision of aqueous shunt 22.38 $70.00 $1,566.60 66185 Revise aqueous shunt eye 24.07 $70.00 $1,684.90 66220 Repair eye lesion 21.29 $70.00 $1,490.30 66225 Repair/graft eye lesion 26.56 $70.00 $1,859.20 66250 Follow-up surgery of eye 21.38 $70.00 $1,496.60 66500 Incision of iris 10.08 $70.00 $705.60 66505 Incision of iris 11.06 $70.00 $774.20 66600 Remove iris and lesion 23.74 $70.00 $1,661.80 66605 Removal of iris 30.09 $70.00 $2,106.30 66625 Removal of iris 12.24 $70.00 $856.80 66630 Removal of iris 16.23 $70.00 $1,136.10 66635 Removal of iris 16.39 $70.00 $1,147.30 66680 Repair iris & ciliary body 14.75 $70.00 $1,032.50 66682 Repair iris & ciliary body 18.19 $70.00 $1,273.30 66700 Destruction ciliary body 12.88 $70.00 $901.60 66710 Ciliary transsleral therapy 12.60 $70.00 $882.00 66711 Ciliary endoscopic ablation 18.33 $70.00 $1,283.10 66720 Destruction ciliary body 13.15 $70.00 $920.50 66740 Destruction ciliary body 12.51 $70.00 $875.70 66761 Revision of iris 8.48 $70.00 $593.60 66762 Revision of iris 13.58 $70.00 $950.60 66770 Removal of inner eye lesion 15.08 $70.00 $1,055.60 66820 Incision secondary cataract 11.26 $70.00 $788.20 66821 After cataract laser surgery 9.40 $70.00 $658.00 66825 Reposition intraocular lens 21.65 $70.00 $1,515.50 66830 Removal of lens lesion 20.29 $70.00 $1,420.30 66840 Removal of lens material 19.86 $70.00 $1,390.20 66850 Removal of lens material 22.60 $70.00 $1,582.00 66852 Removal of lens material 24.07 $70.00 $1,684.90 66920 Extraction of lens 21.49 $70.00 $1,504.30 66930 Extraction of lens 24.41 $70.00 $1,708.70 66940 Extraction of lens 22.30 $70.00 $1,561.00 66982 Cataract surgery complex 22.65 $70.00 $1,585.50 66983 Cataract surg w/iol 1 stage 21.24 $70.00 $1,486.80 66984 Cataract surg w/iol 1 stage 18.23 $70.00 $1,276.10 66985 Insert lens prosthesis 21.96 $70.00 $1,537.20 66986 Exchange lens prosthesis 25.90 $70.00 $1,813.00 66990 Ophthalmic endoscope add-on 2.57 $70.00 $179.90 66999 Eye surgery procedure 0.00 $70.00 $0.00 67005 Partial removal of eye fluid 13.47 $70.00 $942.90 67010 Partial removal of eye fluid 15.47 $70.00 $1,082.90 67015 Release of eye fluid 16.54 $70.00 $1,157.80 67025 Replace eye fluid 20.73 $70.00 $1,451.10 67027 Implant eye drug system 24.29 $70.00 $1,700.30 NON-FACILITY HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL 67028 Injection eye drug 2.90 $70.00 $203.00 67030 Incise inner eye strands 15.19 $70.00 $1,063.30 67031 Laser surgery eye strands 11.11 $70.00 $777.70 67036 Removal of inner eye fluid 25.69 $70.00 $1,798.30 67039 Laser treatment of retina 27.51 $70.00 $1,925.70 67040 Laser treatment of retina 29.73 $70.00 $2,081.10 67041 Vit for macular pucker 32.85 $70.00 $2,299.50 67042 Vit for macular hole 32.85 $70.00 $2,299.50 67043 Vit for membrane dissect 34.71 $70.00 $2,429.70 67101 Repair detached retina crtx 9.36 $70.00 $655.20 67105 Repair detached retina pc 8.46 $70.00 $592.20 67107 Repair detached retina 32.27 $70.00 $2,258.90 67108 Repair detached retina 34.22 $70.00 $2,395.40 67110 Repair detached retina 24.99 $70.00 $1,749.30 67113 Repair retinal detach cplx 38.19 $70.00 $2,673.30 67115 Release encircling material 14.25 $70.00 $997.50 67120 Remove eye implant material 18.71 $70.00 $1,309.70 67121 Remove eye implant material 25.89 $70.00 $1,812.30 67141 Treatment of retina 14.96 $70.00 $1,047.20 67145 Treatment of retina 15.06 $70.00 $1,054.20 67208 Treatment of retinal lesion 17.08 $70.00 $1,195.60 67210 Treatment of retinal lesion 14.77 $70.00 $1,033.90 67218 Treatment of retinal lesion 39.41 $70.00 $2,758.70 67220 Treatment of choroid lesion 15.23 $70.00 $1,066.10 67221 Ocular photodynamic ther 8.17 $70.00 $571.90 67225 Eye photodynamic ther add-on 0.85 $70.00 $59.50 67227 Dstrj extensive retinopathy 8.31 $70.00 $581.70 67228 Treatment x10sv retinopathy 9.75 $70.00 $682.50 67229 Tr retinal les preterm inf 33.23 $70.00 $2,326.10 67250 Reinforce eye wall 22.25 $70.00 $1,557.50 67255 Reinforce/graft eye wall 19.49 $70.00 $1,364.30 67299 Eye surgery procedure 0.00 $70.00 $0.00 67311 Revise eye muscle 17.03 $70.00 $1,192.10 67312 Revise two eye muscles 20.27 $70.00 $1,418.90 67314 Revise eye muscle 19.16 $70.00 $1,341.20 67316 Revise two eye muscles 22.86 $70.00 $1,600.20 67318 Revise eye muscle(s) 20.13 $70.00 $1,409.10 67320 Revise eye muscle(s) add-on 9.21 $70.00 $644.70 67331 Eye surgery follow-up add-on 8.73 $70.00 $611.10 67332 Rerevise eye muscles add-on 9.47 $70.00 $662.90 67334 Revise eye muscle w/suture 8.61 $70.00 $602.70 67335 Eye suture during surgery 4.23 $70.00 $296.10 67340 Revise eye muscle add-on 10.24 $70.00 $716.80 67343 Release eye tissue 18.57 $70.00 $1,299.90 67345 Destroy nerve of eye muscle 6.98 $70.00 $488.60 NON-FACILITY HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL 67346 Biopsy eye muscle 5.54 $70.00 $387.80 67399 Unlisted px extraocular musc 0.00 $70.00 $0.00 67400 Explore/biopsy eye socket 26.50 $70.00 $1,855.00 67405 Explore/drain eye socket 22.52 $70.00 $1,576.40 67412 Explore/treat eye socket 24.26 $70.00 $1,698.20 67413 Explore/treat eye socket 24.35 $70.00 $1,704.50 67414 Explr/decompress eye socket 37.73 $70.00 $2,641.10 67415 Aspiration orbital contents 2.99 $70.00 $209.30 67420 Explore/treat eye socket 46.05 $70.00 $3,223.50 67430 Explore/treat eye socket 35.52 $70.00 $2,486.40 67440 Explore/drain eye socket 34.36 $70.00 $2,405.20 67445 Explr/decompress eye socket 39.90 $70.00 $2,793.00 67450 Explore/biopsy eye socket 35.73 $70.00 $2,501.10 67500 Inject/treat eye socket 2.27 $70.00 $158.90 67505 Inject/treat eye socket 2.49 $70.00 $174.30 67515 Inject/treat eye socket 2.76 $70.00 $193.20 67550 Insert eye socket implant 27.48 $70.00 $1,923.60 67560 Revise eye socket implant 28.18 $70.00 $1,972.60 67570 Decompress optic nerve 33.13 $70.00 $2,319.10 67599 Orbit surgery procedure 0.00 $70.00 $0.00 67700 Drainage of eyelid abscess 7.68 $70.00 $537.60 67710 Incision of eyelid 6.40 $70.00 $448.00 67715 Incision of eyelid fold 6.87 $70.00 $480.90 67800 Remove eyelid lesion 3.64 $70.00 $254.80 67801 Remove eyelid lesions 4.64 $70.00 $324.80 67805 Remove eyelid lesions 5.77 $70.00 $403.90 67808 Remove eyelid lesion(s) 10.51 $70.00 $735.70 67810 Biopsy eyelid & lid margin 4.89 $70.00 $342.30 67820 Revise eyelashes 1.15 $70.00 $80.50 67825 Revise eyelashes 3.66 $70.00 $256.20 67830 Revise eyelashes 7.62 $70.00 $533.40 67835 Revise eyelashes 12.51 $70.00 $875.70 67840 Remove eyelid lesion 7.87 $70.00 $550.90 67850 Treat eyelid lesion 6.12 $70.00 $428.40 67875 Closure of eyelid by suture 4.93 $70.00 $345.10 67880 Revision of eyelid 13.08 $70.00 $915.60 67882 Revision of eyelid 16.11 $70.00 $1,127.70 67900 Repair brow defect 18.24 $70.00 $1,276.80 67901 Repair eyelid defect 21.56 $70.00 $1,509.20 67902 Repair eyelid defect 20.61 $70.00 $1,442.70 67903 Repair eyelid defect 16.92 $70.00 $1,184.40 67904 Repair eyelid defect 20.89 $70.00 $1,462.30 67906 Repair eyelid defect 14.49 $70.00 $1,014.30 67908 Repair eyelid defect 14.08 $70.00 $985.60 67909 Revise eyelid defect 15.31 $70.00 $1,071.70 NON-FACILITY HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL 67911 Revise eyelid defect 16.03 $70.00 $1,122.10 67912 Correction eyelid w/implant 24.99 $70.00 $1,749.30 67914 Repair eyelid defect 13.39 $70.00 $937.30 67915 Repair eyelid defect 8.37 $70.00 $585.90 67916 Repair eyelid defect 16.88 $70.00 $1,181.60 67917 Repair eyelid defect 17.20 $70.00 $1,204.00 67921 Repair eyelid defect 13.14 $70.00 $919.80 67922 Repair eyelid defect 8.29 $70.00 $580.30 67923 Repair eyelid defect 16.87 $70.00 $1,180.90 67924 Repair eyelid defect 18.00 $70.00 $1,260.00 67930 Repair eyelid wound 10.40 $70.00 $728.00 67935 Repair eyelid wound 16.94 $70.00 $1,185.80 67938 Remove eyelid foreign body 6.98 $70.00 $488.60 67950 Revision of eyelid 16.33 $70.00 $1,143.10 67961 Revision of eyelid 16.41 $70.00 $1,148.70 67966 Revision of eyelid 21.90 $70.00 $1,533.00 67971 Reconstruction of eyelid 20.63 $70.00 $1,444.10 67973 Reconstruction of eyelid 26.54 $70.00 $1,857.80 67974 Reconstruction of eyelid 26.47 $70.00 $1,852.90 67975 Reconstruction of eyelid 19.52 $70.00 $1,366.40 67999 Revision of eyelid 0.00 $70.00 $0.00 68020 Incise/drain eyelid lining 3.44 $70.00 $240.80 68040 Treatment of eyelid lesions 1.78 $70.00 $124.60 68100 Biopsy of eyelid lining 4.88 $70.00 $341.60 68110 Remove eyelid lining lesion 6.45 $70.00 $451.50 68115 Remove eyelid lining lesion 8.90 $70.00 $623.00 68130 Remove eyelid lining lesion 15.37 $70.00 $1,075.90 68135 Remove eyelid lining lesion 4.49 $70.00 $314.30 68200 Treat eyelid by injection 1.18 $70.00 $82.60 68320 Revise/graft eyelid lining 20.67 $70.00 $1,446.90 68325 Revise/graft eyelid lining 18.76 $70.00 $1,313.20 68326 Revise/graft eyelid lining 18.42 $70.00 $1,289.40 68328 Revise/graft eyelid lining 20.21 $70.00 $1,414.70 68330 Revise eyelid lining 17.25 $70.00 $1,207.50 68335 Revise/graft eyelid lining 18.50 $70.00 $1,295.00 68340 Separate eyelid adhesions 15.55 $70.00 $1,088.50 68360 Revise eyelid lining 15.14 $70.00 $1,059.80 68362 Revise eyelid lining 18.72 $70.00 $1,310.40 68371 Harvest eye tissue alograft 11.77 $70.00 $823.90 68399 Eyelid lining surgery 0.00 $70.00 $0.00 68400 Incise/drain tear gland 8.12 $70.00 $568.40 68420 Incise/drain tear sac 9.18 $70.00 $642.60 68440 Incise tear duct opening 2.91 $70.00 $203.70 68500 Removal of tear gland 27.80 $70.00 $1,946.00 68505 Partial removal tear gland 27.66 $70.00 $1,936.20 NON-FACILITY HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL 68510 Biopsy of tear gland 12.70 $70.00 $889.00 68520 Removal of tear sac 19.59 $70.00 $1,371.30 68525 Biopsy of tear sac 7.53 $70.00 $527.10 68530 Clearance of tear duct 12.19 $70.00 $853.30 68540 Remove tear gland lesion 26.47 $70.00 $1,852.90 68550 Remove tear gland lesion 32.45 $70.00 $2,271.50 68700 Repair tear ducts 17.23 $70.00 $1,206.10 68705 Revise tear duct opening 6.77 $70.00 $473.90 68720 Create tear sac drain 21.57 $70.00 $1,509.90 68745 Create tear duct drain 21.67 $70.00 $1,516.90 68750 Create tear duct drain 22.42 $70.00 $1,569.40 68760 Close tear duct opening 5.76 $70.00 $403.20 68761 Close tear duct opening 4.23 $70.00 $296.10 68770 Close tear system fistula 17.94 $70.00 $1,255.80 68801 Dilate tear duct opening 2.52 $70.00 $176.40 68810 Probe nasolacrimal duct 4.41 $70.00 $308.70 68811 Probe nasolacrimal duct 3.89 $70.00 $272.30 68815 Probe nasolacrimal duct 11.33 $70.00 $793.10 68816 Probe nl duct w/balloon 18.47 $70.00 $1,292.90 68840 Explore/irrigate tear ducts 3.66 $70.00 $256.20 68850 Injection for tear sac x-ray 1.78 $70.00 $124.60 68899 Tear duct system surgery 0.00 $70.00 $0.00 69000 Drain external ear lesion 5.30 $70.00 $371.00 69005 Drain external ear lesion 6.03 $70.00 $422.10 69020 Drain outer ear canal lesion 6.51 $70.00 $455.70 69090 Pierce earlobes 0.00 $70.00 $0.00 69100 Biopsy of external ear 2.87 $70.00 $200.90 69105 Biopsy of external ear canal 3.93 $70.00 $275.10 69110 Remove external ear partial 12.99 $70.00 $909.30 69120 Removal of external ear 11.48 $70.00 $803.60 69140 Remove ear canal lesion(s) 24.73 $70.00 $1,731.10 69145 Remove ear canal lesion(s) 11.11 $70.00 $777.70 69150 Extensive ear canal surgery 29.56 $70.00 $2,069.20 69155 Extensive ear/neck surgery 46.96 $70.00 $3,287.20 69200 Clear outer ear canal 2.33 $70.00 $163.10 69205 Clear outer ear canal 2.85 $70.00 $199.50 69209 Remove impacted ear wax uni 0.40 $70.00 $28.00 69210 Remove impacted ear wax uni 1.38 $70.00 $96.60 69220 Clean out mastoid cavity 2.32 $70.00 $162.40 69222 Clean out mastoid cavity 6.13 $70.00 $429.10 69300 Revise external ear 17.82 $70.00 $1,247.40 69310 Rebuild outer ear canal 30.74 $70.00 $2,151.80 69320 Rebuild outer ear canal 43.10 $70.00 $3,017.00 69399 Outer ear surgery procedure 0.00 $70.00 $0.00 69420 Incision of eardrum 5.39 $70.00 $377.30 NON-FACILITY HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL 69421 Incision of eardrum 4.20 $70.00 $294.00 69424 Remove ventilating tube 3.60 $70.00 $252.00 69433 Create eardrum opening 5.69 $70.00 $398.30 69436 Create eardrum opening 4.52 $70.00 $316.40 69440 Exploration of middle ear 19.40 $70.00 $1,358.00 69450 Eardrum revision 15.41 $70.00 $1,078.70 69501 Mastoidectomy 20.66 $70.00 $1,446.20 69502 Mastoidectomy 27.45 $70.00 $1,921.50 69505 Remove mastoid structures 33.93 $70.00 $2,375.10 69511 Extensive mastoid surgery 34.76 $70.00 $2,433.20 69530 Extensive mastoid surgery 46.64 $70.00 $3,264.80 69535 Remove part of temporal bone 76.40 $70.00 $5,348.00 69540 Remove ear lesion 5.86 $70.00 $410.20 69550 Remove ear lesion 29.35 $70.00 $2,054.50 69552 Remove ear lesion 44.32 $70.00 $3,102.40 69554 Remove ear lesion 71.25 $70.00 $4,987.50 69601 Mastoid surgery revision 29.52 $70.00 $2,066.40 69602 Mastoid surgery revision 30.70 $70.00 $2,149.00 69603 Mastoid surgery revision 35.55 $70.00 $2,488.50 69604 Mastoid surgery revision 31.39 $70.00 $2,197.30 69605 Mastoid surgery revision 44.01 $70.00 $3,080.70 69610 Repair of eardrum 10.83 $70.00 $758.10 69620 Repair of eardrum 19.47 $70.00 $1,362.90 69631 Repair eardrum structures 24.94 $70.00 $1,745.80 69632 Rebuild eardrum structures 30.39 $70.00 $2,127.30 69633 Rebuild eardrum structures 29.48 $70.00 $2,063.60 69635 Repair eardrum structures 34.94 $70.00 $2,445.80 69636 Rebuild eardrum structures 38.93 $70.00 $2,725.10 69637 Rebuild eardrum structures 39.29 $70.00 $2,750.30 69641 Revise middle ear & mastoid 29.38 $70.00 $2,056.60 69642 Revise middle ear & mastoid 37.71 $70.00 $2,639.70 69643 Revise middle ear & mastoid 34.54 $70.00 $2,417.80 69644 Revise middle ear & mastoid 41.71 $70.00 $2,919.70 69645 Revise middle ear & mastoid 40.90 $70.00 $2,863.00 69646 Revise middle ear & mastoid 43.64 $70.00 $3,054.80 69650 Release middle ear bone 22.68 $70.00 $1,587.60 69660 Revise middle ear bone 26.17 $70.00 $1,831.90 69661 Revise middle ear bone 34.11 $70.00 $2,387.70 69662 Revise middle ear bone 32.73 $70.00 $2,291.10 69666 Repair middle ear structures 22.91 $70.00 $1,603.70 69667 Repair middle ear structures 22.94 $70.00 $1,605.80 69670 Remove mastoid air cells 26.78 $70.00 $1,874.60 69676 Remove middle ear nerve 23.44 $70.00 $1,640.80 69700 Close mastoid fistula 19.34 $70.00 $1,353.80 69710 Implant/replace hearing aid 0.00 $70.00 $0.00 NON-FACILITY HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL 69711 Remove/repair hearing aid 24.32 $70.00 $1,702.40 69714 Implant temple bone w/stimul 30.46 $70.00 $2,132.20 69715 Temple bne implnt w/stimulat 37.55 $70.00 $2,628.50 69717 Temple bone implant revision 31.91 $70.00 $2,233.70 69718 Revise temple bone implant 37.95 $70.00 $2,656.50 69720 Release facial nerve 34.48 $70.00 $2,413.60 69725 Release facial nerve 53.17 $70.00 $3,721.90 69740 Repair facial nerve 32.99 $70.00 $2,309.30 69745 Repair facial nerve 35.09 $70.00 $2,456.30 69799 Middle ear surgery procedure 0.00 $70.00 $0.00 69801 Incise inner ear 5.51 $70.00 $385.70 69805 Explore inner ear 29.80 $70.00 $2,086.00 69806 Explore inner ear 26.67 $70.00 $1,866.90 69905 Remove inner ear 25.89 $70.00 $1,812.30 69910 Remove inner ear & mastoid 28.74 $70.00 $2,011.80 69915 Incise inner ear nerve 43.53 $70.00 $3,047.10 69930 Implant cochlear device 34.61 $70.00 $2,422.70 69949 Inner ear surgery procedure 0.00 $70.00 $0.00 69950 Incise inner ear nerve 50.45 $70.00 $3,531.50 69955 Release facial nerve 55.98 $70.00 $3,918.60 69960 Release inner ear canal 54.48 $70.00 $3,813.60 69970 Remove inner ear lesion 60.63 $70.00 $4,244.10 69979 Temporal bone surgery 0.00 $70.00 $0.00 69990 Microsurgery add-on 6.42 $70.00 $449.40 70010 Contrast x-ray of brain 1.73 $70.00 $121.10 70015 Contrast x-ray of brain 4.09 $70.00 $286.30 70015 TC Contrast x-ray of brain 2.39 $70.00 $167.30 70015 26 Contrast x-ray of brain 1.70 $70.00 $119.00 70030 X-ray eye for foreign body 0.79 $70.00 $55.30 70030 TC X-ray eye for foreign body 0.55 $70.00 $38.50 70030 26 X-ray eye for foreign body 0.24 $70.00 $16.80 7010F Pt info into recall system 0.00 $70.00 $0.00 70100 X-ray exam of jaw <4views 0.93 $70.00 $65.10 70100 TC X-ray exam of jaw <4views 0.67 $70.00 $46.90 70100 26 X-ray exam of jaw <4views 0.26 $70.00 $18.20 70110 X-ray exam of jaw 4/> views 1.07 $70.00 $74.90 70110 TC X-ray exam of jaw 4/> views 0.71 $70.00 $49.70 70110 26 X-ray exam of jaw 4/> views 0.36 $70.00 $25.20 70120 X-ray exam of mastoids 0.94 $70.00 $65.80 70120 TC X-ray exam of mastoids 0.68 $70.00 $47.60 70120 26 X-ray exam of mastoids 0.26 $70.00 $18.20 70130 X-ray exam of mastoids 1.53 $70.00 $107.10 70130 TC X-ray exam of mastoids 1.04 $70.00 $72.80 70130 26 X-ray exam of mastoids 0.49 $70.00 $34.30 70134 X-ray exam of middle ear 1.41 $70.00 $98.70 NON-FACILITY HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL 70134 TC X-ray exam of middle ear 0.92 $70.00 $64.40 70134 26 X-ray exam of middle ear 0.49 $70.00 $34.30 70140 X-ray exam of facial bones 0.84 $70.00 $58.80 70140 TC X-ray exam of facial bones 0.54 $70.00 $37.80 70140 26 X-ray exam of facial bones 0.30 $70.00 $21.00 70150 X-ray exam of facial bones 1.17 $70.00 $81.90 70150 TC X-ray exam of facial bones 0.79 $70.00 $55.30 70150 26 X-ray exam of facial bones 0.38 $70.00 $26.60 70160 X-ray exam of nasal bones 0.93 $70.00 $65.10 70160 TC X-ray exam of nasal bones 0.68 $70.00 $47.60 70160 26 X-ray exam of nasal bones 0.25 $70.00 $17.50 70170 X-ray exam of tear duct 0.00 $70.00 $0.00 70170 TC X-ray exam of tear duct 0.00 $70.00 $0.00 70170 26 X-ray exam of tear duct 0.43 $70.00 $30.10 70190 X-ray exam of eye sockets 1.01 $70.00 $70.70 70190 TC X-ray exam of eye sockets 0.69 $70.00 $48.30 70190 26 X-ray exam of eye sockets 0.32 $70.00 $22.40 7020F Mammo assess cat in dbase 0.00 $70.00 $0.00 70200 X-ray exam of eye sockets 1.20 $70.00 $84.00 70200 TC X-ray exam of eye sockets 0.79 $70.00 $55.30 70200 26 X-ray exam of eye sockets 0.41 $70.00 $28.70 70210 X-ray exam of sinuses 0.84 $70.00 $58.80 70210 TC X-ray exam of sinuses 0.59 $70.00 $41.30 70210 26 X-ray exam of sinuses 0.25 $70.00 $17.50 70220 X-ray exam of sinuses 1.06 $70.00 $74.20 70220 TC X-ray exam of sinuses 0.70 $70.00 $49.00 70220 26 X-ray exam of sinuses 0.36 $70.00 $25.20 70240 X-ray exam pituitary saddle 0.87 $70.00 $60.90 70240 TC X-ray exam pituitary saddle 0.59 $70.00 $41.30 70240 26 X-ray exam pituitary saddle 0.28 $70.00 $19.60 7025F Pt infosys alarm 4 nxt mammo 0.00 $70.00 $0.00 70250 X-ray exam of skull 1.03 $70.00 $72.10 70250 TC X-ray exam of skull 0.67 $70.00 $46.90 70250 26 X-ray exam of skull 0.36 $70.00 $25.20 70260 X-ray exam of skull 1.29 $70.00 $90.30 70260 TC X-ray exam of skull 0.79 $70.00 $55.30 70260 26 X-ray exam of skull 0.50 $70.00 $35.00 70300 X-ray exam of teeth 0.42 $70.00 $29.40 70300 TC X-ray exam of teeth 0.25 $70.00 $17.50 70300 26 X-ray exam of teeth 0.17 $70.00 $11.90 70310 X-ray exam of teeth 1.05 $70.00 $73.50 70310 TC X-ray exam of teeth 0.82 $70.00 $57.40 70310 26 X-ray exam of teeth 0.23 $70.00 $16.10 70320 Full mouth x-ray of teeth 1.49 $70.00 $104.30 70320 TC Full mouth x-ray of teeth 1.14 $70.00 $79.80 NON-FACILITY HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL 70320 26 Full mouth x-ray of teeth 0.35 $70.00 $24.50 70328 X-ray exam of jaw joint 0.86 $70.00 $60.20 70328 TC X-ray exam of jaw joint 0.60 $70.00 $42.00 70328 26 X-ray exam of jaw joint 0.26 $70.00 $18.20 70330 X-ray exam of jaw joints 1.33 $70.00 $93.10 70330 TC X-ray exam of jaw joints 0.98 $70.00 $68.60 70330 26 X-ray exam of jaw joints 0.35 $70.00 $24.50 70332 X-ray exam of jaw joint 2.00 $70.00 $140.00 70332 TC X-ray exam of jaw joint 1.23 $70.00 $86.10 70332 26 X-ray exam of jaw joint 0.77 $70.00 $53.90 70336 Magnetic image jaw joint 9.12 $70.00 $638.40 70336 TC Magnetic image jaw joint 7.03 $70.00 $492.10 70336 26 Magnetic image jaw joint 2.09 $70.00 $146.30 70350 X-ray head for orthodontia 0.55 $70.00 $38.50 70350 TC X-ray head for orthodontia 0.27 $70.00 $18.90 70350 26 X-ray head for orthodontia 0.28 $70.00 $19.60 70355 Panoramic x-ray of jaws 0.59 $70.00 $41.30 70355 TC Panoramic x-ray of jaws 0.27 $70.00 $18.90 70355 26 Panoramic x-ray of jaws 0.32 $70.00 $22.40 70360 X-ray exam of neck 0.80 $70.00 $56.00 70360 TC X-ray exam of neck 0.56 $70.00 $39.20 70360 26 X-ray exam of neck 0.24 $70.00 $16.80 70370 Throat x-ray & fluoroscopy 2.03 $70.00 $142.10 70370 TC Throat x-ray & fluoroscopy 1.58 $70.00 $110.60 70370 26 Throat x-ray & fluoroscopy 0.45 $70.00 $31.50 70371 Speech evaluation complex 2.52 $70.00 $176.40 70371 TC Speech evaluation complex 1.33 $70.00 $93.10 70371 26 Speech evaluation complex 1.19 $70.00 $83.30 70380 X-ray exam of salivary gland 0.91 $70.00 $63.70 70380 TC X-ray exam of salivary gland 0.67 $70.00 $46.90 70380 26 X-ray exam of salivary gland 0.24 $70.00 $16.80 70390 X-ray exam of salivary duct 2.66 $70.00 $186.20 70390 TC X-ray exam of salivary duct 2.12 $70.00 $148.40 70390 26 X-ray exam of salivary duct 0.54 $70.00 $37.80 70450 Ct head/brain w/o dye 3.28 $70.00 $229.60 70450 TC Ct head/brain w/o dye 2.07 $70.00 $144.90 70450 26 Ct head/brain w/o dye 1.21 $70.00 $84.70 70460 Ct head/brain w/dye 4.62 $70.00 $323.40 70460 TC Ct head/brain w/dye 3.00 $70.00 $210.00 70460 26 Ct head/brain w/dye 1.62 $70.00 $113.40 70470 Ct head/brain w/o & w/dye 5.42 $70.00 $379.40 70470 TC Ct head/brain w/o & w/dye 3.61 $70.00 $252.70 70470 26 Ct head/brain w/o & w/dye 1.81 $70.00 $126.70 70480 Ct orbit/ear/fossa w/o dye 6.59 $70.00 $461.30 70480 TC Ct orbit/ear/fossa w/o dye 4.77 $70.00 $333.90 NON-FACILITY HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL 70480 26 Ct orbit/ear/fossa w/o dye 1.82 $70.00 $127.40 70481 Ct orbit/ear/fossa w/dye 7.80 $70.00 $546.00 70481 TC Ct orbit/ear/fossa w/dye 5.83 $70.00 $408.10 70481 26 Ct orbit/ear/fossa w/dye 1.97 $70.00 $137.90 70482 Ct orbit/ear/fossa w/o&w/dye 8.50 $70.00 $595.00 70482 TC Ct orbit/ear/fossa w/o&w/dye 6.44 $70.00 $450.80 70482 26 Ct orbit/ear/fossa w/o&w/dye 2.06 $70.00 $144.20 70486 Ct maxillofacial w/o dye 3.94 $70.00 $275.80 70486 TC Ct maxillofacial w/o dye 2.72 $70.00 $190.40 70486 26 Ct maxillofacial w/o dye 1.22 $70.00 $85.40 70487 Ct maxillofacial w/dye 4.74 $70.00 $331.80 70487 TC Ct maxillofacial w/dye 3.14 $70.00 $219.80 70487 26 Ct maxillofacial w/dye 1.60 $70.00 $112.00 70488 Ct maxillofacial w/o & w/dye 5.78 $70.00 $404.60 70488 TC Ct maxillofacial w/o & w/dye 3.97 $70.00 $277.90 70488 26 Ct maxillofacial w/o & w/dye 1.81 $70.00 $126.70 70490 Ct soft tissue neck w/o dye 4.76 $70.00 $333.20 70490 TC Ct soft tissue neck w/o dye 2.93 $70.00 $205.10 70490 26 Ct soft tissue neck w/o dye 1.83 $70.00 $128.10 70491 Ct soft tissue neck w/dye 5.75 $70.00 $402.50 70491 TC Ct soft tissue neck w/dye 3.78 $70.00 $264.60 70491 26 Ct soft tissue neck w/dye 1.97 $70.00 $137.90 70492 Ct sft tsue nck w/o & w/dye 6.93 $70.00 $485.10 70492 TC Ct sft tsue nck w/o & w/dye 4.62 $70.00 $323.40 70492 26 Ct sft tsue nck w/o & w/dye 2.31 $70.00 $161.70 70496 Ct angiography head 8.29 $70.00 $580.30 70496 TC Ct angiography head 5.80 $70.00 $406.00 70496 26 Ct angiography head 2.49 $70.00 $174.30 70498 Ct angiography neck 8.27 $70.00 $578.90 70498 TC Ct angiography neck 5.78 $70.00 $404.60 70498 26 Ct angiography neck 2.49 $70.00 $174.30 70540 Mri orbit/face/neck w/o dye 7.68 $70.00 $537.60 70540 TC Mri orbit/face/neck w/o dye 5.76 $70.00 $403.20 70540 26 Mri orbit/face/neck w/o dye 1.92 $70.00 $134.40 70542 Mri orbit/face/neck w/dye 9.11 $70.00 $637.70 70542 TC Mri orbit/face/neck w/dye 6.80 $70.00 $476.00 70542 26 Mri orbit/face/neck w/dye 2.31 $70.00 $161.70 70543 Mri orbt/fac/nck w/o &w/dye 11.44 $70.00 $800.80 70543 TC Mri orbt/fac/nck w/o &w/dye 8.40 $70.00 $588.00 70543 26 Mri orbt/fac/nck w/o &w/dye 3.04 $70.00 $212.80 70544 Mr angiography head w/o dye 9.28 $70.00 $649.60 70544 TC Mr angiography head w/o dye 7.57 $70.00 $529.90 70544 26 Mr angiography head w/o dye 1.71 $70.00 $119.70 70545 Mr angiography head w/dye 9.20 $70.00 $644.00 70545 TC Mr angiography head w/dye 7.49 $70.00 $524.30 NON-FACILITY HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL 70545 26 Mr angiography head w/dye 1.71 $70.00 $119.70 70546 Mr angiograph head w/o&w/dye 13.70 $70.00 $959.00 70546 TC Mr angiograph head w/o&w/dye 11.60 $70.00 $812.00 70546 26 Mr angiograph head w/o&w/dye 2.10 $70.00 $147.00 70547 Mr angiography neck w/o dye 9.33 $70.00 $653.10 70547 TC Mr angiography neck w/o dye 7.61 $70.00 $532.70 70547 26 Mr angiography neck w/o dye 1.72 $70.00 $120.40 70548 Mr angiography neck w/dye 10.19 $70.00 $713.30 70548 TC Mr angiography neck w/dye 8.05 $70.00 $563.50 70548 26 Mr angiography neck w/dye 2.14 $70.00 $149.80 70549 Mr angiograph neck w/o&w/dye 14.24 $70.00 $996.80 70549 TC Mr angiograph neck w/o&w/dye 11.68 $70.00 $817.60 70549 26 Mr angiograph neck w/o&w/dye 2.56 $70.00 $179.20 70551 Mri brain stem w/o dye 6.55 $70.00 $458.50 70551 TC Mri brain stem w/o dye 4.43 $70.00 $310.10 70551 26 Mri brain stem w/o dye 2.12 $70.00 $148.40 70552 Mri brain stem w/dye 9.08 $70.00 $635.60 70552 TC Mri brain stem w/dye 6.54 $70.00 $457.80 70552 26 Mri brain stem w/dye 2.54 $70.00 $177.80 70553 Mri brain stem w/o & w/dye 10.71 $70.00 $749.70 70553 TC Mri brain stem w/o & w/dye 7.46 $70.00 $522.20 70553 26 Mri brain stem w/o & w/dye 3.25 $70.00 $227.50 70554 Fmri brain by tech 12.74 $70.00 $891.80 70554 TC Fmri brain by tech 9.73 $70.00 $681.10 70554 26 Fmri brain by tech 3.01 $70.00 $210.70 70555 Fmri brain by phys/psych 0.00 $70.00 $0.00 70555 TC Fmri brain by phys/psych 0.00 $70.00 $0.00 70555 26 Fmri brain by phys/psych 3.56 $70.00 $249.20 70557 Mri brain w/o dye 0.00 $70.00 $0.00 70557 TC Mri brain w/o dye 0.00 $70.00 $0.00 70557 26 Mri brain w/o dye 4.46 $70.00 $312.20 70558 Mri brain w/dye 0.00 $70.00 $0.00 70558 TC Mri brain w/dye 0.00 $70.00 $0.00 70558 26 Mri brain w/dye 4.91 $70.00 $343.70 70559 Mri brain w/o & w/dye 0.00 $70.00 $0.00 70559 TC Mri brain w/o & w/dye 0.00 $70.00 $0.00 70559 26 Mri brain w/o & w/dye 4.63 $70.00 $324.10 71045 X-ray exam chest 1 view 0.56 $70.00 $39.20 71045 TC X-ray exam chest 1 view 0.30 $70.00 $21.00 71045 26 X-ray exam chest 1 view 0.26 $70.00 $18.20 71046 X-ray exam chest 2 views 0.86 $70.00 $60.20 71046 TC X-ray exam chest 2 views 0.55 $70.00 $38.50 71046 26 X-ray exam chest 2 views 0.31 $70.00 $21.70 71047 X-ray exam chest 3 views 1.10 $70.00 $77.00 71047 TC X-ray exam chest 3 views 0.70 $70.00 $49.00 NON-FACILITY HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL 71047 26 X-ray exam chest 3 views 0.40 $70.00 $28.00 71048 X-ray exam chest 4+ views 1.18 $70.00 $82.60 71048 TC X-ray exam chest 4+ views 0.72 $70.00 $50.40 71048 26 X-ray exam chest 4+ views 0.46 $70.00 $32.20 71100 X-ray exam ribs uni 2 views 0.94 $70.00 $65.80 71100 TC X-ray exam ribs uni 2 views 0.62 $70.00 $43.40 71100 26 X-ray exam ribs uni 2 views 0.32 $70.00 $22.40 71101 X-ray exam unilat ribs/chest 1.08 $70.00 $75.60 71101 TC X-ray exam unilat ribs/chest 0.69 $70.00 $48.30 71101 26 X-ray exam unilat ribs/chest 0.39 $70.00 $27.30 71110 X-ray exam ribs bil 3 views 1.13 $70.00 $79.10 71110 TC X-ray exam ribs bil 3 views 0.71 $70.00 $49.70 71110 26 X-ray exam ribs bil 3 views 0.42 $70.00 $29.40 71111 X-ray exam ribs/chest4/> vws 1.33 $70.00 $93.10 71111 TC X-ray exam ribs/chest4/> vws 0.86 $70.00 $60.20 71111 26 X-ray exam ribs/chest4/> vws 0.47 $70.00 $32.90 71120 X-ray exam breastbone 2/>vws 0.84 $70.00 $58.80 71120 TC X-ray exam breastbone 2/>vws 0.55 $70.00 $38.50 71120 26 X-ray exam breastbone 2/>vws 0.29 $70.00 $20.30 71130 X-ray strenoclavic jt 3/>vws 1.02 $70.00 $71.40 71130 TC X-ray strenoclavic jt 3/>vws 0.70 $70.00 $49.00 71130 26 X-ray strenoclavic jt 3/>vws 0.32 $70.00 $22.40 71250 Ct thorax w/o dye 4.61 $70.00 $322.70 71250 TC Ct thorax w/o dye 2.95 $70.00 $206.50 71250 26 Ct thorax w/o dye 1.66 $70.00 $116.20 71260 Ct thorax w/dye 5.56 $70.00 $389.20 71260 TC Ct thorax w/dye 3.79 $70.00 $265.30 71260 26 Ct thorax w/dye 1.77 $70.00 $123.90 71270 Ct thorax w/o & w/dye 6.66 $70.00 $466.20 71270 TC Ct thorax w/o & w/dye 4.69 $70.00 $328.30 71270 26 Ct thorax w/o & w/dye 1.97 $70.00 $137.90 71275 Ct angiography chest 8.49 $70.00 $594.30 71275 TC Ct angiography chest 5.90 $70.00 $413.00 71275 26 Ct angiography chest 2.59 $70.00 $181.30 71550 Mri chest w/o dye 11.76 $70.00 $823.20 71550 TC Mri chest w/o dye 9.68 $70.00 $677.60 71550 26 Mri chest w/o dye 2.08 $70.00 $145.60 71551 Mri chest w/dye 12.95 $70.00 $906.50 71551 TC Mri chest w/dye 10.49 $70.00 $734.30 71551 26 Mri chest w/dye 2.46 $70.00 $172.20 71552 Mri chest w/o & w/dye 16.41 $70.00 $1,148.70 71552 TC Mri chest w/o & w/dye 13.20 $70.00 $924.00 71552 26 Mri chest w/o & w/dye 3.21 $70.00 $224.70 71555 Mri angio chest w or w/o dye 11.32 $70.00 $792.40 71555 TC Mri angio chest w or w/o dye 8.77 $70.00 $613.90 NON-FACILITY HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL 71555 26 Mri angio chest w or w/o dye 2.55 $70.00 $178.50 72020 X-ray exam of spine 1 view 0.63 $70.00 $44.10 72020 TC X-ray exam of spine 1 view 0.41 $70.00 $28.70 72020 26 X-ray exam of spine 1 view 0.22 $70.00 $15.40 72040 X-ray exam neck spine 2-3 vw 0.94 $70.00 $65.80 72040 TC X-ray exam neck spine 2-3 vw 0.62 $70.00 $43.40 72040 26 X-ray exam neck spine 2-3 vw 0.32 $70.00 $22.40 72050 X-ray exam neck spine 4/5vws 1.28 $70.00 $89.60 72050 TC X-ray exam neck spine 4/5vws 0.83 $70.00 $58.10 72050 26 X-ray exam neck spine 4/5vws 0.45 $70.00 $31.50 72052 X-ray exam neck spine 6/>vws 1.58 $70.00 $110.60 72052 TC X-ray exam neck spine 6/>vws 1.06 $70.00 $74.20 72052 26 X-ray exam neck spine 6/>vws 0.52 $70.00 $36.40 72070 X-ray exam thorac spine 2vws 0.96 $70.00 $67.20 72070 TC X-ray exam thorac spine 2vws 0.64 $70.00 $44.80 72070 26 X-ray exam thorac spine 2vws 0.32 $70.00 $22.40 72072 X-ray exam thorac spine 3vws 0.98 $70.00 $68.60 72072 TC X-ray exam thorac spine 3vws 0.67 $70.00 $46.90 72072 26 X-ray exam thorac spine 3vws 0.31 $70.00 $21.70 72074 X-ray exam thorac spine4/>vw 1.10 $70.00 $77.00 72074 TC X-ray exam thorac spine4/>vw 0.79 $70.00 $55.30 72074 26 X-ray exam thorac spine4/>vw 0.31 $70.00 $21.70 72080 X-ray exam thoracolmb 2/> vw 0.95 $70.00 $66.50 72080 TC X-ray exam thoracolmb 2/> vw 0.63 $70.00 $44.10 72080 26 X-ray exam thoracolmb 2/> vw 0.32 $70.00 $22.40 72081 X-ray exam entire spi 1 vw 1.09 $70.00 $76.30 72081 TC X-ray exam entire spi 1 vw 0.71 $70.00 $49.70 72081 26 X-ray exam entire spi 1 vw 0.38 $70.00 $26.60 72082 X-ray exam entire spi 2/3 vw 1.76 $70.00 $123.20 72082 TC X-ray exam entire spi 2/3 vw 1.30 $70.00 $91.00 72082 26 X-ray exam entire spi 2/3 vw 0.46 $70.00 $32.20 72083 X-ray exam entire spi 4/5 vw 2.12 $70.00 $148.40 72083 TC X-ray exam entire spi 4/5 vw 1.60 $70.00 $112.00 72083 26 X-ray exam entire spi 4/5 vw 0.52 $70.00 $36.40 72084 X-ray exam entire spi 6/> vw 2.47 $70.00 $172.90 72084 TC X-ray exam entire spi 6/> vw 1.86 $70.00 $130.20 72084 26 X-ray exam entire spi 6/> vw 0.61 $70.00 $42.70 72100 X-ray exam l-s spine 2/3 vws 0.99 $70.00 $69.30 72100 TC X-ray exam l-s spine 2/3 vws 0.67 $70.00 $46.90 72100 26 X-ray exam l-s spine 2/3 vws 0.32 $70.00 $22.40 72110 X-ray exam l-2 spine 4/>vws 1.38 $70.00 $96.60 72110 TC X-ray exam l-2 spine 4/>vws 0.93 $70.00 $65.10 72110 26 X-ray exam l-2 spine 4/>vws 0.45 $70.00 $31.50 72114 X-ray exam l-s spine bending 1.74 $70.00 $121.80 72114 TC X-ray exam l-s spine bending 1.27 $70.00 $88.90 NON-FACILITY HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL 72114 26 X-ray exam l-s spine bending 0.47 $70.00 $32.90 72120 X-ray bend only l-s spine 1.15 $70.00 $80.50 72120 TC X-ray bend only l-s spine 0.83 $70.00 $58.10 72120 26 X-ray bend only l-s spine 0.32 $70.00 $22.40 72125 Ct neck spine w/o dye 5.22 $70.00 $365.40 72125 TC Ct neck spine w/o dye 3.70 $70.00 $259.00 72125 26 Ct neck spine w/o dye 1.52 $70.00 $106.40 72126 Ct neck spine w/dye 6.45 $70.00 $451.50 72126 TC Ct neck spine w/dye 4.71 $70.00 $329.70 72126 26 Ct neck spine w/dye 1.74 $70.00 $121.80 72127 Ct neck spine w/o & w/dye 7.64 $70.00 $534.80 72127 TC Ct neck spine w/o & w/dye 5.84 $70.00 $408.80 72127 26 Ct neck spine w/o & w/dye 1.80 $70.00 $126.00 72128 Ct chest spine w/o dye 5.11 $70.00 $357.70 72128 TC Ct chest spine w/o dye 3.68 $70.00 $257.60 72128 26 Ct chest spine w/o dye 1.43 $70.00 $100.10 72129 Ct chest spine w/dye 6.48 $70.00 $453.60 72129 TC Ct chest spine w/dye 4.74 $70.00 $331.80 72129 26 Ct chest spine w/dye 1.74 $70.00 $121.80 72130 Ct chest spine w/o & w/dye 7.69 $70.00 $538.30 72130 TC Ct chest spine w/o & w/dye 5.88 $70.00 $411.60 72130 26 Ct chest spine w/o & w/dye 1.81 $70.00 $126.70 72131 Ct lumbar spine w/o dye 5.09 $70.00 $356.30 72131 TC Ct lumbar spine w/o dye 3.66 $70.00 $256.20 72131 26 Ct lumbar spine w/o dye 1.43 $70.00 $100.10 72132 Ct lumbar spine w/dye 6.45 $70.00 $451.50 72132 TC Ct lumbar spine w/dye 4.71 $70.00 $329.70 72132 26 Ct lumbar spine w/dye 1.74 $70.00 $121.80 72133 Ct lumbar spine w/o & w/dye 7.62 $70.00 $533.40 72133 TC Ct lumbar spine w/o & w/dye 5.81 $70.00 $406.70 72133 26 Ct lumbar spine w/o & w/dye 1.81 $70.00 $126.70 72141 Mri neck spine w/o dye 6.37 $70.00 $445.90 72141 TC Mri neck spine w/o dye 4.25 $70.00 $297.50 72141 26 Mri neck spine w/o dye 2.12 $70.00 $148.40 72142 Mri neck spine w/dye 9.25 $70.00 $647.50 72142 TC Mri neck spine w/dye 6.70 $70.00 $469.00 72142 26 Mri neck spine w/dye 2.55 $70.00 $178.50 72146 Mri chest spine w/o dye 6.38 $70.00 $446.60 72146 TC Mri chest spine w/o dye 4.26 $70.00 $298.20 72146 26 Mri chest spine w/o dye 2.12 $70.00 $148.40 72147 Mri chest spine w/dye 9.18 $70.00 $642.60 72147 TC Mri chest spine w/dye 6.64 $70.00 $464.80 72147 26 Mri chest spine w/dye 2.54 $70.00 $177.80 72148 Mri lumbar spine w/o dye 6.37 $70.00 $445.90 72148 TC Mri lumbar spine w/o dye 4.25 $70.00 $297.50 NON-FACILITY HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL 72148 26 Mri lumbar spine w/o dye 2.12 $70.00 $148.40 72149 Mri lumbar spine w/dye 9.13 $70.00 $639.10 72149 TC Mri lumbar spine w/dye 6.58 $70.00 $460.60 72149 26 Mri lumbar spine w/dye 2.55 $70.00 $178.50 72156 Mri neck spine w/o & w/dye 10.77 $70.00 $753.90 72156 TC Mri neck spine w/o & w/dye 7.52 $70.00 $526.40 72156 26 Mri neck spine w/o & w/dye 3.25 $70.00 $227.50 72157 Mri chest spine w/o & w/dye 10.79 $70.00 $755.30 72157 TC Mri chest spine w/o & w/dye 7.54 $70.00 $527.80 72157 26 Mri chest spine w/o & w/dye 3.25 $70.00 $227.50 72158 Mri lumbar spine w/o & w/dye 10.75 $70.00 $752.50 72158 TC Mri lumbar spine w/o & w/dye 7.49 $70.00 $524.30 72158 26 Mri lumbar spine w/o & w/dye 3.26 $70.00 $228.20 72159 Mr angio spine w/o&w/dye 11.57 $70.00 $809.90 72159 TC Mr angio spine w/o&w/dye 9.02 $70.00 $631.40 72159 26 Mr angio spine w/o&w/dye 2.55 $70.00 $178.50 72170 X-ray exam of pelvis 0.90 $70.00 $63.00 72170 TC X-ray exam of pelvis 0.65 $70.00 $45.50 72170 26 X-ray exam of pelvis 0.25 $70.00 $17.50 72190 X-ray exam of pelvis 1.07 $70.00 $74.90 72190 TC X-ray exam of pelvis 0.76 $70.00 $53.20 72190 26 X-ray exam of pelvis 0.31 $70.00 $21.70 72191 Ct angiograph pelv w/o&w/dye 8.65 $70.00 $605.50 72191 TC Ct angiograph pelv w/o&w/dye 6.09 $70.00 $426.30 72191 26 Ct angiograph pelv w/o&w/dye 2.56 $70.00 $179.20 72192 Ct pelvis w/o dye 4.13 $70.00 $289.10 72192 TC Ct pelvis w/o dye 2.58 $70.00 $180.60 72192 26 Ct pelvis w/o dye 1.55 $70.00 $108.50 72193 Ct pelvis w/dye 6.39 $70.00 $447.30 72193 TC Ct pelvis w/dye 4.73 $70.00 $331.10 72193 26 Ct pelvis w/dye 1.66 $70.00 $116.20 72194 Ct pelvis w/o & w/dye 7.36 $70.00 $515.20 72194 TC Ct pelvis w/o & w/dye 5.62 $70.00 $393.40 72194 26 Ct pelvis w/o & w/dye 1.74 $70.00 $121.80 72195 Mri pelvis w/o dye 8.97 $70.00 $627.90 72195 TC Mri pelvis w/o dye 6.89 $70.00 $482.30 72195 26 Mri pelvis w/o dye 2.08 $70.00 $145.60 72196 Mri pelvis w/dye 9.85 $70.00 $689.50 72196 TC Mri pelvis w/dye 7.38 $70.00 $516.60 72196 26 Mri pelvis w/dye 2.47 $70.00 $172.90 72197 Mri pelvis w/o & w/dye 12.07 $70.00 $844.90 72197 TC Mri pelvis w/o & w/dye 8.94 $70.00 $625.80 72197 26 Mri pelvis w/o & w/dye 3.13 $70.00 $219.10 72198 Mr angio pelvis w/o & w/dye 11.35 $70.00 $794.50 72198 TC Mr angio pelvis w/o & w/dye 8.82 $70.00 $617.40 NON-FACILITY HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL 72198 26 Mr angio pelvis w/o & w/dye 2.53 $70.00 $177.10 72200 X-ray exam si joints 0.80 $70.00 $56.00 72200 TC X-ray exam si joints 0.55 $70.00 $38.50 72200 26 X-ray exam si joints 0.25 $70.00 $17.50 72202 X-ray exam si joints 3/> vws 0.93 $70.00 $65.10 72202 TC X-ray exam si joints 3/> vws 0.66 $70.00 $46.20 72202 26 X-ray exam si joints 3/> vws 0.27 $70.00 $18.90 72220 X-ray exam sacrum tailbone 0.80 $70.00 $56.00 72220 TC X-ray exam sacrum tailbone 0.55 $70.00 $38.50 72220 26 X-ray exam sacrum tailbone 0.25 $70.00 $17.50 72240 Myelography neck spine 2.77 $70.00 $193.90 72240 TC Myelography neck spine 1.48 $70.00 $103.60 72240 26 Myelography neck spine 1.29 $70.00 $90.30 72255 Myelography thoracic spine 2.78 $70.00 $194.60 72255 TC Myelography thoracic spine 1.46 $70.00 $102.20 72255 26 Myelography thoracic spine 1.32 $70.00 $92.40 72265 Myelography l-s spine 2.60 $70.00 $182.00 72265 TC Myelography l-s spine 1.43 $70.00 $100.10 72265 26 Myelography l-s spine 1.17 $70.00 $81.90 72270 Myelogphy 2/> spine regions 3.62 $70.00 $253.40 72270 TC Myelogphy 2/> spine regions 1.70 $70.00 $119.00 72270 26 Myelogphy 2/> spine regions 1.92 $70.00 $134.40 72275 Epidurography 3.27 $70.00 $228.90 72275 TC Epidurography 2.16 $70.00 $151.20 72275 26 Epidurography 1.11 $70.00 $77.70 72285 Discography cerv/thor spine 3.17 $70.00 $221.90 72285 TC Discography cerv/thor spine 1.47 $70.00 $102.90 72285 26 Discography cerv/thor spine 1.70 $70.00 $119.00 72295 X-ray of lower spine disk 2.75 $70.00 $192.50 72295 TC X-ray of lower spine disk 1.52 $70.00 $106.40 72295 26 X-ray of lower spine disk 1.23 $70.00 $86.10 73000 X-ray exam of collar bone 0.79 $70.00 $55.30 73000 TC X-ray exam of collar bone 0.55 $70.00 $38.50 73000 26 X-ray exam of collar bone 0.24 $70.00 $16.80 73010 X-ray exam of shoulder blade 0.86 $70.00 $60.20 73010 TC X-ray exam of shoulder blade 0.60 $70.00 $42.00 73010 26 X-ray exam of shoulder blade 0.26 $70.00 $18.20 73020 X-ray exam of shoulder 0.65 $70.00 $45.50 73020 TC X-ray exam of shoulder 0.42 $70.00 $29.40 73020 26 X-ray exam of shoulder 0.23 $70.00 $16.10 73030 X-ray exam of shoulder 0.83 $70.00 $58.10 73030 TC X-ray exam of shoulder 0.56 $70.00 $39.20 73030 26 X-ray exam of shoulder 0.27 $70.00 $18.90 73040 Contrast x-ray of shoulder 2.86 $70.00 $200.20 73040 TC Contrast x-ray of shoulder 2.08 $70.00 $145.60 NON-FACILITY HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL 73040 26 Contrast x-ray of shoulder 0.78 $70.00 $54.60 73050 X-ray exam of shoulders 1.01 $70.00 $70.70 73050 TC X-ray exam of shoulders 0.71 $70.00 $49.70 73050 26 X-ray exam of shoulders 0.30 $70.00 $21.00 73060 X-ray exam of humerus 0.82 $70.00 $57.40 73060 TC X-ray exam of humerus 0.58 $70.00 $40.60 73060 26 X-ray exam of humerus 0.24 $70.00 $16.80 73070 X-ray exam of elbow 0.77 $70.00 $53.90 73070 TC X-ray exam of elbow 0.54 $70.00 $37.80 73070 26 X-ray exam of elbow 0.23 $70.00 $16.10 73080 X-ray exam of elbow 0.89 $70.00 $62.30 73080 TC X-ray exam of elbow 0.64 $70.00 $44.80 73080 26 X-ray exam of elbow 0.25 $70.00 $17.50 73085 Contrast x-ray of elbow 2.71 $70.00 $189.70 73085 TC Contrast x-ray of elbow 1.89 $70.00 $132.30 73085 26 Contrast x-ray of elbow 0.82 $70.00 $57.40 73090 X-ray exam of forearm 0.73 $70.00 $51.10 73090 TC X-ray exam of forearm 0.49 $70.00 $34.30 73090 26 X-ray exam of forearm 0.24 $70.00 $16.80 73092 X-ray exam of arm infant 0.77 $70.00 $53.90 73092 TC X-ray exam of arm infant 0.54 $70.00 $37.80 73092 26 X-ray exam of arm infant 0.23 $70.00 $16.10 73100 X-ray exam of wrist 0.89 $70.00 $62.30 73100 TC X-ray exam of wrist 0.64 $70.00 $44.80 73100 26 X-ray exam of wrist 0.25 $70.00 $17.50 73110 X-ray exam of wrist 0.99 $70.00 $69.30 73110 TC X-ray exam of wrist 0.74 $70.00 $51.80 73110 26 X-ray exam of wrist 0.25 $70.00 $17.50 73115 Contrast x-ray of wrist 3.02 $70.00 $211.40 73115 TC Contrast x-ray of wrist 2.21 $70.00 $154.70 73115 26 Contrast x-ray of wrist 0.81 $70.00 $56.70 73120 X-ray exam of hand 0.80 $70.00 $56.00 73120 TC X-ray exam of hand 0.56 $70.00 $39.20 73120 26 X-ray exam of hand 0.24 $70.00 $16.80 73130 X-ray exam of hand 0.90 $70.00 $63.00 73130 TC X-ray exam of hand 0.65 $70.00 $45.50 73130 26 X-ray exam of hand 0.25 $70.00 $17.50 73140 X-ray exam of finger(s) 0.91 $70.00 $63.70 73140 TC X-ray exam of finger(s) 0.71 $70.00 $49.70 73140 26 X-ray exam of finger(s) 0.20 $70.00 $14.00 73200 Ct upper extremity w/o dye 5.08 $70.00 $355.60 73200 TC Ct upper extremity w/o dye 3.65 $70.00 $255.50 73200 26 Ct upper extremity w/o dye 1.43 $70.00 $100.10 73201 Ct upper extremity w/dye 6.30 $70.00 $441.00 73201 TC Ct upper extremity w/dye 4.64 $70.00 $324.80 NON-FACILITY HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL 73201 26 Ct upper extremity w/dye 1.66 $70.00 $116.20 73202 Ct uppr extremity w/o&w/dye 7.86 $70.00 $550.20 73202 TC Ct uppr extremity w/o&w/dye 6.12 $70.00 $428.40 73202 26 Ct uppr extremity w/o&w/dye 1.74 $70.00 $121.80 73206 Ct angio upr extrm w/o&w/dye 9.28 $70.00 $649.60 73206 TC Ct angio upr extrm w/o&w/dye 6.73 $70.00 $471.10 73206 26 Ct angio upr extrm w/o&w/dye 2.55 $70.00 $178.50 73218 Mri upper extremity w/o dye 10.39 $70.00 $727.30 73218 TC Mri upper extremity w/o dye 8.46 $70.00 $592.20 73218 26 Mri upper extremity w/o dye 1.93 $70.00 $135.10 73219 Mri upper extremity w/dye 11.42 $70.00 $799.40 73219 TC Mri upper extremity w/dye 9.11 $70.00 $637.70 73219 26 Mri upper extremity w/dye 2.31 $70.00 $161.70 73220 Mri uppr extremity w/o&w/dye 14.16 $70.00 $991.20 73220 TC Mri uppr extremity w/o&w/dye 11.10 $70.00 $777.00 73220 26 Mri uppr extremity w/o&w/dye 3.06 $70.00 $214.20 73221 Mri joint upr extrem w/o dye 6.73 $70.00 $471.10 73221 TC Mri joint upr extrem w/o dye 4.79 $70.00 $335.30 73221 26 Mri joint upr extrem w/o dye 1.94 $70.00 $135.80 73222 Mri joint upr extrem w/dye 10.75 $70.00 $752.50 73222 TC Mri joint upr extrem w/dye 8.43 $70.00 $590.10 73222 26 Mri joint upr extrem w/dye 2.32 $70.00 $162.40 73223 Mri joint upr extr w/o&w/dye 13.33 $70.00 $933.10 73223 TC Mri joint upr extr w/o&w/dye 10.27 $70.00 $718.90 73223 26 Mri joint upr extr w/o&w/dye 3.06 $70.00 $214.20 73225 Mr angio upr extr w/o&w/dye 11.56 $70.00 $809.20 73225 TC Mr angio upr extr w/o&w/dye 9.12 $70.00 $638.40 73225 26 Mr angio upr extr w/o&w/dye 2.44 $70.00 $170.80 73501 X-ray exam hip uni 1 view 0.85 $70.00 $59.50 73501 TC X-ray exam hip uni 1 view 0.58 $70.00 $40.60 73501 26 X-ray exam hip uni 1 view 0.27 $70.00 $18.90 73502 X-ray exam hip uni 2-3 views 1.17 $70.00 $81.90 73502 TC X-ray exam hip uni 2-3 views 0.85 $70.00 $59.50 73502 26 X-ray exam hip uni 2-3 views 0.32 $70.00 $22.40 73503 X-ray exam hip uni 4/> views 1.46 $70.00 $102.20 73503 TC X-ray exam hip uni 4/> views 1.05 $70.00 $73.50 73503 26 X-ray exam hip uni 4/> views 0.41 $70.00 $28.70 73521 X-ray exam hips bi 2 views 1.06 $70.00 $74.20 73521 TC X-ray exam hips bi 2 views 0.74 $70.00 $51.80 73521 26 X-ray exam hips bi 2 views 0.32 $70.00 $22.40 73522 X-ray exam hips bi 3-4 views 1.38 $70.00 $96.60 73522 TC X-ray exam hips bi 3-4 views 0.95 $70.00 $66.50 73522 26 X-ray exam hips bi 3-4 views 0.43 $70.00 $30.10 73523 X-ray exam hips bi 5/> views 1.60 $70.00 $112.00 73523 TC X-ray exam hips bi 5/> views 1.14 $70.00 $79.80 NON-FACILITY HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL 73523 26 X-ray exam hips bi 5/> views 0.46 $70.00 $32.20 73525 Contrast x-ray of hip 2.92 $70.00 $204.40 73525 TC Contrast x-ray of hip 2.09 $70.00 $146.30 73525 26 Contrast x-ray of hip 0.83 $70.00 $58.10 73551 X-ray exam of femur 1 0.79 $70.00 $55.30 73551 TC X-ray exam of femur 1 0.55 $70.00 $38.50 73551 26 X-ray exam of femur 1 0.24 $70.00 $16.80 73552 X-ray exam of femur 2/> 0.93 $70.00 $65.10 73552 TC X-ray exam of femur 2/> 0.66 $70.00 $46.20 73552 26 X-ray exam of femur 2/> 0.27 $70.00 $18.90 73560 X-ray exam of knee 1 or 2 0.88 $70.00 $61.60 73560 TC X-ray exam of knee 1 or 2 0.64 $70.00 $44.80 73560 26 X-ray exam of knee 1 or 2 0.24 $70.00 $16.80 73562 X-ray exam of knee 3 1.01 $70.00 $70.70 73562 TC X-ray exam of knee 3 0.74 $70.00 $51.80 73562 26 X-ray exam of knee 3 0.27 $70.00 $18.90 73564 X-ray exam knee 4 or more 1.12 $70.00 $78.40 73564 TC X-ray exam knee 4 or more 0.80 $70.00 $56.00 73564 26 X-ray exam knee 4 or more 0.32 $70.00 $22.40 73565 X-ray exam of knees 1.01 $70.00 $70.70 73565 TC X-ray exam of knees 0.76 $70.00 $53.20 73565 26 X-ray exam of knees 0.25 $70.00 $17.50 73580 Contrast x-ray of knee joint 3.31 $70.00 $231.70 73580 TC Contrast x-ray of knee joint 2.49 $70.00 $174.30 73580 26 Contrast x-ray of knee joint 0.82 $70.00 $57.40 73590 X-ray exam of lower leg 0.81 $70.00 $56.70 73590 TC X-ray exam of lower leg 0.57 $70.00 $39.90 73590 26 X-ray exam of lower leg 0.24 $70.00 $16.80 73592 X-ray exam of leg infant 0.77 $70.00 $53.90 73592 TC X-ray exam of leg infant 0.54 $70.00 $37.80 73592 26 X-ray exam of leg infant 0.23 $70.00 $16.10 73600 X-ray exam of ankle 0.84 $70.00 $58.80 73600 TC X-ray exam of ankle 0.60 $70.00 $42.00 73600 26 X-ray exam of ankle 0.24 $70.00 $16.80 73610 X-ray exam of ankle 0.89 $70.00 $62.30 73610 TC X-ray exam of ankle 0.64 $70.00 $44.80 73610 26 X-ray exam of ankle 0.25 $70.00 $17.50 73615 Contrast x-ray of ankle 3.02 $70.00 $211.40 73615 TC Contrast x-ray of ankle 2.20 $70.00 $154.00 73615 26 Contrast x-ray of ankle 0.82 $70.00 $57.40 73620 X-ray exam of foot 0.74 $70.00 $51.80 73620 TC X-ray exam of foot 0.52 $70.00 $36.40 73620 26 X-ray exam of foot 0.22 $70.00 $15.40 73630 X-ray exam of foot 0.83 $70.00 $58.10 73630 TC X-ray exam of foot 0.59 $70.00 $41.30 NON-FACILITY HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL 73630 26 X-ray exam of foot 0.24 $70.00 $16.80 73650 X-ray exam of heel 0.77 $70.00 $53.90 73650 TC X-ray exam of heel 0.54 $70.00 $37.80 73650 26 X-ray exam of heel 0.23 $70.00 $16.10 73660 X-ray exam of toe(s) 0.80 $70.00 $56.00 73660 TC X-ray exam of toe(s) 0.61 $70.00 $42.70 73660 26 X-ray exam of toe(s) 0.19 $70.00 $13.30 73700 Ct lower extremity w/o dye 5.09 $70.00 $356.30 73700 TC Ct lower extremity w/o dye 3.66 $70.00 $256.20 73700 26 Ct lower extremity w/o dye 1.43 $70.00 $100.10 73701 Ct lower extremity w/dye 6.39 $70.00 $447.30 73701 TC Ct lower extremity w/dye 4.73 $70.00 $331.10 73701 26 Ct lower extremity w/dye 1.66 $70.00 $116.20 73702 Ct lwr extremity w/o&w/dye 7.76 $70.00 $543.20 73702 TC Ct lwr extremity w/o&w/dye 6.03 $70.00 $422.10 73702 26 Ct lwr extremity w/o&w/dye 1.73 $70.00 $121.10 73706 Ct angio lwr extr w/o&w/dye 10.06 $70.00 $704.20 73706 TC Ct angio lwr extr w/o&w/dye 7.37 $70.00 $515.90 73706 26 Ct angio lwr extr w/o&w/dye 2.69 $70.00 $188.30 73718 Mri lower extremity w/o dye 8.70 $70.00 $609.00 73718 TC Mri lower extremity w/o dye 6.77 $70.00 $473.90 73718 26 Mri lower extremity w/o dye 1.93 $70.00 $135.10 73719 Mri lower extremity w/dye 9.69 $70.00 $678.30 73719 TC Mri lower extremity w/dye 7.38 $70.00 $516.60 73719 26 Mri lower extremity w/dye 2.31 $70.00 $161.70 73720 Mri lwr extremity w/o&w/dye 12.05 $70.00 $843.50 73720 TC Mri lwr extremity w/o&w/dye 9.00 $70.00 $630.00 73720 26 Mri lwr extremity w/o&w/dye 3.05 $70.00 $213.50 73721 Mri jnt of lwr extre w/o dye 6.73 $70.00 $471.10 73721 TC Mri jnt of lwr extre w/o dye 4.79 $70.00 $335.30 73721 26 Mri jnt of lwr extre w/o dye 1.94 $70.00 $135.80 73722 Mri joint of lwr extr w/dye 10.82 $70.00 $757.40 73722 TC Mri joint of lwr extr w/dye 8.50 $70.00 $595.00 73722 26 Mri joint of lwr extr w/dye 2.32 $70.00 $162.40 73723 Mri joint lwr extr w/o&w/dye 13.31 $70.00 $931.70 73723 TC Mri joint lwr extr w/o&w/dye 10.26 $70.00 $718.20 73723 26 Mri joint lwr extr w/o&w/dye 3.05 $70.00 $213.50 73725 Mr ang lwr ext w or w/o dye 11.36 $70.00 $795.20 73725 TC Mr ang lwr ext w or w/o dye 8.80 $70.00 $616.00 73725 26 Mr ang lwr ext w or w/o dye 2.56 $70.00 $179.20 74018 X-ray exam abdomen 1 view 0.77 $70.00 $53.90 74018 TC X-ray exam abdomen 1 view 0.51 $70.00 $35.70 74018 26 X-ray exam abdomen 1 view 0.26 $70.00 $18.20 74019 X-ray exam abdomen 2 views 0.94 $70.00 $65.80 74019 TC X-ray exam abdomen 2 views 0.61 $70.00 $42.70 NON-FACILITY HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL 74019 26 X-ray exam abdomen 2 views 0.33 $70.00 $23.10 74021 X-ray exam abdomen 3+ views 1.10 $70.00 $77.00 74021 TC X-ray exam abdomen 3+ views 0.71 $70.00 $49.70 74021 26 X-ray exam abdomen 3+ views 0.39 $70.00 $27.30 74022 X-ray exam series abdomen 1.26 $70.00 $88.20 74022 TC X-ray exam series abdomen 0.80 $70.00 $56.00 74022 26 X-ray exam series abdomen 0.46 $70.00 $32.20 74150 Ct abdomen w/o dye 4.24 $70.00 $296.80 74150 TC Ct abdomen w/o dye 2.54 $70.00 $177.80 74150 26 Ct abdomen w/o dye 1.70 $70.00 $119.00 74160 Ct abdomen w/dye 6.53 $70.00 $457.10 74160 TC Ct abdomen w/dye 4.72 $70.00 $330.40 74160 26 Ct abdomen w/dye 1.81 $70.00 $126.70 74170 Ct abdomen w/o & w/dye 7.43 $70.00 $520.10 74170 TC Ct abdomen w/o & w/dye 5.43 $70.00 $380.10 74170 26 Ct abdomen w/o & w/dye 2.00 $70.00 $140.00 74174 Ct angio abd&pelv w/o&w/dye 10.98 $70.00 $768.60 74174 TC Ct angio abd&pelv w/o&w/dye 7.88 $70.00 $551.60 74174 26 Ct angio abd&pelv w/o&w/dye 3.10 $70.00 $217.00 74175 Ct angio abdom w/o & w/dye 8.69 $70.00 $608.30 74175 TC Ct angio abdom w/o & w/dye 6.12 $70.00 $428.40 74175 26 Ct angio abdom w/o & w/dye 2.57 $70.00 $179.90 74176 Ct abd & pelvis w/o contrast 5.68 $70.00 $397.60 74176 TC Ct abd & pelvis w/o contrast 3.20 $70.00 $224.00 74176 26 Ct abd & pelvis w/o contrast 2.48 $70.00 $173.60 74177 Ct abd & pelv w/contrast 8.82 $70.00 $617.40 74177 TC Ct abd & pelv w/contrast 6.22 $70.00 $435.40 74177 26 Ct abd & pelv w/contrast 2.60 $70.00 $182.00 74178 Ct abd & pelv 1/> regns 9.99 $70.00 $699.30 74178 TC Ct abd & pelv 1/> regns 7.14 $70.00 $499.80 74178 26 Ct abd & pelv 1/> regns 2.85 $70.00 $199.50 74181 Mri abdomen w/o dye 8.00 $70.00 $560.00 74181 TC Mri abdomen w/o dye 5.92 $70.00 $414.40 74181 26 Mri abdomen w/o dye 2.08 $70.00 $145.60 74182 Mri abdomen w/dye 10.85 $70.00 $759.50 74182 TC Mri abdomen w/dye 8.38 $70.00 $586.60 74182 26 Mri abdomen w/dye 2.47 $70.00 $172.90 74183 Mri abdomen w/o & w/dye 12.10 $70.00 $847.00 74183 TC Mri abdomen w/o & w/dye 8.97 $70.00 $627.90 74183 26 Mri abdomen w/o & w/dye 3.13 $70.00 $219.10 74185 Mri angio abdom w orw/o dye 11.42 $70.00 $799.40 74185 TC Mri angio abdom w orw/o dye 8.88 $70.00 $621.60 74185 26 Mri angio abdom w orw/o dye 2.54 $70.00 $177.80 74190 X-ray exam of peritoneum 0.00 $70.00 $0.00 74190 TC X-ray exam of peritoneum 0.00 $70.00 $0.00 NON-FACILITY HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL 74190 26 X-ray exam of peritoneum 0.67 $70.00 $46.90 74210 Contrst x-ray exam of throat 2.20 $70.00 $154.00 74210 TC Contrst x-ray exam of throat 1.69 $70.00 $118.30 74210 26 Contrst x-ray exam of throat 0.51 $70.00 $35.70 74220 Contrast x-ray esophagus 2.50 $70.00 $175.00 74220 TC Contrast x-ray esophagus 1.84 $70.00 $128.80 74220 26 Contrast x-ray esophagus 0.66 $70.00 $46.20 74230 Cine/vid x-ray throat/esoph 3.65 $70.00 $255.50 74230 TC Cine/vid x-ray throat/esoph 2.89 $70.00 $202.30 74230 26 Cine/vid x-ray throat/esoph 0.76 $70.00 $53.20 74235 Remove esophagus obstruction 0.00 $70.00 $0.00 74235 TC Remove esophagus obstruction 0.00 $70.00 $0.00 74235 26 Remove esophagus obstruction 1.76 $70.00 $123.20 74240 X-ray upper gi delay w/o kub 3.19 $70.00 $223.30 74240 TC X-ray upper gi delay w/o kub 2.20 $70.00 $154.00 74240 26 X-ray upper gi delay w/o kub 0.99 $70.00 $69.30 74241 X-ray upper gi delay w/kub 3.31 $70.00 $231.70 74241 TC X-ray upper gi delay w/kub 2.33 $70.00 $163.10 74241 26 X-ray upper gi delay w/kub 0.98 $70.00 $68.60 74245 X-ray upper gi&small intest 4.83 $70.00 $338.10 74245 TC X-ray upper gi&small intest 3.53 $70.00 $247.10 74245 26 X-ray upper gi&small intest 1.30 $70.00 $91.00 74246 Contrst x-ray uppr gi tract 3.57 $70.00 $249.90 74246 TC Contrst x-ray uppr gi tract 2.59 $70.00 $181.30 74246 26 Contrst x-ray uppr gi tract 0.98 $70.00 $68.60 74247 Contrst x-ray uppr gi tract 3.99 $70.00 $279.30 74247 TC Contrst x-ray uppr gi tract 3.01 $70.00 $210.70 74247 26 Contrst x-ray uppr gi tract 0.98 $70.00 $68.60 74249 Contrst x-ray uppr gi tract 5.18 $70.00 $362.60 74249 TC Contrst x-ray uppr gi tract 3.88 $70.00 $271.60 74249 26 Contrst x-ray uppr gi tract 1.30 $70.00 $91.00 74250 X-ray exam of small bowel 2.92 $70.00 $204.40 74250 TC X-ray exam of small bowel 2.25 $70.00 $157.50 74250 26 X-ray exam of small bowel 0.67 $70.00 $46.90 74251 X-ray exam of small bowel 11.83 $70.00 $828.10 74251 TC X-ray exam of small bowel 10.85 $70.00 $759.50 74251 26 X-ray exam of small bowel 0.98 $70.00 $68.60 74260 X-ray exam of small bowel 9.83 $70.00 $688.10 74260 TC X-ray exam of small bowel 9.11 $70.00 $637.70 74260 26 X-ray exam of small bowel 0.72 $70.00 $50.40 74261 Ct colonography dx 13.76 $70.00 $963.20 74261 TC Ct colonography dx 10.34 $70.00 $723.80 74261 26 Ct colonography dx 3.42 $70.00 $239.40 74262 Ct colonography dx w/dye 15.41 $70.00 $1,078.70 74262 TC Ct colonography dx w/dye 11.85 $70.00 $829.50 NON-FACILITY HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL 74262 26 Ct colonography dx w/dye 3.56 $70.00 $249.20 74263 Ct colonography screening 21.57 $70.00 $1,509.90 74263 TC Ct colonography screening 18.34 $70.00 $1,283.80 74263 26 Ct colonography screening 3.23 $70.00 $226.10 74270 Contrast x-ray exam of colon 4.24 $70.00 $296.80 74270 TC Contrast x-ray exam of colon 3.26 $70.00 $228.20 74270 26 Contrast x-ray exam of colon 0.98 $70.00 $68.60 74280 Contrast x-ray exam of colon 6.02 $70.00 $421.40 74280 TC Contrast x-ray exam of colon 4.61 $70.00 $322.70 74280 26 Contrast x-ray exam of colon 1.41 $70.00 $98.70 74283 Contrast x-ray exam of colon 5.94 $70.00 $415.80 74283 TC Contrast x-ray exam of colon 3.01 $70.00 $210.70 74283 26 Contrast x-ray exam of colon 2.93 $70.00 $205.10 74290 Contrast x-ray gallbladder 1.97 $70.00 $137.90 74290 TC Contrast x-ray gallbladder 1.51 $70.00 $105.70 74290 26 Contrast x-ray gallbladder 0.46 $70.00 $32.20 74300 X-ray bile ducts/pancreas 0.00 $70.00 $0.00 74300 TC X-ray bile ducts/pancreas 0.00 $70.00 $0.00 74300 26 X-ray bile ducts/pancreas 0.52 $70.00 $36.40 74301 X-rays at surgery add-on 0.00 $70.00 $0.00 74301 TC X-rays at surgery add-on 0.00 $70.00 $0.00 74301 26 X-rays at surgery add-on 0.30 $70.00 $21.00 74328 X-ray bile duct endoscopy 0.00 $70.00 $0.00 74328 TC X-ray bile duct endoscopy 0.00 $70.00 $0.00 74328 26 X-ray bile duct endoscopy 1.01 $70.00 $70.70 74329 X-ray for pancreas endoscopy 0.00 $70.00 $0.00 74329 TC X-ray for pancreas endoscopy 0.00 $70.00 $0.00 74329 26 X-ray for pancreas endoscopy 1.02 $70.00 $71.40 74330 X-ray bile/panc endoscopy 0.00 $70.00 $0.00 74330 TC X-ray bile/panc endoscopy 0.00 $70.00 $0.00 74330 26 X-ray bile/panc endoscopy 1.30 $70.00 $91.00 74340 X-ray guide for gi tube 0.00 $70.00 $0.00 74340 TC X-ray guide for gi tube 0.00 $70.00 $0.00 74340 26 X-ray guide for gi tube 0.77 $70.00 $53.90 74355 X-ray guide intestinal tube 0.00 $70.00 $0.00 74355 TC X-ray guide intestinal tube 0.00 $70.00 $0.00 74355 26 X-ray guide intestinal tube 1.12 $70.00 $78.40 74360 X-ray guide gi dilation 0.00 $70.00 $0.00 74360 TC X-ray guide gi dilation 0.00 $70.00 $0.00 74360 26 X-ray guide gi dilation 0.80 $70.00 $56.00 74363 X-ray bile duct dilation 0.00 $70.00 $0.00 74363 TC X-ray bile duct dilation 0.00 $70.00 $0.00 74363 26 X-ray bile duct dilation 1.21 $70.00 $84.70 74400 Contrst x-ray urinary tract 3.10 $70.00 $217.00 74400 TC Contrst x-ray urinary tract 2.40 $70.00 $168.00 NON-FACILITY HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL 74400 26 Contrst x-ray urinary tract 0.70 $70.00 $49.00 74410 Contrst x-ray urinary tract 3.14 $70.00 $219.80 74410 TC Contrst x-ray urinary tract 2.44 $70.00 $170.80 74410 26 Contrst x-ray urinary tract 0.70 $70.00 $49.00 74415 Contrst x-ray urinary tract 3.85 $70.00 $269.50 74415 TC Contrst x-ray urinary tract 3.15 $70.00 $220.50 74415 26 Contrst x-ray urinary tract 0.70 $70.00 $49.00 74420 Contrst x-ray urinary tract 0.00 $70.00 $0.00 74420 TC Contrst x-ray urinary tract 0.00 $70.00 $0.00 74420 26 Contrst x-ray urinary tract 0.50 $70.00 $35.00 74425 Contrst x-ray urinary tract 0.00 $70.00 $0.00 74425 TC Contrst x-ray urinary tract 0.00 $70.00 $0.00 74425 26 Contrst x-ray urinary tract 0.50 $70.00 $35.00 74430 Contrast x-ray bladder 1.08 $70.00 $75.60 74430 TC Contrast x-ray bladder 0.62 $70.00 $43.40 74430 26 Contrast x-ray bladder 0.46 $70.00 $32.20 74440 X-ray male genital tract 2.27 $70.00 $158.90 74440 TC X-ray male genital tract 1.75 $70.00 $122.50 74440 26 X-ray male genital tract 0.52 $70.00 $36.40 74445 X-ray exam of penis 0.00 $70.00 $0.00 74445 TC X-ray exam of penis 0.00 $70.00 $0.00 74445 26 X-ray exam of penis 1.59 $70.00 $111.30 74450 X-ray urethra/bladder 0.00 $70.00 $0.00 74450 TC X-ray urethra/bladder 0.00 $70.00 $0.00 74450 26 X-ray urethra/bladder 0.47 $70.00 $32.90 74455 X-ray urethra/bladder 2.33 $70.00 $163.10 74455 TC X-ray urethra/bladder 1.86 $70.00 $130.20 74455 26 X-ray urethra/bladder 0.47 $70.00 $32.90 74470 X-ray exam of kidney lesion 0.00 $70.00 $0.00 74470 TC X-ray exam of kidney lesion 0.00 $70.00 $0.00 74470 26 X-ray exam of kidney lesion 0.75 $70.00 $52.50 74485 X-ray guide gu dilation 2.62 $70.00 $183.40 74485 TC X-ray guide gu dilation 1.88 $70.00 $131.60 74485 26 X-ray guide gu dilation 0.74 $70.00 $51.80 74710 X-ray measurement of pelvis 1.03 $70.00 $72.10 74710 TC X-ray measurement of pelvis 0.54 $70.00 $37.80 74710 26 X-ray measurement of pelvis 0.49 $70.00 $34.30 74712 Mri fetal sngl/1st gestation 13.96 $70.00 $977.20 74712 TC Mri fetal sngl/1st gestation 9.68 $70.00 $677.60 74712 26 Mri fetal sngl/1st gestation 4.28 $70.00 $299.60 74713 Mri fetal ea addl gestation 6.75 $70.00 $472.50 74713 TC Mri fetal ea addl gestation 4.10 $70.00 $287.00 74713 26 Mri fetal ea addl gestation 2.65 $70.00 $185.50 74740 X-ray female genital tract 2.11 $70.00 $147.70 74740 TC X-ray female genital tract 1.57 $70.00 $109.90 NON-FACILITY HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL 74740 26 X-ray female genital tract 0.54 $70.00 $37.80 74742 X-ray fallopian tube 0.00 $70.00 $0.00 74742 TC X-ray fallopian tube 0.00 $70.00 $0.00 74742 26 X-ray fallopian tube 0.88 $70.00 $61.60 74775 X-ray exam of perineum 0.00 $70.00 $0.00 74775 TC X-ray exam of perineum 0.00 $70.00 $0.00 74775 26 X-ray exam of perineum 0.89 $70.00 $62.30 75557 Cardiac mri for morph 9.33 $70.00 $653.10 75557 TC Cardiac mri for morph 6.04 $70.00 $422.80 75557 26 Cardiac mri for morph 3.29 $70.00 $230.30 75559 Cardiac mri w/stress img 12.59 $70.00 $881.30 75559 TC Cardiac mri w/stress img 8.53 $70.00 $597.10 75559 26 Cardiac mri w/stress img 4.06 $70.00 $284.20 75561 Cardiac mri for morph w/dye 12.29 $70.00 $860.30 75561 TC Cardiac mri for morph w/dye 8.66 $70.00 $606.20 75561 26 Cardiac mri for morph w/dye 3.63 $70.00 $254.10 75563 Card mri w/stress img & dye 14.62 $70.00 $1,023.40 75563 TC Card mri w/stress img & dye 10.45 $70.00 $731.50 75563 26 Card mri w/stress img & dye 4.17 $70.00 $291.90 75565 Card mri veloc flow mapping 1.55 $70.00 $108.50 75565 TC Card mri veloc flow mapping 1.20 $70.00 $84.00 75565 26 Card mri veloc flow mapping 0.35 $70.00 $24.50 75571 Ct hrt w/o dye w/ca test 2.92 $70.00 $204.40 75571 TC Ct hrt w/o dye w/ca test 2.10 $70.00 $147.00 75571 26 Ct hrt w/o dye w/ca test 0.82 $70.00 $57.40 75572 Ct hrt w/3d image 8.08 $70.00 $565.60 75572 TC Ct hrt w/3d image 5.61 $70.00 $392.70 75572 26 Ct hrt w/3d image 2.47 $70.00 $172.90 75573 Ct hrt w/3d image congen 11.02 $70.00 $771.40 75573 TC Ct hrt w/3d image congen 7.44 $70.00 $520.80 75573 26 Ct hrt w/3d image congen 3.58 $70.00 $250.60 75574 Ct angio hrt w/3d image 12.01 $70.00 $840.70 75574 TC Ct angio hrt w/3d image 8.65 $70.00 $605.50 75574 26 Ct angio hrt w/3d image 3.36 $70.00 $235.20 75600 Contrast exam thoracic aorta 5.67 $70.00 $396.90 75600 TC Contrast exam thoracic aorta 4.98 $70.00 $348.60 75600 26 Contrast exam thoracic aorta 0.69 $70.00 $48.30 75605 Contrast exam thoracic aorta 3.90 $70.00 $273.00 75605 TC Contrast exam thoracic aorta 2.32 $70.00 $162.40 75605 26 Contrast exam thoracic aorta 1.58 $70.00 $110.60 75625 Contrast exam abdominl aorta 3.88 $70.00 $271.60 75625 TC Contrast exam abdominl aorta 2.29 $70.00 $160.30 75625 26 Contrast exam abdominl aorta 1.59 $70.00 $111.30 75630 X-ray aorta leg arteries 4.82 $70.00 $337.40 75630 TC X-ray aorta leg arteries 2.32 $70.00 $162.40 NON-FACILITY HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL 75630 26 X-ray aorta leg arteries 2.50 $70.00 $175.00 75635 Ct angio abdominal arteries 12.48 $70.00 $873.60 75635 TC Ct angio abdominal arteries 9.11 $70.00 $637.70 75635 26 Ct angio abdominal arteries 3.37 $70.00 $235.90 75705 Artery x-rays spine 7.17 $70.00 $501.90 75705 TC Artery x-rays spine 3.89 $70.00 $272.30 75705 26 Artery x-rays spine 3.28 $70.00 $229.60 75710 Artery x-rays arm/leg 4.87 $70.00 $340.90 75710 TC Artery x-rays arm/leg 2.42 $70.00 $169.40 75710 26 Artery x-rays arm/leg 2.45 $70.00 $171.50 75716 Artery x-rays arms/legs 5.53 $70.00 $387.10 75716 TC Artery x-rays arms/legs 2.79 $70.00 $195.30 75716 26 Artery x-rays arms/legs 2.74 $70.00 $191.80 75726 Artery x-rays abdomen 4.22 $70.00 $295.40 75726 TC Artery x-rays abdomen 2.65 $70.00 $185.50 75726 26 Artery x-rays abdomen 1.57 $70.00 $109.90 75731 Artery x-rays adrenal gland 4.87 $70.00 $340.90 75731 TC Artery x-rays adrenal gland 3.24 $70.00 $226.80 75731 26 Artery x-rays adrenal gland 1.63 $70.00 $114.10 75733 Artery x-rays adrenals 5.23 $70.00 $366.10 75733 TC Artery x-rays adrenals 3.42 $70.00 $239.40 75733 26 Artery x-rays adrenals 1.81 $70.00 $126.70 75736 Artery x-rays pelvis 4.52 $70.00 $316.40 75736 TC Artery x-rays pelvis 2.96 $70.00 $207.20 75736 26 Artery x-rays pelvis 1.56 $70.00 $109.20 75741 Artery x-rays lung 4.24 $70.00 $296.80 75741 TC Artery x-rays lung 2.45 $70.00 $171.50 75741 26 Artery x-rays lung 1.79 $70.00 $125.30 75743 Artery x-rays lungs 4.77 $70.00 $333.90 75743 TC Artery x-rays lungs 2.48 $70.00 $173.60 75743 26 Artery x-rays lungs 2.29 $70.00 $160.30 75746 Artery x-rays lung 4.29 $70.00 $300.30 75746 TC Artery x-rays lung 2.71 $70.00 $189.70 75746 26 Artery x-rays lung 1.58 $70.00 $110.60 75756 Artery x-rays chest 4.88 $70.00 $341.60 75756 TC Artery x-rays chest 3.26 $70.00 $228.20 75756 26 Artery x-rays chest 1.62 $70.00 $113.40 75774 Artery x-ray each vessel 2.45 $70.00 $171.50 75774 TC Artery x-ray each vessel 1.96 $70.00 $137.20 75774 26 Artery x-ray each vessel 0.49 $70.00 $34.30 75801 Lymph vessel x-ray arm/leg 0.00 $70.00 $0.00 75801 TC Lymph vessel x-ray arm/leg 0.00 $70.00 $0.00 75801 26 Lymph vessel x-ray arm/leg 1.27 $70.00 $88.90 75803 Lymph vessel x-ray arms/legs 0.00 $70.00 $0.00 75803 TC Lymph vessel x-ray arms/legs 0.00 $70.00 $0.00 NON-FACILITY HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL 75803 26 Lymph vessel x-ray arms/legs 1.71 $70.00 $119.70 75805 Lymph vessel x-ray trunk 0.00 $70.00 $0.00 75805 TC Lymph vessel x-ray trunk 0.00 $70.00 $0.00 75805 26 Lymph vessel x-ray trunk 1.12 $70.00 $78.40 75807 Lymph vessel x-ray trunk 0.00 $70.00 $0.00 75807 TC Lymph vessel x-ray trunk 0.00 $70.00 $0.00 75807 26 Lymph vessel x-ray trunk 1.61 $70.00 $112.70 75809 Nonvascular shunt x-ray 2.80 $70.00 $196.00 75809 TC Nonvascular shunt x-ray 2.12 $70.00 $148.40 75809 26 Nonvascular shunt x-ray 0.68 $70.00 $47.60 75810 Vein x-ray spleen/liver 0.00 $70.00 $0.00 75810 TC Vein x-ray spleen/liver 0.00 $70.00 $0.00 75810 26 Vein x-ray spleen/liver 1.55 $70.00 $108.50 75820 Vein x-ray arm/leg 3.27 $70.00 $228.90 75820 TC Vein x-ray arm/leg 2.28 $70.00 $159.60 75820 26 Vein x-ray arm/leg 0.99 $70.00 $69.30 75822 Vein x-ray arms/legs 3.84 $70.00 $268.80 75822 TC Vein x-ray arms/legs 2.36 $70.00 $165.20 75822 26 Vein x-ray arms/legs 1.48 $70.00 $103.60 75825 Vein x-ray trunk 3.81 $70.00 $266.70 75825 TC Vein x-ray trunk 2.22 $70.00 $155.40 75825 26 Vein x-ray trunk 1.59 $70.00 $111.30 75827 Vein x-ray chest 3.93 $70.00 $275.10 75827 TC Vein x-ray chest 2.33 $70.00 $163.10 75827 26 Vein x-ray chest 1.60 $70.00 $112.00 75831 Vein x-ray kidney 3.97 $70.00 $277.90 75831 TC Vein x-ray kidney 2.40 $70.00 $168.00 75831 26 Vein x-ray kidney 1.57 $70.00 $109.90 75833 Vein x-ray kidneys 4.70 $70.00 $329.00 75833 TC Vein x-ray kidneys 2.63 $70.00 $184.10 75833 26 Vein x-ray kidneys 2.07 $70.00 $144.90 75840 Vein x-ray adrenal gland 4.20 $70.00 $294.00 75840 TC Vein x-ray adrenal gland 2.57 $70.00 $179.90 75840 26 Vein x-ray adrenal gland 1.63 $70.00 $114.10 75842 Vein x-ray adrenal glands 5.03 $70.00 $352.10 75842 TC Vein x-ray adrenal glands 2.90 $70.00 $203.00 75842 26 Vein x-ray adrenal glands 2.13 $70.00 $149.10 75860 Vein x-ray neck 4.08 $70.00 $285.60 75860 TC Vein x-ray neck 2.49 $70.00 $174.30 75860 26 Vein x-ray neck 1.59 $70.00 $111.30 75870 Vein x-ray skull 4.20 $70.00 $294.00 75870 TC Vein x-ray skull 2.57 $70.00 $179.90 75870 26 Vein x-ray skull 1.63 $70.00 $114.10 75872 Vein x-ray skull epidural 4.20 $70.00 $294.00 75872 TC Vein x-ray skull epidural 2.57 $70.00 $179.90 NON-FACILITY HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL 75872 26 Vein x-ray skull epidural 1.63 $70.00 $114.10 75880 Vein x-ray eye socket 3.56 $70.00 $249.20 75880 TC Vein x-ray eye socket 2.56 $70.00 $179.20 75880 26 Vein x-ray eye socket 1.00 $70.00 $70.00 75885 Vein x-ray liver w/hemodynam 4.43 $70.00 $310.10 75885 TC Vein x-ray liver w/hemodynam 2.49 $70.00 $174.30 75885 26 Vein x-ray liver w/hemodynam 1.94 $70.00 $135.80 75887 Vein x-ray liver w/o hemodyn 4.44 $70.00 $310.80 75887 TC Vein x-ray liver w/o hemodyn 2.50 $70.00 $175.00 75887 26 Vein x-ray liver w/o hemodyn 1.94 $70.00 $135.80 75889 Vein x-ray liver w/hemodynam 4.06 $70.00 $284.20 75889 TC Vein x-ray liver w/hemodynam 2.51 $70.00 $175.70 75889 26 Vein x-ray liver w/hemodynam 1.55 $70.00 $108.50 75891 Vein x-ray liver 4.09 $70.00 $286.30 75891 TC Vein x-ray liver 2.52 $70.00 $176.40 75891 26 Vein x-ray liver 1.57 $70.00 $109.90 75893 Venous sampling by catheter 3.40 $70.00 $238.00 75893 TC Venous sampling by catheter 2.63 $70.00 $184.10 75893 26 Venous sampling by catheter 0.77 $70.00 $53.90 75894 X-rays transcath therapy 0.00 $70.00 $0.00 75894 TC X-rays transcath therapy 0.00 $70.00 $0.00 75894 26 X-rays transcath therapy 2.05 $70.00 $143.50 75898 Follow-up angiography 0.00 $70.00 $0.00 75898 TC Follow-up angiography 0.00 $70.00 $0.00 75898 26 Follow-up angiography 2.56 $70.00 $179.20 75901 Remove cva device obstruct 5.07 $70.00 $354.90 75901 TC Remove cva device obstruct 4.40 $70.00 $308.00 75901 26 Remove cva device obstruct 0.67 $70.00 $46.90 75902 Remove cva lumen obstruct 2.04 $70.00 $142.80 75902 TC Remove cva lumen obstruct 1.50 $70.00 $105.00 75902 26 Remove cva lumen obstruct 0.54 $70.00 $37.80 75956 Xray endovasc thor ao repr 0.00 $70.00 $0.00 75956 TC Xray endovasc thor ao repr 0.00 $70.00 $0.00 75956 26 Xray endovasc thor ao repr 9.87 $70.00 $690.90 75957 Xray endovasc thor ao repr 0.00 $70.00 $0.00 75957 TC Xray endovasc thor ao repr 0.00 $70.00 $0.00 75957 26 Xray endovasc thor ao repr 8.46 $70.00 $592.20 75958 Xray place prox ext thor ao 0.00 $70.00 $0.00 75958 TC Xray place prox ext thor ao 0.00 $70.00 $0.00 75958 26 Xray place prox ext thor ao 5.63 $70.00 $394.10 75959 Xray place dist ext thor ao 0.00 $70.00 $0.00 75959 TC Xray place dist ext thor ao 0.00 $70.00 $0.00 75959 26 Xray place dist ext thor ao 4.94 $70.00 $345.80 75970 Vascular biopsy 0.00 $70.00 $0.00 75970 TC Vascular biopsy 0.00 $70.00 $0.00 NON-FACILITY HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL 75970 26 Vascular biopsy 1.13 $70.00 $79.10 75984 Xray control catheter change 3.00 $70.00 $210.00 75984 TC Xray control catheter change 2.01 $70.00 $140.70 75984 26 Xray control catheter change 0.99 $70.00 $69.30 75989 Abscess drainage under x-ray 3.44 $70.00 $240.80 75989 TC Abscess drainage under x-ray 1.78 $70.00 $124.60 75989 26 Abscess drainage under x-ray 1.66 $70.00 $116.20 76000 Fluoroscopy <1 hr phys/qhp 1.35 $70.00 $94.50 76000 TC Fluoroscopy <1 hr phys/qhp 1.10 $70.00 $77.00 76000 26 Fluoroscopy <1 hr phys/qhp 0.25 $70.00 $17.50 76001 Fluoroscope exam extensive 0.00 $70.00 $0.00 76001 TC Fluoroscope exam extensive 0.00 $70.00 $0.00 76001 26 Fluoroscope exam extensive 1.05 $70.00 $73.50 76010 X-ray nose to rectum 0.74 $70.00 $51.80 76010 TC X-ray nose to rectum 0.48 $70.00 $33.60 76010 26 X-ray nose to rectum 0.26 $70.00 $18.20 76080 X-ray exam of fistula 1.55 $70.00 $108.50 76080 TC X-ray exam of fistula 0.81 $70.00 $56.70 76080 26 X-ray exam of fistula 0.74 $70.00 $51.80 76098 X-ray exam surgical specimen 0.48 $70.00 $33.60 76098 TC X-ray exam surgical specimen 0.25 $70.00 $17.50 76098 26 X-ray exam surgical specimen 0.23 $70.00 $16.10 76100 X-ray exam of body section 2.59 $70.00 $181.30 76100 TC X-ray exam of body section 1.69 $70.00 $118.30 76100 26 X-ray exam of body section 0.90 $70.00 $63.00 76101 Complex body section x-ray 3.01 $70.00 $210.70 76101 TC Complex body section x-ray 2.20 $70.00 $154.00 76101 26 Complex body section x-ray 0.81 $70.00 $56.70 76102 Complex body section x-rays 4.82 $70.00 $337.40 76102 TC Complex body section x-rays 3.83 $70.00 $268.10 76102 26 Complex body section x-rays 0.99 $70.00 $69.30 76120 Cine/video x-rays 2.62 $70.00 $183.40 76120 TC Cine/video x-rays 2.11 $70.00 $147.70 76120 26 Cine/video x-rays 0.51 $70.00 $35.70 76125 Cine/video x-rays add-on 0.00 $70.00 $0.00 76125 TC Cine/video x-rays add-on 0.00 $70.00 $0.00 76125 26 Cine/video x-rays add-on 0.40 $70.00 $28.00 76140 X-ray consultation 0.00 $70.00 $0.00 76376 3d render w/intrp postproces 0.66 $70.00 $46.20 76376 TC 3d render w/intrp postproces 0.38 $70.00 $26.60 76376 26 3d render w/intrp postproces 0.28 $70.00 $19.60 76377 3d render w/intrp postproces 2.01 $70.00 $140.70 76377 TC 3d render w/intrp postproces 0.88 $70.00 $61.60 76377 26 3d render w/intrp postproces 1.13 $70.00 $79.10 76380 Cat scan follow-up study 4.11 $70.00 $287.70 NON-FACILITY HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL 76380 TC Cat scan follow-up study 2.72 $70.00 $190.40 76380 26 Cat scan follow-up study 1.39 $70.00 $97.30 76390 Mr spectroscopy 12.72 $70.00 $890.40 76390 TC Mr spectroscopy 10.73 $70.00 $751.10 76390 26 Mr spectroscopy 1.99 $70.00 $139.30 76496 Fluoroscopic procedure 0.00 $70.00 $0.00 76496 TC Fluoroscopic procedure 0.00 $70.00 $0.00 76496 26 Fluoroscopic procedure 0.00 $70.00 $0.00 76497 Ct procedure 0.00 $70.00 $0.00 76497 TC Ct procedure 0.00 $70.00 $0.00 76497 26 Ct procedure 0.00 $70.00 $0.00 76498 Mri procedure 0.00 $70.00 $0.00 76498 TC Mri procedure 0.00 $70.00 $0.00 76498 26 Mri procedure 0.00 $70.00 $0.00 76499 Radiographic procedure 0.00 $70.00 $0.00 76499 TC Radiographic procedure 0.00 $70.00 $0.00 76499 26 Radiographic procedure 0.00 $70.00 $0.00 76506 Echo exam of head 3.34 $70.00 $233.80 76506 TC Echo exam of head 2.43 $70.00 $170.10 76506 26 Echo exam of head 0.91 $70.00 $63.70 76510 Ophth us b & quant a 3.89 $70.00 $272.30 76510 TC Ophth us b & quant a 1.85 $70.00 $129.50 76510 26 Ophth us b & quant a 2.04 $70.00 $142.80 76511 Ophth us quant a only 2.33 $70.00 $163.10 76511 TC Ophth us quant a only 1.11 $70.00 $77.70 76511 26 Ophth us quant a only 1.22 $70.00 $85.40 76512 Ophth us b w/non-quant a 2.13 $70.00 $149.10 76512 TC Ophth us b w/non-quant a 0.91 $70.00 $63.70 76512 26 Ophth us b w/non-quant a 1.22 $70.00 $85.40 76513 Echo exam of eye water bath 2.72 $70.00 $190.40 76513 TC Echo exam of eye water bath 1.70 $70.00 $119.00 76513 26 Echo exam of eye water bath 1.02 $70.00 $71.40 76514 Echo exam of eye thickness 0.44 $70.00 $30.80 76514 TC Echo exam of eye thickness 0.16 $70.00 $11.20 76514 26 Echo exam of eye thickness 0.28 $70.00 $19.60 76516 Echo exam of eye 1.80 $70.00 $126.00 76516 TC Echo exam of eye 1.09 $70.00 $76.30 76516 26 Echo exam of eye 0.71 $70.00 $49.70 76519 Echo exam of eye 2.11 $70.00 $147.70 76519 TC Echo exam of eye 1.22 $70.00 $85.40 76519 26 Echo exam of eye 0.89 $70.00 $62.30 76529 Echo exam of eye 2.28 $70.00 $159.60 76529 TC Echo exam of eye 1.34 $70.00 $93.80 76529 26 Echo exam of eye 0.94 $70.00 $65.80 76536 Us exam of head and neck 3.32 $70.00 $232.40 NON-FACILITY HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL 76536 TC Us exam of head and neck 2.52 $70.00 $176.40 76536 26 Us exam of head and neck 0.80 $70.00 $56.00 76604 Us exam chest 2.54 $70.00 $177.80 76604 TC Us exam chest 1.77 $70.00 $123.90 76604 26 Us exam chest 0.77 $70.00 $53.90 76641 Ultrasound breast complete 3.06 $70.00 $214.20 76641 TC Ultrasound breast complete 2.02 $70.00 $141.40 76641 26 Ultrasound breast complete 1.04 $70.00 $72.80 76642 Ultrasound breast limited 2.51 $70.00 $175.70 76642 TC Ultrasound breast limited 1.54 $70.00 $107.80 76642 26 Ultrasound breast limited 0.97 $70.00 $67.90 76700 Us exam abdom complete 3.49 $70.00 $244.30 76700 TC Us exam abdom complete 2.34 $70.00 $163.80 76700 26 Us exam abdom complete 1.15 $70.00 $80.50 76705 Echo exam of abdomen 2.61 $70.00 $182.70 76705 TC Echo exam of abdomen 1.77 $70.00 $123.90 76705 26 Echo exam of abdomen 0.84 $70.00 $58.80 76706 Us abdl aorta screen aaa 2.69 $70.00 $188.30 76706 TC Us abdl aorta screen aaa 1.90 $70.00 $133.00 76706 26 Us abdl aorta screen aaa 0.79 $70.00 $55.30 76770 Us exam abdo back wall comp 3.23 $70.00 $226.10 76770 TC Us exam abdo back wall comp 2.18 $70.00 $152.60 76770 26 Us exam abdo back wall comp 1.05 $70.00 $73.50 76775 Us exam abdo back wall lim 1.65 $70.00 $115.50 76775 TC Us exam abdo back wall lim 0.83 $70.00 $58.10 76775 26 Us exam abdo back wall lim 0.82 $70.00 $57.40 76776 Us exam k transpl w/doppler 4.47 $70.00 $312.90 76776 TC Us exam k transpl w/doppler 3.39 $70.00 $237.30 76776 26 Us exam k transpl w/doppler 1.08 $70.00 $75.60 76800 Us exam spinal canal 4.15 $70.00 $290.50 76800 TC Us exam spinal canal 2.45 $70.00 $171.50 76800 26 Us exam spinal canal 1.70 $70.00 $119.00 76801 Ob us < 14 wks single fetus 3.52 $70.00 $246.40 76801 TC Ob us < 14 wks single fetus 2.10 $70.00 $147.00 76801 26 Ob us < 14 wks single fetus 1.42 $70.00 $99.40 76802 Ob us < 14 wks addl fetus 1.85 $70.00 $129.50 76802 TC Ob us < 14 wks addl fetus 0.64 $70.00 $44.80 76802 26 Ob us < 14 wks addl fetus 1.21 $70.00 $84.70 76805 Ob us >/= 14 wks sngl fetus 4.06 $70.00 $284.20 76805 TC Ob us >/= 14 wks sngl fetus 2.62 $70.00 $183.40 76805 26 Ob us >/= 14 wks sngl fetus 1.44 $70.00 $100.80 76810 Ob us >/= 14 wks addl fetus 2.66 $70.00 $186.20 76810 TC Ob us >/= 14 wks addl fetus 1.23 $70.00 $86.10 76810 26 Ob us >/= 14 wks addl fetus 1.43 $70.00 $100.10 76811 Ob us detailed sngl fetus 5.22 $70.00 $365.40 NON-FACILITY HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL 76811 TC Ob us detailed sngl fetus 2.43 $70.00 $170.10 76811 26 Ob us detailed sngl fetus 2.79 $70.00 $195.30 76812 Ob us detailed addl fetus 5.83 $70.00 $408.10 76812 TC Ob us detailed addl fetus 3.21 $70.00 $224.70 76812 26 Ob us detailed addl fetus 2.62 $70.00 $183.40 76813 Ob us nuchal meas 1 gest 3.48 $70.00 $243.60 76813 TC Ob us nuchal meas 1 gest 1.75 $70.00 $122.50 76813 26 Ob us nuchal meas 1 gest 1.73 $70.00 $121.10 76814 Ob us nuchal meas add-on 2.31 $70.00 $161.70 76814 TC Ob us nuchal meas add-on 0.84 $70.00 $58.80 76814 26 Ob us nuchal meas add-on 1.47 $70.00 $102.90 76815 Ob us limited fetus(s) 2.41 $70.00 $168.70 76815 TC Ob us limited fetus(s) 1.48 $70.00 $103.60 76815 26 Ob us limited fetus(s) 0.93 $70.00 $65.10 76816 Ob us follow-up per fetus 3.30 $70.00 $231.00 76816 TC Ob us follow-up per fetus 2.05 $70.00 $143.50 76816 26 Ob us follow-up per fetus 1.25 $70.00 $87.50 76817 Transvaginal us obstetric 2.77 $70.00 $193.90 76817 TC Transvaginal us obstetric 1.69 $70.00 $118.30 76817 26 Transvaginal us obstetric 1.08 $70.00 $75.60 76818 Fetal biophys profile w/nst 3.52 $70.00 $246.40 76818 TC Fetal biophys profile w/nst 1.97 $70.00 $137.90 76818 26 Fetal biophys profile w/nst 1.55 $70.00 $108.50 76819 Fetal biophys profil w/o nst 2.56 $70.00 $179.20 76819 TC Fetal biophys profil w/o nst 1.44 $70.00 $100.80 76819 26 Fetal biophys profil w/o nst 1.12 $70.00 $78.40 76820 Umbilical artery echo 1.37 $70.00 $95.90 76820 TC Umbilical artery echo 0.64 $70.00 $44.80 76820 26 Umbilical artery echo 0.73 $70.00 $51.10 76821 Middle cerebral artery echo 2.66 $70.00 $186.20 76821 TC Middle cerebral artery echo 1.63 $70.00 $114.10 76821 26 Middle cerebral artery echo 1.03 $70.00 $72.10 76825 Echo exam of fetal heart 7.93 $70.00 $555.10 76825 TC Echo exam of fetal heart 5.54 $70.00 $387.80 76825 26 Echo exam of fetal heart 2.39 $70.00 $167.30 76826 Echo exam of fetal heart 4.68 $70.00 $327.60 76826 TC Echo exam of fetal heart 3.50 $70.00 $245.00 76826 26 Echo exam of fetal heart 1.18 $70.00 $82.60 76827 Echo exam of fetal heart 2.15 $70.00 $150.50 76827 TC Echo exam of fetal heart 1.33 $70.00 $93.10 76827 26 Echo exam of fetal heart 0.82 $70.00 $57.40 76828 Echo exam of fetal heart 1.52 $70.00 $106.40 76828 TC Echo exam of fetal heart 0.71 $70.00 $49.70 76828 26 Echo exam of fetal heart 0.81 $70.00 $56.70 76830 Transvaginal us non-ob 3.48 $70.00 $243.60 NON-FACILITY HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL 76830 TC Transvaginal us non-ob 2.49 $70.00 $174.30 76830 26 Transvaginal us non-ob 0.99 $70.00 $69.30 76831 Echo exam uterus 3.41 $70.00 $238.70 76831 TC Echo exam uterus 2.36 $70.00 $165.20 76831 26 Echo exam uterus 1.05 $70.00 $73.50 76856 Us exam pelvic complete 3.14 $70.00 $219.80 76856 TC Us exam pelvic complete 2.16 $70.00 $151.20 76856 26 Us exam pelvic complete 0.98 $70.00 $68.60 76857 Us exam pelvic limited 1.38 $70.00 $96.60 76857 TC Us exam pelvic limited 0.67 $70.00 $46.90 76857 26 Us exam pelvic limited 0.71 $70.00 $49.70 76870 Us exam scrotum 1.93 $70.00 $135.10 76870 TC Us exam scrotum 1.02 $70.00 $71.40 76870 26 Us exam scrotum 0.91 $70.00 $63.70 76872 Us transrectal 2.75 $70.00 $192.50 76872 TC Us transrectal 1.79 $70.00 $125.30 76872 26 Us transrectal 0.96 $70.00 $67.20 76873 Echograp trans r pros study 4.93 $70.00 $345.10 76873 TC Echograp trans r pros study 2.71 $70.00 $189.70 76873 26 Echograp trans r pros study 2.22 $70.00 $155.40 76881 Us compl joint r-t w/img 2.89 $70.00 $202.30 76881 TC Us compl joint r-t w/img 1.99 $70.00 $139.30 76881 26 Us compl joint r-t w/img 0.90 $70.00 $63.00 76882 Us lmtd jt/nonvasc xtr strux 1.64 $70.00 $114.80 76882 TC Us lmtd jt/nonvasc xtr strux 0.94 $70.00 $65.80 76882 26 Us lmtd jt/nonvasc xtr strux 0.70 $70.00 $49.00 76885 Us exam infant hips dynamic 4.12 $70.00 $288.40 76885 TC Us exam infant hips dynamic 3.06 $70.00 $214.20 76885 26 Us exam infant hips dynamic 1.06 $70.00 $74.20 76886 Us exam infant hips static 3.01 $70.00 $210.70 76886 TC Us exam infant hips static 2.12 $70.00 $148.40 76886 26 Us exam infant hips static 0.89 $70.00 $62.30 76930 Echo guide cardiocentesis 0.00 $70.00 $0.00 76930 TC Echo guide cardiocentesis 0.00 $70.00 $0.00 76930 26 Echo guide cardiocentesis 0.94 $70.00 $65.80 76932 Echo guide for heart biopsy 0.00 $70.00 $0.00 76932 TC Echo guide for heart biopsy 0.00 $70.00 $0.00 76932 26 Echo guide for heart biopsy 0.93 $70.00 $65.10 76936 Echo guide for artery repair 7.74 $70.00 $541.80 76936 TC Echo guide for artery repair 4.96 $70.00 $347.20 76936 26 Echo guide for artery repair 2.78 $70.00 $194.60 76937 Us guide vascular access 0.89 $70.00 $62.30 76937 TC Us guide vascular access 0.48 $70.00 $33.60 76937 26 Us guide vascular access 0.41 $70.00 $28.70 76940 Us guide tissue ablation 0.00 $70.00 $0.00 NON-FACILITY HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL 76940 TC Us guide tissue ablation 0.00 $70.00 $0.00 76940 26 Us guide tissue ablation 2.94 $70.00 $205.80 76941 Echo guide for transfusion 0.00 $70.00 $0.00 76941 TC Echo guide for transfusion 0.00 $70.00 $0.00 76941 26 Echo guide for transfusion 1.94 $70.00 $135.80 76942 Echo guide for biopsy 1.70 $70.00 $119.00 76942 TC Echo guide for biopsy 0.78 $70.00 $54.60 76942 26 Echo guide for biopsy 0.92 $70.00 $64.40 76945 Echo guide villus sampling 0.00 $70.00 $0.00 76945 TC Echo guide villus sampling 0.00 $70.00 $0.00 76945 26 Echo guide villus sampling 0.97 $70.00 $67.90 76946 Echo guide for amniocentesis 0.93 $70.00 $65.10 76946 TC Echo guide for amniocentesis 0.37 $70.00 $25.90 76946 26 Echo guide for amniocentesis 0.56 $70.00 $39.20 76948 Echo guide ova aspiration 2.03 $70.00 $142.10 76948 TC Echo guide ova aspiration 1.04 $70.00 $72.80 76948 26 Echo guide ova aspiration 0.99 $70.00 $69.30 76965 Echo guidance radiotherapy 2.61 $70.00 $182.70 76965 TC Echo guidance radiotherapy 0.69 $70.00 $48.30 76965 26 Echo guidance radiotherapy 1.92 $70.00 $134.40 76970 Ultrasound exam follow-up 2.62 $70.00 $183.40 76970 TC Ultrasound exam follow-up 2.08 $70.00 $145.60 76970 26 Ultrasound exam follow-up 0.54 $70.00 $37.80 76975 Gi endoscopic ultrasound 0.00 $70.00 $0.00 76975 TC Gi endoscopic ultrasound 0.00 $70.00 $0.00 76975 26 Gi endoscopic ultrasound 1.21 $70.00 $84.70 76977 Us bone density measure 0.21 $70.00 $14.70 76977 TC Us bone density measure 0.13 $70.00 $9.10 76977 26 Us bone density measure 0.08 $70.00 $5.60 76998 Us guide intraop 0.00 $70.00 $0.00 76998 TC Us guide intraop 0.00 $70.00 $0.00 76998 26 Us guide intraop 1.81 $70.00 $126.70 76999 Echo examination procedure 0.00 $70.00 $0.00 76999 TC Echo examination procedure 0.00 $70.00 $0.00 76999 26 Echo examination procedure 0.00 $70.00 $0.00 77001 Fluoroguide for vein device 2.38 $70.00 $166.60 77001 TC Fluoroguide for vein device 1.85 $70.00 $129.50 77001 26 Fluoroguide for vein device 0.53 $70.00 $37.10 77002 Needle localization by xray 2.67 $70.00 $186.90 77002 TC Needle localization by xray 1.87 $70.00 $130.90 77002 26 Needle localization by xray 0.80 $70.00 $56.00 77003 Fluoroguide for spine inject 2.67 $70.00 $186.90 77003 TC Fluoroguide for spine inject 1.82 $70.00 $127.40 77003 26 Fluoroguide for spine inject 0.85 $70.00 $59.50 77011 Ct scan for localization 6.41 $70.00 $448.70 NON-FACILITY HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL 77011 TC Ct scan for localization 4.63 $70.00 $324.10 77011 26 Ct scan for localization 1.78 $70.00 $124.60 77012 Ct scan for needle biopsy 3.53 $70.00 $247.10 77012 TC Ct scan for needle biopsy 1.90 $70.00 $133.00 77012 26 Ct scan for needle biopsy 1.63 $70.00 $114.10 77013 Ct guide for tissue ablation 0.00 $70.00 $0.00 77013 TC Ct guide for tissue ablation 0.00 $70.00 $0.00 77013 26 Ct guide for tissue ablation 5.48 $70.00 $383.60 77014 Ct scan for therapy guide 3.40 $70.00 $238.00 77014 TC Ct scan for therapy guide 2.14 $70.00 $149.80 77014 26 Ct scan for therapy guide 1.26 $70.00 $88.20 77021 Mr guidance for needle place 11.06 $70.00 $774.20 77021 TC Mr guidance for needle place 8.97 $70.00 $627.90 77021 26 Mr guidance for needle place 2.09 $70.00 $146.30 77022 Mri for tissue ablation 0.00 $70.00 $0.00 77022 TC Mri for tissue ablation 0.00 $70.00 $0.00 77022 26 Mri for tissue ablation 6.15 $70.00 $430.50 77053 X-ray of mammary duct 1.65 $70.00 $115.50 77053 TC X-ray of mammary duct 1.14 $70.00 $79.80 77053 26 X-ray of mammary duct 0.51 $70.00 $35.70 77054 X-ray of mammary ducts 2.16 $70.00 $151.20 77054 TC X-ray of mammary ducts 1.51 $70.00 $105.70 77054 26 X-ray of mammary ducts 0.65 $70.00 $45.50 77058 Mri one breast 15.34 $70.00 $1,073.80 77058 TC Mri one breast 13.02 $70.00 $911.40 77058 26 Mri one breast 2.32 $70.00 $162.40 77059 Mri both breasts 15.27 $70.00 $1,068.90 77059 TC Mri both breasts 12.95 $70.00 $906.50 77059 26 Mri both breasts 2.32 $70.00 $162.40 77061 Breast tomosynthesis uni 0.00 $70.00 $0.00 77061 TC Breast tomosynthesis uni 0.00 $70.00 $0.00 77061 26 Breast tomosynthesis uni 0.00 $70.00 $0.00 77062 Breast tomosynthesis bi 0.00 $70.00 $0.00 77062 TC Breast tomosynthesis bi 0.00 $70.00 $0.00 77062 26 Breast tomosynthesis bi 0.00 $70.00 $0.00 77063 Breast tomosynthesis bi 1.56 $70.00 $109.20 77063 TC Breast tomosynthesis bi 0.71 $70.00 $49.70 77063 26 Breast tomosynthesis bi 0.85 $70.00 $59.50 77065 Dx mammo incl cad uni 3.83 $70.00 $268.10 77065 TC Dx mammo incl cad uni 2.67 $70.00 $186.90 77065 26 Dx mammo incl cad uni 1.16 $70.00 $81.20 77066 Dx mammo incl cad bi 4.84 $70.00 $338.80 77066 TC Dx mammo incl cad bi 3.41 $70.00 $238.70 77066 26 Dx mammo incl cad bi 1.43 $70.00 $100.10 77067 Scr mammo bi incl cad 3.90 $70.00 $273.00 NON-FACILITY HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL 77067 TC Scr mammo bi incl cad 2.82 $70.00 $197.40 77067 26 Scr mammo bi incl cad 1.08 $70.00 $75.60 77071 X-ray stress view 1.37 $70.00 $95.90 77072 X-rays for bone age 0.65 $70.00 $45.50 77072 TC X-rays for bone age 0.38 $70.00 $26.60 77072 26 X-rays for bone age 0.27 $70.00 $18.90 77073 X-rays bone length studies 1.02 $70.00 $71.40 77073 TC X-rays bone length studies 0.61 $70.00 $42.70 77073 26 X-rays bone length studies 0.41 $70.00 $28.70 77074 X-rays bone survey limited 1.82 $70.00 $127.40 77074 TC X-rays bone survey limited 1.17 $70.00 $81.90 77074 26 X-rays bone survey limited 0.65 $70.00 $45.50 77075 X-rays bone survey complete 2.47 $70.00 $172.90 77075 TC X-rays bone survey complete 1.70 $70.00 $119.00 77075 26 X-rays bone survey complete 0.77 $70.00 $53.90 77076 X-rays bone survey infant 2.71 $70.00 $189.70 77076 TC X-rays bone survey infant 1.71 $70.00 $119.70 77076 26 X-rays bone survey infant 1.00 $70.00 $70.00 77077 Joint survey single view 1.05 $70.00 $73.50 77077 TC Joint survey single view 0.59 $70.00 $41.30 77077 26 Joint survey single view 0.46 $70.00 $32.20 77078 Ct bone density axial 3.26 $70.00 $228.20 77078 TC Ct bone density axial 2.91 $70.00 $203.70 77078 26 Ct bone density axial 0.35 $70.00 $24.50 77080 Dxa bone density axial 1.19 $70.00 $83.30 77080 TC Dxa bone density axial 0.90 $70.00 $63.00 77080 26 Dxa bone density axial 0.29 $70.00 $20.30 77081 Dxa bone density/peripheral 0.80 $70.00 $56.00 77081 TC Dxa bone density/peripheral 0.49 $70.00 $34.30 77081 26 Dxa bone density/peripheral 0.31 $70.00 $21.70 77084 Magnetic image bone marrow 11.03 $70.00 $772.10 77084 TC Magnetic image bone marrow 8.74 $70.00 $611.80 77084 26 Magnetic image bone marrow 2.29 $70.00 $160.30 77085 Dxa bone density study 1.61 $70.00 $112.70 77085 TC Dxa bone density study 1.18 $70.00 $82.60 77085 26 Dxa bone density study 0.43 $70.00 $30.10 77086 Fracture assessment via dxa 1.03 $70.00 $72.10 77086 TC Fracture assessment via dxa 0.78 $70.00 $54.60 77086 26 Fracture assessment via dxa 0.25 $70.00 $17.50 77261 Radiation therapy planning 2.03 $70.00 $142.10 77262 Radiation therapy planning 3.06 $70.00 $214.20 77263 Radiation therapy planning 4.74 $70.00 $331.80 77280 Set radiation therapy field 7.98 $70.00 $558.60 77280 TC Set radiation therapy field 6.94 $70.00 $485.80 77280 26 Set radiation therapy field 1.04 $70.00 $72.80 NON-FACILITY HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL 77285 Set radiation therapy field 13.03 $70.00 $912.10 77285 TC Set radiation therapy field 11.44 $70.00 $800.80 77285 26 Set radiation therapy field 1.59 $70.00 $111.30 77290 Set radiation therapy field 14.96 $70.00 $1,047.20 77290 TC Set radiation therapy field 12.64 $70.00 $884.80 77290 26 Set radiation therapy field 2.32 $70.00 $162.40 77293 Respirator motion mgmt simul 13.47 $70.00 $942.90 77293 TC Respirator motion mgmt simul 10.51 $70.00 $735.70 77293 26 Respirator motion mgmt simul 2.96 $70.00 $207.20 77295 3-d radiotherapy plan 14.14 $70.00 $989.80 77295 TC 3-d radiotherapy plan 7.79 $70.00 $545.30 77295 26 3-d radiotherapy plan 6.35 $70.00 $444.50 77299 Radiation therapy planning 0.00 $70.00 $0.00 77299 TC Radiation therapy planning 0.00 $70.00 $0.00 77299 26 Radiation therapy planning 0.00 $70.00 $0.00 77300 Radiation therapy dose plan 1.91 $70.00 $133.70 77300 TC Radiation therapy dose plan 0.99 $70.00 $69.30 77300 26 Radiation therapy dose plan 0.92 $70.00 $64.40 77301 Radiotherapy dose plan imrt 56.48 $70.00 $3,953.60 77301 TC Radiotherapy dose plan imrt 44.67 $70.00 $3,126.90 77301 26 Radiotherapy dose plan imrt 11.81 $70.00 $826.70 77306 Telethx isodose plan simple 4.31 $70.00 $301.70 77306 TC Telethx isodose plan simple 2.23 $70.00 $156.10 77306 26 Telethx isodose plan simple 2.08 $70.00 $145.60 77307 Telethx isodose plan cplx 8.31 $70.00 $581.70 77307 TC Telethx isodose plan cplx 4.03 $70.00 $282.10 77307 26 Telethx isodose plan cplx 4.28 $70.00 $299.60 77316 Brachytx isodose plan simple 5.43 $70.00 $380.10 77316 TC Brachytx isodose plan simple 3.35 $70.00 $234.50 77316 26 Brachytx isodose plan simple 2.08 $70.00 $145.60 77317 Brachytx isodose intermed 7.08 $70.00 $495.60 77317 TC Brachytx isodose intermed 4.38 $70.00 $306.60 77317 26 Brachytx isodose intermed 2.70 $70.00 $189.00 77318 Brachytx isodose complex 10.23 $70.00 $716.10 77318 TC Brachytx isodose complex 5.95 $70.00 $416.50 77318 26 Brachytx isodose complex 4.28 $70.00 $299.60 77321 Special teletx port plan 2.68 $70.00 $187.60 77321 TC Special teletx port plan 1.27 $70.00 $88.90 77321 26 Special teletx port plan 1.41 $70.00 $98.70 77331 Special radiation dosimetry 1.84 $70.00 $128.80 77331 TC Special radiation dosimetry 0.55 $70.00 $38.50 77331 26 Special radiation dosimetry 1.29 $70.00 $90.30 77332 Radiation treatment aid(s) 1.68 $70.00 $117.60 77332 TC Radiation treatment aid(s) 1.00 $70.00 $70.00 77332 26 Radiation treatment aid(s) 0.68 $70.00 $47.60 NON-FACILITY HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL 77333 Radiation treatment aid(s) 2.79 $70.00 $195.30 77333 TC Radiation treatment aid(s) 1.68 $70.00 $117.60 77333 26 Radiation treatment aid(s) 1.11 $70.00 $77.70 77334 Radiation treatment aid(s) 3.69 $70.00 $258.30 77334 TC Radiation treatment aid(s) 1.98 $70.00 $138.60 77334 26 Radiation treatment aid(s) 1.71 $70.00 $119.70 77336 Radiation physics consult 2.30 $70.00 $161.00 77338 Design mlc device for imrt 14.65 $70.00 $1,025.50 77338 TC Design mlc device for imrt 8.30 $70.00 $581.00 77338 26 Design mlc device for imrt 6.35 $70.00 $444.50 77370 Radiation physics consult 3.54 $70.00 $247.80 77371 Srs multisource 0.00 $70.00 $0.00 77372 Srs linear based 31.07 $70.00 $2,174.90 77373 Sbrt delivery 39.52 $70.00 $2,766.40 77385 Ntsty modul rad tx dlvr smpl 0.00 $70.00 $0.00 77386 Ntsty modul rad tx dlvr cplx 0.00 $70.00 $0.00 77387 Guidance for radiaj tx dlvr 0.00 $70.00 $0.00 77399 External radiation dosimetry 0.00 $70.00 $0.00 77399 TC External radiation dosimetry 0.00 $70.00 $0.00 77399 26 External radiation dosimetry 0.00 $70.00 $0.00 77401 Radiation treatment delivery 0.71 $70.00 $49.70 77402 Radiation treatment delivery 0.00 $70.00 $0.00 77407 Radiation treatment delivery 0.00 $70.00 $0.00 77412 Radiation treatment delivery 0.00 $70.00 $0.00 77417 Radiology port images(s) 0.32 $70.00 $22.40 77423 Neutron beam tx complex 0.00 $70.00 $0.00 77424 Io rad tx delivery by x-ray 0.00 $70.00 $0.00 77425 Io rad tx deliver by elctrns 0.00 $70.00 $0.00 77427 Radiation tx management x5 5.31 $70.00 $371.70 77431 Radiation therapy management 2.92 $70.00 $204.40 77432 Stereotactic radiation trmt 11.95 $70.00 $836.50 77435 Sbrt management 18.02 $70.00 $1,261.40 77469 Io radiation tx management 9.11 $70.00 $637.70 77470 Special radiation treatment 3.89 $70.00 $272.30 77470 TC Special radiation treatment 0.89 $70.00 $62.30 77470 26 Special radiation treatment 3.00 $70.00 $210.00 77499 Radiation therapy management 0.00 $70.00 $0.00 77499 TC Radiation therapy management 0.00 $70.00 $0.00 77499 26 Radiation therapy management 0.00 $70.00 $0.00 77520 Proton trmt simple w/o comp 0.00 $70.00 $0.00 77522 Proton trmt simple w/comp 0.00 $70.00 $0.00 77523 Proton trmt intermediate 0.00 $70.00 $0.00 77525 Proton treatment complex 0.00 $70.00 $0.00 77600 Hyperthermia treatment 12.29 $70.00 $860.30 77600 TC Hyperthermia treatment 10.28 $70.00 $719.60 NON-FACILITY HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL 77600 26 Hyperthermia treatment 2.01 $70.00 $140.70 77605 Hyperthermia treatment 21.67 $70.00 $1,516.90 77605 TC Hyperthermia treatment 18.77 $70.00 $1,313.90 77605 26 Hyperthermia treatment 2.90 $70.00 $203.00 77610 Hyperthermia treatment 21.79 $70.00 $1,525.30 77610 TC Hyperthermia treatment 19.91 $70.00 $1,393.70 77610 26 Hyperthermia treatment 1.88 $70.00 $131.60 77615 Hyperthermia treatment 29.70 $70.00 $2,079.00 77615 TC Hyperthermia treatment 26.99 $70.00 $1,889.30 77615 26 Hyperthermia treatment 2.71 $70.00 $189.70 77620 Hyperthermia treatment 13.47 $70.00 $942.90 77620 TC Hyperthermia treatment 11.01 $70.00 $770.70 77620 26 Hyperthermia treatment 2.46 $70.00 $172.20 77750 Infuse radioactive materials 10.68 $70.00 $747.60 77750 TC Infuse radioactive materials 3.29 $70.00 $230.30 77750 26 Infuse radioactive materials 7.39 $70.00 $517.30 77761 Apply intrcav radiat simple 11.25 $70.00 $787.50 77761 TC Apply intrcav radiat simple 5.55 $70.00 $388.50 77761 26 Apply intrcav radiat simple 5.70 $70.00 $399.00 77762 Apply intrcav radiat interm 14.91 $70.00 $1,043.70 77762 TC Apply intrcav radiat interm 6.38 $70.00 $446.60 77762 26 Apply intrcav radiat interm 8.53 $70.00 $597.10 77763 Apply intrcav radiat compl 21.33 $70.00 $1,493.10 77763 TC Apply intrcav radiat compl 8.44 $70.00 $590.80 77763 26 Apply intrcav radiat compl 12.89 $70.00 $902.30 77767 Hdr rdncl skn surf brachytx 6.49 $70.00 $454.30 77767 TC Hdr rdncl skn surf brachytx 4.94 $70.00 $345.80 77767 26 Hdr rdncl skn surf brachytx 1.55 $70.00 $108.50 77768 Hdr rdncl skn surf brachytx 10.19 $70.00 $713.30 77768 TC Hdr rdncl skn surf brachytx 8.11 $70.00 $567.70 77768 26 Hdr rdncl skn surf brachytx 2.08 $70.00 $145.60 77770 Hdr rdncl ntrstl/icav brchtx 9.29 $70.00 $650.30 77770 TC Hdr rdncl ntrstl/icav brchtx 6.41 $70.00 $448.70 77770 26 Hdr rdncl ntrstl/icav brchtx 2.88 $70.00 $201.60 77771 Hdr rdncl ntrstl/icav brchtx 17.27 $70.00 $1,208.90 77771 TC Hdr rdncl ntrstl/icav brchtx 11.64 $70.00 $814.80 77771 26 Hdr rdncl ntrstl/icav brchtx 5.63 $70.00 $394.10 77772 Hdr rdncl ntrstl/icav brchtx 26.35 $70.00 $1,844.50 77772 TC Hdr rdncl ntrstl/icav brchtx 18.38 $70.00 $1,286.60 77772 26 Hdr rdncl ntrstl/icav brchtx 7.97 $70.00 $557.90 77778 Apply interstit radiat compl 23.62 $70.00 $1,653.40 77778 TC Apply interstit radiat compl 10.68 $70.00 $747.60 77778 26 Apply interstit radiat compl 12.94 $70.00 $905.80 77789 Apply surf ldr radionuclide 3.47 $70.00 $242.90 77789 TC Apply surf ldr radionuclide 1.77 $70.00 $123.90 NON-FACILITY HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL 77789 26 Apply surf ldr radionuclide 1.70 $70.00 $119.00 77790 Radiation handling 0.43 $70.00 $30.10 77799 Radium/radioisotope therapy 0.00 $70.00 $0.00 77799 TC Radium/radioisotope therapy 0.00 $70.00 $0.00 77799 26 Radium/radioisotope therapy 0.00 $70.00 $0.00 78012 Thyroid uptake measurement 2.37 $70.00 $165.90 78012 TC Thyroid uptake measurement 2.10 $70.00 $147.00 78012 26 Thyroid uptake measurement 0.27 $70.00 $18.90 78013 Thyroid imaging w/blood flow 5.63 $70.00 $394.10 78013 TC Thyroid imaging w/blood flow 5.11 $70.00 $357.70 78013 26 Thyroid imaging w/blood flow 0.52 $70.00 $36.40 78014 Thyroid imaging w/blood flow 7.08 $70.00 $495.60 78014 TC Thyroid imaging w/blood flow 6.38 $70.00 $446.60 78014 26 Thyroid imaging w/blood flow 0.70 $70.00 $49.00 78015 Thyroid met imaging 6.53 $70.00 $457.10 78015 TC Thyroid met imaging 5.59 $70.00 $391.30 78015 26 Thyroid met imaging 0.94 $70.00 $65.80 78016 Thyroid met imaging/studies 8.26 $70.00 $578.20 78016 TC Thyroid met imaging/studies 7.29 $70.00 $510.30 78016 26 Thyroid met imaging/studies 0.97 $70.00 $67.90 78018 Thyroid met imaging body 9.17 $70.00 $641.90 78018 TC Thyroid met imaging body 8.00 $70.00 $560.00 78018 26 Thyroid met imaging body 1.17 $70.00 $81.90 78020 Thyroid met uptake 2.45 $70.00 $171.50 78020 TC Thyroid met uptake 1.66 $70.00 $116.20 78020 26 Thyroid met uptake 0.79 $70.00 $55.30 78070 Parathyroid planar imaging 8.80 $70.00 $616.00 78070 TC Parathyroid planar imaging 7.69 $70.00 $538.30 78070 26 Parathyroid planar imaging 1.11 $70.00 $77.70 78071 Parathyrd planar w/wo subtrj 10.48 $70.00 $733.60 78071 TC Parathyrd planar w/wo subtrj 8.81 $70.00 $616.70 78071 26 Parathyrd planar w/wo subtrj 1.67 $70.00 $116.90 78072 Parathyrd planar w/spect&ct 12.14 $70.00 $849.80 78072 TC Parathyrd planar w/spect&ct 9.95 $70.00 $696.50 78072 26 Parathyrd planar w/spect&ct 2.19 $70.00 $153.30 78075 Adrenal cortex & medulla img 13.27 $70.00 $928.90 78075 TC Adrenal cortex & medulla img 12.21 $70.00 $854.70 78075 26 Adrenal cortex & medulla img 1.06 $70.00 $74.20 78099 Endocrine nuclear procedure 0.00 $70.00 $0.00 78099 TC Endocrine nuclear procedure 0.00 $70.00 $0.00 78099 26 Endocrine nuclear procedure 0.00 $70.00 $0.00 78102 Bone marrow imaging ltd 4.96 $70.00 $347.20 78102 TC Bone marrow imaging ltd 4.21 $70.00 $294.70 78102 26 Bone marrow imaging ltd 0.75 $70.00 $52.50 78103 Bone marrow imaging mult 6.34 $70.00 $443.80 NON-FACILITY HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL 78103 TC Bone marrow imaging mult 5.34 $70.00 $373.80 78103 26 Bone marrow imaging mult 1.00 $70.00 $70.00 78104 Bone marrow imaging body 7.24 $70.00 $506.80 78104 TC Bone marrow imaging body 6.14 $70.00 $429.80 78104 26 Bone marrow imaging body 1.10 $70.00 $77.00 78110 Plasma volume single 2.37 $70.00 $165.90 78110 TC Plasma volume single 2.14 $70.00 $149.80 78110 26 Plasma volume single 0.23 $70.00 $16.10 78111 Plasma volume multiple 2.27 $70.00 $158.90 78111 TC Plasma volume multiple 2.00 $70.00 $140.00 78111 26 Plasma volume multiple 0.27 $70.00 $18.90 78120 Red cell mass single 2.23 $70.00 $156.10 78120 TC Red cell mass single 1.95 $70.00 $136.50 78120 26 Red cell mass single 0.28 $70.00 $19.60 78121 Red cell mass multiple 2.48 $70.00 $173.60 78121 TC Red cell mass multiple 2.10 $70.00 $147.00 78121 26 Red cell mass multiple 0.38 $70.00 $26.60 78122 Blood volume 2.79 $70.00 $195.30 78122 TC Blood volume 2.19 $70.00 $153.30 78122 26 Blood volume 0.60 $70.00 $42.00 78130 Red cell survival study 3.98 $70.00 $278.60 78130 TC Red cell survival study 3.26 $70.00 $228.20 78130 26 Red cell survival study 0.72 $70.00 $50.40 78135 Red cell survival kinetics 8.37 $70.00 $585.90 78135 TC Red cell survival kinetics 7.61 $70.00 $532.70 78135 26 Red cell survival kinetics 0.76 $70.00 $53.20 78140 Red cell sequestration 3.29 $70.00 $230.30 78140 TC Red cell sequestration 2.57 $70.00 $179.90 78140 26 Red cell sequestration 0.72 $70.00 $50.40 78185 Spleen imaging 5.02 $70.00 $351.40 78185 TC Spleen imaging 4.54 $70.00 $317.80 78185 26 Spleen imaging 0.48 $70.00 $33.60 78191 Platelet survival 3.98 $70.00 $278.60 78191 TC Platelet survival 3.26 $70.00 $228.20 78191 26 Platelet survival 0.72 $70.00 $50.40 78195 Lymph system imaging 10.44 $70.00 $730.80 78195 TC Lymph system imaging 8.77 $70.00 $613.90 78195 26 Lymph system imaging 1.67 $70.00 $116.90 78199 Blood/lymph nuclear exam 0.00 $70.00 $0.00 78199 TC Blood/lymph nuclear exam 0.00 $70.00 $0.00 78199 26 Blood/lymph nuclear exam 0.00 $70.00 $0.00 78201 Liver imaging 5.55 $70.00 $388.50 78201 TC Liver imaging 4.95 $70.00 $346.50 78201 26 Liver imaging 0.60 $70.00 $42.00 78202 Liver imaging with flow 5.85 $70.00 $409.50 NON-FACILITY HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL 78202 TC Liver imaging with flow 5.18 $70.00 $362.60 78202 26 Liver imaging with flow 0.67 $70.00 $46.90 78205 Liver imaging (3d) 6.18 $70.00 $432.60 78205 TC Liver imaging (3d) 5.23 $70.00 $366.10 78205 26 Liver imaging (3d) 0.95 $70.00 $66.50 78206 Liver image (3d) with flow 10.09 $70.00 $706.30 78206 TC Liver image (3d) with flow 8.76 $70.00 $613.20 78206 26 Liver image (3d) with flow 1.33 $70.00 $93.10 78215 Liver and spleen imaging 5.70 $70.00 $399.00 78215 TC Liver and spleen imaging 5.01 $70.00 $350.70 78215 26 Liver and spleen imaging 0.69 $70.00 $48.30 78216 Liver & spleen image/flow 3.70 $70.00 $259.00 78216 TC Liver & spleen image/flow 2.92 $70.00 $204.40 78216 26 Liver & spleen image/flow 0.78 $70.00 $54.60 78226 Hepatobiliary system imaging 9.71 $70.00 $679.70 78226 TC Hepatobiliary system imaging 8.67 $70.00 $606.90 78226 26 Hepatobiliary system imaging 1.04 $70.00 $72.80 78227 Hepatobil syst image w/drug 13.16 $70.00 $921.20 78227 TC Hepatobil syst image w/drug 11.89 $70.00 $832.30 78227 26 Hepatobil syst image w/drug 1.27 $70.00 $88.90 78230 Salivary gland imaging 5.10 $70.00 $357.00 78230 TC Salivary gland imaging 4.45 $70.00 $311.50 78230 26 Salivary gland imaging 0.65 $70.00 $45.50 78231 Serial salivary imaging 3.07 $70.00 $214.90 78231 TC Serial salivary imaging 2.45 $70.00 $171.50 78231 26 Serial salivary imaging 0.62 $70.00 $43.40 78232 Salivary gland function exam 2.93 $70.00 $205.10 78232 TC Salivary gland function exam 2.37 $70.00 $165.90 78232 26 Salivary gland function exam 0.56 $70.00 $39.20 78258 Esophageal motility study 6.59 $70.00 $461.30 78258 TC Esophageal motility study 5.55 $70.00 $388.50 78258 26 Esophageal motility study 1.04 $70.00 $72.80 78261 Gastric mucosa imaging 5.91 $70.00 $413.70 78261 TC Gastric mucosa imaging 5.09 $70.00 $356.30 78261 26 Gastric mucosa imaging 0.82 $70.00 $57.40 78262 Gastroesophageal reflux exam 7.07 $70.00 $494.90 78262 TC Gastroesophageal reflux exam 6.13 $70.00 $429.10 78262 26 Gastroesophageal reflux exam 0.94 $70.00 $65.80 78264 Gastric emptying imag study 9.85 $70.00 $689.50 78264 TC Gastric emptying imag study 8.75 $70.00 $612.50 78264 26 Gastric emptying imag study 1.10 $70.00 $77.00 78265 Gastric emptying imag study 11.69 $70.00 $818.30 78265 TC Gastric emptying imag study 10.32 $70.00 $722.40 78265 26 Gastric emptying imag study 1.37 $70.00 $95.90 78266 Gastric emptying imag study 13.93 $70.00 $975.10 NON-FACILITY HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL 78266 TC Gastric emptying imag study 12.41 $70.00 $868.70 78266 26 Gastric emptying imag study 1.52 $70.00 $106.40 78267 Breath tst attain/anal c-14 0.00 $70.00 $0.00 78268 Breath test analysis c-14 0.00 $70.00 $0.00 78270 Vit b-12 absorption exam 3.00 $70.00 $210.00 78270 TC Vit b-12 absorption exam 2.70 $70.00 $189.00 78270 26 Vit b-12 absorption exam 0.30 $70.00 $21.00 78271 Vit b-12 absrp exam int fac 2.13 $70.00 $149.10 78271 TC Vit b-12 absrp exam int fac 1.89 $70.00 $132.30 78271 26 Vit b-12 absrp exam int fac 0.24 $70.00 $16.80 78272 Vit b-12 absorp combined 2.34 $70.00 $163.80 78272 TC Vit b-12 absorp combined 2.01 $70.00 $140.70 78272 26 Vit b-12 absorp combined 0.33 $70.00 $23.10 78278 Acute gi blood loss imaging 10.23 $70.00 $716.10 78278 TC Acute gi blood loss imaging 8.84 $70.00 $618.80 78278 26 Acute gi blood loss imaging 1.39 $70.00 $97.30 78282 Gi protein loss exam 0.00 $70.00 $0.00 78282 TC Gi protein loss exam 0.00 $70.00 $0.00 78282 26 Gi protein loss exam 0.54 $70.00 $37.80 78290 Meckels divert exam 9.71 $70.00 $679.70 78290 TC Meckels divert exam 8.76 $70.00 $613.20 78290 26 Meckels divert exam 0.95 $70.00 $66.50 78291 Leveen/shunt patency exam 7.51 $70.00 $525.70 78291 TC Leveen/shunt patency exam 6.30 $70.00 $441.00 78291 26 Leveen/shunt patency exam 1.21 $70.00 $84.70 78299 Gi nuclear procedure 0.00 $70.00 $0.00 78299 TC Gi nuclear procedure 0.00 $70.00 $0.00 78299 26 Gi nuclear procedure 0.00 $70.00 $0.00 78300 Bone imaging limited area 6.77 $70.00 $473.90 78300 TC Bone imaging limited area 5.88 $70.00 $411.60 78300 26 Bone imaging limited area 0.89 $70.00 $62.30 78305 Bone imaging multiple areas 8.25 $70.00 $577.50 78305 TC Bone imaging multiple areas 7.08 $70.00 $495.60 78305 26 Bone imaging multiple areas 1.17 $70.00 $81.90 78306 Bone imaging whole body 8.90 $70.00 $623.00 78306 TC Bone imaging whole body 7.69 $70.00 $538.30 78306 26 Bone imaging whole body 1.21 $70.00 $84.70 78315 Bone imaging 3 phase 10.15 $70.00 $710.50 78315 TC Bone imaging 3 phase 8.73 $70.00 $611.10 78315 26 Bone imaging 3 phase 1.42 $70.00 $99.40 78320 Bone imaging (3d) 6.69 $70.00 $468.30 78320 TC Bone imaging (3d) 5.26 $70.00 $368.20 78320 26 Bone imaging (3d) 1.43 $70.00 $100.10 78350 Bone mineral single photon 0.95 $70.00 $66.50 78350 TC Bone mineral single photon 0.63 $70.00 $44.10 NON-FACILITY HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL 78350 26 Bone mineral single photon 0.32 $70.00 $22.40 78351 Bone mineral dual photon 0.44 $70.00 $30.80 78399 Musculoskeletal nuclear exam 0.00 $70.00 $0.00 78399 TC Musculoskeletal nuclear exam 0.00 $70.00 $0.00 78399 26 Musculoskeletal nuclear exam 0.00 $70.00 $0.00 78414 Non-imaging heart function 0.00 $70.00 $0.00 78414 TC Non-imaging heart function 0.00 $70.00 $0.00 78414 26 Non-imaging heart function 0.63 $70.00 $44.10 78428 Cardiac shunt imaging 5.34 $70.00 $373.80 78428 TC Cardiac shunt imaging 4.27 $70.00 $298.90 78428 26 Cardiac shunt imaging 1.07 $70.00 $74.90 78445 Vascular flow imaging 5.47 $70.00 $382.90 78445 TC Vascular flow imaging 4.77 $70.00 $333.90 78445 26 Vascular flow imaging 0.70 $70.00 $49.00 78451 Ht muscle image spect sing 9.98 $70.00 $698.60 78451 TC Ht muscle image spect sing 8.07 $70.00 $564.90 78451 26 Ht muscle image spect sing 1.91 $70.00 $133.70 78452 Ht muscle image spect mult 13.90 $70.00 $973.00 78452 TC Ht muscle image spect mult 11.65 $70.00 $815.50 78452 26 Ht muscle image spect mult 2.25 $70.00 $157.50 78453 Ht muscle image planar sing 8.91 $70.00 $623.70 78453 TC Ht muscle image planar sing 7.51 $70.00 $525.70 78453 26 Ht muscle image planar sing 1.40 $70.00 $98.00 78454 Ht musc image planar mult 12.81 $70.00 $896.70 78454 TC Ht musc image planar mult 10.92 $70.00 $764.40 78454 26 Ht musc image planar mult 1.89 $70.00 $132.30 78456 Acute venous thrombus image 9.08 $70.00 $635.60 78456 TC Acute venous thrombus image 7.70 $70.00 $539.00 78456 26 Acute venous thrombus image 1.38 $70.00 $96.60 78457 Venous thrombosis imaging 5.62 $70.00 $393.40 78457 TC Venous thrombosis imaging 4.55 $70.00 $318.50 78457 26 Venous thrombosis imaging 1.07 $70.00 $74.90 78458 Ven thrombosis images bilat 5.98 $70.00 $418.60 78458 TC Ven thrombosis images bilat 4.70 $70.00 $329.00 78458 26 Ven thrombosis images bilat 1.28 $70.00 $89.60 78459 Heart muscle imaging (pet) 0.00 $70.00 $0.00 78459 TC Heart muscle imaging (pet) 0.00 $70.00 $0.00 78459 26 Heart muscle imaging (pet) 2.01 $70.00 $140.70 78466 Heart infarct image 5.78 $70.00 $404.60 78466 TC Heart infarct image 4.78 $70.00 $334.60 78466 26 Heart infarct image 1.00 $70.00 $70.00 78468 Heart infarct image (ef) 5.64 $70.00 $394.80 78468 TC Heart infarct image (ef) 4.54 $70.00 $317.80 78468 26 Heart infarct image (ef) 1.10 $70.00 $77.00 78469 Heart infarct image (3d) 6.71 $70.00 $469.70 NON-FACILITY HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL 78469 TC Heart infarct image (3d) 5.43 $70.00 $380.10 78469 26 Heart infarct image (3d) 1.28 $70.00 $89.60 78472 Gated heart planar single 6.71 $70.00 $469.70 78472 TC Gated heart planar single 5.34 $70.00 $373.80 78472 26 Gated heart planar single 1.37 $70.00 $95.90 78473 Gated heart multiple 8.46 $70.00 $592.20 78473 TC Gated heart multiple 6.44 $70.00 $450.80 78473 26 Gated heart multiple 2.02 $70.00 $141.40 78481 Heart first pass single 5.12 $70.00 $358.40 78481 TC Heart first pass single 3.76 $70.00 $263.20 78481 26 Heart first pass single 1.36 $70.00 $95.20 78483 Heart first pass multiple 7.06 $70.00 $494.20 78483 TC Heart first pass multiple 5.04 $70.00 $352.80 78483 26 Heart first pass multiple 2.02 $70.00 $141.40 78491 Heart image (pet) single 0.00 $70.00 $0.00 78491 TC Heart image (pet) single 0.00 $70.00 $0.00 78491 26 Heart image (pet) single 2.02 $70.00 $141.40 78492 Heart image (pet) multiple 0.00 $70.00 $0.00 78492 TC Heart image (pet) multiple 0.00 $70.00 $0.00 78492 26 Heart image (pet) multiple 2.55 $70.00 $178.50 78494 Heart image spect 6.59 $70.00 $461.30 78494 TC Heart image spect 4.94 $70.00 $345.80 78494 26 Heart image spect 1.65 $70.00 $115.50 78496 Heart first pass add-on 1.27 $70.00 $88.90 78496 TC Heart first pass add-on 0.58 $70.00 $40.60 78496 26 Heart first pass add-on 0.69 $70.00 $48.30 78499 Cardiovascular nuclear exam 0.00 $70.00 $0.00 78499 TC Cardiovascular nuclear exam 0.00 $70.00 $0.00 78499 26 Cardiovascular nuclear exam 0.00 $70.00 $0.00 78579 Lung ventilation imaging 5.48 $70.00 $383.60 78579 TC Lung ventilation imaging 4.80 $70.00 $336.00 78579 26 Lung ventilation imaging 0.68 $70.00 $47.60 78580 Lung perfusion imaging 7.00 $70.00 $490.00 78580 TC Lung perfusion imaging 5.96 $70.00 $417.20 78580 26 Lung perfusion imaging 1.04 $70.00 $72.80 78582 Lung ventilat&perfus imaging 9.80 $70.00 $686.00 78582 TC Lung ventilat&perfus imaging 8.30 $70.00 $581.00 78582 26 Lung ventilat&perfus imaging 1.50 $70.00 $105.00 78597 Lung perfusion differential 5.95 $70.00 $416.50 78597 TC Lung perfusion differential 4.94 $70.00 $345.80 78597 26 Lung perfusion differential 1.01 $70.00 $70.70 78598 Lung perf&ventilat diferentl 8.94 $70.00 $625.80 78598 TC Lung perf&ventilat diferentl 7.77 $70.00 $543.90 78598 26 Lung perf&ventilat diferentl 1.17 $70.00 $81.90 78599 Respiratory nuclear exam 0.00 $70.00 $0.00 NON-FACILITY HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL 78599 TC Respiratory nuclear exam 0.00 $70.00 $0.00 78599 26 Respiratory nuclear exam 0.00 $70.00 $0.00 78600 Brain image < 4 views 5.41 $70.00 $378.70 78600 TC Brain image < 4 views 4.78 $70.00 $334.60 78600 26 Brain image < 4 views 0.63 $70.00 $44.10 78601 Brain image w/flow < 4 views 6.29 $70.00 $440.30 78601 TC Brain image w/flow < 4 views 5.58 $70.00 $390.60 78601 26 Brain image w/flow < 4 views 0.71 $70.00 $49.70 78605 Brain image 4+ views 5.83 $70.00 $408.10 78605 TC Brain image 4+ views 5.07 $70.00 $354.90 78605 26 Brain image 4+ views 0.76 $70.00 $53.20 78606 Brain image w/flow 4 + views 9.66 $70.00 $676.20 78606 TC Brain image w/flow 4 + views 8.77 $70.00 $613.90 78606 26 Brain image w/flow 4 + views 0.89 $70.00 $62.30 78607 Brain imaging (3d) 10.27 $70.00 $718.90 78607 TC Brain imaging (3d) 8.59 $70.00 $601.30 78607 26 Brain imaging (3d) 1.68 $70.00 $117.60 78608 Brain imaging (pet) 0.00 $70.00 $0.00 78608 TC Brain imaging (pet) 0.00 $70.00 $0.00 78608 26 Brain imaging (pet) 2.04 $70.00 $142.80 78609 Brain imaging (pet) 2.12 $70.00 $148.40 78609 TC Brain imaging (pet) 0.00 $70.00 $0.00 78609 26 Brain imaging (pet) 2.12 $70.00 $148.40 78610 Brain flow imaging only 5.13 $70.00 $359.10 78610 TC Brain flow imaging only 4.70 $70.00 $329.00 78610 26 Brain flow imaging only 0.43 $70.00 $30.10 78630 Cerebrospinal fluid scan 9.93 $70.00 $695.10 78630 TC Cerebrospinal fluid scan 8.97 $70.00 $627.90 78630 26 Cerebrospinal fluid scan 0.96 $70.00 $67.20 78635 Csf ventriculography 9.94 $70.00 $695.80 78635 TC Csf ventriculography 9.06 $70.00 $634.20 78635 26 Csf ventriculography 0.88 $70.00 $61.60 78645 Csf shunt evaluation 9.54 $70.00 $667.80 78645 TC Csf shunt evaluation 8.75 $70.00 $612.50 78645 26 Csf shunt evaluation 0.79 $70.00 $55.30 78647 Cerebrospinal fluid scan 10.30 $70.00 $721.00 78647 TC Cerebrospinal fluid scan 9.01 $70.00 $630.70 78647 26 Cerebrospinal fluid scan 1.29 $70.00 $90.30 78650 Csf leakage imaging 7.99 $70.00 $559.30 78650 TC Csf leakage imaging 7.27 $70.00 $508.90 78650 26 Csf leakage imaging 0.72 $70.00 $50.40 78660 Nuclear exam of tear flow 5.28 $70.00 $369.60 78660 TC Nuclear exam of tear flow 4.54 $70.00 $317.80 78660 26 Nuclear exam of tear flow 0.74 $70.00 $51.80 78699 Nervous system nuclear exam 0.00 $70.00 $0.00 NON-FACILITY HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL 78699 TC Nervous system nuclear exam 0.00 $70.00 $0.00 78699 26 Nervous system nuclear exam 0.00 $70.00 $0.00 78700 Kidney imaging morphol 5.05 $70.00 $353.50 78700 TC Kidney imaging morphol 4.42 $70.00 $309.40 78700 26 Kidney imaging morphol 0.63 $70.00 $44.10 78701 Kidney imaging with flow 6.29 $70.00 $440.30 78701 TC Kidney imaging with flow 5.61 $70.00 $392.70 78701 26 Kidney imaging with flow 0.68 $70.00 $47.60 78707 K flow/funct image w/o drug 6.81 $70.00 $476.70 78707 TC K flow/funct image w/o drug 5.49 $70.00 $384.30 78707 26 K flow/funct image w/o drug 1.32 $70.00 $92.40 78708 K flow/funct image w/drug 5.13 $70.00 $359.10 78708 TC K flow/funct image w/drug 3.45 $70.00 $241.50 78708 26 K flow/funct image w/drug 1.68 $70.00 $117.60 78709 K flow/funct image multiple 10.74 $70.00 $751.80 78709 TC K flow/funct image multiple 8.80 $70.00 $616.00 78709 26 K flow/funct image multiple 1.94 $70.00 $135.80 78710 Kidney imaging (3d) 5.91 $70.00 $413.70 78710 TC Kidney imaging (3d) 5.06 $70.00 $354.20 78710 26 Kidney imaging (3d) 0.85 $70.00 $59.50 78725 Kidney function study 3.13 $70.00 $219.10 78725 TC Kidney function study 2.61 $70.00 $182.70 78725 26 Kidney function study 0.52 $70.00 $36.40 78730 Urinary bladder retention 2.29 $70.00 $160.30 78730 TC Urinary bladder retention 2.06 $70.00 $144.20 78730 26 Urinary bladder retention 0.23 $70.00 $16.10 78740 Ureteral reflux study 6.39 $70.00 $447.30 78740 TC Ureteral reflux study 5.61 $70.00 $392.70 78740 26 Ureteral reflux study 0.78 $70.00 $54.60 78761 Testicular imaging w/flow 6.17 $70.00 $431.90 78761 TC Testicular imaging w/flow 5.16 $70.00 $361.20 78761 26 Testicular imaging w/flow 1.01 $70.00 $70.70 78799 Genitourinary nuclear exam 0.00 $70.00 $0.00 78799 TC Genitourinary nuclear exam 0.00 $70.00 $0.00 78799 26 Genitourinary nuclear exam 0.00 $70.00 $0.00 78800 Tumor imaging limited area 5.65 $70.00 $395.50 78800 TC Tumor imaging limited area 4.69 $70.00 $328.30 78800 26 Tumor imaging limited area 0.96 $70.00 $67.20 78801 Tumor imaging mult areas 7.61 $70.00 $532.70 78801 TC Tumor imaging mult areas 6.49 $70.00 $454.30 78801 26 Tumor imaging mult areas 1.12 $70.00 $78.40 78802 Tumor imaging whole body 9.49 $70.00 $664.30 78802 TC Tumor imaging whole body 8.31 $70.00 $581.70 78802 26 Tumor imaging whole body 1.18 $70.00 $82.60 78803 Tumor imaging (3d) 10.04 $70.00 $702.80 NON-FACILITY HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL 78803 TC Tumor imaging (3d) 8.57 $70.00 $599.90 78803 26 Tumor imaging (3d) 1.47 $70.00 $102.90 78804 Tumor imaging whole body 16.65 $70.00 $1,165.50 78804 TC Tumor imaging whole body 15.17 $70.00 $1,061.90 78804 26 Tumor imaging whole body 1.48 $70.00 $103.60 78805 Abscess imaging ltd area 5.36 $70.00 $375.20 78805 TC Abscess imaging ltd area 4.34 $70.00 $303.80 78805 26 Abscess imaging ltd area 1.02 $70.00 $71.40 78806 Abscess imaging whole body 9.79 $70.00 $685.30 78806 TC Abscess imaging whole body 8.60 $70.00 $602.00 78806 26 Abscess imaging whole body 1.19 $70.00 $83.30 78807 Nuclear localization/abscess 10.06 $70.00 $704.20 78807 TC Nuclear localization/abscess 8.58 $70.00 $600.60 78807 26 Nuclear localization/abscess 1.48 $70.00 $103.60 78808 Iv inj ra drug dx study 1.12 $70.00 $78.40 78811 Pet image ltd area 0.00 $70.00 $0.00 78811 TC Pet image ltd area 0.00 $70.00 $0.00 78811 26 Pet image ltd area 2.17 $70.00 $151.90 78812 Pet image skull-thigh 0.00 $70.00 $0.00 78812 TC Pet image skull-thigh 0.00 $70.00 $0.00 78812 26 Pet image skull-thigh 2.65 $70.00 $185.50 78813 Pet image full body 0.00 $70.00 $0.00 78813 TC Pet image full body 0.00 $70.00 $0.00 78813 26 Pet image full body 2.74 $70.00 $191.80 78814 Pet image w/ct lmtd 0.00 $70.00 $0.00 78814 TC Pet image w/ct lmtd 0.00 $70.00 $0.00 78814 26 Pet image w/ct lmtd 3.05 $70.00 $213.50 78815 Pet image w/ct skull-thigh 0.00 $70.00 $0.00 78815 TC Pet image w/ct skull-thigh 0.00 $70.00 $0.00 78815 26 Pet image w/ct skull-thigh 3.38 $70.00 $236.60 78816 Pet image w/ct full body 0.00 $70.00 $0.00 78816 TC Pet image w/ct full body 0.00 $70.00 $0.00 78816 26 Pet image w/ct full body 3.42 $70.00 $239.40 78999 Nuclear diagnostic exam 0.00 $70.00 $0.00 78999 TC Nuclear diagnostic exam 0.00 $70.00 $0.00 78999 26 Nuclear diagnostic exam 0.00 $70.00 $0.00 79005 Nuclear rx oral admin 3.90 $70.00 $273.00 79005 TC Nuclear rx oral admin 1.40 $70.00 $98.00 79005 26 Nuclear rx oral admin 2.50 $70.00 $175.00 79101 Nuclear rx iv admin 4.12 $70.00 $288.40 79101 TC Nuclear rx iv admin 1.38 $70.00 $96.60 79101 26 Nuclear rx iv admin 2.74 $70.00 $191.80 79200 Nuclear rx intracav admin 3.81 $70.00 $266.70 79200 TC Nuclear rx intracav admin 1.45 $70.00 $101.50 79200 26 Nuclear rx intracav admin 2.36 $70.00 $165.20 NON-FACILITY HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL 79300 Nuclr rx interstit colloid 0.00 $70.00 $0.00 79300 TC Nuclr rx interstit colloid 0.00 $70.00 $0.00 79300 26 Nuclr rx interstit colloid 2.28 $70.00 $159.60 79403 Hematopoietic nuclear tx 5.49 $70.00 $384.30 79403 TC Hematopoietic nuclear tx 2.37 $70.00 $165.90 79403 26 Hematopoietic nuclear tx 3.12 $70.00 $218.40 79440 Nuclear rx intra-articular 3.53 $70.00 $247.10 79440 TC Nuclear rx intra-articular 1.17 $70.00 $81.90 79440 26 Nuclear rx intra-articular 2.36 $70.00 $165.20 79445 Nuclear rx intra-arterial 0.00 $70.00 $0.00 79445 TC Nuclear rx intra-arterial 0.00 $70.00 $0.00 79445 26 Nuclear rx intra-arterial 3.26 $70.00 $228.20 79999 Nuclear medicine therapy 0.00 $70.00 $0.00 79999 TC Nuclear medicine therapy 0.00 $70.00 $0.00 79999 26 Nuclear medicine therapy 0.00 $70.00 $0.00 80047 Metabolic panel ionized ca 0.00 $58.28 $0.00 80048 Metabolic panel total ca 0.00 $58.28 $0.00 80050 General health panel 0.00 $58.28 $0.00 80051 Electrolyte panel 0.00 $58.28 $0.00 80053 Comprehen metabolic panel 0.00 $58.28 $0.00 80055 Obstetric panel 0.00 $58.28 $0.00 80061 Lipid panel 0.00 $58.28 $0.00 80069 Renal function panel 0.00 $58.28 $0.00 80074 Acute hepatitis panel 0.00 $58.28 $0.00 80076 Hepatic function panel 0.00 $58.28 $0.00 80081 Obstetric panel 0.00 $58.28 $0.00 80150 Assay of amikacin 0.00 $58.28 $0.00 80155 Drug assay caffeine 0.00 $58.28 $0.00 80156 Assay carbamazepine total 0.00 $58.28 $0.00 80157 Assay carbamazepine free 0.00 $58.28 $0.00 80158 Drug assay cyclosporine 0.00 $58.28 $0.00 80159 Drug assay clozapine 0.00 $58.28 $0.00 80162 Assay of digoxin total 0.00 $58.28 $0.00 80163 Assay of digoxin free 0.00 $58.28 $0.00 80164 Assay dipropylacetic acd tot 0.00 $58.28 $0.00 80165 Dipropylacetic acid free 0.00 $58.28 $0.00 80168 Assay of ethosuximide 0.00 $58.28 $0.00 80169 Drug assay everolimus 0.00 $58.28 $0.00 80170 Assay of gentamicin 0.00 $58.28 $0.00 80171 Drug screen quant gabapentin 0.00 $58.28 $0.00 80173 Assay of haloperidol 0.00 $58.28 $0.00 80175 Drug screen quan lamotrigine 0.00 $58.28 $0.00 80176 Assay of lidocaine 0.00 $58.28 $0.00 80177 Drug scrn quan levetiracetam 0.00 $58.28 $0.00 80178 Assay of lithium 0.00 $58.28 $0.00 NON-FACILITY HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL 80180 Drug scrn quan mycophenolate 0.00 $58.28 $0.00 80183 Drug scrn quant oxcarbazepin 0.00 $58.28 $0.00 80184 Assay of phenobarbital 0.00 $58.28 $0.00 80185 Assay of phenytoin total 0.00 $58.28 $0.00 80186 Assay of phenytoin free 0.00 $58.28 $0.00 80188 Assay of primidone 0.00 $58.28 $0.00 80190 Assay of procainamide 0.00 $58.28 $0.00 80192 Assay of procainamide 0.00 $58.28 $0.00 80194 Assay of quinidine 0.00 $58.28 $0.00 80195 Assay of sirolimus 0.00 $58.28 $0.00 80197 Assay of tacrolimus 0.00 $58.28 $0.00 80198 Assay of theophylline 0.00 $58.28 $0.00 80199 Drug screen quant tiagabine 0.00 $58.28 $0.00 80200 Assay of tobramycin 0.00 $58.28 $0.00 80201 Assay of topiramate 0.00 $58.28 $0.00 80202 Assay of vancomycin 0.00 $58.28 $0.00 80203 Drug screen quant zonisamide 0.00 $58.28 $0.00 80299 Quantitative assay drug 0.00 $58.28 $0.00 80305 Drug test prsmv dir opt obs 0.00 $58.28 $0.00 80306 Drug test prsmv instrmnt 0.00 $58.28 $0.00 80307 Drug test prsmv chem anlyzr 0.00 $58.28 $0.00 80320 Drug screen quantalcohols 0.00 $58.28 $0.00 80321 Alcohols biomarkers 1or 2 0.00 $58.28 $0.00 80322 Alcohols biomarkers 3/more 0.00 $58.28 $0.00 80323 Alkaloids nos 0.00 $58.28 $0.00 80324 Drug screen amphetamines 1/2 0.00 $58.28 $0.00 80325 Amphetamines 3or 4 0.00 $58.28 $0.00 80326 Amphetamines 5 or more 0.00 $58.28 $0.00 80327 Anabolic steroid 1 or 2 0.00 $58.28 $0.00 80328 Anabolic steroid 3 or more 0.00 $58.28 $0.00 80329 Analgesics non-opioid 1 or 2 0.00 $58.28 $0.00 80330 Analgesics non-opioid 3-5 0.00 $58.28 $0.00 80331 Analgesics non-opioid 6/more 0.00 $58.28 $0.00 80332 Antidepressants class 1 or 2 0.00 $58.28 $0.00 80333 Antidepressants class 3-5 0.00 $58.28 $0.00 80334 Antidepressants class 6/more 0.00 $58.28 $0.00 80335 Antidepressant tricyclic 1/2 0.00 $58.28 $0.00 80336 Antidepressant tricyclic 3-5 0.00 $58.28 $0.00 80337 Tricyclic & cyclicals 6/more 0.00 $58.28 $0.00 80338 Antidepressant not specified 0.00 $58.28 $0.00 80339 Antiepileptics nos 1-3 0.00 $58.28 $0.00 80340 Antiepileptics nos 4-6 0.00 $58.28 $0.00 80341 Antiepileptics nos 7/more 0.00 $58.28 $0.00 80342 Antipsychotics nos 1-3 0.00 $58.28 $0.00 80343 Antipsychotics nos 4-6 0.00 $58.28 $0.00 NON-FACILITY HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL 80344 Antipsychotics nos 7/more 0.00 $58.28 $0.00 80345 Drug screening barbiturates 0.00 $58.28 $0.00 80346 Benzodiazepines1-12 0.00 $58.28 $0.00 80347 Benzodiazepines 13 or more 0.00 $58.28 $0.00 80348 Drug screening buprenorphine 0.00 $58.28 $0.00 80349 Cannabinoids natural 0.00 $58.28 $0.00 80350 Cannabinoids synthetic 1-3 0.00 $58.28 $0.00 80351 Cannabinoids synthetic 4-6 0.00 $58.28 $0.00 80352 Cannabinoid synthetic 7/more 0.00 $58.28 $0.00 80353 Drug screening cocaine 0.00 $58.28 $0.00 80354 Drug screening fentanyl 0.00 $58.28 $0.00 80355 Gabapentin non-blood 0.00 $58.28 $0.00 80356 Heroin metabolite 0.00 $58.28 $0.00 80357 Ketamine and norketamine 0.00 $58.28 $0.00 80358 Drug screening methadone 0.00 $58.28 $0.00 80359 Methylenedioxyamphetamines 0.00 $58.28 $0.00 80360 Methylphenidate 0.00 $58.28 $0.00 80361 Opiates 1 or more 0.00 $58.28 $0.00 80362 Opioids & opiate analogs 1/2 0.00 $58.28 $0.00 80363 Opioids & opiate analogs 3/4 0.00 $58.28 $0.00 80364 Opioid &opiate analog 5/more 0.00 $58.28 $0.00 80365 Drug screening oxycodone 0.00 $58.28 $0.00 80366 Drug screening pregabalin 0.00 $58.28 $0.00 80367 Drug screening propoxyphene 0.00 $58.28 $0.00 80368 Sedative hypnotics 0.00 $58.28 $0.00 80369 Skeletal muscle relaxant 1/2 0.00 $58.28 $0.00 80370 Skel musc relaxant 3 or more 0.00 $58.28 $0.00 80371 Stimulants synthetic 0.00 $58.28 $0.00 80372 Drug screening tapentadol 0.00 $58.28 $0.00 80373 Drug screening tramadol 0.00 $58.28 $0.00 80374 Stereoisomer analysis 0.00 $58.28 $0.00 80375 Drug/substance nos 1-3 0.00 $58.28 $0.00 80376 Drug/substance nos 4-6 0.00 $58.28 $0.00 80377 Drug/substance nos 7/more 0.00 $58.28 $0.00 80400 Acth stimulation panel 0.00 $58.28 $0.00 80402 Acth stimulation panel 0.00 $58.28 $0.00 80406 Acth stimulation panel 0.00 $58.28 $0.00 80408 Aldosterone suppression eval 0.00 $58.28 $0.00 80410 Calcitonin stimul panel 0.00 $58.28 $0.00 80412 Crh stimulation panel 0.00 $58.28 $0.00 80414 Testosterone response 0.00 $58.28 $0.00 80415 Estradiol response panel 0.00 $58.28 $0.00 80416 Renin stimulation panel 0.00 $58.28 $0.00 80417 Renin stimulation panel 0.00 $58.28 $0.00 80418 Pituitary evaluation panel 0.00 $58.28 $0.00 NON-FACILITY HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL 80420 Dexamethasone panel 0.00 $58.28 $0.00 80422 Glucagon tolerance panel 0.00 $58.28 $0.00 80424 Glucagon tolerance panel 0.00 $58.28 $0.00 80426 Gonadotropin hormone panel 0.00 $58.28 $0.00 80428 Growth hormone panel 0.00 $58.28 $0.00 80430 Growth hormone panel 0.00 $58.28 $0.00 80432 Insulin suppression panel 0.00 $58.28 $0.00 80434 Insulin tolerance panel 0.00 $58.28 $0.00 80435 Insulin tolerance panel 0.00 $58.28 $0.00 80436 Metyrapone panel 0.00 $58.28 $0.00 80438 Trh stimulation panel 0.00 $58.28 $0.00 80439 Trh stimulation panel 0.00 $58.28 $0.00 80500 Lab pathology consultation 0.66 $58.28 $38.46 80502 Lab pathology consultation 2.10 $58.28 $122.39 81000 Urinalysis nonauto w/scope 0.00 $58.28 $0.00 81001 Urinalysis auto w/scope 0.00 $58.28 $0.00 81002 Urinalysis nonauto w/o scope 0.00 $58.28 $0.00 81003 Urinalysis auto w/o scope 0.00 $58.28 $0.00 81005 Urinalysis 0.00 $58.28 $0.00 81007 Urine screen for bacteria 0.00 $58.28 $0.00 81015 Microscopic exam of urine 0.00 $58.28 $0.00 81020 Urinalysis glass test 0.00 $58.28 $0.00 81025 Urine pregnancy test 0.00 $58.28 $0.00 81050 Urinalysis volume measure 0.00 $58.28 $0.00 81099 Urinalysis test procedure 0.00 $58.28 $0.00 81105 Hpa-1 genotyping 0.00 $58.28 $0.00 81106 Hpa-2 genotyping 0.00 $58.28 $0.00 81107 Hpa-3 genotyping 0.00 $58.28 $0.00 81108 Hpa-4 genotyping 0.00 $58.28 $0.00 81109 Hpa-5 genotyping 0.00 $58.28 $0.00 81110 Hpa-6 genotyping 0.00 $58.28 $0.00 81111 Hpa-9 genotyping 0.00 $58.28 $0.00 81112 Hpa-15 genotyping 0.00 $58.28 $0.00 81120 Idh1 common variants 0.00 $58.28 $0.00 81121 Idh2 common variants 0.00 $58.28 $0.00 81161 Dmd dup/delet analysis 0.00 $58.28 $0.00 81162 Brca1&2 seq & full dup/del 0.00 $58.28 $0.00 81170 Abl1 gene 0.00 $58.28 $0.00 81175 Asxl1 full gene sequence 0.00 $58.28 $0.00 81176 Asxl1 gene target seq alys 0.00 $58.28 $0.00 81200 Aspa gene 0.00 $58.28 $0.00 81201 Apc gene full sequence 0.00 $58.28 $0.00 81202 Apc gene known fam variants 0.00 $58.28 $0.00 81203 Apc gene dup/delet variants 0.00 $58.28 $0.00 81205 Bckdhb gene 0.00 $58.28 $0.00 NON-FACILITY HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL 81206 Bcr/abl1 gene major bp 0.00 $58.28 $0.00 81207 Bcr/abl1 gene minor bp 0.00 $58.28 $0.00 81208 Bcr/abl1 gene other bp 0.00 $58.28 $0.00 81209 Blm gene 0.00 $58.28 $0.00 81210 Braf gene 0.00 $58.28 $0.00 81211 Brca1&2 seq & com dup/del 0.00 $58.28 $0.00 81212 Brca1&2 185&5385&6174 var 0.00 $58.28 $0.00 81213 Brca1&2 uncom dup/del var 0.00 $58.28 $0.00 81214 Brca1 full seq & com dup/del 0.00 $58.28 $0.00 81215 Brca1 gene known fam variant 0.00 $58.28 $0.00 81216 Brca2 gene full sequence 0.00 $58.28 $0.00 81217 Brca2 gene known fam variant 0.00 $58.28 $0.00 81218 Cebpa gene full sequence 0.00 $58.28 $0.00 81219 Calr gene com variants 0.00 $58.28 $0.00 81220 Cftr gene com variants 0.00 $58.28 $0.00 81221 Cftr gene known fam variants 0.00 $58.28 $0.00 81222 Cftr gene dup/delet variants 0.00 $58.28 $0.00 81223 Cftr gene full sequence 0.00 $58.28 $0.00 81224 Cftr gene intron poly t 0.00 $58.28 $0.00 81225 Cyp2c19 gene com variants 0.00 $58.28 $0.00 81226 Cyp2d6 gene com variants 0.00 $58.28 $0.00 81227 Cyp2c9 gene com variants 0.00 $58.28 $0.00 81228 Cytogen micrarray copy nmbr 0.00 $58.28 $0.00 81229 Cytogen m array copy no&snp 0.00 $58.28 $0.00 81230 Cyp3a4 gene common variants 0.00 $58.28 $0.00 81231 Cyp3a5 gene common variants 0.00 $58.28 $0.00 81232 Dpyd gene common variants 0.00 $58.28 $0.00 81235 Egfr gene com variants 0.00 $58.28 $0.00 81238 F9 full gene sequence 0.00 $58.28 $0.00 81240 F2 gene 0.00 $58.28 $0.00 81241 F5 gene 0.00 $58.28 $0.00 81242 Fancc gene 0.00 $58.28 $0.00 81243 Fmr1 gene detection 0.00 $58.28 $0.00 81244 Fmr1 gene characterization 0.00 $58.28 $0.00 81245 Flt3 gene 0.00 $58.28 $0.00 81246 Flt3 gene analysis 0.00 $58.28 $0.00 81247 G6pd gene alys cmn variant 0.00 $58.28 $0.00 81248 G6pd known familial variant 0.00 $58.28 $0.00 81249 G6pd full gene sequence 0.00 $58.28 $0.00 81250 G6pc gene 0.00 $58.28 $0.00 81251 Gba gene 0.00 $58.28 $0.00 81252 Gjb2 gene full sequence 0.00 $58.28 $0.00 81253 Gjb2 gene known fam variants 0.00 $58.28 $0.00 81254 Gjb6 gene com variants 0.00 $58.28 $0.00 81255 Hexa gene 0.00 $58.28 $0.00 NON-FACILITY HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL 81256 Hfe gene 0.00 $58.28 $0.00 81257 Hba1/hba2 gene 0.00 $58.28 $0.00 81258 Hba1/hba2 gene fam vrnt 0.00 $58.28 $0.00 81259 Hba1/hba2 full gene sequence 0.00 $58.28 $0.00 81260 Ikbkap gene 0.00 $58.28 $0.00 81261 Igh gene rearrange amp meth 0.00 $58.28 $0.00 81262 Igh gene rearrang dir probe 0.00 $58.28 $0.00 81263 Igh vari regional mutation 0.00 $58.28 $0.00 81264 Igk rearrangeabn clonal pop 0.00 $58.28 $0.00 81265 Str markers specimen anal 0.00 $58.28 $0.00 81266 Str markers spec anal addl 0.00 $58.28 $0.00 81267 Chimerism anal no cell selec 0.00 $58.28 $0.00 81268 Chimerism anal w/cell select 0.00 $58.28 $0.00 81269 Hba1/hba2 gene dup/del vrnts 0.00 $58.28 $0.00 81270 Jak2 gene 0.00 $58.28 $0.00 81272 Kit gene targeted seq analys 0.00 $58.28 $0.00 81273 Kit gene analys d816 variant 0.00 $58.28 $0.00 81275 Kras gene variants exon 2 0.00 $58.28 $0.00 81276 Kras gene addl variants 0.00 $58.28 $0.00 81283 Ifnl3 gene 0.00 $58.28 $0.00 81287 Mgmt gene methylation anal 0.00 $58.28 $0.00 81288 Mlh1 gene 0.00 $58.28 $0.00 81290 Mcoln1 gene 0.00 $58.28 $0.00 81291 Mthfr gene 0.00 $58.28 $0.00 81292 Mlh1 gene full seq 0.00 $58.28 $0.00 81293 Mlh1 gene known variants 0.00 $58.28 $0.00 81294 Mlh1 gene dup/delete variant 0.00 $58.28 $0.00 81295 Msh2 gene full seq 0.00 $58.28 $0.00 81296 Msh2 gene known variants 0.00 $58.28 $0.00 81297 Msh2 gene dup/delete variant 0.00 $58.28 $0.00 81298 Msh6 gene full seq 0.00 $58.28 $0.00 81299 Msh6 gene known variants 0.00 $58.28 $0.00 81300 Msh6 gene dup/delete variant 0.00 $58.28 $0.00 81301 Microsatellite instability 0.00 $58.28 $0.00 81302 Mecp2 gene full seq 0.00 $58.28 $0.00 81303 Mecp2 gene known variant 0.00 $58.28 $0.00 81304 Mecp2 gene dup/delet variant 0.00 $58.28 $0.00 81310 Npm1 gene 0.00 $58.28 $0.00 81311 Nras gene variants exon 2&3 0.00 $58.28 $0.00 81313 Pca3/klk3 antigen 0.00 $58.28 $0.00 81314 Pdgfra gene 0.00 $58.28 $0.00 81315 Pml/raralpha com breakpoints 0.00 $58.28 $0.00 81316 Pml/raralpha 1 breakpoint 0.00 $58.28 $0.00 81317 Pms2 gene full seq analysis 0.00 $58.28 $0.00 81318 Pms2 known familial variants 0.00 $58.28 $0.00 NON-FACILITY HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL 81319 Pms2 gene dup/delet variants 0.00 $58.28 $0.00 81321 Pten gene full sequence 0.00 $58.28 $0.00 81322 Pten gene known fam variant 0.00 $58.28 $0.00 81323 Pten gene dup/delet variant 0.00 $58.28 $0.00 81324 Pmp22 gene dup/delet 0.00 $58.28 $0.00 81325 Pmp22 gene full sequence 0.00 $58.28 $0.00 81326 Pmp22 gene known fam variant 0.00 $58.28 $0.00 81327 Sept9 methylation analysis 0.00 $58.28 $0.00 81328 Slco1b1 gene com variants 0.00 $58.28 $0.00 81330 Smpd1 gene common variants 0.00 $58.28 $0.00 81331 Snrpn/ube3a gene 0.00 $58.28 $0.00 81332 Serpina1 gene 0.00 $58.28 $0.00 81334 Runx1 gene targeted seq alys 0.00 $58.28 $0.00 81335 Tpmt gene com variants 0.00 $58.28 $0.00 81340 Trb@ gene rearrange amplify 0.00 $58.28 $0.00 81341 Trb@ gene rearrange dirprobe 0.00 $58.28 $0.00 81342 Trg gene rearrangement anal 0.00 $58.28 $0.00 81346 Tyms gene com variants 0.00 $58.28 $0.00 81350 Ugt1a1 gene 0.00 $58.28 $0.00 81355 Vkorc1 gene 0.00 $58.28 $0.00 81361 Hbb gene com variants 0.00 $58.28 $0.00 81362 Hbb gene known fam variant 0.00 $58.28 $0.00 81363 Hbb gene dup/del variants 0.00 $58.28 $0.00 81364 Hbb full gene sequence 0.00 $58.28 $0.00 81370 Hla i & ii typing lr 0.00 $58.28 $0.00 81371 Hla i & ii type verify lr 0.00 $58.28 $0.00 81372 Hla i typing complete lr 0.00 $58.28 $0.00 81373 Hla i typing 1 locus lr 0.00 $58.28 $0.00 81374 Hla i typing 1 antigen lr 0.00 $58.28 $0.00 81375 Hla ii typing ag equiv lr 0.00 $58.28 $0.00 81376 Hla ii typing 1 locus lr 0.00 $58.28 $0.00 81377 Hla ii type 1 ag equiv lr 0.00 $58.28 $0.00 81378 Hla i & ii typing hr 0.00 $58.28 $0.00 81379 Hla i typing complete hr 0.00 $58.28 $0.00 81380 Hla i typing 1 locus hr 0.00 $58.28 $0.00 81381 Hla i typing 1 allele hr 0.00 $58.28 $0.00 81382 Hla ii typing 1 loc hr 0.00 $58.28 $0.00 81383 Hla ii typing 1 allele hr 0.00 $58.28 $0.00 81400 Mopath procedure level 1 0.00 $58.28 $0.00 81401 Mopath procedure level 2 0.00 $58.28 $0.00 81402 Mopath procedure level 3 0.00 $58.28 $0.00 81403 Mopath procedure level 4 0.00 $58.28 $0.00 81404 Mopath procedure level 5 0.00 $58.28 $0.00 81405 Mopath procedure level 6 0.00 $58.28 $0.00 81406 Mopath procedure level 7 0.00 $58.28 $0.00 NON-FACILITY HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL 81407 Mopath procedure level 8 0.00 $58.28 $0.00 81408 Mopath procedure level 9 0.00 $58.28 $0.00 81410 Aortic dysfunction/dilation 0.00 $58.28 $0.00 81411 Aortic dysfunction/dilation 0.00 $58.28 $0.00 81412 Ashkenazi jewish assoc dis 0.00 $58.28 $0.00 81413 Car ion chnnlpath inc 10 gns 0.00 $58.28 $0.00 81414 Car ion chnnlpath inc 2 gns 0.00 $58.28 $0.00 81415 Exome sequence analysis 0.00 $58.28 $0.00 81416 Exome sequence analysis 0.00 $58.28 $0.00 81417 Exome re-evaluation 0.00 $58.28 $0.00 81420 Fetal chrmoml aneuploidy 0.00 $58.28 $0.00 81422 Fetal chrmoml microdeltj 0.00 $58.28 $0.00 81425 Genome sequence analysis 0.00 $58.28 $0.00 81426 Genome sequence analysis 0.00 $58.28 $0.00 81427 Genome re-evaluation 0.00 $58.28 $0.00 81430 Hearing loss sequence analys 0.00 $58.28 $0.00 81431 Hearing loss dup/del analys 0.00 $58.28 $0.00 81432 Hrdtry brst ca-rlatd dsordrs 0.00 $58.28 $0.00 81433 Hrdtry brst ca-rlatd dsordrs 0.00 $58.28 $0.00 81434 Hereditary retinal disorders 0.00 $58.28 $0.00 81435 Hereditary colon ca dsordrs 0.00 $58.28 $0.00 81436 Hereditary colon ca dsordrs 0.00 $58.28 $0.00 81437 Heredtry nurondcrn tum dsrdr 0.00 $58.28 $0.00 81438 Heredtry nurondcrn tum dsrdr 0.00 $58.28 $0.00 81439 Hrdtry cardmypy gene panel 0.00 $58.28 $0.00 81440 Mitochondrial gene 0.00 $58.28 $0.00 81442 Noonan spectrum disorders 0.00 $58.28 $0.00 81445 Targeted genomic seq analys 0.00 $58.28 $0.00 81448 Hrdtry perph neurphy panel 0.00 $58.28 $0.00 81450 Targeted genomic seq analys 0.00 $58.28 $0.00 81455 Targeted genomic seq analys 0.00 $58.28 $0.00 81460 Whole mitochondrial genome 0.00 $58.28 $0.00 81465 Whole mitochondrial genome 0.00 $58.28 $0.00 81470 X-linked intellectual dblt 0.00 $58.28 $0.00 81471 X-linked intellectual dblt 0.00 $58.28 $0.00 81479 Unlisted molecular pathology 0.00 $58.28 $0.00 81490 Autoimmune rheumatoid arthr 0.00 $58.28 $0.00 81493 Cor artery disease mrna 0.00 $58.28 $0.00 81500 Onco (ovar) two proteins 0.00 $58.28 $0.00 81503 Onco (ovar) five proteins 0.00 $58.28 $0.00 81504 Oncology tissue of origin 0.00 $58.28 $0.00 81506 Endo assay seven anal 0.00 $58.28 $0.00 81507 Fetal aneuploidy trisom risk 0.00 $58.28 $0.00 81508 Ftl cgen abnor two proteins 0.00 $58.28 $0.00 81509 Ftl cgen abnor 3 proteins 0.00 $58.28 $0.00 NON-FACILITY HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL 81510 Ftl cgen abnor three anal 0.00 $58.28 $0.00 81511 Ftl cgen abnor four anal 0.00 $58.28 $0.00 81512 Ftl cgen abnor five anal 0.00 $58.28 $0.00 81519 Oncology breast mrna 0.00 $58.28 $0.00 81520 Onc breast mrna 58 genes 0.00 $58.28 $0.00 81521 Onc breast mrna 70 genes 0.00 $58.28 $0.00 81525 Oncology colon mrna 0.00 $58.28 $0.00 81528 Oncology colorectal scr 0.00 $58.28 $0.00 81535 Oncology gynecologic 0.00 $58.28 $0.00 81536 Oncology gynecologic 0.00 $58.28 $0.00 81538 Oncology lung 0.00 $58.28 $0.00 81539 Oncology prostate prob score 0.00 $58.28 $0.00 81540 Oncology tum unknown origin 0.00 $58.28 $0.00 81541 Onc prostate mrna 46 genes 0.00 $58.28 $0.00 81545 Oncology thyroid 0.00 $58.28 $0.00 81551 Onc prostate 3 genes 0.00 $58.28 $0.00 81595 Cardiology hrt trnspl mrna 0.00 $58.28 $0.00 81599 Unlisted maaa 0.00 $58.28 $0.00 82009 Test for acetone/ketones 0.00 $58.28 $0.00 82010 Acetone assay 0.00 $58.28 $0.00 82013 Acetylcholinesterase assay 0.00 $58.28 $0.00 82016 Acylcarnitines qual 0.00 $58.28 $0.00 82017 Acylcarnitines quant 0.00 $58.28 $0.00 82024 Assay of acth 0.00 $58.28 $0.00 82030 Assay of adp & amp 0.00 $58.28 $0.00 82040 Assay of serum albumin 0.00 $58.28 $0.00 82042 Other source albumin quan ea 0.00 $58.28 $0.00 82043 Ur albumin quantitative 0.00 $58.28 $0.00 82044 Ur albumin semiquantitative 0.00 $58.28 $0.00 82045 Albumin ischemia modified 0.00 $58.28 $0.00 82075 Assay of breath ethanol 0.00 $58.28 $0.00 82085 Assay of aldolase 0.00 $58.28 $0.00 82088 Assay of aldosterone 0.00 $58.28 $0.00 82103 Alpha-1-antitrypsin total 0.00 $58.28 $0.00 82104 Alpha-1-antitrypsin pheno 0.00 $58.28 $0.00 82105 Alpha-fetoprotein serum 0.00 $58.28 $0.00 82106 Alpha-fetoprotein amniotic 0.00 $58.28 $0.00 82107 Alpha-fetoprotein l3 0.00 $58.28 $0.00 82108 Assay of aluminum 0.00 $58.28 $0.00 82120 Amines vaginal fluid qual 0.00 $58.28 $0.00 82127 Amino acid single qual 0.00 $58.28 $0.00 82128 Amino acids mult qual 0.00 $58.28 $0.00 82131 Amino acids single quant 0.00 $58.28 $0.00 82135 Assay aminolevulinic acid 0.00 $58.28 $0.00 82136 Amino acids quant 2-5 0.00 $58.28 $0.00 NON-FACILITY HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL 82139 Amino acids quan 6 or more 0.00 $58.28 $0.00 82140 Assay of ammonia 0.00 $58.28 $0.00 82143 Amniotic fluid scan 0.00 $58.28 $0.00 82150 Assay of amylase 0.00 $58.28 $0.00 82154 Androstanediol glucuronide 0.00 $58.28 $0.00 82157 Assay of androstenedione 0.00 $58.28 $0.00 82160 Assay of androsterone 0.00 $58.28 $0.00 82163 Assay of angiotensin ii 0.00 $58.28 $0.00 82164 Angiotensin i enzyme test 0.00 $58.28 $0.00 82172 Assay of apolipoprotein 0.00 $58.28 $0.00 82175 Assay of arsenic 0.00 $58.28 $0.00 82180 Assay of ascorbic acid 0.00 $58.28 $0.00 82190 Atomic absorption 0.00 $58.28 $0.00 82232 Assay of beta-2 protein 0.00 $58.28 $0.00 82239 Bile acids total 0.00 $58.28 $0.00 82240 Bile acids cholylglycine 0.00 $58.28 $0.00 82247 Bilirubin total 0.00 $58.28 $0.00 82248 Bilirubin direct 0.00 $58.28 $0.00 82252 Fecal bilirubin test 0.00 $58.28 $0.00 82261 Assay of biotinidase 0.00 $58.28 $0.00 82270 Occult blood feces 0.00 $58.28 $0.00 82271 Occult blood other sources 0.00 $58.28 $0.00 82272 Occult bld feces 1-3 tests 0.00 $58.28 $0.00 82274 Assay test for blood fecal 0.00 $58.28 $0.00 82286 Assay of bradykinin 0.00 $58.28 $0.00 82300 Assay of cadmium 0.00 $58.28 $0.00 82306 Vitamin d 25 hydroxy 0.00 $58.28 $0.00 82308 Assay of calcitonin 0.00 $58.28 $0.00 82310 Assay of calcium 0.00 $58.28 $0.00 82330 Assay of calcium 0.00 $58.28 $0.00 82331 Calcium infusion test 0.00 $58.28 $0.00 82340 Assay of calcium in urine 0.00 $58.28 $0.00 82355 Calculus analysis qual 0.00 $58.28 $0.00 82360 Calculus assay quant 0.00 $58.28 $0.00 82365 Calculus spectroscopy 0.00 $58.28 $0.00 82370 X-ray assay calculus 0.00 $58.28 $0.00 82373 Assay c-d transfer measure 0.00 $58.28 $0.00 82374 Assay blood carbon dioxide 0.00 $58.28 $0.00 82375 Assay carboxyhb quant 0.00 $58.28 $0.00 82376 Assay carboxyhb qual 0.00 $58.28 $0.00 82378 Carcinoembryonic antigen 0.00 $58.28 $0.00 82379 Assay of carnitine 0.00 $58.28 $0.00 82380 Assay of carotene 0.00 $58.28 $0.00 82382 Assay urine catecholamines 0.00 $58.28 $0.00 82383 Assay blood catecholamines 0.00 $58.28 $0.00 NON-FACILITY HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL 82384 Assay three catecholamines 0.00 $58.28 $0.00 82387 Assay of cathepsin-d 0.00 $58.28 $0.00 82390 Assay of ceruloplasmin 0.00 $58.28 $0.00 82397 Chemiluminescent assay 0.00 $58.28 $0.00 82415 Assay of chloramphenicol 0.00 $58.28 $0.00 82435 Assay of blood chloride 0.00 $58.28 $0.00 82436 Assay of urine chloride 0.00 $58.28 $0.00 82438 Assay other fluid chlorides 0.00 $58.28 $0.00 82441 Test for chlorohydrocarbons 0.00 $58.28 $0.00 82465 Assay bld/serum cholesterol 0.00 $58.28 $0.00 82480 Assay serum cholinesterase 0.00 $58.28 $0.00 82482 Assay rbc cholinesterase 0.00 $58.28 $0.00 82485 Assay chondroitin sulfate 0.00 $58.28 $0.00 82495 Assay of chromium 0.00 $58.28 $0.00 82507 Assay of citrate 0.00 $58.28 $0.00 82523 Collagen crosslinks 0.00 $58.28 $0.00 82525 Assay of copper 0.00 $58.28 $0.00 82528 Assay of corticosterone 0.00 $58.28 $0.00 82530 Cortisol free 0.00 $58.28 $0.00 82533 Total cortisol 0.00 $58.28 $0.00 82540 Assay of creatine 0.00 $58.28 $0.00 82542 Col chromotography qual/quan 0.00 $58.28 $0.00 82550 Assay of ck (cpk) 0.00 $58.28 $0.00 82552 Assay of cpk in blood 0.00 $58.28 $0.00 82553 Creatine mb fraction 0.00 $58.28 $0.00 82554 Creatine isoforms 0.00 $58.28 $0.00 82565 Assay of creatinine 0.00 $58.28 $0.00 82570 Assay of urine creatinine 0.00 $58.28 $0.00 82575 Creatinine clearance test 0.00 $58.28 $0.00 82585 Assay of cryofibrinogen 0.00 $58.28 $0.00 82595 Assay of cryoglobulin 0.00 $58.28 $0.00 82600 Assay of cyanide 0.00 $58.28 $0.00 82607 Vitamin b-12 0.00 $58.28 $0.00 82608 B-12 binding capacity 0.00 $58.28 $0.00 82610 Cystatin c 0.00 $58.28 $0.00 82615 Test for urine cystines 0.00 $58.28 $0.00 82626 Dehydroepiandrosterone 0.00 $58.28 $0.00 82627 Dehydroepiandrosterone 0.00 $58.28 $0.00 82633 Desoxycorticosterone 0.00 $58.28 $0.00 82634 Deoxycortisol 0.00 $58.28 $0.00 82638 Assay of dibucaine number 0.00 $58.28 $0.00 82652 Vit d 1 25-dihydroxy 0.00 $58.28 $0.00 82656 Pancreatic elastase fecal 0.00 $58.28 $0.00 82657 Enzyme cell activity 0.00 $58.28 $0.00 82658 Enzyme cell activity ra 0.00 $58.28 $0.00 NON-FACILITY HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL 82664 Electrophoretic test 0.00 $58.28 $0.00 82668 Assay of erythropoietin 0.00 $58.28 $0.00 82670 Assay of estradiol 0.00 $58.28 $0.00 82671 Assay of estrogens 0.00 $58.28 $0.00 82672 Assay of estrogen 0.00 $58.28 $0.00 82677 Assay of estriol 0.00 $58.28 $0.00 82679 Assay of estrone 0.00 $58.28 $0.00 82693 Assay of ethylene glycol 0.00 $58.28 $0.00 82696 Assay of etiocholanolone 0.00 $58.28 $0.00 82705 Fats/lipids feces qual 0.00 $58.28 $0.00 82710 Fats/lipids feces quant 0.00 $58.28 $0.00 82715 Assay of fecal fat 0.00 $58.28 $0.00 82725 Assay of blood fatty acids 0.00 $58.28 $0.00 82726 Long chain fatty acids 0.00 $58.28 $0.00 82728 Assay of ferritin 0.00 $58.28 $0.00 82731 Assay of fetal fibronectin 0.00 $58.28 $0.00 82735 Assay of fluoride 0.00 $58.28 $0.00 82746 Assay of folic acid serum 0.00 $58.28 $0.00 82747 Assay of folic acid rbc 0.00 $58.28 $0.00 82757 Assay of semen fructose 0.00 $58.28 $0.00 82759 Assay of rbc galactokinase 0.00 $58.28 $0.00 82760 Assay of galactose 0.00 $58.28 $0.00 82775 Assay galactose transferase 0.00 $58.28 $0.00 82776 Galactose transferase test 0.00 $58.28 $0.00 82777 Galectin-3 0.00 $58.28 $0.00 82784 Assay iga/igd/igg/igm each 0.00 $58.28 $0.00 82785 Assay of ige 0.00 $58.28 $0.00 82787 Igg 1 2 3 or 4 each 0.00 $58.28 $0.00 82800 Blood ph 0.00 $58.28 $0.00 82803 Blood gases any combination 0.00 $58.28 $0.00 82805 Blood gases w/o2 saturation 0.00 $58.28 $0.00 82810 Blood gases o2 sat only 0.00 $58.28 $0.00 82820 Hemoglobin-oxygen affinity 0.00 $58.28 $0.00 82930 Gastric analy w/ph ea spec 0.00 $58.28 $0.00 82938 Gastrin test 0.00 $58.28 $0.00 82941 Assay of gastrin 0.00 $58.28 $0.00 82943 Assay of glucagon 0.00 $58.28 $0.00 82945 Glucose other fluid 0.00 $58.28 $0.00 82946 Glucagon tolerance test 0.00 $58.28 $0.00 82947 Assay glucose blood quant 0.00 $58.28 $0.00 82948 Reagent strip/blood glucose 0.00 $58.28 $0.00 82950 Glucose test 0.00 $58.28 $0.00 82951 Glucose tolerance test (gtt) 0.00 $58.28 $0.00 82952 Gtt-added samples 0.00 $58.28 $0.00 82955 Assay of g6pd enzyme 0.00 $58.28 $0.00 NON-FACILITY HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL 82960 Test for g6pd enzyme 0.00 $58.28 $0.00 82962 Glucose blood test 0.00 $58.28 $0.00 82963 Assay of glucosidase 0.00 $58.28 $0.00 82965 Assay of gdh enzyme 0.00 $58.28 $0.00 82977 Assay of ggt 0.00 $58.28 $0.00 82978 Assay of glutathione 0.00 $58.28 $0.00 82979 Assay rbc glutathione 0.00 $58.28 $0.00 82985 Assay of glycated protein 0.00 $58.28 $0.00 83001 Assay of gonadotropin (fsh) 0.00 $58.28 $0.00 83002 Assay of gonadotropin (lh) 0.00 $58.28 $0.00 83003 Assay growth hormone (hgh) 0.00 $58.28 $0.00 83006 Growth stimulation gene 2 0.00 $58.28 $0.00 83009 H pylori (c-13) blood 0.00 $58.28 $0.00 83010 Assay of haptoglobin quant 0.00 $58.28 $0.00 83012 Assay of haptoglobins 0.00 $58.28 $0.00 83013 H pylori (c-13) breath 0.00 $58.28 $0.00 83014 H pylori drug admin 0.00 $58.28 $0.00 83015 Heavy metal qual any anal 0.00 $58.28 $0.00 83018 Heavy metal quant each nes 0.00 $58.28 $0.00 83020 Hemoglobin electrophoresis 0.00 $58.28 $0.00 83020 26 Hemoglobin electrophoresis 0.52 $58.28 $30.31 83021 Hemoglobin chromotography 0.00 $58.28 $0.00 83026 Hemoglobin copper sulfate 0.00 $58.28 $0.00 83030 Fetal hemoglobin chemical 0.00 $58.28 $0.00 83033 Fetal hemoglobin assay qual 0.00 $58.28 $0.00 83036 Glycosylated hemoglobin test 0.00 $58.28 $0.00 83037 Glycosylated hb home device 0.00 $58.28 $0.00 83045 Blood methemoglobin test 0.00 $58.28 $0.00 83050 Blood methemoglobin assay 0.00 $58.28 $0.00 83051 Assay of plasma hemoglobin 0.00 $58.28 $0.00 83060 Blood sulfhemoglobin assay 0.00 $58.28 $0.00 83065 Assay of hemoglobin heat 0.00 $58.28 $0.00 83068 Hemoglobin stability screen 0.00 $58.28 $0.00 83069 Assay of urine hemoglobin 0.00 $58.28 $0.00 83070 Assay of hemosiderin qual 0.00 $58.28 $0.00 83080 Assay of b hexosaminidase 0.00 $58.28 $0.00 83088 Assay of histamine 0.00 $58.28 $0.00 83090 Assay of homocystine 0.00 $58.28 $0.00 83150 Assay of homovanillic acid 0.00 $58.28 $0.00 83491 Assay of corticosteroids 17 0.00 $58.28 $0.00 83497 Assay of 5-hiaa 0.00 $58.28 $0.00 83498 Assay of progesterone 17-d 0.00 $58.28 $0.00 83500 Assay free hydroxyproline 0.00 $58.28 $0.00 83505 Assay total hydroxyproline 0.00 $58.28 $0.00 83516 Immunoassay nonantibody 0.00 $58.28 $0.00 NON-FACILITY HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL 83518 Immunoassay dipstick 0.00 $58.28 $0.00 83519 Ria nonantibody 0.00 $58.28 $0.00 83520 Immunoassay quant nos nonab 0.00 $58.28 $0.00 83525 Assay of insulin 0.00 $58.28 $0.00 83527 Assay of insulin 0.00 $58.28 $0.00 83528 Assay of intrinsic factor 0.00 $58.28 $0.00 83540 Assay of iron 0.00 $58.28 $0.00 83550 Iron binding test 0.00 $58.28 $0.00 83570 Assay of idh enzyme 0.00 $58.28 $0.00 83582 Assay of ketogenic steroids 0.00 $58.28 $0.00 83586 Assay 17- ketosteroids 0.00 $58.28 $0.00 83593 Fractionation ketosteroids 0.00 $58.28 $0.00 83605 Assay of lactic acid 0.00 $58.28 $0.00 83615 Lactate (ld) (ldh) enzyme 0.00 $58.28 $0.00 83625 Assay of ldh enzymes 0.00 $58.28 $0.00 83630 Lactoferrin fecal (qual) 0.00 $58.28 $0.00 83631 Lactoferrin fecal (quant) 0.00 $58.28 $0.00 83632 Placental lactogen 0.00 $58.28 $0.00 83633 Test urine for lactose 0.00 $58.28 $0.00 83655 Assay of lead 0.00 $58.28 $0.00 83661 L/s ratio fetal lung 0.00 $58.28 $0.00 83662 Foam stability fetal lung 0.00 $58.28 $0.00 83663 Fluoro polarize fetal lung 0.00 $58.28 $0.00 83664 Lamellar bdy fetal lung 0.00 $58.28 $0.00 83670 Assay of lap enzyme 0.00 $58.28 $0.00 83690 Assay of lipase 0.00 $58.28 $0.00 83695 Assay of lipoprotein(a) 0.00 $58.28 $0.00 83698 Assay lipoprotein pla2 0.00 $58.28 $0.00 83700 Lipopro bld electrophoretic 0.00 $58.28 $0.00 83701 Lipoprotein bld hr fraction 0.00 $58.28 $0.00 83704 Lipoprotein bld quan part 0.00 $58.28 $0.00 83718 Assay of lipoprotein 0.00 $58.28 $0.00 83719 Assay of blood lipoprotein 0.00 $58.28 $0.00 83721 Assay of blood lipoprotein 0.00 $58.28 $0.00 83727 Assay of lrh hormone 0.00 $58.28 $0.00 83735 Assay of magnesium 0.00 $58.28 $0.00 83775 Assay malate dehydrogenase 0.00 $58.28 $0.00 83785 Assay of manganese 0.00 $58.28 $0.00 83789 Mass spectrometry qual/quan 0.00 $58.28 $0.00 83825 Assay of mercury 0.00 $58.28 $0.00 83835 Assay of metanephrines 0.00 $58.28 $0.00 83857 Assay of methemalbumin 0.00 $58.28 $0.00 83861 Microfluid analy tears 0.00 $58.28 $0.00 83864 Mucopolysaccharides 0.00 $58.28 $0.00 83872 Assay synovial fluid mucin 0.00 $58.28 $0.00 NON-FACILITY HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL 83873 Assay of csf protein 0.00 $58.28 $0.00 83874 Assay of myoglobin 0.00 $58.28 $0.00 83876 Assay myeloperoxidase 0.00 $58.28 $0.00 83880 Assay of natriuretic peptide 0.00 $58.28 $0.00 83883 Assay nephelometry not spec 0.00 $58.28 $0.00 83885 Assay of nickel 0.00 $58.28 $0.00 83915 Assay of nucleotidase 0.00 $58.28 $0.00 83916 Oligoclonal bands 0.00 $58.28 $0.00 83918 Organic acids total quant 0.00 $58.28 $0.00 83919 Organic acids qual each 0.00 $58.28 $0.00 83921 Organic acid single quant 0.00 $58.28 $0.00 83930 Assay of blood osmolality 0.00 $58.28 $0.00 83935 Assay of urine osmolality 0.00 $58.28 $0.00 83937 Assay of osteocalcin 0.00 $58.28 $0.00 83945 Assay of oxalate 0.00 $58.28 $0.00 83950 Oncoprotein her-2/neu 0.00 $58.28 $0.00 83951 Oncoprotein dcp 0.00 $58.28 $0.00 83970 Assay of parathormone 0.00 $58.28 $0.00 83986 Assay ph body fluid nos 0.00 $58.28 $0.00 83987 Exhaled breath condensate 0.00 $58.28 $0.00 83992 Assay for phencyclidine 0.00 $58.28 $0.00 83993 Assay for calprotectin fecal 0.00 $58.28 $0.00 84030 Assay of blood pku 0.00 $58.28 $0.00 84035 Assay of phenylketones 0.00 $58.28 $0.00 84060 Assay acid phosphatase 0.00 $58.28 $0.00 84066 Assay prostate phosphatase 0.00 $58.28 $0.00 84075 Assay alkaline phosphatase 0.00 $58.28 $0.00 84078 Assay alkaline phosphatase 0.00 $58.28 $0.00 84080 Assay alkaline phosphatases 0.00 $58.28 $0.00 84081 Assay phosphatidylglycerol 0.00 $58.28 $0.00 84085 Assay of rbc pg6d enzyme 0.00 $58.28 $0.00 84087 Assay phosphohexose enzymes 0.00 $58.28 $0.00 84100 Assay of phosphorus 0.00 $58.28 $0.00 84105 Assay of urine phosphorus 0.00 $58.28 $0.00 84106 Test for porphobilinogen 0.00 $58.28 $0.00 84110 Assay of porphobilinogen 0.00 $58.28 $0.00 84112 Eval amniotic fluid protein 0.00 $58.28 $0.00 84119 Test urine for porphyrins 0.00 $58.28 $0.00 84120 Assay of urine porphyrins 0.00 $58.28 $0.00 84126 Assay of feces porphyrins 0.00 $58.28 $0.00 84132 Assay of serum potassium 0.00 $58.28 $0.00 84133 Assay of urine potassium 0.00 $58.28 $0.00 84134 Assay of prealbumin 0.00 $58.28 $0.00 84135 Assay of pregnanediol 0.00 $58.28 $0.00 84138 Assay of pregnanetriol 0.00 $58.28 $0.00 NON-FACILITY HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL 84140 Assay of pregnenolone 0.00 $58.28 $0.00 84143 Assay of 17-hydroxypregneno 0.00 $58.28 $0.00 84144 Assay of progesterone 0.00 $58.28 $0.00 84145 Procalcitonin (pct) 0.00 $58.28 $0.00 84146 Assay of prolactin 0.00 $58.28 $0.00 84150 Assay of prostaglandin 0.00 $58.28 $0.00 84152 Assay of psa complexed 0.00 $58.28 $0.00 84153 Assay of psa total 0.00 $58.28 $0.00 84154 Assay of psa free 0.00 $58.28 $0.00 84155 Assay of protein serum 0.00 $58.28 $0.00 84156 Assay of protein urine 0.00 $58.28 $0.00 84157 Assay of protein other 0.00 $58.28 $0.00 84160 Assay of protein any source 0.00 $58.28 $0.00 84163 Pappa serum 0.00 $58.28 $0.00 84165 Protein e-phoresis serum 0.00 $58.28 $0.00 84165 26 Protein e-phoresis serum 0.52 $58.28 $30.31 84166 Protein e-phoresis/urine/csf 0.00 $58.28 $0.00 84166 26 Protein e-phoresis/urine/csf 0.52 $58.28 $30.31 84181 Western blot test 0.00 $58.28 $0.00 84181 26 Western blot test 0.52 $58.28 $30.31 84182 Protein western blot test 0.00 $58.28 $0.00 84182 26 Protein western blot test 0.52 $58.28 $30.31 84202 Assay rbc protoporphyrin 0.00 $58.28 $0.00 84203 Test rbc protoporphyrin 0.00 $58.28 $0.00 84206 Assay of proinsulin 0.00 $58.28 $0.00 84207 Assay of vitamin b-6 0.00 $58.28 $0.00 84210 Assay of pyruvate 0.00 $58.28 $0.00 84220 Assay of pyruvate kinase 0.00 $58.28 $0.00 84228 Assay of quinine 0.00 $58.28 $0.00 84233 Assay of estrogen 0.00 $58.28 $0.00 84234 Assay of progesterone 0.00 $58.28 $0.00 84235 Assay of endocrine hormone 0.00 $58.28 $0.00 84238 Assay nonendocrine receptor 0.00 $58.28 $0.00 84244 Assay of renin 0.00 $58.28 $0.00 84252 Assay of vitamin b-2 0.00 $58.28 $0.00 84255 Assay of selenium 0.00 $58.28 $0.00 84260 Assay of serotonin 0.00 $58.28 $0.00 84270 Assay of sex hormone globul 0.00 $58.28 $0.00 84275 Assay of sialic acid 0.00 $58.28 $0.00 84285 Assay of silica 0.00 $58.28 $0.00 84295 Assay of serum sodium 0.00 $58.28 $0.00 84300 Assay of urine sodium 0.00 $58.28 $0.00 84302 Assay of sweat sodium 0.00 $58.28 $0.00 84305 Assay of somatomedin 0.00 $58.28 $0.00 84307 Assay of somatostatin 0.00 $58.28 $0.00 NON-FACILITY HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL 84311 Spectrophotometry 0.00 $58.28 $0.00 84315 Body fluid specific gravity 0.00 $58.28 $0.00 84375 Chromatogram assay sugars 0.00 $58.28 $0.00 84376 Sugars single qual 0.00 $58.28 $0.00 84377 Sugars multiple qual 0.00 $58.28 $0.00 84378 Sugars single quant 0.00 $58.28 $0.00 84379 Sugars multiple quant 0.00 $58.28 $0.00 84392 Assay of urine sulfate 0.00 $58.28 $0.00 84402 Assay of free testosterone 0.00 $58.28 $0.00 84403 Assay of total testosterone 0.00 $58.28 $0.00 84410 Testosterone bioavailable 0.00 $58.28 $0.00 84425 Assay of vitamin b-1 0.00 $58.28 $0.00 84430 Assay of thiocyanate 0.00 $58.28 $0.00 84431 Thromboxane urine 0.00 $58.28 $0.00 84432 Assay of thyroglobulin 0.00 $58.28 $0.00 84436 Assay of total thyroxine 0.00 $58.28 $0.00 84437 Assay of neonatal thyroxine 0.00 $58.28 $0.00 84439 Assay of free thyroxine 0.00 $58.28 $0.00 84442 Assay of thyroid activity 0.00 $58.28 $0.00 84443 Assay thyroid stim hormone 0.00 $58.28 $0.00 84445 Assay of tsi globulin 0.00 $58.28 $0.00 84446 Assay of vitamin e 0.00 $58.28 $0.00 84449 Assay of transcortin 0.00 $58.28 $0.00 84450 Transferase (ast) (sgot) 0.00 $58.28 $0.00 84460 Alanine amino (alt) (sgpt) 0.00 $58.28 $0.00 84466 Assay of transferrin 0.00 $58.28 $0.00 84478 Assay of triglycerides 0.00 $58.28 $0.00 84479 Assay of thyroid (t3 or t4) 0.00 $58.28 $0.00 84480 Assay triiodothyronine (t3) 0.00 $58.28 $0.00 84481 Free assay (ft-3) 0.00 $58.28 $0.00 84482 T3 reverse 0.00 $58.28 $0.00 84484 Assay of troponin quant 0.00 $58.28 $0.00 84485 Assay duodenal fluid trypsin 0.00 $58.28 $0.00 84488 Test feces for trypsin 0.00 $58.28 $0.00 84490 Assay of feces for trypsin 0.00 $58.28 $0.00 84510 Assay of tyrosine 0.00 $58.28 $0.00 84512 Assay of troponin qual 0.00 $58.28 $0.00 84520 Assay of urea nitrogen 0.00 $58.28 $0.00 84525 Urea nitrogen semi-quant 0.00 $58.28 $0.00 84540 Assay of urine/urea-n 0.00 $58.28 $0.00 84545 Urea-n clearance test 0.00 $58.28 $0.00 84550 Assay of blood/uric acid 0.00 $58.28 $0.00 84560 Assay of urine/uric acid 0.00 $58.28 $0.00 84577 Assay of feces/urobilinogen 0.00 $58.28 $0.00 84578 Test urine urobilinogen 0.00 $58.28 $0.00 NON-FACILITY HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL 84580 Assay of urine urobilinogen 0.00 $58.28 $0.00 84583 Assay of urine urobilinogen 0.00 $58.28 $0.00 84585 Assay of urine vma 0.00 $58.28 $0.00 84586 Assay of vip 0.00 $58.28 $0.00 84588 Assay of vasopressin 0.00 $58.28 $0.00 84590 Assay of vitamin a 0.00 $58.28 $0.00 84591 Assay of nos vitamin 0.00 $58.28 $0.00 84597 Assay of vitamin k 0.00 $58.28 $0.00 84600 Assay of volatiles 0.00 $58.28 $0.00 84620 Xylose tolerance test 0.00 $58.28 $0.00 84630 Assay of zinc 0.00 $58.28 $0.00 84681 Assay of c-peptide 0.00 $58.28 $0.00 84702 Chorionic gonadotropin test 0.00 $58.28 $0.00 84703 Chorionic gonadotropin assay 0.00 $58.28 $0.00 84704 Hcg free betachain test 0.00 $58.28 $0.00 84830 Ovulation tests 0.00 $58.28 $0.00 84999 Clinical chemistry test 0.00 $58.28 $0.00 85002 Bleeding time test 0.00 $58.28 $0.00 85004 Automated diff wbc count 0.00 $58.28 $0.00 85007 Bl smear w/diff wbc count 0.00 $58.28 $0.00 85008 Bl smear w/o diff wbc count 0.00 $58.28 $0.00 85009 Manual diff wbc count b-coat 0.00 $58.28 $0.00 85013 Spun microhematocrit 0.00 $58.28 $0.00 85014 Hematocrit 0.00 $58.28 $0.00 85018 Hemoglobin 0.00 $58.28 $0.00 85025 Complete cbc w/auto diff wbc 0.00 $58.28 $0.00 85027 Complete cbc automated 0.00 $58.28 $0.00 85032 Manual cell count each 0.00 $58.28 $0.00 85041 Automated rbc count 0.00 $58.28 $0.00 85044 Manual reticulocyte count 0.00 $58.28 $0.00 85045 Automated reticulocyte count 0.00 $58.28 $0.00 85046 Reticyte/hgb concentrate 0.00 $58.28 $0.00 85048 Automated leukocyte count 0.00 $58.28 $0.00 85049 Automated platelet count 0.00 $58.28 $0.00 85055 Reticulated platelet assay 0.00 $58.28 $0.00 85060 Blood smear interpretation 0.71 $58.28 $41.38 85097 Bone marrow interpretation 2.60 $58.28 $151.53 85130 Chromogenic substrate assay 0.00 $58.28 $0.00 85170 Blood clot retraction 0.00 $58.28 $0.00 85175 Blood clot lysis time 0.00 $58.28 $0.00 85210 Clot factor ii prothrom spec 0.00 $58.28 $0.00 85220 Blooc clot factor v test 0.00 $58.28 $0.00 85230 Clot factor vii proconvertin 0.00 $58.28 $0.00 85240 Clot factor viii ahg 1 stage 0.00 $58.28 $0.00 85244 Clot factor viii reltd antgn 0.00 $58.28 $0.00 NON-FACILITY HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL 85245 Clot factor viii vw ristoctn 0.00 $58.28 $0.00 85246 Clot factor viii vw antigen 0.00 $58.28 $0.00 85247 Clot factor viii multimetric 0.00 $58.28 $0.00 85250 Clot factor ix ptc/chrstmas 0.00 $58.28 $0.00 85260 Clot factor x stuart-power 0.00 $58.28 $0.00 85270 Clot factor xi pta 0.00 $58.28 $0.00 85280 Clot factor xii hageman 0.00 $58.28 $0.00 85290 Clot factor xiii fibrin stab 0.00 $58.28 $0.00 85291 Clot factor xiii fibrin scrn 0.00 $58.28 $0.00 85292 Clot factor fletcher fact 0.00 $58.28 $0.00 85293 Clot factor wght kininogen 0.00 $58.28 $0.00 85300 Antithrombin iii activity 0.00 $58.28 $0.00 85301 Antithrombin iii antigen 0.00 $58.28 $0.00 85302 Clot inhibit prot c antigen 0.00 $58.28 $0.00 85303 Clot inhibit prot c activity 0.00 $58.28 $0.00 85305 Clot inhibit prot s total 0.00 $58.28 $0.00 85306 Clot inhibit prot s free 0.00 $58.28 $0.00 85307 Assay activated protein c 0.00 $58.28 $0.00 85335 Factor inhibitor test 0.00 $58.28 $0.00 85337 Thrombomodulin 0.00 $58.28 $0.00 85345 Coagulation time lee & white 0.00 $58.28 $0.00 85347 Coagulation time activated 0.00 $58.28 $0.00 85348 Coagulation time otr method 0.00 $58.28 $0.00 85360 Euglobulin lysis 0.00 $58.28 $0.00 85362 Fibrin degradation products 0.00 $58.28 $0.00 85366 Fibrinogen test 0.00 $58.28 $0.00 85370 Fibrinogen test 0.00 $58.28 $0.00 85378 Fibrin degrade semiquant 0.00 $58.28 $0.00 85379 Fibrin degradation quant 0.00 $58.28 $0.00 85380 Fibrin degradj d-dimer 0.00 $58.28 $0.00 85384 Fibrinogen activity 0.00 $58.28 $0.00 85385 Fibrinogen antigen 0.00 $58.28 $0.00 85390 Fibrinolysins screen i&r 0.00 $58.28 $0.00 85390 26 Fibrinolysins screen i&r 0.52 $58.28 $30.31 85396 Clotting assay whole blood 0.59 $58.28 $34.39 85397 Clotting funct activity 0.00 $58.28 $0.00 85400 Fibrinolytic plasmin 0.00 $58.28 $0.00 85410 Fibrinolytic antiplasmin 0.00 $58.28 $0.00 85415 Fibrinolytic plasminogen 0.00 $58.28 $0.00 85420 Fibrinolytic plasminogen 0.00 $58.28 $0.00 85421 Fibrinolytic plasminogen 0.00 $58.28 $0.00 85441 Heinz bodies direct 0.00 $58.28 $0.00 85445 Heinz bodies induced 0.00 $58.28 $0.00 85460 Hemoglobin fetal 0.00 $58.28 $0.00 85461 Hemoglobin fetal 0.00 $58.28 $0.00 NON-FACILITY HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL 85475 Hemolysin acid 0.00 $58.28 $0.00 85520 Heparin assay 0.00 $58.28 $0.00 85525 Heparin neutralization 0.00 $58.28 $0.00 85530 Heparin-protamine tolerance 0.00 $58.28 $0.00 85536 Iron stain peripheral blood 0.00 $58.28 $0.00 85540 Wbc alkaline phosphatase 0.00 $58.28 $0.00 85547 Rbc mechanical fragility 0.00 $58.28 $0.00 85549 Muramidase 0.00 $58.28 $0.00 85555 Rbc osmotic fragility 0.00 $58.28 $0.00 85557 Rbc osmotic fragility 0.00 $58.28 $0.00 85576 Blood platelet aggregation 0.00 $58.28 $0.00 85576 26 Blood platelet aggregation 0.52 $58.28 $30.31 85597 Phospholipid pltlt neutraliz 0.00 $58.28 $0.00 85598 Hexagnal phosph pltlt neutrl 0.00 $58.28 $0.00 85610 Prothrombin time 0.00 $58.28 $0.00 85611 Prothrombin test 0.00 $58.28 $0.00 85612 Viper venom prothrombin time 0.00 $58.28 $0.00 85613 Russell viper venom diluted 0.00 $58.28 $0.00 85635 Reptilase test 0.00 $58.28 $0.00 85651 Rbc sed rate nonautomated 0.00 $58.28 $0.00 85652 Rbc sed rate automated 0.00 $58.28 $0.00 85660 Rbc sickle cell test 0.00 $58.28 $0.00 85670 Thrombin time plasma 0.00 $58.28 $0.00 85675 Thrombin time titer 0.00 $58.28 $0.00 85705 Thromboplastin inhibition 0.00 $58.28 $0.00 85730 Thromboplastin time partial 0.00 $58.28 $0.00 85732 Thromboplastin time partial 0.00 $58.28 $0.00 85810 Blood viscosity examination 0.00 $58.28 $0.00 85999 Hematology procedure 0.00 $58.28 $0.00 86000 Agglutinins febrile antigen 0.00 $58.28 $0.00 86001 Allergen specific igg 0.00 $58.28 $0.00 86003 Allg spec ige crude xtrc ea 0.00 $58.28 $0.00 86005 Allg spec ige multiallg scr 0.00 $58.28 $0.00 86008 Allg spec ige recomb ea 0.00 $58.28 $0.00 86021 Wbc antibody identification 0.00 $58.28 $0.00 86022 Platelet antibodies 0.00 $58.28 $0.00 86023 Immunoglobulin assay 0.00 $58.28 $0.00 86038 Antinuclear antibodies 0.00 $58.28 $0.00 86039 Antinuclear antibodies (ana) 0.00 $58.28 $0.00 86060 Antistreptolysin o titer 0.00 $58.28 $0.00 86063 Antistreptolysin o screen 0.00 $58.28 $0.00 86077 Phys blood bank serv xmatch 1.60 $58.28 $93.25 86078 Phys blood bank serv reactj 1.60 $58.28 $93.25 86079 Phys blood bank serv authrj 1.59 $58.28 $92.67 86140 C-reactive protein 0.00 $58.28 $0.00 NON-FACILITY HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL 86141 C-reactive protein hs 0.00 $58.28 $0.00 86146 Beta-2 glycoprotein antibody 0.00 $58.28 $0.00 86147 Cardiolipin antibody ea ig 0.00 $58.28 $0.00 86148 Anti-phospholipid antibody 0.00 $58.28 $0.00 86152 Cell enumeration & id 0.00 $58.28 $0.00 86153 26 Cell enumeration phys interp 0.98 $58.28 $57.11 86155 Chemotaxis assay 0.00 $58.28 $0.00 86156 Cold agglutinin screen 0.00 $58.28 $0.00 86157 Cold agglutinin titer 0.00 $58.28 $0.00 86160 Complement antigen 0.00 $58.28 $0.00 86161 Complement/function activity 0.00 $58.28 $0.00 86162 Complement total (ch50) 0.00 $58.28 $0.00 86171 Complement fixation each 0.00 $58.28 $0.00 86200 Ccp antibody 0.00 $58.28 $0.00 86215 Deoxyribonuclease antibody 0.00 $58.28 $0.00 86225 Dna antibody native 0.00 $58.28 $0.00 86226 Dna antibody single strand 0.00 $58.28 $0.00 86235 Nuclear antigen antibody 0.00 $58.28 $0.00 86255 Fluorescent antibody screen 0.00 $58.28 $0.00 86255 26 Fluorescent antibody screen 0.52 $58.28 $30.31 86256 Fluorescent antibody titer 0.00 $58.28 $0.00 86256 26 Fluorescent antibody titer 0.52 $58.28 $30.31 86277 Growth hormone antibody 0.00 $58.28 $0.00 86280 Hemagglutination inhibition 0.00 $58.28 $0.00 86294 Immunoassay tumor qual 0.00 $58.28 $0.00 86300 Immunoassay tumor ca 15-3 0.00 $58.28 $0.00 86301 Immunoassay tumor ca 19-9 0.00 $58.28 $0.00 86304 Immunoassay tumor ca 125 0.00 $58.28 $0.00 86305 Human epididymis protein 4 0.00 $58.28 $0.00 86308 Heterophile antibody screen 0.00 $58.28 $0.00 86309 Heterophile antibody titer 0.00 $58.28 $0.00 86310 Heterophile antibody absrbj 0.00 $58.28 $0.00 86316 Immunoassay tumor other 0.00 $58.28 $0.00 86317 Immunoassay infectious agent 0.00 $58.28 $0.00 86318 Immunoassay infectious agent 0.00 $58.28 $0.00 86320 Serum immunoelectrophoresis 0.00 $58.28 $0.00 86320 26 Serum immunoelectrophoresis 0.52 $58.28 $30.31 86325 Other immunoelectrophoresis 0.00 $58.28 $0.00 86325 26 Other immunoelectrophoresis 0.52 $58.28 $30.31 86327 Immunoelectrophoresis assay 0.00 $58.28 $0.00 86327 26 Immunoelectrophoresis assay 0.59 $58.28 $34.39 86329 Immunodiffusion nes 0.00 $58.28 $0.00 86331 Immunodiffusion ouchterlony 0.00 $58.28 $0.00 86332 Immune complex assay 0.00 $58.28 $0.00 86334 Immunofix e-phoresis serum 0.00 $58.28 $0.00 NON-FACILITY HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL 86334 26 Immunofix e-phoresis serum 0.52 $58.28 $30.31 86335 Immunfix e-phorsis/urine/csf 0.00 $58.28 $0.00 86335 26 Immunfix e-phorsis/urine/csf 0.52 $58.28 $30.31 86336 Inhibin a 0.00 $58.28 $0.00 86337 Insulin antibodies 0.00 $58.28 $0.00 86340 Intrinsic factor antibody 0.00 $58.28 $0.00 86341 Islet cell antibody 0.00 $58.28 $0.00 86343 Leukocyte histamine release 0.00 $58.28 $0.00 86344 Leukocyte phagocytosis 0.00 $58.28 $0.00 86352 Cell function assay w/stim 0.00 $58.28 $0.00 86353 Lymphocyte transformation 0.00 $58.28 $0.00 86355 B cells total count 0.00 $58.28 $0.00 86356 Mononuclear cell antigen 0.00 $58.28 $0.00 86357 Nk cells total count 0.00 $58.28 $0.00 86359 T cells total count 0.00 $58.28 $0.00 86360 T cell absolute count/ratio 0.00 $58.28 $0.00 86361 T cell absolute count 0.00 $58.28 $0.00 86367 Stem cells total count 0.00 $58.28 $0.00 86376 Microsomal antibody each 0.00 $58.28 $0.00 86382 Neutralization test viral 0.00 $58.28 $0.00 86384 Nitroblue tetrazolium dye 0.00 $58.28 $0.00 86386 Nuclear matrix protein 22 0.00 $58.28 $0.00 86403 Particle agglut antbdy scrn 0.00 $58.28 $0.00 86406 Particle agglut antbdy titr 0.00 $58.28 $0.00 86430 Rheumatoid factor test qual 0.00 $58.28 $0.00 86431 Rheumatoid factor quant 0.00 $58.28 $0.00 86480 Tb test cell immun measure 0.00 $58.28 $0.00 86481 Tb ag response t-cell susp 0.00 $58.28 $0.00 86485 Skin test candida 0.00 $58.28 $0.00 86486 Skin test nos antigen 0.14 $58.28 $8.16 86490 Coccidioidomycosis skin test 2.54 $58.28 $148.03 86510 Histoplasmosis skin test 0.18 $58.28 $10.49 86580 Tb intradermal test 0.23 $58.28 $13.40 86590 Streptokinase antibody 0.00 $58.28 $0.00 86592 Syphilis test non-trep qual 0.00 $58.28 $0.00 86593 Syphilis test non-trep quant 0.00 $58.28 $0.00 86602 Antinomyces antibody 0.00 $58.28 $0.00 86603 Adenovirus antibody 0.00 $58.28 $0.00 86606 Aspergillus antibody 0.00 $58.28 $0.00 86609 Bacterium antibody 0.00 $58.28 $0.00 86611 Bartonella antibody 0.00 $58.28 $0.00 86612 Blastomyces antibody 0.00 $58.28 $0.00 86615 Bordetella antibody 0.00 $58.28 $0.00 86617 Lyme disease antibody 0.00 $58.28 $0.00 86618 Lyme disease antibody 0.00 $58.28 $0.00 NON-FACILITY HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL 86619 Borrelia antibody 0.00 $58.28 $0.00 86622 Brucella antibody 0.00 $58.28 $0.00 86625 Campylobacter antibody 0.00 $58.28 $0.00 86628 Candida antibody 0.00 $58.28 $0.00 86631 Chlamydia antibody 0.00 $58.28 $0.00 86632 Chlamydia igm antibody 0.00 $58.28 $0.00 86635 Coccidioides antibody 0.00 $58.28 $0.00 86638 Q fever antibody 0.00 $58.28 $0.00 86641 Cryptococcus antibody 0.00 $58.28 $0.00 86644 Cmv antibody 0.00 $58.28 $0.00 86645 Cmv antibody igm 0.00 $58.28 $0.00 86648 Diphtheria antibody 0.00 $58.28 $0.00 86651 Encephalitis californ antbdy 0.00 $58.28 $0.00 86652 Encephaltis east eqne anbdy 0.00 $58.28 $0.00 86653 Encephaltis st louis antbody 0.00 $58.28 $0.00 86654 Encephaltis west eqne antbdy 0.00 $58.28 $0.00 86658 Enterovirus antibody 0.00 $58.28 $0.00 86663 Epstein-barr antibody 0.00 $58.28 $0.00 86664 Epstein-barr nuclear antigen 0.00 $58.28 $0.00 86665 Epstein-barr capsid vca 0.00 $58.28 $0.00 86666 Ehrlichia antibody 0.00 $58.28 $0.00 86668 Francisella tularensis 0.00 $58.28 $0.00 86671 Fungus nes antibody 0.00 $58.28 $0.00 86674 Giardia lamblia antibody 0.00 $58.28 $0.00 86677 Helicobacter pylori antibody 0.00 $58.28 $0.00 86682 Helminth antibody 0.00 $58.28 $0.00 86684 Hemophilus influenza antibdy 0.00 $58.28 $0.00 86687 Htlv-i antibody 0.00 $58.28 $0.00 86688 Htlv-ii antibody 0.00 $58.28 $0.00 86689 Htlv/hiv confirmj antibody 0.00 $58.28 $0.00 86692 Hepatitis delta agent antbdy 0.00 $58.28 $0.00 86694 Herpes simplex nes antbdy 0.00 $58.28 $0.00 86695 Herpes simplex type 1 test 0.00 $58.28 $0.00 86696 Herpes simplex type 2 test 0.00 $58.28 $0.00 86698 Histoplasma antibody 0.00 $58.28 $0.00 86701 Hiv-1antibody 0.00 $58.28 $0.00 86702 Hiv-2 antibody 0.00 $58.28 $0.00 86703 Hiv-1/hiv-2 1 result antbdy 0.00 $58.28 $0.00 86704 Hep b core antibody total 0.00 $58.28 $0.00 86705 Hep b core antibody igm 0.00 $58.28 $0.00 86706 Hep b surface antibody 0.00 $58.28 $0.00 86707 Hepatitis be antibody 0.00 $58.28 $0.00 86708 Hepatitis a antibody 0.00 $58.28 $0.00 86709 Hepatitis a igm antibody 0.00 $58.28 $0.00 86710 Influenza virus antibody 0.00 $58.28 $0.00 NON-FACILITY HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL 86711 John cunningham antibody 0.00 $58.28 $0.00 86713 Legionella antibody 0.00 $58.28 $0.00 86717 Leishmania antibody 0.00 $58.28 $0.00 86720 Leptospira antibody 0.00 $58.28 $0.00 86723 Listeria monocytogenes 0.00 $58.28 $0.00 86727 Lymph choriomeningitis ab 0.00 $58.28 $0.00 86732 Mucormycosis antibody 0.00 $58.28 $0.00 86735 Mumps antibody 0.00 $58.28 $0.00 86738 Mycoplasma antibody 0.00 $58.28 $0.00 86741 Neisseria meningitidis 0.00 $58.28 $0.00 86744 Nocardia antibody 0.00 $58.28 $0.00 86747 Parvovirus antibody 0.00 $58.28 $0.00 86750 Malaria antibody 0.00 $58.28 $0.00 86753 Protozoa antibody nos 0.00 $58.28 $0.00 86756 Respiratory virus antibody 0.00 $58.28 $0.00 86757 Rickettsia antibody 0.00 $58.28 $0.00 86759 Rotavirus antibody 0.00 $58.28 $0.00 86762 Rubella antibody 0.00 $58.28 $0.00 86765 Rubeola antibody 0.00 $58.28 $0.00 86768 Salmonella antibody 0.00 $58.28 $0.00 86771 Shigella antibody 0.00 $58.28 $0.00 86774 Tetanus antibody 0.00 $58.28 $0.00 86777 Toxoplasma antibody 0.00 $58.28 $0.00 86778 Toxoplasma antibody igm 0.00 $58.28 $0.00 86780 Treponema pallidum 0.00 $58.28 $0.00 86784 Trichinella antibody 0.00 $58.28 $0.00 86787 Varicella-zoster antibody 0.00 $58.28 $0.00 86788 West nile virus ab igm 0.00 $58.28 $0.00 86789 West nile virus antibody 0.00 $58.28 $0.00 86790 Virus antibody nos 0.00 $58.28 $0.00 86793 Yersinia antibody 0.00 $58.28 $0.00 86794 Zika virus igm antibody 0.00 $58.28 $0.00 86800 Thyroglobulin antibody 0.00 $58.28 $0.00 86803 Hepatitis c ab test 0.00 $58.28 $0.00 86804 Hep c ab test confirm 0.00 $58.28 $0.00 86805 Lymphocytotoxicity assay 0.00 $58.28 $0.00 86806 Lymphocytotoxicity assay 0.00 $58.28 $0.00 86807 Cytotoxic antibody screening 0.00 $58.28 $0.00 86808 Cytotoxic antibody screening 0.00 $58.28 $0.00 86812 Hla typing a b or c 0.00 $58.28 $0.00 86813 Hla typing a b or c 0.00 $58.28 $0.00 86816 Hla typing dr/dq 0.00 $58.28 $0.00 86817 Hla typing dr/dq 0.00 $58.28 $0.00 86821 Lymphocyte culture mixed 0.00 $58.28 $0.00 86825 Hla x-math non-cytotoxic 0.00 $58.28 $0.00 NON-FACILITY HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL 86826 Hla x-match noncytotoxc addl 0.00 $58.28 $0.00 86828 Hla class i&ii antibody qual 0.00 $58.28 $0.00 86829 Hla class i/ii antibody qual 0.00 $58.28 $0.00 86830 Hla class i phenotype qual 0.00 $58.28 $0.00 86831 Hla class ii phenotype qual 0.00 $58.28 $0.00 86832 Hla class i high defin qual 0.00 $58.28 $0.00 86833 Hla class ii high defin qual 0.00 $58.28 $0.00 86834 Hla class i semiquant panel 0.00 $58.28 $0.00 86835 Hla class ii semiquant panel 0.00 $58.28 $0.00 86849 Immunology procedure 0.00 $58.28 $0.00 86850 Rbc antibody screen 0.00 $58.28 $0.00 86860 Rbc antibody elution 0.00 $58.28 $0.00 86870 Rbc antibody identification 0.00 $58.28 $0.00 86880 Coombs test direct 0.00 $58.28 $0.00 86885 Coombs test indirect qual 0.00 $58.28 $0.00 86886 Coombs test indirect titer 0.00 $58.28 $0.00 86890 Autologous blood process 0.00 $58.28 $0.00 86891 Autologous blood op salvage 0.00 $58.28 $0.00 86900 Blood typing serologic abo 0.00 $58.28 $0.00 86901 Blood typing serologic rh(d) 0.00 $58.28 $0.00 86902 Blood type antigen donor ea 0.00 $58.28 $0.00 86904 Blood typing patient serum 0.00 $58.28 $0.00 86905 Blood typing rbc antigens 0.00 $58.28 $0.00 86906 Bld typing serologic rh phnt 0.00 $58.28 $0.00 86910 Blood typing paternity test 0.00 $58.28 $0.00 86911 Blood typing antigen system 0.00 $58.28 $0.00 86920 Compatibility test spin 0.00 $58.28 $0.00 86921 Compatibility test incubate 0.00 $58.28 $0.00 86922 Compatibility test antiglob 0.00 $58.28 $0.00 86923 Compatibility test electric 0.00 $58.28 $0.00 86927 Plasma fresh frozen 0.00 $58.28 $0.00 86930 Frozen blood prep 0.00 $58.28 $0.00 86931 Frozen blood thaw 0.00 $58.28 $0.00 86932 Frozen blood freeze/thaw 0.00 $58.28 $0.00 86940 Hemolysins/agglutinins auto 0.00 $58.28 $0.00 86941 Hemolysins/agglutinins 0.00 $58.28 $0.00 86945 Blood product/irradiation 0.00 $58.28 $0.00 86950 Leukacyte transfusion 0.00 $58.28 $0.00 86960 Vol reduction of blood/prod 0.00 $58.28 $0.00 86965 Pooling blood platelets 0.00 $58.28 $0.00 86970 Rbc pretx incubatj w/chemicl 0.00 $58.28 $0.00 86971 Rbc pretx incubatj w/enzymes 0.00 $58.28 $0.00 86972 Rbc pretx incubatj w/density 0.00 $58.28 $0.00 86975 Rbc serum pretx incubj drugs 0.00 $58.28 $0.00 86976 Rbc serum pretx id dilution 0.00 $58.28 $0.00 NON-FACILITY HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL 86977 Rbc serum pretx incubj/inhib 0.00 $58.28 $0.00 86978 Rbc pretreatment serum 0.00 $58.28 $0.00 86985 Split blood or products 0.00 $58.28 $0.00 86999 Transfusion procedure 0.00 $58.28 $0.00 87003 Small animal inoculation 0.00 $58.28 $0.00 87015 Specimen infect agnt concntj 0.00 $58.28 $0.00 87040 Blood culture for bacteria 0.00 $58.28 $0.00 87045 Feces culture aerobic bact 0.00 $58.28 $0.00 87046 Stool cultr aerobic bact ea 0.00 $58.28 $0.00 87070 Culture othr specimn aerobic 0.00 $58.28 $0.00 87071 Culture aerobic quant other 0.00 $58.28 $0.00 87073 Culture bacteria anaerobic 0.00 $58.28 $0.00 87075 Cultr bacteria except blood 0.00 $58.28 $0.00 87076 Culture anaerobe ident each 0.00 $58.28 $0.00 87077 Culture aerobic identify 0.00 $58.28 $0.00 87081 Culture screen only 0.00 $58.28 $0.00 87084 Culture of specimen by kit 0.00 $58.28 $0.00 87086 Urine culture/colony count 0.00 $58.28 $0.00 87088 Urine bacteria culture 0.00 $58.28 $0.00 87101 Skin fungi culture 0.00 $58.28 $0.00 87102 Fungus isolation culture 0.00 $58.28 $0.00 87103 Blood fungus culture 0.00 $58.28 $0.00 87106 Fungi identification yeast 0.00 $58.28 $0.00 87107 Fungi identification mold 0.00 $58.28 $0.00 87109 Mycoplasma 0.00 $58.28 $0.00 87110 Chlamydia culture 0.00 $58.28 $0.00 87116 Mycobacteria culture 0.00 $58.28 $0.00 87118 Mycobacteric identification 0.00 $58.28 $0.00 87140 Culture type immunofluoresc 0.00 $58.28 $0.00 87143 Culture typing glc/hplc 0.00 $58.28 $0.00 87147 Culture type immunologic 0.00 $58.28 $0.00 87149 Dna/rna direct probe 0.00 $58.28 $0.00 87150 Dna/rna amplified probe 0.00 $58.28 $0.00 87152 Culture type pulse field gel 0.00 $58.28 $0.00 87153 Dna/rna sequencing 0.00 $58.28 $0.00 87158 Culture typing added method 0.00 $58.28 $0.00 87164 Dark field examination 0.00 $58.28 $0.00 87164 26 Dark field examination 0.52 $58.28 $30.31 87166 Dark field examination 0.00 $58.28 $0.00 87168 Macroscopic exam arthropod 0.00 $58.28 $0.00 87169 Macroscopic exam parasite 0.00 $58.28 $0.00 87172 Pinworm exam 0.00 $58.28 $0.00 87176 Tissue homogenization cultr 0.00 $58.28 $0.00 87177 Ova and parasites smears 0.00 $58.28 $0.00 87181 Microbe susceptible diffuse 0.00 $58.28 $0.00 NON-FACILITY HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL 87184 Microbe susceptible disk 0.00 $58.28 $0.00 87185 Microbe susceptible enzyme 0.00 $58.28 $0.00 87186 Microbe susceptible mic 0.00 $58.28 $0.00 87187 Microbe susceptible mlc 0.00 $58.28 $0.00 87188 Microbe suscept macrobroth 0.00 $58.28 $0.00 87190 Microbe suscept mycobacteri 0.00 $58.28 $0.00 87197 Bactericidal level serum 0.00 $58.28 $0.00 87205 Smear gram stain 0.00 $58.28 $0.00 87206 Smear fluorescent/acid stai 0.00 $58.28 $0.00 87207 Smear special stain 0.00 $58.28 $0.00 87207 26 Smear special stain 0.52 $58.28 $30.31 87209 Smear complex stain 0.00 $58.28 $0.00 87210 Smear wet mount saline/ink 0.00 $58.28 $0.00 87220 Tissue exam for fungi 0.00 $58.28 $0.00 87230 Assay toxin or antitoxin 0.00 $58.28 $0.00 87250 Virus inoculate eggs/animal 0.00 $58.28 $0.00 87252 Virus inoculation tissue 0.00 $58.28 $0.00 87253 Virus inoculate tissue addl 0.00 $58.28 $0.00 87254 Virus inoculation shell via 0.00 $58.28 $0.00 87255 Genet virus isolate hsv 0.00 $58.28 $0.00 87260 Adenovirus ag if 0.00 $58.28 $0.00 87265 Pertussis ag if 0.00 $58.28 $0.00 87267 Enterovirus antibody dfa 0.00 $58.28 $0.00 87269 Giardia ag if 0.00 $58.28 $0.00 87270 Chlamydia trachomatis ag if 0.00 $58.28 $0.00 87271 Cytomegalovirus dfa 0.00 $58.28 $0.00 87272 Cryptosporidium ag if 0.00 $58.28 $0.00 87273 Herpes simplex 2 ag if 0.00 $58.28 $0.00 87274 Herpes simplex 1 ag if 0.00 $58.28 $0.00 87275 Influenza b ag if 0.00 $58.28 $0.00 87276 Influenza a ag if 0.00 $58.28 $0.00 87278 Legion pneumophilia ag if 0.00 $58.28 $0.00 87279 Parainfluenza ag if 0.00 $58.28 $0.00 87280 Respiratory syncytial ag if 0.00 $58.28 $0.00 87281 Pneumocystis carinii ag if 0.00 $58.28 $0.00 87283 Rubeola ag if 0.00 $58.28 $0.00 87285 Treponema pallidum ag if 0.00 $58.28 $0.00 87290 Varicella zoster ag if 0.00 $58.28 $0.00 87299 Antibody detection nos if 0.00 $58.28 $0.00 87300 Ag detection polyval if 0.00 $58.28 $0.00 87301 Adenovirus ag ia 0.00 $58.28 $0.00 87305 Aspergillus ag ia 0.00 $58.28 $0.00 87320 Chylmd trach ag ia 0.00 $58.28 $0.00 87324 Clostridium ag ia 0.00 $58.28 $0.00 87327 Cryptococcus neoform ag ia 0.00 $58.28 $0.00 NON-FACILITY HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL 87328 Cryptosporidium ag ia 0.00 $58.28 $0.00 87329 Giardia ag ia 0.00 $58.28 $0.00 87332 Cytomegalovirus ag ia 0.00 $58.28 $0.00 87335 E coli 0157 ag ia 0.00 $58.28 $0.00 87336 Entamoeb hist dispr ag ia 0.00 $58.28 $0.00 87337 Entamoeb hist group ag ia 0.00 $58.28 $0.00 87338 Hpylori stool ia 0.00 $58.28 $0.00 87339 H pylori ag ia 0.00 $58.28 $0.00 87340 Hepatitis b surface ag ia 0.00 $58.28 $0.00 87341 Hepatitis b surface ag ia 0.00 $58.28 $0.00 87350 Hepatitis be ag ia 0.00 $58.28 $0.00 87380 Hepatitis delta ag ia 0.00 $58.28 $0.00 87385 Histoplasma capsul ag ia 0.00 $58.28 $0.00 87389 Hiv-1 ag w/hiv-1 & hiv-2 ab 0.00 $58.28 $0.00 87390 Hiv-1 ag ia 0.00 $58.28 $0.00 87391 Hiv-2 ag ia 0.00 $58.28 $0.00 87400 Influenza a/b ag ia 0.00 $58.28 $0.00 87420 Resp syncytial ag ia 0.00 $58.28 $0.00 87425 Rotavirus ag ia 0.00 $58.28 $0.00 87427 Shiga-like toxin ag ia 0.00 $58.28 $0.00 87430 Strep a ag ia 0.00 $58.28 $0.00 87449 Ag detect nos ia mult 0.00 $58.28 $0.00 87450 Ag detect nos ia single 0.00 $58.28 $0.00 87451 Ag detect polyval ia mult 0.00 $58.28 $0.00 87471 Bartonella dna amp probe 0.00 $58.28 $0.00 87472 Bartonella dna quant 0.00 $58.28 $0.00 87475 Lyme dis dna dir probe 0.00 $58.28 $0.00 87476 Lyme dis dna amp probe 0.00 $58.28 $0.00 87480 Candida dna dir probe 0.00 $58.28 $0.00 87481 Candida dna amp probe 0.00 $58.28 $0.00 87482 Candida dna quant 0.00 $58.28 $0.00 87483 Cns dna amp probe type 12-25 0.00 $58.28 $0.00 87485 Chylmd pneum dna dir probe 0.00 $58.28 $0.00 87486 Chylmd pneum dna amp probe 0.00 $58.28 $0.00 87487 Chylmd pneum dna quant 0.00 $58.28 $0.00 87490 Chylmd trach dna dir probe 0.00 $58.28 $0.00 87491 Chylmd trach dna amp probe 0.00 $58.28 $0.00 87492 Chylmd trach dna quant 0.00 $58.28 $0.00 87493 C diff amplified probe 0.00 $58.28 $0.00 87495 Cytomeg dna dir probe 0.00 $58.28 $0.00 87496 Cytomeg dna amp probe 0.00 $58.28 $0.00 87497 Cytomeg dna quant 0.00 $58.28 $0.00 87498 Enterovirus probe&revrs trns 0.00 $58.28 $0.00 87500 Vanomycin dna amp probe 0.00 $58.28 $0.00 87501 Influenza dna amp prob 1+ 0.00 $58.28 $0.00 NON-FACILITY HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL 87502 Influenza dna amp probe 0.00 $58.28 $0.00 87503 Influenza dna amp prob addl 0.00 $58.28 $0.00 87505 Nfct agent detection gi 0.00 $58.28 $0.00 87506 Iadna-dna/rna probe tq 6-11 0.00 $58.28 $0.00 87507 Iadna-dna/rna probe tq 12-25 0.00 $58.28 $0.00 87510 Gardner vag dna dir probe 0.00 $58.28 $0.00 87511 Gardner vag dna amp probe 0.00 $58.28 $0.00 87512 Gardner vag dna quant 0.00 $58.28 $0.00 87516 Hepatitis b dna amp probe 0.00 $58.28 $0.00 87517 Hepatitis b dna quant 0.00 $58.28 $0.00 87520 Hepatitis c rna dir probe 0.00 $58.28 $0.00 87521 Hepatitis c probe&rvrs trnsc 0.00 $58.28 $0.00 87522 Hepatitis c revrs trnscrpj 0.00 $58.28 $0.00 87525 Hepatitis g dna dir probe 0.00 $58.28 $0.00 87526 Hepatitis g dna amp probe 0.00 $58.28 $0.00 87527 Hepatitis g dna quant 0.00 $58.28 $0.00 87528 Hsv dna dir probe 0.00 $58.28 $0.00 87529 Hsv dna amp probe 0.00 $58.28 $0.00 87530 Hsv dna quant 0.00 $58.28 $0.00 87531 Hhv-6 dna dir probe 0.00 $58.28 $0.00 87532 Hhv-6 dna amp probe 0.00 $58.28 $0.00 87533 Hhv-6 dna quant 0.00 $58.28 $0.00 87534 Hiv-1 dna dir probe 0.00 $58.28 $0.00 87535 Hiv-1 probe&reverse trnscrpj 0.00 $58.28 $0.00 87536 Hiv-1 quant&revrse trnscrpj 0.00 $58.28 $0.00 87537 Hiv-2 dna dir probe 0.00 $58.28 $0.00 87538 Hiv-2 probe&revrse trnscripj 0.00 $58.28 $0.00 87539 Hiv-2 quant&revrse trnscripj 0.00 $58.28 $0.00 87540 Legion pneumo dna dir prob 0.00 $58.28 $0.00 87541 Legion pneumo dna amp prob 0.00 $58.28 $0.00 87542 Legion pneumo dna quant 0.00 $58.28 $0.00 87550 Mycobacteria dna dir probe 0.00 $58.28 $0.00 87551 Mycobacteria dna amp probe 0.00 $58.28 $0.00 87552 Mycobacteria dna quant 0.00 $58.28 $0.00 87555 M.tuberculo dna dir probe 0.00 $58.28 $0.00 87556 M.tuberculo dna amp probe 0.00 $58.28 $0.00 87557 M.tuberculo dna quant 0.00 $58.28 $0.00 87560 M.avium-intra dna dir prob 0.00 $58.28 $0.00 87561 M.avium-intra dna amp prob 0.00 $58.28 $0.00 87562 M.avium-intra dna quant 0.00 $58.28 $0.00 87580 M.pneumon dna dir probe 0.00 $58.28 $0.00 87581 M.pneumon dna amp probe 0.00 $58.28 $0.00 87582 M.pneumon dna quant 0.00 $58.28 $0.00 87590 N.gonorrhoeae dna dir prob 0.00 $58.28 $0.00 87591 N.gonorrhoeae dna amp prob 0.00 $58.28 $0.00 NON-FACILITY HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL 87592 N.gonorrhoeae dna quant 0.00 $58.28 $0.00 87623 Hpv low-risk types 0.00 $58.28 $0.00 87624 Hpv high-risk types 0.00 $58.28 $0.00 87625 Hpv types 16 & 18 only 0.00 $58.28 $0.00 87631 Resp virus 3-5 targets 0.00 $58.28 $0.00 87632 Resp virus 6-11 targets 0.00 $58.28 $0.00 87633 Resp virus 12-25 targets 0.00 $58.28 $0.00 87634 Rsv dna/rna amp probe 0.00 $58.28 $0.00 87640 Staph a dna amp probe 0.00 $58.28 $0.00 87641 Mr-staph dna amp probe 0.00 $58.28 $0.00 87650 Strep a dna dir probe 0.00 $58.28 $0.00 87651 Strep a dna amp probe 0.00 $58.28 $0.00 87652 Strep a dna quant 0.00 $58.28 $0.00 87653 Strep b dna amp probe 0.00 $58.28 $0.00 87660 Trichomonas vagin dir probe 0.00 $58.28 $0.00 87661 Trichomonas vaginalis amplif 0.00 $58.28 $0.00 87662 Zika virus dna/rna amp probe 0.00 $58.28 $0.00 87797 Detect agent nos dna dir 0.00 $58.28 $0.00 87798 Detect agent nos dna amp 0.00 $58.28 $0.00 87799 Detect agent nos dna quant 0.00 $58.28 $0.00 87800 Detect agnt mult dna direc 0.00 $58.28 $0.00 87801 Detect agnt mult dna ampli 0.00 $58.28 $0.00 87802 Strep b assay w/optic 0.00 $58.28 $0.00 87803 Clostridium toxin a w/optic 0.00 $58.28 $0.00 87804 Influenza assay w/optic 0.00 $58.28 $0.00 87806 Hiv antigen w/hiv antibodies 0.00 $58.28 $0.00 87807 Rsv assay w/optic 0.00 $58.28 $0.00 87808 Trichomonas assay w/optic 0.00 $58.28 $0.00 87809 Adenovirus assay w/optic 0.00 $58.28 $0.00 87810 Chylmd trach assay w/optic 0.00 $58.28 $0.00 87850 N. gonorrhoeae assay w/optic 0.00 $58.28 $0.00 87880 Strep a assay w/optic 0.00 $58.28 $0.00 87899 Agent nos assay w/optic 0.00 $58.28 $0.00 87900 Phenotype infect agent drug 0.00 $58.28 $0.00 87901 Genotype dna hiv reverse t 0.00 $58.28 $0.00 87902 Genotype dna/rna hep c 0.00 $58.28 $0.00 87903 Phenotype dna hiv w/culture 0.00 $58.28 $0.00 87904 Phenotype dna hiv w/clt add 0.00 $58.28 $0.00 87905 Sialidase enzyme assay 0.00 $58.28 $0.00 87906 Genotype dna/rna hiv 0.00 $58.28 $0.00 87910 Genotype cytomegalovirus 0.00 $58.28 $0.00 87912 Genotype dna hepatitis b 0.00 $58.28 $0.00 87999 Microbiology procedure 0.00 $58.28 $0.00 88000 Autopsy (necropsy) gross 0.00 $58.28 $0.00 88005 Autopsy (necropsy) gross 0.00 $58.28 $0.00 NON-FACILITY HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL 88007 Autopsy (necropsy) gross 0.00 $58.28 $0.00 88012 Autopsy (necropsy) gross 0.00 $58.28 $0.00 88014 Autopsy (necropsy) gross 0.00 $58.28 $0.00 88016 Autopsy (necropsy) gross 0.00 $58.28 $0.00 88020 Autopsy (necropsy) complete 0.00 $58.28 $0.00 88025 Autopsy (necropsy) complete 0.00 $58.28 $0.00 88027 Autopsy (necropsy) complete 0.00 $58.28 $0.00 88028 Autopsy (necropsy) complete 0.00 $58.28 $0.00 88029 Autopsy (necropsy) complete 0.00 $58.28 $0.00 88036 Limited autopsy 0.00 $58.28 $0.00 88037 Limited autopsy 0.00 $58.28 $0.00 88040 Forensic autopsy (necropsy) 0.00 $58.28 $0.00 88045 Coroners autopsy (necropsy) 0.00 $58.28 $0.00 88099 Necropsy (autopsy) procedure 0.00 $58.28 $0.00 88104 Cytopath fl nongyn smears 2.06 $58.28 $120.06 88104 TC Cytopath fl nongyn smears 1.23 $58.28 $71.68 88104 26 Cytopath fl nongyn smears 0.83 $58.28 $48.37 88106 Cytopath fl nongyn filter 1.83 $58.28 $106.65 88106 TC Cytopath fl nongyn filter 1.26 $58.28 $73.43 88106 26 Cytopath fl nongyn filter 0.57 $58.28 $33.22 88108 Cytopath concentrate tech 1.73 $58.28 $100.82 88108 TC Cytopath concentrate tech 1.07 $58.28 $62.36 88108 26 Cytopath concentrate tech 0.66 $58.28 $38.46 88112 Cytopath cell enhance tech 1.95 $58.28 $113.65 88112 TC Cytopath cell enhance tech 1.13 $58.28 $65.86 88112 26 Cytopath cell enhance tech 0.82 $58.28 $47.79 88120 Cytp urne 3-5 probes ea spec 18.05 $58.28 $1,051.95 88120 TC Cytp urne 3-5 probes ea spec 16.36 $58.28 $953.46 88120 26 Cytp urne 3-5 probes ea spec 1.69 $58.28 $98.49 88121 Cytp urine 3-5 probes cmptr 15.05 $58.28 $877.11 88121 TC Cytp urine 3-5 probes cmptr 13.60 $58.28 $792.61 88121 26 Cytp urine 3-5 probes cmptr 1.45 $58.28 $84.51 88125 Forensic cytopathology 0.76 $58.28 $44.29 88125 TC Forensic cytopathology 0.35 $58.28 $20.40 88125 26 Forensic cytopathology 0.41 $58.28 $23.89 88130 Sex chromatin identification 0.00 $58.28 $0.00 88140 Sex chromatin identification 0.00 $58.28 $0.00 88141 Cytopath c/v interpret 0.92 $58.28 $53.62 88142 Cytopath c/v thin layer 0.00 $58.28 $0.00 88143 Cytopath c/v thin layer redo 0.00 $58.28 $0.00 88147 Cytopath c/v automated 0.00 $58.28 $0.00 88148 Cytopath c/v auto rescreen 0.00 $58.28 $0.00 88150 Cytopath c/v manual 0.00 $58.28 $0.00 88152 Cytopath c/v auto redo 0.00 $58.28 $0.00 88153 Cytopath c/v redo 0.00 $58.28 $0.00 NON-FACILITY HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL 88155 Cytopath c/v index add-on 0.00 $58.28 $0.00 88160 Cytopath smear other source 2.06 $58.28 $120.06 88160 TC Cytopath smear other source 1.30 $58.28 $75.76 88160 26 Cytopath smear other source 0.76 $58.28 $44.29 88161 Cytopath smear other source 1.87 $58.28 $108.98 88161 TC Cytopath smear other source 1.14 $58.28 $66.44 88161 26 Cytopath smear other source 0.73 $58.28 $42.54 88162 Cytopath smear other source 2.75 $58.28 $160.27 88162 TC Cytopath smear other source 1.62 $58.28 $94.41 88162 26 Cytopath smear other source 1.13 $58.28 $65.86 88164 Cytopath tbs c/v manual 0.00 $58.28 $0.00 88165 Cytopath tbs c/v redo 0.00 $58.28 $0.00 88166 Cytopath tbs c/v auto redo 0.00 $58.28 $0.00 88167 Cytopath tbs c/v select 0.00 $58.28 $0.00 88172 Cytp dx eval fna 1st ea site 1.64 $58.28 $95.58 88172 TC Cytp dx eval fna 1st ea site 0.58 $58.28 $33.80 88172 26 Cytp dx eval fna 1st ea site 1.06 $58.28 $61.78 88173 Cytopath eval fna report 4.39 $58.28 $255.85 88173 TC Cytopath eval fna report 2.31 $58.28 $134.63 88173 26 Cytopath eval fna report 2.08 $58.28 $121.22 88174 Cytopath c/v auto in fluid 0.00 $58.28 $0.00 88175 Cytopath c/v auto fluid redo 0.00 $58.28 $0.00 88177 Cytp fna eval ea addl 0.87 $58.28 $50.70 88177 TC Cytp fna eval ea addl 0.22 $58.28 $12.82 88177 26 Cytp fna eval ea addl 0.65 $58.28 $37.88 88182 Cell marker study 3.72 $58.28 $216.80 88182 TC Cell marker study 2.59 $58.28 $150.95 88182 26 Cell marker study 1.13 $58.28 $65.86 88184 Flowcytometry/ tc 1 marker 1.89 $58.28 $110.15 88185 Flowcytometry/tc add-on 0.85 $58.28 $49.54 88187 Flowcytometry/read 2-8 1.34 $58.28 $78.10 88188 Flowcytometry/read 9-15 1.85 $58.28 $107.82 88189 Flowcytometry/read 16 & > 2.47 $58.28 $143.95 88199 Cytopathology procedure 0.00 $58.28 $0.00 88199 TC Cytopathology procedure 0.00 $58.28 $0.00 88199 26 Cytopathology procedure 0.00 $58.28 $0.00 88230 Tissue culture lymphocyte 0.00 $58.28 $0.00 88233 Tissue culture skin/biopsy 0.00 $58.28 $0.00 88235 Tissue culture placenta 0.00 $58.28 $0.00 88237 Tissue culture bone marrow 0.00 $58.28 $0.00 88239 Tissue culture tumor 0.00 $58.28 $0.00 88240 Cell cryopreserve/storage 0.00 $58.28 $0.00 88241 Frozen cell preparation 0.00 $58.28 $0.00 88245 Chromosome analysis 20-25 0.00 $58.28 $0.00 88248 Chromosome analysis 50-100 0.00 $58.28 $0.00 NON-FACILITY HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL 88249 Chromosome analysis 100 0.00 $58.28 $0.00 88261 Chromosome analysis 5 0.00 $58.28 $0.00 88262 Chromosome analysis 15-20 0.00 $58.28 $0.00 88263 Chromosome analysis 45 0.00 $58.28 $0.00 88264 Chromosome analysis 20-25 0.00 $58.28 $0.00 88267 Chromosome analys placenta 0.00 $58.28 $0.00 88269 Chromosome analys amniotic 0.00 $58.28 $0.00 88271 Cytogenetics dna probe 0.00 $58.28 $0.00 88272 Cytogenetics 3-5 0.00 $58.28 $0.00 88273 Cytogenetics 10-30 0.00 $58.28 $0.00 88274 Cytogenetics 25-99 0.00 $58.28 $0.00 88275 Cytogenetics 100-300 0.00 $58.28 $0.00 88280 Chromosome karyotype study 0.00 $58.28 $0.00 88283 Chromosome banding study 0.00 $58.28 $0.00 88285 Chromosome count additional 0.00 $58.28 $0.00 88289 Chromosome study additional 0.00 $58.28 $0.00 88291 Cyto/molecular report 0.94 $58.28 $54.78 88299 Cytogenetic study 0.00 $58.28 $0.00 88300 Surgical path gross 0.47 $58.28 $27.39 88300 TC Surgical path gross 0.34 $58.28 $19.82 88300 26 Surgical path gross 0.13 $58.28 $7.58 88302 Tissue exam by pathologist 0.88 $58.28 $51.29 88302 TC Tissue exam by pathologist 0.67 $58.28 $39.05 88302 26 Tissue exam by pathologist 0.21 $58.28 $12.24 88304 Tissue exam by pathologist 1.16 $58.28 $67.60 88304 TC Tissue exam by pathologist 0.82 $58.28 $47.79 88304 26 Tissue exam by pathologist 0.34 $58.28 $19.82 88305 Tissue exam by pathologist 1.95 $58.28 $113.65 88305 TC Tissue exam by pathologist 0.84 $58.28 $48.96 88305 26 Tissue exam by pathologist 1.11 $58.28 $64.69 88307 Tissue exam by pathologist 7.50 $58.28 $437.10 88307 TC Tissue exam by pathologist 5.06 $58.28 $294.90 88307 26 Tissue exam by pathologist 2.44 $58.28 $142.20 88309 Tissue exam by pathologist 11.39 $58.28 $663.81 88309 TC Tissue exam by pathologist 7.06 $58.28 $411.46 88309 26 Tissue exam by pathologist 4.33 $58.28 $252.35 88311 Decalcify tissue 0.63 $58.28 $36.72 88311 TC Decalcify tissue 0.26 $58.28 $15.15 88311 26 Decalcify tissue 0.37 $58.28 $21.56 88312 Special stains group 1 2.76 $58.28 $160.85 88312 TC Special stains group 1 1.98 $58.28 $115.39 88312 26 Special stains group 1 0.78 $58.28 $45.46 88313 Special stains group 2 2.00 $58.28 $116.56 88313 TC Special stains group 2 1.65 $58.28 $96.16 88313 26 Special stains group 2 0.35 $58.28 $20.40 NON-FACILITY HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL 88314 Histochemical stains add-on 2.42 $58.28 $141.04 88314 TC Histochemical stains add-on 1.76 $58.28 $102.57 88314 26 Histochemical stains add-on 0.66 $58.28 $38.46 88319 Enzyme histochemistry 2.50 $58.28 $145.70 88319 TC Enzyme histochemistry 1.72 $58.28 $100.24 88319 26 Enzyme histochemistry 0.78 $58.28 $45.46 88321 Microslide consultation 2.92 $58.28 $170.18 88323 Microslide consultation 3.47 $58.28 $202.23 88323 TC Microslide consultation 0.93 $58.28 $54.20 88323 26 Microslide consultation 2.54 $58.28 $148.03 88325 Comprehensive review of data 5.27 $58.28 $307.14 88329 Path consult introp 1.48 $58.28 $86.25 88331 Path consult intraop 1 bloc 2.77 $58.28 $161.44 88331 TC Path consult intraop 1 bloc 0.92 $58.28 $53.62 88331 26 Path consult intraop 1 bloc 1.85 $58.28 $107.82 88332 Path consult intraop addl 1.51 $58.28 $88.00 88332 TC Path consult intraop addl 0.60 $58.28 $34.97 88332 26 Path consult intraop addl 0.91 $58.28 $53.03 88333 Intraop cyto path consult 1 2.55 $58.28 $148.61 88333 TC Intraop cyto path consult 1 0.70 $58.28 $40.80 88333 26 Intraop cyto path consult 1 1.85 $58.28 $107.82 88334 Intraop cyto path consult 2 1.58 $58.28 $92.08 88334 TC Intraop cyto path consult 2 0.45 $58.28 $26.23 88334 26 Intraop cyto path consult 2 1.13 $58.28 $65.86 88341 Immunohisto antb addl slide 2.63 $58.28 $153.28 88341 TC Immunohisto antb addl slide 1.80 $58.28 $104.90 88341 26 Immunohisto antb addl slide 0.83 $58.28 $48.37 88342 Immunohisto antb 1st stain 3.10 $58.28 $180.67 88342 TC Immunohisto antb 1st stain 2.06 $58.28 $120.06 88342 26 Immunohisto antb 1st stain 1.04 $58.28 $60.61 88344 Immunohisto antibody slide 4.96 $58.28 $289.07 88344 TC Immunohisto antibody slide 3.82 $58.28 $222.63 88344 26 Immunohisto antibody slide 1.14 $58.28 $66.44 88346 Immunofluor antb 1st stain 2.66 $58.28 $155.02 88346 TC Immunofluor antb 1st stain 1.61 $58.28 $93.83 88346 26 Immunofluor antb 1st stain 1.05 $58.28 $61.19 88348 Electron microscopy 9.84 $58.28 $573.48 88348 TC Electron microscopy 7.62 $58.28 $444.09 88348 26 Electron microscopy 2.22 $58.28 $129.38 88350 Immunofluor antb addl stain 2.05 $58.28 $119.47 88350 TC Immunofluor antb addl stain 1.21 $58.28 $70.52 88350 26 Immunofluor antb addl stain 0.84 $58.28 $48.96 88355 Analysis skeletal muscle 3.73 $58.28 $217.38 88355 TC Analysis skeletal muscle 1.35 $58.28 $78.68 88355 26 Analysis skeletal muscle 2.38 $58.28 $138.71 NON-FACILITY HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL 88356 Analysis nerve 6.26 $58.28 $364.83 88356 TC Analysis nerve 2.66 $58.28 $155.02 88356 26 Analysis nerve 3.60 $58.28 $209.81 88358 Analysis tumor 2.69 $58.28 $156.77 88358 TC Analysis tumor 1.33 $58.28 $77.51 88358 26 Analysis tumor 1.36 $58.28 $79.26 88360 Tumor immunohistochem/manual 3.79 $58.28 $220.88 88360 TC Tumor immunohistochem/manual 2.49 $58.28 $145.12 88360 26 Tumor immunohistochem/manual 1.30 $58.28 $75.76 88361 Tumor immunohistochem/comput 4.12 $58.28 $240.11 88361 TC Tumor immunohistochem/comput 2.74 $58.28 $159.69 88361 26 Tumor immunohistochem/comput 1.38 $58.28 $80.43 88362 Nerve teasing preparations 5.93 $58.28 $345.60 88362 TC Nerve teasing preparations 2.71 $58.28 $157.94 88362 26 Nerve teasing preparations 3.22 $58.28 $187.66 88363 Xm archive tissue molec anal 0.68 $58.28 $39.63 88364 Insitu hybridization (fish) 3.75 $58.28 $218.55 88364 TC Insitu hybridization (fish) 2.73 $58.28 $159.10 88364 26 Insitu hybridization (fish) 1.02 $58.28 $59.45 88365 Insitu hybridization (fish) 5.10 $58.28 $297.23 88365 TC Insitu hybridization (fish) 3.81 $58.28 $222.05 88365 26 Insitu hybridization (fish) 1.29 $58.28 $75.18 88366 Insitu hybridization (fish) 7.45 $58.28 $434.19 88366 TC Insitu hybridization (fish) 5.63 $58.28 $328.12 88366 26 Insitu hybridization (fish) 1.82 $58.28 $106.07 88367 Insitu hybridization auto 3.04 $58.28 $177.17 88367 TC Insitu hybridization auto 2.03 $58.28 $118.31 88367 26 Insitu hybridization auto 1.01 $58.28 $58.86 88368 Insitu hybridization manual 3.43 $58.28 $199.90 88368 TC Insitu hybridization manual 2.22 $58.28 $129.38 88368 26 Insitu hybridization manual 1.21 $58.28 $70.52 88369 M/phmtrc alysishquant/semiq 3.10 $58.28 $180.67 88369 TC M/phmtrc alysishquant/semiq 2.16 $58.28 $125.88 88369 26 M/phmtrc alysishquant/semiq 0.94 $58.28 $54.78 88371 Protein western blot tissue 0.00 $58.28 $0.00 88371 26 Protein western blot tissue 0.52 $58.28 $30.31 88372 Protein analysis w/probe 0.00 $58.28 $0.00 88372 26 Protein analysis w/probe 0.52 $58.28 $30.31 88373 M/phmtrc alys ishquant/semiq 2.23 $58.28 $129.96 88373 TC M/phmtrc alys ishquant/semiq 1.43 $58.28 $83.34 88373 26 M/phmtrc alys ishquant/semiq 0.80 $58.28 $46.62 88374 M/phmtrc alys ishquant/semiq 9.76 $58.28 $568.81 88374 TC M/phmtrc alys ishquant/semiq 8.48 $58.28 $494.21 88374 26 M/phmtrc alys ishquant/semiq 1.28 $58.28 $74.60 88375 Optical endomicroscpy interp 1.45 $58.28 $84.51 NON-FACILITY HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL 88377 M/phmtrc alys ishquant/semiq 11.60 $58.28 $676.05 88377 TC M/phmtrc alys ishquant/semiq 9.74 $58.28 $567.65 88377 26 M/phmtrc alys ishquant/semiq 1.86 $58.28 $108.40 88380 Microdissection laser 3.89 $58.28 $226.71 88380 TC Microdissection laser 2.29 $58.28 $133.46 88380 26 Microdissection laser 1.60 $58.28 $93.25 88381 Microdissection manual 3.47 $58.28 $202.23 88381 TC Microdissection manual 2.74 $58.28 $159.69 88381 26 Microdissection manual 0.73 $58.28 $42.54 88387 Tiss exam molecular study 0.99 $58.28 $57.70 88387 TC Tiss exam molecular study 0.17 $58.28 $9.91 88387 26 Tiss exam molecular study 0.82 $58.28 $47.79 88388 Tiss ex molecul study add-on 0.98 $58.28 $57.11 88388 TC Tiss ex molecul study add-on 0.28 $58.28 $16.32 88388 26 Tiss ex molecul study add-on 0.70 $58.28 $40.80 88399 Surgical pathology procedure 0.00 $58.28 $0.00 88399 TC Surgical pathology procedure 0.00 $58.28 $0.00 88399 26 Surgical pathology procedure 0.00 $58.28 $0.00 88720 Bilirubin total transcut 0.00 $58.28 $0.00 88738 Hgb quant transcutaneous 0.00 $58.28 $0.00 88740 Transcutaneous carboxyhb 0.00 $58.28 $0.00 88741 Transcutaneous methb 0.00 $58.28 $0.00 88749 In vivo lab service 0.00 $58.28 $0.00 89049 Chct for mal hyperthermia 6.89 $58.28 $401.55 89050 Body fluid cell count 0.00 $58.28 $0.00 89051 Body fluid cell count 0.00 $58.28 $0.00 89055 Leukocyte assessment fecal 0.00 $58.28 $0.00 89060 Exam synovial fluid crystals 0.00 $58.28 $0.00 89060 26 Exam synovial fluid crystals 0.52 $58.28 $30.31 89125 Specimen fat stain 0.00 $58.28 $0.00 89160 Exam feces for meat fibers 0.00 $58.28 $0.00 89190 Nasal smear for eosinophils 0.00 $58.28 $0.00 89220 Sputum specimen collection 0.46 $58.28 $26.81 89230 Collect sweat for test 0.10 $58.28 $5.83 89240 Pathology lab procedure 0.00 $58.28 $0.00 89250 Cultr oocyte/embryo <4 days 0.00 $58.28 $0.00 89251 Cultr oocyte/embryo <4 days 0.00 $58.28 $0.00 89253 Embryo hatching 0.00 $58.28 $0.00 89254 Oocyte identification 0.00 $58.28 $0.00 89255 Prepare embryo for transfer 0.00 $58.28 $0.00 89257 Sperm identification 0.00 $58.28 $0.00 89258 Cryopreservation embryo(s) 0.00 $58.28 $0.00 89259 Cryopreservation sperm 0.00 $58.28 $0.00 89260 Sperm isolation simple 0.00 $58.28 $0.00 89261 Sperm isolation complex 0.00 $58.28 $0.00 NON-FACILITY HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL 89264 Identify sperm tissue 0.00 $58.28 $0.00 89268 Insemination of oocytes 0.00 $58.28 $0.00 89272 Extended culture of oocytes 0.00 $58.28 $0.00 89280 Assist oocyte fertilization 0.00 $58.28 $0.00 89281 Assist oocyte fertilization 0.00 $58.28 $0.00 89290 Biopsy oocyte polar body 0.00 $58.28 $0.00 89291 Biopsy oocyte polar body 0.00 $58.28 $0.00 89300 Semen analysis w/huhner 0.00 $58.28 $0.00 89310 Semen analysis w/count 0.00 $58.28 $0.00 89320 Semen anal vol/count/mot 0.00 $58.28 $0.00 89321 Semen anal sperm detection 0.00 $58.28 $0.00 89322 Semen anal strict criteria 0.00 $58.28 $0.00 89325 Sperm antibody test 0.00 $58.28 $0.00 89329 Sperm evaluation test 0.00 $58.28 $0.00 89330 Evaluation cervical mucus 0.00 $58.28 $0.00 89331 Retrograde ejaculation anal 0.00 $58.28 $0.00 89335 Cryopreserve testicular tiss 0.00 $58.28 $0.00 89337 Cryopreservation oocyte(s) 0.00 $58.28 $0.00 89342 Storage/year embryo(s) 0.00 $58.28 $0.00 89343 Storage/year sperm/semen 0.00 $58.28 $0.00 89344 Storage/year reprod tissue 0.00 $58.28 $0.00 89346 Storage/year oocyte(s) 0.00 $58.28 $0.00 89352 Thawing cryopresrved embryo 0.00 $58.28 $0.00 89353 Thawing cryopresrved sperm 0.00 $58.28 $0.00 89354 Thaw cryoprsvrd reprod tiss 0.00 $58.28 $0.00 89356 Thawing cryopresrved oocyte 0.00 $58.28 $0.00 89398 Unlisted reprod med lab proc 0.00 $58.28 $0.00 9001F Aortic aneurysm<5cm diam ct 0.00 $44.28 $0.00 9002F Aortic aneurysm 5-5.4cm diam 0.00 $44.28 $0.00 9003F Aortic anrysm5.5-5.9cm diam 0.00 $44.28 $0.00 9004F Aortic anrysm 6/> cm diam 0.00 $44.28 $0.00 9005F Asympt carot/vrtbrbas sten 0.00 $44.28 $0.00 9006F Sympt sten-tia/strk<120days 0.00 $44.28 $0.00 9007F Other carot sten 120 days/> 0.00 $44.28 $0.00 90281 Human ig im 0.00 $44.28 $0.00 90283 Human ig iv 0.00 $44.28 $0.00 90284 Human ig sc 0.00 $44.28 $0.00 90287 Botulinum antitoxin 0.00 $44.28 $0.00 90288 Botulism ig iv 0.00 $44.28 $0.00 90291 Cmv ig iv 0.00 $44.28 $0.00 90296 Diphtheria antitoxin 0.00 $44.28 $0.00 90371 Hep b ig im 0.00 $44.28 $0.00 90375 Rabies ig im/sc 0.00 $44.28 $0.00 90376 Rabies ig heat treated 0.00 $44.28 $0.00 90378 Rsv mab im 50mg 0.00 $44.28 $0.00 NON-FACILITY HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL 90384 Rh ig full-dose im 0.00 $44.28 $0.00 90385 Rh ig minidose im 0.00 $44.28 $0.00 90386 Rh ig iv 0.00 $44.28 $0.00 90389 Tetanus ig im 0.00 $44.28 $0.00 90393 Vaccina ig im 0.00 $44.28 $0.00 90396 Varicella-zoster ig im 0.00 $44.28 $0.00 90399 Immune globulin 0.00 $44.28 $0.00 90460 Im admin 1st/only component 0.58 $44.28 $25.68 90461 Im admin each addl component 0.36 $44.28 $15.94 90471 Immunization admin 0.58 $44.28 $25.68 90472 Immunization admin each add 0.36 $44.28 $15.94 90473 Immune admin oral/nasal 0.58 $44.28 $25.68 90474 Immune admin oral/nasal addl 0.36 $44.28 $15.94 90476 Adenovirus vaccine type 4 0.00 $44.28 $0.00 90477 Adenovirus vaccine type 7 0.00 $44.28 $0.00 90581 Anthrax vaccine sc or im 0.00 $44.28 $0.00 90585 Bcg vaccine percut 0.00 $44.28 $0.00 90586 Bcg vaccine intravesical 0.00 $44.28 $0.00 90587 Dengue vacc quad 3 dose subq 0.00 $44.28 $0.00 90620 Menb-4c vacc 2 dose im 0.00 $44.28 $0.00 90621 Menb-fhbp vacc 2/3 dose im 0.00 $44.28 $0.00 90625 Cholera vaccine live oral 0.00 $44.28 $0.00 90630 Flu vacc iiv4 no preserv id 0.00 $44.28 $0.00 90632 Hepa vaccine adult im 0.00 $44.28 $0.00 90633 Hepa vacc ped/adol 2 dose im 0.00 $44.28 $0.00 90634 Hepa vacc ped/adol 3 dose 0.00 $44.28 $0.00 90636 Hep a/hep b vacc adult im 0.00 $44.28 $0.00 90644 Hib-mency vacc 6wk-18m0 im 0.00 $44.28 $0.00 90647 Hib prp-omp vacc 3 dose im 0.00 $44.28 $0.00 90648 Hib prp-t vaccine 4 dose im 0.00 $44.28 $0.00 90649 4vhpv vaccine 3 dose im 0.00 $44.28 $0.00 90650 2vhpv vaccine 3 dose im 0.00 $44.28 $0.00 90651 9vhpv vaccine 2/3 dose im 0.00 $44.28 $0.00 90653 Iiv adjuvant vaccine im 0.00 $44.28 $0.00 90654 Flu vacc iiv3 no preserv id 0.00 $44.28 $0.00 90655 Iiv3 vacc no prsv 0.25 ml im 0.00 $44.28 $0.00 90656 Iiv3 vacc no prsv 0.5 ml im 0.00 $44.28 $0.00 90657 Iiv3 vaccine splt 0.25 ml im 0.00 $44.28 $0.00 90658 Iiv3 vaccine splt 0.5 ml im 0.00 $44.28 $0.00 90660 Laiv3 vaccine intranasal 0.00 $44.28 $0.00 90661 Cciiv3 vac no prsv 0.5 ml im 0.00 $44.28 $0.00 90662 Iiv no prsv increased ag im 0.00 $44.28 $0.00 90664 Laiv vacc pandemic intranasl 0.00 $44.28 $0.00 90666 Flu vac pandem prsrv free im 0.00 $44.28 $0.00 90667 Iiv vacc pandemic adjuvt im 0.00 $44.28 $0.00 NON-FACILITY HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL 90668 Iiv vaccine pandemic im 0.00 $44.28 $0.00 90670 Pcv13 vaccine im 0.00 $44.28 $0.00 90672 Laiv4 vaccine intranasal 0.00 $44.28 $0.00 90673 Riv3 vaccine no preserv im 0.00 $44.28 $0.00 90674 Cciiv4 vac no prsv 0.5 ml im 0.00 $44.28 $0.00 90675 Rabies vaccine im 0.00 $44.28 $0.00 90676 Rabies vaccine id 0.00 $44.28 $0.00 90680 Rv5 vacc 3 dose live oral 0.00 $44.28 $0.00 90681 Rv1 vacc 2 dose live oral 0.00 $44.28 $0.00 90682 Riv4 vacc recombinant dna im 0.00 $44.28 $0.00 90685 Iiv4 vacc no prsv 0.25 ml im 0.00 $44.28 $0.00 90686 Iiv4 vacc no prsv 0.5 ml im 0.00 $44.28 $0.00 90687 Iiv4 vaccine splt 0.25 ml im 0.00 $44.28 $0.00 90688 Iiv4 vaccine splt 0.5 ml im 0.00 $44.28 $0.00 90690 Typhoid vaccine oral 0.00 $44.28 $0.00 90691 Typhoid vaccine im 0.00 $44.28 $0.00 90696 Dtap-ipv vaccine 4-6 yrs im 0.00 $44.28 $0.00 90697 Dtap-ipv-hib-hepb vaccine im 0.00 $44.28 $0.00 90698 Dtap-ipv/hib vaccine im 0.00 $44.28 $0.00 90700 Dtap vaccine < 7 yrs im 0.00 $44.28 $0.00 90702 Dt vaccine under 7 yrs im 0.00 $44.28 $0.00 90707 Mmr vaccine sc 0.00 $44.28 $0.00 90710 Mmrv vaccine sc 0.00 $44.28 $0.00 90713 Poliovirus ipv sc/im 0.00 $44.28 $0.00 90714 Td vacc no presv 7 yrs+ im 0.00 $44.28 $0.00 90715 Tdap vaccine 7 yrs/> im 0.00 $44.28 $0.00 90716 Var vaccine live subq 0.00 $44.28 $0.00 90717 Yellow fever vaccine subq 0.00 $44.28 $0.00 90723 Dtap-hep b-ipv vaccine im 0.00 $44.28 $0.00 90732 Ppsv23 vacc 2 yrs+ subq/im 0.00 $44.28 $0.00 90733 Mpsv4 vaccine subq 0.00 $44.28 $0.00 90734 Mcv4 menacwy vaccine im 0.00 $44.28 $0.00 90736 Hzv vaccine live subq 0.00 $44.28 $0.00 90738 Inactivated je vacc im 0.00 $44.28 $0.00 90739 Hepb vacc 2 dose adult im 0.00 $44.28 $0.00 90740 Hepb vacc 3 dose immunsup im 0.00 $44.28 $0.00 90743 Hepb vacc 2 dose adolesc im 0.00 $44.28 $0.00 90744 Hepb vacc 3 dose ped/adol im 0.00 $44.28 $0.00 90746 Hepb vaccine 3 dose adult im 0.00 $44.28 $0.00 90747 Hepb vacc 4 dose immunsup im 0.00 $44.28 $0.00 90748 Hib-hepb vaccine im 0.00 $44.28 $0.00 90749 Vaccine toxoid 0.00 $44.28 $0.00 90750 Hzv vacc recombinant im njx 0.00 $44.28 $0.00 90756 Cciiv4 vacc abx free im 0.00 $44.28 $0.00 90785 Psytx complex interactive 0.41 $44.28 $18.15 NON-FACILITY HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL 90791 Psych diagnostic evaluation 3.79 $44.28 $167.82 90792 Psych diag eval w/med srvcs 4.24 $44.28 $187.75 90832 Psytx w pt 30 minutes 1.84 $44.28 $81.48 90833 Psytx w pt w e/m 30 min 1.92 $44.28 $85.02 90834 Psytx w pt 45 minutes 2.46 $44.28 $108.93 90836 Psytx w pt w e/m 45 min 2.42 $44.28 $107.16 90837 Psytx w pt 60 minutes 3.69 $44.28 $163.39 90838 Psytx w pt w e/m 60 min 3.20 $44.28 $141.70 90839 Psytx crisis initial 60 min 3.85 $44.28 $170.48 90840 Psytx crisis ea addl 30 min 1.84 $44.28 $81.48 90845 Psychoanalysis 2.64 $44.28 $116.90 90846 Family psytx w/o pt 50 min 2.97 $44.28 $131.51 90847 Family psytx w/pt 50 min 3.09 $44.28 $136.83 90849 Multiple family group psytx 1.04 $44.28 $46.05 90853 Group psychotherapy 0.74 $44.28 $32.77 90863 Pharmacologic mgmt w/psytx 0.74 $44.28 $32.77 90865 Narcosynthesis 4.74 $44.28 $209.89 90867 Tcranial magn stim tx plan 0.00 $44.28 $0.00 90868 Tcranial magn stim tx deli 0.00 $44.28 $0.00 90869 Tcran magn stim redetemine 0.00 $44.28 $0.00 90870 Electroconvulsive therapy 4.96 $44.28 $219.63 90875 Psychophysiological therapy 1.77 $44.28 $78.38 90876 Psychophysiological therapy 3.07 $44.28 $135.94 90880 Hypnotherapy 2.93 $44.28 $129.74 90882 Environmental manipulation 0.00 $44.28 $0.00 90885 Psy evaluation of records 1.41 $44.28 $62.43 90887 Consultation with family 2.50 $44.28 $110.70 90889 Preparation of report 0.00 $44.28 $0.00 90899 Psychiatric service/therapy 0.00 $44.28 $0.00 90901 Biofeedback train any meth 1.12 $44.28 $49.59 90911 Biofeedback peri/uro/rectal 2.46 $44.28 $108.93 90935 Hemodialysis one evaluation 2.06 $44.28 $91.22 90937 Hemodialysis repeated eval 2.94 $44.28 $130.18 90940 Hemodialysis access study 0.00 $44.28 $0.00 90945 Dialysis one evaluation 2.42 $44.28 $107.16 90947 Dialysis repeated eval 3.50 $44.28 $154.98 90951 Esrd serv 4 visits p mo <2yr 26.69 $44.28 $1,181.83 90952 Esrd serv 2-3 vsts p mo <2yr 0.00 $44.28 $0.00 90953 Esrd serv 1 visit p mo <2yrs 0.00 $44.28 $0.00 90954 Esrd serv 4 vsts p mo 2-11 23.00 $44.28 $1,018.44 90955 Esrd srv 2-3 vsts p mo 2-11 12.91 $44.28 $571.65 90956 Esrd srv 1 visit p mo 2-11 8.97 $44.28 $397.19 90957 Esrd srv 4 vsts p mo 12-19 18.19 $44.28 $805.45 90958 Esrd srv 2-3 vsts p mo 12-19 12.34 $44.28 $546.42 90959 Esrd serv 1 vst p mo 12-19 8.38 $44.28 $371.07 NON-FACILITY HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL 90960 Esrd srv 4 visits p mo 20+ 8.01 $44.28 $354.68 90961 Esrd srv 2-3 vsts p mo 20+ 6.74 $44.28 $298.45 90962 Esrd serv 1 visit p mo 20+ 5.21 $44.28 $230.70 90963 Esrd home pt serv p mo <2yrs 15.43 $44.28 $683.24 90964 Esrd home pt serv p mo 2-11 13.47 $44.28 $596.45 90965 Esrd home pt serv p mo 12-19 12.81 $44.28 $567.23 90966 Esrd home pt serv p mo 20+ 6.72 $44.28 $297.56 90967 Esrd home pt serv p day <2 0.51 $44.28 $22.58 90968 Esrd home pt srv p day 2-11 0.44 $44.28 $19.48 90969 Esrd home pt srv p day 12-19 0.43 $44.28 $19.04 90970 Esrd home pt serv p day 20+ 0.22 $44.28 $9.74 90989 Dialysis training complete 0.00 $44.28 $0.00 90993 Dialysis training incompl 0.00 $44.28 $0.00 90997 Hemoperfusion 2.52 $44.28 $111.59 90999 Dialysis procedure 0.00 $44.28 $0.00 91010 Esophagus motility study 5.03 $44.28 $222.73 91010 TC Esophagus motility study 3.12 $44.28 $138.15 91010 26 Esophagus motility study 1.91 $44.28 $84.57 91013 Esophgl motil w/stim/perfus 0.72 $44.28 $31.88 91013 TC Esophgl motil w/stim/perfus 0.45 $44.28 $19.93 91013 26 Esophgl motil w/stim/perfus 0.27 $44.28 $11.96 91020 Gastric motility studies 6.70 $44.28 $296.68 91020 TC Gastric motility studies 4.56 $44.28 $201.92 91020 26 Gastric motility studies 2.14 $44.28 $94.76 91022 Duodenal motility study 4.82 $44.28 $213.43 91022 TC Duodenal motility study 2.68 $44.28 $118.67 91022 26 Duodenal motility study 2.14 $44.28 $94.76 91030 Acid perfusion of esophagus 3.90 $44.28 $172.69 91030 TC Acid perfusion of esophagus 2.54 $44.28 $112.47 91030 26 Acid perfusion of esophagus 1.36 $44.28 $60.22 91034 Gastroesophageal reflux test 5.35 $44.28 $236.90 91034 TC Gastroesophageal reflux test 3.90 $44.28 $172.69 91034 26 Gastroesophageal reflux test 1.45 $44.28 $64.21 91035 G-esoph reflx tst w/electrod 13.71 $44.28 $607.08 91035 TC G-esoph reflx tst w/electrod 11.32 $44.28 $501.25 91035 26 G-esoph reflx tst w/electrod 2.39 $44.28 $105.83 91037 Esoph imped function test 4.59 $44.28 $203.25 91037 TC Esoph imped function test 3.15 $44.28 $139.48 91037 26 Esoph imped function test 1.44 $44.28 $63.76 91038 Esoph imped funct test > 1hr 12.76 $44.28 $565.01 91038 TC Esoph imped funct test > 1hr 11.12 $44.28 $492.39 91038 26 Esoph imped funct test > 1hr 1.64 $44.28 $72.62 91040 Esoph balloon distension tst 12.74 $44.28 $564.13 91040 TC Esoph balloon distension tst 11.35 $44.28 $502.58 91040 26 Esoph balloon distension tst 1.39 $44.28 $61.55 NON-FACILITY HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL 91065 Breath hydrogen/methane test 2.05 $44.28 $90.77 91065 TC Breath hydrogen/methane test 1.76 $44.28 $77.93 91065 26 Breath hydrogen/methane test 0.29 $44.28 $12.84 91110 Gi tract capsule endoscopy 25.73 $44.28 $1,139.32 91110 TC Gi tract capsule endoscopy 22.04 $44.28 $975.93 91110 26 Gi tract capsule endoscopy 3.69 $44.28 $163.39 91111 Esophageal capsule endoscopy 21.20 $44.28 $938.74 91111 TC Esophageal capsule endoscopy 19.71 $44.28 $872.76 91111 26 Esophageal capsule endoscopy 1.49 $44.28 $65.98 91112 Gi wireless capsule measure 30.52 $44.28 $1,351.43 91112 TC Gi wireless capsule measure 27.41 $44.28 $1,213.71 91112 26 Gi wireless capsule measure 3.11 $44.28 $137.71 91117 Colon motility 6 hr study 3.98 $44.28 $176.23 91120 Rectal sensation test 12.10 $44.28 $535.79 91120 TC Rectal sensation test 10.68 $44.28 $472.91 91120 26 Rectal sensation test 1.42 $44.28 $62.88 91122 Anal pressure record 6.55 $44.28 $290.03 91122 TC Anal pressure record 3.97 $44.28 $175.79 91122 26 Anal pressure record 2.58 $44.28 $114.24 91132 Electrogastrography 4.28 $44.28 $189.52 91132 TC Electrogastrography 3.51 $44.28 $155.42 91132 26 Electrogastrography 0.77 $44.28 $34.10 91133 Electrogastrography w/test 4.92 $44.28 $217.86 91133 TC Electrogastrography w/test 3.94 $44.28 $174.46 91133 26 Electrogastrography w/test 0.98 $44.28 $43.39 91200 Liver elastography 1.14 $44.28 $50.48 91200 TC Liver elastography 0.74 $44.28 $32.77 91200 26 Liver elastography 0.40 $44.28 $17.71 91299 Gastroenterology procedure 0.00 $44.28 $0.00 91299 TC Gastroenterology procedure 0.00 $44.28 $0.00 91299 26 Gastroenterology procedure 0.00 $44.28 $0.00 92002 Eye exam new patient 2.36 $44.28 $104.50 92004 Eye exam new patient 4.27 $44.28 $189.08 92012 Eye exam establish patient 2.48 $44.28 $109.81 92014 Eye exam&tx estab pt 1/>vst 3.57 $44.28 $158.08 92015 Determine refractive state 0.56 $44.28 $24.80 92018 New eye exam & treatment 4.13 $44.28 $182.88 92019 Eye exam & treatment 2.06 $44.28 $91.22 92020 Special eye evaluation 0.76 $44.28 $33.65 92025 Corneal topography 1.08 $44.28 $47.82 92025 TC Corneal topography 0.51 $44.28 $22.58 92025 26 Corneal topography 0.57 $44.28 $25.24 92060 Special eye evaluation 1.84 $44.28 $81.48 92060 TC Special eye evaluation 0.75 $44.28 $33.21 92060 26 Special eye evaluation 1.09 $44.28 $48.27 NON-FACILITY HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL 92065 Orthoptic/pleoptic training 1.53 $44.28 $67.75 92065 TC Orthoptic/pleoptic training 1.02 $44.28 $45.17 92065 26 Orthoptic/pleoptic training 0.51 $44.28 $22.58 92071 Contact lens fitting for tx 1.07 $44.28 $47.38 92072 Fit contac lens for managmnt 3.77 $44.28 $166.94 92081 Visual field examination(s) 0.98 $44.28 $43.39 92081 TC Visual field examination(s) 0.51 $44.28 $22.58 92081 26 Visual field examination(s) 0.47 $44.28 $20.81 92082 Visual field examination(s) 1.37 $44.28 $60.66 92082 TC Visual field examination(s) 0.75 $44.28 $33.21 92082 26 Visual field examination(s) 0.62 $44.28 $27.45 92083 Visual field examination(s) 1.82 $44.28 $80.59 92083 TC Visual field examination(s) 1.03 $44.28 $45.61 92083 26 Visual field examination(s) 0.79 $44.28 $34.98 92100 Serial tonometry exam(s) 2.30 $44.28 $101.84 92132 Cmptr ophth dx img ant segmt 0.89 $44.28 $39.41 92132 TC Cmptr ophth dx img ant segmt 0.42 $44.28 $18.60 92132 26 Cmptr ophth dx img ant segmt 0.47 $44.28 $20.81 92133 Cmptr ophth img optic nerve 1.07 $44.28 $47.38 92133 TC Cmptr ophth img optic nerve 0.43 $44.28 $19.04 92133 26 Cmptr ophth img optic nerve 0.64 $44.28 $28.34 92134 Cptr ophth dx img post segmt 1.18 $44.28 $52.25 92134 TC Cptr ophth dx img post segmt 0.44 $44.28 $19.48 92134 26 Cptr ophth dx img post segmt 0.74 $44.28 $32.77 92136 Ophthalmic biometry 2.23 $44.28 $98.74 92136 TC Ophthalmic biometry 1.34 $44.28 $59.34 92136 26 Ophthalmic biometry 0.89 $44.28 $39.41 92145 Corneal hysteresis deter 0.50 $44.28 $22.14 92145 TC Corneal hysteresis deter 0.23 $44.28 $10.18 92145 26 Corneal hysteresis deter 0.27 $44.28 $11.96 92225 Special eye exam initial 0.77 $44.28 $34.10 92226 Special eye exam subsequent 0.71 $44.28 $31.44 92227 Remote dx retinal imaging 0.42 $44.28 $18.60 92228 Remote retinal imaging mgmt 0.96 $44.28 $42.51 92228 TC Remote retinal imaging mgmt 0.38 $44.28 $16.83 92228 26 Remote retinal imaging mgmt 0.58 $44.28 $25.68 92230 Eye exam with photos 1.64 $44.28 $72.62 92235 Fluorescein angrph uni/bi 2.44 $44.28 $108.04 92235 TC Fluorescein angrph uni/bi 1.20 $44.28 $53.14 92235 26 Fluorescein angrph uni/bi 1.24 $44.28 $54.91 92240 Icg angiography uni/bi 5.95 $44.28 $263.47 92240 TC Icg angiography uni/bi 4.62 $44.28 $204.57 92240 26 Icg angiography uni/bi 1.33 $44.28 $58.89 92242 Fluorescein icg angiography 6.48 $44.28 $286.93 92242 TC Fluorescein icg angiography 4.92 $44.28 $217.86 NON-FACILITY HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL 92242 26 Fluorescein icg angiography 1.56 $44.28 $69.08 92250 Eye exam with photos 1.62 $44.28 $71.73 92250 TC Eye exam with photos 1.00 $44.28 $44.28 92250 26 Eye exam with photos 0.62 $44.28 $27.45 92260 Ophthalmoscopy/dynamometry 0.52 $44.28 $23.03 92265 Eye muscle evaluation 2.50 $44.28 $110.70 92265 TC Eye muscle evaluation 1.16 $44.28 $51.36 92265 26 Eye muscle evaluation 1.34 $44.28 $59.34 92270 Electro-oculography 2.64 $44.28 $116.90 92270 TC Electro-oculography 1.47 $44.28 $65.09 92270 26 Electro-oculography 1.17 $44.28 $51.81 92275 Electroretinography 4.25 $44.28 $188.19 92275 TC Electroretinography 2.70 $44.28 $119.56 92275 26 Electroretinography 1.55 $44.28 $68.63 92283 Color vision examination 1.56 $44.28 $69.08 92283 TC Color vision examination 1.30 $44.28 $57.56 92283 26 Color vision examination 0.26 $44.28 $11.51 92284 Dark adaptation eye exam 1.78 $44.28 $78.82 92284 TC Dark adaptation eye exam 1.42 $44.28 $62.88 92284 26 Dark adaptation eye exam 0.36 $44.28 $15.94 92285 Eye photography 0.59 $44.28 $26.13 92285 TC Eye photography 0.50 $44.28 $22.14 92285 26 Eye photography 0.09 $44.28 $3.99 92286 Internal eye photography 1.09 $44.28 $48.27 92286 TC Internal eye photography 0.46 $44.28 $20.37 92286 26 Internal eye photography 0.63 $44.28 $27.90 92287 Internal eye photography 3.93 $44.28 $174.02 92287 TC Internal eye photography 2.60 $44.28 $115.13 92287 26 Internal eye photography 1.33 $44.28 $58.89 92310 Contact lens fitting 2.76 $44.28 $122.21 92311 Contact lens fitting 2.89 $44.28 $127.97 92312 Contact lens fitting 3.35 $44.28 $148.34 92313 Contact lens fitting 2.74 $44.28 $121.33 92314 Prescription of contact lens 2.30 $44.28 $101.84 92315 Rx cntact lens aphakia 1 eye 2.13 $44.28 $94.32 92316 Rx cntact lens aphakia 2 eye 2.66 $44.28 $117.78 92317 Rx corneoscleral cntact lens 2.23 $44.28 $98.74 92325 Modification of contact lens 1.23 $44.28 $54.46 92326 Replacement of contact lens 1.04 $44.28 $46.05 92340 Fit spectacles monofocal 1.01 $44.28 $44.72 92341 Fit spectacles bifocal 1.16 $44.28 $51.36 92342 Fit spectacles multifocal 1.24 $44.28 $54.91 92352 Fit aphakia spectcl monofocl 1.15 $44.28 $50.92 92353 Fit aphakia spectcl multifoc 1.34 $44.28 $59.34 92354 Fit spectacles single system 0.39 $44.28 $17.27 NON-FACILITY HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL 92355 Fit spectacles compound lens 0.60 $44.28 $26.57 92358 Aphakia prosth service temp 0.33 $44.28 $14.61 92370 Repair & adjust spectacles 0.88 $44.28 $38.97 92371 Repair & adjust spectacles 0.33 $44.28 $14.61 92499 Eye service or procedure 0.00 $44.28 $0.00 92499 TC Eye service or procedure 0.00 $44.28 $0.00 92499 26 Eye service or procedure 0.00 $44.28 $0.00 92502 Ear and throat examination 2.74 $44.28 $121.33 92504 Ear microscopy examination 0.83 $44.28 $36.75 92507 Speech/hearing therapy 2.22 $44.28 $98.30 92508 Speech/hearing therapy 0.65 $44.28 $28.78 92511 Nasopharyngoscopy 3.09 $44.28 $136.83 92512 Nasal function studies 1.68 $44.28 $74.39 92516 Facial nerve function test 1.94 $44.28 $85.90 92520 Laryngeal function studies 2.18 $44.28 $96.53 92521 Evaluation of speech fluency 3.23 $44.28 $143.02 92522 Evaluate speech production 2.60 $44.28 $115.13 92523 Speech sound lang comprehen 5.60 $44.28 $247.97 92524 Behavral qualit analys voice 2.49 $44.28 $110.26 92526 Oral function therapy 2.43 $44.28 $107.60 92531 Spontaneous nystagmus study 0.00 $44.28 $0.00 92532 Positional nystagmus test 0.00 $44.28 $0.00 92533 Caloric vestibular test 0.00 $44.28 $0.00 92534 Optokinetic nystagmus test 0.00 $44.28 $0.00 92537 Caloric vstblr test w/rec 1.15 $44.28 $50.92 92537 TC Caloric vstblr test w/rec 0.25 $44.28 $11.07 92537 26 Caloric vstblr test w/rec 0.90 $44.28 $39.85 92538 Caloric vstblr test w/rec 0.59 $44.28 $26.13 92538 TC Caloric vstblr test w/rec 0.14 $44.28 $6.20 92538 26 Caloric vstblr test w/rec 0.45 $44.28 $19.93 92540 Basic vestibular evaluation 2.88 $44.28 $127.53 92540 TC Basic vestibular evaluation 0.62 $44.28 $27.45 92540 26 Basic vestibular evaluation 2.26 $44.28 $100.07 92541 Spontaneous nystagmus test 0.70 $44.28 $31.00 92541 TC Spontaneous nystagmus test 0.10 $44.28 $4.43 92541 26 Spontaneous nystagmus test 0.60 $44.28 $26.57 92542 Positional nystagmus test 0.80 $44.28 $35.42 92542 TC Positional nystagmus test 0.09 $44.28 $3.99 92542 26 Positional nystagmus test 0.71 $44.28 $31.44 92544 Optokinetic nystagmus test 0.48 $44.28 $21.25 92544 TC Optokinetic nystagmus test 0.07 $44.28 $3.10 92544 26 Optokinetic nystagmus test 0.41 $44.28 $18.15 92545 Oscillating tracking test 0.45 $44.28 $19.93 92545 TC Oscillating tracking test 0.07 $44.28 $3.10 92545 26 Oscillating tracking test 0.38 $44.28 $16.83 NON-FACILITY HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL 92546 Sinusoidal rotational test 2.96 $44.28 $131.07 92546 TC Sinusoidal rotational test 2.53 $44.28 $112.03 92546 26 Sinusoidal rotational test 0.43 $44.28 $19.04 92547 Supplemental electrical test 0.17 $44.28 $7.53 92548 Posturography 2.80 $44.28 $123.98 92548 TC Posturography 2.06 $44.28 $91.22 92548 26 Posturography 0.74 $44.28 $32.77 92550 Tympanometry & reflex thresh 0.61 $44.28 $27.01 92551 Pure tone hearing test air 0.35 $44.28 $15.50 92552 Pure tone audiometry air 0.90 $44.28 $39.85 92553 Audiometry air & bone 1.08 $44.28 $47.82 92555 Speech threshold audiometry 0.68 $44.28 $30.11 92556 Speech audiometry complete 1.08 $44.28 $47.82 92557 Comprehensive hearing test 1.07 $44.28 $47.38 92558 Evoked auditory test qual 0.28 $44.28 $12.40 92559 Group audiometric testing 0.00 $44.28 $0.00 92560 Bekesy audiometry screen 0.00 $44.28 $0.00 92561 Bekesy audiometry diagnosis 1.11 $44.28 $49.15 92562 Loudness balance test 1.32 $44.28 $58.45 92563 Tone decay hearing test 0.88 $44.28 $38.97 92564 Sisi hearing test 0.74 $44.28 $32.77 92565 Stenger test pure tone 0.44 $44.28 $19.48 92567 Tympanometry 0.41 $44.28 $18.15 92568 Acoustic refl threshold tst 0.45 $44.28 $19.93 92570 Acoustic immitance testing 0.91 $44.28 $40.29 92571 Filtered speech hearing test 0.78 $44.28 $34.54 92572 Staggered spondaic word test 1.50 $44.28 $66.42 92575 Sensorineural acuity test 1.34 $44.28 $59.34 92576 Synthetic sentence test 1.07 $44.28 $47.38 92577 Stenger test speech 0.41 $44.28 $18.15 92579 Visual audiometry (vra) 1.30 $44.28 $57.56 92582 Conditioning play audiometry 1.93 $44.28 $85.46 92583 Select picture audiometry 1.40 $44.28 $61.99 92584 Electrocochleography 2.10 $44.28 $92.99 92585 Auditor evoke potent compre 3.84 $44.28 $170.04 92585 TC Auditor evoke potent compre 3.08 $44.28 $136.38 92585 26 Auditor evoke potent compre 0.76 $44.28 $33.65 92586 Auditor evoke potent limit 2.53 $44.28 $112.03 92587 Evoked auditory test limited 0.61 $44.28 $27.01 92587 TC Evoked auditory test limited 0.09 $44.28 $3.99 92587 26 Evoked auditory test limited 0.52 $44.28 $23.03 92588 Evoked auditory tst complete 0.93 $44.28 $41.18 92588 TC Evoked auditory tst complete 0.11 $44.28 $4.87 92588 26 Evoked auditory tst complete 0.82 $44.28 $36.31 92590 Hearing aid exam one ear 0.00 $44.28 $0.00 NON-FACILITY HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL 92591 Hearing aid exam both ears 0.00 $44.28 $0.00 92592 Hearing aid check one ear 0.00 $44.28 $0.00 92593 Hearing aid check both ears 0.00 $44.28 $0.00 92594 Electro hearng aid test one 0.00 $44.28 $0.00 92595 Electro hearng aid tst both 0.00 $44.28 $0.00 92596 Ear protector evaluation 1.94 $44.28 $85.90 92597 Oral speech device eval 2.04 $44.28 $90.33 92601 Cochlear implt f/up exam <7 4.68 $44.28 $207.23 92602 Reprogram cochlear implt <7 2.90 $44.28 $128.41 92603 Cochlear implt f/up exam 7/> 4.34 $44.28 $192.18 92604 Reprogram cochlear implt 7/> 2.57 $44.28 $113.80 92605 Ex for nonspeech device rx 2.64 $44.28 $116.90 92606 Non-speech device service 2.35 $44.28 $104.06 92607 Ex for speech device rx 1hr 3.71 $44.28 $164.28 92608 Ex for speech device rx addl 1.49 $44.28 $65.98 92609 Use of speech device service 3.11 $44.28 $137.71 92610 Evaluate swallowing function 2.43 $44.28 $107.60 92611 Motion fluoroscopy/swallow 2.48 $44.28 $109.81 92612 Endoscopy swallow (fees) vid 5.41 $44.28 $239.55 92613 Endoscopy swallow (fees) i&r 1.08 $44.28 $47.82 92614 Laryngoscopic sensory vid 4.09 $44.28 $181.11 92615 Laryngoscopic sensory i&r 0.94 $44.28 $41.62 92616 Fees w/laryngeal sense test 5.86 $44.28 $259.48 92617 Fees w/laryngeal sense i&r 1.18 $44.28 $52.25 92618 Ex for nonspeech dev rx add 0.96 $44.28 $42.51 92620 Auditory function 60 min 2.68 $44.28 $118.67 92621 Auditory function + 15 min 0.64 $44.28 $28.34 92625 Tinnitus assessment 1.99 $44.28 $88.12 92626 Eval aud rehab status 2.55 $44.28 $112.91 92627 Eval aud status rehab add-on 0.64 $44.28 $28.34 92630 Aud rehab pre-ling hear loss 0.00 $44.28 $0.00 92633 Aud rehab postling hear loss 0.00 $44.28 $0.00 92640 Aud brainstem implt programg 3.26 $44.28 $144.35 92700 Ent procedure/service 0.00 $44.28 $0.00 92920 Prq cardiac angioplast 1 art 15.47 $44.28 $685.01 92921 Prq cardiac angio addl art 0.00 $44.28 $0.00 92924 Prq card angio/athrect 1 art 18.44 $44.28 $816.52 92925 Prq card angio/athrect addl 0.00 $44.28 $0.00 92928 Prq card stent w/angio 1 vsl 17.21 $44.28 $762.06 92929 Prq card stent w/angio addl 0.00 $44.28 $0.00 92933 Prq card stent/ath/angio 19.29 $44.28 $854.16 92934 Prq card stent/ath/angio 0.00 $44.28 $0.00 92937 Prq revasc byp graft 1 vsl 17.19 $44.28 $761.17 92938 Prq revasc byp graft addl 0.00 $44.28 $0.00 92941 Prq card revasc mi 1 vsl 19.33 $44.28 $855.93 NON-FACILITY HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL 92943 Prq card revasc chronic 1vsl 19.33 $44.28 $855.93 92944 Prq card revasc chronic addl 0.00 $44.28 $0.00 92950 Heart/lung resuscitation cpr 8.64 $44.28 $382.58 92953 Temporary external pacing 0.03 $44.28 $1.33 92960 Cardioversion electric ext 4.53 $44.28 $200.59 92961 Cardioversion electric int 7.26 $44.28 $321.47 92970 Cardioassist internal 5.74 $44.28 $254.17 92971 Cardioassist external 2.91 $44.28 $128.85 92973 Prq coronary mech thrombect 5.15 $44.28 $228.04 92974 Cath place cardio brachytx 4.72 $44.28 $209.00 92975 Dissolve clot heart vessel 10.96 $44.28 $485.31 92977 Dissolve clot heart vessel 1.64 $44.28 $72.62 92978 Endoluminl ivus oct c 1st 0.00 $44.28 $0.00 92978 TC Endoluminl ivus oct c 1st 0.00 $44.28 $0.00 92978 26 Endoluminl ivus oct c 1st 2.77 $44.28 $122.66 92979 Endoluminl ivus oct c ea 0.00 $44.28 $0.00 92979 TC Endoluminl ivus oct c ea 0.00 $44.28 $0.00 92979 26 Endoluminl ivus oct c ea 2.23 $44.28 $98.74 92986 Revision of aortic valve 38.33 $44.28 $1,697.25 92987 Revision of mitral valve 39.54 $44.28 $1,750.83 92990 Revision of pulmonary valve 31.59 $44.28 $1,398.81 92992 Revision of heart chamber 0.00 $44.28 $0.00 92993 Revision of heart chamber 0.00 $44.28 $0.00 92997 Pul art balloon repr percut 19.05 $44.28 $843.53 92998 Pul art balloon repr percut 9.45 $44.28 $418.45 93000 Electrocardiogram complete 0.48 $44.28 $21.25 93005 Electrocardiogram tracing 0.24 $44.28 $10.63 93010 Electrocardiogram report 0.24 $44.28 $10.63 93015 Cardiovascular stress test 2.02 $44.28 $89.45 93016 Cardiovascular stress test 0.63 $44.28 $27.90 93017 Cardiovascular stress test 0.97 $44.28 $42.95 93018 Cardiovascular stress test 0.42 $44.28 $18.60 93024 Cardiac drug stress test 3.16 $44.28 $139.92 93024 TC Cardiac drug stress test 1.54 $44.28 $68.19 93024 26 Cardiac drug stress test 1.62 $44.28 $71.73 93025 Microvolt t-wave assess 4.63 $44.28 $205.02 93025 TC Microvolt t-wave assess 3.58 $44.28 $158.52 93025 26 Microvolt t-wave assess 1.05 $44.28 $46.49 93040 Rhythm ecg with report 0.36 $44.28 $15.94 93041 Rhythm ecg tracing 0.16 $44.28 $7.08 93042 Rhythm ecg report 0.20 $44.28 $8.86 93050 Art pressure waveform analys 0.47 $44.28 $20.81 93050 TC Art pressure waveform analys 0.23 $44.28 $10.18 93050 26 Art pressure waveform analys 0.24 $44.28 $10.63 93224 Ecg monit/reprt up to 48 hrs 2.58 $44.28 $114.24 NON-FACILITY HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL 93225 Ecg monit/reprt up to 48 hrs 0.75 $44.28 $33.21 93226 Ecg monit/reprt up to 48 hrs 1.07 $44.28 $47.38 93227 Ecg monit/reprt up to 48 hrs 0.76 $44.28 $33.65 93228 Remote 30 day ecg rev/report 0.74 $44.28 $32.77 93229 Remote 30 day ecg tech supp 20.65 $44.28 $914.38 93260 Prgrmg dev eval impltbl sys 1.85 $44.28 $81.92 93260 TC Prgrmg dev eval impltbl sys 0.62 $44.28 $27.45 93260 26 Prgrmg dev eval impltbl sys 1.23 $44.28 $54.46 93261 Interrogate subq defib 1.68 $44.28 $74.39 93261 TC Interrogate subq defib 0.61 $44.28 $27.01 93261 26 Interrogate subq defib 1.07 $44.28 $47.38 93268 Ecg record/review 5.83 $44.28 $258.15 93270 Remote 30 day ecg rev/report 0.26 $44.28 $11.51 93271 Ecg/monitoring and analysis 4.85 $44.28 $214.76 93272 Ecg/review interpret only 0.72 $44.28 $31.88 93278 Ecg/signal-averaged 0.88 $44.28 $38.97 93278 TC Ecg/signal-averaged 0.52 $44.28 $23.03 93278 26 Ecg/signal-averaged 0.36 $44.28 $15.94 93279 Pm device progr eval sngl 1.40 $44.28 $61.99 93279 TC Pm device progr eval sngl 0.48 $44.28 $21.25 93279 26 Pm device progr eval sngl 0.92 $44.28 $40.74 93280 Pm device progr eval dual 1.65 $44.28 $73.06 93280 TC Pm device progr eval dual 0.56 $44.28 $24.80 93280 26 Pm device progr eval dual 1.09 $44.28 $48.27 93281 Pm device progr eval multi 1.79 $44.28 $79.26 93281 TC Pm device progr eval multi 0.57 $44.28 $25.24 93281 26 Pm device progr eval multi 1.22 $44.28 $54.02 93282 Prgrmg eval implantable dfb 1.73 $44.28 $76.60 93282 TC Prgrmg eval implantable dfb 0.52 $44.28 $23.03 93282 26 Prgrmg eval implantable dfb 1.21 $44.28 $53.58 93283 Prgrmg eval implantable dfb 2.21 $44.28 $97.86 93283 TC Prgrmg eval implantable dfb 0.57 $44.28 $25.24 93283 26 Prgrmg eval implantable dfb 1.64 $44.28 $72.62 93284 Prgrmg eval implantable dfb 2.41 $44.28 $106.71 93284 TC Prgrmg eval implantable dfb 0.62 $44.28 $27.45 93284 26 Prgrmg eval implantable dfb 1.79 $44.28 $79.26 93285 Ilr device eval progr 1.21 $44.28 $53.58 93285 TC Ilr device eval progr 0.46 $44.28 $20.37 93285 26 Ilr device eval progr 0.75 $44.28 $33.21 93286 Peri-px pacemaker device evl 0.85 $44.28 $37.64 93286 TC Peri-px pacemaker device evl 0.42 $44.28 $18.60 93286 26 Peri-px pacemaker device evl 0.43 $44.28 $19.04 93287 Peri-px device eval & prgr 1.08 $44.28 $47.82 93287 TC Peri-px device eval & prgr 0.42 $44.28 $18.60 93287 26 Peri-px device eval & prgr 0.66 $44.28 $29.22 NON-FACILITY HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL 93288 Pm device eval in person 1.09 $44.28 $48.27 93288 TC Pm device eval in person 0.48 $44.28 $21.25 93288 26 Pm device eval in person 0.61 $44.28 $27.01 93289 Interrog device eval heart 1.54 $44.28 $68.19 93289 TC Interrog device eval heart 0.48 $44.28 $21.25 93289 26 Interrog device eval heart 1.06 $44.28 $46.94 93290 Icm device eval 1.04 $44.28 $46.05 93290 TC Icm device eval 0.42 $44.28 $18.60 93290 26 Icm device eval 0.62 $44.28 $27.45 93291 Ilr device interrogate 0.93 $44.28 $41.18 93291 TC Ilr device interrogate 0.41 $44.28 $18.15 93291 26 Ilr device interrogate 0.52 $44.28 $23.03 93292 Wcd device interrogate 1.04 $44.28 $46.05 93292 TC Wcd device interrogate 0.43 $44.28 $19.04 93292 26 Wcd device interrogate 0.61 $44.28 $27.01 93293 Pm phone r-strip device eval 1.51 $44.28 $66.86 93293 TC Pm phone r-strip device eval 1.08 $44.28 $47.82 93293 26 Pm phone r-strip device eval 0.43 $44.28 $19.04 93294 Pm device interrogate remote 0.87 $44.28 $38.52 93295 Dev interrog remote 1/2/mlt 1.56 $44.28 $69.08 93296 Pm/icd remote tech serv 0.75 $44.28 $33.21 93297 Icm device interrogat remote 0.75 $44.28 $33.21 93298 Ilr device interrogat remote 0.76 $44.28 $33.65 93299 Icm/ilr remote tech serv 0.00 $44.28 $0.00 93303 Echo transthoracic 6.85 $44.28 $303.32 93303 TC Echo transthoracic 5.04 $44.28 $223.17 93303 26 Echo transthoracic 1.81 $44.28 $80.15 93304 Echo transthoracic 4.56 $44.28 $201.92 93304 TC Echo transthoracic 3.52 $44.28 $155.87 93304 26 Echo transthoracic 1.04 $44.28 $46.05 93306 Tte w/doppler complete 5.94 $44.28 $263.02 93306 TC Tte w/doppler complete 3.86 $44.28 $170.92 93306 26 Tte w/doppler complete 2.08 $44.28 $92.10 93307 Tte w/o doppler complete 4.04 $44.28 $178.89 93307 TC Tte w/o doppler complete 2.76 $44.28 $122.21 93307 26 Tte w/o doppler complete 1.28 $44.28 $56.68 93308 Tte f-up or lmtd 3.00 $44.28 $132.84 93308 TC Tte f-up or lmtd 2.27 $44.28 $100.52 93308 26 Tte f-up or lmtd 0.73 $44.28 $32.32 93312 Echo transesophageal 7.03 $44.28 $311.29 93312 TC Echo transesophageal 3.92 $44.28 $173.58 93312 26 Echo transesophageal 3.11 $44.28 $137.71 93313 Echo transesophageal 0.33 $44.28 $14.61 93314 Echo transesophageal 6.79 $44.28 $300.66 93314 TC Echo transesophageal 4.18 $44.28 $185.09 NON-FACILITY HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL 93314 26 Echo transesophageal 2.61 $44.28 $115.57 93315 Echo transesophageal 0.00 $44.28 $0.00 93315 TC Echo transesophageal 0.00 $44.28 $0.00 93315 26 Echo transesophageal 3.67 $44.28 $162.51 93316 Echo transesophageal 0.78 $44.28 $34.54 93317 Echo transesophageal 0.00 $44.28 $0.00 93317 TC Echo transesophageal 0.00 $44.28 $0.00 93317 26 Echo transesophageal 2.65 $44.28 $117.34 93318 Echo transesophageal intraop 0.00 $44.28 $0.00 93318 TC Echo transesophageal intraop 0.00 $44.28 $0.00 93318 26 Echo transesophageal intraop 2.99 $44.28 $132.40 93320 Doppler echo exam heart 1.54 $44.28 $68.19 93320 TC Doppler echo exam heart 1.02 $44.28 $45.17 93320 26 Doppler echo exam heart 0.52 $44.28 $23.03 93321 Doppler echo exam heart 0.78 $44.28 $34.54 93321 TC Doppler echo exam heart 0.57 $44.28 $25.24 93321 26 Doppler echo exam heart 0.21 $44.28 $9.30 93325 Doppler color flow add-on 0.73 $44.28 $32.32 93325 TC Doppler color flow add-on 0.64 $44.28 $28.34 93325 26 Doppler color flow add-on 0.09 $44.28 $3.99 93350 Stress tte only 5.89 $44.28 $260.81 93350 TC Stress tte only 3.87 $44.28 $171.36 93350 26 Stress tte only 2.02 $44.28 $89.45 93351 Stress tte complete 6.64 $44.28 $294.02 93351 TC Stress tte complete 4.22 $44.28 $186.86 93351 26 Stress tte complete 2.42 $44.28 $107.16 93352 Admin ecg contrast agent 0.96 $44.28 $42.51 93355 Echo transesophageal (tee) 6.49 $44.28 $287.38 93451 Right heart cath 20.69 $44.28 $916.15 93451 TC Right heart cath 16.90 $44.28 $748.33 93451 26 Right heart cath 3.79 $44.28 $167.82 93452 Left hrt cath w/ventrclgrphy 23.53 $44.28 $1,041.91 93452 TC Left hrt cath w/ventrclgrphy 16.61 $44.28 $735.49 93452 26 Left hrt cath w/ventrclgrphy 6.92 $44.28 $306.42 93453 R&l hrt cath w/ventriclgrphy 30.58 $44.28 $1,354.08 93453 TC R&l hrt cath w/ventriclgrphy 21.32 $44.28 $944.05 93453 26 R&l hrt cath w/ventriclgrphy 9.26 $44.28 $410.03 93454 Coronary artery angio s&i 23.87 $44.28 $1,056.96 93454 TC Coronary artery angio s&i 16.88 $44.28 $747.45 93454 26 Coronary artery angio s&i 6.99 $44.28 $309.52 93455 Coronary art/grft angio s&i 27.94 $44.28 $1,237.18 93455 TC Coronary art/grft angio s&i 19.78 $44.28 $875.86 93455 26 Coronary art/grft angio s&i 8.16 $44.28 $361.32 93456 R hrt coronary artery angio 30.22 $44.28 $1,338.14 93456 TC R hrt coronary artery angio 21.12 $44.28 $935.19 NON-FACILITY HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL 93456 26 R hrt coronary artery angio 9.10 $44.28 $402.95 93457 R hrt art/grft angio 34.22 $44.28 $1,515.26 93457 TC R hrt art/grft angio 23.98 $44.28 $1,061.83 93457 26 R hrt art/grft angio 10.24 $44.28 $453.43 93458 L hrt artery/ventricle angio 28.78 $44.28 $1,274.38 93458 TC L hrt artery/ventricle angio 20.14 $44.28 $891.80 93458 26 L hrt artery/ventricle angio 8.64 $44.28 $382.58 93459 L hrt art/grft angio 31.90 $44.28 $1,412.53 93459 TC L hrt art/grft angio 22.10 $44.28 $978.59 93459 26 L hrt art/grft angio 9.80 $44.28 $433.94 93460 R&l hrt art/ventricle angio 34.37 $44.28 $1,521.90 93460 TC R&l hrt art/ventricle angio 23.40 $44.28 $1,036.15 93460 26 R&l hrt art/ventricle angio 10.97 $44.28 $485.75 93461 R&l hrt art/ventricle angio 39.34 $44.28 $1,741.98 93461 TC R&l hrt art/ventricle angio 27.23 $44.28 $1,205.74 93461 26 R&l hrt art/ventricle angio 12.11 $44.28 $536.23 93462 L hrt cath trnsptl puncture 6.11 $44.28 $270.55 93463 Drug admin & hemodynmic meas 2.81 $44.28 $124.43 93464 Exercise w/hemodynamic meas 7.26 $44.28 $321.47 93464 TC Exercise w/hemodynamic meas 4.77 $44.28 $211.22 93464 26 Exercise w/hemodynamic meas 2.49 $44.28 $110.26 93503 Insert/place heart catheter 2.99 $44.28 $132.40 93505 Biopsy of heart lining 19.98 $44.28 $884.71 93505 TC Biopsy of heart lining 13.64 $44.28 $603.98 93505 26 Biopsy of heart lining 6.34 $44.28 $280.74 93530 Rt heart cath congenital 0.00 $44.28 $0.00 93530 TC Rt heart cath congenital 0.00 $44.28 $0.00 93530 26 Rt heart cath congenital 5.95 $44.28 $263.47 93531 R & l heart cath congenital 0.00 $44.28 $0.00 93531 TC R & l heart cath congenital 0.00 $44.28 $0.00 93531 26 R & l heart cath congenital 12.38 $44.28 $548.19 93532 R & l heart cath congenital 0.00 $44.28 $0.00 93532 TC R & l heart cath congenital 0.00 $44.28 $0.00 93532 26 R & l heart cath congenital 14.91 $44.28 $660.21 93533 R & l heart cath congenital 0.00 $44.28 $0.00 93533 TC R & l heart cath congenital 0.00 $44.28 $0.00 93533 26 R & l heart cath congenital 10.04 $44.28 $444.57 93561 Cardiac output measurement 0.00 $44.28 $0.00 93561 TC Cardiac output measurement 0.00 $44.28 $0.00 93561 26 Cardiac output measurement 0.35 $44.28 $15.50 93562 Card output measure subsq 0.00 $44.28 $0.00 93562 TC Card output measure subsq 0.00 $44.28 $0.00 93562 26 Card output measure subsq 0.03 $44.28 $1.33 93563 Inject congenital card cath 1.69 $44.28 $74.83 93564 Inject hrt congntl art/grft 1.78 $44.28 $78.82 NON-FACILITY HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL 93565 Inject l ventr/atrial angio 1.31 $44.28 $58.01 93566 Inject r ventr/atrial angio 4.62 $44.28 $204.57 93567 Inject suprvlv aortography 3.89 $44.28 $172.25 93568 Inject pulm art hrt cath 4.13 $44.28 $182.88 93571 Heart flow reserve measure 0.00 $44.28 $0.00 93571 TC Heart flow reserve measure 0.00 $44.28 $0.00 93571 26 Heart flow reserve measure 2.77 $44.28 $122.66 93572 Heart flow reserve measure 0.00 $44.28 $0.00 93572 TC Heart flow reserve measure 0.00 $44.28 $0.00 93572 26 Heart flow reserve measure 2.23 $44.28 $98.74 93580 Transcath closure of asd 28.42 $44.28 $1,258.44 93581 Transcath closure of vsd 38.72 $44.28 $1,714.52 93582 Perq transcath closure pda 19.36 $44.28 $857.26 93583 Perq transcath septal reduxn 21.61 $44.28 $956.89 93590 Perq transcath cls mitral 31.07 $44.28 $1,375.78 93591 Perq transcath cls aortic 25.80 $44.28 $1,142.42 93592 Perq transcath closure each 11.35 $44.28 $502.58 93600 Bundle of his recording 0.00 $44.28 $0.00 93600 TC Bundle of his recording 0.00 $44.28 $0.00 93600 26 Bundle of his recording 3.46 $44.28 $153.21 93602 Intra-atrial recording 0.00 $44.28 $0.00 93602 TC Intra-atrial recording 0.00 $44.28 $0.00 93602 26 Intra-atrial recording 3.36 $44.28 $148.78 93603 Right ventricular recording 0.00 $44.28 $0.00 93603 TC Right ventricular recording 0.00 $44.28 $0.00 93603 26 Right ventricular recording 3.36 $44.28 $148.78 93609 Map tachycardia add-on 0.00 $44.28 $0.00 93609 TC Map tachycardia add-on 0.00 $44.28 $0.00 93609 26 Map tachycardia add-on 8.09 $44.28 $358.23 93610 Intra-atrial pacing 0.00 $44.28 $0.00 93610 TC Intra-atrial pacing 0.00 $44.28 $0.00 93610 26 Intra-atrial pacing 4.76 $44.28 $210.77 93612 Intraventricular pacing 0.00 $44.28 $0.00 93612 TC Intraventricular pacing 0.00 $44.28 $0.00 93612 26 Intraventricular pacing 4.72 $44.28 $209.00 93613 Electrophys map 3d add-on 9.38 $44.28 $415.35 93615 Esophageal recording 0.00 $44.28 $0.00 93615 TC Esophageal recording 0.00 $44.28 $0.00 93615 26 Esophageal recording 1.10 $44.28 $48.71 93616 Esophageal recording 0.00 $44.28 $0.00 93616 TC Esophageal recording 0.00 $44.28 $0.00 93616 26 Esophageal recording 1.77 $44.28 $78.38 93618 Heart rhythm pacing 0.00 $44.28 $0.00 93618 TC Heart rhythm pacing 0.00 $44.28 $0.00 93618 26 Heart rhythm pacing 6.44 $44.28 $285.16 NON-FACILITY HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL 93619 Electrophysiology evaluation 0.00 $44.28 $0.00 93619 TC Electrophysiology evaluation 0.00 $44.28 $0.00 93619 26 Electrophysiology evaluation 11.37 $44.28 $503.46 93620 Electrophysiology evaluation 0.00 $44.28 $0.00 93620 TC Electrophysiology evaluation 0.00 $44.28 $0.00 93620 26 Electrophysiology evaluation 18.26 $44.28 $808.55 93621 Electrophysiology evaluation 0.00 $44.28 $0.00 93621 TC Electrophysiology evaluation 0.00 $44.28 $0.00 93621 26 Electrophysiology evaluation 3.41 $44.28 $150.99 93622 Electrophysiology evaluation 0.00 $44.28 $0.00 93622 TC Electrophysiology evaluation 0.00 $44.28 $0.00 93622 26 Electrophysiology evaluation 5.01 $44.28 $221.84 93623 Stimulation pacing heart 0.00 $44.28 $0.00 93623 TC Stimulation pacing heart 0.00 $44.28 $0.00 93623 26 Stimulation pacing heart 4.62 $44.28 $204.57 93624 Electrophysiologic study 0.00 $44.28 $0.00 93624 TC Electrophysiologic study 0.00 $44.28 $0.00 93624 26 Electrophysiologic study 7.25 $44.28 $321.03 93631 Heart pacing mapping 0.00 $44.28 $0.00 93631 TC Heart pacing mapping 0.00 $44.28 $0.00 93631 26 Heart pacing mapping 11.51 $44.28 $509.66 93640 Evaluation heart device 0.00 $44.28 $0.00 93640 TC Evaluation heart device 0.00 $44.28 $0.00 93640 26 Evaluation heart device 5.20 $44.28 $230.26 93641 Electrophysiology evaluation 0.00 $44.28 $0.00 93641 TC Electrophysiology evaluation 0.00 $44.28 $0.00 93641 26 Electrophysiology evaluation 9.09 $44.28 $402.51 93642 Electrophysiology evaluation 9.82 $44.28 $434.83 93642 TC Electrophysiology evaluation 2.36 $44.28 $104.50 93642 26 Electrophysiology evaluation 7.46 $44.28 $330.33 93644 Electrophysiology evaluation 5.81 $44.28 $257.27 93644 TC Electrophysiology evaluation 1.54 $44.28 $68.19 93644 26 Electrophysiology evaluation 4.27 $44.28 $189.08 93650 Ablate heart dysrhythm focus 17.20 $44.28 $761.62 93653 Ep & ablate supravent arrhyt 24.33 $44.28 $1,077.33 93654 Ep & ablate ventric tachy 32.59 $44.28 $1,443.09 93655 Ablate arrhythmia add on 12.40 $44.28 $549.07 93656 Tx atrial fib pulm vein isol 32.68 $44.28 $1,447.07 93657 Tx l/r atrial fib addl 12.39 $44.28 $548.63 93660 Tilt table evaluation 4.54 $44.28 $201.03 93660 TC Tilt table evaluation 1.87 $44.28 $82.80 93660 26 Tilt table evaluation 2.67 $44.28 $118.23 93662 Intracardiac ecg (ice) 0.00 $44.28 $0.00 93662 TC Intracardiac ecg (ice) 0.00 $44.28 $0.00 93662 26 Intracardiac ecg (ice) 4.08 $44.28 $180.66 NON-FACILITY HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL 93668 Peripheral vascular rehab 0.55 $44.28 $24.35 93701 Bioimpedance cv analysis 0.69 $44.28 $30.55 93702 Bis xtracell fluid analysis 3.50 $44.28 $154.98 93724 Analyze pacemaker system 7.73 $44.28 $342.28 93724 TC Analyze pacemaker system 0.82 $44.28 $36.31 93724 26 Analyze pacemaker system 6.91 $44.28 $305.97 93740 Temperature gradient studies 0.23 $44.28 $10.18 93745 Set-up cardiovert-defibrill 0.00 $44.28 $0.00 93745 TC Set-up cardiovert-defibrill 0.00 $44.28 $0.00 93745 26 Set-up cardiovert-defibrill 0.00 $44.28 $0.00 93750 Interrogation vad in person 1.58 $44.28 $69.96 93770 Measure venous pressure 0.23 $44.28 $10.18 93784 Ambulatory bp monitoring 1.52 $44.28 $67.31 93786 Ambulatory bp recording 0.84 $44.28 $37.20 93788 Ambulatory bp analysis 0.15 $44.28 $6.64 93790 Review/report bp recording 0.53 $44.28 $23.47 93792 Pt/caregiver trainj home inr 1.53 $44.28 $67.75 93793 Anticoag mgmt pt warfarin 0.34 $44.28 $15.06 93797 Cardiac rehab 0.46 $44.28 $20.37 93798 Cardiac rehab/monitor 0.71 $44.28 $31.44 93799 Cardiovascular procedure 0.00 $44.28 $0.00 93799 TC Cardiovascular procedure 0.00 $44.28 $0.00 93799 26 Cardiovascular procedure 0.00 $44.28 $0.00 93880 Extracranial bilat study 5.81 $44.28 $257.27 93880 TC Extracranial bilat study 4.67 $44.28 $206.79 93880 26 Extracranial bilat study 1.14 $44.28 $50.48 93882 Extracranial uni/ltd study 3.72 $44.28 $164.72 93882 TC Extracranial uni/ltd study 3.00 $44.28 $132.84 93882 26 Extracranial uni/ltd study 0.72 $44.28 $31.88 93886 Intracranial complete study 7.78 $44.28 $344.50 93886 TC Intracranial complete study 6.44 $44.28 $285.16 93886 26 Intracranial complete study 1.34 $44.28 $59.34 93888 Intracranial limited study 4.42 $44.28 $195.72 93888 TC Intracranial limited study 3.68 $44.28 $162.95 93888 26 Intracranial limited study 0.74 $44.28 $32.77 93890 Tcd vasoreactivity study 7.96 $44.28 $352.47 93890 TC Tcd vasoreactivity study 6.50 $44.28 $287.82 93890 26 Tcd vasoreactivity study 1.46 $44.28 $64.65 93892 Tcd emboli detect w/o inj 9.13 $44.28 $404.28 93892 TC Tcd emboli detect w/o inj 7.42 $44.28 $328.56 93892 26 Tcd emboli detect w/o inj 1.71 $44.28 $75.72 93893 Tcd emboli detect w/inj 9.90 $44.28 $438.37 93893 TC Tcd emboli detect w/inj 8.20 $44.28 $363.10 93893 26 Tcd emboli detect w/inj 1.70 $44.28 $75.28 93895 Carotid intima atheroma eval 0.00 $44.28 $0.00 NON-FACILITY HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL 93895 TC Carotid intima atheroma eval 0.00 $44.28 $0.00 93895 26 Carotid intima atheroma eval 0.00 $44.28 $0.00 93922 Upr/l xtremity art 2 levels 2.51 $44.28 $111.14 93922 TC Upr/l xtremity art 2 levels 2.15 $44.28 $95.20 93922 26 Upr/l xtremity art 2 levels 0.36 $44.28 $15.94 93923 Upr/lxtr art stdy 3+ lvls 3.89 $44.28 $172.25 93923 TC Upr/lxtr art stdy 3+ lvls 3.26 $44.28 $144.35 93923 26 Upr/lxtr art stdy 3+ lvls 0.63 $44.28 $27.90 93924 Lwr xtr vasc stdy bilat 4.84 $44.28 $214.32 93924 TC Lwr xtr vasc stdy bilat 4.14 $44.28 $183.32 93924 26 Lwr xtr vasc stdy bilat 0.70 $44.28 $31.00 93925 Lower extremity study 7.45 $44.28 $329.89 93925 TC Lower extremity study 6.32 $44.28 $279.85 93925 26 Lower extremity study 1.13 $44.28 $50.04 93926 Lower extremity study 4.36 $44.28 $193.06 93926 TC Lower extremity study 3.67 $44.28 $162.51 93926 26 Lower extremity study 0.69 $44.28 $30.55 93930 Upper extremity study 5.97 $44.28 $264.35 93930 TC Upper extremity study 4.83 $44.28 $213.87 93930 26 Upper extremity study 1.14 $44.28 $50.48 93931 Upper extremity study 3.71 $44.28 $164.28 93931 TC Upper extremity study 3.01 $44.28 $133.28 93931 26 Upper extremity study 0.70 $44.28 $31.00 93970 Extremity study 5.61 $44.28 $248.41 93970 TC Extremity study 4.63 $44.28 $205.02 93970 26 Extremity study 0.98 $44.28 $43.39 93971 Extremity study 3.44 $44.28 $152.32 93971 TC Extremity study 2.80 $44.28 $123.98 93971 26 Extremity study 0.64 $44.28 $28.34 93975 Vascular study 8.08 $44.28 $357.78 93975 TC Vascular study 6.43 $44.28 $284.72 93975 26 Vascular study 1.65 $44.28 $73.06 93976 Vascular study 4.70 $44.28 $208.12 93976 TC Vascular study 3.57 $44.28 $158.08 93976 26 Vascular study 1.13 $44.28 $50.04 93978 Vascular study 5.48 $44.28 $242.65 93978 TC Vascular study 4.35 $44.28 $192.62 93978 26 Vascular study 1.13 $44.28 $50.04 93979 Vascular study 3.46 $44.28 $153.21 93979 TC Vascular study 2.75 $44.28 $121.77 93979 26 Vascular study 0.71 $44.28 $31.44 93980 Penile vascular study 3.59 $44.28 $158.97 93980 TC Penile vascular study 1.83 $44.28 $81.03 93980 26 Penile vascular study 1.76 $44.28 $77.93 93981 Penile vascular study 2.19 $44.28 $96.97 NON-FACILITY HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL 93981 TC Penile vascular study 1.57 $44.28 $69.52 93981 26 Penile vascular study 0.62 $44.28 $27.45 93990 Doppler flow testing 4.55 $44.28 $201.47 93990 TC Doppler flow testing 3.85 $44.28 $170.48 93990 26 Doppler flow testing 0.70 $44.28 $31.00 93998 Noninvas vasc dx study proc 0.00 $44.28 $0.00 94002 Vent mgmt inpat init day 2.63 $44.28 $116.46 94003 Vent mgmt inpat subq day 1.90 $44.28 $84.13 94004 Vent mgmt nf per day 1.40 $44.28 $61.99 94005 Home vent mgmt supervision 2.63 $44.28 $116.46 94010 Breathing capacity test 1.02 $44.28 $45.17 94010 TC Breathing capacity test 0.78 $44.28 $34.54 94010 26 Breathing capacity test 0.24 $44.28 $10.63 94011 Spirometry up to 2 yrs old 2.47 $44.28 $109.37 94012 Spirmtry w/brnchdil inf-2 yr 4.02 $44.28 $178.01 94013 Meas lung vol thru 2 yrs 0.55 $44.28 $24.35 94014 Patient recorded spirometry 1.60 $44.28 $70.85 94015 Patient recorded spirometry 0.88 $44.28 $38.97 94016 Review patient spirometry 0.72 $44.28 $31.88 94060 Evaluation of wheezing 1.72 $44.28 $76.16 94060 TC Evaluation of wheezing 1.35 $44.28 $59.78 94060 26 Evaluation of wheezing 0.37 $44.28 $16.38 94070 Evaluation of wheezing 1.72 $44.28 $76.16 94070 TC Evaluation of wheezing 0.90 $44.28 $39.85 94070 26 Evaluation of wheezing 0.82 $44.28 $36.31 94150 Vital capacity test 0.73 $44.28 $32.32 94150 TC Vital capacity test 0.62 $44.28 $27.45 94150 26 Vital capacity test 0.11 $44.28 $4.87 94200 Lung function test (mbc/mvv) 0.78 $44.28 $34.54 94200 TC Lung function test (mbc/mvv) 0.62 $44.28 $27.45 94200 26 Lung function test (mbc/mvv) 0.16 $44.28 $7.08 94250 Expired gas collection 0.80 $44.28 $35.42 94250 TC Expired gas collection 0.64 $44.28 $28.34 94250 26 Expired gas collection 0.16 $44.28 $7.08 94375 Respiratory flow volume loop 1.13 $44.28 $50.04 94375 TC Respiratory flow volume loop 0.71 $44.28 $31.44 94375 26 Respiratory flow volume loop 0.42 $44.28 $18.60 94400 Co2 breathing response curve 1.64 $44.28 $72.62 94400 TC Co2 breathing response curve 1.08 $44.28 $47.82 94400 26 Co2 breathing response curve 0.56 $44.28 $24.80 94450 Hypoxia response curve 2.03 $44.28 $89.89 94450 TC Hypoxia response curve 1.46 $44.28 $64.65 94450 26 Hypoxia response curve 0.57 $44.28 $25.24 94452 Hast w/report 1.64 $44.28 $72.62 94452 TC Hast w/report 1.23 $44.28 $54.46 NON-FACILITY HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL 94452 26 Hast w/report 0.41 $44.28 $18.15 94453 Hast w/oxygen titrate 2.27 $44.28 $100.52 94453 TC Hast w/oxygen titrate 1.73 $44.28 $76.60 94453 26 Hast w/oxygen titrate 0.54 $44.28 $23.91 94610 Surfactant admin thru tube 1.59 $44.28 $70.41 94617 Exercise tst brncspsm 2.70 $44.28 $119.56 94617 TC Exercise tst brncspsm 1.75 $44.28 $77.49 94617 26 Exercise tst brncspsm 0.95 $44.28 $42.07 94618 Pulmonary stress testing 0.97 $44.28 $42.95 94618 TC Pulmonary stress testing 0.32 $44.28 $14.17 94618 26 Pulmonary stress testing 0.65 $44.28 $28.78 94621 Cardiopulm exercise testing 4.68 $44.28 $207.23 94621 TC Cardiopulm exercise testing 2.72 $44.28 $120.44 94621 26 Cardiopulm exercise testing 1.96 $44.28 $86.79 94640 Airway inhalation treatment 0.53 $44.28 $23.47 94642 Aerosol inhalation treatment 0.00 $44.28 $0.00 94644 Cbt 1st hour 1.28 $44.28 $56.68 94645 Cbt each addl hour 0.46 $44.28 $20.37 94660 Pos airway pressure cpap 1.84 $44.28 $81.48 94662 Neg press ventilation cnp 1.03 $44.28 $45.61 94664 Evaluate pt use of inhaler 0.49 $44.28 $21.70 94667 Chest wall manipulation 0.76 $44.28 $33.65 94668 Chest wall manipulation 0.91 $44.28 $40.29 94669 Mechanical chest wall oscill 0.93 $44.28 $41.18 94680 Exhaled air analysis o2 1.66 $44.28 $73.50 94680 TC Exhaled air analysis o2 1.30 $44.28 $57.56 94680 26 Exhaled air analysis o2 0.36 $44.28 $15.94 94681 Exhaled air analysis o2/co2 1.62 $44.28 $71.73 94681 TC Exhaled air analysis o2/co2 1.33 $44.28 $58.89 94681 26 Exhaled air analysis o2/co2 0.29 $44.28 $12.84 94690 Exhaled air analysis 1.58 $44.28 $69.96 94690 TC Exhaled air analysis 1.47 $44.28 $65.09 94690 26 Exhaled air analysis 0.11 $44.28 $4.87 94726 Pulm funct tst plethysmograp 1.56 $44.28 $69.08 94726 TC Pulm funct tst plethysmograp 1.21 $44.28 $53.58 94726 26 Pulm funct tst plethysmograp 0.35 $44.28 $15.50 94727 Pulm function test by gas 1.25 $44.28 $55.35 94727 TC Pulm function test by gas 0.90 $44.28 $39.85 94727 26 Pulm function test by gas 0.35 $44.28 $15.50 94728 Pulm funct test oscillometry 1.17 $44.28 $51.81 94728 TC Pulm funct test oscillometry 0.81 $44.28 $35.87 94728 26 Pulm funct test oscillometry 0.36 $44.28 $15.94 94729 Co/membane diffuse capacity 1.55 $44.28 $68.63 94729 TC Co/membane diffuse capacity 1.29 $44.28 $57.12 94729 26 Co/membane diffuse capacity 0.26 $44.28 $11.51 NON-FACILITY HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL 94750 Pulmonary compliance study 2.34 $44.28 $103.62 94750 TC Pulmonary compliance study 2.03 $44.28 $89.89 94750 26 Pulmonary compliance study 0.31 $44.28 $13.73 94760 Measure blood oxygen level 0.08 $44.28 $3.54 94761 Measure blood oxygen level 0.13 $44.28 $5.76 94762 Measure blood oxygen level 0.70 $44.28 $31.00 94770 Exhaled carbon dioxide test 0.21 $44.28 $9.30 94772 Breath recording infant 0.00 $44.28 $0.00 94772 TC Breath recording infant 0.00 $44.28 $0.00 94772 26 Breath recording infant 0.00 $44.28 $0.00 94774 Ped home apnea rec compl 0.00 $44.28 $0.00 94775 Ped home apnea rec hk-up 0.00 $44.28 $0.00 94776 Ped home apnea rec downld 0.00 $44.28 $0.00 94777 Ped home apnea rec report 0.00 $44.28 $0.00 94780 Car seat/bed test 60 min 1.48 $44.28 $65.53 94781 Car seat/bed test + 30 min 0.59 $44.28 $26.13 94799 Pulmonary service/procedure 0.00 $44.28 $0.00 94799 TC Pulmonary service/procedure 0.00 $44.28 $0.00 94799 26 Pulmonary service/procedure 0.00 $44.28 $0.00 95004 Percut allergy skin tests 0.15 $44.28 $6.64 95012 Exhaled nitric oxide meas 0.57 $44.28 $25.24 95017 Perq & icut allg test venoms 0.22 $44.28 $9.74 95018 Perq&ic allg test drugs/biol 0.60 $44.28 $26.57 95024 Icut allergy test drug/bug 0.23 $44.28 $10.18 95027 Icut allergy titrate-airborn 0.13 $44.28 $5.76 95028 Icut allergy test-delayed 0.37 $44.28 $16.38 95044 Allergy patch tests 0.16 $44.28 $7.08 95052 Photo patch test 0.19 $44.28 $8.41 95056 Photosensitivity tests 1.30 $44.28 $57.56 95060 Eye allergy tests 1.00 $44.28 $44.28 95065 Nose allergy test 0.71 $44.28 $31.44 95070 Bronchial allergy tests 0.88 $44.28 $38.97 95071 Bronchial allergy tests 1.00 $44.28 $44.28 95076 Ingest challenge ini 120 min 3.39 $44.28 $150.11 95079 Ingest challenge addl 60 min 2.38 $44.28 $105.39 95115 Immunotherapy one injection 0.25 $44.28 $11.07 95117 Immunotherapy injections 0.29 $44.28 $12.84 95120 Immunotherapy one injection 0.00 $44.28 $0.00 95125 Immunotherapy 2/> injections 0.00 $44.28 $0.00 95130 Immntx 1 sting insect 0.00 $44.28 $0.00 95131 Immntx 2 sting insects 0.00 $44.28 $0.00 95132 Immntx 3 sting insects 0.00 $44.28 $0.00 95133 Immntx 4 sting insects 0.00 $44.28 $0.00 95134 Immntx 5 sting insects 0.00 $44.28 $0.00 95144 Antigen therapy services 0.38 $44.28 $16.83 NON-FACILITY HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL 95145 Antigen therapy services 0.73 $44.28 $32.32 95146 Antigen therapy services 1.34 $44.28 $59.34 95147 Antigen therapy services 1.43 $44.28 $63.32 95148 Antigen therapy services 2.04 $44.28 $90.33 95149 Antigen therapy services 2.68 $44.28 $118.67 95165 Antigen therapy services 0.37 $44.28 $16.38 95170 Antigen therapy services 0.28 $44.28 $12.40 95180 Rapid desensitization 3.86 $44.28 $170.92 95199 Allergy immunology services 0.00 $44.28 $0.00 95249 Cont gluc mntr pt prov eqp 1.56 $44.28 $69.08 95250 Cont gluc mntr phys/qhp eqp 4.35 $44.28 $192.62 95251 Cont gluc mntr analysis i&r 1.02 $44.28 $45.17 95782 Polysom <6 yrs 4/> paramtrs 25.99 $44.28 $1,150.84 95782 TC Polysom <6 yrs 4/> paramtrs 22.40 $44.28 $991.87 95782 26 Polysom <6 yrs 4/> paramtrs 3.59 $44.28 $158.97 95783 Polysom <6 yrs cpap/bilvl 27.72 $44.28 $1,227.44 95783 TC Polysom <6 yrs cpap/bilvl 23.81 $44.28 $1,054.31 95783 26 Polysom <6 yrs cpap/bilvl 3.91 $44.28 $173.13 95800 Slp stdy unattended 5.02 $44.28 $222.29 95800 TC Slp stdy unattended 3.54 $44.28 $156.75 95800 26 Slp stdy unattended 1.48 $44.28 $65.53 95801 Slp stdy unatnd w/anal 2.57 $44.28 $113.80 95801 TC Slp stdy unatnd w/anal 1.17 $44.28 $51.81 95801 26 Slp stdy unatnd w/anal 1.40 $44.28 $61.99 95803 Actigraphy testing 4.06 $44.28 $179.78 95803 TC Actigraphy testing 2.81 $44.28 $124.43 95803 26 Actigraphy testing 1.25 $44.28 $55.35 95805 Multiple sleep latency test 12.24 $44.28 $541.99 95805 TC Multiple sleep latency test 10.56 $44.28 $467.60 95805 26 Multiple sleep latency test 1.68 $44.28 $74.39 95806 Sleep study unatt&resp efft 4.82 $44.28 $213.43 95806 TC Sleep study unatt&resp efft 3.08 $44.28 $136.38 95806 26 Sleep study unatt&resp efft 1.74 $44.28 $77.05 95807 Sleep study attended 13.05 $44.28 $577.85 95807 TC Sleep study attended 11.28 $44.28 $499.48 95807 26 Sleep study attended 1.77 $44.28 $78.38 95808 Polysom any age 1-3> param 19.86 $44.28 $879.40 95808 TC Polysom any age 1-3> param 17.34 $44.28 $767.82 95808 26 Polysom any age 1-3> param 2.52 $44.28 $111.59 95810 Polysom 6/> yrs 4/> param 17.75 $44.28 $785.97 95810 TC Polysom 6/> yrs 4/> param 14.29 $44.28 $632.76 95810 26 Polysom 6/> yrs 4/> param 3.46 $44.28 $153.21 95811 Polysom 6/>yrs cpap 4/> parm 18.64 $44.28 $825.38 95811 TC Polysom 6/>yrs cpap 4/> parm 15.04 $44.28 $665.97 95811 26 Polysom 6/>yrs cpap 4/> parm 3.60 $44.28 $159.41 NON-FACILITY HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL 95812 Eeg 41-60 minutes 9.16 $44.28 $405.60 95812 TC Eeg 41-60 minutes 7.51 $44.28 $332.54 95812 26 Eeg 41-60 minutes 1.65 $44.28 $73.06 95813 Eeg over 1 hour 11.51 $44.28 $509.66 95813 TC Eeg over 1 hour 9.04 $44.28 $400.29 95813 26 Eeg over 1 hour 2.47 $44.28 $109.37 95816 Eeg awake and drowsy 10.33 $44.28 $457.41 95816 TC Eeg awake and drowsy 8.68 $44.28 $384.35 95816 26 Eeg awake and drowsy 1.65 $44.28 $73.06 95819 Eeg awake and asleep 12.01 $44.28 $531.80 95819 TC Eeg awake and asleep 10.36 $44.28 $458.74 95819 26 Eeg awake and asleep 1.65 $44.28 $73.06 95822 Eeg coma or sleep only 10.82 $44.28 $479.11 95822 TC Eeg coma or sleep only 9.17 $44.28 $406.05 95822 26 Eeg coma or sleep only 1.65 $44.28 $73.06 95824 Eeg cerebral death only 0.00 $44.28 $0.00 95824 TC Eeg cerebral death only 0.00 $44.28 $0.00 95824 26 Eeg cerebral death only 1.13 $44.28 $50.04 95827 Eeg all night recording 17.79 $44.28 $787.74 95827 TC Eeg all night recording 16.18 $44.28 $716.45 95827 26 Eeg all night recording 1.61 $44.28 $71.29 95829 Surgery electrocorticogram 54.27 $44.28 $2,403.08 95829 TC Surgery electrocorticogram 44.64 $44.28 $1,976.66 95829 26 Surgery electrocorticogram 9.63 $44.28 $426.42 95830 Insert electrodes for eeg 6.65 $44.28 $294.46 95831 Limb muscle testing manual 0.93 $44.28 $41.18 95832 Hand muscle testing manual 0.92 $44.28 $40.74 95833 Body muscle testing manual 1.16 $44.28 $51.36 95834 Body muscle testing manual 1.54 $44.28 $68.19 95851 Range of motion measurements 0.57 $44.28 $25.24 95852 Range of motion measurements 0.52 $44.28 $23.03 95857 Cholinesterase challenge 1.53 $44.28 $67.75 95860 Muscle test one limb 3.50 $44.28 $154.98 95860 TC Muscle test one limb 2.02 $44.28 $89.45 95860 26 Muscle test one limb 1.48 $44.28 $65.53 95861 Muscle test 2 limbs 4.96 $44.28 $219.63 95861 TC Muscle test 2 limbs 2.60 $44.28 $115.13 95861 26 Muscle test 2 limbs 2.36 $44.28 $104.50 95863 Muscle test 3 limbs 6.33 $44.28 $280.29 95863 TC Muscle test 3 limbs 3.48 $44.28 $154.09 95863 26 Muscle test 3 limbs 2.85 $44.28 $126.20 95864 Muscle test 4 limbs 7.08 $44.28 $313.50 95864 TC Muscle test 4 limbs 4.04 $44.28 $178.89 95864 26 Muscle test 4 limbs 3.04 $44.28 $134.61 95865 Muscle test larynx 4.18 $44.28 $185.09 NON-FACILITY HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL 95865 TC Muscle test larynx 1.79 $44.28 $79.26 95865 26 Muscle test larynx 2.39 $44.28 $105.83 95866 Muscle test hemidiaphragm 3.83 $44.28 $169.59 95866 TC Muscle test hemidiaphragm 1.91 $44.28 $84.57 95866 26 Muscle test hemidiaphragm 1.92 $44.28 $85.02 95867 Muscle test cran nerv unilat 2.89 $44.28 $127.97 95867 TC Muscle test cran nerv unilat 1.68 $44.28 $74.39 95867 26 Muscle test cran nerv unilat 1.21 $44.28 $53.58 95868 Muscle test cran nerve bilat 3.85 $44.28 $170.48 95868 TC Muscle test cran nerve bilat 2.05 $44.28 $90.77 95868 26 Muscle test cran nerve bilat 1.80 $44.28 $79.70 95869 Muscle test thor paraspinal 2.66 $44.28 $117.78 95869 TC Muscle test thor paraspinal 2.09 $44.28 $92.55 95869 26 Muscle test thor paraspinal 0.57 $44.28 $25.24 95870 Muscle test nonparaspinal 2.70 $44.28 $119.56 95870 TC Muscle test nonparaspinal 2.13 $44.28 $94.32 95870 26 Muscle test nonparaspinal 0.57 $44.28 $25.24 95872 Muscle test one fiber 5.61 $44.28 $248.41 95872 TC Muscle test one fiber 1.20 $44.28 $53.14 95872 26 Muscle test one fiber 4.41 $44.28 $195.27 95873 Guide nerv destr elec stim 2.09 $44.28 $92.55 95873 TC Guide nerv destr elec stim 1.52 $44.28 $67.31 95873 26 Guide nerv destr elec stim 0.57 $44.28 $25.24 95874 Guide nerv destr needle emg 2.13 $44.28 $94.32 95874 TC Guide nerv destr needle emg 1.56 $44.28 $69.08 95874 26 Guide nerv destr needle emg 0.57 $44.28 $25.24 95875 Limb exercise test 3.71 $44.28 $164.28 95875 TC Limb exercise test 2.02 $44.28 $89.45 95875 26 Limb exercise test 1.69 $44.28 $74.83 95885 Musc tst done w/nerv tst lim 1.68 $44.28 $74.39 95885 TC Musc tst done w/nerv tst lim 1.14 $44.28 $50.48 95885 26 Musc tst done w/nerv tst lim 0.54 $44.28 $23.91 95886 Musc test done w/n test comp 2.60 $44.28 $115.13 95886 TC Musc test done w/n test comp 1.28 $44.28 $56.68 95886 26 Musc test done w/n test comp 1.32 $44.28 $58.45 95887 Musc tst done w/n tst nonext 2.30 $44.28 $101.84 95887 TC Musc tst done w/n tst nonext 1.21 $44.28 $53.58 95887 26 Musc tst done w/n tst nonext 1.09 $44.28 $48.27 95905 Motor &/ sens nrve cndj test 2.06 $44.28 $91.22 95905 TC Motor &/ sens nrve cndj test 1.98 $44.28 $87.67 95905 26 Motor &/ sens nrve cndj test 0.08 $44.28 $3.54 95907 Nvr cndj tst 1-2 studies 2.78 $44.28 $123.10 95907 TC Nvr cndj tst 1-2 studies 1.25 $44.28 $55.35 95907 26 Nvr cndj tst 1-2 studies 1.53 $44.28 $67.75 95908 Nrv cndj tst 3-4 studies 3.60 $44.28 $159.41 NON-FACILITY HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL 95908 TC Nrv cndj tst 3-4 studies 1.67 $44.28 $73.95 95908 26 Nrv cndj tst 3-4 studies 1.93 $44.28 $85.46 95909 Nrv cndj tst 5-6 studies 4.29 $44.28 $189.96 95909 TC Nrv cndj tst 5-6 studies 1.99 $44.28 $88.12 95909 26 Nrv cndj tst 5-6 studies 2.30 $44.28 $101.84 95910 Nrv cndj test 7-8 studies 5.65 $44.28 $250.18 95910 TC Nrv cndj test 7-8 studies 2.58 $44.28 $114.24 95910 26 Nrv cndj test 7-8 studies 3.07 $44.28 $135.94 95911 Nrv cndj test 9-10 studies 6.74 $44.28 $298.45 95911 TC Nrv cndj test 9-10 studies 2.91 $44.28 $128.85 95911 26 Nrv cndj test 9-10 studies 3.83 $44.28 $169.59 95912 Nrv cndj test 11-12 studies 7.48 $44.28 $331.21 95912 TC Nrv cndj test 11-12 studies 2.93 $44.28 $129.74 95912 26 Nrv cndj test 11-12 studies 4.55 $44.28 $201.47 95913 Nrv cndj test 13/> studies 8.63 $44.28 $382.14 95913 TC Nrv cndj test 13/> studies 3.24 $44.28 $143.47 95913 26 Nrv cndj test 13/> studies 5.39 $44.28 $238.67 95921 Autonomic nrv parasym inervj 2.37 $44.28 $104.94 95921 TC Autonomic nrv parasym inervj 1.08 $44.28 $47.82 95921 26 Autonomic nrv parasym inervj 1.29 $44.28 $57.12 95922 Autonomic nrv adrenrg inervj 2.77 $44.28 $122.66 95922 TC Autonomic nrv adrenrg inervj 1.39 $44.28 $61.55 95922 26 Autonomic nrv adrenrg inervj 1.38 $44.28 $61.11 95923 Autonomic nrv syst funj test 3.69 $44.28 $163.39 95923 TC Autonomic nrv syst funj test 2.38 $44.28 $105.39 95923 26 Autonomic nrv syst funj test 1.31 $44.28 $58.01 95924 Ans parasymp & symp w/tilt 4.29 $44.28 $189.96 95924 TC Ans parasymp & symp w/tilt 1.75 $44.28 $77.49 95924 26 Ans parasymp & symp w/tilt 2.54 $44.28 $112.47 95925 Somatosensory testing 3.76 $44.28 $166.49 95925 TC Somatosensory testing 2.97 $44.28 $131.51 95925 26 Somatosensory testing 0.79 $44.28 $34.98 95926 Somatosensory testing 3.69 $44.28 $163.39 95926 TC Somatosensory testing 2.91 $44.28 $128.85 95926 26 Somatosensory testing 0.78 $44.28 $34.54 95927 Somatosensory testing 3.87 $44.28 $171.36 95927 TC Somatosensory testing 3.09 $44.28 $136.83 95927 26 Somatosensory testing 0.78 $44.28 $34.54 95928 C motor evoked uppr limbs 6.05 $44.28 $267.89 95928 TC C motor evoked uppr limbs 3.77 $44.28 $166.94 95928 26 C motor evoked uppr limbs 2.28 $44.28 $100.96 95929 C motor evoked lwr limbs 6.22 $44.28 $275.42 95929 TC C motor evoked lwr limbs 3.92 $44.28 $173.58 95929 26 C motor evoked lwr limbs 2.30 $44.28 $101.84 95930 Visual ep test cns w/i&r 1.98 $44.28 $87.67 NON-FACILITY HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL 95930 TC Visual ep test cns w/i&r 1.44 $44.28 $63.76 95930 26 Visual ep test cns w/i&r 0.54 $44.28 $23.91 95933 Blink reflex test 2.22 $44.28 $98.30 95933 TC Blink reflex test 1.32 $44.28 $58.45 95933 26 Blink reflex test 0.90 $44.28 $39.85 95937 Neuromuscular junction test 2.33 $44.28 $103.17 95937 TC Neuromuscular junction test 1.35 $44.28 $59.78 95937 26 Neuromuscular junction test 0.98 $44.28 $43.39 95938 Somatosensory testing 9.80 $44.28 $433.94 95938 TC Somatosensory testing 8.48 $44.28 $375.49 95938 26 Somatosensory testing 1.32 $44.28 $58.45 95939 C motor evoked upr&lwr limbs 14.40 $44.28 $637.63 95939 TC C motor evoked upr&lwr limbs 10.98 $44.28 $486.19 95939 26 C motor evoked upr&lwr limbs 3.42 $44.28 $151.44 95940 Ionm in operatng room 15 min 0.93 $44.28 $41.18 95941 Ionm remote/>1 pt or per hr 0.00 $44.28 $0.00 95943 Parasymp&symp hrt rate test 0.00 $44.28 $0.00 95943 TC Parasymp&symp hrt rate test 0.00 $44.28 $0.00 95943 26 Parasymp&symp hrt rate test 0.00 $44.28 $0.00 95950 Ambulatory eeg monitoring 9.73 $44.28 $430.84 95950 TC Ambulatory eeg monitoring 7.44 $44.28 $329.44 95950 26 Ambulatory eeg monitoring 2.29 $44.28 $101.40 95951 Eeg monitoring/videorecord 0.00 $44.28 $0.00 95951 TC Eeg monitoring/videorecord 0.00 $44.28 $0.00 95951 26 Eeg monitoring/videorecord 9.13 $44.28 $404.28 95953 Eeg monitoring/computer 12.30 $44.28 $544.64 95953 TC Eeg monitoring/computer 7.62 $44.28 $337.41 95953 26 Eeg monitoring/computer 4.68 $44.28 $207.23 95954 Eeg monitoring/giving drugs 12.12 $44.28 $536.67 95954 TC Eeg monitoring/giving drugs 8.68 $44.28 $384.35 95954 26 Eeg monitoring/giving drugs 3.44 $44.28 $152.32 95955 Eeg during surgery 6.09 $44.28 $269.67 95955 TC Eeg during surgery 4.55 $44.28 $201.47 95955 26 Eeg during surgery 1.54 $44.28 $68.19 95956 Eeg monitor technol attended 45.24 $44.28 $2,003.23 95956 TC Eeg monitor technol attended 39.78 $44.28 $1,761.46 95956 26 Eeg monitor technol attended 5.46 $44.28 $241.77 95957 Eeg digital analysis 8.17 $44.28 $361.77 95957 TC Eeg digital analysis 5.20 $44.28 $230.26 95957 26 Eeg digital analysis 2.97 $44.28 $131.51 95958 Eeg monitoring/function test 16.52 $44.28 $731.51 95958 TC Eeg monitoring/function test 10.03 $44.28 $444.13 95958 26 Eeg monitoring/function test 6.49 $44.28 $287.38 95961 Electrode stimulation brain 8.65 $44.28 $383.02 95961 TC Electrode stimulation brain 4.04 $44.28 $178.89 NON-FACILITY HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL 95961 26 Electrode stimulation brain 4.61 $44.28 $204.13 95962 Electrode stim brain add-on 7.47 $44.28 $330.77 95962 TC Electrode stim brain add-on 2.52 $44.28 $111.59 95962 26 Electrode stim brain add-on 4.95 $44.28 $219.19 95965 Meg spontaneous 0.00 $44.28 $0.00 95965 TC Meg spontaneous 0.00 $44.28 $0.00 95965 26 Meg spontaneous 12.07 $44.28 $534.46 95966 Meg evoked single 0.00 $44.28 $0.00 95966 TC Meg evoked single 0.00 $44.28 $0.00 95966 26 Meg evoked single 6.14 $44.28 $271.88 95967 Meg evoked each addl 0.00 $44.28 $0.00 95967 TC Meg evoked each addl 0.00 $44.28 $0.00 95967 26 Meg evoked each addl 5.41 $44.28 $239.55 95970 Analyze neurostim no prog 1.97 $44.28 $87.23 95971 Analyze neurostim simple 1.45 $44.28 $64.21 95972 Analyze neurostim complex 1.67 $44.28 $73.95 95974 Cranial neurostim complex 5.91 $44.28 $261.69 95975 Cranial neurostim complex 3.18 $44.28 $140.81 95978 Analyze neurostim brain/1h 7.17 $44.28 $317.49 95979 Analyz neurostim brain addon 3.08 $44.28 $136.38 95980 Io anal gast n-stim init 1.32 $44.28 $58.45 95981 Io anal gast n-stim subsq 0.95 $44.28 $42.07 95982 Io ga n-stim subsq w/reprog 1.53 $44.28 $67.75 95990 Spin/brain pump refil & main 2.65 $44.28 $117.34 95991 Spin/brain pump refil & main 3.39 $44.28 $150.11 95992 Canalith repositioning proc 1.23 $44.28 $54.46 95999 Neurological procedure 0.00 $44.28 $0.00 96000 Motion analysis video/3d 2.75 $44.28 $121.77 96001 Motion test w/ft press meas 3.69 $44.28 $163.39 96002 Dynamic surface emg 0.63 $44.28 $27.90 96003 Dynamic fine wire emg 0.49 $44.28 $21.70 96004 Phys review of motion tests 3.28 $44.28 $145.24 96020 Functional brain mapping 0.00 $44.28 $0.00 96020 TC Functional brain mapping 0.00 $44.28 $0.00 96020 26 Functional brain mapping 4.60 $44.28 $203.69 96040 Genetic counseling 30 min 1.34 $44.28 $59.34 96101 Psycho testing by psych/phys 2.33 $44.28 $103.17 96102 Psycho testing by technician 1.74 $44.28 $77.05 96103 Psycho testing admin by comp 0.78 $44.28 $34.54 96105 Assessment of aphasia 3.07 $44.28 $135.94 96110 Developmental screen w/score 0.29 $44.28 $12.84 96111 Developmental test extend 3.83 $44.28 $169.59 96116 Neurobehavioral status exam 2.65 $44.28 $117.34 96118 Neuropsych tst by psych/phys 2.74 $44.28 $121.33 96119 Neuropsych testing by tec 2.25 $44.28 $99.63 NON-FACILITY HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL 96120 Neuropsych tst admin w/comp 1.35 $44.28 $59.78 96125 Cognitive test by hc pro 3.36 $44.28 $148.78 96127 Brief emotional/behav assmt 0.18 $44.28 $7.97 96150 Assess hlth/behave init 0.63 $44.28 $27.90 96151 Assess hlth/behave subseq 0.61 $44.28 $27.01 96152 Intervene hlth/behave indiv 0.58 $44.28 $25.68 96153 Intervene hlth/behave group 0.13 $44.28 $5.76 96154 Interv hlth/behav fam w/pt 0.56 $44.28 $24.80 96155 Interv hlth/behav fam no pt 0.64 $44.28 $28.34 96160 Pt-focused hlth risk assmt 0.11 $44.28 $4.87 96161 Caregiver health risk assmt 0.11 $44.28 $4.87 96360 Hydration iv infusion init 1.32 $44.28 $58.45 96361 Hydrate iv infusion add-on 0.39 $44.28 $17.27 96365 Ther/proph/diag iv inf init 2.06 $44.28 $91.22 96366 Ther/proph/diag iv inf addon 0.62 $44.28 $27.45 96367 Tx/proph/dg addl seq iv inf 0.89 $44.28 $39.41 96368 Ther/diag concurrent inf 0.59 $44.28 $26.13 96369 Sc ther infusion up to 1 hr 4.91 $44.28 $217.41 96370 Sc ther infusion addl hr 0.44 $44.28 $19.48 96371 Sc ther infusion reset pump 1.80 $44.28 $79.70 96372 Ther/proph/diag inj sc/im 0.58 $44.28 $25.68 96373 Ther/proph/diag inj ia 0.54 $44.28 $23.91 96374 Ther/proph/diag inj iv push 1.31 $44.28 $58.01 96375 Tx/pro/dx inj new drug addon 0.51 $44.28 $22.58 96376 Tx/pro/dx inj same drug adon 0.00 $44.28 $0.00 96377 Applicaton on-body injector 0.58 $44.28 $25.68 96379 Ther/prop/diag inj/inf proc 0.00 $44.28 $0.00 96401 Chemo anti-neopl sq/im 2.27 $44.28 $100.52 96402 Chemo hormon antineopl sq/im 0.87 $44.28 $38.52 96405 Chemo intralesional up to 7 2.29 $44.28 $101.40 96406 Chemo intralesional over 7 3.36 $44.28 $148.78 96409 Chemo iv push sngl drug 3.10 $44.28 $137.27 96411 Chemo iv push addl drug 1.66 $44.28 $73.50 96413 Chemo iv infusion 1 hr 4.02 $44.28 $178.01 96415 Chemo iv infusion addl hr 0.88 $44.28 $38.97 96416 Chemo prolong infuse w/pump 4.09 $44.28 $181.11 96417 Chemo iv infus each addl seq 1.93 $44.28 $85.46 96420 Chemo ia push tecnique 3.00 $44.28 $132.84 96422 Chemo ia infusion up to 1 hr 5.24 $44.28 $232.03 96423 Chemo ia infuse each addl hr 2.38 $44.28 $105.39 96425 Chemotherapy infusion method 5.48 $44.28 $242.65 96440 Chemotherapy intracavitary 22.33 $44.28 $988.77 96446 Chemotx admn prtl cavity 5.89 $44.28 $260.81 96450 Chemotherapy into cns 5.19 $44.28 $229.81 96521 Refill/maint portable pump 4.17 $44.28 $184.65 NON-FACILITY HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL 96522 Refill/maint pump/resvr syst 3.38 $44.28 $149.67 96523 Irrig drug delivery device 0.79 $44.28 $34.98 96542 Chemotherapy injection 3.79 $44.28 $167.82 96549 Chemotherapy unspecified 0.00 $44.28 $0.00 96567 Pdt dstr prmlg les skn 3.24 $44.28 $143.47 96570 Photodynmc tx 30 min add-on 1.48 $44.28 $65.53 96571 Photodynamic tx addl 15 min 0.84 $44.28 $37.20 96573 Pdt dstr prmlg les phys/qhp 5.37 $44.28 $237.78 96574 Dbrdmt prmlg les w/pdt 6.92 $44.28 $306.42 96900 Ultraviolet light therapy 0.59 $44.28 $26.13 96902 Trichogram 0.61 $44.28 $27.01 96904 Whole body photography 1.77 $44.28 $78.38 96910 Photochemotherapy with uv-b 3.21 $44.28 $142.14 96912 Photochemotherapy with uv-a 2.71 $44.28 $120.00 96913 Photochemotherapy uv-a or b 3.78 $44.28 $167.38 96920 Laser tx skin < 250 sq cm 4.67 $44.28 $206.79 96921 Laser tx skin 250-500 sq cm 5.12 $44.28 $226.71 96922 Laser tx skin >500 sq cm 6.97 $44.28 $308.63 96931 Rcm celulr subcelulr img skn 4.78 $44.28 $211.66 96932 Rcm celulr subcelulr img skn 3.47 $44.28 $153.65 96933 Rcm celulr subcelulr img skn 1.16 $44.28 $51.36 96934 Rcm celulr subcelulr img skn 2.10 $44.28 $92.99 96935 Rcm celulr subcelulr img skn 0.99 $44.28 $43.84 96936 Rcm celulr subcelulr img skn 1.11 $44.28 $49.15 96999 Dermatological procedure 0.00 $44.28 $0.00 97010 Hot or cold packs therapy 0.18 $44.28 $7.97 97012 Mechanical traction therapy 0.42 $44.28 $18.60 97014 Electric stimulation therapy 0.44 $44.28 $19.48 97016 Vasopneumatic device therapy 0.45 $44.28 $19.93 97018 Paraffin bath therapy 0.25 $44.28 $11.07 97022 Whirlpool therapy 0.54 $44.28 $23.91 97024 Diathermy eg microwave 0.20 $44.28 $8.86 97026 Infrared therapy 0.18 $44.28 $7.97 97028 Ultraviolet therapy 0.23 $44.28 $10.18 97032 Electrical stimulation 0.44 $44.28 $19.48 97033 Electric current therapy 0.59 $44.28 $26.13 97034 Contrast bath therapy 0.43 $44.28 $19.04 97035 Ultrasound therapy 0.38 $44.28 $16.83 97036 Hydrotherapy 1.01 $44.28 $44.72 97039 Physical therapy treatment 0.00 $44.28 $0.00 97110 Therapeutic exercises 0.87 $44.28 $38.52 97112 Neuromuscular reeducation 0.99 $44.28 $43.84 97113 Aquatic therapy/exercises 1.11 $44.28 $49.15 97116 Gait training therapy 0.86 $44.28 $38.08 97124 Massage therapy 0.87 $44.28 $38.52 NON-FACILITY HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL 97127 Ther ivntj w/focus cog funcj 0.00 $44.28 $0.00 97139 Physical medicine procedure 0.00 $44.28 $0.00 97140 Manual therapy 1/> regions 0.79 $44.28 $34.98 97150 Group therapeutic procedures 0.52 $44.28 $23.03 97161 Pt eval low complex 20 min 2.38 $44.28 $105.39 97162 Pt eval mod complex 30 min 2.38 $44.28 $105.39 97163 Pt eval high complex 45 min 2.38 $44.28 $105.39 97164 Pt re-eval est plan care 1.61 $44.28 $71.29 97165 Ot eval low complex 30 min 2.57 $44.28 $113.80 97166 Ot eval mod complex 45 min 2.57 $44.28 $113.80 97167 Ot eval high complex 60 min 2.57 $44.28 $113.80 97168 Ot re-eval est plan care 1.75 $44.28 $77.49 97169 Athletic trn eval low cmplx 0.00 $44.28 $0.00 97170 Athletic trn eval mod cmplx 0.00 $44.28 $0.00 97171 Athletic trn eval high cmplx 0.00 $44.28 $0.00 97172 Athletic trn re-eval plan cr 0.00 $44.28 $0.00 97530 Therapeutic activities 1.15 $44.28 $50.92 97533 Sensory integration 0.97 $44.28 $42.95 97535 Self care mngment training 0.98 $44.28 $43.39 97537 Community/work reintegration 0.94 $44.28 $41.62 97542 Wheelchair mngment training 0.95 $44.28 $42.07 97545 Work hardening 0.00 $44.28 $0.00 97546 Work hardening add-on 0.00 $44.28 $0.00 97597 Rmvl devital tis 20 cm/< 2.37 $44.28 $104.94 97598 Rmvl devital tis addl 20cm/< 0.79 $44.28 $34.98 97602 Wound(s) care non-selective 0.00 $44.28 $0.00 97605 Neg press wound tx 50 cm 1.48 $44.28 $65.53 97607 Neg press wnd tx 50 cm 0.00 $44.28 $0.00 97610 Low frequency non-thermal us 3.79 $44.28 $167.82 97750 Physical performance test 1.07 $44.28 $47.38 97755 Assistive technology assess 1.11 $44.28 $49.15 97760 Orthotic mgmt&trainj 1st enc 1.33 $44.28 $58.89 97761 Prosthetic trainj 1st enc 1.15 $44.28 $50.92 97763 Orthc/prostc mgmt sbsq enc 1.37 $44.28 $60.66 97799 Physical medicine procedure 0.00 $44.28 $0.00 97802 Medical nutrition indiv in 0.98 $44.28 $43.39 97803 Med nutrition indiv subseq 0.85 $44.28 $37.64 97804 Medical nutrition group 0.45 $44.28 $19.93 97810 Acupunct w/o stimul 15 min 1.03 $44.28 $45.61 97811 Acupunct w/o stimul addl 15m 0.78 $44.28 $34.54 97813 Acupunct w/stimul 15 min 1.10 $44.28 $48.71 97814 Acupunct w/stimul addl 15m 0.88 $44.28 $38.97 98925 Osteopath manj 1-2 regions 0.90 $44.28 $39.85 NON-FACILITY HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL 98926 Osteopath manj 3-4 regions 1.30 $44.28 $57.56 98927 Osteopath manj 5-6 regions 1.70 $44.28 $75.28 98928 Osteopath manj 7-8 regions 2.06 $44.28 $91.22 98929 Osteopath manj 9-10 regions 2.46 $44.28 $108.93 98940 Chiropract manj 1-2 regions 0.81 $44.28 $35.87 98941 Chiropract manj 3-4 regions 1.16 $44.28 $51.36 98942 Chiropractic manj 5 regions 1.51 $44.28 $66.86 98943 Chiropract manj xtrspinl 1/> 0.78 $44.28 $34.54 98960 Self-mgmt educ & train 1 pt 0.79 $44.28 $34.98 98961 Self-mgmt educ/train 2-4 pt 0.39 $44.28 $17.27 98962 Self-mgmt educ/train 5-8 pt 0.28 $44.28 $12.40 98966 Hc pro phone call 5-10 min 0.40 $44.28 $17.71 98967 Hc pro phone call 11-20 min 0.76 $44.28 $33.65 98968 Hc pro phone call 21-30 min 1.12 $44.28 $49.59 98969 Online service by hc pro 0.00 $44.28 $0.00 99000 Specimen handling office-lab 0.00 $44.28 $0.00 99001 Specimen handling pt-lab 0.00 $44.28 $0.00 99002 Device handling phys/qhp 0.00 $44.28 $0.00 99024 Postop follow-up visit 0.00 $44.28 $0.00 99026 In-hospital on call service 0.00 $44.28 $0.00 99027 Out-of-hosp on call service 0.00 $44.28 $0.00 99050 Medical services after hrs 0.00 $44.28 $0.00 99051 Med serv eve/wkend/holiday 0.00 $44.28 $0.00 99053 Med serv 10pm-8am 24 hr fac 0.00 $44.28 $0.00 99056 Med service out of office 0.00 $44.28 $0.00 99058 Office emergency care 0.00 $44.28 $0.00 99060 Out of office emerg med serv 0.00 $44.28 $0.00 99070 Special supplies phys/qhp 0.00 $44.28 $0.00 99071 Patient education materials 0.00 $44.28 $0.00 99075 Medical testimony 0.00 $44.28 $0.00 99078 Group health education 0.00 $44.28 $0.00 99080 Special reports or forms 0.00 $44.28 $0.00 99082 Unusual physician travel 0.00 $44.28 $0.00 99090 Computer data analysis 0.00 $44.28 $0.00 99091 Collect/review data from pt 1.63 $44.28 $72.18 99100 Special anesthesia service 0.00 $44.28 $0.00 99116 Anesthesia with hypothermia 0.00 $44.28 $0.00 99135 Special anesthesia procedure 0.00 $44.28 $0.00 99140 Emergency anesthesia 0.00 $44.28 $0.00 99151 Mod sed same phys/qhp <5 yrs 2.20 $44.28 $97.42 99152 Mod sed same phys/qhp 5/>yrs 1.46 $44.28 $64.65 99153 Mod sed same phys/qhp ea 0.31 $44.28 $13.73 99155 Mod sed oth phys/qhp <5 yrs 2.74 $44.28 $121.33 99156 Mod sed oth phys/qhp 5/>yrs 2.15 $44.28 $95.20 99157 Mod sed other phys/qhp ea 1.64 $44.28 $72.62 NON-FACILITY HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL 99170 Anogenital exam child w imag 4.49 $44.28 $198.82 99172 Ocular function screen 0.00 $44.28 $0.00 99173 Visual acuity screen 0.09 $44.28 $3.99 99174 Ocular instrumnt screen bil 0.17 $44.28 $7.53 99175 Induction of vomiting 0.73 $44.28 $32.32 99177 Ocular instrumnt screen bil 0.14 $44.28 $6.20 99183 Hyperbaric oxygen therapy 3.14 $44.28 $139.04 99184 Hypothermia ill neonate 6.32 $44.28 $279.85 99188 App topical fluoride varnish 0.35 $44.28 $15.50 99190 Special pump services 0.00 $44.28 $0.00 99191 Special pump services 0.00 $44.28 $0.00 99192 Special pump services 0.00 $44.28 $0.00 99195 Phlebotomy 2.89 $44.28 $127.97 99199 Special service/proc/report 0.00 $44.28 $0.00 99201 Office/outpatient visit new 1.26 $44.28 $55.79 99202 Office/outpatient visit new 2.12 $44.28 $93.87 99203 Office/outpatient visit new 3.05 $44.28 $135.05 99204 Office/outpatient visit new 4.65 $44.28 $205.90 99205 Office/outpatient visit new 5.85 $44.28 $259.04 99211 Office/outpatient visit est 0.61 $44.28 $27.01 99212 Office/outpatient visit est 1.24 $44.28 $54.91 99213 Office/outpatient visit est 2.06 $44.28 $91.22 99214 Office/outpatient visit est 3.04 $44.28 $134.61 99215 Office/outpatient visit est 4.10 $44.28 $181.55 99217 Observation care discharge 2.07 $44.28 $91.66 99218 Initial observation care 2.83 $44.28 $125.31 99219 Initial observation care 3.85 $44.28 $170.48 99220 Initial observation care 5.27 $44.28 $233.36 99221 Initial hospital care 2.87 $44.28 $127.08 99222 Initial hospital care 3.87 $44.28 $171.36 99223 Initial hospital care 5.74 $44.28 $254.17 99224 Subsequent observation care 1.13 $44.28 $50.04 99225 Subsequent observation care 2.07 $44.28 $91.66 99226 Subsequent observation care 2.97 $44.28 $131.51 99231 Subsequent hospital care 1.11 $44.28 $49.15 99232 Subsequent hospital care 2.06 $44.28 $91.22 99233 Subsequent hospital care 2.95 $44.28 $130.63 99234 Observ/hosp same date 3.77 $44.28 $166.94 99235 Observ/hosp same date 4.79 $44.28 $212.10 99236 Observ/hosp same date 6.18 $44.28 $273.65 99238 Hospital discharge day 2.07 $44.28 $91.66 99239 Hospital discharge day 3.05 $44.28 $135.05 99241 Office consultation 1.34 $44.28 $59.34 99242 Office consultation 2.52 $44.28 $111.59 99243 Office consultation 3.45 $44.28 $152.77 NON-FACILITY HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL 99244 Office consultation 5.16 $44.28 $228.48 99245 Office consultation 6.29 $44.28 $278.52 99251 Inpatient consultation 1.38 $44.28 $61.11 99252 Inpatient consultation 2.11 $44.28 $93.43 99253 Inpatient consultation 3.25 $44.28 $143.91 99254 Inpatient consultation 4.72 $44.28 $209.00 99255 Inpatient consultation 5.68 $44.28 $251.51 99281 Emergency dept visit 0.60 $44.28 $26.57 99282 Emergency dept visit 1.17 $44.28 $51.81 99283 Emergency dept visit 1.75 $44.28 $77.49 99284 Emergency dept visit 3.32 $44.28 $147.01 99285 Emergency dept visit 4.89 $44.28 $216.53 99288 Direct advanced life support 0.00 $44.28 $0.00 99291 Critical care first hour 7.76 $44.28 $343.61 99292 Critical care addl 30 min 3.47 $44.28 $153.65 99304 Nursing facility care init 2.58 $44.28 $114.24 99305 Nursing facility care init 3.69 $44.28 $163.39 99306 Nursing facility care init 4.72 $44.28 $209.00 99307 Nursing fac care subseq 1.26 $44.28 $55.79 99308 Nursing fac care subseq 1.96 $44.28 $86.79 99309 Nursing fac care subseq 2.59 $44.28 $114.69 99310 Nursing fac care subseq 3.85 $44.28 $170.48 99315 Nursing fac discharge day 2.06 $44.28 $91.22 99316 Nursing fac discharge day 3.00 $44.28 $132.84 99318 Annual nursing fac assessmnt 2.72 $44.28 $120.44 99324 Domicil/r-home visit new pat 1.56 $44.28 $69.08 99325 Domicil/r-home visit new pat 2.27 $44.28 $100.52 99326 Domicil/r-home visit new pat 3.94 $44.28 $174.46 99327 Domicil/r-home visit new pat 5.27 $44.28 $233.36 99328 Domicil/r-home visit new pat 6.17 $44.28 $273.21 99334 Domicil/r-home visit est pat 1.70 $44.28 $75.28 99335 Domicil/r-home visit est pat 2.68 $44.28 $118.67 99336 Domicil/r-home visit est pat 3.83 $44.28 $169.59 99337 Domicil/r-home visit est pat 5.47 $44.28 $242.21 99339 Domicil/r-home care supervis 2.19 $44.28 $96.97 99340 Domicil/r-home care supervis 3.07 $44.28 $135.94 99341 Home visit new patient 1.55 $44.28 $68.63 99342 Home visit new patient 2.25 $44.28 $99.63 99343 Home visit new patient 3.69 $44.28 $163.39 99344 Home visit new patient 5.17 $44.28 $228.93 99345 Home visit new patient 6.28 $44.28 $278.08 99347 Home visit est patient 1.56 $44.28 $69.08 99348 Home visit est patient 2.38 $44.28 $105.39 99349 Home visit est patient 3.64 $44.28 $161.18 99350 Home visit est patient 5.06 $44.28 $224.06 NON-FACILITY HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL 99354 Prolong e&m/psyctx serv o/p 3.69 $44.28 $163.39 99355 Prolong e&m/psyctx serv o/p 2.79 $44.28 $123.54 99356 Prolonged service inpatient 2.61 $44.28 $115.57 99357 Prolonged service inpatient 2.62 $44.28 $116.01 99358 Prolong service w/o contact 3.16 $44.28 $139.92 99359 Prolong serv w/o contact add 1.52 $44.28 $67.31 99360 Physician standby services 1.74 $44.28 $77.05 99366 Team conf w/pat by hc prof 1.21 $44.28 $53.58 99367 Team conf w/o pat by phys 1.60 $44.28 $70.85 99368 Team conf w/o pat by hc pro 1.04 $44.28 $46.05 99374 Home health care supervision 1.98 $44.28 $87.67 99375 Home health care supervision 2.96 $44.28 $131.07 99377 Hospice care supervision 1.98 $44.28 $87.67 99378 Hospice care supervision 2.96 $44.28 $131.07 99379 Nursing fac care supervision 1.98 $44.28 $87.67 99380 Nursing fac care supervision 2.96 $44.28 $131.07 99381 Init pm e/m new pat infant 3.13 $44.28 $138.60 99382 Init pm e/m new pat 1-4 yrs 3.27 $44.28 $144.80 99383 Prev visit new age 5-11 3.40 $44.28 $150.55 99384 Prev visit new age 12-17 3.84 $44.28 $170.04 99385 Prev visit new age 18-39 3.72 $44.28 $164.72 99386 Prev visit new age 40-64 4.32 $44.28 $191.29 99387 Init pm e/m new pat 65+ yrs 4.68 $44.28 $207.23 99391 Per pm reeval est pat infant 2.81 $44.28 $124.43 99392 Prev visit est age 1-4 3.00 $44.28 $132.84 99393 Prev visit est age 5-11 2.99 $44.28 $132.40 99394 Prev visit est age 12-17 3.28 $44.28 $145.24 99395 Prev visit est age 18-39 3.35 $44.28 $148.34 99396 Prev visit est age 40-64 3.57 $44.28 $158.08 99397 Per pm reeval est pat 65+ yr 3.85 $44.28 $170.48 99401 Preventive counseling indiv 1.07 $44.28 $47.38 99402 Preventive counseling indiv 1.78 $44.28 $78.82 99403 Preventive counseling indiv 2.48 $44.28 $109.81 99404 Preventive counseling indiv 3.19 $44.28 $141.25 99406 Behav chng smoking 3-10 min 0.41 $44.28 $18.15 99407 Behav chng smoking > 10 min 0.79 $44.28 $34.98 99408 Audit/dast 15-30 min 1.00 $44.28 $44.28 99409 Audit/dast over 30 min 1.94 $44.28 $85.90 99411 Preventive counseling group 0.51 $44.28 $22.58 99412 Preventive counseling group 0.64 $44.28 $28.34 99415 Prolong clincl staff svc 0.28 $44.28 $12.40 99416 Prolong clincl staff svc add 0.13 $44.28 $5.76 99429 Unlisted preventive service 0.00 $44.28 $0.00 99441 Phone e/m phys/qhp 5-10 min 0.40 $44.28 $17.71 99442 Phone e/m phys/qhp 11-20 min 0.76 $44.28 $33.65 NON-FACILITY HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL 99443 Phone e/m phys/qhp 21-30 min 1.12 $44.28 $49.59 99444 Online e/m by phys/qhp 0.00 $44.28 $0.00 99446 Interprof phone/online 5-10 0.51 $44.28 $22.58 99447 Interprof phone/online 11-20 1.01 $44.28 $44.72 99448 Interprof phone/online 21-30 1.52 $44.28 $67.31 99449 Interprof phone/online 31/> 2.03 $44.28 $89.89 99450 Basic life disability exam 0.00 $44.28 $0.00 99455 Work related disability exam 0.00 $44.28 $0.00 99456 Disability examination 0.00 $44.28 $0.00 99460 Init nb em per day hosp 2.71 $44.28 $120.00 99461 Init nb em per day non-fac 2.57 $44.28 $113.80 99462 Sbsq nb em per day hosp 1.18 $44.28 $52.25 99463 Same day nb discharge 3.14 $44.28 $139.04 99464 Attendance at delivery 2.12 $44.28 $93.87 99465 Nb resuscitation 4.13 $44.28 $182.88 99466 Ped crit care transport 6.76 $44.28 $299.33 99467 Ped crit care transport addl 3.38 $44.28 $149.67 99468 Neonate crit care initial 26.04 $44.28 $1,153.05 99469 Neonate crit care subsq 11.27 $44.28 $499.04 99471 Ped critical care initial 22.54 $44.28 $998.07 99472 Ped critical care subsq 11.66 $44.28 $516.30 99475 Ped crit care age 2-5 init 15.87 $44.28 $702.72 99476 Ped crit care age 2-5 subsq 9.78 $44.28 $433.06 99477 Init day hosp neonate care 9.88 $44.28 $437.49 99478 Ic lbw inf < 1500 gm subsq 3.88 $44.28 $171.81 99479 Ic lbw inf 1500-2500 g subsq 3.52 $44.28 $155.87 99480 Ic inf pbw 2501-5000 g subsq 3.39 $44.28 $150.11 99483 Assmt & care pln pt cog imp 6.72 $44.28 $297.56 99484 Care mgmt svc bhvl hlth cond 1.35 $44.28 $59.78 99485 Suprv interfacilty transport 2.17 $44.28 $96.09 99486 Suprv interfac trnsport addl 1.89 $44.28 $83.69 99487 Cmplx chron care w/o pt vsit 2.63 $44.28 $116.46 99489 Cmplx chron care addl 30 min 1.31 $44.28 $58.01 99490 Chron care mgmt srvc 20 min 1.19 $44.28 $52.69 99492 1st psyc collab care mgmt 4.48 $44.28 $198.37 99493 Sbsq psyc collab care mgmt 3.58 $44.28 $158.52 99494 1st/sbsq psyc collab care 1.85 $44.28 $81.92 99495 Trans care mgmt 14 day disch 4.64 $44.28 $205.46 99496 Trans care mgmt 7 day disch 6.57 $44.28 $290.92 99497 Advncd care plan 30 min 2.39 $44.28 $105.83 99498 Advncd care plan addl 30 min 2.11 $44.28 $93.43 99499 Unlisted e&m service 0.00 $44.28 $0.00 99500 Home visit prenatal 0.00 $44.28 $0.00 99501 Home visit postnatal 0.00 $44.28 $0.00 99502 Home visit nb care 0.00 $44.28 $0.00 NON-FACILITY HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL 99503 Home visit resp therapy 0.00 $44.28 $0.00 99504 Home visit mech ventilator 0.00 $44.28 $0.00 99505 Home visit stoma care 0.00 $44.28 $0.00 99506 Home visit im injection 0.00 $44.28 $0.00 99507 Home visit cath maintain 0.00 $44.28 $0.00 99509 Home visit day life activity 0.00 $44.28 $0.00 99510 Home visit sing/m/fam couns 0.00 $44.28 $0.00 99511 Home visit fecal/enema mgmt 0.00 $44.28 $0.00 99512 Home visit for hemodialysis 0.00 $44.28 $0.00 99600 Home visit nos 0.00 $44.28 $0.00 99601 Home infusion/visit 2 hrs 0.00 $44.28 $0.00 99602 Home infusion each addtl hr 0.00 $44.28 $0.00 99605 Mtms by pharm np 15 min 0.00 $44.28 $0.00 99606 Mtms by pharm est 15 min 0.00 $44.28 $0.00 99607 Mtms by pharm addl 15 min 0.00 $44.28 $0.00